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Influence of choroidal microvasculature dropout on progressive retinal nerve fibre layer thinning in primary open-angle glaucoma: comparison of parapapillary β-zones and γ-zones
  1. Hye Seong Hwang1,
  2. Eun Ji Lee1,
  3. Jeong-Ah Kim2,
  4. Seung Hyen Lee3,
  5. Tae-Woo Kim1
  1. 1Department of Ophthalmology, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
  2. 2Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea
  3. 3Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
  1. Correspondence to Dr Eun Ji Lee, Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam 13620, Korea; opticdisc{at}gmail.com

Abstract

Background/aims To compare the influence of choroidal microvasculature dropout (cMvD) on progressive retinal nerve fibre layer (RNFL) thinning in glaucomatous eyes with parapapillary β-zones and γ-zones.

Methods 294 eyes with primary open-angle glaucoma (POAG) and parapapillary atrophy (PPA) underwent optical coherence tomography (OCT) to determine the type of PPA and OCT angiography scanning of the optic nerve head to determine the presence of cMvD. Eyes were classified based on the type of PPA (β-zones and γ-zones), and their clinical characteristics were compared. Factors associated with the rate of rapid progressive RNFL thinning were determined in each group, including the presence of cMvD as an independent variable.

Results Of the 294 eyes, 186 and 108 were classified as having β-zones and γ-zones, respectively. The rate of RNFL thinning was slower (p<0.001), axial length was longer (p<0.001) and presence of cMvD was less frequent (57.4% vs 73.1%, p=0.006) in eyes with γ-zone than those with β-zone. Multivariate analyses showed that greater lamina cribrosa curvature (p=0.047) and the presence of cMvD (p=0.010) were associated with a faster rate of RNFL thinning in eyes with β-zone, whereas larger intraocular pressure fluctuation (p<0.001), shorter axial length (p=0.042) and greater baseline RNFL thickness (p<0.001) were associated with a faster rate of RNFL thinning in eyes with γ-zone.

Conclusions The presence of cMvD was significantly associated with a faster rate of RNFL thinning in POAG eyes with β-zone, but not γ-zone. The pathogenic consequences of cMvD in POAG eyes may depend on accompanying peripapillary structures.

  • glaucoma
  • optic nerve
  • imaging

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors HSH, EJL, JAK, SHL and TWK are contributed to the study concept and design, acquisition, analysis or interpretation of data and critical revision of the manuscript for important intellectual content. HSH and EJL drafted the manuscript. HSH contributed to the statistical analysis. EJL is responsible for the overall content as the guarantor.

  • Funding This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (grant numbers: HI19C0481, HC19C0276), National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (grant numbers: 2016R1D1A1B02011696) and Seoul National University Bundang Hospital Research fund (grant number: 02-2017-0037 and 14-2022-0024).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.