Juxtapapillary Deep-Layer Microvasculature Dropout and Retinal Nerve Fiber Layer Thinning in Glaucoma

• Published in: American journal of ophthalmology 2021-07, Vol.227, p.154-165
• Main Authors: Kwon, Ji Min, Weinreb, Robert N., Zangwill, Linda M., Suh, Min Hee
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Choroid - blood supply; Choroid - diagnostic imaging; Ciliary Arteries - diagnostic imaging; Ciliary Arteries - physiopathology; Female; Glaucoma; Glaucoma, Open-Angle - diagnostic imaging; Glaucoma, Open-Angle - physiopathology; Humans; Intraocular Pressure; Male; Microvessels; Middle Aged; Nerve Fibers - pathology; Optic Disk - blood supply; Optic Disk - diagnostic imaging; Optic nerve; Optic Nerve Diseases - diagnostic imaging; Optic Nerve Diseases - physiopathology; Patients; Retinal Ganglion Cells - pathology; Retrospective Studies; Standard deviation; Tomography, Optical Coherence; Tonometry, Ocular; Visual Field Tests; Visual Fields
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2021.02.014

Purpose: We sought to characterize juxtapapillary (JP) and non-JP microvasculature dropout in patients with primary open-angle glaucoma and to compare their rate of retinal nerve fiber layer (RNFL) thinning. Design: Retrospective cohort study. Methods: A total of 141 eyes with primary open-angle glaucoma with ≥4 serial optical coherence tomography (OCT) images after initial OCT angiography for ≥2 years were included. Based on OCT angiography imaging, the 3 groups were matched by age and visual field mean deviation: JP group (parapapillary deep-layer microvasculature dropout in contact with the optic disc boundary, n = 47), non-JP group (dropout not reaching the optic disc boundary, n = 47), and no-dropout group (lacking the dropout, n = 47). The RNFL thinning rate was compared among the 3 groups. Results: The rate of RNFL thinning tended to be fastest in the JP group followed by the non-JP group and no-dropout group in all areas except the temporal and nasal sectors. Post hoc analysis revealed that the JP group had significantly faster RNFL thinning than did the no-dropout group in the global area and the inferotemporal and inferonasal sectors (P < .05). When subgroup analysis was performed for subjects in which the main sector of dropout was the inferotemporal sector, the JP group had significantly faster RNFL thinning than the other 2 groups in the corresponding inferotemporal sector (P < .001). Conclusion: Eyes with JP microvasculature dropout showed faster RNFL thinning than eyes without dropout. These findings suggest that deep-layer microvasculature dropout, especially in contact with the optic disc boundary, is associated with rapid glaucoma progression.