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Journal Français d'Ophtalmologie
Volume 41, n° 7
pages 619-629 (septembre 2018)
Doi : 10.1016/j.jfo.2018.02.004
Received : 7 December 2017 ;  accepted : 7 February 2018
Articles originaux

Accuracy of peripapillary versus macular vessel density in diagnosis of early to advanced primary open angle glaucoma
Intérêt de la mesure de la densité vasculaire maculaire et peri-papillaire par OCT-angiographie dans le diagnostic du glaucome débutant à avancé
 

M. Poli a, b, , P.-L. Cornut a, A.-M. Nguyen a, c, F. De Bats a, c, P. Denis c
a Centre ophtalmologique, pôle vision Val d’Ouest, clinique du Val d’Ouest, 69130 Ecully, France 
b Department of ophthalmology, Lyon Sud University Hospital, 69310 Pierre-Bénite, France 
c Department of ophthalmology, Croix-Rousse University Hospital, 69004 Lyon, France 

Corresponding author at: Centre ophtalmologique, pôle vision Val d’Ouest, Clinique du Val d’Ouest, 39, chemin de la Vernique, 69130 Ecully, France.Centre ophtalmologique, pôle vision Val d’Ouest, Clinique du Val d’Ouest39, chemin de la VerniqueEcully69130France
Summary
Purpose

To evaluate macular and peripapillary vessel density (mVD, pVD) using optical coherence tomography angiography (OCT-A) in healthy subjects, patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG) patients.

Methods

In this prospective observational study, OCT-A images were obtained from 60 eyes of 36 healthy, ocular hypertension (OHT), preperimetric glaucoma (PPG), early glaucoma (EG) and moderate and advanced POAG subjects. Superficial mVD was acquired over a 6×6-mm cube centered on the foveal avascular zone and pVD over a 4.5×4.5-mm cube centered on the optic disc. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thickness was calculated using spectral-domain OCT. Correlations between vascular, structural and Humphrey VF indices were evaluated (Spearman's rank correlation coefficient).

Results

Median pVD and mVD in the PPG eyes were lower than in healthy eyes (51.87% and 47.23% versus 55.70% and 53.61%, respectively; P <0.001 and P =0.003), but higher than in mild glaucoma eyes (46.21% and 41.98%, P <0.001 compared to normal eyes) and moderate to advanced glaucoma eyes (37.45% and 39.89%, P <0.0001 compared to normal eyes). The highest correlations were found between structural parameters and pVD (r =0.87 and 0.86 for pRNFL and GCC, P <0.0001), followed by mVD (r =0.69 for both pRNFL and GCC, P <0.0001). Correlations with mean VF sensitivity were similar for pVD and mVD (r =0.61 and 0.56) and for GCC and pRNFL (r =0.60 and 0.52, P <0.0001 for all).

Conclusions

VD measured with OCT-A shows reduction in POAG. Detection of this damage differentiates PPG from normal and perimetric POAG eyes with a high correlation with structural parameters. Peripapillary VD accuracy is higher than mVD in detecting the disease. These results suggest that OCT-A could improve POAG diagnosis and understanding of the pathophysiologic mechanisms behind glaucoma.

The full text of this article is available in PDF format.
Résumé
Objectif

Évaluer la densité vasculaire superficielle maculaire et peri-papillaire (mDV et pDV) par OCT-angiographie (OCT-A) chez des patients sains, hypertones (HTO) et atteints de glaucome primitif à angle ouvert (GPAO).

Méthode

Dans cette étude prospective observationnelle, 60 yeux de 36 patients contrôles, HTO ou GPAO pré-périmétriques (GPP), débutants (GD) et modérés à avancés (GMA) ont bénéficié d’une mesure des pDV et mDV par OCT-A, d’une mesure de l’épaisseur des fibres nerveuses rétiniennes peri-papillaires (RNFL) et du complexe ganglionnaire maculaire (CGM) par OCT spectral domain, et d’un champ visuel (CV). La corrélation entre ces différents paramètres était évaluée (r  : coefficient de corrélation de Spearman).

Résultats

Les pDV et mDV moyennes des patients GPAO étaient significativement abaissées (patients contrôles : 55,70 % et 53,61 % respectivement ; GPP : 51,87 % et 47,23 % p <0,05 ; GD : 46,21 % et 41,98 % p <0,001 ; GMA : 37,45 % et 39,89 % p <0,0001). Il n’existait pas de différence significative de ces paramètres entre les patients contrôles et HTO. Le plus fort coefficient de corrélation était retrouvé entre les paramètres pDV et RNFL (r =0,87), suivis de pDV et CGM (r =0,86), mDV et RNFL (r =0,69), mDV et CGM (r =0,69), pDV et CV (r =0,61) et mDV et CV (r =0,56).

Conclusion

La densité vasculaire superficielle est réduite en cas de GPAO, dès le stade pré-périmétrique de la maladie, avec une forte corrélation aux paramètres structurels. La valeur diagnostique de pDV serait supérieure à celle de mVD. L’OCT-A pourrait améliorer le diagnostic et la compréhension des mécanismes physiopathologiques à l’origine du glaucome.

The full text of this article is available in PDF format.

Keywords : Optical coherence tomography angiography, Open-angle glaucoma, Optic disc perfusion, Macular perfusion, Early diagnosis

Mots clés : OCT-angiographie, Glaucome à angle ouvert, Perfusion du disque optique, Perfusion maculaire, Diagnostic précoce



 Meeting presentation: the data included in this article were presented at the French Society of Ophthalmology (SFO) as well as the French Society of Glaucoma (SFG) annual congresses, Paris, France, May 6–9, 2017.



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