Quantitative Analysis Of Peripapillary And Macular Vessel Densities In Acute Primary Angle-closure Glaucoma By Angio OCT

?Purpose? : To observe the characteristics of retinal vascular density(VD)in primary acute angle-closure glaucoma(APACG)by using optical coherence tomography angiography(OCTA)and to explore the important role of vascular factors in the pathogenesis of APACG.?Methods?: This is a cross-sectional case-control study.We studied 30 people of unilateral APACG whose one eye were suffered acute attack before(including 30 eyes of the acute stage group and 30 eyes of the contralateral preclinical group)and 30 eyes of normal people,two groups of case-control studies were performed according to the inclusion criteria: 30 eyes of the acute stage group and 30 eyes of the contralateral preclinical group,30 eyes of the contralateral preclinical eyes and 30 eyes of the normal control group.All subjects underwent the examination of axial,intraocular pressure,UBM,visual field,and OCTA with the mode of retinal blood flow imaging in macular area and papillary area.And using OCTA to quantify the VD,nerve fiber layer thickness(RNFL),and ganglion cell complex(GCC)in the optic papilla and superficial,deep layer of the macular areas.We compare the vessel parameters and structural parameters of the above-mentioned areas in the acute stage group and the preclinical group,the preclinical group and the normal control group,respectively.And we study the influence of factors such as the age?blood pressure?the axis of the eye on the VD.The area under the curve(AUC)of the receiver operating characteristic curve(ROC)was used to assess the ability of these parameters to diagnose the disease.?Results? The peripapillary VD in the acute stage group showed a negative correlation with the age,the days of attack and the absolute value of mean deviation(MD),and was significantly positively correlated with RNFL and GCC.However,there was no significant correlation between VD and age in the macular area,but VD in the superficial macular area was significant positively correlated with GCC and RNFL,but was significant negative correlation with the absolute value of MD.Among the four quadrants of the peripapillary VD in the acute attack group,only temporal VD was significantly higher than the inferior VD,while the VD between the superior,nasal and inferior quadrants was not statistically significant The VD of parafovea area in superficial and deep macular area was higher than that of the perifovea area,and the nasal VD of the superficial macular area was significantly greater than that of the other three perifovea area.There was a significant difference in VD between the optic disc and the macular area in the two groups of case-control studies,but the extent of the decrease of VD in macular parafovea area was approximately the same as that in macular perifovea area.In the diagnostic ability of the acute attack group,the VD parameters of the superficial macular area,the area under the curve of the optic disc VD and the RNFL(AUC)were all>0.900,and there was no statistically significant difference of and the AUC of each VD parameter in GCC and deep macular area were <0.75.In the ability to diagnose preclinical eyes,the AUC of each VD in the superficial macular area was >0.940,and the AUC of each VD in the deep macular area was <0.900.And the AUC of the two were significantly different(P<0.05),and the AUC of the VD,GCC and RNFL were <0.700.?Conclusions?The vascular supply of the area between the temporal region of peripapillary and the nasal region of the macular in the APACG,where the nerve fiber bundle between the macular and the optic disc is located,is relatively richer.The VD of the optic disc and the macular area in the acute stage group decreased with the increase of the absolute value of MD,and the thicker the RNFL and GCC,the higher the VD.Besides,the VD of the optic papilla is also increased with the age and the days of attack.The results of this study found that the preclinical group and the normal control group also showed a general decline in the VD of the optic papilla and macular area,and the change in the VD was found earlier than RNFL and GCC in the comparison between the preclinical group and the normal control group.The change indicates that VD may be the pathogenesis and predictor of APACG,and can be used as a novel and effective indicator for screening APACG in the future.Compared with the preclinical group,the VD in the optic papilla and macular area of the acute stage group was generally decreased.In addition,the diagnosed ability of the RNFL and the VD in the superficial macular and peripapillary area were equivalent and can be used as an indicator to assist in the diagnosis of APACG.