Factors Associated with Retinal Microvasculature Dropout Induced by Elevation of Intraocular Pressure in Primary Open-Angle Glaucoma

Alex T Vasconcelos; Lucas A Rosa; Lígia I De Fendi; Vítor J B Fontes; Denny M Garcia; George C Cardoso; Carlos Gustavo De Moraes; Jayter S Paula

doi:10.1007/s00417-024-06652-1

Factors Associated with Retinal Microvasculature Dropout Induced by Elevation of Intraocular Pressure in Primary Open-Angle Glaucoma

Graefes Arch Clin Exp Ophthalmol. 2024 Oct 9. doi: 10.1007/s00417-024-06652-1. Online ahead of print.

Authors

Alex T Vasconcelos¹, Lucas A Rosa², Lígia I De Fendi², Vítor J B Fontes², Denny M Garcia², George C Cardoso³, Carlos Gustavo De Moraes⁴, Jayter S Paula²

Affiliations

¹ Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. jspaula@fmrp.usp.br.
² Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
³ Department of Physics, FFCLRP, University of São Paulo, Ribeirão Preto, Brazil.
⁴ Columbia University Irving Medical Center, New York, NY, USA.

PMID: 39382637
DOI: 10.1007/s00417-024-06652-1

Abstract

Purpose: To investigate the risk factors related to decrease in vessel density (VD) observed in primary open-angle glaucoma (POAG), due to acute increase in intraocular pressure (IOP) by an ophthalmodynamometer (OPD).

Methods: This cross-sectional study involved 42 eyes of participants (22 Controls and 20 POAG patients) that underwent optical coherence tomography angiography (OCT-A) to assess VD in the peripapillary region in three examination sets: primary gaze position (1), 25-degree adduction (2) and 25-degree adduction with OPD compression (3). Individual relationships between IOP levels and changes in the superficial complex VD were evaluated after image processing and exclusion of large retinal vessels. Multivariable regression analysis was used to verify factors associated with differences in VD induced by IOP elevation.

Results: A significant increase in IOP was induced by OPD compression during adduction (mean ± SD, Control: + 13.8 ± 2.8; POAG: + 13.4 ± 2.1 mmHg). Only during IOP elevation (set 3), a significant VD decrease was observed both in POAG eyes (p = 0.008) and controls (p = 0.022). Baseline IOP (p = 0.022), maximum IOP (p = 0.003), and scleral rigidity (p = 0.029) were significantly associated with VD decreases in eyes with POAG. No changes were observed in VD during adduction gaze exclusively.

Conclusion: Acute IOP elevation induced with OPD, but not adduction gaze, decreased peripapillary VD measured with OCT-A imaging. IOP levels and scleral rigidity significantly affected VD reduction in POAG patients. Thus, high scleral rigidity may decrease the ability of the globe to dampen the well-known effects of IOP fluctuation on glaucoma onset and progression.

Key messages: What is known Decrease vascular density in the peripapillary retina was associated with POAG, but factors related to the vascular response to elevated IOP are unexplored. What is new OCT-A quantification shows decreases in vascular density of the superficial layers of the peripapillary retina during an acute elevation in IOP. High IOP levels and scleral rigidity significantly affected vascular density reduction in POAG patients.

Keywords: Intraocular pressure; OCT angiography; Primary open angle glaucoma; Scleral stiffness.

Grants and funding

2019/03027-3/Fundação de Amparo à Pesquisa do Estado de São Paulo