Elsevier

American Journal of Ophthalmology

Volume 208, December 2019, Pages 313-322
American Journal of Ophthalmology

Original Article
Anterior Segment Optical Coherence Tomography Angiography Imaging of Conjunctiva and Intrasclera in Treated Primary Open-Angle Glaucoma

https://doi.org/10.1016/j.ajo.2019.05.008Get rights and content

Purpose

To investigate conjunctival and intrascleral vasculature in glaucoma eyes using anterior segment (AS)-optical coherence tomography angiography (OCTA) and assess the factors contributing to the vessel density in AS-OCTA images.

Design

Prospective, cross-sectional study.

Methods

Thirty-four patients with primary open-angle glaucoma and 20 healthy subjects were included. A swept-source OCT system was used to obtain the AS-OCTA images of the corneoscleral limbus at the nasal and temporal quadrants. Vessel densities were measured in the superficial (from the conjunctival epithelium to a depth of 200 μm) and deep (from a depth of 200 to 1000 μm) layers. The vessel density was compared between healthy and glaucoma eyes, and the associations of the vessel density with possible confounding factors were analyzed using univariable and multivariable analyses.

Results

The vessel density was not significantly different between healthy eyes and eyes with glaucoma. There was a significant association of superficial vessel density with the use of a prostaglandin analog (P = .007) and with nasal location (P = .016) in eyes with glaucoma. Deep vessel density was significantly smaller with advancing age (P = .029) in healthy eyes and greater with higher intraocular pressure (P = .021) in eyes with treated glaucoma.

Conclusions

AS-OCTA images may be useful for the objective assessment of conjunctival hyperemia and helpful for understanding the pathophysiology of post-trabecular aqueous humor outflow.

Section snippets

Methods

This prospective, cross-sectional study was approved by the Institutional Review Board and Ethics Committee at Kyoto University Graduate School of Medicine, and was registered with the University Hospital Medical Information Network Clinical Trials Registry of Japan (UMIN: 000028853). All aspects of the study adhered to the tenets of the Declaration of Helsinki. After the study design and risks and benefits of participation were thoroughly explained, written informed consent was obtained from

Results

Twenty healthy subjects and 36 patients with glaucoma were initially enrolled. Two glaucomatous eyes were subsequently excluded because of poor-quality AS-OCTA images, leaving 20 healthy eyes and 34 eyes with glaucoma available for analysis. The demographics and clinical characteristics of the study subjects are summarized in Table 1. There was no significant difference in age, sex, axial length, or central corneal thickness between the healthy eyes and eyes with glaucoma (all P > .05). The

Discussion

The current study is the first report to investigate the conjunctival and intrascleral vasculature using AS-OCTA in eyes with glaucoma. There was a significant association between the superficial vessel density and use of prostaglandin eye drops. The deep vessel density decreased significantly with age in healthy eyes and increased with increasing IOP in treated eyes with glaucoma. Our findings indicate that AS-OCTA images might be useful for objective assessment of conjunctival hyperemia and

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