Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Macular and Peripapillary Microvasculature in Acromegaly, an Optical Coherence Tomography Angiography Study: Cross-Sectional Study
Akromegalide Makular ve Peripapiller Mikrovasküler Yapı, Optik Koherens Tomografi Anjiyografi Çalışması: Kesitsel Çalışma
Şerife ÇİLOĞLU HAYATa , Yusuf Cem YILMAZa , Merve KELEBEKa , Esra HATİPOĞLUb
aUniversity of Health Sciences Başakşehir Çam and Sakura City Hospital, Department of Ophthalmology, İstanbul, Türkiye
bUniversity of Health Sciences Başakşehir Çam and Sakura City Hospital, Division of Endocrinology and Metabolism, İstanbul, Türkiye
Turkiye Klinikleri J Ophthalmol. 2025;34(1):17-23
doi: 10.5336/ophthal.2024-104960
Article Language: EN
Full Text
ABSTRACT
 Objective: To assess macular and optic nerve head capillary network in patients with acromegaly using optical coherence tomography angiography (OCTA). Material and Methods: This study included 54 acromegaly patients and 50 healthy control subjects. All participants underwent comprehensive ophthalmological examinations, including optical coherence tomography and OCTA. Vessel densities (VD) in the superficial (SCP) and deep capillary plexuses (DCP), and the radial peripapillary capillary (RPC) segment were recorded. Results: The corrected distance visual acuity was significantly worse in the acromegaly group. Both superior and nasal retinal nerve fiber layer (RNFL) thicknesses were significantly thinner, in patient group (p<0.05). Optic neuropathy (ON) was detected in 40.7% of patients. RPC VD was significantly reduced in the inferior region (p=0.034), and macular OCTA analysis showed decreased VD in SCP whole, inferior, nasal, and DCP inferior and nasal quadrants in the acromegaly group. In patients with ON, RNFL superior thickness showed a negative correlation with RPC superior VD (r=-0.475, p=0.026). Correlations were observed between RNFL temporal thickness and RPC temporal VD (r=0.584, p=0.004) and between RNFL nasal thickness and RPC nasal VD (r=0.510, p=0.015). In the group without ON, RNFL nasal thickness negatively correlated with RPC nasal VD (r=-0.478, p=0.006). Conclusion: Our study showed significantly reduced VD in the RPC inferior quadrant and various macular SCP and DCP quadrants in acromegaly patients. Our findings suggest that vascular compensatory mechanisms may activate prior to ON and might persist even with ON. OCTA provides a noninvasive means to explore retinal microcirculation.

Keywords: Acromegaly; insulin like growth factor-1; optical coherence tomography angiography; ocular hypoperfusion; vessel density
ÖZET
 Amaç: Akromegali hastalarında, optik koherens tomografi anjiyografi (OKTA) ile makular ve optik sinir başı kapiller damar yoğunluğunu (DY) değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu kesitsel çalışmaya, 54 akromegali hastası ve 50 sağlıklı katılımcı dâhil edildi. Tüm katılımcılara kapsamlı göz muayeneleri yapıldı, OKT ve OKTA görüntülemeleri gerçekleştirildi. Süperfisyal kapiller pleksus (SKP) ve derin kapiller pleksus (DKP) ve radial peripapiller kapiller (RPK) segmentlerinde DY'ler kaydedildi. Bulgular: Akromegali grubunda en iyi düzeltilmiş görme keskinliği anlamlı derecede düşük, superior ve nasal retinal sinir lifi tabaka [retinal nerve fiber (RNFL)] kalınlıkları anlamlı derecede inceydi (p<0,05). Optik nöropati (ON) %40,7 oranında hastada tespit edildi. RPK DY, inferior bölgede anlamlı azalmıştı (p=0,034). Akromegali grubunda SKP bütün, inferior, nazal ve DKP inferior ve nazal bölgelerde DY'nin kontrole göre azaldığı gözlendi. ON bulunan hastalarda superior RNFL kalınlığı ile RPK superior DY arasında negatif korelasyon (r=-0,475, p=0,026) bulundu. Temporal RNFL kalınlığı ile RPK temporal DY (r=0,584, p=0,004) ve nazal RNFL kalınlığı ile RPK nazal DY (r=0,510, p=0,015) arasında pozitif korelasyon gözlendi. ON bulunmayan grupta ise nazal RNFL kalınlığı ile RPK nazal VD arasında negatif korelasyon (r=-0,478, p=0,006) saptandı. Sonuç: Çalışmamızda, akromegali hastalarında RPK inferior ve çeşitli SKP ve DKP alt bölgelerinde anlamlı DY azalması gözlemlenmiştir. Çalışmamız sonuçları, vasküler kompansasyon mekanizmalarının ON gelişiminden önce aktive olabildiğini ve ON mevcut olduğunda bile devam edebileceğini öne sürmektedir. OKTA, retinal mikro dolaşımın noninvaziv bir şekilde incelenmesini sağlayarak akromegali hastalarındaki erken mikrovasküler değişikliklerin anlaşılmasına yardımcı olabilir.

Anahtar Kelimeler: Akromegali; insülin benzeri büyüme faktörü-1; optik koherens tomografi anjiyografi; oküler hipoperfüzyon; damar yoğunluğu
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