Retinal microvascular changes in patients with ischemic coronary artery disease

In this study, it was aimed to correlate the changes in retinal vascular density densities by using optical coherence tomography angiography (OCTA) in patients with coronary artery occlusion who underwent coronary angiography for coronary artery disease (CAD). Materials and Methods Between 01/ 05/ 2022-31/ 05/ 2022, ocular examination of the patients who underwent coronary angiography by a cardiologist in the Cardiology Department due to coronary artery disease (CAD) and occlusion in their vessels was performed by an ophthalmologist within the first week. Best corrected visual acuity (BCVA) biomicroscopic and funduscopic examinations of the patients included in the study were performed. Intraocular pressure measurements were taken. Smoking status was questioned. Height and weight measurements were taken. Forty patients with coronary artery occlusion detected by coronary angiography due to CAD were grouped as CAD group and 40 healthy individuals were grouped as control group. The right eyes of individuals with acquisition signal strength >0.7 in OCTA were included in the study. Before the OCTA measurements, the pupils of the patients were dilated with 1% tropicamide. FAZ area (mm2), FAZ perim (mm) and Foveal vascular Density (%), Non-flow Area (mm2) imaging with OCTA was performed using RTVue-XR SD-OCT (AngioVue, v2018.1.1.60) OCTA device. By evaluating the 3x3 mm OCTA images, the vascular density (%) of the capillary plexuses in the superior, inferior, temporal and nasal quadrants of the DKP and DKP in the parafoveal region was measured automatically with the device software. The blood flow in the determined region was determined using the SSADA algorithm. Results Participants were evaluated as Control and CAD groups. The gender distribution was 33 males and 7 females in the control group, and 25 males and 15 females in the CAD group. A statistically significant decrease was observed in the foveal vascular density (VD) parameter in the CAD group between the CAD and the Control group (p= 0.004). There was a statistically significant decrease in CAD VD whole inferior hemi, parafoveal inferior, parafoveal temporal, and foveal VD parameters in the CAD group between CAD and the control group (p=0.03, p=0.026, p=0.04, p=0.031, respectively). It was observed that there was a decrease in all parameters of SCP VD between CAD and control group in the CAD group. Statistically significant decreases were observed in whole image, whole superior hemi, whole inferior hemi, parafoveal, parafoveal superior hemi, parafoveal inferior hemi, parafoveal temporal, parafoveal inferior VD parameters (p=0.001, p=0.013, p<0.001, p=0.003, p=0.04, p<0.001, p<0.001, p<0.001, respectively). When the SCP VD rates of 29 patients with HT in the CAD group and 11 patients without HT were compared, there was a statistically significant decrease in foveal and parafoveal inferior VD parameters between the 2 groups (p=0.023, p=0.037, respectively). When the FAZ parameters of 29 patients with HT in the CAD group and 11 patients without HT were compared, there was a statistically significant increase in FAZ (mm2) and FAZ perimeter (mm) parameters (p=0.026, p=0.008, respectively). When the DCP VD parameters were compared according to the smoking status of all individuals in the CAD and Control groups, it was observed that there was a statistically significant decrease in the whole superior hemi, whole inferior hemi, and parafoveal inferior VD parameters (p=0.043, p=0.018, p=0.004, respectively). When parameters were correlated with BMI and coronary artery occlusion rates, no significant correlation was observed. When OCTA FAZ parameters were correlated with BMI and coronary artery occlusion rates, no significant correlation was observed. When OCTA SCP VD parameters were correlated with BMI; A significant negative correlation was observed in whole image inferior hemi, parafoveal inferior hemi, temporal and inferior VD parameters (p=0.002, p=0.001, p=0.009, p=0.001, respectively). When the rates of LAD and RCA occlusion from coronary artery occlusions were correlated with SCP VD parameters, no significant correlation was observed. When CX vessel occlusion rates were correlated with SCP VD parameters, a significant negative correlation was observed in whole image, parafoveal, parafoveal inferior and temporal VD parameters (p=0.035, p=0.049, p=0.016, p=0.035, respectively). Conclusions OCTA is a noninvasive device with fast processing time that can measure retinal vascular density and can measure changes that may occur in retinal vascular density. The decrease in vascular density in retinal vessels may be a precursor to stenosis that may occur in coronary vessels with similar structural features. Retinal vascular changes that can be measured with OCTA may be useful for the detection of coronary artery disease in the early stage. OCTA can be used in the early diagnosis and treatment follow-up of coronary artery diseases.