Parapapillary Intrachoroidal Cavitation in Glaucoma: Association with Choroidal Microvasculature Dropout

Purpose: To characterize the choroidal microvasculature in glaucomatous eyes with parapapillary intrachoroidal cavitation(PICC) using optical coherence tomography angiography (OCTA) and its association with parapapillary choroidal microvasculaturedropout (MvD). Methods: This study included 47 glaucomatous eyes with PICC, as identified by color fundus photography and optical coherencetomography scanning of the optic nerve head area. Peripapillary choroidal microvasculature was evaluated on en-faceOCTA images. Choroidal MvD was defined as a focal sectoral capillary dropout with no visible microvascular network. Results: PICC was visible as a well-demarcated area with homogeneously reduced vessel density in en-face OCTA images ofthe choroidal layer. MvD was detected in 42 eyes (89.4%). Although located in the juxtapapillary area adjacent to the PICC,MvD was confined to the area of parapapillary atrophy. MvD observed in OCTA en-face images was distinguished from thearea of PICC by the absence of vascular signal. Of the 50 PICCs, 49 (98.0%) had hemifield visual field defects at the locationcorresponding to the hemispheric location of PICC. Conclusions: PICC was found to have a characteristic microvascular feature in choroidal en-face OCTA images, and to betopographically associated with glaucomatous visual field defect. PICC was frequently accompanied by MvD and was locatedadjacent to the area of MvD, suggesting that PICC and MvD have similar pathogenesis.