Association of Peripapillary Arterial Circle of Zinn-Haller with Glaucoma in Highly Myopic Eyes

Abstract

Précis: The visualization of circle of Zinn-Haller (CZH) on optical coherence tomography angiography (OCTA) or its pattern does not have a clear effect on glaucoma, whereas the location of CZH is associated with axial length (AXL) in highly myopic eyes. Purpose: To investigate the association between the CZH and the presence of glaucoma using swept-source optical coherence tomography angiography (SS-OCTA) images of the optic nerve of patients with high myopia (HM). Methods: This retrospective case series included 227 eyes with HM, comprising 134 and 93 eyes with and without glaucoma, respectively. The characteristics of CZH, including visualization, pattern, and location, were assessed using SS-OCTA. Vascular parameters, such as vessel density and microvascular dropout (MvD), were quantified. The factors affecting the presence of glaucoma and the correlations between the CZH distance and AXL were identified using logistic regression analysis and Pearson correlation analysis, respectively. Results: CZH was detected more frequently in HM patients with glaucoma (71.6%) than in patients without glaucoma (51.6%) (P < 0.002). However, the visualization of CZH was not related to the presence of glaucoma in multivariate regression analysis (odds ratio [OR], 0.688; 95% confidence interval [CI], 0.328-1.444; P = 0.322). Moreover, compared with the annular pattern used as a reference, triangular and irregular patterns were not associated with the presence of glaucoma (OR: 1.043, 95% CI: 0.101-10.763, P = 0.971; OR: 0.527, 95% CI: 0.255-1.092, P = 0.085, respectively). MvD was significantly higher in patients with glaucoma (61.2%) than that in patients without glaucoma (2.2%) (P < 0.001) and was identified as a significant factor affecting the presence of glaucoma (OR, 42.120; 95% CI, 9.416-188.413; P < 0.001). AXL showed a significant correlation with CZH distance in all patients (R = 0.399; P < 0.001). Conclusions: CZH was more commonly detected in HM patients with glaucoma. However, no clear associations of glaucoma with the visualization, pattern, or location of CZH were observed in the present study. The correlation between AXL and CZH distance in eyes with HM warrants further investigation. These results may offer insights into the pathogenesis of glaucoma in eyes with HM as OCTA technology advances.