Ocular surface vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography

Ocular surface vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Ocular surface vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography Seyed Mohsen Rafizadeh, Mostafa Heidari, Amirhosein Aghajani, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4181662/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Thyroid eye disease (TED) is a common ophthalmologic manifestation of thyroid dysfunction. No imaging modality has become popular for the assessment of anterior segment vasculature of patients with TED. We aimed to assess changes in ocular surface circulation after orbital decompression in patients with TED and to explore the modifying factors of its alteration. Ocular surface vascularity features (vessel density (VD), vessel diameter index (VDI), and vessel length density (VLD)) were assessed via anterior segment optical coherence tomography-angiography (AS-OCTA) before and after orbital decompression in addition to ophthalmic examinations. AS-OCTA of the ocular surface vasculature showed that the temporal vasculature measurements decreased significantly 6 weeks after decompression surgery (p value < 0.05), but in the nasal region, the difference did not reach statistical significance. Ocular surface circulation changes after orbital decompression in patients with TED. These changes can significantly affect the control of IOP and ocular surface symptoms. Someone can use AS-OCTA in evaluating the success of the decompression surgery and the need for further treatments. Health sciences/Diseases/Eye diseases Health sciences/Endocrinology/Endocrine system and metabolic diseases Anterior segment—OCT angiography Ocular surface Thyroid eye disease Background Optical coherence tomography angiography (OCTA) is an imaging technique that can take fast pictures from all retinal layers noninvasively and simultaneously image the blood flow of retinal vessels. 1,2 Other methods include slit lamp photography, fluorescein angiography, and indocyanine green angiography. 3,4 The usage of dyes in dye-based angiography methods has some contraindications. 3,5,6 However, OCTA is a noninvasive imaging method that involves no contact with the eye and significantly helps in the diagnosis of diseases. Therefore, its use has been extended to the anterior segment of the eye. Some authors have used anterior segment OCT angiography to delineate the cornea, conjunctiva, sclera, and iris vasculature and to visualize anterior segment neovascularization and its hyperemia and ischemia. 7 Recently, several studies have assessed ocular surface vasculature by OCTA. Vascular changes after pterygium surgery and keratoplasty were visualized by AS-OCTA. 4,8,9 The increase in the episcleral venous congestion that occurs in patients with carotid-cavernous fistulas and is usually imaged by more invasive methods is detected by AS-OCTA. 10 Interestingly, peripapillary vessels can be assessed simultaneously by OCTA of the retina to show early glaucomatous damage in CCF. Thyroid eye disease (TED) is an orbital disease that is frequently associated with thyroid dysfunction. Women are affected 2.5 to 6 times as often as men are, but men are affected by the more severe forms and are older. The onset of TED usually occurs between 30 and 50 years of age, and its course is more severe after age 50. 11 TED has a wide spectrum of clinical signs and symptoms. The inflammatory factors are the first. 11 These conditions include peri-orbital edema, conjunctival hyperemia, chemosis, and superior limbic keratoconjunctivitis. Peri-orbital edema causes fat prolapse into the eyelids, venous drainage disorder, and retroseptal infiltration. 11 Recent studies have indicated that the circulation of ocular structures changes in patients with TED. A superior ophthalmic vein assessment revealed decreased flow in TED patients. 12 Efficient orbital decompression surgery increases the blood flow velocity in SOV, hence decreases the episcleral venous pressure and episcleral venous congestion. 13 The more the exophthalmos decreases, the more this arterial resistance decreases. 14 Choroidal thickness and choroidal vasculature increase in TED patients. It can be a result of enlarged extraocular muscles and other orbital tissues as well as orbital congestion. 15 Although vascular changes in the ocular surface are among the most common symptoms of TED, assessments of ocular surface vasculature are less common. All scoring systems for TED activity are concentrated on conjunctiva and scleral redness (clinical activity score [CAS] and VISA). Considering the effect of an efficient orbital decompression on SOV blood flow and episcleral venous pressure, someone can evaluate the change in ocular surface circulation to confirm the success of the decompression surgery. However, imaging methods for ocular surface assessment are less commonly used. 16 In anterior segment OCT angiography (OCT-A) in ophthalmology, the indices VD, VLD, and VDI are used to analyze the vascular density and blood flow characteristics of the anterior segment of the eye. These indices include: 1. VD (vessel density): VD represents the percentage of area occupied by blood vessels in a specific region of interest (ROI). It provides information about the overall vessel density in that area. 2. VLD (vessel length density): The VLD measures the total length of blood vessels per unit area in a specific ROI. It provides information about the length of vessels within a given region. 3. VDI (vessel diameter index): The VDI calculates the average diameter or caliber of blood vessels within a specific ROI. It provides information about vessel caliber or thickness. These indices are calculated using specialized software that analyzes OCT-A images and extracts vascular parameters from them. Considering the vast use of qualitative assessments of ocular surface vasculature changes in the diagnosis of TED and the need for surgery in these patients, we aimed to study conjunctiva and scleral circulation by OCT-A in patients with TED before and after decompression and to perform a quantitative assessment of ocular surface vasculature. Methods The study adhered to the Declaration of Helsinki and is approved by the Hospital’s Ethics Committee of Farabi Eye Hospital. All study participants provided written informed consent before enrollment. Study Participants In this prospective observational study, we evaluated patients clinically diagnosed with TED who presented at the orbit and oculoplastic clinic of Farabi Eye Hospital in Tehran, Iran. The study spanned 14 months, from January 2023 to February 2024. Patients with proven TED who planned to undergo decompression surgery were consecutively enrolled in the study. The demographic data, ophthalmic examinations, and vascular features were documented one week before and 6 weeks after decompression surgery. The exclusion criteria included inability to undergo OCT and OCT-A imaging, concurrent ocular surface disease (e.g. Glaucoma, diabetic retinopathy, and any optic neuropathy unrelated to TEDD), active thyroid eye disease, orbital decompression, strabismus, or eyelid surgery, and uncontrolled thyroid function tests. The demographic data and past medical history (history of smoking, history of thyroidectomy, and treatment with radioactive iodine) were documented via interviews. All enrolled patients underwent comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), Hertel exophthalmometry, margin-to-reflex distance (MRD) measurements of 1 and 2, and intraocular pressure (IOP) measurements. Disease activity was evaluated using the CAS, which includes spontaneous retrobulbar pain, pain in vertical eye movement, eyelid erythema, eyelid edema, conjunctival injection, conjunctival chemosis, and caruncle inflammation. A score was considered for each of these criteria. Patients with CASs ≥ 3 were classified as having active TED and excluded from the study. Surgical technique: To decompress the medial orbital wall, a medial transcaruncular orbitotomy was performed first after general anesthesia and the placement of a blepharostat. For this purpose, a conjunctival incision was made in the medial part and the tissue under the caruncle using Westcut scissors, and then the dissection was performed to the periorbita level. Then, the medial orbital wall was exposed by incising the exposed periorbita. After that, the bone was removed posterior to the posterior lacrimal crest and inferior to the ethmoidal arteries. Finally, the conjunctiva was repaired with an 8/0 Vicryl suture. If inferior wall decompression is needed due to severe proptosis and requires double-wall decompression, inferior wall decompression was also performed in the same session. The periosteum was incised, and the orbital rim was exposed. The medial portion of the orbital floor was removed medial to the infraorbital nerve canal and extended posteriorly to the posterior wall of the maxillary sinus. The bone was preserved one centimeter behind the inferior orbital rim and at the junction of the lower and medial walls of the orbit. Finally, the conjunctiva in the inferior fornix was repaired with an 8/0 Vicryl suture. Anterior Segment Optical Coherence Tomography Angiography All study participants underwent AS-OCTA imaging at the designated imaging site. Experienced photographers conducted the imaging sessions using the AngioVue OCTA system manufactured by Optovue, CA, USA. The total scan acquisition time of AngioVue OCTA was less than 3 seconds. The device operated at a central wavelength of 840 nm and had a beam width of 22 µm. It achieved a scanning speed of 70,000 A-scans/second and provided an optical axial resolution of approximately 5 µm. The device acquired 304 × 304 A-scans, capturing two consecutive B-scans at each position to distinguish between static tissues and structures with high signal fluctuations. Blood flow was detected by combining the two images at the exact location using proprietary angiography algorithms and motion correction techniques. The split spectrum amplitude decorrelation angiography (SSADA) algorithm in AngioVue enhances the signal-to-noise ratio and improves flow detection. Image acquisition and segmentation We employed the Angioretina mode of the AngioVue OCTA system to capture the vasculature of the anterior segment of the eye. The image of the temporal and nasal halves of each eye is captured separately. The vascular parameters of each scanned image, including vessel density (VD), vessel length density (VLD), and vessel diameter index (VDI), were assessed at two distinct depths: 1) Superficial, from the conjunctival epithelium to a depth of 200 µm. 2) Deep, from a depth of 200 µm to a depth of 1000 µm, indicating the intrascleral layer. The conjunctival area within the image was manually identified by aligning it with the inner limiting membrane as indicated by the device. Additionally, each image was subdivided into temporal and nasal halves. Statistical analysis Descriptive statistics were calculated for the study variables, including the mean and standard deviation. We compared the means of the parameters before and after the operation. Given the inclusion of data from both eyes of the same individuals, we employed a generalized estimating equation model with robust estimators to compare the preoperative and postoperative data. We constructed a generalized linear model in which vascular features were the dependent variables, while age, sex, demographic data, and ophthalmic data (including LogMAR BCVA, MRD1, MRD2, CAS, and IOP) were considered independent variables. We excluded missing data from the analysis. To determine the effect of each independent variable on vascular features, we used multivariable analysis. Statistical significance was defined as a p value less than 0.05. All statistical analyses were performed using IBM SPSS Statistics software, version 27 (IBM Corp, New York, USA). Results Thirty-one eyes from 22 patients with TED, with a sex distribution of 64% female (14 patients), were included in this study. The mean (± SD) age of the patients was 45.36 (± 10.35) years. The demographic data of the patients are shown in Table 1. The ocular surface vasculature in the deep and superficial layers was measured before decompression surgery. The results of these measurements besides the results of the preoperative ocular examinations are presented in Table 2. We observed no difference between men and women regarding AS-OCTA parameters. The nasal-superficial VD, deep-temporal VD, nasal-superficial VLD, deep-nasal VLD, and the deep-temporal VLD were greater in smokers than in nonsmokers. The preoperative MRD2 was greater in patients with a history of treatment with radioactive iodine. Preoperative VD-nasal-superior, VD-temporal-superior, VLD-nasal-superior, and VLD-temporal superior) were higher in patients without a history of treatment with radioactive iodine. The AS-OCTA parameters were measured one week before and 6 weeks after decompression surgery. Analysis of these data revealed that the temporal vasculature measurements decreased significantly 6 weeks after decompression surgery (p value < 0.05), but in the nasal region, the difference did not reach statistical significance. The complete results of the preoperative AS-OCTA measurements, in addition to the confidence intervals and p values of the comparisons, are presented in Table 3. Furthermore, the results of the ophthalmologic examinations of the participants one week before and 6 weeks after decompression surgery indicated that all of these measurements improved significantly except for the MRD1. The complete results of the preoperative and postoperative ophthalmologic examinations, in addition to the confidence intervals and p values of the comparisons, are presented in Table 3. The mean decrease in proptosis in patients who underwent one-wall decompression (medial) was 2.17 mm, and in patients who underwent two-wall decompression (inferomedial) was 3.97 mm (p value<0.05). The decreases in MRD2 in patients who underwent medial and infero-medial wall decompression were 0.79 mm and 1.5 mm, respectively (p value<0.05). To determine which demographic variables and changes in ophthalmologic examinations had significant modifying effects on changes in AS-OCTA parameters, we performed a multivariate analysis of the changes in these parameters, and the mentioned variables were chosen as cofactors. This analysis was performed for the AS-OCTA parameters of the temporal region because the changes in these parameters in the nasal region were not significant. Multivariate analysis revealed that sex and history of thyroidectomy had a significant modifying effect on the changes in the superficial layer of the temporal half of ocular surface vascularity after decompression. Changes in Hertel exophthalmometry and intraocular pressure (IOP) were significantly correlated with changes in the deep layer of the temporal half of ocular surface vascularity after decompression. Table 4 (Table 4) presents the demographic data and the (changes in) ophthalmologic examinations that had a significant effect on these parameters. Discussion In this study, we assessed changes in the superficial ocular vasculature in 31 eyes with inactive TED before and after decompression surgery using AS-OCTA imaging. We observed that the superficial ocular vasculature decreased significantly after decompression surgery in the temporal region. Based on our literature review, there are no other published studies assessing the effect of decompression surgery on the superficial ocular vasculature using AS-OCTA. The retro-orbital crowding due to orbital muscle and fat hypertrophy decreases blood velocity in superior ophthalmic vein and increases intra-orbital pressure and orbital venous congestion. 17-20 The more crowding in the severe TED might induce retrograde blood flow in SOV and dysthyroid optic neuropathy. 21 Venous congestion thickens the choroidal layer in patients with TED. One study reported that choroidal vasculature increases from 63.34% in healthy controls to 65.9% in patients with TED. 15 Also, the orbital venous congestion Increases episcleral venous pressure hence, interrupting aqueous humor output flow and increases IOP. 22,23 Orbital venous congestion occurs in patients with carotid-cavernous fistula as well. Blood flow reversal in the superior ophthalmic vein results in blood congestion in episcleral venous plexus in the deep layer of episcleral vascular layer (350-400 µm) that was imaged by AS-OCTA. 19 Episcleral venous congestion raises the IOP and induces glaucomatous optic neuropathy. OCTA imaging showed vascular dropout in peri-papillary region indicating the early stages of glaucomatous optic neuropathy. 19 The rise in episcleral venous pressure is the major suggested mechanism for IOP rise in TED that might result in glaucomatous optic neuropathy that can aggravate the pre-existing dys-thyroid optic neuropathy. Assessment of macular and peripapillary vasculature using OCTA has shown that vascular density in the retinal and peri-papillary regions is significantly lower in patients with TED than in healthy controls. 24 Regarding the effect of TED activity on the peri-papillary vasculature there might be an increase in the peri-papillary blood circulation due to increased inflammatory mediators or a decrease in peri-papillary vasculature due to increased orbital pressure and orbital congestion due to inflamed orbital tissues. 24,25 Elucidating the net change in retinal and peri-papillary vasculature in patients with active TED deserves further studies with larger sample sizes. We could not find a published article evaluating conjunctival and scleral vasculature changes after decompression surgery. However, Chung presented at the annual ARVO meeting in 2018 and reported that deep episcleral venous velocity and vascular density increased after decompression surgery in patients suffering from TED. However, their sample size was small. 16 We couldn’t find a significant correlation between the number of decompressed walls and the change in AS-OCTA parameters. There was no significant correlation between Hertel exophthalmometry and changes in AS-OCTA parameters. However, Multivariate analysis revealed that postoperative changes in Hertel exophthalmometry readings and IOP measurements were significantly correlated with changes in AS-OCTA parameters in the deep layer of the ocular surface vasculature. Therefore, future studies concentrating on the deep layer of the episcleral and conjunctival vasculature are necessary to assess the pathogenesis of IOP increment in patients with TED. As it is mentioned above, glaucoma and ocular hypertension are more prevalent in TED patients than in healthy individuals. 22,26 One of the most important suggested causes of this increase in IOP is increased episcleral venous pressure. 22 Similar to previous studies, we observed a small but statistically significant decrease in IOP after decompression surgery. 27 We couldn’t find a significant correlation between the number of decompressed walls and the change in AS-OCTA parameters. There was no significant correlation between Hertel exophthalmometry and changes in AS-OCTA parameters. However, Multivariate analysis revealed that postoperative changes in Hertel exophthalmometry readings and IOP measurements were significantly correlated with changes in AS-OCTA parameters in the deep layer of the ocular surface vasculature. Comparison of aqueous angiography imaging by ICG imaging and AS-OCTA images of a deep layer of episcleral and conjunctival vasculature revealed that functional posttrabecular aqueous humor output images are similar to the segmental pattern of the deep layer vasculature that is denser in the limbal zone than in the peripheral zone. 28 This finding is in concordance with our findings. Therefore, future studies concentrating on the deep layer of the episcleral and conjunctival vasculature are necessary to assess the pathogenesis of the IOP increment in patients with TED. A comparison of the AS-OCTA parameters before and after decompression surgery revealed that the vascular density, vascular diameter index, and vascular length index in the temporal region of the ocular surface decreased in the superficial and deep layers (p value<0.01). It seems that after decompression surgery, the pressure inside the orbit and, as a result, the pressure on the vessels decreases. These changes reduce venous stasis and vascular congestion. Therefore, in addition to the vascular changes that occur in the choroid layer, similar decreasing changes occur in the vasculature of the ocular surface. We detected a decrease in AS-OCTA parameters in the temporal region of the ocular surface after decompression surgery. In this study, we obtained AS-OCTA images one week before and 6 weeks after decompression surgery. Medial wall decompression was performed in all of our patients, and the remaining inflammation in the nasal conjunctiva due to the transcaruncular incision may have prevented a decrease in the ocular surface vasculature six weeks after surgery. A longer follow-up time can resolve the inflammation caused by the surgical approach in the nasal region and more accurately show the changes in the AS-OCTA parameters in nasal area of the ocular surface. In this study, we observed that TED patients who smoked had greater amounts of proptosis (27 millimeters vs 24.3 millimeters) and MRD2 (7.9 millimeters vs 3.6 millimeters) than did nonsmokers (p<0.05). Recent studies have reported that smoking increases CAS, decreases ocular motility, and decreases the response to treatment. 29-31 Nevertheless, we did not find a statistically significant difference between changes in AS-OCTA parameters in smokers and nonsmokers after decompression surgery. The differences in the CAS and changes after surgery between smokers and nonsmokers were also not significant. Regarding the effect of past medical history of treatment with radioactive iodine on TED and AS-OCTA parameters, the results were not conclusive. This could be due to the lack of adjustment in the time interval between treatment with radioactive iodine and our study. More studies with larger sample sizes can reveal the effect of treatment with radioactive iodine on ocular surface vasculature. Past studies have revealed that treatment with radioactive iodine, especially without the use of prophylactic corticosteroids, aggravates thyroid ophthalmopathy in the short-term and long-term. Notably, this effect has not been reported after thyroidectomy. 32,33 Lowering the orbital pressure and orbital and ocular venous congestion is one of the main aims of TED treatment. Decrease in venous congestion improves redness of ocular surface apparatus and disease activity. Also, a decrease in orbital and intraocular pressure treats and prevents further compressive and glaucomatous optic neuropathy. Evaluation of ocular surface vasculature by AS-OCTA should be considered as a non-invasive and feasible approach for the assessment of TED treatment success. Limitation: We had some limitations in this study. Although we had the largest sample size compared with other similar studies, a larger sample size might help us to find more significant differences in our subgroup analyses. Of course, finding more patients compatible with our inclusion and exclusion criteria is difficult. Our center is a referral center and patients come from other distant cities and some of them can’t be referred for longer and repeated follow-up sessions. Ocular surface vasculature might need more time to respond completely to decompression. Furthermore, post-operative inflammation improves completely within a longer interval after surgery. Larger studies with longer follow-up times will find more interesting changes and modifying factors in ocular surface vasculature after decompression surgery. Conclusion Orbital changes in thyroid eye disease induce alterations in the circulation of the posterior segment and anterior segment. These alterations are important in the diagnosis and follow-up of patients with TED. Several authors have studied quantitative changes in the circulation of the posterior segment in TED patients. However, changes in the circulation of the anterior segment in patients with thyroid ophthalmopathy are assessed only qualitatively. AS-OCTA will help us significantly in research and clinical studies of patients with TED. Declarations Acknowledgment: There are no conflicts of interest. Ethics approval and consent to participate: The study adhered to the Declaration of Helsinki. Ethics committee approval was obtained from the Tehran University of Medical Sciences. All study participants provided written informed consent before enrollment. Consent for publication: All study participants provided written informed consent for publication before enrollment Availability of data and materials: the data of this study are documented in some Excel data sheets and are available on reasonable requests. Competing interests: The authors declare that they have no competing interests. Funding: No person or institute fund for this study. Authors' contributions: SMR and MR visited and operated the patients. PA, SM, and ZM extracted the data from the AS-OCTA system. AM and AA performed the follow-up visits. MH was the major contributor to writing the manuscript. All authors read and approved the final manuscript. Acknowledgments: no other person contributed towards the article who does not meet the criteria for authorship. Financial Support: None Conflict of interest: No conflicting relationships exist for any of the authors. References Koustenis A, Harris A, Gross J, Januleviciene I, Shah A, Siesky B. Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research. British Journal of Ophthalmology . 2017;101(1):16-20. Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Progress in retinal and eye research . 2018;64:1-55. 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Tables Table 1- Participants demographics and clinical features of TED patients Demographics Case Percent Female 1 4 64 Age, mean year (± SD) 45.36(± 10.35) - Hx of smoking 6 3 6 Hx of thyroidectomy 3 14 Hx of iodotherapy 1 1 50 SD: standard deviation, Hx: history Table 2- Summary of Generalized Estimation Equation Comparing Ophthalmic Examination Between subgroups Characteristics Mean ± SD Mean ± SD Mean ± SD Female Male p-value Non-Smokers smokers P-value No Hx of thyroidectomy Hx of thyroidectomy P- value logMAR_pre 0.07 ± 0.12 0.05 ± 0.12 0.93 0.08 ± 0.14 0.01 ± 0.02 0.032 0.07 ± 0.13 0 ± 0 0.14 Hertel_Pre 24 ± 3.8 26.5 ± 2 0.015 24.2 ± 3.5 27 ± 2.5 0.18 24.9 ± 3.6 24.7 ± 0.6 0.01 MRD1_Pre 6 ± 2.1 6.9 ± 3.6 0.034 6.1 ± 2 6.8 ± 4.2 <0.001 6.4 ± 2.6 5.3 ± 3.5 0.75 MRD2_pre 6.6 ± 1.2 6.8 ± 1.8 0.361 6.2 ± 1 7.9 ± 1.6 0.31 6.7 ± 1.4 6.5 ± 1.3 0.82 IOP_pre 16.5 ± 3.5 17.6 ± 2.2 0.081 16.8 ± 3.1 17.3 ± 3.2 0.64 16.8 ± 3.2 17.7 ± 0.6 <0.01 CAS_Pre 0.7 ± 0.92 1.36 ± 0.81 0.867 0.91 ± 0.95 1 ± 0.93 0.50 0.96 ± 0.92 0.67 ± 1.15 0.44 Vessel density- Nasal Superficial 0.37±0.07 0.42 ± 0.08 0.64 0.38±0.05 0.41±0.12 <0.001 0.38 ± 0.07 0.41 ± 0.11 0.44 Vessel density- Nasal Deep 0.31±0.07 0.37 ± 0.09 0,70 0.32±0.06 0.37±0.12 0.06 0.34 ± 0.07 0.29 ± 0.16 0.01 Vessel density -Temporal Superficial 0.4 ± 0.08 0.41 ± 0.07 0.90 0.4 ± 0.08 0.4 ± 0.08 0.52 0.4 ± 0.08 0.4 ± 0.06 0.52 Vessel density -Temporal Deep 0.34±0.11 0.38 ± 0.1 0.85 0.35 ± 0.1 0.36±0.14 0.03 0.36 ± 0.11 0.34 ± 0.11 0.56 Vessel length density- Nasal Superficial 0.18±0.03 0.21 ± 0.04 0.42 0.19±0.02 0.19±0.06 <0.001 0.19 ± 0.03 0.21 ± 0.07 0.04 Vessel length density- Nasal Deep 0.16±0.03 0.2 ± 0.05 0.13 0.17±0.03 0.19±0.07 0.01 0.18 ± 0.03 0.16 ± 0.11 <0.001 Vessel length density -Temporal Superficial 0.2 ± 0.03 0.21 ± 0.03 0.83 0.2 ± 0.03 0.21±0.04 0.31 0.2 ± 0.03 0.21 ± 0.03 0.83 Vessel length density -Temporal Deep 0.19±0.05 0.2 ± 0.05 0.63 0.2 ± 0.04 0.19±0.07 0.04 0.2 ± 0.05 0.2 ± 0.04 0.60 Vessel diameter index- Nasal Superficial 2.08±0.17 2.01 ± 0.12 0.45 2.05±0.17 2.09±0.14 0.68 2.06 ± 0.16 2.01 ± 0.12 0.55 Vessel diameter index- Nasal Deep 1.93±0.14 1.9 ± 0.13 0.87 1.92±0.14 1.93±0.14 0.70 1.93 ± 0.13 1.88 ± 0.18 0.59 Vessel diameter index -Temporal Superficial 2 ± 0.17 1.93 ± 0.14 0.53 1.99±0.17 1.95±0.15 0.92 1.98 ± 0.16 1.94 ± 0.19 0.65 Vessel diameter index -Temporal Deep 1.84±0.21 1.87 ± 0.17 0.62 1.85±0.19 1.84±0.22 0.84 1.86 ± 0.19 1.72 ± 0.2 0.97 CI, Confidence interval; SD, Standard deviation. CAS: clinical activity score. Log-MAR: logarithm of the minimum angle of resolution. IOP: intraocular pressure, MRD1: margin-reflex diameter 1. MRD2: margin reflex diameter 2. Hx: History Table 3- Summary of Generalized Estimation Equation Comparing ophthalmic examinations before and after decompression Characteristics Mean ± SD Mean differences 95% CI P-value Pre-operation post-operation eyes Log-MAR 0.06 ± 0.12 0.11 ± 0.15 -0.05 ± 0.12 -0.1 -0.01 0.013 Hurtle 24.9 ± 3.5 21.6 ± 3.1 3.27 ± 1.38 2.77 3.78 <0.001 MRD1 6.3 ± 2.7 6.2 ± 2.8 0.06 ± 1.1 -0.34 0.47 0.747 MRD2 6.6 ± 1.4 5.4 ± 1.4 1.23 ± 0.95 0.88 1.57 <0.001 IOP 16.9 ± 3.1 15 ± 2.9 1.9 ± 3.08 0.77 3.03 0.002 CAS 0.94 ± 0.93 0.58 ± 0.89 0.35 ± 0.49 0.18 0.53 <0.001 Vessel density- Nasal Superficial 0.39 ± 0.07 0.38 ± 0.09 0.02 ± 0.08 -0.01 0.05 0.164 Vessel density- Nasal Deep 0.33 ± 0.08 0.31 ± 0.1 0.03 ± 0.11 -0.01 0.07 0.146 Vessel density- Temporal Superficial 0.4 ± 0.08 0.34 ± 0.08 0.06 ± 0.08 0.03 0.1 <0.001 Vessel density- Temporal Deep 0.36 ± 0.11 0.28 ± 0.07 0.08 ± 0.1 0.04 0.12 <0.001 Vessel length density- Nasal Superficial 0.19 ± 0.03 0.19 ± 0.04 0.01 ± 0.03 0 0.02 0.152 Vessel length density- Nasal Deep 0.17 ± 0.04 0.17 ± 0.05 0.01 ± 0.05 -0.01 0.03 0.201 Vessel length density- Temporal Superficial 0.2 ± 0.03 0.18 ± 0.04 0.02 ± 0.03 0.01 0.04 <0.001 Vessel length density- Temporal Deep 0.2 ± 0.05 0.16 ± 0.04 0.04 ± 0.05 0.02 0.05 <0.001 Vessel diameter index- Nasal Superficial 2.06 ± 0.16 2.03 ± 0.15 0.02 ± 0.16 -0.04 0.08 0.519 Vessel diameter index- Nasal Deep 1.92 ± 0.13 1.86 ± 0.19 0.08 ± 0.23 -0.01 0.17 0.082 Vessel diameter index- Temporal Superficial 1.98 ± 0.16 1.89 ± 0.13 0.1 ± 0.17 0.03 0.17 0.007 Vessel diameter index- Temporal Deep 1.85 ± 0.19 1.73 ± 0.15 0.13 ± 0.17 0.06 0.2 <0.001 CI, Confidence interval; SD, Standard deviation. CAS: clinical activity score. Log-MAR: logarithm of the minimum angle of resolution. IOP: intraocular pressure, MRD1: margin-reflex diameter 1. MRD2: margin reflex diameter 2. Hx: history Table 4- Summary of multivariate analysis of influencing cofactors on AS-OCTA parameters changes after decompression surgery Characteristics Region Layer depth Co-factor B Std. Error P value Temporal Vessel density Superficial Sex 0.169 0.0246 <0.001 Thyroidectomy -0.227 0.0388 <0.001 CAS 0.138 0.0347 <0.001 Deep Hertel 0.065 0.0193 0.001 IOP -0.018 0.0090 0.049 Temporal Vessel length density Superficial Sex 0.049 0.0082 <0.001 Thyroidectomy -0.073 0.0116 <0.001 Age 0.001 0.0003 0.008 Log-MAR -0.105 0.0478 0.028 CAS 0.055 0.0104 <0.001 Deep Thyroidectomy -0.069 0.0233 0.003 Hertel 0.027 0.0075 <0.001 MRD1 -0.037 0.0142 0.010 IOP -0.011 0.0042 0.010 Temporal Vessel diameter index Superficial Sex 0.290 0.0693 <0.001 Thyroidectomy -0.374 0.0911 <0.001 Hertel 0.074 0.0278 0.007 Deep Sex 0.189 0.0756 0.013 Hertel 0.058 0.0245 0.017 IOP 0.022 0.0093 0.017 SD: standard deviation, IOP: intraocular pressure, CAS: clinical activity score Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4181662","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":288987980,"identity":"52463bd0-c058-4552-be24-feae3e049375","order_by":0,"name":"Seyed Mohsen Rafizadeh","email":"","orcid":"","institution":"Department of Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Mohsen","lastName":"Rafizadeh","suffix":""},{"id":288987981,"identity":"586d0153-3f1c-4b58-a48e-4ae57d3aa7eb","order_by":1,"name":"Mostafa 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10:54:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4181662/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4181662/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54440849,"identity":"ce522fb5-cdc8-4374-9eb6-609cb05aba70","added_by":"auto","created_at":"2024-04-10 15:10:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":464460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4181662/v1/16b10d8c-b7f5-4937-b9f9-185e83751d9e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ocular surface vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography","fulltext":[{"header":"Background","content":"\u003cp\u003eOptical coherence tomography angiography (OCTA) is an imaging technique that can take fast pictures from all retinal layers noninvasively and simultaneously image the blood flow of retinal vessels. \u003csup\u003e1,2\u003c/sup\u003e Other methods include slit lamp photography, fluorescein angiography, and indocyanine green angiography. \u003csup\u003e3,4\u003c/sup\u003e The usage of dyes in dye-based angiography methods has some contraindications. \u003csup\u003e3,5,6\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eHowever, OCTA is a noninvasive imaging method that involves no contact with the eye and significantly helps in the diagnosis of diseases. Therefore, its use has been extended to the anterior segment of the eye. Some authors have used anterior segment OCT angiography to delineate the cornea, conjunctiva, sclera, and iris vasculature and to visualize anterior segment neovascularization and its hyperemia and ischemia. \u003csup\u003e7\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eRecently, several studies have assessed ocular surface vasculature by OCTA. Vascular changes after pterygium surgery and keratoplasty were visualized by AS-OCTA. \u003csup\u003e4,8,9\u003c/sup\u003e The increase in the episcleral venous congestion that occurs in patients with carotid-cavernous fistulas and is usually imaged by more invasive methods is detected by AS-OCTA. \u003csup\u003e10\u003c/sup\u003e Interestingly, peripapillary vessels can be assessed simultaneously by OCTA of the retina to show early glaucomatous damage in CCF.\u003c/p\u003e\n\u003cp\u003eThyroid eye disease (TED) is an orbital disease that is frequently associated with thyroid dysfunction. Women are affected 2.5 to 6 times as often as men are, but men are affected by the more severe forms and are older. The onset of TED usually occurs between 30 and 50 years of age, and its course is more severe after age 50. \u003csup\u003e11\u003c/sup\u003e TED has a wide spectrum of clinical signs and symptoms. The inflammatory factors are the first. \u003csup\u003e11\u003c/sup\u003e These conditions include peri-orbital edema, conjunctival hyperemia, chemosis, and superior limbic keratoconjunctivitis. Peri-orbital edema causes fat prolapse into the eyelids, venous drainage disorder, and retroseptal infiltration. \u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eRecent studies have indicated that the circulation of ocular structures changes in patients with TED. A superior ophthalmic vein assessment revealed decreased flow in TED patients. \u003csup\u003e12\u003c/sup\u003e Efficient orbital decompression surgery increases the blood flow velocity in SOV, hence decreases the episcleral venous pressure and episcleral venous congestion. \u003csup\u003e13\u003c/sup\u003e The more the exophthalmos decreases, the more this arterial resistance decreases. \u003csup\u003e14\u003c/sup\u003e Choroidal thickness and choroidal vasculature increase in TED patients. It can be a result of enlarged extraocular muscles and other orbital tissues as well as orbital congestion.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAlthough vascular changes in the ocular surface are among the most common symptoms of TED, assessments of ocular surface vasculature are less common. All scoring systems for TED activity are concentrated on conjunctiva and scleral redness (clinical activity score [CAS] and VISA). Considering the effect of an efficient orbital decompression on SOV blood flow and episcleral venous pressure, someone can evaluate the change in ocular surface circulation to confirm the success of the decompression surgery. However, imaging methods for ocular surface assessment are less commonly used. \u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn anterior segment OCT angiography (OCT-A) in ophthalmology, the indices VD, VLD, and VDI are used to analyze the vascular density and blood flow characteristics of the anterior segment of the eye. These indices include:\u003c/p\u003e\n\u003cp\u003e1. VD (vessel density): VD represents the percentage of area occupied by blood vessels in a specific region of interest (ROI). It provides information about the overall vessel density in that area.\u003c/p\u003e\n\u003cp\u003e2. VLD (vessel length density): The VLD measures the total length of blood vessels per unit area in a specific ROI. It provides information about the length of vessels within a given region.\u003c/p\u003e\n\u003cp\u003e3. VDI (vessel diameter index): The VDI calculates the average diameter or caliber of blood vessels within a specific ROI. It provides information about vessel caliber or thickness.\u003c/p\u003e\n\u003cp\u003eThese indices are calculated using specialized software that analyzes OCT-A images and extracts vascular parameters from them. Considering the vast use of qualitative assessments of ocular surface vasculature changes in the diagnosis of TED and the need for surgery in these patients, we aimed to study conjunctiva and scleral circulation by OCT-A in patients with TED before and after decompression and to perform a quantitative assessment of ocular surface vasculature.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study adhered to the Declaration of Helsinki and is approved by the Hospital\u0026rsquo;s Ethics Committee of Farabi Eye Hospital. All study participants provided written informed consent before enrollment.\u003c/p\u003e\n\u003cp\u003eStudy Participants\u003c/p\u003e\n\u003cp\u003eIn this prospective observational study, we evaluated patients clinically diagnosed with TED who presented at the orbit and oculoplastic clinic of Farabi Eye Hospital in Tehran, Iran. The study spanned 14 months, from January 2023 to February 2024. Patients with proven TED who planned to undergo decompression surgery were consecutively enrolled in the study. The demographic data, ophthalmic examinations, and vascular features were documented one week before and 6 weeks after decompression surgery. The exclusion criteria included inability to undergo OCT and OCT-A imaging, concurrent ocular surface disease (e.g. Glaucoma, diabetic retinopathy, and any optic neuropathy unrelated to TEDD), active thyroid eye disease, orbital decompression, strabismus, or eyelid surgery, and uncontrolled thyroid function tests.\u003c/p\u003e\n\u003cp\u003eThe demographic data and past medical history (history of smoking, history of thyroidectomy, and treatment with radioactive iodine) were documented via interviews. All enrolled patients underwent comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), Hertel exophthalmometry, margin-to-reflex distance (MRD) measurements of 1 and 2, and intraocular pressure (IOP) measurements. Disease activity was evaluated using the CAS, which includes spontaneous retrobulbar pain, pain in vertical eye movement, eyelid erythema, eyelid edema, conjunctival injection, conjunctival chemosis, and caruncle inflammation. A score was considered for each of these criteria. Patients with CASs \u0026ge; 3 were classified as having active TED and excluded from the study.\u003c/p\u003e\n\u003cp\u003eSurgical technique:\u003c/p\u003e\n\u003cp\u003eTo decompress the medial orbital wall, a medial transcaruncular orbitotomy was performed first after general anesthesia and the placement of a blepharostat. For this purpose, a conjunctival incision was made in the medial part and the tissue under the caruncle using Westcut scissors, and then the dissection was performed to the periorbita level. Then, the medial orbital wall was exposed by incising the exposed periorbita. After that, the bone was removed posterior to the posterior lacrimal crest and inferior to the ethmoidal arteries. Finally, the conjunctiva was repaired with an 8/0 Vicryl suture.\u003c/p\u003e\n\u003cp\u003eIf inferior wall decompression is needed due to severe proptosis and requires double-wall decompression, inferior wall decompression was also performed in the same session. The periosteum was incised, and the orbital rim was exposed. The medial portion of the orbital floor was removed medial to the infraorbital nerve canal and extended posteriorly to the posterior wall of the maxillary sinus. The bone was preserved one centimeter behind the inferior orbital rim and at the junction of the lower and medial walls of the orbit. Finally, the conjunctiva in the inferior fornix was repaired with an 8/0 Vicryl suture.\u003c/p\u003e\n\u003cp\u003eAnterior Segment Optical Coherence Tomography Angiography\u003c/p\u003e\n\u003cp\u003eAll study participants underwent AS-OCTA imaging at the designated imaging site. Experienced photographers conducted the imaging sessions using the AngioVue OCTA system manufactured by Optovue, CA, USA. The total scan acquisition time of AngioVue OCTA was less than 3 seconds. The device operated at a central wavelength of 840 nm and had a beam width of 22 \u0026micro;m. It achieved a scanning speed of 70,000 A-scans/second and provided an optical axial resolution of approximately 5 \u0026micro;m. The device acquired 304 \u0026times; 304 A-scans, capturing two consecutive B-scans at each position to distinguish between static tissues and structures with high signal fluctuations. Blood flow was detected by combining the two images at the exact location using proprietary angiography algorithms and motion correction techniques. The split spectrum amplitude decorrelation angiography (SSADA) algorithm in AngioVue enhances the signal-to-noise ratio and improves flow detection.\u003c/p\u003e\n\u003cp\u003eImage acquisition and segmentation\u003c/p\u003e\n\u003cp\u003eWe employed the Angioretina mode of the AngioVue OCTA system to capture the vasculature of the anterior segment of the eye. The image of the temporal and nasal halves of each eye is captured separately. The vascular parameters of each scanned image, including vessel density (VD), vessel length density (VLD), and vessel diameter index (VDI), were assessed at two distinct depths: 1) Superficial, from the conjunctival epithelium to a depth of 200 \u0026micro;m. 2) Deep, from a depth of 200 \u0026micro;m to a depth of 1000 \u0026micro;m, indicating the intrascleral layer. The conjunctival area within the image was manually identified by aligning it with the inner limiting membrane as indicated by the device. Additionally, each image was subdivided into temporal and nasal halves.\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were calculated for the study variables, including the mean and standard deviation. We compared the means of the parameters before and after the operation. Given the inclusion of data from both eyes of the same individuals, we employed a generalized estimating equation model with robust estimators to compare the preoperative and postoperative data. We constructed a generalized linear model in which vascular features were the dependent variables, while age, sex, demographic data, and ophthalmic data (including LogMAR BCVA, MRD1, MRD2, CAS, and IOP) were considered independent variables. We excluded missing data from the analysis. To determine the effect of each independent variable on vascular features, we used multivariable analysis. Statistical significance was defined as a p value less than 0.05. All statistical analyses were performed using IBM SPSS Statistics software, version 27 (IBM Corp, New York, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThirty-one eyes from 22 patients with TED, with a sex distribution of 64% female (14 patients), were included in this study. The mean (\u0026plusmn; SD) age of the patients was 45.36 (\u0026plusmn; 10.35) years. The demographic data of the patients are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eThe ocular surface vasculature in the deep and superficial layers was measured before decompression surgery. The results of these measurements besides the results of the preoperative ocular examinations are presented in Table 2. We observed no difference between men and women regarding AS-OCTA parameters. The nasal-superficial VD, deep-temporal VD, nasal-superficial VLD, deep-nasal VLD, and the deep-temporal VLD were greater in smokers than in nonsmokers. The preoperative MRD2 was greater in patients with a history of treatment with radioactive iodine. Preoperative VD-nasal-superior, VD-temporal-superior, VLD-nasal-superior, and VLD-temporal superior) were higher in patients without a history of treatment with radioactive iodine.\u003c/p\u003e\n\u003cp\u003eThe AS-OCTA parameters were measured one week before and 6 weeks after decompression surgery. Analysis of these data revealed that the temporal vasculature measurements decreased significantly 6 weeks after decompression surgery (p value \u0026lt; 0.05), but in the nasal region, the difference did not reach statistical significance. The complete results of the preoperative AS-OCTA measurements, in addition to the confidence intervals and p values of the comparisons, are presented in Table 3. Furthermore, the results of the ophthalmologic examinations of the participants one week before and 6 weeks after decompression surgery indicated that all of these measurements improved significantly except for the MRD1. The complete results of the preoperative and postoperative ophthalmologic examinations, in addition to the confidence intervals and p values of the comparisons, are presented in Table 3. The mean decrease in proptosis in patients who underwent one-wall decompression (medial) was 2.17 mm, and in patients who underwent two-wall decompression (inferomedial) was 3.97 mm (p value\u0026lt;0.05). The decreases in MRD2 in patients who underwent medial and infero-medial wall decompression were 0.79 mm and 1.5 mm, respectively (p value\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eTo determine which demographic variables and changes in ophthalmologic examinations had significant modifying effects on changes in AS-OCTA parameters, we performed a multivariate analysis of the changes in these parameters, and the mentioned variables were chosen as cofactors. This analysis was performed for the AS-OCTA parameters of the temporal region because the changes in these parameters in the nasal region were not significant. Multivariate analysis revealed that sex and history of thyroidectomy had a significant modifying effect on the changes in the superficial layer of the temporal half of ocular surface vascularity after decompression. Changes in Hertel exophthalmometry and intraocular pressure (IOP) were significantly correlated with changes in the deep layer of the temporal half of ocular surface vascularity after decompression.\u003c/p\u003e\n\u003cp\u003eTable 4 (Table 4) presents the demographic data and the (changes in) ophthalmologic examinations that had a significant effect on these parameters.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we assessed changes in the superficial ocular vasculature in 31 eyes with inactive TED before and after decompression surgery using AS-OCTA imaging. We observed that the superficial ocular vasculature decreased significantly after decompression surgery in the temporal region. Based on our literature review, there are no other published studies assessing the effect of decompression surgery on the superficial ocular vasculature using AS-OCTA.\u003c/p\u003e\n\u003cp\u003eThe retro-orbital crowding due to orbital muscle and fat hypertrophy decreases blood velocity in superior ophthalmic vein and increases intra-orbital pressure and orbital venous congestion. \u003csup\u003e17-20\u003c/sup\u003e The more crowding in the severe TED might induce retrograde blood flow in SOV and dysthyroid optic neuropathy. \u003csup\u003e21\u003c/sup\u003e Venous congestion thickens the choroidal layer in patients with TED. One study reported that choroidal vasculature increases from 63.34% in healthy controls to 65.9% in patients with TED. \u003csup\u003e15\u003c/sup\u003e Also, the orbital venous congestion Increases episcleral venous pressure hence, interrupting aqueous humor output flow and increases IOP. \u003csup\u003e22,23\u003c/sup\u003e Orbital venous congestion occurs in patients with carotid-cavernous fistula as well. Blood flow reversal in the superior ophthalmic vein results in blood congestion in episcleral venous plexus in the deep layer of episcleral vascular layer (350-400 \u0026micro;m) that was imaged by AS-OCTA. \u003csup\u003e19\u003c/sup\u003e Episcleral venous congestion raises the IOP and induces glaucomatous optic neuropathy. OCTA imaging showed vascular dropout in peri-papillary region indicating the early stages of glaucomatous optic neuropathy. \u003csup\u003e19\u003c/sup\u003e The rise in episcleral venous pressure is the major suggested mechanism for IOP rise in TED that might result in glaucomatous optic neuropathy that can aggravate the pre-existing dys-thyroid optic neuropathy. Assessment of macular and peripapillary vasculature using OCTA has shown that vascular density in the retinal and peri-papillary regions is significantly lower in patients with TED than in healthy controls. \u003csup\u003e24\u003c/sup\u003eRegarding the effect of TED activity on the peri-papillary vasculature there might be an increase in the peri-papillary blood circulation due to increased inflammatory mediators or a decrease in peri-papillary vasculature due to increased orbital pressure and orbital congestion due to inflamed orbital tissues. \u003csup\u003e24,25\u003c/sup\u003e Elucidating the net change in retinal and peri-papillary vasculature in patients with active TED deserves further studies with larger sample sizes. We could not find a published article evaluating conjunctival and scleral vasculature changes after decompression surgery. However, Chung presented at the annual ARVO meeting in 2018 and reported that deep episcleral venous velocity and vascular density increased after decompression surgery in patients suffering from TED. However, their sample size was small.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWe couldn\u0026rsquo;t find a significant correlation between the number of decompressed walls and the change in AS-OCTA parameters. There was no significant correlation between Hertel exophthalmometry and changes in AS-OCTA parameters. However, Multivariate analysis revealed that postoperative changes in Hertel exophthalmometry readings and IOP measurements were significantly correlated with changes in AS-OCTA parameters in the deep layer of the ocular surface vasculature. Therefore, future studies concentrating on the deep layer of the episcleral and conjunctival vasculature are necessary to assess the pathogenesis of IOP increment in patients with TED.\u003c/p\u003e\n\u003cp\u003eAs it is mentioned above, glaucoma and ocular hypertension are more prevalent in TED patients than in healthy individuals.\u003csup\u003e22,26\u003c/sup\u003e One of the most important suggested causes of this increase in IOP is increased episcleral venous pressure. \u003csup\u003e22\u003c/sup\u003e Similar to previous studies, we observed a small but statistically significant decrease in IOP after decompression surgery.\u003csup\u003e27\u003c/sup\u003e We couldn\u0026rsquo;t find a significant correlation between the number of decompressed walls and the change in AS-OCTA parameters. There was no significant correlation between Hertel exophthalmometry and changes in AS-OCTA parameters. However, Multivariate analysis revealed that postoperative changes in Hertel exophthalmometry readings and IOP measurements were significantly correlated with changes in AS-OCTA parameters in the deep layer of the ocular surface vasculature. Comparison of aqueous angiography imaging by ICG imaging and AS-OCTA images of a deep layer of episcleral and conjunctival vasculature revealed that functional posttrabecular aqueous humor output images are similar to the segmental pattern of the deep layer vasculature that is denser in the limbal zone than in the peripheral zone.\u003csup\u003e28\u003c/sup\u003e This finding is in concordance with our findings. Therefore, future studies concentrating on the deep layer of the episcleral and conjunctival vasculature are necessary to assess the pathogenesis of the IOP increment in patients with TED.\u003c/p\u003e\n\u003cp\u003eA comparison of the AS-OCTA parameters before and after decompression surgery revealed that the vascular density, vascular diameter index, and vascular length index in the temporal region of the ocular surface decreased in the superficial and deep layers (p value\u0026lt;0.01). It seems that after decompression surgery, the pressure inside the orbit and, as a result, the pressure on the vessels decreases. These changes reduce venous stasis and vascular congestion. Therefore, in addition to the vascular changes that occur in the choroid layer, similar decreasing changes occur in the vasculature of the ocular surface. We detected a decrease in AS-OCTA parameters in the temporal region of the ocular surface after decompression surgery. In this study, we obtained AS-OCTA images one week before and 6 weeks after decompression surgery. Medial wall decompression was performed in all of our patients, and the remaining inflammation in the nasal conjunctiva due to the transcaruncular incision may have prevented a decrease in the ocular surface vasculature six weeks after surgery. A longer follow-up time can resolve the inflammation caused by the surgical approach in the nasal region and more accurately show the changes in the AS-OCTA parameters in nasal area of the ocular surface.\u003c/p\u003e\n\u003cp\u003eIn this study, we observed that TED patients who smoked had greater amounts of proptosis (27 millimeters vs 24.3 millimeters) and MRD2 (7.9 millimeters vs 3.6 millimeters) than did nonsmokers (p\u0026lt;0.05). Recent studies have reported that smoking increases CAS, decreases ocular motility, and decreases the response to treatment.\u003csup\u003e29-31\u003c/sup\u003e Nevertheless, we did not find a statistically significant difference between changes in AS-OCTA parameters in smokers and nonsmokers after decompression surgery. The differences in the CAS and changes after surgery between smokers and nonsmokers were also not significant.\u003c/p\u003e\n\u003cp\u003eRegarding the effect of past medical history of treatment with radioactive iodine on TED and AS-OCTA parameters, the results were not conclusive. This could be due to the lack of adjustment in the time interval between treatment with radioactive iodine and our study. More studies with larger sample sizes can reveal the effect of treatment with radioactive iodine on ocular surface vasculature. Past studies have revealed that treatment with radioactive iodine, especially without the use of prophylactic corticosteroids, aggravates thyroid ophthalmopathy in the short-term and long-term. Notably, this effect has not been reported after thyroidectomy.\u003csup\u003e32,33\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eLowering the orbital pressure and orbital and ocular venous congestion is one of the main aims of TED treatment. Decrease in venous congestion improves redness of ocular surface apparatus and disease activity. Also, a decrease in orbital and intraocular pressure treats and prevents further compressive and glaucomatous optic neuropathy. Evaluation of ocular surface vasculature by AS-OCTA should be considered as a non-invasive and feasible approach for the assessment of TED treatment success.\u003c/p\u003e\n\u003cp\u003eLimitation:\u003c/p\u003e\n\u003cp\u003eWe had some limitations in this study. Although we had the largest sample size compared with other similar studies, a larger sample size might help us to find more significant differences in our subgroup analyses. Of course, finding more patients compatible with our inclusion and exclusion criteria is difficult. Our center is a referral center and patients come from other distant cities and some of them can\u0026rsquo;t be referred for longer and repeated follow-up sessions. Ocular surface vasculature might need more time to respond completely to decompression. Furthermore, post-operative inflammation improves completely within a longer interval after surgery. Larger studies with longer follow-up times will find more interesting changes and modifying factors in ocular surface vasculature after decompression surgery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOrbital changes in thyroid eye disease induce alterations in the circulation of the posterior segment and anterior segment. These alterations are important in the diagnosis and follow-up of patients with TED. Several authors have studied quantitative changes in the circulation of the posterior segment in TED patients. However, changes in the circulation of the anterior segment in patients with thyroid ophthalmopathy are assessed only qualitatively. AS-OCTA will help us significantly in research and clinical studies of patients with TED.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgment: There are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: The study adhered to the Declaration of Helsinki. Ethics committee approval was obtained from the Tehran University of Medical Sciences. All study participants provided written informed consent before enrollment.\u003c/p\u003e\n\u003cp\u003eConsent for publication: All study participants provided written informed consent for publication before enrollment\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: the data of this study are documented in some Excel data sheets and are available on reasonable requests.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: No person or institute fund for this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: SMR and MR visited and operated the patients. PA, SM, and ZM extracted the data from the AS-OCTA system. AM and AA performed the follow-up visits. MH was the major contributor to writing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments: no other person contributed towards the article who does not meet the criteria for authorship.\u003c/p\u003e\n\u003cp\u003eFinancial Support: None\u003c/p\u003e\n\u003cp\u003eConflict of interest: No conflicting relationships exist for any of the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKoustenis A, Harris A, Gross J, Januleviciene I, Shah A, Siesky B. Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research. \u003cem\u003eBritish Journal of Ophthalmology\u003c/em\u003e. 2017;101(1):16-20.\u003c/li\u003e\n\u003cli\u003eSpaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. \u003cem\u003eProgress in retinal and eye research\u003c/em\u003e. 2018;64:1-55.\u003c/li\u003e\n\u003cli\u003eBrunner M, Romano V, Steger B, et al. 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Conjunctival and intrascleral vasculatures assessed using anterior segment optical coherence tomography angiography in normal eyes. \u003cem\u003eAmerican journal of ophthalmology\u003c/em\u003e. 2018;196:1-9.\u003c/li\u003e\n\u003cli\u003eCawood T, Moriarty P, O\u0026apos;Shea D. Recent developments in thyroid eye disease. \u003cem\u003eBmj\u003c/em\u003e. 2004;329(7462):385-390.\u003c/li\u003e\n\u003cli\u003eKrassas GE, Wiersinga W. Smoking and autoimmune thyroid disease: the plot thickens. \u003cem\u003eEuropean Journal of Endocrinology\u003c/em\u003e. 2006;154(6):777-780.\u003c/li\u003e\n\u003cli\u003eSolberg Y, Rosner M, Belkin M. The association between cigarette smoking and ocular diseases. \u003cem\u003eSurvey of ophthalmology\u003c/em\u003e. 1998;42(6):535-547.\u003c/li\u003e\n\u003cli\u003eLiu X, Wong CK, Chan WW, et al. Long-term outcome of patients treated with antithyroid drugs, radioactive iodine or surgery for persistent or relapsed Graves\u0026rsquo; disease. \u003cem\u003eBritish Journal of Surgery\u003c/em\u003e. 2022;109(4):381-389.\u003c/li\u003e\n\u003cli\u003eAzizi F, Abdi H, Mehran L, Perros P, Masoumi S, Amouzegar A. Long-term follow-up of graves orbitopathy after treatment with short-or long-term methimazole or radioactive iodine. \u003cem\u003eEndocrine Practice\u003c/em\u003e. 2023;29(4):240-246.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1- Participants demographics and clinical features of TED patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e1\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\n \u003cp\u003eAge, mean year (\u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e45.36(\u0026plusmn; 10.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\n \u003cp\u003eHx of smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\n \u003cp\u003eHx of thyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.430555555555557%\"\u003e\n \u003cp\u003eHx of iodotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.11805555555556%\"\u003e\n \u003cp\u003e1\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.451388888888886%\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eSD: standard deviation, Hx: history\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2- Summary of Generalized Estimation Equation Comparing Ophthalmic Examination Between subgroups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"780\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" rowspan=\"2\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.923076923076923%\" colspan=\"3\" style=\"width: 20.8653%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" colspan=\"2\" style=\"width: 18.2878%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.46153846153846%\" colspan=\"3\" style=\"width: 32.2798%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.144927536231885%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.66183574879227%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.729468599033816%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Smokers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.628019323671497%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e\u003cstrong\u003esmokers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.560386473429952%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Hx of thyroidectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.526570048309178%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHx of \u0026nbsp;thyroidectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.66183574879227%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003elogMAR_pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.07 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.05 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.08 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.01 \u0026plusmn; 0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.07 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0 \u0026plusmn; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003eHertel_Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e24 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e26.5 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e24.2 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e27 \u0026plusmn; 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e24.9 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e24.7 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003eMRD1_Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e6 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e6.9 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e6.1 \u0026plusmn; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e6.8 \u0026plusmn; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e6.4 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e5.3 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003eMRD2_pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e6.6 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e6.8 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e6.2 \u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e7.9 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e6.7 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e6.5 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003eIOP_pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e16.5 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e17.6 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e16.8 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e17.3 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e16.8 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e17.7 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003eCAS_Pre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.7 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e1.36 \u0026plusmn; 0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.91 \u0026plusmn; 0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e1 \u0026plusmn; 0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.96 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.67 \u0026plusmn; 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.37\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.42 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.38\u0026plusmn;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.41\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.38 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.41 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.31\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.37 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0,70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.32\u0026plusmn;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.37\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.34 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.29 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density\u003c/strong\u003e-Temporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.41 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density\u003c/strong\u003e-Temporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.34\u0026plusmn;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.38 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.35 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.36\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.36 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.34 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.18\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.19 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.16\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.17\u0026plusmn;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.18 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.16 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density\u003c/strong\u003e-Temporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.21\u0026plusmn;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density\u003c/strong\u003e-Temporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e2.08\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e2.01 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e2.05\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e2.09\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e2.06 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e2.01 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e1.93\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e1.9 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e1.92\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e1.93\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e1.93 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e1.88 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index\u003c/strong\u003e-Temporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e2 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e1.93 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e1.99\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e1.95\u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e1.98 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e1.94 \u0026plusmn; 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.384615384615383%\" style=\"width: 15.5876%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index\u003c/strong\u003e-Temporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.076923076923077%\" style=\"width: 8.7143%;\"\u003e\n \u003cp\u003e1.84\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.3823%;\"\u003e\n \u003cp\u003e1.87 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.153846153846154%\" style=\"width: 5.7686%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" style=\"width: 9.328%;\"\u003e\n \u003cp\u003e1.85\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.461538461538462%\" style=\"width: 8.9598%;\"\u003e\n \u003cp\u003e1.84\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\" style=\"width: 6.7505%;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" style=\"width: 12.8874%;\"\u003e\n \u003cp\u003e1.86 \u0026plusmn; 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.76923076923077%\" style=\"width: 13.3783%;\"\u003e\n \u003cp\u003e1.72 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\" style=\"width: 6.0141%;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI, Confidence interval; SD, Standard deviation. CAS: clinical activity score. Log-MAR: logarithm of the minimum angle of resolution. IOP: intraocular pressure, MRD1: margin-reflex diameter 1. MRD2: margin reflex diameter 2. Hx: History\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3- Summary of Generalized Estimation Equation Comparing ophthalmic examinations before and after decompression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.199372056514914%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Mean differences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.03703703703704%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.50617283950617%\"\u003e\n \u003cp\u003e\u003cstrong\u003epost-operation eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.45679012345679%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLog-MAR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.06 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e-0.05 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHurtle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e24.9 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e21.6 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e3.27 \u0026plusmn; 1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMRD1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e6.3 \u0026plusmn; 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e6.2 \u0026plusmn; 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.06 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMRD2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e6.6 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e5.4 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e1.23 \u0026plusmn; 0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e16.9 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e15 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e1.9 \u0026plusmn; 3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003eCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.94 \u0026plusmn; 0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.58 \u0026plusmn; 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.35 \u0026plusmn; 0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.39 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.38 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.02 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.33 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.31 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.03 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eTemporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.4 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.34 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.06 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel density-\u003c/strong\u003eTemporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.36 \u0026plusmn; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.28 \u0026plusmn; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.08 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.19 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.19 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.01 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.17 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.17 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.01 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eTemporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.18 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.02 \u0026plusmn; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel length density-\u003c/strong\u003eTemporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e0.2 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e0.16 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.04 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eNasal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e2.06 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e2.03 \u0026plusmn; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.02 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eNasal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e1.92 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e1.86 \u0026plusmn; 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.08 \u0026plusmn; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eTemporal Superficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e1.98 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e1.89 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.1 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.524332810047095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVessel diameter index-\u003c/strong\u003eTemporal Deep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.1287284144427%\"\u003e\n \u003cp\u003e1.85 \u0026plusmn; 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.070643642072213%\"\u003e\n \u003cp\u003e1.73 \u0026plusmn; 0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.838304552590266%\"\u003e\n \u003cp\u003e0.13 \u0026plusmn; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.558869701726845%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.948194662480377%\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI, Confidence interval; SD, Standard deviation. CAS: clinical activity score. Log-MAR: logarithm of the minimum angle of resolution. IOP: intraocular pressure, MRD1: margin-reflex diameter 1. MRD2: margin reflex diameter 2. Hx: history\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4- Summary of multivariate analysis of influencing cofactors on AS-OCTA parameters changes after decompression surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.42215088282504%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.125200642054574%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.92776886035313%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLayer depth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\"\u003e\n \u003cp\u003eCo-factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.556982343499197%\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.754414125200642%\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.547351524879616%\" colspan=\"2\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal Vessel density\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.92776886035313%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eSuperficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.556982343499197%\" valign=\"top\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.754414125200642%\" valign=\"top\"\u003e\n \u003cp\u003e0.0246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eThyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.463768115942027%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDeep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.120772946859905%\" valign=\"top\"\u003e\n \u003cp\u003eHertel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.183574879227052%\" valign=\"top\"\u003e\n \u003cp\u003e0.0193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eIOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.547351524879616%\" colspan=\"2\" rowspan=\"9\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal Vessel length density\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.92776886035313%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eSuperficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.556982343499197%\" valign=\"top\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.754414125200642%\" valign=\"top\"\u003e\n \u003cp\u003e0.0082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eThyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eLog-MAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.463768115942027%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDeep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.120772946859905%\" valign=\"top\"\u003e\n \u003cp\u003eThyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e-0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.183574879227052%\" valign=\"top\"\u003e\n \u003cp\u003e0.0233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eHertel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eMRD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eIOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.547351524879616%\" colspan=\"2\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal Vessel diameter index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.92776886035313%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eSuperficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.693418940609952%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.556982343499197%\" valign=\"top\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.754414125200642%\" valign=\"top\"\u003e\n \u003cp\u003e0.0693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.520064205457464%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eThyroidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e-0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eHertel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.463768115942027%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDeep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.120772946859905%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.183574879227052%\" valign=\"top\"\u003e\n \u003cp\u003e0.0756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.840579710144926%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eHertel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.398753894081%\" valign=\"top\"\u003e\n \u003cp\u003eIOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.87227414330218%\" valign=\"top\"\u003e\n \u003cp\u003e0.0093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.299065420560748%\" valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eSD: standard deviation, IOP: intraocular pressure, CAS: clinical activity score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anterior segment—OCT angiography, Ocular surface, Thyroid eye disease","lastPublishedDoi":"10.21203/rs.3.rs-4181662/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4181662/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Thyroid eye disease (TED) is a common ophthalmologic manifestation of thyroid dysfunction. No imaging modality has become popular for the assessment of anterior segment vasculature of patients with TED. We aimed to assess changes in ocular surface circulation after orbital decompression in patients with TED and to explore the modifying factors of its alteration. Ocular surface vascularity features (vessel density (VD), vessel diameter index (VDI), and vessel length density (VLD)) were assessed via anterior segment optical coherence tomography-angiography (AS-OCTA) before and after orbital decompression in addition to ophthalmic examinations. AS-OCTA of the ocular surface vasculature showed that the temporal vasculature measurements decreased significantly 6 weeks after decompression surgery (p value \u003c 0.05), but in the nasal region, the difference did not reach statistical significance. Ocular surface circulation changes after orbital decompression in patients with TED. These changes can significantly affect the control of IOP and ocular surface symptoms. Someone can use AS-OCTA in evaluating the success of the decompression surgery and the need for further treatments.","manuscriptTitle":"Ocular surface vascular changes after orbital decompression in patients with thyroid ophthalmopathy measured by anterior segment OCT angiography","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-10 15:02:22","doi":"10.21203/rs.3.rs-4181662/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-29T21:01:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-29T05:44:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-24T09:36:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"f0de8ea5-5260-47b6-8207-087656955d4c","date":"2024-04-18T07:24:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1ab9bf91-5d0e-42b0-9ac7-6a2adbd57678","date":"2024-04-16T14:39:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-16T00:11:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-15T23:46:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-08T17:06:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-05T09:38:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-03-28T10:52:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0f95334-15ec-4388-ab05-25b3f35e4cce","owner":[],"postedDate":"April 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":30428620,"name":"Health sciences/Diseases/Eye diseases"},{"id":30428621,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases"}],"tags":[],"updatedAt":"2024-06-14T04:41:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-10 15:02:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4181662","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4181662","identity":"rs-4181662","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}