Potential Retinal Imaging Markers for Moyamoya Disease: Changes in Retinal Microvasculature and Thickness

Potential Retinal Imaging Markers for Moyamoya Disease: Changes in Retinal Microvasculature and Thickness | 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 Potential Retinal Imaging Markers for Moyamoya Disease: Changes in Retinal Microvasculature and Thickness Hong Wei, Cheng Chen, Xian-Zhe Qian, Qian-Min Ge, Jin-Yu Hu, Qi Hong, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5325211/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Moyamoya disease (MMD) is a structural abnormality of the cerebral vasculature characterized by cerebral ischemia, and is rare but its incidence is increasing. Digital subtraction angiography (DSA) of the brain is the primary means of diagnosing and evaluating this disease. But its high price and invasiveness limit its use as a monitoring tool for disease progression. As a non-invasive test for ophthalmic disorders, the optical coherence tomography angiography (OCTA) is widely used. In addition to ophthalmic diseases, OCTA has also been used in some neurological diseases. The aim of this study was to assess fundus changes in patients with MMD by OCTA and to investigate whether these changes could be a diagnostic and assessment marker for MMD. This study evaluated cerebral vessels, superficial macular capillary vessel density (SMC-VD) and macular retinal thickness (MRT) in subjects in the non-operated group (nGO), operated group (OG) and healthy controls (HC) using DSA, OCTA and other techniques. Analyses of variance (ANOVA) and Bonferroni post hoc analysis were used to calculate statistical differences between the three groups. Correlations between SMC-VD and MRT were assessed using Pearson correlation analysis. In addition, the ability of the SMC-VD and the MRT to distinguish MMD from HC was analyzed using receiver operating characteristic (ROC) curves. We found that the SMC-VD and MRT in the nOG group were significantly lower than those in the HC group and had not returned to normal levels at one month postoperatively. In the nOG, the SMC-VD and MRT were positively correlated in the Full region (6*6 mm) and in the Inner region (3*3 mm), and in many subregions they showed high ability to distinguish MMD from HC. The above findings indicate significant reduction in the SMC-VD and the MRT in patients with MMD even in the absence of ocular clinical manifestation. Most importantly, SMC-VD and MRT have a strong ability to distinguish between MMD patients and HC, suggesting that OCTA, a relatively inexpensive and non-invasive method, is useful in assessing cerebrovascular changes in MMD patients. Health sciences/Diseases Health sciences/Neurology Health sciences/Biomarkers Moyamoya disease Vessel density retinal thickness OCTA Diagnostic markers Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction A rare structural abnormality of the cerebral vasculature called Moyamoya disease (MMD). It presents as the proximal intracranial carotid artery (ICA) is stenosed and the distal end is hyperplastic. The abundant collateral vessels at its distal end look like smoke 1 – 4 . Recent reports indicate that the average prevalence of MMD is 3.92/100,000 in China and about 10.5/100,000 in Japan, while the prevalence in the United States is only 1/11,000,000. However, in many regions globally, its prevalence has gradually increased in recent years 3 , 5 – 7 . The main clinical symptom of MMD is cerebral ischemia. Children often present with transient ischemic attack and adults with ischemic cerebral infarction. Complications such as seizures, headache, and cognitive dysfunction may also be associated with cerebral ischemia 2 , 3 , 8 , 9 and cerebral ischemic events have a high risk of recurrence 10 . In previous studies, a few cases of MMD were reported with ocular complications 11 – 14 . For example, Ashok et al. reported a young man who had central retinal artery occlusion (CRAO) and was diagnosed with MMD 15 . Alekya et al. reported a case of the patient with both CRAO and MMD, whose optical coherence tomography (OCT) results suggested a reduction in retinal thickness 16 . As a revolutionary imaging method, optical coherence tomography angiography (OCTA) can provide quantitative and morphological data on retinal microvascular changes in vivo 17 . A variety of measures such as blood flow 18 , size of FAZ 19 , vessel density and others 20 can be calculated using the OCTA technique. In addition, morphological data include vessel length, diameter and number of branches 21 . Currently, OCTA is widely used for the diagnosis and monitoring of ocular diseases which include glaucoma 22 , age-related macular degeneration (AMD) 23 , and diabetic retinopathy 24 . In the neurological system, OCTA is also considered to assist in monitoring the progression of Alzheimer's disease 25 – 27 , multiple sclerosis 28 – 30 , and other diseases. To investigate whether microvascular and structural changes in the macula reflect the cerebrovascular status of patients with MMD, that is, whether OCTA can be an assistance in the diagnosis of MMD, we collected superficial macular capillary vessel density (SMC-VD) and macular retinal thickness (MRT) in MMD patients and healthy controls (HC). We also collected SMC-VD and MRT data from patients with MMD who had undergone revascularization in a bid to observe the impact of cerebral blood flow alterations on the retina. Materials and Methods Subject Recruitment Thirty-two subjects with MMD who met the criteria were recruited by the diagnostic criteria for MMD proposed by the Japanese Committee for the Study of Spontaneous Occlusion of the Ring of Willis 31 . Sixteen of them did not be treated surgically and were the non-operated group (nOG). The other 16 were treated with revascularization (superficial temporal artery-middle cerebral artery anastomosis) and were the operated group (OG). Healthy controls (HC) were included in the study with 16 subjects who met the appropriate criteria. All subjects were assessed between 2018 and 2022 by specialists in the relevant disciplines in the First Affiliated Hospital of Nanchang University. Subjects for inclusion in nOG and OG matched the following criteria: 1) patients with classic MMD diagnosed by Digital subtraction angiography (DSA) and other exams; 2) OG patients undergoing revascularization for one month. Exclusion from the study: 1) DSA results are atypical and/or cannot be confirmed in patients with MMD; 2) other diseases that can affect the vasculature of the brain or a history of brain surgery (e.g. atherosclerosis, congenital malformations of the cerebral vessels, cranio-cerebral tumours, etc.); 3) diseases or history of ocular surgery that can clearly affect the retina and its blood vessels (e.g. glaucoma, ocular tumours, age-related macular degeneration (AMD), etc.); 4) systemic diseases that can affect the retina and its blood vessels (e.g. diabetes, systemic lupus erythematosus (SLE), hypertension, etc.); 5) individuals who are unable to undergo DSA and/or OCT (e.g. with allergic reaction to contrast media). 16 HC were matched for age and gender to nOG and OG patients and met the following criteria: 1) absence of cerebrovascular diseases and history of cranio-cerebral surgery (e.g. MMD, atherosclerosis, cranio-cerebral tumours, etc.); 2) absence of diseases affecting the retina and its blood vessels or history of ocular surgery (e.g. AMD, glaucoma, ocular tumours, etc.); 3) without systemic diseases affecting the retina and its blood vessels (e.g. diabetes, SLE, hypertension, etc.); 4) acceptable for relevant investigations such as DSA and OCTA. Clinical Examinations The following medical examinations were performed on all subjects: 1) routine blood and blood biochemical examinations, such as hemoglobin, triglycerides, total cholesterol, glucose, and electrolytes; 2) blood pressure examination; 3) Visual Acuity (VA); 4) DSA of the brain; 5) OCTA. (Some clinical results that did not differ significantly are not shown in the article). DSA A DSA machine was applied to the subject to perform DSA of the brain. The patient was advised to take the appropriate position (supine position was chosen for this study). After proper disinfection and anaesthesia, a small incision is opened at the puncture site and a guide wire is inserted using a puncture needle, along which an arterial sheath is placed. The imaging modality (internal carotid arteriography, common carotid arteriography, etc.) is chosen according to the subject's actual condition. A pigtail tube is connected and 5–8 ml of contrast media is injected uniformly at the appropriate location. Frontal and lateral contrast examinations are performed after adjusting the contrast field under fluoroscopy and the results are recorded. OCTA We use the Carl Zeiss Meditec AngioPlex system for OCTA imaging. This SD-OCT system operates at an A-scan speed of 68,000 scans per second, a 840 nm light source centre and a 90 nm bandwidth. The system operates with an axial resolution of 5ɥm, a 15ɥm lateral resolution and a 2.0mm A-scan depth parameter. Each eye recorded 6*6 mm and 3*3 mm 3D OCTA images. After scanning, each retina of 6*6 mm was divided into nine Early Treatment Diabetic Retinopathy Study (ETDRS) subzones, comprising three concentric circles (1.0 mm, 3.0 mm and 6.0 mm radii, respectively). The 3*3 mm retina was divided into 5 subzones consisting of two concentric circles (radii of 1.0 mm and 3.0 mm, respectively). The vascular density is the percentage of the vascular perfusion area over the measured area. Vessel density was calculated from 2D frontal images created of the superficial retinal layers with a threshold method. Assigned each pixel to perfusion (1) or background (0) by identifying the value of the image block. Results from the region of interest were scaled according to pixel size to calculate the vascular density from the macular centre to the edges of the 6*6 mm and 3*3 mm images. The SMC-VD in this study ranged from the inner limiting membrane (ILM) to the inner plexiform layer (IPL). The left and right eyes of all subjects were evaluated. Statistical analysis Analysis of the results was performed with GraphPad Prism version 8 (La Jolla, California, USA) and SPSS version 22.0 (IBM, Armonk, NY, USA). Both ANOVA and Bonferroni Post Hoc Analysis were used for comparison between groups. Linear correlations between MRT and SMC-VD were performed for each group by applying person correlation analysis. For the analysis of differences between HC and MMD patients, subject work characteristic (ROC) curves were plotted. Results Fundamental Information As shown in Table 1 , there were 16 subjects in the HC group, nOG and OG, respectively, in this study. It was analyzed for both eyes of each subject. The three groups of subjects did not differ in age (p = 0.200), gender (p = 0.055) and visual acuity (0.144) between the groups. Figure 1 illustrates typical DSA, SMC-VD and MRT images in MMD patients. Table 1 Fundamental information on the HC, nOG and OG. HC nOG OG ANOVA N 16 16 16 N/A Eyes (N) 32 32 32 N/A Age (year) 44.00 ± 12.90 49.44 ± 6.13 49.38 ± 8.71 0.200 Sex, male % 25.00% 18.75% 56.25% 0.055 Disease duration(month) N/A 14.75 ± 30.40 27.56 ± 19.90 0.169 Visual Acuity (log MAR) 4.67 ± 0.16 4.72 ± 0.17 4.75 ± 0.15 0.144 Systolic blood pressure (mm Hg) 122.86 ± 3.98 121.00 ± 13.87 127.44 ± 18.16 0.384 Diastolic blood pressure (mm Hg) 82.81 ± 4.81 82.82 ± 10.83 84.31 ± 12.24 0.884 ANOVA Showed the Statistical Differences Across Groups. Age, disease duration, visual Acuity and blood puressure were expressed as mean ± SD. HC, healthy controls; nOG, non-operated group; OG, operated group; SD, standard deviation. Analysis of the 6*6 mm SMC-VD SMC-VD in the HC, nOG and the OG in the 6*6 mm region are shown in Table 2 and Figs. 2 . The SMC-VD was markedly lower in the nOG than HC group in the IS ( p = 0.020), OS ( p = 0.001), IN ( p = 0.016), ON ( p < 0.001), OI ( p = 0.028), Outer ( p = 0.022) and Full ( p = 0.042) regions. In regions II ( p = 1.000), IT ( p = 1.000), OT ( p = 0.168), C ( p = 1.000) and Inner (Inner, p = 0.134) decreases were not statistically significant (Table 2 and Fig. 2 a, 2 c). In the OS ( p = 0.036), IN ( p = 0.040) and ON ( p < 0.001) subregions, the SMC-VD declined markedly in the OG. The alterations in the remaining subregions were not statistically significant (Table 2 and Fig. 2 b, 2 d). The change in FAZ ( p = 0.334) was also not statistically significant. Table 2 6*6 mm SMC-VD (mean ± SD) in HC group, nOG and OG Subregion HC nOG OG Bonferroni HC vs. nOG Bonferroni HC vs. OG ANOVA Inner Superior 0.455 ± 0.016 0.438 ± 0.030 0.448 ± 0.029 0.020 0.683 0.025 Outer Superior 0.482 ± 0.012 0.464 ± 0.025 0.470 ± 0.024 0.001# 0.036# 0.002 Inner Nasal 0.449 ± 0.015 0.421 ± 0.053 0.427 ± 0.047 0.016# 0.040# 0.020 Outer Nasal 0.503 ± 0.015 0.469 ± 0.032 0.485 ± 0.014 < 0.001# < 0.001# < 0.001 Inner Inferior 0.444 ± 0.017 0.440 ± 0.023 0.435 ± 0.040 1.000 0.674 0.475 Outer Inferior 0.474 ± 0.018 0.459 ± 0.023 0.467 ± 0.028 0.028 0.765 0.032 Inner Temporal 0.439 ± 0.027 0.433 ± 0.027 0.434 ± 0.038 1.000 1.000 0.654 Outer Temporal 0.445 ± 0.028 0.429 ± 0.039 0.448 ± 0.030 0.168# 0.854# 0.047 Center 0.207 ± 0.060 0.194 ± 0.050 0.178 ± 0.060 1.000 0.130 0.128 Inner 0.446 ± 0.016 0.433 ± 0.025 0.435 ± 0.036 0.130 0.304 0.100 Outer 0.470 ± 0.014 0.456 ± 0.025 0.467 ± 0.020 0.020# 0.739# 0.017 Full 0.460 ± 0.013 0.446 ± 0.021 0.454 ± 0.023 0.019 0.663 0.023 FAZ 0.358 ± 0.140 0.311 ± 0.099 0.358 ± 0.054 0.586 1.000 0.334 Statistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. #Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance. SMC-VD, superficial macular capillary vessel density; SD, standard deviation; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone. Analysis of the 3*3 mm SMC-VD SMC-VD changes in the three groups in the 3*3 mm region are shown in Table 3 and Figs. 3 . In comparison to the HC group, the SMC-VD was markedly decreased in the S ( p = 0.001), N ( p < 0.001), I ( p = 0.042), T ( p = 0.001) and Inner ( p = 0.002) regions in nOG patients. Changes in SMC-VD in the C ( p = 0.084) and Full ( p = 0.080) regions were not statistically significant (Table 3 and Fig. 3 a, 3 c). SMC-VD in the OG remained markedly lower than in the HC in the S ( p = 0.026), N ( p = 0.002), I ( p = 0.039), C ( p = 0.018) and Inner ( p = 0.020) regions. The SMC-VD was not statistically different from HC in T ( p = 0.686) and Full ( p = 0.464) subregions of the OG (Table 3 and Fig. 3 b, 3 d). The change in FAZ ( p = 0.808) was not statistically significant. Table 3 3*3 mm SMC-VD (mean ± SD) in HC group, nOG and OG Subregion HC nOG OG Bonferroni HC vs. nOG Bonferroni HC vs. OG ANOVA Superior 0.419 ± 0.022 0.397 ± 0.029 0.403 ± 0.021 0.001 0.026 0.001 Nasal 0.420 ± 0.016 0.396 ± 0.032 0.397 ± 0.028 < 0.001 0.002 < 0.001 Inferior 0.405 ± 0.017 0.388 ± 0.034 0.391 ± 0.025 0.042# 0.039# 0.030 Temporal 0.410 ± 0.013 0.388 ± 0.027 0.405 ± 0.028 0.001# 0.686# 0.001 Center 0.187 ± 0.051 0.158 ± 0.043 0.151 ± 0.060 0.084 0.018 0.015 Inner 0.412 ± 0.011 0.392 ± 0.028 0.400 ± 0.021 0.002# 0.020# 0.001 Full 0.379 ± 0.017 0.367 ± 0.027 0.371 ± 0.021 0.080 0.464 0.080 FAZ 0.360 ± 0.144 0.340 ± 0.099 0.356 ± 0.140 1.000 1.000 0.808 Statistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. # Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance. SMC-VD, superficial macular capillary vessel density; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone. MRT The MRT in the three groups are shown in Table 4 and Figs. 4 . In all subregions except C ( p = 0.954), MRT in the nOG was significantly thinner than in the HC group (IT, p = 0.011; p < 0.001 for all remaining regions; Table 4 and Fig. 4 a, 4 c). Reductions in MRT remained in the IS ( p = 0.012), IN ( p < 0.001), ON ( p < 0.001), Outer ( p = 0.008) and Full ( p = 0.023) regions in the OG compared with the HC group (Table 4 and Fig. 4 b, 4 d). Table 4 MRT (mean ± SD) in HC group, nOG and OG Subregion HC nOG OG Bonferroni HC vs. nOG Bonferroni HC vs. OG ANOVA Inner Superior 332.44 ± 14.70 312.94 ± 15.15 320.69 ± 17.94 < 0.001 0.012 < 0.001 Outer Superior 298.59 ± 20.72 277.81 ± 16.06 287.91 ± 18.23 < 0.001 0.068 < 0.001 Inner Nasal 330.06 ± 15.11 311.00 ± 15.35 307.19 ± 19.40 < 0.001 < 0.001 < 0.001 Outer Nasal 317.25 ± 8.14 290.69 ± 11.24 274.28 ± 13.85 < 0.001 < 0.001 < 0.001 Inner Inferior 323.50 ± 14.32 304.41 ± 22.22 321.88 ± 19.58 < 0.001 1.000 < 0.001 Outer Inferior 279.19 ± 5.38 262.50 ± 13.37 282.00 ± 14.87 < 0.001# 0.578# < 0.001 Inner temporal 316.50 ± 14.28 303.25 ± 14.96 315.84 ± 22.88 0.011 1.000 0.005 Outer Temporal 275.69 ± 7.12 261.13 ± 9.17 295.34 ± 22.38 < 0.001# < 0.001# < 0.001 Center 238.75 ± 22.85 243.91 ± 21.78 241.78 ± 16.40 0.954 1.000 0.603 Inner 325.75 ± 12.83 308.03 ± 14.30 316.47 ± 18.74 < 0.001 0.056 < 0.001 Outer 292.75 ± 7.44 273.19 ± 11.27 285.00 ± 10.94 < 0.001 0.008 < 0.001 Full 301.28 ± 9.49 285.31 ± 10.06 294.19 ± 11.50 < 0.001 0.023 < 0.001 Statistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. # Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance.MRT, macular retinal thickness; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone. Correlation Analysis In the nOG, SMC-VD in the Full region was positively correlated with the corresponding MRT value (Pearson r = 0.590, p < 0.001) (Fig. 5 a), suggesting that a decrease in MRT was associated with a decrease in SMC-VD. The SMC-VD (3*3 mm) in the Inner region was correlated with the MRT in the corresponding subregion (Fig. 5 b). ROC Curves The ability of MRT to discriminate MMD is represented by the area under the curve (AUC) shown in Fig. 6 a. The regions with AUC > 0.9 were ON (AUC = 0.989; p < 0.001), OI (AUC = 0.909; p < 0.001), OT (AUC = 0.912; p < 0.001), and Outer (AUC = 0.969; p 0.9 was ON (AUC = 0.907; p < 0.001). The analysis of ROC curves for other regions is shown in Table 6 . Table 5 ROC Curve Analysis of MRT MRT AUC SE 95% CI P value Inner Superior 0.815 0.052 0.714 to 0.917 < 0.001 Outer Superior 0.839 0.050 0.741 to 0.937 < 0.001 Inner Nasal 0.796 0.054 0.690 to 0.902 < 0.001 Outer Nasal 0.989 0.009 0.972 to 1.000 < 0.001 Inner Inferior 0.804 0.056 0.695 to 0.913 < 0.001 Outer Inferior 0.909 0.039 0.832 to 0.986 < 0.001 Inner Temporal 0.735 0.062 0.614 to 0.856 0.001 Outer Temporal 0.912 0.034 0.845 to 0.979 < 0.001 Center 0.574 0.072 0.432 to 0.716 0.308 Inner 0.818 0.051 0.718 to 0.919 < 0.001 Outer 0.969 0.018 0.933 to 1.000 < 0.001 Full 0.872 0.042 0.790 to 0.955 < 0.001 AUC values, SE, 95% CI and P-values for each subregion. ROC, receiver operating characteristic; MRT, Macular retinal thickness; AUC, area under ROC curve; SE, standard errors; 95% CI, 95% confidence intervals. Table 6 ROC Curve Analysis of SMC-VD(6*6mm) SMC-VD(6*6mm) AUC SE 95% CI P value Inner Superior 0.672 0.067 0.540 to 0.804 0.018 Outer Superior 0.731 0.062 0.609 to 0.852 0.002 Inner Nasal 0.648 0.069 0.513 to 0.784 0.041 Outer Nasal 0.907 0.038 0.832 to 0.981 < 0.001 Inner Inferior 0.560 0.075 0.413 to 0.706 0.413 Outer Inferior 0.698 0.067 0.567 to 0.829 0.007 Inner Temporal 0.598 0.073 0.454 to 0.742 0.177 Outer Temporal 0.607 0.072 0.466 to 0.748 0.142 Center 0.600 0.072 0.459 to 0.741 0.171 Inner 0.648 0.069 0.513 to 0.783 0.042 Outer 0.651 0.069 0.516 to 0.786 0.038 Full 0.673 0.067 0.543 to 0.804 0.017 AUC values, SE, 95% CI and P-values for each subregion. ROC, receiver operating characteristic; SMC-VD, superficial macular capillary vessel density; AUC, area under ROC curve; SE, standard errors; 95% CI, 95% confidence intervals. Discussion We collected and compared SMC-VD and MRT in the nOG, OG and HC groups to investigate whether microvasculature and retinal thickness were altered in patients with MMD and to assess their diagnostic potential for MMD. Most subregions of the nOG had lower SMC-VD than HC based on OCTA results (Table 2 , 3 and Figs. 2 , 3 ). This finding suggests that cerebral vascular disease in patients with MMD may affect superficial retinal capillary density. Several branches are given off by the ICA in the neck and skull, including the ophthalmic artery, which supplies blood to the eyes. The central retinal artery is derived from the ophthalmic artery and supplies blood to the inner five layers of the retina. Blood to the outer five layers of the retina is supplied primarily by the ciliary artery system emanating from the ophthalmic artery 32 – 36 . Blood from the central retinal artery supplies the retinal nerve fiber layer, ganglion cell layer and inner plexiform layer through the superficial capillary plexus (SCP), and continues to extend to become the deep capillary plexus (DCP) in the inner nuclear layer. The radial peripapillary capillary plexus (RPCP) is in the nerve fibre layer (NFL)that runs parallel to the axons of the nerve fibres 32 , 37 – 40 . The capillaries of the SMC-VD we measured in this study are part of the temporal branch of the SCP (Fig. 7 ). The temporal retinal arteries arch around the macula, forming the superior macular arteriole and the arteriola macularis inferior 34 , 35 (Fig. 7 ). Stenosis of the ICA is a feature of MMD, and in these cases the blood supply to the branches of the ICA will be reduced. Previous studies have also suggested that retinal ischemia is associated with severe stenosis of the ICA 41 , 42 . Therefore, we suggested that the narrowing of ICA led to the reduction of SMC-VD. These changes suggest questions about their role in structural and functional variations in the retina. In the present study, MRT of patients in the nOG was significantly thinner than that of healthy subjects in all subregions but C (Table 4 and Figs. 4 ), yet these subjects did not show significant visual impairment. Blockage of the central retinal artery and its branches can often be observed as retinal edema 33 , 34 , 39 , 43 , 44 . Due to ischemia and hypoxia, the retinal cells become edematous, and if ischemia is prolonged the inner retinal cells gradually become necrotic, leading to reduced retinal thickness 34 , 39 . The MMD subjects we included in our study all had long disease duration (Table 1 ). Therefore, we interpret their MRT reduction as an alteration caused by prolonged ischemia and hypoxia. That means the reduction of MRT is associated with the reduction of SMC-VD. And a correlation was found in nOG between MRT and SMC-VT in the Full region at 6*6mm (Fig. 5 a) and in the Inner region at 3*3mm (Fig. 5 b). This evidence indicates a close association between reduced MRT and reduced SMC-VD in patients with MMD. To further investigate this link in patients with MMD we evaluated structural and microvascular variations in the retinas of MMD subjects one month after revascularization. The results indicated that in this group (OG) the SMC-VD remained significantly lower than HC in OS, IN, ON, S, I and Inner regions (Table 2 , 3 and Fig. 2 b, 2 d, 3 b, 3 d). The MRT did not return to normal in the IS, IN, ON, Outer, and Full regions compared to HC (Table 4 and Fig. 4 b, 4 d). We speculate that the above results may be due to the occurrence of ischemia-reperfusion injury. Ischemia-reperfusion injury mainly refers to tissue damage caused by the restoration of blood supply after ischemia or/and hypoxia 45 , 46 . This can manifest as endothelial damage, increased permeability and leukocyte obstruction in microvessels, especially small arteries and capillaries 47 , 48 . A recent case report also showed that a patient with MMD who underwent left superficial temporal artery-middle cerebral artery anastomosis for one month had a significantly reduced superficial retinal vessels of the left eye which did not return to normal until nine months postoperatively. This vascular complex, however, did not show any significant abnormality before surgery 49 . It has also been shown that patients with MMD have cerebral hyperperfusion and a range of complications after revascularization treatment 50 , 51 . On this basis, it seems feasible that in the present study small arteries and capillaries in the macula may have suffered reperfusion injury in addition to ischemia. In future studies we may need more specialized neurologists to evaluate the results of cerebral revascularization, rather than assuming that the cerebral vessels are back to normal just by the results of DSA. Although the cerebral vascular system has a complex structure, Goto et al. suggested that retinal vasculopathy may in part reflect cerebral microvascular lesions 52 – 54 . In embryology, the retina was considered to be the central nervous system’s extension with a common origin in the embryonic neural tube. The anterior part of the neural tube differentiates into brain tissue and forms a pair of optic vesicles which develop into the right and left retinas 35 , 55 , 56 . Moreover, anatomically, blood of the retina, the anterior two-thirds of the telencephalon, and part of the mesencephalon are supplied by the ICA 35 , 36 , 57 and alterations in the retinal arteries are related to vascular disease in the brain 58 , 59 . Strokes have been linked to retinal vessel changes even since the early studies using fundus photography 60 , 61 and changes in cognitive abilities 62 , 63 . We therefore hypothesized that OCTA measurement of retinal vascular structure and perfusion may also reflect in part the cerebral blood flow in patients with MMD. We evaluated the diagnostic accuracy of MRT and SMC-VD for MMD using ROC curves. The results showed high AUC values for MRT in all sub-regions except for region C. The AUC values of ON, OI, OT and Outer were all over 0.9, and approaching this value (at 0.87) in the Full region (Table 5 and Fig. 6 a). It is suggested that MRT has strong potential to discriminate between MMD and HC. However, for SMC-VD only ON had an AUC greater than 0.9, values of the remaining subregions being mostly in the range of 0.6–0.7 (Table 6 and Fig. 6 b). The diagnostic accuracy of SMC-VD for MMD was therefore inferior to that of MRT. In our analysis, this may reflect the fact that vascular lesions in MMD affect not only the superficial retinal vessels, but also the deeper vascular layers, such as those of the choroid. However, the limitations of our study need to be considered. For example, our sample size was so small that it limited the accuracy of the study. In the study, we only focused on the capillaries in the superficial layers of the retina. Other vessels of the retina, such as the DCP and choroidal capillaries, may also altered. And, we should assess the correspondence between cerebral and retinal vascular alterations by long-term, relatively frequent DSA and OCTA in future studies. Conclusion In summary, we conclude that patients with MMD still have significant SMC-VD and MRT reduction even in the absence of ocular clinical manifestations. And MRT reduction is closely associated with SMC-VD reduction. These reductions are not immediately restored with the re-establishment of cerebral blood flow. This may be related to ischemia-reperfusion damage to the retinal arteries. Importantly, the SMC-VD and MRT have a strong ability to distinguish MMD from HC, suggesting that alterations in retinal microvasculature and structure may be a cheaper non-invasive marker for assessing vascular changes in the brain in patients with MMD. The OCTA may serve as a more convenient way to monitor changes in MMD. Declarations Conflict of interests : There is no declaration for authors about conflict of interests in this study. Ethical Statement Every aspect of the work is under the responsibility of the author, including the investigation and resolution of any questions of accuracy or integrity. A Medical Ethics Committee of Nanchang University First Affiliated Hospital (cdyfy2021039) approved the study based on the Declaration of Helsinki (revised 2013). All subjects voluntarily undertook to sign an informed consent form after understanding the potential risks, objectives and methods. Open Access Statement In accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), this article is distributed as Open Access. Under this license, the article may be reproduced and distributed for non-commercial purposes only if no changes or edits have been made and the original work is properly cited (Links to official publications are available by relevant DOI and license). Funding: Supported by National Natural Science Foundation of China (No.82160195); Foundation of Jiangxi Provincial Department of Science and Technology (No. 20212BAG70021); Jiangxi Double-Thousand Plan High-Level Talent Project of Science and Technology Innovation (No.jxsq2023201036); Key R & D Program of Jiangxi Province (20223BBH80014); Science and Technology Project of Jiangxi Province Health Commission of Traditional Chinese Medicine (No. 2022B258); Science and Technology Project of Jiangxi Health Commission (No. 202210017). Author Contribution (I) Conception and design: Y Shao, EM Zeng and JY Kang; (II) Administrative support: Y Shao; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: JY Kang, J Yan, F Lin, SH Xu, LQ He, XL Liao, H Wei; (V) Data analysis and interpretation: JY Kang, YP Li, JY Hu, J Yan; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Suzuki, J. & Takaku, A. Cerebrovascular moyamoya disease. Disease showing abnormal net-like vessels in base of brain. Arch. Neurol. 20 , 288–299. https://doi.org:10.1001/archneur.1969.00480090076012 (1969). Scott, R. M. & Smith, E. R. Moyamoya disease and moyamoya syndrome. N Engl. J. Med. 360 , 1226–1237. https://doi.org:10.1056/NEJMra0804622 (2009). Shang, S. et al. Progress in moyamoya disease. Neurosurg. Rev. 43 , 371–382. https://doi.org:10.1007/s10143-018-0994-5 (2020). Kiyoshi Sato, T. S. in Cerebrovascular Diseases in Children 227–243 (Springer, 1992). Goto, Y. & Yonekawa, Y. Worldwide distribution of moyamoya disease. Neurol. Med. Chir. (Tokyo) . 32 , 883–886. https://doi.org:10.2176/nmc.32.883 (1992). Kuroda, S. & Houkin, K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 7 , 1056–1066. https://doi.org:10.1016/s1474-4422(08)70240-0 (2008). Hishikawa, T., Sugiu, K., Date, I. & Moyamoya Disease A Review of Clinical Research. Acta Med. Okayama . 70 , 229–236. https://doi.org:10.18926/amo/54497 (2016). Kim, S. K. et al. Pediatric moyamoya disease: An analysis of 410 consecutive cases. Ann. Neurol. 68 , 92–101. https://doi.org:10.1002/ana.21981 (2010). Kazumata, K. et al. Chronic ischemia alters brain microstructural integrity and cognitive performance in adult moyamoya disease. Stroke . 46 , 354–360. https://doi.org:10.1161/strokeaha.114.007407 (2015). Chiu, D., Shedden, P., Bratina, P. & Grotta, J. C. Clinical features of moyamoya disease in the United States. Stroke . 29 , 1347–1351. https://doi.org:10.1161/01.str.29.7.1347 (1998). Slamovits, T. L., Klingele, T. G., Burde, R. M. & Gado, M. H. Moyamoya disease with central retinal vein occlusion. Case report. J. Clin. Neuroophthalmol . 1 , 123–127 (1981). Chace, R. & Hedges, T. R. 3 Retinal artery occlusion due to moyamoya disease. J. Clin. Neuroophthalmol . 4 , 31–34 (1984). Ushimura, S., Mochizuki, K., Ohashi, M., Ito, S. & Hosokawa, H. Sudden blindness in the fourth month of pregnancy led to diagnosis of moyamoya disease. Ophthalmologica . 207 , 169–173. https://doi.org:10.1159/000310428 (1993). Albrecht, P. et al. Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography. Neurology . 85 , 521–527. https://doi.org:10.1212/wnl.0000000000001832 (2015). Kumar, M. A. & Ganesh, B. A. CRAO in Moyamoya Disease. J. Clin. Diagn. Res. 7 , 545–547. https://doi.org:10.7860/JCDR/2013/4579.2819 (2013). Rajanala, A. P., Le, H. T. & Gill, M. K. Central retinal artery occlusion as initial presentation of Moyamoya disease in a middle-aged woman. Am. J. Ophthalmol. Case Rep. 18 , 100705. https://doi.org:10.1016/j.ajoc.2020.100705 (2020). Campbell, J. P. et al. Detailed Vascular Anatomy of the Human Retina by Projection-Resolved Optical Coherence Tomography Angiography. Sci. Rep. 7 , 42201. https://doi.org:10.1038/srep42201 (2017). Wang, R. K., Zhang, Q., Li, Y. & Song, S. Optical coherence tomography angiography-based capillary velocimetry. J. Biomed. Opt. 22 , 66008. https://doi.org:10.1117/1.Jbo.22.6.066008 (2017). Choi, J. et al. Quantitative optical coherence tomography angiography of macular vascular structure and foveal avascular zone in glaucoma. PLoS One . 12 , e0184948. https://doi.org:10.1371/journal.pone.0184948 (2017). Akil, H., Falavarjani, K. G., Sadda, S. R. & Sadun, A. A. Optical Coherence Tomography Angiography of the Optic Disc; an Overview. J. Ophthalmic Vis. Res. 12 , 98–105. https://doi.org:10.4103/2008-322x.200162 (2017). Wylęgała, A., Wylęgała, F. & Wylęgała, E. Aflibercept Treatment Leads to Vascular Abnormalization of the Choroidal Neovascularization. J Healthc Eng 8595278 (2018). (2018). https://doi.org:10.1155/2018/8595278 Scripsema, N. K. et al. Optical Coherence Tomography Angiography Analysis of Perfused Peripapillary Capillaries in Primary Open-Angle Glaucoma and Normal-Tension Glaucoma. Invest. Ophthalmol. Vis. Sci. 57 , 611–oct620. https://doi.org:10.1167/iovs.15-18945 (2016). Roisman, L., Goldhardt, R. O. C. T. & Angiography An Upcoming Non-invasive Tool for Diagnosis of Age-related Macular Degeneration. Curr. Ophthalmol. Rep. 5 , 136–140. https://doi.org:10.1007/s40135-017-0131-6 (2017). Schaal, K. B. et al. Retina 39 , 79–87 https://doi.org:10.1097/iae.0000000000001938 (2019). Ferrari, L. et al. Optical Coherence Tomography Reveals Retinal Neuroaxonal Thinning in Frontotemporal Dementia as in Alzheimer's Disease. J. Alzheimers Dis. 56 , 1101–1107. https://doi.org:10.3233/jad-160886 (2017). Santos, C. Y. et al. [P4–058]: Retinal Nerve Fiber Layer and Ganglion Cell Layer Volume Changes in Preclinical Alzheimer's Disease over 27 Months. Alzheimer's Dement. 13 https://doi.org:10.1016/j.jalz.2017.06.1923 (2017). Santos, C. Y. et al. Change in retinal structural anatomy during the preclinical stage of Alzheimer's disease. Alzheimers Dement. (Amst) . 10 , 196–209. https://doi.org:10.1016/j.dadm.2018.01.003 (2018). Behbehani, R. et al. Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis. PLoS One . 12 , e0172120. https://doi.org:10.1371/journal.pone.0172120 (2017). Feucht, N. et al. Optical coherence tomography angiography indicates associations of the retinal vascular network and disease activity in multiple sclerosis. Mult Scler. 25 , 224–234. https://doi.org:10.1177/1352458517750009 (2019). Oertel, F. C., Zimmermann, H. G., Brandt, A. U. & Paul, F. Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis. Expert Rev. Neurother. 19 , 31–43. https://doi.org:10.1080/14737175.2019.1559051 (2019). Fujimura, M. & Tominaga, T. Diagnosis of moyamoya disease: international standard and regional differences. Neurol. Med. Chir. (Tokyo) . 55 , 189–193. https://doi.org:10.2176/nmc.ra.2014-0307 (2015). Stone, J., van Driel, D., Valter, K., Rees, S. & Provis, J. The locations of mitochondria in mammalian photoreceptors: relation to retinal vasculature. Brain Res. 1189 , 58–69. https://doi.org:10.1016/j.brainres.2007.10.083 (2008). Mac Grory, B. et al. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke 52, e282-e294 (2021). https://doi.org:10.1161/str.0000000000000366 Yannuzzi, K. B. F. D. S. W. F. M. L. A. The Retinal Atlas second deition,. (2017). Shitian Zhong, Z. D. & Wang, Z. Zuguo Liu, Jianhua Yan. Clinical Anatomy of Ophthalmology second edition,. (2020). Zuguo Liu, N. W. & Sun, X. Luosheng Tang 眼科学基础. (人民卫生出版社, (2018). Henkind, P. Radial peripapillary capillaries of the retina. I. Anatomy: human and comparative. Br. J. Ophthalmol. 51 , 115–123. https://doi.org:10.1136/bjo.51.2.115 (1967). Provis, J. M. Development of the primate retinal vasculature. Prog Retin Eye Res. 20 , 799–821. https://doi.org:10.1016/s1350-9462(01)00012-x (2001). Antonia, M., Joussen, T. W. G., Kirchhof, B., Stephen, J. & Ryan Retinal Vascular Disease (2011). David, R. & Chow, P. R. OCT Angiography . (2018). Mizener, J. B., Podhajsky, P. & Hayreh, S. S. Ocular ischemic syndrome. Ophthalmology . 104 , 859–864. https://doi.org:10.1016/s0161-6420(97)30221-8 (1997). Babikian, V. et al. Retinal ischemia and embolism. Etiologies and outcomes based on a prospective study. Cerebrovasc. Dis. 12 , 108–113. https://doi.org:10.1159/000047689 (2001). Hayreh, S. S. Acute retinal arterial occlusive disorders. Prog Retin Eye Res. 30 , 359–394. https://doi.org:10.1016/j.preteyeres.2011.05.001 (2011). Ochakovski, G. A. et al. Retinal oedema in central retinal artery occlusion develops as a function of time. Acta Ophthalmol. 98 , e680–e684. https://doi.org:10.1111/aos.14375 (2020). Jianzhi Wang, R. Q., Wu, L., Sun, L. & Li, W. Zhisheng Jiang 病理生理学 (2018). (人民卫生出版社. Xianzhong Xiao Y. G. 病理生理学. (高等教育出版社, (2018). Carden, D. L. & Granger, D. N. Pathophysiology of ischaemia–reperfusion injury. J. Pathol. 190 , 255–266. 10.1002/(SICI)1096-9896(200002)190:33.0.CO;2-6 (2000). https://doi.org:https://doi.org/ Eltzschig, H. K. & Eckle, T. Ischemia and reperfusion–from mechanism to translation. Nat. Med. 17 , 1391–1401. https://doi.org:10.1038/nm.2507 (2011). Lo, K. J., Wang, A. G. & Cheng, H. C. Retinal Vasculature Changes after Bypass Surgery for Moyamoya Disease. Ophthalmology . 128 , 120. https://doi.org:10.1016/j.ophtha.2020.08.014 (2021). Kuroda, S., Kamiyama, H., Abe, H., Asaoka, K. & Mitsumori, K. Temporary neurological deterioration caused by hyperperfusion after extracranial-intracranial bypass–case report and study of cerebral hemodynamics. Neurol. Med. Chir. (Tokyo) . 34 , 15–19. https://doi.org:10.2176/nmc.34.15 (1994). Fujimura, M., Kaneta, T., Mugikura, S., Shimizu, H. & Tominaga, T. Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg. Neurol. 67 , 273–282. https://doi.org:10.1016/j.surneu.2006.07.017 (2007). Goto, I., Katsuki, S., Ikui, H., Kimoto, K. & Mimatsu, T. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases. Stroke . 6 , 263–269. https://doi.org:10.1161/01.str.6.3.263 (1975). Patton, N. et al. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J. Anat. 206 , 319–348. https://doi.org:10.1111/j.1469-7580.2005.00395.x (2005). Moss, H. E. Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases. Curr. Neurol. Neurosci. Rep. 15 , 40. https://doi.org:10.1007/s11910-015-0561-1 (2015). Stenkamp, D. L. Development of the Vertebrate Eye and Retina. Prog Mol. Biol. Transl Sci. 134 , 397–414. https://doi.org:10.1016/bs.pmbts.2015.06.006 (2015). Miesfeld, J. B. & Brown, N. L. Eye organogenesis: A hierarchical view of ocular development. Curr. Top. Dev. Biol. 132 , 351–393. https://doi.org:10.1016/bs.ctdb.2018.12.008 (2019). Rim, T. H., Teo, A. W. J., Yang, H. H. S., Cheung, C. Y. & Wong, T. Y. Retinal Vascular Signs and Cerebrovascular Diseases. J. Neuroophthalmol . 40 , 44–59. https://doi.org:10.1097/wno.0000000000000888 (2020). Hughes, A. D. et al. Association of Retinopathy and Retinal Microvascular Abnormalities With Stroke and Cerebrovascular Disease. Stroke . 47 , 2862–2864. https://doi.org:10.1161/strokeaha.116.014998 (2016). Nelis, P. et al. OCT-Angiography reveals reduced vessel density in the deep retinal plexus of CADASIL patients. Sci. Rep. 8 , 8148. https://doi.org:10.1038/s41598-018-26475-5 (2018). Lindley, R. I. et al. Retinal microvasculature in acute lacunar stroke: a cross-sectional study. Lancet Neurol. 8 , 628–634. https://doi.org:10.1016/s1474-4422(09)70131-0 (2009). Kawasaki, R. et al. Fractal dimension of the retinal vasculature and risk of stroke: a nested case-control study. Neurology . 76 , 1766–1767. https://doi.org:10.1212/WNL.0b013e31821a7d7d (2011). Patton, N. et al. The association between retinal vascular network geometry and cognitive ability in an elderly population. Invest. Ophthalmol. Vis. Sci. 48 , 1995–2000. https://doi.org:10.1167/iovs.06-1123 (2007). Ding, J. et al. Association of retinal arteriolar dilatation with lower verbal memory: the Edinburgh Type 2 Diabetes Study. Diabetologia . 54 , 1653–1662. https://doi.org:10.1007/s00125-011-2129-1 (2011). Additional Declarations No competing interests reported. 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version\u003c/p\u003e","description":"","filename":"FIG.7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5325211/v1/59ab9d967f86d132adbb5b9e.jpg"},{"id":86180477,"identity":"faedc162-2394-4f25-90ce-e92e5653138d","added_by":"auto","created_at":"2025-07-07 16:22:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2140202,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5325211/v1/0c460fd0-8e75-49e4-9743-c0853098bb5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Potential Retinal Imaging Markers for Moyamoya Disease: Changes in Retinal Microvasculature and Thickness","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA rare structural abnormality of the cerebral vasculature called Moyamoya disease (MMD). It presents as the proximal intracranial carotid artery (ICA) is stenosed and the distal end is hyperplastic. The abundant collateral vessels at its distal end look like smoke\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Recent reports indicate that the average prevalence of MMD is 3.92/100,000 in China and about 10.5/100,000 in Japan, while the prevalence in the United States is only 1/11,000,000. However, in many regions globally, its prevalence has gradually increased in recent years\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The main clinical symptom of MMD is cerebral ischemia. Children often present with transient ischemic attack and adults with ischemic cerebral infarction. Complications such as seizures, headache, and cognitive dysfunction may also be associated with cerebral ischemia\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and cerebral ischemic events have a high risk of recurrence\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In previous studies, a few cases of MMD were reported with ocular complications\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. For example, Ashok et al. reported a young man who had central retinal artery occlusion (CRAO) and was diagnosed with MMD\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Alekya et al. reported a case of the patient with both CRAO and MMD, whose optical coherence tomography (OCT) results suggested a reduction in retinal thickness\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAs a revolutionary imaging method, optical coherence tomography angiography (OCTA) can provide quantitative and morphological data on retinal microvascular changes in vivo\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. A variety of measures such as blood flow\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, size of FAZ\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, vessel density and others\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e can be calculated using the OCTA technique. In addition, morphological data include vessel length, diameter and number of branches \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Currently, OCTA is widely used for the diagnosis and monitoring of ocular diseases which include glaucoma\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, age-related macular degeneration (AMD)\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, and diabetic retinopathy\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In the neurological system, OCTA is also considered to assist in monitoring the progression of Alzheimer's disease\u003csup\u003e\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, multiple sclerosis \u003csup\u003e\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, and other diseases.\u003c/p\u003e \u003cp\u003eTo investigate whether microvascular and structural changes in the macula reflect the cerebrovascular status of patients with MMD, that is, whether OCTA can be an assistance in the diagnosis of MMD, we collected superficial macular capillary vessel density (SMC-VD) and macular retinal thickness (MRT) in MMD patients and healthy controls (HC). We also collected SMC-VD and MRT data from patients with MMD who had undergone revascularization in a bid to observe the impact of cerebral blood flow alterations on the retina.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubject Recruitment\u003c/h2\u003e \u003cp\u003eThirty-two subjects with MMD who met the criteria were recruited by the diagnostic criteria for MMD proposed by the Japanese Committee for the Study of Spontaneous Occlusion of the Ring of Willis\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Sixteen of them did not be treated surgically and were the non-operated group (nOG). The other 16 were treated with revascularization (superficial temporal artery-middle cerebral artery anastomosis) and were the operated group (OG). Healthy controls (HC) were included in the study with 16 subjects who met the appropriate criteria. All subjects were assessed between 2018 and 2022 by specialists in the relevant disciplines in the First Affiliated Hospital of Nanchang University.\u003c/p\u003e \u003cp\u003eSubjects for inclusion in nOG and OG matched the following criteria: 1) patients with classic MMD diagnosed by Digital subtraction angiography (DSA) and other exams; 2) OG patients undergoing revascularization for one month. Exclusion from the study: 1) DSA results are atypical and/or cannot be confirmed in patients with MMD; 2) other diseases that can affect the vasculature of the brain or a history of brain surgery (e.g. atherosclerosis, congenital malformations of the cerebral vessels, cranio-cerebral tumours, etc.); 3) diseases or history of ocular surgery that can clearly affect the retina and its blood vessels (e.g. glaucoma, ocular tumours, age-related macular degeneration (AMD), etc.); 4) systemic diseases that can affect the retina and its blood vessels (e.g. diabetes, systemic lupus erythematosus (SLE), hypertension, etc.); 5) individuals who are unable to undergo DSA and/or OCT (e.g. with allergic reaction to contrast media).\u003c/p\u003e \u003cp\u003e16 HC were matched for age and gender to nOG and OG patients and met the following criteria: 1) absence of cerebrovascular diseases and history of cranio-cerebral surgery (e.g. MMD, atherosclerosis, cranio-cerebral tumours, etc.); 2) absence of diseases affecting the retina and its blood vessels or history of ocular surgery (e.g. AMD, glaucoma, ocular tumours, etc.); 3) without systemic diseases affecting the retina and its blood vessels (e.g. diabetes, SLE, hypertension, etc.); 4) acceptable for relevant investigations such as DSA and OCTA.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Examinations\u003c/h3\u003e\n\u003cp\u003eThe following medical examinations were performed on all subjects: 1) routine blood and blood biochemical examinations, such as hemoglobin, triglycerides, total cholesterol, glucose, and electrolytes; 2) blood pressure examination; 3) Visual Acuity (VA); 4) DSA of the brain; 5) OCTA. (Some clinical results that did not differ significantly are not shown in the article).\u003c/p\u003e\n\u003ch3\u003eDSA\u003c/h3\u003e\n\u003cp\u003eA DSA machine was applied to the subject to perform DSA of the brain. The patient was advised to take the appropriate position (supine position was chosen for this study). After proper disinfection and anaesthesia, a small incision is opened at the puncture site and a guide wire is inserted using a puncture needle, along which an arterial sheath is placed. The imaging modality (internal carotid arteriography, common carotid arteriography, etc.) is chosen according to the subject's actual condition. A pigtail tube is connected and 5\u0026ndash;8 ml of contrast media is injected uniformly at the appropriate location. Frontal and lateral contrast examinations are performed after adjusting the contrast field under fluoroscopy and the results are recorded.\u003c/p\u003e\n\u003ch3\u003eOCTA\u003c/h3\u003e\n\u003cp\u003eWe use the Carl Zeiss Meditec AngioPlex system for OCTA imaging. This SD-OCT system operates at an A-scan speed of 68,000 scans per second, a 840 nm light source centre and a 90 nm bandwidth. The system operates with an axial resolution of 5ɥm, a 15ɥm lateral resolution and a 2.0mm A-scan depth parameter. Each eye recorded 6*6 mm and 3*3 mm 3D OCTA images. After scanning, each retina of 6*6 mm was divided into nine Early Treatment Diabetic Retinopathy Study (ETDRS) subzones, comprising three concentric circles (1.0 mm, 3.0 mm and 6.0 mm radii, respectively). The 3*3 mm retina was divided into 5 subzones consisting of two concentric circles (radii of 1.0 mm and 3.0 mm, respectively). The vascular density is the percentage of the vascular perfusion area over the measured area. Vessel density was calculated from 2D frontal images created of the superficial retinal layers with a threshold method. Assigned each pixel to perfusion (1) or background (0) by identifying the value of the image block. Results from the region of interest were scaled according to pixel size to calculate the vascular density from the macular centre to the edges of the 6*6 mm and 3*3 mm images. The SMC-VD in this study ranged from the inner limiting membrane (ILM) to the inner plexiform layer (IPL). The left and right eyes of all subjects were evaluated.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAnalysis of the results was performed with GraphPad Prism version 8 (La Jolla, California, USA) and SPSS version 22.0 (IBM, Armonk, NY, USA). Both ANOVA and Bonferroni Post Hoc Analysis were used for comparison between groups. Linear correlations between MRT and SMC-VD were performed for each group by applying person correlation analysis. For the analysis of differences between HC and MMD patients, subject work characteristic (ROC) curves were plotted.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eFundamental Information\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there were 16 subjects in the HC group, nOG and OG, respectively, in this study. It was analyzed for both eyes of each subject. The three groups of subjects did not differ in age (p\u0026thinsp;=\u0026thinsp;0.200), gender (p\u0026thinsp;=\u0026thinsp;0.055) and visual acuity (0.144) between the groups. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates typical DSA, SMC-VD and MRT images in MMD patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFundamental information on the HC, nOG and OG.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eANOVA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEyes (N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, male %\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease duration(month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;30.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.56\u0026thinsp;\u0026plusmn;\u0026thinsp;19.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVisual Acuity (log MAR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic blood pressure (mm Hg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121.00\u0026thinsp;\u0026plusmn;\u0026thinsp;13.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.44\u0026thinsp;\u0026plusmn;\u0026thinsp;18.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic blood pressure (mm Hg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.81\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.31\u0026thinsp;\u0026plusmn;\u0026thinsp;12.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eANOVA Showed the Statistical Differences Across Groups. Age, disease duration, visual Acuity and blood puressure were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e \u003cp\u003eHC, healthy controls; nOG, non-operated group; OG, operated group; SD, standard deviation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis of the 6*6 mm SMC-VD\u003c/h3\u003e\n\u003cp\u003eSMC-VD in the HC, nOG and the OG in the 6*6 mm region are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The SMC-VD was markedly lower in the nOG than HC group in the IS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020), OS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), IN (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), ON (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), OI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028), Outer (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022) and Full (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042) regions. In regions II (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000), IT (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000), OT (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.168), C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000) and Inner (Inner, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134) decreases were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec). In the OS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036), IN (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040) and ON (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) subregions, the SMC-VD declined markedly in the OG. The alterations in the remaining subregions were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed). The change in FAZ (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.334) was also not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e6*6 mm SMC-VD (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) in HC group, nOG and OG\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubregion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBonferroni HC vs. nOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBonferroni HC vs. OG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eANOVA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.455\u0026thinsp;\u0026plusmn;\u0026thinsp;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.438\u0026thinsp;\u0026plusmn;\u0026thinsp;0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.448\u0026thinsp;\u0026plusmn;\u0026thinsp;0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.482\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.464\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.470\u0026thinsp;\u0026plusmn;\u0026thinsp;0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.036#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.449\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.421\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.427\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.040#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.503\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.469\u0026thinsp;\u0026plusmn;\u0026thinsp;0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.485\u0026thinsp;\u0026plusmn;\u0026thinsp;0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.444\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.440\u0026thinsp;\u0026plusmn;\u0026thinsp;0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u0026thinsp;\u0026plusmn;\u0026thinsp;0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.474\u0026thinsp;\u0026plusmn;\u0026thinsp;0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.459\u0026thinsp;\u0026plusmn;\u0026thinsp;0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.467\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.439\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.433\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.434\u0026thinsp;\u0026plusmn;\u0026thinsp;0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.445\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.429\u0026thinsp;\u0026plusmn;\u0026thinsp;0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.448\u0026thinsp;\u0026plusmn;\u0026thinsp;0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.168#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.854#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.207\u0026thinsp;\u0026plusmn;\u0026thinsp;0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.194\u0026thinsp;\u0026plusmn;\u0026thinsp;0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.178\u0026thinsp;\u0026plusmn;\u0026thinsp;0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.446\u0026thinsp;\u0026plusmn;\u0026thinsp;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.433\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u0026thinsp;\u0026plusmn;\u0026thinsp;0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.470\u0026thinsp;\u0026plusmn;\u0026thinsp;0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.456\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.467\u0026thinsp;\u0026plusmn;\u0026thinsp;0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.739#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.460\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.446\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.454\u0026thinsp;\u0026plusmn;\u0026thinsp;0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFAZ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.358\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.311\u0026thinsp;\u0026plusmn;\u0026thinsp;0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.358\u0026thinsp;\u0026plusmn;\u0026thinsp;0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eStatistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. #Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance.\u003c/p\u003e \u003cp\u003eSMC-VD, superficial macular capillary vessel density; SD, standard deviation; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of the 3*3 mm SMC-VD\u003c/h2\u003e \u003cp\u003eSMC-VD changes in the three groups in the 3*3 mm region are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In comparison to the HC group, the SMC-VD was markedly decreased in the S (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), N (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), I (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042), T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and Inner (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) regions in nOG patients. Changes in SMC-VD in the C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.084) and Full (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.080) regions were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ec). SMC-VD in the OG remained markedly lower than in the HC in the S (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), N (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), I (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039), C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018) and Inner (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020) regions. The SMC-VD was not statistically different from HC in T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.686) and Full (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.464) subregions of the OG (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ed). The change in FAZ (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.808) was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e3*3 mm SMC-VD (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) in HC group, nOG and OG\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubregion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBonferroni HC vs. nOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBonferroni HC vs. OG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eANOVA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuperior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.419\u0026thinsp;\u0026plusmn;\u0026thinsp;0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.397\u0026thinsp;\u0026plusmn;\u0026thinsp;0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.403\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.420\u0026thinsp;\u0026plusmn;\u0026thinsp;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.396\u0026thinsp;\u0026plusmn;\u0026thinsp;0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.397\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.405\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.388\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.391\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.039#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTemporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.410\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.388\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.405\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.686#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.187\u0026thinsp;\u0026plusmn;\u0026thinsp;0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.158\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u0026thinsp;\u0026plusmn;\u0026thinsp;0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.412\u0026thinsp;\u0026plusmn;\u0026thinsp;0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.392\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.400\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.020#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.379\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.367\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.371\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFAZ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.360\u0026thinsp;\u0026plusmn;\u0026thinsp;0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.340\u0026thinsp;\u0026plusmn;\u0026thinsp;0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.356\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eStatistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. # Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance.\u003c/p\u003e \u003cp\u003eSMC-VD, superficial macular capillary vessel density; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMRT\u003c/h2\u003e \u003cp\u003eThe MRT in the three groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. In all subregions except C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.954), MRT in the nOG was significantly thinner than in the HC group (IT, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all remaining regions; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ea, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ec). Reductions in MRT remained in the IS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), IN (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ON (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Outer (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) and Full (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023) regions in the OG compared with the HC group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ed).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMRT (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) in HC group, nOG and OG\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubregion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBonferroni HC vs. nOG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBonferroni HC vs. OG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eANOVA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e332.44\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312.94\u0026thinsp;\u0026plusmn;\u0026thinsp;15.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e320.69\u0026thinsp;\u0026plusmn;\u0026thinsp;17.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298.59\u0026thinsp;\u0026plusmn;\u0026thinsp;20.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e277.81\u0026thinsp;\u0026plusmn;\u0026thinsp;16.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e287.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e330.06\u0026thinsp;\u0026plusmn;\u0026thinsp;15.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e307.19\u0026thinsp;\u0026plusmn;\u0026thinsp;19.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e317.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290.69\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e274.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e323.50\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304.41\u0026thinsp;\u0026plusmn;\u0026thinsp;22.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321.88\u0026thinsp;\u0026plusmn;\u0026thinsp;19.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e279.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282.00\u0026thinsp;\u0026plusmn;\u0026thinsp;14.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.578#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e316.50\u0026thinsp;\u0026plusmn;\u0026thinsp;14.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e303.25\u0026thinsp;\u0026plusmn;\u0026thinsp;14.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e315.84\u0026thinsp;\u0026plusmn;\u0026thinsp;22.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e275.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e261.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e295.34\u0026thinsp;\u0026plusmn;\u0026thinsp;22.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e238.75\u0026thinsp;\u0026plusmn;\u0026thinsp;22.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243.91\u0026thinsp;\u0026plusmn;\u0026thinsp;21.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e241.78\u0026thinsp;\u0026plusmn;\u0026thinsp;16.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e325.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308.03\u0026thinsp;\u0026plusmn;\u0026thinsp;14.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e316.47\u0026thinsp;\u0026plusmn;\u0026thinsp;18.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e292.75\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e285.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e301.28\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285.31\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e294.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eStatistical differences between the nGO, OG and HC groups were calculated by ANOVA and Bonferroni post hoc analysis. # Games-Howell Post Hoc Analysis display the Statistical Differences of the values with the heterogeneous variance.MRT, macular retinal thickness; HC, healthy controls; nOG, non-operated group; OG, operated group; FAZ, fluorescein angiography zone.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Analysis\u003c/h2\u003e \u003cp\u003eIn the nOG, SMC-VD in the Full region was positively correlated with the corresponding MRT value (Pearson r\u0026thinsp;=\u0026thinsp;0.590, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea), suggesting that a decrease in MRT was associated with a decrease in SMC-VD. The SMC-VD (3*3 mm) in the Inner region was correlated with the MRT in the corresponding subregion (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eROC\u003c/b\u003e Curves\u003c/p\u003e \u003cp\u003eThe ability of MRT to discriminate MMD is represented by the area under the curve (AUC) shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003ea. The regions with AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.9 were ON (AUC\u0026thinsp;=\u0026thinsp;0.989; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), OI (AUC\u0026thinsp;=\u0026thinsp;0.909; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), OT (AUC\u0026thinsp;=\u0026thinsp;0.912; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and Outer (AUC\u0026thinsp;=\u0026thinsp;0.969; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The analysis of ROC curves for other regions is shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The diagnostic accuracy of SMC-VD for MMD is indicated by the AUC shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eb. The only region with AUC\u0026thinsp;\u0026gt;\u0026thinsp;0.9 was ON (AUC\u0026thinsp;=\u0026thinsp;0.907; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The analysis of ROC curves for other regions is shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC Curve Analysis of MRT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.714 to 0.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.741 to 0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.690 to 0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.972 to 1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.695 to 0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.832 to 0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.614 to 0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.845 to 0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.432 to 0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.718 to 0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.933 to 1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.790 to 0.955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAUC values, SE, 95% CI and P-values for each subregion.\u003c/p\u003e \u003cp\u003eROC, receiver operating characteristic; MRT, Macular retinal thickness; AUC, area under\u0026nbsp;ROC\u0026nbsp;curve; SE, standard errors; 95% CI, 95% confidence intervals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC Curve Analysis of SMC-VD(6*6mm)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMC-VD(6*6mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.540 to 0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Superior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.609 to 0.852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.513 to 0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Nasal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.832 to 0.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.413 to 0.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Inferior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.567 to 0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.454 to 0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter Temporal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.466 to 0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.459 to 0.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.513 to 0.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOuter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.516 to 0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFull\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.543 to 0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAUC values, SE, 95% CI and P-values for each subregion.\u003c/p\u003e \u003cp\u003eROC, receiver operating characteristic; SMC-VD, superficial macular capillary vessel density; AUC, area under\u0026nbsp;ROC\u0026nbsp;curve; SE, standard errors; 95% CI, 95% confidence intervals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe collected and compared SMC-VD and MRT in the nOG, OG and HC groups to investigate whether microvasculature and retinal thickness were altered in patients with MMD and to assess their diagnostic potential for MMD.\u003c/p\u003e \u003cp\u003eMost subregions of the nOG had lower SMC-VD than HC based on OCTA results (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This finding suggests that cerebral vascular disease in patients with MMD may affect superficial retinal capillary density. Several branches are given off by the ICA in the neck and skull, including the ophthalmic artery, which supplies blood to the eyes. The central retinal artery is derived from the ophthalmic artery and supplies blood to the inner five layers of the retina. Blood to the outer five layers of the retina is supplied primarily by the ciliary artery system emanating from the ophthalmic artery\u003csup\u003e\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Blood from the central retinal artery supplies the retinal nerve fiber layer, ganglion cell layer and inner plexiform layer through the superficial capillary plexus (SCP), and continues to extend to become the deep capillary plexus (DCP) in the inner nuclear layer. The radial peripapillary capillary plexus (RPCP) is in the nerve fibre layer (NFL)that runs parallel to the axons of the nerve fibres \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. The capillaries of the SMC-VD we measured in this study are part of the temporal branch of the SCP (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The temporal retinal arteries arch around the macula, forming the superior macular arteriole and the arteriola macularis inferior\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Stenosis of the ICA is a feature of MMD, and in these cases the blood supply to the branches of the ICA will be reduced. Previous studies have also suggested that retinal ischemia is associated with severe stenosis of the ICA\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Therefore, we suggested that the narrowing of ICA led to the reduction of SMC-VD.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThese changes suggest questions about their role in structural and functional variations in the retina. In the present study, MRT of patients in the nOG was significantly thinner than that of healthy subjects in all subregions but C (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), yet these subjects did not show significant visual impairment. Blockage of the central retinal artery and its branches can often be observed as retinal edema \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e ,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Due to ischemia and hypoxia, the retinal cells become edematous, and if ischemia is prolonged the inner retinal cells gradually become necrotic, leading to reduced retinal thickness \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. The MMD subjects we included in our study all had long disease duration (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Therefore, we interpret their MRT reduction as an alteration caused by prolonged ischemia and hypoxia. That means the reduction of MRT is associated with the reduction of SMC-VD. And a correlation was found in nOG between MRT and SMC-VT in the Full region at 6*6mm (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea) and in the Inner region at 3*3mm (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb). This evidence indicates a close association between reduced MRT and reduced SMC-VD in patients with MMD.\u003c/p\u003e \u003cp\u003eTo further investigate this link in patients with MMD we evaluated structural and microvascular variations in the retinas of MMD subjects one month after revascularization. The results indicated that in this group (OG) the SMC-VD remained significantly lower than HC in OS, IN, ON, S, I and Inner regions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ed). The MRT did not return to normal in the IS, IN, ON, Outer, and Full regions compared to HC (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ed). We speculate that the above results may be due to the occurrence of ischemia-reperfusion injury. Ischemia-reperfusion injury mainly refers to tissue damage caused by the restoration of blood supply after ischemia or/and hypoxia\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. This can manifest as endothelial damage, increased permeability and leukocyte obstruction in microvessels, especially small arteries and capillaries\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. A recent case report also showed that a patient with MMD who underwent left superficial temporal artery-middle cerebral artery anastomosis for one month had a significantly reduced superficial retinal vessels of the left eye which did not return to normal until nine months postoperatively. This vascular complex, however, did not show any significant abnormality before surgery \u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. It has also been shown that patients with MMD have cerebral hyperperfusion and a range of complications after revascularization treatment \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. On this basis, it seems feasible that in the present study small arteries and capillaries in the macula may have suffered reperfusion injury in addition to ischemia. In future studies we may need more specialized neurologists to evaluate the results of cerebral revascularization, rather than assuming that the cerebral vessels are back to normal just by the results of DSA.\u003c/p\u003e \u003cp\u003eAlthough the cerebral vascular system has a complex structure, Goto et al. suggested that retinal vasculopathy may in part reflect cerebral microvascular lesions\u003csup\u003e\u003cspan additionalcitationids=\"CR53\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. In embryology, the retina was considered to be the central nervous system\u0026rsquo;s extension with a common origin in the embryonic neural tube. The anterior part of the neural tube differentiates into brain tissue and forms a pair of optic vesicles which develop into the right and left retinas\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e. Moreover, anatomically, blood of the retina, the anterior two-thirds of the telencephalon, and part of the mesencephalon are supplied by the ICA\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e and alterations in the retinal arteries are related to vascular disease in the brain \u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e. Strokes have been linked to retinal vessel changes even since the early studies using fundus photography\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e,\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e and changes in cognitive abilities\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e. We therefore hypothesized that OCTA measurement of retinal vascular structure and perfusion may also reflect in part the cerebral blood flow in patients with MMD. We evaluated the diagnostic accuracy of MRT and SMC-VD for MMD using ROC curves. The results showed high AUC values for MRT in all sub-regions except for region C. The AUC values of ON, OI, OT and Outer were all over 0.9, and approaching this value (at 0.87) in the Full region (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003ea). It is suggested that MRT has strong potential to discriminate between MMD and HC. However, for SMC-VD only ON had an AUC greater than 0.9, values of the remaining subregions being mostly in the range of 0.6\u0026ndash;0.7 (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eb). The diagnostic accuracy of SMC-VD for MMD was therefore inferior to that of MRT. In our analysis, this may reflect the fact that vascular lesions in MMD affect not only the superficial retinal vessels, but also the deeper vascular layers, such as those of the choroid.\u003c/p\u003e \u003cp\u003eHowever, the limitations of our study need to be considered. For example, our sample size was so small that it limited the accuracy of the study. In the study, we only focused on the capillaries in the superficial layers of the retina. Other vessels of the retina, such as the DCP and choroidal capillaries, may also altered. And, we should assess the correspondence between cerebral and retinal vascular alterations by long-term, relatively frequent DSA and OCTA in future studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, we conclude that patients with MMD still have significant SMC-VD and MRT reduction even in the absence of ocular clinical manifestations. And MRT reduction is closely associated with SMC-VD reduction. These reductions are not immediately restored with the re-establishment of cerebral blood flow. This may be related to ischemia-reperfusion damage to the retinal arteries. Importantly, the SMC-VD and MRT have a strong ability to distinguish MMD from HC, suggesting that alterations in retinal microvasculature and structure may be a cheaper non-invasive marker for assessing vascular changes in the brain in patients with MMD. The OCTA may serve as a more convenient way to monitor changes in MMD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e Conflict of interests\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThere is no declaration for authors about conflict of interests in this study.\u003c/p\u003e \u003ch2\u003eEthical Statement\u003c/h2\u003e \u003cp\u003eEvery aspect of the work is under the responsibility of the author, including the investigation and resolution of any questions of accuracy or integrity. A Medical Ethics Committee of Nanchang University First Affiliated Hospital (cdyfy2021039) approved the study based on the Declaration of Helsinki (revised 2013). All subjects voluntarily undertook to sign an informed consent form after understanding the potential risks, objectives and methods.\u003c/p\u003e \u003ch2\u003eOpen Access Statement\u003c/h2\u003e \u003cp\u003eIn accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), this article is distributed as Open Access. Under this license, the article may be reproduced and distributed for non-commercial purposes only if no changes or edits have been made and the original work is properly cited (Links to official publications are available by relevant DOI and license).\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eSupported by National Natural Science Foundation of China (No.82160195); Foundation of Jiangxi Provincial Department of Science and Technology (No. 20212BAG70021); \u003cem\u003eJiangxi Double-Thousand Plan High-Level Talent Project of Science and Technology Innovation\u003c/em\u003e(No.jxsq2023201036); \u003cem\u003eKey R \u0026amp; D Program of Jiangxi Province (20223BBH80014);\u003c/em\u003e Science and Technology Project of Jiangxi Province Health Commission of Traditional Chinese Medicine (No. 2022B258); Science and Technology Project of Jiangxi Health Commission (No. 202210017).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e(I) Conception and design: Y Shao, EM Zeng and JY Kang; (II) Administrative support: Y Shao; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: JY Kang, J Yan, F Lin, SH Xu, LQ He, XL Liao, H Wei; (V) Data analysis and interpretation: JY Kang, YP Li, JY Hu, J Yan; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSuzuki, J. \u0026amp; Takaku, A. Cerebrovascular moyamoya disease. Disease showing abnormal net-like vessels in base of brain. \u003cem\u003eArch. Neurol.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e, 288\u0026ndash;299. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1001/archneur.1969.00480090076012\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1001/archneur.1969.00480090076012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1969).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScott, R. M. \u0026amp; Smith, E. R. Moyamoya disease and moyamoya syndrome. \u003cem\u003eN Engl. J. Med.\u003c/em\u003e \u003cb\u003e360\u003c/b\u003e, 1226\u0026ndash;1237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1056/NEJMra0804622\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1056/NEJMra0804622\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShang, S. et al. Progress in moyamoya disease. \u003cem\u003eNeurosurg. Rev.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e, 371\u0026ndash;382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s10143-018-0994-5\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s10143-018-0994-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiyoshi Sato, T. S. \u003cem\u003ein Cerebrovascular Diseases in Children\u003c/em\u003e227\u0026ndash;243 (Springer, 1992).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoto, Y. \u0026amp; Yonekawa, Y. Worldwide distribution of moyamoya disease. \u003cem\u003eNeurol. Med. Chir. (Tokyo)\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e, 883\u0026ndash;886. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.2176/nmc.32.883\u003c/span\u003e\u003cspan address=\"https://doi.org:10.2176/nmc.32.883\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1992).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuroda, S. \u0026amp; Houkin, K. Moyamoya disease: current concepts and future perspectives. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, 1056\u0026ndash;1066. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/s1474-4422(08)70240-0\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/s1474-4422(08)70240-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHishikawa, T., Sugiu, K., Date, I. \u0026amp; Moyamoya Disease A Review of Clinical Research. \u003cem\u003eActa Med. Okayama\u003c/em\u003e. \u003cb\u003e70\u003c/b\u003e, 229\u0026ndash;236. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.18926/amo/54497\u003c/span\u003e\u003cspan address=\"https://doi.org:10.18926/amo/54497\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, S. K. et al. Pediatric moyamoya disease: An analysis of 410 consecutive cases. \u003cem\u003eAnn. Neurol.\u003c/em\u003e \u003cb\u003e68\u003c/b\u003e, 92\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1002/ana.21981\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1002/ana.21981\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazumata, K. et al. Chronic ischemia alters brain microstructural integrity and cognitive performance in adult moyamoya disease. \u003cem\u003eStroke\u003c/em\u003e. \u003cb\u003e46\u003c/b\u003e, 354\u0026ndash;360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1161/strokeaha.114.007407\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1161/strokeaha.114.007407\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu, D., Shedden, P., Bratina, P. \u0026amp; Grotta, J. C. Clinical features of moyamoya disease in the United States. \u003cem\u003eStroke\u003c/em\u003e. \u003cb\u003e29\u003c/b\u003e, 1347\u0026ndash;1351. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1161/01.str.29.7.1347\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1161/01.str.29.7.1347\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1998).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlamovits, T. L., Klingele, T. G., Burde, R. M. \u0026amp; Gado, M. H. Moyamoya disease with central retinal vein occlusion. Case report. \u003cem\u003eJ. Clin. Neuroophthalmol\u003c/em\u003e. \u003cb\u003e1\u003c/b\u003e, 123\u0026ndash;127 (1981).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChace, R. \u0026amp; Hedges, T. R. 3 Retinal artery occlusion due to moyamoya disease. \u003cem\u003eJ. Clin. Neuroophthalmol\u003c/em\u003e. \u003cb\u003e4\u003c/b\u003e, 31\u0026ndash;34 (1984).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUshimura, S., Mochizuki, K., Ohashi, M., Ito, S. \u0026amp; Hosokawa, H. Sudden blindness in the fourth month of pregnancy led to diagnosis of moyamoya disease. \u003cem\u003eOphthalmologica\u003c/em\u003e. \u003cb\u003e207\u003c/b\u003e, 169\u0026ndash;173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1159/000310428\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1159/000310428\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1993).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbrecht, P. et al. Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography. \u003cem\u003eNeurology\u003c/em\u003e. \u003cb\u003e85\u003c/b\u003e, 521\u0026ndash;527. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1212/wnl.0000000000001832\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1212/wnl.0000000000001832\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar, M. A. \u0026amp; Ganesh, B. A. CRAO in Moyamoya Disease. \u003cem\u003eJ. Clin. Diagn. Res.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, 545\u0026ndash;547. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.7860/JCDR/2013/4579.2819\u003c/span\u003e\u003cspan address=\"https://doi.org:10.7860/JCDR/2013/4579.2819\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajanala, A. P., Le, H. T. \u0026amp; Gill, M. K. Central retinal artery occlusion as initial presentation of Moyamoya disease in a middle-aged woman. \u003cem\u003eAm. J. Ophthalmol. Case Rep.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e, 100705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.ajoc.2020.100705\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.ajoc.2020.100705\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell, J. P. et al. Detailed Vascular Anatomy of the Human Retina by Projection-Resolved Optical Coherence Tomography Angiography. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, 42201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1038/srep42201\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1038/srep42201\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, R. K., Zhang, Q., Li, Y. \u0026amp; Song, S. Optical coherence tomography angiography-based capillary velocimetry. \u003cem\u003eJ. Biomed. Opt.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e, 66008. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1117/1.Jbo.22.6.066008\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1117/1.Jbo.22.6.066008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi, J. et al. Quantitative optical coherence tomography angiography of macular vascular structure and foveal avascular zone in glaucoma. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e, e0184948. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1371/journal.pone.0184948\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1371/journal.pone.0184948\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkil, H., Falavarjani, K. G., Sadda, S. R. \u0026amp; Sadun, A. A. Optical Coherence Tomography Angiography of the Optic Disc; an Overview. \u003cem\u003eJ. Ophthalmic Vis. Res.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 98\u0026ndash;105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.4103/2008-322x.200162\u003c/span\u003e\u003cspan address=\"https://doi.org:10.4103/2008-322x.200162\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWylęgała, A., Wylęgała, F. \u0026amp; Wylęgała, E. Aflibercept Treatment Leads to Vascular Abnormalization of the Choroidal Neovascularization. \u003cem\u003eJ Healthc Eng\u003c/em\u003e 8595278 (2018). (2018). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1155/2018/8595278\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1155/2018/8595278\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScripsema, N. K. et al. Optical Coherence Tomography Angiography Analysis of Perfused Peripapillary Capillaries in Primary Open-Angle Glaucoma and Normal-Tension Glaucoma. \u003cem\u003eInvest. Ophthalmol. Vis. Sci.\u003c/em\u003e \u003cb\u003e57\u003c/b\u003e, 611\u0026ndash;oct620. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1167/iovs.15-18945\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1167/iovs.15-18945\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoisman, L., Goldhardt, R. O. C. T. \u0026amp; Angiography An Upcoming Non-invasive Tool for Diagnosis of Age-related Macular Degeneration. \u003cem\u003eCurr. Ophthalmol. Rep.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e, 136\u0026ndash;140. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s40135-017-0131-6\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s40135-017-0131-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaal, K. B. et al. \u003cem\u003eRetina\u003c/em\u003e \u003cb\u003e39\u003c/b\u003e, 79\u0026ndash;87 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1097/iae.0000000000001938\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1097/iae.0000000000001938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrari, L. et al. Optical Coherence Tomography Reveals Retinal Neuroaxonal Thinning in Frontotemporal Dementia as in Alzheimer's Disease. \u003cem\u003eJ. Alzheimers Dis.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e, 1101\u0026ndash;1107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.3233/jad-160886\u003c/span\u003e\u003cspan address=\"https://doi.org:10.3233/jad-160886\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos, C. Y. et al. [P4\u0026ndash;058]: Retinal Nerve Fiber Layer and Ganglion Cell Layer Volume Changes in Preclinical Alzheimer's Disease over 27 Months. \u003cem\u003eAlzheimer's Dement.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.jalz.2017.06.1923\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.jalz.2017.06.1923\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos, C. Y. et al. Change in retinal structural anatomy during the preclinical stage of Alzheimer's disease. \u003cem\u003eAlzheimers Dement. (Amst)\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e, 196\u0026ndash;209. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.dadm.2018.01.003\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.dadm.2018.01.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehbehani, R. et al. Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis. \u003cem\u003ePLoS One\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e, e0172120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1371/journal.pone.0172120\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1371/journal.pone.0172120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeucht, N. et al. Optical coherence tomography angiography indicates associations of the retinal vascular network and disease activity in multiple sclerosis. \u003cem\u003eMult Scler.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e, 224\u0026ndash;234. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1177/1352458517750009\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1177/1352458517750009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOertel, F. C., Zimmermann, H. G., Brandt, A. U. \u0026amp; Paul, F. Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis. \u003cem\u003eExpert Rev. Neurother.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e, 31\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1080/14737175.2019.1559051\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1080/14737175.2019.1559051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujimura, M. \u0026amp; Tominaga, T. Diagnosis of moyamoya disease: international standard and regional differences. \u003cem\u003eNeurol. Med. Chir. (Tokyo)\u003c/em\u003e. \u003cb\u003e55\u003c/b\u003e, 189\u0026ndash;193. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.2176/nmc.ra.2014-0307\u003c/span\u003e\u003cspan address=\"https://doi.org:10.2176/nmc.ra.2014-0307\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStone, J., van Driel, D., Valter, K., Rees, S. \u0026amp; Provis, J. The locations of mitochondria in mammalian photoreceptors: relation to retinal vasculature. \u003cem\u003eBrain Res.\u003c/em\u003e \u003cb\u003e1189\u003c/b\u003e, 58\u0026ndash;69. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.brainres.2007.10.083\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.brainres.2007.10.083\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMac Grory, B. et al. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. \u003cem\u003eStroke\u003c/em\u003e 52, e282-e294 (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1161/str.0000000000000366\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1161/str.0000000000000366\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYannuzzi, K. B. F. D. S. W. F. M. L. A. \u003cem\u003eThe Retinal Atlas\u003c/em\u003esecond deition,. (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShitian Zhong, Z. D. \u0026amp; Wang, Z. Zuguo Liu, Jianhua Yan. \u003cem\u003eClinical Anatomy of Ophthalmology\u003c/em\u003esecond edition,. (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZuguo Liu, N. W. \u0026amp; Sun, X. Luosheng Tang 眼科学基础. (人民卫生出版社, (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenkind, P. Radial peripapillary capillaries of the retina. I. Anatomy: human and comparative. \u003cem\u003eBr. J. Ophthalmol.\u003c/em\u003e \u003cb\u003e51\u003c/b\u003e, 115\u0026ndash;123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1136/bjo.51.2.115\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1136/bjo.51.2.115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1967).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProvis, J. M. Development of the primate retinal vasculature. \u003cem\u003eProg Retin Eye Res.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e, 799\u0026ndash;821. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/s1350-9462(01)00012-x\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/s1350-9462(01)00012-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntonia, M., Joussen, T. W. G., Kirchhof, B., Stephen, J. \u0026amp; Ryan \u003cem\u003eRetinal Vascular Disease\u003c/em\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid, R. \u0026amp; Chow, P. R. \u003cem\u003eOCT Angiography\u003c/em\u003e. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMizener, J. B., Podhajsky, P. \u0026amp; Hayreh, S. S. Ocular ischemic syndrome. \u003cem\u003eOphthalmology\u003c/em\u003e. \u003cb\u003e104\u003c/b\u003e, 859\u0026ndash;864. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/s0161-6420(97)30221-8\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/s0161-6420(97)30221-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1997).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBabikian, V. et al. Retinal ischemia and embolism. Etiologies and outcomes based on a prospective study. \u003cem\u003eCerebrovasc. Dis.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 108\u0026ndash;113. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1159/000047689\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1159/000047689\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayreh, S. S. Acute retinal arterial occlusive disorders. \u003cem\u003eProg Retin Eye Res.\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e, 359\u0026ndash;394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.preteyeres.2011.05.001\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.preteyeres.2011.05.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchakovski, G. A. et al. Retinal oedema in central retinal artery occlusion develops as a function of time. \u003cem\u003eActa Ophthalmol.\u003c/em\u003e \u003cb\u003e98\u003c/b\u003e, e680\u0026ndash;e684. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1111/aos.14375\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1111/aos.14375\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJianzhi Wang, R. Q., Wu, L., Sun, L. \u0026amp; Li, W. \u003cem\u003eZhisheng Jiang 病理生理学\u003c/em\u003e (2018). (人民卫生出版社.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXianzhong Xiao Y. G. 病理生理学. (高等教育出版社, (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarden, D. L. \u0026amp; Granger, D. N. Pathophysiology of ischaemia\u0026ndash;reperfusion injury. \u003cem\u003eJ. Pathol.\u003c/em\u003e \u003cb\u003e190\u003c/b\u003e, 255\u0026ndash;266. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/(SICI)1096-9896(200002)190:3\u0026lt;255::AID-PATH526\u0026gt;3.0.CO;2-6\u003c/span\u003e\u003cspan address=\"10.1002/(SICI)1096-9896(200002)190:3%3C255::AID-PATH526%3E3.0.CO;2-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2000). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:https://doi.org/\u003c/span\u003e\u003cspan address=\"https://doi.org:https://doi.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEltzschig, H. K. \u0026amp; Eckle, T. Ischemia and reperfusion\u0026ndash;from mechanism to translation. \u003cem\u003eNat. Med.\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e, 1391\u0026ndash;1401. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1038/nm.2507\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1038/nm.2507\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo, K. J., Wang, A. G. \u0026amp; Cheng, H. C. Retinal Vasculature Changes after Bypass Surgery for Moyamoya Disease. \u003cem\u003eOphthalmology\u003c/em\u003e. \u003cb\u003e128\u003c/b\u003e, 120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.ophtha.2020.08.014\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.ophtha.2020.08.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuroda, S., Kamiyama, H., Abe, H., Asaoka, K. \u0026amp; Mitsumori, K. Temporary neurological deterioration caused by hyperperfusion after extracranial-intracranial bypass\u0026ndash;case report and study of cerebral hemodynamics. \u003cem\u003eNeurol. Med. Chir. (Tokyo)\u003c/em\u003e. \u003cb\u003e34\u003c/b\u003e, 15\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.2176/nmc.34.15\u003c/span\u003e\u003cspan address=\"https://doi.org:10.2176/nmc.34.15\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1994).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujimura, M., Kaneta, T., Mugikura, S., Shimizu, H. \u0026amp; Tominaga, T. Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. \u003cem\u003eSurg. Neurol.\u003c/em\u003e \u003cb\u003e67\u003c/b\u003e, 273\u0026ndash;282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.surneu.2006.07.017\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.surneu.2006.07.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoto, I., Katsuki, S., Ikui, H., Kimoto, K. \u0026amp; Mimatsu, T. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases. \u003cem\u003eStroke\u003c/em\u003e. \u003cb\u003e6\u003c/b\u003e, 263\u0026ndash;269. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1161/01.str.6.3.263\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1161/01.str.6.3.263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1975).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatton, N. et al. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. \u003cem\u003eJ. Anat.\u003c/em\u003e \u003cb\u003e206\u003c/b\u003e, 319\u0026ndash;348. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1111/j.1469-7580.2005.00395.x\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1111/j.1469-7580.2005.00395.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoss, H. E. Retinal Vascular Changes are a Marker for Cerebral Vascular Diseases. \u003cem\u003eCurr. Neurol. Neurosci. Rep.\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e, 40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s11910-015-0561-1\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s11910-015-0561-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStenkamp, D. L. Development of the Vertebrate Eye and Retina. \u003cem\u003eProg Mol. Biol. Transl Sci.\u003c/em\u003e \u003cb\u003e134\u003c/b\u003e, 397\u0026ndash;414. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/bs.pmbts.2015.06.006\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/bs.pmbts.2015.06.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiesfeld, J. B. \u0026amp; Brown, N. L. Eye organogenesis: A hierarchical view of ocular development. \u003cem\u003eCurr. Top. Dev. Biol.\u003c/em\u003e \u003cb\u003e132\u003c/b\u003e, 351\u0026ndash;393. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/bs.ctdb.2018.12.008\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/bs.ctdb.2018.12.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRim, T. H., Teo, A. W. J., Yang, H. H. S., Cheung, C. Y. \u0026amp; Wong, T. Y. Retinal Vascular Signs and Cerebrovascular Diseases. \u003cem\u003eJ. Neuroophthalmol\u003c/em\u003e. \u003cb\u003e40\u003c/b\u003e, 44\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1097/wno.0000000000000888\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1097/wno.0000000000000888\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHughes, A. D. et al. Association of Retinopathy and Retinal Microvascular Abnormalities With Stroke and Cerebrovascular Disease. \u003cem\u003eStroke\u003c/em\u003e. \u003cb\u003e47\u003c/b\u003e, 2862\u0026ndash;2864. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1161/strokeaha.116.014998\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1161/strokeaha.116.014998\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelis, P. et al. OCT-Angiography reveals reduced vessel density in the deep retinal plexus of CADASIL patients. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cb\u003e8\u003c/b\u003e, 8148. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1038/s41598-018-26475-5\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1038/s41598-018-26475-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindley, R. I. et al. Retinal microvasculature in acute lacunar stroke: a cross-sectional study. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e8\u003c/b\u003e, 628\u0026ndash;634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/s1474-4422(09)70131-0\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/s1474-4422(09)70131-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawasaki, R. et al. Fractal dimension of the retinal vasculature and risk of stroke: a nested case-control study. \u003cem\u003eNeurology\u003c/em\u003e. \u003cb\u003e76\u003c/b\u003e, 1766\u0026ndash;1767. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1212/WNL.0b013e31821a7d7d\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1212/WNL.0b013e31821a7d7d\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatton, N. et al. The association between retinal vascular network geometry and cognitive ability in an elderly population. \u003cem\u003eInvest. Ophthalmol. Vis. Sci.\u003c/em\u003e \u003cb\u003e48\u003c/b\u003e, 1995\u0026ndash;2000. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1167/iovs.06-1123\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1167/iovs.06-1123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing, J. et al. Association of retinal arteriolar dilatation with lower verbal memory: the Edinburgh Type 2 Diabetes Study. \u003cem\u003eDiabetologia\u003c/em\u003e. \u003cb\u003e54\u003c/b\u003e, 1653\u0026ndash;1662. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s00125-011-2129-1\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s00125-011-2129-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Moyamoya disease, Vessel density, retinal thickness, OCTA, Diagnostic markers","lastPublishedDoi":"10.21203/rs.3.rs-5325211/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5325211/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMoyamoya disease (MMD) is a structural abnormality of the cerebral vasculature characterized by cerebral ischemia, and is rare but its incidence is increasing. Digital subtraction angiography (DSA) of the brain is the primary means of diagnosing and evaluating this disease. But its high price and invasiveness limit its use as a monitoring tool for disease progression. As a non-invasive test for ophthalmic disorders, the optical coherence tomography angiography (OCTA) is widely used. In addition to ophthalmic diseases, OCTA has also been used in some neurological diseases. The aim of this study was to assess fundus changes in patients with MMD by OCTA and to investigate whether these changes could be a diagnostic and assessment marker for MMD. This study evaluated cerebral vessels, superficial macular capillary vessel density (SMC-VD) and macular retinal thickness (MRT) in subjects in the non-operated group (nGO), operated group (OG) and healthy controls (HC) using DSA, OCTA and other techniques. Analyses of variance (ANOVA) and Bonferroni post hoc analysis were used to calculate statistical differences between the three groups. Correlations between SMC-VD and MRT were assessed using Pearson correlation analysis. In addition, the ability of the SMC-VD and the MRT to distinguish MMD from HC was analyzed using receiver operating characteristic (ROC) curves. We found that the SMC-VD and MRT in the nOG group were significantly lower than those in the HC group and had not returned to normal levels at one month postoperatively. In the nOG, the SMC-VD and MRT were positively correlated in the Full region (6*6 mm) and in the Inner region (3*3 mm), and in many subregions they showed high ability to distinguish MMD from HC. The above findings indicate significant reduction in the SMC-VD and the MRT in patients with MMD even in the absence of ocular clinical manifestation. Most importantly, SMC-VD and MRT have a strong ability to distinguish between MMD patients and HC, suggesting that OCTA, a relatively inexpensive and non-invasive method, is useful in assessing cerebrovascular changes in MMD patients.\u003c/p\u003e","manuscriptTitle":"Potential Retinal Imaging Markers for Moyamoya Disease: Changes in Retinal Microvasculature and Thickness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 08:58:59","doi":"10.21203/rs.3.rs-5325211/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-28T03:16:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-09T03:19:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34068789394710644638390047706377217908","date":"2025-02-06T09:20:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29736896812796842887065184054616069328","date":"2025-02-06T07:29:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-28T13:59:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280322008966796860574593353790463272526","date":"2024-12-17T18:39:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-12-12T19:59:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-12T19:57:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-11T06:16:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-07T10:19:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-24T10:41:53+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":"d16a761e-d71b-4a74-9d42-bcde1bdd6af6","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":40555206,"name":"Health sciences/Diseases"},{"id":40555207,"name":"Health sciences/Neurology"},{"id":40555208,"name":"Health sciences/Biomarkers"}],"tags":[],"updatedAt":"2025-07-07T16:18:12+00:00","versionOfRecord":{"articleIdentity":"rs-5325211","link":"https://doi.org/10.1038/s41598-025-08501-5","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-01 15:58:44","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2024-12-09 08:58:59","video":"","vorDoi":"10.1038/s41598-025-08501-5","vorDoiUrl":"https://doi.org/10.1038/s41598-025-08501-5","workflowStages":[]},"version":"v1","identity":"rs-5325211","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5325211","identity":"rs-5325211","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}