Longitudinal and cross-sectional study of retinal and choroidal changes in primary aldosteronism

To investigate the structural and vascular changes of central and peripheral retina/choroid in patients with primary aldosteronism (PA) using ultra-widefield (24 × 20 mm²) swept source optical coherence tomography angiography (SS-OCTA), and explore the relationship between systemic factors and ocular indicators.

This is a prospective study with both cross-sectional and longitudinal self-controlled comparisons. A total of 61 PA patients (122 eyes) due to unilateral adrenal adenoma and 59 healthy individuals (118 eyes) were recruited. The parameters assessed included retinal/choroidal thickness (RT, ChT), choroidal vascular index (CVI), choroid vessel/stromal volume per unit area (CVV/a, CSV/a), and deep capillary plexus vessel density (DCPVD). SS-OCTA images were divided into 3 × 3 grid, with the grid center defined as central area and the rest as peripheral area. And receiver operating characteristics curves were generated to determine the discriminative power of choroidal parameters.

Compared to healthy controls, PA patients exhibited increased RT, ChT, CVI, CSV/a, CVV/a and DCPVD (P < 0.05). After adrenalectomy, the decline in aldosterone levels was accompanied by the recovery of choroidal parameters (P < 0.05). After controlling confounding factors, SFCT and mean peripheral ChT were related to aldosterone and serum potassium, while central and mean peripheral CVI metrics were correlated with serum potassium. The AUC values of choroidal parameters were greater in the combination of peripheral subfields than the central area alone.

PA patients demonstrated abnormal retinal/choroidal thickness and choroidal volume. Choroidal parameters were positively correlated with endogenous aldosterone levels, underscoring the pivotal role of aldosterone in ocular health.