Hypertension, Deep Retinal Perfusion, and Concurrent Visual Acuity in Retinal Vein Occlusion: A Cross-Sectional OCTA...

To investigate the cross-sectional association between hypertension and OCTA-derived retinal microvascular characteristics and to assess whether deep capillary plexus perfusion area (DCP-PA) provides additional explanatory information for concurrent visual acuity in retinal vein occlusion (RVO).

This retrospective secondary cross-sectional analysis included 88 RVO-affected eyes from 88 patients. Best-corrected visual acuity (BCVA) and swept-source OCTA were assessed at the same visit. Multivariable linear regression evaluated associations between hypertension and six OCTA outcomes after adjustment for age, sex, RVO subtype, and hyperlipidemia, with Benjamini-Hochberg false-discovery-rate (FDR) correction. The association between DCP-PA and concurrent logMAR BCVA was assessed using a clinical-structural model including age, sex, RVO subtype, hypertension, hyperlipidemia, and total retinal thickness (TRT), followed by an extended model incorporating DCP-PA.

Hypertension was associated with lower DCP-PA (β=-1.71; 95% CI, -2.85 to -0.57; FDR-adjusted P=0.011) and lower DCP vessel length density (β=-3.29; 95% CI, -5.48 to -1.09; FDR-adjusted P=0.011). Lower DCP-PA remained independently associated with worse concurrent visual acuity after adjustment for clinical factors and TRT (β=-0.12 per mm²; 95% CI, -0.16 to -0.08; P<0.001). Hyperlipidemia was also associated with worse visual acuity (β=0.34; 95% CI, 0.18 to 0.49; P<0.001). Adding DCP-PA increased adjusted R ² from 0.40 to 0.59 and reduced AIC from 94.60 to 61.99 (partial F=38.54; P<0.001). No significant interaction was observed between DCP-PA and RVO subtype (P=0.353).

Hypertension was associated with reduced deep retinal perfusion in RVO. Lower DCP-PA was independently associated with worse concurrent visual acuity and provided additional explanatory information beyond clinical factors and retinal thickness. These cross-sectional findings do not establish causality or prospective prognostic value.