Microstructure of Nonjuxtapapillary Microvasculature Dropout in Healthy Myopic Eyes

PURPOSE. The purpose of this study was to characterize the microstructure of the nonjuxtapapillary microvasculature dropout (MvD) in healthy myopic eyes. METHODS. This cross-sectional study included 50 eyes (25 eyes with a nonjuxtapapillary MvD and 25 age-matched eyes without any MvD) from a cohort of 126 nonglaucomatous healthy myopic eyes having parapapillary atrophy (PPA) gamma-zone. The parapapillary deep-layer microvasculature was evaluated in en-face images obtained using swept-source optical coherence tomography (OCT) angiography (OCTA). A nonjuxtapapillary MvD was defined as an area with focal absence of vascular signals in the distal portion of PPA confined to the nonjuxtapapillary area. Enhanced depth-imaging OCT scanning was performed to assess the parapapillary microstructure. RESULTS. Nonjuxtapapillary MvD was found in 25 eyes (19.8%). The parapapillary microstructure at the nonjuxtapapillary MvD in 18 eyes was characterized by the misalignment of Bruch's membrane (BM)-retinal pigment epithelium (RPE) complex, which was identified by the absence of BM-RPE complex and the presence of the inner retina and sclera. In seven eyes with a nonjuxtapapillary MvD but without such misaligned BM-RPE complex, RPE atrophy was observed at the location of the nonjuxtapapillary MvD. Eyes with a nonjuxtapapillary MvD had a longer axial length (AXL; P = 0.013) and a wider gamma-zone (P < 0.001) than age-matched control eyes without any MvD. CONCLUSIONS. The microstructure at the nonjuxtapapillary MvD in healthy myopic eyes was characterized in approximately 70% of eyes by temporally misaligned BM-RPE complex. Although the clinical importance of the nonjuxtapapillary MvD remains to be determined, it should be differentiated from the parapapillary choroidal MvD observed in glaucoma.