Avaliação da vascularização retiniana por meio da angiografia por tomografia de coerência óptica em usuárias de contraceptivos orais

Abstract

Retinal vascular changes related to hormonal contraceptive use are still poorly understood. Optical coherence tomography angiography (OCTA) enables a noninvasive and detailed assessment of the retinal microvasculature. The aim of this study was to evaluate the superficial and deep retinal vasculature using OCTA. To measure macular and choroidal thickness using optical coherence tomography (OCT) in women taking combined oral contraceptives (COC) and progestogen-only contraceptives (POC). To compare measurements between these women and women who had never used hormonal contraceptives. To evaluate the influence of duration of use on the same parameters. To this end, a cross-sectional study was carried out in 180 healthy women without clinical or ophthalmologic pathologies, aged between 18 and 40 years, divided into three equal groups: women using COC, POC, and women who had never used contraceptives (control). Foveal avascular zone (FAZ) parameters and superficial and deep plexus vascular densities were assessed using OCTA in a 3 x 3 mm field. Macular and choroidal thickness were also measured using OCT. For statistical tests, measurements were obtained from a single randomly selected eye per participant. The three groups were compared using analysis of variance (ANOVA) and Tukey's multiple comparison test for variables with normal distribution assessed by the Shapiro-Wilk test. When variables were not normally distributed, the Kruskal-Wallis test was used, supplemented by Dunnett’s multiple comparison test. A 5% significance level was used for all the tests. It was observed that the average age was 26.78 ± 8.40, 35.07 ± 5.23, and 30.13 ± 6.51 years in the control, POC, and COC groups, respectively (P<0.0001). Body mass index was 23.88 ± 4.62, 27.74 ± 5.44, and 25.52 ± 3.65 kg/m² in the control, POC, and COC groups, respectively (P<0.0001). No statistically significant differences were observed between the groups when evaluating FAZ parameters. When comparing vascular density in the superficial and deep vascular plexuses in the foveal and parafoveal regions, there was no statistically significant difference between the groups. When evaluating macular thickness in the foveal, parafoveal, and perifoveal regions, it was observed that patients in the COC group had a lower average thickness in the inferior parafoveal region than those in the other groups (P=0.034). When comparing the vascular density in the superficial and deep vascular plexuses in the foveal and parafoveal regions, there was no statistically significant difference between the groups. When evaluating macular thickness in the foveal, parafoveal, and perifoveal regions, patients in the COC group had a lower mean thickness in the inferior parafoveal region than those in the other groups (P=0.034). When comparing the choroidal measurements, the COC group had a significantly lower thickness than the POC group (P=0.04) but did not differ from the control group. Thus, it can be concluded that the use of COC or POC did not significantly alter the FAZ parameters or the vascular density of the superficial and deep plexuses. Women taking COC had thinner macular thickness in the inferior parafoveal region compared to POC and control groups. These findings highlight the potential of OCTA as a promising tool for investigating retinal microvascular changes associated with hormonal contraceptive use, with possible implications for ophthalmologic monitoring.