OCTA-based assessment of macular and peripapillary vessel changes during the menstrual cycle.

BACKGROUND

To investigate the effect of menstrual cycle-related hormonal fluctuations on retinal and choroidal microvasculature using swept-source optical coherence tomography angiography (SS-OCTA).

METHODS

In this prospective study, a cohort of 31 healthy women with regular menstrual cycles was enrolled. SS-OCTA imaging was performed during three standardized menstrual phases: early follicular (day 3), ovulatory (day 14), and mid-luteal (day 21). Macular and peripapillary regions were evaluated using 3 × 3 mm and 4.5 × 4.5 mm scan protocols, respectively. Vessel density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) was automatically quantified using the device's software. Choroidal thickness (CT) was manually measured in all quadrants, and the foveal avascular zone (FAZ) area was manually delineated by two independent graders. To control for diurnal variation, all measurements were conducted between 11:00 a.m. and 12:00 p.m.

RESULTS

A statistically significant decrease in macular CT was observed across the menstrual phases (p = 0.002), along with significant variations in peripapillary CT in the temporal and inferior quadrants (p = 0.004 for both). VD in the peripapillary region showed significant differences in the superior quadrant of the SCP (p = 0.040), the inferior quadrant of the DCP (p = 0.008), and in the temporal and inferior quadrants of the CC (p = 0.011 and p = 0.007, respectively). In the macula, CC-VD in the inferior quadrant differed significantly (p = 0.030). FAZ area remained stable throughout the cycle. Post-hoc analysis revealed significant differences between the early follicular, ovulatory, and mid-luteal phases.

CONCLUSION

Hormonal fluctuations throughout the menstrual cycle appear to influence both retinal and choroidal microvasculature, particularly in the choriocapillaris and peripapillary regions. These findings underscore the importance of considering menstrual phase when interpreting OCTA measurements in women of reproductive age, to improve diagnostic accuracy and consistency in clinical and research settings.