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Abstract #56348 Published in IGR 16-1
Microstructure of β-Zone Parapapillary Atrophy and Rate of Retinal Nerve Fiber Layer Thinning in Primary Open-Angle Glaucoma
Kim YW; Lee EJ; Kim TW; Kim M; Kim HOphthalmology 2014; 121: 1341-1349
See also comment(s) by Jost Jonas •
OBJECTIVE: To investigate whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the microstructure of β-zone parapapillary atrophy (PPA) as evaluated by spectral-domain (SD) optical coherence tomography (OCT) in primary open-angle glaucoma (POAG). DESIGN: Prospective, observational, comparative study. PARTICIPANTS: A total of 195 eyes with POAG that had been evaluated by serial SD-OCT RNFL thickness measurements for ≥2 years. METHODS: On the basis of the extent of Bruch's membrane (BM) within the β-zone PPA (area without retinal pigment epithelium [RPE]), as shown in the infrared fundus images, PPA was divided into PPA+BM (PPA with intact BM) and PPA-BM (PPA devoid of BM). Eyes were categorized into group A (having PPA+BM only, n=64), group B (having both PPA+BM and PPA-BM, n=58), group C (having PPA-BM only, n=32), and group D (without β-zone PPA, n=41). The rate of progressive OCT RNFL thinning was determined by linear regression and compared between groups. Factors influencing the rate of RNFL thinning were evaluated, including age, sex, follow-up duration, history of filtering surgery, baseline RNFL thickness, baseline intraocular pressure (IOP), mean IOP and IOP fluctuation during follow-up, PPA types, baseline PPA width, PPA width increase, axial length (AXL), central corneal thickness, and visual field mean deviation (MD). MAIN OUTCOME MEASURES: Rate of thinning of OCT RNFL thicknesses over time. RESULTS: Patients in groups B and C were significantly younger and more myopic, and had a greater AXL, than those in groups A and D (all P < 0.001). The rate of global RNFL thinning was significantly faster in group A (-1.66±2.94 μm/year) than in the other groups (group B, -0.87±1.28 μm/year; group C, 0.20±1.86 μm/year; group D, -0.28±1.74 μm/year; P = 0.001). Multivariate regression showed a significant association of shorter follow-up period (P = 0.016), greater baseline global RNFL thickness (P = 0.035), type of β-zone PPA (group A, P = 0.023), and greater baseline PPA+BM width (P = 0.034) with a faster rate of RNFL thinning. CONCLUSIONS: The rate of RNFL thinning differed according to the microstructure of β-zone PPA. It was faster for eyes with β-zone PPA with intact BM than for eyes without β-zone PPA or with β-zone PPA devoid of BM.
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Classification:
2.12 Choroid, peripapillary choroid, peripapillary atrophy (Part of: 2 Anatomical structures in glaucoma)
2.13 Retina and retinal nerve fibre layer (Part of: 2 Anatomical structures in glaucoma)
6.9.2.2 Posterior (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis > 6.9.2 Optical coherence tomography)
