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Editors Selection IGR 10-4

Examination methods: Parapapillary autofluorescence

Comment by Andreas Boehm on:

13838 Parapapillary autofluorescence as indicator for glaucoma, Viestenz A; Langenbucher A; Mardin CY, Klinische Monatsblätter für Augenheilkunde, 2006; 223: 315-320

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Besides the optic disc the parapapillary region provides useful information in the course of the glaucomatous disease. It is well known that zone beta is more pronounced in glaucomatous eyes than in normals. However, until now the evaluation of zone alpha has no significant impact on diagnosis or management in glaucoma. It was shown earlier histologically that lipofuscin accumulates in the parapapillary region of the optic disc in glaucoma patients. Based on the lipofuscin autofluorescence Viestenz et al. (436) presented a study for the evaluation of the parapapillary zone. After lipofuscin-excitation with an argon blue laser (488 nm) the autofluorescence of the parapapillary region was examined using a confocal laser scanning ophthalmoscope. Autofluorescence was detected in zone alpha, but not in zone beta of the parapapillary region, which suggests that the lipofuscin is mainly located in zone alpha. Zone alpha showed an increasing autofluorescence with increasing glaucomatous stage. As the method was not able to differentiate clearly between normals and glaucoma due to the high standard deviation, the diagnostic value seems to be limited. However, the study seems interesting as it utilizes information of the parapapillary region which has not been used yet. Possibly a further development of the method allowing a better quantification of the autofluorescence phenomenon might increase the diagnostic value of this approach.

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