Abstract
We analysed retinal nerve fibre layer (RNFL) defects in eyes with normal circumpapillary RNFL (cpRNFL) thickness using posterior pole asymmetry analysis (PPAA) and investigated the parameters of Bruch membrane opening (BMO) and neural canals using enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT). A total of 112 preperimetric glaucomatous eyes of 92 patients were examined to obtain cpRNFL thickness using SD-OCT. Posterior pole asymmetry analysis (PPAA) and central cross-sectional images of the optic nerve head (ONH) were obtained using EDI-SDOCT. Minimal and horizontal distances between the BMO and ONH surfaces (BMOM, BMOH) and the terminal of retinal pigment epithelium (RPE) and ONH surfaces (RPEM, RPEH) were measured. The distribution of the absolute black cells in PPAA was more concentrated in eyes with “U”-shaped neural canals (p < 0.0001). The area under the receiver operating characteristic curve of the ratio of RPEM to RPEH (RPE-R, 0.771 ± 0.08) was significantly larger than the ratio of BMOM to BMOH (BMO-R, 0.719 ± 0.009) for PPAA results. A U-shaped neural canal, lower ratio of RPEM to RPEH, and lower ratio of BMOM to BMOH were considered early indicators of RNFL defects in preperimetric glaucomatous eyes with normal cpRNFL.
Highlights
In the retinal ganglion cell (RGC) is more readily detected in the macula than the peripheral retina
The correlation between the morphology of optic nerve head (ONH) and posterior pole asymmetry analysis (PPAA) has not been assessed in preperimetric glaucomatous eyes, eyes with normal circumpapillary retinal nerve fibre layer (cpRNFL) results
The results demonstrated that the area under the receiver operating characteristic curve (AUROC) of retinal pigment epithelium (RPE)-R (0.771 ± 0.08) was significantly larger than the BM opening (BMO)-R (0.719 ± 0.009) for PPAA (+ ) results (Fig. 6 & Table 1)
Summary
In the RGCs is more readily detected in the macula than the peripheral retina. Early glaucomatous defects are generally localized to either side of the horizontal meridian, which allows the possible evaluation of asymmetry in hemifield macular thickness. Et al.[10] and Asrani et al.[11] introduced a new method, termed as posterior pole asymmetry analysis (PPAA), using SD-OCT to test the difference between upper and lower macular thickness and detect localized RNFLD with higher sensitivity and specificity than the cpRNFL thickness[10]. They reported that the retinal thickness maps acquired through SD-OCT identified the presence of visible localized RNFLD and detected the thinning of RNFL, which is not otherwise detectable using stereo-photographic assessments[12]. We further analysed PPAA patterns and the correlation between PPAA results and ONH morphology and present new parameters for the diagnosis of glaucoma in patients with normal cpRNFL results
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