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Anthony T. Hsu, Sung Chul Park, Daniel Su, Joseph Simonson, Christopher Teng, Celso Tello, Jeffrey Liebmann, Robert Ritch; Risk Factors for Focal Lamina Cribrosa Defects in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2815.
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© ARVO (1962-2015); The Authors (2016-present)
To assess risk factors for focal lamina cribrosa (LC) defects in glaucoma detected by enhanced depth imaging optical coherence tomography (EDI OCT).
Patients with a range of glaucomatous damage were prospectively enrolled and had full eye examinations including serial horizontal and vertical enhanced depth imaging optical coherence tomography (EDI OCT) B-scans of the optic nerve head (interval between scans, approximately 30 µm). For one randomly selected eye of each patient, EDI OCT scans were reviewed for the presence of focal LC defects (focal LC disinsertion or full-thickness LC defect) that violated the smooth curvilinear contour of the normal anterior laminar surface. The maximum width of each focal LC defect was required to be ≥100 µm. Clinical characteristics (age, central corneal thickness [CCT], visual field [VF] mean deviation [MD], exfoliation syndrome, and disc hemorrhage detection and intraocular pressure [IOP] during past follow-up) were recorded and compared between eyes with and without focal LC defects.
Among 114 eyes included (114 patients; mean age, 64±14 yr; mean VF MD, -9.9±7.7 dB), 50 (44%) eyes had focal LC defects and 64 (56%) did not. The mean follow-up period for IOP and disc hemorrhage data collection was similar between eyes with and without focal LC defects (6.4±4.0 vs. 6.7±3.3 years; P=0.67). Eyes with focal LC defects had significantly greater mean follow-up IOP (15.0 vs. 13.5 mmHg), higher disc hemorrhage detection rate (20.5% vs. 6.8%), and worse VF MD (-15.9 vs. -10.2 dB) than those without focal LC defects (P=0.008, 0.031 and 0.039, respectively). Age, CCT and proportion of exfoliation syndrome were similar between the 2 groups (all P>0.24). In univariate logistic regression analysis, mean follow-up IOP (OR, 1.14; P=0.037), disc hemorrhage detection (OR, 3.54; P=0.048), and VF MD (odds ratio [OR], 1.11; P<0.001) were significantly associated with the presence of focal LC defects. In multivariate analysis, mean follow-up IOP (OR, 1.18; P=0.024), disc hemorrhage detection (OR, 5.07; P=0.024), and VF MD (odds ratio [OR], 1.13; P<0.001) remained significant factors associated with the presence of focal LC defects.
IOP, disc hemorrhage and disease severity are associated with focal LC defects. Future investigation is needed to elucidate the pathogenetic relationships between focal LC defects and these risk factors.
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