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Dilraj Singh Grewal, Dan Merlau, Marion Ronit Munk, Amani A Fawzi, Lee M Jampol, Angelo P Tanna; Comparison of Peripapillary Schisis Visualized on OCT in Glaucoma and Glaucoma Suspect Patients Compared to a Control Population.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4733.
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To identify the prevalence of peripapillary schisis in patients with glaucoma or glaucoma suspects compared to a control population of normal subjects.
Medical records for 800 consecutive patients examined in the glaucoma clinic over a six-month period were reviewed. A total of 495 patients (990 eyes) who had undergone optic nerve head raster OCT and did not have optic nerve pits, pseudopits or coloboma were included in the study. Optic nerve head scans (Raster lines protocol: 4 mm by 4 mm area centered on the optic disc) using spectral domain OCT (Spectralis HRA-OCT, version 4; Heidelberg Engineering, Heidelberg, Germany) were reviewed. 278 eyes, from 144 participants (81 females, 63 males) with a mean age of 37.6 years (range 18 to 74; SD = 15.5) were used as controls and were scanned using the 3D OCT-1000 (Topcon Corp., Tokyo, Japan) using the raster 3D-OCT scan protocol (512 × 128 scans centering at the optic nerve head). Scans with poor quality were excluded. OCT scans for both groups were reviewed by a single observer. Four cases with uncertain findings on the initial evaluation were adjudicated by a team of a two retina specialists and one glaucoma specialist.
None of the 278 eyes of control subjects had peripapillary schisis. A total of 11 eyes of 7 patients (2 females, 5 males, mean age 64.5 ± 9.2 years) had peripapillary schisis (Figure 1), 2/11 eyes also had extension of the schisis cavity into the macula. Of these 7 patients, 2 (28.6%) had primary open angle glaucoma, 3 (42.9%) were glaucoma suspects, 1 (14.3%) had chronic narrow angle glaucoma and 1 (14.3%) had pigmentary glaucoma. Mean IOP at the time of imaging was 15.4±5.1 mmHg. The mean Humphrey visual field mean deviation was -3.48 dB and PSD was 3.45 dB. 7/11 (63.6%) eyes had vitreous traction visualized on OCT and 6/11 eyes (54.5%) had beta-zone peripapillary atrophy.
We report an increased prevalence of peripapillary schisis among patients seen in the glaucoma clinic compared to controls. 11/990 eyes (1.1%) with glaucoma or suspected to have glaucoma had evidence of peripapillary schisis on OCT compared to 0/278 control eyes. A majority of the 11 eyes had evidence of adherent vitreous with traction and had peripapillary atrophy.
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