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Mohammed B Khalil, Sung Chul Park, Pengcheng Li, Christopher C Teng, Jeffrey M Liebmann, Robert Ritch; Clinical Optic Disc Findings Associated With Focal Lamina Cribrosa Defects in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):902.
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To investigate the clinical optic disc findings associated with focal lamina cribrosa defects (FLCD) in glaucoma.
Serial enhanced depth imaging optical coherence tomography (EDI OCT) B-scans (interval between scans, ~30 μm) of the optic nerve head were obtained from glaucoma patients at various disease stages. EDI OCT scans were reviewed for presence/absence of focal LC defects (laminar holes or disinsertions) by a masked observer. The best quality stereo disc photo taken within 6 months from EDI OCT was selected for each eye by another masked observer. The disc photos were reviewed by another a third masked observer for presence/absence of a notch with remaining neuroretinal rim tissue, a notch with no remaining rim tissue, diffuse rim thinning, bayoneting of circumlinear vessel, beta-zone parapapillary atrophy (PPA), and acquired pit of the optic nerve (APON). Strength of association with the EDI OCT finding (presence/absence of FLCD) was calculated for each of the 6 clinical optic disc findings using Cramér's V test. Disc findings significantly associated with FLCD in Cramér's V test were entered into a multivariable logistic regression model. Disc hemorrhage was not included in the study because it would not be meaningful to include a transient finding such as disc hemorrhage in a cross-sectional analysis of irreversible findings.
186 eyes of 186 glaucoma patients (mean age, 68±18 years) were included for analysis. A notch with no remaining rim tissue, diffuse rim thinning and APON were significantly correlated with FLCD (all p<0.02), but a notch with remaining rim tissue, beta-zone PPA and bayoneting of circumlinear vessels were not (all p>0.10) (Table 1). In the multivariable logistic regression model, a notch with no remaining rim tissue (p=0.001, odds ratio [OR]=3.47) and APON (p=0.004, OR=10.31) were significantly associated with FLCD. The association between diffuse rim thinning and FLCD was marginally significant (p=0.052 OR=2.26).
A notch with no remaining rim tissue was associated with FLCD, whereas a notch with remaining rim tissue was not. The association between APON and FLCD, previously reported by our group, was confirmed. These clinical optic disc features may be helpful in predicting the presence of FLCD and deciding EDI OCT-guided evaluation of the LC.
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