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Daiyan Xin, Christine L. Talamini, Ali S. Raza, Gustavo V. De Moraes, Vivienne C. Greenstein, Jeffrey M. Liebmann, Robert Ritch, Donald C. Hood; Hypodense Regions ("Holes") Are Seen in the Retinal Nerve Fiber Layer of the Frequency-Domain OCT Scans of Glaucoma Patients and Glaucoma Suspects. Invest. Ophthalmol. Vis. Sci. 2011;52(14):178.
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To better understand hypodense regions ("holes") that appear in the retinal nerve fiber layer (RNFL) of frequency-domain optic coherence tomography (fdOCT) scans of glaucoma patients and glaucoma suspects.
Peripapillary circle (1.7 mm radius) and 3D optic disc fdOCT scans (Topcon 3D OCT 2000) were obtained on 205 eyes from 108 patients (57.7±12.8 yrs) with glaucomatous optic neuropathy (GON) and 45 eyes of 45 controls (48.0±12.6 yrs) with normal fundus exams. Consecutive patients with GON referred for multifocal VEP testing were included if they were over 25 yrs, and had good quality scans and reliable 24-2 visual fields (VF) (Zeiss Meditec). The 205 eyes were divided into those with normal and abnormal VFs, where a VF was considered abnormal if the PSD and/or GHT was abnormal. Holes in the RNFL were identified independently by 2 observers on the circle scans; presence of holes was verified on successive slices of 3D disc scans.
A total of 90 holes were found in 32 (16%) eyes of 27 (25%) patients. While some holes were relatively large (fig. left), some were small (fig. right). 72 (80%) of the holes were located adjacent to blood vessels. Holes were not found in any of the healthy control eyes. Of the 32 eyes with holes, 9 were glaucoma suspect eyes with normal VFs (e.g. fig. right). Five of the remaining 23 eyes had abnormal VFs with holes that were associated with a hemifield without a VF defect, as defined as a cluster of 3 abnormal points.
The RNFL holes seen in patients with GON are probably due to local loss of RNFL fibers and can occur in eyes of glaucoma suspects with normal VFs.
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