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Clemente Maria Iodice, Jibran Mohamed-Noriega, Brigid Ning, Hari Jayaram, Deborah Kamal, Nicholas Strouthidis, David F Garway-Heath; Long-term follow-up of peripapillary atrophy in a cohort of patients with progressive normal tension glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5598.
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© ARVO (1962-2015); The Authors (2016-present)
Peripapillary atrophy (PPA) is a feature seen in healthy individuals and, more frequently, in glaucoma patients. Expansion of PPA has been described and is associated with rim or visual field loss, but the frequency of its expansion in progressive glaucoma is still unclear. We therefore analyzed how commonly PPA expansion occurs in a cohort of patients with progressive normal tension glaucoma (NTG) over extended follow-up (FU).
We analyzed a retrospective consecutive, non-comparative case series of 84 patients (108 eyes) with progressive NTG, defined as visual field (VF) progression on PROGRESSOR (Medisoft, Leeds, UK). All patients underwent trabeculectomy between 2007 and 2013. Heidelberg Retina Tomography (HRT) was routinely acquired in the clinic and two observers, masked to all clinical information, but unmasked to the order of images, retrospectively identified and delineated baseline and last visit PPA using the PPA Zone Analysis software (Heidelberg Engineering GmbH). Both observers analyzed all images and reached a consensus. PPA expansion was defined as change that exceeds the 99.5% limits of test-retest variability, which was established on 456 participants of the United Kingdom Glaucoma Treatment Study (UKGTS) with a minimum of two baseline and two FU images. One observer analyzed the PPA on these HRT scans, taken on the same day, two at baseline and at last FU. The second observer exported data and calculated variability limits.
We analyzed 84 patients (108 eyes) throughout a mean FU of 16.5 years (SD 5.2) between first and last HRT scans. All eyes had PPA present at baseline with median (IQR) area and angular extent of 0.80 mm2 (IQR 0.52-1.33) and 202° (IQR 146-360). At last FU, median area and angular extent were 1.08 mm2 (IQR 0.76-1.79) and 262° (IQR 177-360), significantly different from baseline (p <0.0001). Median expansion of PPA area and angular extent was 0.27 mm2 (IQR 0.14-0.47) and 14° (IQR 0-43). The 99.5% limits of test-retest variability of PPA area and angular extent was 0.18 mm2 and 34°. During FU, PPA area and angular expansion were present in 68 (63%) and 34 (31.5%) eyes, respectively.
PPA expansion occurred in two-thirds of eyes with progressive glaucoma. It appears to be a common but not universal feature of progressive NTG.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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