Purchase this article with an account.
Fabio Lavinsky, Glauber Correa Gobbato, Fernanda Mari Fagundes Fujihara, Anne Elise do Carmo Chaves, Rodrigo Leivas Lindenmeyer, Camila Zanella Benfica, Nedio Castoldi, Egidio Picetti, Jaco Lavinsky, Daniel Lavinsky, Helena Messinger Pakter, Paulo Augusto de Arruda Mello; Measurement of the Optic Nerve Head Cup Associated Pre-Laminar Tissue Area in Advanced Glaucoma . Invest. Ophthalmol. Vis. Sci. 2020;61(9):PB00134.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
This study aims to evaluate the optic nerve head cup associated pre-laminar tissue area (CAPLA) in advanced glaucoma subjects and compare it with early to moderate glaucoma.
Subjects with glaucoma presenting typical optic nerve head findings, high intraocular pressure with or without visual field (VF) damage were included. Patients underwent 24-2 perimetry (SITA standard; Humphrey Field Analyzer; Zeiss) and Spectral Domain Optical Coherence Tomography (Spectralis; Heidelberg Engineering) where circumpapillary retinal nerve fiber layer (cRNFL), macular ganglion cell layer, inner plexiform layer, the summation of both (GCIPL) were obtained. Subjects with VF mean deviation (MD) < -12 dB and >-12 dB were considered advanced and non-advanced glaucoma respectively. A vertical B-scan of the ONH with the largest cup extension was selected. CAPLA was calculated using the hyperreflective anterior lamina cribrosa margin as the posterior limit and the plan beginning with the inner limiting membrane (ILM) of the descending fibers at the Bruch's membrane level as the superior and inferior limits. The anterior limit was the margin of the pre-laminar tissue itself (figure 1). Statistical analysis was performed using generalized estimating equations (GEE) to allow for clustered observations. Age, image quality score and disc area were accounted in the model.
89 eyes (55 subjects, 68.8% females) qualified for the study. The mean age was 68.04 ± 10.43. The number of eyes was 22 in advanced glaucoma and 67 in non-advanced glaucoma group. CAPLA was 0.222± 0.10 and 0.168± 0.072 mm2 in the advanced and non-advanced glaucoma respectively (p=0.016).OCT parameters and VF MD are described in table 1. Age, image quality and disc area weren't significant in the model. The agreement of the measurements of CAPLA between two examiners was 0.86.
CAPLA was significantly larger in advanced glaucoma than in non-advanced glaucoma. This finding may represent a biomarker of severe neurodegenerative damage. The mechanism of formation and the biological components of this tissue should be further explored in experimental and clinical studies.
This is a 2020 Imaging in the Eye Conference abstract.
Figure 1 – Measurement of the Cup Associated Pre-Laminar Tissue Area Vertical B-scan depicting the optic nerve head cup. The red lines: the inferior and superior planes to determine the limits of CAPLA (yellow area).
TABLE 1: Visual Field and OCT Parameters
This PDF is available to Subscribers Only