ABSTRACT
Objective:To observe the peripapillary atrophy (PPA) and peripapillary choroidal vascularity index (CVI) in patients with different degrees of myopia and to analyze their correlations.Methods:A cross-sectional clinical study. From September 2021 to December 2021, 281 mypoic patients of 281 eyes treated in Eye Hospital of Wenzhou Medical University at Hangzhou were included in this study, and the right eye was used as the treated eye. There were 135 eyes in 135 males and 146 eyes in 146 females. The age was 28.18±5.78 years. The spherical equivalent refraction (SE) was -5.13±2.33 D. The patients were divided into three groups: low myopia group (group A, -3.00 D <SE≤-0.50 D), moderate myopia group (group B, -6.00 D≤SE≤-3.00 D);high myopia group (group C, SE<-6.00 D). The spherical equivalent refraction was statistically different among the three groups ( H=241.353, P<0.05). All of the affected eyes were examined by swept-source optical coherence tomography. Combined with B-scan image,assessment and area measurement of β area, γ area (β-PPA and γ-PPA) were carried out on the en-face image. After binarization of the collected images, the nasal, superior, temporal and inferior CVI of the optic disc were calculated. For comparison between groups, one-way ANOVA was used for continuous variables with normal distribution, Kruskal-Wallis test was used for continuous variables with abnormal distribution, and categorical variables were used χ2 inspection. Linear regression analysis was used for the relationship between β-PPA and γ-PPA area and peripapillary CVI of different regions. Linear regression analysis was used to evaluate the relationships between the area of peripapillary atrophy and peripapillary choroidal vascularity index in different regions. Results:There was no statistical difference in the incidence of β-PPA among the three groups ( χ2=4.672, P=0.097). The incidence of γ-PPA in group A was lower than that in group B anc C, and the difference was statistically different ( χ2=33.053, P<0.001), in which both group A was lower than group B and C. Among the three groups, the area of β-PPA and γ-PPA was statistically significant ( H=36.535, 39.503; P<0.001, 0.001); the β-PPA area of group A and B was lower than that of group C; the γ-PPA area was group A <group B <group C. Peripapillary CVI of different regions in group A, group B and group C was statistically significant ( F=11.450, 5.037, 6.018, 4.489; P<0.05). The temporal CVI in group C was lower than that in group A and B; The inferior CVI of group C was lower than that of group A, and the superior and nasal CVI of group B and C were lower than that of group A. In multivariate analysis, SE ( β=0.374, P<0.001), temporal CVI ( β=-0.299, P<0.001) were correlated with the area of β-PPA (adjusted R2=296, P<0.001); AL ( β=0.452, P<0.001), temporal CVI ( β=-0.220, P<0.001) were correlated with the area of γ-PPA (adjusted R2=0.309, P<0.001). Conclusions:The incidence and area of γ-PPA are increased in the higher degree of myopia group. The area of γ-PPA is positively correlated with the axial length, and both the area of β-PPA and γ-PPA are negatively correlated with temporal CVI.
ABSTRACT
Objective: To investigate the clinicopathological correlation of parapapillary atrophy. Materials and Methods: The study included 16 eyes of rhesus monkeys (Macaca mulatta) – 4 eyes with experimental glaucoma, 11 eyes after experimental temporary occlusion of the central retinal artery, and 1 normal eye. On histological sections, we measured zones with different histological characteristics.On fundus photographs, alpha zone and beta zone of parapapillary atrophy were measured and correlated with the histological data. Results: The size of the clinical alpha zone of parapapillary atrophy was significantly correlated with the size of the histological region with irregularities of the retinal pigment epithelium (P = 0.05; correlation coefficient r = 0.49) and with the size of the histological region with a decreased density of retinal photoreceptors (P = 0.01; r = 0.60). The size of clinical beta zone of parapapillary atrophy significantly correlated with the size of the histological region with complete loss of the retinal pigment epithelium (P <0.001; r = 0.91), with the size of the histological zone with a complete loss of photoreceptors (P <0.001; r = 0.81), and with the size of the histological zone with a closed choriocapillaris (P <0.001; r = 0.89). Conclusions: The clinically seen alpha zone of parapapillary atrophy correlates with histological parapapillary irregularities of the retinal pigment epithelium and decreased density of retinal photoreceptors. The clinically seen beta zone of parapapillary atrophy correlates with histological complete loss of the retinal pigment epithelium and of the photoreceptors, and a closure of the choriocapillaris.
ABSTRACT
Quantitiative evaluation of optic disc parameters such as neural rim area requires relatively sophisticated instruments and time consuming methods which are not generally available for the average ophthalmologist. This study was performed to determine which qualitative sign of optic disc distinguishes best between eyes with and without early glaucomatous visual field defects. Using color polaroid photographs we examined qualitative signs in 207 optic discs of 207 patients with primary open-angle glaucoma and in 158 optic discs of 158 normal subjects matched for age and refractive error. In the group with mild (mean deviation(MD) ; better than -5dB, group 1) to moderate (MD; -6~-10dB, group 2) glaucomatous visual field defects, the best results of specificity and sensitivity were achieved using alterations in the configuration of neural rim width (group 1; Specificity =70.3%, Sensitivity =93.4%), while abnormally large parapapillary chorioretinal atrophy, thinnest neural rim width outside the temporal horizontal sector, and presence of zone beta were signs with relatively high specificity and high sensitivity. In the group with advanced (MD; worse than -11 dB, group 3) visual field defects, thinnest neural rim width outside the temporal horizontal sector was the best sign to distinguish between normal and glaucoma eyes. Signs with high specificity and low sensitivity were optic disc hemorrhage, bayonetting of vessel and baring of circumlinear vessel. These results suggest that alterations in the configuration of neural rim width and parapapillary signs were valuable for early diagnosis of glaucomatous optic nerve damage without sophisticated instruments.