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Correlation Between Para-papillary Atrophy and Retinal and Optic Nerve Head Perfusion Measurements in Normal-pressure Glaucoma

1Papastathopoulos K., 2Michelson G., 3Harazny J., 1Budde W. M., 2Mardin C. Y., 1Jonas J. B.,
1Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)
2Friedrich-Alexander-Universität, Augenklinik (Erlangen)
3Friedrich-Alexander-Universität, Augenklinik, Labor für okuläre Perfusion (Erlangen)

Purpose: Parapapillary atrophy is one of the morphologic features of optic nerve damage in glaucoma. As one of its possible pathogenic mechanisms, a reduction of the blood flow in the choroid in the parapapillary region has been discussed. It was the purpose of the present study to assess and to correlate measurements of the parapapillary atrophy with measurements of blood perfusion in the retina and in the optic disc in patients with normal-pressure glaucoma.
Methods: As part of the Erlanger Glaucoma Registry, 133 eyes of patients with normal pressure glaucoma with a mean age of 55.50 ± 9.99 year and a mean refractive error of -0.57 ± 2.61 diopters, and 159 eyes of normal persons of an age-adapted control group with a mean age of 54.75 ± 7.58 years and a mean refractive error of -0.13 ± 1.28 diopters were included in the prospective study. For all patients and subjects, 15 degree color stereo optic disc photographs were taken and morphometrically examined. Parapapillary atrophy was divided into a peripheral alpha zone with irregular pigmentation, and a beta zone with visible sclera and large visible choroidal vessels. The mean capillary blood perfusion was measured by confocal laser scanning flowmetry (Heidelberg Retinal Flow Meter) in the neuroretinal rim inside of the optic disc, and in the retina close to the temporal and nasal border of the optic nerve head.
Results: Measured in the neuroretinal rim inside of the optic disc and in the retina at the nasal optic disc border and at the temporal disc border, respectively, mean capillary blood flow was not significantly associated with the area of alpha zone of parapapillary atrophy (p=0.29; p=0.25; and p=0.49, resp.) and with the area of beta zone of parapapillary atrophy (p=0.47; p=0.81; and p=0.42, resp.). Within the normal pressure glaucoma group, eyes with beta zone and eyes without beta zone did not vary significantly in the mean capillary blood flow in the neuroretinal rim (p=0.20), and in the retina at the nasal optic disc border (p=0.40) and in the retina at the temporal disc border (p=0.17).
Conclusions: In eyes with normal-pressure glaucoma, parapapillary atrophy with its alpha zone and beta zone is not correlated with capillary blood flow measurements within the neuroretinal rim and in the parapapillary retina, as obtained by confocal laser scanning flowmetry.