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Follow-Up of Parapapillary Atrophy in Chronic Open-Angle Glaucoma

1Budde W. M., 2Jünemann A., 2Nguyen N. X., 2Mardin C. Y., 1Jonas J. B.,
1Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)
2Friedrich-Alexander-Universität, Augenklinik (Erlangen)

Purpose: Occurrence and size of parapapillary atrophy (zone beta) has been associated with glaucomatous optic atrophy. Aim of the study was to assess the frequency of enlargement of parapapillary atrophy in open-angle glaucoma. 
Method: In a prospective glaucoma follow-up study 102 patients with open-angle glaucoma were examined annually including optic disc photographs and automated visual fields with a mean follow-up of 4.2 ± 1.8 years (min. 2 years, max. 10 years). All patients had controlled intraocular pressure before enrollment in the study and during the study. Eyes with a refractive error exceeding -8 D were excluded due to a different morphology of the optic disc and occurrence of parapapillary myopic crescent. Two independent examiners judged optic disc slides of 427 follow-up examinations for progression of parapapillary atrophy zone beta in comparison with baseline examination.
Results: In 13 eyes of 11 patients an enlargement of parapapillary atrophy zone beta could be observed after 2-3 years of follow-up. The enlargement of zone beta resulted in a replacement of a former zone alpha with parapapillary atrophy type beta, whereas a new zone alpha appeared at the peripheral border of the new zone beta. The visual field had remained stable in these eyes. Of 11 of the 13 eyes a further follow-up of at least one year was documented. In 6 of these 11 eyes a deterioration of the visual field was documented 1 - 3 years after the detection of enlargement of zone beta.
Conclusions: Parapapillary atrophy (zone beta) may enlarge during the course of open-angle glaucoma. Beside diminishing neuroretinal rim the enlargement of parapapillary atrophy zone beta may be an additional morphologic sign of glaucoma progression.
Supported by DFG (SFB 539)