The Region of Largest ¦Â-Zone Parapapillary Atrophy Area Predicts the Location of Most Rapid Visual Field Progression

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• 作者：Christopher C. Teng MD¹ ;   ; ² ;   ; ³ ; Carlos Gustavo De Moraes MD¹ ;   ; ³ ; Tiago S. Prata MD¹ ; Craig A. Liebmann¹ ; Celso Tello MD¹ ;   ; ² ; Robert Ritch MD¹ ;   ; ² ; Jeffrey M. Liebmann MD¹ ;   ; ³ ;   ; ^{jm118@earthlink.net}
• 刊名：Ophthalmology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：118
• 期：12
• 页码：2409-2413
• 全文大小：203 K

文摘

Purpose

To determine if visual field (VF) progression occurs most rapidly in the region of largest ¦Â-zone parapapillary atrophy (PPA).

Design

Retrospective cohort.

Participants

One hundred twenty-five patients from the New York Glaucoma Progression Study with both ¦Â-zone PPA and VF progression.

Methods

Treated open-angle glaucoma patients with 8 or more Swedish Interactive Threshold Algorithm Standard 24-2 VFs (Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) in either eye were identified. Eyes with optic disc photographs, ¦Â-zone PPA, less than 6 diopters myopia, and VF progression were studied. Visual field progression was defined using trend analysis as the presence of at least 2 adjacent progressing points in the same hemifield using standard pointwise linear regression (PLR) criteria.

Main Outcome Measures

The correlation between ¦Â-zone PPA and location of most rapid future VF progression.

Results

One hundred twenty-five eyes (125 patients; mean age, 71.9¡À12.3 years; 58 % women; 75 % European descent) with ¦Â-zone PPA and VF progression were enrolled. The mean follow-up was 6.8¡À1.7 years and the mean number of VFs was 12.5¡À3.6. Ninety-three patients (74 % ) had more ¦Â-zone PPA inferiorly and 32 patients (26 % ) had more ¦Â-zone PPA superiorly. The fastest VF progression occurred in the superior hemifield in 77 patients (62 % ) and in the inferior hemifield in 48 (38 % ) patients. Patients with superior VF progression had a superior localized mean rate of progression of ?.57¡À1.7 dB/year, and patients with inferior VF progression had an inferior localized mean rate of ?.94¡À1.4 dB/year (P = 0.012). The mean number of points reaching the predefined PLR end points was 5.6¡À7.5 for the superior VF hemifield and 3.0¡À4.9 for the inferior hemifield (P = 0.006). The hemifield with more points reaching PLR progression end points, with fastest average velocity of progression, or both was spatially consistent with the location of largest ¦Â-zone PPA in 89 (71 % ) patients (P = 0.0001, Fisher exact test; ¦Ê = 0.35; 95 % confidence interval, 0.17?.53).

Conclusions

In treated glaucoma patients with ¦Â-zone PPA and VF progression, the location of largest ¦Â-zone PPA typically correlates spatially with the region of the most rapid future VF progression.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.