[In-vivo measurement of autofluorescence in the parapapillary atrophic zone of optic discs with and without glaucomatous atrophy].
BACKGROUND
To assess the level of autofluorescence (lipofuscin) of atrophic parapapillary zones in different stages of glaucomatous optic disc atrophy.


METHODS
Controlled cross-sectional prospective analysis of 79 consecutive eyes (15 normals as controls, 26 with ocular hypertension, 38 with primary open angle glaucoma). Eyes with retinal diseases or retinal pigment epithelial pathologies were excluded. The confocal scanning laser ophthalmoscope (HRA, Heidelberg Retina Angiograph) was used after lipofuscin excitation with argon blue laser (488 nm) to detect parapapillary autofluorescence in a spectrum above 500 nm. Size, extension of the parapapillary autofluorescent area and its mean distance to the optic nerve head were measured using the HRA standard software. Additional optic nerve head photographs taken with the 15 degrees Zeiss telecentric fundus camera (30 degrees camera with 2 x magnifier) were examined by two experienced ophthalmologists to determine the stage of glaucomatous optic disc atrophy (stages 0 to 4).


RESULTS
Very small autofluorescent areas were found in vital discs (optic nerve glaucoma stage 0) in the parapapillary atrophic area (0.08 +/- 0.12 mm (2)) in contrast to glaucomatous discs in stage 1 (0.24 +/- 0.26 mm (2)) and stages 2, 3 and 4 (0.59 +/- 1.29 mm (2), logistic regression analysis r = 0.71; P = 0.029). The circular extension of the autofluorescent area correlated borderlined with the stage of the glaucomatous disc atrophy (higher glaucoma stages: r = 0.82; P = 0.09). The autofluorescent area was larger in OHT than in controls (0.11 mm (2) vs. 0.04 mm (2), P < 0.03). The circular extension of the autofluorescent area was longer in OHT than in controls (0.5 mm vs. 1.15 mm, P < 0.04).


CONCLUSIONS
As a sign of pronounced lipofuscin accumulation in the parapapillary atrophic zone higher degrees of fundus autofluorescence can be detected in OHT and manifest primary open angle glaucoma in contrast to normals. The lipofuscin accumulation is correlated with the stage of progression of glaucoma and the stage of optic disc atrophy. The detection of active parapapillary autofluorescent areas especially in OHT may offer the ophthalmologist an important tool for early diagnosis.
Viestenz
Arne
A
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Kopfklinikum Erlangen, Germany. Arne.Viestenz@t-online.de
Mardin
Christian Y
CY
Langenbucher
Achim
A
Naumann
Gottfried O H
GO
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D005902:Glaucoma, Open-Angle / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008062:Lipofuscin / Q000378:metabolism*; D008297:Male; D018613:Microscopy, Confocal / Q000295:instrumentation*; D008875:Middle Aged; D009798:Ocular Hypertension / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D009887:Ophthalmoscopy; D009896:Optic Atrophy / Q000175:diagnosis* / Q000473:pathology; D009898:Optic Disk / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012984:Software
D008062:Lipofuscin
In-vivo-Messung der Autofluoreszenz in der parapapillären Atrophiezone bei Papillen mit und ohne glaukomatöse Optikusatrophie.