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Impressum
Correlation of retinal nerve fiber layer thickness and neuroretinal rim microcirculation in the course of primary open angle glaucoma
Kamppeter B., Michelson G., Harazny J., Mardin C.
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
Objective: It is still unclear, whether the reduction of retinal
microcirculation is cause or result of the glaucomatous optic atrophy.
Therefore, knowledge of the correlation of retinal nerve fiber layer thickness
(RNFL) and microcirculation in retinal capillaries (Flow) is essential
to clarify this aetiology. Several publications showed without or with
limited differentiation of glaucoma stages a reduced RNFL or capillary
blood flow in the neuroretinal rim (NNR) area in patients with POWG in
comparison to healthy individuals. This paper correlates and assesses
the parameters retinal nerve fiber layer thickness and capillary flow
in the NNR area simultaneously in different stages of POWG.
Methods: Using the Heidelberger Retina Tomograph (HRT) and the
Scanning Laser Doppler Flowmeter (SLDF, Heidelberg Engineering) 137 eyes
of POWG Patients registered in the Erlanger Glaucoma Database were measured.
RNFL and Flow were correlated separately in 5 papillomorphometrical stages
according to Jonas and 5 mean defect (MD) groups in 4 identical 30°
sectors next to the horizontal and vertical axis of the optic disc. Temporal
sector: 345°-15°; superior sector: 75°-105°; nasal sector:
165°-195°; inferior sector: 255°-285°;
Results: The highest reduction of the microcirculation (Flow) was
already seen in the first glaucoma stage in all measured areas. No loss
of RNFL could be detected at this stage. Capillary flow remained constantly
low in stages 2 and 3. RNFL showed a significant decrease beginning in
stage 2.
Conclusion: All measured sectors showed a reduction of flow in
earlier stages of glaucoma than a loss of RNFL. These results might hint
to a primarily impaired perfusion of the neuroretinal rimarea, which is
secondarily followed by a loss of RNFL thickness.