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Absolute Filling Defects of the Optic Nerve Head and Quantitative Morphological Analysis with the Heidelberg Retina Tomograph II in Normal Tension Glaucoma

Plange N., Kaup M., Remky A., Arend O.,
RWTH Aachen, Universitätsaugenklinik (Aachen)

Purpose: To evaluate absolute fluorescein filling defects of the optic nerve head in normal tension glaucoma (NTG) and to compare these filling defects with topographic analysis of the optic disc using the Heidelberg Retina Tomograph II (HRT II).
Methods: 25 patients with NTG (mean age 64±9 years) and 25 healthy controls (mean age 47±17 years) were included in the study. Fluorescein angiograms were performed with a Scanning Laser Ophthalmoscope and the extent of absolute fluorescein filling defects of the optic nerve head was assessed by means of digital image analysis. Topographic measurements of the optic nerve head were acquired using the HRT II.
Results: Absolute filling defects of the optic nerve head were significantly larger in NTG (p<0.0001). The cup area (p<0.05), rim area (p<0.01), rim volume (p<0.01), cup/disc area ratio (p<0.0001), linear cup/disc ratio (p<0.0001), cup shape measure (p<0.01), nerve fiber layer thickness (p<0.001), and nerve fiber layer cross sectional area (p<0.001) were significantly different between these groups. No significant difference was found for the parameters disc area, cup volume, mean and maximum cup depth and height variation contour. The absolute filling defects were significantly correlated with the topographic parameters cup area (p<0.01, r=0.36), rim area (p<0.001, r=-0.45), rim volume (p<0.0001, r=-0.51), cup/disc area ratio (p<0.001, r=0.5), linear cup/disc ratio (p<0.001, r=0.48), cup shape measure (p<0.05, r=0.31), nerve fiber layer thickness (p<0.0001, r=-0.53) and nerve fiber layer cross sectional area (p<0.0001, r=-0.53). No significant correlation was found for the parameters disc area, cup volume, mean and maximum cup depth and height variation contour.
Conclusions: Fluorescein filling defects of the optic nerve head are present in NTG. The extent of these filling defects is correlated with morphological disc damage.

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