Korean J Ophthalmol.  2010 Dec;24(6):353-359. 10.3341/kjo.2010.24.6.353.

Characterization of Peripapillary Atrophy Using Spectral Domain Optical Coherence Tomography

• Na JH
• Moon BG
• Sung KR
• Lee Y
• Kook MS

• KMID: 1769089
• DOI: http://doi.org/10.3341/kjo.2010.24.6.353

Abstract

PURPOSE
To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT).
METHODS
SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral beta-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized.
RESULTS
Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes.
CONCLUSIONS
The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.

Keyword

Bruch's membrane; Glaucoma; Peripapillary atrophy; Retinal nerve fiber layer; Spectral-domain optical coherence tomography

MeSH Terms

Adult
Aged
Bruch Membrane/pathology
Female
Glaucoma/*complications
Humans
Male
Middle Aged
Nerve Fibers/pathology
Optic Atrophy/*diagnosis/*etiology
Optic Disk/*pathology
Photoreceptor Cells, Vertebrate/pathology
Retina/pathology
Retinal Pigment Epithelium/pathology
Tomography, Optical Coherence/*methods

Figure

• 

  Fig. 1 (A) The optic disc image acquired in the fast optic disc mode of the Stratus optical coherence tomography (OCT). The posterior boundary of the retina was shown as a single thick hyper-reflective red-colored band, displayed in false color (black arrow). This posterior boundary has been interpreted as the complex of the retinal pigment epithelium (RPE) and the junction between the inner and outer segment (IS/OS) of photoreceptor layer. The white arrow indicates peripapillary retinal nerve fiber layer (RNFL). (B) Spectralis OCT images showed posterior retinal boundaries as composed of at least two layers, one thick and one thin layer. The red arrow indicates peripapillary RNFL, and the inner thinner layer has been defined as the junction between the IS/OS of the photoreceptor layer (yellow arrow), whereas the outer thicker layer has been considered to represent the Bruch's membrane/RPE border (blue arrow).

• 

  Fig. 2 (A) Showed the extent of the β-zone (red arrow) and optic disc margin (blue arrow) demarcated on the temporal side of a glaucomatous optic disc. (B) Peripapillary atrophy (PPA) was visualized on scanning laser ophthalmoscope (SLO) images from the Spectralis optical coherence tomography (OCT). (C) The extent of the β-zone (red arrow) was described in SLO and cross-sectional images of the Spectralis OCT. The retinal nerve fiber layer (yellow arrow) and Bruch's membrane/retinal pigment epithelium complex layer (BRL) (green arrow) were easily seen in the β-zone of OCT PPA images. The BRL was intact around the optic disc margin and showed hyper-reflectance. However, the inner and outer segment complexes (pink arrow) were absent from the β-zone of the PPA area.

• 

  Fig. 3 (A) Showed the extent of the β-zone (red arrow) and optic disc margin (blue arrow) on the temporal side of a healthy optic disc. (B) Peripapillary atrophy (PPA) was well-visualized by Spectralis optical coherence tomography (OCT) scanning laser ophthalmoscope imaging. (C) In a cross-sectional image of the optic disc scanned by the Spectralis OCT, the retinal nerve fiber layer (yellow arrow) and Bruch's membrane/retinal pigment epithelium complex layer (BRL) (green arrow) were observed in the β-zone PPA area, whereas the inner and outer segment complexes (pink arrow) were absent. The BRL edge showed slight posterior bowing around the optic disc margin. (D) The Stratus OCT image also showed slight posterior bowing of the BRL (white arrow), and the automatic disc margin detection algorithm failed to detect the edge of the optic disc margin (black arrow).

• 

  Fig. 4 (A) Showed the extent of the β-zone (red arrow) and optic disc margin (blue arrow) on the temporal side of a glaucomatous optic disc. (B) Peripapillary atrophy (PPA) and retinal nerve fiber layer (RNFL) bundle defects were also seen on Spectralis optical coherence tomography (OCT) scanning laser ophthalmoscope imaging. In a cross-sectional image of the optic disc obtained by Spectralis OCT, the RNFL was thinner when the scan line passed through the RNFL bundle defect area (green scan line in B), but RNFL (yellow arrow) was observed in the β-zone of PPA. Inner and outer segment complexes (pink arrow) were absent from the β-zone of the PPA area. The Bruch's membrane/retinal pigment epithelium complex layer was atrophic and posteriorly bowed in the β-zone of the PPA area (C).

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