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 Table of Contents    
LETTER TO THE EDITOR
Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 204-205  

Review of retinal morphology around optic disc in Peripapillary atrophy by using Spectralis Optical Coherent Tomography


1 Department of Ophthalmology, Medical School, King Faisal University; Al Jabr Eye and Ear Hospital, Ministry of Health, Al Hassa, Kingdom of Saudi Arabia
2 Eye and Ear Health Care, Ministry of Health, Muscat, Oman
3 Department of Ophthalmology, Medical School, King Faisal University, Al Hassa, Kingdom of Saudi Arabia

Date of Web Publication15-Jan-2013

Correspondence Address:
Rajiv Khandekar
EHCP, NCD, DGHA, MOH (HQ), POB:393, POB: 100, Muscat
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.106111

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How to cite this article:
Al Wadani F, Khandekar R, Asbali T, Gigan S. Review of retinal morphology around optic disc in Peripapillary atrophy by using Spectralis Optical Coherent Tomography. Oman J Ophthalmol 2012;5:204-5

How to cite this URL:
Al Wadani F, Khandekar R, Asbali T, Gigan S. Review of retinal morphology around optic disc in Peripapillary atrophy by using Spectralis Optical Coherent Tomography. Oman J Ophthalmol [serial online] 2012 [cited 2020 May 27];5:204-5. Available from: http://www.ojoonline.org/text.asp?2012/5/3/204/106111

Sir,

In 2010, we studied the clinical and optical coherent tomography (OCT) findings of 32 eyes of 16 patients (9 male and 6 female) with paripaillary optic atrophy (PPA) at eye unit of King Faisal University hospital. Two medical retina specialists and one ophthalmic technician examined patients with clinical PPA. Cycloplegic refraction of each eye of the participants was carried out. To have stereoscopic view of retina and optic nerve head (ONH), we used slit lamp bio-microscope (Topcon-Japan) and +90D fundus lens (Volk-Germany). For assessment of posterior segment, we also used indirect binocular ophthalmoscope (Keelar, UK) with + 20D fundus lens. The retinal area temporal to the ONH were evaluated with Spectralis OCT. The outer Alpha zone of PPA around ONH was defined as an irregular hypo- and hyper-pigmentation of the retinal pigment epithelium. The inner beta zone of PPA was identified with area of marked atrophy of the retinal pigment epithelium and choriocapillaris with thinning of the chorioretinal tissues and good visibility of the large choroidal vessels and sclera. [1]

Retinal examination and digital photograph using red free filter suggested that more prominent crescent on the temporal side of ONH had two zones. The alpha zone was large, whereas inner smaller zone had visible sclera and large chorio-retinal vessels [Figure 1]. The OCT of same area showed larger alpha zone characterized by a disruption of the photoreceptor and underlying pigment epithelium layers. The smaller beta zone was characterized by termination of photoreceptor and retinal pigment epithelium layers [Figure 2].
Figure 1: Digital image of optic nerve head showing paripapillary optic atrophy

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Figure 2: Optical coherent tomography of retina temporal to the optic nerve head (a) Alpha zone and (b) Beta zone

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OCT findings correlated well with the digital image of the retina near ONH in all cases. The alpha zone matched with the thinning of neuro-epithelium, whereas beta zone signified absence of neuro-epithelium and pigment epithelium making the large choriodal vessels and sclera clearly visible on fundus examination.

The findings of our study matched with the histopathological findings of Curcio et al. They demonstrated loss of photoreceptors and alteration of Bruc's membrane in PPA. [2] The functioning of photo receptor in alpha zone was demonstrated by the presence of a relative scotoma compared with the absolute scotoma corresponding to the beta zone while testing the field of vision. [3] PPA and its correlation to the ONH changes could enable the glaucoma expert to reach diagnosis even in early stages. [4]

Manjunath et al demonstrated usefulness of spectrum OCT in eyes with PPA to confirm clinical diagnosis of different retinal conditions. Both optic disc morphology and RNFL around optic disc were showing significant changes in glaucoma, age related macular degeneration, high myopia, and other conditions of retina. [5]

Our findings demonstrate that alpha zone is caused by disruption of the photoreceptor and underlying pigment epithelium layer and the beta zone was caused by a termination of photoreceptor and retinal pigment epithelium. Further study with a larger sample is recommended to review correlation of clinical and OCT findings in different ocular conditions.


   Acknowledgments Top


The authors thank administrators of King Faisal University Hospital for giving consent to undertake this study and to guide them during different stages of field part of the study. The authors also thank all the staff of hospital for the support extended in maintaining high quality of the study.

 
   References Top

1.Jonas JB, Budde WM, Panda-Jonas S. Ophthalmoscopic evaluation of the parapapillary region of the optic nerve head. Klin Oczna 2004;106 (1-2 Suppl):279-89.  Back to cited text no. 1
    
2.Curcio CA, Saunders PL, Younger PW, Malek G. Peripapillary chorioretinal atrophy: Bruch's membrane changes and photoreceptor loss. Ophthalmology 2000;107:334-43.  Back to cited text no. 2
[PUBMED]    
3.Jonas JB, Budde WM. Diagnosis and pathogenesis of glaucomatous optic neuropathy: Morphological aspects. Prog Retin Eye Res 2000;19:1-40.  Back to cited text no. 3
[PUBMED]    
4.Chen J, Lee L. Clinical applications and new developments of optical coherence tomography: An evidence-based review. Clin Exp Optom 2007;90:317-35.  Back to cited text no. 4
[PUBMED]    
5.Manjunath V, Shah H, Fujimoto JG, Duker JS. Analysis of peripapillary atrophy using spectral domain optical coherence tomography. Ophthalmology 2011;118:531-6.  Back to cited text no. 5
[PUBMED]    


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