Issue: Vojnosanit Pregl 2017; Vol. 74 (No. 2)

Peripapillary retinal nerve fiber layer thickness in different glaucoma stages measured by optical coherence tomography

Authors:
Maja Živković, Vesna Jakšić, Predrag Jovanović, Marko Zlatanović, Gordana Zlatanović, Jasmina Djordjević-Jocić

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Background/Aim. One of the most reliable methods for
structural measurements of glaucomatous damage is spectral
domain optical coherence tomography (SD-OCT). The aim of
this study was to measure peripapillary retinal nerve fiber layer
(RNFL) thickness with SD-OCT in eyes with different stages
of glaucoma, as well as to determine which sector in the peripapillary
circle is the most vulnerable to glaucomatous damage.
Methods. The study included 153 eyes of 93 patients with
confirmed primary open angle glaucoma (POAG). All the patients
underwent a complete ophthalmic examination, including
visual field testing and peripapillary RNFL thickness measured
by SD-OCT. They were divided into three subgroups:
early, moderate and severe stage of glaucoma based on the
mean deviation (MD) index of visual field. The results were
presented as mean RNFL thickness: total, in the four quadrants
and 12 clock-hour RNFL thickness. Results. The overall mean
peripapillary RNFL was 74.95  14.51 μm. The lower quadrant
had the thickest RNFL (92.78  25.84 μm), followed by upper
(88.82  22.04 μm), nasal (64.31  11.67 μm) and temporal
ones (54.02  12.76 μm), showing a significant difference (χ2 =
273.36, DF = 3, p < 0.001). Comparison between RNFL thickness
in early glaucoma and moderate and severe stages revealed
that the most sensitive sectors were inferior and superior ones,
as well as sectors at 5–7 clock hour position. The greatest decrease
in RNFL thickness was observed in the 9 o'clock hour
sector in all three glaucoma subgroups (46.99  13.28 μm), while
the RNFL was the thickest in the 6 o'clock hour sector (102.63 
34.12 μm). Conclusion. Peripapillary RNFL thickness is inversely
proportional to the degree of glaucomatous damage: the
greater the damage, the thinner peripapillary RNFL.