Aim To evaluate the progressive change in peripapillary atrophy (PPA) according to its shape and to explore the relationship between PPA progression and glaucoma worsening in myopic eyes.
Methods A total of 159 eyes of 159 patients with myopic (axial length (AXL) >24 mm) glaucoma (mean follow-up 4.4 years, 35 eyes with minimal PPA, 40 concentric-type PPA eyes (>270° around the optic disc) and 84 eccentric-type PPA eyes (<270°)) were included. Sequential stereoscopic colour optic disc photographs were evaluated to qualitatively determine PPA progression. Factors associated with PPA progression were explored by Cox proportional hazard modelling in each PPA group.
Results Patients with concentric PPA were older than patients with eccentric PPA (54.1±11.7 vs 44.1±11.7 years; P<0.001), and AXL was longer in the eccentric group than in the other groups (25.54±1.68 vs 25.28±1.53 vs 26.41±1.29 mm; P<0.001). Twenty-six eyes (65%) in the concentric group and 36 eyes (42.9%) in the eccentric group showed PPA progression. Older age (hazard ratio (HR) 1.059, P=0.008), worse baseline visual field mean deviation (HR 0.857, P=0.009) and greater baseline PPA area (HR 1.000, P=0.012) were associated with PPA progression in the concentric type. Glaucoma progression (HR 3.690, P=0.002) and longer AXL (HR 1.521, P=0.002) were associated with PPA progression in the eccentric type.
Conclusions Relationship between glaucoma worsening and PPA progression was strongest in myopic glaucomatous eyes with eccentric type PPA.
- intraocular pressure
- optic nerve
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Contributors MKS was responsible for the data collection, analysis and manuscript writing. KRS was involved in the study design, data collection, analysis, manuscript writing and critical revision. JWS, JK, JYL and JMP were responsible for data collection and analysis.
Funding This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), which is funded by the Ministry of Education, Science and Technology (no. NRF-2014R1A1A3A04051089).
Competing interests None declared.
Ethics approval Institutional Review Board of Asan Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.
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