Sunday, December 3, 2023
| Parameters | CACG group (n = 65) | Control group (n = 65) | P-value |
|---|---|---|---|
| Age (year) | 59.91 ± 10.45 | 54.21 ± 13.67 | 0.008 |
| Axial length (mm) | 22.65 ± 0.87 | 22.72 ± 0.80 | 0.636 |
| Spherical equivalent(D) | 0.088 ± 0.425 | 0.049 ± 0.437 | 0.691 |
| cpRNFL thickness (μm) Beta zone area (mm²) |
60.79 ± 13.99 0.97 ± 0.93 |
118.53 ± 15.47 0.41 ± 0.53 |
<0.001 <0.001 |
| Gamma zone area (mm²) | 0.073 ± 0.176 | 0.093 ± 0.183 | 0.517 |
| Mean PCT (μm) | 114.61 ± 42.24 | 124.33 ± 28.59 | 0.137 |
| PCT nasal superior (μm) | 114.02 ± 43.84 | 126.62 ± 32.67 | 0.064 |
| PCT nasal (μm) | 113.24 ± 40.56 | 121.08 ± 41.88 | 0.279 |
| PCT nasal inferior (μm) | 104.52 ± 49.00 | 116.32 ± 30.25 | 0.099 |
| PCT temporal superior (μm) | 119.79 ± 47.33 | 134.52 ± 39.20 | 0.054 |
| PCT temporal (μm) | 119.26 ± 48.41 | 116.56 ± 40.19 | 0.729 |
| PCT temporal inferior (μm) | 106.12 ± 49.79 | 118.76 ± 31.49 | 0.085 |
Main ocular parameters between chronic primary angleclosure glaucoma (CACG) and control eyes
| Parameter | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| P-value | Standardized coefficient beta | P-value | Standardized coefficient beta | |
| Beta zone area | ||||
| Age (year) | <0.001 | 0.372 | 0.001 | 0.300 |
| Axial length (mm) | 0.182 | 0.119 | ||
| CACG | <0.001 | 0.349 | 0.016 | 0.228 |
| Optic disc ovality index | 0.858 | 0.016 | ||
| BMO ovality ratio | 0.108 | −0.144 | ||
| Mean PCT (μm) cpRNFL thickness |
0.002 <0.001 |
−0.280 −0.347 |
||
| Central cornea thickness (μm) | 0.003 | −0.290 | 0.030 | −0.199 |
| Lens thickness (mm) | 0.047 | 0.228 | ||
| Gamma zone area | ||||
| Age (year) | 0.134 | −0.132 | ||
| Axial length (mm) | 0.659 | −0.040 | ||
| CACG | 0.517 | −0.057 | ||
| Optic disc ovality index | <0.001 | −0.404 | <0.001 | −0.926 |
| BMO ovality ratio | 0.001 | 0.287 | <0.001 | 0.803 |
| Mean PCT (μm) | 0.501 | 0.061 | ||
| cpRNFL thickness | 0.505 | 0.059 | ||
| Central cornea thickness (μm) | 0.116 | 0.157 | ||
| Lens thickness (mm) | 0.750 | 0.037 | ||
Linear regression analysis of parameters associated with peripapillary beta zone area and gamma zone area
| PCT location | Mean PCT(μm) | Univariate analysis | Multivariate analysis | R² | ||
|---|---|---|---|---|---|---|
| Parameter | P-value | Parameter | P-value | |||
| Temporal inferior | 112.44 ± 41.75 | Age | <0.001 | Age | <0.001 | 0.220 |
| Beta zone area | 0.002 | |||||
| Temporal | 117.90 ± 44.31 | Age | <0.001 | Age | <0.001 | 0.237 |
| Temporal superior | 127.21 ± 43.88 | Age | <0.001 | Age | 0.002 | 0.192 |
| Beta zone area | 0.001 | |||||
| Nasal superior | 120.37 ± 38.98 | Age | <0.001 | Age | 0.002 | 0.254 |
| Beta zone area | 0.016 | |||||
| Nasal | 117.13 ± 41.25 | Age | 0.003 | Age | 0.003 | 0.106 |
| Nasal inferior | 110.42 ± 40.77 | Age | <0.001 | Age | <0.001 | 0.229 |
| Beta zone area | 0.016 | |||||
Parameters show significant association with peripapillary choroidal thickness (PCT) in univariate and multivariate linear regression
This activity is intended for ophthalmologists and other physicians who treat and manage patients with chronic primary angle-closure glaucoma (CACG).
The goal of this activity is to describe the morphological features of the parapapillary beta and gamma zone and associated factors in eyes with CACG, according to an observational cross-sectional study.
Upon completion of this activity, participants will:
As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0
AMA PRA Category 1 Credit(s)™
. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME Released: 8/30/2019
Valid for credit through: 8/30/2020, 11:59 PM EST
processing....
Purpose: To investigate the morphological features of parapapillary beta zone and gamma zone and their associated factors in eyes with chronic primary angle-closure glaucoma (CACG).
Methods: The observational cross-sectional study included 65 CACG eyes and 65 non-myopic control eyes. On enhanced depth imaging of optical coherent tomography images, the area of parapapillary beta zone and gamma zone, and the peripapillary choroidal thickness at 6 sectors were measured. The optic disc ovality index and Bruch's membrane opening (BMO) shape were further calculated.
Results: Beta zone was present in 103 (79.2%) eyes and gamma zone in 29 (22.3%) eyes. Compared to control eyes, CACG was associated with larger parapapillary beta zone, female gender, and older age (P < 0.01). No significant difference was observed in axial length and peripapillary choroidal thickness between both groups (P > 0.05). In multivariate analysis, beta zone area was positively associated with older age and higher prevalence of CACG (P < 0.01), while a larger gamma zone area was associated with a smaller disc ovality index and a higher BMO ovality ratio (P < 0.01). The peripapillary choroidal thickness at six sectors was decreased with older age (P < 0.01).
Conclusions: In mainly non-myopic subjects with or without CACG, larger parapapillary beta zone was correlated with older age and presence of glaucoma, while a larger parapapillary gamma zone was correlated with disc ovality but not with glaucoma. Parapapillary beta zone and gamma zone may play different roles in physiological and glaucomatous changes around optic nerve head.
The conventional ophthalmoscopic beta zone[1] of parapapillary atrophy characterized by visible choroidal vessels and the sclera has recently been divided into two subzones: gamma zone and (new) beta zone.[2,3] Based on spectral domain optical coherence tomography (SD-OCT) findings, gamma zone could be distinguished as the parapapillary region free of Bruch's membrane, and beta zone could be distinguished by the presence of Bruch's membrane and absence of RPE. Both gamma zone and beta zone were whitish zones upon ophthalmoscopy, while a delicate color difference could be noticed to distinguish these two subzones occasionally.
Growing evidence has suggested that parapapillary beta zone was associated mainly with primary open angle glaucoma and to a lower degree with axial myopia, while parapapillary gamma zone was strongly correlated with axial myopia.[3-5] Studies on the characteristics of SDOCT defined parapapillary atrophy in eyes with primary angle-closure glaucoma have only scarcely been performed,[6] if at all. Moreover, the etiology of the parapapillary beta and gamma zone in glaucoma has remained elusive so far.
Using the enhanced depth imaging of SD-OCT technology, we therefore performed this study to investigate the morphological features of parapapillary beta zone and gamma zone and associated factors in eyes with chronic primary angle-closure glaucoma (CACG).
