Pur­po­se:

To evaluate the relationship between peripapillary atrophy and optic disc parameters measured by Heidelberg Retina Tomography (HRT) and visual field findings in eyes with primary open-angle glaucoma.

Methods:

Thirty eyes of 30 patients with primary open-angle glaucoma were included in this study. In addition to routine ophthalmic examination, optic disc parameters were evaluated with HRT and visual field was evaluated with Humphrey Visual Field Analyzer. Peripapillary atrophy area was measured by drawing contour of the border of the peripapillary atrophy (Beta zone: chorioretinal atrophy area in which sclera and big choroid blood vessels were seen) in HRT. The relationship between this atrophy area and both visual field findings and optic disc parameters was evaluated. Pearson’s correlation coefficient and statistical significance were calculated.

The study was performed in four Polish pediatric diabetes centers. Of 330 children with T1DM and AIT followed between 2008 and 2012, 101 received L-T4 and 160 underwent clinical observation for 24 months. Thyroid stimulating hormone (TSH), free T4 (fT4), anti thyroid peroxidase antibody (anti-TPO), anti thyroglobulin antibody (anti-TG), glycosylated hemoglobin (HbA1c) levels, and lipid profile were assessed in all patients. Ultrasonographic evaluation was also performed in all children at each examination.

Patients treated with thyroid hormones had higher TSH levels (3.99; interquantile 3.5 to 4.52 vs. 2.09 mIU/L; interquantile 1.55 to 3.06; p<0.0001). A fall in TSH level (0.87 mIU/L 95% CI 0.43-1.30; p<0.0001) was documented after the first year of treatment. FT4 level did not differ between the groups at baseline (p=0.7434), but rose in the treatment group and fell in the control group [mean difference 0.78 95% CI-0.22-1.53 pmol/L (p=0.02) after 12 months and 0.98 95% CI 0.04-1.76 (p=0.005) after 24 months]. Higher levels of anti-TPO were initially found in the treated patients (p<0.0001) and significantly decreased over the 24-month period (p<0.0001). Children in the treatment group had higher anti-TG levels (p<0.0001), which showed a borderline decrease (p=0.08) in time. In the control group, anti-TG levels rose marginally (p=0.06) during the study.

The data demonstrate that treatment with L-T4 in euthyroid pediatric patients with T1DM and AIT stabilizes autoimmune inflammation in the thyroid gland and is to be recommended as soon as the diagnosis is established.

Conclusion:

Significant correlation was seen between peripapillary beta zone atrophy area and some important optic disk parameters in primary open-angle glaucoma patients. More meaningful information would have been obtained if sectoral investigation of the optic disc was performed. (Turk J Ophthalmol 2011; 41: 291-4)

Keywords: Primary open-angle glaucoma, peripapillary atrophy, Heidelberg retinal tomography