Bruch Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Helps Differentiate Compressive Optic Neuropathy From Glaucoma - 02/02/22

Doi : 10.1016/j.ajo.2021.08.008

Thais de Souza Andrade ^a, Rafael Barbosa de Araújo ^b, Arthur Andrade do Nascimento Rocha ^a, Luiz Guilherme Marchesi Mello ^a, Leonardo P. Cunha ^a,^c, Mário L.R. Monteiro ^a,^⁎
^a Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (T.dS.A., A.A.dN.R., L.G.M.M., L.P.C., M.L.R.M), University of São Paulo Medical School, São Paulo, Brazil
^b Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte (R.B.dA.), Brazil
^c Federal University of Juiz de Fora (L.P.C.), Juiz de Fora, Minas Gerais, Brazil.

^⁎Corresponding author: Mário L. R. Monteiro, Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology, LIM 33, University of São Paulo Medical School, Av Angélica 1757 conj 61, 01227-200, São Paulo, São Paulo, BrazilDivision of Ophthalmology and the Laboratory of Investigation in OphthalmologyLIM 33, University of São Paulo Medical SchoolAv Angélica 1757 conj 61São PauloSão Paulo01227-200Brazil

Résumé

Purpose

To compare optical coherence tomography–measured Bruch membrane opening minimum rim width (MRW), peripapillary retinal nerve fiber layer (pRNFL) measurements, and MRW:pRNFL ratios in eyes with compressive optic neuropathy (CON) and glaucoma and controls, and evaluate the ability of these parameters to differentiate CON from glaucoma.

Design

Prospective, cross-sectional study.

Methods

Setting: Single-center tertiary hospital and outpatient clinic. Patient population: One hundred fifteen eyes of 77 participants, 34 with CON from chiasmal lesions, 21 with glaucoma, and 22 healthy controls. Observation procedures: Optical coherence tomography–measured MRW, pRNFL, and MRW:pRNFL ratios for each optic disc sector and global average. Main outcome measures: MRW, pRNFL, and MRW:pRNFL ratios compared using generalized estimated equations. Area under the receiver operating characteristic curve and positive and negative likelihood ratios were calculated.

Results

MRW and pRNFL measurements were significantly reduced in CON and glaucoma compared with controls. In glaucoma, MRW was thinner than in CON in the global, inferotemporal, superonasal, inferonasal, and vertical average measurements, but a significant overlap was observed in many parameters. MRW:pRNFL ratios increased the ability to discriminate between CON and glaucoma, as shown by the high area under the receiver operating characteristic curve, high positive likelihood ratios, and low negative likelihood ratios, especially in the nasal disc sector and the nasal and temporal average.

Conclusions

MRW measurements alone cannot reliably distinguish CON from glaucoma, but the combination of MRW, pRNFL, and MRW:pRNFL ratios significantly improves accuracy. When comparing the 2 conditions, MRW:pRNFL ratios yielded higher area under the receiver operating characteristic curve and positive and negative likelihood ratios, suggesting this parameter may be helpful in clinical practice.

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