Chiang Jaclyn, Yapp Michael, Ly Angelica, Hennessy Michael P, Kalloniatis Michael, Zangerl Barbara
Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.
School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
Optom Vis Sci. 2018 Mar;95(3):239-246. doi: 10.1097/OPX.0000000000001179.
This study resulted in the identification of an optic nerve head (ONH) feature associated with tilted optic discs, which might potentially contribute to ONH pathologies. Knowledge of such findings will enhance clinical insights and drive future opportunities to understand disease processes related to tilted optic discs.
The aim of this study was to identify novel retinal nerve fiber layer (RNFL) anomalies by evaluating tilted optic discs using optical coherence tomography. An observed retinal nerve fiber protrusion was further investigated for association with other morphological or functional parameters.
A retrospective review of 400 randomly selected adult patients with ONH examinations was conducted in a referral-only, diagnostic imaging center. After excluding other ONH pathologies, 215 patients were enrolled and evaluated for optic disc tilt and/or torsion. Gross anatomical ONH features, including size and rim or parapapillary region elevation, were assessed with stereoscopic fundus photography. Optical coherence tomography provided detailed morphological information of individual retinal layers. Statistical analysis was applied to identify significant changes between individual patient cohorts.
A dome-shaped hyperreflective RNFL bulge, protruding into the neurosensory retina at the optic disc margins, was identified in 17 eyes with tilted optic discs. Available follow-up data were inconclusive regarding natural changes with this ONH feature. This RNFL herniation was significantly correlated with smaller than average optic disc size (P = .005), congenital disc tilt (P < .0001), and areas of rim or parapapillary elevation (P < .0001).
This study reports an RNFL protrusion associated with tilted optic discs, which has not previously been assessed as an independent ONH structure. The feature is predominantly related to congenital crowded, small optic discs and variable between patients. This study is an important first step to elucidate diagnostic capabilities of tilted disc morphological changes and understanding associated functional deficits.
本研究发现了一种与倾斜视盘相关的视神经乳头（ONH）特征，这可能对视神经乳头病变有潜在影响。了解这些发现将增强临床洞察力，并为未来理解与倾斜视盘相关的疾病过程提供机会。
本研究的目的是通过光学相干断层扫描评估倾斜视盘，以识别新的视网膜神经纤维层（RNFL）异常。对观察到的视网膜神经纤维突出与其他形态学或功能参数的相关性进行了进一步研究。
在一家仅提供转诊服务的诊断成像中心，对400例随机选择的接受视神经乳头检查的成年患者进行回顾性研究。排除其他视神经乳头病变后，纳入215例患者，评估视盘倾斜和/或扭转情况。通过立体眼底摄影评估视神经乳头的大体解剖特征，包括大小、边缘或视乳头旁区域的隆起。光学相干断层扫描提供了各视网膜层的详细形态学信息。应用统计分析来确定各患者队列之间的显著变化。
在17只倾斜视盘的眼中，发现了一个穹顶状的高反射性视网膜神经纤维层隆起，突出到视盘边缘的神经感觉视网膜内。关于这种视神经乳头特征的自然变化，现有的随访数据尚无定论。这种视网膜神经纤维层疝与小于平均视盘大小（P = 0.005）、先天性视盘倾斜（P < 0.0001）以及边缘或视乳头旁隆起区域（P < ）显著相关。
本研究报告了一种与倾斜视盘相关的视网膜神经纤维层突出，此前未被评估为独立的视神经乳头结构。该特征主要与先天性拥挤、小视盘有关，且在患者之间存在差异。本研究是阐明倾斜视盘形态学变化的诊断能力以及理解相关功能缺陷的重要第一步。
