Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Center for Health Promotion, Digital Innovation Center, Samsung Medical Center, Seoul, Korea.
Sci Rep. 2024 Apr 17;14(1):8889. doi: 10.1038/s41598-024-59419-3.
We aimed to investigate the changes in cupping in chiasmal lesion optic neuropathy (chON) compared to baseline optic disc and glaucoma. We used a novel study design to enroll patients who had fundus photographs incidentally taken during routine health check-ups prior to the onset of optic neuropathy. In 31 eyes (21 patients) with chON and 33 eyes (30 patients) with glaucoma, we investigated the change in cup-to-disc (C/D) area from the baseline to overt cupping using flicker analysis. Compared to the baseline, 23 eyes (74.2%) had increased cup size and 3 (9.7%) had vascular configuration changes in the chONgroup; in contrast, all glaucoma eyes exhibited changes in cup size and vascular configuration. The increase in C/D area ratio was significantly smaller in chON (0.04 ± 0.04) compared to glaucoma (0.10 ± 0.04, P < 0.001); the minimum residual neuroretinal rim width showed a more pronounced difference (29.7 ± 8.2% vs 7.1 ± 3.9%, P < 0.001). The changes distributed predominantly towards the nasal direction in chON, contrasting the changes to the arcuate fibers in glaucoma. In conclusion, our results provide the first longitudinal evidence of true pathological cupping in chONcompared to photographically disease-free baseline. The marked difference in the residual minimum rim width reaffirms the importance of rim obliteration in the differential diagnosis between the two diseases.
我们旨在研究视交叉病变性视神经病变（chON）与视盘和青光眼相比，其视杯的变化。我们使用一种新颖的研究设计，招募了在视神经病变发作前，在常规健康检查中偶然拍摄眼底照片的患者。在 31 只患有 chON 的眼睛（21 名患者）和 33 只患有青光眼的眼睛（30 名患者）中，我们使用闪烁分析研究了从基线到明显视杯的杯盘比（C/D）区域的变化。与基线相比，23 只眼睛（74.2%）的杯盘比增大，3 只眼睛（9.7%）的血管结构发生变化；相比之下，所有青光眼眼睛的杯盘比和血管结构均发生改变。chON 组的 C/D 面积比增加（0.04±0.04）明显小于青光眼组（0.10±0.04，P<0.001）；最小残余神经视网膜边缘宽度的增加更为明显（29.7±8.2%比 7.1±3.9%，P<0.001）。chON 组的变化主要向鼻侧分布，与青光眼的弓形纤维变化形成对比。总之，我们的结果首次提供了 chON 中真正病理性视杯变化的纵向证据，与无病基线的照片相比。最小残余边缘宽度的显著差异再次证实了边缘消失在这两种疾病的鉴别诊断中的重要性。
