Clinical Features of Advanced Glaucoma With Optic Nerve Head Prelaminar Schisis

PURPOSE: To investigate the clinical characteristics of optic nerve head (ONH) prelaminar schisis in eyes with advanced glaucoma. DESIGN: Cross-sectional study. METHODS: One hundred sixteen eyes with advanced glaucoma (30-2 mean deviation <-12 dB) were included. ONH prelaminar schisis was identified using the spectral-domain optical coherence tomography independently by 2 evaluators and only eyes that reached consensus for the presence of ONH prelaminar schisis were included. Bruch membrane opening-minimum rim width (BMO-MRW), thickness and depth of lamina cribrosa (LC), peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness (total, RNFL, ganglion cell layer, inner plexiform layer), and peripapillary and subfoveal choroidal thickness were additionally obtained. Clinical characteristics were compared between the 2 groups based on the presence of ONH prelaminar schisis. RESULTS: ONH prelaminar schisis was identified in 48 of 116 eyes. Multivariate logistic regression analysis revealed that short axial length, thin and deep LC, and thick macula were associated with the presence of ONH prelaminar schisis. When the structure-function relation-ships were determined, macular structural parameters tended to have a better relationship with functional parameters than the BMO-MRW and peripapillary RNFL thickness parameters in eyes with ONH prelaminar schisis. CONCLUSIONS: The ONH prelaminar schisis was associated with thin and deep LC, short axial length, and generally thick macula. In patients with this features, the macular measurements, rather than peripapillary or ONH measurements, better predict the functional status of the eye. Our findings may have significant clinical implications for management of advanced glaucoma eyes with and without ONH prelaminar schisis. ((C) 2021 Elsevier Inc. All rights reserved.)

Automated summary

The study found that the presence of optic nerve head (ONH) prelaminar schisis in eyes with advanced glaucoma is associated with specific characteristics of the lamina cribrosa and macular thickness. In patients with these features, macular measurements are better predictors of functional status than peripapillary or ONH measurements.