Exit of disc -a new pathogenesis of parapapillary atrophy

1. Martha Kim¹
2. Tae-Woo Kim¹
3. Robert N. Weinreb²
4. Se Joon Woo¹
5. Kyu Hyung Park¹
6. Jeong-Min Hwang¹

¹Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
²Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California

Purpose: To describe the morphologic changes of the optic nerve head (ONH) and peripapillary tissue associated with the development/progression of parapapillary atrophy (PPA) in children.

Design: Retrospective observational study

Participants: This study included 266 eyes of 133 subjects who were assessed by serial disc photography at intervals of one year or more.

Methods: All disc photographs were reviewed by two experienced ophthalmologists, and eyes with progressive PPA were selected. The morphologic changes of the ONH and peripapillary tissue associated with the development/progression of PPA were analyzed.

Main Outcome Measures: The morphologic changes of the ONH in serial disc photographs.

Results: Progressive PPA was detected in 72 eyes of 43 subjects. Mean age of subjects was 7.7 ± 2.6 years (range, 1 to 16 years) and mean period of follow-up was 37.0 ± 18.2 months (range, 12 to 77 months). The morphologic changes were able to be classified into 4 categories. The most common type was inward development/growth of PPA with apparent shrinkage of the ONH (51 eyes, 70.8%) followed by, in order of incidence, bidirectional (14 eyes, 19.4%), apparent shifting of ONH (5 eyes, 6.9%) and outward development/growth of PPA (2 eyes, 2.8%).

Conclusions: We demonstrate that the morphologic changes associated with the development/progression of PPA vary considerably among children. Inward growth of PPA with accompanying shrinkage of the optic nerve head, a previously unreported process, was the predominant manifestation.