Morphologic predictive factors for development of optic disc hemorrhages in glaucoma

PURPOSE: To evaluate which optic disc parameters are predictive factors for the development of disc hemorrhages in chronic open-angle glaucoma. METHODS: The prospective comparative clinical observational study included 432 eyes of 281 white patients with chronic open-angle glaucoma. Mean follow-up time was 38.8 months (median, 31.5). Eyes in the whole study group were divided into those with an optic disc hemorrhage during the follow-up period (hemorrhagic group; n = 38; 8.8%), those without disc hemorrhages and with neuroretinal rim loss as sign of progression of glaucoma (rim loss group; n = 42; 9.7%), and those with neither disc hemorrhages nor neuroretinal rim loss (stable group; n = 352; 81.5%). Color stereo optic disc photographs were obtained repeatedly in all patients and subjected to qualitative and morphometric evaluation. RESULTS: At baseline, neuroretinal rim area was significantly (P < 0.03) smaller and the beta zone of parapapillary atrophy (temporal lower sector) was significantly (P < 0.03) larger in the hemorrhagic group than in the stable group. Both study groups did not vary significantly (P > 0.05) in optic disc size and shape, optic cup depth, alpha zone of parapapillary atrophy, and retinal vessel diameter. In multivariate analysis, the neuroretinal rim area was the only significant predictor of hemorrhages. The hemorrhagic group and the rim loss group did not differ significantly (P > 0.05) in any optic disc parameter measured. CONCLUSIONS: In chronic open-angle glaucoma, morphologic predictive factors for the development of disc hemorrhages are small size of neuroretinal rim and, possibly, a large parapapillary beta zone. Development of disc hemorrhages is independent of optic disc size and shape, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth. Optic nerve heads in eyes with eventual development of disc hemorrhages and in eyes with eventual progressive rim loss without observed disc hemorrhages do not differ markedly in appearance.     

Optic nerve damage in highly myopic eyes with chronic open-angle glaucoma

PURPOSE: To compare the amount of optic nerve damage in relation to intraocular pressure in highly myopic eyes with chronic open-angle glaucoma versus non-highly myopic eyes with chronic open-angle glaucoma. METHODS: The comparative clinical observational study included 1841 eyes of 1100 patients with chronic open-angle glaucoma. The highly myopic study group consisted of 25 eyes with a myopic refractive error equal to or higher than -8 diopters. It was subdivided into eyes with an optic disc size larger than 2.7 mm2 and eyes with an optic disc smaller than 2.7 mm2. The control group included the remaining, non-highly myopic eyes (n=1816). For all patients, a morphometric analysis of color stereo optic disc photographs was performed. Main outcome measures were morphometric optic disc measurements and intraocular pressure. RESULTS: In the highly myopic, large-optic-disc study group compared with the control group, maximal and minimal intraocular pressure readings were significantly (p<0.05) lower and neuroretinal rim area corrected for optic disc size was slightly (p=0.16) smaller. Comparing the total highly myopic study group with a control group adjusted for optic disc area, neuroretinal rim area was significantly (p=0.039) smaller in the study group with no significant difference in intraocular pressure measurements between the groups. CONCLUSIONS: At a given intraocular pressure in chronic open-angle glaucoma, optic nerve damage may be more pronounced in highly myopic eyes with large optic discs than in non-highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes than in non-highly myopic eyes.     

Keratometry, optic disc dimensions, and degree and progression of glaucomatous optic nerve damage

PURPOSE: To evaluate whether keratometric readings as a measure of corneal shape are associated with optic disc dimensions and with the degree and rate of perimetric progression of chronic open-angle glaucoma or ocular hypertension. METHODS: The hospital-based observational study included 1826 eyes of 936 patients with ocular hypertension, patients with chronic open-angle glaucoma, or normal individuals. For 733 ocular hypertensive or glaucomatous eyes, follow-up examinations were performed with a mean follow-up time of 58.0+/-34.7 months. Observation procedures were keratometry, morphometric optic disc analysis, tonometry, and perimetry. RESULTS: In the normal study group, area of the neuroretinal rim, alpha zone and beta zone of parapapillary atrophy, and retinal vessel diameter were not significantly associated with keratometric readings. In the entire study population, the optic disc area was significantly (P<0.001; r=-0.27) correlated with low keratometric readings as expressed in diopters. Keratometric readings were significantly (P<0.001 adjusted for age, intraocular pressure, baseline damage, and corneal asphericity) smaller in the normal-pressure glaucoma group than in the normal study group and in the groups with ocular hypertension or primary and secondary open-angle glaucoma. Rate of perimetric progression was not significantly associated with low keratometric readings, either in simple or in multiple Cox regression analysis, controlling for baseline damage, ocular hypertension, age, corneal asphericity, and intraocular pressure. CONCLUSIONS: Large optic disc area is statistically significantly, but clinically weakly, correlated with low keratometric readings (diopters). In Caucasian individuals with ocular hypertension and patients with chronic open-angle glaucoma, the rate of development or progression of glaucomatous visual field defects is not significantly associated with keratometric readings.     

Morphology of the optic papilla in glaucoma. II. Secondary chronic open angle glaucoma

Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc shows specific features among various types of secondary chronic open-angle glaucoma. METHODS: Clinical data and color-stereo optic disc photographs of 126 patients with pseudoexfoliative glaucoma and 47 patients with pigmentary glaucoma were compared with those of 501 patients with primary open-angle glaucoma (POAG) and of 481 normal subjects. The glaucoma groups did not differ in neuroretinal rim nor in perimetric mean defect. RESULTS: Mean optic disc area was significantly smaller in the pseudoexfoliative glaucoma eyes (2.54 +/- 0.51 mm2 vs. 2.71 +/- 0.63 mm2, p = 0.03) than in the primary open-angle glaucoma eyes. The pigmentary glaucoma group did not vary significantly from the primary open-angle glaucoma group in size of the optic disc. No significant differences were found for neuroretinal rim area, configuration of neuroretinal rim, depth of optic cup and diameters of the retinal arterioles and venules at the disc border between the secondary glaucoma groups and the POAG group respectively. Size of zone beta of the parapapillary atrophy was slightly, but not significantly smaller in the secondary glaucoma groups than in POAG. In the secondary glaucoma groups, the maximal intraocular pressure measurements were significantly (p < 0.001) higher than in the group with POAG. All glaucoma groups had a significantly smaller neuroretinal rim, significantly smaller retinal arterioles, and significantly larger parapapillary atrophy compared to the normal group. CONCLUSIONS: Except of a slightly smaller optic disc in eyes with pseudoexfoliative glaucoma, eyes with secondary glaucoma due to pseudoexfoliation or due to pigmentary dispersion do not vary significantly in their optic disc morphology compared to POAG and do not show pathognomonic features of the optic disc despite marked changes in the anterior segment of the eye.     

Inter-eye differences in chronic open-angle glaucoma patients with unilateral disc hemorrhages

OBJECTIVE: Flame-shaped optic disc hemorrhages are a hallmark of glaucomatous optic neuropathy. The purpose of this study was to evaluate which parameters differ between companion eyes with and without an optic disc hemorrhage in patients with chronic open-angle glaucoma. DESIGN: Comparative (companion eye) observational case series. PATIENTS: The study included 99 white patients with bilateral chronic open-angle glaucoma and unilateral flame-shaped optic disc hemorrhages. METHODS: All patients underwent qualitative and morphometric evaluation of color stereo optic disc photographs. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, and both mean value and loss variance value of the visual field examination. RESULTS: In an intraindividual inter-eye comparison, the eyes with disc hemorrhages and the contralateral eyes without disc bleeding did not vary significantly (P > 0.20) in size and shape of the optic disc and neuroretinal rim, optic cup depth, size of alpha and beta zone of parapapillary atrophy, retinal vessel diameter, intraocular pressure measurements, refractive error, and perimetric indices. CONCLUSIONS: In bilateral chronic open-angle glaucoma, the development of unilateral optic disc hemorrhages does not depend on inter-eye differences in size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, or visual field loss.     

Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for progressive neuroretinal rim loss in chronic open-angle glaucoma. DESIGN: Prospective, observational case series. PARTICIPANTS: The study included 394 eyes of 257 white patients with chronic open-angle glaucoma. Mean follow-up time was 31.8 months (median, 39.7 months). Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Presence of optic disc hemorrhages was not taken into account. METHODS: All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Statistical analysis included Kaplan-Meier curves, and bivariate and multivariate Cox regression analysis adjusted for patients' ages. Dependency of left and right eyes from the same subject was taken into account. MAIN OUTCOME MEASURES: Qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Progression of glaucomatous optic nerve changes was detected in 42 eyes (11%). At baseline of the study, neuroretinal rim area (total area, P = 0.03) was significantly smaller, and beta zone of parapapillary atrophy (total area, P = 0.04) was significantly larger in the progressive study group compared with the nonprogressive study group. Neither study group varied significantly in size and shape of the optic disc, optic cup depth, alpha zone of parapapillary atrophy, and diameter of the retinal arteries and veins (P > 0.05). Multiple Cox regression analysis revealed that the progression of glaucoma depended significantly on the area of the neuroretinal rim (temporal sector, P = 0.003) and beta zone of parapapillary atrophy (temporal inferior sector, P = 0.02). CONCLUSIONS: Important morphologic predictive factors for progression of the glaucomatous appearance of the optic nerve head in white persons are small size of neuroretinal rim and large area of beta zone of parapapillary atrophy. Progression of glaucomatous optic nerve head changes is independent of size and shape of the optic disc, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.     

Anisometropia and degree of optic nerve damage in chronic open-angle glaucoma

PURPOSE: To address the question of whether the refractive error plays a role in the amount of optic nerve damage in glaucoma, we intraindividually compared inter-eye differences in refractive error with inter-eye differences in parameters indicating the degree of glaucomatous optic nerve damage, and we interindividually correlated refractive error with neuroretinal rim area and visual field loss.DESIGN: Comparative clinical observational study.METHODS: This comparative clinical observational study was conducted in a university eye hospital. The study included 1,444 eyes of 876 patients with primary or secondary chronic open-angle glaucoma. Patients with a highly myopic refractive error (> or = -8 diopters) were excluded, owing to differences in the anatomy of the optic nerve head. Color stereo optic disk photographs were taken and morphometrically evaluated. The main outcome measures were refractive error, neuroretinal rim area, horizontal and vertical cup/disk diameter ratios, and visual field loss.RESULTS: In an interindividual statistical analysis, area of neuroretinal rim, horizontal and vertical cup/disk diameter ratios, and mean visual field loss were not significantly (P >.10) correlated with refractive error. In an intraindividual comparison, inter-eye differences in refractive error were not significantly (P >.05) correlated with inter-eye differences in neuroretinal rim area and mean visual field defect. The eye with the more myopic refractive error and the contralateral eye with the less myopic refractive error did not vary significantly in neuroretinal rim area and mean visual field defect.CONCLUSIONS: For nonhighly myopic (< -8 diopters) patients with primary or secondary chronic open-angle glaucoma, the refractive error may not play a major role for the amount of glaucomatous optic neuropathy. For nonhighly myopic (< -8 diopters) patients with primary or secondary chronic open-angle glaucoma, myopia may not be an important risk factor for glaucoma.     

Clinical implications of peripapillary atrophy in glaucoma

PURPOSE OF REVIEW: To elucidate peripapillary atrophy in glaucomatous optic neuropathy; its ranking in the morphologic diagnosis of the glaucoma, and its value for the differentiation of various types of chronic open-angle glaucoma, for the separation of glaucomatous eyes from nonglaucomatous eyes, and for the detection of progression of glaucoma. RECENT FINDINGS: Recent studies showed an association of peripapillary atrophy with glaucoma and the eventual development of glaucomatous disc hemorrhages independent of a small neuroretinal rim area, and an association between increasing peripapillary atrophy and progressive glaucoma. A ranking of optic disc parameters to detect glaucomatous damage revealed that the alpha and beta zones of peripapillary atrophy, compared with neuroretinal rim parameters, are less useful. Pseudoexfoliation syndrome without glaucoma is not a risk factor for peripapillary atrophy. In arteritic anterior ischemic optic neuropathy, peripapillary atrophy does not enlarge. Peripapillary atrophy does not differ markedly between Europeans and South Indians. In contrast to the position of the central retinal vessel trunk, the presence and position of cilioretinal arteries do not markedly influence the progression of peripapillary atrophy in glaucoma. SUMMARY: Peripapillary chorioretinal atrophy is one among several morphologic variables to detect glaucomatous abnormalities. Ranking optic disc variables for the detection of glaucomatous optic nerve damage, peripapillary atrophy is a variable of second order. It is useful for the differentiation of various types of chronic open-angle glaucomas. In contrast to glaucomatous eyes, eyes with nonglaucomatous optic nerve atrophy, including eyes after arteritic anterior ischemic optic neuropathy, do not show an enlarged peripapillary atrophy.     

Predictive factors of the optic nerve head for development or progression of glaucomatous visual field loss

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for the development or progression of visual field loss in chronic open-angle glaucoma. METHODS: The prospective observational clinical study included 763 eyes of 416 white subjects with ocular hypertension and chronic open-angle glaucoma. During the follow-up time (mean, 67.4 months; median, 65.1; range, 6.2-104.5), all patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs and white-on-white visual field examination. Progression of glaucomatous visual field damage was defined by point-wise regression analysis for each of the 59 locations in the visual field. Outcome measures were qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Development or progression of glaucomatous visual field defects was detected in 106 (13.9%) eyes. At baseline of the study, neuroretinal rim area was significantly (P < 0.002) smaller, the beta zone of parapapillary atrophy (P < 0.003, nasal sector) was significantly larger, and age was significantly higher (P < 0.003) in the progressive study group than in the nonprogressive study group. Both study groups did not vary significantly in size of the optic disc and the alpha zone of parapapillary atrophy. Cox proportional hazard regression analysis revealed that the progression of glaucomatous visual field loss depended significantly on the area of the neuroretinal rim (P < 0.001) and age (P < 0.001), but was independent of diameter of the retinal arterioles and veins. CONCLUSIONS: Morphologic predictive factors for development or progression of glaucomatous visual field defects in whites are small neuroretinal rim area and large beta zone of parapapillary atrophy. Age is an additional nonmorphologic parameter. Progression of glaucomatous optic nerve head changes is independent of the size of the optic disc and alpha-zone of parapapillary atrophy and retinal vessel diameter.     

Monitoring glaucoma progression with visual evoked potentials of the blue-sensitive pathway

PURPOSE: To determine the value of visual evoked potentials with blue-on-yellow pattern stimulation in follow-up of glaucoma. METHODS: This prospective longitudinal concurrent study included a heterogeneous cohort of two groups, perimetric (n = 161) and preperimetric (n = 118), of patients with chronic open-angle glaucoma and 113 healthy control subjects. In the preperimetric glaucoma group, patients showed glaucomatous abnormalities of the optic disc, maximum intraocular pressure higher than 21 mm Hg, and unremarkable computerized visual field examination results. Patients underwent up to three VEP measurements with blue-on-yellow pattern stimulation, as well as qualitative and morphometric evaluation of color stereo optic disc photographs. Mean follow-up time between measurements was 24 months. VEP measurements were separately analyzed in preperimetric subjects, with and without progression of optic nerve damage. Progression of glaucoma was defined as increasing loss of neuroretinal rim. RESULTS: A separate analysis of VEP peak times in patients in the preperimetric group, with and without progression of glaucomatous optic nerve damage, showed no significant difference at baseline but a significant prolongation (P = 0.01) in patients with progressive disease, 2 years before morphologic changes were evident. VEPs in patients with nonprogressive disease were statistically unchanged during the observation period. The perimetric group and both preperimetric groups showed significantly prolonged VEP peak times in comparison with the control group (P < 0.001). CONCLUSIONS: In addition to photographic evaluation to detect glaucomatous disc atrophy, the blue-on-yellow VEP may be an objective electrophysiological tool for monitoring patients with glaucoma, because peak times are significantly associated with progression of optic nerve damage.     

Follow up of focal narrowing of retinal arterioles in glaucoma

AIM: To evaluate whether focal narrowing of retinal arterioles increases with progressive glaucomatous optic neuropathy. METHODS: Focal narrowing of retinal arterioles and area of neuroretinal rim were morphometrically evaluated on colour stereo optic disc photographs of 59 patients with primary open angle glaucoma, 22 patients with normal pressure glaucoma, 11 patients with secondary open angle glaucoma, and 31 patients with ocular hypertension. Minimum follow up was 8 months. Focal arteriolar narrowing was quantified by calculating the ratio of the vessel width in the broadest to the narrowest vessel part. RESULTS: In the subgroup of patients with progressive glaucomatous optic nerve damage (n = 37), focal narrowing of retinal arterioles increased significantly (p < 0.005) with decreasing neuroretinal rim area. In the subgroup of patients with stable appearance of the optic disc (n = 86), focal narrowing of retinal arterioles did not change significantly (p = 0.79). The positive correlation between increasing focal thinning of retinal arterioles and progression of glaucomatous optic neuropathy was present, although not statistically significant, in all the glaucoma subtypes examined. The location of focal thinning of retinal arterioles did not change in the follow up. CONCLUSIONS: Focal narrowing of retinal arterioles increases significantly with progressive glaucomatous optic neuropathy, independent of the type of glaucoma. It is stable in patients with non-progressive glaucoma. The findings agree with previous reports on a higher degree of focal arteriole narrowing in eyes with pronounced optic nerve damage in comparison with those with moderate optic nerve atrophy or normal eyes. In the clinical management of patients with glaucoma, in some eyes, increasing focal arteriole narrowing may suggest progression of disease.     

Nachfolgeuntersuchung von Augen mit chronischem Offenwinkelglaukom und streifenförmigen Papillenblutungen

PURPOSE: To evaluate the frequency of neuroretinal rim loss in glaucomatous eyes with ophthalmoscopically detected optic disc hemorrhages. METHODS: The prospective comparative clinical observational study included 78 eyes from 69 Caucasian patients with chronic open-angle glaucoma and a flame-shaped optic disc hemorrhage at the time of presentation, and 386 eyes from 252 patients with chronic open-angle glaucoma without disc hemorrhages. All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. RESULTS: Patients with disc hemorrhages were older than patients without hemorrhages and showed an initially smaller neuroretinal rim area. Of the 78 eyes with disc hemorrhages 39 showed loss of neuroretinal rim during the follow-up period. For the remaining 39 eyes, no changes of the neuroretinal rim could be detected on optic disc photographs. Of the 386 eyes without disc hemorrhages 71 showed loss of neuroretinal rim during the follow-up period. A survival analysis confirmed a hazard ratio of three between eyes with and without disc hemorrhages and a hazard ratio of 1.85 per decade of patient's age (multivariate analysis). CONCLUSIONS: Disc hemorrhages lead to a 3-fold increase of risk for further retinal rim loss in eyes with chronic open-angle glaucoma.     

Changes in optic disk characteristics and number of nerve fibers in experimental glaucoma.

We compared the change in cup/disk ratio and neuroretinal rim area-to-disk area to estimated change in the number of optic nerve fibers in 12 cynomolgus monkeys with unilateral experimental glaucoma. Changes in the cup/disk ratios and neuroretinal rim area-to-disk area were estimated from stereoscopic optic disk photographs that were obtained before and after the development of increased intraocular pressure. Change in the number of optic nerve fibers in the glaucomatous nerves was estimated by comparing them to their fellow normal nerves. A significant linear correlation was present between change in the cup/disk ratios and neuroretinal rim area-to-disk area, and estimated change in the number of optic nerve fibers (r > or = .85; P < .0002). In optic disks with initial cup/disk ratios of 0.2 to 0.3 and neuroretinal rim area-to-disk area of 0.9, an increase in the cup/disk ratio of 0.1 and a decrease of 0.1 in the neuroretinal rim area-to-disk area is associated with a 10% and 9% loss of optic nerve fibers, respectively.     

Assessment of optic disk blood flow in patients with open-angle glaucoma

PURPOSE: To characterize optic disk blood flow in patients with open-angle glaucoma compared with age-matched healthy control subjects. METHODS: In this prospective cross-sectional study, 90 eyes of 90 patients with open-angle glaucoma and 61 eyes of 61 age-matched healthy control subjects were evaluated. Flow in the optic disk cup and the neuroretinal rim were assessed with scanning laser Doppler flowmetry. Fundus pulsation amplitude in the cup and the macula were assessed with laser interferometry. Visual field mean deviation was measured with the Humphrey 30 to 2 program. RESULTS: Flow in the neuroretinal rim (-18%, P =.002), and in the cup (-46%, P <.001) and fundus pulsation amplitude in the cup (-33%, P <.001) and in the macula (-24%, P <.001) were significantly lower in patients with open-angle glaucoma compared with healthy control subjects. A significant association between blood flow measurements in the cup and fundus pulsation amplitudes in the cup was observed in both study cohorts. A significant association was also observed between the mean defect from visual field testing and ocular hemodynamic parameters. CONCLUSIONS: Reduced optic disk perfusion in patients with open-angle glaucoma is evidenced from two independent methods in the present study. Moreover, our data indicate that reduced ocular blood flow in these patients is linked to visual field changes. It remains to be established whether compromised optic disk and choroidal blood flow contributes to optic disk damage in glaucomatous eyes or is a secondary functional phenomenon.     

Optic nerve blood flow is diminished in eyes of primary open-angle glaucoma suspects.

PURPOSE: The purpose of this study was to evaluate optic nerve blood flow in primary open-angle glaucoma suspect eyes with normal automated visual fields, in an attempt to elucidate how early in the glaucomatous disease process changes in optic nerve blood flow become apparent. METHODS: Twenty-one eyes (21 patients) suspected of having primary open-angle glaucoma were studied prospectively and compared with a previously reported cohort of 22 eyes (22 patients) with primary open-angle glaucoma and 15 eyes (15 subjects) of age-matched controls. Primary open-angle glaucoma suspect eyes had untreated intraocular pressure greater than 21 mm Hg and normal visual fields using Humphrey program 24-2 or 30-2 with a full threshold strategy. Laser Doppler flowmetry was used to measure optic nerve head blood velocity, volume, and flow at four quadrants in the optic nerve, in the cup, and in the foveola of one eye of each patient. The mean flow from the superotemporal rim, inferotemporal rim, and cup was calculated (Flow(3)) and identified as the main outcome measure. Measurements from primary open-angle glaucoma suspect eyes were compared with corresponding measurements from controls and eyes with primary open-angle glaucoma; a Student t test was employed with a Bonferroni corrected P value of.025 to account for comparisons of primary open-angle glaucoma suspects both to controls and to eyes with primary open-angle glaucoma. RESULTS: Compared with controls, Flow(3) was 24% lower in primary open-angle glaucoma suspect eyes (P <.0003). In primary open-angle glaucoma suspect eyes, flow was 16% lower in the superotemporal rim (P <.007), 35% lower in the cup (P <.007), and 22% lower in the inferotemporal neuroretinal rim (P <.029) compared with controls. No significant difference between primary open-angle glaucoma suspect and control eyes was seen in the inferonasal rim, superonasal rim, or foveola. No significant difference was detected at any location between primary open-angle glaucoma suspect eyes and eyes with primary open-angle glaucoma. CONCLUSIONS: Laser Doppler flowmetry detected circulatory abnormalities in primary open-angle glaucoma suspects who did not have any manifest visual field defect. Decreases in flow in glaucoma suspects were similar in magnitude to those of subjects with primary open-angle glaucoma. These data suggest that impaired optic nerve blood flow develops early in the glaucomatous process and does not develop solely as a result of glaucoma damage.     

Central corneal thickness and development of glaucomatous optic disk hemorrhages

PURPOSE: To evaluate whether central corneal thickness influences the development of optic disk hemorrhages in chronic open-angle glaucoma. DESIGN: Prospective observational clinical study. METHODS: The study included 390 eyes of 223 white subjects with chronic open-angle glaucoma observed during a mean follow-up time of 61.3 +/- 36.4 months. Central corneal thickness was measured by corneal pachymetry. RESULTS: The event of optic disk hemorrhages during follow-up was detected in 63 eyes (16.2%). Development of optic disk hemorrhages was, univariately (P = .73) as well as in a multiple Cox regression analysis, controlling for age, sex, normal tension glaucoma, intraocular pressure, neuroretinal rim area, and size of beta zone of peripapillary atrophy, statistically independent (P = .56) of central corneal thickness. CONCLUSIONS: Development of optic disk hemorrhages may not be markedly influenced by central corneal thickness.     

Einfluss zilioretinaler Gefäße auf funktionelle Schädigungen beim Offenwinkelglaukom

PURPOSE: The pattern of functional perimetric loss and morphologic neuroretinal rim loss in glaucoma depends on the localization of the central retinal vessel trunk in the lamina cribrosa. The purpose of the present study was to determine if the pattern of perimetric loss and rim loss are influenced by the presence and position of cilioretinal arteries. PATIENTS AND METHODS: Using automated perimetry and 15 degrees color stereo optic disc photographs of the optic disc, we compared 20 open-angle glaucoma patients exhibiting cilioretinal arteries in the temporal horizontal disc region with 70 open-angle glaucoma patients without cilioretinal arteries. RESULTS: Eyes with cilioretinal arteries and eyes without cilioretinal arteries did not differ significantly in global visual field indices nor in the mean defect for the central 10 degrees. No differences were detected for the areas of optic disc, neuroretinal rim, ratios of the temporal horizontal area-to-total area of rim and ratio of temporal horizontal rim area-to-nasal rim area. CONCLUSIONS: In contrast to the position of the central retinal vessel trunk, the presence and position of cilioretinal arteries do not markedly influence the pattern of glaucomatous damage.     

颅内压与青光眼及其无创测量技术的研究进展

青光眼是世界上第二位致盲性眼病,第一位不可复性致盲性眼病。尽管眼压增高被认为是青光眼性视神经损害的主要危险因素,但是50%的原发性开角型青光眼患者的日常眼压正常,还有一些患者尽管眼压控制良好,但青光眼性视神经损害仍继续发展。这些现象无法用高眼压理论来解释,青光眼患者视神经损害的发病机制仍待探讨。目前国内外的一些研究表明：（1）视神经周围的生物力学的解剖结构包括眼内压,筛板和球后的脑脊液压力在原发性开角型青光眼的发病机制中发挥重要的作用;（2）正常眼压性青光眼患者的脑脊液压力比正常人低,而跨筛板压力差比正常人高;（3）高眼压症患者的脑脊液压力比正常人群高,而跨筛板压力差和正常人之间没有统计学意义。基于以上研究,本文就颅内压与青光眼性视神经损害之间关系的相关研究进展及临床上可行的无创颅内压测量方法作一综述。     

原发性开角型青光眼不同发展阶段盘沿缺失的形态特征及其临床意义

目的:探讨青光眼病情发展阶段盘沿缺失的形态特征。方法:对青光眼92眼和正常人124眼进行立体彩色视盘照像,侧重分析盘沿的形态。结果:与视力正常眼比较,青光眼不同病情阶段盘沿缺失有其好发区域。早期青光眼盘沿缺失在视盘颞下极明显,中期青光眼盘沿缺失在颞上极较为明显,极晚期青光眼盘沿仅保留视盘鼻侧区域,并且鼻上区大于鼻下区。结论:青光眼盘沿缺失的形态特征与青光眼性视野缺损的发展及筛板的形态密切相关。     

Parapapillary atrophy in patients with focal visual field loss

PURPOSE: To examine parapapillary atrophy in normal subjects and patients with primary open-angle glaucoma with focal visual field loss. METHODS: Twenty-nine patients with repeatable early focal visual field loss according to standard automated perimetry (Humphrey program 24-2) and 29 matched (age and disk area) normal subjects were included. Parapapillary atrophy area and optic disk topography were evaluated with a confocal scanning laser ophthalmoscope. The difference in parapapillary atrophy area between normal subjects and patients with glaucoma was examined. Optic disk topography was evaluated by means of the rim-disk area ratio in 36 10-degree sectors and classified into diffuse and focal patterns of neuroretinal rim thinning. In patients with a focal pattern, the locations of rim thinning and parapapillary beta zone atrophy were compared. RESULTS: Beta zone atrophy was detected more frequently in patients with glaucoma (45% [13/29]) than in normal subjects (7% [2/29]), and it was located both superiorly and inferiorly in 92% (12/13) of the glaucoma patients. Alpha zone atrophy was significantly larger in patients with glaucoma than normal subjects (P = .009) but not more frequent (97% [28/29] in both groups). Sixty-one percent (8/13) of glaucoma patients with beta atrophy had diffuse thinning and 31% (4/13) had focal thinning. Eight percent (1/13) did not have neuroretinal rim thinning. In the four patients with both focal rim thinning and beta zone atrophy, the location of rim thinning corresponded to the location of the beta zone atrophy (100% [4/4]). CONCLUSIONS: In patients with early focal glaucomatous visual field loss, the presence and location of parapapillary beta zone atrophy and neuroretinal rim thinning are in good correspondence. Observation of localized parapapillary beta zone atrophy in clinical practice should direct one to more closely examine the optic disk in this region, as it may reveal localized rim thinning in a disk previously considered to be normal. Moreover, diffuse structural change in an eye with only focal functional change, as determined by standard automated perimetry, is consistent with the possibility that structural damage may be more widespread than functional damage in these patients.