A case of optic nerve atrophy with severe disc cupping after methanol poisoning

We report a rare case of optic nerve atrophy with severe disc cupping resulting from methanol poisoning. A 30-year-old man presented to the hospital complaining of decreased visual acuity in both eyes a day after drinking alcohol containing methanol. His initial visual acuity allowed for only visualizing hand motion and not corrected in either eye. Initial intraocular pressure was within normal limits in both eyes. Initial fundus examination showed optic disc swelling in both eyes. Four years later, he visited our hospital for an eye evaluation. Visual acuity in both eyes still only allowed for visualizing hand motion. No nystagmus was observed in either eye during the optokinetic nystagmus test, and no waves were found in a visual evoked potential test. No specific change was noted on brain magnetic resonance imaging. On fundus examination, there was disc pallor in both eyes and disc cupping with a high cup/disc (C/D) ratio above 0.9 in the left eye. C/D ratio of the right eye was 0.5. Methanol poisoning may induce glaucomatous disc cupping in the late stage as well as optic atrophy. One possible mechanism of disc cupping is ganglion cell loss due to acute demyelination of the retrobulbar optic nerve. This report is the first photographic evidence of methanol induced optic disc cupping in Korea.     

Optic disc cupping: prevalence findings from the WESDR

Increased cupping of the optic disc is considered to be an indication of pressure-related damage of the optic nerve. This paper explores the relationship of intraocular pressure and cupping in persons with diabetes mellitus, a group of people whose optic nerves may be more susceptible to the effects of intraocular pressure. Stereoscopic fundus photographs of the seven standard fields were obtained in all persons participating in the Wisconsin Epidemiologic Study of Diabetic Retinopathy at the time of the initial prevalence survey. Measurements of disc and cup diameters in the vertical and horizontal meridia were made by two trained graders. Cup-to-disc ratios were computed for both diameters of each eye and the mean of the two gradings was used. A history of glaucoma was significantly associated with larger cup-to-disc ratios at the prevalence examination. Cup-to-disc ratios were not larger in those with high IOP, nor in those who had panretinal photocoagulation.     

Correlation between neuroretinal rim and optic disc areas in normal melanoderm and glaucoma patients

BACKGROUND: To evaluate optic disc size and its relationship with neuroretinal rim areas. MATERIAL AND METHODS: The study was prospective; 400 hundred patients with 292 glaucomatous and 108 non glaucomatous were enrolled in this study.Optic disc size quantification was assessed by the use of Goldmann 3 mirror contact lens; diameter reading were adjusted by the magnification factor of the lens, squares of the disc and the cupping were calculated using an ellipse formula, the neuroretinal rim area was then obtained by reducing the cupping area from the whole optic disc area. RESULTS: The mean age of the sample was 36.80 years (sd: 15.68 years).The average value of the vertical disc diameter was 2.045 mm (sd: 0.254) for glaucoma patients and 1.966 mm (sd: 0.237) in the control group; p<0.001. Neuroretinal rim area was 1.886 mm(2) (sd: 0.675) in the glaucoma group; and 2.165 mm(2) (sd: 0.425) in the control one; p<0. 004. In the glaucoma group, 72.97% of large optic disc were found (vertical diameter over 1.90 mm); and 63.80% in the control one. In the control group, neuroretinal rim area was wider in the large optic discs compared to the small discs, p<0.001, Anova test. Neuroretinal rim area was thinner in the glaucoma large disc compared to the control, p<0.005, Student test. Meanwhile, there was no difference in the medium and the small discs in the glaucoma and control groups; p > 0.005, Student Newmann test. CONCLUSION: Neuroretinal rim areas are thinner in the large glaucoma discs compared to the non glaucoma large discs. In Africa, this parameter could be helpful in the diagnosis and survey of glaucoma patients.     

Frequency of sustained glaucomatous-type visual field loss and associated optic nerve cupping in Beaver Dam, Wisconsin

Purpose : To determine the prevalence of persisting glaucomatous‐type visual field loss in a Midwestern American adult population, in association with four grades of disc cupping. Methods : On two separate occasions (1988–1990 and 1993–1995) 2955 predominantly Caucasian adults aged 43–84 provided medical history, underwent applanation tonometry, slit‐lamp examination, quantitative suprathreshold perimetry and stereoscopic disc analysis as part of the National Institutes of Health‐sponsored Beaver Dam Eye Study. Those demonstrating evidence of glaucomatous‐type visual field loss at both visits were the subject of the present analysis. Among these individuals, associations were determined for four categories of optic disc cupping (vertical cup/disc < 0.5, > 0.5, > 0.6, > 0.8), intraocular pressure, blood pressure, cardiovascular pathology and prior glaucoma diagnosis. Results : Of the 2955 subjects assessed, 120 (4%; 57 women, 63 men) demonstrated glaucomatous‐type visual field defects at each visit. Fifty‐five of these 120 (2% of the tested population) also exhibited some degree of disc cupping in a related eye at both visits. Among these 2%, positive associations relating the extent of field loss, cupping and intraocular pressure were confirmed, but the majority in each cupping category had normal eye pressures. Only seven of the 120 were aware of the presence or suspicion of eye disease prior to the screening. Conclusions : A majority of those found to have visual field loss and optic nerve cupping persisting together in the same eye after 3–5 years had normal pressures in each eye at both visits. Despite good access to medical care, very few who demonstrated persisting cupping and field loss (even among those with elevated eye pressure) were aware of their ocular condition through prior contact with an eye care professional.     

Reversal of optic disc cupping after trabeculotomy in primary congenital glaucoma

BACKGROUND: The phenomenon of reversal of glaucomatous cupping of the optic disc following lowering of the intraocular pressure (IOP) was originally recognized in infants. We evaluated the change in optic disc cupping with normalization of the IOP after trabeculotomy in primary congenital glaucoma and assessed the factors associated with reversal of cupping. METHODS: We reviewed the records of 17 patients (24 eyes) who underwent trabeculotomy between July 1993 and June 1999 and who had been followed for at least 1 year. Surgical success was defined as IOP less than 22 mm Hg without anti-glaucoma medication, stable or reduced optic disc cupping, and lack of further corneal enlargement disproportionate to normal growth. Patients who required more than one surgical procedure to control the IOP and those with cloudy media that precluded documentation of cupping were excluded from analysis. Optic disc cupping was assessed independently before and after surgery by two clinicians. The cup:disc ratio was estimated as the percentage of surface area of the optic disc occupied by cupping in the vertical axis. We accepted a difference of 0.1 or 0.2 in the cup:disc ratio between the two observers in each subjective assessment and used the mean value of the two results for data analysis. If the difference was more than 0.2, the eye was excluded from further study. RESULTS: Of the 17 patients 4 were excluded: 2 because they received antiglaucoma medication to control the IOP postoperatively, 1 because he underwent more than one surgical procedure to control the IOP during follow-up, and 1 owing to disagreement in the assessment of the cup:disc ratio between the two observers. Eighteen eyes of 13 patients were thus included in the analysis. Twelve eyes were from boys and six, from girls. The patients were followed for a mean of 43.2 (standard deviation [SD] 30.4) months (range 12 to 90 months). The mean cup:disc ratios pre- and postoperatively were 0.74 (SD 0.20) and 0.60 (SD 0.21) respectively (p = 0.003). Of the 18 eyes 11 (61.1%) had documented reduction in optic disc cupping. The mean time to stabilization of cupping reversal was 4.8 (SD 2.8) months (range 2 to 12 months). In multivariable analysis the age of the patient at surgery was the only variable significantly associated with reversal of cupping (p = 0.027). The mean age at surgery for the 11 eyes with reduction in cupping was 6.9 (range 3 to 15) months, compared with 23.4 (range 12 to 42) months for the 7 eyes with unchanged cupping. The mean preoperative cup:disc ratio was 0.67 (SD 0.17) in the former group and 0.83 (SD 0.17) in the latter group. Six of the seven eyes with unchanged cupping had advanced cupping. INTERPRETATION: Optic disc cupping can be reversed at an early stage of primary congenital glaucoma following successful reduction of IOP. Younger age at surgery was associated with reversal of cupping.     

Changes in reversal of cupping in experimental glaucoma. Longitudinal study.

BACKGROUND: The authors prospectively and longitudinally studied changes in optic disc topography during spontaneous reduction of intraocular pressure (IOP) in five monkeys with experimental glaucoma, using a computerized image analyzing system (Topcon IMAGEnet). METHODS: Glaucomatous optic neuropathy was produced in one eye of each animal by repeated argon laser photocoagulation of the trabecular meshwork. The duration of follow-up was 12 months. After laser treatment, IOP fluctuated and tended to increase. Spontaneous reduction in IOP was frequently observed during follow-up. Changes in optic disc parameters (vertical and horizontal cup-to-disc ratios, rim area/disc area, cup volume/disc area) that accompanied a given magnitude of spontaneous reduction in IOP at the early stage of glaucoma (first 4 months of follow-up) were compared with those at the later stage of glaucoma (last 4 months of follow-up). RESULTS: All optic disc parameters improved significantly during IOP reduction at each stage of glaucoma. Although there was no significant difference between the two stages in the magnitude of IOP reduction, the extent of improvement in each disc parameter was significantly less in the later stage than in the early stage. In both stages, reversal of cupping occurred symmetrically in the vertical and horizontal dimensions. Expansion of the cup occurred symmetrically in the early stage, but this was predominantly vertical in the later stage. CONCLUSION: These results suggest that the extent of cupping reversal after IOP reduction may decrease with progressive glaucomatous damage in primate glaucoma.     

A population based survey of the prevalence and types of glaucoma in rural West Bengal: the West Bengal Glaucoma Study

AIM: To determine (i) the prevalence of glaucoma in people aged > or =50 years, (ii) the proportions of different types of glaucoma, (iii) the distributions of intraocular pressure and vertical cup disc ratio. METHOD: Population based prevalence survey in rural West Bengal. People aged > or =50 years in randomly selected villages in 24 Parganas South district. The main outcome measures were diagnosis of glaucoma, based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. RESULTS: 1594 people aged > or =50 years were enumerated in nine villages; 1324 (83.1%) were surveyed and 1269 people adequately examined. 42 definite cases of glaucoma were identified, with prevalence increasing from 2.7% (95% CI 1.7 to 3.7) in people aged 50-59 years to 6.5% (95% CI 0.0 to 14.1) in those aged > or =80 years. The age standardised estimate for the prevalence of all glaucoma in people aged > or =50 years was 3.4%. Only three cases of primary angle closure glaucoma (PACG) were identified, giving a crude ratio of primary open angle glaucoma (POAG) to PACG of more than 10:1. Three people with glaucoma were blind in one eye but none was blind in both eyes. CONCLUSION: Compared to other surveys of glaucoma in India, the age standardised prevalence observed was less than in Hyderabad, but similar to Tamil Nadu and Dhaka. The ratio of POAG to PACG was much higher than found previously, suggesting that PACG may be less prevalent in Bengalis than in Indian populations living in south India. The authors conclude that ophthalmic services in West Bengal should focus on detecting POAG. Since there is still no satisfactory method of screening for POAG, there is no alternative to case detection (opportunistic screening) in eye clinics.     

Changes in optic disc in ocular hypertension and glaucoma

Most ophthalmologists use subjective methods to evaluate the optic disc for abnormalities and changes that occur in ocular hypertension and glaucoma. We have developed new techniques that allow more accurate evaluation of the blood supply to the optic disc and of changes in disc cupping and pallor. To evaluate the blood supply we use the technique of fluorescein angiography of the optic disc. With this technique, we have found that fluorescein defects commonly appear in open-angle glaucoma and ocular hypertension and are more frequent and larger in glaucomatous and ocular hypertensive discs than in normal optic discs. Fluorescein angiography demonstrates distinct changes in the blood supply to the optic disc in the glaucomatous or ocular hypertensive eye. Cupping of the optic disc is measured by photogrammetry from stereophotographs, which provide three-dimensional measurements not only of the volume of the cup, but of the depth, the slopes of the walls of the optic cup, and the area of the surface opening. This technique also allows us to determine a volume profile of the cup: that is, its cross-sectional area from top to bottom. The volume profile characterizes the shape of the optic cup and shows distinct differences in shape between normal, ocular hypertensive and glaucomatous cups. Pallor is measured by computerized image analysis. This technique allows us to determine the percent area of pallor of the optic disc. These three techniques permit us not only to evaluate abnormalities, but to measure changes over time in the optic disc in ocular hypertension and glaucoma, thereby increasing our diagnostic capability and improving patient management.     

假性剥脱综合征中的Charles Bonnet综合征(英文)

目的:报道1例进展期假性剥脱性青光眼中的Charles Bonnet综合征。方法:病例报告。结果:一例92岁的马来男性诉2a前出现幻视,并加重2mo。称看见成人及百余儿童生动活泼地出现在不同场合。他甚至有几次看见一只兔子偶尔跑过他的房间。但是,他觉察到这是一种异常的经历。与同年龄人相比,他的认知功能是正常的。精神病学评估包括精神状态检查是正常的。他曾经被诊断患有开角型青光眼,左眼以前接受过常规的白内障手术和小梁切除术。其视力为右眼手动,左眼6/7.5(0.8)伴管状视野。眼底镜检查显示左眼进行性青光眼性视杯加深。目前诊断为右眼大泡性角膜病变合并绝对期青光眼,左眼进展期假性剥脱性青光眼,有功能性滤过泡。结论:对诉有幻视的老年患者,特别是在痴呆和精神病的诊断标准不明确的情况下,诊断通常是很困难的。如果这些患者洞察到不复存在的东西进入其视觉范围,并伴有视觉功能恶化,应高度怀疑患有Charles Bonnet综合征的可能。     

Prevalence and risk factors for angle‐closure disease in a rural Northeast China population: a population‐based survey in Bin County,Harbin

Purpose: To estimate the prevalence of primary angle‐closure glaucoma (PACG), primary angle closure (PAC) and primary angle‐closure suspect (PACS) and associated risk factors for PACG in a rural population in Northeast China. Methods: A population‐based survey was conducted in Bin County, Harbin, Northeast China. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. All subjects underwent a complete ophthalmic examination. Results: A total of 4956 (86.01%) of 5762 subjects aged 40 years or older were examined. The mean intraocular pressure (IOP) of the right eyes was 14.0 mmHg. The mean vertical cup‐to‐disc ratio of the right and the left eyes was 0.31 and 0.31, respectively. The prevalence of PACG, PAC and PACS was 1.57% [95% confidence interval (CI), 1.469–1.671], 1.33% (95% CI, 1.236–1.424), and 4.68% (95% CI, 4.541–4.819), respectively. Among all PACG subjects, 42 (53.84%) had elevated IOP >21 mmHg in either eye and 37 (47.44%) had been treated by laser, surgical iridectomy or trabeculectomy. Sixty‐four subjects (82.05%) had vision impairment of varying degrees. Multivariate analysis revealed that old age, family history of PACG, constipation and IOP were significant independent risk factors. Conclusions: Primary angle‐closure glaucoma was a disease of high prevalence in rural Northeast China. Old age, family history of PACG, constipation and IOP were significant independent risk factors for PACG.     

Measurements of reversibility of optic disc cupping in glaucoma using a computerized videographic image analyzer

Optic disc changes were studied in young and elderly glaucoma patients who underwent reduction of intraocular pressure (IOP) by filtrating surgery. A computerized videographic image analysis system (Optic Nerve Head Analyzer, Rodenstock) was used to measure the cup/disc-ratio, the ratio of the rim area over the disc area (rim area/disc area-ratio), and the ratio of the cup volume over the disc area (cup volume/disc area-ratio) before and after filtrating surgery. Each parameter was assessed as total and quadrantal values. Materials consisted of 19 eyes of 15 patients (8 eyes of 5 patients with primary open angle glaucoma, 2 eyes of 2 patients with secondary glaucoma, and 9 eyes of 7 patients with developmental glaucoma). Sixteen eyes (84%) of 12 patients showed a decrease of the total cup/disc-ratio after operation. In this group, the patients had a decrease in IOP of 18.9 +/- 10. 6mmHg (mean +/- SD) after the operation. Among 16 eyes that had a decreased total cup/disc-ratio, statistically significant decrease of the cup/disc-ratio (p less than 0.01) and statistically significant increase of the rim area/disc area-ratio (p less than 0.01) were noted in total and for all quadrants except for the temporal. The greatest improvement of cupping was seen in the nasal quadrant. With regard to cup volume/disc area-ratio, a statistically significant decrease was observed in total and in all quadrants (p less than 0.01). The IOP change correlated linearly with that of the total cup volume/disc area-ratio (R = 0.51, p less than 0.05). No statistically significant linear correlation was noted between age and the change in any disc parameter.     

Optic Disc Cupping in Arteritic Anterior Ischemic Optic Neuropathy Resembles Glaucomatous Cupping

Five cases of anterior ischemic optic neuropathy secondary to biopsy-proven giant cell arteritis are presented. In each case, cupping of the optic disc, which closely resembled glaucomatous cupping, was observed in the affected eye. The presence of glaucoma was ruled out on the basis of normal intraocular pressures and normal tonographic measurements of facility of outflow. These cases indicate that arteritic ischemic optic neuropathy can result in optic disc cupping, which closely resembles glaucomatous cupping. The similarities in the appearance of cupping of these discs with that seen in eyes with glaucoma suggest that the pathogenesis of cupping in glaucoma and in arteritic ischemic optic neuropathy may share some common mechanisms.     

Optic disc imaging in conscious rats and mice

PURPOSE:To determine whether useful images of the optic discs of conscious rats and mice can be obtained by using a photo slit lamp and a modified Goldmann-type fundus contact lens. METHODS: Testing was performed with a photo slit lamp equipped with two 2x teleconverters and a digital camera through a Goldmann-type fundus contact lens that was fabricated for the rodent eye. RESULTS: Images of the rat and mouse optic discs were obtained that are comparable to those used by ophthalmologists to assess optic neuropathy in glaucoma, a key part of the standard of care and of clinical investigation of this disease. The cup in the optic disc image of these rodents is darker than the neural rim of the disc, rather than lighter, as it is in humans. CONCLUSIONS: In addition to the application of this imaging method to studies of the effect on optic disc cupping of induced increased intraocular pressure in rats and mice, by detecting and documenting the onset and the course of optic neuropathy, it should be valuable in identifying animal models of glaucoma, in studying neuropathogenic mechanisms, and in assessing the effects of experimental therapies.     

Splinter Hemorrhage Associated with Low Tension Glaucoma

The case of a patient with an asymptomatic splinter hemorrhage on the left disc and previously noted central cupping of both discs is reported. The a etiology of the hemorrhage is F investigated with respect to open angle glaucoma and ^A systemic hypertension.     

Chronic angle closure glaucoma secondary to frail zonular fibres and spherophakia

PURPOSE: We describe a 39-year-old Japanese woman with chronic angle closure glaucoma secondary to spherophakia and frail zonular fibres. The patient was 143 cm in height with short fingers and had no family history of eye problems. High intraocular pressure, total optic disc cupping and severe visual field constriction were found in the right eye. METHODS: The patient was treated successfully with trabeculectomy in the right eye and laser iridotomy in the left eye. CONCLUSION: The clinical findings imply that this was a borderline case of Weil-Marchesani syndrome.     

Rate of optic disc cup progression in treated primary open-angle glaucoma

PURPOSE: To quantitatively evaluate the rate of cup-to-disc ratio progression in treated patients with primary open-angle glaucoma and to identify clinical factors associated with cup progression. PATIENTS AND METHODS: Fifty one eyes of 51 treated primary open-angle glaucoma patients with a minimum of 9-year longitudinal series of stereoscopic optic disc photographs were studied. Eyes with any other ocular disease except for mild cataract were excluded. Each set of stereoscopic photographs was digitized and viewed stereoscopically on a computer screen using a hand-held stereoscope. Computer-aided planimetry was performed on each set of photographs with examiner-defined cup and disc margins using custom-made software. The software computed linear cup-to-disc ratios as well as peripapillary atrophy area. Both inter-observer and intra-observer reliabilities were evaluated in a masked, random fashion using intra-class correlation. Changes in linear cup-to-disc ratios and peripapillary atrophy were estimated using linear regression over time. All available clinical factors were evaluated for association with the rate of cup progression using a multiple regression model. RESULTS: All patients studied were Caucasian; 31(61%) were females. The mean age at the beginning of the study was 61.6 +/- 7.8 years (range 46-81). The mean follow-up period was 14.3 +/- 3.5 years (median 14.0, range 9.6-22.3). A total of 173 sets of stereo disc photographs were analyzed (3.4 +/- 1.3 per patient). The initial and final linear cup-to-disc ratios were 0.64 +/- 0.15 and 0.73 +/- 0.14 respectively. The inter-rater and intra-rater intraclass correlations were 0.76 (95% CI 0.61-0.87) and 0.97 (95% CI 0.93-0.98) respectively. Using linear regression the rate of linear cup-to-disc ratio change was 0.0068 +/- 0.0062 per year (range -0.0025- 0.0269). Three eyes had an increase in the peripapillary atrophy area. The higher yearly average intraocular pressure was significantly associated with faster rate of linear cup-to-disc ratios progression (P = 0.03). CONCLUSIONS: In treated patients with primary open-angle glaucoma, the rate of progressive optic disc cupping was slow (LCDR progression of 0.0068 per year). The higher yearly average intraocular pressure was significantly associated with a faster rate of cup progression.     

Early optic disc changes in open-angle glaucoma

INTRODUCTION: Early diagnosis of chronic open-angle glaucoma is difficult: early changes in the optic disc often precede troubles in the field of vision, which occur gradually with no typical initial aspect. We report here the results of optic disc observations in normal subjects who became glaucomatous. OBSERVATIONS AND METHODS: A study was conducted on 64 eyes of 51 subjects followed on average over 12 years. At the start these eyes were normal or at risk for glaucoma for various reasons. Doubtful, difficult cases (severe myopia, dysversion or with associated pathology) were eliminated. Eventually, all the eyes presented open-angle glaucoma. All patients underwent clinical and paraclinical examinations by the same examiner. The optic discs of 78 dilated eyes were examined with a slit lamp and a 78-dioptre lens and the results systematically tabulated. Of the 78 optic discs, 40% had initial morphological characteristics (including cup/disc ratios) that were difficult to identify precisely. Preference was given to certain criteria that were easy to evaluate and likely to change. RESULTS: The classic aspects of glaucomatous papillary excavation appearance were observed. Forty-four discs showed notable changes (19 typical changes, 25 atypical), which were observed before visual field abnormalities. The size of the disc influences how the disease develops. Also noted were the frequency of changes in the slope of the papillary profile curve (third moment) and the frequency of changes in the quality of the papillary tissue, which takes on a translucent character locally. CONCLUSION: Documented and comparative observation of the optic disc remains a good and simple means for supervising subjects at risk for and in early diagnosis of chronic open-angle glaucoma. The evaluation of changes in the optic disc is greatly aided by the collection and the systematic recording of observations.     

Optic disc morphology in porencephaly

Purpose. To report a porencephalic cyst in a child with large optic disc cup but normal-sized discs. Methods. Case report with figures. Results. Clinical findings of a patient with porencephaly presenting with large cups in normal-sized optic discs are discussed. Conclusions. Optic disc morphology is not a reliable indicator of the timing of ischemic brain injury. Intracranial pathology should be suspected in children with disc cupping but no other features of glaucoma.     

Longitudinal changes in central corneal thickness and their relation to glaucoma status: an 8 year follow up study

AIMS: To determine if central corneal thickness (CCT) changes over time and if this change relates to glaucoma progression. METHODS: 39 patients (64 eyes) with open angle glaucoma, ocular hypertension, glaucoma suspect status, or a normal eye examination were examined at two visits. CCT, age, race, sex, family history of glaucoma, presence of diabetes and systemic hypertension, diagnosis, visual acuity, spherical equivalent, intraocular pressure, vertical and horizontal cup to disc ratios, number of glaucoma medications prescribed, Advanced Glaucoma Intervention Study (AGIS) score and mean deviation of Humphrey visual fields, and interventions required were recorded. Statistical analysis used the Wilcoxon signed ranks test, linear regression, and analysis of variance. RESULTS: Between the two visits (mean 8.2 years apart), mean CCT decreased by 17 mum in right eyes (p<0.002) and by 23 mum in left eyes (p<0.001). This decrease was greater in right eyes of patients with primary open angle glaucoma than in normals (p = 0.041). There was no significant association between change in CCT and other examination parameters. Change in CCT was not associated with topical carbonic anhydrase inhibitor use. CONCLUSION: In this longitudinal study, CCT decreased over time, but this may not be related to glaucoma progression.     

Changes in optic disc parameters after intraocular pressure reduction in adult glaucoma patients.

PURPOSE: To quantitatively evaluate the change in the optic disc topographic parameters associated with reduction in the intraocular pressure (IOP) after trabeculectomy in adult patients with glaucoma. METHODS: A series of 22 patients (mean age: 45.7+/-15.1 years) with several types of glaucoma were examined for various parameters of optic disc before and after trabeculectomy. Cup area, cup-to-disc area ratio, cup volume, rim volume, mean cup depth, and maximum cup depth were determined by means of laser scanning tomography (LST), and the parameters were correlated with the degree of postsurgical IOP decrease. RESULTS: The IOP in adult glaucoma patients showed significant reductions after trabeculectomy. The values for all topographic parameters examined. except cup volume, showed statistically significant postsurgical changes as compared to the presurgical values. Of all postsurgical changes in parameters. the increase in the rim volume was the most noticeable; it was remarkably evident in those eyes with postsurgical IOP levels less than 15 mm Hg. It was also demonstrated that the anterior displacement of the glaucomatous cupping may occur after surgery. CONCLUSIONS: It is obvious that optic disc parameters can change after IOP reduction after successful surgery in adult glaucoma patients as well as in infantile glaucoma patients. The site of changeable glaucomatous optic cupping is topographically variable among patients and it may be related to the presurgical shape of the optic cup.