A Clinical Study for Terminal Stage of Primary Glaucoma

As glaucoma progresses, the visual field changes continuously and the disk cupping 'enlarges progressively' At the terminal stage the visual field constrics concentrically and the disk cupping enlarges markedly with or without atrophic changes. Also many other ocular tissues run degenerative courses. Author studied 157 pat1ents(215 eyes) who visited Busan National University Hospital 'during the period from January 1976 to December 1980. The duration of follow-up ranged from 3 months to 3 years. Among the 215 glaucoma eyes terminal stage of primary glaucoma which was classified as author's criteria were 76 eyes(67 patients). The clinical analysis of the terminal stage of primary glaucoma were resumed as follows: 1. There were 83 patients(121 eyes, 56.3%) of primary glaucoma in total 157 glaucoma patients(215 eyes). 2. 61 eyes(80.3%) of the 76 eyes of terminal glaucoma showed ocular finding which disturbed visual acuiy. Those ocular findings were as follows: Bullous keratopathy(38.3%), lens sclerosis(9.2%). anterior chamber flare(11.8%), pigments on the corneal endothelium and anterior lens capsule(9.2%), vitreous floaters(1.3%), cataract(5.4%), corneal ulcer(1.3%). 3. Systemic diseases found in the terminal glaucoma patients were hypertension with cardiologic problems(6.5%), diabetes mellitus(1.6%), and thyrotoxicosis(1.6%). 4. 36 patients(58.1%) of the terminal glaucoma patients accompanied glaucoma in the opposite eye, and 14 patients(22.6%) were bilateral terminal glaucoma patients. 5. Medical treatment only was effective in 8 eyes(14.8%) and surgical treatments were effective in 30 eyes(76.9%) of the treated terminal glaucoma eyes. 6. The average duration from the time of initial appearance of the glaucomatous symptoms to the time diagnosed as terminal stage glaucoma was 2 years and 5 months in open-angle glaucoma and 50 days in angle-closure glaucoma.

Congenital Absence of the Canaliculus and Punctum

Absence or atresia of the canaliculus and punctum is rare. The primordium of the lacrimal passage which is derived from surface ectoderm is developed along the line of the cleft between the lateral nasal and the maxillary processes at about 10 mm. (5th week) embryo. At 15 mm. (6th week) embryo, it becomes detached from the surface ectoderm to form an irregular solid rod of cells; the epithelial cord thus formed represents the rudiments of the lacrimal passages. By bud-like cutgrowths from the upper extremity of the uppermost rod of cells, these are rudiments of the lacrimal canaliculi and they reach the epithelium of the lid margins at the 35 mm. embryo. During the 3rd month the central cells of the solid rod begin to disintegrate; the originally solid naso-lacrimal passages thus become canalized. Although the lumina of the canaliculi become patent during the 4th month, the lacrimal puncta do not open onto the lid margins until just before the lids separate during the 7th month. The three main types of developmental anomaly affecting the passages are gross changes; due to failure in the regular fusing of the nasal and maxillary processes, samller changes: due to an abnormal course being followed by the budding cells, and failures in canalization resulting in atresia. Authors presented 2 cases of absence of puncta combined with atresia of canaliculi which send to be resulted from failure in canalization.