The Difference of Reversal of Glaucomatous Cupping After Filtration Surgery Between Advanced Glaucoma and Less Advanced Glaucoma

We investigated whether there was any difference in the extent of cupping reversal after reduction of intraocular pressure(IOP) by trabeculectomy between advanced glaucoma(stage IV of Jonas classification; 6 eyes) and less advanced glaucoma(stage III or less; 5 eyes). Computer-aided morphometry was performed in 11 eyes of 10 adult patients with chronic open-angle glaucoma in whom reversal of glaucomatous cupping was apparent photographically. Mean preoperative IOP, postoperative IOP, and percent reduction of IOP respectively were 42.5+/-8.3mmHg, 12.5+/-3.8mmHg, and 69.1+/-13.2%(range, 40.6 to 81.0%) over a mean period of 22.7+/-14.6 months(range, 5 to 53 months). Mean cup area and cup to disc ratio decreased significantly(P<0.01, Wilcoxon signed rank test). The reversal of rim area/disc area ratio showed a marginally significant correlation with the percent reduction of IOP(Spearman`s correlation coefficient=0.57, P=0.07). The reversal of vertical cup to disc ratio was significaltly lower in eyes with advanced glaucoma than in eyes with less advenced glaucoma(P=0.03, Mann-Whitney U test). Although reversal of other disc parameters tended to be lower in eyes with advanced glaucoma, they were not statistically significant. In eyes with advanced glaucoma, reversal of rim area/disc area ratio was more pronounced in the nasal disc region than in the superior or inferior disc region. Our results suggest that the extent of cupping reversal after reduction of IOP may decrease in the advanced stage of glaucoma than in mild to moderate stages of glaucoma.

The Difference of Reversal of Glaucomatous Cupping After Filtration Surgery Between Advanced Glaucoma and Less Advanced Glaucoma

We investigated whether there was any difference in the extent of cupping reversal after reduction of intraocular pressure(IOP) by trabeculectomy between advanced glaucoma(stage IV of Jonas classification; 6 eyes) and less advanced glaucoma(stage III or less; 5 eyes). Computer-aided morphometry was performed in 11 eyes of 10 adult patients with chronic open-angle glaucoma in whom reversal of glaucomatous cupping was apparent photographically. Mean preoperative IOP, postoperative IOP, and percent reduction of IOP respectively were 42.5+/-8.3mmHg, 12.5+/-3.8mmHg, and 69.1+/-13.2%(range, 40.6 to 81.0%) over a mean period of 22.7+/-14.6 months(range, 5 to 53 months). Mean cup area and cup to disc ratio decreased significantly(P<0.01, Wilcoxon signed rank test). The reversal of rim area/disc area ratio showed a marginally significant correlation with the percent reduction of IOP(Spearman`s correlation coefficient=0.57, P=0.07). The reversal of vertical cup to disc ratio was significaltly lower in eyes with advanced glaucoma than in eyes with less advenced glaucoma(P=0.03, Mann-Whitney U test). Although reversal of other disc parameters tended to be lower in eyes with advanced glaucoma, they were not statistically significant. In eyes with advanced glaucoma, reversal of rim area/disc area ratio was more pronounced in the nasal disc region than in the superior or inferior disc region. Our results suggest that the extent of cupping reversal after reduction of IOP may decrease in the advanced stage of glaucoma than in mild to moderate stages of glaucoma.

Peripapillary Atrophy: 1, Comparison of Normal Eyes and Eyes with Primary Open-Angle Glaucoma

To confirm the value of the peripapillary atrophy(PPA) for the diagnosis and follow-up of patients with glaucoma, we performed magnification-corrected morphometry of photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. For the data analysis, only one eye of each patient was randomly selected. Both groups did not differ significantly in age. refractive error and disc area. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(1; more than 0.61, 2; 0.60~0.41, 3; 0.40~0.21, 4; less than 0.20). PPA differentiated into two different zones(alpha and beta). Zone alpha(0.76+/-0.55mm2 vs 0.47+/-0.32mm2) and zone beta(0.50+/-0.63mm2 vs 0.06+/-0.15mm2) and the total PPA(1.26+/-0.97mm2 vs 0.54+/-0.38mm2) were significantly larger(p=0.0001), and zone beta occurred more often(59.5% vs 17.4%, P=0.0001) in the glaucoma group than in the normal group. The area, angular extent and width of both zones enlarged significantly with increasing stage of glaucoma. The frequency of zone beta increased with advancing stage of glaucoma. These findings suggest that both zone alpha and beta increase continuously with advancing neural rim damage. Therefore, the PPA is useful for the diagnosis and progression of glaucomatous nerve damage.

A Case of Guillain-Barre Syndrome Presented as Bilateral Sixth Nerve Palsy

Guillain-Barre syndrome, acute inflammatory polyradiculoneuropathy, is sometimes accompanied by a typical ophthalmoplegia, usually with bilateral sixth nerve palsy. It also has a similar clinical appearance with Miller-Fisher syndrome, but it is differentiated by limb weakness without ataxia. We observed a 47 year old man with acute onset diplopia and bilateral sixth nerve palsy one week after URI symptoms, diagnosed as Guillain-Barre syndrome with ophthalmoplegia.

Retinal Vessel Diameter: 1. Comparison of Normal and Glaucoma Eyes

Narrowing of the retinal vessels in chronic glaucoma has been recognized only recently. We performed this study to evaluate the vessel diameter in normal and glaucoma eyes, addressing whether the retinal vessel diameters differ with the degree of glaucomatous optic nerve damage. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The photographic magnification was corrected according to Littmanns method. Only one eye per patient and subject was taken for statistical analysis. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(early; more than 0.61, medium; 0.60~0.41, advanced; 0.40~0.21, far advanced; less than 0.20). In the normal group the diameter of the inferior temporal vein(0.130+/-0.020mm) was the largest, followed by the superior temporal vein(0.117+/-0.017mm), the inferior temporal artery(0.102+/-0.016mm), finally the superior temporal artery(0.093+/-0.012mm). The retinal vessel diameter decreased significantly with decreasing of the neuroretinal rim/disc area ratio. In the glaucomatous eyes as compared to the normal eyes, the diameters of the inferior temporal and superior temporal retinal artery were significantly smaller at the early and medium stages(p<0.03, p<0.02, respectively). Whereas both inferior temporal and superior temporal retinal vein diameters were significantly samller at the far advanced stage(p=0.01, p=0.005, respectively). The results indicate that generalized reduction of the retinal vessel diameter throughout the retina is related to the severity of glaucoma. From a diagnostic point of view, evaluation of artery diameter rather than vein diameter may be helpful for the differentiation between normal and glaucomatous eyes.

Comparative study of Eosinophil and Eosinophil Cationic Protein (ECP) of Tears and Sera in Children with Allergic Conjunctivitis

The objective of this study is to measure eosinophil count and Eosinophil Cationic Protein (ECP) levels of tears and sera in patients with acute allergic conjunctivitis and normal subjects and to assess the correlation of this mediator with allergic conjuctivitis and the clinical usefulness. Seventeen subjects were selected on the basis of clinical manifestation, history, skin prick test, total IgE. Serum IgE and eosinophil count were increased in 10patients, and eosinophilia in conjunctival epithelium were present in 11subjects. ECP in tears were increased in patients significantly (12.0+/-8.0 vs 3.9+/-3.8ng/ml,p=0.01), but not in serum (52.5+/-43.1 vs 28.3+/-25.9ng/ml). There was significant relationship beween serum and tear eosinophil count(p=0.004,r=0.66). But there was no significant correlation between eosinophil count and ECP in serum (p>0.05m r=0.19), and no significant correlation between eosinophil count of conjectival epithelium and tears ECP (p=0.043, r=0.05). In conclusion, ECP in tears may be very important role in allergic conjunctivitis and is more reliable indicatior of diagnosis clinically rather than eosinophil count in tear and conjunctival epithelium.