RESUMEN
Purpose@#To evaluate the applicability of the ISNT rule (neuroretinal rim thickness order: inferior > superior > nasal > temporal)when using Bruch's membrane opening-based optic nerve head parameters to discriminate between normal and glaucomatouseyes. @*Methods@#The medical records of 41 normal eyes and 62 open-angle glaucoma eyes were reviewed retrospectively. We analyzedthe neuroretinal rim thickness values corresponding to the superior, inferior, nasal, and temporal sides of the optic disc asmeasured using color stereo optic-disc photographs, Bruch’s membrane opening-minimum rim width (BMO-MRW), theBMO-MRW average, and Bruch’s membrane opening-minimum rim area (BMO-MRA). The sensitivity and specificity of the ISNTrule in differentiating normal and glaucomatous eyes were compared across the four methods. @*Results@#In normal and glaucomatous eyes, measuring neuroretinal rim thickness in color stereo optic-disc photographs producedlarger values for the superior, inferior, nasal, and temporal sides compared to measurements using BMO-MRW and theBMO-MRW average (p< 0.001). With respect to ISNT rule compliance using the four methods, the sensitivities of theBMO-MRW average and BMO-MRA methods were significantly higher than that when disc photographs were used (82.3% vs.98.4%, p< 0.05; and 82.3% vs. 95.2%, p< 0.05, respectively). Specificity did not differ significantly among the four methods. @*Conclusion@#BMO-based optic nerve head parameters exhibited higher diagnostic power for differentiating between normal andglaucomatous eyes based on the ISNT rule, compared with the classic method of using disc photographs.
RESUMEN
PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.