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.

A Case of Adenoid Cystic CArcinoma of Unusually Located Lacrimal Gland

An adenoid cystic carcinoma of the lacrimal gland is the most common epithelial neoplasms in lacrimal gland. But it is rare in clinical practice and is poor prognosis below 50% at 2 year survival rate with various clinical management. We experienced a case of a 62-year-old woman who had complained just proptosis and no other tumor symtoms. Being different from the other adenoid cystic carcinoma of the lacrimal gland, MRI revealed mass of the right superiotemporal lacrimal gland which was well demarcated and displaced in nasal area to the optic nerve and no metastasis to adjacent nerves and bones. We performed the lateral orbitotomy followed by macroscopical complete resection of tumors. The histopathologic findings revealed the adenoid cystic carcinoma of the lacrimal gland and were showed variable. So we would report our case with a brief review of the literature.

An Efficacy of Head Tilt Test in the Patients with Unilateral Superior Oblique Palsy

Head tilt test is useful in diagnosing cyclovertical muscle palsy, especially superior oblique palsy, In this study, we observed efficacy and pattern of head tilt test in 12 patients of unilateral superior oblique palsy(7 congenital, 4 traumatic and 1 vascular) who had abnormal head tilt to nonparetic side. The results of head tilt test were compared to preoperative status in 8 patient, 3 month after surgery. All patients in this study showed positive response of head tilt test. Among them, 9 patients showed definite elevation of paretic eye. However, 2 patients mainly showed definite depression of nonparetic eyes that were amblyopic. The last patient did not show definite vertical deviation in either eye but complained of increasing diplopia. After surgery, abnormal head tilt and positive head tilt response disappeared in 7 patients. In conclusion, preoperative head tilt test is one of the valuable methods in diagnosisng unilateral superior oblique palsy especially in young patients and in those who developed spread of comitance. In addition, the positive head tilt test does no always mean the elevation of paretic eye.

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.

Retinal Vessel Diameter: 2. Its Correlation with Glaucomatous Optic Nerve Damage

Generalized narrowing of the retinal vessels has been recognized for glaucomatous and nonglaucomatous optic neuropathies. To evaluate how closely peripapillary retinal vessel diameters were related to functional and structural optic nerve damage in primary open-angle glaucoma, the data of the vessel diameters were correlated with intra- and peripapillary morphometric parameters and visual field indices. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the opticdisc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. Only one eye per patient and subject was taken for statistical analysis. The diameters of the inferior temporal and superior temporal retinal artery were significantly correlated with the intrapapillary parameters, the peripapillary parameters and the visual field indices. The correlation coefficients were highest for the neuroretinal rim data (r>0.37, p=0.0001), followed by mean deviation, vertical cup to disc ratios, whereas total peripapillary atrophy data, zone beta and zone alpha data were relatively low. Concerning the vessel diameter, the highest correlation coefficients were calculated for the inferior temporal artery, followed by the superior temporal artery. No correlation was found with age and refraction. The results indicate that, in primary open-angle glaucoma, the vessel diameter redduces with decreasing area of the neuroretinal rim, increasing visual field defects and increasing peripapillary atrophy. Its evaluation can be helpful for the diagnosis of glaucoma and possibly also for follow-up.