A Case of Optic Nerve Head Swelling in a Patient with Primary Open-angle Glaucoma

PURPOSE: To report a case of masked glaucomatous optic nerve head damage due to acute swelling in a primary open-angle glaucoma patient. CASE SUMMARY: A healthy 21-year-old male visited our clinic complaining of blurred vision in the right eye for 1 week. The intraocular pressure (IOP) was 60 mmHg, as measured by a Goldmann applanation tonometer. No specific anterior segment finding other than severe corneal edema was found on slit lamp examination. Maximum tolerated medical therapy was performed, and a further examination was done 1 day after the IOP lowering. No glaucomatous change in the optic disc or retinal nerve fiber layer was observed on fundus examination and optical coherence tomography (OCT), but the optic disc of the right eye was more hyperemic than that of the left eye. A superonasal visual field defect was also observed using automated perimetry. After treatment, the IOP was kept within the normal range using IOP-lowering eye drops. However, an inferonasal retinal nerve fiber layer defect was observed on fundus examination and OCT, and a superonasal scotoma was detected by perimetry.

Fluorescein Angiographic Features in Central Retinal Vein Occlusion With and Without Optic Nerve Head Swelling

PURPOSE: To investigate the characteristics of fluorescein angiograms (FAG) of the optic nerve head and retina according to the presence of optic nerve head swelling (ONHS) in central retinal vein occlusion (CRVO). METHODS: The records of 69 eyes were reviewed, confirmed with the diagnosis of CRVO, and compared for several features according to the presence of ONHS. The best-corrected visual acuities and intraocular pressures were recorded and patterns of retinal hemorrhage were described. The presence of fluorescein filling defects of the optic disc, time till fluorescein started to fill at the optic disc, arteriovenous transit time, and nonperfused areas were assessed using FAG. RESULTS: Forty-one patients without ONHS (group 1) and 28 patients with ONHS (group 2) were included. The mean ages for groups 1 and 2 were 61.4 and 56.9 years, respectively, and there was no significant difference the mean ages between the groups. The fluorescein filling defect of the optic disc was seen more often in group 1 (n=13) than in group 2 (n=2). Marginal irregularity of the foveal avascular zone due to perifoveal capillary drop out was seen significantly more often in group 1 (n=12) than in group 2 (n=2). CONCLUSIONS: Fluorescein filling defects of the optic disc and perifoveal capillary drop out were more frequently seen in CRVO patients without ONHS. However, longitudinal studies are needed to confirm the prognostic value of ONHS and the correlation of filling defects with progressive optic neuropathy in CRVO.