ABSTRACT
PURPOSE: To determine if qualitatively defining the appearance of optic disc change was a valid characteristic of myopia in subjects with Graves' ophthalmopathy (GO) or primary open-angle glaucoma (POAG). METHODS: WE DEFINED TYPICAL TILT APPEARANCE AS THE SIMULTANEOUS PRESENCE OF THE FOLLOWING: an elliptical optic disc, a crescent, unequal sharpness of the cupping margin (horizontally), and nasally displaced vessels in the optic cup. Ninety-two eyes from 92 subjects each with GO or with POAG and no severe complications were included in the study after matching for spherical refractive errors. Using our definition of tilt appearance, two independent observers subjectively judged optic disc photographs. One observer repeated judgments in 70 randomly selected eyes and judgment reproducibility was assessed using kappa statistics. Tilt ratio was used as a quantitative parameter. RESULTS: The numbers of eyes judged as having a typical tilt appearance in the GO group and in the POAG group were 25 (27.2%) and 39 (42.4%), respectively, by one observer (P = 0.0297), and 12 (13%) and 44 (47.8%), respectively, by another observer (P < 0.0001). Intra- and interobserver reproducibility of tilt judgment were very good (kappa = 0.93) and good (kappa = 0.65), respectively. Tilt ratio did not significantly differ between the two groups. Analytical results including background factors were essentially the same for the two observers: multivariate logistic regression for one observer's judgment showed that the presence of the typical tilt appearance was associated with belonging to the glaucoma group (odds ratio [OR], 6.25; P = 0.0054), tilt ratio (OR per 0.01, 0.77; P < 0.0001), and spherical refractive error (OR per diopter, 0.80; P < 0.003). CONCLUSION: The optic disc feature we designated as typical tilt was associated with myopia, and its frequency was higher in subjects with POAG compared to those with GO.
ABSTRACT
The major focus of this study is to evaluate the ophthalmic surgery performed to treat patients with various eye changes of dysthyroid ophthalmopathy (DO) in Japan. The medical charts of DO cases that underwent eye surgery at the Olympia Eye Hospital in 1999 were reviewed. In 1999, 898 patients underwent ophthalmologic examination at the thyroid eye clinic in our hospital, and 51 cases were excluded out of the first visiting cases because they were hyperthyroid only and not associated with ophthalmopathy. This study consists of 847 cases (151 male, 696 female), mean age of 40.9 +/- 14.7 years, age distribution of 10-84 years. Surgical therapy was used on 129 eyes of 93 cases (11%) among the 847 patients. Orbital decompression was performed on 26 eyes of 15 cases. Most Japanese patients are not associated with a strong degree of proptosis, showing on average less than 20 mm. Cases with 25 mm of proptosis were scarcely observed. Extraocular muscle surgery was performed on 84 eyes of 60 cases (bilateral 17 cases, unilateral 33 cases). Types of diplopia are as follows: upward gaze, 28 cases; outward gaze, 10 cases; downward gaze, 2 cases; and complex type, 10 cases. Concerning the pathogenesis of diplopia in DO, fibrotic change plays a dominant role, in which cicatrical adhesion to the surface of the muscle is always observed in extraocular muscle surgery. After removal of cicatrical adhesion, the forced duction is completely recovered. This explains the precise mechanism of this involvement. Eyelid surgery was used on 39 eyes of 30 cases (upper eyelid, 33 eyes; lower eyelid, 6 eyes). Eyelid surgery was indicated for treatment of various anterior eye changes including upper eyelid retraction, entropion of eyelids. Better results and few complications are considered attributable to the stabilization of orbitopathy.
