Pharmacotherapeutic candidates for myopia: A review.

This review provides insights into the mechanism underlying the pathogenesis of myopia and potential targets for clinical intervention. Although the etiology of myopia involves both environmental and genetic factors, recent evidence has suggested that the prevalence and severity of myopia appears to be affected more by environmental factors. Current pharmacotherapeutics are aimed at inhibiting environmentally induced changes in visual input and subsequent changes in signaling pathways during myopia pathogenesis and progression. Recent studies on animal models of myopia have revealed specific molecules potentially involved in the regulation of eye development. Among them, the dopamine receptor plays a critical role in controlling myopia. Subsequent studies have reported pharmacotherapeutic treatments to control myopia progression. In particular, atropine treatment yielded favorable outcomes and has been extensively used; however, current studies are aimed at optimizing its efficacy and confirming its safety. Furthermore, future studies are required to assess the efficacy of combinatorial use of low-dose atropine and contact lenses or orthokeratology.

Myopia among schoolchildren in East Asia and Singapore.

Myopia is highly prevalent among schoolchildren in East Asia and Singapore; however, its prevalence has been gradually increasing, and the number of population-based and non-population-based studies assessing this trend has increased in the past 10 years. Although the causes of this high prevalence in East Asia and Singapore remain poorly identified, related studies have discussed the associated risk factors. We summarize the data concerning the prevalence rates reported in related studies and discuss the most crucial risk factors among these schoolchildren.

Examining rhodopsin retention in endoplasmic reticulum and intracellular localization in vitro and in vivo by using truncated rhodopsin fragments.

More than 100 mutations of rhodopsin have been identified to be associated with retinitis pigmentosa (RP), and mostly autosomal-dominant RP (ADRP). The majority of rhodopsin-associated ADRP is caused by protein misfolding and ER retention. In this study, we aimed to evaluate rhodopsin folding, exiting the ER and intracellular localization through expression of the rhodopsin fragments in COS-1 cells as well as in the transgenic zebrafish. We cloned human rhodopsin cDNA, which was then divided into the N-terminal domain, the C-terminal domain, and the fragment between the N- and C-terminal domains, and examine their intracellular expression in vitro and in vivo. We introduced a point mutation, either F45L or G51V, into this fragment and observed the intracellular localization of these mutants in COS-1 cells and in the zebrafish. The results revealed all of the truncated rhodopsin fragments except for the C-terminal domain and the full-length rhodopsin which had some plasma membrane localization, formed aggregates nearby or within the ER in COS-1 cells; however, the N-terminally truncated rhodopsin fragment, the C-terminal domain, and the full-length rhodopsin could traffic to the ROS in the zebrafish. Besides, the F45L mutation and the G51Vmutation in the rhodopsin fragment between the N- and C-terminal domains produced different effects on the aggresome formation and the intracellular distribution of the mutants both in vivo and in vitro. This current study provides new information about the mutant rhodopsin as well as in treatment of the RP in humans in the future.

Comparing myopic progression of urban and rural Taiwanese schoolchildren.

PURPOSE: To compare myopic progression rates in Taiwanese schoolchildren between urban and rural areas. METHODS: Several longitudinal studies of myopic progression were performed in urban and rural areas. Five primary schools, four junior high schools, and two senior high schools were selected from both urban and rural areas. Ages ranged from 7 to 18 years. The refractive state of each student was measured with an autorefractometer under cycloplegia. RESULTS: Mean myopic progression in primary school children (ages 7 to 12) in the urban areas was around 0.20 D/year for boys and 0.27 D/year for girls. The mean myopic progression rate in urban children from primary to junior high school age (ages 10 to 15) was 0.43 D/year for boys and 0.50 D/year for girls, faster than that in rural children (0.24 and 0.31 D/year, respectively). The average progression rate was fastest in children in junior high school (ages 13 to 15), around 0.45 D/year in urban areas and 0.28 D/year in rural areas. In senior high schools (ages 16 to 18), myopic progression slowed to 0.17 D/ year in boys and 0.33 D/year in girls. Myopic progression in all groups was faster in myopic eyes than in emmetropic or hyperopic eyes. CONCLUSIONS: The average myopic progression in urban areas was greater than that in rural areas. Environmental factors such as urban development and academic grade level may be important contributing factors to myopic progression.

Estimation of heritability in myopic twin studies.

PURPOSE: To examine the genetic and environmental factors for myopia at the family level, as well as risk factors such as ocular measurements and environmental covariates at the individual level, by analysis of myopic twin data. METHODS: A myopic twin study was conducted on participants from the 2000 Guinness World Records for twins in Taiwan. A total of 130 participants comprising 58 twin pairs and 13 siblings were recruited. The generalized estimating equation approach was used to evaluate the covariate effects. A Bayesian linear mixed model was then used to estimate the heritability. RESULTS: Pearson's intrapairwise correlation coefficients for ocular refraction and its components were higher among monozygotic twins than among dizygotic twins. The significance of sex suggested that women are more myopic than men. Both axial length and anterior chamber depth were significant factors associated with myopia. The results also showed that people with higher education levels were more likely to have a higher degree of myopia. After accounting for genetic and environmental effects and other covariates, the estimate of heritability of myopia was as high as 0.306. CONCLUSIONS: After adjusting for environmental covariates, heritability still plays a decisive genetic role in the development of myopia.

Balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes in the treatment of congenital nasolacrimal duct obstruction.

PURPOSE: To report our experience with combined use of balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes for treating congenital nasolacrimal duct obstruction. DESIGN: Retrospective consecutive interventional case series. MATERIALS AND METHODS: This retrospective study consisted of 25 consecutive pediatric patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes between November 2003 and November 2006. Outcome evaluations included an ophthalmologic examination and a dye appearance test postoperatively. Age, history of a prior probing and complications related to the main outcome were also analyzed. RESULTS: Thirty-three eyes of 25 patients aged 8 months to 9 years (3.5 +/- 2.4 years old) were included. Of the obstructed ducts treated, 97% (32/33) showed complete resolution of epiphoria. When analyzed by age groups, patients more than 1 year of age had higher success rate (30 successes in 30 patients) than patients less than 1 year of age (two successes in three patients). Statistical analysis revealed no statistically significant difference in success rate between both age groups (p = 0.09). The mean duration of intubation was 5.7 +/- 2.2 months. No significant complication was noted, except that early tube dislodgements occurred in six out of 31 Monoka intubations (19%). CONCLUSIONS: The combined use of balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes is an effective procedure for children with congenital nasolacrimal duct obstruction after failure of conservative treatment or probing.

Lens thickness changes among schoolchildren in Taiwan.

PURPOSE: To explore the possible influence of ocular growth, refractive error and age on the crystalline lens in school-age children. METHODS: A Taiwan nationwide survey of myopia performed in 2006 was used to determine the prevalence and severity of myopia and the changes in ocular components. A total of 11,656 students were enrolled, including 5,390 boys and 6,266 girls, with ages ranging from 7 to 18 years. Refractive status was measured with an autorefractometer with the subject under cycloplegia. Lens thickness, anterior chamber depth, and axial length were measured with biometric ultrasound. RESULTS: Data revealed that the crystalline lens became thinner between the ages of 7 and 11. Subsequent increases in the lens thickness correlated with age and the stability of myopia. This phenomenon was found not only in myopic eyes, but also in emmetropic and hyperopic eyes. The changes in anterior chamber depth inversely correlated with the changes in the lens. In school-age children, the ratio of lens/axial length was found to be significant: approximately 0.147 in the emmetropic group. However the ratio was seen to increase with age. The ratio of anterior segment/axial length was found to be approximately 0.3 in emmetropic eyes among all age groups and less than 0.3 in the myopic eyes of schoolchildren. CONCLUSIONS: Lens thinning appeared to be compensatory in nature with respect to the increased axial length of normal eye growth. Myopic eye growth induces the lens to compensate by becoming much thinner. The change in anterior chamber depth corresponded inversely with lens thickness.

The association of membrane frizzled-related protein (MFRP) gene with acute angle-closure glaucoma--a pilot study.

PURPOSE: The membrane frizzled-related protein (MFRP) has been proposed as a probable candidate gene for extreme hyperopia and nanophthalmos, which are factors for angle-closure glaucoma. The purpose of our study was to investigate whether there are significant associations between angle-closure glaucoma and sequence variants in the MFRP gene reported previously in Taiwanese subjects. METHODS: Genomic DNA was collected from 63 subjects with angle-closure glaucoma and 66 age-matched and gender-matched controls without angle-closure glaucoma. Three sequence variants were detected by polymerase chain reaction (PCR) and direct sequencing in all of the cases and controls. RESULTS: None of the three sequence variants showed a significant result in terms of association with disease. The pairwise linkage disequilibrium (LD) mapping confirmed that these alleles have a comparatively strong LD index greater than 0.7 for D' and greater than 0.4 for r(2) at these polymorphisms. However, we found there were no statistical associations between any of the three sequence variants located on MFRP and angle-closure glaucoma. CONCLUSIONS: In our pilot study, variations that we tested in MFRP were not associated with the development of acute angle-closure glaucoma in Taiwanese subjects.

Improvements in vision-related quality of life with AcrySof IQ SN60WF aspherical intraocular lenses.

PURPOSE: To compare vision-related quality of life and higher-order aberrations (HOAs) with an aspherical intraocular lens (IOL) (AcrySof IQ SN60WF) and a conventional spherical IOL (AcrySof SA60AT) (both Alcon) after phacoemulsification. SETTING: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China. METHODS: Sixty-five patients were prospectively randomized to receive an Alcon AcrySof IQ SN60WF IOL (30 eyes) or an AcrySof SA60AT IOL (35 eyes). All patients had a complete ophthalmologic examination including uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), and wavefront analysis preoperatively and 3 months postoperatively. Patients also completed the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to evaluate vision-related quality of life. RESULTS: The mean postoperative BSCVA (logMAR) was 0.09 +/- 0.07 (SD) in the aspherical IOL group and 0.12 +/- 0.08 in the spherical IOL group; the difference was not statistically significant. Spherical aberrations were statistically significantly lower in the aspherical IOL group (mean 0.12 +/- 0.23 microm) than in the spherical IOL group (mean 0.33 +/- 0.20 microm) (P = .001). Both IOL types improved most aspects of patients' vision-related quality of life. The aspherical IOL group had clinically significant improvement on more NEI VFQ-25 subscales, although the difference between groups in vision-related quality of life was not statistically significant. CONCLUSION: Eyes with the aspherical AcrySof IQ SN60WF IOL had reduced HOAs and spherical aberrations compared with eyes with the spherical AcrySof SA60AT IOL; however, there were no statistically significant differences in visual acuity or vision-related quality of life between groups.

Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation.

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.

The genetic effect on refractive error and anterior corneal aberration: twin eye study.

PURPOSE: To investigate the role of heredity in determining refractive variables, anterior corneal curvature, and anterior corneal aberrations. METHODS: Thirty-three monozygotic and 10 dizygotic twin pairs were enrolled in this study. Corneal curvature, corneal astigmatism, and corneal topography were obtained from computerized videokeratoscope. The CTView program was used to compute anterior corneal aberrations from corneal height data of the videokeratoscope. Correlation analysis was performed to investigate the symmetry of the refractive error, corneal curvature, corneal astigmatism, and anterior corneal aberrations between right and left eyes of each twin pair. Heritability (h2) of these parameters was also calculated. RESULTS: Positive correlations were noted between right and left eyes for spherical power, total astigmatism, mean corneal curvature, and corneal astigmatism. In monozygotic twins, vertical coma, secondary vertical coma, spherical aberration, and secondary spherical aberration were moderately correlated. In dizygotic twins, vertical coma, secondary horizontal coma, and spherical aberration were moderately correlated. In unrelated controls, secondary vertical coma, secondary horizontal coma, and secondary spherical aberration were moderately correlated. Root-mean-square (RMS) of higher order aberrations (3rd to 6th orders), RMS of spherical aberration, and RMS of coma were moderately correlated between right and left eyes in all three groups. Heritability of spherical aberration, RMS of spherical aberration, and corneal astigmatism (h2 = 0.56, 0.44, and 0.46) were greater than those of refractive power, corneal curvature, and other higher order aberrations. CONCLUSIONS: These results suggest that corneal astigmatism and spherical aberration possess a greater genetic predisposition than those of other refractive errors and higher order aberrations.

Porous polyethylene implants in orbital floor reconstruction.

BACKGROUND/PURPOSE: Various alloplastic materials are used in orbital wall reconstruction. This study investigated the outcome of patients treated with porous polyethylene sheet implants in the reconstruction of orbital floor fracture. METHODS: Twenty-one patients who underwent orbital reconstructions using 0.85-mm porous polyethylene sheets for the repair of orbital floor fracture were included. A transconjunctival approach was used in all patients. The mean duration of postoperative follow-up was 29.7 +/- 12.3 months. Postoperatively, results and complications such as infection and implant extrusion were followed-up on the first day, the first week, monthly for the first 3 months and then every 3-6 months thereafter. RESULTS: All 21 patients had symptomatic diplopia before surgery. The diplopia resolved in 14 patients and improved in seven patients within the first month after surgery. All patients except one were free from diplopia at follow-up periods exceeding 6 months. Preoperative enophthalmos resolved in four of seven patients and improved in three. None of the patients developed orbital infection, implant exposure or migration, worsening diplopia, infraorbital anesthesia or loss of vision during follow-up. CONCLUSION: The study demonstrated that porous polyethylene implants in the repair of orbital wall fractures had good results with few complications.

Prevention of exposure of porous orbital implants following enucleation.

PURPOSE: To investigate effectiveness of adding a scleral patch graft on a Vicryl mesh-wrapped porous orbital implant to prevent exposure following enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: From October 1996 to February 2006, 74 consecutive patients (74 sockets) who received porous orbital implants primarily or secondarily after enucleation at National Taiwan University Hospital (72 cases) and at Far Eastern Memorial Hospital (2 cases) were collected. Patient demographics, ocular diagnosis, the surgical technique, prior ophthalmic surgery, type, covering, and size of the implant, follow-up periods, and complications associated with pegs and implants were recorded. Group 1 patients received a Vicryl mesh-wrapped implant without a scleral patch graft. Group 2 patients received anterior capping with a scleral patch on the Vicryl mesh-wrapped implant. RESULTS: Of 74 identified cases, 12 were excluded for insufficient follow-up. The 62 remaining cases had more than a two-year follow-up. There were two implant exposures (12%, two of 17) in group 1. Retroauricular myoperiosteal graft and scleral patch were used to repair exposed implants successfully. No exposure was noted in group 2 (n = 45). A significant between-group difference in exposure rate was found (P = .02). Early conjunctival dehiscence followed by spontaneous healing occurred in three group 2 patients. CONCLUSIONS: Scleral patch graft and Vicryl mesh can act as duplicate barriers between anterior surface of implants and overlying soft tissue. The modified wrapping technique prevents porous implants from exposure effectively.

Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome.

PURPOSE: To determine the efficacy of optical coherence tomography (OCT) in the management of retinal detachment in morning glory syndrome (MGS). DESIGN: Prospective, interventional case series. METHODS: Five eyes of five consecutive MGS patients who developed retinal detachment between August 2000 and June 2004 were enrolled and examined by OCT at presentation of retinal detachment. Four eyes were found to have a slit-like break at the margin of the excavation by careful OCT scanning 360 degrees around the excavation. All four eyes underwent pars plana vitrectomy, gas injection and postoperative laser photocoagulation. Postoperative OCT was performed to confirm the closure of the retinal break and reattachment of the retina. RESULTS: Optical coherence tomography detected a slit-like break at the margin of excavation in four of five patients. The retina reattached in all five eyes over the subsequent 3-50-months (average 28 months) follow-up period. Postoperative OCT showed retinal break closure at the margin of the excavation. In the one eye in which no retinal break could be detected by OCT, the retina was reattached after pars plana vitrectomy and removal of gel-like tissue. CONCLUSIONS: Optical coherence tomography is beneficial in the detection of subtle slit-like breaks at the margin of excavation in retinal detachment in MGS. It provides good guidance in subsequent surgery and is very helpful in confirming the closure of the retinal break.

Transcaruncular orbital decompression: an alternate procedure for Graves ophthalmopathy with compressive optic neuropathy.

PURPOSE: To study the efficacy of transcaruncular orbital apex decompression for Graves ophthalmopathy with compressive optic neuropathy nonresponsive to pulse corticosteroids. DESIGN: Retrospective, interventional case series study. METHODS: From August 1999 to November 2003, transcaruncular orbital decompression was performed in 22 consecutive Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. The average period of corticosteroid treatment was 16.1 +/- 5.2 days. Main outcome measures were preoperative and postoperative best-corrected vision, Hertel exophthalmometry, 100-hue color sensation test, visual evoked potential, visual field, and new-onset diplopia. RESULTS: Visual acuity improved significantly from 1.08 +/- 0.24 logarithm of minimal angle of resolution (logMAR) preoperatively to 0.29 +/- 0.18 logMAR postoperatively (P < .0001). Average improvement in retinal sensitivity was 9.4 +/- 8.2 dB, in P(100) value of visual evoked potential was 27.5 +/- 20.1, and in "total errors" of the 100-hue test was 309.9 +/- 214.3 after surgery. Average retroplacement effect was 3.7 +/- 1.6 mm. Statistical analysis showed significant differences between preoperative and postoperative measurements for all above parameters (P < .0001). New-onset diplopia occurred in 38% of patients. There were no complications specifically attributable to the transcaruncular technique. CONCLUSIONS: The transcaruncular approach offers access to the medial and inferior wall for orbital apex decompression in Graves ophthalmopathy patients with compressive optic neuropathy refractory to pulse corticosteroids. Advantages over other approaches included no external scar, less damage to adjacent tissue, and wide exposure to the entire medial wall.

A procedure to minimize lower lid retraction during large inferior rectus recession in graves ophthalmopathy.

PURPOSE: To determine whether complete detachment of the fascia of the capsulopalpebral head during large inferior rectus recession can help to prevent induced lower lid retraction in Graves ophthalmopathy. DESIGN: Retrospective consecutive case series. METHODS: Data from patients (39 eyes) with Graves ophthalmopathy undergoing inferior rectus recession were collected retrospectively. Inferior rectus recession was performed by limbus-based incision with adjustable suture. Simultaneous detachment of the fascia of the capsulopalpebral head was achieved by sharp dissection and severing of the fascia. Inferior rectus recession with simultaneous detachment of the fascia of the capsulopalpebral head was performed in 27 eyes and without detachment in 12 eyes. Margin reflex distance (MRD2) was documented preoperatively and 3 months postoperatively. RESULTS: Of the 39 eyes included in this study, four eyes with preexisting lower lid retraction in the detachment group improved after surgery. Eighteen eyes in the detachment group exhibited the same MRD2 values, and only five eyes showed increased MRD2 values. In contrast, all but one of the 12 eyes in the nondetachment group showed increased MRD2 values. The average change in the MRD2 value 3 months after surgery was 0.04+/-0.59 mm in the detachment group and 1.58+/-0.73 mm in the nondetachment group. There was a statistically significant difference between the two groups (P<.01). CONCLUSIONS: Simultaneous detachment of the fascia of the capsulopalpebral head during inferior rectus recession can minimize the possibility of lower lid retraction.

Primary orbital leiomyosarcoma.

An 84-year-old woman presented with a right upper eyelid nodule, first noted 1 month earlier. Incisional biopsy revealed leiomyosarcoma, which was subsequently treated with wide excision and adjunctive radiotherapy. There has been no evidence of tumor recurrence in 3 years of follow-up.

Primary placement of a hydroxyapatite-coated sleeve in bioceramic orbital implants.

PURPOSE: To study a new surgical option of primary placement of a hydroxyapatite-coated sleeve into the Bioceramic implant during enucleation or evisceration. DESIGN: Retrospective, observational case series. METHODS: A standard enucleation or evisceration was performed, followed by the preplacement of a hydroxyapatite-coated sleeve into the Bioceramic implant. Care must be taken to ensure the sleeve has been positioned centrally when the implant is put inside the orbital socket. Complications such as sleeve exposure, Bioceramic implant exposure, and infection were closely observed. RESULTS: Twenty-seven patients were treated in above fashion with five enucleation and 22 evisceration procedures. Five of the sleeves have exposed spontaneously during 1 to 4 months after original surgery. They had no further complication, except for one sleeve around which there were visible Bioceramic spicules attributable to long-term corticosteroid usage. The remaining 22 sleeves that did not spontaneously expose pursued secondary exposure of the sleeve and peg insertion by the conjunctival cutdown procedure 3 months postoperatively. One sleeve was medially positioned far away from the implant center. Re-insertion of new sleeve and peg was scheduled 2 weeks later. One additional sleeve was obliquely positioned after conjunctival cutdown procedure. Fortunately, all 27 patients were successfully fitted with a peg-coupled prosthesis with good motility. CONCLUSIONS: Primary placement of a hydroxyapatite-coated sleeve into the Bioceramic implants has several advantages, including high patient acceptance, technical simplicity, and an office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging studies and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.

Peculiar arcuate scotoma in pathologic myopia--optical coherence tomography to detect peripapillary neural tissue loss over the disc crescent.

BACKGROUND: Optical coherence tomography (OCT) was used to detect peripapillary neural tissue loss (PPNTL) over the disc crescent in pathologic myopia. The retinal neural tissue loss located inside the disc crescent in pathologic myopia is a newly recognized fundus lesion. METHODS: Review of ten eyes of ten patients with peripapillary yellowish-white retinal lesions who underwent OCT for evaluation of the nature of PPNTL in pathologic myopia. OCT, fluorescein angiography, automated visual fields, axial length measurement with ultrasound A scan, and ultrasound B scan were performed. RESULTS: Ten eyes of ten patients were identified during a 14-year period to have findings characteristic of PPNTL. The mean age of the patients was 46 years. They were followed up for an average of 9 years. The mean spherical equivalent correction was -10.50 diopters (D) (range -6.0--16.0 D). The mean axial length was 28.6 mm (range 26.30-31.50 mm). In each case, OCT showed a complete retinal discontinuity in the PPNTL lesion. Automated visual field examination showed corresponding arcuate scotoma. During the follow-up period, the inner retina layer of the retinal defect margin was elevated by posterior hyaloid and partial retinal detachment developed in one eye. CONCLUSIONS: PPNTL in pathologic myopia is a relatively asymptomatic, yellowish-white peripapillary retinal discontinuity. Recognition of this lesion is important because the visual field defect may mimic glaucomatous changes owing to the loss of nerve fiber layer. Progressive partial retinal detachment may ensue as one of the complications of the peripapillary lesion.