ABSTRACT
An 84-year-old woman presented with bilateral visual loss that had appeared 3 days previously. Split lamp examination showed bilateral corneal edema with normal intraocular pressure. The patient complained of headache and vomiting, and finally collapsed. Elevated levels of inflammation markers led to the suspicion of an inflammatory disease. After investigation for internal or neurological diseases, a biopsy of the temporal artery was performed. Giant cell arteritis (Horton's disease) was found, and steroid therapy was begun. The patient's general condition then improved.
Subject(s)
Corneal Edema/etiology , Giant Cell Arteritis/diagnostic imaging , Vision Disorders/etiology , Acute Disease , Adrenal Cortex Hormones/therapeutic use , Aged, 80 and over , Corneal Edema/diagnostic imaging , Corneal Edema/drug therapy , Diagnosis, Differential , Female , Giant Cell Arteritis/drug therapy , Humans , Optic Neuropathy, Ischemic/diagnostic imaging , Optic Neuropathy, Ischemic/drug therapy , Optic Neuropathy, Ischemic/etiology , Papilledema/diagnostic imaging , Papilledema/drug therapy , Papilledema/etiology , Ultrasonography , Vision Disorders/diagnostic imaging , Vision Disorders/drug therapyABSTRACT
BACKGROUND: The purpose of this study was to investigate whether digital planimetry is appropriate for quantification of neuroretinal rim loss in patients with glaucoma, with and without progression. PATIENTS AND METHODS: The optic discs of 44 patients, whose illness had been well documented with photographs over a period of at least eight years were divided in a progression group and an unchanged group with regard to glaucoma. After this evaluation we measured each disc by digital planimetry and correlated the results. The researcher conducting the measurements was unaware of the patients' date of examination and the diagnosis. RESULTS: While the neuroretinal rim decreased by only 0.06 A+/- 0.15 mm(2) on average in the group of patients without glaucoma, the average decrease was 0.30 A+/- 0.27 mm(2) in the group with progression. This corresponds to a yearly decrease on average of merely 0.0043 A+/- 0.011 mm(2) (0.25%/a) in the group without progression and one of 0.0228 A+/- 0.025 mm(2) (1.9%/a) in the group with progression. Mean neuroretinal rim loss was 0.25% per year in the group without progression of glaucoma, and 1.9% per year in the group with progression. This annual difference is significant. (p = 0.003). The average observation time in the morphologically better group was on average significantly shorter (12.3 years compared to 14.5 years). CONCLUSION: Digital planimetry was able to determine if a morphological progression was found in a clinical examination or if a glaucoma showed no signs of worsening. So we can use this method of digital planimetry of optic discs to examine and re-examine older and more recent photographs to always get the best results of a possible progression of glaucoma.
