Arguments for a vascular glaucoma etiology.

A material of Open Angle Glaucoma (G) collected by an eye practitioner (B S) from 1980 to 1991 is analysed with special respect to the occurrence of disc haemorrhages (Hs) and retinal vein occlusions (VOs). There is a close association between Hs and VOs and G, which in all categories increases with increasing follow-up time. Furthermore, the occurrence of mixed cases--H in one eye and VO in the same or the other--support the opinion that Hs, branch vein occlusions and central vein occlusions are manifestations of the same vascular disease, the difference between them being the size of the vessel affected. The well known morphological changes in the retinal veins of glaucomas and in central vein occlusions are endothelial proliferations causing progressive increase of flow resistance. Similar changes most probably also cause branch occlusions and disc haemorrhages. The vascular affection which obstructs the vessels with hindrance of the blood flow and impaired nutrition of neuronal tissue, might be the primary cause of glaucoma.

Similarities between disc haemorrhages and thromboses of the retinal veins.

999 patients with glaucoma (G) visited the office from the beginning of 1980 until the end of 1991. 381 patients with disc haemorrhages and 164 with thrombosis (T) were found and followed when possible. At the detection 17 cases with thrombosis and 41 cases with disc haemorrhage (H) had glaucoma. During follow-up 52 cases with glaucoma got a thrombosis and 26 cases with thrombosis developed glaucoma, 105 cases with glaucoma got a disc haemorrhage and 33 cases with disc haemorrhage developed glaucoma. At the end of the follow-up 179 cases with glaucoma have had a disc haemorrhage, and 95 have had a thrombosis. In this material disc haemorrhages and thromboses, both thromboses of a branch (TB) and thromboses of the central vein (TC), behaved in the same way with respect to the occurrence of glaucoma, and the hypothesis that the materials H, TB or TC are of similar origin and symptoms of glaucoma seems reasonable.

Occurrence of disc haemorrhages in open-angle glaucoma treated with pilocarpine or timolol.

1573 examinations were performed on 397 eyes. hh was found in 55 eyes--thromboses included--at 91 examinations. Part of this material qualified for use in a comparative study with pilocarpine in 81 eyes and timolol in 82 eyes. The relative frequency of hh in the treated groups and in the pretreatment group was not significantly different from that of the whole material. No indication of pressure reduction with effect on the occurrence of hh could be detected. The average probability of hh at an examination chosen at random was 6 per cent in this material of ordinary simple and capsular glaucoma cases. The occurrence of haemorrhages in relation to age, sex, general hypertension and diabetes are discussed.

Observations concerning the course of glaucoma.

Four cases with glaucomatous damage to the optic nerve head preceding a rise in intraocular pressure from normal or borderline to high values, are reported. The question of whether such cases are exceptional or typical and, therefore, best explained by a coincidence of diseases or by one disease going through successive stages is discussed on the basis of 10 further cases from a population study. Many clinicians claim that there are two groups of patients: a large one with 'ordinary' glaucomas supposedly caused by high intraocular pressures and a small one with low tension glaucomas presumed to have low perfusion pressures for other reasons. This classification circumvents the discussion on etiology and gives theoretical support to conventional treatment. Accumulated clinical observations indicate, however, that it should not be accepted without discussion. We describe here a few selected cases with glaucomatous damage to the optic nerve head preceding a rise in the intraocular pressure from normal or borderline to high values.

Disc haemorrhages and glaucoma in a general ophthalmic practice.

The composition of the clientele from an ophthalmological practitioner's office is described with special reference to the occurrence of glaucoma and disc haemorrhages (h in singular; hh in plural). This study could not be planned as an epidemiological survey and gives no clue to sensitivity or specificity of hh in glaucoma. During a period of about 10 years ending with 1986 there were 731 patients with h and/or glaucoma. When detected, 185 patients had h but no glaucoma, 33 had both h and glaucoma and 513 had glaucoma but no h. During the follow-up period hh were detected in 83 cases of glaucoma, and glaucoma developed in 27 cases with hh. The detection rate of hh among glaucoma was low but steady, indicating that hh may occur at any stage of the glaucoma process. This study shows no predilection for hh in cases with general hypertension or diabetes, nor is the frequency of hh among pseudoexfoliation cases significantly lower than among cases without this stigma.

Glaucomatous disc haemorrhages photographed at short intervals.

Fundus photography was performed at an interval of 1-2 weeks on two glaucoma patients with disc haemorrhages (hh). It was shown that Haemorrhages (hh) appear again and again at the same place over a long period, which may, if the observations are made at long intervals, give the false impression of one, very slowly resorbed h. The opinion that hh are caused by a singular vascular acute disorder is not supported. The blood is seen propagating peripherically along the nerve fibres. After resorption of the papillary part the h may remain only outside the disc, thus giving the impression of a completely extrapapillary h. The resorption of blood occurs probably more rapidly over the papillary tissue than in regions outside the disc.