Numerous cicatrizing and granulomatous diseases that simultaneously involve choroid, retina and their intervening Bruch's membrane may cause choroidoretinal vascular anastomoses. Anastomoses at capillary level and in neovascular granulomatous tissue are probably not uncommon under these and related circumstances, but choroidal connections to large-caliber segments of otherwise normal retinal arterioles and venules are unusual. We retrospectively studied 44 eyes of 44 patients with choroidal ruptures after blunt trauma. Of 44 choroidal ruptures, three patients had chorioretinal ruptures and choroidoretinal vascular anastomoses. This report describes three cases of large-caliber choroidoretinal anastomoses after chorioretinal ruptures.

Prolonged hypotony and related complications can occur after trabeculectomy, especially with adjunctive mitomycin C. Prolonged hypotony can produce a permanent reduction in vision. A 22-year-old woman with primary open-angle glaucoma underwent uncomplicated trabeculectomy. A sponge soaked with a 0.5mg/ml solution of mitomycin C was placed between the conjunctiva and the scleral flap for 5 minutes. Two weeks after surgery, visual acuity was reduced to 20/400 and intraocular pressure was 3mmHg. There were disc edema, vascular tortuosity, and radiating chorioretinal folds in the macular area. The bleb was pale, highly elevated, and extended for 270 degrees of the limbus. The anterior chamber was formed, and no bleb leak, cyclodialysis cleft, choroidal detachment were seen. Her intraocular pressure was 2-7mmHg during the 12 weeks after surgery. At the last examination, visual acuity improved at the preoperative level of 20/30 and intraocular pressure was 10mmHg. Fortunately, hypotony maculopathy had improved without any specific management.
Anterior Chamber ; Blister ; Choroid ; Conjunctiva ; Edema ; Female ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin* ; Porifera ; Trabeculectomy* ; Visual Acuity ; Young Adult

To elucidate the family history of glaucoma (FHG) as a risk factor for ocular hypertension(OH) vs glaucomatous optic nerve damage, we reviewed the clinical records of 361 primary open-angle glaucoma(POAG) patients, 178 OH subjects, and 927 normal controls randomly selected from an urban medical center eye clinic. The prevalence of a positive FHG was 27% in the POAG patients, 47% in the OH subjects, and 11% in the normal controls. Whereas a positive FHG was a significant risk factor for both OH and glaucoma compared to normal control subjects (OR = 7.56, 95% CI: 5.27-10.85, P < .0001 for OH; OR = 3.15, 95% CI: 2.31-4.31, P < .0001), it was a risk factor more significantly for OH than for glaucoma being significantly more prevalent in OH than in POAG (OR = 2.40, 95% CI: 1.65-3.49, P < .0001). These results suggest the importance of additional risk factors other than IOP for glaucomatous optic nerve damage.
Aged ; Family Health ; Female ; Glaucoma, Open-Angle/epidemiology/*genetics ; Humans ; *Intraocular Pressure ; Male ; Ocular Hypertension/epidemiology/*genetics ; Optic Nerve Diseases/epidemiology/*genetics ; Prevalence ; Questionnaires ; Random Allocation ; Risk Factors

To investigate the risk factors for glaucoma, we reviewed the clinical record of 361 primary open-angle glaucoma (POAG) patients, 178 ocular hypertensives (OH), and 927 controls without POAG or OH, randomly selected from an urban medical center eye clinic. Old age defined as > or = 55 year, (odds ratio ratio (OR) = 3.13 95% confidence interval (CI): 2.06-4.76, P < .0001), black race (OR = 2.58, 95% CI: 1.79-3.74, p < .0001), hypertension (OR = 1.709, 95% CI: 1.15-2.51, P < .0108), and diabetes mellitus (OR = 1.83, 95% CI: 1.08-3.09, P = .0308) were identified as significant risk factors in POAG compared to OH. Old Age (OR = 4.94, 95% CI: 3.62-6.76, p < .0001), and black race (OR = 2.04, 95% CI: 1.59-2.61, P < .0001), HTN (OR = 1.63, 95% CI: 1.26-2.11, P = .0002), and DM (OR = 1.40 95% CI: 1.02-1.92 P = .0450) were also significant risk factors when compared to normal controls. However, when the 361 POAG patients were compared to 361 controls matched with respect to age, race, and sex, hypertension and diabetes mellitus did not appear to be independent risk factors. Family history of glaucoma was found to be a risk factors more significantly for OH (OR = 6.79, 95% CI: 4.39-10.50, P < .0001) than for POAG (OR = 2.83, 95% CI: 1.90-4.21, P < .0001) compared to the matched control subjects. The apparent importance of hypertension and diabetes as risk factors for POAG may therefore be due at least in part to a higher prevalence of hypertension and diabetes mellitus in the elderly than the young and also in the black race as risk factors for glaucoma may be in part due to an increased prevalence of hypertension and diabetes mellitus in the elderly and blacks. Positive family history of glaucoma appears to be a risk factor more specifically for elevated intraocular pressure than for glaucomatous visual field defects.
African Continental Ancestry Group ; Age Factors ; Aged ; Aged, 80 and over ; Diabetes Complications ; Female ; Glaucoma, Open-Angle/ethnology/*etiology ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Ocular Hypertension/ethnology/*etiology ; Odds Ratio ; Prevalence ; Random Allocation ; Risk Factors

Quantification of the optic nerve head topography is getting more and more important in diagnosis, differential diagnosis and follow-up of optic nerve diseases, especially in glaucoma. This study was undartaken to measura optic disc parameters and further to determine side, gender, age, refractive errorrelated differences in the size and topography of the optic disc. The radius and angle of the optic disc and cup were measured every 30 degrees by a computer graphic program(Adobe Photoshop(TM)) in 142 eyes of 78 normal subjects(37 men, 41 women, mean age 47.2 +/- 14.2). The actual optic disc sizes were corrected based on refraction and anterior corneal curvature utilizing Littmanns method. Optic disc area averaged 2.47 +/- 0.48mm2, vertical disc diameter 1.86 +/- 0.18mm, horizontal disc diameter 1.68 +/- 0.18mm. Optic cup area averaged 0.56 +/- 0.28mm2, vertical cup diameter 0.68 +/- 0.28mm, horizontal cup diameter 0.84 +/- 0.27mm. Neuroretinal rim area averaged 1.90 +/- 0.37mm2 and rim width was widest in the inferior disc pole, followed by the superior, nasal, and temporal poles. A highly significant linear correlation between disc area and rim area was observed(r=0.81, p=0.0001) together with a correlation between the disc area and cup area(r=0.58, p=0.0001). Concerning optic disc area, side differences of 0.25mm2 or less were found in 60% and of 0.5 mm2 or less in 90%. Concerning neuroretinal rim area, side differences of 0.25mm2 or less were found in 73% and of 0.5mm2 or less in 90%. There were no significant correlations between these morphometric optic disc data and side, gender, age, or refractive error.
Computer Graphics ; Diagnosis ; Diagnosis, Differential ; Female ; Glaucoma ; Humans ; Male ; Microcomputers* ; Optic Disk ; Optic Nerve Diseases ; Radius ; Refractive Errors

PURPOSE: To generate a map relating visual field (VF) test points to corresponding areas of the retinal nerve fiber layer (RNFL) measured with optical coherence tomography (OCT) in patients with localized RNFL defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects, underwent standard automated perimetry (SAP) and OCT measurements. To define zones of related point, factor analysis of the mean thresholds for the SAP test points was performed, independently for each hemifield. A map relating the VF zones to the 12 OCT sectors was plotted based on the strongest correlations between both techniques. RESULTS: Factor analysis divided the VF points into five VF zones for each hemifield. Distribution of the VF zones for the superior and inferior hemifields was slightly asymmetric. Linear regression results showed that superior VF zones corresponding to the superior arcuate and nasal step regions were best correlated with 6- and 7-o'clock RNFL sectors (inferior and inferior temporal) of thickness (r = 0.51-0.59). RNFL thinning (defined by abnormal sector at p < 5%) and regional decreases in SAP sensitivity (defined by abnormal pattern deviation at p < 5%) were topographically related. CONCLUSIONS: A newly developed VF cluster map revealed significant topographical structure-function relationships, especially in the arcuate and nasal step region of the VF.
Factor Analysis, Statistical ; Glaucoma ; Humans ; Linear Models ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields

The efficacy and safety of mitomycin C(MMC) trabeculectomy was tested in patients with uncomplicated glaucoma(low-risk group) and the result was compared with that in patients with refractory glaucoma(high-risk group). Subjects included 37 eyes of 26 consecutive patients in low-risk group and 36 eyes of 26 patients in high-risk group. The mean preoperative IOP was 32.9 +/- 9.7 mmHg and 31.9 +/- 8.7 mmHg, respectively(p=1.45). The mean number of preoperative medications was 2.8 +/- 0.8 and 2.0 +/- 0.9, respectively(p<0.05). MMC(0.25 mg/ml or 0.5 mg/ml) was applied between Tenon's capsule and the sclera during trabeculectomy for 3 minutes in low-risk group, for 5 minutes in high-risk group. Scleral-flap was closed with tight releasable sutures. Eyes followed longer than 3 months were included(mean of 14.1 +/- 8.0 months vs 11.9 +/- 6.8 months, p=0.23). The low-risk group had better postoperative results including: a lower IOP at last follow-up(13.7 +/- 3.2 vs 17.2 +/- 8.4 mmHg, p=0.02), a better success rate(94% vs 83% with or without medications, p=0.23: 83% vs 55% without medications, p=0.02), a lower postoperative need for glaucoma medications(0.2 +/- 0.4 vs 0.6 +/- 08, p=0.005). Overall complications were similar between both groups. One of 37 eyes(3%) in the low-risk group developed a hypotony(p=0.51) and one of 36 eyes(3%) in the high-risk group developed a hypotony maculopathy(p=0.49). This study suggests that MMC trabeculectomy with tight releasable scleralflap sutures is safe and effective in controlling IOP not only in refractory glaucoma but also, more successfully, in uncomplicated glaucoma.
Glaucoma* ; Humans ; Mitomycin* ; Sclera ; Sutures ; Tenon Capsule ; Trabeculectomy*

PURPOSE: To determine the characteristics of visual field defects in acute primary angle-closure glaucoma and identify risk factors affecting such field defects. METHODS: Automated static perimetry was performed in 60 patients at least 3 months after remission of the acute attack. Glaucomatous visual field defects were defined as 3 or more contiguous points on the pattern deviation plot depressed at p<5% level and one point depressed at a p<1% level. RESULTS: Visual field defects were seen in 40 (67%) of 60 patients. The upper nasal area was most frequently and more severely affected. Only 2 cases (5%) presented a localized type defect. The multiple logistic regression showed that sex (odds ratio=23.1, 95% confidence interval [CI]=3.2 ~ 168.6, p=0.002) and vertical cup to disc ratio (odds ratio=5.5, 95% CI=1.2 ~ 24.8, p=0.03) were significant risk factors for visual field defects. Duration of the acute attack was a marginally significant risk factor (odds ratio=5.2, 95% CI=0.8 ~ 31.8, p=0.08). CONCLUSIONS: The upper nasal visual field was affected most frequently and more severely. The localized defect was rare. Women and the large vertical cup to disc ratio were associated with increased risk for visual field defects. A longer duration of the acute attack seems to more likely develop visual field damage.
Female ; Glaucoma, Angle-Closure* ; Humans ; Logistic Models ; Risk Factors* ; Visual Field Tests ; Visual Fields*

PURPOSE: To identify the risk factors associated with false negative findings of optical coherence tomography (Stratus OCT) in patients with photographic localized retinal nerve fiber layer (RNFL) defects. METHODS: Twenty-four patients with preperimetric glaucoma and 173 patients with perimetric glaucoma, all with localized RNFL defects were included in the present study. The patients were divided into 2 groups according to the presence or absence of detection of photographic defects by OCT. Gender, age, refractive error, diabetes, hypertension, central corneal thickness, type of glaucoma, mean deviation, pattern standard deviation, average RNFL thickness, disc area, and photographic RNFL defect related variables (location, number, and angular width) were compared between the 2 groups. Each variable was initially evaluated by univariate analysis and significant variables (p < 0.1) were included in the logistic regression analysis. RESULTS: Photographic RNFL defects were not detected by OCT in 51 (25.9%) of the 197 eyes. The angular locations and widths of RNFL defects by OCT were significantly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient R = 0.98 and 0.64, respectively). Logistic regression analysis revealed the risk factors for false negative findings of OCT included average RNFL thickness (odds ratio = 1.106, 95% confidence interval [CI] = 1.057-1.156, p < 0.001) and angular width of defect (odds ratio = 0.929, 95% CI = 0.884-0.977, p = 0.004). CONCLUSIONS: This present study suggests that false negative findings of OCT in patients with photographic localized RNFL defects were associated with thicker RNFL thickness and smaller angular width of RNFL defect.
Eye ; Glaucoma ; Humans ; Hypertension ; Logistic Models ; Nerve Fibers ; Refractive Errors ; Retinaldehyde ; Risk Factors ; Tomography, Optical Coherence

The aim of this study was to compare optic disc size obtained using the two methods Color polaroid photographs of optic disc of 130 normal subjects and 174 patients with glaucoma were evaluated by means of computeraided morphometry. In the first method, the optic disc size were calculated by applying the modified formula of an ellipse, where area=pi/4xthe horizontal diameterxthe vertical diameter. In the second method, we obtained optic disc size [] using the twelve radii that were measured every 30 degrees. Magnification effects of the eye and camera were corrected in the two methods. The measurements of the optic disc area(2.49mm2), cup area(1.01mm2) and neuroretinal rim area (1.49mm2) by the first method were significantly(P<0.003, Wilcoxon signed -rank test) different from the measurements by the second method(2.48mm2, 1.03mm2, 1.45mm2, respectively) (the average difference; 0.05+/-0.05mm2, 0.05+/-0.05mm2, 0.07+/-0.06mm2,respectively). The mean error for the neuroretinal rim area was 4.2+/-3.3% in the normal group and 7.5+/-8.5% in the glaucoma group(P=0.005). It increased with decreasing neuroretinal rim area and increasing visual field defects. Thus the magnification corrected measurements of the horizontal and vertical diameters and the modified formula of an ellipse can be used for a quick approximate estimation of the optic disc size, but cannot replace more accurate method of optic disc measurements using twelve radii.
Glaucoma ; Humans ; Visual Fields