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.

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

To determine the optimum concentration of mitomycin C(MMC) in patients with refractory glaucoma undergoing trabeculectomy, we retrospectively examined 31 eyes of 22 patients with refractory glaucoma who underwent trabeculectomy with 0.25mg/ml MMC for 5 minutes. They were case matched with a group of 36 eyes of 28 patients who had undergone trabeculectomy with 0.5mg/ml MMC for 5 minutes by using age, gender, type of refractory glaucoma, preoperative intraocular pressure(IOP), and preoperative medications as variables. MMC was applied between the sclera and Tenon's capsule during trabeculectomy, and scleral flap was closed with tight releasable sutures. No statistically significant differences were found in mean IOP between the two groups at the one, three, six, and nine months postoperative periods. The mean follow-up was 9.3 months in the 0.25mg group and 9.8 months in the 0.5 mg group(p=0.70). At the last postoperative visit, 81%(25 eyes) in the 0.25mg group and 86%(31 eyes) in the 0.5mg group had an IOP less than 21mmHg with or without glaucoma medication(p=0.79). At the last postoperative visit, there were no statistically significant differences in mean IOP(17.2 +/- 8.6mmHg and 17.2 +/- 7.3mmHg, respectively, p=0.99), mean number of medications(0.6 +/- 0.9 and 0.5 +/- 0.7, respectively, p=0.77), and change in visual acuity(3 eyes and 6 eyes lost more than 2 lines of vision, respectively, p=0.75) between the two groups. The incidence of complications were similar between the two groups. Our data suggests similar efficacy and safety in trabeculectomy with 0.25 and 0.5mg/ml MMC for 5 minutes.
Follow-Up Studies ; Glaucoma* ; Humans ; Incidence ; Intraocular Pressure ; Mitomycin* ; Postoperative Period ; Retrospective Studies ; Sclera ; Sutures ; Tenon Capsule ; Trabeculectomy*

The purpose of this study is to compare the efficacy and safety of 0.25 and 0.5mg/ml of mitomycin C(MMC) on the outcome of glaucoma filtration surgery in eyes undergoing primary trabeculectomy. Twenty-eight eyes of 20 patients with primary open-angle glaucoma or primary angle-closure glaucoma, who underwent primary trabeculectomy with 0.25mg/ml MMC for 3 minutes were compared with a demographically similar group of 31 eyes of 22 patients with primary open-angle glaucoma or primary angle-closure glaucoma, who had undergone primary trabeculectomy with 0.5mg/ml MMC for 3 minutes. MMC was applied between the sclera and Tenon's capsule during trabeculectomy, and scleral flap was closed with tight releasable sutures. The mean preoperative intraocular pressure was 35.2 +/- 9.3mmHg in the 0.25mg group and 32.1 +/- 9.2mmHg in the 0.5mg group(p=0.21, Student's unpaired t-test). The mean number of preoperative medications was 2.7 +/- 0.9 and 2.7 +/- 0.8(p=0.92, Mann Whitney U test), respectively. No statistically significant differences were found in mean intraocular pressures between the two groups at the three. six, and nine months postoperative periods. The mean follow-up was 9.2 months in the 0.25mg group and 9.0 months in the 0.5mg group(p=0.82, Student's unpaired t-test). At the last postoperative visit. 89%(25 eyes) in the 0.25mg group and 97%(30 eyes) in the 0.5mg group had an intraocular pressure less than 21mmHg with or without glaucoma medication(p=0.50, Fisher exact test). The mean intraocular pressures were 16.0 +/- 6.9mmHg and 13.6 +/- 3.6mmHg, respectively (p=0.10, Student's unpaired t-test). The 0.25mg group received an average of 0.5 medications for IOP control, and the 0.5mg group received an average of 0.2 medications(p=0.32, Mann Whitney U test). The postoperative visual outcome of the two groups did not differ significantly(p=0.27, Fisher exact test). There was no significant difference in complications between the two groups. Hypotony developed in one eye in the 0.5mg group. These results suggest that using 0.25 and 0.5mg/ml MMC for 3 minutes in primary trabeculectomy yields similar results in terms of efficacy and safety.
Filtering Surgery ; Follow-Up Studies ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin* ; Postoperative Period ; Sclera ; Sutures ; Tenon Capsule ; Trabeculectomy*

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 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*

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

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