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.

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

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

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

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*

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

Generalized narrowing of the retinal vessels has been recognized for glaucomatous and nonglaucomatous optic neuropathies. To evaluate how closely peripapillary retinal vessel diameters were related to functional and structural optic nerve damage in primary open-angle glaucoma, the data of the vessel diameters were correlated with intra- and peripapillary morphometric parameters and visual field indices. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the opticdisc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. Only one eye per patient and subject was taken for statistical analysis. The diameters of the inferior temporal and superior temporal retinal artery were significantly correlated with the intrapapillary parameters, the peripapillary parameters and the visual field indices. The correlation coefficients were highest for the neuroretinal rim data (r>0.37, p=0.0001), followed by mean deviation, vertical cup to disc ratios, whereas total peripapillary atrophy data, zone beta and zone alpha data were relatively low. Concerning the vessel diameter, the highest correlation coefficients were calculated for the inferior temporal artery, followed by the superior temporal artery. No correlation was found with age and refraction. The results indicate that, in primary open-angle glaucoma, the vessel diameter redduces with decreasing area of the neuroretinal rim, increasing visual field defects and increasing peripapillary atrophy. Its evaluation can be helpful for the diagnosis of glaucoma and possibly also for follow-up.
Atrophy ; Diagnosis ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Optic Nerve Diseases ; Optic Nerve* ; Retinal Artery ; Retinal Vessels* ; Retinaldehyde* ; Temporal Arteries ; Veins ; Visual Fields

Narrowing of the retinal vessels in chronic glaucoma has been recognized only recently. We performed this study to evaluate the vessel diameter in normal and glaucoma eyes, addressing whether the retinal vessel diameters differ with the degree of glaucomatous optic nerve damage. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The photographic magnification was corrected according to Littmanns method. Only one eye per patient and subject was taken for statistical analysis. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(early; more than 0.61, medium; 0.60~0.41, advanced; 0.40~0.21, far advanced; less than 0.20). In the normal group the diameter of the inferior temporal vein(0.130+/-0.020mm) was the largest, followed by the superior temporal vein(0.117+/-0.017mm), the inferior temporal artery(0.102+/-0.016mm), finally the superior temporal artery(0.093+/-0.012mm). The retinal vessel diameter decreased significantly with decreasing of the neuroretinal rim/disc area ratio. In the glaucomatous eyes as compared to the normal eyes, the diameters of the inferior temporal and superior temporal retinal artery were significantly smaller at the early and medium stages(p<0.03, p<0.02, respectively). Whereas both inferior temporal and superior temporal retinal vein diameters were significantly samller at the far advanced stage(p=0.01, p=0.005, respectively). The results indicate that generalized reduction of the retinal vessel diameter throughout the retina is related to the severity of glaucoma. From a diagnostic point of view, evaluation of artery diameter rather than vein diameter may be helpful for the differentiation between normal and glaucomatous eyes.
Arteries ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Optic Nerve ; Retina ; Retinal Artery ; Retinal Vein ; Retinal Vessels* ; Retinaldehyde* ; Veins

The relationship between quantitative structual measurements of the optic nerve head and visual field defects was studied in 150 eyes of 150 patients with primary open-angle glaucoma(POAG). The radius and angle of the optic disc and cup were measured every 30 degrees to obtain rim area, rim area to disc area ratio, cup area, and cup to disc ratio with a computer graphic program(Adobe PhotoshopTM) and the photographic magnification was corrected according to Littmann`s method. The visual field indices including mean deviation(MD) and corrected pattern standard deviation(CPSD), using a Humphrey Field Analyzer(C 302) were obtained. Each intrapapillary parameter showed statistically significant linear correlation with MD. And those disc parameters also significantly correlated with CPSD, although this correlation was relatively lower than that of intrapapillary parameter with MD. Rim area to disc area ratio and MD were most highly correlated(r=0.712, p=0.0001), and correlation of rim are with MD followed next(r=0.670, p=0.0001). These findings suggest that intrapapillary parameters in POAG were more correlated with the overall visual field depression(MD) than the localized visual field change(CPSD). The rim area to disc area ratio rather than the rim area itself, was more related to the diffuse visual field defects.
Computer Graphics ; Glaucoma, Open-Angle* ; Humans ; Optic Disk ; Radius ; Visual Fields*