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.

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

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

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*

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*

Several studies have reported that the extent of cupping reversal after reduction of intraocular pressure may decrease with the progression of glaucomatous optic nerve damage. Three cases of reversal of glaucomatous cupping occurred after mitomycin C trabeculectomy in 20 and 22-year-old patients with advanced open angle glaucoma. The magnitude of intraocular pressure reduction was 35 to 38mmHg(average 36.7mmHg), a 79.1% drop from initial pressures. An improvement in the visual field occurred in one eye after re versa 1 of cupping. The most likely mechanism to explain reversal of cupping is a reduction in the posterior bowing of the lamina cribrosa. Even in the advan ced stage of glaucoma, reversal of cupping may be possible in young adults, as seen in our cases.
Adult* ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Mitomycin ; Optic Nerve ; Trabeculectomy ; Visual Fields ; Young Adult