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

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 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 evaluate the diagnostic ability of Stratus optical coherence tomography (OCT) parameters to distinguish normal eyes from those with early glaucomatous visual field defects. METHODS: One eye each of 52 normal-tension glaucoma patients with early visual field defects (mean deviation, -3.98+/-1.30dB; range, -0.01 to -5.86dB) and 88 age-matched normal subjects were enrolled. The Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were scanned using the Stratus OCT. Areas under the receiver operating characteristic curve (AROC) and the sensitivity and specificity for various OCT parameters were used to assess the performance of OCT. RESULTS: The AROC for the C/D area ratio was 0.865. Other high AROC values included the vertical C/D ratio (0.848), the average RNFL thickness (0.813), and the RNFL thickness in the inferior quadrant (0.791). A stepwise discriminant analysis found that a combination of the C/D area ratio and RNFL thickness in the inferior quadrant could correctly identify 86.4% of the normals and 80.8% of the glaucoma patients (AROC=0.893). CONCLUSIONS: In our sample of patients with early visual field defects, Stratus OCT parameters showed moderate discriminating abilities. Combining the C/D area ratio and RNFL thickness in the inferior quadrant by discriminant analysis improved the diagnostic ability to detect glaucoma.
Discriminant Analysis ; Discrimination (Psychology)* ; Glaucoma ; Humans ; Nerve Fibers ; Optic Disk ; Optic Nerve ; Retinaldehyde ; ROC Curve ; Sensitivity and Specificity ; Tomography, Optical Coherence* ; 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*

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*