Correlation between optic disc atrophy and aetiology: anterior ischaemic optic neuropathy vs optic neuritis

BACKGROUND

The morphologic features of swollen disc in the acute stage of optic neuritis and anterior ischaemic optic neuropathy (AION) have been extensively investigated in contrast to the morphologic features of optic disc atrophy after these events.

OBJECTIVE

: A prospective study to evaluate the morphologic features of optic disc atrophy 6 months or more after optic neuritis and nonarteritic AION.

PATIENTS AND METHODS

A total of 35 optic discs after nonarteritic AION (n=27) and 24 after optic neuritis (n=19) in otherwise healthy subjects have been evaluated by direct fundoscopic examination with a +90 diopters lens and optic disc photography. The average age of patients at the onset of AION was 57.8 years (range: 38-80) and at the onset of optic neuritis was 32.6 (range: 19-46). The female:male ratio was 18 : 17 in the former and 15 : 9 in the latter. The evaluated parameters included: degree of rim pallor (0 to +3), location of rim pallor, height of rim above the retina, depth and width of cup, peripapillary retinal artery to vein (A : V) ratio, and peripapillary pigment epithelial atrophy. A comparison was made also with 17 age-matched normal discs of 17 patients. Statistical significance was calculated with chi(2) and Fisher's exact test.

RESULTS

Most of the discs after AION were paler (+2: 70%, +3: 26%) than after optic neuritis (normal colour: 8%, +1: 58%, P< or =0.007). Rim segmental involvement after AION was usually either superior 'altitudinal' (53%) or inferior 'altitudinal' (29%), whereas after optic neuritis, it was usually either temporal-central (papillomacular) (42%) or diffuse temporal (42%, P<0.0001). Discs had lower A : V ratio (1 : 3, 40%) after AION compared with optic neuritis (1 : 3, 8%) (P=0.007). There were no significant differences between the two groups in height of the rim, cupping, and peripapillary atrophy.

CONCLUSIONS

: A combination of the degree of rim pallor, location of rim pallor, and A : V ratio may be of value in assessing the aetiology of optic disc atrophy when no previous clinical data are available and a compressive lesion has been ruled out.

Relationship between optic disc cupping change and intraocular pressure control in adult glaucoma patients

BACKGROUND

Until recently, there has been a paucity of quantitative evidence for intraocular pressure (IOP)-dependent optic disc cupping change in adult glaucoma patients. Therefore, we investigated the relationship between optic disc cupping change and IOP control.

METHODS

The study involved 78 eyes of 78 randomly selected adult patients with early to moderate chronic open-angle glaucoma (CO-AG), treated on various therapeutic regimens, who had had two consecutive successful optic disc analyses with the Rodenstock Optic Nerve Head Analyzer 15.8 +/- 14.8 weeks apart.

RESULTS

The mean initial IOP of 27 eyes (34%) with cupping reversal did not differ from that of 17 eyes (22%) demonstrating progressive deterioration (29.2 +/- 8.8 vs 26.2 +/- 6.1 mmHg, P > 0.5), but the reversal group did have a significantly greater mean IOP decrease than the progression group (-10.8 +/- 7.9 vs-1.0 +/- 7.7 mmHg, P < 0.001) and significantly lower mean final IOP (18.3 +/- 6.1 vs 25.2 +/- 7.9 mmHg, P < 0.003).

CONCLUSION

A decrease of optic disc cupping is more likely with a greater IOP reduction and a lower final IOP, and an increase of cupping is more likely with less or no IOP reduction and a higher final IOP.

Risk factors for retinal vein occlusions. A case-control study

The authors conducted a case-control study of risk factors for retinal vein occlusions using 87 patients with vein occlusions, chosen randomly from photographic files from their institution between 1985 and 1990, and a control group of 85 subjects 38 years of age (the youngest individual in the vein occlusion group) or older, who were randomly selected from the records of two general ophthalmologists in the authors' department. Certain risk factors for retinal vein occlusion were highly significant when subjects with retinal vein occlusion were compared with the control group. These risk factors included systemic hypertension (odds ratio [OR], 3.86; 95% confidence interval [Cl], 2.08 to 7.16), open-angle glaucoma (OR, 2.89; 95% Cl, 1.38 to 6.05), and male sex (OR, 2.61; 95% Cl, 1.43 to 4.79). Race, presence of diabetes mellitus, history of coronary artery disease or stroke, and family history of diabetes, glaucoma, coronary artery disease, or stroke were not significant risk factors in the population studied. Logistic analysis of the risk factors showed no interactions. Risk factors for branch retinal vein occlusion and central retinal vein occlusion were identical.