Atlas of Ophthalmology

Primary Open Angle Glaucoma with Glaucomatous Optic Nerve Atrophy (Photography, VF, OCT, HRT)

Glaucomas, Ocular Hypertension -> Primary Chronic Open-Angle Glaucoma (POAG)
Patient: 66 years of age, female, BCVA 0.7 at OD, 0.5 at OS; pachmetry 555µm/560µm; IOP 14/14 mmHg under topical Carboanhydrase-inhibition, Ocular Medical History: 24-IOP profile 8-16 mmHg; epiretinal gliosis at OS, Heidelberg Retina Tomography HRT: reduced rim area with 0.38 mm² at OD, 0.8 mm² at OS, optic nerve head area 1.9 mm² at OD, 2.1 mm² at OS. General Medical History: diabetes type 2 since 4 years, Purpose: to present progressed optic nerve head changes in Primary Open Angle Glaucoma (POAG). Methods: Colour Photography Posterior Pole, Octopus G1, Retinal Nerve Fiber Thickness Spectralis OCT Heidelberg Engineering. Findings: Colour Photography Posterior Pole: progressed optic neuropathy with loss rim area and degeneration of retinal ganglion cells at OD and OS, peripapillary bleeding at 2h at OS. Octopus G1: progressed visual field loss at OD and OS (OD>OS), mean defect 19 dB at OD, 17 dB at OS. Spectralis OCT Heidelberg Engineering: thinned retinal nerve fiber thickness at OD and OS. Discussion: Primary open angle glaucoma is a progressive optic neuropathy characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. Burr et al. (1) assessed the effects of medication compared with initial surgery in adults with OAG. They found that primary surgery lowers IOP more than primary medication but is associated with more eye discomfort. They reported that one trial suggests that visual field restriction at five years is not significantly different whether initial treatment is medication or trabeculectomy. Literature: (1) Burr J, Azuara-Blanco A, Avenell A, Tuulonen A. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev. 2012 Sep 12;9:

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