Atlas of Ophthalmology

Homonymous Defect of Visual Field after Infarct of Posterior Cerebral Artery (FDT, w-w-perimetry, HRT, MRI, DTI)

Brain and Optical Pathway
Male, 71 years, arterial hypertension, atrial fibrillation; eye diagnosis: OD/OS ocular hypertension and open angle glaucoma, homonymous visual field defect with posterior cerebral infarction right. Best corrected visual acuity: OD 0.8 and OS 0.7; IOP: OD 23 mmHg and OS 28 mmHg. Assessment: The configuration of the visual field defect is not typical for glaucomatous disease but typical for a lesion in the area of the optic radiation or visual cortex, respectively. This finding is compatible with causation by the posterior infarction which is suggested to have influenced the visual cortex below and above the calcarine sulcus. The microangiopathic lesions in the area of the optic radiations may account for their impairment. The impact for the visual field related to the temporal retina of the left eye appears to be stronger than for the visual field related to the nasal retina of the right eye. The normal retinal nerve fiber layer thickness reveals a predominantly unaffected 3rd neuron of the visual pathway, but a primary damage of the 4th neuron.

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