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Abstract #10087 Published in IGR 6-1
Bilateral visual field defects in pseudoexfoliation glaucoma with optic disc drusen: clinical correlation with the HRA
Viestenz A; Langenbucher A; Mardin CYKlinische Monatsblätter für Augenheilkunde 2004; 221: 280-284
BACKGROUND: Arcuate visual field defects are a typical sign of glaucomatous damage. Elevated intraocular pressure (IOP) in combination with pseudoexfoliation syndrome (PSX) manifests the diagnosis of glaucoma. Beyond this state, in microdiscs with optic disc drusen, the exact classification of the visual field defects is crucial. CASE REPORT: A 57-year-old male with pseudoexfoliation glaucoma was referred because of progressive glaucomatous visual field defects. Visual acuity was 20/40 right and 20/25 left. Maximum IOP was 36 mmHg. A simple optic nerve atrophy was diagnosed superonasally. The optic disc size was OD 2.24 mmμ2 and OS 1.89 mm2 (HRT I). An ultrasound B-mode scan demonstrated the diagnosis of optic disc drusen. Over a one-year follow-up, a growth tendency was observed, especially in the superonasal quadrant. The mulberry-shaped surface of the drusen was visualized with infrared reflection images (HRA II, 830 nm). Confocal scanning laser ophthalmoscopy (HRA II, excitation 488 nm, 500 nm notch filter) showed increased intrapapapillary autofluorescence (> 50 papillary area: OD 1.67 mm2, OS 1.26 mm2). This technique could detect drusen in areas that looked normal in classical retinoscopy. CONCLUSIONS: The differential diagnosis of arcuate scotomas includes simple optic nerve atrophy and glaucomatous optic nerve atrophy. Optic disc drusen in glaucoma eyes can obscure the main cause of progressive visual field loss. Superficial optic disc drusen can be measured planimetrically over the years. An adequate reduction of IOP should be realized in these eyes.LA: German
Dr. A. Vietstenz, Augenklinik mit Poliklinik der Universitat Erlangen-Nurnberg, Erlangen, Germany
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
