Ординатура / Офтальмология / Английские материалы / The Glaucomas Volume 1 Pediatric Glaucomas_Sampaolesi, Zarate_2009
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Congenital Anomalies of the Optic Nerve |
241 |
IX. Pseudopapilla
A 20-degree tomography of pseudopapilla is shown in Fig. 17.45, which contains both discs (the papilla and the pseudopapilla) [71]. In Fig. 17.46 both discs are displayed separately, in two 10-degree field examinations (the real optic disc is at the top of the image and pseudopapilla is at the bottom). The main features of pseudopapilla are described in Fig. 17.47.
Fig. 17.47 Pseudopapilla
Clinical Cases |
243 |
Clinical Cases
Case 1:
Congenital Glaucoma Type I
17 years of follow up
That is, in this case I kept the trabeculotome very close to the cornea and detached the Descemet membrane (Figs. 17.48, 17.49, 17.50, 17.51, 17.52, Table 17.19).
Right eye |
Left eye |
The clinical doctor told the parents to wait until the age |
1988 |
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of 8 months in order to unblock the lacrimal passages. |
Axial length |
22.06 mm |
25.98 mm |
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The pediatric specialist suspected glaucoma and sent |
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him to the ophthalmologist. |
IOP |
10 mmHg |
20 mmHg |
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We were able to follow up this male patient for |
Corneal diameter |
13 mm |
14.5 mm |
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17 years after surgery with six visual field examina- |
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tions, eight confocal tomographies of the optic nerve, |
Chamber angle |
Normal |
Type I |
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six daily pressure curves, and one HRF. His vision is |
Surgery 1988 |
– |
Trabeculotomy |
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20/25 in the operated eye, and his visual field is normal |
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with Octopus 101 and with doubling frequency tech- |
2005 |
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nology. He has excellent grades in high school and is |
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an outstanding soccer player. |
Axial length |
23.81 mm |
24.85 mm |
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After trabeculotomies (Chap. 16), three gonio- |
Visual acuity |
−0.50 180° |
−0.50 180° |
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synechiae appeared: a central one, where the trabe- |
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= 20/20 |
= 20/20 |
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culotome enters, and two peripheral goniosynechiae |
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through which it exits to the anterior chamber. The |
IOP |
16 mmHg |
13 mmHg |
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open Schlemm canal at each side of this with pigment |
Daily pressure curve |
Normal |
Normal |
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can be seen on the goniophotograph, as well as the |
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central goniosynechia. In the left part, the Descemet |
Optic nerve (HRT) |
Normal |
Normal |
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membrane can be seen detached by the trabeculotome. |
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Table 17.19 Case 1. HRT 2005 |
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Left eye |
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Right eye |
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Parameters |
Global |
Parameters |
Global |
Disc area (mm²) |
2.276 |
Disc area (mm²) |
3.029 |
Cup area (mm²) |
0.453 |
Cup area (mm²) |
0.660 |
Rim area |
1.823 |
Rim area |
2.370 |
Cup/disc area ratio |
0.199 |
Cup/disc area ratio |
0.218 |
Rim/disc area ratio |
0.801 |
Rim/disc area ratio |
0.782 |
Cup volume (mm3) |
0.084 |
Cup volume (mm3) |
0.189 |
Rim volume (mm3) |
0.272 |
Rim volume (mm3) |
0.520 |
Mean cup depth (mm) |
0.159 |
Mean cup depth (mm) |
0.240 |
Maximum cup depth (mm) |
0.606 |
Maximum cup depth (mm) |
0.784 |
Height variation contour (mm) |
0.212 |
Height variation contour (mm) |
0.331 |
Cup shape measure |
–0.311 |
Cup shape measure |
0.285 |
Mean RNFL thickness (mm) |
0.140 |
Mean RNFL thickness (mm) |
0.207 |
RNFL cross-sectional area (mm²) |
0.749 |
RNFL cross-sectional area (mm²) |
1.278 |
244 Chapter 17 Optic Nerve
Fig. 17.48 HRT of the right eye
Fig. 17.49 HRT of the left eye
Clinical Cases |
245 |
Fig. 17.50 Peripheral ruptures of Descemet membrane (Haab striae)
246 Chapter 17 Optic Nerve
Fig. 17.51 Visual field with Octopus in FDT of right and left eyes
Clinical Cases |
247 |
Fig. 17.52 a Goniophotograph and drawing after surgery. b Photograph of the eyes of the patient and the same patient as a soccer player
248 Chapter 17 Optic Nerve
Case 2:
Congenital Glaucoma Type I (Unilateral)
35 years of follow up
This child was treated until 5 months for dacryocystitis. At 10 months, the right eye was seen to be much larger and 5 days later corneal edema appeared in this eye. Nonetheless, it was not operated until the age of 1 year and 8 months (Figs. 17.53, 17.54, 17.55, 17.56, 17.57, 17.58).
The fact that the parents waited 1 year and 3 months to decide to operate the right eye and that the glaucoma in the left eye appeared later gave rise in the first eye to glaucoma alterations of the optic nerve and the visual field and a reduction in visual acuity of 20/80.
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Right eye |
Left eye |
1970 |
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Axial length |
24.32 mm |
22.6 mm |
IOP |
25 mmHg |
9 mmHg |
Corneal diameter |
13.5 mm |
11.5 mm |
Chamber anglea |
Type I |
Normal |
Surgery 1970 |
Trabeculotomy |
– |
2005 |
(35 years later) |
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Axial length |
25.4 mm |
24.46 mm |
Visual acuity |
Sph + 2, Cil. |
20/20 |
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+1.50 140° |
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= 20/80 |
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Optic nerve (HRT) |
Phase II |
Normal |
Visual field |
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Octopus 101 G2 |
Stage 2 |
Normal |
FDT |
Stage 3 |
Normal |
IOP |
16 mmHg |
13 mmHg |
DPC |
Normal |
Normal |
aPersistence of pathological mesodermal remains and Barkan’s membrane. The ciliary body band is visible
Clinical Cases |
249 |
Fig. 17.53 HRT right and left eye, phase II in Goldmann stereochronoscopy
250 Chapter 17 Optic Nerve
Fig. 17.54 Goldmann perimetry. Octopus perimetry, stage II, right eye
Fig. 17.55 Golmann perimetry in Octopus, normal, left eye
Clinical Cases |
251 |
Fig. 17.56 Double-frequency perimetry, right eye, stage III; left eye normal