1. Neuroretinal Rim Recovery In Narrow Angle Glaucoma After Intraocular Pressure Lowering With Topical Medications  – Case Report
Božić M.1,2, Marković V. 1,2 , Marjanovic I. 1,2 , Marić V. 1,2
1University of Belgrade, Medical Faculty
2University Eye Hospital, Clinical Center of Serbia, Belgrade
CASE OUTLINE
Female patient aged 45 years, presented with repeated headaches accompanied by vision deterioration and pain in the left eye. During one of the headache attacks, IOP was 45 mmHg on the left eye. Slit lamp examination showed shallow anterior ocular chambers and narrow chamber angle on both sides. C/D ratio was 0.2 in the right, and 0.7 in the left.
On the prescribed therapy (Miocarpini 2% 3x to both eyes, Cosopt 2x, and Alphagan 2x to the left eye) IOP went down to 18 mmHg in the left eye. Yag laser peripheral iridotomies were performed on both eyes.
Six months after IOP's are 14 (right) and 16 (left) mmHg (Cosopt and Saflutan for left eye).
DISCUSSION
The traditional believe is that glaucomatous optic disc damage is irreversible. However, the reversal of glaucomatous cupping after medication or surgical reduction of IOP has been described, especially in cases of congenital and juvenile glaucoma. Despite the fact that uncontrolled glaucoma causes definite damage to the optic nerve, some authors state the possible existence of the so-called a "buffer-zone", or a time interval in which it is possible to achieve a reversal of the optical nerve damage by adequate therapeutic interventions. The length of this time interval, as well as the mechanism underlying this recovery of the nervous tissue, is currently unknown.
The reversal of the cupping probably depends on the degree of reduction of the IOP, the age of the patient and the elasticity of the lamina cribrosa.
It is necessary to achieve IOP reduction of at least 30% of the initial value, in order to achieve a reversal of the cupping.
HRT II of the right eye.
Humphrey visual field testing- both eyes.
HRT II of the left eye before and after IOP reduction.
The degree of potential changes in the optic nerve head decreases with the age of the patient, which leads us to conclusion that this phenomenon has to be related to the ability of the lamina cribrosa to shift back and forth due to IOP changes.The reversal of the cupping will occur more likely in the early stages of the disease.The controversial question is whether the described structural changes are related to a functional ones.
CONSLUSION.
IOP reduction remains the best way to control glaucoma. Glaucoma should be detected as early as possible and treated as aggressively as possible.
FINANCIAL DISCLOSURE : This study was done without any financial support whatsoever.