Journal List > J Korean Ophthalmol Soc > v.58(12) > 1010693

Kim and Kim: A Case of Optic Nerve Head Swelling in a Patient with Primary Open-angle Glaucoma

Abstract

Purpose

To report a case of masked glaucomatous optic nerve head damage due to acute swelling in a primary open-angle glaucoma patient.

Case summary

A healthy 21-year-old male visited our clinic complaining of blurred vision in the right eye for 1 week. The intraocular pressure (IOP) was 60 mmHg, as measured by a Goldmann applanation tonometer. No specific anterior segment finding other than severe corneal edema was found on slit lamp examination. Maximum tolerated medical therapy was performed, and a further examination was done 1 day after the IOP lowering. No glaucomatous change in the optic disc or retinal nerve fiber layer was observed on fundus examination and optical coherence tomography (OCT), but the optic disc of the right eye was more hyperemic than that of the left eye. A superonasal visual field defect was also observed using automated perimetry. After treatment, the IOP was kept within the normal range using IOP-lowering eye drops. However, an inferonasal retinal nerve fiber layer defect was observed on fundus examination and OCT, and a superonasal scotoma was detected by perimetry.

Figures and Tables

Figure 1

Color and red-free fundus photographs of 21-year-old male who visited our clinic with ocular hypertension. On the initial fundus photographs, there was no prominent glaucomatous change of optic nerve head, butthe optic nerve was slightly congested (A, C). For the next two months, intraocular pressure (IOP) was maintained within normal range with IOP-lowering medication but fundus examination after two months showed increased cupping of the optic disc, superotemporal and inferotemporal side retinal nerve fiber layer defect (B, D, white arrows).

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Figure 2

Automated perimetery of the patient. At the initial visit, superonasal defect was observed without typical glaucomatous damage on the fundus examination (A). Such visual field defect persisted after 2 months (B). GHT = glaucoma hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.

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Figure 3

Optical coherence tomography (OCT) of 21-year old male. Initial OCT showed no neuroretinal rim thinning or retinal nerve fiber layer defect (A). However, inferotemporal rim thinning and retinal nerve fiber layer defect was observed after 2 months (B). ONH = optic nerve head; RNFL = retinal nerve fiber layer; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; C/D = cup/disc; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; N = nasal; I = inferior; T = temporal.

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Notes

This study was supported by the Korea Healthcare Technology Research and Development (R&D) Project of the Ministry of Health and Welfare Affairs grant HI15C1142.

Conflicts of Interest The authors have no conflicts to disclose.

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