Abstracts of Papers Presented at the 67th Research Meeting of The Medical Research Centre of Bombay Hospital on Monday, 14th June 1999, 2.30 pm in The SP Jain Cafeteria
(Convenor Dr. HL Dhar)
1. 2 CASES OF GLAUCOMA - THE SILENT BLINDER
RC Patel, Sangeeta, Mufazzal, Manoj Kakkar
Although our modern understanding of glaucoma dates back only to the middle of 19th Century. This group of disorders was recognised by the Greeks as early as 400 BC. In Hippocratic writings it appears as ‘glaucosis’ in reference to bluish green hue of affected eye. Glaucoma is the leading cause of irreversible blindness. Glaucoma is not a single disease process but an entire group of disorders the common denominator of which are optic disc. Intra ocular pressure and a very important diagnostic tool - the visual fields. The visual fields have been rightly described as showing the islands of vision in the sea of blindness.
We would like to share two interesting cases of glaucoma who came to our OPD.
Mr. VMP, 69 year old male presented to us with complaints of diminished vision in both eyes. He had been diagnosed as a case of normal tension glaucoma and was on treatment with Timolol Maleate for 6 months. There was no history of headache, haloes or any other systemic illness. His best corrected visual acuity was Rt 6/12 and Lt 6/9. On examination the anterior chamber depth was normal and he had early lenticular sclerosis.
- Gonioscopy showed open angles.
- On fundus examination : - Both eyes showed circular disc with healthy neuroretinal rim, cup disc ratio of 0.8:1, no pallor, normal blood vessels over the disc. The rest of the fundus was normal.
- Intra ocular pressures recorded with schiotz tonometer were 17.3 mmHg in the right eye and 14.6 mmHg in the left eye. In view of these findings visual fields and ocular blood analysis was done. Visual fields did not show any significant findings and ocular blood flow valves were also normal.
Hence we came to the conclusion that though he had a cup disc ratio of 0.8 he had no other positive markers to label his either as a normal tensive glaucoma, or primary open angle glaucoma or a glaucoma suspect. So we stopped his drops and monitored his intraocular pressure. Pressures were maintained at 14.6 mmkg in both eyes. Visual fields and vision remained to be normal. Thus this patient would be having just a variant of the normal physiological cup.
There was another interesting case who came with diminished vision both eyes. No other complaints or any history of systemic illness. Best corrected vision was 6/9 BE. On examination, he had minimal lenticular sclerosis. Gonioscopy showed open angles both eyes. Fundus examination in both eyes showed an oval disc with cup disc ratio of 0.2:1, neuroretinal rim was normal, no pallor rest of the fundus was normal. The intraocular pressure recorded were 23.1 mmHg in both eyes. It was rechecked after one week and was found to remain the same. Hence we did the visual fields and ocular blood flow studies. Visual field in right eye showed double arcuate scotoma and superior arcuate scotoma in left eye. But the pattern filter did not show these changes. Ocular blood flow studies were normal. Thus this patient could have been labelled as a case of chronic simple glaucoma considering the intraocular pressures and gray scale visual field findings. But as the pattern filter did not show any changes. This patient could be a case of ocular hypertension. Thus it was interesting to know how changes in visual field are so important in the diagnosis. We have not started this patient on any treatment and have kept him under observation.Hence we see how every patient is different and one can learn so much from every patient.
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