Objective: To point out difficulties in glaucoma diagnosis in a patient with optic nerve head d rusen (ONHD).
Materials and methods: a caucasic male aged 64 years was referred because of ocular hypertension. Corrected visual acuity was 20/20 in both eyes. Intraocular pressure (applanation method) was 25 mmHg in OD and 27 mmHg en OS without medication . The optic disks of both eyes had diffused limits, a yellowish white colour and a pseudopapilledema appearance.
Results:Computerized perimetry (CP)(dG1X program, Octopus 1.2.3, Schlieren, Switzerland), demonstrated diffuse depression of sensibility and arcuate scotomata in both eyes. Mode B ultrasonography determined high reflectivity echoes in the discs, and red-free retinography showed disc autofluorescence. Confocal tomography of the ONH (Heidelberg Retinal Tomograph, Germany) confirmed absence of cupping and disk areas and neuroretinal rim areas bigger than normal. Blood flow by doppler ultrasound in both central retinal arteries and in the posterior ciliary arteries of the left eye was reduced. All these findings were considered as characteristic of bilateral ONHD.
Discussion: Coexistence of glaucoma and ONHD is extremely rare. Its calculated prevalence is 0.05 up to 0.4 ‰. The patterns of visual field damage, damage progression and blood flow involvement are similar in both diseases and glaucomatous cupping cannot be seen.
Conclusion: Serial intraocular pressure measurements appears to be the only reliable mean for the diagnosis and follow-up of glaucoma in these patients.