PDF(Pubmed)
Abstract：
The identification of glaucomatous optic neuropathy in the setting of optic disc drusen (ODD) is a challenge, and the decision of whether to offer treatment in the form of intraocular pressure (IOP) reduction is controversial. Here, we present a series of patients with coexisting ocular hypertension and ODD to evaluate clinical features, treatment options, and progression of optic neuropathy. In addition, a review of the literature on ODD with elevated IOP is provided.
Six patients with ODD and a history of ocular hypertension are presented. Components of the examination and imaging modalities used to establish the diagnosis of ODD were recorded and a description of ocular hypertension history, glaucoma testing, and the potential treatment of IOP were also provided.
In this series, 4 of 6 patients with concurrent ocular hypertension and ODD showed progression of optic neuropathy as assessed by visual field or retinal nerve fiber layer thickness. Of the 2 patients who did not show evidence of progression, 1 was treated with IOP-lowering medications and 1 was observed off treatment. Of the 4 patients who showed evidence of progression, all 4 were initially treated with IOP-lowering medications and 2 ultimately went on to have trabeculectomy surgery. In the patients with progressive optic neuropathy, lowering the IOP seemed to halt the progression suggesting there was a pressure-sensitive component.
Distinguishing changes to the optic nerve, particularly the structural changes at the lamina cribrosa of true glaucomatous optic neuropathy in the setting of ODD, is a challenge. Careful consideration of risk factors including age, presenting features, progression indicators, and management goals is to be accounted for in the decision to offer treatment. We see the presence ODD in the patients with ocular hypertension as an additional risk for progressive changes to the nerve fiber layer and visual field that needs to be considered when determining whether to initiate therapy. Our data suggest that treatment of IOP in the patients with ocular hypertension with ODD and evidence of progression reduces the risk of further progression. Further work is needed to determine whether progression of optic neuropathy in the setting of coexisting ODD and ocular hypertension is related mechanistically to predominantly an ODD-type process, a glaucomatous process, or a combination thereof.
Six patients with ODD and a history of ocular hypertension are presented. Components of the examination and imaging modalities used to establish the diagnosis of ODD were recorded and a description of ocular hypertension history, glaucoma testing, and the potential treatment of IOP were also provided.
In this series, 4 of 6 patients with concurrent ocular hypertension and ODD showed progression of optic neuropathy as assessed by visual field or retinal nerve fiber layer thickness. Of the 2 patients who did not show evidence of progression, 1 was treated with IOP-lowering medications and 1 was observed off treatment. Of the 4 patients who showed evidence of progression, all 4 were initially treated with IOP-lowering medications and 2 ultimately went on to have trabeculectomy surgery. In the patients with progressive optic neuropathy, lowering the IOP seemed to halt the progression suggesting there was a pressure-sensitive component.
Distinguishing changes to the optic nerve, particularly the structural changes at the lamina cribrosa of true glaucomatous optic neuropathy in the setting of ODD, is a challenge. Careful consideration of risk factors including age, presenting features, progression indicators, and management goals is to be accounted for in the decision to offer treatment. We see the presence ODD in the patients with ocular hypertension as an additional risk for progressive changes to the nerve fiber layer and visual field that needs to be considered when determining whether to initiate therapy. Our data suggest that treatment of IOP in the patients with ocular hypertension with ODD and evidence of progression reduces the risk of further progression. Further work is needed to determine whether progression of optic neuropathy in the setting of coexisting ODD and ocular hypertension is related mechanistically to predominantly an ODD-type process, a glaucomatous process, or a combination thereof.
摘要：
在视盘玻璃疣（ODD）的背景下识别青光眼视神经病变是一个挑战，是否以降低眼压（IOP）的形式提供治疗的决定存在争议。这里,我们介绍了一系列同时存在高眼压和ODD的患者，以评估临床特征，治疗方案,和视神经病变的进展。此外,本文对ODD伴IOP升高的文献进行了综述.
介绍了6例ODD和高眼压病史的患者。记录用于建立ODD诊断的检查和成像方式的组成部分，并描述高眼压病史，青光眼测试，还提供了潜在的IOP治疗方法。
在本系列中,通过视野或视网膜神经纤维层厚度评估，6例并发高眼压和ODD患者中有4例显示视神经病变的进展。在没有显示进展证据的2名患者中，1用降低IOP的药物治疗，1在治疗后观察到。在有进展迹象的4名患者中，所有4例患者最初均接受了降低IOP的药物治疗,2例最终接受了小梁切除术.在进行性视神经病变的患者中，降低IOP似乎阻止了进展,提示存在压力敏感成分.
视神经的改变，特别是在ODD背景下，真正的青光眼视神经病变的筛板结构变化，是一个挑战。仔细考虑风险因素，包括年龄，呈现特征，进展指标，管理目标是在提供治疗的决定中考虑的。我们认为高眼压患者中存在ODD是神经纤维层和视野进行性变化的额外风险，在确定是否开始治疗时需要考虑。我们的数据表明，对ODD和进展证据的高眼压患者进行IOP治疗可降低进一步进展的风险。需要进一步的工作来确定在共存的ODD和高眼压的情况下视神经病变的进展是否与主要的ODD型过程在机械上相关。青光眼的过程，或其组合。
介绍了6例ODD和高眼压病史的患者。记录用于建立ODD诊断的检查和成像方式的组成部分，并描述高眼压病史，青光眼测试，还提供了潜在的IOP治疗方法。
在本系列中,通过视野或视网膜神经纤维层厚度评估，6例并发高眼压和ODD患者中有4例显示视神经病变的进展。在没有显示进展证据的2名患者中，1用降低IOP的药物治疗，1在治疗后观察到。在有进展迹象的4名患者中，所有4例患者最初均接受了降低IOP的药物治疗,2例最终接受了小梁切除术.在进行性视神经病变的患者中，降低IOP似乎阻止了进展,提示存在压力敏感成分.
视神经的改变，特别是在ODD背景下，真正的青光眼视神经病变的筛板结构变化，是一个挑战。仔细考虑风险因素，包括年龄，呈现特征，进展指标，管理目标是在提供治疗的决定中考虑的。我们认为高眼压患者中存在ODD是神经纤维层和视野进行性变化的额外风险，在确定是否开始治疗时需要考虑。我们的数据表明，对ODD和进展证据的高眼压患者进行IOP治疗可降低进一步进展的风险。需要进一步的工作来确定在共存的ODD和高眼压的情况下视神经病变的进展是否与主要的ODD型过程在机械上相关。青光眼的过程，或其组合。
