Trudności diagnostyczne w rozpoznaniu jaskry w przypadku współistnienia druz tarczy nerwu wzrokowego i zaburzeń krążenia gałkowego – opis przypadku
Diagnostic Difficulties in Recognizing Glaucoma with Coexisting Optic Disc Drusen and Ocular Circulation Disturbances – Case Report
Monika Modrzejewska, Ewelina Lachowicz, Danuta Karczewicz
Katedra i Klinika Okulistyki Pomorskiego Uniwersytetu Medycznego w Szczecinie
Samodzielny Publiczny Szpital Kliniczny nr 2 w Szczecinie
Kierownik: prof. dr hab. n. med. Danuta Karczewicz
Summary: Purpose: The purpose of this report was to present diagnostic difficulties associated with recognizing primary open angle glaucoma (POAG) coexisting with bilateral optic disc drusen causing progressing visual field defects and significant blood flow disturbance in ocular vessels.
Patient and methods: The cause for conducting detailed ophthalmological diagnostics were changes in visualization of bilateral optic disc coexisting with increased intraocular pressure in examined patient. The ophthalmic examination included: evaluation of irido-corneal angle (Goldmann gonioscope), intraocular pressure measurement (Pascal tonometer), the automated Humphrey visual field testing (Humphrey 24.2), scanning laser ophthalmoscopy (HRT), scanning laser polarymetry (GDx), optic disc computer tomography (OCT) and fluorescein angiography (AF). Additional examinations such as US with assessment of Doppler blood flow velocity, electrophysiological examinations (pERG) as well as head computer tomography (TK) were performed. Risk factors associated with glaucoma and systemic disorders were also analyzed.
Results: Of the conducted research confirmed the presence of optic disc drusen and small visual field defects characteristic for glaucoma. The automated Humphrey visual field testing noted presence of paracentral scotoma. GDX examination noted reduction in thickness of nerve fiber layer of retina, HRT and OCT measurement did not present pathological changes in optic nerve region. Electrophysiological examination confirmed deterioration of ganglion retinal cells. Intraocular pressure measurement presented increase of its values from 20.6 to 23.4 mmHg (open angle IVº Shaffer). Significant alteration of blood flow velocity in central retinal artery and posterior ciliary arteries in color Doppler ultrasonography was observed. Hyperechogenic changes in optic nerve region in type B-ultrasonography were noted. Antiglaucoma treatment was included, achieving improvement of the retinal function.
Conclusions: The presence of optic disc drusen and increased values of intraocular pressure might imply diagnostic doubts for glaucoma recognition. Comorbidity of both types of pathological lesions may be the cause of hemodynamic alteration occurrence in ocular circulation.
Słowa kluczowe: druzy tarczy nerwu wzrokowego, jaskra, zaburzenie krążenia ocznego, trudności diagnostyczne.
Keywords: optic disc drusen, glaucoma, ocular circulation disturbances, diagnostic difficulties.