Makropapillen mit physiologischer Makroexkavation (Pseudo-Glaukompapillen) - Papillometrische Charakteristika in 17 Augen

Abstract

Characteristics of 17 optic disks larger than 4.4 mm2 and thus satisfying the papillometric criteria of macrodisks (larger than normal optic disks plus two-fold standard deviation) were as follows: (1) Form: similar to normal optic nerve heads but even more circular. The vertical diameter was about 6% larger than the horizontal. (2) Optic cup: abnormally large, therefore "pseudoglaucomatous." (3) Neuroretinal rim: normal-sized when correlated to the total optic disk area, larger in the temporal lower than in the temporal upper optic disk region, narrowest on the temporal optic disk side, larger nasally at the top, and widest at the upper optic disk pole. (4) Cup/disk ratio: abnormally high (0.76 +/- 0.06 horizontally, 0.69 +/- 0.05 vertically), larger horizontally than vertically. (5) Perimetry: the only abnormality was an increased blind spot corresponding to the enlarged optic disk area. (6) Refraction. -0.25 +/- 1.90 diopters (high myopics less than -8.00 diopters) had been excluded). (7) Central retinal artery and vein penetrating the superficial lamina cribrosa almost at the center of the cup, bayonetlike vessel bending at the border of the optic cup. (8) Increased number of cilioretinal arteries, corresponding to their correlation with the optic disk area. These macrodisks with physiologic macrocups can be differentiated by their morphology or by optic disk planimetry in absolute values from: normal-sized optic nerve heads with glaucomatous cupping, abnormally large optic nerve heads in highly myopic eyes, and abnormally large optic nerve heads with pitting of the optic disk.

Anterior ischemic optic neuropathy: Nonarteritic form in small and giant cell arteritis in normal sized optic discs

“…The optic nerve heads with nonarteritic anterior ischemic optic neuropathy were not only smaller than unselected normal optic discs but also significantly smaller (p<0.0001) than so called 'congenital asymptomatic macrodiscs' [10], smaller than discs with pits [11] and smaller than discs with 'Morning-Glory-Syndrome' [16] (Table 2). They were significantly larger than optic nerve heads with drusen [17] and with pseudopapiUedema [18].…”

“…1; Table 1). They were significantly smaller (p<0.001) than 457 unselected normal optic discs (2.69 + -0.70mm 2) [13], smaller than 17 so called 'congenital asymptomatic macrodiscs' (4.91+ -0.34ram 2) [10], smaller than 15 optic nerve heads with pits (4.84 + -1.42 mm 2) [11], and smaller than 17 optic discs with 'Morning-GlorySyndrome' (7.47+ -2.63mm 2) [16]. They were significantly larger (p<0.001) than 26 optic nerve heads with drusen (1.79 + -0.50mm 2) [17], and larger than 35 unselected optic discs with pseudopapilledema (1.95 + -0.33 mm 2) [18] ( Table 2).…”

“…Mean horizontal and vertical cup/ disc ratios were 0.23 +-0. 23 [13] and in congenital asymptomatic macrodiscs (0.76+-0.06 and 0.69+-0.06) [10].…”

Cilioretinal Arteries in Large Optic Disks

“…Optic disk drusen [6], pseudopapilledema [7] and nonarteritic an terior ischemic optic neuropathy [8,9] are associated with abnormally small optic disks while pits of the nerve head [10] and the morning glory syndrome [11] occur signifi cantly (p < 0.00001) more often in larger optic disks. Furthermore, the so-called mac rodisks with pseudoglaucomatous but physi ologic macrocups [12] have to be differen tiated from optic nerve heads with acquired glaucomatous cupping.…”

“…Certain optic nerve anomalies and diseases are correlated to the optic disk size [6][7][8][9][10][11], and a congenitally large optic cup in a large optic disk has to be differentiated from glaucomatous optic disk cupping [12].…”