Reversal of Glaucomatous Optic Disc Cupping in Adult Patients

Marked Cup Reversal Presumably Associated With Scleral Biomechanics in a Case of Adult Glaucoma

“…Previous studies that also used the Heidelberg Retina Tomograph 2 as well as those that used other techniques 3 have demonstrated the reversibility of cupping in adult cases of glaucoma. Those studies claimed that the compliance and position of the optic disc and lamina cribrosa were primary determinants for the cup reversal.…”

“…Those studies claimed that the compliance and position of the optic disc and lamina cribrosa were primary determinants for the cup reversal. 2,3 Sigal et al 4 proposed that elevated IOP deforms ONH tissues indirectly through its influence on the sclera rather than direct action on the internal surface of the ONH. According to them, the highest magnitude of compression occurred within the ONH neural tissues.…”

“…[1][2][3] Clinically, there are 2 orientations of tilting of the optic disc: temporal and inferior 1 ( Figure 1). Optical coherence tomography (OCT) demonstrates an acceptable diagnostic ability for glaucoma by comparing an individual patient's NFL thickness profile with those in a normative database.…”

“…2,3 This phenomenon is postulated to be due to a reversal of the backward bowing of the lamina cribrosa, swelling of the optic disc, and increased intravascular volume. 2,3 In contrast, recent studies using finite element modeling predict that optic nerve head (ONH) biomechanics strongly depend on scleral biomechanical properties.…”

“…2,3 This phenomenon is postulated to be due to a reversal of the backward bowing of the lamina cribrosa, swelling of the optic disc, and increased intravascular volume. 2,3 In contrast, recent studies using finite element modeling predict that optic nerve head (ONH) biomechanics strongly depend on scleral biomechanical properties. 4,5 In support of this prediction, we report an adult case of secondary glaucoma in which the ONH tissue deformation and restoration due to IOP fluctuation were associated with changes in axial length and optic disc size.…”