Título

OPTIC DISC CUPPING, RETINAL NEURAL LOSS AND VISUAL FIELD DEFECT FROM SUBTLE RETROCHIASMAL LESIONS MIMICKING GLAUCOMA

Objetivo

Anterior optic pathway diseases masquerading as glaucoma is a relatively common problem in ophthalmology practice but confusion with retrochiasmal lesions is rare. We report series of patients with optic disc cupping (ODC), visual field (VF) defect and OCT abnormalities that had posterior optic pathway lesions misdiagnosed as glaucoma. All had subtle lesions initially missed on high-resolution magnetic resonance imaging (MRI) studies.

Método

Four patients treating for glaucoma based on the presence of VF defect, peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer (mGCL) loss and unremarkable neurologic examination were submitted to complete neuro-ophthalmic evaluation including intraocular pressure (IOP) measurement, automated (24-2 Strategy) and manual (Goldmann) VF examination and OCT examination of the pRNFL and the mGCL. In all subjects MRI studies were re-evaluated searching for subtle retrochiasmal abnormalities.

Resultado

Table 1 provides clinical data and Figure 1 the main ophthalmic and MRI findings. Patients were treated for glaucoma for 1, 2, 10 and 20 years. All had ODC and unspecific pRNFL loss. Two had hemianopic and 2 unspecific mGCL loss. VF showed that 2 had homonymous defect and 2 bilateral constrictions. In all, VF defect was not self-perceived. In only one congruity of VF defect could be detected on automated perimetry (Case 1). Revision of MRI studies showed congenital optic tract hypoplasia in 2 and bilateral subtle occipital lesions in two, one from neonatal hypoglicemia/prematurity and one due to prematurity.

Conclusão

Subtle, particularly congenital or early acquired, retrochiasmal optic pathway lesions should be included in the differential diagnosis of glaucoma. Congenital optic tract hypoplasia should be suspected in patients with hemianopic mGCL loss and subtle occipital lesions in diffuse retinal neural and VF loss, in premature infants. Revision of MRI studies with the clinical data is of utmost importance to avoid unnecessary and potentially harmful erroneous treatment