الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
Optic cupping means cup to disc ratio of 0.4 or more , differential diagnosis of optic disc cupping is congenital anomalies of optic disc (congenital deep cup, optic disc with anomalous embryonic hyaloid glial vascular remnants, coloboma of the optic disc, tilted disc and optic pit), pallor of the optic disc associated with high myopia, and optic neuropathy( anterior ischemic optic neuropathy, traumatic optic neuropathy, compressive optic neuropathy, Leber’s hereditary optic neuropathy, parasyphlitic optic neuropathy , methanol induced optic disc excavation).
In this study, optic nerve head cupping was studied in relation to the IOP to detect the cases of glaucomatous optic cupping and differentiate them from the other causes of optic cupping.
In our study, 1728 patients were examined for visual acuity, tonometry and ophthalmoscopic examination.
Landolt C chart was used to measure the visual acuity, applanation tonometry was used to measure the IOP, (while shiotz tonometry was used in the patients in which I could not use the applanation like children and bed ridden patients) indirect opthalmoscope was used for fundus examination, slit lamp biomicroscopy was used to examine optic nerve head with the help of the indirect opthalmoscope .
Among these 1728 patients, 286 patients complained of DROP of vision (16.6 % of all the patients), those who follow up the IOP were 18(1.0 % of all the patients), while those who follow up after surgery were 372(21.5 % of all the patients), the patients complaining of headache were 355(20.5 % of all the patients), other complains (like sandy sensations, itching, foreign body sensation, etc) were 697(40.3 % of all the patients).
The most important cases for this study are distributed as follows, glaucoma cases were 107 (representing 6.2 % of all the patients), papilledema were 21 cases (representing 1.2 % of all the patients), Optic atrophy ,optic neuritis or ischemic optic neuropathy were 35 cases (representing 2 % of all the patients), retinitis pigmentosa were 22 cases (representing 1.3 % of all the patients), Myopia cases were 163 (representing 9.4 % of all the patients), Congenital disc anomalies represent 51 cases (representing 3.0 % of all the patients),allergy were 242 cases (representing 14.0 % of all the patients), while those who are ophthalmologically normal were 197 (representing 11.4 % of all the patients) .
We have 72 patients who detected to have optic nerve head cupping (C/D ratio is 0.4 or more) minimum C/D ratio was 0.1, while the maximum was 0.9, the mean was 0.3 and the standard deviation is 0.1.
We have 144 eyes of 72 patients who detected to have optic nerve head cupping (C/D ratio is 0.4 or more) minimum C/D ratio was 0.1, while the maximum was 0.9, the mean was 0.3 and the standard deviation is 0.1. Cases that were suitable for perimetry were 36 patients, from the rest of the 72 cupping patients, 19 patients had best corrected visual acuity that did not permit measurement of perimetry, while 17 cases were children or too young, so the perimetry could not be done in them.
from the 36 cases that were suitable for perimetry, we had 27 patients (75%) were glaucomatous cupping that was evidenced by the glaucomatios field changes. Four patients (11.1%) had normal field so the cupping was physiological cupping. Three patients(8.3 %) were diagnosed to have anterior ischaemic optic neuropathy it was evidenced by the pattern of visual field defect (altitudinal) in addition to history of medical problems like diabetes mellitus and hypertension. One case (2.8%) was coloboma of optic disc. One case (2.8%) was compressive optic neuropathy, that patient come to our clinic complaining of some sort of headache, acromegaly and hyperglycaemia, fundus examination revealed cupping 0.5, MRI was requested and revealed pituitary adenoma.
from the 72 cases who had cupping (C/D ratio 0.4 or more) there were 34 cases had IOP above 24, the cases approved to be glaucomatous cupping by visual field examination (cases suitable for perimetry) were 27, 3 of them were normal tension glaucoma and 5 cases received glaucoma therapy, so 19 patients had cupping and high IOP, from them 3 patients( 15.5 % ) had cupping 0.4, 2 patients (10.5%) had cupping 0.2 and 4 patients (21%) had cupping 0.6 those 9 patients (47 %) had IOP from 25 to 36 mmHg. The rest of patients were distributed as follows : 5 cases (26%) had cupping 0.7 , 4 cases(21%) had cupping 0.8 and 1 patient (6%) had cupping 0.9,and those 10 patients( 53 %) were detected to have IOP from 36 to 44 mmHg. So this study wants to say that the cupping severity is high with the higher IOP.
A multicenter study with more follow up periods on larger number of eyes is recommended to draw out the relation between the IOP and optic cupping. Proper examination techniques and devices are recommended.