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Photo Essay
December 1999

Demonstration of the Reversibility of Optic Disc Topography by Scanning Laser Ophthalmoscopy

Arch Ophthalmol. 1999;117(12):1664-1665. doi:10.1001/archopht.117.12.1664

GLAUCOMA was discovered in the left eye of a 9-year-old boy with dominantly inherited partial anirida (Figure 1). Visual acuity was 6/6 m (20/20) OD and 6/9 m (20/30) OS. The cup-disc ratio was 0.3 OD and 0.6 OS (Figure 2, left). Initially the intraocular pressure (IOP) was 18 mm Hg OD and 26 mm Hg OS. Despite a maximal medical therapeutic regimen including topical brimonidine tartrate, latanoprost, timolol maleate, 0.25% betaxolol hydrochloride suspension, and oral acetazolamide sodium, IOP remained elevated up to 35 mm Hg OS. The SITA Fast (Swedish interactive thresholding algorithm) automated perimetry1 showed progressive left glaucomatous field loss. Left trabeculectomy was preformed using topical preoperative fluorouracil.2 Apparent improvement in the left optic disc after surgery (Figure 2, right) was demonstrated by confocal scanning laser ophthalmoscopy using the Heidelberg retina tomograph (Heidelberg Engineering, Heidelberg, Germany) (Figure 3 and Table 1). Postoperative IOP remains below 21 mm Hg OS without medication. The control of IOP is well maintained in the fellow eye without surgery by using the combination therapy of latanoprost and brimonidine. Subsequently his sister and mother were found to have complete aniridia. The boy's sister's condition has required almost identical management that has proved equally successful with over 1 year's postoperative follow-up.