Pathogenesis of cupping of the optic disc
نویسنده
چکیده
Optic disc cupping (ODC) is a classical feature of chronic simple glaucoma. In attempts to explain the pathogenesis of ODC, a very large volume of literature has accumulated since its discovery over I 20 years ago, but the mechanism is still far from clear. The presence of ODC with no rise in intraocular pressure (IOP), first described by von Graefe (I857), has further contributed to the confusion on the subject. Various theories attempt to explain the pathogenesis of the changes in the optic disc (OD) in these cases, postulating either a mechanical or a vascular basis, in addition to many more theories concerning cavernous degeneration; the subject has been reviewed elsewhere (Hayreh, I974d). I recently found a very high incidence of ODC in anterior ischaemic optic neuropathy (AION) due to temporal arteritis (Hayreh, I974b, d) identical in all aspects to that seen in glaucoma and low tension glaucoma. Thus, identical pathological ODC occurs in glaucoma, low tension glaucoma (pseudo-glaucoma), and AION. Since AION, being an acute process, has a much-telescoped natural history, resulting in marked cupping within 4 to 5 months after its onset, it has been possible to follow in patients its entire natural history with modern techniques, e.g. stereoscopic ophthalmoscopy, fluorescein fundus angiography, and histopathology. On the basis of these clinical studies and also of experimental studies, I have tried to explain the pathogenesis of ODC in AION, and also, presumably, of ODC in glaucoma and low tension glaucoma, since the three conditions present an ischaemic disorder of the anterior part of the optic nerve (ON)-AION being an acute process while the other two are chronic.
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