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G Arunagiri, S Shareef, RG Notz; Two unusual Neuro-ophthalmic cases mimicking Glaucoma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2645.
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Purpose: To describe two unusual cases that were thought to be glaucoma due to the appearance of the optic nerves. Method: Case reports. Both the patients were referred to the Glaucoma Service at Geisinger Medical Center, a tertiary care hospital. Case 1: A 60 year old white male referred to our tertiary care hospital as his insurance had changed. He was diagnosed with normal pressure glaucoma two years ago. He was tried on various combinations of four eye drops. Applanation tonometry was 17 mm OD and 19 mm OS. Fundus examination showed C/D of 0.9 OD and 0.7 OS. The disks appeared anomalous due to the origin of the blood vessels and were also pale. Case 2: a 29 year old white female with a remote history of migraine and seizures was referred as glaucoma suspect. BCVA was 20/60 OD and 20/25 OS. She did not recall any sudden onset of visual disturbance. Her intraocular pressures were 14 OU. She had cecocentral scotoma OD and paracentral scotoma OS. Results: Case 1: Neuroimaging showed form fruste of septo-optic dysplasia. MRI showed partial absence of septum pellucidum and thin corpus callosum. The patient also had thin optic nerves and chiasm. Endocrinological evaluation was normal. He was advised to discontinue his glaucoma medications. Case 2: Neuroimaging was essentially normal. Mitochondrial mutation was positive for G11778 and she was diagnosed with Leber's hereditary optic neuropathy. Conclusion: The two cases demonstrate that normal pressure glaucoma is a diagnosis of exclusion. Cupping can occur in any neuropathy.
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