ORIGINAL ARTICLE Topography and Fluorescein Angiography of the Optic Nerve Head in Primary Open-Angle and Chronic Primary Angle Closure Glaucoma RAMANJIT SIHOTA, MD, FRCS, FRCOphth, ROHIT SAXENA, MD, NISHANT TANEJA, MD, PRADEEP VENKATESH, MD, and ANKUR SINHA, MD Dr. R. P. Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India ABSTRACT Purpose. The purpose of this study is to correlate optic nerve head topography with fluorescein angiography of the optic nerve head in patients with primary open-angle glaucoma (POAG), chronic primary angle closure glaucoma (CPACG), and normal controls. Methods. This was an institution-based, cross-sectional, case– control study of 30 consecutive patients each with POAG or CPACG, which were compared with 30 age- and sex-matched controls. The fluorescein angiograms undertaken in one eye of each of the 90 subjects were then analyzed both qualitatively and quantitatively. Results. The mean age of controls (group 1) was 51.73  9.6 years, patients with CPACG (group II) was 53.26  9.5 years, and patients with POAG (group III) was 54.5  10.4 years. The mean deviation and corrected pattern standard deviation on Humphrey visual field analyzer, respectively, were -1.51  2.01 dB and 2.09  1.04 dB the in control group, -9.4  9.3 dB and 5.32  4.02 dB in the CPACG group, and -11.27  7.7 dB and 7.57  5.34 dB in the POAG group. There was no significant difference in the disc areas between the three groups (analysis of variance [ANOVA], p = 0.157). All circulatory parameters were delayed in both glaucoma groups compared with controls with the disc filling time (ANOVA, p = 0.001) and the choroidal filling time being significantly delayed (ANOVA, p = 0.006). The Moorfield regression analysis showed good correlation with the pattern of disc fluorescence in all quadrants in cases of CPACG and POAG. Conclusion. The optic nerve head and choroidal circulation was delayed in both patients with POAG and those with CPACG, which correlates with loss of neuroretinal rim and retinal nerve fiber layer on the Heidelberg Retina Tomograph II (HRT). Patients with POAG showed diffuse damage with significant rim loss, whereas patients with CPACG showed marked sectorial abnormalities (superotemporal and the inferior–temporal) on fluorescein angiography and HRT. One possible reason for this discrepancy could be sectorial ischemia occurring in cases of CPACG as a result of a sudden rise of intraocular pressure causing disc and visual field damage. (Optom Vis Sci 2006;83:520–526) Key Words: primary open-angle glaucoma, chronic primary angle closure glaucoma, optic nerve head, choroidal circulation, Heidelberg Retina Tomograph II G laucoma is a chronic optic neuropathy with elevated in- traocular pressure being a major risk factor for progres- sion. 1 There is evidence that microcirculatory defect or compromised perfusion of the optic nerve head may contribute to the structural glaucomatous damage. 2–5 Decreased perfusion pres- sure, vascular autoregulatory dysfunction, and vasospasm are thought to lead to ischemia of the optic nerve head. 3 Such ischemic changes could be expected in chronic primary angle closure glau- coma (CPACG) eyes, in which sudden changes in the intraocular pressure (IOP) could accentuate any vascular autoregulatory dys- function in the optic nerve head. Using fluorescein angiography, qualitative and quantitative as- sessment of angiograms has shown hemodynamic changes in pa- tients with primary open-angle glaucoma (POAG), 2,6,7 normal tension glaucoma 8 and ocular hypertension. 9 However, to the best of our knowledge, there are no studies evaluating the fluorescein angiographic (FA) findings of the optic nerve head in cases of CPACG. In the present study, the authors have made an attempt 1040-5488/06/8307-0520/0 VOL. 83, NO. 7, PP. 520–526 OPTOMETRY AND VISION SCIENCE Copyright © 2006 American Academy of Optometry Optometry and Vision Science, Vol. 83, No. 7, July 2006