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Editors Selection IGR 17-1

Clinical Forms of Glaucoma: Provocative Tests in PACG

Comment by Min Hee Suh on:

60890 Optic nerve head changes after short-term intraocular pressure elevation in acute primary angle-closure suspects, Jiang R; Xu L; Liu X et al., Ophthalmology, 2015; 122: 730-737

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Jiang et al. Investigated changes of the optic nerve head (ONH) morphology after acute IOP elevation during dark room prone provocative test (DRPPT) in acute primary angle-closure suspects. Deepening and widening of the optic cup, decrease in neuroretinal rim width, and thinning of the lamina cribrosa (LC) was observed after darkness-induced acute IOP increase > 15 mmHg. Meanwhile, the diameter of the Bruch's membrane opening (BMO) and position of the anterior LC remained unchanged. These results are in line with the study by Agumi et al. Reporting the compression of prelaminar tissue without displacement of the anterior LC after acute IOP elevation in both glaucoma patients and healthy subjects.¹ Despite several limitations the authors mentioned in the discussion, this study has a strength in the study design. They enabled physiologic IOP elevation with relatively long duration by undergoing DRPPT for two hours.

Interestingly, authors showed an increase of the optic disc rim width, as well as the reversal of the optic disc cupping with normalization of the IOP on the follow-up scans one day after the DRPPT.² Although the number of the subjects (n = 9) was small,² this observation is valuable in that it gives hint to the reversibility the ONH morphology related with the short term IOP changes. In clinical practice, we can expect the recovery of the neuroretinal rim structure through prompt normalization of the acute IOP increase. Furthermore, the question arises about the duration and degree of the IOP rise at which the ONH losses the reversibility. Future clinical and experimental studies with large subset of subjects are warranted to elucidate this issue.

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