A Case of Normal Tension Glaucoma Associated with Buerger's Disease

Abstract

OHGURO, I., OHGURO, H., OHTA, T. and NAKAZAWA, M. A Case of Normal Tension Glaucoma Associated with Buerger's Disease. Tohoku J. Exp. Med., 2006, 209 (1), [49][50][51][52] Open angle glaucoma, a slowly progressive optic atrophy, is clinically characterized by visual field defects corresponding to excavation of the optic disc, called glaucomatous cupping. Open angle glaucoma is further divided into primary open angle glaucoma caused by elevated intraocular pressure (higher than the normal limit of 21 mmHg), and normal tension glaucoma, in which intraocular pressure is in the normal range. Here we report a case of normal tension glaucoma associated with Buerger's disease, also known as thromboangiitis obliterans, which causes systemic blood flow disturbance. A 66-year-old man suffering from Buerger's disease for 10 years was diagnosed as having branch retinal artery occlusion in his left eye. He was referred to our clinic due to progressive visual field disturbance in that eye. Ophthalmologic examinations revealed occlusion in the inferotemporal retinal artery in the left eye, and glaucomatous cupping, normal intraocular pressure, retinal vessel tortuosity and retinal arteriosclerosis in both eyes. Visual field examination revealed decreased retinal sensitivities in the areas within the visual field arches above and below fixation from the blind spot to the median raphe, corresponding to the arcuate retinal nerve fibers comprising the Bjerrum areas and the area corresponding to the retinal artery occlusion. Buerger's disease is characterized by the development of segmental thrombotic occlusions and vasospasm of the medium and small arteries. Our case suggests that the blood flow disturbance due to arteriosclerosis, thrombotic occlusions and vasospasm associated with Buerger's disease might affect the ophthalmic circulation system, thereby contributing to the etiology of normal tension glaucoma. normal tension glaucoma; Buerger's disease; arteriosclerosis; vasospasm; ophthalmic circulation © 2006 Tohoku University Medical PressOpen angle galucoma (OAG) is a chronic and progressive optic neuropathy characterized by excavated appearance of the optic nerve head called glaucomatous cupping and visual field defects corresponding to the decreased areas of retinal sensitivity resulting from loss of retinal ganglion cells and their axons. Clinically, there are two types of OAG; primary OAG caused by elevated intraocular pressure (IOP) (higher than 21 mmHg), and normal tension glaucoma (NTG) in which IOP is within normal range (dose not exceeded 21 mmHg). A recent glaucoma survey

Ocular Manifestations of Buerger’s Disease – A Review of Current Knowledge

“…The first condition mentioned above could be explained by vasospasm and thrombotic occlusion in the course of Buerger’s disease. 26 , 30 Vasospasm may also be responsible for the development of normal tension glaucoma and non-arteritic anterior ischemic optic neuropathy, as it may lead to disturbances in the blood flow within the optic nerve head. 27 , 28 , 30 There are studies suggesting an autoimmune background in thromboangiitis obliterans, which might be connected with the development of uveitis (also an autoimmune disease) in two cases.…”

‘’The association of normal tension glaucoma with Buerger’s disease: a case report‘’

“…The ophthalmic artery (OA) is the main blood supply to the orbit and gives rise to ciliary arteries that supply the choroid and optic nerve head, and to the central retinal artery that supplies the retina [ 12 ]. Early sclerotic changes and arteriosclerosis of the retinal arteries were previously reported in Buerger’s disease, suggesting that changes in blood flow by vasospasm and thrombotic occlusions ocur within the ocular arteries [ 9 , 13 ]. However, except for our case, there is only one case in the literature that describes Buerger’s disease with dysfunctional regulation of ocular blood flow within the optic nerve head and retinal arteriole having caused NTG [ 13 ].…”

Occlusive retinal vasculitis and periphlebitis in Buerger’s disease: a case report

“…Bernardczykowa and Zawilski [4] reported fundoscopic findings in the spectrum of hypertensive retinopathy among 52 affected individuals, including narrowing of the retinal arteries, early sclerotic changes and arteriosclerosis. Case reports have also described other rare ocular manifestations of TAO, varying from non-arteritic ischemic optic neuropathy (NAION) [5,6] and papillophlebitis [7] to normal tension glaucoma [8]. There has only been a single case report of central retinal artery ischemic event associated with TAO [9] that lacked visible retinal emboli.…”