Reversal of glaucomatous cupping in adults
J. E. Pederson and J. Herschler
Six cases of reversal of cupping have been collected in 28- to 62-year-old
patients with open angle glaucoma. Reversal of cupping occurred after
filtration surgery in five of the cases and after resolution of a
glaucomatocyclitic crisis in one. The average intraocular pressure
reduction was 27.5 mm Hg (a 68% fall). Reversal of cupping preponderantly
consisted of a reduction in saucerization and undermining of the cup wall.
An omnidirectional decrease in cup size resulted. A slight improvement in
the visual field occurred in one eye after reversal of cupping. The most
likely mechanism to explain reversal of cupping is a reduction in the
posterior bowing of the lamina cribrosa and a reduction of scleral canal
diameter after normalization of IOP. A distinction between true reversal of
cupping and pseudoreversal (caused by disc edema from hypotony) could be
made from studying the caliber of the large retinal veins. Treatment of
early glaucoma, at which stage reversal of cupping is possible, is
suggested.
