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Martin B. Wax, MD; Gülgün Tezel, MD; P. Deepak Edward, MD

Arch Ophthalmol. 1998;116:993-1001.

Objective  To study the histopathological changes of eyes from a patient with normal-pressure glaucoma whose clinical and laboratory findings were well documented.

Methods  Postmortem histopathological findings in a patient with normal-pressure glaucoma who had monoclonal gammopathy and serum immunoreactivity to retinal proteins were examined in comparison with those of an age-matched control subject. Clinicopathological correlations to laboratory findings were examined.

Results  Clinical and histopathological findings of the patient, including cavernous degeneration of optic nerve and characteristic optic nerve cupping, were similar to those in patients with glaucoma who had high intraocular pressure. In addition, we found immunoglobulin G and immonuglobulin A deposition in the ganglion cells, inner and outer nuclear layers of the retina, and evidence of apoptotic retinal cell death using terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick end labeling technique.

Conclusions  Serum antibodies to retinal proteins and retinal immunoglobulin deposition constitute novel findings in a patient with normal-pressure glaucoma and may contribute to better understanding of the mechanisms underlying glaucomatous optic neuropathy in this disorder.

From the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Mo (Drs Wax and Tezel), and the University of Illinois, Chicago (Dr Edward). The authors have no proprietary interest in any of the materials used in this study.

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