[Diagnostic references in optic nerve diseases using retinal nerve fiber photography].

Two patients with optic nerve disease are reported. The first patient was 20 years old and had suffered a closed head injury 1 year earlier. She presented with an incongruous right hemianopsia; retinal nerve fiber layer photography disclosed an infragenicular lesion and descending atrophy of the medial postchiasmal parts of the optic tract. The second patients was 24 years old. He had had depressed visual acuity in his right eye for 7 h before presentation. Perimetry showed a quadrant anopsia of the lower nasal field. The diagnosis made on the basis of fluorescein-angiography was recurrent retinochorioiditis with acute occlusion of an arterial branch. Retinal nerve fiber layer photography in this early stage showed a more pronounced nerve fiber pattern in the area normally supplied by the occluded artery, most probably caused by axoplasmic edema; along the course nerve fibers showed ascending atrophy in this circumscribed area. In both cases papillometry had given no evidence of any alteration in the area of the neuroretinal rim. In contrast to glaucomatous optic atrophy, localized disturbances of perfusion apparently cannot be detected by examination of the area of the neuroretinal rim of the optic nerve. In nonglaucomatous optic nerve diseases retinal nerve fiber layer photography is more informative.