The effect of arterial stiffness on the severity and progression of primary open angle claucoma in Malay patients

Introduction The pathogenesis of glaucoma is still unclear. The direct effect of elevated intraocular pressure (IOP) has been proposed as important risk factor for developing of glaucomatous optic neuropathy (GON) based on mechanical theory. Despite well controlled IOP, glaucoma still progress in some patients. Vascular theory suggested that insufficient blood supply causes GON. A combination of high IOP and inadequate ocular perfusion may theoretically accelerate GON lead to rapid progression and more severe disease. Objectives Our objectives are to compare the mean of arterial stiffness between POAG patients and controls and to compare the mean of arterial stiffness on severity and progression of POAG. Methodology 110 Malay patients were recruited for this study. 55 patients were POAG while 55 were age and gender matched controls. Arterial stiffness was measured in pulse wave analysis ( PWA) and pulse wave velocity (PWV) parameters using sphygmocor device. Results Mean age was 66.9 ± 9.0 years in POAG group and 66.6 ± 8.9 years in controls. PWA was 26.98 ± 6.15% in POAG and 25.90 ± 5.39% in controls while PWV was 15.73 ± 4.14 m/s in POAG and 15.18 ± 3.26 m/s in controls. There were no significant differences of PWA and PWV between the two groups. Meanwhile, no significant difference of PWA and PWV on the severity and progression of POAG were noted. However, PWV showed significant difference on progression of POAG after analysed with multivariate ANCOVA with p < 0.05. Conclusion In this study, there were no significant difference of arterial stiffness between POAG and controls and the severity of POAG. PWV was found to be significant on progression of glaucoma after controlling the confounding factors

Recurrent Bilateral Occipital Infarct with Cortical Blindness and Anton Syndrome

Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation