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Case 12-10. Paracentral Scotoma

Clinical Summary

A 50-year-old white woman had an intraocular pressure of 16 mm Hg in her left eye and a visual acuity of 20/ 20 associated with the diagnosis of normal tension glaucoma. She was being treated with timolol 0.5% twice daily and apraclonidine 0,5% three times a day. Slit-lamp examination and gonioscopy were normal, with visualization of the ciliary body band throughout 360°. Ophthalmoscopy (A,B) revealed marked cupping of the disc and attenuation of the neuroretinal rim from 3:00 to 6:00. A superior paracentral scotoma was evident on the Humphrey visual field (D).

Optical Coherence Tomography

The overall nerve fiber layer thickness was slightly attenuated throughout a 3.4 mm diameter circular tomogram around the disc (E). A focal area of almost total nerve fiber layer drop-out was identified inferotemporally at 5:00, corresponding to the visual field defect.

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