[Fluorescent angiography of the papillary region in glaucoma]

The results of fluorescent angiography show that the main blood supply to the papilla comes from the ciliary circulation in the region of the lamina cribrosa, generally from the posterior ciliary arteries and less frequently from Zinn's corona, in the prelaminar region, to a considerable extent from the peripapillary choroid membrane and in the retrolaminar part also from the recurrent branches of the peripapillary choroid membrane. It also emerges that the vascular supply of the papilla in this region is arranged by segments, which explains, for example, the formation of nerve-fibre bundle defects in glaucoma. Papillary irrigation and the peripapillary choroid membrane are extremely sensitive to an increase in intra-ocular pressure. All these results provide a good basis for the assumption that, in glaucoma, the main factor producing restriction of the field of vision and excavations of the papilla is defective irrigation of the papillary vessels, originating in the choroid membrane, with chronic ischemia of the papilla. Our own studies lead us to suspect that disturbances of irrigation can precede functional disorders. For several reasons, fluorescence angiography is ill-suited to routine diagnosis. In general, however, this method does underline the significance of disturbances of papillary irrigation in the origin of glaucoma damage.