[Dysgenetic changes of the angle of the anterior chamber in patients with glaucoma or suspected glaucoma acquired before age 40]

OBJECTIVE

The aim of this study is to determine percentage and degree of dysgenetic changes in the chamber angle in glaucoma suspects and in patients who acquired glaucoma before the age of fourty and to compare the primary classification with the classification after reexamination.

PATIENTS AND METHODS

200 eyes of 104 patients (59 males, 45 females, 0-40 yrs old (median 29) at time of detection) could be examined or reexaminded by gonioscopy and photography with the CGA-1 goniolens. The angles were documented by drawing and by goniophotography. The different features of dysgenesis served to establish a point-scale.

RESULTS

Out of 200 eyes in 24 eyes (12%) a slight, in 81 (40.5%) an intermediate and in 49 (24.5%) a severe goniodysgenesis was found. By reexamination the dysgenesis rate rose from 48 to 77%.

CONCLUSIONS

The high frequency of dysgenetic changes in the chamber angle of glaucoma patients affected under the age of fourty suggests, that in this age group developmental glaucoma is predominant and has to be separated as a special entity from POAG. Two questions arise: 1. Were these dysgenetic changes overlooked most of the time in the newer genetic studies of patients with GLC1A, or, if not, 2nd: Do glaucoma suspects and patients with open angle glaucomas before the age of 40 with and without dysgenetic changes belong to groups with different glaucoma genes, the "with" to genes IRID 1 and IRID 2 and the "without" to genes GLC1A to GLC1F?

Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors

AIM

Membrane formation in the chamber angle induced by argon laser trabeculoplasty (ALT) can be a cause of treatment failure. Identification of risk factors for membrane formation was the primary aim of this retrospective study.

METHODS

Semithin sections of trabeculectomy specimens obtained in a 2 year period were examined by light microscopy. 122 eyes which were treated with one or more ALTs before trabeculectomy were identified. In 46 eyes, a sufficient amount of trabecular meshwork was obtained to permit morphological analysis.

RESULTS

Eyes treated with ALT had a significantly higher incidence of membrane formation (p=0.001). In 23/46 specimens a cellular and collagenous membrane was observed covering the entire trabecular meshwork. In 14/23 specimens (61%), this membrane was readily visible at low power magnification (x40). Comparison of these eyes with those without membrane formation revealed a significant difference in the number of ALTs (mean 2.07 (SD 0.73) v 1.48 (0.59); p=0.026) and in preoperative IOP (32.0 (9. 7) v 26.2 (8.4) mm Hg; p=0.04).

CONCLUSIONS

Membrane formation in the chamber angle is a frequent cause of ALT failure. The major risk factor is the number of ALTs performed.

[Bilateral cystoid macular edema after successful treatment of AIDS-associated cytomegalovirus retinitis]

BACKGROUND

Cystoid macular edema (CME) in AIDS patients with inactive cytomegalovirus (CMV) retinitis is an uncommon but potentially sight-threatening complication. The pathogenesis of CME in these patients is unclear. This study tries to identify possible risk factors by analyzing the charts of five patients.

METHODS

Ten eyes of 5 patients that finally developed CME were followed for an average of 18 months. The initial retinal lesions, their response to antiviral treatment, the development of CME, and the patients' immune status were prospectively monitored.

RESULTS

CMV retinitis was diagnosed at a median CD4+ count of 3 cells/mm3 (range 0-11). All eyes responded to the initial systemic anti-viral treatment. At the onset of CME, CMV retinitis was controlled by antiviral maintenance therapy in all patients [ganciclovir (n = 2), cidofovir (n = 2), foscarnet (n = 1)]. The median time between diagnosis of CMV retinitis and onset of CME was 11.5 months (range 5-24). Development of CME was associated with significant visual loss: acuity ranged from 0.05 to 0.7 when CME was first noticed, compared to 0.8-1.25 at diagnosis of CMV retinitis. Duration of inflammation, size or zone of retinal necrosis did not favor the development of CME, neither did the antiviral therapy. A weak correlation of CME development and immune status (expressed as increase of CD4+ cells) was found. Due to systemic corticosteroids CME resolved.

CONCLUSIONS

CME is a new visual threat to AIDS-patients with CMV retinitis whose immune status improved under the latest combined antiretroviral therapy. Therapy with oral corticosteroids may positively influence this condition.

Retinal degeneration in the rd mouse in the absence of c-fos

PURPOSE

Apoptosis is the final common death pathway of photoreceptors in light-induced retinal degeneration and in several animal models for retinal dystrophy. To date, little is known about gene regulation of apoptosis in the retina. The expression of the immediate early gene c-fos is upregulated concomitant with apoptosis in light-induced photoreceptor degeneration and in the rd mouse, an animal model for inherited retinal degeneration. In a recent study it was shown that c-Fos is essential for light-induced apoptosis of photoreceptors in vivo. To determine whether c-Fos is also involved in the apoptotic pathway of inherited retinal degeneration, rd/rd, c-fos -/- double-mutant mice have been generated.

METHODS

Double-mutant mice (rd/rd, c-fos -/-) were crossbred from c-fos+/- mice and rd/rd mice. Their genotype was determined by polymerase chain reaction analysis of genomic DNA. Wild-type control mice and homozygous rd mice were killed at 2-day intervals from postnatal day (P)9 through P21. Double-mutant mice were killed at postnatal days P9, P11, P13, P15, and P21. To determine levels of apoptosis in the retina, eyes were enucleated and processed for light microscopy and in situ nick-end labeling. Total retinal DNA was extracted from isolated retinas for DNA fragmentation analysis.

RESULTS

Morphologic, histochemical, and biochemical analyses showed that the time course of apoptosis and the outcome of photoreceptor degeneration in rd/rd, c-fos-/- double-mutant mice was indistinguishable from that in rd mice carrying functional c-fos.

CONCLUSIONS

These data suggest that in contrast to its role in light-induced photoreceptor degeneration, c-Fos is not essential for apoptosis in the rd mouse.

[Risk factors for trabeculectomy failure]

BACKGROUND

Trabeculectomy is today the filtering procedure of choice, because complications are rare and success-rates high. A modification of our technique (fornix-based conjunctival flap closed by a running suture) introduced 3 years ago, has lead us to this retrospective assessment of complications and success-rates. Some of the risk factors for failure are known, others however remain obscure. This retrospective series was also used to further identify some of these risk factors for trabeculectomy failure.

PATIENTS AND METHODS

All 388 trabeculectomies performed between January 1992 and June 1994 at our hospital were included in the study. Important pre- and postoperative data were retrospectively assessed from patients case notes, with a special interest in the course of post-operative intra-ocular pressure (IOP). Two major groups were differentiated: Those with open-angle glaucoma (OAG) (i.e. primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX) and pigment dispersion syndrome (PDS)), and other various glaucoma diagnoses. Risk factors were assessed using Cox-proportional hazard model adopting three different criteria for success.

RESULTS

The best success-rate after 12 months of follow-up had patients with narrow angle glaucoma (93.1%)(at least those suitable for filtering surgery), followed by patients with POAG (92.8%), 2 degrees open-angle glaucoma (81.8%), aphakic (75%), juvenile (70.6%) and PDS (52.9%). Pseudophakia and development of an encapsulated bleb (Tenon' cyst) were identified as significant (p < 0.05) risk factors for failure. In addition, YAG-Laser Iridotomy in OAG-group and Aphakia in the group of various glaucoma diagnoses were identified as risk factors for successful post-operative IOP control.

CONCLUSIONS

Filtering surgery (trabeculectomy) is a potent method to reduce IOP. Pseudophakia and an encapsulated bleb are the main risk factors for surgical failure. Because of amazingly high success-rates we tend to perform filtering surgery today earlier than ten years ago, especially as previous long-term topical antiglaucoma treatment may reduce filtering surgery success.

[Livedo reticularis, acral necroses and renal failure. Cholesterol crystal embolisms]

In a 67 year old patient with multiple cardiovascular risk factors a livedo reticularis, ischemic acral lesions as well as deterioration of renal function five weeks after cardiac catheterism and aorto-coronary bypass surgery led to suspicion of cholesterol embolism. Fundoscopy revealed cholesterol crystals in retinal vascular branches thus delivering important diagnostic information. Atheromatous lesions of the entire aorta and the ilio-femoral arteries were possible sources for embolism. The outcome was favorable. The lesions of the toes regressed and renal failure did not progress to dialysis. The diagnostic steps taken, the clinical picture of cholesterol embolism, the use of imaging and therapeutic options are discussed.

[Value of scanning laser ophthalmoscopy and polarimetry compared with perimetry in evaluating glaucomatous changes in the optic papilla and nerve fiber layer]

The aim of the study was to establish quantitative correlations between morphological changes at the optic nerve head (ONH) and the retinal nerve fiber layer (NFL) and functional abnormalities i.e. visual field alterations in glaucoma. A cross-sectional study of open-angle glaucoma patients of various stages was performed. Scanning laser tomographic (TopSS) assessment of the ONH and scanning laser polarimetric (Nerve Fiber Analyzer) measurements of the peripapillary NFL thickness (NFLT) were compared to results of computerized static perimetry (Octopus G-1). One eye from each of 157 glaucoma suspects (n = 58) and patients with established open-angle glaucoma (n = 99) was assessed. The parameter "modulation" (difference between maximum and minimum of NFLT) gave the best correlation (r2 = 0.23) to the visual field index for mean sensitivity. Tomography gave the best correlation between the neuroretinal rim area at the inferior and superior pole of the ONH and the visual field index loss variance (r2 = 0.20). Conventional planimetric data of the ONH and clinical assessment of the NFL yielded slightly better correlations to the visual field data than the scanning laser tomography or polarimetry. Although NFL parameters are more complicated to obtain, they yield better correlations to diffuse visual field loss than parameters of the ONH. The new scanning laser techniques do not improve these correlations between morphology and function; however, they allow objective assessment of ONH and NFL parameters without mydriasis.

[Risk factors for development of argon laser trabeculoplasty failure producing membrane in the chamber angle]

INTRODUCTION

The major cause of ALT failure is membrane formation in the chamber angle. The aim of this retrospective study was to identify possible risk factors.

MATERIAL AND METHODS

We studied sections from the surgical specimens from all trabeculectomies at our department within 2 years. We identified 122 eyes with at least one preoperative ALT. In 46 specimens enough trabecular meshwork for morphological analysis was present.

RESULTS

Half of the patients showed a membrane covering the trabecular meshwork. In 14 of 23 eyes we could see this membrane even at low-power magnification (40 x). Various possible risk factors were evaluated, but none showed a significant correlation. When we compared only these eyes with membranes visible at low-power magnification with eyes without, however, we found a significant difference in the number of ALTs (mean +/- SD 2.07 +/- 0.73 vs 1.48 +/- 0.59; P = 0.026) and preoperative intraocular pressure (32.0 +/- 9.7 mmHg vs 26.2 +/- 8.4 mmHg; P = 0.04).

CONCLUSION

We found no distinct risk factor for membrane formation, but it becomes more frequent with every additional laser treatment.

Reversal of topical antiglaucoma medication effects on the conjunctiva

OBJECTIVE

To determine whether the adverse effects of antiglaucoma medications could be reversed before filtration surgery, potentially reducing the risk of subsequent failure.

METHODS

One month before surgery, 30 patients who were receiving multiple antiglaucoma medications underwent an inferior bulbar conjunctival biopsy, ceased using sympathomimetic drops, and began treatment with topical corticosteroid, (1% fluorometholone four times daily). At the time of surgery two conjunctival biopsy specimens were obtained, one from the operation site (superior bulbar region), and one from the inferior bulbar region. The biopsy specimens were quantitatively analyzed by light microscopy. In addition, the outcome of first trabeculectomy for 16 of these patients was compared with that of 16 matched patients who had not undergone an altered preoperative regimen of topical therapy.

RESULTS

During a 1-month period a notable decrease occurred in the number of fibroblasts and inflammatory cells throughout the conjunctiva. Inferior bulbar conjunctiva was found to be representative of superior bulbar conjunctiva with respect to these changes. Furthermore, evidence comparing the matched patients suggested that the altered preoperative regimen may have improved the success rate of trabeculectomy.

CONCLUSIONS

The preoperative regimen used reversed the adverse conjunctival effect of topical medication. The regimen may be of clinical benefit in improving the success rate of trabeculectomy.

Optic disc size and optic nerve damage in normal pressure glaucoma

BACKGROUND

Recent reports indicate that eyes with normal pressure glaucoma have larger optic discs than eyes with primary open angle glaucoma or normal eyes. This study was performed to find whether, in normal pressure glaucoma, a large disc is associated with more optic nerve damage than a small disc.

METHODS

Colour optic disc photographs of 74 patients with normal pressure glaucoma were assessed morphometrically.

RESULTS

Taking the study group as a whole, the optic disc size decreased significantly (p = 0.04) with increasing visual field defect. In an intraindividual bilateral comparison, the side differences in the disc area of the right minus the left eye of the same individual were not significantly correlated with the side differences in the mean visual field defect.

CONCLUSIONS

The results indicate that the eye with the larger optic disc, when compared with the contralateral eye with the smaller optic nerve head, showed neither a significantly more marked nor less pronounced glaucomatous optic nerve damage. It suggests that for a given patient the degree of glaucomatous optic nerve atrophy was not markedly associated with the optic disc size. The finding that patients with large visual field defects had smaller discs than patients with moderate perimetric loss may indicate that the results of previous cross sectional studies reporting on an unusually large disc size in normal pressure glaucoma may be due partially to selection.

[Follow-up of a pilot study of trabeculectomy with low dosage mitomycin C (0.2 mg/ml for 1 minute). Independent evaluation of a retrospective nonrandomized study]

BACKGROUND

The application of anti fibroses agents during glaucoma surgery leads to more satisfactory results with lower i.o. pressure, yet eliciting complications in wound healing, avascular filtering blebs and frequent chronic hypotonias. In patients with lower risk for failure a reduction of concentration and application time of Mitomycin C should minimise side effects while maintaining the beneficial effect of lower intraocular pressure.

PATIENTS AND METHODS

34 eyes of 32 patients (age 72 +/- 8) underwent trabeculectomy (14 combined with phacoemulsification and implantation of a foldable posterior chamber lens). During filtering surgery, Mitomycin C (0.2 mg/ml for 1 min) was applied after preparation of the scleral flap. An 11.5 +/- 5.0 (3-21), month followup, 30 (34) eyes (88.2%) had an i.o. pressure of < or = 21 mm Hg (14.0 +/- 4.3 mm Hg at the last control) without additional glaucoma medications.

RESULTS

The majority of filtering blebs (30/34; 88.2%) were well vascularised, often showing polycystic degenerations near the limbus. Only 3 eyes developed an avascular filtering bleb. No persisting leaks were observed and only 2 of 34 eyes (5.9%) developed short transient hypotonia (IOP < 6 mm Hg).

CONCLUSIONS

Adjunctive treatment with low concentration of Mitomycin C during filtering surgery results in good i.o. pressure with little risk of avascular bleb development. A prospective, randomised trial is required to assess the safety and efficacy of adjuvantive Mitomycin C treatment in low risk filtering surgery.

[Normal pressure glaucoma: a diagnostic challenge]

PURPOSE

Normal-tension glaucoma (NTG) is a frequently discussed optic neuropathy. The purpose of this retrospective study was to evaluate the final diagnosis of patients with presumed NTG and to select the best distinguishing examination methods.

PATIENTS

All patients with presumed NTG hospitalized for diurnal IOP curves from 1987-1992 were studied. We evaluated retrospectively which diagnostic tests contributed most to the final diagnosis.

RESULTS

In 26 out of 50 patients with presumed NTG the final diagnosis had to be changed, mainly because the diurnal IOP curve showed a dysregulation; often only the early-morning IOP in supine position was elevated.

CONCLUSIONS

We suggest that early-morning IOP spikes are one of the important pathogenetic factors in patients with glaucomatous changes without other pathology. Early morning IOP measurement in supine position before rising should therefore be a mandatory part of diurnal IOP curves in patients with presumed NTG.

The diagnosis of normal-tension glaucoma

The diagnosis of normal-tension glaucoma includes optic nerve head and retinal nerve-fiber layer assessment, standard static computerized visual field testing, gonioscopy, and a diurnal (24-hour) intraocular pressure curve. In addition to a careful history to exclude previous phases of increased intraocular pressure, an internal medicine checkup including 24-hour ambulatory blood pressure measurements and neurological assessment are required. Additionally, carotid artery Doppler sonography, nailfold capillary microscopy, and a computed tomography scan of the brain may be performed.

Single intraoperative applications of 5-fluorouracil during filtration surgery: early results

Experimental studies from our laboratory have suggested that single exposures to 5-fluorouracil (5-FU) would have a similar effect to subconjunctival injections of 5-FU and a less permanent effect on subconjunctival fibroblasts than mitomycin C (MMC). Thirty four eyes of 33 glaucoma patients with an increased risk of filtration surgery failure were treated with a single intraoperative 5 minute exposure of sclera and subconjunctival tissues to 5-FU, 25 mg/ml. The follow up period ranged from 3-9 months, during which two high risk eyes failed completely and one required topical beta blockers to control intraocular pressure. No low/moderate risk eyes failed. Single 5 minute intraoperative exposures to 5-FU are convenient, inexpensive, have no significant corneal side effects, and may be a useful adjunctive treatment to optimise the results of glaucoma filtration surgery, particularly in the large group of low/moderate risk patients.

Young patient trabeculectomy. Assessment of risk factors for failure

BACKGROUND

Various risk factors for failure of glaucoma filtering surgery, including young age, have been suggested.

METHODS

A retrospective study of 113 trabeculectomies in 113 patients, ranging in age between 11 and 49 years (mean, 33.3 +/- 10.5 years), was carried out to determine the influence of these risk factors in young patients.

RESULTS

A successful outcome (intraocular pressure [IOP] < or = 21 mmHg without antiglaucoma treatment), assessed by life-table analysis, was achieved in 54% of trabeculectomies after 38 months (mean follow-up, 36.7 +/- 29.7 months). Previous ocular surgery (e.g., glaucoma filtering, cataract, or conjunctival surgery) and previous laser therapy (i.e., argon laser trabeculoplasty and YAG laser iridotomy) both significantly reduced the success rate. An IOP greater than 40 mmHg during the course of the disease was found to adversely affect the outcome. No direct correlation between success rate and age and no racial difference were demonstrated. Success rates for specific diagnoses were not significantly different. Postoperative subconjunctival injections of 5-fluorouracil (5-FU) did not significantly improve the success rate. A Cox regression analysis of various prognostic variables identified previous cataract surgery (hazard ratio, 4.4), argon laser trabeculoplasty (hazard ratio, 3.4), previous glaucoma filtering surgery (hazard ratio, 2.5), nonfiltering glaucoma surgery (hazard ratio, 2.2) and IOP greater than 40 mmHg (hazard ratio, 2.4) to be the major risk factors for glaucoma filtering surgery failure.

CONCLUSION

A majority (74%) of the patients in our series had at least one of these risk factors, thus explaining why young patients, in general, have lower success rates for trabeculectomy.

Pattern of glaucomatous neuroretinal rim loss

BACKGROUND

In advancing glaucomatous optic nerve damage, the area of the neuroretinal rim progressively diminishes, and its form continuously changes. This cross-sectional study was undertaken to establish a set pattern behind glaucomatous rim loss.

METHODS

The authors evaluated morphometrically stereo color optic disc photographs of 801 glaucomatous eyes and 496 visually normal eyes.

RESULTS

Compared with the visually normal eyes, glaucomatous neuroretinal rim loss occurred in all sectors of the optic disc with regional preferences depending on the stage of the disease. In the eyes with modest glaucomatous damage, rim loss was usually most pronounced in the inferotemporal disc region. In the eyes with moderately progressed glaucomatous changes, rim was decreased most markedly in the superotemporal sector, then in the temporal horizontal area, the nasal inferior region, and finally in the superior nasal sector. In very advanced glaucoma, rim remnants usually were present only in the nasal disc region. At that stage, they were significantly larger in the superior nasal region than in the nasal inferior area.

CONCLUSION

Other than occurring in a diffuse way, glaucomatous neuroretinal rim loss took place in a sequence of sectors. Generally, it began in the inferotemporal disc region and then progressed to the superotemporal, the temporal horizontal, the inferior nasal, and finally the superior nasal sectors. This correlates with the progression of visual field defects and the morphology of the lamina cribrosa. This finding may be important for "early" glaucoma diagnosis.

Intra- and inter-observer variation of optic nerve head measurements in glaucoma suspects using disc-data

The aim of this study was to determine the intra- and inter-observer variation in the use of a system designed for exact measurements from standard optic nerve head photographs. The commercially available system consisted of a colour CCD Videocamera, a dedicated frame grabber and customized software run on a IBM AT compatible computer. Masked measurements were made 3 times by 2 observers, from stereophotographs of the optic nerve head of 56 eyes from 30 glaucoma suspects. The cup was defined on the basis of contour, not pallor and the disc area was defined as the area inside Elschnig's ring. Intra-observer variances were 0.001 +/- 0.001 mm2 for cup area (mean +/- SD), 0.002 +/- 0.002 mm2 for disc area and 0.002 +/- 0.003 mm2 for rim area. These values for intra-observer variance were comparable with the results obtained using manual planimetric techniques. Intra-observer variance for disc area was significantly larger for the less trained of the two experienced observers. Inter-observer variances were 0.004 +/- 0.009 mm2 for cup area, 0.008 +/- 0.013 mm2 for disc area and 0.009 +/- 0.014 mm2 for rim area. These inter-observer variances were significantly larger than those previously reported for manual planimetry. The absolute differences between the two observers ranged from -0.35 to +0.20 mm2 (-0.08 +/- 0.11 mm2) for cup area, from -0.38 to +0.15 mm2 (-0.08 +/- 0.11 mm2) for disc area and from -0.29 to +0.34 mm2 (-0.06 +/- 0.12 mm2) for rim area.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural versus haploscopic stereopsis

Natural stereopsis is better with a large interpupillary distance (IPD). With haploscopic devices, depth perception is better with a small IPD. This apparently unknown fact has been trigonometrically calculated and experimentally shown by enlarging and diminishing the IPD in 20 subjects.

[Comparison of tonometry with the Keeler air puff non-contact tonometer "Pulsair" and the Goldmann applanation tonometer]

Intraocular pressure (IOP) readings were performed with the Keeler Air-Puff Non-Contact Tonometer "Pulsair" in 126 patients before (NCT1) and after (NCT2) applanation-tonometry with the Goldmann device (GAT). For the whole population of 126 patients, in each of whom only one eye was selected, there was a significant difference of the mean IOP measurement, but the difference between the two measurement methods was only slightly significant when the NCT was applied before the GAT, and highly significant vice versa. Also the variation of the NCT-measurements was significantly larger than that for the GAT, while the before- and after GAT measurements had equal variations. If only the measurements under 18 mmHg mean GAT are taken into account (n = 101), the difference between GAT and NCT1 was not significant (p = 0.437), as opposed to the GAT-measurements above 18 mmHg, where a highly significant difference between the means was found (p = 0.0033). In most cases, the IOP-readings were underestimated using NCT. The Non Contact Tonometer "Pulsair" could be used for IOP-readings in patients with increased risk of infection, as well as in those with known allergic reactions to topical anesthetic agents, with poor or absent fixation ability, with corneal edema, and postoperative after anterior-segment surgery. The possibility of IOP-measurement in a reclined position is a true advantage of the Non-Contact Tonometer presented here. A measuring strategy for the above-mentioned applications is presented.

[Initial experiences with a computer program for diagnostic localization of visual field deficits]

A computer program for localizing visual field defects is presented. It is based on a decision tree which has been converted into a program written in Turbo-Pascal and can be run on any IBM-compatible computer. A question-and-answer routine guides the examiner to the localization of the defect.

[Measuring the optic papilla with planimetry and the optic nerve head analyzer in glaucoma and suspected glaucoma. II. Correlations of the results of both methods with changes in the visual field, studied with the Octopus automatic perimeter]

Sixty-seven optic nerve heads of 40 patients with proven or suspected glaucoma were measured by planimetry and with the Rodenstock Optic Nerve Head Analyser (ONHA). The results were compared to visual field indices obtained with the Octopus program G-1. Good correlation of the results obtained by the two measurement procedures has been shown (Stürmer et al. 1989), between values for the disk area, the excavation area, and the cup/disk ratio. However, there is only weak correlation of values for the neuroretinal rim. The planimetrically measured neuroretinal rim area in the total population examined proved to be significantly correlated only with the visual field index for mean retinal sensitivity (MS; r2 = 0.106; P = 0.007) and short-term fluctuations (SF; r2 = 0.066; P = 0.036). After division of the population examined into different diagnostic groups, further statistically significant correlations between optic nerve head parameters and the various visual field indices were shown; here, the cup/disk ratio of both measurement procedures in two subgroups showed the best correlation with the visual field indices MS and mean defect (MD). Neither in the total population nor in any of the subgroups was a statistically significant correlation found between the volume of the excavation and one of the visual field indices. Comparing only the data for the temporal quadrant of the optic nerve head with the visual field did not improve the correlations. The best, i.e. highly significant, correlations were between optic nerve head parameters and the age of the patient. The correlation factors are much lower than other published data. A variety of factors could be responsible for these weak correlations: different optic nerve head configurations on the one hand, and localized or diffuse visual field defects on the other. In unselected cases it appears impossible to predict the visual field of a given optic nerve head. Both methods are suitable for follow-up, but not all anatomical configuration of the optic nerve head permit this.

[Measuring the optic papilla with planimetry and the optic nerve head analyzer in glaucoma and suspected glaucoma. I. Comparison of the 2 measuring methods]

Two-dimensional planimetric measurement of the neuroretinal rim using the method described by Betz has proved to be one of the most objective parameters in evaluating the optic nerve head. Using a three-dimensional stereoscopic measuring procedure (ONHA) described by Cornsweet, the volume of the papillary excavation can be quantified. The two methods were compared in a study involving 67 eyes with confirmed and suspected glaucoma. In agreement with published data, the correlation between the two measuring procedures was good as regards the disk surface (r2 = 0.73), the surface of the excavation (r2 = 0.90), and the cup/disk ratio (r2 = 0.63), although the last-mentioned parameter is calculated differently. While the disk surface as measured by planimetry was significantly greater than with ONHA, the cup surface measurements were almost exactly the same. In contrast to the results of other authors, the measurements of the neuroretinal rim surface correlated poorly (r2 = 0.09). The difference between the two methods in measuring the rim surfaces depends to a great extent on their absolute size and on the cup surface. The different procedures for defining the boundary of the excavation (in planimetry horizontal boundary definition, with the ONHA 150 micrometers below the retinal surface) are considered responsible for this. Advantages and drawbacks of these two clinical measuring methods are discussed. Once the currently excessive variability in the measurements has been reduced, measurement of the excavation volume could prove to be an important parameter for assessing the development of the optic nerve head in confirmed or suspected glaucoma cases.

[Granuloma of the pancreas]

1. Granulomas in the pancreas are not equivalent to granulomatous pancreatitis. 2. Apart from foreign body granulomas on the pseudocyst margin (endogenous foreign body), and around the past operation stitch rests (exogenous foreign body), we have found thirty-six cases of granulomas in 1000 cases of chronic pancreatitis. Occasionally one could find granulomas around Ethibloc residues. The frequency could not be exactly determined, because most of Ethibloc reacted parts of the glands were not operated (removed). 3. We could not clarify the etiology in 20 cases (so-called cryptogenous granulomas). There were 7 cases of vessel granulomas, partly with complete obliteration of the arteries: arteriitic granulomas. The granulomas were always found in many arteries of the same caliber, never in solitary vessels. These findings were always preceded by arteriography. 4. Granulomatous pancreatitis was organ manifestation in primary Syphilis (2 cases) and primary M. Boeck (2 cases). We found fungal granulomas in AIDS. 5. Granulomatous pancreatitis plays a subordinate role in the complete picture of the basic disease; but it can cause an obstructive icterus and show a tumoral symptom.