A nearby transiting rocky exoplanet that is suitable for atmospheric investigation

Spectroscopy of transiting exoplanets can be used to investigate their atmospheric properties and habitability. Combining radial velocity (RV) and transit data provides additional information on exoplanet physical properties. We detect a transiting rocky planet with an orbital period of 1.467 days around the nearby red dwarf star Gliese 486. The planet Gliese 486 b is 2.81 Earth masses and 1.31 Earth radii, with uncertainties of 5%, as determined from RV data and photometric light curves. The host star is at a distance of ~8.1 parsecs, has a J-band magnitude of ~7.2, and is observable from both hemispheres of Earth. On the basis of these properties and the planet's short orbital period and high equilibrium temperature, we show that this terrestrial planet is suitable for emission and transit spectroscopy.

A giant exoplanet orbiting a very-low-mass star challenges planet formation models

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

Three Cases of Spontaneous Hyphaema

Background Spontaneous anterior chamber bleeding is a rare event. We present three photodocumented cases treated in our clinic. History and Findings Three patients sought medical assistance in our clinic because of bleeding inside the eye and/or visual impairment. None of them had a history of trauma or intraocular surgery. Treatment and Outcome Two patients had oral anticoagulation, which was discontinued. These cases were treated with topical steroids. The third patient had no anticoagulation and no topical steroids were used in treatment. Topical intraocular pressure-lowering drugs were administered as needed. In all three cases, the anterior chamber bleeding stopped spontaneously. No intervention was required. Even after resolution of the bleeding, there were no signs of iris abnormalities. Conclusions In cases of spontaneous anterior chamber bleeding without a history of trauma, oral anticoagulation, hypertension and iris abnormalities such as microaneurysm, pseudoexfoliation, iridocyclitis or neovascularisation have to be considered.

Sweet but dangerous - the role of immunoglobulin G glycosylation in autoimmunity and inflammation

Glycosylation is well-known to modulate the functional capabilities of immunoglobulin G (IgG)-mediated cellular and humoral responses. Indeed, highly sialylated and desialylated IgG is endowed with anti- and pro-inflammatory activities, respectively, whereas fully deglycosylated IgG is a rather lame duck, with no effector function besides toxin neutralization. Recently, several studies revealed the impact of different glycosylation patterns on the Fc part and Fab fragment of IgG in several autoimmune diseases, including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Here, we provide a synoptic update summarizing the most important aspects of antibody glycosylation, and the current progress in this field. We also discuss the therapeutic options generated by the modification of the glycosylation of IgG in a potential treatment for chronic inflammatory diseases.

[One Year Experience with Quality Control of Cataract Surgery Using an Internet-Based EUREQUO Database]

Purpose Quality control is particularly important in invasive medicine. As cataract surgery is the most frequently performed and most successful ophthalmic surgery, quality control should become mandatory. Patients and Methods Retrospective analysis of all cataract procedures performed in a 12 months period (01. 07. 2014 - 30. 06. 2015) at our hospital, using an internet-based EUREQOU database. This database is easy to use and allows local results to be compared with all participants in Switzerland and elsewhere in Europe. Results During one year, 904 cataract procedures were performed at our hospital. Of these, 892 with complete data were compared to 2918 operations performed in Switzerland and 274,644 in other European countries. Our sample contained more patients with markedly reduced visual acuity (< 0.1; 8.4/4.8/3.5 %; KSW/Switzerland/Europe), more patients with glaucoma (28.1/13.9/7.1 %) and more patients with pseudoexfoliation (22.8/11.5/0.56 %). Despite our training of young ophthalmic surgeons, the rate of capsular complications was as low (0.67/0.34/0.67 %) as in other series. Four to 6 weeks after surgery, the majority of patients achieved a best corrected visual acuity of ≥ 0.8 (79.2 vs. 87.4 % in Europe, not enough data from Switzerland). Biometric prediction error (79.2 % within ± 0.75 D) was within the target range, but in the lower quartile. Conclusions Despite the relatively high number of complex patients in our hospital, quality control reveals that we performed cataract surgery with low complication rates and good results. Although quality control is rapid and easy, only three centres in Switzerland are participating.

[Lens exchange for subluxation of posterior chamber lenses implanted in the capsular bag or in the ciliary sulcus]

PURPOSE

There are an increasing number of patients with decreased vision due to dislocated posterior chamber lenses, with pseudoexfoliation being the main risk factor. Various techniques for refixation of the subluxated posterior chamber IOL have been described. Experience with our technique of IOL-explantation, anterior vitrectomy and implantation of an Artisan anterior chamber lens are presented.

PATIENTS AND METHODS

In a retrospective study design all lens exchanges with implantation of an Artisan anterior chamber lens performed between 2003 and 2012 are analyzed. The study included 65 eyes of 61 patients (age 79.6 ± 9.2 years: 43-98). The majority of eyes (46/65; 70.8%) had Sundown Syndrome (late in-the-bag intraocular lens dislocation), in 19 eyes the posterior chamber lens was implanted primary or secondary into the ciliary sulcus. In the 46 eyes with Sundown Syndrome cataract surgery with implantation of a posterior chamber lens in the capsular bag was performed 7.4 ± 3.7 (1-22) years before subluxation within the bag. Pseudoexfoliation was the main risk factor in 42/46 (91.2%) of these eyes. A capsular tension ring (CTR) was implanted during cataract surgery in 34/46 (73.9%) eyes. The 34 IOLs with a CTR luxated significantly earlier (p < 0.02 Mann-Whitney U) than the 12 IOLs without a CTR (6.6 ± 3.6 years; median 5.8 vs. 9.4 ± 3.1 years; median 9.2).

RESULTS

The average visual gain was 0.2 logMAR in the group of luxated capsular bag lenses and 0.12 logMAR in the group of luxated sulcus lenses. Postoperative IOP decompensation was seen in 17/65 (26.2%) eyes (requiring IOP-lowering surgery in 8 eyes), 7 eyes developed corneal decompensation, 5 eyes had central retinal vein occlusion and one eye developed postoperative endophthalmitis.

CONCLUSIONS

Lens exchange with implantation of an Artisan anterior chamber lens has become a routine procedure to improve vision in patients with subluxated IOLs. Postoperative IOP decompensation and vascular problems are the major complications.

[Arguments against pressure-lowering treatment of ocular hypertension. Prophylactic treatment is unnecessary]

The main argument against a pressure-lowering treatment for patients with ocular hypertension (OHT) is the principle of "first do no harm". The imprecision of intraocular pressure (IOP) measurements and the fact that increased IOP is only a risk factor for glaucoma raise major doubts on a clinical definition of OHT. The use of IOP-lowering treatment in the absence of functional or morphological glaucomatous changes should only be initiated if the IOP is very high (>32 mmHg). If the IOP is between 21 and 32 mmHg the glaucoma conversion risk of the individual patient should be estimated. The risk factors as proven in major prospective trials (OHTS/EGPS) should be assessed using the risk calculator. Only patients with a high risk (>13%) of conversion profit from prophylactic IOP-lowering treatment. For all patients with intermediate or low risk of conversion the potential side-effects (local and systemic) of the treatment outweigh the possible benefit, so that the principle of "watchful waiting" is the best for patients with OHT. If morphological or functional progression is observed IOP-lowering treatment should be started immediately.

Comparison of histopathological findings with duplex sonography of the temporal arteries in suspected giant cell arteritis

INTRODUCTION

In clinical practice the temporal artery biopsy (TAB) in suspected giant cell arteritis (GCA) is still believed to be the "gold standard". The purpose of this study was to compare the histopathological findings of the TAB with duplex sonography of the temporal artery.

PATIENTS AND METHODS

In our retrospective study we analysed 85 consecutive patients (52 female, mean age 71.5, range 55 - 91 years; 33 male, mean age 71.6, range 44 - 91 years) with suspected GCA who underwent TAB in our clinic between January 1999 - February 2011. All patients received a preoperative duplex sonography, 57 patients including description of the temporal arteries.

RESULTS

38 of 85 (44.7 %) of the artery biopsies were proven positive for GCA by histopathology. Interpretation of the duplex sonography was congruent of histopathological interpretation of the biopsy in 39 patients (68.4 %) and incongruent in 18 patients (31.6 %). Sensitivity of duplex-sonography was 44.4 %, specificity 90 %, positive predictive value 80 %.

DISCUSSION

Duplex sonography is a non-invasive and very helpful diagnostic tool to guide the clinician in cases of suspected GCA but needs considerable skills. It shows a good specificity and relatively high positive predictive value as there are only few false positive results. A negative report however does not rule out GCA, so that in our opinion the TAB - at least in those cases - should still be performed.

[First experience with the Heidelberg Edge Perimeter® on patients with ocular hypertension and preperimetric glaucoma]

BACKGROUND

The white-on-white computerised static perimetry is not very sensitive to detect a beginning visual field loss. A newer technique to test the central visual field with a flicker defined form technology (FDF) is the Heidelberg Edge Perimeter® (HEP).

PATIENTS AND METHODS

A study with 90 eyes from 50 patients (mean age 59 ± 14 years) with ocular hypertension and/or optic nerve suspicious for glaucoma without detectable visual field loss in the Octopus® perimetry (Program dG-2) with the Heidelberg Edge Perimeter® was performed. The "mean defect" (MD), the "pattern standard deviation" and the glaucoma hemifield test (GHT) were calculated and compared with the indices of the Octopus®.

RESULTS

Despite normal visual field findings in the Octopus® perimetry (MD < 2.0 dB) we detected in 48 out of 90 eyes (53 %) pathological visual fields in the HEP examination.

CONCLUSIONS

As a new research method the Heidelberg Edge perimetry® seems to be more sensitive than conventional static perimetry in early detection of visual field alterations in patients between ocular hypertension and incipient glaucoma.

[Mechanical dilatation of the pupil in phacoemulsification surgery: first experiences with the 6.25 mm Malyugin-ring]

PURPOSE

Inadequate mydriasis may cause major problems in phacoemulsification surgery. Usually 4 iris retractors are used to allow adequate pupillary dilatation. Implantation of a Malyugin ring to maintain a 6.25 mm pupil is a new alternative.

PATIENTS AND METHODS

A Malyugin ring was used in 46 eyes of 39 patients (aged 80.1 ± 6.2 years). The ring is im- and explanted with a disposable shooter through the main incision. Indications for the use of the ring were inadequate mydriasis due to pseudoexfoliation (n = 27), intraoperative floppy iris syndrome (n = 5), the combination of PEX and IFIS (n = 11), extensive posterior synechiae (n = 2) or inadquate mydriasis after long-term pilocarpine treatment (n = 1).

RESULTS

In 44/46 eyes phacoemulsification with implantation of foldable posterior chamber lens was performed without complications. In 2 eyes with massive phakodonesis an Artisan anterior chamber lens had to be implanted after anterior vitrectomy because of total zonulolysis. There where no complications associated to the use of the device and with increasing experience duration of implantation as well as explantation was reduced to 2 - 4.5 min (median 2:51 min).

CONCLUSIONS

In cases of phacoemulsification surgery with inadequate mydriasis implantation of a Malyugin ring is a simple, safe and fast alternative to iris-retractors; it allows better pupil-size without additional stab incisions.

[Sinusitis and ocular motility disorders]

BACKGROUND

Secondary inflammatory orbital involvement due to acute or chronic sinusitis is common. The pneumatized system of the paranasal sinuses is abut to the bones of the orbit in up to 80 percent, therefore the association is a seductive theory due to their anatomic closeness. Typically, sinusitis can influence ocular motility by affecting single muscles or a combination of muscles/cranial nerves due to a local inflammatory tissue reaction. The expected picture would be a more or less complex restriction of eye movements.

PATIENTS AND METHODS

In this case study nine consecutive patients were prospectively included between January 2006 and August 2007.

RESULTS

Five of the patients did not experience any motility disorder, the other four had a restricted motility. Case reports of the four patients are presented to demonstrate the range of ocular motility disorders related to sinusitis.

CONCLUSIONS

Orbital complications due to sinusitis include motility disorders among others. They can even cause orbital sepsis and cavernous sinus thrombosis. On the one hand sinusitis can affect almost the whole spectrum of ocular motility disorders, on the other hand it may mask a dangerous cerebral aneurysm. The "close-lying" connections, as seductive they are, should not divert from the rule: infrequent causes are infrequent and frequent causes are frequent!

[Surgery for intraocular hypotony due to avascular filtering blebs]

BACKGROUND

The incidence of ocular hypotony after filtering procedures has increased due to the widespread use of antimetabolites. In cases of persistent hypotony with leaking filtering bleb and/or hypotony-maculopathy surgical repair should be discussed.

PATIENTS AND METHODS

Between 2001 and 2007 twelve patients (age between 35 and 88 years) underwent surgical repair of an avascular bleb with autologous scleral patch and conjunctival advancement. Indication for surgery was in 9 / 12 patients ocular hypotony, in 2 patients inadvertent filtering blebs after cataract extraction and in one patient a leaking bleb with blebitis.

RESULTS

Intraocular pressure was normalized in all cases by the end of the follow-up period (4 - 66 months) (preop: 5.7 +/- 4.1 mmHg; postop 14.8 +/- 3.1 mmHg). Eight out of twelve patients required IOP-lowering medications (1 - 3) to maintain the target IOP. Best-corrected visual acuity increased from 0.4 +/- 0.1 to 0.67 +/- 0.2 (Snellen), 3 / 8 phakic patients required cataract surgery.

CONCLUSIONS

Revision of avascular filtering blebs with autologous scleral patch and conjunctival advancement is a successful surgical approach to eliminate ocular hypotony. However, the majority of patients need IOP-lowering drugs after surgery.

Wie sehen Glaukomgesichtsfelder wirklich aus?

Analysis of the visual fields of 20 glaucoma patients using 229 F2 programmes consisting of 30 degrees long profiles with 1 degree resolution and double measurements of the light sensitivity threshold, revealed that there is a positive correlation between mean loss and mean short-term fluctuations; short-term fluctuations tend to be larger with increasing loss of sensitivity. However, small short-term fluctuations were also seen in areas of greatly reduced sensitivity. Analysis of the F2 programmes showed 12 different abnormal patterns. The pattern most frequently found, "increased scatter with normal sensitivity", appears to be the earliest perimetric sign of glaucoma. Progression of the glaucomatous damage produces a "gray area of increased scatter", usually accompanied by reduced sensitivity with a poorly defined lower and upper threshold.

[Ocular pulse amplitude: a new biometrical parameter for the diagnose of glaucoma?]

BACKGROUND

Dynamic contour tonometry (DCT) enables accurate transcorneal measurements of the intraocular pressure and ocular pulse amplitude (OPA). In this study, we investigated whether this new biometrical parameter can characterize different glaucoma types and serve as a helpful tool in the diagnosis and therapy of the disease.

PATIENTS AND METHODS

A total of 441 eyes of 222 patients were included. Pressure measurements were performed with contour and applanation tonometry.

RESULTS

Mean OPA was 3.1+/-1.4 mmHg. Eyes with ocular hypertension showed significantly higher OPA values (3.6+/-1.3 mmHg) than healthy eyes (3.1+/-1.4 mmHg) and eyes with low-tension glaucoma (2.9+/-1.4 mmHg). After trabeculectomy, the values were significantly lower (2.4+/-1.3 mmHg) than in healthy eyes.

CONCLUSION

The size of the OPA seems to be characteristic for different types of glaucoma and directly dependent on intraocular pressure levels. Further investigation is indicated to clarify its diagnostic usefulness.

[Quality assurance in biometry before cataract surgery: which patients have an increased risk of aberrance from target refraction?]

BACKGROUND

An important factor for patient satisfaction after cataract surgery is the achievement of the planned target refraction. The formulae which are used to calculate the necessary refractive power of the intraocular lens (IOL) to be implanted have been improved over time in order to deliver exact predictions even in those cases in which the measurements of an eye deviate greatly from the norm. We examined which of the routinely measured biometric values have an influence on reaching target refraction.

PATIENTS AND METHODS

This retrospective investigation reports on a case series of 153 eyes of 146 patients within 6 months in which a cataract operation was performed. The average age at the time of operation was 73.5 years. Four measurements were taken preoperatively: refraction (Ref), axial length (AL), corneal refractive power (CR) and anterior chamber depth (ACD). Each of these measurements was examined regarding its influence on the refractive outcome. One of three end points was possible for each eye: achievement of target refraction within +/- 0.5 dpt, aberrance from target refraction by more than + 0.5 dpt and aberrance from target refraction by more than - 0.5 dpt. A multivariate regression analysis was performed in which aberrance from target refraction was defined as the dependent variable and the four mentioned measurements were set as independent variables.

RESULTS

Of the 153 eyes, in 91 eyes the target refraction was achieved within 0.5 dpt (group 1). In 37 eyes the aberrance from target refraction was more than - 0.5 dpt (group 2) and in 25 eyes it was more than + 0.5 dpt (group 3). The mean measurement values in groups 1, 2 and 3 were as follows: for preoperative refraction 0.0 dpt/0.5 dpt/0.625 dpt, for corneal refractive power 42.84 dpt/42.29 dpt/42.67 dpt, for axial length 23.41 mm/23.36 mm/23.73 mm and for anterior chamber depth 3.07 mm/3.00 mm/3.20 mm. No statistically significant relation between the respective measured values or a combination thereof and the refractive result could be demonstrated.

CONCLUSIONS

The formulae for calculating IOL power available today are highly developed and integrate preoperative biometries in a non-linear way, so that there is little difference between measurements within the norm and outlying ones concerning their influence on the refractive result. When conducting quality assurance efforts, we recommend to direct attention to factors influencing anterior chamber depth.

Positiver Ibopamin Provokationstest bei Verdacht auf Niederdruckglaukom

BACKGROUND

Ibopamine is an alpha-adrenergic agent and causes an elevation of intraocular pressure in eyes with increased outflow resistance. It has been proposed as a test substance for the detection of early ocular hydrodynamic disorders.

PATIENTS AND METHODS

A total of 64 normal-tension glaucoma suspect eyes without anti-hypertensive treatment were enrolled. A daily pressure curve was registered with measurements at 7:00 am, 8:00 am, 12:00 am, 17:00 pm using an applanation tonometer and a contour tonometer followed by instillation of ibopamine 2% in both eyes. Tonometry was performed every 15 minutes during the following hour. An IOP increase of > 2.0 mmHg was considered positive.

RESULTS

The positive test group showed a significant pressure increase from 18.04 to 22.06 mmHg. Ocular pulse amplitude increased from 2.96 to 3.97 mmHg and was positively correlated with the pressure. Intraocular pressure was unchanged in the negative test group. Central corneal thickness was not significantly different in the two groups (p = 0.32).

CONCLUSIONS

Ibopamine 2% eye drops have a positive pressure effect in 50% of suspected normal-tension glaucoma eyes and may differentiate between eyes with normal trabecular outflow capacity and eyes with increased resistance in the trabecular meshwork that are prone to pressure peaks and deterioration to glaucoma.

Kataraktoperation und kombinierte Katarakt-/Glaukomoperation als augeninnendrucksenkende Maßnahme in Augen mit relativem anterioren Mikrophthalmus

PURPOSE

Eyes with relative anterior microphthalmos (RAM) (normal [> 20.0 mm] axial length but disproportionally small anterior segment [horizontal corneal diameter < 11 mm]) often present with increased intraocular pressure. Under these difficult conditions cataract surgery alone or in combination with a glaucoma filtering procedure is often required.

PATIENTS AND METHODS

We retrospectively reviewed the records of 71 patients (108 eyes) with RAM in whom cataract only (n = 72) or combined cataract/glaucoma surgery (n = 36) was performed. Preoperative clinical and biometric findings, intraoperative complications and postoperative results (visual acuity and intraocular pressure) were analysed.

RESULTS

Median preoperative values were 7.46 mm for corneal curvature, 2.53 mm for anterior chamber depth and 22.44 mm for axial length. The implanted lens had a median 25.0 dioptric power. The IOP was reduced from 15.6 +/- 3.9 mm Hg to 13.5 +/- 3.1 mm Hg with cataract surgery alone and from 22.4 +/- 5.5 mm Hg to 15.4 +/- 4.0 mm Hg with combined surgery. Mean best corrected visual acuity improved from 0.4 +/- 0.2 to 0.79 +/- 0.25 with cataract surgery and from 0.5 +/- 0.3 to 0.81 +/- 0.24 with combined surgery. Intraoperatively only 3 eyes had a rupture of the posterior capsule and postoperatively 2 eyes developed malignant glaucoma in the combined group.

CONCLUSIONS

The results show that, in eyes with RAM, cataract surgery alone or in combination with glaucoma surgery can be performed with excellent results and low complication rate if adequate precautions are taken (especially the use of hyperosmotic agents).

Pfeffersprayverletzungen des vorderen Augensegmentes

BACKGROUND

A wide variety of pepper sprays is currently available and gaining increasing popularity among both professional guardians and amateurs. Adverse side effects to the anterior segment of the eye are known but underestimated.

HISTORY AND SIGNS

We present two cases with severe corneal and conjunctival damage after accidental self injury by a pepper spray (Jet Protector Guardian Angel), benzyl alcohol 90.1 %, capsaicinoids 2.6 %).

THERAPY AND OUTCOME

Despite immediate and intensive irrigation, a complete epithelial defect, extensive ischemia to the limbus and the conjunctiva and a circular conjunctival chemosis were diagnosed. After slow re-epithelialization in both cases, a neurotrophic superficial keratitis, a reduced corneal sensibility and in one case deep stromal scarring were noted.

CONCLUSIONS

Pepper spray application to the eye might result in severe and permanent damage to the corneo-conjunctival tissue which is not adequately addressed in the current literature. From the present case reports arise the discussion whether the irritative and lipophilic capsacin/benzyl alcohol mixture or the pyrotechnical additives nitrocellulose und sinoxide are responsible for the anterior segment injuries.

[Filtering glaucoma surgery as outpatient procedure]

BACKGROUND

While cataract surgery is nowadays performed routinely as an outpatient procedure, performing filtering glaucoma surgery under these conditions remains questionable due to the more demanding perioperative management.

PATIENTS AND METHODS

Outpatient filtering glaucoma surgery (trabeculectomy and combined phakoemulsification and trabeculectomy (phakotrab)) is performed at the Ophthalmology Department of Kantonsspital Winterthur when requested by the patient. This paper provides a retrospective review of all outpatient filtering glaucoma procedures performed in the last three and a half years.

RESULTS

Forty-six filtering procedures (21 trabeculectomies and 25 phakotrabs) were performed in 45 eyes of 40 patients (50 - 84 years) as outpatient procedures. Mitomycin C was administered in 16/21 trabeculectomies and in 7/25 combined procedures. In the trabeculectomy group, intraocular pressure (IOP) was surgically lowered from 23.3 +/- 7.2 mm Hg (under 2.4 +/- 0.8 IOP-lowering medications) to 12.7 +/- 3.5 mm Hg (20/21 patients without medication). In the combined group, IOP was lowered from 20.8 +/- 6.3 (under 2.0 +/- 0.7 medications) to 13.7 +/- 2.7 mm Hg (only 5/25 patients still requiring IOP-lowering medications). In the latter group, the best corrected visual acuity was below 20/40 only in 2 eyes due to advanced glaucomatous optic atrophy. One patient developed relative intraocular hypotony (IOP 6 mm Hg), one patient required needling + 5-fluorouracil injection and one patient required surgical revision of the trabeculectomy after 14 months.

DISCUSSION

Adequate patient selection and refined surgical technique (tight wound closure and releasable sutures or argon laser suturolysis) allow performing filtering glaucoma surgery as an outpatient procedure. Extended post-operative care during the first 2 months is the key for IOP-lowering success.

Axonal loss from acute optic neuropathy documented by scanning laser polarimetry

BACKGROUND/AIMS

Retinal nerve fibre layer analysis by scanning laser polarimetry has been shown to facilitate diagnosis of glaucoma while its role in glaucoma follow up is still unclear. A major difficulty is the slow reduction of retinal nerve fibre layer thickness in glaucomatous optic neuropathy. Eyes of patients were studied after acute retrobulbar optic nerve lesion in order to evaluate the usefulness of scanning laser polarimetry in documenting retinal nerve fibre layer loss over time.

METHODS

Five patients who suffered severe retrobulbar optic neuropathy have had repeated measurements of the retinal nerve fibre layer using scanning laser polarimetry at various intervals, the first examination being within 1 week of injury.

RESULTS

All eyes showed a marked decrease in peripapillary retinal nerve fibre layer thickness, which followed an exponential curve and occurred predominantly within 8 weeks of injury. Compared to a previous study using red-free photographs, scanning laser polarimetry showed retinal nerve fibre layer loss earlier in the course of descending atrophy.

CONCLUSION

Scanning laser polarimetry is useful for early detection and documentation of retinal nerve fibre layer loss following acute injury to the retrobulbar optic nerve. It seems to be a promising tool for follow up of individual glaucoma patients.

[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.