Subject(s)
Exophthalmos/diagnosis , Exophthalmos/etiology , Eye Foreign Bodies/complications , Eye Foreign Bodies/diagnosis , Eye Injuries, Penetrating/complications , Eye Injuries, Penetrating/diagnosis , Facial Pain/diagnosis , Diagnosis, Differential , Facial Pain/etiology , Humans , Male , Middle AgedSubject(s)
Multiple Sclerosis/complications , Uveitis, Intermediate , Adult , Age Factors , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Azathioprine/administration & dosage , Azathioprine/therapeutic use , Child , Drug Therapy, Combination , Female , Fluocortolone/administration & dosage , Fluocortolone/therapeutic use , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Interferon-beta/therapeutic use , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Time Factors , Uveitis, Intermediate/diagnosis , Uveitis, Intermediate/drug therapy , Uveitis, Intermediate/surgery , Visual Acuity , VitrectomySubject(s)
Acanthosis Nigricans/pathology , Carcinoma, Transitional Cell/pathology , Conjunctival Diseases/pathology , Lip Diseases/pathology , Mouth Diseases/pathology , Paraneoplastic Syndromes/pathology , Urinary Bladder Neoplasms/pathology , Aged , Aged, 80 and over , Conjunctiva/pathology , Disease Progression , Humans , Male , Urinary Bladder/pathologySubject(s)
Eye Foreign Bodies/surgery , Eye Injuries, Penetrating/surgery , Orbit/injuries , Aged , Anti-Bacterial Agents , Combined Modality Therapy , Diagnosis, Differential , Drug Therapy, Combination/therapeutic use , Eye Foreign Bodies/diagnostic imaging , Eye Injuries, Penetrating/diagnostic imaging , Female , Humans , Orbit/diagnostic imaging , Orbit/surgery , Radiography , Wood , Wound Infection/diagnostic imaging , Wound Infection/surgeryABSTRACT
BACKGROUND: In the pathogenesis of glaucoma, besides an elevated intraocular pressure (IOP), cardiovascular risk factors, such as arterial hypotension and hypertension, vasospasms, autoregulatory defects, atherosclerosis, and diabetes mellitus are of increasing importance, especially in normal tension glaucoma. Recently, there have been several reports of an additional risk factor: obstructive sleep apnea syndrome. METHODS: Literature review (Medline) and case report. RESULTS: The authors report on a 8 1/2 years follow-up of a 60-year-old patient with normal tension glaucoma. Despite successful pharmacological and surgical lowering of intraocular pressure a progressive glaucomatous damage with optic nerve atrophy and increasing visual field defects occurred. As a result of intensive investigations of possible cardiovascular risk factors, an obstructive sleep apnea syndrome was diagnosed. Since the beginning of therapy with nCPAP (nasal continuous positive airway pressure) more than 3 1/2 years ago, no further progression of glaucomatous optic nerve damage or visual field defects have been observed. CONCLUSIONS: In clinical practice, obstructive sleep apnea syndrome often is underdiagnosed. In patients suffering from glaucoma and obstructive sleep apnea syndrome, intraocular pressure lowering therapy may not be enough, whereas an additional nCPAP-therapy potentially could prevent the beginning/progression of glaucomatous optic nerve damage.
Subject(s)
Glaucoma/etiology , Intermittent Positive-Pressure Breathing , Laryngeal Masks , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , Glaucoma/therapy , Humans , Intraocular Pressure , Male , Middle Aged , Polysomnography , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Retinal nerve fiber layer defects are part of early glaucomatous damage. In the present study, we compared the ability of retinal nerve fiber layer photography (NFP) and scanning laser polarimetry (SLP) to detect nerve fiber layer defects in glaucoma patients. METHODS: Besides ophthalmological standard examinations, we performed NFP (Zeiss Ikon fundus camera 30 degrees, green filter), SLP (GDx, 1.0.14 and 2.0.09, LDT) and automated perimetry (Oculus, Twinfield, 30 degrees) in 150 glaucoma patients [74 with primary open-angle glaucoma (POAG) and 76 with normal-tension glaucoma (NTG)]. The perimetric results were evaluated according to a modified Aulhorn classification. NFP and SLP were graded according to Quigley. RESULTS: In POAG, 42% of NFP and 5% of SLP were not evaluable. In NTG, 24% of NFP and 4% of SLP were not evaluable. In POAG, NFP and SLP revealed a direct agreement in 54.5%, and in NTG, 55%; there was a small difference of one stage in 39.5% (POAG) and 41% (NTG). In POAG, NFP/SLP showed agreement with perimetric results in 35%/30% of cases and differences of one stage in 56%/58%. In NTG, NFP/SLP agreed with perimetry in 52%/48% of cases and differed by only one stage in 32%/39%. Larger deviations were found in less than 13% of the cases. CONCLUSIONS: NFP and SLP mostly showed good agreement or little deviation as to grading of nerve fiber layer damage. In clinical use, SLP has advantages over NFP because a higher rate of good-quality images can be obtained and pupils do not have to be dilated. Additionally, SLP measurements provide quantitative data and a large normative data base exists.
