[Pseudoexfoliation syndrome: no central zone of pseudoexfoliation material in patients with pseudophakia - a clinical study]. / Pseudoexfoliationssyndrom: Fehlen der zentralen Zone des Pseudoexfoliations-Materials bei Patienten mit Pseudophakie - eine klinische Studie.

BACKGROUND, MATERIAL AND METHODS: 1. An evaluation of medical findings and photodocumentation of 6 patients with pseudoexfoliation (PEX) material on the anterior surface of posterior chamber intraocular lenses was undertaken. Molecular genetic analysis of mutations in LOX-L1 was performed in order to confirm the association with pseudoexfoliation syndrome or glaucoma. Age of patients, the maximal intraocular pressure and perimetry with Octopus and Goldmann perimeters were documented as well as the time between implantation of the posterior chamber lens and diagnosis of pseudoexfoliation material on the anterior surface of posterior chamber lens. 2. Consecutive examinations of 35 patients with pseudoexfoliation syndrome or -glaucoma and pseudophakia were made to evaluate the frequency of patients with pseudoexfoliation material on the anterior surface of posterior chamber lenses. RESULTS: 1. The characteristic formation of stripe-shaped peripheral pseudoexfoliation material is seen in all examined patients on the anterior surface of posterior chamber lenses, but there is no central homogeneous round zone of pseudoexfoliation material in all patients. 2. the mean observation time of patients with pseudophakia and pseudoexfoliation syndrome or glaucoma is 4.4 ± 3.9 years. 5.7 % of the patients show pseudoexfoliation material in the periphery of posterior chamber lenses. The mean time between implantation of the intraocular lens and diagnosis of pseudoexfoliation material on the lenses is 3 years. CONCLUSIONS: The lack of a central homogeneous round zone of pseudoexfoliation material deposits on the anterior surface of posterior chamber lenses seems to be characteristic. The change in topography of PEX material on intraocular lenses is described here for the first time. A knowledge of this change in the topography of pseudoexfoliation material in pseudophakia is important for glaucoma screening, because pseudoexfoliation deposits can only be detected in mydriasis due to the peripheral location on the intraocular lens. Due to the old age of patients at the onset of pseudoexfoliation deposits, a pseudoexfoliation syndrome frequently is likely to develop after cataract surgery in many patients.

[Anticipation in patients with iridescent multicoloured posterior capsular lens opacities ("Christmas tree cataract") : The Role in the diagnosis of myotonic dystrophy]. / Antizipation bei Patienten mit Christbaumschmuckkatarakt : Ihre Bedeutung für die Diagnose der myotonen Dystrophie.

BACKGROUND: Myotonic dystrophy (DM type 1) is the most common type of muscular dystrophy in adults, accompanied by myotonia, iridescent multicoloured posterior capsular lens opacities ("Christmas tree cataract", CTC), and, for example, cardiac arrhythmias and respiratory failure. A further feature is anticipation, which is the occurrence of increasing disease severity and decreasing age of onset in successive generations, depending on inherited unstable DNA sequences that become larger with each generation. AIM: To evaluate the frequency of clinically manifest DM in patients with CTC and the age at diagnosis of CTC. METHODS: Retrospective analysis of ophthalmologic, neurologic, and internal findings in 18 consecutively diagnosed patients with CTC. RESULTS: Three of 18 CTC patients showed clinical signs of DM. The mean age at diagnosis was 72,8+/-16,5 years (range 36-94 years). DISCUSSION: A relationship existed between CTC and manifest DM in 16.7% of the patients with CTC. A hypothesis states that the other 83.3% might have premutations in the DMPK gene, which might lead to a complete mutation after transmission through subsequent generations. In the meantime, molecular genetic DM tests are available. Because of clinical heterogeneity and the anticipation phenomenon in DM, confirmation with such molecular genetic DM tests should be obtained.

[Optic disc drusen]. / Drusenpapille.

Optic disc drusen (ODD) are an initially symptom-free, usually bilateral, progressive type of optic neuropathy with genetic disposition. We observed visual field loss (VFL) in 64% (49 of 77) of our patients. Vascular complications such as AION are common. Initially, papilledema is often diagnosed and the diagnosis of ODD is confirmed by means of ultrasound examination. We found an average time interval of 7 years between groups of patients with preperimetric stage and onset of VFL. We also observed more advanced stages of VFL, faster progression of visual field loss and greater visibility of ODD with increasing age. VFL frequently results in loss of driving ability according to driving permission regulations. The aim of our therapy concept is to reduce intraocular pressure (IOP). In a pilot study we found that patients who underwent IOP-lowering therapy showed significantly less progression of VFL than patients who did not undergo this therapy. The present article summarizes current knowledge on epidemiology, pathogenesis, clinical presentation, diagnostics and therapy of optic disc drusen.

A novel mutation in the FOXC1 gene in a family with Axenfeld-Rieger syndrome and Peters' anomaly.

Peters anomaly and Axenfeld-Rieger syndrome (ARS) belong to the overlapping spectrum of disorders summarized as anterior segment dysgenesis (ASD). Five patients from a family with Peters' anomaly and ARS were screened for mutations in the PITX2, CYP1B1 and FOXC1 genes by direct sequencing. All affected family members examined were heterozygous for a single nucleotide substitution, resulting in a nonsense mutation (Q120X) at a highly conserved residue of the FOXC1 gene that is essential for DNA binding. In this pedigree, all affected family members were diagnosed with ARS except for one who shows bilateral Peters' anomaly. Our findings support the role of FOXC1 mutations in the spectrum of ASD.

[Morphology, family history, and age at diagnosis of 26 patients with Axenfeld-Rieger syndrome and glaucoma or ocular hypertension]. / Morphologie, Familienanamnese und Diagnosezeitpunkt bei 26 Patienten mit Axenfeld-Rieger-Syndrom und Glaukom oder okulärer Hypertension.

PURPOSE: The Axenfeld-Rieger syndrome (ARS) shows genetic and morphologic heterogeneity and is associated with glaucoma in 50% of the patients. METHODS: Ocular, dental, and systemic anomalies, maximum intraocular pressure (IOPmax), frequency of ARS or glaucoma in the family history (FH), and age at diagnosis (AAD) of 26 consecutively examined patients with ARS and glaucoma or elevated IOP were evaluated retrospectively. RESULTS: In 65.4% of the patients hypoplasia of the iris was found. Almost 50% of the patients had systemic anomalies, dental anomalies being the most frequent. Of 26 patients, 12 (46.2%) had an ARS in the FH; 57.7% of the patients had a FH of glaucoma with or without ARS. No significant differences in IOPmax and frequency of iris hypoplasia and glaucoma surgery were found when patients with and without ARS in their FH and patients with and without iris hypoplasia were compared. CONCLUSION: Patients with iris hypoplasia and patients with ARS and/or glaucoma in the FH do not show a worse glaucoma prognosis than patients without iris hypoplasia or without a FH of glaucoma or ARS. ARS was diagnosed within the 1st year of life in approximately half of the patients. Therefore, children of ARS patients should be screened as soon as possible to improve early diagnosis of ARS and glaucoma and to improve glaucoma prognosis. As the dental and facial anomalies may require treatment in the first dentition, patients with ARS should be referred to a dentist or orthodontist.

[Penetrating and perforating eye injuries in 343 patients due to auto accidents before and after compulsory seat belt legislation resulting in fines (1966-1998)]. / Penetrierende und perforierende Augenverletzungen bei PKW-Unfällen von 343 Patienten vor und nach Einführung des Bussgeldes für "Gurtmuffel" (1966-1998).

BACKGROUND: Constructional improvements of passengers safety in cars alone did not result in a significant decline of open globe injuries in traffic accidents. Only after compulsory seat belt legislation was introduced in Germany and Great Britain, a 60%-75% reduction in ocular injuries was observed. We examined, how the characteristics of severe eye injuries in car accidents changed during the last 28 years. PATIENTS AND METHODS: The case records of 343 patients, who suffered from open globe injuries during car accidents between 1966 and 1993 and were primarily admitted in the University Eye Hospitals of Freiburg and Würzburg, have been analyzed retrospectively. Injuries were evaluated for their extent, time of injury (hour and season), age, sex and outcome of visual acuity after surgery. RESULTS: Between 1966 and 1984 wind-screen injuries declined slowly from 25/year to 16/year. Since the introduction of compulsory seat belt legislation in Germany in 1984 we observed a sudden reduction to 4 injuries/year, followed by an additional slow decline to 2.5 injuries/year. Male/female ratio changed from 2.1/1 before to 9/1 after 1984. Due to the seat belt legislation, injuries declined during summer season (april through september) by factor 7.6, during winter season (october through march) by factor 3.8. Injuries during daylight (6 a.m. to 6 p.m.) decreased more rapidly (by factor 14) than during nighttime (6 p.m. to 6 a.m.: factor 4). The decline of eye injuries was most pronounced among those with an age of less than 23 years (by factor 10.8) and those who were 31-50 years old (by factor 6.8), but least among those between 23 and 30 years of age (2.2). Since 1984, open globe injuries combined with mid-facial and cranial fractures increased resulting in a poorer visual outcome: 29% of eyes became blind before 1984 and 40% since then due to the higher survival probability of very severe accidents. A majority of injured persons still had not fastened their seat belt and about 50% were drunk. CONCLUSION: Compulsory seat belt legislation introduced in Germany in 1984 was most effective in preventing eye injuries among female passengers, during daytime or among persons younger than 23 years. However, 23-30 year old male drivers who had not fastened their seat belt, drove in darkness or during winter and had drunk alcohol, were still at highest risk for an open globe injury. The increase of victims with a combination of open globe injuries and midfacial injuries, polytrauma or cerebral trauma may be related to the airbag and other improved safety measures.

[Imaging nerve fiber bundle defects with laser polarimetry in glaucoma. A clinical study with the Nerve Fiber Analyzer I]. / Zur Darstellbarkeit von Nervenfaserbündeldefekten mittels Laser-Polarimetrie bei Glaukom. Eine klinische Studie mit dem Nerve-Fiber-Analyzer I.

PURPOSE: To verify whether nerve fiber bundle defects (NFBD) can be detected by the polarization technique of the Nerve Fiber Analyzer I (NFA I), we compared the localization of localized visual field (VF) defects with the localization of the expected corresponding NFBD. METHODS: We examined 25 eyes of 25 glaucoma patients. All examined glaucomatous eyes had localized VF defects stage II and III. The glaucoma stage was defined by examination of the central 30 degrees VF using computer perimetry. NFBD were determined by masked examination of NFA I images by three examiners. As controls 22 eyes of 22 normals were examined. RESULTS: In 18 (72%) of 25 glaucomatous eyes the three examiners agreed in their findings. In 15 of 25 glaucomatous eyes (60%) all three examiners found a NFBD, which corresponded to a localized VF defect. In 18 of 22 healthy eyes all three examiners found no NFBD. The first examiner had no false-positive results, the second three, and the third four. CONCLUSIONS: The three examiners often disagreed in their findings of NFBD, which indicates high subjective variability. Examiner-dependent specificity and sensitivity show that detection of glaucomatous NFBD is often not possible by laser polarimetry (software version 06/93).

[Posterior synechiae after Nd:YAG laser iridotomy. A clinical study]. / Hintere Synechien nach Nd:YAG-LASER-Iridotomie. Eine klinische Studie.

METHODS: In 146 eyes/patients who underwent Nd:YAG laser iridotomy after glaucomatous attack or after prophylactic iridotomy, we evaluated whether the frequency of posterior synechiae depends on (1) glaucomatous attack, (2) preoperative miotic therapy, (3) postoperative antiglaucomatous therapy or (4) mode of intraoperative laser therapy. Out of 616 eyes with YAG iridotomy between 1983 and 1987, 146 eyes/patients fulfilled the inclusion criteria: observation time of minimum 3 months after iridotomy, preoperative examination without signs of preexisting synechiae, postoperative examination at discharge and a later control examination in mydriasis to exclude posterior synechiae. RESULTS: Eyes with and without glaucomatous attack and eyes with an without pre-operative long-term miotic therapy showed no significant difference in frequency of posterior synechiae. Eyes with postoperative long-term therapy with miotics or beta-blockers showed posterior synechiae significantly more often than eyes without post-operative miotic or beta-blocker therapy. Eyes that received DPE in the early post-operative period developed posterior synechiae significantly less often. The number of laser pulses and the mean total energy used were significantly higher in eyes which later developed posterior synechiae. In the group of patients with glaucomatous attack women outnumbered men by four to one, but there was no significant difference in refraction between women and men. CONCLUSIONS: Patients with glaucomatous attack are not at a higher risk of developing posterior synechiae than those without glaucomatous attack. Post-operative antiglaucomatous therapy, the number of laser pulses and the total energy alter the frequency of postoperatively developed posterior synechiae.

[Family history of glaucoma and risk factors in pigmentary glaucoma. A new clinical study]. / Familienanamnese Glaukom und Risikofaktoren bei Pigmentglaukom. Eine klinische Studie.

BACKGROUND: Whether a family history of glaucoma (FHG) in patients with pigmentary glaucoma (PG) is a prognostical indicator, is unknown. Therefore the aim of this study was to evaluate the influence of FHG on the severity of the disease in PG and pigment dispersion syndrome (PDS). Furthermore risk factors in PG and PDS were evaluated. METHODS: The findings of 207 patients with PG and PDS, who were able to give information about FHG, were evaluated (149 PG, 43 PDS with ocular hypertension (OH), 15 PDS without OH). RESULTS: Significance of FHG: FHG was found in 39.1%, and in one third of the patients more than one relative had the disease. FHG was found in PG not more frequent than in PDS. Pigmentary glaucomas in advanced stages of the disease did not have a higher incidence of FHG than patients in beginning stages. Out of 207 patients with PG and PDS 71% were male and 29% female (p < 0.001). In patients with FHG the share of men was 64.2% and not significantly different to the group without FHG with 75.4%. The sex distribution in parents and grandparents having a glaucomatous disease was 1:1. RISK FACTORS: The pf1p4nts with and without FHG in PDS with and without OH, PG, and within the different stages of visual field loss, showed no significant differences in risk factors, for example in maximum intraocular pressure, refraction and cup-disc ratio. Myopia: Patients with PG had a significantly higher myopia than patients with PDS (p < 0.01). The higher the myopia, the earlier the disease was diagnosed (p = 0.008). Krukenberg spindle: During miotic therapy the Krukenberg spindle decreased in the upper half of the cornea. Time of diagnosis: PG was diagnosed at a higher age compared to PDS. CONCLUSION: FHG does not influence the severity of the disease in PG. Family history of glaucoma is a risk factor in patients with PG, but no prognostical indicator. Patients with FHG do not have primarily larger cup-disc ratios than patients without FHG. Myopia is a risk factor.

[Can the extent of glaucoma damage be assessed by measuring the asymmetry of the peripapillary height profile between the upper and lower retinal half? A clinical study with the Heidelberg Retina Tomograph]. / Lässt sich durch Messung der Asymmetrie des peripapillären Höhenprofils zwischen oberer und unterer Retinahälfte das Ausmass des Glaukomschadens erfassen? Eine klinische Studie mit dem HRT.

BACKGROUND: Peripapillary height measurements are possible using 2 different reference planes of the Heidelberg-Retina-Tomograph. It is not tested yet, whether the extent of glaucoma damage should be better quantified using reference plane 1 or 2. PATIENTS AND METHODS: In 32 eyes of 32 glaucoma patients with a defined up-down asymmetry of visual field loss is tested I.) if there is a significant correlation between peripapillary height and visual field loss comparing reference plane 1 and 2. II.) if there is a conformable up-down asymmetry of the peripapillary height using a new "retinal-asymmetry-difference" (RAD). III.) if conformity between peripapillary height and visual field loss depends on the distance from the disc margin. RESULTS: 1.) For an advanced visual field loss there was a significant correlation between visual field loss and peripapillary height using reference plane 1. II.) In eyes with a big up-down asymmetry of visual field loss there was a bigger conformity between the up-down asymmetry of visual field loss and the up-down asymmetry of peripapillary height (11 of 12 eyes), as for a small up-down asymmetry (12 of 20 eyes). III.) Conformity decreases with the distance from the disc margin. CONCLUSIONS: Peripapillary height should be examined using measurement circles near the disc margin. Because of its independence on the age and on different reference planes additional calculation of an up-down "retinal-asymmetry-difference" (RAD) seems to be useful. Using this up-down "retinal-asymmetry-difference" (RAD) a big up-down asymmetry of visual field loss, equivalent to an advanced glaucomatous disease, is quantified with high sensitivity.

Measurement of the retinal nerve fiber layer thickness in clinical routine.

The possibilities and limitations of methods for indirect and direct nerve fiber layer thickness (NFLT) measurements, and a summary of our own clinical studies using Optic Nerve Head Analyzer (Rodenstock, Munich, Germany) (ONHA), Laser Tomographic Scanner (Heidelberg Engineering, Heidelberg, Germany) (LTS), Heidelberg Retinal Tomograph (Heidelberg Engineering, Heidelberg, Germany) (HRT), Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, CA) (NFA) and Optical Coherence Tomography (OCT), together with the literature of the review period, are highlighted. A retinal hemifield test with the new parameters, retinal asymmetry difference and retinal asymmetry index, is introduced. These relative nerve fiber layer thickness (NFLT) measurement values are found to be independent of age, reference plane, and disc size. This reduces the interindividual variation of the measurements and may improve screening possibilities for glaucoma. The detection probability for nerve fiber bundle defects was found to be stage-dependent using HRT and NFA. For laser polarimetry, a decreasing correlation between NFLT and visual field loss with advanced glaucomatous disease was found. In the lower retina, a 6.9% higher NFLT was evident compared with the upper peripapillary NFLT in healthy eyes using NFA and OCT. This is not in correlation with perimetric retinal sensitivity, which was found to be 3.9% higher in the lower hemifield compared with the upper hemifield. In general, quantitative NFLT measures (HRT, NFA, OCT) were correlated with visual field loss in glaucoma. The interindividual variability of NFLT measurements, among other things, induces limitations on distinguishing beginning glaucoma from normals. Clinical and scientific significance and future directions of NFLT measurements are discussed.

[Improved eyedrop administration and compliance in glaucoma patients. A clinical study]. / Verbesserung der Augentropfenapplikation und Compliance bei Glaukompatienten. Eine klinische Studie.

BACKGROUND: Poor compliance can be dangerous to successful medical treatment of glaucoma. Among other things one reason for non-compliance represents the inability of the patients to place drops in the eye appropriately. Therefore information regarding the patients ability to administer an eyedrop safely are a prerequisite to determining a therapy scheme which ensures the compliance of glaucoma patients. PATIENTS AND METHODS: 100 glaucoma patients on medical therapy who first presented in the outpatient glaucoma clinic of the University Eye Hospital of Würzburg were examined by standardised questionnaire and ability tests. We evaluated: 1. Can the eyedrop administration of glaucoma patients be improved by a standardised instruction? 2. Can the eyedrop administration be improved by the use of a drop aid (Autodrop)? 3. Can the accuracy of aiming and the manual ability be evaluated with a target-test on a sheet of paper with a series of concentric circles? 4. How do patients on combined therapy distinguish between their different bottles and where is the dosage regimen noted? 5. What kind of distinguishing marks of eyedrop-bottles do the patients prefer? RESULTS: 1. Before verbal instruction 76% of the patients applied the eyedrops appropriately, after instruction 94% (p < 0.001) were capable. Touching the eye with the tip of the dropper was reduced significantly. Touching the eye before instruction was found in 63% of the patients, after instruction it was found in 41% (p < 0.001). 2. When patients used the drop aid 81% were able to place a drop in the eye appropriately. Only by 46% of the patients the Autodrop was welcomed. 3. 16% of the patients were not able to place a drop within 1.5 cm of the center of the target (according to the size of an eye). 4. 47% of the patients who use more than one eyedrop bottle admitted problems in distinguishing the bottles, only 38% of the patients read the labels. 5. 76% of the patients would prefer markable stickers of different colours for the bottom of the bottles to improve distinguishing the bottles in combined therapy. CONCLUSION: Instruction improves eyedrop administration in 18% of our patients. In combined therapy with several drugs new distinguishing marks are requested by the patients. To improve compliance combination preparations should be administered if available.

[Can the extent of glaucoma damage be quantified with laser polarimetry by in vivo measurement of retinal nerve fiber density? A clinical study]. / Lässt sich mittels Laserpolarimetrie durch In-vivo-Messung der retinalen Nervenfaserschichtdicke das Ausmass des Glaukomschadens quantifizieren? Eine Klinische Studie.

Thirty-eight eyes of 38 glaucoma patients with a defined up-down asymmetry of visual field loss (VFL) were examined to ascertain whether there was corresponding up-down asymmetry of nerve fiber layer thickness (NFLT), calculated by laser polarimetry (LP). The correspondence was found to be closer for small up-down asymmetry of VFL then for medium or large up-down asymmetry. An approximately 6% greater NFLT in the lower than in the upper retinal half was revealed found by examination of 62 eyes of 62 normals. Considering this NFLT asymmetry in normals, there was a non-significant tendency towards correspondence between the up-down asymmetry of VFL and the up-down asymmetry of NFLT for the group of glaucoma patients with large up-down asymmetry of VFL. However, in about 40% of cases there was no such correspondence, so that staging of the glaucomatous disease has to be done by perimetry and is not possible by LP (software version 06/93).

Time of diagnosis, reoperations and long-term results of goniotomy in the treatment of primary congenital glaucoma: a clinical study.

PURPOSE: The aim of our study was to get information about the development of visual acuity, visual field and cup-disc ratio of patients with primary congenital glaucoma after IOP-regulating goniotomy by means of a katamnestic inquiry. The preoperative conditions of IOP, corneal diameter and corneal opacity were related to postoperative findings of visual acuity, visual field and cup-disc ratio reported by the treating ophthalmologists. METHODS: 196 patients were contacted, who had a goniotomy in the period from 1965 to 1983 at the University Eye Hospital Würzburg. Out of the 92 returned replies, the address of the treating ophthalmologists could be ascertained from 77 patients. Sixty of the 77 patients fulfilled the inclusion criteria: (1) primary congenital glaucoma and (2) IOP-regulating goniotomy as last surgery. RESULTS: I. In 76% of 106 eyes childhood glaucoma was diagnosed during the first year of life. II. In 72% of 60 eyes/patients with primary congenital glaucoma one goniotomy was sufficient to reach a normal IOP. In 18% a second and in 10% a third goniotomy was necessary, but without influence on the visual outcome. III. Even in the groups of eyes with a preoperative IOP of more than 40 mmHg, preoperative corneal diameter of more than 13 mm and preoperative severe corneal opacity more than 50% reached a visual acuity of 0.4-1.2 and more than 80% had a normal visual field. Only 9% of the eyes showed a cup-disc ratio of 0.6 or more. CONCLUSIONS: In primary congenital glaucoma even eyes with high preoperative IOP, large corneal diameters and severe corneal edemas had a good prognosis of visual outcome after goniotomy.

[High mean pallor value--a risk factor for deterioration of the visual field in glaucoma and ocular hypertension. A pilot study using the optic nerve head analyzer]. / Hoher mittlerer Blässewert der Papille. Ein Risikofaktor für die Gesichtsfeldverschlechterung bei Glaukom und okulärer Hypertension. Eine Pilotstudie mit dem Optic Nerve Head Analyzer (ONHA).

UNLABELLED: Does the disc parameter "mean pallor value" suggest a risk for further deterioration of visual field defects? PATIENTS: In 10 patients with ocular hypertension and 23 patients with primary open-angle glaucoma (Octopus 201, Humphrey perimeter) disc pallor was calculated by double examinations with the ONHA in 1987-1988, and a long-term follow-up of the visual field was performed. In all patients we also acquired information about the IOP level and visual field during the observation time from the ophthalmologists. Only one eye per patient was evaluated after randomized selection. RESULTS: In ocular hypertensive patients only 1 of 10 eyes showed deterioration of the visual field. In the glaucoma group 4 eyes out of 23 showed an increase in visual field loss. The eyes with a tendency to deteriorate had a higher mean pallor value compared with the mean value of the corresponding group [ocular hypertensives: 0.40 compared to 0.31 +/- 0.07 (0.02); POAG: 0.50 +/- 0.06 (0.03) compared to 0.33 +/- 0.08 (0.02); mean value +/- SE (SEM)]. The difference was statistically significant in the glaucoma group; Wilcoxon, Mann and Whitney U-test; P < 0.005. CONCLUSIONS: Taking into consideration all risk factors, the mean pallor value might help additionally to prognosticate the risk of deterioration of the visual field as far as 5-year follow-up allows this preliminary conclusion. The pallor value alone is not suitable for the follow-up of glaucoma patients because of the influence of increasing lens opacities and changes in the video system of the ONHA over years.

[Sensitivity and specificity of the Heidelberg retinal tomograph for imaging nerve fiber bundle defects in glaucoma patients with localized visual field defects. Clinical study]. / Sensitivität und Spezifität des Heidelberger Retina-Tomographen für die Darstellung von Nervenfaserbündeldefekten bei Glaukompatienten mit lokalisierten Gesichtsfeldausfällen. Klinische Studie.

In order to verify whether nerve fiber bundle defects can be detected by the confocal technique of the Heidelberg Retina Tomograph (HRT), we compared the localization of localized visual field defects with the localization of the expected corresponding nerve fiber bundle defect. We examined 105 patients: 49 with primary open-angle glaucoma (POAG), 26 with low-tension glaucoma (LTG) and 10 with ocular hypertension (OH), and as a control-group 20 healthy eyes. The glaucoma stage had been defined by examination of the central visual field with the Octopus Perimeter 201 program 31 or 32 and/or the Humphrey Perimeter GG program. In healthy eyes, eyes with OH and POAG stage I (n = 19), no nerve fiber bundle defect could be found. In stage II (n = 15) and stage III (n = 14) we found nerve fiber bundle defects in all patients with POAG and LTG (except for one patient with POAG stage III). In stage IV (n = 27) no localized nerve fiber bundle defects were detected in eyes with POAG, but in 4 of 7 patients with LTG, defects could be seen. In glaucoma stages II and III, nerve fiber bundle defects can be detected with the HRT. The control group shows, that the appearance of a nerve fiber bundle defect is no artifact caused by the HRT. However, examination of eyes with OH and POAG stage I also shows that this method is not sensitive enough to be useful for early diagnosis of glaucoma. Nevertheless, it may be possible to develop the confocal HRT method further as a nerve-fiber diagnostic method for glaucoma.

[Perimetry with a glaucoma-specific test grid. A clinical study with the GG program]. / Perimetrie mit einem glaukomspezifischen Prüfpunktraster. Eine klinische Studie mit dem GG-Programm.

UNLABELLED: The GG program pattern of the Humphrey Field Analyzer includes the 76 test points of the 30-2 program and an additional 52 test points in a glaucoma-specific distribution. In 18 test points in the nasal step area beyond 30 degrees the threshold is also determined. The findings obtained with the GG program and the 30-2 program were investigated by means of three questions: (1) Do the additional test points increase the sensitivity in ocular hypertension and glaucoma in stage I? For this purpose 41 eyes of 41 patients were examined. (2) Is the new grid useful for the determination of form and size of scotomas? For this purpose 46 eyes of 46 patients were examined. (3) What information is gained from a new asymmetry index, the glaucoma hemifield index (GHI), evaluated on the retinal threshold sensitivity of the GG program grid? To evaluate the information gained, the GHI of the test points in program 30-2 was compared to the GHI of the GG program in 11 eyes of 11 healthy persons, 21 eyes of 21 patients with ocular hypertension, and 32 eyes of 32 patients with primary open-angle glaucoma, stage I and II. RESULTS: (1) In ocular hypertension and glaucoma stage I, the higher grid density of the GG program leads to a higher sensitivity in comparison to program 30-2. (2) In the 46 eyes with scotomas in stages II-IV, the condensed grid allowed better assessment of form and size of them. Ninety-one percent of the eyes with glaucoma stage II-IV showed nasal scotomas out of 30 degrees excentricity, which were now detected with the GG program. (3) The GHI of program 30-2 and the GG program showed no significant difference in retinal threshold sensitivity in glaucoma stage I. The asymmetry of the visual field loss in glaucoma stage II with localized scotomas can be detected significantly better with the GHI of the GG program. At the beginning of visual field loss with diffuse sensitivity loss, the grid density of program 30-2 seems to be sufficient. In stage II with localized scotomas, the higher grid density of the GG program yield more information for the detection of hemifield asymmetries. After examination with the 30-2 program it seems to be useful to examine the 52 additional test points and combine these two with the print-out from the GG program.

[Measuring retinal nerve fiber density with laser polarimetry in patients with AIDS in comparison with health probands with reference to computer perimetry findings. A pilot study using the nerve fiber analyzer]. / Messungen der retinalen Nervenfaserschichtdicke mittels Laserpolarimetrie bei Patienten mit AIDS im Vergleich zu Gesunden unter Berücksichtigung computerperimetrischer Befunde. Eine Pilotstudie unter Einsatz des Nerve-Fiber Analyzer.

BACKGROUND: Several authors postulated a retinal nerve-fiber loss in HIV-infection because of functional alterations (reduced colour sensitivity, alterations in perimetry). This hypothesis has been reevaluated for the first time by means of direct in-vivo measurement of the retinal nerve-fiber-layer thickness by laser polarimetry using the Nerve-Fiber-Analyzer. PATIENTS AND METHODS: Retinal nerve-fiber-layer thickness in 14 eyes of 7 patients has been compared to equally-sided eyes of equally-aged healthy controls. Visual fields showed a bilateral diffuse sensitivity reduction in 5 patients. Visual fields of 2 patients and all healthy controls were normal. RESULTS: A significant difference in measurement values of nerve-fiber-layer thickness did not show between AIDS-patients and healthy controls. There was no correlation between visual field alterations and measurement values of nerve-fiber-layer thickness. CONCLUSION: In AIDS patients, a retinal nerve-fiber loss corresponding to their visual-field alterations has not been found. However, these visual-field alterations may also be explained by central-nervous disorders, lens opacifications or neuro-retinal dysfunctions without nerve-fiber loss.

The risk profile of the glaucomatous patient.

This article briefly overviews risk factors involved in the multifactorial glaucomatous disease such as hypotension, preexisting field damage, location of scotomas, intraocular pressure, vasospasm, vasoactive agents, and less connective tissue of the optic disc. We summarize some of these risk factors in a formula allowing the calculation of a glaucoma progression risk index. This index helps to identify patients who are at risk for further visual field deterioration already at the time of the initial perimetric examination. Diagnostic and therapeutic aspects are highlighted.