[Tumors and tumor-like lesions of the orbit]. / Tumoren und tumorähnliche Läsionen der Orbita.

This article gives an overview of the most common and clinically relevant tumors of the orbit and their treatment. The most common orbital tumors in childhood are cystic tumors, such as dermoid and epidermoid cysts. Capillary hemangiomas are the most common primary benign tumors of the orbit and appear mostly in the first year of life. In contrast teratomas are rare and histologically mostly benign. Neural tumors are, for example, gliomas of the optic nerve and in 25-50% of cases are associated with neurofibromatosis. Rhabdomyosarcoma is a rapidly growing malignant orbital tumor whereby the stage and localization are the most important prognostic factors for survival chance in children. Leukemia can be associated with a chloroma especially in the first decade of life. Lymphoproliferative diseases, vascular and cystic tumors in particular are known as tumors of adulthood. In addition to fibroosseous and mesenchymal tumors, neural forms, such as schwannomas are also important. Secondary tumors of the orbit are often manifested in the nose and paranasal sinuses.

Long-term results of Erbium YAG-laser-assisted deep sclerectomy.

PURPOSE: To evaluate the long-term results of Erbium YAG-laser-assisted deep sclerectomy (DS). In this procedure, the delicate dissection of a deep corneoscleral lamella is greatly simplified by using the Erbium YAG-laser. METHODS: Data of 14 consecutive patients (10 male, four female, age 67.7+/-10.4 years), who underwent surgery from 1999 to 2000 were analysed retrospectively. The procedure was begun as a standard DS. The deep corneoscleral lamella was dissected with a pulsed Erbium YAG-laser (energy: 40-100 mJ, frequency: 5-10 Hz). Schlemm's canal was unroofed and the lamella thinned until aqueous percolated continuously through the membrane. RESULTS: The mean follow-up time was 50.4+/-6.8 months. The mean preoperative intraocular pressure (IOP) was 37.7+/-10.5 mmHg. The mean postoperative IOP was 16.1+/-3.9 mmHg at 1 month, 15.1+/-4.3 mmHg at 3 months, 16.4+/-4.5 mmHg at 12 months, and 17.6+/-8.7 mmHg at 50.5 months. The complete success rates (IOP< or =21 mmHg+IOP reduction > or =20% without glaucoma medication) were 83.3% at 3 months and 50% at 12 and 50.5 months. Rates for qualified success (IOP< or =21 mmHg+IOP reduction > or =20% with glaucoma medication) were 91.7% at 3 months, 92.9% at 12 months, and 78.6% at 50.5 months. The number of glaucoma medications was reduced from 3.07+/-0.92 preoperatively to 1.14+/-1.41 at 50.5 months. A single case of anterior-chamber penetration, requiring iridectomy, was the only intraoperative complication. CONCLUSIONS: Erbium YAG-laser-assisted DS has the advantage of a greatly simplified dissection, while offering a successful long-term IOP control comparable to conventional DS.

Filtering bleb function after clear cornea phacoemulsification: a prospective study.

AIM: To evaluate the influence of clear cornea phacoemulsification on filtering bleb morphology, function, and intraocular pressure (IOP) in glaucomatous eyes with previously successful filtering surgery. METHODS: The clinical course of 30 patients (30 eyes) who underwent clear cornea phacoemulsification after successful filtering glaucoma surgery was prospectively evaluated. Mean IOP and filtering bleb morphology (standardised assessment criteria and score 0-12, 12 = optimum) were determined before surgery, and 3 days, 6 months, and 12 months after surgery. The control group consisted of 36 patients with glaucoma after clear cornea phacoemulsification without previous filtering surgery. RESULTS: Mean IOP increased after phacoemulsification by about 2 mm Hg (preoperatively 14.28 (SD 3.71) mm Hg, 12 months postoperatively 16.33 (3.31) mm Hg, p = 0.006). 15 patients (50%) showed an IOP increase of >2 mm Hg, 11 patients (36.7%) had no IOP difference (within 2 mm Hg), and in four patients (13.3%) IOP decreased >2 mm Hg. Mean score of filtering bleb morphology 1 year after surgery decreased from 9.5 to 9.0 (p = 0.154). In three of 30 preoperatively IOP regulated eyes the postoperative IOP was 21 mm Hg. The control group showed an average IOP decrease of 2.01 mm Hg (p = 0.014) 12 months after cataract surgery. CONCLUSION: An increase in IOP was found 1 year after phacoemulsification in half of the filtered glaucomatous eyes. IOP in glaucomatous eyes without previous filtering surgery decreased in the same period. Cataract extraction using clear cornea phacoemulsification may be associated with a partial loss of the previously functioning filter and with an impairment of filtering bleb morphology.

[Filtering bleb revision. Techniques and outcome]. / Sickerkissenrevisionen Techniken und Ergebnisse.

BACKGROUND: The surgical management and outcome of bleb-related complications such as leaking blebs,overfiltration and blebitis are reported. METHODS: A retrospective analysis was carried out of 35 patients who underwent surgical repair of the filtering bleb in our hospital between 1991 and 2000. RESULTS: Surgical techniques used were autologous blood injection, fibrin glue injection, conjunctival suturing, resuturing of the trabeculectomy flap, bleb excision, conjunctival advancement, lyodura and tenon patching. In the eyes with leaking blebs the mean preoperative intraocular pressure (IOP) was 11.6+/-10.3 mmHg. After an average followup of 12 months the IOP was 11.9+/-3.3 mmHg. In the eyes with overfiltration the mean IOP was 2.4+/-1.5 mmHg and after an average follow-up of 18 months the mean IOP increased to 13.5+/-3.7 mmHg. In 77.1% the IOP was regulated between 8 and 21 mmHg without glaucoma medication. Mean visual acuity improved by 3.6+/-5.9 lines postoperatively. CONCLUSION: Surgical bleb revision has a high success rate with regard to maintaining a functioning filtering bleb and to preserving vision.

[Dacryocystostomy and microsurgical lacrimal sac reconstruction in dacryolithiasis]. / Dakryozystotomie und mikrochirurgische Tränensackrekonstruktion bei Dakryolithen.

BACKGROUND: The incidence of dacryoliths ranges between 8 and 14% of patients undergoing a dacryocystorhinostomy. Lacrimal duct stenoses with dacryoliths can be managed either by surgery or minimally invasive techniques. We present two patients who underwent removal of dacryoliths by dacryocystotomy and microsurgical reconstruction without osteotomy. PATIENTS AND METHODS: Case report 1: A 47-year-old male patient presented with chronic epiphora. The dacryocystogram revealed a filling defect in the dilated lacrimal sac. Case report 2: A 22-year-old female patient suffered from a hemorrhagic right-sided dacryocystitis. Two years previously the patient had undergone lacrimal endoscopy with silicone intubation for 3 months. Preoperative dacryocystography showed an obliteration of the superior portion of the lacrimal sac. In both patients, we performed the extraction of the dacryolith by dacryocystotomy followed by silicone tube intubation of the lacrimal system for 3 months. Both patients with a follow-up of 24 and 29 months, respectively, showed good clinical results and patent nasolacrimal pathways on digital dacryocystography. RESULTS: Methods to extract dacryoliths include minimally invasive techniques such as nonsurgical radiologic or endoscopic removal during dacryoplasty or surgical approaches such as external or endonasal dacryocystorhinostomy. CONCLUSION: Dacryocystotomy with primary microsurgical lacrimal sac reconstruction combined with silicone intubation is an alternative surgical procedure to remove dacryoliths. An osteotomy is not always required.

[Early and late findings with optical coherence tomography (OCT) in patients with postoperative hypotonia]. / Frühe und späte Befunde der optischen Kohärenztomographie (OCT) bei Patienten mit postoperativer Hypotonie.

PURPOSE: To study early and late findings of macular retinal thickness in patients with hypotony following filtering procedures. PATIENTS AND METHODS: 13 patients who had undergone trabeculectomy (9 with antimetabolites) developed ocular hypotony. The macular region appeared normal during biomicroscopy in 8 patients. In the hypotensive phase, macular thickness was measured using optical coherence tomography (OCT). Directly after attempted and successful normalization of intraocular pressure (7 spontaneous, 5 operative, 1 failure) as well as 6 months later, OCT measurements were repeated. Foveal thickness in the hypotonous eye was correlated with visual acuity and foveal thickness in the fellow eye. RESULTS: Intraocular pressure could be raised from a mean of 2.5 +/- 1.3 mmHg to 11.5 +/- 5.5 mmHg and later on to 13 +/- 3.7 mmHg (follow-up). Mean foveal thickness was reduced from 211 +/- 73 microns during hypotony to 170 +/- 44 microns after normalization of intraocular pressure and to 171 +/- 38 microns at late follow-up. Mean visual acuity improved from 0.17 to 0.33 and finally to 0.6. CONCLUSIONS: Despite normal appearance of the macula (8 patients) using biomicroscopy in patients with hypotony, retinal thickness in the fovea is increased. Apart from refractive changes, this retinal thickening can be held responsible for the deterioration of visual acuity in eyes with hypotony. OCT analysis and measurements may be useful to distinguish between retinal thickening that is reversible after normalization of intraocular pressure and cystoid macular edema that leads to permanent visual impairment.

[Imaging of orbital metastasis of small-intestine carcinoid by octreotide scintigraphy. A critical evaluation of the methodology]. / Darstellung einer Orbitametastase eines Dünndarmkarzinoids mittels Oktreotidszintigraphie. Eine kritische Betrachtung der Methodik.

BACKGROUND: An orbital carcinoid metastasis can be specifically imaged by octreotide scintigraphy. Orbital metastases of carcinoid tumors are rare. In the current literature only 27 cases have been published. CASE REPORT: We report on a 59 year-old woman who presented with diplopia 6 years after resection of a carcinoid tumor of the ileum. She also complained about flush and diarrhea. The diplopia was caused by limited extensibility of the right inferior muscle. Computed tomography with contrast revealed an enhancing tumor in the area of the right inferior rectus muscle, which appeared in the MRT as an isointense structure in the T1-weighted image. On staging, we found a contrast-enhancing nodular hepatic lesion. In octreotide scintigraphy, enhancement of the liver, thoracic and abdominal para-aortic lymph nodes and of the right inferior orbit was found. CONCLUSION: The survival times of patients with orbital metastasis of carcinoid tumors range between 7 months and 11 years. No specific treatment is available. Surgical excision is indicated for a symptomatic solitary metastasis. Octreotide is helpful in two ways: (1) as a radiolabeled tracer to detect extra-abdominal and extrahepatic secondary tumors; (2) as a treatment modality for flush and diarrhea, which is successful in over 60% of patients (life expectancy uninfluenced). Our patient is presently being treated with 200 micrograms of octreotide three times a day subcutaneously. Flush episodes and diarrhea have been reduced, but her ophthalmologic symptoms remain unchanged, and she has recently developed cardiac insufficiency.

[CO2 and erbium YAG laser in eyelid surgery. A comparison]. / CO2- und Erbium-YAG-Laser in der Lidchirurgie. Ein Vergleich.

BACKGROUND: Lasers are finding increasing use in cosmetic and reconstructive plastic surgery. We compared the erbium-YAG laser and the CO2 laser to conventional eyelid surgery with a scalpel. MATERIAL AND METHODS: We operated on 58 patients using the erbium-YAG laser and on 32 using the CO2 laser. Surgeries were benign tumor excisions and removal, xanthelasma removal, lower and upper eyelid blepharoplasties, and skin resurfacing in the area of the lower eyelid. RESULTS: Wound healing with the CO2 laser was significantly slower because of its larger thermal necrosis zone, but the hemostasis with the CO2 laser makes removal of deeper lesions easier. Advantages are the wide application spectrum for incisional and ablative surgery. The erbium-YAG laser is an excellent for ablating superficial benign lesions, including that in the area of the lid margin and close to the lacrimal puncta without scars. SUMMARY: The application spectrums of the erbium-YAG and CO2 lasers complement one another. The erbium-YAG laser is superior for esthetic skin resurfacing and ablation of superficial lesions, and the CO2 laser allows hemorrhage-free noncontact incisional surgery.

[Orbital surgery. Perioperative problems and results]. / Orbitachirurgie. Perioperative Probleme und Ergebnisse.

BACKGROUND: Orbitotomies have special place in ophthalmic surgery because of the anatomical structures involved and the variety of perioperative problems. We performed a retrospective analysis of orbitotomies carried out in our department in order to give us some more detailed information about the frequency and extent of the various intra- and postoperative problems of orbital surgery. PATIENTS: We evaluated 48 orbitotomies of 46 patients operated on between August 1995 and February 1998. RESULTS: Severe intraoperative complications rarely occurred. Two patients had severe hemorrhages and needed transfusion, and once there was a CSF leakage. Interdisciplinary treatment was performed in these cases. Postoperatively, we saw transitory dysfunction such as reduction of visual acuity (35%), restriction of ocular motility with or without diplopia (20%) and eyelid malposition. These dysfunctions are primarily caused by postoperative edema and hematoma. On the other hand, permanent dysfunctions were rare. CONCLUSIONS: Our analysis shows that the main perioperative problems of orbitotomies are transient dysfunctions that generally resolve quickly. Severe complications are rare. They generally occur intraoperatively and sometimes require interdisciplinary management.

Color Doppler imaging of the eye and orbit.

Since the development of A- and B-scan ultrasound technique in the 1950s, significant progress in ophthalmic ultrasound has appeared. As the technology advances and ultrasound systems improve their ability to acquire and detect ultrasonic signals and to analyze them in terms of a spatial resolution and frequency distribution, there is no doubt that the extent of clinical applications will expand accordingly. Nevertheless, the fundamental physical restrictions of ultrasonography and Doppler will always remain the same. For ophthalmology, we hope that less expensive color Doppler systems with specifically designed probes, improved two-dimensional resolution, and Doppler spectrum acquisition will become more widely available. Because CDI allows for the first time a noninvasive assessment of the retrobulbar vasculature, we feel that many applications of this technology will develop for ophthalmology.

[Quantitative and objective follow-up of papilledema with the Heidelberg Retina Tomograph]. / Quantitative und objektive Verlaufskontrolle der Papillenschwellung mit dem Heidelberg-Retina-Tomographen.

UNLABELLED: The Heidelberg retina tomograph (HRT) is a new instrument to analyze the three-dimensional structure of the retina. It is based on confocal laser scanning technology. Scientific interest has so far focused on the follow-up of glaucomatous optic nerve head damage. As parameters such as cup depth and cup volume can be reproduced with a high degree of accuracy, this new instrument may prove to be an excellent tool to follow up swelling of the optic disk. PATIENTS AND METHOD: A total of 21 patients suffering from optic disk swelling of various etiologies were included in a pilot study. Measurements were taken at six different time points. The maximum optic disk elevation and the volume of swelling were evaluated. Visual acuity and the visual field were determined, and fundus photographs were taken. RESULTS: A reduction in optic disk swelling over time may be demonstrated by both morphological parameters and correlates with improvement in fundus changes. The change in the volume of swelling is greater than the change in maximum disk elevation. The course of optic disk swelling differs between patients with anterior ischemic optic neuropathy and those with pseudotumor cerebri. No correlation was found between our measurements with the HRT and functional parameters (visual acuity and visual field). CONCLUSION: The HRT is a good tool for the follow-up of optic disk swelling, particularly optic disk elevation due to increased intracranial pressure.

[Papular xanthoma of the eyelids]. / Papulöse Xanthome der Lider.

BACKGROUND: Xanthomatous tumors are common tumors of the eyelid. We report the rare case of a patient with a papular xanthoma of the eyelid. CASE REPORT: The 87-year old patient suffered from multiple xanthomatous lesion in the face and the trunk. The tumors were painless and elastic. A biopsy of the largest tumor was performed. RESULTS: The histologic examination revealed multiple histiocytes and giant cells of the Touton type. Immunohistochemistry showed a positive stain for CD68. CONCLUSIONS: The clinical, histologic and immunohistochemical findings are typical for a papular xanthoma and help to differentiate from other xanthomatous lesions such as xanthelasma, xanthoma disseminatum, necrobiotic xanthogranuloma and fibrous histiocytoma.

[Microsurgical endonasal decompression in traumatic and neoplastic optic nerve compression]. / Mikrochirurgische endonasale Dekompression bei traumatischer und neoplastischer Optikuskompression.

UNLABELLED: The therapy of traumatic optic neuropathy remains controversial. Some authors recommend observation and others, the use of megadose corticosteroids or surgical decompression of the optic nerve. Improvements in visual acuity from no light perception (NLP) preoperatively to close to normal visual acuities have been reported after transethmoidal decompression and systemic steroids. The transnasal microscopic approach offers safe and effective access to the optic canal. MATERIALS AND METHODS: Retrospectively 15 patients (13 men/2 women) ranging in age from 17 to 67 years, who were surgically decompressed in the Ear-Nose-Throat Department between 1989 and 1994, were analyzed. Thirteen patients had experienced sudden visual loss after trauma; in 2 patients a tumor was diagnosed. After an initial ophthalmologic examination and CT scans, the patients underwent transnasal decompression of the optic canal for at least 180 degrees. In the postoperative period, visual acuity, pupillary reaction, visual field and optic nerve morphology were monitored. RESULTS: The overall visual results were poor. In 8 patients with no light perception (NLP) preoperatively, no improvement in visual acuity was found. Minor improvements were seen with an initial vision of 20/200 or less. Dramatic improvements were found in both patients with rapidly progressive neoplastic optic nerve compression. No intra- or postoperative complications were seen. CONCLUSION: In our study we were unable to reproduce the good visual results of some series. If there is NLP preoperatively, surgical intervention does not seem to be promising. However, in patients with incurable tumors transnasal decompression of the optic canal offers a minimally invasive palliative measure to preserve and restore vision.

[Ultrasound biomicroscopy findings in various forms of glaucoma]. / Ultraschallbiomikroskopische Befunde bei verschiedenen Glaukomformen.

Ultrasound biomicroscopy is a new imaging technology that uses high-frequency ultrasound and thus allows depiction of the anterior portion of the globe in microscopic resolution. It is independent on the clarity of the optical media and allows, for the first time, a non-invasive demonstration of the structures of the posterior chamber and their relationship to each other. Therefore, it is especially suitable for diagnosis and research on the various forms of glaucoma. Our examinations were performed with an ultrasound biomicroscope (UBM Humphrey Model 840) with a 50 MHz transducer. This allows resolution of structures up to 50 microns. Thirty-nine patients with different forms of glaucoma were examined: POAG, pigmentary glaucoma, pseudoexfoliation glaucoma, pupillary block, plateau iris syndrome, ciliolenticular block, congenital glaucoma, traumatic glaucoma and situations after glaucoma surgery. The following findings could be demonstrated: configuration of the anterior chamber angle region, iris curvature, ciliary body and lens position, differentiation between solid and cystic tumors, traumatic changes and trabeculectomy openings. With this information ultrasound biomicroscopy offers additional details for the differential diagnosis and treatment of various forms of glaucoma.

Color Doppler imaging: a new technique to assess orbital blood flow in patients with diabetic retinopathy.

PURPOSE: Color Doppler imaging is a new noninvasive technique that enables measuring blood flow velocity in small orbital vessels, arteries as well as veins. Because hemodynamic changes are seen in patients with diabetic retinopathy by other techniques, the authors compared 61 eyes with proliferative, 59 eyes with nonproliferative, and 26 eyes with preproliferative diabetic fundus changes with a matched control group of 70 patients without diabetes (128 eyes). METHODS: The central retinal artery (CRA), short posterior ciliary artery (PCA), and ophthalmic artery (OA) of all patients were examined, and the systolic, diastolic, and mean velocities were measured for each vessel. RESULTS: Differences between the groups were most prominent in the CRA. The perfusion velocity was significantly lower (P < 0.001) in proliferative eyes (Vsystolic 5.7 +/- 1.8 cm/sec) than in the control group (Vsystolic 9.4 +/- 1.2 cm/sec) or in nonproliferative eyes (Vsystolic 8.4 +/- 1.8 cm/sec). In the preproliferative group, there was greater variability in velocity distribution. Consequently, no statistically significant difference could be deduced, either in the group with background retinopathy or in the group with proliferative diabetes. In the OA and PCA, neither group showed significant differences from normal. CONCLUSIONS: Measurements indicate a correlation between severity of diabetic retinopathy and decreased flow velocity in the CRA.

[Changes in orbital hemodynamics caused by nitroglycerin and nifedipine. A study using color duplex ultrasound]. / Veränderungen der orbitalen Hämodynamik durch Glyzerintrinitrat und Nifedipin. Eine Studie mit Hilfe der Farb-Duplex-Sonographie.

Color Doppler imaging has demonstrated orbital hemodynamic changes in diseases such as central vein occlusion, the ocular ischemic syndrome and diabetic retinopathy. Reports of pharmacologically induced changes are, however, rare and inconsistent. In order to verify the sensitivity of color Doppler imaging to demonstrate pharmacologically induced changes in orbital hemodynamics, nitroglycerin and nifedipine served as vasoactive agents with a clear pharmacological spectrum. Twelve healthy volunteers were examined before and after drug application. After the administration of 0.8 mg nitroglycerin, the end diastolic bloodflow velocity was increased in the central retinal artery (before: Vdiastolic 2.2 +/- 1.0 cm/s, after: Vdiastolic 3.1 +/- 1.1 cm/s) as well as the ophthalmic artery (before: Vdiastolic 5.8 +/- 1.7 cm/s, after: Vdiastolic 7.4 +/- 1.8 cm/s). The resistance index of orbital blood flow decreased in all three vessels. After sublingual administration of 10 mg nifedipine, peak systolic blood flow velocity was slightly higher in the ciliary arteries and in the ophthalmic artery (before: Vsystolic 34.7 +/- 4.6 cm/s, after: Vsystolic 37.8 +/- 3.6 cm/s). Blood-flow velocity in the central retinal vein was elevated as well (before: Vmax 3.81 +/- 0.66 cm/s, after: Vmax 4.66 +/- 0.83 cm/s). Those slightly divergent results may be due to the different pharmacological spectrum of the two drugs investigated While nitroglycerin leads to dilatation of venous vessels, nifedipine acts primarily on small arteries. As nifedipine and other calcium channel blockers have been tested in patients with low-tension glaucoma, future color Doppler studies of such a population seem to be promising.

Color Doppler imaging of arterial blood flow in central retinal vein occlusion.

PURPOSE: The hemodynamics of the retrobulbar arterial circulation of patients with central retinal vein occlusion were evaluated in order to better understand the pathophysiology of this disease. METHODS: Color Doppler imaging was used to measure the peak systolic velocity and vascular resistance (pulsatility index) in the retrobulbar arteries of involved eyes and clinically healthy fellow eyes of patients with central retinal vein occlusion and in the control eyes of age- and sex-matched healthy volunteers. RESULTS: Average peak systolic velocity was significantly lower and average vascular resistance was significantly higher in the central retinal artery of involved eyes of patients with central retinal vein occlusion compared with clinically healthy fellow eyes and compared with control eyes. There also was a trend toward higher vascular resistance in the central retinal artery of clinically healthy fellow eyes of patients with central retinal vein occlusion compared with control eyes. In the ophthalmic arteries and short posterior ciliary arteries, vascular resistance was significantly higher in both the involved eyes and clinically healthy fellow eyes of patients with central retinal vein occlusion compared with control eyes. CONCLUSION: Color Doppler imaging parameters of the central retinal artery circulation were abnormal in eyes with central retinal vein occlusion, suggesting impaired arterial blood flow associated with this disease. The high vascular resistance in the central retinal arteries, ophthalmic arteries, and short posterior ciliary arteries of both involved and clinically healthy fellow eyes of patients with central retinal vein occlusion suggests that diffuse small vessel disease may predate and contribute to the development of central retinal vein occlusion.

Color Doppler hemodynamics of giant cell arteritis.

OBJECTIVES: To determine quantitative and qualitative hemodynamic alterations within the ophthalmic, central retinal, and short posterior ciliary arteries in patients with giant cell arteritis (GCA) proved by biopsy specimen. DESIGN, PATIENTS, AND SETTING: A consecutive case series of patients with GCA referred to an urban eye hospital who were evaluated with color Doppler imaging that was used to analyze orbital blood flow velocities and vascular resistance in 22 consecutive patients with GCA compared with age and sex-matched controls. RESULTS: Patients with GCA all demonstrated significantly reduced central retinal and short posterior ciliary arterial mean flow velocities as well as significantly increased vascular resistance compared with matched controls. Ophthalmic artery mean flow velocity demonstrated marked variation depending on the anatomic location studied. Other color Doppler imaging characteristics of GCA included the following: ophthalmic artery aliasing (high velocity and turbulent flow at presumed focal vasculitic stenoses), reversal of flow within the ophthalmic artery, reduced and truncated time-velocity waveforms of the central retinal and short posterior ciliary arteries, and absolute deficits of flow within the central retinal and short posterior ciliary arteries. Aliasing of flow velocity within the ophthalmic artery (two patients) was associated with clinical progression of GCA. CONCLUSIONS: These data support the concept that quantitative and qualitative alterations in blood flow or pathophysiologic mechanisms of visual loss in GCA. This technique may be useful in the diagnosis and management of GCA since some of the color Doppler waveforms observed in GCA have not been seen in non-arteritic optic neuropathy. Treatment with corticosteroids often appears to stop the progression of these hemodynamic abnormalities but generally does not improve preexisting vascular abnormalities.