Diurnal Intraocular Pressure Profiles in Chronic Open-Angle Glaucoma.

PURPOSE: To evaluate day-and-night intraocular pressure (IOP) profiles in normal and glaucomatous eyes. DESIGN: Hospital-based clinical observational study. METHODS: The study included 3561 day-and-night profiles of IOP measurements performed by Goldmann applanation tonometry on 1408 eyes of 720 normal Caucasian subjects or chronic open-angle glaucoma patients. RESULTS: For all groups except the secondary open-angle glaucoma group, IOP was highest at 7 a.m., followed by noon and 5 p.m., and finally at 9 p.m. or midnight. In secondary open-angle glaucoma, mean measurements did not vary significantly during day and night. The profile amplitude (mean: 5.5 2.8 mm Hg) was significantly (P < 0.001) higher in the secondary open-angle glaucoma group than in the normal-pressure glaucoma group and the normal group. The two latter groups did not vary significantly (P = 0.47) in profile amplitude. Expressed as percentage of the mean IOP, the IOP amplitude did not vary significantly between any of the study groups. The inter-eye IOP difference for any measurement time was significantly (P < 0.001) smaller than the IOP profile amplitude. CONCLUSIONS: Treated secondary open-angle glaucoma eyes did not exhibit the normal day-and-night pressure profile which was usually shown in normal eyes and eyes treated for other types of chronic open-angle glaucoma. The day-and-night IOP amplitude in absolute terms is highest in secondary open-angle glaucoma. In relative terms, the IOP amplitude did not vary significantly between the various types of chronic open-angle glaucoma. Inter-eye IOP differences were significantly (P < 0.001) smaller than the IOP profile amplitude.

Circadian intraocular pressure profiles in chronic open angle glaucomas.

PURPOSE: To evaluate circadian intraocular pressure (IOP) profiles in eyes with different types of chronic open-angle glaucoma (COAG) and normal eyes. METHODS: This study included 3,561 circadian IOP profiles obtained from 1,408 eyes of 720 Caucasian individuals including glaucoma patients under topical treatment (1,072 eyes) and normal subjects (336 eyes). IOP profiles were obtained by Goldmann applanation tonometry and included measurements at 7 am, noon, 5 pm, 9 pm, and midnight. RESULTS: Fluctuations of circadian IOP in the secondary open-angle glaucoma (SOAG) group (6.96±3.69 mmHg) was significantly (P<0.001) higher than that of the normal pressure glaucoma group (4.89±1.99 mmHg) and normal eyes (4.69±1.95 mmHg); but the difference between the two latter groups was not significant (P=0.47). Expressed as percentages, IOP fluctuations did not vary significantly among any of the study groups. Inter-ocular IOP difference for any measurement was significantly (P<0.001) smaller than the profile fluctuations. In all study groups except the SOAG group, IOP was highest at 7 am, followed by noon, 5 pm, and finally 9 pm or midnight. In the SOAG group, mean IOP measurements did not vary significantly during day and night. CONCLUSIONS: In contrast to normal eyes and eyes with primary open-angle glaucoma under topical antiglaucoma treatment, eyes with SOAG under topical treatment do not show the usual circadian IOP profile in which the highest IOP values occur in the morning, and the lowest in the evening or at midnight. These findings may have implications for timing of tonometry. Fluctuation of circadian IOP was highest in SOAG compared to other types of open angle glaucomas.

Heritable features of the optic disc: a novel twin method for determining genetic significance.

PURPOSE: Numerous genetic diseases and environmental stimuli affect optic nerve morphology. The purpose of this study was to identify the principal heritable components of visible optic nerve head structures in a population-based sample of twins. METHODS: Fifteen optic nerve specialists viewed stereoscopic optic nerve head photographs (Stereo Viewer-II; Pentax Corp., Tokyo, Japan) from 50 randomly selected monozygotic or dizygotic twin pairs. Before viewing, each expert was questioned about which optic nerve head traits they believed were inherited. After viewing a standardized teaching set, the experts indicated which twin pairs they thought were monozygotic. Participants were then questioned about how their decisions were reached. A rank-ordered Rasch analysis was used to determine the relative weighting and value applied to specific optic nerve head traits. RESULTS: The proportion of twin pairs for which zygosity was correctly identified ranged from 74% to 90% (median, 82%) across the panel. Experts who correctly identified the zygosity in more than 85% of cases placed most weighting on shape and size of the optic disc and cup, whereas experts with the lowest scores placed greater weighting on the optic nerve head vasculature in reaching their decisions. CONCLUSIONS: In determining the genetic components of the optic nerve head, the results of this study suggest that the shape and size of the optic disc and cup are more heritable and should receive a greater priority for quantification than should vascular features.

Effect of uncomplicated phacoemulsification on the central retina in diabetic and non-diabetic subjects.

BACKGROUND: The purpose of this study was to evaluate the subclinical influence of uncomplicated cataract surgery on foveal thickness and volume in the early postoperative period. METHODS: In a prospective study, 108 eyes were assessed by optical coherence tomography preoperatively and 1 day, 1 week and 4 weeks after uncomplicated small incisional phacoemulsification with endocapsular intraocular lens (IOL) implantation under topical anesthesia. The study included 24 eyes of diabetic patients. Eyes with diseases predisposing them for postoperative macular edema, preexisting macular edema, and eyes that developed cystoid macular edema during follow-up were excluded. Main outcome measures were minimal foveal thickness (MFT) and foveal volume. Secondary outcome measure was VA. RESULTS: Visual acuity (LogMAR) increased significantly (p<0.001) from 0.43+/-0.21 to 0.11+/-0.15 4 weeks after surgery, with a significantly (p=0.001) higher increase in VA for nondiabetic subjects. MFT increased from 183+/-27 mum preoperatively to 191+/-37 mum 4 weeks after surgery (p=0.001), with diabetic patients showing a tendency toward a more pronounced increase in minimal retinal thickness than nondiabetic subjects (p=0.058). One day and 1 week after surgery, MFT measurements were not significantly different from preoperative results. Foveal volume showed a significant increase at 1 week and 4 weeks after surgery (p<0.001), independent of the presence of diabetes (p=0.565). The proportion of patients exhibiting subclinical macular swelling was about 1/5 in the nondiabetic group and 1/3 in the diabetic group. Mean duration of surgery was 11.5+/-6.6 min. CONCLUSION: Foveal thickness and foveal volume demonstrate a subclinical increase within 4 weeks after uncomplicated cataract surgery in up to 1/3 of the patients. The amount and frequency of early postoperative subclinical retinal thickening was higher than expected.

Iris colour, optic disc dimensions, degree and progression of glaucomatous optic nerve damage.

PURPOSE: To evaluate whether iris colour influences size and shape of the optic nerve head and risk for glaucoma progression. METHODS: The hospital-based observational study included 1973 eyes of 1012 Caucasian subjects with ocular hypertension or chronic open-angle glaucoma. For all patients, colour stereo optic disc photographs were evaluated, and corneal pachymetry and achromatic perimetry were performed. Main outcome measures were optic nerve head parameters, the development or progression of visual field defects and iris colour. RESULTS: In most of the study groups, size of the optic disc, neuroretinal rim, alpha zone and beta zone of parapapillary atrophy, retinal vessel diameter and central corneal thickness did not differ significantly between eyes with blue, green, brown and mixed iris colour. In the normal-pressure glaucoma group, neuroretinal rim area was smallest in the population with mixed-coloured eyes and largest in the group of eyes with brown irides (P = 0.001 after correction for inter-eye dependency and multiple testing). For the ocular hypertensive subjects and glaucoma patients with follow-up examinations, the rate of development or progression of glaucomatous visual field loss was not significantly associated with iris colour (P = 0.060). CONCLUSIONS: In Caucasian subjects, iris colour does not have a major association with the size of the optic nerve head structures, central corneal thickness and retinal arterial diameter. In Caucasian patients with ocular hypertension or chronic open-angle glaucoma, an influence of iris colour on the risk for development or progression of glaucomatous visual field defects could not be confirmed.

Triamcinolone acetonide-induced ocular hypertension.

PURPOSE: The aim of this study is to report on the clinical course of a patient showing markedly increased intraocular pressure (IOP) caused by intravitreal triamcinolone acetonide. METHODS: A 33-year-old patient received an intravitreal injection of approximately 20 mg of triamcinolone acetonide (TA) as treatment of otherwise therapy-resistant uveitis. She experienced an IOP rise to values over 40 mmHg for a period for more than 3 months, despite maximal antiglaucomatous medical therapy. Peak IOP was 55 mmHg. RESULTS: Neither confocal scanning laser tomography nor qualitative assessment of optic disc photographs nor perimetry showed development of glaucomatous changes. Scanning laser polarimetry of the retinal nerve fiber layer suggested a slight loss in the nasal upper fundus quadrant. CONCLUSIONS: Relatively young patients with a pronounced TA-induced rise in IOP, unresponsive to maximal antiglaucomatous medication, may not necessarily undergo antiglaucomatous surgery if the rise in IOP does not last longer than approximately 3 months.

Optical coherence tomography of the optic nerve head: interindividual reproducibility.

PURPOSE: Optical coherence tomography may be a new technique for quantitative 3-dimensional assessment of the optic nerve head for diagnosis of optic nerve anomalies and diseases such as the glaucomas. The purpose of the present study was to examine its reproducibility. PATIENTS AND METHODS: The clinical noninterventional study included 10 randomly chosen eyes of 10 healthy individuals who underwent 24 optical coherence tomographic examinations with the high-resolution and fast scan program, interactively corrected or uncorrected. The pupils were not dilated. All examinations were performed by 3 examiners independently of one another. The coefficient of variation was calculated as the ratio of the mean of the standard deviations divided by the mean of the means. RESULTS: The coefficients of variation for redetermination of optic disc area, ranging between 0.047 and 0.119, were lowest for the manually corrected fast scan mode and highest for the uncorrected fast scan mode. For remeasurements of the neuroretinal rim area, the best mean coefficient of variation was 0.073+/-0.026 (corrected fast scan mode). CONCLUSIONS: In healthy eyes, the morphometric measurements of the optic nerve head by optical coherence tomography show a relatively high reproducibility with mean coefficients of variation lower than 10% for remeasurements of the optic disc and neuroretinal rim area. With undilated pupils, reproducibility is better with the fast scan mode with interactive correction of the outlining of the optic disc border than it is with the high-resolution mode.

Optic disc morphometry with optical coherence tomography: comparison with planimetry of fundus photographs and influence of parapapillary atrophy and pigmentary conus.

PURPOSE: Optical coherence tomography (OCT) is an established method for visualising macular pathology and for measuring the thickness of parapapillary retinal nerve fibre layer. The purpose of the present study was to compare OCT measurements of the optic disc with those obtained by planimetry of fundus photographs and to investigate whether OCT measurements are influenced by the amount of parapapillary atrophy or pigmentary conus at the disc margin. MATERIALS AND METHODS: Eighty-two eyes of 41 randomly selected Asian-Indian subjects were included. The mean age was 44.2+/-14.3 years (mean+/-SD). All eyes underwent optic disc assessment by OCT (fast optical disc protocol) and digital 20 degree disc photos.. Planimetry of the discs were performed by outlining the disc and the cup. The amount of parapapillary atrophy (zone beta) was quantified as the number of clock-hours around the disc with adjacent parapapillary atrophy. The same procedure was performed to quantify the amount of pigmentary conus around the disc. RESULTS: Mean+/-SD disc size and mean+/-SD cup size in OCT measurements (2.37+/-0.51, 1.29+/-0.55) were significantly smaller than in photographic planimetry (2.83+/-0.62, 1.56+/-0.5: P<0.001, P<0.001). Optic discs with parapapillary atrophy (P=0.2) in their relative difference of disc sizes between OCT and planimetry. Similarly, optic discs with pigmentary conus (n=12) and discs without pigmentary conus (n=70) did not differ significantly (P=0.65). The relative difference in disc size between the two measurement modalities did not correlate with the amount of parapapillary atrophy (r=-0.17, P=0.29) or with the amount of pigmentary conus (r=-0.04, P=0.9). CONCLUSION: OCT analysis of the optic disc produces significantly smaller parameters, compared to the established method of optic disc planimetry. Neither presence, nor extent of parapapillary atrophy zone beta and pigmentary conus seems to produce a systematic error in measurements of disc size with the OCT.

Predictive factors for progressive optic nerve damage in various types of chronic open-angle glaucoma.

PURPOSE: To evaluate whether various types of chronic open-angle glaucoma differ in predictive factors for progression of glaucomatous optic nerve damage. DESIGN: Observational cohort study. SETTING: Prospective observational clinical study. PATIENTS: 517 eyes of 300 Caucasian patients with chronic open-angle glaucoma with elevated intraocular pressure (primary open-angle glaucoma, n = 289; secondary open-angle glaucoma, n = 50) and with normal intraocular pressure (n = 178). OBSERVATION PROCEDURE: During follow-up (median: 49 months, 6 months-130 months), all patients underwent repeated evaluation of color stereo optic disk photographs and white-on-white visual field examination. MAIN OUTCOME MEASURES: Progression of glaucoma was defined as neuroretinal rim loss during the study period. RESULTS: For patients with elevated intraocular pressure, significantly predictive factors for eventual progression were older age, advanced perimetric damage, smaller neuroretinal rim, and larger area of beta zone of parapapillary atrophy. In contrast, in the normal intraocular pressure group, a significant predictive factor was presence of disk hemorrhages at baseline. Within the patients with elevated intraocular pressure, the primary open-angle glaucoma group and the secondary open-angle glaucoma group did not differ in predictive factors for progression of glaucoma. CONCLUSIONS: Open-angle glaucoma patients with normal intraocular pressure and open-angle glaucoma patients with elevated intraocular pressure differ in predictive factors for eventual progression of glaucomatous optic nerve damage. It may have clinical importance and may be helpful in the discussion of the pathogenesis of the glaucomas.

Central corneal thickness correlated with glaucoma damage and rate of progression.

PURPOSE: To evaluate whether the amount of glaucomatous optic nerve damage at presentation of the patient and the rate of progression of glaucoma during follow-up are related to central corneal thickness. METHODS: The prospective observational clinical study included 861 eyes of 454 white subjects (239 normal eyes of 121 subjects, 250 ocular hypertensive eyes of 118 patients, 372 eyes of 215 patients with chronic open-angle glaucoma). For 567 eyes (304 patients) with ocular hypertension or chronic open-angle glaucoma, follow-up examinations were performed, with a mean follow-up time of 62.7 +/- 33.2 months (median, 60.8; range, 6.2-124.9). All patients underwent qualitative and morphometric evaluation of color stereo optic disc photographs and white-on-white visual field examination. Central corneal thickness was measured by corneal pachymetry. RESULTS: Central corneal thickness correlated significantly (P < 0.001) and positively with the area of the neuroretinal rim and negatively with the loss of visual field. Development or progression of glaucomatous visual field defects detected in 119 (21.0%) eyes was statistically independent of central corneal thickness, in univariate (P = 0.99) and multivariate Cox regression analyses (P = 0.19). CONCLUSIONS: At the time of patient referral, the amount of glaucomatous optic nerve damage correlated significantly with a thin central cornea. Progression of glaucomatous optic nerve neuropathy was independent of central corneal thickness, suggesting that central corneal thickness may not play a major role in the pathogenesis of progressive glaucomatous optic nerve damage.

Optical coherence tomography and confocal scanning laser tomography for assessment of macular edema.

PURPOSE: To compare optical coherence tomography (OCT) and confocal scanning laser tomography (cSLT) for quantitative retinal thickness mapping of the macula and their ability to detect macular edema. DESIGN: Prospective, comparative, clinical observational study. METHODS: The study population of 138 eyes (97 patients) was divided into a study group consisting of 45 (32.6%) eyes with macular edema and a control group consisting of 93 (67.4%) eyes without macular edema. All patients underwent OCT and cSLT of the macula. Retinal thickness measurements obtained by OCT were compared with signal width and edema index, determined by cSLT. RESULTS: The OCT measurements and cSLT edema index were significantly (P <.001) correlated with each other. Correlation coefficients decreased (P <.001) with increasing diameter of the measurement circle. In the macular edema group, correlation coefficients were significantly (P <.001) higher than in the control group. To separate the study and control groups, receiver operator characteristic curves covered a larger area for OCT measurements than for cSLT measurements. Retinal thickness measurements and edema index correlate with visual acuity (correlation coefficient r = -.653 for OCT, r = -.608 for cSLT; P <.001). CONCLUSIONS: Macular edema can be quantitatively mapped by OCT and cSLT. The retinal thickness and edema index measurements correlate with visual acuity. The fast and standard examination modes of OCT give similar measurements. Both OCT and cSLT can differentiate between eyes with and without macular edema, with OCT showing a higher predictive value.

Predictive factors of the optic nerve head for development or progression of glaucomatous visual field loss.

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for the development or progression of visual field loss in chronic open-angle glaucoma. METHODS: The prospective observational clinical study included 763 eyes of 416 white subjects with ocular hypertension and chronic open-angle glaucoma. During the follow-up time (mean, 67.4 months; median, 65.1; range, 6.2-104.5), all patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs and white-on-white visual field examination. Progression of glaucomatous visual field damage was defined by point-wise regression analysis for each of the 59 locations in the visual field. Outcome measures were qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Development or progression of glaucomatous visual field defects was detected in 106 (13.9%) eyes. At baseline of the study, neuroretinal rim area was significantly (P < 0.002) smaller, the beta zone of parapapillary atrophy (P < 0.003, nasal sector) was significantly larger, and age was significantly higher (P < 0.003) in the progressive study group than in the nonprogressive study group. Both study groups did not vary significantly in size of the optic disc and the alpha zone of parapapillary atrophy. Cox proportional hazard regression analysis revealed that the progression of glaucomatous visual field loss depended significantly on the area of the neuroretinal rim (P < 0.001) and age (P < 0.001), but was independent of diameter of the retinal arterioles and veins. CONCLUSIONS: Morphologic predictive factors for development or progression of glaucomatous visual field defects in whites are small neuroretinal rim area and large beta zone of parapapillary atrophy. Age is an additional nonmorphologic parameter. Progression of glaucomatous optic nerve head changes is independent of the size of the optic disc and alpha-zone of parapapillary atrophy and retinal vessel diameter.

Enlargement of parapapillary atrophy in follow-up of chronic open-angle glaucoma.

PURPOSE: To assess the frequency of an enlargement of parapapillary atrophy in follow-up of eyes with open-angle glaucoma. METHODS: Prospective observational longitudinal study. SETTING: Institutional. PATIENTS: The study included 978 eyes (511 Caucasian subjects) with open-angle glaucoma (n = 548; including 194 eyes with normal-pressure glaucoma), ocular hypertension (n = 289), or without optic nerve disease (n = 141). Highly myopic eyes with a myopic refractive error exceeding -8 diopters were excluded. Mean follow-up was 4.5 +/- 2.4 years (median, 3.8 years; range: 1.5 to 9.8 years). OBSERVATION PROCEDURES: Optic disk photographs taken annually. MAIN OUTCOME MEASURES: Two examiners compared optic disk slides for enlargement of parapapillary atrophy (zone beta) and for signs of progressive disk damage. RESULTS: An enlargement of parapapillary beta zone was detected in 16 eyes (1.6%) after 3.9 +/- 2.6 (0.6 to 9.1) years of follow-up. It was observed in 15 eyes (2.7%) with open-angle glaucoma, 1 eye (0.3%) with ocular hypertension, and in none of the normal eyes. After excluding eyes with a myopic refractive error exceeding -3 diopters, enlargement of beta zone was significantly more common in eyes with progressive glaucoma (5/81 or 6.2%) than in eyes with nonprogressive glaucoma (3/354 or 0.8%; P <.001). CONCLUSIONS: Parapapillary atrophy (zone beta) enlarges during follow-up of relatively few eyes with chronic open-angle glaucoma. In the refractive range above -3 diopters, enlargement of beta zone occurs significantly more frequently (P <.001) in progressive glaucoma than in nonprogressive glaucoma. In view of its low frequency, enlargement of beta zone may not be a very useful marker for glaucoma progression.

The optic disc hemifield test.

PURPOSE: To evaluate whether an optic disc hemifield test comparing the superior half of the optic disc with the inferior disc half is useful for glaucoma diagnosis. METHODS: The clinical observational study included 1268 patients with primary or secondary open-angle glaucoma and 649 normal subjects. The glaucoma group was divided into 1118 patients with glaucomatous visual field defects ("perimetric glaucoma"), and 150 patients with optic nerve head changes and normal visual fields ("preperimetric glaucoma"). Color stereo optic disc photographs were morphometrically evaluated. The optic disc area was divided into four sectors: temporal horizontal (60 degrees), superotemporal (90 degrees), inferotemporal (90 degrees), and nasal (120 degrees). Area and width of the neuroretinal rim were measured, and the ratio of superotemporal-to-inferotemporal rim area, the ratio of superior (12 o'clock)-to-inferior (6 o'clock) rim width, the difference of inferotemporal minus superotemporal rim area, and the difference of inferior rim width minus superior rim width were calculated. RESULTS: For the differentiation between the normal group and the whole glaucoma group, and for the differentiation between the normal group and the preperimetric glaucoma group, respectively, areas under the ROC curves were significantly smaller for the parameters of the optic disc hemifield test (superior-to-inferior rim width ratio: 0.448 and 0.412, respectively; and superotemporal-to-inferotemporal rim area ratio: 0.395 and 0.434, respectively) than for any other rim parameter tested such as inferotemporal rim area (0.827 and 0.745, reps.), total rim area (0.814 and 0.741, respectively), and superotemporal rim area (0.781 and 0.705, respectively). DISCUSSION: An optic disc hemifield test with the parameters superior-to-inferior rim width ratio and superotemporal-to-inferotemporal rim area ratio is not markedly helpful for the morphometric diagnosis of glaucomatous optic nerve damage, either in the preperimetric stage or in the perimetric stage of the disease.

Intravitreal reinjection of triamcinolone for exudative age-related macular degeneration.

OBJECTIVE: To evaluate the outcome of repeated intravitreal injections of triamcinolone acetonide for the treatment of exudative age-related macular degeneration. METHODS: This prospective, comparative nonrandomized clinical interventional study included 13 patients with progressive exudative age-related macular degeneration with occult, or predominantly occult, subfoveal neovascularization. All patients had shown an increase or stabilization of visual acuity after a first intravitreal injection of 25 mg of triamcinolone acetonide. They received a second intravitreal injection of 25 mg of triamcinolone acetonide 3.1 to 18 months after the first injection. Mean +/- SD follow-up time after the second injection was 5.2 +/- 3.6 months (median, 5.3 months). A control group included 24 patients with exudative age-related macular degeneration who did not receive treatment for their maculopathy. The main outcome measures were visual acuity and intraocular pressure. RESULTS: In the study group, mean +/- SD visual acuity increased significantly (P =.005 and P =.003, respectively) from 0.17 +/- 0.11 to 0.32 +/- 0.26 and from 0.15 +/- 0.14 to 0.23 +/- 0.19, respectively, after the first and second injections. An increase in visual acuity was found for 10 patients (77%) after the first and second injections. In the control group, visual acuity did not vary significantly during follow-up (P =.81). The difference in change in visual acuity between the study group and control group was significant (P =.01 [Snellen lines] and P =.05 [logMAR units]). The peak in visual acuity and, in a chronologically parallel manner, the peak in intraocular pressure elevation occurred 2 to 5 months after each injection. CONCLUSIONS: Repeated intravitreal injection of 25 mg of triamcinolone acetonide may lead to an increase in visual acuity in patients with exudative age-related macular degeneration, with the peak in visual acuity and intraocular pressure elevation occurring about 2 to 5 months after each injection.

Glaucomatous optic disc hemorrhages on confocal scanning laser tomographic images.

PURPOSE: To evaluate the detectability of glaucomatous optic disc hemorrhages by confocal scanning laser tomography. METHODS: The study included 73 eyes of 63 patients, who consecutively showed optic disc hemorrhages on 15 degrees color optic disc photographs taken at baseline or during follow-up examinations and for whom confocal scanning laser tomographic images were additionally available. Of the total number of 92 observed hemorrhages, 51 hemorrhages extended into the parapapillary region and 41 hemorrhages were restricted to the intrapapillary region. The scanning laser tomographic images were searched for the disc hemorrhages already seen on the conventional disc photographs. RESULTS: Using the reflectivity images, 29 (32%) hemorrhages were detected on the scanning laser tomographs. None of the hemorrhages restricted to the intrapapillary region could be seen on the scanning laser tomographs. By evaluating each of the 32 single images of the scanning laser tomographic image series, 44 (48%) of the hemorrhages were identified on at least one single image. The detectability of disc hemorrhages on the scanning laser tomographs depended significantly on their extension into the parapapillary region or their intrapapillary location. Detectability of disc bleedings was statistically independent of the disc quadrant where the hemorrhage was located, width of the bleeding, size of the optic disc, neuroretinal rim, parapapillary atrophy, and type of glaucoma. CONCLUSIONS: Confocal scanning laser tomography is not very suitable for detection or documentation of optic disc hemorrhages in patients with glaucoma.

Optic disc morphometry correlated with confocal laser scanning Doppler flowmetry measurements in normal-pressure glaucoma.

PURPOSE: To examine the relationship between morphologic optic disc parameters and hemodynamic parameters as measured by confocal laser scanning Doppler flowmetry in patients with normal-pressure glaucoma. METHODS: The study included 91 eyes of 54 patients with normal-pressure glaucoma (mean age: 57.7 +/- 9.8 years), and 136 eyes of 77 age-adjusted normal controls. Color stereo optic disc photographs were morphometrically examined, and confocal laser scanning flowmetry (Heidelberg Retinal Flowmeter) in the neuroretinal rim inside of the optic disc, and in the retina close to the temporal and nasal border of the optic nerve head was performed. RESULTS: Mean confocal laser scanning flowmetric measurements in the neuroretinal rim, temporal parapapillary retina, and nasal parapapillary retina were significantly (P<0.03) lower in the normal-pressure glaucoma group than in the age-adjusted control group. Correspondingly, mean confocal laser scanning flowmetric measurements within the neuroretinal rim decreased significantly, with relatively low correlation coefficients, decreasing neuroretinal rim area (P = 0.016; correlation coefficient r2 = 0.026), and increasing mean visual field defect (P = 0.011; r2 = 0.029). Measurements were statistically independent of alpha zone (P = 0.38; r2 = 0.004) and beta zone (P = 0.57; r2 = 0.002) of parapapillary atrophy. CONCLUSIONS: Confocal laser scanning flowmetric measurements within the neuroretinal rim were lower in eyes with normal-pressure glaucoma than in age-matched normal eyes. Confocal laser scanning flowmetric measurements decrease with increasing glaucomatous optic nerve damage. There is, however, a marked variability preventing a clear relationship between stage of glaucoma and decrease in confocal laser scanning flowmetric measurements. The correlation between parapapillary atrophy and confocal laser scanning flowmetric measurements is not statistically significant in normal-pressure glaucoma.

Influence of cilioretinal arteries on neuroretinal rim and parapapillary atrophy in glaucoma.

PURPOSE: The pattern of neuroretinal rim loss and increase in the area of parapapillary atrophy in glaucoma depend on the localization of the central retinal vessel trunk in the lamina cribrosa. The purpose of the present study was to determine whether, in a similar way, the pattern of rim loss and progression of parapapillary atrophy are influenced by the presence and position of cilioretinal arteries. METHODS: Color stereo optic disc photographs (15 degrees) for morphometric evaluation of the optic nerve head were used to compare the appearance of the optic disc in 41 patients exhibiting unilateral or bilateral cilioretinal arteries in the temporal horizontal disc region with the optic disc morphology of 127 patients without cilioretinal arteries. The areas of the neuroretinal rim and alpha and beta zones of parapapillary atrophy were measured in the total disc and in four disc sectors. RESULTS: Eyes with and eyes without cilioretinal arteries did not differ significantly in the areas of neuroretinal rim and alpha and beta zones of parapapillary atrophy, when measured in the whole optic disc and in the four disc sectors separately; in ratios of the temporal horizontal area to total area of rim and parapapillary atrophy; and in the ratio of temporal horizontal rim area-to-nasal rim area, neither in an interindividual comparison nor in an intraindividual intereye comparison. CONCLUSIONS: In contrast to the position of the central retinal vessel trunk, presence and position of cilioretinal arteries do not markedly influence the pattern of neuroretinal rim loss and progression of parapapillary atrophy in glaucoma.

Inter-eye differences in chronic open-angle glaucoma patients with unilateral disc hemorrhages.

OBJECTIVE: Flame-shaped optic disc hemorrhages are a hallmark of glaucomatous optic neuropathy. The purpose of this study was to evaluate which parameters differ between companion eyes with and without an optic disc hemorrhage in patients with chronic open-angle glaucoma. DESIGN: Comparative (companion eye) observational case series. PATIENTS: The study included 99 white patients with bilateral chronic open-angle glaucoma and unilateral flame-shaped optic disc hemorrhages. METHODS: All patients underwent qualitative and morphometric evaluation of color stereo optic disc photographs. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, and both mean value and loss variance value of the visual field examination. RESULTS: In an intraindividual inter-eye comparison, the eyes with disc hemorrhages and the contralateral eyes without disc bleeding did not vary significantly (P > 0.20) in size and shape of the optic disc and neuroretinal rim, optic cup depth, size of alpha and beta zone of parapapillary atrophy, retinal vessel diameter, intraocular pressure measurements, refractive error, and perimetric indices. CONCLUSIONS: In bilateral chronic open-angle glaucoma, the development of unilateral optic disc hemorrhages does not depend on inter-eye differences in size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, or visual field loss.