Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Three Cases of Spontaneous Hyphaema.

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

[One Year Experience with Quality Control of Cataract Surgery Using an Internet-Based EUREQUO Database]. / Ein Jahr Erfahrung mit der Qualitätssicherung der Kataraktoperation (EUREQUO) an einem öffentlichen Spital.

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

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

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

[Role of ocular pulse amplitude in glaucoma]. / Stellenwert der okulären Pulsamplitude beim Glaukom.

The ocular pulse amplitude is defined as the difference between diastolic and systolic intraocular pressure. The ocular pulse is generated by the pulsatile ocular blood flow in the choroid. It is dependent on the dynamics of the cardiovascular system, the rigidity of the ocular vessels on one side and the biomechanical properties of the eye on the other side. In addition the influence of outflow facility of the aqueous humor, the level of the intraocular pressure itself and last but not least the rigidity of the sclera on the ocular pulse amplitude is until now not clear. Dynamic contour tonometry (Pascal®) does not only measure intraocular pressure almost independent of corneal thickness and curvature but also allows easy and fast measurement of ocular pulse amplitude on the slit lamp. The ocular pulse amplitude in healthy subjects is between 1.2 and 4 mmHg. If the ocular pulse amplitude is larger than 1.2 mmHg spontaneous pulsations of the central retinal vein are visible on fundoscopy. In patients with ocular hypertension the ocular pulse amplitude is larger than in normal subjects but this is mainly due to higher IOP levels. In patients with manifest open-angle glaucoma the ocular pulse amplitude stays initially within the normal range. In more advanced stages of the disease and especially in patients with ocular perfusion pressure dependent optic neuropathy the ocular pulse amplitude is gradually reduced. Due to the various factors influencing ocular pulse amplitude a direct correlation between reduced ocular pulse amplitude and reduced ocular perfusion pressure has not been established as yet. New approaches investigating the variations of the ocular pressure Fourier spectral analysis are promising, especially when simultaneous analysis of the arterial blood pressure is performed. These techniques may allow a fast and easy discrimination between healthy and glaucomatous patients in the near future. If ocular pulse amplitude exhibits a massive inter-ocular asymmetry in the presence of symmetrical ocular findings of extraocular vascular pathologies (i.e. carotid stenosis) are the most likely cause and therefore should be excluded.

[Lens exchange for subluxation of posterior chamber lenses implanted in the capsular bag or in the ciliary sulcus]. / Linsenaustausch bei subluxierten Kapselsack- und Sulkuslinsen.

PURPOSE: There are an increasing number of patients with decreased vision due to dislocated posterior chamber lenses, with pseudoexfoliation being the main risk factor. Various techniques for refixation of the subluxated posterior chamber IOL have been described. Experience with our technique of IOL-explantation, anterior vitrectomy and implantation of an Artisan anterior chamber lens are presented. PATIENTS AND METHODS: In a retrospective study design all lens exchanges with implantation of an Artisan anterior chamber lens performed between 2003 and 2012 are analyzed. The study included 65 eyes of 61 patients (age 79.6 ± 9.2 years: 43-98). The majority of eyes (46/65; 70.8%) had Sundown Syndrome (late in-the-bag intraocular lens dislocation), in 19 eyes the posterior chamber lens was implanted primary or secondary into the ciliary sulcus. In the 46 eyes with Sundown Syndrome cataract surgery with implantation of a posterior chamber lens in the capsular bag was performed 7.4 ± 3.7 (1-22) years before subluxation within the bag. Pseudoexfoliation was the main risk factor in 42/46 (91.2%) of these eyes. A capsular tension ring (CTR) was implanted during cataract surgery in 34/46 (73.9%) eyes. The 34 IOLs with a CTR luxated significantly earlier (p < 0.02 Mann-Whitney U) than the 12 IOLs without a CTR (6.6 ± 3.6 years; median 5.8 vs. 9.4 ± 3.1 years; median 9.2). RESULTS: The average visual gain was 0.2 logMAR in the group of luxated capsular bag lenses and 0.12 logMAR in the group of luxated sulcus lenses. Postoperative IOP decompensation was seen in 17/65 (26.2%) eyes (requiring IOP-lowering surgery in 8 eyes), 7 eyes developed corneal decompensation, 5 eyes had central retinal vein occlusion and one eye developed postoperative endophthalmitis. CONCLUSIONS: Lens exchange with implantation of an Artisan anterior chamber lens has become a routine procedure to improve vision in patients with subluxated IOLs. Postoperative IOP decompensation and vascular problems are the major complications.

[First experience with the Heidelberg Edge Perimeter® on patients with ocular hypertension and preperimetric glaucoma]. / Erste Erfahrungen mit dem Heidelberg-Edge-Perimeter® bei Patienten mit okulärer Hypertension und präperimetrischem Glaukom.

BACKGROUND: The white-on-white computerised static perimetry is not very sensitive to detect a beginning visual field loss. A newer technique to test the central visual field with a flicker defined form technology (FDF) is the Heidelberg Edge Perimeter® (HEP). PATIENTS AND METHODS: A study with 90 eyes from 50 patients (mean age 59 ± 14 years) with ocular hypertension and/or optic nerve suspicious for glaucoma without detectable visual field loss in the Octopus® perimetry (Program dG-2) with the Heidelberg Edge Perimeter® was performed. The "mean defect" (MD), the "pattern standard deviation" and the glaucoma hemifield test (GHT) were calculated and compared with the indices of the Octopus®. RESULTS: Despite normal visual field findings in the Octopus® perimetry (MD < 2.0 dB) we detected in 48 out of 90 eyes (53 %) pathological visual fields in the HEP examination. CONCLUSIONS: As a new research method the Heidelberg Edge perimetry® seems to be more sensitive than conventional static perimetry in early detection of visual field alterations in patients between ocular hypertension and incipient glaucoma.

[Mechanical dilatation of the pupil in phacoemulsification surgery: first experiences with the 6.25 mm Malyugin-ring]. / Mechanische Pupillenerweiterung zur Kataraktoperation: erste Erfahrungen mit dem 6,25 mm Malyugin-Ring.

PURPOSE: Inadequate mydriasis may cause major problems in phacoemulsification surgery. Usually 4 iris retractors are used to allow adequate pupillary dilatation. Implantation of a Malyugin ring to maintain a 6.25 mm pupil is a new alternative. PATIENTS AND METHODS: A Malyugin ring was used in 46 eyes of 39 patients (aged 80.1 ± 6.2 years). The ring is im- and explanted with a disposable shooter through the main incision. Indications for the use of the ring were inadequate mydriasis due to pseudoexfoliation (n = 27), intraoperative floppy iris syndrome (n = 5), the combination of PEX and IFIS (n = 11), extensive posterior synechiae (n = 2) or inadquate mydriasis after long-term pilocarpine treatment (n = 1). RESULTS: In 44/46 eyes phacoemulsification with implantation of foldable posterior chamber lens was performed without complications. In 2 eyes with massive phakodonesis an Artisan anterior chamber lens had to be implanted after anterior vitrectomy because of total zonulolysis. There where no complications associated to the use of the device and with increasing experience duration of implantation as well as explantation was reduced to 2 - 4.5 min (median 2:51 min). CONCLUSIONS: In cases of phacoemulsification surgery with inadequate mydriasis implantation of a Malyugin ring is a simple, safe and fast alternative to iris-retractors; it allows better pupil-size without additional stab incisions.

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

INTRODUCTION: In clinical practice the temporal artery biopsy (TAB) in suspected giant cell arteritis (GCA) is still believed to be the "gold standard". The purpose of this study was to compare the histopathological findings of the TAB with duplex sonography of the temporal artery. PATIENTS AND METHODS: In our retrospective study we analysed 85 consecutive patients (52 female, mean age 71.5, range 55 - 91 years; 33 male, mean age 71.6, range 44 - 91 years) with suspected GCA who underwent TAB in our clinic between January 1999 - February 2011. All patients received a preoperative duplex sonography, 57 patients including description of the temporal arteries. RESULTS: 38 of 85 (44.7 %) of the artery biopsies were proven positive for GCA by histopathology. Interpretation of the duplex sonography was congruent of histopathological interpretation of the biopsy in 39 patients (68.4 %) and incongruent in 18 patients (31.6 %). Sensitivity of duplex-sonography was 44.4 %, specificity 90 %, positive predictive value 80 %. DISCUSSION: Duplex sonography is a non-invasive and very helpful diagnostic tool to guide the clinician in cases of suspected GCA but needs considerable skills. It shows a good specificity and relatively high positive predictive value as there are only few false positive results. A negative report however does not rule out GCA, so that in our opinion the TAB - at least in those cases - should still be performed.

[Arguments against pressure-lowering treatment of ocular hypertension. Prophylactic treatment is unnecessary]. / Argumente gegen eine drucksenkende Behandlung der okulären Hypertension. Prophylaktische Behandlung nicht notwendig.

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

[Trabeculectomy with mitomycin C supplemented with cross-linking hyaluronic acid: a pilot study]. / Erste Erfahrungen mit einem retikulierten Hyaluronsäurepräparat bei der Trabekulektomie.

BACKGROUND: Besides antimetabolites (5-fluorouracil [5-FU]), cytostatic agents (mitomycin C [MMC]) and topical steroids, various substances have been used for the modulation of wound healing in filtering glaucoma surgery. The anti-inflammatory effects of hyaluronic acid and its space-occupying properties may be useful in filtering as well as in non-filtering glaucoma surgery. PATIENTS AND METHODS: In a non-randomised pilot study cross-linking hyaluronic acid (HealaFlow) was injected below the scleral flap and under the conjunctiva in 66 patients undergoing filtering surgery. All 66 patients (age 70.3 +/- 9.6 years; 41 - 88) had a standard trabeculectomy with MMC (0.25 % for 3 min). Glaucoma diagnoses were pseudoexfoliation glaucoma in 32 cases, primary open-angle glaucoma in 32 cases, ICE syndrome in one case and Axenfeld/Rieger in one case. RESULTS: Intraocular pressure (IOP) levels were reduced from preoperatively 22.3 +/- 6.0 mmHg (12 - 40) with 2.7 +/- 1.0 (1 - 4) IOP-lowering medications to 11.9 +/- 5.1 mmHg (2 - 26) after 29.8 +/- 12.4 weeks (13 - 56) follow-up. Fifty-nine of the 66 patients (89.4 %) did not need IOP lowering medications at the end of the follow-up, 52 / 66 patients (78.8 %) had an IOP < or = 14 mmHg, 47 of these 52 patients (90.4 %) without medication. Argon laser suturolysis had to be performed in 28 / 66 eyes (42.4 %), 40 / 66 patients (60.6 %) required 1 - 4 subconjunctival injections of 15 mg (0.3 mL) 5-fluorouracil. CONCLUSIONS: Injections of HealaFlow below the scleral flap and the conjunctiva at the end of the surgery along with intraoperative application of MMC showed promising IOP-lowering effects in trabeculectomy. A prospective randomised study is required to confirm these preliminary results.

[Surgery for intraocular hypotony due to avascular filtering blebs]. / Chirurgische Therapie der okulären Hypotonie mit autologem Sklerapatch und Bindehautplastik.

BACKGROUND: The incidence of ocular hypotony after filtering procedures has increased due to the widespread use of antimetabolites. In cases of persistent hypotony with leaking filtering bleb and/or hypotony-maculopathy surgical repair should be discussed. PATIENTS AND METHODS: Between 2001 and 2007 twelve patients (age between 35 and 88 years) underwent surgical repair of an avascular bleb with autologous scleral patch and conjunctival advancement. Indication for surgery was in 9 / 12 patients ocular hypotony, in 2 patients inadvertent filtering blebs after cataract extraction and in one patient a leaking bleb with blebitis. RESULTS: Intraocular pressure was normalized in all cases by the end of the follow-up period (4 - 66 months) (preop: 5.7 +/- 4.1 mmHg; postop 14.8 +/- 3.1 mmHg). Eight out of twelve patients required IOP-lowering medications (1 - 3) to maintain the target IOP. Best-corrected visual acuity increased from 0.4 +/- 0.1 to 0.67 +/- 0.2 (Snellen), 3 / 8 phakic patients required cataract surgery. CONCLUSIONS: Revision of avascular filtering blebs with autologous scleral patch and conjunctival advancement is a successful surgical approach to eliminate ocular hypotony. However, the majority of patients need IOP-lowering drugs after surgery.

[Sinusitis and ocular motility disorders]. / Sinusitis und okuläre Motilitätseinschränkungen.

BACKGROUND: Secondary inflammatory orbital involvement due to acute or chronic sinusitis is common. The pneumatized system of the paranasal sinuses is abut to the bones of the orbit in up to 80 percent, therefore the association is a seductive theory due to their anatomic closeness. Typically, sinusitis can influence ocular motility by affecting single muscles or a combination of muscles/cranial nerves due to a local inflammatory tissue reaction. The expected picture would be a more or less complex restriction of eye movements. PATIENTS AND METHODS: In this case study nine consecutive patients were prospectively included between January 2006 and August 2007. RESULTS: Five of the patients did not experience any motility disorder, the other four had a restricted motility. Case reports of the four patients are presented to demonstrate the range of ocular motility disorders related to sinusitis. CONCLUSIONS: Orbital complications due to sinusitis include motility disorders among others. They can even cause orbital sepsis and cavernous sinus thrombosis. On the one hand sinusitis can affect almost the whole spectrum of ocular motility disorders, on the other hand it may mask a dangerous cerebral aneurysm. The "close-lying" connections, as seductive they are, should not divert from the rule: infrequent causes are infrequent and frequent causes are frequent!

Glaucoma phenotype in a large Swiss pedigree with the myocilin Gly367Arg mutation.

AIMS: To characterize genotype, phenotype, and age-related penetrance in a Swiss pedigree with juvenile open-angle glaucoma (JOAG). METHODS: In a large Swiss family with history of glaucoma and 82 living members of four generations, we conducted molecular analysis and a detailed phenotype characterization in 52 family members. Mutation analysis was carried out using single-strand conformation polymorphism and DNA sequence analyses of the suspected candidate gene, myocilin (MYOC). RESULTS: We detected a Gly367Arg mutation in the MYOC gene of 13 family members. Nine of them (69.2%) had glaucoma: mean IOP 35.3 mm Hg, range 24-50 mm Hg; mean age at diagnosis 34.9 years, range 28-51 years. Two mutation carriers were glaucoma suspects, one (age 15) was unaffected, and one (age 16) not available for clinical examinations. Age-related glaucoma penetrance was 50% at 30 and 78% at 40. Untreated IOP resulted in rapid disease progression, whereas good IOP control, usually only by means of filtration surgery, could stabilize the disease. None of the wild-type members had glaucoma. CONCLUSIONS: This Swiss family is the largest reported Gly367Arg pedigree to date. The exact genotype and phenotype characterization allowed a reliable risk and prognosis assessment and targeted eye-care planning for the family. The study demonstrates the importance of genetic investigations in glaucoma families, carrying the potential of long-term socio-economic benefits.

[Quality assurance in biometry before cataract surgery: which patients have an increased risk of aberrance from target refraction?]. / Qualitätssicherung in der Biometrie vor Kataraktoperationen: Welche Patienten haben ein erhöhtes Risiko für Abweichungen von der Zielrefraktion?

BACKGROUND: An important factor for patient satisfaction after cataract surgery is the achievement of the planned target refraction. The formulae which are used to calculate the necessary refractive power of the intraocular lens (IOL) to be implanted have been improved over time in order to deliver exact predictions even in those cases in which the measurements of an eye deviate greatly from the norm. We examined which of the routinely measured biometric values have an influence on reaching target refraction. PATIENTS AND METHODS: This retrospective investigation reports on a case series of 153 eyes of 146 patients within 6 months in which a cataract operation was performed. The average age at the time of operation was 73.5 years. Four measurements were taken preoperatively: refraction (Ref), axial length (AL), corneal refractive power (CR) and anterior chamber depth (ACD). Each of these measurements was examined regarding its influence on the refractive outcome. One of three end points was possible for each eye: achievement of target refraction within +/- 0.5 dpt, aberrance from target refraction by more than + 0.5 dpt and aberrance from target refraction by more than - 0.5 dpt. A multivariate regression analysis was performed in which aberrance from target refraction was defined as the dependent variable and the four mentioned measurements were set as independent variables. RESULTS: Of the 153 eyes, in 91 eyes the target refraction was achieved within 0.5 dpt (group 1). In 37 eyes the aberrance from target refraction was more than - 0.5 dpt (group 2) and in 25 eyes it was more than + 0.5 dpt (group 3). The mean measurement values in groups 1, 2 and 3 were as follows: for preoperative refraction 0.0 dpt/0.5 dpt/0.625 dpt, for corneal refractive power 42.84 dpt/42.29 dpt/42.67 dpt, for axial length 23.41 mm/23.36 mm/23.73 mm and for anterior chamber depth 3.07 mm/3.00 mm/3.20 mm. No statistically significant relation between the respective measured values or a combination thereof and the refractive result could be demonstrated. CONCLUSIONS: The formulae for calculating IOL power available today are highly developed and integrate preoperative biometries in a non-linear way, so that there is little difference between measurements within the norm and outlying ones concerning their influence on the refractive result. When conducting quality assurance efforts, we recommend to direct attention to factors influencing anterior chamber depth.

[Positive ibopamine provocative test in normal-tension glaucoma suspects]. / Positiver Ibopamin Provokationstest bei Verdacht auf Niederdruckglaukom.

BACKGROUND: Ibopamine is an alpha-adrenergic agent and causes an elevation of intraocular pressure in eyes with increased outflow resistance. It has been proposed as a test substance for the detection of early ocular hydrodynamic disorders. PATIENTS AND METHODS: A total of 64 normal-tension glaucoma suspect eyes without anti-hypertensive treatment were enrolled. A daily pressure curve was registered with measurements at 7:00 am, 8:00 am, 12:00 am, 17:00 pm using an applanation tonometer and a contour tonometer followed by instillation of ibopamine 2% in both eyes. Tonometry was performed every 15 minutes during the following hour. An IOP increase of > 2.0 mmHg was considered positive. RESULTS: The positive test group showed a significant pressure increase from 18.04 to 22.06 mmHg. Ocular pulse amplitude increased from 2.96 to 3.97 mmHg and was positively correlated with the pressure. Intraocular pressure was unchanged in the negative test group. Central corneal thickness was not significantly different in the two groups (p = 0.32). CONCLUSIONS: Ibopamine 2% eye drops have a positive pressure effect in 50% of suspected normal-tension glaucoma eyes and may differentiate between eyes with normal trabecular outflow capacity and eyes with increased resistance in the trabecular meshwork that are prone to pressure peaks and deterioration to glaucoma.

[Ocular pulse amplitude: a new biometrical parameter for the diagnose of glaucoma?]. / Okuläre Pulsamplitude als biometrischer Messwert in der Glaukomdiagnostik.

BACKGROUND: Dynamic contour tonometry (DCT) enables accurate transcorneal measurements of the intraocular pressure and ocular pulse amplitude (OPA). In this study, we investigated whether this new biometrical parameter can characterize different glaucoma types and serve as a helpful tool in the diagnosis and therapy of the disease. PATIENTS AND METHODS: A total of 441 eyes of 222 patients were included. Pressure measurements were performed with contour and applanation tonometry. RESULTS: Mean OPA was 3.1+/-1.4 mmHg. Eyes with ocular hypertension showed significantly higher OPA values (3.6+/-1.3 mmHg) than healthy eyes (3.1+/-1.4 mmHg) and eyes with low-tension glaucoma (2.9+/-1.4 mmHg). After trabeculectomy, the values were significantly lower (2.4+/-1.3 mmHg) than in healthy eyes. CONCLUSION: The size of the OPA seems to be characteristic for different types of glaucoma and directly dependent on intraocular pressure levels. Further investigation is indicated to clarify its diagnostic usefulness.