[Diagnostic Precision of the Confocal Scanning Laser Ophthalmoscopy in the Large Optic Disc with Physiological Excavation - a Long-Term Study]. / Diagnostische Zuverlässigkeit der konfokalen Scanning-Laser-Ophthalmoskopie bei großen Papillen mit physiologischer Exkavation ­ eine Langzeitstudie.

We repeatedly examined 17 subjects with presumed bilateral physiological excavation labeled as pathological and/or borderline via HRT to verify the diagnosis of physiological cupping or to monitor the long-term progression into normal tension glaucoma. PATIENTS AND METHODS: 17 Subjects with presumed bilateral physiological cupping and large optic discs were included in this long-term follow-up study. All subjects underwent regular detailed ophthalmologic examinations, including intraocular pressure measurement via Goldmann applanation tonometry (GAT), retinal nerve fiber layer imaging via optical coherence tonometry (OCT) and visual field testing and optic disc imaging using the HRT. Glaucomatous progression was identified using the HRT's tools (stereometric trend analysis [STA] and topographic change analysis [TCA]). RESULTS: In the initial examination, all 17 subjects were classified as "pathological", by the HRT's Moorfield's Regression Analysis (MRA). Over the observation period of 9.2 ± 5 years, only 1 of the 17 subjects showed an ensured conversion to normal tension glaucoma with glaucomatous visual field defects. The remaining 16 subjects show no visual field defects to date. STA showed significant changes in 3 subjects alone, in 1 subject TCA showed a significant change alone, and in 1 subject both analyses showed a progressive change. CONCLUSION: After 9 years of regular examinations, 16 of the 17 subjects that were classified as "pathological" using MRA showed no glaucomatous visual field defects. In 5 out of these 16 subjects, progressive changes of the optic disc could be recorded via HRT. Therefore, the diagnostic precision of the HRT measurements seems to be limited in patients with large discs and physiological cupping.

Central corneal thickness determination in corneal edema using ultrasound pachymetry, a Scheimpflug camera, and anterior segment OCT.

PURPOSE: The purpose of this study is to determine the influence of post-surgical corneal edema on the reliability and reproducibility of central corneal thickness (CCT) measurements by a Scheimpflug camera (Pentacam), ultrasound pachymetry (USP), and anterior-segment spectral-domain optical coherence tomography (AS-OCT). METHODS: Thirty-two patients planned for cataract surgery (n = 16) or vitrectomy (n = 6) were included in a prospective study. The non-surgery eye was used as control. Two investigators acquired two measurements each, with the Pentacam (Oculus, Germany) and the AS-OCT (Heidelberg Engineering, Germany) in a randomized order, followed by USP (Tomey SP-100, Germany). CCT was evaluated using the apex value for Pentacam, the corneal apex cut in AS-OCT and averaging eight single measurements for USP. Coefficients of variation (COV) and intra-class correlation coefficients (ICC) were determined. RESULTS: Post-surgery corneas showed a thickness of (investigators 1 and 2): Pentacam (615.9 ± 58.02 µm and 615.1 ± 60.17 µm), USP (601.4 ± 63.77 µm and 614.5 ± 70.91 µm), AS-OCT (608.8 ± 65.67 µm and 606.9 ± 64.41 µm) ,with no significant difference (ANOVA p > 0.99). The COVs (investigators 1 and 2) for control eyes were: Pentacam (0.78 ± 0.52 and 0.70 ± 0.76), USP (0.66 ± 0.29 and 0.98 ± 0.44), AS-OCT (0.59 ± 0.61 and 0.59 ± 0.40). The COVs (investigators 1 and 2) for post-surgical eyes were: Pentacam (0.98 ± 1.25 and 0.97 ± 0.73), USP (0.73 ± 0.64 and 1.35 ± 0.85), AS-OCT (1.34 ± 1.57 and 1.19 ± 1.18).The ICC was determined in post-surgery corneas (ICC > 0.96) and control corneas (ICC > 0.95). CONCLUSION: USP measurements have the highest user dependence. Post-surgical corneal edema leads to higher intraobserver variability. All methods reached a high level of agreement in CCT determination in edematous as well as healthy corneas.

Arteriovenous passage times and visual field progression in normal tension glaucoma.

PURPOSE: Fluorescein angiographic studies revealed prolonged arteriovenous passage (AVP) times and increased fluorescein filling defects in normal tension glaucoma (NTG) compared to healthy controls. The purpose of this study was to correlate baseline AVP and fluorescein filling defects with visual field progression in patients with NTG. PATIENTS AND METHODS: Patients with a follow-up period of at least 3 years and at least 4 visual field examinations were included in this retrospective study. Fluorescein angiography was performed at baseline using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr.); fluorescein filling defects and AVP were measured by digital image analysis and dye dilution curves (25 Hz). Visual field progression was evaluated using regression analysis of the MD (Humphrey-Zeiss, SITA-24-2, MD progression per year (dB/year)). 72 patients with NTG were included, 44 patients in study 1 (fluorescein filling defects) and 28 patients in study 2 (AVP). RESULTS: In study 1 (mean follow-up 6.6 ± 1.9 years, 10 ± 5 visual field tests), MD progression per year (-0.51 ± 0.59 dB/year) was significantly correlated to the age (P = 0.04, r = -0.29) but not to fluorescein filling defects, IOP, or MD at baseline. In study 2 (mean follow-up 6.6 ± 2.2 years, 10 ± 5 visual field tests), MD progression per year (-0.45 ± 0.51 dB/year) was significantly correlated to AVP (P = 0.03, r = 0.39) but not to age, IOP, or MD at baseline. CONCLUSION: Longer AVP times at baseline are correlated to visual field progression in NTG. Impaired retinal blood flow seems to be an important factor for glaucoma progression.

Blood Pressure and Heart Rate Variability to Detect Vascular Dysregulation in Glaucoma.

Purpose. To investigate blood pressure and heart rate variability in patients with primary open-angle glaucoma (POAG) to detect disturbed blood pressure regulation. Methods. Thirty-one patients with POAG (mean age 68 ± 10 years) and 48 control subjects (mean age 66 ± 10 years) were included in a prospective study. Continuous blood pressure and heart rate were simultaneously and noninvasively recorded over 30 min (Glaucoscreen, aviant GmbH, Jena, Germany). Data were analyzed calculating univariate linear (time domain and frequency domain), nonlinear (Symbolic Dynamics, SD) and bivariate (Joint Symbolic Dynamics, JSD) indices. Results. Using nonlinear methods, glaucoma patients were separated with more parameters compared to linear methods. In POAG, nonlinear univariate indices (pW113 and pW120_Sys) were increased while the indices pTH10_Sys and pTH11_Sys reflect a reduction of dominant patterns. Bivariate indices (JSDdia29, JSDdia50, and JSDdia52; coupling between heart rate and diastolic blood pressure) were increased in POAG. The optimum set consisting of six parameters (JSDdia29, JSDdia58, pTH9_Sys, pW231, pW110_Sys and pW120_Sys) revealed a sensitivity of 83.3% and specificity of 80.6%. Conclusions. Nonlinear uni- and bivariate indices of continuous recordings of blood pressure and heart rate are altered in glaucoma. Abnormal blood pressure variability suggests disturbed autonomic regulation in patients with glaucoma.