Arterial pre-hypertension and hypertension in intracranial versus extracranial cerebrovascular stenosis.

BACKGROUND AND PURPOSE: Since it has remained unclear whether arterial pre-hypertension is a risk factor for cerebrovascular diseases, potential associations between arterial pre-hypertension and intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed. METHODS: The population-based Asymptomatic Polyvascular Abnormalities in Community Study was a sub-study of employees and retirees of the coal mining industry in China. Our study examined asymptomatic polyvascular abnormalities in a general population and with an age of 40+ years without history of stroke, transient ischaemic attacks and coronary heart disease. ICAS was diagnosed by transcranial Doppler sonography and was defined by peak flow velocity criteria; ECAS was diagnosed by carotid duplex sonography and was defined by the diameter of the common carotid artery or internal carotid artery. RESULTS: Out of 4422 study participants, 711 (16.1%) subjects showed an asymptomatic ICAS and 292 (6.6%) showed an asymptomatic ECAS. After adjusting for relevant risk factors, higher prevalence of ICAS was significantly associated with higher prevalence of pre-hypertension [odds ratio (OR) 1.55; 95% confidence interval (CI) 1.11, 2.16; P = 0.010] and hypertension (OR 1.80; 95% CI 1.53, 2.11; P < 0.001). Stratified by gender, the association was stronger for men than for women. Asymptomatic ECAS was not significantly associated with the prevalence of pre-hypertension (OR 0.78; 95% CI 0.55, 1.10) or of hypertension (OR 1.06; 95% CI 0.91, 1.24). CONCLUSIONS: The results suggest that arterial pre-hypertension in addition to hypertension is associated with a higher prevalence of asymptomatic ICAS, more in men.

A novel frameshift deletion in the COL1A1 gene identified in a Chinese family with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a genetically heterogeneous group of disorders, characterized by abnormal bone fragility, blue sclera, deafness, joint laxity, and soft-tissue dysplasia. The purpose of this study was to elucidate the genetic or molecular basis for OI type IA in a Chinese family. We evaluated the members of a family, in which six individuals are affected with increased bone fragility and blue sclera. Results of exome sequencing revealed a novel 1-bp deletion (c.2329delG, p.A777fs) in exon 33 of the COL1A1 gene in two affected individuals, but not in a control family member without OI. The variation co-segregated with the disease in all the OI patients but not in the unaffected family members. The mutation caused a frameshift alteration after codon 777, leading to premature termination of the COL1A1 protein. Thus, our findings identified a novel frameshift deletion c.2329delG (p.A777fs) in the COL1A1 gene, which is associated with OI type IA in a Chinese family.

[Entropion: objective and subjective evaluation of two different surgical procedures]. / Objektive und subjektive Evaluierung zweier unterschiedlicher Entropium-OP-Techniken.

BACKGROUND: The aim of this study was to compare two different surgical techniques for the therapy of senile entropion. PATIENTS AND METHODS: Our retrospective case series study included patients who were operated on for a senile entropion, either according to the technique described by Quickert or by surgery of the lateral tarsal strip in combination with resection of a part of the hypertrophic orbicularis muscle. All patients who had undergone entropion surgery according to one of the two procedures between 2008 and 2010 were contacted. Main outcome measures were patients' satisfaction and recurrence of entropion. RESULTS: The study included 38 patients (age: 75.5 ± 7.7 years) who could be contacted and who were able to perform a telephone interview; 13 of these patients were additionally examined clinically. Mean follow-up after surgery was 43.1 ± 5.6 months. 83 % were happy to do the operation again. There was no statistical difference in patients' satisfaction with the operations. The clinical examination showed two recurrences of entropion in the Quickert group and none in the lateral tarsal strip group. CONCLUSIONS: Quickert's operation and the lateral tarsal strip procedure in combination with resection of a part of the hypertrophic orbicularis muscle are efficient procedures for therapy of an entropion.

The Influence of Diabetes, Hypertension, and Hyperlipidemia on the Onset of Age-Related Macular Degeneration in North China: The Kailuan Eye Study.

Objective: To analyze the prevalence of dry and wet age-related macular degeneration (AMD) in patients with diabetes, hypertension and hyperlipidemia, and to analyze the risk factors for AMD. Methods: A population-based cross-sectional epidemiologic study was conducted involving 14,440 individuals. We assessed the prevalence of dry and wet AMD in diabetic and non-diabetic subjects and analyzed the risk factors for AMD. Results: The prevalence of wet AMD in diabetic and non-diabetic patients was 0.3% and 0.5%, respectively, and the prevalence of dry AMD was 17% and 16.4%, respectively. The prevalence of wet AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 0.5%, 0.3%, 0.2%, and 0.7%, respectively. The prevalence of dry AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 16.6%, 16.2%, 15.2%, and 17.2%, respectively. Age, sex, body mass index, and use of hypoglycemic drugs or lowering blood pressure drugs were corrected in the risk factor analysis of AMD. Diabetes, diabetes/hypertension, diabetes/hyperlipidemia, and diabetes/hypertension/hyperlipidemia were analyzed. None of the factors analyzed in the current study increased the risk for the onset of AMD. Conclusion: There was no significant difference in the prevalence of wet and dry AMD among diabetic and non-diabetic subjects. Similarly, there was no significant difference in the prevalence of wet and dry AMD among subjects with hypertension and hyperlipidemia. Diabetes co-existing with hypertension and hyperlipidemia were not shown to be risk factors for the onset of dry AMD.

Prevalence of diabetic retinopathy among subjects with known diabetes in China: the Beijing Eye Study.

PURPOSE: To evaluate the prevalence of diabetic retinopathy and risk factors among patients with self-reported diabetes mellitus in China. METHODS: The Beijing Eye Study, a population-based study on inhabitants aged 40+ years, included 4439 subjects. Fundus photographs of the worse eye from participants with self-reported diabetes were graded. RESULTS: Fundus photographs ready for evaluation and a filled out questionnaire were available for 4127 (93.0%) subjects. The prevalence of self-reported diabetes was 235/4127 (5.7%). Among the subjects with a self-reported diagnosis of diabetes, diabetic retinopathy was detected on the fundus photographs of 86 (37.1%) subjects, with macular edema in 12 (5.2%) subjects, clinically significant macular edema in 6 (2.6%) subjects, and a vision- threatening stage of the retinopathy in 12 (5.2%) subjects. Diabetic retinopathy was associated with rural region (p=0.004), longer duration of diabetes (p=0.009), use of diabetic medications (p=0.02), and lower education background (p=0.003). CONCLUSIONS: Prevalence of diabetic retinopathy among Chinese patients aged 40+ years with a self-reported diagnosis of diabetes is about 37%, with a vision-threatening stage of the retinopathy detected in 5% of the subjects. About 5.7% of the adult Chinese population report on a known diagnosis of diabetes mellitus, with about 15% of these subjects knowing about the presence of diabetic retinopathy. The frequency of known diabetes mellitus is lower in rural regions than in urban regions, while diabetic retinopathy overall and macular edema among the subjects with known diabetes mellitus were significantly more common in the rural group.

Prevalence of diabetes mellitus in China.

PURPOSE: To investigate the prevalence of diabetes mellitus in China. METHODS: The Beijing Eye Study 2006 is a population-based investigation including 3251 subjects aged 45+ years. Anthropometric measurements and blood biochemical analyses were performed for 2960 (91.0%) subjects. RESULTS: Defining diabetes mellitus as fasting glucose concentrations > or =7.0 mmol/L (detected in 227 subjects (prevalence rate: 7.67+/-0.49%)) or self-reported diagnosis of diabetes mellitus (154 subjects), 381 subjects were diabetic (prevalence rate: 12.87+/-0.62%). Within the diabetic group, 246 (64.6%) subjects were on diabetic diet or on additional anti-diabetic therapy, 205 (53.8%) subjects took oral anti-diabetic medication, and 44 (11.5%) subjects were on insulin therapy. Systemic complications due to diabetes mellitus were reported by 64 (16.8%) subjects. In multivariate analysis, diabetes mellitus was significantly associated with higher age, higher body mass index, higher systolic blood pressure, higher triglyceride concentrations, and lower high-density lipoprotein level. In addition, the diabetic subjects came significantly (P<0.001) more often from the urban region. CONCLUSIONS: This prevalence figure translates into more than 30 million diabetic individuals in China. Compared with previous studies, it suggests an increasing diabetes prevalence.

Intravitreal steroid slow-release device replacing repeated intravitreal triamcinolone injections for sympathetic ophthalmia.

PURPOSE: To report on the intraocular use of a steroid slow-release device in an attempt to avoid multiple intraocular triamcinolone injections in chronic sympathetic ophthalmia. METHODS: A 47-year-old patient with sympathetic ophthalmia had received 17 intravitreal triamcinolone injections to suppress the uveitis, to increase intraocular pressure, and to reduce systemic anti-inflammatory medication. To avoid the frequent reinjections combined with the temporary reduction in vision and potential risk of infection and a recurrence of sympathetic ophthalmia, a slow-release device of 2.1-mg fluocinolone acetonide was intravitreally implanted. RESULTS: During the follow-up of 11 months after the procedure, intraocular pressure stabilized at 12 to 18 mmHg and visual acuity at 0.40 to 0.50. The systemic immunosuppressive therapy was stopped, and consequently, the insulin treatment could be halted. CONCLUSIONS: Despite the limitations of a single case report, the results suggest that an intravitreal slow-release device of fluocinolone may be an alternative to repeatedly administered intravitreal triamcinolone injection for the long-term treatment of sympathetic ophthalmia. The intraocular slow-release application of steroids has enabled patients to live free from diabetic treatment and immunosuppressive medication after 21 years of systemic immunosuppressive therapy with secondary Cushing disease including diabetes mellitusand arterial hypertension.

[Ophthalmodynamometry of diastolic retinal arterial collapse pressure: correlation with systemic blood pressure]. / Ophthalmodynamometrie des diastolischen retinalen arteriellen Kollapsdruckes: Korrelation mit dem systemischen Blutdruck.

BACKGROUND: The aim of the study was to examine whether estimations of the central retinal artery collapse pressure obtained by corneal contact lens ophthalmodynamometry are correlated with measurements of the systemic blood pressure. PATIENTS AND METHODS: The clinical observational case series study included 168 eyes (from 111 patients) without retinal vascular diseases. The mean age was 65.6+/-13.6 years (mean +/- standard deviation) and the mean refractive error was 0.31+/-2.89 diopters (-13.75 to +6,50 diopters). After conventional measurement of the diastolic arterial blood pressure at the upper arm, Goldmann contact lens ophthalmodynamometry was non-invasively performed with the patient under topical corneal anesthesia. Ten measurements were taken, the mean of which were taken for statistical analysis. RESULTS: The ophthalmodynamometric estimations of the retinal central artery collapse pressure obtained in arbitrary units, showed a correlation coefficient of r=0.40 (P<0.001) with systemic diastolic arterial blood pressure measurements, with or without taking the intraocular pressure into account. The correlation coefficients were slightly higher for the measurements on the left eyes (r=0:47; P<0.001) than on the right eyes (r=0.43; P<0.001). CONCLUSION: Estimations of the central retinal artery collapse pressure in arbitrary units did not show a strong linear correlation with measurements of the systemic blood pressure. There were signs of an autoregulation mechanism of the ophthalmic artery.

Incidence of nonarteritic anterior ischemic optic neuropathy in adult Chinese: the Beijing Eye Study.

PURPOSE: To determine the incidence of optic nerve damage due to nonarteritic anterior ischemic optic neuropathy (NAION) in the adult Chinese population. METHODS: The Beijing Eye Study, a population-based, longitudinal study which included 4439 subjects (age 40+ years) in 2006, was repeated in 2006. In the follow-up examination, 3169 (71.4%) subjects participated. Optic disc photographs were assessed. Diagnostic criteria for incident NAION were a small optic disc, segmental pallor, and loss of retinal nerve fiber layer and visual field in the follow-up examination, with a normal optic nerve head appearance at baseline. RESULTS: New NAION was found in one eye, with an incidence rate of 0.03+/-0.03% per 5 years (mean +/- standard error) (95% confidence interval: -0.03, 0.09), or about 1:16,000 subjects per year. CONCLUSIONS: Within a 5-year period, new NAION may develop in 1 out of 3200 adult Chinese, or 1:16,000 adult Chinese per year.

Associated factors for age related maculopathy in the adult population in China: the Beijing eye study.

BACKGROUND: To evaluate factors associated with the prevalence of age related maculopathy (ARM) in the adult Chinese population. METHODS: The Beijing Eye Study, a population based prevalence study, included 4439 out of 5324 subjects from a rural area and an urban region of greater Beijing, aged 40+ years and invited to participate (response rate 83.4%). Fundus photographs were graded using the Wisconsin Age-Related Maculopathy Grading system. The following parameters were graded: drusen size, drusen type, and the area covered by drusen; pigmentary abnormalities; geographic atrophy; and exudative ARM. RESULTS: Fundus photographs were available for 8655 eyes of 4376 (98.6%) subjects. Early age related macular degeneration (ARD), late ARD, and exudative ARD, respectively, were present in 1.4%, 0.20%, and 0.10% of the subjects. In a binary logistic regression analysis, early ARM was statistically associated with age (p<0.001; 95% CI: 1.04 to 1.08), hyperopic refractive error (p = 0.008; 95% CI: 1.04 to 1.28), rural region (p<0.001; 95% CI: 0.17 to 0.49), and lower level of education (p = 0.01; 95% CI: 1.07 to 1.65). Early ARM was not significantly associated with the optic disc size (p = 0.42), and size of beta zone of peripapillary atrophy (p = 0.28), the self reported diagnosis of diabetes mellitus (p = 0.39; OR: 1.37; 95% CI: 0.66 to 2.85), amount of cortical cataract (p = 0.72), subcapsular cataract (p = 0.98), nuclear cataract (p = 0.26), sex (p = 0.23), cataract surgery (p = 1.0; OR: 0.96; 95% CI: 0.13 to 6.95), glaucomatous optic nerve damage (p = 0.77; OR: 0.62; 95% CI: 0.15 to 2.52), and history of smoking (p = 0.66; OR: 1.14; 95% CI: 0.65 to 2.00). CONCLUSIONS: Hyperopic refractive error besides age was the single most important risk factor for ARM in adult Chinese. Other associated factors were rural region and lower level of education.

Optic disc size in a population based study in northern China: the Beijing Eye Study.

AIM: To determine the optic disc size in the adult Chinese population in an urban and a rural region of Beijing. METHODS: The population based, cross sectional cohort study included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%). It was divided into a rural part (1973 (44.4%) subjects) and an urban part (2466 (55.6%) subjects). Mean age was 56.2 (SD 10.6) years (range 40-101 years). Colour optic disc photographs were morphometrically examined. Main outcome measure was optic disc area. RESULTS: Optic disc photographs were available for 4027 (90.7%) subjects. Mean optic disc area measured 2.65 (0.57) mm2 (range 1.03 mm2-7.75 mm2). Optic disc area was significantly (p<0.001) correlated with myopic refractive error, with a steep decrease in optic disc area from high myopia to the mid-range of refractive error, a slightly horizontal course in the refractive error range between -8 dioptres and +4 dioptres, and a further decrease in optic disc area towards higher hyperopia. Optic disc area was not related to age (p = 0.14) or sex (p = 0.93) (optic disc area, males: 2.65 (0.56) mm2 versus females: 2.65 (0.57) mm2). "Microdiscs" may be defined as smaller than 1.51 mm2, and "macrodiscs" as larger than 3.79 mm2. CONCLUSIONS: Compared with data of preceding studies, mean optic disc size is larger in Chinese people than in white people. In Chinese people highly hyperopic eyes have significantly smaller optic discs, and highly myopic eyes have significantly larger optic discs than emmetropic eyes.

Prevalence of congenital optic disc pits in adult Chinese: The Beijing Eye Study.

PURPOSE: To determine the prevalence of optic disc pits in the elderly Chinese population. METHODS. The Beijing Eye Study, a population-based, cross-sectional cohort study, included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. The present study included 4027 (90.7%) subjects for whom readable optic disc photographs were available. RESULTS: A pit of the optic nerve head was detected in one (0.02%) patient. Prevalence was 0.02 +/-1.58% (95% confidence interval: -0.02, 0.07). CONCLUSIONS: A congenital optic disc pit was found in one subject of the present population-based study in mainland China. In a mathematical sense, the calculated prevalence of optic disc pits in the whole population would be 0.02 +/- 1.58% (95% confidence interval: -0.02, 0.07) or about 1:4.000 subjects. From a statistical point of view, however, population-based studies with about 10,000 subjects are necessary to confirm this finding.

Cataract surgery under systemic anticoagulant therapy with coumarin.

PURPOSE: To evaluate clinical outcome of cataract surgery under systemic anticoagulant therapy using coumarin. METHODS: This clinical interventional comparative nonrandomized study included 441 patients (441 eyes) consecutively undergoing standard phacoemulsification with clear cornea incision and topical anesthesia. The study group consisted of 21 (4.8%) patients for whom systemic coumarin therapy was continued despite surgery. The control group included 420 patients without anticoagulant coumarin therapy prior to surgery. Study group and control group did not vary significantly in age, preoperative visual acuity, axial length, refractive error, preoperative intraocular pressure, or surgeon. RESULTS: Frequency of intraoperative or postoperative hemorrhages, intraoperative complications such as posterior capsule rupture, postoperative visual acuity, and intraocular pressure did no vary significantly (p>0.30) between study group and control group. CONCLUSIONS: For patients under systemic coumarin therapy, the rate of surgical complications may not markedly be increased compared to patients without coumarin therapy, when standard phacoemulsification with clear cornea incisions is performed with topical anesthesia. Systemic coumarin therapy does not have to be stopped prior to cataract surgery.

Prevalence of retinitis pigmentosa in urban and rural adult Chinese: The Beijing Eye Study.

PURPOSE: To determine the prevalence of retinitis pigmentosa in the elderly Chinese population. METHODS: The Beijing Eye Study is a population-based, cross-sectional cohort study and included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. Readable fundus photographs were available for 4027 (90.7%) subjects. Diagnostic criteria for retinitis pigmentosa were visual field defects on frequency doubling perimetry, typical ophthalmoscopic abnormalities such as retinal pigment deposits, retinal arteriole attenuation, and pigment epithelial atrophy, and no other reason for perimetric defects and fundus abnormalities. RESULTS: Retinitis pigmentosa was diagnosed in four subjects (all men). Its prevalence was 0.099+/-3.15% (95% CI: 0.00, 0.2). CONCLUSIONS: Retinitis pigmentosa with typical fundus appearance and functional loss may be present in about 1 out of 1000 elderly Chinese in Northern China. Calculated for the whole population in China, the figure would be 1.3 million patients with retinitis pigmentosa.

Follow-up after intravitreal triamcinolone acetonide for diabetic macular edema.

PURPOSE: To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema. METHODS: The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 +/- 6.2 months. RESULTS: Visual acuity improved significantly (p<0.001) from 0.89 +/- 0.33 logMAR to a best minimum of 0.65 +/- 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, respectively. Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected. CONCLUSIONS: The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.

Bevacizumab for occult subfoveal neovascularization in age-related macular degeneration.

PURPOSE: To report on the treatment of exudative age-related macular degeneration by intravitreal bevacizumab (Avastin). METHODS: A 78-year-old patient experienced a progressive loss of visual acuity in her right eye due to an occult subfoveal neovascular membrane in age-related macular degeneration. She received an intravitreal injection of 1.5 mg bevacizumab. RESULTS: Within 4 weeks after the injection, visual acuity improved from 0.40 to 0.60 with complete resolution of subretinal and intraretinal leakage and edema as shown on optical coherence tomography. Pre-existing metamorphopsias disappeared. Intraocular pressure remained in the normal range. During the follow-up, there were no sings of intraocular inflammation or any other intraocular pathology induced by the intravitreal injection. CONCLUSIONS: Intravitreal bevacizumab may potentially be helpful in the treatment of exudative age-related macular degeneration and may deserve further evaluation.

Sympathetic ophthalmia in vater association combined with persisting hyperplastic primary vitreous after cyclodestructive procedure.

PURPOSE: To report on the occurrence of histology-proven sympathetic ophthalmia in a patient with VATER association and persisting hyperplastic primary vitreous (PHPV) after a cyclodestructive procedure was performed to treat secondary angle-closure glaucoma. METHODS: The left eye of a 13-year-old boy with VATER association was microphthalmic from birth and had been diagnosed with PHPV at age 1 year. It developed iris neovascularization and secondary angle-closure glaucoma, which was treated by combined cyclocryocoagulation and cyclophotocoagulation. Six weeks later, a bilateral fibrinous iritis developed. Despite intensive topical and systemic steroid treatment, the iritis persisted so that the left blind eye was enucleated. RESULTS: Histology of the enucleated eye showed a marked intraocular inflammation with lymphocytes, epithelioid cells, and multinuclear giant cells grouped around remnants of melanin-bearing cells. CONCLUSIONS: Sympathetic ophthalmia may occur in patients with VATER association and PHPV after a secondary angle-closure glaucoma is treated by a combined cyclocryocoagulation and cyclophotocoagulation.

[Fluctuations depending on time of day in measurements of the optic disc using confocal laser canning tomography]. / Tageszeitliche Schwankungen von Messungen der Papilla Nn. optici mit dem konfokalen Laser-Scanning-Tomographen.

PURPOSE: The aim of this study was to evaluate whether confocal laser scanning tomographic measurements of the optic nerve head depend on the time of day when the examinations are performed. PATIENTS: Thirty-two eyes of 20 subjects repeatedly underwent optic disc confocal laser scanning tomography using the Heidelberg Retina Tomograph I. Operated by a single examiner, measurements were performed at 10 a.m. and 4 p.m. on the same day. RESULTS: Comparing both measurements, differences in optic cup area (0.119+/-0.126 mm(2); p=0.89), neuroretinal rim area (0.120+/-0.131 mm(2); p=0.86), cup volume (0.069+/-0.086 mm(3); p=0.86), rim volume (0.083+/-0.090 mm(3); p=0.51), and retinal nerve fiber layer thickness (0.075+/-0.063 mm; p=0.31) were statistically not significant. Intraocular pressure differences between morning and afternoon ranged between 0 and 14 mmHg. CONCLUSIONS: Confocal laser scanning tomographic measurements of the optic nerve head are not markedly influenced by the time of day.

[Intravitreal triamcinolone acetonide Complication of infectious and sterile endophthalmitis]. / Intravitreales Triamcinolonacetonid Komplikation von infektiöser und steriler Endophthalmitis.

PURPOSE: Intravitreal triamcinolone acetonide (TA), applied as treatment for various edematous and neovascular ocular diseases, was analyzed for infectious or sterile endophthalmitis and pseudoendophthalmitis. METHODS: In a prospective interventional study, 645 eyes were treated with approximately 20 mg intravitreal TA. The removal of the vehicle and the intravitreal injection were performed under sterile conditions. A total of 97 eyes received a second TA injection, 13 a third, 1 a fourth, 2 a fifth, and 1 a sixth injection. The mean follow-up was 7.5 months (median: 5.7 months). RESULTS: In the 1st week after 759 TA injections, 758 resulted in no hypopyon or Tyndall phenomenon >2(+), but in one eye a pseudoendophthalmitis with hypopyon was present. Anterior chamber lavage demonstrated TA crystals, and the culture was negative. In the 2nd week, one patient developed infectious endophthalmitis after a fall had caused ocular perforation. CONCLUSIONS: Intravitreal TA injections (approximately 20 mg) harbor a low risk of infectious or sterile endophthalmitis and pseudoendophthalmitis, if the injection and vehicle removal are performed under sterile conditions.

Diagnosis and pathogenesis of glaucomatous optic neuropathy: morphological aspects.

Glaucomatous optic neuropathy is classified by morphologic changes in the intrapapillary and parapapillary region of the optic nerve head and the retinal nerve fibre layer. These changes can be evaluated using descriptive optic nerve head variables which are the size and shape of the optic disc; size, shape and pallor of the neuroretinal rim; size of the optic cup in relation to the area of the disc; configuration and depth of the optic cup; cup-to-disc diameter ratio and cup-to-disc area ratio; position of the exit of the central retinal vessel trunk on the lamina cribrosa surface; presence and location of splinter-shaped haemorrhages; occurrence, size, configuration and location of parapapillary chorioretinal atrophy; diffuse and/or focal decrease of the diameter of the retinal arterioles; and visibility of the retinal nerve fibre layer. Assessment of these variables is useful for the early detection of glaucomatous optic nerve damage, to follow-up patients with glaucoma, to differentiate various types of the chronic open-angle glaucomas, and to get hints for the pathogenesis of glaucomatous optic nerve fibre loss.