Dosage dependence of the effect of Ginkgo biloba on the rat retinal ganglion cell survival after optic nerve crush.

PURPOSE: To investigate the dosage dependence of the Ginkgo biloba effect on retinal ganglion cell survival in the rat optic nerve crush model. METHODS: The study included 56 Sprague-Dawley rats, the right optic nerve of which was crushed in a standardized manner. Two hours after the crush and once daily during the follow-up, the animals received intragastral applications of saline (saline group; n=13), or of a G. biloba extract of 0.25% concentration (n=14; low-dosage group), 1% concentration (n=15; medium-dosage group), or 4% concentration (n=14; high-dosage group). At 23 days after the optic nerve crush, the retinal ganglion cells were retrogradely labelled by injecting 3% fluorogold into the superior colliculi of the brain. At 4 weeks after baseline, the animals were killed. Retinal flat mount photographs were assessed for number and density of the retinal ganglion cells. RESULTS: The mean survival rate defined as the ratio of retinal ganglion cell density in the right eye with optic nerve crash divided by the retinal ganglion cell density in left eye without optic nerve intervention increased significantly (P<0.001) from 58.4+/-9.0% in the saline group to 68.5+/-5.7% in the low-dosage group, to 73.7+/-6.4% in the medium-dosage group, and to 74.2+/-6.8% in the high-dosage group. CONCLUSIONS: Intragastral applications of a G. biloba extract applied after an experimental and standardized optic nerve crush in rats were associated with a higher survival rate of retinal ganglion cells in a dosage-dependent manner.

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.

Anesthesia through a novel retrobulbar catheter provides perioperative pain control for 24 h after pars plana vitrectomy.

PURPOSE: The purpose of this study was to assess the retrobulbar catheter technique for perioperative pain control in pars plana vitrectomy. METHODS: One hundred consecutive pars plana vitrectomies (duration 20-220 minutes) in 88 patients (age range 37-88 years) were performed by the same surgeon under retrobulbar anesthesia using a commercially available retrobulbar needle. Initially, 7 ml of mepivacaine 2% were injected, a 28-gauge flexible catheter was introduced into the retrobulbar space and the needle was withdrawn. The catheter was removed 24 h after surgery. Intraoperatively and postoperatively, the patients were asked to rate pain using a numerical scale from 0 to 10. When pain was more than grade 3, 2 ml of a local anesthetic were re-injected through the catheter. RESULTS: A first re-injection was given intraoperative/y 53.0 +/- 34.6 minutes after the start of surgery during 35/100 procedures, and second and third injections were needed during 12 /100 and 4/100 procedures, respectively. The first postoperative re-injection was given 3.9 +/- 1.5 hours after the start of surgery in 54 procedures, and second and third injections were carried out in 35/100 and 10/100 procedures respectively. CONCLUSIONS: The results suggest that a temporary indwelling retrobulbar catheter allows long-lasting titratable local anesthesia during pars plana vitrectomy and titratable postoperative analgesia.

Optic disc morphology after arteritic anterior ischemic optic neuropathy.

OBJECTIVE: To evaluate the appearance of the nerve head in patients after giant cell arteritis-induced arteritic anterior ischemic optic neuropathy (A-AION). DESIGN: Noncomparative clinical case series. PATIENTS: The study comprised 29 patients who presented with unilateral A-AION and temporal artery biopsy-proven giant cell arteritis. Stereoscopic optic disc photographs, taken of both the affected and unaffected eyes at the onset of the disease and after a follow-up period of 20.10 +/- 25.36 months (median, 11 months; range, 2-102 months), were morphometrically evaluated. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim, optic cup, and alpha and beta zones of parapapillary atrophy. RESULTS: In the eyes after A-AION, at the end of the study, the neuroretinal rim was significantly (P = 0.002) smaller, and the optic disc cup area was significantly (P = 0.001) larger than those of the contralateral unaffected eyes. Alpha zone and beta zone of parapapillary atrophy did not vary significantly (P > 0.50). CONCLUSIONS: A-AION, like glaucomatous optic neuropathy, results in neuroretinal rim loss and optic disc cupping. However, in contrast to glaucoma, A-AION is not associated with an enlargement of parapapillary atrophy. The reasons and mechanisms responsible for these similarities and dissimilarities are discussed. Marked clinical, morphologic, and histopathologic similarities in optic disc cupping and loss of neuroretinal rim between A-AION and glaucomatous optic neuropathy are highly suggestive of a common mechanism for the development of the two diseases (i.e., ischemia of the optic nerve head). The subject is discussed at length.

Influence of optic disc size on neuroretinal rim shape in healthy eyes.

PURPOSE: To evaluate the influence of optic disc size on segmental neuroretinal rim area in healthy eyes. PATIENTS AND METHODS: The study included 193 eyes of 193 healthy patients with physiologic disc cupping. On 15 degrees color stereophotographic optic disc diapositives, optic disc area and neuroretinal rim area were morphometrically determined in 36 radial optic disc segments each measuring 10 degrees. RESULTS: The correlations of segmental rim area to disc area were significantly strongest (P < 0.01) and the regression lines were steepest in the inferior disc region, and the values were lowest in the temporal disc region. Complementary to the rim data, the correlations of segmental cup area to disc area were significantly strongest (P < 0.01) and the regression lines were steepest in the temporal disc region, and the values were lowest in the inferior disc region. In comparison with neuroretinal rim area, cup area was significantly (P < 0.01) more strongly correlated with disc area and the regression line was steeper in the whole optic disc and in each disc segment. The regional distribution of the widest rim part and smallest rim part was independent of disc size. CONCLUSIONS: The increase of rim area and cup area with increasing disc size differs between various disc regions. Because cup area increases more than rim area with increasing disc size, correction for disc size may be more important for segmental cup area than for segmental rim area. The rim shape with respect to the location of the smallest or broadest rim part is independent of disc size.

Indwelling temporary retrobulbar catheter for long-lasting titratable local anesthesia.

OBJECTIVE: To evaluate an indwelling temporary retrobulbar catheter for repeatable injections of local anesthetics for long-lasting and titratable retrobulbar anesthesia in intraocular surgery. PARTICIPANTS: The prospective clinic-based study included 153 patients who underwent vitreoretinal surgery (n=111) or buckling procedures with cryocoagulation (n=34). The mean duration of surgery was 84.7 +/- 49.5 minutes (range, 25-310 minutes). Using commercially available retrobulbar needles with a diameter of 0.60 or 0.80 mm and a length of 38 mm, 5 mL of 2% mepivacaine hydrochloride was injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space. The needle was withdrawn and the catheter was fixed. When the patients started to feel pain during surgery, 2 mL of mepivacaine hydrochloride was reinjected through the catheter. RESULTS: Ten to 240 minutes after the start of the operation, 96 patients needed an intraoperative reinjection of mepivacaine after which they felt comfortable again. Forty-two patients needed a second reinjection of mepivacaine 30 to 270 minutes after the start of the operation, and 13 patients needed a third reinjection 45 to 145 minutes after the start of surgery. Removal of the catheter after surgery was unremarkable. No infections were observed. Microbiologic examination results of the catheter tip were negative for organisms. Diplopia or other motility problems were not detected. Introduction and fixation of the catheter took less than 5 minutes in all patients. CONCLUSIONS: An indwelling temporary retrobulbar catheter for repeatable intraoperative injections of local anesthetics is simple, effective, and useful, and in comparison with general anesthesia, it is a time-saver for long-lasting and titratable local anesthesia in intraocular surgery. Arch Ophthalmol. 2000;118:996-1000

Optic nerve head appearance in juvenile-onset chronic high-pressure glaucoma and normal-pressure glaucoma.

OBJECTIVE: To evaluate the appearance of the optic nerve head in chronic high-pressure glaucoma and normal-pressure glaucoma. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: The study included 52 eyes with normal-pressure glaucoma and 28 eyes with juvenile-onset primary open-angle glaucoma that served as models for chronic high-pressure glaucoma. METHODS: Color stereo optic disc photographs and wide-angle retinal nerve fiber layer photographs were morphometrically examined. MAIN OUTCOME MEASURES: Localized retinal nerve fiber layer defects; parapapillary chorioretinal atrophy; disc hemorrhages; optic cup shape; retinal arteriole narrowing. RESULTS: Both study groups did not vary significantly in count of localized retinal nerve fiber layer defects, size of parapapillary atrophy, optic cup depth, steepness of disc cupping, rim/disc area ratio, diameter of retinal arterioles, and frequency and degree of focal retinal arteriole narrowing. In normal-pressure glaucoma versus juvenile open-angle glaucoma, localized retinal nerve fiber layer defects were significantly broader, disc hemorrhages were found significantly more often and were larger, and neuroretinal rim notches were present more frequently and were deeper. CONCLUSIONS: Chronic high-pressure glaucoma and normal-pressure glaucoma show morphologic similarities in the appearance of the optic nerve head. The lower frequencies of detected disc hemorrhages and rim notches in high-pressure glaucoma may be due to a smaller size of hemorrhages and localized retinal nerve fiber layer defects in high-pressure glaucoma. Both glaucoma types have morphologic features in common, suggesting that they may possibly belong to a spectrum of the same pathologic process.

Postoperative analgesia by reinjections of local anesthetic through an indwelling retrobulbar catheter.

PURPOSE: To evaluate an indwelling retrobulbar catheter for repeatable postoperative retrobulbar injections of local anesthetics for titratable analgesia after intraocular surgery. METHODS: The prospective study included all 124 patients (124 eyes) who consecutively underwent retinal or cyclocryocoagulation (n = 22), pars plana vitrectomy, or retinal detachment surgery (n = 102), and who were operated on by the same surgeon with local anesthesia within a period of 12 months. Using commercially available retrobulbar needles with a diameter of 0.60 mm or 0.80 mm and a length of 38 mm, 5 ml of mepivacaine 2% with hyaluronidase were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients started to feel pain after surgery, 2 ml of mepivacaine 2% or 2 ml of bupivacaine 0.75% were reinjected through the catheter. The catheter was removed 24 to 72 hours after surgery. RESULTS: Because of increasing pain in the postoperative period, 93 patients (93 of 124, or 75%) received a reinjection 4.2+/-2.0 hours after the preoperative injection. Seventy patients received a second reinjection after an additional 2.7+/-1.9 hours, and 42 patients received a third reinjection 3.1+/-2.0 hours later. After each reinjection, the patients became pain free. Removal of the catheter after surgery was unremarkable. CONCLUSIONS: An indwelling retrobulbar catheter for repeatable postoperative injection of short-acting local anesthetics is useful and effective for titratable postoperative analgesia after intraocular surgery, and it allows patients to avoid the side effects of systemic analgesics and sedatives.

[Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma]. / Die Morphologie der Papille beim Glaukom. I. Primäre Offenwinkelglaukome.

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.

[Titration of intraoperative anesthesia and postoperative analgesia]. / Titrierbare intraoperative Anästhesie und postoperative Analgesie.

PURPOSE: To evaluate a temporary retrobulbar catheter for local anesthesia in intraocular surgery and for postoperative analgesia after intraocular surgery. PATIENTS AND METHODS: The study included 40 patients undergoing pars-plana vitrectomy (n = 24) or cyclocryocoagulation (n = 16). After a retrobulbar injection through a 23 G needle, a commercially available 28 G flexible catheter was inserted through the needle. As soon as the patients complained about pain during or up to 24 hours after surgery, local anesthetics were injected through the catheter. RESULTS: Repetitive injections of anesthetics were necessary in 13 patients during pars plana vitrectomy. Starting about 2 hours after surgery, 13 patients after pars-plana vitrectomy and all patients who had undergone cyclocryocoagulation received up to 6 re-injections (every 1.5-5 hours). After all re-injections, the patients became pain-free within two minutes. The catheter was removed after 24 hours. CONCLUSIONS: The results suggest that a temporary insertion of a catheter into the retrobulbar space allows repetitive application of local anesthetics thus leading to a titrable local anesthesia and postoperative analgesia in intraocular surgery.

Comparison of measurements of neuroretinal rim area between confocal laser scanning tomography and planimetry of photographs.

BACKGROUND: To compare neuroretinal rim area measurements by confocal scanning laser tomography and planimetric evaluation of optic disc photographs. METHODS: For 221 patients with primary and secondary open angle glaucoma, 72 subjects with ocular hypertension, and 139 normal subjects, the optic disc was morphometrically analysed by the confocal scanning laser tomograph HRT (Heidelberg retina tomograph) and by planimetric evaluation of stereo colour optic disc photographs. RESULTS: Absolute rim area and rim to disc area were significantly (p < 0.0001) larger with the HRT than with planimetric evaluation of photographs. Differences between the two methods were significantly (p < 0.01) larger in normal eyes with small cupping than in normal eyes with large cupping, and differences were significantly (p < 0.01) larger in glaucomatous eyes with marked nerve damage than in glaucomatous eyes with moderate nerve damage. Coefficients of correlations between rim measurements of both methods were R2 = 0.60 for rim to disc area and R2 = 0.33 for absolute rim area. Planimetric measurements of rim area correlated significantly (p < 0.05) better than HRT determinations of rim area with mean visual field defect and retinal nerve fibre layer visibility. CONCLUSIONS: Measurements of absolute rim area and rim to disc area are significantly larger with the HRT compared with planimetry of disc photographs. Differences between both methods depend on disc area, cup size and glaucoma stage. The reason may be that the HRT measures the retinal vessel trunk as part of the neuroretinal rim. The differences between both methods, which should be taken into account if disc measurements performed by both methods are compared with each other, may not influence the main advantage of the HRT--that is, morphological follow up examination of patients with glaucoma.

Optic disc morphology in myopic primary open-angle glaucoma.

OBJECTIVE: To evaluate the morphology of the optic disc in highly myopic eyes with primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 44 patients with primary open-angle glaucoma and a myopic refractive error exceeding -8 diopters were morphometrically examined and compared with disc photographs of 571 patients with primary open-angle glaucoma and a myopic refractive error of less than -8 diopters. RESULTS: In the highly myopic group, compared to the control group, the optic disc was significantly (P < 0.0001) larger, the disc shape was significantly (P < 0.0005) more elongated, and the optic cup depth was significantly (P < 0.0001) more shallow. The loss of neuroretinal rim was more concentric, and localized retinal nerve fiber layer defects were found significantly less frequently in the highly myopic group than in the control group. In the highly myopic group, zone beta of parapapillary atrophy was significantly (P < 0.0001) larger. CONCLUSION: The optic disc morphology in primary open-angle glaucoma differs significantly between highly myopic eyes and eyes with hyperopia or low to moderate myopia. The highly myopic eyes are characterized by secondary macro-discs with elongated shape, shallow and concentric disc cupping, large parapapillary atrophy, and low frequency of localized retinal nerve fiber layer defects. Glaucomatous optic nerve damage in highly myopic eyes, compared to eyes with a normal refractive error, is more diffuse than localized.

Optic disc morphology in "age-related atrophic glaucoma".

BACKGROUND: This study was performed in order to evaluate whether, in primary open-angle glaucoma (POAG), patients with a different degree of fundus tessellation vary in optic disc morphology and level of intraocular pressure. METHODS: Color stereo optic disc photographs of 562 patients with POAG and a myopic refractive error of less than -8 diopters were morphometrically examined. According to the degree of fundus tessellation, the total group was divided into a tessellated subgroup (n = 256) and a nontessellated subgroup (n = 306), both matched for neuroretinal rim area and refractive error. RESULTS: In the tessellated subgroup, as compared to the nontessellated subgroup, the mean maximal intraocular pressure values were significantly lower, the parapapillary atrophy was significantly larger, the optic cup was significantly more shallow, frequency of disc hemorrhages was lower, the mean visual field defect was significantly more marked, and patient age was significantly higher. Within the whole study group, the degree of fundus tessellation increased significantly (P < 0.005) with decreasing mean maximal intraocular pressure, decreasing optic cup depth, and increasing degree of parapapillary atrophy. In the subgroups with the highest degree of fundus tessellation, parapapillary atrophy was the greatest and the mean maximal intraocular pressure was the lowest compared to other subgroups. CONCLUSION: At the low-pressure end of POAG, marked fundus tessellation is associated with large parapapillary atrophy, shallow disc cupping, mostly concentric emaciation of the neuroretinal rim, and high patient age. The results suggest a distinct subtype of POAG in older patients with relatively low intraocular pressure leading to a mainly diffuse atrophy of the optic nerve.

Optic disc morphology in juvenile primary open-angle glaucoma.

BACKGROUND: The aim of the study was to evaluate whether, in primary open-angle glaucoma (POAG), patients younger than 40 years differ in optic disc morphology from patients older than 40 years. METHODS: Out of a total group of 419 patients with POAG, we formed and compared two subgroups, one consisting of 37 patients with an age of less than 40 years, the other composed of 382 patients with an age equal to or more than 40 years. Both subgroups were matched for neuroretinal rim area. We examined the optic disc morphometrically using stereo disc photographs. RESULTS: The younger subgroup, as compared to the older subgroup, showed deeper and steeper optic disc cupping, concentric emaciation of the neuroretinal rim, a significantly smaller area of parapapillary atrophy, and significantly higher maximal and minimal intraocular pressure measurements (P < 0.001). The size and shape of the optic disc and the diameter of the retinal vessels at the optic disc border did not vary significantly. CONCLUSIONS: In POAG, patients younger than 40 years differ in optic disc morphology from patients older than 40 years. The younger patients with POAG have high minimal and maximal intraocular pressure readings and an optic disc morphology with deep and steep cupping, concentric loss of neuroretinal rim, and an almost unremarkable parapapillary atrophy. POAG in patients under 40 represents chronic high-pressure open-angle glaucoma with mainly diffuse optic nerve damage.

[Morphologic papillar signs of high pressure glaucoma]. / Papillenmorphologische Kennzeichen der Hochdruckglaukome.

PURPOSE: To examine the morphology of the optic disc in eyes with high-pressure open-angle glaucoma. MATERIAL AND METHODS: Using color stereo optic slides, 306 eyes of 183 patients with secondary open-angle glaucoma and 65 eyes of 35 patients with juvenile open-angle glaucoma (group I) were morphometrically examined and compared with 1119 eyes of 585 patients older than 40 years and suffering from with primary open-angle glaucoma (group II). RESULTS: The eyes of group I as compared to group II showed significantly (P < 0.0001) higher maximal intraocular pressure values and a significantly (P < 0.05) smaller optic disc and parapapillary atrophy. There was a tendency towards steeper and deeper cupping and a lower frequency of optic disc hemorrhages in group I than in group II. The optic disc shape did not vary significantly between the two groups. CONCLUSIONS: Minor parapapillary atrophy suggests high-pressure glaucoma. Barotrauma may be associated with a mostly diffuse damage of the optic nerve. The only slight enlargement of the parapapillary atrophy in the eyes with high-pressure glaucoma indicates that the development of the parapapillary atrophy may at least partially be independent of an elevation of intraocular pressure. The optic disc shape is not useful to identify eyes with high-pressure glaucoma.

Direct clinico-histological correlation of parapapillary chorioretinal atrophy.

Parapapillary chorioretinal atrophy is a morphological feature of glaucomatous optic nerve damage since it occurs more often and is larger in glaucomatous eyes than in normal eyes. This study was undertaken to find the histological correlation. Optic disc photographs and histological sections through the optic disc of 21 human eyes enucleated because of malignant uveal melanoma were morphometrically evaluated. Seventeen eyes had normal intraocular pressure and four eyes showed elevated intraocular pressure and glaucomatous optic disc cupping. Ophthalmoscopically, the parapillary chorioretinal atrophy was divided into zone 'alpha', located peripherally and characterised by irregular hypopigmentation and hyperpigmentation, and zone 'beta' located close to the optic disc border and showing visible sclera and visible large choroidal vessels. Histologically, zones 'A' and 'B' were differentiated. Zone 'A' peripheral to zone 'B' showed irregularities in the retinal pigment epithelium. It consisted of an unequal distribution of melanin granules and partial atrophy of cells. In zone 'B' adjacent to the optic disc, Bruch's membrane was bared of retinal pigment epithelium cells and the photoreceptors were markedly reduced in density or were completely missing. In a direct clinical histological comparison, zone 'A' correlated significantly with zone 'alpha' (r = 0.66; p < 0.01), and zone 'B' correlated with zone 'beta' (r = 0.99; p < 0.0001). Zone 'A', 'B', 'alpha' and 'beta' were larger in the four glaucomatous eyes than in the normal ones. The findings indicate that zone 'beta' represents histologically a complete loss of retinal pigment epithelium cells and an incomplete loss of adjacent photoreceptors. Zone 'alpha' may be the histological correlate of irregularities in the retinal pigment epithelium.

Glaucomatous parapapillary atrophy. Occurrence and correlations.

Glaucomatous optic nerve damage is typically associated with intrapapillary changes, such as neuroretinal rim loss. In this study, parapapillary chorioretinal atrophy was evaluated in 691 normal eyes, 1081 glaucomatous eyes, and 31 eyes with ocular hypertension. It was significantly larger and occurred more often in the glaucomatous eyes (parapapillary atrophy area, 1.07 +/- 0.83 mm2) (mean +/- SD) than in the normal eyes (0.55 +/- 0.64 mm2) or in the eyes with ocular hypertension (0.55 +/- 0.37 mm2). These differences were significant also for eyes with moderate glaucomatous damage (0.86 +/- 0.62 mm2). Parapapillary chorioretinal atrophy was associated with shallow glaucomatous cupping, diffuse nerve fiber loss, a marked tessellated fundus, and only moderately elevated intraocular pressure. It increased with a decreasing neuroretinal rim area. It showed a spatial correlation to neuroretinal rim loss inside the optic disc. In unilateral glaucoma, it was larger in the affected eye than in the unaffected eye. Parapapillary chorioretinal atrophy is associated with glaucoma.

[Morphometry of the optic disc in glaucoma eyes with and without pseudoexfoliation syndrome]. / Papillenmorphometrie in Glaukomaugen mit und ohne Pseudoexfoliationssyndrom.

Eyes with pseudoexfoliation (PEX) have typical features in the morphology of the anterior segment of the eye. We carried out an investigation to ascertain whether there are also differences in the posterior segment. Using 15 degrees color stereo optic disc photographs, 55 eyes with chronic open-angle glaucoma and pseudoexfoliation and 398 eyes with primary chronic open-angle glaucoma without PEX were examined morphometrically. There were no significant differences in: (1) quantitative parameters, such as the size and form of the optic disc, optic cup, neuroretinal rim, peripapillary scleral ring Elschnig, and the alpha and beta zones of the parapapillary chorioretinal atrophy; (2) qualitative parameters such as the location of the smallest part of the neuroretinal rim, the count of bared circumlinear and cilioretinal vessels, the number and localization of optic disc hemorrhages, the discrepancy between a smaller area with pallor and a larger area with cupping, and decreased visibility of the retinal nerve-fiber bundles in the parapapillary region; (3) localized and diffuse defects in the retinal nerve fiber layer; (4) perimetric indices. Although the maximal values of the intraocular pressure were significantly higher in the PEX group, the morphology of the intra- and parapapillary region was not significantly different.

[Para-papillary chorioretinal atrophy in eyes with shallow glaucomatous optic disk cupping]. / Parapapilläre chorioretinale Atrophie in Augen mit flacher glaukomatöser Papillenexkavation.

Parapapillary chorioretinal atrophy is present in some, but not all glaucomatous eyes. We examined whether eyes with shallow or with deep optic cupping showed more pronounced parapapillary atrophy. To this end, we analyzed 15 degree color stereo optic disc photographs of 141 eyes of 95 normal subjects and 211 eyes of 120 patients suffering from chronic open-angle glaucoma morphometrically. Optic cup depth was semiquantitatively estimated in a relative score ranging from 0 to 5. It increased significantly with increasing glaucoma damage indicated by smaller neuroretinal rim area, higher visual field loss, decreased retinal nerve fiber layer index and more advanced morphological glaucoma stage. Conversely, optic cup depth was inversely correlated with parapapillary atrophy. It decreased significantly with increasing glaucomatous parapapillary atrophy. When two subgroups of eyes with deep and eyes with shallow cups, were formed, matched for neuroretinal rim area, perimetric defects and retinal nerve fiber layer index, the parapapillary atrophy was found to be significantly more pronounced in the subgroup with shallow optic cups than in the subgroup with deep cupping. We conclude that there is a correlation between shallow optic disc cupping and pronounced parapapillary chorioretinal atrophy. This may indicate a common element in their pathogenesis.

Non-quantitative morphologic features in normal and glaucomatous optic discs.

Glaucoma is associated with changes of the optic disc topography. Using color stereo photographs we examined non-quantitative signs in 584 optic discs of 308 patients with chronic primary open-angle glaucoma and in 383 optic discs of 236 age and refraction matched normal subjects. Only one eye per patient and normal subject was chosen for statistical analysis. Highest predictive value to differentiate between normal and glaucoma eyes had the parameters 'changes in the juxtapapillary retinal nerve fiber layers' (86.7%), 'abnormal size (79.8%) and abnormal location (68.6%) of the parapapillary chorio-retinal atrophy', 'smallest neuroretinal rim part outside of the temporal horizontal disc sector' (78.5%), and area with cupping larger than area with pallor' (68.2%). Characteristics with high specificity and low sensitivity were 'optic disc haemorrhages', 'bared cilioretinal arteries', and 'bared circumlinear vessels'. With their evaluation being independent of sophisticated techniques the non-quantitative parameters are helpful for the ad hoc diagnosis of glaucomatous optic nerve damage.