[Sport and Glaucoma]. / Sport und Glaukom.

Traumatic changes in the iridocorneal angle, e.g. in ball sports, can lead to secondary glaucoma. High intensity resistance exercise or yoga exercises - such as the headstand - can increase IOP, and deterioration in the visual field and acute narrow angle glaucoma attacks have been described in some case reports. Glaucoma therapy of professional athletes with steroids, carbonic anhydrase inhibitors and beta-blockers can result in positive doping tests. In manifest glaucoma, moderate aerobic exercise is presumably of use because of the IOP lowering effect, improved retinal perfusion and reduction in oxidative stress.

[Value of Pressure Measurements: Methods and Sources of Errors]. / Aktueller Stellenwert der Druckmessung: Messverfahren und Fehlerquellen.

Tonometry is still an essential component of diagnostic testing in glaucoma. Functional and morphological investigations can provide very detailed information about the extent of glaucomatous damage. They are useful in the early detection of glaucoma damage; when damage is manifest, they are useful in estimating the rate of progression in follow-up studies. In contrast, tonometric procedures are much less perfect and sensitive and provide no information at all about the extent of glaucoma damage. However, they often provide the first evidence that glaucoma may be present at all and they are the decisive parameter in controlling surgical or medical treatment to reduce pressure, as the reduction in intraocular pressure (IOD) is still the most common approach in treating glaucoma - in spite of our awareness of numerous other risk factors for glaucoma. There is no reason to doubt that reducing IOD is an effective therapy in many forms of glaucoma, as this has been demonstrated in numerous large epidemiological studies. Tonometric procedures have become more precise in recent years. Goldmann applanation tonometry (GAT) and pneumatonometry are widely used. There are also some areas for which the rarer forms of tonometry can be recommended. Procedures for quasi-continuous pressure measurements and, in the future, these may replace the current approach of measuring IOD at discrete time points. There are a variety of snares in clinical practice, which may lead to misinterpretation and wrong therapeutic decisions, so that these must be repeatedly emphasised.

[Contact lens dynamometry influences the systemic blood circulation: clinical significance]. / Die Kontaktglasdynamometrie beeinflusst den Systemkreislauf: Folgerungen für die Praxis.

BACKGROUND: The diastolic and systolic pressure in the ophthalmic artery (OAPdia, OAPsys) as well as the venous pulsation pressure (VPP) can be determined by contact lens dynamometry (CLD). With these parameters, carotid artery stenosis, ocular perfusion, e.g., in glaucoma patients and the cerebrospinal pressure can be examined indirectly. In the underlying study comparative data were collected and it was investigated to what extent CLD itself leads to changes of the systemic blood pressure. SUBJECTS/METHODS: In the course of a prospective trial CLD was performed in 162 eyes of 81 healthy volunteers (mean age 41.0 ± 17.3 years). VPP, OAPdia and OAPsys were measured. A mean was calculated from 5 single readings. Directly before and after CLD automated blood pressure measurements according to Riva-Rocci (RR) and the heart rate were obtained in both arms. RESULTS: In the entire group, the mean VPP was 21 ± 9 mmHg on the right side and 19 ± 8 mmHg on the left side. The mean OAPdia was 60 ± 14 mmHg on the right and 67 ± 14 mmHg on the left side. The mean OAPsys was 91 ± 17 and 101 ± 21 mmHg, respectively. The mean variation coefficient from 5 single readings was 13/16 % for VPP (right/left), 7.4/8.2 % for OAPdia and 6.2/6.2 % for OAPsys. The difference between right and left eyes concerning OAPdia and OAPsys was statistically significant (Wilcoxon test; p < 0.001). VPP and OAPsys were not correlated with age, OAPdia showed a weak correlation with age on the right side (Spearman R = 0.23; p = 0.03). Blood pressure (RR) dropped from a mean 137/84 to 135/82 mmHg in the right arm and from 135/84 to 132/83 mmHg in the left arm. The change of the diastolic values of the right side and of the systolic values of the left side reached statistical significance (p < 0.05). The difference of the systolic blood pressure and the heart rate before and after CLD were weakly correlated (Spearman R = - 0.28; p = 0.01). The extent of the systemic blood pressure drop was not correlated with the maximum force affecting the globe. CONCLUSIONS: The slightly lower blood pressure after CLD could be related to the oculocardiac reflex. This has to be confirmed in further trials with continuous blood pressure determination. In agreement with literature reports, significant differences between right and left eyes were found regarding OAPdia and OAPsys.

[Symptoms and therapy for steroid glaucoma]. / Klinik und Therapie des Steroidglaukoms.

In steroid responders, topical or systemic application of steroids leads to extracellular deposits in the trabecular meshwork which increase trabecular meshwork outflow resistance. 30-40 % of the normal population are steroid responders. About 5 % develop an intraocular pressure (IOP) rise of > 15 mmHg. These patients are termed "high responders". In patients with primary open angle glaucoma (POAG), the proportion of steroid responders sums up to 90 %. The extent of steroid response depends on the kind of steroid used and on the duration of its administration. Dexamethasone has the highest IOP increasing potency. Differential diagnoses are POAG, ocular hypertension, normal tension glaucoma, pseudoexfoliation glaucoma and secondary glaucoma due to different reasons. To make the diagnosis, a detailed anamnesis is crucial. A recompensated IOP after the end of steroid use proves the diagnosis. The treatment of steroid glaucoma includes topical antiglaucoma medications, glaucoma filtration surgery, trabeculotomy, and laser surgery. So far, only few comparative studies on different treatment options have been published on steroid glaucoma. In some cases of therapy-resistant IOP increases following intravitreal or subconjunctival steroid administration, operative removal of the steroids can be considered. A gene therapy treatment of steroid glaucoma is still a topic of research.

[Influence of dry eye syndrome on glaucoma diagnostic procedures]. / Einflüsse des trockenen Auges auf die Glaukomdiagnostik.

Approximately 50-60% of primary open angle glaucoma patients suffer from dry eye and ocular surface disease and have a reduced corneal thickness. The measurements by imaging procedures are weakened by signal noise and perimetry procedures are affected by generalized loss of sensitivity. In dry eye patients, possible influences on new perimetry procedures, such as frequency doubling technology (FDT), flicker-defined form (FDF) perimetry and pulsar perimetry (PP) potentially result from stray light and reduced contrast sensitivity. In glaucoma patients with ocular surface disturbances, measuring procedures with high sensitivity and low specificity should be carefully checked for plausibility by the examiner. Using these procedures uncritically involves the danger of over interpretation in terms of non-existent glaucoma progression. If necessary, eyes should be pretreated with lubricating eye drops or therapy should be switched to preservative-free pressure lowering drops. Afterwards, new control measurements should be taken to exclude glaucoma pseudoprogression.

[Sources of error in Goldmann applanation tonometry]. / Fehlerquellen bei der Goldmann-Applanationstonometrie.

Reliable measurements of the intraocular pressure (IOP) are necessary for glaucoma patients. The measuring procedure, anatomical changes of the eye or extraocular influences can lead to errors during applanation tonometry. The IOP is overestimated if measured through the wrong eyepiece of the slit lamp, if a force is interfering with the tonometer arm during the measurement, if the lid comes into contact with the tonometer tip, if blepharospasm occurs, if there is lid retraction or if a Valsalva maneuver is present. An underestimation of the IOP occurs if staining with fluorescein is absent or insufficient, if the illumination is not bright enough, if a corneal stromal edema is present, after LASIK, during accommodation, during repeated measures within a few minutes or during systemic blood pressure drop. Discrepancies of the IOP in both directions can appear if the calibration of the tonometer is irregular, if abnormal central corneal thickness or astigmatism is present. For correct measurements calibrations are advised once or twice a year.

[Physiology of aqueous humor formation, diurnal fluctuation of intraocular pressure and its significance for glaucoma]. / Physiologie der Kammerwasserproduktion sowie der Tagesdruckschwankungen und deren Bedeutung für das Glaukom.

In the human eye there is a balance between production of aqueous humor as well as its drainage. The intraocular pressure is held through different mechanisms in a stable balance. The aqueous humor is secreted by the ciliary epithelium lining the ciliary processes. Three physiological processes contribute to the formation and chemical composition of the aqueous humor: diffusion (5 %), ultrafiltration (15 %) and active secretion (80 %). The normal intraocular pressure amounts to 15 ± 3 mmHg, the normal diurnal fluctuation 5 mmHg. Aqueous humor leaves the eye by passive bulk flow via two pathways: the trabecular route and the uveoscleral route. In glaucoma patients this balance is disturbed resulting in individual high intraocular pressure or, respectively, high diurnal fluctuations. This leads to loss of retinal ganglion cells and visual field loss. As a recommendation for glaucoma patients it is useful to construct diurnal intraocular pressure curves to evaluate the "type of pressure" and to determine the diurnal fluctuations or, respectively, the time of the pressure maxima. With this knowledge, treatment of glaucoma patients can be managed in a more individualised manner and it seems to slow down the progress of the disease better than by merely reducing the intraocular pressure.

[Ophthalmological screening via a hospital boat: field study for planning future health care services in remote villages at the Volta Lake in Ghana]. / Ophthalmologisches Screening mit einem Hospitalschiff: Feldstudie zur strategischen Planung der zukünftigen augenärztlichen Versorgung in abgelegenen Dörfern am Voltastausee in Ghana.

BACKGROUND: A maiden voyage on a hospital boat was carried out to determine the spectrum of ophthalmological diseases in a rural and secluded area on the Volta Lake in Ghana in order to improve future health care services. PATIENTS AND METHODS: Portable water, electricity, and an operating theatre were available on the hospital boat. Visual acuity was determined using Snellen E charts, and Lea boards were used in children up to the age of 4 years. The anterior segments were examined using hand held slit lamps. After pupil dilation indirect binocular ophthalmoscopy was performed and tonometry was carried out using a Perkins tonometer RESULTS: A total of 1,246 citizens were examined. The mean age was 23.7 years and the mean visual acuity was 6/6 (log MAR 0.0+/-0.3. The main cause of blindness was a cataract with 45.8%, followed by pathological conditions of the optic disc with 29.2%. CONCLUSIONS: The hospital boat is suitable for screening and for carrying out minor extraocular operations. Looking just at the technical aspect, it is possible to perform major intraocular operations on the hospital boat. However, due to the lack of immediate follow-up visits, it is advisable to carry out major operations in the next eye clinic on shore.

[Retinal laser coagulation with the pattern scanning laser--report of first clinical experience]. / Retinale Laserkoagulation mit dem Pattern Scanning Laser--erster klinischer Erfahrungsbericht.

BACKGROUND: The PASCAL pattern scanning laser can be applied to induce multiple lesions in retinal laser coagulation. First clinical experience is evaluated. PATIENTS/MATERIALS UND METHODS: The PASCAL pattern scanning laser is a frequency doubled Nd:YAG laser (532 nm). Exposition times are 10-30 msec and power is up to 2000 mW per single lesion. Clinical experience was gained in 33 patients and the subjective perception of pain was compared in 27 patients. The pain of 14 patients in group 1 (pattern) and the pain of 13 patients in group 2 (single lesion) were compared to the pain of previous conventional single spot laser coagulation. RESULTS: No complications occurred. In group 1 (pattern), 10 patients had less severe pain than in conventional laser coagulation, 4 patients had similar pain. In group 2 (single lesion), 6 patients had less severe pain, 7 patients had similar pain. Differences were not significant in Fisher's exact test (p = 0.17). CONCLUSIONS: In the pattern technique, pain also occurs. Time saving seems to be possible. A wide understanding of the interaction between laser and tissue is necessary to avoid over-coagulation. For macular grid laser coagulation, the single spot technique seems to be safer.

[Intravitreal administration of triamcinolone and bevacizumab for pigment epithelial detachment in conjunction with AMD]. / Intravitreales Triamcinolon und Bevacizumab bei Pigmentepithelabhebung im Rahmen der AMD.

BACKGROUND: The effect of the vascular endothelial growth factor (VEGF) inhibitors triamcinolone and bevacizumab (Avastin) on serous pigment epithelial detachment (PED) related to age-dependent macular degeneration (AMD) was analysed retrospectively. PATIENTS AND METHODS: Data of 45 patients (45 eyes) were evaluated: 11 patients received an intravitreal injection with triamcinolone and 16 with bevacizumab. The remaining 18 patients received no therapy. Visual acuity (VA), height of the PED, retinal thickness and the cystoid component of the PED were compared after 6 months follow-up. RESULTS: Over 90% showed a stabilisation or improvement in VA after bevacizumab therapy; 63% of those who received triamcinolone showed VA stabilisation. Patients who received no therapy had a significant decrease in VA. CONCLUSIONS: Our data seem to implicate that VA outcome is much better after bevacizumab treatment. VA outcome seems to correlate with the cystoid component of the foveal oedema rather than with the height of PED. A greater number of patients with a longer period of follow-up are necessary to confirm these results.

[Comparison of central and peripheral corneal thicknesses between normal subjects and patients with primary open angle glaucoma, normal tension glaucoma and pseudoexfoliation glaucoma]. / Vergleich von zentraler und peripherer Hornhautdicke zwischen Normalprobanden und Patienten mit chronischem Offenwinkelglaukom, Normaldruckglaukom und Pseudoexfoliationsglaukom.

BACKGROUND: While many comparative data are available about central corneal thickness in different types of open angle glaucoma, peripheral corneal thickness has been much less investigated up to now. Thus, the aim of this study was to compare the central and peripheral corneal thicknesses in patients with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudoexfoliation glaucoma (PEXG) to values of normal subjects. PATIENTS: 104 patients with POAG, 20 patients with NTG, 23 patients with PEXG and 127 normal subjects were investigated with the Orbscan II. The central corneal thickness and the peripheral corneal thickness at 3 mm distance from the centre were determined in 4 quadrants. The acoustic equivalent factor of 0.92 was not used. Patients with eye diseases, patients who had undergone eye surgery or wearers of contact lenses were excluded. Differences were analysed with the Bonferroni-adjusted Mann-Whitney U Test for statistical significance. RESULTS: The median central corneal thickness in POAG was 600 +/- 35 microm, in NTG 577 +/- 31 microm, in PEXG 603 +/- 25 microm and in the control group 606 +/- 38 microm. The difference between NTG and the control group was statistically significant (p = 0.01). Superiorly the peripheral corneal thickness was lower in POAG (670 +/- 47 microm) and NTG (639 +/- 37 microm) compared to the control group (686 +/- 46 microm). Nasally the peripheral corneal thickness was lower in POAG (656 +/- 48 microm), NTG (658 +/- 55 microm) and PEXG (642 +/- 47 microm) compared to the control group (677 +/- 46 microm). Temporally and inferiorly there were only small differences compared to the control group. The differences in peripheral corneal thickness were not statistically significant. DISCUSSION: In accord with literature data the central corneal thickness was lower in patients with normal tension glaucoma compared to normal subjects. Superiorly and nasally the peripheral corneal thickness was lower in patients with open angle glaucoma than in normal subjects which was, however, not statistically significant. To what extent these characteristics of the corneal architecture are relevant for the pathogenesis of open angle glaucomas has to be clarified in further larger trials.

[Comparison of ILM peeling with and without the use of indocyanine green. Functional results for idiopathic macular hole after pars plana vitrectomy]. / Vergleich des ILM-Peelings mit und ohne Einsatz von Indozyaningrün. Funktionelle Ergebnisse bei idiopathischem Makulaforamen nach Pars-plana-Vitrektomie.

BACKGROUND: Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the best known therapy for idiopathic macular holes. Indocyanine green (ICG) is useful for staining the ILM, although there is a dose related toxic effect on the inner retinal layers. We compared outcome results with and without the use of ICG. METHOD: Data from 61 patients with idiopathic macular holes, who underwent macular hole surgery were analyzed retrospectively. ICG was used on 36 eyes while for 25 eyes it was not used. After calculating logMAR, differences in visual acuity between both groups were analyzed for significance using the Mann-Whitney-U-Test. RESULTS: The logMAR for the entire group was 0.71+/-0.30 (20/100) preoperatively, after 1 month 0.71+/-0.36 (20/100), after 3 months 0.57+/-0.26 (20/80), after 6 months 0.54+/-0.38 (20/66) and after 12 months 0.36+/-0.32 (20/50). There were no significant differences between groups. CONCLUSION: There seem to be no significant differences in the development of visual acuity and the occlusion rate between patients treated with or without the use of ICG.

[Central and peripheral corneal pachymetry--standard evaluation with the Pentacam system]. / Zentrale und periphere Hornhautpachymetrie -- Normevaluation mit dem Pentacam-System.

BACKGROUND: Corneal thickness measurements are important in refractive surgery, for interpretation of IOP and in corneal diseases. The purpose of this study was to generate specific standard values for the Pentacam system and to investigate the influence of body size, body mass index, body weight, gender and refraction on central and peripheral corneal thickness for a more detailed characterization of the corneal anatomy. MATERIALS AND METHODS: The Pentacam system is based on a 180 degrees rotating computer-aided Scheimpflug camera, which generates reconstructions of the anterior segment from 12 to 50 single captures. The central corneal thickness was calculated from 25 single captures in both eyes of 182 normal Caucasian subjects (age: 18 - 83 years). The peripheral corneal thickness was measured within 3 mm distances at 0 degrees , 90 degrees , 180 degrees and 270 degrees . All subjects underwent an ophthalmological examination. Correlations between corneal thickness and body size, body mass index, body weight, gender and refraction were analyzed statistically by non-parametric tests. RESULTS: The mean central corneal thickness of all 364 eyes was 534 +/- 36 microm. Divided into sides it was the same, 534 +/- 36 microm, in the right and in the left eyes. The mean central corneal thickness for female subjects was 533 +/- 40 microm, for males it was 534 +/- 35 microm. Statistically there was no proof of any dependence of the central corneal thickness values on the sides, gender, age, height, body mass index (BMI) or refraction. However, there was a positive significant correlation between central corneal thickness and body weight. The peripheral corneal thickness values were lowest in the temporal and inferior areas and greatest in the superior and in the nasal areas. In the superior and in the nasal areas there was a statistically significant negative correlation between age and peripheral corneal thickness. CONCLUSIONS: The corneal thickness can be measured touchless with the Pentacam system. The central corneal thickness seems to be correlated with the body weight. Anatomical features lead to lower peripheral corneal thickness values in the temporal and inferior areas than in the nasal and superior areas. In the nasal and in the superior areas the corneal thickness seems to decrease with age. Further trials are necessary to confirm these findings and to evaluate the precision, reproducibilitiy and independence of investigators of the corneal pachymetry with the Pentacam system.

[Analysis of risk factors and comparison of heparin and hemodilution therapies for retinal artery occlusion]. / Risikofaktorenanalyse und Therapievergleich zwischen Heparin und Hämodilution bei Zentralarterienverschluss des Auges.

No standards are available for the treatment of central retinal artery occlusion (CRAO). The aim of this study was to compare data about visual acuity development under heparin treatment with those from hemodilution. Data on 139 patients suffering from CRAO between 1991 and 2000 were examined retrospectively. Risk factors were listed. Therapies were compared in 38 of these patients, 23 of whom received full heparinization and 15 of whom received hemodilution. Many risk factors were shown. Neither therapy showed serious complications. Visual acuity improved significantly, by three or more lines, in five of 23 patients (21.7%) under full heparinization and six of 15 patients (40%) receiving hemodilution. Differences were not significant. For ethical reasons, the normal cause of disease in these patients cannot be studied and is still unknown. Because of many vascular risk factors, we recommend adapted therapies. Treatments should be examined in controlled studies.