Long-term fluctuations versus actual field loss in glaucoma patients.

In following glaucomatous visual fields with automated perimetry, one becomes aware of the difficulty in differentiating between long-term fluctuations and actual changes. We have analyzed visual fields of one randomly selected eye of each of 34 patients (mean age = 61.8 +/- 12.3 years) with proven glaucoma chronicum simplex and at least 4 (mean = 5.6 +/- 1.9) visual field examinations with programs 31 and/or 33 of the Octopus 201 within at least 21 months (mean = 32.6 +/- 6 months). When a group of earlier visual fields is compared with a group of later ones utilizing the statistical program delta-change, the results of regression analysis, based on data from program delta-series, are juxtaposed to the results of the t test with very good correlation. This investigation confirms that glaucomatous visual fields exhibit considerable long-term fluctuations; as long as field loss and gain observed over a longer time period are evenly distributed, the symmetrical portions of the distribution curve may serve as the outer limits of long-term fluctuation. In this regard, definite visual field deterioration was discerned in none of our medically treated patients over an average observation period of 32 months. If more selective criteria for differentiating between long-term fluctuations and actual field change are used (such as measurement of long-term fluctuations performed in earlier investigations, the t test of program delta-change, regression analysis of the data produced by program delta-series, as well as the correspondence between the t test and the correlation coefficient of the regression analysis), 3 eyes have changed for the worse regarding loss per test location, and 3 have changed for the worse regarding sensitivity.

Cell cycle time and life-span of cells in the mouse eye. Measurements during the postfetal period using repeated 3H-thymidine injections.

In this investigation the cell cycle time and the life-span of cells in different tissues of the mouse eye were determined during postfetal development not with single but, instead, by means of repeated 3H-thymidine injections. The potential of this method applied for the first time in the mammalian eye, is thoroughly discussed. Essentially, four groups of 19-21 mice each, aged 1, 10, 20, and 60 days at the start of the experiment, received intraperitoneal injections of 3H-thymidine at a dose of 1 microCi/g body weight every 4 h for a maximum of 14 days, i.e. a total of up to 85 injections. Further animals were sacrificed after the 13th, 19th, 25th, 31st, 37th, 49th, 61st, 73rd, and 85th injections, i.e. 2, 3, 4, 5, 6, 8, 10, 12, and 14 days after the start of the experiment. When all the injections had been given, animals from each group were sacrificed on the 1st, 4th, 8th, 16th, and sometimes the 32rd, 48th, and 64th days, respectively, after the last injection. With this experimental paradigm it was possible: (1) to determine the cell cycle time and the life-span of the cells during postfetal development up to maturity without gaps; (2) to establish the end of the development by means of cell proliferation in various tissues of the mouse eye; herewith it was possible to determine the times at which the development by cell proliferation is replaced by development by cell differentiation, and (3) to clearly prove in which mature ocular tissues cell turnover still exists and in which it does not; this appears to be especially important, since in recent years the importance of cell proliferation process following injury and stimulation was also recognized in the eye, for example, in massive periretinal proliferation in connection with retinal detachment and retinal surgery, as well as in endothelial injuries following intraocular lens implantation; only when normal conditions are known can pathological proliferative processes be recognized as such and be distinguished from normal ones. The results are cumulatively represented in tabular form, from which details are to be extracted. As expected, cell cycle times are very short and seemingly homogeneous in tissues which develop within themselves, but become longer and inhomogeneous, except in the inner and outer granular layer of the retina, in which the cell proliferation comes to a particularly abrupt end. The shortest cell cycle time occurred in the cells of the vascular walls of the retina at the time of birth and was 24 h.(ABSTRACT TRUNCATED AT 400 WORDS)

[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.

[Operation for retinal detachment caused by holes in the posterior pole area, simple, long-tolerated silver span and cerclage (author's transl)]. / Operation der Netzhautablösung bei Löchern im Bereich des hinteren Poles mit einfacher, lang verträglicher Silberspange und Cerclage.

A method for treatment of retinal detachments caused by macular holes or by holes at the posterior pole of the eye is presented. A simple silver clasp is sutured on the sclera. The silver clasp usually is well tolerated for many month and has remained on several eyes for more than 4 years, nevertheless removal of the instrument 6 months after the primary operation is advised. Lasting indentation by the clasp is provided by an additional encircling silicon band. In 10 out of 11 cases of a total or subtotal retinal detachment caused by a hole at the posterior pole, the retina could be reattached; in one case of massive pre-retinal retraction the puckering focus was successfully tamponed. The method is especially suited for the treatment of detachments in globes with posterior staphylomas.

[Problems and complications of the wound closure in cataract operations (author's transl)]. / Probleme und Komplikationen des Wundverschlusses bei Kataraktoperationen.

A presentation is given of some complications resulting from wound closure technique following cataract extraction, without postoperative loss of the anterior chamber. Group 1: In 3 cases a filtering bleb developed within the first 10 days postoperatively, due to faulty suture technique. Wound revision was not necessary. Group 2: In 6 cases wound dehiscence only developed after 3 weeks or longer. In 5 of these cases the fistula, and the subsequent dehiscence, occured at the site of a Barraquer silk suture; which appeared to be at least partially responsible for the complication. 2 of these 5 cases required resuturing, the remaining 3 slowly improved spontaneously. In the 6th case, which also required surgical intervention, the fistula was not situated near a suture. Due to the problems encountered with Barraquer silk sutures the same 3 step cataract incision previously employed was closed instead with interrupted Tübinger nylon sutures, the knots being buried whenever possible. The results were analysed in 81 eyes operated upon with this technique. Postoperative astigmatism lay within normal limits. In one case a filtering bleb developed at the site of a suture. Tübinger nylon sutures are now preferred to Barraquer silk sutures due to the better results obtained so far.

Radioisotopes for research into vitreous and zonule.

A survey of the use of radioisotopes for research into the vitreous and the zonule is presented. gamma-Rays emitting isotopes are useful for the investigation of transport and diffusion of substances, while 3H-thymidine is the substance of choice for the investigation of cell kinetics. The formation of the vitreous and the zonule during and after embryonal development can be studied by histoautoradiography using labelled precursors of collagen and aminoglycans. Cell kinetic investigations shows that the cells usually found in the vitreous are macrophages which have migrated into the eye. Therefore the existence of a specific vitreous cell is unlikely. The development of the zonule can be readily traced by histoautoradiography which shows that it is neither topographically nor temporally related to regression of the primary vitreous. The incorporation of cystine and glucose into the zonular fibers is of special interest. This suggests that the zonular fibers are not made up of normal collagen; they may consist of some sort of procollagen which is perhaps secreted by the ciliary epithelium.

[Evaluation of glaucomas. Frequently misdiagnosed glaucoma conditions]. / Evaluation der Glaukome. Häufig verkannte Glaukomsituationen.

On the basis of a number of examples the authors describe specific glaucomas which have often reached their final stages by the time the patients are referred to the clinic. They include sub-acute and chronic angle-closure glaucoma, pseudoexfoliation syndrome, and pigmentary glaucoma. An unpleasant feature of these glaucomas is that, somehow or other, treatment comes too late: complete cupping of the optic disk when the ophthalmologist is first consulted, increased intraocular pressure in exfoliation syndrome detected too late, or a tardy decision to perform an iridotomy or a fistulizing operation. The following are some important points: gonioscopy should be performed not only at the initial examination but also at subsequent ones; subacute and chronic pupillary or angle-closure glaucomas are progressive diseases for which the sensible therapy is not miotics but laser iridotomy; because papillary changes usually precede visual field changes (automated perimetry notwithstanding), particular attention must be paid to the former. This can only be accomplished with exact documentation. Therefore, glaucoma follow-up means pressure measurement and gonioscopy and examination of the optic disk and visual field. In conclusion, aids for decision-making and a follow-up schedule are presented.

Therapy-resistant papilledema in achondroplasia.

A 20-year-old achondroplastic dwarf developed severe papilledema over a short period of time. Since the age of 3 he had a ventriculoperitoneal shunt for presumed hydrocephalus. Severe ventriculomegaly was never documented, neither in the past, nor at presentation. Intracranial pressure was high, and the shunt was obliterated. Despite prompt shunt revision and subsequent bilateral optic nerve sheath decompression the patient developed postpapilledema optic atrophy with bilateral blindness. The pathophysiology of increased intracranial pressure in achondroplasia is discussed.

Vitreoretinal juncture; healing of experimental wounds.

Healing of mechanically-induced, minimal wounds of vitreoretinal juncture in non-vascularized retina of rabbits was studied with electron microscopy at 1 and 3 days, and 1, 2, 6 and 10 weeks. Neuroectodermal scar was formed by two processes, each having a specific anatomical relationship to wound. Accessory gliocytosis, in which accessory glia adjacent to wound become phagocytic and proliferate; following this their progeny migrate to wound and progressively differentiate into fibrous astrocytes to fill in the wound proper. Plexiform gliosis, in which the Müller cell side branches proliferate to form a layer about the perimeter of wound. The retinal inner limiting lamina did not regenerate. The significance of these findings in relation to epiretinal membrane formation in man is discussed.

[Specific pathological findings in trabeculectomy]. / Ausgewählte pathologische Befunde bei Trabekulektomie

A quick embedding method for trabeculectomy specimens is desirable. It allows a comparison between the observations made during surgery and the histological material as long as the facts are remembered by the surgeon. Embedding by butoxy-ethanol-glycol-methacrylate proved to be adequate. It allows 1- to 2-mu thick sections. 39 trabeculectomy specimens were investigated in regard of topographical origin. In 26 of them, an exact localization was possible. Only 8 pieces contained Schlemm's canal or major parts of it. The others where cut more anteriorly and contained cornea and parts of the trabecular meshwork. The different topographical localization of the ectomized pieces did not influence the regulation of the intraocular tension in the early follow-up period. It is suggested that trabeculectomy does not give direct access to the aqueous to the cut ends of Schlemm's canal and to collector channels but rather by letting filter the aqueous externally along the scleral openings.

[60 years Alfred Vogt Foundation. The prize winners and their work]. / 60 Jahre Alfred-Vogt-Stiftung. Die Preisträger und ihre Arbeiten.

BACKGROUND: The Alfred Vogt-Prize is the highest award in Switzerland for scientific research in ophthalmology and related fields of research. The Alfred Vogt institution was founded 60 years ago in Zürich, where Alfred Vogt was working as the head of the department of Ophthalmology of the University Hospital. For this reason the activity of the foundation was recognized on the occasion of the annual meeting of the Swiss Ophthalmology Society in Zürich 1998. METHOD AND RESULTS: The biographical notes of Alfred Vogt were compiled. The winners of the prize and their distinguished papers are listed below. During the 60 years since the establishment of the foundation the prize was rewarded to 53 researchers or research teams. The awards were divided among several researchers in those years when many outstanding papers were submitted. On the other hand in many years no award was given due to lack of award worthing research papers. 7 researchers received the prize more than once. CONCLUSION: The list of the winners of the Alfred Vogt-Prize reflects the history of the Swiss Ophthalmology. To a number of researchers the awards allowed them further research, which let to excellent contributions to international Ophthalmology.

[Leiomyoma of the ciliary body - misdiagnosis leading to an unconventional but successful surgical approach]. / Leiomyom des Ziliarkörpers - Durch Fehldiagnose auf ungewöhnliche Weise erfolgreich operiert.

Report on a leiomyoma of the ciliary body in a 12-year-old girl. The clinical findings were misinterpreted as a traumatic ciliary body cyst because of the associated iridodialysis, the fact that the tumor could be transilluminated, because it appeared cystic on ultrasonography, and because there was a history of severe cranial trauma. In the course of an attempt to puncture the presumed cyst a cherry-sized ciliary body tumor was revealed. It proved possible to shell this out without performing an iridocyclectomy. An elective enucleation would have been performed had the true diagnosis been known preoperatively. Due to the misdiagnosis and the resulting unconventional approach the eye was preserved with some residual functions. the histological picture was that of a leiomyoma, a tumor rarely found in the ciliary body. The histological and electronmicroscopic appearance are described and compared with the few cases previously reported.

Treatment of chronic simple glaucoma with an adrenaline/guanethidine combination at three different dosages (comparative double-blind study).

Undesirable side effects have limited the use of adrenaline/guanethidine combinations in the usual concentrations in the treatment of chronic simple glaucoma. Better tolerance to lower concentrations has already been demonstrated in other studies. In the double-blind study described here, three different combinations (adrenaline 1%, 0.5% and 0.2% combined respectively with guanethidine 5%, 3% and 1%) were compared in respect of their depressive action on intraocular pressure and the tolerance shown to them. All three combinations were found to be effective. The combination with the lowest concentration was significantly less hypotensive in its effect than the other two but the number of patients treated was too small to allow a clear distinction to be made between the effects of the other two combinations. Nevertheless, there was a tendency for the effectiveness to fall with decreasing concentration. As far as tolerance was concerned, there was little difference between the middle and lowest concentrations, the latter being that best tolerated. The excellent effect of the strongest concentration was impaired by the poor tolerance shown to it. The comparison between the three combinations was followed by a study of the diurnal pressure changes in patients during the course of the treatment. The slow rise up to midday and the abrupt afternoon fall remain unexplained. The low concentration of the preparation had a better hypotensive action than pilocarpine, while the middle concentration proved even a little better than the beta-blocker Timolol

[The bane of giant cell arteritis from an ophthalmological viewpoint]. / Die Tücken der Riesenzellarteriitis aus ophthalmologischer Sicht.

We report a series of 21 consecutive patients seen at the Ophthalmology Department of the University Hospital Zurich, Switzerland, with the arteritic form of anterior ischemic optic neuropathy (AION). 19 patients had giant cell arteritis, one had periarteritis nodosa and one had cP-arteritis. They comprised 11 men and 10 women, ranging in age between 66 and 88 years. The median age was 80. We analyzed the course of events in each case before and after involvement of the first eye, as well as the frequency and possible causes of involvement of the second eye. The diagnosis was regarded as delayed when, despite typical signs, symptoms amd laboratory abnormalities, systemic vasculitis was not considered in the differential diagnosis. Treatment was considered inadequate if, following visual loss in one eye and diagnosis of a systemic vasculitis, a dose of 1 mg/kg prednisone or less was given, and/or the initial dose was reduced by more than 50% during the first month. Of 21 patients, 10 suffered bilateral visual loss. 8 of these 10 patients became legally blind. In 13 out of 21 cases there was no delay in diagnosis and treatment was adequately given. All 11 patients with unilateral involvement, who did not suffer a substantial loss in quality of life, belong to this subgroup. In 8 cases diagnosis was either delayed or treatment was inadequate. All of these patients had bilateral ocular involvement. In one patient, visual loss in the second eye could not be avoided despite correct diagnosis and treatment (M.A., No. 1). In this patient the interval between involvement of the first and second eye was very short (3 days). One patient had a mature cataract in the first affected eye and sought medical help only after his good eye became involved (K. F., No. 15). In this report we would like to draw attention to the extremely poor visual prognosis due to frequent bilateral ocular involvement in giant cell arteritis. Corticosteroid treatment cannot restore vision in the already affected eye, but it is, in the majority of cases, highly effective in preventing visual loss in the second eye. Thus, it is crucial to begin treatment immediately, to start with a high dose (preferably 1 g methyl-prednisolone i.v.), and to continue high-dose oral treatment long enough to prevent delayed visual loss in the second eye. The most vulnerable period appears to be the first month following involvement of the first eye. Caring for patients with giant cell arteritis who have lost vision in one eye is a challenge to all involved physicians. It resembles a "high-wire act" with the threat of blindness on the one hand and the dangers of long term corticosteroid treatment on the other. An interdisciplinary approach with ongoing communication between the family physician and the ophthalmologist is required.

[Wound healing in the feline retina following mechanical trauma (author's transl)]. / Retinale Wundheilung nach mechanischem trauma bei der Hauskatze Licht- und elektronenmikroskopische Untersuchung.

The healing of superficial retinal scratches inflicted with a Sato knife was followed from days 1 to 135 in 20 domestic cats. Breakdown of retinal tissue continued for 18 weeks. Glial proliferation was extremely sparse and never observed before day 6. Microvilli and cell processes, derived mainly from Müller cells, were also seen in the wound. Regeneration of the internal limiting membrane was never observed. The choroid, pigment epithelium, retinal blood vessels, and vitreous played no part in the healing process.

[Transport of 131J-iodo-o-hippurate and 22Na out of the retroretinal space in experimental non rhegmatogenous detachment of the retina (author's transl)]. / Abtransport von 131qhippursäure und 22Na aus dem Retroretinal-Raum bei experimenteller arhegmatogener Netzhautablösung

A model of an experimental arhegmatogenous retinal detachment is presented, to allow the measurement of the transport of radioactive labeled substances out of the subretinal space. Experiments were performed on 19 male cats. 131I-iodo-o-hippurate and 22Na were used as test substances. There was no significant difference between the rate of disappearance of 131I-hippurate if injected retroretinally or intravitreally. The rate of disappearance of 131I-hippurate could be slowed down by intravenous infusion of penicillin-G. The rate of disappearance of 22Na following retroretinal injection is not only slower than the rate of disappearance of 22Na injected intravitreally, but significantly slower than the rate of disappearance of 131I-hippurate. For graphic analysis ("curve peeling") of the terms embodied in the curves, more densly situated points of measurements will be necessary. Then the experimental model will serve well to analyze the components influencing the transport of labeled sodium out of the subretinal space.

[Transport of 131I-hippuric acid and 22Na from the space between retina and pigment epithelium after experimental amotio]. / Abtransport von 131J-Hippursäure (Hippuran) und 22Na aus dem Raum zwischen Retina und Pigmentepithel nach experimenteller Amotio

A method was developed which allows up to puncture and fill the virtual space between retina and pigment epithelium with radioactive-labeled substances and to measure the transport of the injected substances out of this space. Experiments have been performed on 28 cats. 131I-iodo-omicron-hippurate and 22Na were used. The transport out of the space between retina and pigment epithelium of 22Na is much slower than that of 131I-iodo-omicron-hippurate. It is concluded that an active system in the pigment epithelium and/or retina is responsible for the transport of iodo-omicron-hippurate out of the eye