[Impact of Drugs on Glaucoma and Intraocular Pressure]. / Der Einfluss von Medikamenten auf das Glaukom und den Augeninnendruck.

Purpose Systemic drugs may have unfavourable effects on intraocular pressure, glaucoma and the efficacy of glaucoma drugs. Material and Methods The article provides a review of the literature from PubMed and clinical experience. Results Topical and systemic corticosteroids induce complex changes inside the trabecular meshwork. New genetic results improve the understanding of pathogenetic processes, although many questions are still open. Arterial hypertension and antihypertonic drugs may influence the risk of glaucoma, intraocular pressure and ocular perfusion pressure. Intravitreal anti-VEGF therapy may be associated with the risk of sustained intraocular pressure elevation. Systemic drugs with parasympaticolytic activity (e.g. psychopharmaceuticals) are able to induce acute angle block glaucoma. Conclusion New insights into the interactions between drugs (e.g. antihypertensives, corticosteroids) and glaucomatous optic neuropathy affect large patient groups and may improve understanding of the underlying pathogenetic processes in open angle glaucoma. There is a great need for further clinical and experimental research.

[Mode of action, clinical profile and significance of beta-blockers in antiglaucoma therapy]. / Wirkmechanismen, klinisches Profil und Stellenwert von Betablockern in der antiglaukomatösen Therapie.

Beta-blockers are among the most important groups of drugs for glaucoma therapy. The advantages of beta-blockers are a good efficacy in primary and secondary types of glaucoma, different dosages, clinical experiences over decades, easy use in combination with all other glaucoma drugs, and low costs. Timolol is the most frequently used drug in fixed glaucoma medications. In comparison with other glaucoma drugs, beta-blockers have the most severe systemic side effects and may interact with other systemic medication.

[Dopamine receptors of the corneal epithelium and endothelium]. / Dopaminrezeptoren des Hornhautepithels und -endothels.

BACKGROUND: Dopamine is a major neurotransmitter and its two receptor subgroups, termed D1-like and D2-like receptors, are found both in the central and peripheral nervous systems. D1-like receptors signal through increases, D2-like receptors through decreases in cAMP production. Reports about the presence of dopamine receptors in the cornea are rare and inconsistant. The aim of this study was to examine if native bovine corneal epithelial and endothelial cells express dopamine receptors and whether these receptors belong to the D1-like or D2-like group. MATERIALS AND METHODS: Dopamine receptors were studied using polyclonal antibodies. The cAMP concentration after receptor stimulation with dopamine was determined by means of an enzyme immunoassay. RESULTS: In bovine corneal epithelium and endothelium immunohistochemical staining was positive for D1-like receptors but not for D2-like receptors. Stimulation of corneal D1-like receptors with dopamine revealed a dose-dependent increase of the intracellular cAMP concentration which was blocked by SCH23 390 (a selective D1-like antagonist). CONCLUSION: Our data demonstrate that bovine corneal epithelium and endothelium express a functional D1-like receptor positively coupled to adenylyl cyclase and cAMP production. However, at the present time the physiological role of this receptor remains a matter of speculation.

[Effect of brimonidine on central corneal thickness]. / Einfluss von Brimonidin auf die zentrale Hornhautdicke.

BACKGROUND: Brimonidine, an alpha-2 adrenoceptor agonist, is widely used in glaucoma treatment. Although it is known that it is quickly taken up by the cornea following topical administration and although it is well established that the cornea expresses alpha-2 adrenoceptors there are only few studies available on the impact brimonidine has on the cornea. The aim of the present study was to show if topical application of brimonidine leads to an interaction with corneal alpha-2 adrenoceptors in terms of an increase in central corneal thickness. MATERIALS AND METHODS: Ten healthy test persons (five female and five male subjects) - mean age 30 ± 7years - were tested in a pilot study. Measured were intraocular pressure, epithelial, stromal and endothelial thickness before as well as ten minutes, 24, 48, 72 and 96 hours after administration of brimonidine 0.1 % eye drops twice daily. To check the impact of this medication, sodium hyaluronate eye drops were administered to the other eye twice daily. RESULTS: Administration of brimonidine 0.1 % resulted in a reduction of intraocular pressure from an initial value of 17 ± 2 mmHg to 13 ± 4 mmHg after four days (p = 0.001) as well as an increase in total corneal thickness from 559 ± 8 µm from the time of the baseline examination to 581 ± 11 µm (p < 0.001), an increase of epithelial thickness from 61 ± 1 µm to 68 ± 7 µm (p = 0.008) and stromal thickness from 488 ± 8 µm to 503 ± 8 µm (p < 0.001) after two days each. Another two days later total corneal thickness was 566 ± 10 µm (p = 0.032), epithelial thickness 64 ± 3 µm (p = 0.104) and stromal thickness 492 ± 8 µm (p = 0.139), which means that the values had returned more or less to the initial values measured. In contrast, endothelial thickness did not vary following administration of brimonidine 0.1 % (p = 0.109). CONCLUSION: Topical administration of brimonidine 0.1 % results in a reversible increase in corneal thickness. The question as to whether this increase is of clinical significance has to be answered by larger studies.

[Homonymous visual field defect in established migraine with aura]. / Homonymer Gesichtsfeldausfall bei bekannter Migräne mit Aura. Diagnose: Zerebrovaskulärer Insult bei offenem Foramen ovale und Migräne mit Aura.

A 48-year-old patient was referred by his general practitioner for opthalmological work-up to clarify sudden onset of a persistent temporal visual field defect of the left eye and a dull headache. Diagnostic testing revealed a cerebrovascular insult with open foramen ovale and migraine with aura. The foramen was successfully closed and resulted in disappearance of the migraine attacks.

Repeatability of intraocular pressure and corneal biomechanical properties measurements by the ocular response analyser.

BACKGROUND: The Ocular Response Analyser (ORA, Reichert Ophthalmic Instruments) is a non-contact applanation tonometer, providing two measures of intraocular pressure (IOP) - IOPg which represents a Goldmann equivalent IOP measure and IOPcc, representing a measure of IOP independent of corneal effects. In addition, the device provides two measures believed to represent corneal biomechanical properties: corneal hysteresis (CH) and corneal resistance factor (CRF). The aim of this study was to assess the repeatability of these measurements. PATIENTS AND METHODS: One randomly chosen eye from 49 healthy volunteers was measured four times consecutively with the ORA prior to Goldmann applanation tonometry (GAT). The repeatability coefficient (RC), the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) were calculated as a measure of intrasession repeatability. RESULTS: CH was the most variable and IOPg the most repeatable measure, with an RC of 2.61 and 1.97, respectively, and ICC of 0.86 and 0.92, respectively. CV ranged between 5.73 % for IOPg and 12.38 % for CH. ORA IOP measurements were higher than GAT (IOPcc = 17.43 +/- 3.23; IOPg = 17.53 +/- 3.0; GAT = 15.75 +/- 2.77 mmHg). CONCLUSIONS: ORA measurements show good short-term repeatability in normal volunteers. Thus, this device appears to be applicable in clinical practice.

[Glaucoma in childhood uveitis]. / Glaukom bei Uveitis im Kindesalter.

Secondary glaucoma is a common complication in childhood uveitis. The incidence of glaucoma depends on the anatomic localisation of inflammation and the associated underlying disease. The pathophysiology can be divided in secondary angle closure and open angle glaucoma. Data on conservative and operative therapy often rely on small patient groups or can only be transferred from children with non-uveitic glaucoma. The selection of topical medication must reflect the special quality of the juvenile organism. Topical therapy of first choice seems to be antagonists of carboanhydrase due to their good clinical effect without elevated risk profile. As second choice beta-receptor antagonists are suitable. Gel formulations of 0.1% timolol seem to exhibit fewer of the known side effects. Children aged 2 years and under have a special risk of apnoea. Alpha agonists should not be used in children of 6 years and younger because of their central nervous side effects. Prostaglandins might induce more recurrences of uveitis and might aggravate cystoid macular oedema, therefore this group should only be used with restrictions. Active uveitis is a contraindication for the use of prostaglandins. Parasympathomimetics are generally not recommended in uveitis due to the known side effects. Surgical therapy follows ineffective conservative therapy. The choice of the adequate surgical approach depends on individual factors and general recommendations cannot be made. Techniques include filtering procedures, cyclodestructive procedures, trabecular meshwork surgery, and glaucoma drainage devices. Before surgery the duration of quiescence of inflammation should be 8 weeks or longer.

Real-time imaging of transscleral diode laser cyclophotocoagulation by optical coherence tomography.

PURPOSE: To present optical coherence tomography (OCT) for real-time imaging of cyclophotocoagulation effects. METHODS: In a pilot study, real-time transscleral OCT images were generated during diode laser cyclophotocoagulation in four eyes of four patients suffering from uncontrolled glaucoma using a specially designed contact applicator containing the OCT fiber, a focussing fiber optic and the fiber of the diode laser. RESULTS: When the contact system was used, two layers could be differentiated: a superficial thick hyperreflective complex representing conjunctiva, Tenon's capsule, episclera and sclera, and a thinner hyporeflective layer representing the ciliary body. During cyclophotocoagulation, real-time OCT showed a clear and sudden thickening of the ciliary body in the treated area. CONCLUSION: This new OCT device represents a first step towards visual, real-time imaging of cyclophotocoagulation. After further adaptation of the delivery system, further trials are needed to correlate OCT findings with aqueous production and intraocular pressure.

[Traumatic glaucoma--a survey]. / Traumatische Glaukome -- Eine Ubersicht.

Traumatic glaucomas represent a very heterogeneous group of entities due to a variety of pathomechanisms which increase the intraocular pressure in the early or late phase after traumatic injury (blunt or penetrating injury, acid or alkali burn). Little is known about the real prevalence of traumatic glaucoma. Angle recession, hyphema-associated and lens-associated mechanisms are the most common causes of traumatic glaucoma after blunt ocular trauma. Secondary angle closure due to peripheral anterior synechiae is the most common pathomechanism leading to glaucoma in patients with penetrating eye injury or acid or alkali burn. Early anti-inflammatory therapy for eye injuries is the most important step in the prevention of traumatic glaucoma. Although no general recommendations exist, topical potent corticosteroids significantly decrease the risk of glaucoma development. Medical and surgical treatment of traumatic glaucoma has often been disappointing. Therefore the visual prognosis of these eyes is often restricted. Antiglaucomatous drugs that reduce the secretion of aqueous humor (e. g., beta-blockers) should be preferred. Mitomycin-augmented trabeculectomy is the surgical method of first choice in patients with open angle traumatic glaucoma. Transscleral cyclophotocoagulation represents the method of first choice in secondary angle closure glaucoma due to anterior peripheral synechiae. New surgical techniques will increase the possibilities of an effective reduction of the intraocular pressure in secondary angle closure glaucoma. These new procedures are endoscopic cyclophotocoagulation, retinectomy, and the implantation of drainage devices via the pars plana. Further evaluation and modifications of these surgical techniques should markedly improve the visual prognosis of eyes with secondary angle closure glaucoma. For a few types of traumatic glaucoma (e. g., after epithelial ingrowth) no effective treatment modality is available at present.

[Neoplastic secondary glaucomas]. / Neoplastische Sekundärglaukome.

With few exceptions all intraocular tumours can principally induce elevation of intraocular pressure (IOP). The frequency of IOP-elevation is mainly dependent on the biologic behaviour of the neoplasm (benign / malignant), its dimensions, localization, and its ability to provoke secondary changes like retinal detachment, hemorrhages, inflammation, and necroses. There are many and diverse pathomechanisms which may cause a "neoplastic glaucoma". The leading mechanisms are direct invasion of the chamber angle by tumour cells, rubeosis iridis, and forward displacement of the iris-lens-diaphragm with (lens induced) pupillary block. As intraocular tumours may have pressure-lowering effects too, eyes bearing a tumour may also be hypotonic or normotonic inspite of a "glaucomatous chamber angle morphology". The therapy of the tumour-induced glaucomas is hardly validated and generally follows the treatment of the other secondary glaucomas. However, filtration procedures are contraindicated when a malignant tumour is diagnosed or suspected. Because of the progress of tumour therapy with salvation of eyes which had to be enucleated in former times and prolongation of survival in some tumour entities (like Non Hodgkin's lymphoma and metastases) the significance of tumour-induced glaucomas will probably further increase in the future.

[Intraocular pressure difference in Goldmann applanation tonometry versus a transpalpebral tonometer TGDc-01"PRA" in glaucoma patients]. / Augeninnendruckmessung mit dem transpalpebralen Tonometer TGDc-01"PRA" im Vergleich zur Applanationstonometrie nach Goldmann bei Glaukompatienten.

PURPOSE: The object of this study was to compare intraocular pressure measurements obtained with the TGDc-01"PRA", a new, transpalpebral indentation tonometer, with those from Goldmann applanation tonometry in normal and glaucomatous eyes. METHODS AND PATIENTS: Forty healthy eyes and 185 eyes suffering from glaucoma were included in the study. For Goldmann tonometry three measurements and for the TGDc-01 ten measurements were performed in a random order. All participants were placed in an upright position for all measurements. RESULTS: In both groups a systematic increase of intraocular pressure was found within the TGDc-01-measurements. Therefore, the first 3 measurements of each device were used for further statistical analysis. No learning curve could be demonstrated for the TGDc-01-measurement with normal eyes. Within the group of normal eyes the mean IOD obtained with the TGDc-01 was 1.84 mmHg lower than the mean IOD obtained with Goldmann tonometry (two-sided Student's t-test; P = 0.003). In the group of glaucomatous eyes, the mean intraocular pressure obtained with the Goldmann tonometry was 19.7 +/- 10.1 mmHg, with the TGDC-01 18.1 +/- 7.1 mmHg (coefficient of correlation r = 0.64, P < 0.001). The mean standard deviation of intraocular pressure measurements with Goldmann tonometry was 1.2 +/- 0.9 mmHg, with the TGDc-01 3.1 +/- 2.1 mmHg. TGDc-01-measurements overestimated intraocular pressure compared to Goldmann tonometry up to values of 16 mmHg and underestimated intraocular pressure at values over 16 mmHg. The difference increased by 5.5 mmHg per 10 mmHg Goldmann tonometry. The probability of success, defined as TGDc-01-recordings within +/- 3 mmHg of the Goldmann tonometry recordings, was less than 53 % between 5 and 20 mmHg and less than 30 % between 20 and 30 mmHg. Intraocular pressure (Goldmann tonometry) over 30 mmHg was always accompanied by TGDc-01-measurements lower than 3 mmHg. CONCLUSION: In eyes with elevated intraocular pressure, the TGDc-01"PRA" significantly underestimated the intraocular pressure measurement when compared to the gold standard, Goldmann tonometry. At present, measurement of the intraocular pressure with the TGDc-01 should not be used for clinical management of patients with glaucoma.

[Blinking activity during visual display terminal work. Part 1: Ocular discomfort and pathophysiological principles]. / Lidschlagaktivität während der Bildschirmarbeit. Teil 1: Okuläre Beschwerden und pathophysiologische Grundlagen.

Up to three-fourths of visual display operators complain about ocular discomfort after lengthy work at a monitor. The increase of displays at work has resulted in a problem area with growing impact for the economy and healthcare. Symptoms overlapping the complaints of dry eye disease point to the joint pathophysiological origin. In numerous studies the drastic decrease in blinking frequency was shown to be an essential cause of dry eye symptoms. Lid movements not only have the purpose of smoothing the precorneal tear film ("windshield effect"), but also affect the composition and stability of the different layers. Unfortunately, previous work has often been limited by the heterogeneity of measurement settings, leading to inconsistent results.

[Blinking activity during visual display terminal work. 2: reduced blinking and therapeutic approaches]. / Lidschlagaktivität während der Bildschirmarbeit. Teil 2: Reduzierter Lidschlag und therapeutische Ansätze.

New findings based on a noninvasive, automated long-term measurement method revealed interindividual differences in lid movement behavior, existence of blinking patterns, and the dominance of cognitive influence in the regulation of blinking frequency during increased concentration and especially visual attention. The development of an individual blinking animation promises long-lasting increase and harmonization of lid movements during visual display work. Maintenance of the integrity of the ocular surface by preventing surface evaporation and providing sufficient precorneal environment eradicates important pathogenic factors of ocular discomfort. An animation program for stimulation of blinking has been developed. First results showed that an increase in blinking rate initiated by the computer itself is feasible in principle during work at a visual display terminal. Further improvement of this new approach is promising.

[Anticoagulative therapy in patients with exudative age-related macular degeneration: acute angle closure glaucoma after massive intraocular hemorrhage]. / Akutes Winkelblockglaukom nach massiver intraokularer Blutung bei exsudativer altersbedingter Makuladegeneration unter gerinnungshemmender Therapie.

BACKGROUND: Acute secondary angle closure glaucoma after massive vitreous and subretinal hemorrhage from exudative age related macular degeneration is a seldom, but devastating complication of an anticoagulative therapy. PATIENTS: Four patients (age range 70-76 years) developed unilateral acute angle closure glaucoma after massive intraocular bleeding due to exudative age-related macular degeneration and anticoagulative therapy. Three patients received Phenprocomoun and one patient thrombolytic therapy with heparin. One eye had led to blindness at initial investigation. Pars plana vitrectomy was performed in the remaining three eyes. Within a few months, 2 of these 3 eyes were blind, one eye had light perception and all three eyes developed hypotonia. CONCLUSION: Acute angle closure glaucoma after intraocular bleeding may be the initial clinical manifestation of overtreatment with anticoagulants. Early pars plana vitrectomy probably will increase the surveillance rate of the eye but not the visual prognosis.