Luz pulsada intensa: resultados en ojo seco crónico tras LASIK

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: Schirmer I 14.7 ± 5.6; 15.6 ± 3.4 mm, tear breakup time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2 s (P > .003), DEWS 3.4 ± 0.5; 1.6 ± 0.7 (P < .003), Oxford grade 0.8 ± 0.77; 0.4 ± 0.75 (P > .003), VA 0.67 ± 0.26; 0.90 ± 0.15 (P < .0001), best corrected VA 0.83 ± 0.18; 0.92 ± 0.14 (P > .003), spherical equivalent −0.31 ± 0.6; −0.08 ± 0.38 D (P > .003), OSDI 34 ± 16; 28 ± 11.0 points (P > .003), frequency artificial tear use 3.4 ± 2.0; 2.5 ± 1.9 times/day (P > .03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment.     

Assessing the impact of non-dilating the eye on full-field electroretinogram and standard flash response

We investigated the possibility of performing electroretinography (ERG) in non-pharmacologically dilated eyes using brighter flash (time-integrated) luminance. Photopic (N = 26; background 25.5 cd·m⁻², white LED flashes) and scotopic ERG (N = 23, green LED flashes) luminance response functions were obtained simultaneously in a dilated (DE) and non-dilated eye (NDE). In the NDE, photopic V _max b-wave amplitude was reduced by 14% (P < 0.0001), implicit time prolonged (P < 0.0001), and retinal sensitivity (log K) decreased by 0.38 log units (P < 0.0001) with no effect on a-wave. Using a xenon strobe light (N = 6) to increase flash luminance, V _max remained lower by about 12% in the NDE (P = 0.02). V _max with LED and xenon was achieved at 3.9 ± 1.0 cd·s·m⁻² and 3.3 ± 0.81 cd·s·m⁻² in the DE and 10.6 ± 1.2 cd·s·m⁻² and 12.3 ± 1.90 cd·s·m⁻² in the NDE, that is an increase of 0.43 and 0.57 log unit (P < 0.0001), respectively. Increasing background luminance by 0.50 log units (80 cd·m⁻², N = 4) resulted in implicit time normalization but not V _max amplitude. Rod V _max was decreased by 7% in NDE (P < 0.05) and sensitivity reduced by 0.40 log units (P < 0.0001), but our data suggest that the luminance may have not been sufficient to reach V _max in all participants in the NDE and that the sensitivity change may have been due to an inadequate inter-stimulus interval. For the photopic ERG, increasing flash luminance is not sufficient to compensate for the smaller pupil size, whereas for the scotopic ERG, more data are needed to establish proper inter-stimulus interval to perform recordings in a non-pharmacologically dilated.     

Sehschärfe bei farbunterschieden ohne helligkeitsunterschiede

Die Sehschärfe wurde für Gitter gemessen, in denen sich die Gitterstriche nur durch die Farbe (Wellenlänge) nicht jedoch durch die Leuchtdichte unterschieden. Diese “chromatische Sehschärfe” steigt mit zunehmendem Wellenlängenunterschied an, erreicht jedoch, im Widerspruch zu früheren Literaturangaben, nicht die hohen Werte der achromatischen Sehschärfe.

Былa иccгeдoвaнa ocтpoтa зpeния для peшeтки, y кoтopoй дoлocы имeли paзнлй цвeт, пpи oдинaкoвoй яpкocти их. Этa хpoмaтихecкaя ocтpoтa зpeния yвeлихивacтcя c yвeлихeниeм paзлихий в длинe вoлны, нo нe дocтигaт тaких выcoких вeлихин кaк ocтpoтa зpeния для aхpoмaтихecких peшoтoк, вoпpeки бoлee paнним cooбщeниям.     

Alterations in corneal nerves in different subtypes of dry eye disease: An in vivo confocal microscopy study

PurposeTo evaluate corneal subbasal nerve alterations in evaporative and aqueous-deficient dry eye disease (DED) as compared to controls.MethodsIn this retrospective, cross-sectional, controlled study, eyes with a tear break-up time of less than 10 s were classified as DED. Those with an anesthetized Schirmer's strip of less than 5 mm were classified as aqueous-deficient DED. Three representative in vivo confocal microscopy images were graded for each subject for total, main, and branch nerve density and numbers.ResultsCompared to 42 healthy subjects (42 eyes), the 70 patients with DED (139 eyes) showed lower total (18,579.0 ± 687.7 μm/mm² vs. 21,014.7 ± 706.5, p = 0.026) and main (7,718.9 ± 273.9 vs. 9,561.4 ± 369.8, p < 0.001) nerve density, as well as lower total (15.5 ± 0.7/frame vs. 20.5 ± 1.3, p = 0.001), main (3.0 ± 0.1 vs. 3.8 ± 0.2, p = 0.001) and branch (12.5 ± 0.7 vs. 16.5 ± 1.2, p = 0.004) nerve numbers. Compared to the evaporative DED group, the aqueous-deficient DED group showed reduced total nerve density (19,969.9 ± 830.7 vs. 15,942.2 ± 1,135.7, p = 0.006), branch nerve density (11,964.9 ± 749.8 vs. 8,765.9 ± 798.5, p = 0.006), total nerves number (16.9 ± 0.8/frame vs. 13.0 ± 1.2, p = 0.002), and branch nerve number (13.8 ± 0.8 vs. 10.2 ± 1.1, p = 0.002).ConclusionsPatients with DED demonstrate compromised corneal subbasal nerves, which is more pronounced in aqueous-deficient DED. This suggests a role for neurosensory abnormalities in the pathophysiology of DED.     

Ankle-brachial index and ocular diseases in a Russian population

BackgroundTo assess potential associations between the ankle-brachial blood pressure index (ABI) and ocular disorders.MethodsIn the population-based cross-sectional Russian Ural Eye and Medical Study including 5,899 (80.5%) out of 7328 eligible participants aged 40+ years, the participants underwent a series of ocular and medical examinations including measurement of ABI.ResultsBlood pressure measurements of both arms and ankles were available for 3187 (54.0%) individuals. The mean ABI was 1.26 ± 0.19 (median:1.20; range: 0.61, 2.20). In multivariate analysis, a higher ABI was associated with younger age (P < 0.001; non-standardized regression coefficient B: −0.001; 95% confidence interval (CI): −0.002, −0.001), female sex (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04), lower body mass index (P < 0.001; B: −0.004; 95% CI: −0.006, −0.003), lower waist-to-hip ratio (P = 0.01; B: −0.10; 95% CI: −0.17, −0.02), lower glucose serum concentration (P = 0.008; B: −0.005; 95% CI: −0.009, −0.001), lower prevalence of arterial hypertension (P < 0.001; B: −0.14; 95% CI: −0.16, −0.12), higher mean systolic blood pressure (P < 0.001; B: 0.003; 95% CI: 0.002, 0.003), and higher prevalence of any alcohol consumption (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04). In that multivariate model, prevalence of glaucoma (P = 0.67) as a whole, open-angle glaucoma (P = 0.86) and angle-closure glaucoma (P = 0.54), stage of glaucomatous optic neuropathy (P = 0.57), prevalence of age-related macular degeneration (P = 0.88), prevalence and stage of diabetic retinopathy (P = 0.30, and P = 0.29, respectively), nuclear cataract (P = 0.32, and P = 0.41, resp.), cortical cataract (P = 0.33, and P = 0.92, resp.), subcapsular cataract (P = 0.74 and P = 0.60, resp.), and pseudoexfoliation (P = 0.44 and P = 0.47, resp.), intraocular pressure (P = 0.52), axial length (P = 0.20), and peripapillary retinal nerve fibre layer thickness (P = 0.55) were not significantly associated with the ABI.ConclusionsIn this ethnically mixed population from Russia, none of the major ocular diseases was associated with ABI suggesting that subclinical atherosclerosis is not markedly associated with the aetiology of these ocular disorders.Subject terms: Retinal diseases, Lens diseases     

Endogenous cortisol profile in patients with central serous chorioretinopathy

AIM—To study the endogenous cortisol levels in patients with central serous chorioretinopathy (CSCR).
METHODS—Endogenous cortisol levels in urine and plasma were determined in 30 patients with acute CSCR and compared with 30 age and sex matched controls.
RESULTS—The mean values of the 8 am plasma cortisol (29.97 µg/dl v 18.76 µg/dl), 11 pm plasma cortisol (22.03 µg/dl v 13.06 µg/dl), and 24 hour urine cortisol (11.01 mg/24 h v 7.39 mg/24 h) revealed significantly higher values in the patient group (p<0.001).
CONCLUSIONS—Increased levels of endogenous cortisol are present in patients with CSCR.

     

Proliferation of the juxtapapillary retinal pigment epithelium simulating malignant melanoma

Summary Four cases of pseudomelanomas of the nerve head are described; two have been studied histopathologically. All patients had in common: a) disturbance in and adjacent to the optic nerve head with ill-defined borders and a particular pattern described as mottled, mossy, or filigree; b) slight elevation of the affected tissues, but without definite tumefaction; c) fine retinal folds or striae radiating from the lesion to the macula; d) stationary or slowly progressive course; and e) enlargement of the blind spot with deterioration of vision.Only two quite similar cases could be found in the literature.

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Zusammenfassung Vier Fälle von Pseudomelanoma des Sehnervenkopfes werden beschrieben; 2 davon wurden histologisch untersucht. Als gemeinsame Merkmale bestanden: a) in der Papille oder an sie angrenzend ein Krankheitsherd mit unbestimmten Grenzen und einem besonderen Anblick, der mit einem Streifenmuster, einer Moosfläche oder einer Filigranarbeit verglichen werden kann; b) eine leichte Vorwölbung der betroffenen Gewebe, jedoch ohne daß von einer Tumormasse gesprochen werden kann; c) feine Netzhautfalten oder von der Läsion aus gegen die Makula ausstrahlende Streifen; d) ein stationärer oder nur langsam progressiver Verlauf; e) eine Vergrößerung des blinden Flecks mit Herabsetzung der Sehkraft.In der Literatur konnten nur zwei ganz ähnliche Fälle gefunden werden.

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Résumé Quatre cas de pseudo-mélanome de la papille sont décrits; l'examen anatomopathologique a été fait chez deux d'entre eux. Chez tous ces malades on a constaté: a) une anomalie dans et immédiatement à côté de la papille; ses bords sont mal délimités et son aspect très particulier a été comparé à de la mousse, à des marbrures ou à un filigrane; b) une légère saillie des tissus touchés, sans qu'il n'existe une réelle tumeur; c) de fins plis rétiniens et des stries irradiant de la lésion à la macula; d) un état stationnaire ou évoluant très lentement; e) un élargissement de la tache aveugle et une baisse de l'acuité visuelle.On n'a trouvé dans la littérature que 2 rapports concernant des cas similaires.

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This work was supported in part by Training Grant 5-J01-NB-5379.     

S-opsin protein is incompletely modified during N-glycan processing in Rpe65 mice

Retinal pigment epithelium-specific protein 65 kDa (RPE65) is a key enzyme for the visual cycle in the eye. Rpe65^−/− mice lack 11-cis-retinal, and show early cone degeneration and mislocalization of cone opsins. The present study investigated whether abnormal modification of cone opsins at the protein level is present in Rpe65^−/− mice. Retina-RPE-choroids of Rpe65^−/− mice at 3, 5 and 7 weeks old were used. Immunohistochemistry of opsins was performed using cryosections and retinal flatmounts. We evaluated levels of mRNA for cone and rod opsin genes by RT-PCR and levels of proteins by western blotting. To examine modification patterns of N-glycan in Rpe65^−/− mice, cone opsins were digested with peptide-N-glycosidase (PNGase) F. S-opsin protein was detected at ∼40-kDa as a major band in wild-type mice, whereas ∼42-kDa S-opsin protein was detected in Rpe65^−/− mice. After PNGase F treatment, mobility of S-opsin protein in wild-type and Rpe65^−/− mice on SDS-PAGE was similar. In addition, ∼25-kDa S-opsin polypeptide was notably detected in Rpe65^−/− mice. Conversely, M-opsin proteins were not observed by immunohistochemistry or western blotting in Rpe65^−/− mice, but expression of M-opsin mRNA in Rpe65^−/− mice did not differ significantly from that in wild-type mice at 3 and 5 weeks. Mobility of M-opsin protein in Rpe65^−/− mice was unchanged. Our data suggest that S-opsin protein is incompletely modified during N-glycan processing in Rpe65^−/− mice, whereas M-opsin protein is severely reduced by posttranslational degradation in the absence of incomplete N-glycan processing in Rpe65^−/− mice.     

Influencia de la longitud axial ocular en el grosor de la capa de fibras nerviosas peripapilar medido con tomografía de coherencia óptica

BackgroundOptical coherence tomography (OCT) allows the measurement of the peripapillary optic nerve fiber layer (RNFL) thickness. The effect of ocular axial length (AL) on RNFL thickness measurement may be relevant in the interpretation of OCT results in diagnosing optic nerve diseases.PurposesTo assess the influence of ocular AL on RNFL thickness and on optic disc topographic parameters (optic disc area, rim area and cup volume) measured by OCT, in healthy individuals.MethodA sample of 109 healthy eyes classified into three groups according to AL (A: AL <22 mm; B: AL 22–24.5 mm; C: AL >24.5 mm) was studied. RNFL thickness and optic disc topographic parameters were measured using Swept-Source OCT Triton (Topcon Corporation, Tokyo, Japan) and were compared between groups using a variance analysis. Correlation between the AL and the study variables was performed using a Pearson's correlation coefficient test.ResultsThe RNFL thickness was lower in eyes with higher AL in the superior (r = −0.41; p < 0.001), inferior (r = 0.58; p < 0.001) and nasal (r = −0.43; p < 0.001) quadrants, in the mean value of the RNFL (r = −0.49; p < 0.001), optic disc area (r = −0.40; p < 0.001) and rim area (r = −0.25; p = 0.01).ConclusionAL is negatively correlated with RNFL thickness and optic disc topographic parameters measured by Swept-Source OCT Triton (Topcon).     

Characteristics of saccadic intrusions

Primary fixation is never perfectly stable, but is frequently interrupted by slow drifts, microsaccades and saccadic intrusions (SI). SI are involuntary, conjugate movements which take the form of an initial fast movement away from the desired eye position and followed after a short duration, by either a return secondary saccade or a drift. The purpose of this study was to examine the prevalence and metrics of SI in a population of 50 healthy subjects. Using both one and two dimensional recordings we find that all 50 members of the subject group exhibited SI. The SI were bilateral, conjugate and horizontal. No purely vertical SI were detected when examined in three subjects. SI amplitude mean and range was 0.6° ± 0.5°, 0.1°-4.1°; SI frequency mean and range was 18.0 ± 14.3 per min, 1.0-54.8 per min; SI duration mean and range was 225 ± 150, 20-870 ms. The mean SI amplitude and frequency when SI < 0.5° were removed was 0.97° ± 0.56° and 7.0 ± 11.4 per min respectively. Age was positively correlated with SI amplitude (p < 0.01), but there was no correlation between age and SI frequency. Three of four types of SI monophasic square wave intrusions (MSWI), biphasic square wave intrusions (BSWI) and double saccadic pulses (DSP) were found to be exclusively saccadic, whilst the fourth type, the single saccadic pulses (SSP), were confirmed to exhibit a slow secondary component. MSWI were the most frequently observed SI occurring in 47 out of 50 (94%) of the subjects with a mean amplitude, frequency and duration of 0.7° ± 0.5°, 11.5 ± 11.6 per min, and 255 ± 147 ms respectively. Mean amplitudes and frequencies for BSWI (n = 20), SSP (n = 11) and DSP (n = 34) were found to be 0.50° ± 0.2°, 1.2 ± 2.5 per min; 0.40° ± 0.20°, 0.4 ± 1.0 per min and 0.3° ± 0.4°, 5.0 ± 8.7 per min respectively. No differences in MSWI characteristics were found between binocular and monocular viewing. Possible explanations for SI occurrence include experimental viewing conditions, subject fatigue and covert shifts in attention.     

Treatment of ocular symptoms of Behçet's disease with interferon α2a: a pilot study

AIM—To study long term effects of interferon α_2a (IFNα_2a) on panuveitis in seven patients with Behçet's disease in a prospective, open clinical trial.
METHODS—Seven patients were treated with IFNα_2a for a mean of 23.6 months (14-37 months). They received an initial dose of IFNα_2a of 6×10⁶ IU/day, followed by 3×10⁶ IU/day after 1 month and 3×10⁶ IU every other day after 3 months. Two patients received low dose prednisolone (between 0.2 and 0.4 mg/kg/body weight) additionally at the beginning of the therapy. Complete cessation of IFNα_2a was possible in three patients (observation period 22, 6, and 4 months).
RESULTS—Marked improvement occurred in six patients who had ocular manifestations of Behçet's disease for the first time or with minor damage during their course of chronic relapsing panuveitis. In one patient with advanced ocular Behçet's disease, new relapses were prevented. Retinal infiltrates resolved within 2 weeks; vasculitis, macular oedema, infiltration of the anterior chamber and vitreous resolved within 4 weeks. Mean posterior uveitis score before treatment (nine affected eyes) was 6.6, 4 weeks after IFN it was reduced to 0.4. The mean observation period is 27.6 months, ranging from 14 to 42 months.
CONCLUSION—Treatment of ocular symptoms of Behçet's disease with IFNα_2a alone or in combination with low dose steroids led to complete remission of ocular vasculitis in all patients treated in this open, uncontrolled trial. Treatment with IFNα_2a may prevent permanent retinal or optic nerve damage due to vascular occlusion. No severe side effects occurred. Controlled randomised studies are warranted in order to prove the efficacy of IFNα_2a in ocular Behçet's disease and to compare it with other, established treatments such as azathioprine or cyclosporin A.

Keywords: Behçet's disease; uveitis; interferon α_2a     

Kerato-Iritis mit sogenannten Tuberkuliden der Iris bei Erythema induratum (Bazin)

Zusammenfassung Erstmalige Beschreibung flüchtiger Irisknötchen und Hornhauttrübungen bei Erytheme induratum(Bazin), wobei die Augenerkrankung schubweise im Verlauf der Hautschübe auftrat. Bis zur endgültigen Klärung des Krankheitsgeschehens wird es für zweckmäßig gehalten, im Falle gesicherter tuberkulöser Ätiologie für diese Veränderungen den bisher gebräuchlichen Namen Tuberkulide beizubehalten. In den anderen Fällen ist eine allgemeine Bezeichnung, wie flüchtige Irisgranula, angebracht, da es sich augenscheinlich nicht um spezifische Knötchen handelt.Herrn Prof. Dr.F. Salzer zum 75. Geburtstag gewidmet.     

Sodium orthovanadate effect on outflow facility and intraocular pressure in live monkeys

Sodium orthovanadate (Na₃VO₄) is reported to reduce IOP by affecting aqueous formation, but whether it also affects outflow facility (OF) is unclear. We tested the effect of Na₃VO₄ on OF and intraocular pressure (IOP) in live cynomolgus monkeys, and on actin and cell adhesion organization in cultured human trabecular meshwork (HTM) cells. Total OF (n = 12) was measured by 2-level constant pressure perfusion of the monkey anterior chamber (AC) before and after exchange with 1 mM Na₃VO₄ or vehicle in opposite eyes. Topical 1% Na₃VO₄ or vehicle only was given twice daily (each 2 × 20 μL drops) for 4 days to opposite eyes (n = 8), and Goldmann IOP was measured before and hourly after treatment for 6 h on Days 1 and 4. Filamentous actin and vinculin-containing cell adhesions were examined by epifluorescence microscopy after the cells had been incubated with 1 mM Na₃VO₄ for 24 h. A) In monkeys, Na₃VO₄ increased OF by 29.3 ± 8.8% (mean ± s.e.m.) over the perfusion interval when adjusted for baseline and contralateral eye washout (p = 0.01; n = 12). B) Day 1 baseline IOP was 16.2 ± 1.5 mmHg in treated eyes and 15.9 ± 1.3 mmHg in the contralateral control eyes. Following treatment on Day 1, IOP was no different (p > 0.05) between treated eyes and control eyes at any time-point or compared to baseline. Day 4 mean IOP averaged over hours 2-6 was 13.5 ± 0.8 mmHg in treated eyes and 16.1 ± 0.2 mmHg in control eyes. Treated eye IOP was lower than its Day 4 baseline (p < 0.005), lower than control eyes for the same Day 4 interval (p = 0.009), and lower than the Day 1 baseline (p = 0.0000). Control eye IOP on Day 4 was not significantly different from baseline on Day 1. C) Incubation of HTM cells with 1 mM Na₃VO₄ for 24 h caused a loss of actin stress fibers and vinculin-containing adhesions. Cell retraction and separation was also observed in vanadate-treated cultures. Reformation of actin stress fibers, vinculin-containing adhesions and confluent monolayers occurred within 24 h after Na₃VO₄-containing culture medium was replaced with Na₃VO₄-free medium. Ocular administration of Na₃VO₄ to live monkeys significantly increases OF and reduces IOP. Na₃VO₄ reversibly disrupts actin and cell adhesion organization and causes retraction and separation of cultured HTM cells. Na₃VO₄ increases pressure-dependent outflow in live monkeys. Altered actin architecture in the TM may play a part in this increased OF.     

Total ocular, anterior corneal and lenticular higher order aberrations in hyperopic, myopic and emmetropic eyes

Total ocular higher order aberrations and corneal topography of myopic, emmetropic and hyperopic eyes of 675 adolescents (16.9 ± 0.7 years) were measured after cycloplegia using COAS aberrometer and Medmont videokeratoscope. Corneal higher order aberrations were computed from the corneal topography maps and lenticular (internal) higher order aberrations derived by subtraction of corneal aberrations from total ocular aberrations. Aberrations were measured for a pupil diameter of 5 mm. Multivariate analysis of variance followed by multiple regression analysis found significant difference in the fourth order aberrations (SA RMS, primary spherical aberration coefficient) between the refractive error groups. Hyperopic eyes (+0.083 ± 0.05 μm) had more positive total ocular primary spherical aberration compared to emmetropic (+0.036 ± 0.04 μm) and myopic eyes (low myopia = +0.038 ± 0.05 μm, moderate myopia = +0.026 ± 0.06 μm) (p < 0.05). No difference was observed for the anterior corneal spherical aberration. Significantly less negative lenticular spherical aberration was observed for the hyperopic eyes (−0.038 ± 0.05 μm) than myopic (low myopia = −0.088 ± 0.04 μm, moderate myopia = −0.095 ± 0.05 μm) and emmetropic eyes (−0.081 ± 0.04 μm) (p < 0.05). These findings suggest the existence of differences in the characteristics of the crystalline lens (asphericity, curvature and gradient refractive index) of hyperopic eyes versus other eyes.     

Über die Beeinflussung der Unterschiedsempfindlichkeit des Auges durch Nebenreize

Zusammenfassung 1. Die Unterschiedsempfindlichkeit des einen Auges wird durch das Beleuchten des anderen erniedrigt.2. Dieses Abnehmen der Unterschiedsempfindlichkeit kann man als eine Folge der zentralen, dem Sehzentrum des untersuchten Auges durch den Nebenreiz hinzugefügten ErregungZ verstehen.3. DieseZ-Größe läßt sich aus der Gleichung berechnen.4. Im Vergleich zur Größe des Nebenreizes selbst betrug dieZ-Größe bei unseren Versuchsanordnungen nur etwa einige Hundertstel eines Prozents.5. Das Anwachsen derZ-Erregung mit der Verstärkung des NebenreizesJ _N folgt der Formel einer linearen Beziehung:Z=a·10^–5·J _N. Die Größe der Konstantea schwankte individuell bei unserer Versuchsanordnung für verschiedene Versuchspersonen von 0,20 bis 0,58.6. Nach dem Abschluß des Beleuchtens des einen Auges klingt die von ihm hervorgerufeneZ-Erregung im Sehzentrum des anderen in einer exponentiellen Abhängigkeit von der verflossenen Zeit ab.Die oben beschriebenen Experimente wurden im Jahre 1931 im Moskauer Institut für Physik und Biophysik ausgeführt. Allen meinen Kollegen, welche als Versuchspersonen an dieser Arbeit teilnahmen, bin ich sehr dankbar.     

Long term results of surgery on patients with tubular fields due to glaucoma simplex

Summary From a survey of over 1700 glaucoma patients, I have found 33 cases where patients with impaired vision and tubular fields retained their sight almost unchanged for a long period of time of 10 to 22 years after having been operated on by iridencleisis. According to my own experience, I strongly advocate a surgical rather than a medical treatment of such patients, however, always with regard to age and other factors.

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Zusammenfassung Unter mehr als 1700 beobachteten Glaukompatienten habe ich 33 Fälle gefunden, bei denen das geschädigte Sehvermögen und ein röhrenförmiges Gesichtsfeld nach durchgeführter Iridencleisis während eines langen Zeitraumes von 10–20 Jahren unverändert erhalten geblieben war. Meinen eigenen Erfahrungen gemäss, bin ich in solchen Fällen entschieden mehr für eine operative als für eine medikamentöse Behandlung, jedoch unter Berücksichtigung des Alters des Patienten und anderer Faktoren.

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Résumé Parmi plus de 1700 malades observés j'ai trouvé 33 cas, où la vision et un champ visuel tabulaire restèrent presque inchangés pendant une longue période de 10 à 20 ans après un iridencléisis. D'après ma propre expérience, je recommande dans des cas de ce genre le traitement opératoire plutôt que la thérapeutique médicale, prenant toutefois l'âge du malade et d'autres facteurs en considération.

     

Tonometrie und differentialtonometrie,tension und rigiditaetskoeffizient

Zusammenfassung Die Befunde über die Änderung des Rigiditätskoeffizienten unter verschiedenen diagnostischen und therapeutischen Bedingungen, wie sie in der Augenheilkunde besonders im Zusammenhang mit dem Glaukom üblich sind, machen es notwendig, entweder in jedem einzelnen Fall, selbst bei kleineren Druckänderungen, den Rigiditätskoeffizienten im Rahmen der Tonometrie jeweils zu berücksichtigen, oder solche Methoden anzuwenden, bei denen der Rigiditätskoeffizient das Resultat nicht beeinflusst. Ist es seit den Arbeiten Friedenwalds möglich, mit dem Schiötz-Tonometer Rigiditätskoeffizient und P₀-Wert zu bestimmen, so kann man mit Hilfe des Applanationstonometers nach Goldmann im Rahmen der Differenzwert-Bestimmung neben der Rigidität auch instrumenteile Mängel und Kalibrationsungenauigkeiten des Schiötz-Tonometers und Abweichungen des Hornhautradius vom Mittelwert korrigieren. Mit Hilfe des Applanationstonometers nach Goldmann war es uns ausserdem möglich, Druck-Volumen-Schemata für Applanationstonometer zu konstruierten. Nach Färbung sowohl mit wässerigen als auch Glycerinhaltigen Farbstoffen kann man Rigiditäts-oder Differenzwertbestimmungen auch mit dem Maklakoff-Tonometer durchführen. Man kommt so bei Verwendung von Schiötz- und Maklakoff-Tonometer Tonometern ganz verschiedenen Prinzips, die in der Welt am meisten gebraucht werden, zu gleichen Resultaten.

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Summary The findings of change of the coefficient of scieral rigidity under different diagnostic and therapeutic conditions, as they are particularly frequent in connection with glaucoma, necessitate either to take into consideration the rigidity coefficient in every single case even when small changes of pressure occur or to apply such methods, the results of which are not influenced by the rigidity. Friedenwald's work enables us to determine with the Schiötz-tonometer the rigidity coefficient and the P₀-value, the Goldmann-Applanation-tonometer provides us with the differential-value-method to correct beside the rigidity also instrumental shortcomings and calibration inexactitudes of the Schiotz-tonometer and deviations of the mean value of corneal curvature. With the Goldmann-Applanation-tonometer it has been possible for us to design pressure-volume charts for Applanation-tonometer. Rigidity- and Differential-value-determination can be carried out with the Maklakoff-tonometer using aqueous or glycerine dyes. Thus the same results are obtained with the Schiötz and Maklakoff-tonometer, tonometers of entirely different principle which are most commonly used in the world.

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Résumé Le coefficient de rigidité étant variable dans les différents procédés d'exploration de l'oeil glaucomateux, on est obligé d'en tenir compte dans chaque mensuration tonométrique, même lors de variations minimes de la tension. Ceci peut être évité par l'emploi de méthodes dont le résultat n'est pas influencé par le coefficient de rigidité. C'est par les travaux de Friedenwald qu'il a été possible d'évaluer le coefficient de rigidité et le P₀ au moyen du tonomètre de Schiötz. Le tonomètre par aplanissement de Goldmann nous permet, en mesurant la valeur différentielle, de corriger non seulement la rigidité oculaire, mais encore les défauts instrumentaux du tonomètre de Schiötz, les fautes dues à une calibration inexacte de cet appareil et même l'influence des variations de la courbure cornéenne. Au moyen du tonomètre par aplanissement de Goldmann nous avons réussi à construire des schémas tension-volume pour les tonomètres par aplanissement. La mensuration de la rigidité oculaire et de la valeur-différentielle peut se faire aussi avec le tonomètre de Maklakoff, employé avec des colorants aqueux ou glycérines. Dans ces conditions le tonomètre de Schiötz et le tonomètre de Maklakoff, quoique basés sur des principes totalement différents, nous fournissent des résultats identiques.

     

Klinische Fluorometrie und Uveitis-Atiologie

Zusammenfassung Die Untersuchung der Fluoresceinpermeabilität der Blut-Kammerwasser-Schranke, bzw. die auf der Amsler-Huberschen Methode aufgebaute klinische Fluorometrie, liess sich in der Untersuchung der Uveitisätiologie mit Erfolg verwenden. Nach der Anfertigung der fluorometrischen Kurve ist der Kranke sorgfältig zu untersuchen. Besteht der Verdacht einer Herdinfektion, wird mit dem Extrakt des verdächtigen Herdes (Antigen) eine Kutanprobe vorgenommen. Liefert die Fluorometrie 48h nach der positiven Kutanprobe erhöhte Permeabilitätswerte, ist der Herd als Ursache anzusehen, nach dessen Entfernung - oder nach Desensibilisierung- die Uveitis heilt. Zur Erkenntnis der tuberkulösen Ätiologie oder der Strepto-Staphylokokkenallergie ist die Fluorometrie ebenfalls geeignet. Es hat sich durch die Anwendung dieses Verfahrens gezeigt, dass bei 30% ein Zahnherd, bei 10% die Tonsille, bei 16% die Prostata und bei 36% ein Tuberkuloseherd für die Uveitis verantwortlich war (92% ätiologisch geklärt). Heilung ist anzunehmen, wenn nach Herdentfernung (bzw. Desensibilisierung und antibiotischer Behandlung) die Fluoresceinpermeabilität abnimmt und allmählich normal wird.

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Summary The examination of the fluorescein-permeability of the blood-aqueousbarrier, respectively the clinical fluorometry basing on the method of Amsler & Huber could be successfully applied in the investigation of the aetiology of uveitis. After the drawing up of the fluorometric curve the patient has to be examined carefully. If a focal infection is suspected a skin test is made with an extract of the questionable focus or antigen. If the fluorometry supplies enhanced values of permeability 48 hours after the positive cutaneous test, the focus is to be thought the cause. After its removal or after the desensitization the uveitis will heal. The fluorometry also is apt to elucidate a tuberculous aetiology or a strepto-staphylococciallergy. By applying the method in 30% a dental focus, in 10% the tonsils, in 16% the prostrate and in 36% a tuberculous focus could be incriminated to induce the uveitis. Healing is to be assumed, when after the removal of the focus or desensitization and antibiotic treatment, respectively, the permeability to fluorescein decreases and gradually becomes normal.

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Résumé L'examen de la perméabilité de la barrière hémato-oculaire à la fluorescéine, c.à.d. la fluorométrie telle qu'elle a été développée à partir de la méthode d' Amsler & Huber, s'est révelé une méthode efficace dans l'étude étiologique de l'uvéite.Dans l'hypothèse d'une infection focale on procède au test cutané avec un extrait du foyer (antigène). Si l'examen fluorométrique montre 48 h après un test positif une perméabilité accrue, le foyer peut être retenu comme facteur étiologique et l'uvéite guérit après élimination du foyer ou après désensibilisation.La fluorométrie sert également à détecter une étiologie tuberculeuse ou une allergie aux streptocoques et aux staphylocoques.A l'aide de cette méthode 92% des cas examinés ont pu être étiologiquement diagnostiqués. 30% montraient un foyer dentaire, 10% une tonsillite, 16% une prostatite et 36% une foyer tuberculeux.L'uvéite peut être considérée comme étant guérie, si après élimination du foyer, désensibilisation ou traitement antibiotique, la perméablilité à la fluorescéine devient progressivement normale.

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Augenabteilung des Staatl. Institutes für Rheuma und Bäderwesen. Direktor: Professor K. Farkas.     

Adaptation and the electrical excitability of the eye

Summary Recent discoveries on the ommatidium mosaic structure of the human retina for sharp vision in colour are shortly reviewed and discussed in terms of new experimental results of electric phosphene threshold measurements with sinusoidal and pulse-shaped current.

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Zusammenfassung Nach einem kurzen Überblick über die letzten Beobachtungen der Ommatidien-Mosaikstruktur der menschlichen Retina für scharfes Farbsehen werden diese im Hinblick auf experimentelle Resultate für elektrische Phosphenschwellenmessungen mit sinusförmigem und pulsförmigem Strom diskutiert.

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Résumé Les dernières découvertes sur la disposition en mosaique des ommatidies dans la rétine humaine sont passées en revue et leur importance pour une bonne vision des couleurs est soulignée. Elles sont discutées étant donné que de nouveaux résultats expérimentaux portant sur des mesures du seuil de phosphènes électriques, provoqués par un courant sénusoidal ou puisé, ont été obtenus.