Automatic (Octopus) and manual (Goldmann) perimetry in glaucoma

Of 115 patients with chronic open angle glaucoma or suspected glaucoma 115 eyes were subjected to a visual field examination with the manual Goldmann perimeter and the automatic Octopus perimeter. In 84.4 ±8.9% the automaton detected more visual field loss, including 27.8±10.9% of the eyes where no visual field loss was found by the manual perimetry. Since some eyes with normal fields on manual perimetry and abnormal fields detected by automatic perimetry remained abnormal on retesting, it is assumed that scotomas found by automatic perimetry and not shown by manual perimetry constitute false-negative manual fields rather than false-positive automatic fields.Presented in part at the First International Meeting on Automated Perimetry, System OCTOPUS, in Zurich, April 6–7, 1979 and at the ARVO Spring Meeting in Sarasota, Florida, 1979 Offprint requests to: Professor B. Gloor, Universitäts-Augenklinik, Mittlere Strasse 91, CH-4056 Basel, Switzerland     

Optical coherence tomography (OCT) angiomatous prolifieration (RAP) in retinal

PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.     

Application of the Metaireau tube (M-tube) in conjunctivodacryocystorhinostomy (CDCR)

PurposeA new tube, Metaireau tube (M-tube), was examined for its proficiency, durability, and safety for use in conjunctivodacryocystorhinostomy (CDCR). The frequent complications associated with this procedure and Jones tubes, such as tube migration, pyogenic granuloma, and tube obstruction, were particularly checked.MethodsThe study was a retrospective interventional case series conducted at a single institution between January 2009 and October 2012. An M-tube was used in 13 cases of external CDCR and four endoscopic CDCR. Ten cases were females and seven were males. Patients aged from 20 years old to 82 years old, mean 52.7 years. Six cases were complicated traumatic canalicular laceration. Five cases were replacement of lost or dislocated Jones tubes. The M-tube is flexible and slick. The tube length that remains in the nasal cavity is adjustable by scissor trimming with endoscopic observation.ResultsThe surgery was uneventful. The tear drainage function works well when the tube is in situ. Twelve cases developed dry eye requiring artificial tear postoperatively. Nasal migration of the tube is frequently encountered in the early postoperative period (5/17, 29.4%). Reposition is easy using an endoscope. The tube is pulled out from the nose and replaced in the original tract. Mild tube extrusion occurred in one case without epiphora. Granuloma developed in one case. The follow-up took place from 2 months to 36 months, mean 21.6 months.ConclusionThe M-tube is easy to use in either external or endoscopic CDCR. When dislocated, the tube is simple to reposition. Frequent follow-up in the postoperative 6 months is suggested for early detection of minor migration.     

Photocoagulation in retinal branch vein occlusion (RBVO) (author's transl)

54 cases of retinal branch vein occlusion, 19 of which received photocoagulation treatment, were reviewed to assess the value of photocoagulation in this disease. Our results suggest that the effect of photocoagulation in the treatment of macular edema is not convincing. This finding is in contrast to the main stream in literature. On the other hand the treatment's beneficial effect in destroying or preventing neovascularisations in the course of RBVO seems established and may even be enhanced with the technique described. On the basis of our results and theoretical considerations, some guidelines for the care and treatment of RBVO patients are suggested.     

Optical Coherence Tomography Angiography (OCT-A) in young choroideremia (CHM) patients

Purpose: To study OCT-A findings in young patients affected with CHM

Methods: Young patients affected with CHM and age-matched control subjects were consecutively enrolled at the Regional Reference Center for Hereditary Retinal Degenerations at the Eye Clinic in Florence. All patients underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), fundus autofluorescence (FA), optical coherence tomography (SS-OCT) and 3 × 3 mm swept-source OCT angiography (SS-OCTA). Superficial capillary plexus (SCP), deep capillary plexus (DCP) and OCT-A choriocapillaris slabs (CC) were processed using Imagej software to identify vessel density (VD).

Results: Seven patients affected with CHM (14 eyes) and 7 age – matched control subjects (14 eyes) were included in our study. Visual acuity was 20/20 in all subjects. The detected CRT was significantly lower in the control group (212 ± 8,01 µm) in comparison with the patients (234 ± 53,7 µm), p < 0.01. The CC VD was reduced compared to controls (p < 0.01). Quantitative analysis of the inner retinal vasculature disclosed a significant impairment of both SCP (P < 0.01) and DCP (p < 0.01) vessel density compared to the control group. The FAZ area of the patients was smaller than controls (p < 0.01).

Conclusion: OCT-A examinations revealed early vascular abnormalities in both inner retinal layers and choriocapillaris. A reduced vascular flow was also detectable in the presence of a preserved macular RPE at the color fundus, FA, and OCT examinations. OCT-A is clinically useful for evaluating early involvement of the retinal and choriocapillaris vascular network in choroideremia.     

視網膜色素變性(RP)患者的EOG异常改變

目的探討RP患者眼電圖(EOG)的特徵以及EOG作為評估RP手術療效的客觀指標的可能性.方法采用MVT-3型視覺電生理儀的EOG采集和分析軟件,對正常對照組和RP患者組在術前與術後進行檢測.結果(1)105名RP患者的EOG曲綫大體可分為兩種類型,即彎曲型與平坦型.彎曲型EOG各項參數較接近正常組EOG,該組絕大部分患者的視野為斑駁狀;而平坦型EOG的一些主要參數(如Arden比和G比值等),明顯地低于正常組,該組患者的視野多為管狀視野或視野完全缺損.(2)在進行手術後半年以上復查EOG,則一些主要參數數值增加,有的患者(34.5%)的EOG由平坦型轉變為彎曲型.結倫RP患者的EOG具有為該病所特有的特徵,術後隨主觀癥狀的改善,EOG异常也恢復或部分恢復,這些都可作為該病診斷以及術後療效評估的客觀指標之一.     

Optical coherence tomography (OCT) in idiopathic polypoidal choroidal vasculopathy (IPCV)

Purpose: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a distinct clinical entity characterized by an edematous maculopathy and typical choroidal vascular change. The purpose of this study is to evaluate the use of optical coherence tomography (OCT) for diagnosing of this disease. Methods: 4 patients affected by IPVC (mean age 71–84 years) underwent biomicroscopy with a three mirror conctact lens, fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT (Humphrey Zeiss) scan. Results: in all 4 cases OCT tomograms acquired at the location of the typical choroidal abnormalities demonstrated by ICGA, revealed a characteristic hyper-reflectivity in the choroidal layers. Conclusion: ICGA is essential to diagnose IPVC, but OCT may be able to identify characteristic reflectivity patterns. This revised version was published online in July 2006 with corrections to the Cover Date.     

TV-pattern reversal stimulus (VECPs) in determination of refraction (author's transl)

Pattern reversal VECPs show a dependence on visual acuity and therefore are suitable for objective determination of refraction, this method, however, was of limited clinical use for two reasons, as, on the one hand, the required impulse parameter was difficult to change using the traditional mechanically functioning pattern stimulator and, on the other hand, diagnosis war very timeconsuming. Using a pattern impulse picture presented on a monitor by an electornic impulse apparatus all impulse parameters can easily be changed and throught he introduction of a microprocessorsystem the evaluation can be observed on-line.     

Vasoactive intestinal peptide (VIP) exacerbates endotoxin-induced uveitis (EIU) in mice

PURPOSE: We have previously shown that inhibition of the proinflammatory cytokine tumor necrosis factor- (TNF)-alpha exacerbates the inflammatory process of EIU. To further examine this paradoxic phenomenon, we investigated here the effect on EIU of VIP, a neuropeptide that inbibits TNF-alpha production. METHODS: VIP was injected concurrently with endotoxin at doses that induce EIU or lethality in mice. Severity of EIU was measured by counting infiltrating cells in eye sections, at 1 or 5 days post endotoxin injection. Survival of mice was monitored periodically, while serum levels of TNF-alpha, interleukin-(IL)-1beta and IL-10 were determined by caputure ELISA. RESULTS: Treatment with VIP exacerbated EIU but provided partial protection from the lethal endotoxin effect. VIP treatment also reduced serum levels of TNF-alpha and IL-1beta, but increased levels of IL-10. CONCLUSION: This study further established the paradoxical observation that EIU is exacerbated by lowering the levels of circulating pro-inflammatory cytokines, in particular TNF-alpha.     

Radiotherapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD)

AIM OF THE STUDY: Several pilot studies have indicated, that radiation therapy might have a beneficial effect on the course of CNV in AMD. This controlled study was aimed at the question, whether such treatment might halt progression of neovascular AMD and whether a low or a high radiation dose should be applied. METHODS AND PATIENTS: Enclosed were patients aged > or = 60 and < or = 85 and eyes with a VA of > or = 0.1 and < or = 0.6, revealing a juxta/subfoveal CNV either of the occult or the classic type. Treatment was performed with a linear accelerator at fractions of 2 Gy up to a total dose of 10 Gy or 36 Gy. 95 eyes had completed follow-up of > or = 12 < or = 24 months. RESULTS: Among eyes with occult CNV 8 received 36 Gy, 16 were treated with 10 Gy and 21 were in the control group. Mean visual loss was 3.5 lines after 12 months and 5 lines after 24 months with no difference between irradiated eyes and those in the control group. In the groups with classic CNV 8 eyes were treated with 36 Gy, 27 eyes received 10 Gy and 15 eyes were in the control group. Mean visual loss after 6 months was 2.2 lines in eyes of both groups treated with radiation and 5.7 lines in the control group. This was statistically significant (p < 0.05). VA was < 0.1 after 12 (24) months of follow-up in 50 (75)% of the cases with 36 Gy, in 48 (83)% with 10 Gy and in 60 (83)% of the controls. These results were statistically significant after 12 months only. DISCUSSION AND CONCLUSIONS: The natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In eyes with classic CNV a VA of > or = 0.1 was maintained significantly more often in irradiated eyes than in those of the control group. Treatment with 36 Gy however was associated with an unacceptable incidence of radiation retinopathy.     

Anti-herpes simplex virus (HSV) effect of 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) in rabbit cornea

The anti-herpes simplex virus (HSV) effect and cytotoxicity of a new nucleoside analogue, 9-(1,3-dihydroxy-2-propoxymethyl)guanine (DHPG) in rabbit cornea were studied. In tests of the anti-HSV effect of DHPG, even 0.03% ointment, given 5 times per day for 2 days, prevented lesion formation. The preventive effect of DHPG was much stronger than that of acyclovir (ACV) or 5-iodo-2'-deoxyuridine (IDU). In tests on the therapeutic effect of DHPG against dendritic ulcers, 0.3% ointment, given 5 times per day for 4 days, had a dramatic therapeutic effect. The effect was stronger than that of 3% ACV or 0.5% IDU ointment. Application of 0.3%, 1% or 3% DHPG ointment to normal rabbit corneas, 5 times per day for 2 weeks resulted in no histopathological abnormalities. The above results show that DHPG is superior to ACV or IDU for treatment of HSV infections.