Deglutition in patients treated with reconstructive laryngectomy]

BACKGROUND: Chronic papilledema may lead to irreversible damage of optic nerve fibers. To preserve visual functions, a decompression of the optic nerve is recommended by means of a fenestration of the optic nerve sheath. In this study long-term results after optic nerve sheath fenestration in patients with idiopathic pseudotumor cerebri are reported. PATIENTS AND METHODS: 14 patients were re-examined 15 to 145 months (mean 62 months) after a fenestration of the retrobulbar optic nerve sheath on 23 eyes by a transconjunctival approach. Surgery was done to treat progressive visual loss or in severe obscurations. The patient's symptoms, visual acuity, visual fields, and ophthalmoscopic findings of the optic nerve head and the central fundus were compared to the preoperative status. RESULTS: Re-examination revealed improvement or stabilisation of objective and subjective findings in 17 eyes, one of them was operated on the more involved contralateral side only. Six eyes showed a recurrence of the papilledema without a functional change for the worse after an interval of 7 to 121 months. Three eyes of two patients ended up with optic atrophy and extensive visual loss. Preoperatively, these eyes had shown cotton wool spots in the optic nerve head and a rapid deterioration of vision. CONCLUSIONS: Fenestration of the retrobulbar optic nerve sheath can prevent further visual loss in most patients with pseudotumor cerebri, unless the eye has already become nearly blind. Postoperatively, ophthalmological controls are necessary at regular intervals because relapses after successful surgery can occur after months or years.     

The cupped disc. Who needs neuroimaging?

OBJECTIVE: To determine the incidence of positive neuroradiologic studies in consecutive patients with glaucoma associated with normal intraocular pressure and to compare the psychophysical and clinical characteristics of these eyes with eyes with disc cupping associated with intracranial masses. DESIGN: Retrospective case-controlled study. PARTICIPANTS: Fifty-two eyes of 29 patients with glaucoma associated with normal intraocular pressure and 44 eyes of 28 control patients with compressive lesions were reviewed. INTERVENTION: The medical records of consecutive glaucoma patients with normal intraocular pressure who underwent brain magnetic resonance imaging or computed tomography scanning as part of a diagnostic evaluation between January 1, 1985, and July 1, 1995, were reviewed. A masked reading of optic nerve photographs and visual fields was performed by one observer. A similar analysis was performed on a control group of consecutive patients with nonglaucomatous optic nerve cupping with known intracranial mass lesions. MAIN OUTCOME MEASURES: The neuroradiologic findings, clinical characteristics, optic nerve head appearance, and patterns of visual field loss were compared between groups. RESULTS: None of the patients diagnosed with glaucoma had neuroradiologic evidence of a mass lesion involving the anterior visual pathway. Compared to control subjects, patients with glaucoma were older (P = 0.0001), had better visual acuity (P = 0.002), greater vertical loss of neuroretinal rim tissue (P = 0.0001), more frequent optic disc hemorrhages (P = 0.01), less neuroretinal rim pallor (P = 0.0001), and more nerve fiber bundle visual field defects aligned at the horizontal midline (P = 0.0001). Visual acuity less than 20/40, vertically aligned visual field defects, optic nerve pallor in excess of cupping, and age younger than 50 years were 77%, 81%, 90%, and 93% specific for nonglaucomatous cupping associated with compressive lesions, respectively. CONCLUSIONS: Anterior visual pathway compression is an uncommon finding in the neuroradiologic evaluation of patients with a presumptive diagnosis of normal-tension glaucoma. Younger age, lower levels of visual acuity, vertically aligned visual field defects, and neuroretinal rim pallor may increase the likelihood of identifying an intracranial mass lesion.     

The role of early trabeculectomy in the control of chronic simple glaucoma

Seventy patients of bilateral chronic simple glaucoma with a mean age of 59.7 years, an intra-ocular pressure over 25 mmg Hg, optic disc cupping, and without visual field loss were selected. The eye with higher intra-ocular pressure or the larger optic disc cup was treated by early trabeculectomy while the other eye of the same patient was subjected to medical therapy with topical beta blockers for 3 years (without any surgical treatment). Both the eyes of 70 patients were compared after 3 years. Eyes which had undergone trabeculectomy had a mean intra-ocular pressure of 11.7 mm Hg against 18 mm Hg in the medically treated eyes. Surgically treated eyes had decrease in the mean cup : disc ratio (from 0.54 : 1 to 0.48 : 1) whereas medically treated eyes showed an increase from 0.41:1 to 0.51: 1. Visual field loss occurred in 3/70 operated eyes and in 27/70 medically treated eyes. Twenty-one of 70 treated eyes developed cataract and 12 of these required cataract surgery. Only 18/70 medically treated eyes developed cataracts but none of these required cataract surgery. Early trabeculectomy in cases of chronic simple glaucoma resulted in a large reduction of intra-ocular pressure and consequently reduced the size of optic disc cup and the chances of visual field loss.     

Peripapillary fluorescein angiographic findings in primary open angle glaucoma

BACKGROUND: Detailed fluorescein angiographic findings in the disc circumference may be useful for evaluating the possible relation of the circumference to glaucomatous nerve damage. METHODS: Fluorescein angiograms of 25 eyes of 25 subjects with primary open angle glaucoma were observed after they had undertaken Octopus perimetry. Based on the retinotopic projection, disc sectors and corresponding visual field regions were set. RESULTS: Twenty three eyes (92%) showed a zone of no fluorescence around the disc (non-fluorescent zone). Of these, the zone width of the 20 eyes that had visible ciliary vessels within the zone was wider than that of the other three eyes, and showed fluorescein diffusion from the outer boundary of the zone towards the disc. The diffusion reached the disc if the zone was narrow. In those 20 eyes, a standardised difference in the zone width of inferior temporal sector minus superior temporal sector correlated with the difference in mean loss of corresponding visual field regions (r = 0.48, p = 0.0312). CONCLUSION: The visible ciliary vessels suggest the absence of the choriocapillaris in the non-fluorescent zone, the width of which correlated with the visual field defect and may affect the amount of the fluorescein diffusion to the disc. This suggests that the diffusion might be related to optic nerve damage in glaucoma.     

Analysis of depressive symptomatology in mood disorders

BACKGROUND: At this time little information is available about the relationship between glaucomatous visual field defects and impaired blood flow in the optic nerve head. The purpose of this study was to examine blood flow of the juxtapapillary retina and the rim area of the optic nerve head in primary open-angle glaucoma with a borderline visual defect. METHODS: Juxtapapillary retinal and neuroretinal rim area blood flow was measured by scanning laser Doppler flowmetry (SLDF). The visual field was evaluated by static perimetry (Octopus-G1). The optic nerve head was assessed on 15 degrees color stereo photographs. We examined 116 eyes of 91 patients with POAG with controlled IOP and 66 eyes of 44 healthy individuals. The POAG group was divided into eyes with a mean defect lower than 2 dB (POAG group I) and in eyes with a mean defect equal to or greater than 2 dB (POAG group II). The mean age of POAG group I and POAG group II was 55 +/- 11 years and 57 +/- 10 years, respectively. The mean age of the control group was 45 +/- 15 years. The eyes of POAG group I had an average C/D ratio of 0.71 +/- 0.18 with an average mean defect of the visual field of 0.97 +/- 0.68 dB; the eyes of POAG group II had an average C/D ratio of 0.80 +/- 0.17 with an average mean defect of the visual field of 8.2 +/- 6.0 dB. The intraocular pressure on the day of measurement in POAG group I was 18.2 +/- 3.7 mmHg, in POAG group II 17.6 +/- 4.0 mmHg, and in the control group 15.1 +/- 2.5 mmHg. For statistical analysis, age-matched groups of 32 normal eyes of 32 subjects (mean age 52 +/- 10 years) were compared to 18 glaucomatous eyes of 18 patients (POAG group I, mean age 55 +/- 11 years) and 59 glaucomatous eyes of 59 patients (POAG group II, mean age 55 +/- 10 years). RESULTS: In the eyes of POAG group I and POAG group II, both juxtapapillary retinal blood flow and neuroretinal rim area blood flow were significantly decreased compared to an age-matched control group: neuroretinal rim area "flow" POAG group I -65%, POAG group II -66%; juxtapapillary retina "flow" POAG group I -52%, POAG group II -44%. All eyes of the POAG group I (MD < 2 dB) and 56 of 61 eyes of the POAG group II (MD > = 2 dB) showed a retinal perfusion lower than the 90% percentile of normal blood flow. We found no correlation between reduction of juxtapapillary or papillary blood flow and mean defect in POAG eyes. CONCLUSION: Glaucomatous eyes with no defects or borderline visual field defects as well as glaucomatous eyes in an advanced disease stage show significantly decreased optic nerve head and juxtapapillary retinal capillary blood flow.     

Nerve fiber layer defects with normal visual fields. Do normal optic disc and normal visual field indicate absence of glaucomatous abnormality?

PURPOSE: When the optic disc has normal appearance with no abnormalities in routine automated perimetry, the subject is not considered to have glaucoma. The purpose of this study is to show how such patients may have localized retinal nerve fiber layer defects with corresponding functional abnormality. METHODS: The authors selected eight eyes of eight patients who had a localized retinal nerve fiber layer defect extending within a few degrees from fovea but in whom the optic disc appearance and Humphrey 30-2 visual fields were normal. Of the eight patients, three had positive family history of glaucoma, two had suspected retinal nerve fiber layer abnormality in routine eye examination, two had increased intraocular pressure (IOP), and one had advanced low-tension glaucoma in one eye with a normal fellow eye. The authors examined the central 10 degrees visual field with 1 degree resolution using Humphrey perimeter and the Ring and Centring programs of the high-pass resolution perimeter. RESULTS: A central field defect corresponding to retinal nerve fiber layer defect was found in six of eight patients: in both 10 degrees Humphrey field and Centring programs (2 eyes), in Humphrey only (2 eyes), and in Centring only (2 eyes). CONCLUSION: The results indicate that retinal nerve fiber layer photographs are helpful in diagnosing glaucoma because early glaucomatous abnormalities cannot be excluded without nerve fiber layer photography. Currently available routine perimetric examination programs do not always detect very early functional damage.     

Use of scanning laser ophthalmoscopy to monitor papilloedema in idiopathic intracranial hypertension

AIMS: To determine the sensitivity of confocal scanning laser ophthalmoscopy (SLO) in detecting clinically significant changes in papilloedema secondary to idiopathic intracranial hypertension (IIH) and the correlation with visual field loss. METHODS: Eight patients--three new, two recurrent, and three chronic cases of IIH--were examined over a 9 month period with SLO (Heidelberg retina tomograph) of optic nerve head and 30-2 Humphrey visual fields (six cases). Optic disc swelling (volume) was assessed in each eye using a circular contour line placed around the swollen optic nerve head on the mean image of three topographic images. Nine volume measurements from single images in each eye of every patient were performed on one occasion to assess repeatability. RESULTS: In the five acute cases optic disc volumes (range 1-16 mm3) decreased with treatment to stable, normal levels. Three of these had mild, reproducible, field defects which resolved. Two chronic cases had stable or fluctuating disc volume with no detectable change in grade of papilloedema and mild field loss. In one case which underwent theco-peritoneal shunting both disc volume and field worsened, indicating therapeutic failure. Both improved postoperatively. CONCLUSIONS: SLO has a high sensitivity for detecting small changes in disc volumes and correlates closely with visual field change in the short term. It can confirm therapeutic failure by detecting stable or increasing disc volume. Decreasing volume may indicate resolution of papilloedema or secondary optic atrophy, so accompanying funduscopy and visual fields remain essential.     

Foveal dysfunction and central visual field loss in glaucoma

OBJECTIVE: To determine whether foveal function distal to the ganglion cell layer is an independent predictor of central visual field function in glaucoma. SETTING: University affiliated hospital and private practice. PARTICIPANTS: Twenty-seven eyes (27 patients) with normal-pressure glaucoma, 10 eyes (10 patients) with primary open-angle glaucoma, and 47 eyes of 47 matched normal volunteers. INTERVENTION AND MAIN OUTCOME MEASURES: Foveal cone electroretinogram (ERG) amplitude, relative optic cup to disc area and their relations to Humphrey full-threshold 30-2 visual field central 4-point mean total deviation (C4MTD) and pattern deviation (C4MPD). RESULTS: Foveal cone ERG amplitude was subnormal in 14 (37.8%) of the 37 glaucomatous eyes and lower in the glaucoma group compared with normal eyes (P<.01). The C4MTD and C4MPD were lower in glaucomatous eyes with subnormal amplitudes compared with those with normal amplitudes (P<.01 and P<.05, respectively). Amplitude was directly correlated with C4MTD (P<.01) and C4MPD (P<.01). Relative optic cup to disc area was inversely correlated with C4MTD (P<.001) and C4MPD (P<.001). Partial correlation analysis revealed that amplitude and relative optic cup to disc area were independent predictors of C4MTD and C4MPD. CONCLUSION: Foveal function distal to the ganglion cell layer and optic disc cupping independently predict central visual field function in glaucoma.     

Unilateral testing of utricular function

PURPOSE: To examine acquired pit of the optic nerve as a risk factor for progression of glaucoma. METHODS: In a retrospective longitudinal study, 25 open-angle glaucoma patients with acquired pit of the optic nerve were compared with a group of 24 open-angle glaucoma patients without acquired pit of the optic nerve. The patients were matched for age, mean intraocular pressure, baseline ratio of neuroretinal rim area to disk area, visual field damage, and duration of follow-up. Serial optic disk photographs and visual fields of both groups were evaluated by three independent observers for glaucomatous progression. RESULTS: Of 46 acquired pits of the optic nerve in 37 eyes of 25 patients, 36 pits were located inferiorly (76%) and 11 superiorly (24%; P < .001). Progression of optic disk damage occurred in 16 patients (64%) in the group with acquired pit and in three patients (12.5%) in the group without acquired pit (P < .001). Progression of visual field loss occurred in 14 patients (56%) in the group with acquired pit and in six (25%) in the group without pit (P=.04). Bilateral acquired pit of the optic nerve was present in 12 patients (48%). Disk hemorrhages were observed more frequently in the group with acquired pit (10 eyes, 40%) compared with the group without pit (two eyes, 8%; P=.02). CONCLUSION: Among patients with glaucoma, patients with acquired pit of the optic nerve represent a subgroup who are at increased risk for progressive optic disk damage and visual field loss.     

Evaluation of coexisting optic nerve head drusen and glaucoma with optical coherence tomography

OBJECTIVE: Optic nerve head drusen often make evaluation of the nerve head difficult to interpret. In addition, visual field defects are known to occur in patients with optic disk drusen, resembling glaucomatous damage. The authors report two cases of coincident optic nerve head drusen and glaucoma, in which the use of optical coherence tomography (OCT) in evaluating the nerve fiber layer was beneficial. PARTICIPANTS: Two patients with both optic nerve head drusen and glaucoma, one with primary open angle glaucoma, the other with pseudoexfoliation glaucoma were evaluated. Both patients had asymmetric optic disk drusen, with clinically visible drusen only in one eye. INTERVENTION: Ophthalmologic examination, color and red-free photography, automated Humphrey visual field testing and OCT were performed. RESULTS: Nerve fiber layer loss as measured by OCT was found to be greater than expected by the appearance of the optic nerve head and red-free photography, with visual fields consistent with findings in case 1. In case 2, visual fields were full, despite nerve fiber layer thinning seen by OCT and red-free photography. CONCLUSIONS: There can be significant nerve fiber layer thinning in patients with both glaucoma and optic disk drusen, despite the appearance of the optic nerve head in these patients. The cup margin may be obscured by the drusen, giving rise to a falsely full-appearing disk. In such cases, OCT may provide a useful means to quantitatively measure the nerve fiber layer thickness and to aid in the management of these patients by detecting nerve fiber layer thinning earlier than would otherwise be possible.     

Sensitivity and specificity of optic disc variables and analysis of a new variable (MP/D) for glaucoma diagnosis with the Glaucoma-Scope

AIM: In an attempt to use the quantitative optic disc measurements of the Glaucoma-Scope (OIS Sacramento, CA, USA) to distinguish glaucomatous from normal optic discs, a new variable was investigated, the mean disc corrected for the disc size by dividing by the disc area: MP/D. METHODS: Glaucoma-Scope disc evaluation was performed on 81 eyes of 51 patients split into the following groups based on Humphrey 24-2 visual field and clinical criteria of glaucoma: chronic glaucoma n = 27 (including only early, n = 17, and low tension glaucoma, n = 10), ocular hypertension n = 24, pseudoglaucomatous large discs, n = 12, and normal eyes, n = 18. Classic optic disc variables (the vertical and horizontal c/d ratios, and the c/d area) were compared with the new MP/D index calculating receiver operating characteristic curves. RESULTS: The MP/D ratio was able to identify the glaucomatous eyes more easily than other ratios. Areas under the curves were: 0.91 (MP/D); 0.87 (c/d area); 0.85 (c/d vertical); and 0.80 (c/d horizontal). The MP/D index was also correlated with the mean deviation (r = 0.466; p = 0.001). CONCLUSION: MP/D may prove useful in detecting glaucomatous optic nerve damage and could be an interesting screening tool for primary open angle glaucoma.     

Location of the fovea at the fundus in relation to the optic nerve head

BACKGROUND: Exact determination of the location of the fovea may be difficult, especially in patients suffering from macular pathology. The purpose of this study was to evaluate whether the distance between the optic nerve head and fovea in healthy eyes may be helpful in such patients. PATIENTS AND METHODS: We measured the distance between the center of the optic nerve head and the fovea in 165 healthy eyes in a horizontal and vertical direction. Results were correlated to the refractive status. RESULTS: There was a relatively high deviation between all eyes for the distance between the optic disc and the fovea (15.5 +/- 1.2 degrees [12.8 to 21.3 degrees]). There was a significant relationship between this distance and the refraction (r = 0.353, P < 0.001). Intraindividual deviation between the right and left eyes showed a markedly lower variance (0.67 +/- 0.49 degree [0.05 to 2.3 degrees]). CONCLUSION: The distance between the optic nerve head and the fovea does not allow for meaningful determination of the location of the fovea in eyes in which morphological changes have occurred. However, knowledge of this distance from the other eye of the same patient is helpful.     

Parapapillary chorioretinal atrophy in patients with ocular hypertension. II. An evaluation of progressive changes

OBJECTIVE: To determine whether parapapillary chorioretinal atrophy in patients with ocular hypertension remained stationary or progressed along with glaucomatous optic nerve damage. METHODS: The morphometric parameters and progression of parapapillary atrophy were retrospectively investigated, using serial photographs, in 350 eyes of 175 patients with ocular hypertension. The association of parapapillary atrophy progression with subsequent glaucomatous conversion and with other baseline patient- and eye-specific characteristics was analyzed. RESULTS: Progression in the area and extension of parapapillary atrophy before noticeable optic disc or visual field changes was observed in 48 (49.0%) of 98 eyes that converted to glaucoma, while parapapillary atrophy progression was noted in 25 (9.9%) of 252 ocular hypertensive eyes that did not develop glaucomatous damage (P<.001). The predictive sensitivity and specificity of this observation were 49% and 90%, respectively. In a logistic multiple regression model, the progression of parapapillary atrophy was associated with a family history of glaucoma (odds ratio, 2.7) and the initial size of zone beta (odds ratio, 1.64, for an increase of 0.10 of the zone beta area-disc area ratio). CONCLUSION: The progression of parapapillary chorioretinal atrophy may be an early glaucomatous finding in some patients with ocular hypertension.     

The intramitochondrial ATP/ADP-ratio controls cytochrome c oxidase activity allosterically

BACKGROUND: This study was carried out to evaluate intraocular or systemic factors associated with the visual field damage progression in eyes with normal-tension glaucoma (NTG). PATIENTS AND METHODS: Forty-seven NTG eyes with a minimum follow-up of 5 years were enrolled into the retrospective study. A stepwise regression analysis was performed to correlate the visual field damage progression, expressed as the mean deviation (MD) change per year, with several independent clinical factors including age, history of disc hemorrhage, initial MD, mean intraocular pressure (IOP), peak IOP, diurnal fluctuation of IOP, presence of a beta zone of peripapillary atrophy, and use of Ca(2+)-channel blockers. RESULTS: Statistical analysis revealed that non-use of Ca(2+)-channel blockers (P = 0.01), peripapillary atrophy (P = 0.03) and disc hemorrhage (P = 0.04) were associated with visual loss progression. CONCLUSIONS: Risk factors unrelated to IOP were suggested to be associated with progression of visual field loss. Systemic use of Ca(2+)-channel blockers has a favorable effect on visual field prognosis in NTG eyes.     

High levels of serum allopregnanolone in women with premature ovarian failure

BACKGROUND: Blue-on-yellow (B/Y) perimetry can reveal visual field defects earlier and larger in extent than white-on-white (W/W) perimetry. The Heidelberg Retina Tomograph (HRT) produces a three-dimensional image of the optic disc. The aim of this study was to compare the strength of the association of the B/Y and W/W visual hemifield mean deviation (HMD) variables with the optic nerve head (ONH) morphological variables of the respective area. METHODS: We evaluated one randomly chosen eye of 40 normal subjects and 37 patients with ocular hypertension and different stages of glaucoma. The B/Y and W/W visual fields (program 30-2) were obtained with a Humphrey perimeter. Results of both visual fields were adjusted for the patient's age and lens transmission index measured with a lens fluorometer. HMD was calculated as the difference between the measured and expected hemifield mean sensitivity values, predicted by the regression model fitted in our nonglaucomatous subject data. The HRT with the software version 1.11 was used to acquire and evaluate the topographic measurements of the optic disc. RESULTS: The B/Y and W/W visual field HMDs showed statistically significant correlation with ONH parameters such as cup shape measure (CSM), rim volume, rim area, mean retinal nerve fiber layer (RNFL) thickness and RNFL cross-sectional area. With forward stepwise logistic regression analysis using B/Y hemifield data 38% of the glaucoma patient's normal W/W hemifields were classified abnormal. With the CSM alone in the model 52% of the cases were classified abnormal. CONCLUSIONS: B/Y visual field hemifield mean deviation values correlate well with ONH parameters examined with the HRT.     

Contralateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysms

OBJECTIVE: The vicinity of carotid-ophthalmic aneurysms to the roof of the cavernous sinus, to the anterior clinoid process, and to the optic nerve or the optic chiasm requires well-defined surgical techniques. Although microsurgical techniques with ipsilateral direct approaches to these aneurysms have been described in detail, studies about contralateral strategies for the microsurgical treatment of carotid-ophthalmic aneurysms are rare and are mainly confined to case reports. The aim of this study is to describe how to decide on the ipsilateral and contralateral microsurgical approaches to such aneurysms and to demonstrate the surgical techniques for the ipsilateral and contralateral exposure of carotid-ophthalmic aneurysms. METHODS: In a series of 51 patients with 58 aneurysms of the ophthalmic segment of the internal carotid artery, nine patients with 10 aneurysms (4 large aneurysms, 6 small aneurysms) were treated via a contralateral microsurgical approach after careful preoperative planning. Preoperative planning was based on the analysis of clinical and radiographic data, including cranial computed tomography, magnetic resonance imaging, magnetic resonance angiography, and conventional cerebral angiography. RESULTS: The postoperative results were good in 38 (75%) of the patients, fair in 2 (4%), and poor in 3 (6%); 8 (15%) of the patients died after surgery. The postoperative follow-up was 4 months to 10 years. Postoperatively, 15 of 19 patients with uni- or bilateral visual deficits or visual field defects improved, 3 of the 19 patients experienced postoperative impairment of visual function, and 1 of the 19 patients had an unchanged visual field deficit. Visual impairment or unchanged visual function was observed in patients who underwent ipsilateral approaches, which was possibly caused by inappropriate intraoperative retraction of the optic nerve or chiasm. In all patients presenting with preoperative visual deficits who were treated via contralateral approaches, visual function improved in the postoperative course. CONCLUSION: Giant carotid-ophthalmic aneurysms that are eligible for surgical treatment as well as small and large aneurysms dislocating the optic nerve or the chiasm superomedially or medially should be approached via ipsilateral craniotomies. It is recommended that small and large aneurysms of the carotid-ophthalmic segment originating medially, superomedially, or superiorly, displacing the optic nerve or the chiasm superiorly, superolaterally, or laterally, be approached via contralateral craniotomies.     

Visual field defects after macular hole surgery. A new finding

PURPOSE: The purpose of the study is to report the problem of a temporal visual field defect occurring after macular hole surgery. METHODS: The authors reviewed the records of 13 patients found to have visual field defects after vitrectomy for macular holes. Fluorescein angiograms (13 patients), optic nerve photographs (13 patients), focal electroretinograms (3 patients), and nerve fiber analyses (8 patients) were performed in patients with visual field defects. RESULTS: An absolute, temporal, usually inferior field defect was noted in 13 patients. In eight patients, the defect was detected because of specific reports or retrospective field examination results. Five patients examined in a prospective manner were found to have field defects. No history of abnormal intraocular pressure or direct trauma to the optic nerve or retinal vessels was identified. Four patients showed optic nerve pallor and three had an anomalous-appearing disc. Focal electroretinograms were of similar amplitude in the involved retina compared to corresponding areas in the healthy fellow eye. Nerve fiber analysis showed a reduction in nerve fiber layer thickness correlating to the visual field defect in those eight patients in which this test was used. CONCLUSION: A significant temporal field defect may occur in patients after otherwise uncomplicated surgery for macular holes. The cause is unclear; however, reductions in nerve fiber layer thickness from the superior and nasal peripapillary area suggest that acute surgical release of the posterior hyaloid and the use of long-acting intraocular gas may in certain patients result in visual field defects.     

Determination of long-life radiocesiums Cs-134 and Cs-137 in food by gamma-ray spectrometry: summary of collaborative study

PURPOSE: The authors evaluated the ability of a confocal scanning laser ophthalmoscope to detect glaucomatous visual field loss by using their previously described discriminant formula on a prospectively obtained cohort. The relationship of optic disc size to diagnostic classification was also evaluated. METHODS: One eye was chosen randomly from each of 153 subjects. Sixty control eyes had intraocular pressure less than 21 mmHg and normal visual fields; 93 glaucomatous eyes had intraocular pressure greater than 21 mmHg and abnormal visual fields. The optic disc status purposely was not used for classification purposes. All subjects were examined with the Heidelberg Retina Tomograph (HRT; Heidelberg Engineering GMBH, Heidelberg, Germany) and Humphrey Perimeter, program 30-2 (Humphrey Instruments, Inc., San Leandro, CA). Visual fields were considered abnormal by the authors' previously published criteria. The HRT classification used age, adjusted cup shape measure, rim volume, and height variation contour to classify the optic disc as normal or glaucomatous. Then the authors assessed the sensitivity, specificity, and diagnostic precision for the entire group, and for three subsets classified by disc area: disc area less than 2 mm2, between 2 and 3 mm2, and more than 3 mm2. RESULTS: The entire group had a sensitivity, specificity, and diagnostic precision of 74%, 88%, and 80%, respectively. The specificity was 83% when disc area was less than 2 mm2 and improved to 89% when disc area was more than 2 mm2. The sensitivity tended to improve from 65% to 79%, and to 83% if the disc area increased, but the difference was not statistically significant. CONCLUSIONS: In a prospective cohort of patients, the HRT discriminant analysis formula was capable of detecting glaucomatous visual field loss with good precision. Unusually small optic discs continue to present diagnostic difficulties.     

Long-term epinephrine therapy of ocular hypertension

Nineteen patients with symmetrical ocular hypertension and symmetrical cupping of the optic nerves were made asymmetric with respect to intraocular pressure for one to five years by unilateral topical treatment with epinephrine hydrochloride. Development of glaucomatous visual field defects was observed in 32% of the untreated eyes and in none of the treated eyes (P less than .05). Progressive cupping of the optic nerve was noted in 53% of the untreated eyes and in 11% of the treated eyes (P less than .025). Evidence of glaucomatous damage was observed more frequently in subjects maintained on this regimen for longer periods and in subjects with initial horizontal cup/disc ratios greater than 0.4 (P less than .05). None of the eyes, either treated or untreated, with mean intraocular pressures less than 24 mm Hg developed glaucomatous damage during the period of this study.     

Measurement of optic disc compliance by digitized image analysis in the normal monkey eye

PURPOSE: To characterize the compliance of the normal monkey optic disc under conditions of induced short-term fluctuations in intraocular pressure (IOP). METHODS: In 10 monkeys, one eye was compliance tested on three separate days followed by a single test of the contralateral eye (40 compliance tests). In a testing session, the optic disc was imaged at 2 and 47 minutes (baseline time point) after IOP was lowered to 10 mmHg; then at 2, 17, 32, and 47 minutes after IOP was elevated to 45 mmHg; then at 2, 47, and, in some cases, 92 minutes after IOP was lowered back to 10 mmHg. Eight digitized images were analyzed at each time point, yielding two parameters to characterize the position of the disc: the Mean Position of the Disc (MPD) and the Change from MPDBaseline (the value of MPD at a given time point minus the value for MPD at the baseline time point of that testing session). Analysis of variance (ANOVA) testing was used to evaluate the overall effect of IOP on both parameters while taking into account the effects of variability due to different monkeys and repetitions of the test as well as differences between the two eyes of an individual monkey. With the addition of data from 11 compliance tests performed on eight additional monkeys, the overall results were calculated in terms of the mean Change from MPDBaseline at each time point for a total of 51 compliance testing sessions. RESULTS: The mean Change from MPDBaseline was -28 microns (95% confidence interval, -23 to -33 microns) 47 minutes after elevation of IOP. The disc surface returned to its baseline position 92 minutes after IOP was lowered back to 10 mmHg. Elevation of IOP within a compliance test had a significant effect on the position of the optic disc surface (P = 0.0002, ANOVA), as characterized by the parameter Change from MPDBaseline. Neither the difference in the amount of movement between the two eyes of an individual monkey nor the variability within the three repetitions of the test in a given eye was statistically significant. CONCLUSION: Small, reversible (elastic) posterior deformations of the optic disc surface follow acute elevations of IOP in the normal monkey eye. Detection of acute IOP-induced deformations of the optic disc surface may represent a means by which to mechanically test the deeper load-bearing tissues of the optic nerve head.