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J Funk

Publications and source records attributed to J Funk.

At least 37 records · Page 2Linked to original sources
PubMed1997

Blind spot size depends on the optic disc topography: a study using SLO controlled scotometry and the Heidelberg retina tomograph.

AIMS: To find out whether the size of the blind spot area, determined by static perimetry, depends on the surface topography of the optic disc and its surrounding area. METHODS: Ten eyes were examined; all had a parapapillary atrophy adjacent to the temporal side of the disc. Microperimetry was performed under direct fundus control using a Rodenstock scanning laser ophthalmoscope. The horizontal meridian of the optic discs was examined in 0.5 degree steps using five stimulus sizes (Goldmann I to V), each with 10 different degrees of brightness. Optic disc topography was measured with the Heidelberg retina tomograph (HRT). RESULTS: Stimuli with a high luminance level (Goldmann IV, 4 dB), presented on the horizontal meridian, were seen up to 0.75 degree centrally (that is, towards the optic disc centre) from the temporal edge of the parapapillary atrophy but up to 1.85 degrees centrally from the nasal optic disc border (p < 0.01). Horizontal HRT section profiles of the optic disc consistently showed prominent nasal disc borders contrasting with a shallow excavation within the temporal parapapillary atrophy. CONCLUSIONS: The size of scotomas depends on the surface topography of the tested area. The prominent nasal part of the optic disc appears less 'blind' than the shallow temporal part, probably because of more intensive light scattering by the prominent nasal part of the disc. These considerations should also apply to other scotomas.

Adult↗
PubMed1996

[How can the success of a glaucoma operation be predicted?].

PURPOSE: The effect of glaucoma surgery can simply be measured in terms of intraocular pressure (IOP) reduction. However, IOP reduction is not the final goal of glaucoma surgery, but rather long-term visual field preservation. Visual field preservation, on the other hand, can only be judged many years after surgery. Therefore, a formula that could be used to define the success of a pressure-lowering operation soon after surgery should take account of IOP reduction, but the correlation between "successful IOP reduction" and "long-term visual field preservation" should be as high as possible. METHODS: In an attempt to find such a formula, we examined the long-term course with reference to both IOP and visual field in 108 patients (mean follow-up 7.9 years). Several criteria were tested for their ability to predict the long-term visual field preservation. RESULT: The best correlation was obtained by a combined criterion specifying both an absolute upper limit and a relative IOP decrease (i.e. IOP postoperatively < 0.8*IOP preoperatively and IOP postoperatively < 21 mmHg). CONCLUSION: We recommend use of this criterion whenever the effect of a pressure-lowering operation has to be estimated shortly after surgery.

Aged↗
PubMed1996

[Band-like keratopathy after treatment of postoperative fibrin reaction with tissue plasminogen activator].

BACKGROUND: In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, postoperative fibrin reaction in the anterior chamber. So far no serious side effects of this treatment have been reported. PATIENTS AND METHODS: Altogether, 32 patients received 0.2 ml solution with 20 micrograms TPA intracamerally. In 2 cases a dense corneal opacity was observed 12-24 hours after the injection of TPA which was resistant to treatment with local dexamethasone and lubricants. Therefore it was removed by superficial keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy. RESULTS: In the keratectomy specimen a selective, fine-granular calcification of Bowman's membrane could be demonstrated. CONCLUSIONS: The intracameral TPA treatment for postoperative fibrin reaction can cause a rapid band keratopathy. Therefore the application of TPA should be restricted to severe therapy-resistant cases of intracameral fibrin reaction. In cases with the development of a band keratopathy EDTA-treatment is recommended.

Aged↗
PubMed1996

Twenty four hour blood pressure monitoring in normal tension glaucoma.

BACKGROUND: The few investigations that used continuous 24 hour blood pressure monitoring to investigate whether blood pressure in patients with normal tension glaucoma is lower than in normal subjects yielded conflicting results. Therefore, a prospective controlled trial was carried out. METHODS: Systemic blood pressure was recorded continuously over a 24 hour period in 20 patients with normal tension glaucoma (IOP < or = 21 mm Hg). Eight of them showed a localised loss of the neuroretinal rim area and, in addition, optic disc haemorrhages-that is, focal ischaemic signs. Twenty healthy patients without glaucoma, who were hospitalised for cataract or retinal surgery, served as controls. Blood pressure was automatically measured every 20 minutes during the day and every 40 minutes at night. RESULTS: Both groups showed a significant (physiological) blood pressure drop at night, which was significantly (p < 0.001, ANOVA) more pronounced in the group with normal tension glaucoma than in the control group. There was a weak trend towards lower blood pressure values in the normal tension glaucoma group. Minima, maxima, and mean values of the systolic, diastolic, and mean arterial pressures did not differ significantly between the group with normal tension glaucoma and the control group. The greatest differences occurred with nocturnal systolic and diurnal diastolic values. There were no significant differences between the subgroup with focal lesions and the other patients with normal tension glaucoma. CONCLUSIONS: Patients with normal tension glaucoma tend to have lower blood pressure values (p > 0.05, ANOVA) than normals; this difference is probably much smaller than formerly assumed. Patients with normal tension glaucoma, however, have significantly greater nocturnal blood pressure drops (p < 0.001, ANOVA) than normal controls. Nocturnal blood pressure drops (relative day-night differences) may play a more important role in the pathogenesis of normal tension glaucoma than the absolute height of the blood pressure.

Aged↗
PubMed1996

Pattern electroretinogram and computerized optic nerve-head analysis in ocular hypertension--interim results after 2.5 years.

Evidence exists that both the pattern electroretinogram (PERG) as a parameter of ganglion-cell function and computerized morphometric disc analysis (ONHA) predict subsequent glaucomatous visual field defects in ocular hypertensive eyes. Since November 1991 we have conducted a prospective longitudinal study to evaluate the suitability of PERG and ONHA for detecting incipient glaucoma damage. Inclusion criteria were: an intraocular pressure of > or = 25 mmHG (at least two measurements taken on different days) or, in eyes with additional risk factors, > or = 23 mmHG; a normal Octopus visual field (mean defect < or = 2 dB, no local defect); and no definite glaucomatous disc cupping. After a mean follow-up period of 14.6 +/- 8.8 (range 1-33) months and with a mean intraocular pressure of 24.4 (range 18-42) mmHg, none of the 66 patients (115 eyes) converted to glaucoma. Furthermore, PERG and ONHA do not agree in their estimation of the glaucoma risk at this stage.

Electroretinography↗
PubMed1996

Effect of surgical technique on the increase in intraocular pressure after cataract extraction.

BACKGROUND AND OBJECTIVE: A prospective study was performed to determine the influence of surgical technique on the increase in intraocular pressure (IOP) after cataract surgery. PATIENTS AND METHODS: Three groups of 30 patients each underwent either extracapsular cataract extraction with sclerocorneal suture (ECCE), phacoemulsification with sclerocorneal suture (PS), or phacoemulsification with a sutureless scleral tunnel (PT). RESULTS: Each group experienced a significant increase in IOP 5 to 7 hours after surgery: 20.2 +/- 7.9 mm Hg for ECCE, 11.2 +/- 8.3 mm Hg for PS, and 4.7 +/- 8.7 mm Hg for PT. The differences in the increases among the three groups were significant. CONCLUSION: PT [corrected] produces the lowest postoperative increase in IOP and should be considered for patients with glaucomatous damage.

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PubMed1996

[Variability of findings in light sense and ring perimetry].

The variability of the interpretation of visual fields by physicians has so far been thoroughly examined only with reference to light sense perimetry. Therefore, we studied the variability in assigning visual fields to topical diagnoses of the visual pathway with the ring perimeter. For this purpose we examined the proportion of correct assignments of physicians and the reproducibility of their assignments. Two experienced ophthalmologists had to assign 76 selected pairs of right and left visual fields to one of the following diagnosis without any information about further clinical findings: (1) normal (n = 5), (2) media opacity (n = 5), (3) retinal lesion (n = 5), (4) optic disc lesion (n = 6), (5) optic nerve lesion (n = 6), (6) lesion of the chiasma (n = 5) and (7) retrochiasmal lesion (n = 6). The assignment was repeated after intervals of 6 weeks and 10 months. Our statistical analysis of the number of correct assignments revealed no significant differences between the perimeters or between the physicians. The amount of correct assignments with both perimeters decreased from 75% and 66% during the first run through 60% and 70% during the second run to 58% and 60% during the third. Neither perimeter showed any major differences in the reproducibility of the assignments (Fig. 4). During the three runs only 47% (physician 1) and 58% (physician 2) of the cases were assigned three times to the same diagnoses with the octopus. The corresponding figures for the ring perimeter were 58% and 60%. This is regarded as an indicator of the unreliability in the interpretation of visual fields.

Adult↗
PubMed1996

Results of combined trabeculectomy and phacoemulsification via tunnel incision.

Currently a cataract is usually surgically treated by phacoemulsification via tunnel incision. In cases of coexisting cataract and glaucoma a combined surgical procedure is desirable. We combine cataract and filtering surgery by simply dissecting a 1 x 1-mm piece from the inner tunnel lamella of a standard corneoscleral tunnel. The results of treatment of the first 20 eyes by the proposed combined procedure were compared with the results of traditional phacoemulsification and traditional trabeculectomy. With regard to visual acuity, combined surgery was as good as traditional phacoemulsification via tunnel incision. In terms of the regulation of intraocular pressure, combined surgery was as good as traditional trabeculectomy. As with trabeculectomy, mild early postoperative complications occur frequently, which require intensive post-operative care. Thus, the combination of trabeculectomy and phacoemulsification via tunnel incision proved to be a successful technique for the surgical treatment of combined cataract and glaucoma.

Aged↗
PubMed1996

The role of YAG-laser iridotomy in pigment dispersion syndrome.

We determined iris configuration and posterior-chamber depth before and after YAG-laser iridotomy in 20 eyes with pigment dispersion syndrome using high-resolution ultrasound and measured the intraocular pressure after a mean of 9.1 months. The iris configuration and posterior-chamber depth of our patients were compared with those of an age- and refraction-matched control group of 20 eyes without pigment dispersion. In the patient group, 8 eyes had a concave iris configuration with shallow posterior chambers and 12 eyes had planar irides. In the former group the posterior-chamber depth increased significantly after treatment. In the latter group it did not change. In the normal control group, three subjects also had concave irides. There was a significant correlation between posterior-chamber depth and refraction in patients with pigment dispersion syndrome, but not in the normal control group. After the follow-up period the intraocular pressure of treated eyes was not significantly lower than that of untreated eyes. Iris concavity can also occur in normal individuals and may therefore be only a pathogenetic cofactor in the pigment dispersion syndrome. Laser iridotomy proved to flatten irides but did not significantly decrease the intraocular pressure.

Adult↗
PubMed1995

Optic nerve head analyzer and Heidelberg retina tomograph: relative error and reproducibility of topographic measurements in a model eye with simulated cataract.

BACKGROUND: We measured the relative error and reproducibility of the optic nerve head analyzer (ONHA) and the Heidelberg retina tomograph (HRT) in a model eye with a cataract that was simulated by Bangerter foils. METHODS: There were two artificial discs and one retinal elevation (the latter could not be analyzed by the ONHA) that could be inserted into the model eye. The relative error of the parameter 'cup area' ('cup volume') of the ONHA for the measurement of artificial disc no. 1 changed from 1.1% (5.4%) without Bangerter foil to 7.9% (7.6%) with Bangerter foil 0.6. The standard deviation of the ONHA increased from 0.059 mm2 (0.1 mm3) without Bangerter foil to 0.142 mm2 (0.121 mm3) with Bangerter foil 0.6. With the smaller artificial disc no. 2, no measurements with Bangerter foils were obtained. RESULTS: Relative error and reproducibility of the parameter 'volume below (above) surface' of the HRT did not show any consistent change with increasing intensity of the simulated cataract. With artificial disc no. 1, the relative error without Bangerter foil was 14.6%, while the worst relative error with one of the Bangerter foils 0.8 to 0.4 was 16.4%. The corresponding values for the standard deviation were 0.019 mm3 and 0.033 mm3. With the smaller artificial disc no. 2, the relative error without Bangerter foil was 6.3%, while the worst relative error with one of the Bangerter foils 0.8 to 0.2 was 18.3%. The corresponding values for the standard deviation were 0.016 mm3 and 0.017 mm3. The relative error in measuring a retinal elevation without a Bangerter foil was 2.3%, with a Bangerter foil 11.2-18.0%. The standard deviation was 0.068 mm3 without Bangerter foil and 0.013-0.023 mm3 with Bangerter foils. CONCLUSION: Our data support the assumption that the HRT is able to measure fundus structures even in the case of opaque optical media. The HRT is superior to the ONHA in this regard.

Adult↗
PubMed1995

[Long-term reduction of intraocular pressure by goniotrepanation or laser trabeculoplasty].

BACKGROUND: Reports concerning the long term efficacy of goniotrephination or lasertrabeculoplasty are still rather inconsistent. Therefore we once again investigated the long term IOP reduction of these two procedures. PATIENTS AND METHODS: In 1983 we started a prospective monitoring of patients having either goniotrephination or lasertrabeculoplasty. We now reinvestigated the patients originally included in this study (mean follow up 7.7 years, n = 116 patients/143 eyes). IOP reduction was defined to be successful if the following two criteria were met simultaneously: 1. IOP post op < 25 mm Hg. 2. IOP post op < 0.8 x IOP prä op. RESULTS: According to the criteria given above the long term success rate of goniotrephination was 67%, the long term success rate of lasertrabeculoplasty was 32%. There were no severe complications. The frequency of mild complications during the early postoperative period was the same for eyes with successful long term IOP reduction as for eyes with unsuccessful long term IOP reduction. When eyes with glaucoma chronicum simplex and eyes with secondary glaucomas were evaluated separately the following success rates were found: goniotrephination in eyes with glaucoma chronicum simplex 68%, goniotrephination in eyes with secondary glaucomas 67%, lasertrabeculoplasty in eyes with glaucoma chronicum simplex 37%, lasertrabeculoplasty in eyes with secondary glaucomas 18%. The correlation between successful lasertrabeculoplasty in the first eye and successful lasertrabeculoplasty in the fellow eye was marginally significant (p = 0.1). CONCLUSIONS: The long term IOP reduction is clearly more pronounced after goniotrephination than after lasertrabeculoplasty. However, long term IOP reduction after lasertrabeculoplasty is still better than expected. Mild complications during the early postoperative period obviously do not influence the long term results of both procedures. The success rate of lasertrabeculoplasty in eyes with secondary glaucomas is clearly worse compared to eyes with glaucoma chromicum simplex. There is no difference between these two groups when goniotrephination was performed. The success of lasertrabeculoplasty in the first eye cannot really predict the success of the same procedure in the fellow eye.

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PubMed1995

[Increased intraocular pressure after cataract extraction--effect of surgical technique, surgical procedure and preventive drug administration. A prospective, randomized double-blind study].

BACKGROUND: We performed a double-masked, randomized and prospective study to compare the effect of surgical technique, surgeon's experience, and prophylactic medication on the intraocular pressure rise after cataract extraction. PATIENTS AND METHODS: Intraocular pressure of 120 patients was measured the day before, as well as two to four, five to seven and 22 to 24 hours after uncomplicated cataract extraction. 47 patients were operated with phacoemulsification and sclerocorneal sutureless tunnel (phaco/tunnel). 61 patients with phacoemulsification and corneoscleral incision and suture (phaco/suture), and 12 patients with extracapsular technique (ECCE). 48 operations were done by inexperienced surgeons (less than 200 intraocular operations), 72 by experienced surgeons (300-2000 intraocular operations). Patients were treated with either levobunolol, acetazolamide, apraclonidine, or placebo. Each treatment group contained 30 patients. RESULTS: In all groups, the mean intraocular pressure increased to a maximum at five to seven hours after surgery. The pressure rise was significantly higher in the ECCE group (20.6 mm Hg) than in the phaco/suture group (10.5 mm Hg) and in the phaco/tunnel group (5.4 mm Hg, p always < 0.05). Eyes operated by inexperienced surgeons had a significantly (p < 0.005) greater pressure rise (12.9 mm Hg) than eyes operated by experienced surgeons (7.1 mm Hg). Treatment had no significant (p = 0.41) effect on the intraocular pressure rise. CONCLUSION: The intraocular pressure rise after cataract extraction strongly depends on the surgical technique and to a lesser extent, on the surgeon's experience. At least for phacoemulsification, the effect of the prophylactic medication used in this study is small and appears to be clinically irrelevant.

Acetazolamide↗
PubMed1995

[Computer controlled analysis of the optic papilla in patients with anterior ischemic optic neuropathy].

BACKGROUND: In patients with non-arteritic anterior ischaemic optic neuropathy disc parameters have been measured with a largely objective method (Optic Nerve Head Analyzer). We wanted to find out, whether the measurements of different disc parameters allow an assertion of predisposition to AION. METHODS: Measurements have been done with the Optic Nerve Head Analyzer (ONHA). In 25 patients with AION disc area and neuroretinal rim area was measured in the nonaffected fellow eye. The results were compared to those of 19 healthy subjects. In 12 of the 25 patients the disc structure of the AION-eye was measured over time with an average of 4 measurements in 16 months. RESULTS: 1) Disc area and neuroretinal rim area of the AION-eyes do not differ significantly from those of the healthy subjects. 2) Disc area and neuroretinal rim area of the healthy fellow eyes of the AION patients were not significantly different from those of the healthy subjects. 3) Measurements of disc parameters over time did not show significant differences between the parameters of the beginning of AION and after 16 months. CONCLUSIONS: Measurements of disc area and neuroretinal rim area with the Optic Nerve Head Analyzer do not allow assertions of predisposition to AION.

Adult↗
PubMed1995

Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon's experience.

AIMS: A prospective clinical trial was carried out to evaluate the effect of prophylactic medication, the technique of wound closure, and the surgeon's experience on the intraocular pressure rise after cataract extraction. METHODS: In 100 eyes, the intraocular pressure was measured before as well as 2-4, 5-7, and 22-24 hours after phacoemulsification and posterior chamber lens implantation. Each of 25 patients received either 1% topical apraclonidine, 0.5% topical levobunolol, 500 mg oral acetazolamide, or placebo. Forty four eyes were operated with sclerocorneal sutureless tunnel and 56 eyes with corneoscleral incision and suture. Sixty three operations were performed by experienced surgeons (more than 300 intraocular operations) and 37 by inexperienced surgeons (less than 200 intraocular operations). RESULTS: The pressure increase from baseline to the maximum 5-7 hours after surgery did not differ significantly (p = 0.8499) for apraclonidine (9.5 mm Hg), levobunolol (7.2 mm Hg), acetazolamide (7.8 mm Hg), and placebo (8.6 mm Hg). The increase was significantly (p = 0.0095) lower in eyes with corneoscleral tunnel (5.5 mm Hg) than in eyes with corneoscleral suture (10.5 mm Hg) and significantly (p = 0.0156) lower for experienced (6.6 mm Hg) than for inexperienced surgeons (11.2 mm Hg). CONCLUSIONS: The intraocular pressure rise after phacoemulsification and posterior chamber lens implantation depends strongly on the technique of wound closure and the surgeon's experience. Compared with these two factors, the effect of prophylactic medication can be neglected.

Acetazolamide↗
PubMed1995

High-pass resolution perimetry and light-sense perimetry in open-angle glaucoma.

To determine the correlation between the results obtained with light-sense and ring perimetry in glaucoma, we examined 201 eyes of 107 patients with ocular hypertension or different stages of glaucoma using Octopus 1-2-3 and the Ophthimus ring perimeter. Statistical parameters describing the mean visual field defect ["global defect, GD," or "neural capacity, NC" (Ophthimus)] were significantly correlated (P < 0.0001). Statistical parameters describing the local deviations were significantly correlated as well ["loss of variance, LV" (Octopus) and "local defect, LD" (Ophthimus), P < 0.0001]. Correlation between the MD and the LV or LD was somewhat less significant. As compared with the MD or LV (Octopus) the Ophthimus parameters GD, NC, and LD were less often pathological. We conclude from our data that due to the good correlation between light-sense and resolution perimetry results, both perimeters are equally suited for the follow-up of glaucoma patients. Sensitivity to early glaucomatous damage seems to be higher in light-sense perimetry (Octopus 1-2-3).

Adult↗
PubMed1995

Iridotomy in the treatment of pigmentary glaucoma: documentation with high resolution ultrasound.

In pigmentary glaucoma, reverse pupillary block is one mechanism presumed possible for backward bowing of the iris leading to iris-zonular rubbing. Therefore, increasing numbers of patients are being treated by laser iridotomy. We demonstrate five patients with pigmentary glaucoma whose iris configuration was examined by high-resolution ultrasound biomicroscopy before and after laser iridotomy. Of these patients, three had a severe case of posterior iris bowing with iris-zonular rubbing. In these cases, the ultrasound biomicroscope revealed an anterior motion of the iris diaphragm after iridotomy. The other two patients had no direct iris-zonular contact and displayed a normal iris curvature that did not change after iridotomy. YAG-laser iridotomy is a prophylactic treatment in pigmentary glaucoma for a subgroup of patients in whom an iris concavity with iris-zonular rubbing can be demonstrated by high-resolution ultrasound or equivalent methods.

Adult↗