Diurnal variations in intraocular pressure.
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The usefulness of the noise-field spontaneously generated on a home television screen for subjective perception of visual field defects was studied in 196 eyes of ocular hypertensive or normal subjects, 166 eyes with primary open angle glaucoma and 124 eyes with low-tension glaucoma. All subjects had never perceived their field defects. In 290 glaucoma eyes, including 71 eyes of early glaucoma, 265 eyes (91.4%) could perceive abnormality of the noise-field which corresponded to visual field defects confirmed by static perimetry. In 6 normal eyes abnormality of the noise-field was perceived at the blind spot. The sensitivity and specificity of the test was 91% and 97%, respectively. The time required for testing one eye was 3-5 seconds. The results indicate that the Noise-Field Test using a home television set can be an excellent method for subjective perception of visual field defects, and can also be used for glaucoma screening.
For differential, therapeutic, and prognostic reasons the recognition of early lesions in glaucoma chronicum simplex is very important. Besides sophisticated ophthalmological investigations optic nerve and retinal functions can be tested by flash and pattern-reversal evoked visual potentials and electroretinograms. 38 glaucomatous eyes were investigated by VEP and ERG applying single and flicker flashes as well as transient pattern-reversal stimuli of different check sizes. The results related to the degree of visual field disturbances show the damage of retinal and neuronal elements in a descending order affecting first of all the macular cones, then the rod system, and later on the elements of the second retinal neuron. The ganglion cells seems to be affected after all.
32 rabbits suffering from simple hereditary glaucoma were studied from the ophthalmological, otological and histopathological point of view. Gonioscopy, tonometry, ophthalmo- and retinography, otoscopy, tympanometry, ABR and the corresponding histopathological studies of the eye and of the cochlea were performed. The simple hereditary glaucoma seems to be causally related with concomitant hearing loss due to congenital endolymphatic hydrops. Further studies are planed.
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As part of a pilot study for glaucoma surgery, the use of 3 infrared solid state lasers with 4 fiber optic delivery systems to ablate human trabecular meshwork was investigated. Laser trabecular ablation (LTA) was attempted with the Erbium:YAG (2.94 microns), Erbium:YSGG (2.79 microns), and Holmium:YSGG (2.1 microns) lasers. Laser energy was delivered as a single pulse (250 microseconds) by tissue fiber optic contact with low hydroxyl-fused silica (200 and 500 microns), zirconium fluoride (250 microns), or sapphire (250 microns) fiber optics. Total energy required and thermal effects decreased as laser wavelength increased. LTA was best achieved at 2.94 microns (4 mJ total energy; energy densities = 8.2-12.7 J/cm2; pulse length 250 microseconds) with average thermal damage zones of 5.3-10.3 +/- 1.3-2.4 microns (means +/- SDs) to contiguous structures. This finding has potential applications in the surgical treatment of open-angle and congenital glaucoma and may minimize failure rates seen in other types of surgery on the trabecular meshwork where disrupted trabecular meshwork is not removed.
One hundred fifty-one eyes of 101 consecutive patients with chronic open-angle and low tension glaucoma showed typical visual field changes. Sixty of the eyes had a nasal step, either alone or in combination with other defects. In 17 of these eyes, it was possible to demonstrate an isolated scotoma in the nasal periphery. It was concluded that the peripheral nasal step is a nerve fiber bundle defect that in its earliest phase produces a scotoma. In this sense, it behaves similar to the more central defects, rather than simply as a depression of isopters nasally.
The authors present the results of 2 years' observation of 47 eyes operated with diathermo-trabeculotomy ab externo. This technique, based on a diathermic effect in association with trabeculotomy ab externo, allows an ample opening of Schlemm's canal and of the trabecular meshwork, with normalisation of intraocular pressure and outflow facility, for a period of up to 2 years, in open-angle and congenital glaucoma.
Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angle-closure with peripheral anterior synechias, combined open-angle and angle-closure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant. Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg. Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant. The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare. We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.
Oxprenolol is a new beta-adrenergic blocking drug, whose effectiveness in the treatment of various forms of glaucoma has been evaluated. The drug was administered topically as 0.5% -1%-2% solution. The results of the investigation may be summarized as follows: The instillation of the drug produces a transient and slight conjunctival hyperaemia and a not significant miosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaumiosis. A significnat ocular hypotensive action has been observed in the treatment of chronic open-angle, hemorrhagic and congenital glaucoma. The concentration of 0.5% Oxprenolol seems to be as effective as topical 1% Propranolol. At the same concentration (0.5%), Oxprenolol produces no significnat change of the systemic blood pressure or of the heart rate. Topical pre-treatment with 1% Oxprenolol inhibits the systemic side-effects (tachycardia) produced by topical Isoproterenol, a wellknown ocular hypotensive drug. The authors conclude the investigation affirming that Oxprenolol may represent a new effective means for the medical treatment of glaucoma.
The effect of pilocarpine hydrochloride on the anterior chamber depth and lens thickness was measured in 20 eyes of patients with chronic open-angle glucoma who were receiving long-term glaucoma therapy with pilocarpine. Measurements were made with high-resolution ultrasonic biometry. This study demonstrated that regardless of their age (58.4 years, average) and the fact that they had been regularly using pilocarpine from two to four times a day, 85% of these patients demonstrated narrowing of the anterior chamber (AC) depth (average, 0.19 mm) and thickening of the lens (average, 0.21 mm) with each instillation of pilocarpine. In approximately 15% of eyes, a repeatable deepening of the AC depth and flattening of the lens was noted.
Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.
Anti-cicatricial cytostatic therapy with 5-fluorouracil and prospidin was carried out after antiglaucoma surgery in 78 eyes of 67 patients aged 6 to 42 (2/3 of the patients were aged from 21 to 40). Half (34) of the patients suffered from open-angle (pigmented in 3 cases) and 6 from closed-angle glaucoma, the rest patients presented with common hydrophthalmia, the Frank-Kamenetsky, Sturdge-Weber, Riger's syndromes, etc. The cytostatics were injected subconjunctivally. The results of 67 surgeries were followed up for 6 months to 3 years. Stable normalization of the ophthalmic tone and stabilization of the process were achieved in 60 eyes (89.2%). The authors emphasize that cytostatics may be recommended for children and young subjects after surgery involving fistulization, on condition of thorough biomicroscopic monitoring in the postoperative period, because of a possible disadaptation of the edges of the mucosal incision and corneal diseases.
Primary open-angle galucoma (POAG) patients are more responsive to glucocorticoids, and have increased prevalences of the histocompatibility antigens HLA-B7 and HLA-B12. We report herein a comparison of in vitro cellular responsiveness to glucocorticoids and HLA classification for 25 POAG patients, and 25 individuals who respond to topical dexamethasone with intraocular pressure is greater than 31 mm. HG. (GG responders). Within both the POAG and GG groups, significantly greater responsiveness to prednisolone occurs in patients with HLA-B12 antigen. No such association occurs for patients with HLA-B7.
Tonography was carried out at 8 AM, 2 PM, and 8 PM on 43 normal eyes, 58 open-angle glaucomatous eyes and 10 ocular hypertensive eyes. Diurnal variations in outflow facility and their relation to those in intraocular pressure (IOP) were studied. Diurnal variations in outflow facility were present in almost all eyes, with approximately a 10% exception. The average diurnal variation in true outflow facility (deltaCtrue) was 0.10 microliter/min/mm Hg in normal eyes and 0.07 microliter/min/mm Hg in glaucomatous eyes. The average rate of diurnal variation in true outflow facility: formula: (see text) was 43.6% in normal eyes and 69.1% in glaucomatous eyes. The value was greater in glaucomatous eyes than in normal eyes. The curve of diurnal variations in true outflow facility was divided into 5 types, and in glaucomatous eyes the value of outflow facility was apt to increase in the morning and decrease in the evening. In 42% of the normal and 45% of the glaucomatous eyes, inverse relation was seen between diurnal variations in outflow facility and diurnal rhythm in IOP. It is thought that diurnal variations in outflow facility, along with diurnal fluctuations in the rate of aqueous formation, are one of the factors responsible for the diurnal rhythm found in IOP.