Christina Raitta

Optic disc changes in normotensive persons with unilateral exfoliation syndrome: a 3-year follow-up study

Abstractu2002· Background: If, at the time of glaucoma diagnosis, the intraocular pressure (IOP) is higher and the initial field loss more advanced in glaucomatous eyes with than without exfoliation, the cause of the optic disc damage has been suggested to be the high IOP associated with the exfoliation syndrome (EXS). We decided to investigate whether EXS alone, without the contributory effect of measured raised IOP, is a risk factor for optic nerve damage. · Methods: Twenty-two non-glaucomatous, normotensive persons with clinically unilateral EXS were examined for IOP, visual fields (Octopus G1) and disc topography (Imagenet, Topcon) and followed up for 3 years. · Results: At the start, the paired exfoliative (E) and non-exfoliative (NE) eyes did not differ in IOP, disc, rim, or cup areas, or cup volumes. They differed in R/D (rim/disc) radius ratio in the inferior section of the optic disc. During the follow-up period, the IOP increased in the E and the NE eyes, and changes indicative of nerve fiber loss were measured in both eyes. In those (n=14) in whom the IOP in the two eyes was equal throughout the follow-up period, disc changes took place only in the E eye. · Conclusion: The exfoliative process in itself may be a risk factor for optic disc changes.

Adverse reactions to fluorescein angiography

Abstract Adverse reactions to ophthalmic patients during 9909 fluorescein angiographies during 9 years were registered. Nausea (4.6%) and vomiting (1.3%) were the most common untoward reactions. Allergic skin manifestations occurred in 48 patients, and 5 patients complained of shortness of breath. 56 patients (0.6%) felt dizzy during or immediately after the investigation. Nine patients complained of chest pain, three of whom developed myocardial infarction.

A Review of the Outcome of Trabeculectomy in Open-Angle Glaucoma

BACKGROUND AND OBJECTIVEnThe outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed.nnnPATIENTS AND METHODSnThe study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes.nnnRESULTSnIn a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more.nnnCONCLUSIONnThe diffuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.

Ophthalmologic findings in cohen syndrome: A long-term follow-up

OBJECTIVEnTo determine the nature and course of ophthalmologic abnormalities and their clinical significance in Cohen syndrome.nnnSTUDY DESIGNnObservational case series.nnnPARTICIPANTSnTwenty-two Cohen syndrome patients aged 2 to 57 years were examined, and a retrospective review of ophthalmologic records was carried out for 14 of them. All but one were part of the Finnish study of refined mapping of the Cohen syndrome gene by linkage disequilibrium in chromosome 8.nnnMAIN OUTCOME MEASURESnVisual acuity (VA), cycloplegic refraction, biomicroscopy, lens opacitometry, ophthalmoscopy, and fundus photography.nnnRESULTSnWith the exception of the two youngest patients, all had symptoms such as nyctalopia, impaired vision, and visual field loss. Progressive, often high-grade myopia, astigmatism, and retinochoroidal dystrophy resembling retinitis pigmentosa occurred in all, except for the youngest patients. The earliest fundus changes were pale disc and pale fundus with or without pigment granularity, followed by narrowed vessels, pigment clumps, and bone spiculelike pigment accumulations by 10 to 20 years of age. Pigment deposits increased and approached the posterior pole by 35 to 40 years of age. Patients more than 45 years of age had severe retinochoroidal atrophy. A bulls-eye macula was seen in most patients. Teenagers had peripheral lens opacities, and young adults had early nuclear sclerosis confirmed by lens opacitometry. Older patients also had posterior subcapsular cataracts, iris atrophy, and iridophacodonesis. Vision started to deteriorate at the age of 6 to 10 years, but remained relatively good (VA 0.5-0.1) in most patients until 30 and, in one case, 46 years of age. Older patients were severely visually handicapped (VA hand motion to light perception), but none were completely blind.nnnCONCLUSIONSnProgressive myopia and retinochoroidal dystrophy are essential features in Cohen syndrome and, together with early lens opacities, lead to deterioration of vision. Cohen syndrome patients need careful ophthalmologic follow-up at all ages. Nyctalopia and restricted visual fields should be considered when planning the patients daily activities.

Optic Disc Topography Before and After Trabeculectomy in Advanced Glaucoma

BACKGROUND AND OBJECTIVEnTo analyze changes in the optic disc topography after filtration surgery.nnnPATIENTS AND METHODSnLaser scanning tomography was performed in 10 eyes of 9 patients (mean age 65.6 +/- 8.1 years; age range 55 to 75 years) after a mean follow-up of 3.7 months, and in 8 eyes of 7 patients (mean age 63.1 +/- 7.6 years; age range 55 to 75 years) after a mean follow-up of 13.1 months.nnnRESULTSnPreoperatively, the mean intraocular pressure (IOP) was 24.4 +/- 6.9 mm Hg with maximal medication. Postoperatively at 3.7 months it was 11.0 +/- 2.2 mm Hg, and at l2.1 months it was l3.6 +/- 2.8 mm Hg. An initial reduction in IOP of more than 30 percent at 3.7 months was achieved without medication in all but 1 eye. After 12.1 months, an IOP reduction of more than 30 percent was achieved in 6 of 8 eyes (1 with medication), while 2 eyes had IOP reductions of less than 15 percent (< or = 3 mm Hg) despite medication. In the 6 eyes, the optic disc cup volume showed a decrease of more than 30 percent, while the 2 eyes without marked IOP reductions had slight increases in cup volume. Of the 2 eyes without marked decreases in cup size, 1 had normal-tension glaucoma and 1 experienced an increase in IOP of more than 25 mm Hg during the first postoperative week.nnnCONCLUSIONnThe postoperative IOP should be kept low enough to permit reversal of optic disc changes.

Extracapsular Cataract Extraction and Posterior Chamber Lens Implantation in Controlled Open-Angle Glaucoma

A consecutive series of 103 eyes, 37 with controlled simple glaucoma (SG) and 66 with capsular glaucoma (CG), underwent extracapsular cataract extraction (ECCE) and posterior chamber lens (PC-IOL) implantation. Two to 6 weeks after surgery, 48% of the SG eyes and 62% of the CG eyes had visual acuities better than 0.4, as compared with 8% and 3%, respectively, preoperatively. The corresponding figures after 12 to 43 months in the SG eyes were 62%, and after 14 to 38 months in the CG eyes, 55%. A slight increase of mean intraocular pressure (IOP), from 19.0 +/- 4.8 mm Hg to 25.3 +/- 13.3 mm Hg in the SG eyes, and from 19.0 +/- 3.9 mm Hg to 24.5 +/- 9.6 mm Hg in the CG eyes occurred 1 to 2 weeks after surgery; at 2 to 6 weeks the mean IOPs had returned to preoperative levels: 18.1 +/- 6.4 mm Hg in the SG eyes and 18.4 +/- 5.9 mm Hg in the CG eyes. After a mean of 26.5 months (range, 12 to 43 months), IOP had decreased to 17.3 +/- 2.9 mm Hg in the SG eyes; and after 24.2 months (range, 14 to 38 months) to 17.6 +/- 5.7 mm Hg in the CG eyes. The need for glaucoma medication was diminished at 2 to 6 weeks after surgery: IOP was controlled (less than 21 mm Hg) without glaucoma medication in 43% of the SG, and in 50% of the CG eyes (preoperatively, all of the SG and 89% of the CG eyes required medication).(ABSTRACT TRUNCATED AT 250 WORDS)

Interocular differences in optic disc configuration in the unilateral exfoliation syndrome

Abstract Thirty‐seven patients with normal visual fields and open angles in both eyes, and lens exfoliation in only one eye, were examined for intraocular pressure, and optic disc topography was determined from stereo‐photographs of the fundi with the computerized three‐dimensional image analyzer. The rim‐to‐disc radius ratios at intervals of 30° were obtained with the instrument. The mean intraocular pressure of the exfoliative eyes (17.5 ± 2.9 mmHg) was significantly higher than that of the nonexfoliative eyes (15.9 ± 2.8 mmHg). In the exfoliative eyes, the mean rim‐to‐disc radius ratio at the inferior‐temporal was significantly smaller, and the higher the intraocular pressure of the exfoliative eye in comparison with that of the nonexfoliative eye, the smaller were the rim‐to‐disc radius ratios at the inferior‐temporal and inferior radii. In the exfoliative eyes, pressure‐dependent changes are observable in the inferior and inferior‐temporal areas of the optic disc prior to visual field loss.

Peripapillary atrophy in unilateral capsular glaucoma

Pairwise comparisons of peripapillary crescents and haloes were performed for 56 eyes of 28 patients with early or moderate unilateral capsular glaucoma and no signs of exfoliation in the contralateral eye. The eyes differed highly significantly in rim area, rim/disc area ratio, cup area, and cup volume. They did not differ in disc areas, scleral ring areas, or size of peripapillary crescents. In the nonglaucomatous and glaucomatous eyes a significant correlation existed between the intraocular pressure (IOP) and the area of peripapillary atrophy. The area of peripapillary atrophy was significantly correlated with the damage to the glaucomatous optic nerve head. We concluded that the area of peripapillary atrophy is largely an inborn feature, and that nerve fiber loss can occur without differences in the peripapillary tissues. Nevertheless, an IOP-induced change in the retinal pigment epithelium cannot be ruled out.

Microcirculatory disturbances of occlusive diseases of the eye

Vascular changes of the retina, choroid and iris were studied by fluorescein photography in selected typical cases of branch vein and central retinal vein occlusion from our series of about 300 cases with venous occlusions.The basic circulatory disturbance is discussed. Branch vein occlusion is a local vascular insult with typical late stage fluorescein-angiographic features.Arterial involvement in the form of arteriolar and capillary obliteration was found to be typical. At the border of the ischemic, atrophic area saccular dilatations, microaneurysms and palisades of shunts were present. Extravasation of dye indicated severe vascular damage and alteration of the blood rheology.Underfilling of the choroid in the area involved and late profuse extravasation of fluorescein as well as severe changes of the retinal arterioles, venules and capillaries represented another type.The benefit of photocoagulation is pointed out.In central retinal vein occlusion changes in the blood rheology lead to severe edema, ischemic infarcation and vascular changes as seen by damage to the vessel wall, arteriovenous shunts, capillary dilatations, shunting and microaneurysms.The importance of restoring circulation as soon as possible is pointed out. For this purpose, photocoagulation combined with medical therapy is suggested and the results of some cases are presented.Prognostic signs are presented. In addition to latent simple glaucoma and profuse hemorrhages, under- and non-filling of the peripapillary and macular choroid might indicate a bad risk. The pathomechanism of hemorrhagic glaucoma is discussed.The use of photocoagulation for the prevention of hemorrhagic glaucoma is suggested.

Trabeculectomy with the use of sodium hyaluronate. One year follow-up.

Abstract The effect of sodium hyaluronate (Healon) on the post‐operative course 1 week, 1 month and 1 year after trabeculectomy is reported. Forty‐six eyes of 38 patients with open‐angle glaucoma (16 simple, 16 capsular and 14 secondary glaucomas) were operated with the use of sodium hyaluronate. The study was prospective. For comparison, 46 eyes of 38 age‐, sex‐and diagnosis‐matched patients with glaucoma operated during the pre‐Healon period were selected. Patients in the study group were operated by the same surgeon and in the control group by different senior staff members. IOP decrease was essentially the same in both groups. No differences in post‐operative pressure level existed between the different types of glaucoma. Extremely shallow or flat chamber occurred more frequently in the control series: 15 versus 9. Statistical analysis could not be applied. The trend in favour of Healon is discussed. Pressure rise ≥ 30 ramHg 2–7 days after the operation was diagnosed in 8 eyes of the Healon group and 13 eyes of the control group. IOP rise was relieved by argon laser treatment of the fistula during the first week post‐operatively in 6/8 eyes of the Healon group in order to facilitate aqueous drainage. Sodium hyaluronate facilitated the technical performance and prevented collapse of anterior chamber and AC haemorrhages during the operation. Sodium hyaluronate seems to prevent excessive early filtration and hypotony. After follow‐up of one year, 7 patients in the control series and 4 in Healon series had progression of cataract. Two of the patients in the control‐group needed cataract operation during the follow‐up period. A definite conclusion in favour of Healon has to be verified.