Et Matthiessen

Effects of glaucoma drugs on ocular hemodynamics in normal tension glaucoma: a randomized trial comparing bimatoprost and latanoprost with dorzolamide [ISRCTN18873428]

BackgroundReduced choroidal perfusion is hypothesized to play a role in the pathogenesis of normal tension glaucoma. Thus the impact of antiglaucomatous eye drops on ocular perfusion has been the focus of recent research and the subject of intensive investigations. The present study investigates whether topically applied latanoprost or bimatoprost influence ocular perfusion in patients with normal tension glaucoma and compares these effects with that changes detected after the treatment with dorzolamide.MethodsOcular hemodynamics were assessed by color Doppler imaging (CDI) shortly before and after a one-month treatment with either latanoprost, bimatoprost or dorzolamide. Primary end-points of the study were peak systolic and end-diastolic blood flow velocities in the short posterior ciliary artery (SPCA) under the new therapy. Intraocular pressure (IOP) and additional perfusion parameters in the SPCA and other retrobulbar vessels were tracked as observational parameters. n = 42 patients with normal tension glaucoma were enrolled in the study.ResultsSystolic and diastolic blood flow velocities in the SPCA showed no significant alteration after the treatment with latanoprost or bimatoprost. Dorzolamide lead to increase of peak systolic velocity. IOP was reduced by all three agents in a range reported in the literature.ConclusionTopically applied latanoprost and bimatoprost act in a hemodynamically neutral manner and have the capability to lower IOP even in patients with normal tension glaucoma and low initial IOP level. Dorzolamide accelerates blood flow in systole. None of the tested compounds has a negative impact on hemodynamics in the short posterior ciliary arteries.

Estimation of choroid perfusion by colour Doppler imaging vs. other methods

Ocular haemodynamics play a prominent role in several ocular diseases. Recently, new methods for the determination of ocular perfusion were developed. Colour Doppler imaging (CDI) of orbital vessels has come up in the past decade and was shown to be useful in ophthalmological diagnostics. Little is known about measurement of choroid perfusion by CDI in comparison with other methods. Therefore, 49 eyes were examined with CDI, laser Doppler flowmetry (LDF) and the method of Langham (LOBF). Correlations between the methods were identified by the Spearman correlation coefficient (r). LDF readings correlated with time-averaged mean velocity assessed by CDI in the long posterior ciliary artery (r = 0.47; p = 0.039; n = 20), but not in the short posterior ciliary artery. LOBF measurements correlated with pulsatility index (PI) of CDI in short (r = 0.50; p = 0.005; n = 30) and long posterior ciliary arteries (r = 0.41; p = 0.024; n = 30). Methods strengthened each other by partial correlation. The study demonstrates that CDI allows a more detailed insight into ocular perfusion.

Bilateral Crystalline Corneal Deposits as First Clinical Manifestation of Monoclonal Gammopathy: A Case Report

Aims: To report the clinical and diagnostic findings of a patient with bilateral corneal deposits caused by an underlying monoclonal gammopathy. Methods: Slit-lamp biomicroscopy, confocal microscopy and additional serological tests were performed on a 35-year-old man presenting with bilateral crystalline corneal deposits. Results: The patient was diagnosed as having monoclonal gammopathy based on elevated levels of serum immunoglobulin G. Confocal microscopy showed highly reflective (protein) deposits throughout the entire cornea, with the highest density in the epithelium and anterior stromal keratocytes. Conclusions: Monoclonal gammopathy, a potential sign of a life-threatening disease, can lead to dense, bilateral corneal deposits. As such changes can occur long before ocular or systemic discomforts appear, an early diagnosis is crucial. Ophthalmologists should be aware of corneal deposits as potential warning signs of monoclonal gammopathy.