Johannes C. Fleischhauer

High prevalence of glaucoma in patients with sleep apnea syndrome.

OBJECTIVEnTo determine the prevalence of glaucoma in sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of cardiovascular and neurologic sequelae.nnnDESIGNnCross-sectional study.nnnPARTICIPANTSnA total of 114 white patients consecutively referred for polysomnographic evaluation of suspected SAS.nnnINTERVENTIONnComplete ophthalmologic examination, including computerized perimetry and simultaneous stereoscopic optic disc photographs.nnnMAIN OUTCOME MEASURESnSpearman rank correlations between the respiratory disturbance index during night sleep (RDI), a value used to diagnose and grade SAS, and visual acuity, intraocular pressure (IOP), visual field indices, presence or absence of glaucomatous optic disc changes, and diagnosis of glaucoma. Each correlation was controlled for age and body mass index. To compare proportions of patients harboring glaucoma, the binomial test was used.nnnRESULTSnSixty-nine (60.5%) of the 114 patients had an RDI > or =10, which indicates SAS. Three patients had primary open-angle glaucoma, and two had normal-tension glaucoma. All patients with glaucoma had SAS. The observed prevalence of glaucoma in patients with SAS (5 of 69, 7.2%) was significantly higher than expected in a white population (2%) (P = 0.01). The RDI correlated positively with IOP (P = 0.025), visual field loss variance (P = 0.03), glaucomatous optic disc changes (P = 0.001), and diagnosis of glaucoma (P = 0.01).nnnCONCLUSIONSnPatients with SAS constitute a high-risk population for glaucoma and should therefore be screened for glaucoma.

Eyelid, conjunctival, and corneal findings in sleep apnea syndrome

OBJECTIVEnTo determine the prevalence of eyelid, conjunctival, and corneal findings in patients with sleep apnea syndrome (SAS).nnnDESIGNnCase series.nnnPARTICIPANTSnSeventy-two white patients referred for evaluation of suspected SAS.nnnINTERVENTIONnComplete examination of eyelids, conjunctiva, and cornea, including videokeratography.nnnMAIN OUTCOME MEASURESnSpearman rank correlations were determined between the respiratory disturbance index (RDI) during night sleep, a value used to diagnose and grade SAS, and tear film break-up time, eyelid distraction distance, presence or absence of ocular irritation symptoms, blepharoptosis, floppy eyelids, lacrimal gland prolapse, keratoconus, and endothelial dystrophy. Each correlation was controlled for age and body mass index.nnnRESULTSnAccording to the RDI, 44 (61 %) of the 72 patients had SAS. The RDI correlated positively with the eyelid distraction distance (P = 0.05), presence or absence of floppy eyelids (P = 0.01), and lacrimal gland prolapse (P = 0.01), and correlated negatively with tear film break-up time (P = 0.02). None of our patients with floppy eyelids had corneal abnormalities. One patient with SAS had bilateral keratoconus; another had bilateral Fuch endothelial dystrophy.nnnCONCLUSIONSnSleep apnea syndrome was significantly associated with reduced tear film break-up time, floppy eyelids, and lacrimal gland prolapse. However, ocular irritation symptoms and corneal involvement were rare among patients with SAS. These findings do not confirm previous studies that reported a high prevalence of corneal involvement in floppy eyelid syndrome.

Impact of optic media opacities and image compression on quantitative analysis of optical coherence tomography

PURPOSEnTo analyze the impact of opacities in the optical pathway and image compression of 32-bit raw data to 8-bit jpg images on quantified optical coherence tomography (OCT) image analysis.nnnMETHODSnIn 18 eyes of nine healthy subjects, OCT images were acquired from the central macula. To simulate opacities in the optical system, neutral-density (ND) filters with linear absorption spectra were placed between the OCT device and examined eyes. Light reflection profiles (LRPs) of images acquired with various ND filters were compared. LRPs of the 32-bit raw data were compared with those obtained from the 8-bit jpg compressed images.nnnRESULTSnND filters induced a linear decrease of reflectivity in OCT images, depending on initial signal intensity. Quantitative OCT analysis showed no significant difference between 32-bit raw data and 8-bit jpg files (P > 0.05).nnnCONCLUSIONSnQuantitative OCT analysis is not significantly influenced by data compression. A mathematical model can correct for optical opacities to improve OCT images.

In glaucoma, should enthusiasm about neuroprotection be tempered by the experience obtained in other neurodegenerative disorders?

Some in vitro and in vivo evidence, as well as rare observations in human eyes with glaucoma, suggests that retinal ganglion cells could be lost by apoptosis during the course of glaucomatous optic neuropathy. There exist also observations indicating that in the vitreous of patients with glaucoma it is possible to measure an increased concentration of glutamate (an excitotoxic amino acid known to induce neuronal apoptosis in animal models). These observations, among others, suggest the possibility of an excitotoxicity mechanism in the pathogenesis of glaucoma and as a consequence the potential for a neuroprotective approach to treating this disorder. Amazingly, not only in glaucoma but also in other neurodegenerative disorders (Parkinsons disease, amyotrophic lateral sclerosis, stroke, etc.) it has been postulated that neurons could be lost through an excitotoxic mechanism. In these non- glaucomatous disorders, quite a large number of clinical trials have already been conducted to determine the potential benefit of different neuroprotective therapies. Unfortunately, with a few rare exceptions, the results of these clinical studies have been very disappointing (in contrast to encouraging results obtained in preclinical trials). The experience acquired in other neurodegenerative disorders should probably be kept in mind when addressing the question of neuroprotection in glaucoma. In particular, the hope raised by preclinical studies showing that drugs could have a beneficial effect on the survival of retinal ganglion cells should certainly be tempered until such an effect is confirmed by clinical trials conducted in patients with glaucoma.

Combined meropenem and linezolid as a systemic treatment for postoperative endophthalmitis.

PURPOSEnThe aim of this study was to evaluate the antibiotic treatment of postoperative endophthalmitis with combined systemic meropenem and linezolid.nnnMETHODSnA retrospective analysis of endophthalmitis treated with systemic meropenem and linezolid compared to conventional systemic antibiotics by evaluation of outcome and adverse effects was carried out.nnnRESULTSn26 patients with unilateral postoperative endophthalmitis with a systemic combination regimen of meropenem (2 g TID, mean duration of treatment 5.5 days) and linezolid (600 mg BID, mean duration of treatment 8.9 days) (group 1, mean follow-up time 140 days) were included in this study and compared to 45 postoperative endophthalmitis patients treated with conventional systemic antibiotics (group 2; mean follow-up time 320 days). In group 1, 69.2 % of eyes additionally received intravitreal amikacin and vancomycin (vs. 24.4 % in group 2; p < 0.001), in 92.3 % pars plana vitrectomy was performed (vs. 68.9 % in group 2, p = 0.047). Mean best corrected visual acuity improved from a baseline of 1.76 logMar for group 1 and 1.83 logMar for group 2 to 0.91 logMar (p = 0.0001) and 0.90 logMar (p < 0.0001), respectively, at the end of the follow-up, revealing no significant differences between the two groups at any time point (p > 0.05). Ocular complications were observed in 34.6 % of eyes in group 1 (vs. 37.8 % in group 2; p > 0.05). Adverse drug effects occurred significantly more frequently in group 1 (26.9 % vs. 4.4 % p = 0.02).nnnCONCLUSIONnIn spite of the reported better penetration through the blood-ocular barrier and the broader antibacterial spectrum of meropenem and linezolid, no benefit in outcome was found in the present study. In contrast, adverse effects and costs of the combination regimen were significantly higher.

Pupillary examination with infrared consumer videocamera

BACKGROUNDnPupillary observation in the dark is always a problem in a general ophthalmological practice or an outpatient clinic without specialized equipment. We present two methods for observation of the pupils in darkness: 1) illumination of the pupils with the skiascope as a routine examination and 2) infrared observation of the pupils with a consumer digital video camera.nnnMETHODSn(1) Pupillary reactions are observed with the skiascope/retinoscope, the observation beam of the device focused to infinity and documented with a video camera. (2) Infrared observation of the pupils was performed with a digital consumer video camera, allowing observation of the pupillary reaction in darkness. After recording, video sequences of interest were transferred to a personal computer and the still images of interest extracted.nnnRESULTSnIn everyday clinical routine, observation of the pupillary reaction with the skiascope/retinoscope proves as a reliable tool with a large bandwidth of illumination and a high contrast between pupil and surrounding area. The infrared video camera allows an excellent visualization of the pupillary reflex in darkness. The transfer of the video sequences to a personal computer proved to be simple and single images can easily be chosen.nnnCONCLUSIONnObservation of the pupillary reflex with the skiascope proved a useful tool that is available in practically every ophthalmological office. Use of the infrared digital consumer video camera (available at low prices) is a highly sophisticated tool for observation and documentation of pupillary reflex in darkness.