R. Augsten

Anterior segment optical coherence tomography for evaluation of changes in anterior chamber angle and depth after intraocular lens implantation in eyes with glaucoma

Purpose. To examine anterior chamber depth (ACD) and anterior chamber angle (ACA) in patients with glaucoma after cataract extraction with an anterior optical coherence tomography (OCT) system. Methods. A new commercially available 1310 nm infrared light anterior segment OCT system was used for anterior chamber evaluation. Sixty patients (n=20 with primary open angle glaucoma [POAG], n=20 with angle closure glaucoma [ACG], and n=20 with no known glaucoma as control group) with a mean age of 68.8±13.9 years undergoing cataract surgery were enrolled. Results. Before cataract surgery, ACD and ACA of the ACG group were significantly lower compared to the POAG and control groups (ACD p<0.005; ACA p<0.005). After cataract extraction, ACD and ACA increased significantly in the ACG group (3.1±0.4 mm vs 1.8±0.2 mm, p<0.005 and 32.3°±7.7° vs 16.0°±4.7°, p<0.005). In the POAG and control groups, ACD and ACA also increased postoperatively, but not as much as in the ACG group. After cataract extraction, IOP decreased significantly in the glaucoma groups (ACG: 15.6±6.1 vs 18.6±5.7 mm Hg, p=0.008; POAG: 16.2±3.4 vs 20.7±8.0 mmHg, p=0.02) and was almost the same in all three groups after surgery (control group after surgery: 15.2±2.8 mmHg). Conclusions. Both ACD and ACA increased significantly after cataract extraction and IOL implantation. IOP reduction after surgery was higher in the glaucoma groups compared to the control group.

Impact of Macular Pigment on Fundus Autofluorescence Lifetimes.

PURPOSE To characterize the macular region and to investigate the influence of the macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo. METHODS Forty-eight healthy subjects with a mean age of 24.1 ± 3.6 years (range, 20-37 years) were included. A 30° retinal field was investigated using the fluorescence lifetime imaging ophthalmoscope (FLIO), based on a Heidelberg Engineering Spectralis system, detecting FAF decays in a short (498-560 nm; ch1)- and a long (560-720 nm; ch2)-wavelength channel. The mean fluorescence lifetime τm was calculated from a 3-exponential approximation of the FAF decays. Macular pigment optical density (MPOD) was measured by one-wavelength reflectometry, and macular optical coherence tomogram (OCT) scans were recorded. Correlations between τm and MPOD were analyzed. RESULTS The τm showed shortest values at the macular region with a mean of 82 ps (ch1) and 126 ps (ch2). We found a strong correlation of τm to the MPOD (ch1: r = -0.760; ch2: r = -0.663; P < 0.001), as well as a topologic agreement of shortest τm with highest MPOD. CONCLUSIONS Macular pigment, which is known to have very short fluorescence decays, considerably contributes to the macular autofluorescence (AF). This study gives indirect evidence for a strong impact of MP on macular τm, although no direct measurement of MP autofluorescence lifetimes in vivo is possible at this point. Potentially, imaging the FAF lifetimes could lead to a novel methodology for the detection of macular pigment properties and pathology-induced changes in the living human retina.

Endogene Endophthalmitis bei schweren Allgemeinerkrankungen

Hintergrund: Die endogene Endophthalmitis bei schweren Allgemeinerkrankungen und reduziertem Allgemeinzustand hat trotz moderner antibakterieller, antimykotischer und operativer Therapie eine äußerst schlechte Prognose.Patienten: Die Studie zeigt den Krankheitsverlauf bei 5 Augen von 4 Patienten mit endogener Endophthalmitis. Das Alter der Patienten lag zwischen 58 und 71 Jahren. Die Zeitspanne zwischen dem Auftreten der ersten Augensymptome und der stationären Aufnahme betrug 1 Woche bis 3 Monate. An Allgemeinerkrankungen waren Endometriumkarzinom, Kolonkarzinom, Korpuskarzinom (mit Bauchfistel) und Pankreasinsuffizienz (mit Subklaviakatheter) sowie Diabetes mellitus bekannt.Ergebnisse: Entsprechend dem Keimnachweis (Candida albicans in 3 Augen, Bakterien in 2 Augen) wurde antibakteriell bzw. antimykotisch lokal, subkonjunktival und systemisch behandelt sowie eine Pars-plana-Vitrektomie und/oder Glaskörperpunktion mit Antibiotika- bzw. Antimykotikaeingabe durchgeführt. Trotzdem lagen abschließend folgende Befunde vor: 1 Auge Enucleatio bulbi, 1 Auge Evisceratio bulbi, 2 Augen Lichtschein, 1 Auge Visus 0,2.Schlußfolgerung: Die Einweisung der Patienten in Kliniken mit einer Abteilung für Glaskörperchirurgie sollte möglichst frühzeitig erfolgen. Nur so ist es möglich, schnell mit einer adäquaten Therapie zu beginnen.Background: In spite of modern antibacterial, antimycotic and operative therapies, endogenous endophthalmitis connected with other severe diseases and an impaired state of health is an eye complication with a very poor prognosis.Patients: The study presents observations about the progress of the endogenous endophthalmitis in five eyes of four patients. The age of the patients ranged from 58 to 71 years. The span between the appearance of the first eye symptoms and hospital treatment amounted to 1 week and 3 months. The general diseases have been diagnosed as endometrium cancer, colon cancer, corpus uteri cancer (with intestinal fistula) and pancreatic insufficiency (with subclavian catheter) as well as diabetes mellitus.Results: In regard to the infections we analyzed (Candida albicans in 3 eyes, bacteria in 2 eyes), very intensive medical treatment was initiated, including antibacterial or antimycotic therapy (local, subconjunctival, intraocular and systemic) as well as pars plana vitrectomy and/or vitreous puncture. Nevertheless, by the end of the clinical attendance, the following statements were established: one-eye enucleation, one-eye evisceration, two eyes perception of light, one eye visual acuity 0.2.Conclusion: The patients should be immediately admitted to a hospital with a department for vitreous surgery. Only with this option is it possible to initiate adequate therapy.

Surgical approach in Terson syndrome : vitreous and retinal findings

Purpose To report some interesting findings in patients with bilateral Terson syndrome. Methods We describe six eyes from three patients with Terson syndrome. Pars plana vitrectomy was performed in one eye twelve weeks, and in four eyes six months after the acute event. In one eye blood was suddenly spontaneously absorbed after four months. Results The four eyes operated six months after injury showed severe complications and final visual acuity was between light perception and 0.6. The eye with surgical attendance twelve weeks after the acute injury had an uneventful course, and final visual acuity was 0.7. Conclusions Because of severe ocular complications and with a view to early rehabilitation, vitrectomy has been recommended for eyes with bilateral Terson syndrome, without spontaneous blood resorption. Surgery should be performed in at least one eye not later than four to eight weeks after the acute injury.

Fundus autofluorescence lifetimes are increased in non‐proliferative diabetic retinopathy

To discriminate non‐proliferative diabetic retinopathy (NPDR) patients from healthy controls by fluorescence lifetime imaging ophthalmoscopy (FLIO).

Monitoring macular pigment changes in macular holes using fluorescence lifetime imaging ophthalmoscopy

To investigate the impact of macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo by characterizing full‐thickness idiopathic macular holes (MH) and macular pseudo‐holes (MPH).

Nonproliferative diabetic retinopathy-reflection spectra of the macula before and after laser photocoagulation.

This study examines the influence of diabetic and laser photocoagulation on the reflection spectra of the macula. In the investigation 43 patients with type II diabetes mellitus and 33 normals were included. It was shown that the optical density in diabetics is increased compared to normals. After laser photocoagulation the reflection spectra have changed, suggesting a decrease in optical density. It is proposed that the therapeutic effect of photocoagulation in diabetic retinopathy is related to an alteration in blood flow in the choroid.

Multisubstance analysis of reflection spectra before and after laser photocoagulation for proliferative diabetic retinopathy

Purpose The aim of the study was to provide new data that add to the understanding of diabetic retinopathy and its treatment by photocoagulation. Patients and Methods. Using a spectrometric method, the reflection spectra of the macula in six type II diabetics with proliferative diabetic retinopathy were measured before and after laser photocoagulation and compared with normals. The investigations were done one day before laser photocoagulation and again the day after. Further measurements were made 14 days, 6 weeks and 4 months after coagulation. The reflection spectra were assessed by multisubstance analysis. Results and Conclusions. The contents of xanthophyll, melanin and choroidal oxyhemoglobin and the intensity of scattered light were significantly altered after laser coagulation. For example, in patients with proliferative diabetic retinopathy the content of oxyhemoglobin in the choroid was lower than normal, but it rose after laser treatment. This suggests an improved oxygen supply of the choroid after laser coagulation, implying reduced retinal hypoxia.

Dependence of diameters and oxygen saturation of retinal vessels on visual field damage and age in primary open-angle glaucoma

To investigate the interrelationship between the oxygen supply of the retina and its regulation with the severity of primary open‐angle glaucoma (POAG).

Venous retinal oxygen saturation is independent from nerve fibre layer thickness in glaucoma patients

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