Search

Zusammenfassung Hintergrund Untersuchung der langfristigen Effizienz und Sicherheit der transskleralen Lasertherapie (TLT) mittels MicroPulse über 24 Monate bei Patienten mit primärem Offenwinkelglaukom (POWG). Material und Methoden In dieser prospektiven interventionellen Fallserie wurden die Daten von 44 Augen von medikamentös behandelten POWG-Patienten ausgewertet, die eine MicroPulse-TLT erhielten, um eine weitere Senkung des Augeninnendrucks (IOD) zu erreichen. Es wurden die Reduktion des 24-h-IODs, der zirkadianen IOD-Fluktuationen und der IOD-Spitzen nach 3, 12 und 24 Monaten untersucht. Zudem sollten postoperative Komplikationen, die Misserfolgsquote und Einflussfaktoren auf den Therapieerfolg analysiert werden. Ergebnisse Der IOD ist von 16,1 ± 3,4 mmHg präoperativ auf 13,0 ± 2,9 mmHg (n = 31; p Schlussfolgerung Die MicroPulse-TLT zeigt eine gute IOD-Senkung bei Patienten mit primärem Offenwinkelglaukom und maximal tolerierter drucksenkender Lokaltherapie, wobei etwa 50% der Augen ihren individuellen Zieldruck erreichten.

PURPOSE Chronic hyperglycemia induces morphological and functional changes of the cornea. Corneal clarity is essential for visual function, and the measurement of corneal optical density (COD) might provide further information on diabetes mellitus (DM)-induced alterations. METHODS COD of patients with DM and age-matched healthy subjects was measured using the Pentacam HR. Furthermore, central and thinnest corneal thickness and peripheral pachymetry of concentric circles around thinnest corneal thickness were investigated. In DM, information on disease duration, type, presence of diabetic retinopathy and maculopathy, and HbA1c value was recorded. RESULTS In this study, 76 patients with DM and 65 healthy subjects were included. In patients with DM, the COD values of nearly all corneal layers and zones were reduced in comparison with healthy subjects (P < 0.05). Furthermore, the COD measurements were inversely correlated with the HbA1c value (total COD central layer: r = -0.424, P = 0.044) and stage of diabetic retinopathy (total COD: r = -0.271, P = 0.019). Diabetic patients with maculopathy revealed lower total COD values than patients without maculopathy (16.5 ± 5.6 vs. 21 ± 7.6, P = 0.031), and COD was lower in DM type 1 than in type 2 (16.1 ± 5.1 vs. 20.8 vs. 7.5, P = 0.035). In both groups, the COD values increased with age (patients with DM: r = 0.336, P = 0.003; healthy subjects: r = 0.679, P < 0.001) and decreased with peripheral corneal thickness increase. CONCLUSIONS In patients with DM, COD was significantly reduced in comparison with healthy subjects. These changes were associated to disease-specific factors and measurements of peripheral corneal thickness profiles.

PURPOSE Diabetes mellitus (DM) induces changes in corneal biomechanical properties. The influence of disease-specific factors was evaluated, and a novel DM index was created. METHODS Eighty-one patients with DM and 75 healthy subjects were matched according to age, intraocular pressure, and central corneal thickness. Information on the disease was collected, and measurements with the Ocular Response Analyzer and the Corvis ST were taken. Results were compared between the groups, and the influence of disease-specific factors was evaluated. From dynamic corneal response parameters, a DM index was calculated. RESULTS In DM, corneal hysteresis was higher than in healthy subjects (10.5 ± 1.9 vs. 9.7 ± 1.9 mm Hg, P = 0.008). In addition, dynamic corneal response parameters showed significant differences. Among others, highest concavity (HC) (17.212 ± 0.444 vs. 16.632 ± 0.794 ms, P < 0.001) and A2 time (21.85 ± 0.459 vs. 21.674 ± 0.447 ms, P = 0.017) as well as A1 (0.108 ± 0.008 vs. 0.104 ± 0.011 mm, P = 0.019) and A2 deflection amplitudes (0.127 ± 0.014 vs. 0.119 ± 0.014 mm, P < 0.001) were increased in DM. In DM type 1, HC deformation amplitude (1.14 ± 0.19 vs. 1.095 ± 0.114 mm, P = 0.035) was higher than in type 2. The time of deflection amplitude max correlated with the severity of retinopathy (R = 0.254, P= 0.023). In case of diabetic maculopathy, A1 velocity (0.155 ± 0.018 vs. 0.144 ± 0.019 ms, P = 0.043) and A2 time (22.052 ± 0.395 vs. 21.79 ± 0.46 ms, P = 0.04) were increased. Deformation amplitude max (R = 0.297, P = 0.024), HC time (R = 0.26, P = 0.049), HC deformation amplitude (R = 0.297, P = 0.024), and A2 deformation amplitude (R = 0.276, P = 0.036) were associated to disease duration. The DM index revealed a sensitivity of 0.773 and a specificity of 0.808 (area under the curve of receiver operating characteristic = 0.833). CONCLUSIONS In DM, changes in corneal biomechanics were correlated with disease-specific factors. The DM index achieved reliable sensitivity and specificity values.

To investigate optic nerve head (ONH) pallor quantitatively in patients with primary open-angle glaucoma (POAG) and in healthy subjects, and to examine the relationship to mean deviation in perimetry (MD), cup-disk ratio (CDR), and diameters of retinal vessels.A total of 89 POAG patients (67.6 ± 11.1 years) and 48 healthy subjects (63.3 ± 14 years) were included. A dual-bandpass transmission filter was introduced in the illumination path of the fundus camera of the Dynamic Vessel Analyzer (Imedos Systems UG) and two monochromatic images at different wavelenghts (548 ± 10 and 610 ± 10 nm) were recorded simultaneously. ONH pallor was defined as the quotient of light reflection in both spectral channels. Pallor values were averaged over four fields which were positioned on the ONH. The mean of these measurements was calculated. In 47 of 89 POAG patients diameters of retinal vessels were determined peripapillary.In POAG, the ONH showed a significantly higher pallor value compared to healthy subjects (82.34 ± 19.28 vs. 62.67 ± 10.41, p0.001). ONH pallor was correlated to indicators used to estimate disease severity: MD (r = -0.565, p0.001) and CDR (r = 0.561, p0.001). The pallor value was associated to diameters of retinal arterioles (r = -0.313, p = 0.032) and venules (r = -0.397, p = 0.006).Pallor determined by this method was higher in POAG patients than in healthy subjects and increased in patients with advanced disease. ONH pallor might result from a reduced blood perfusion of the ONH or tissue atrophy accompanied by vessel obliteration in POAG. By measuring ONH pallor additional diagnostic information about the vitality of the neuroretinal rim might be gained in glaucoma patients.

To examine the supply of oxygen to the retina in primary open-angle glaucoma (POAG). Forty-one patients with primary open-angle glaucoma (mean age 64.1 ± 12.9 years) and 40 healthy subjects (63.6 ± 14.1 years) were included. Fundus images, centered at the optic disc, were taken using the Retinal Vessel Analyzer (RVA). The vessel diameters were calculated as central retinal artery (CRAE) and vein equivalent (CRVE) from diameter measurements in the peripapillary vessels. The oxygen saturation of the arteries and veins was investigated employing a two-wavelengths technique. After the measurement at baseline, the vascular response to flicker light exposure was measured. In glaucoma patients the mean oxygen saturation of the retinal veins at baseline was higher than in the healthy controls (64.36 ± 7.11 vs. 59.78 ± 8.47, p = 0.01), whereas the mean arteriovenous oxygen saturation difference was lower (33.07 ± 5.24 vs. 37.53 ± 6.95, p = 0.002). The arterial oxygen saturation as well as the arterial and venous diameters showed no difference between the groups. The increase of the CRVE during flicker light stimulation (3.72 ± 3.29 % vs. 5.43 ± 4.04, p = 0.039), as well as the change of the venous oxygen saturation (2.08 ± 3.74 % vs. 4.18 ± 3.88 %, p = 0.016) and the arteriovenous saturation difference (−2.1 ± 3.31 % vs. −4.43 ± 3.6 %, p = 0.003) were smaller in POAG patients than in the healthy group. The reduction in the arteriovenous difference in oxygen saturation in POAG patients might show a decreased oxygen demand of the retina caused by the glaucomatous loss of neuroretinal tissue. The lower extent of the flicker light-induced change of the diameter of retinal veins and the venous oxygen saturation could indicate an impairment of blood flow regulation.