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Using optic disk photographs, qualitative morphologic characteristics of the optic nerve head were determined in 251 nonselected normal eyes and 308 eyes with chronic primary open-angle glaucoma. These characteristics were correlated to morphometric (both intra- and parapapillary) and perimetric data. The highest degree of accuracy in distinguishing normal from glaucomatous optic disks was found with the characteristics "localization of narrowest point of neuroretinal rim outside the temporal horizontal optic disk sector" (85.5%) and "changes in the parapapillary retinal nerve fiber layer" (87.9%). The signs "baring of circumlinear vessels," "baring of cilioretinal arteries," "epipapillary flame-shaped hemorrhages," and "bridging of the vessel trunk" were highly specific for glaucomatous optic nerve damage (94.4%-100%) and less sensitive (5.8%-25.3%). Bayonetlike vessel kinking," "prevalence of cupping nasal to the main vessel trunk," "baring of the lamina cribrosa pores," and "undermining of the cup border" were less useful in qualitative evaluation of the optic disk. The location of the central artery in relation to the central vein (nasal in 98.4%), prevalence of the cilioretinal arteries, and the total number of circumlinear vessels were not significantly correlated to changes associated with glaucoma and are therefore of no importance for optic disk evaluation in glaucoma.

BACKGROUND The diagnosis of idiopathic intracranial hypertension results from a synopsis of standardised examinations including MRI. Since the cerebrospinal fluid pressure influences the pressure of the central retinal vein, it was the purpose of the present study to evaluate whether the ophthalmodynamometric estimation of the central retinal vein collapse pressure is helpful for the diagnosis of idiopathic intracranial hypertension. PATIENTS AND METHODS The study included 5 patients with idiopathic intracranial hypertension with a mean age of 38.3+/-10.8 years and 88 subjects of a control group with a mean age of 66.8+/-13.1 years. Using a modified corneal contact lens-associated ophthalmodynamometry, the collapse pressure of the central retinal vein was estimated. RESULTS The central retinal vein collapse pressure was significantly higher in the study group (33.0+/-27.3 relative units) than in the control group (2.0+/-6.7 relative units) (p

Background: To evaluate the clinical outcome of macular grid laser photocoagulation in the treatment of diffuse diabetic macular oedema. Patients and method: The retrospective study included 30 consecutive patients (41 eyes) who were treated by macular argon green grid laser photocoagulation for diffuse diabetic macular oedema. Follow-up time was 31.4 ′ 19.6 weeks. Results: Visual acuity decreased from 0.25 ′ 0.18 (range, 0.03-0.8) to 0.20 ′ 0.18 (range, 0.02-0.8) (P=0.045), representing a change of -0.9 ′ 2,32 lines. 5 (12.2%) eyes gained in visual acuity, visual acuity remained unchanged for 23 (56.1%) eyes, and 13 (31.7%) eyes showed a visual loss of more than one line. In eyes with a baseline visual acuity ≥ 0.2 (N=24) visual acuity dropped from 0.36 ′ 0.15 (0.2-0.8; median 0.3) to 0.29 ′ 0.19 (0.05 - 0.8; median 0.2) (p=0.038). 3 eyes (12.5%) gained ≥2 lines, 11 eyes (45.8%) lost ≥2 lines, 10 eyes (41.7%) remained stable. Mean loss was - 1.63 ′ 2.53 lines. Eyes with a baseline visual acuity

Background Recent studies have suggested that intravitreal triamcinolone acetonide may be a therapeutical possibility for treating of various intraocular neovascular, oedematous and proliferative diseases. Methods and results Gain in visual acuity was relatively highest for eyes with intraretinal oedematous diseases such as diffuse diabetic macular oedema and various types of cystoid macular oedema due to reasons such as retinal venous occlusions and uveitis. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularisation and proliferative ischaemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration. In eyes with chronic therapy resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure. The role of intravitreal triamcinolone as adjunctive treatment of proliferative vitreoretinopathy has not been determined so far. Complications of intravitreal triamcinolone include secondary ocular hypertension in about 50 % of the eyes injected, with one per cent of the eyes necessitating antiglaucomatous filtrating surgery; a cataractogenic effect; and postoperative infectious endophthalmitis. Long-term studies of more than 3 years follow-up have been missing so far, so that there is no reliable information on long-term complications. The injection can be combined with cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months. Triamcinolone acetonide was detected in the aqueous humour nine months after an intravitreal injection of 25 mg. Conclusions Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous, neovascular and proliferative diseases.

BACKGROUND To evaluate the clinical outcome of an intravitreal injection of crystalline triamcinolone acetonide as treatment of clinically significant diffuse diabetic macular oedema. PATIENTS AND METHODS The study included 8 patients (10 eyes) who received an intravitreal injection of 25 mg crystalline triamcinolone acetonide as treatment of clinically significant diffuse diabetic macular oedema follow-up time was 3.48 +/- 3.25 months (mean +/- SD). The study group was compared with a control group of 16 patients with diffuse diabetic macular oedema who underwent grid laser coagulation of the macular region. RESULTS In the study group, visual acuity increased significantly (p = 0.03) from 0.11 +/- 0.09 at baseline of the study to a maximum of 0.19 +/- 0.13 during the follow-up period. Six (85.7 %) of the seven eyes with a follow-up period of more than 4 weeks gained in visual acuity. Towards the end of the follow-up period, the triamcinolone acetonide crystals completely resolved and visual acuity decreased to 0.15 +/- 0.11, which was higher, but not significantly (p = 0.14) higher than the baseline value. Visual acuity was significantly (p < 0.05) higher in the study group than in the control group for the examinations obtained up to 12 weeks after the injection. CONCLUSIONS Intravitreal injection of 25 mg crystalline triamcinolone acetonide may be beneficial for temporarily increasing visual acuity in patients with clinically significant diffuse diabetic macular oedema.

AIM Aim of this study was to measure morphometric changes in optic discs with laser-scanning tomography (HRT, Heidelberg-Retina-Tomograph, Heidelberg) in eyes with early glaucomatous morphologic progression. PATIENTS AND METHODS 61 eyes of 36 patients with marked neuroretinal rim loss or its early morphologic signs (1. optic disc hemorrhages, 2. reduced visibility of the retinal nerve fiber layer (RNF), 3. appearance of narrowing of retinal vessels, 4. enlargement of the choroidal, parapapillary atrophy) were compared to 74 normal eyes of 39 probands. 15 degrees stereographs of the optic discs were evaluated for morphologic changes. The morphometric variables of the neuroretinal rim and excavation measured by the HRT were examined in the course of the disease. RESULTS In the group of normals no significant changes of the neuroretinal rim in the course of 2.0 +/- 1.2 years were found. In the group of glaucomatous eyes (3.0 +/- 1.5 years follow-up) 34 eyes showed marked neuroretinal rim loss, 17 disc hemorrhages, 4 vessel narrowing, 3 an increased chorioidal atrophy, 3 a decreased visibility of the retinal nerve fiber layer. In these eyes a significant loss of rim area (p = 0.01) and an increase of excavation area (p = 0.0001) and volume (p = 0.003) was measured by the HRT. Only three eyes showed a perimetric loss of sensitivity (0.8-3.4 db) in Octopus static perimetry. CONCLUSIONS Laser-scanning tomography of the optic disc seems to be able to measure morphometric changes in eyes with morphologic progression of glaucomatous optic atrophy, even before perimetric changes occur.

BACKGROUND A cataract is frequently observed after pars plana vitrectomy with silicone oil endotamponade. PATIENTS AND METHODS Forty-three consecutive patients underwent cataract surgery combined with transpupillary removal of silicone oil. After phacoemulsification of the lens material through a sclerocorneal tunnel incision, a planned posterior capsulorhexis with a diameter of 3-4 mm was performed. By injecting saline through the capsulorhexis into the vitreous cavity, the silicone oil was rinsed out. Widening of the sclerocorneal tunnel facilitated the drainage of the silicone oil through the pupil and tunnel. After ophthalmoscopic evaluation of the fundus, a plano-convex PMMA posterior chamber lens was implanted into the capsular bag or ciliary sulcus, and the corneoscleral tunnel was closed by a 10-0 nylon suture. RESULTS Depending on the underlying retinal disease the visual acuity improved in some eyes. Silicone oil bubbles left behind in the vitreous cavity were smaller than 0.5 mm in diameter. Persisting corneal decompensation or a clinically detectable cystoid macular edema related to cataract surgery did not occur. Due to the posterior capsulorhexis, secondary cataract did not develop postoperatively. Small postoperative vitreous hemorrhages resolved during the first three post-operative days. Retinal detachment recurred in 11 eyes (11/42 or 26.2%). In one eye, dislocation of the pseudophacos occurred which had to be corrected surgically. Since the pars plana region remained untouched, direct retinal lesions in the periphery of the fundus or marked vitreous hemorrhages were not encountered. CONCLUSIONS Silicone oil removal can be combined with cataract surgery with transpupillary drainage of the silicone oil.

Background Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. Methods Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. Results Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping ; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping ; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. Conclusions These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.

UNLABELLED Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc shows specific features among various types of secondary chronic open-angle glaucoma. METHODS Clinical data and color-stereo optic disc photographs of 126 patients with pseudoexfoliative glaucoma and 47 patients with pigmentary glaucoma were compared with those of 501 patients with primary open-angle glaucoma (POAG) and of 481 normal subjects. The glaucoma groups did not differ in neuroretinal rim nor in perimetric mean defect. RESULTS Mean optic disc area was significantly smaller in the pseudoexfoliative glaucoma eyes (2.54 +/- 0.51 mm2 vs. 2.71 +/- 0.63 mm2, p = 0.03) than in the primary open-angle glaucoma eyes. The pigmentary glaucoma group did not vary significantly from the primary open-angle glaucoma group in size of the optic disc. No significant differences were found for neuroretinal rim area, configuration of neuroretinal rim, depth of optic cup and diameters of the retinal arterioles and venules at the disc border between the secondary glaucoma groups and the POAG group respectively. Size of zone beta of the parapapillary atrophy was slightly, but not significantly smaller in the secondary glaucoma groups than in POAG. In the secondary glaucoma groups, the maximal intraocular pressure measurements were significantly (p < 0.001) higher than in the group with POAG. All glaucoma groups had a significantly smaller neuroretinal rim, significantly smaller retinal arterioles, and significantly larger parapapillary atrophy compared to the normal group. CONCLUSIONS Except of a slightly smaller optic disc in eyes with pseudoexfoliative glaucoma, eyes with secondary glaucoma due to pseudoexfoliation or due to pigmentary dispersion do not vary significantly in their optic disc morphology compared to POAG and do not show pathognomonic features of the optic disc despite marked changes in the anterior segment of the eye.

Purpose To examine whether the optic disc size can be measured with common ophthalmoscopic lenses. Patients and methods The horizontal and vertical disc diameters in 125 eyes of 65 patients were measured ophthalmoscopically using a commercial slit lamp with adjustable length of the beam and a Volk 60 diopters lens or a Volk Superfield lens. The refractive error of the subjects ranged between -7.25 D and +3.25 D (mean +/- S.D.: -0.34 +/- 1.77). Based on these measurements we calculated the optic disc area by applying a modified formula for an ellipse, where area = horizontal diameter x vertical diameter x pi/4. Additionally, we measured planimetrically the horizontal and vertical diameters of the optic disc on color stereo disc photographs after correcting the ocular and camera magnification according to Littmann's method. Results The values of the horizontal and vertical disc diameters evaluated on the photographs were by factors of 1.0 and 1.5 larger than those values measured with the Volk 60 D lens, and the Volk Superfield lens, respectively. Taking into account these constant linear correction factors, the optic disc diameters as measured by the Volk 60 D lens and the Volk Superfield lens varied by 0.11 +/- 0.09 mm (5.9 +/- 5.1%), and 0.11 +/- 0.09 mm (5.9 +/- 4.9%), respectively, from the values measured on the photographs. The error for the ophthalmoscopic measurement of the disc diameters decreased slightly with increasing disc size. With highly myopic eyes excluded, it was independent of the refractive error. Conclusion For clinical purposes, the optic disc and other structures of the posterior fundus can be determined by ophthalmoscopy using a slit lamp and commonly used ophthalmoscopical lenses.

Background Elevation of intraocular pressure in the supine position has been previously described in literature. Aim of this study is to investigate the elevation of intraocular pressure in normal tension glaucoma and its effect on the morphology of the optic disc. visual field function and capillary blood flow of the retina and optic disc. Patients and methods 56 eyes of 28 preperimetric and advanced normal tension glaucoma patients were prospectively evaluated. Ten eyes of ten normal patients served as a control group for the measurements of the intraocular pressure. In the course of a 24-h pressure profile applanation tonometry was performed in the morning in a supine and three and ten minutes later in a sitting position with Draeger's and Goldmann's tonometers. Arterial blood pressure was measured at the same time. The optic disc's morphology was evaluated by stereo photographs and Laser Scanning Tomography. As a sensory test computer perimetry was used. Capillary blood flow was measured at defined areas of the retina and optic disc. An intraocular pressure above 21 mm Hg in the supine position was used as a criterium to define two groups of normal tension glaucoma patients. Results In the supine position a statistically significant elevation of intraocular pressure was observed in 24 normal tension glaucoma patients by 6.2±2.8 mmHg up to 21.8± 3 mm Hg. Diastolic blood pressure in the supine position (80± 10.5 mm Hg) was significantly lower than in the sitting position (94±11 mm Hg, p=0.021). 12 of 28 normal tension glaucoma patients showed an intraocular pressure lower than 22 mm Hg in the supine postion. In these patients a tendency towards a higher incidence for the occurence of optic disc haemorrhages and significantly higher values for blood flow (p

Background The aim of the present study was to investigate whether the morphological variability of the optic disc has an influence on sensory test procedures. Patients and methods In 52 eyes of 52 normal persons psychophysical (perimetry, color vision, contrast sensitivity) and electrophysiological (pattern-ERG and pattern-VEP) tests and planimetric papillometry were performed. A correlation analysis was made between sensory tests and area of optic disc (1.79 to 5.2 mm2) and neuroretinal rim. Results There was no significant correlation between perimetry, color vision, pattern-ERG, pattern-VEP, spatio-temporal and temporal contrast sensitivity on the one hand and optic disc area or neuroretinal rim area on the other. Conclusion Results of psychophysical and electrophysiological tests do not have to be corrected with respect to the neuroretinal rim area.

The size of the optic nerve head influences the prevalence of optic disk anomalies and diseases. The authors investigated whether this also holds true for retinal vessel occlusions. The optic disks of 140 patients with central or branch occlusions of the retinal veins and arteries were measured, using photographs of the optic disk and correcting the photographic enlargement by Littmann's method. There were no significant differences in size and shape (Mann-Whitney Test) between the disks thus studied and 457 nonselected optic nerve heads. The incidence of retinal vessel occlusions appears to be unrelated to the shape and size of the optic disk.

PURPOSE To evaluate a temporary retrobulbar catheter for local anesthesia in intraocular surgery and for postoperative analgesia after intraocular surgery. PATIENTS AND METHODS The study included 40 patients undergoing pars-plana vitrectomy (n = 24) or cyclocryocoagulation (n = 16). After a retrobulbar injection through a 23 G needle, a commercially available 28 G flexible catheter was inserted through the needle. As soon as the patients complained about pain during or up to 24 hours after surgery, local anesthetics were injected through the catheter. RESULTS Repetitive injections of anesthetics were necessary in 13 patients during pars plana vitrectomy. Starting about 2 hours after surgery, 13 patients after pars-plana vitrectomy and all patients who had undergone cyclocryocoagulation received up to 6 re-injections (every 1.5-5 hours). After all re-injections, the patients became pain-free within two minutes. The catheter was removed after 24 hours. CONCLUSIONS The results suggest that a temporary insertion of a catheter into the retrobulbar space allows repetitive application of local anesthetics thus leading to a titrable local anesthesia and postoperative analgesia in intraocular surgery.

PURPOSE To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. METHODS Color stereo optic disc photographs of 79 patients with primary or secondary open-angle glaucoma and 53 normal subjects were morphometrically evaluated. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy in four 90 degrees quadrants. RESULTS After correction for normal values, the beta zone area of parapapillary atrophy in the glaucoma eyes was significantly larger, when measured in the disc quadrant most distant to the central retinal vessel trunk exit than as if measured in the quadrant containing the vessel trunk exit. CONCLUSIONS Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy.

Background Visual disturbances after high altitude exposure were first reported in 1969. Later, the term "High Altitude Retinal Hemorrhage-HARH" has been used for the ensuing retinal hemorrhages and vascular engorgement. Case report A 31-year-old Caucasian male presented to our outpatient department 1 week after climbing Mt. Gosainthan in the Himalayas. He had spent 25 days without oxygen supply above 5000 meters, with a maximum of 8046 meters. He now complained of glare and decreased vision in twilight. Visual acuity was 20/25 OD and 20/20 OS. Ophthalmoscopy revealed intraretinal hemorrhages and tortuosity of dilated arterioles and venoles. After 6 weeks of gradual improvement, visual acuity was 20/20 OD and 20/16 OS with normal visual fields. Discussion The hypoxia at high altitude causes increased retinal blood flow and blood volume possibly via autoregulatory mechanisms. Furthermore, retinal venous pressure can be increased by extreme physical exertion and Valsalva maneuvers during mountain climbing. A hypoxic retinal capillary bed exposed to increased retinal venous pressure predisposes to intraretinal hemorrhage. Retinal changes include marked increase of retinal vessel diameter with tortuosity of arterioles and venoles and hyperemia or edema of the optic disc. The intra- or preretinal hemorrhages often spare the macular area. These patients do not experience debilitating symptoms unless vitreous hemorrhage occurs. This may be potentially hazardous when the patient is still in the high mountains. Clinically, all these retinal changes are reversible within weeks. To prevent high altitude retinopathy, ascending slowly and use of supplemental oxygen is recommended.

Background Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Ocular involvement has been reported in about 25% of patients (1). Band keratopathy is rare in sarcoidosis. Patient A 31 year-old clerk presented to our clinic with a 10 months' history of foreign body sensation OU. Visual acuity was OD1.2, OS 1.0. Intraocular pressure was 10 mm Hg OU. We found a moderate band keratopathy OU (Fig. 1a, 1b). The rest of the ocular exam was unremarkable. 10 months before, the patient had experienced symmetrical swelling of his large joints and his creatinine and calcium levels had been elevated at that time. Therefore, we referred the patient to the internist to rule out primary hyperparathyroidism (2). The differential diagnosis included myeloma, paraneoplasia and sarcoidosis (3). The general medical examination was unremarkable. Calcium (2,5 mmol/l), creatinine (2.0 mg/dl) and ACE-levels (177 U/ml) were elevated, parathormone (

Patient A polycyclic lesion slightly prominent and yellowish in colour with a mulberry-like surface was incidentally detected in the left eye of a 69-year-old white female. It was located in the nasal horizontal sector of the fundus in a distance of about 5.5 mm from the optic disk. It was surrounded by a bright halo. Retinal arterioles penetrated the lesion superficially and more deeply. The vitreous body was unremarkable. Visual acuity was 0.8 to 1.0 p with a hyperopia of 3.5 dpt. Intraocular pressure was 116 mm Hg. In both eyes partially confluent drusen of the retinal pigment epithelium were present without a serous detachment of the retina. Ultrasound examination revealed an ovally shaped, 1.3-mm prominent solid tumor consisting of highly reflective granular internal echos with acoustic shadowing behind. X-ray of the skull showed punctate calcifications in the medial orbit. The brain was unremarkable (incl. MRI). In fluorescein angiography the whole tumor was diffusely stained without signs of leakage or subretinal neovascularization. On red-free wide-angle photographs of the retinal nerve fiber layer no localized defects were detected. Neurological and dermatological examination were unremarkable without any hints for tuberous sclerosis or neurofibromatosis. All these findings led to the diagnosis of a solitary retinal astrocytoma. With no therapy performed, the functional and morphological status of the eye remained unchanged one year later. Conclusion A retinal astrocytoma is a hamartoma that usually shows no tendency to grow and there is no need for treatment. It can rarely be the reason of a serous retinal detachment or vitreous hemorrhage. Especially solitary astrocytomas have sometimes been reported to show a tendency towards severe intraocular damage. Additional calcifications showing acoustic shadowing in ultrasound examination are important for the differential diagnosis of retinoblastoma

Characteristics of 17 optic disks larger than 4.4 mm2 and thus satisfying the papillometric criteria of macrodisks (larger than normal optic disks plus two-fold standard deviation) were as follows: (1) Form: similar to normal optic nerve heads but even more circular. The vertical diameter was about 6% larger than the horizontal. (2) Optic cup: abnormally large, therefore "pseudoglaucomatous." (3) Neuroretinal rim: normal-sized when correlated to the total optic disk area, larger in the temporal lower than in the temporal upper optic disk region, narrowest on the temporal optic disk side, larger nasally at the top, and widest at the upper optic disk pole. (4) Cup/disk ratio: abnormally high (0.76 +/- 0.06 horizontally, 0.69 +/- 0.05 vertically), larger horizontally than vertically. (5) Perimetry: the only abnormality was an increased blind spot corresponding to the enlarged optic disk area. (6) Refraction. -0.25 +/- 1.90 diopters (high myopics less than -8.00 diopters) had been excluded). (7) Central retinal artery and vein penetrating the superficial lamina cribrosa almost at the center of the cup, bayonetlike vessel bending at the border of the optic cup. (8) Increased number of cilioretinal arteries, corresponding to their correlation with the optic disk area. These macrodisks with physiologic macrocups can be differentiated by their morphology or by optic disk planimetry in absolute values from: normal-sized optic nerve heads with glaucomatous cupping, abnormally large optic nerve heads in highly myopic eyes, and abnormally large optic nerve heads with pitting of the optic disk.

The diameter of the temporal superior or inferior artery and vein was measured at the optic disk border and 2 mm from the disk center in 309 nonselected eyes with chronic primary open-angle glaucoma. The values obtained were compared with those of 264 nonselected normal eyes. The calibers of both vessels were significantly larger in the normal eyes than in the glaucomatous ones (p = 0.000 or p less than 0.01; Wilcoxon-Mann-Whitney test). Their diameters diminished significantly (p less than 0.001) with decreasing width and area of the neuroretinal rim as a whole and when divided into different optic disk sectors, and with increasing optic cup area, horizontal and vertical cup/disk ratios, area of the subtotal to total parapapillary choriopigmentepithelioretinal atrophy, perimetric loss, and glaucoma stage. Thus, the caliber of the parapapillary retinal vessels decreases significantly with increasing glaucomatous optic nerve damage.

From January 1979 to August 1984 intraocular pressure (IOP) was measured on the first Friday of each month under comparable conditions (same instruments, nearly always the same examiner) in a total of 109 patients in whom a primary chronic open-angle glaucoma or ocular hypertension had been diagnosed: The IOP was correlated to the local weather parameters (atmospheric pressure, cloud cover, relative air humidity, mean, maximum and minimum temperature, precipitation, duration of sunshine, mean and maximum wind velocity). In the large number of measurements a significant correlation was found only between IOP and atmospheric pressure: IOP was lower when air pressure was high. There was only a suggestion of a significant correlation between IOP and relative air humidity. However, further statistical analysis revealed that in fact both atmospheric pressure and relative air humidity account for only a negligible part of the variation in IOP values. From a practical point of view, therefore, the IOP of patients with primary chronic open-angle glaucoma or ocular hypertension is not influenced by weather conditions.

The planimetric values of the parapapillary region in 312 unselected eyes with chronic primary open-angle glaucoma and 125 normal eyes of an age-/and refraction-matched control group were correlated to the intrapapillary, perimetric, and general data of these eyes. High myopics (less than -8.00 D) and "ocular hypertensives" were excluded. Zone "Alpha" and "Beta" incipient to advanced or subtotal to total parapapillary chorio-pigmentepithelioretinal atrophy) were significantly correlated (p less than 0.001) to: 1) area and width of the neuroretinal rim as a whole and in four different optic disk sectors; 2) cup area; 3) horizontal and vertical c/d ratios; 4) glaucoma stage; 5) age, and 6) refraction. Zone "Beta" was additionally correlated to the perimetric indices. Its correlation coefficients were generally higher than those of zone "Alpha." Sex and side showed no significant relationships. Divided into four different radial sectors, both zones "Alpha" and "Beta" were significantly larger (p less than 0.001) the smaller the neuroretinal rim area (intrapapillary) in the same sector was. Additionally, zone "Beta" was significantly (p less than 0.001) most often largest in the sector where the rim area was smallest. Thus, besides the temporal there was also a spatial correlation between the intrapapillary and parapapillary glaucomatous alterations. "Conus pigmentosus" and the peripapillary scleral rim showed no significant glaucoma-associated correlations and are thus without importance for quantified optic disk evaluation in glaucoma. Zones "Alpha" and "Beta", as regions of early to advanced of subtotal to total parapapillary, chorio-pigmentepithelioretinal atrophy, are not only chronologically but also spatially correlated to intrapapillary glaucomatous changes and are important in optic disk evaluation in glaucoma.

Among 820 eyes enucleated between 1980 and 1984 and examined histologically there were 132 globes with central corneal-perforations. In ten of these there was a leukoma adherens not in contact with the anterior chamber angle. In all cases it was endothelialized with formation of a new basal lamina. The mean interval between trauma and enucleation of these ten eyes was 22.6 +/- 16.7 years (0.5-52 years), the mean age of the patients at the time of enucleation 50.7 +/- 22.4 years (15-78 years). Common to all these eyes and therefore of possible pathogenetic importance were: suitable tissue in contact with the corneal endothelium; traumatization of the endothelium and other intraocular structures; intraocular inflammation. The tissue which was pathologically changed and adherent to the cornea served as a "scaffold" for the endothelialization. Healing of the wound caused cell migration and proliferation and, together with intraocular inflammation, secretion of growth factors.

The diameter of the temporal superior and inferior retinal artery and vein were measured at the optic disk border and 2 mm from the disk center in 264 nonselected normal eyes on the basis of photographs, with correction of magnification. Additionally, the individual ocular magnification factor was determined by Littmann's method. The mean caliber of the artery was 0.113 +/- 0.019 mm at the disk border and 0.118 +/- 0.023 2 mm from the disk center. The corresponding values for the vein were 0.149 +/- 0.026 mm and 0.159 +/- 0.026 mm. The correlations between vessel caliber and disk size were not significant, but the relationship between disk size and the quotient of vessel diameter divided by disk size was highly significant (p less than 0.0001). Vessel diameter can therefore be taken as an independent unit for determining optic disk size in relative and approximately also in absolute units. Thus, mean horizontal disk diameter (1.77 +/- 0.33 mm) corresponded to 16.3 +/- 3.5 artery and 12.3 +/- 2.6 vein diameters (measured at the optic disk border). The mean individual ocular magnification factor was 0.302 +/- 0.017, with a Gauss standard distribution. If the optical characteristics of a photographed eye are not known and the ocular magnification factor is assumed to be 0.302, then 68.3% of all eyes will be covered with an inaccuracy of 5.6% and 95.5% of all eyes with an inaccuracy of 11.2%.

Seventeen optic disks with morning glory syndrome were measured in absolute and relative size units (millimeters and parapapillary retinal vessel caliber) in 5 and 12 eyes, respectively. Their respective mean areas were 7.47 +/- 2.63 mm2 and 7.84 +/- 4.96 mm2. They were significantly (Mann-Whitney test) larger than 457 unselected normal optic nerve heads (2.69 +/- 0.70 mm2; p less than 0.0001) and 15 optic disks with pits (4.84 +/- 1.42 mm2; p less than 0.001). They are the largest optic nerve heads, probably with constant postnatal size, measured so far, and form part of a spectrum of optic disk anomalies and diseases whose frequency correlates with the size of the optic disk. This spectrum includes abnormally small optic nerve heads with increased prevalence of drusen, pseudopapilledema and nonarteritic anterior ischemic optic neuropathy, asymptomatic macrodisks with physiologic, "pseudoglaucomatous" macrocups, symptomatic macrodisks with pits and, finally, optic nerve heads with morning glory syndrome. The last-mentioned may be considered an extreme variation of optic disks with pits which have combined to form a single macropit covering the entire optic nerve head.

Magnification-corrected planimetry of the parapapillary region was performed according to Littmann's method in 312 unselected eyes with chronic primary open-angle glaucoma and in 125 normal eyes of an age- and refraction-matched control group using optic disk photographs. The glaucoma group was divided into five pathomorphologic subgroups. High myopics (less than -8.00 D) and "ocular hypertensives" had been excluded. The coefficient of variation ranged intraindividually from 0.0 to 0.17 and interindividually from 0.0 to 0.16. Two different morphologic variants were defined and examined: 1) Zone "Alpha" with incipient to advanced parapapillary chorio-pigmentepithelio-retinal atrophy - characterized by irregular hypo- and hyperpigmentation - was statistically proven in the control group (0.60 +/- 0.44 mm2; p less than 0.05; Wilcoxon-Mann-Whitney test) to be smaller than in the glaucoma group (0.81 +/- 0.70 mm2). It increased significantly (p = 0.0000) with advancing glaucoma stage. In the glaucoma and normal group it was broadest in the temporal horizontal sector (p less than 0.001; Wilcoxon test), followed by the temporal lower (p less than 0.001), temporal upper (p less than 0.001) and nasal sectors (p less than 0.001). There was no significant difference in prevalence between the two groups. 2) Zone "Beta" with subtotal to total parapapillary chorio-pigment-epithelio-retinal atrophy was also smaller in the normal eyes (0.18 +/- 0.52 mm2, prevalence: 20.0%; p = 0.0000) than in the glaucomatous ones (0.85 +/- 1.42 mm2, prevalence 66.7%) and was also, in both groups, broadest in the temporal horizontal sector, followed by the temporal lower, temporal upper and nasal sectors. In the control group it was smaller than zone "Alpha" (p less than 0.00001), while in the glaucoma group there was no difference. 3) The difference between normal eyes and earliest glaucoma stage I was for zone "Beta" (p = 0.0000); the difference between the normal eyes and those of glaucoma stage II was significant for both zones (p = 0.0000 and p less than 0.05, respectively). In both groups and in all glaucoma stages both zones were larger in the lower half of the optic disk than in the upper half. 4) "Conus pigmentosus" and the peripapillary scleral rim in normal and glaucomatous eyes showed no significant difference as regards their area and frequency. The parapapillary chorio-pigmentepithelio-retinal alterations are precursors of, or are equivalent to the so-called "halo glaucomatosus".(ABSTRACT TRUNCATED AT 400 WORDS)

The retinal nerve fiber layer is different in normal and glaucomatous eyes. We correlated semi-quantitative data of the retinal nerve fiber layer of 398 eyes with chronic primary open-angle glaucoma and of 234 normal eyes with the intra- and parapapillary morphometric signs and with the perimetric indices. The three parameters "sequence of the fundus sectors concerning the best visibility of the retinal nerve fiber bundles", "visibility of the nerve fiber bundles", and "localized defects" were significantly (p less than 0.001) correlated to 1) area of the neuroretinal rim as a whole and in four different optic disc sectors, 2) neuroretinal rim width determined every 30 degrees, 3) optic cup area, diameters and form, 4) horizontal and vertical cup/disc ratios and the quotient of the horizontal to vertical cup/disc ratio, 5) area and width of zone "Alpha", zone "Beta", and the total parapapillary chorio-retinal atrophy, 6) diameter of the retinal vessels, 7) grade of a "tesselated fundus", and 8) the visual field loss. If only the inferior temporal and the superior temporal sectors were considered, the retinal nerve fiber bundles were less visible in that sector with the largest notch in the neuroretinal rim, the smaller neuroretinal rim area and width, the thinner retinal vessels, and the larger zone "Alpha", zone "Beta", and total parapapillary chorio-retinal atrophy. The glaucomatous changes in the retinal nerve fiber layer are correlated in time and location with the intra- and parapapillary and the perimetric alterations. Evaluation of the retinal nerve fiber layer is a useful method to detect a glaucomatous optic nerve damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrophy of the optic nerve is associated with changes of the retinal fiber layer (RNFL). Using red-free photographs the authors examined the RNFL of 398 eyes with chronic primary open-angle glaucoma and compared it with the RNFL of 234 normal eyes. The glaucoma group was divided into five stages and the fundus into four sectors. Differences between the normal and glaucoma eyes were: (1) The sequence of the sectors, with regard to the best visibility of the retinal nerve fiber bundles, was changed. In the normal eyes the nerve fiber bundles were most often best visible in the inferior temporal sector, followed by the superior temporal sector, the temporal horizontal area and finally the nasal region. In the glaucoma group the nerve fiber bundles were significantly more often best detectable in the superior temporal sector and the temporal horizontal area. (2) The degree of visibility of the retinal nerve fibers decreased significantly with increasing glaucoma stage. (3) Localized defects were seen in 15% of the eyes with glaucoma and none of the normal eyes. The specificity of this qualitative parameter was, therefore, 100%. The defects were found most often in the superior and inferior temporal regions. These differences between normal and glaucomatous eyes were also significant for the first glaucoma stage of this study. The localization of the foveola below the optic disk center (0.53 +/- 0.34 mm in the glaucoma group and 0.55 +/- 0.29 mm in the normal eyes) was not significantly different.