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Low-tension glaucoma: our clinical experience.
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[Modification of retinal hemodynamics by induced changes in intraocular pressure: a videoangiographic study].
This study used videoangiography to observe the effect of artificially produced rises in pressures in the eye on the haemodynamics of the retinal vessels. The intraocular pressure was increased with Müller's ophthalmodynamometer in stages of 10 mm Hg. A demonstrable effect upon the arterial and early venous times as well as the arm-retina time appeared. A constant rise in pressure appeared in the acute experiment: here the circulatory times more than doubled when intraocular pressure rose from under 20 mm Hg to 40 mm Hg. Above 50 mm Hg a further, statistically highly significant increase in the circulatory times of the eye became evident. The retinal vessels were obliterated in the rule at intraocular pressures above 50 mm Hg. When the data on changes in retinal circulation acquired by videoangiography are compared with the data on blood volume flow-through reached with microspheres, both methods reveal a good correlation. This shows that the determination of circulatory times in the eye is also a source of information on blood volume flow.
[Assessment of aqueous humor dynamics with Ulrich oculopressure tonometry].
Oculopression tonometry according to Ulrich can be used for the judgement of the facility of outflow like the tonography according to Grant. As shown by us for the first time, oculopression tonometry can also serve to evaluate aqueous humor formation. The results of a planned prospective study in 30 glaucoma patients and in 30 healthy volunteers are shown. It can be concluded that the recovery time of the intraocular pressure seems to be a better criterion for the diagnosis of glaucoma than the intraocular pressure measured immediately after the artificial pressure enhancement.
Echographic and ophthalmodynamometric study in the empty sella syndrome.
A group of patients with empty sella syndrome (ESS) and visual field defect with or without visual loss has been examined with standardized echography and ophthalmodynamometric examination. The optic nerve thickness has been evaluated with standardized echography; the pressure of the central retina artery has been evaluated with ophthalmodynamometric examination with or without compression on the external carotid. Our results point out two different pathogeneses in the ESS: vascular defects or irregular endocranial hypertension.
An electrophysiological approach to the diagnosis and treatment of glaucoma.
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Cranial arterial circulation and ocular pulsations in the dog.
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Internal carotid artery occlusion diagnosed by Doppler ultrasound.
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Occlusive thromboaortopathy (Takayasu's disease): cervical arterial stenoses, retinal arterial pressure, retinal microaneurysms and prognosis.
Eighty-one young Japanese patients with occlusive thromboaortopathy (Takayasu's disease) were classed into three groups according to the degree and extent of diameter stenosis in the 4 cervical arterial systems, as determined by serial aortography. Class I was made up of 63 patients with 70% or greater stenosis in less than 3 systems, including 33 patients without systemic hypertension (Class Ia). Class II was made up of 6 patients with 70% or greater stenosis in 3 systems and less than 50% stenosis in the remaining 1, including 5 patients without systemic hypertension (Class IIa). Class III was up of 12 patients with 70% or greater stenosis in 3 systems and 50% or greater stenosis in 1 system. Ophthalmodynamometric systolic pressure in patients in Class III was significantly lower than that in patients in Class IIa (p less than 0.001), but there was no significant difference between patients in Classes Ia and IIa. Microaneurysms and/or arteriovenous anastomoses in the retinal vessels were found in all but one patient in Class III and in only one patient in combined Classes I and II. These results indicate that each of the ophthalmodynamometric values and fundoscopic findings are very helpful in identifying the markedly severe occlusive lesions (Class III) of the 4 cervical arterial systems. In this chronic disease, however, angiography is most useful for evaluation of these severe lesions, to monitor progression from Classes I and II to Class III, in which the prognosis is rather poor.
Carotid artery noninvasive testing is being overused.
The most frequent tests done in the evaluation of patients with potential cerebrovascular disease are Oculoplethysmography (OPG) and Imaging procedures. These procedures are useful in the evaluation of asymptomatic carotid bruits and may be helpful in evaluating patients with nonhemispheric symptoms. However, there is no reasonable indication for the use of these noninvasive procedures on patients with lateralizing hemispheric or ocular transient ischemic attacks. Lateralizing transient ischemic attacks are very often caused by ulcerated non-stenosing lesions which are easily missed by these noninvasive means. Arteriography is mandatory in this group whenever the patient is a potential surgical candidate should an appropriate lesion be found. Finally, progress made in bruit analysis is acknowledged but the clinical relevance of this datum is questioned.
The detection of carotid artery obstruction: a correlation with arteriography.
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Retinal arterial pressure before and after surgery for carotid artery stenosis.
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Amaurosis fugax: diagnostic and therapeutic aspects.
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Asymptomatic occlusion of an internal carotid artery in a hospital population: determined by directional Doppler ophthalmosonometry.
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The force required to induce hemivein pulsation is associated with the site of maximum field loss in glaucoma.
PURPOSE: To determine the factors associated with central retinal vein pulsation changes in glaucoma and identify any hemiretinal vein pulsation changes and their association with sectoral visual field loss. METHODS: One hundred twenty-six patients with glaucoma and 40 normal subjects had automated perimetry, blood pressure, and intraocular pressure measured. A hemifield sensitivity loss was calculated from the upper and lower halves of each field. Those without spontaneous venous pulsation on the optic disc had an ophthalmodynamometer applied, to measure the minimum ophthalmodynamometric force (ODF) necessary to induce venous pulsation. When ODF was restricted to the hemiveins, the force needed to induce pulsation in each hemivein was measured. RESULTS: Eighty-three patients with glaucoma had no spontaneous venous pulsation. The minimum ODF was strongly correlated with mean deviation (Spearman rank r = -0.475, P < 0.0001). Mixed linear regression analysis showed that mean deviation (P < 0.0001) and pulse blood pressure (P < 0.0001) were significantly associated with minimum ODF. There was a strong association between differences in hemifield sensitivity loss and in hemivein ODF (rank r = 0.369, P < 0.0001, n = 80). Multiple linear regression modeling demonstrated that lower hemivein ODF was independently associated with upper field loss (P = 0.003) and upper hemivein ODF with lower field loss (P < 0.0001). CONCLUSIONS: These venous pulsation findings in glaucoma are independent of blood pressure. The hemifield and hemivein association suggests that the major hemivein change is adjacent to the site of major disc damage.
Experience with a noninvasive evaluation for cerebral vascular disease.
This report describes a newly developed noninvasive method for extracranial cerebrovascular evaluation. Two hundred consecutive cases were studied at the Massachusetts General Hospital and matched with clinical and angiographic findings. There were three false negative and five false positive results. Two ulcerated plaques without stenosis were not detected. Management routes for different groups of patients with central nervous system symptoms are outlined. We emphasize the usefulness of monitoring postoperative ophthalmic artery pressure to aid in the early detection of carotid occlusion in patients developing neurologic symptoms following carotid endarterectomy.
Retinal vessel reaction to short-term IOP elevation in ocular hypertensive and glaucoma patients.
PURPOSE: Regulation of ocular blood flow might be impaired in glaucoma patients. We compared the reaction of retinal vessels to a short-term increase of intraocular pressure (IOP), using a retinal vessel analyzer (RVA), in normal volunteers, ocular hypertensive patients (OH) and primary open angle glaucoma patients (POAG). METHODS: Ten healthy subjects (56+/-8 years, IOP 13.7+/-1.6 mmHg), 10 OH patients (55+/-12 years, IOD 23.4+/-4.1 mmHg) and 11 POAG patients (60+/-11 years, IOP 23.3+/-1.95 mmHg) were evaluated. Arterial and venous retinal vessel diameter was measured continuously before, during and after raising IOP to suprasystolic values by the suction cup method, described as ocular oscillo-dynamography. RESULTS: The change in vessel diameter after the IOP rise differed in its temporal sequence and in absolute values depending on the group examined. In the retinal branch veins the reduction of vessel diameter during the IOP rise was significantly different in POAG (0%+/-6.7) and volunteers (-6.7%+/-8.5; p = 0.06) and in POAG and OH (-6.7%+/-7.0; p = 0.04). At 70-130 sec after IOP increase a dilatation occurred, again differing significantly in POAG (+5.8%+/-3.9) and volunteers (+9.7%+/-4.3; p = 0.03). Systemic blood pressure did not show any significant differences between groups or during the course of the examination. DISCUSSION: At short-term rise in IOP leads to less retinal vessel reaction in POAG patients than in volunteers and OH. This might be due to impaired autoregulation to ocular perfusion changes in POAG patients.
Carotid hemodynamics and the ocular pulse in carotid stenosis.
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