J F Jordan

Universitätsklinikum Freiburg, Freiburg an der Elbe, Lower Saxony, Germany

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Publications (75)101.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare combined trabectome-cataract surgery with cataract-alone surgery regarding their refractive and visual outcomes and complications. In 137 eyes that underwent combined trabectome-cataract surgery, the postoperative refraction error and best visual acuity after at least 2 months postoperatively were compared to those of an in-house control group of 1,704 eyes that underwent outpatient cataract surgery. Combined trabectome-cataract surgery showed no significant differences regarding the biometry prediction error (BPE, mean 0.53 D vs. 0.48 D, p = 0.24) or visual outcome (BCVA, 0.81 vs. 0.78, p = 0.06). The rate of postoperative cystoid macular edema was slightly higher in the combined surgery group (2.2 % vs. 1.9 %). Refractive and visual outcomes were similar in both groups. Despite the slightly higher rate of postoperative macula edema, we were able to observe that the combination of these two procedures is a feasible method in glaucoma and cataract surgeries.
  • T Wecker, J F Jordan
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    ABSTRACT: The main barrier reducing outflow of aqueous humor in open angle glaucomas is the juxtacanalicular trabecular meshwork. The trabectome removes this pathophysiologically altered tissue by electroablation, thus allowing for the collector channels draining Schlemm's canal to directly communicate with the anterior chamber. In studies published so far, about 30 % decrease of intraocular pressure and a simultaneous 42 % reduction of pressure-lowering eyedrops could be achieved in primary and secondary open angle glaucomas. A clear cornea tunnel is used to advance the trabectome to the trabecular meshwork, leaving the conjunctiva unaffected. Hence minimally invasive chamber angle surgery using this device is in particular suitable for patients with an altered ocular surface. Lowering of intraocular pressure and reduction of needed topical medication seems to be distinct in pseudoexfoliative glaucoma. Surgery with the trabectome and phacoemulsification can easily be combined in one procedure. Using a minimally invasive approach, the complication profile of the trabectome is rather advantageous, not exceeding the general risks of globe-opening surgery. Ab-interno trabeculotomy is a safe and effective method for treatment of patients with primary or secondary open angle glaucomas and moderate target pressures.
    Klinische Monatsblatter fur Augenheilkunde. 10/2014;
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    ABSTRACT: To evaluate the potential of lowering intraocular pressure in pseudoexfoliation glaucoma with combined phacoemulsification, Trabectome, and trabecular aspiration (triple procedure) compared to phacoemulsification and trabecular aspiration alone.
    Albrecht von Graæes Archiv für Ophthalmologie 09/2014; · 2.33 Impact Factor
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    ABSTRACT: Background: The aim of this study was to investigate a possible influence of body mass index (BMI) to the outcome of trabectome surgery. Methods: 131 eyes with primary open angle glaucoma, myopia-associated glaucoma and pseudoexfoliation glaucoma were included into this retrospective study. The data were extracted from the Freiburg trabectome database from June 2009 to April 2013. We fitted a Cox proportional hazards model in order to assess the influence of the BMI on trabectome outcome. Results: The absolute success after trabectome surgery (20 % pressure reduction without anti-glaucomatous medication) was statistically significantly better in the group with BMI > 25 kg/m(2) (p = 0.047). No statistically significant effect was observed for relative success or the rate of re-operation respectively. Conclusion: In our patient cohort of 131 eyes, a high BMI was associated with a reduced success, as long as an absolute success is required. No difference is seen if additional anti-glaucomatous medication is acceptable (relative success).
    Klinische Monatsblatter fur Augenheilkunde. 09/2014;
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    ABSTRACT: Primary intraocular lymphoma can cause an elevation of intraocular pressure (IOP), resulting from infiltration of the trabecular meshwork with neoplastic lymphocytes. More rarely, therapeutic procedures can induce a highly synchronised death of tumor cells, leading to congestion of the trabecular meshwork with cell debris. We report on a case of severe IOP elevation after intraocular therapy with methotrexate and rituximab. As medical glaucoma therapy failed, a trabeculotomy with the trabectome was performed, leading to an immediate and sustained decrease in IOP. This novel approach is discussed considering pathogenic aspects of lymphoma-associated glaucoma and alternative surgical techniques.
    Journal of Glaucoma 09/2014; 23(7):482-484. · 2.43 Impact Factor
  • A Anton, M Neuburger, T Wecker, J F Jordan
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    ABSTRACT: We performed a minimally invasive trabeculotomy using a trabectome on a 9-year-old boy with a trauma-related secondary glaucoma where the intraocular pressure (IOP) could not be controlled by conservative approaches. After a 1-year follow-up the patient showed well controlled IOP values without using drugs to reduce pressure.
    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 06/2014;
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    ABSTRACT: In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups. Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis. For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed. Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to glaucoma surgery.
    Albrecht von Graæes Archiv für Ophthalmologie 10/2013; · 1.93 Impact Factor
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    ABSTRACT: To evaluate the success rate and adverse effects of Gold Micro Shunt Plus (GMS+) implantation into the supraciliary space. This retrospective study included 31 eyes of 31 patients diagnosed with severe glaucoma and uncontrolled intraocular pressure (IOP) with implantation of a GMS+ by means of a full-thickness scleral flap. The main outcome measures were surgical failure or success, based on the intraocular pressure and adverse effects. Clinical examination data are reported up to 4 years postoperatively. Thirty eyes (97%) met one of our criteria for failure. Within a mean of 7.3 +/- 7.7 months another surgery was performed because of elevated IOP in 24 of 31 eyes (77%) and because of adverse effects in 2 (6%). The remaining 4 eyes, that met one of our criteria for failure, had an IOP reduction of less than 20% with comparable medication. Six GMS+'s were explanted; because of IOP elevation, 2; rubeosis iridis, 2; and low grade inflammation, 2. GMS+ implantation is not an effective method to control IOP in patients with glaucoma, when using our surgical technique. The reason for the found signs of chronic low grade inflammation or rubeosis iridis in 4 eyes (13%) remains unknown and has to be further investigated.
    BMC Ophthalmology 07/2013; 13(1):35. · 1.08 Impact Factor
  • C M Jass, D Böhringer, C Erb, J F Jordan
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    ABSTRACT: Background: Glaucoma is an ocular disease with typical progressive damage of the optic nerve. In the past it was postulated that glaucoma induces acquired colour vision disorders. Until now all studies about glaucoma and colour vision disorders did not include vascular risk factors. In the present study we determined several vascular risk factors concerning the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients.Patients and Methods: On the basis of an analysis of variance (ANOVA) we determined the influence of several risk factors, such as arteriosclerotic and vasospastic risk factors, on the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients. 353 glaucoma patients were included in this study.Results: We detected a strong influence of age and mean defect in perimetry and an additional effect of arteriosclerotic and vasospastic risk factors on the results of the colour vision test Roth 28-hue (E) desaturated in glaucoma patients.Conclusions: We suspect that arteriosclerotic and vasospastic risk factors independently to glaucoma have an influence on colour vision. In the future attention additionally has to be given to vascular risk factors in the colour vision testing of glaucoma patients.
    Klinische Monatsblätter für Augenheilkunde 07/2013; · 0.70 Impact Factor
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    ABSTRACT: Trabeculectomy is no longer the gold standard for combined cataract glaucoma surgery considering the successful results following cataract surgery combined with trabeculotomy, viscocanalostomy and canaloplasty. The main disadvantage of these mostly non-penetrating procedures is the induction of conjunctival scarring which jeopardizes subsequent filtering surgery. Ab interno glaucoma surgery, including trabecular surgery and endocyclophotocoagulation, does not interfere with the conjunctival situation. These surgical options have a relatively minor risk profile for combined cataract glaucoma surgery compared to traditional filtering surgery; however, the pressure reducing efficacy of these ab interno approaches is limited with respect to the absolute reduction of intraocular pressure (IOP) and the achievable level of IOP. This has to be kept in mind when planning surgery.
    Der Ophthalmologe 04/2013; 110(4):310-5. · 0.72 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of the present study was to compare the measurement of intraocular pressure (IOP) through a therapeutic soft contact lens with the "native" measurement. We additionally investigate whether a rebound tonometer (RT) or non-contact tonometer (NCT) is more suitable to measure IOP through a bandage contact lens. METHODS: The IOP was determined using each of the two methods, three times successively with (lens measurement) and without (native measurement) a soft contact lens. The Icare tonometer (Icare® TA01i, Icare Finland Oy, 23 subjects) and the Airpuff tonometer (Nidek NT 53OP, Nidek CO., LTD, Hiroishi Gamagori, Aichi, Japan, 16 subjects) were used. We compared the mean values (validity parameter) and standard deviation (precision parameter) of the three individual measurements in each case using the paired t-test. In addition, we conducted a power analysis to estimate the maximum error in the measurement caused by the contact lens (power level set to 0.8). RESULTS: With the Airpuff tonometer we detected no statistically significant between the lens and the native measurement (15.6 ± 2.6 vs. 15.3 ± 2.6 mmHg; p = 0.42). The power analysis revealed that the maximum error caused by the contact lens was 1.2 mmHg. The Icare tonometry, however, trended toward higher values in the contact lens measurements (17.5 ± 4.3 vs. 16.4 ± 3.5 mmHg in the native measurements; p = 0.05). Interestingly, this difference exhibited a statistically significant correlation with the corneal thickness (0.03 mmHg per μm corneal thickness; p = 0.04). CONCLUSION: The use of NCT and RT for IOP measurement over a soft contact lens is feasible. The accuracy appears to be sufficient for the most common clinical applications.
    Albrecht von Graæes Archiv für Ophthalmologie 03/2013; · 1.93 Impact Factor
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    ABSTRACT: Die kombinierte Katarakt-Glaukom-Chirurgie beschränkt sich schon seit Langem nicht mehr nur allein auf die traditionelle Trabekulektomie. Längst haben sich auch Verfahren wie die Trabekulotomie, Viskokanalostomie und Kanaloplastik im kombinierten Ansatz als erfolgreich erwiesen. Nachteil dieser meist zur nicht penetrierenden Chirurgie gehörenden Prozeduren ist die Induktion einer Bindehautvernarbung, die später notwendig werdende Filtrationseingriffe erschwert. Zu den Ab-interno-Verfahren, die diesen Nachteil nicht besitzen, gehören die Trabekelwerkchirurgie und die Endozyklophotokoagulation. Sie besitzen in Kombination mit der Kataraktchirurgie ein relativ günstiges Komplikationsspektrum verglichen mit der traditionellen Filtrationschirurgie. Bei diesen Ab-interno-Verfahren ist im Allgemeinen aber von einer begrenzten Drucksenkung auszugehen, die auch nicht den tief-normalen Augendruckbereich erreichen kann. Dies muss bei der Indikationsstellung bedacht werden.
    Der Ophthalmologe 01/2013; 110(4). · 0.72 Impact Factor
  • J F Jordan
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    ABSTRACT: The classical filtration surgery with trabeculectomy or drainage of chamber fluid with episcleral implants is the most effective method for permanent reduction of intraocular pressure to lower and normal levels. Even though both operative procedures are well-established the high efficiency of the method causes potentially dangerous intraoperative as well as interoperative complications with a frequency which cannot be ignored. In the past this led to a search for low complication alternatives with non-penetrating glaucoma surgery (NPGS) and the search is still continuing. Trabecular meshwork surgery in particular with continuous development of new operation techniques steered the focus to a complication-poor and minimally invasive, gonioscopic glaucoma surgery.
    Der Ophthalmologe 07/2012; 109(7):713-23; quiz 724. · 0.72 Impact Factor
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    ABSTRACT: Disturbed axonal transport is an important pathogenic factor in many neurodegenerative diseases, such as glaucoma, an eye disease characterised by progressive atrophy of the optic nerve. Quantification of retrograde axonal transport in the optic nerve usually requires labour intensive histochemical techniques or expensive equipment for in vivo imaging. Here, we report on a robust alternative method using Fluorogold (FG) as tracer, which is spectrometrically quantified in retinal tissue lysate. To determine parameters reflecting the relative FG content of a sample FG was dissolved in retinal lysates at different concentrations and spectra were obtained. For validation in vivo FG was injected uni- or bilaterally into the superior colliculus (SC) of Sprague Dawley rats. The retinal lysate was analysed after 3, 5 and 7 days to determine the time course of FG accumulation in the retina (n = 15). In subsequent experiments axona transport was impaired by optic nerve crush (n = 3), laser-induced ocular hypertension (n = 5) or colchicine treatment to the SC (n = 10). Spectrometry at 370 nm excitation revealed two emission peaks at 430 and 610 nm. We devised a formula to calculate the relative FG content (c(FG)), from the emission spectrum. c(FG) is proportional to the real FG concentration as it corrects for variations of retinal protein concentration in the lysate. After SC injection, c(FG) monotonously increases with time (p = 0.002). Optic nerve axonal damage caused a significant decrease of c(FG) (crush p = 0.029; hypertension p = 0.025; colchicine p = 0.006). Lysates are amenable to subsequent protein analysis. Spectrometrical FG detection in retinal lysates allows for quantitative assessment of retrograde axonal transport using standard laboratory equipment. It is faster than histochemical techniques and may also complement morphological in vivo analyses.
    PLoS ONE 06/2012; 7(6):e38820. · 3.53 Impact Factor
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    ABSTRACT: PURPOSE:: Among other corneal biomechanical properties, Goldmann applanation tonometry (GAT) has been shown to depend on corneal edema. New tonometry devices have been designed, such as the Tono-Pen XL, iCare, and ocular response analyzer (ORA), to measure the intraocular pressure (IOP) accurately. This study aims to investigate the influence of corneal edema on the accuracy of these IOP-measuring devices in an in vitro model. METHODS:: A model of an artificial anterior chamber was developed using a guided trephination system. Eight donor corneas not suitable for keratoplasty were clamped into this artificial anterior chamber. All corneas showed signs of stromal edema. Intracameral pressure (ICP) was adjusted manometrically to 10, 20, 30, 40, and 50 mm Hg. The central corneal thickness (CCT) was determined by ultrasonic pachymetry. For each manometrically defined ICP, tonometry was performed using the iCare, Tono-Pen XL, GAT, and ORA. RESULTS:: The mean CCT increased from 616.1±29.6 µm to 626.9±36.1 µm. At 10 mm Hg, GAT yielded a higher ICP than those manometrically adjusted (10.4±3.3 mm Hg); at all other ICP levels, GAT yielded lower ICP levels than those adjusted. The Tono-Pen XL and iCare showed the greatest difference at 10 mm Hg, with the Tono-Pen XL yielding a value of 14.0±4.0 mm Hg and the iCare yielding a value of 12.5±2.6 mm Hg. All other results of the 2 devices fell within a range of ±2 mm Hg from the adjusted ICP. The ORA provided accurate results only at "physiological" ICP levels with a maximum difference of 2.6 mm Hg at 30 mm Hg. At higher ICP levels, corneal hysteresis decreased significantly with increasing ICP. None of the measurement devices revealed a statistically relevant dependence on CCT in this experimental setting. CONCLUSIONS:: The Tono-Pen XL and the iCare yielded the most accurate ICP values across all the adjusted ICP values. This may be because of their relatively small contact area with the cornea and, consequently, greater independence from corneal biomechanical properties. The ORA yielded accurate measurement results only at physiological ICP levels. As anticipated, GAT underestimated ICP. The Tono-Pen XL and the iCare should therefore be used to determine IOP in patients suffering from corneal edema, such as bullous keratopathy or Fuchs endothelial dystrophy.
    Journal of glaucoma 02/2012; · 1.74 Impact Factor
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    ABSTRACT: The aim of this study was to differentiate the pressure-reducing results following trabecular aspiration combined with small incision cataract surgery in eyes with pseudoexfoliation depending on preoperative pressure and medication score. A retrospective analysis was made of 104 exfoliative eyes of 104 patients who underwent combined phaco/trabecular aspiration. Success was defined as a relative reduction of IOP of at least 20 %, absolute IOP of ≤ 20 mmHg, stable or reduced medication score and a lack of any further pressure-reducing surgery. The success rate was 0.68 and 0.64 after 1 and 2 years. In eyes with medically uncontrolled preoperative IOP (> 20 mmHg) the IOP dropped significantly from 25.4 ± 4.3 mmHg to 17.0 ± 3.4 mmHg after two years. In eyes with preoperative controlled IOP the pressure lowering effect was low (17.1 ± 2.3 to 15.9 ± 2.3 mmHg) with a significant reduction of medication. Combined cataract surgery and trabecular aspiration is a reasonable option in exfoliative eyes with IOP values in the low twenties in order to achieve a reduction of topical medications and to reach a stable IOP level.
    Klinische Monatsblätter für Augenheilkunde 02/2012; 229(6):641-4. · 0.70 Impact Factor
  • Alexandra Anton, Jens Jordan
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    ABSTRACT: -Agonisten werden am Auge zur Behandlung des Glaukoms eingesetzt. Sie senken über eine Hemmung der Kammerwasserproduktion und über eine Steigerung des Kammerwasserabflusses den Augeninnendruck. Heutzutage werden aufgrund des geringeren Nebenwirkungsprofils bevorzugt selektive 2-Agonisten angewandt. Sie gehören aufgrund ihrer lokalen und systemischen Nebenwirkungen jedoch zu den Therapeutika der 2. Wahl. Experimentelle Ergebnisse weisen darauf hin, dass 2-Agonisten einen additiven neuroprotektiven Effekt haben. In klinischen Studien konnte dies jedoch bisher nicht belegt werden.
    Pharmazie in unserer Zeit 11/2011; 40(6):483-8.
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    ABSTRACT: In vivo imaging of the retina is becoming an increasingly important research method. General anesthesia rapidly compromises the corneal surface, which increases scattering. In addition, wavefront aberrations limit the maximum imaging resolution. Three common methods of stabilizing the air-cornea interface and reducing scattering are the use of a contact lens, a microscopy slide coverslip, or mineral oil. These methods have not yet been analyzed regarding their impact on scattering and wavefront aberrations. Nineteen eyes of 19 rats were analyzed with a custom-made Hartmann-Shack (HS) wavefront sensor. The amount of scattering was determined by analysis of the HS spot width, and the wavefront was reconstructed for the naked eye and each scattering-reducing method. Their effect on optical quality was determined by calculating the modulation transfer function (MTF). The three methods applied significantly reduced scattering but were differentially effective, with the coverslip performing the best and the mineral oil the worst. The root mean square (RMS) of the wavefront aberration, as well as the intereye variability of the RMS, was significantly smaller with the contact lens than with the coverslip. The MTF was best for the contact lens and worst for the coverslip, which was also illustrated by image simulations. The coverslip, contact lens, and mineral oil, when applied to the cornea, all reduced scattering. The best-performing method, the coverslip, increased wavefront aberrations. Overall, the contact lens had the best influence on image quality, and it appears to be the method of choice for high-resolution retinal imaging in rats.
    Investigative ophthalmology & visual science 05/2011; 52(7):4551-9. · 3.43 Impact Factor
  • Jens Jordan
    Albrecht von Graæes Archiv für Ophthalmologie 05/2011; 250(5). · 2.33 Impact Factor
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    ABSTRACT: Applanation tonometry has been the gold standard in clinical ophthalmology for more than fifty years. The most popular factor is central corneal thickness that is now routinely considered in glaucoma management. However, other individual features of the cornea can also play a key role for the interpretation of the applanation values. Other factors influencing applanation tonometry that have been well known for decades include tear film, fluorescein illumination etc., and should be kept in mind. According to the available literature the absence of a correct calibration cannot be neglected.
    Klinische Monatsblätter für Augenheilkunde 02/2011; 228(2):109-13. · 0.70 Impact Factor

Publication Stats

336 Citations
101.37 Total Impact Points


  • 2009–2014
    • Universitätsklinikum Freiburg
      • Department of Ophthalmology
      Freiburg an der Elbe, Lower Saxony, Germany
  • 2013
    • Bundeswehrkrankenhaus Hamburg
      Hamburg, Hamburg, Germany
  • 2008–2013
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 2010–2011
    • Evangelische Hochschule Freiburg, Germany
      Freiburg, Baden-Württemberg, Germany
  • 2001–2009
    • University of Cologne
      • Department of Ophthalmology
      Köln, North Rhine-Westphalia, Germany