Article

Goniodysgenesis in elderly glaucoma and non‐glaucoma patients

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Abstract

Abstract The aim was to elucidate whether goniodysgenesis is more frequently observed in elderly patients with glaucoma, and furthermore, which signs of goniodysgenesis are of importance and most unanimously detected. Thus, 3 examiners evaluated 21 glaucoma patients and 19 non-glaucoma patients in a masked fashion. None of the patients had a First-degree heredity. Gonioscopy, slit-lamp examination and measurements of the corneal and pupillary diameter were performed, in all 26 variables. Significantly (P < 0.05) more frequent in glaucoma were an increased corneal diameter, scleral overriding, hypoplasia of the pupillary seam, abnormal Schwalbe's line and an opaque pretrabecular membrane (one examiner). Less frequent were a peripupillary yellow pigment ring and pigment stars on the lens. Inter-observer variation was small regarding e.g. corneal diameter but rather large regarding e.g. the pretrabecular membrane.

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... Traditionally, the patient's anterior chamber angle is assessed before and after laser peripheral iridotomy using gonioscope. 1 However, gonioscopic examination is associated with interobserver bias and does not estimate the angle accurately. 2 Ultrasound biomicroscopy (UBM) is an imaging modality that has near light microscopic precision for examination of anterior segment. Laser peripheral iridotomy (LPI) has replaced incisional iridectomy for most part, mainly due to its non-invasiveness and safety. ...
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This second volume in a short series on the glaucomas is devoted to the two main types of the disease, open angle glaucoma and angle closure glaucoma. The contents are based on observations and experience gained during the management of more than 40,000 hospital and 7,000 private patients, with follow-up of 10 to 50 years. The book is comprehensive in scope. All aspects of diagnosis are carefully examined, surgical indications and techniques are explained, and the role of medical treatment is evaluated. Importantly, chapters are included on topics that are frequently overlooked in other books but are important to early diagnosis, such as diurnal pressure curve, HRT, and non-conventional perimetry. This volume provides a wealth of information and includes almost 1000 illustrations, the majority in color, as well as an accompanying DVD of surgical techniques. It will be an invaluable asset for all ophthalmologists. © Springer-Verlag Berlin Heidelberg 2014. All rights are reserved.
Article
Results of a pilot study to evaluate goniodysge-nesis as a cause of familial open-angle glaucoma are reported. Patients with a familial high tension open-angle glaucoma and a goniodysgenetic chamber angle (n = 11), a number of their relatives with glaucoma (n = 12), and their relatives without glaucoma (n = 26) were compared to a group of normals (n = 120). Eight characteristics of gonio-dysgenesis were scored and summed into a total gonio-dysgenesis-score for each chamber angle examined, a higher score corresponding to a more dysgenetic chamber angle. The distribution of the goniodysgenesis-score was compared between the four groups studied. A highly significant difference (p < 0.001) was found between the prob-ands and the normal population, but there was no difference in distribution between the relatives with glaucoma and the relatives without glaucoma. It is concluded that goniodysgenesis cannot explain the occurrence of glaucoma in the families investigated in this study. A significant difference was also found between the normal population and all the relatives combined, with higher scores in the group of relatives. An explanation could be that goniodysgenesis is inherited within the families studied, possibly in an autosomal dominant way, but independent of the occurrence of glaucoma.
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Argon laser trabeculoplasty (ALT) has had an immense impact on glaucoma treatment since the pioneering pilot report by Wise & Witter (1979). ALT in capsular glaucoma (CG) has been reported to be different from simplex glaucoma (SG) - or pirmary open-angle glaucoma (POAG) - in the following aspects: acute effects on intraocular pressure (IOP), therapeutic effects on IOP, success or failure, repeated ALT, primary ALT. Each aspect will be considered in the following review, by no means covering the vast literature on the subject but rather tending to favour the Scandinavian reports. Furthermore, general aspects on ALT will be discussed in terms of: chamber angle, mechanisms of action, effects on visual fields.
Article
A prospective gonioscopic evaluation was carried out upon a cohort of Greek patients who had undergone trabeculectomy for open-angle glaucoma. Sixty-five patients were found to show clinical evidence of exfoliation glaucoma (EXG), whilst nine patients were deemed to have primary open angle glaucoma (POAG). The gonioscopic features of these eyes and of 43 non-operated eyes from the same patients with either exfoliation syndrome (EXS) or EXG are presented. The median degree of angle pigmentation was significantly higher in the operated eyes with EXG when compared with the POAG cases. In the operated eyes, deposition of exfoliation was found on the ciliary processes in 82% of cases and on the zonules in 52%.
Article
• A retrospective analysis was undertaken to estimate the effect on measurements of cup-disc ratio (CDR) that result from overall differences among examination methods used by experienced investigators. The findings suggest large interobserver differences, that is, large differences in measurement attributable to differences in definitions and methods between one observer and another. Extreme caution is indicated before attaching wide clinical or investigative importance to a specific value of CDR. A value of CDR regarded as the dividing line between normalcy and suspicion by one observer may be a highly inappropriate cutoff for another observer. Similarly, if different observers record measurements on the same patient, it may be impossible to determine whether the cup of an individual patient changes with time. Interobserver differences also can cast doubt on conclusions drawn from the comparison of data collected by different investigators. There is a need for standardization of definitions and methods in such clinical or research situations.
Article
Wir prüften unter kontrollierten Bedingungen bei 163 Augen von 101 Patienten die Differenzen zwischen Erst- und Zweituntersuchung bei der Perimetrie des zentralen Gesichtsfeldes mit dem kinetischen Perimeter nach Goldmann und dem computergesteuerten, statischen Perimeter nach Krakau/ Heijl. Die Abweichungen zwischen Erst- und Zweitbefund wurden nach quantitativen Parametern statistisch beurteilt. Die Übereinstimmung zwischen Erst- und Zweitbefund bei der kinetischen Perimetrie lag bei Einteilung in normale und in pathologische Gesichtsfelder bei 72%, bei der Computer-Perimetrie bei 88%. - Die bessere Reproduzierbarkeit der Gesichtsfeldbefunde bei mehrfachen Untersuchungen des gleichen Auges bei der statischen, computergesteuerten Perimetrie ist im Wegfall der Untersuchervarianz zu sehen. Der Computer stellt einen unveränderlichen, standardisierten Untersucher dar, der mit seiner festgelegten Teststrategie einen konstanten Untersuchungsablauf garantiert. Die Bedienung des Computer-Perimeters ist einfach und auch durch nicht geschultes Personal möglich. - Alle Patienten, bei denen eine kinetische Perimetrie möglich ist, konnten auch am Computer-Perimeter untersucht werden. Summary Under controlled conditions the differences between duplicated examinations with the Goldmann kinetic perimeter and the Krakau/Heijl static computerized perimeter were evaluated. Kinetic visual fields were obtained independently by two well trained examiners and duplicate examinations were performed by computer perimetry. The differences between the two examinations were statistically evaluated using quantitative criteria. The agreement between first and second examination -based on normal and pathologic findings - was 72% for the Goldmann and 88% for the computer perimeter. The greater reproducibility of central visual field testing with the computer perimeter is most probably due to the subjectivity of the observer in the kinetic manual technique. The computer obviously represents a standardized observer using a constant strategy with a fixed time course. The computerized perimeter was easy to operate and did not require a specially trained technician. All the patients in whom kinetic visual field testing was possible were able to undergo computerized perimetry.
Article
According to our material the exfoliation glaucoma can be regarded as the result of an interplay of at least two different pathologic conditions: a primary genetic goniodysgenesis creating a relative block to the outflow, and a probable vasculopathy in the iris. Subsequent degeneration of the iris will lead to a liberation of pigment and debris, i.e., the exfoliation syndrome, eventually causing obliteration of the outflow pathways.
Article
A retrospective analysis was undertaken to estimate the effect on measurements of cup-disc ratio (CDR) that result from overall differences among examination methods used by experienced investigators. The findings suggest large inter-observer differences, that is, large differences in measurement attributable to differences in definitions and methods between one observer and another. Extreme caution is indicated before attaching wide clinical or investigative importance to a specific value of CDR. A value of CDR regarded as the dividing line between normalcy and suspicion by one observer may be a highly inappropriate cutoff for another observer. Similarly, if different observers record measurements on the same patient, it may be impossible to determine whether the cup of an individual patient changes with time. Interobserver differences also can cast doubt on conclusions drawn from the comparison of data collected by different investigators. There is a need for standardization of definitions and methods in such clinical or research situations.
Article
Gonioscopy was performed on 110 patients with primary open-angle glaucoma over 40 years of age and an equal number of normal sugjects, matched by race and age. The frequency distribution of various angle features differed in the two groups: in the glaucoma group, there were more iris processes at all levels of insertion, a higher insertion of the iris root and more trabecular pigmentation. A congenital angle anomaly is one important factor in the pathogenesis of the elevated pressure.
Article
The presence of abundant iris processes inserting anterior to the scleral spur is discussed in light of its significance in glaucoma. This gonioscopic sign is presented as a valuable adjunct to the diagnosis of certain cases of primary open-angle glaucoma and pigmentary glaucoma. Gonioscopy was performed on 104 consecutive eyes referred for glaucoma consultation. The eyes with primary open-angle glaucoma and those with ocular hypertension revealed a high incidence of abnormal iris processes. Six siblings from one family are also presented. Both pigmentary glaucoma and primary open-angle glaucoma exist in this family. An additional two cases of open-angle glaucoma are presented as well. From the angle appearance in the eight cases and the relatively high incidence of abnormal iris processes in the groups of primary open-angle glaucoma eyes, it is indicated that a relationship may well exist between some cases of pigmentary glaucoma and primary open-angle glaucoma.
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From a comparison of the results obtained by examining 'monocular' and 'stereoscopic' photographs of the optic disc it was concluded that each afforded similar levels of accuracy in identifying glaucomatous visual field defects.
Article
Three typical pedigrees with hereditary glaucoma are presented, in which dominant goniodysgenesis is shown to be the actual genetic trait. Because of a marked variation in the expressivity of dysgenesis, the symptoms of the genetic malformation (elevated intraocular pressure and subsequent glaucoma) may appear early or late in life. Therefore, there is no justification in letting the patient's age at the onset of the symptoms decide the classification or the mode of inheritance of the glaucoma (infantile, juvenile, simple), when the common etiologic factor is a dominant dysgenic trait. Consequently, the term "congenital glaucoma" is inadequate and even misleading for glaucoma caused by an inborn malformation, but which may be manifested only after several years or even decades. Instead a new term "dysgenic glaucoma" is suggested as the logical term that also indicates the etiology.
Article
In a region where both simple and capsular glaucoma are common, the observed prevalence of glaucoma with glaucomatous visual field defects based on hospital records is presented. The prevalence increased with increasing age to a maximum of 4.5% of the age group 81-85. Capsular glaucomas accounted for two thirds of the glaucomatous visual field defects. A comparison with previous population surveys indicates that the frequency of simple glaucoma is of the same magnitude as elsewhere. The high frequency of glaucomatous visual field defects can be due to the occurrence of capsular glaucoma. This supports the hypothesis that capsular glaucoma has its own epidemiology.
Article
The ability to detect glaucomatous field defects of three automatic computerized perimeters (COMPETER, OCTOPUS, and PERIMETRON) was compared in a clinical study of 74 patients. This study included patients with glaucoma, those with suspected glaucoma in whom the visual fields were completely normal, and normal subjects. The reference fields were obtained by careful static and kinetic manual perimetry on the Tübinger perimeter. All the automatic instruments gave similar high rates of detection of visual field loss and low false-positive test results. Quantity conventional manual perimetry is necessary to support automatic perimetric results, but automatic perimeters already can do a large proportion of routine perimetric screening.
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