Background:Arcuate visual field defects are a typical sign of glaucomatous damage.Elevated in traocular pressure in combination with pseudoexfoliatio n syndrome (PSX)manifests the diagnosis glaucoma.B eyond this state...Background:Arcuate visual field defects are a typical sign of glaucomatous damage.Elevated in traocular pressure in combination with pseudoexfoliatio n syndrome (PSX)manifests the diagnosis glaucoma.B eyond this state,in microdiscs with optic disc drusen,t he exact classifica-tion of the visual field defects is crucial.Case Report:A57-year-old male with pseudoexfoli ation glaucoma was referred because of progressive gla ucomatous visual field defects.The visual acuity was right 20/40and left 20/25.Maximum intraocular pressure was 36mm Hg.A simple optic nerve atrophy was diagnosed su peronasally.The optic disc size was OD 2.24mm 2 and OS 1.89mm 2 (HRT 1).An Ultrasound B-mode scan demonstr ated the diagnosis of optic disc drusen.Over a follow-up of 1year,a growth tendency was observed,especially in the superonasal quadrant.The mulberry-shaped surface of the drusen was visualized with infra red reflection im-ages(HRA II,830nm).Confocal scanning laser oph-thalmoscopy(HRA II,excitation 488nm,500nm notc h filter)showed an increased intrapapapilla ry autofluo-rescence(>50%papillary area:OD 1.67mm 2 ,OS1.26mm 2 ).This technique could detect drusen in areas that looked normal in classical reti noscopy.Conclusion:The differential diagnosis of arcuate scotomas includes simple optic nerve atrophy and glaucomatous optic nerve atrophy.Optic disc drusen in glauco ma eyes can obscure the main cause of progressive visual field loss.Superficial optic disc drusen can be measured pla nimetrically over the years.An adequate reduction of intr aocular pressure should be realized in these eyes.展开更多
PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). D...PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.展开更多
文摘Background:Arcuate visual field defects are a typical sign of glaucomatous damage.Elevated in traocular pressure in combination with pseudoexfoliatio n syndrome (PSX)manifests the diagnosis glaucoma.B eyond this state,in microdiscs with optic disc drusen,t he exact classifica-tion of the visual field defects is crucial.Case Report:A57-year-old male with pseudoexfoli ation glaucoma was referred because of progressive gla ucomatous visual field defects.The visual acuity was right 20/40and left 20/25.Maximum intraocular pressure was 36mm Hg.A simple optic nerve atrophy was diagnosed su peronasally.The optic disc size was OD 2.24mm 2 and OS 1.89mm 2 (HRT 1).An Ultrasound B-mode scan demonstr ated the diagnosis of optic disc drusen.Over a follow-up of 1year,a growth tendency was observed,especially in the superonasal quadrant.The mulberry-shaped surface of the drusen was visualized with infra red reflection im-ages(HRA II,830nm).Confocal scanning laser oph-thalmoscopy(HRA II,excitation 488nm,500nm notc h filter)showed an increased intrapapapilla ry autofluo-rescence(>50%papillary area:OD 1.67mm 2 ,OS1.26mm 2 ).This technique could detect drusen in areas that looked normal in classical reti noscopy.Conclusion:The differential diagnosis of arcuate scotomas includes simple optic nerve atrophy and glaucomatous optic nerve atrophy.Optic disc drusen in glauco ma eyes can obscure the main cause of progressive visual field loss.Superficial optic disc drusen can be measured pla nimetrically over the years.An adequate reduction of intr aocular pressure should be realized in these eyes.
文摘PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.
