Mobile Augeninnendruckmessung: Von der Palpation bis zu ersten klinischen Erfahrungen mit dem handgehaltenen dynamischen Konturtonometer

Zusammenfassung: Die Goldmann-Applanationstonometrie gilt immer noch als der Goldstandard der Augeninnendruckmessung und spielt bei der Früherkennung des Glaukoms eine zentrale Rolle. Die Applanationstonometrie wird normalerweise am sitzenden Patienten an der Spaltlampe durchgeführt. Manchmal ist es jedoch notwendig, den Augeninnendruck (IOD) spaltlampenunabhängig messen zu können. Mit den handgehaltenen Geräten wird die Druckmessung ins Krankenzimmer, in den Operationssaal sowie zu Patienten, die nicht in sitzender Position an der Spaltlampe untersuchen werden können, gebracht. Das dynamische Konturtonometer (DCT) stellt eine neue Methode der direkten intraokularen Druckmessung dar. Es arbeitet nach dem Prinzip der piezoelektronischen Konturanpasstonometrie und soll weniger von den biomechanischen Eigenschaften der Hornhaut abhängig sein. Neben dem IOD kann auch die okulare Pulsamplitude erfasst werden. Bisher fanden die DCT-Messungen spaltlampenadaptiert statt. Wir präsentieren einen portablen Prototyp des Geräts. Im Vergleich mit dem Perkins-Tonometer und dem TONO-PENXL zeigt das handgehaltene DCT eine geringere Intra- und Interuntersuchervariabilität. Außerdem bietet das Gerät die Möglichkeit, die okulare Pulsamplitude (OPA) in liegender Position zu erfasse

Okuläre Pulsamplitude als biometrischer Messwert in der Glaukomdiagnostik

Zusammenfassung: Hintergrund: Die dynamische Konturtonometrie (DCT) ermöglicht direkte transkorneale Messungen des Augeninnendrucks und der okulären Pulsamplitude (OPA). Ziel dieser Studie war es, herauszufinden, ob die OPA als biometrischer Messwert Aussagen über verschiedene Glaukomformen erlaubt. Patienten und Methoden: Es wurden 441 Augen von 222Patienten in die Studie aufgenommen. Zur Druckmessung dienten die DCT und ein Applanationstonometer nach Goldmann. Ergebnisse: Die mittlere OPA betrug 3,1±1,4mmHg. Augen mit okulärer Hypertension (3,6±1,3mmHg) zeigten signifikant höhere Werte als gesunde Augen (3,1±1,4mmHg) und solche mit Niederdruckglaukom (2,9±1,4mmHg). Nach erfolgreicher Trabekulektomie wurden signifikant tiefere Werte (2,4±1,3mmHg) als bei Gesunden gemessen. Schlussfolgerung: Die OPA scheint diverse Formen des Glaukoms zu charakterisieren, könnte aber auch direkt von der Höhe des Augendrucks abhängen. Es muss weiter abgeklärt werden, ob sie einen prädiktiven Faktor in der Diagnose und der Verlaufsbeurteilung des Glaukoms darstell

Progressive improvement of impaired visual acuity during the first year after transsphenoidal surgery for non-functioning pituitary macroadenoma

Improvement of visual field defects continues even years after the initial surgical treatment. Because this process of continuing improvement has not been documented for visual acuity, we audited our data to explore the pattern of recovery of visual acuity until 1 year after transsphenoidal surgery for non-functioning pituitary macroadenoma. Retrospective follow-up study. Forty-three patients (mean age 56 +/- 14 years), treated by transsphenoidal surgery for non-functioning pituitary macroadenoma, were included in this analysis. Visual acuity improved significantly within 3 months after transsphenoidal surgery. The mean visual acuity increased from 0.65 +/- 0.37 to 0.75 +/- 0.36 (P <0.01) (right eye), and from 0.60 +/- 0.32 to 0.82 +/- 0.30 (P <0.01) (left eye). Visual acuity was improved 1 year after transsphenoidal surgery compared to the 3 months postoperative values. The mean visual acuity increased from 0.75 +/- 0.36 to 0.82 +/- 0.34 (P <0.05) (right eye), and from 0.82 +/- 0.30 to 0.88 +/- 0.27 (P <0.05) (left eye). Visual acuity improves progressively after surgical treatment for non-functioning pituitary macroadenomas, at least within the first year after transsphenoidal surger

Angioid streaks in types I and II congenital dyserythropoietic anaemia (CDA)

Background. Angioid streaks (AS) are visible irregular breaks in Bruch's membrane, extending radially from the optic nerve head and with overlaying atrophic retinal pigment epithelium. In 50 % of patients, AS are associated with Pseudoxanthoma elasticum, Ehlers-Danlos syndrome, sickle cell anaemia or Paget's disease. In 50 % of patients, AS are idiopathic. Congenital Dyserythropoietic Anaemia (CDA) is a rare, inherited disorder of ineffective erythropoiesis with morphologically abnormal erythroblasts. CDA was first recognised as a separate entity in 1968 and classified into three main groups. CDA demographics have identified 614 known families and > 700 cases worldwide. A few case reports of AS in CDA I and III have been published, but there is no report of AS in CDA II, the most frequent of the CDAs, as well no follow-up. History and Signs. 8 eyes of 4 CDA patients were examined. The CDA I patients were a 46 year old man and a 52 year old woman. They were first seen in 2009 and followed up for 9 and 11 months, respectively. The 2 female CDA II patients were seen in 2010 and were aged 35 and 42 years at first presentation. Vision, Amsler grid, optical coherence tomography (OCT), fundus pictures and fluorescent angiography were performed. Blood was drawn for neutrophil elastase determination (ELA2). Therapy and Outcome. All patients showed bilateral AS. Mean best corrected visual acuity was 20/20 without metamorphopsia and with normal OCT. During the follow-up period, no progression occurred. No choroidal neovascularisation (CNV) was detected. ELA2 serum levels were normal. Conclusions. This is the first report of AS in CDA II and the first follow-up in CDA I. No evidence of progression was seen within this period of time. Longer follow-up is needed to detect whether AS progresses. All patients with AS should be seen by an ophthalmologist on a regular basis. The risk of CNV is given. Therapy is possible and the outcome is best if the CNV is recognised and treated early

Mobile Augeninnendruckmessung

Goldmann applanation tonometry is still the gold standard of intraocular pressure measurement (IOP) and an essential part in the diagnosis of glaucoma. Applanation tonometry is usually performed on a sitting patient at the slit lamp. However, under certain circumstances it is necessary to measure the IOP outside the office setting. With handheld devices the measuring procedure is brought to bedside and surgery theatres, as well as to patients who are not able to sit behind the slit lamp. The dynamic contour tonometer (DCT) represents a new method of direct IOP measurement. Its physical principle is based on piezo-electronic contour matching tonometry and is claimed to be less dependent on biochemical properties of the cornea. Besides the IOP, the ocular pulse amplitude can also be measured. Until now, the DCT had been available as a slit lamp mounted device. In this report, we present a portable prototype of the device. In comparison with the Perkins tonometer and the TONO-PEN XL, the handheld DCT shows smaller intra- and inter-examiner variability. Additionally, the device offers the unique possibility to display the ocular pulse amplitude while the patient is in a horizontal position