Screening for glaucoma with stereo disc photography.

Purpose: To determine the value of taking simultaneous stereo photographs of the optic nerve head as a basis for identification of patients with glaucoma.

Methods: Two hundred fifty-eight patients received complete ophthalmological examinations and were ranked on a scale of 1-5 regarding the likelihood of their having glaucoma. Each eye was also photographed using the NIDEK camera, providing stereo pairs of the optic nerve head.

Trabeculectomy for traumatic hyphema with increased intraocular pressure.

We reviewed the medical records of 11 consecutive patients who underwent trabeculectomy with anterior chamber washout and peripheral iridectomy as the primary surgical treatment for traumatic hyphema that was unresponsive to medical management. The mean intraocular pressure before surgery was 48 mm Hg. In ten of the patients the intraocular pressure was lowered to 21 mm Hg or lower after surgery and remained below that level up to the most recent follow-up visit, which ranged from eight to 97 months.

Ab interno sclerostomy with a high-powered argon endolaser. Clinicopathologic correlation.

A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a patient undergoing enucleation for a blind painful eye. Despite the presence of diffuse rubeosis, 360 degrees peripheral anterior synechiae, and superior conjunctival scarring, it was possible to create a full-thickness defect from the anterior chamber angle to the subconjunctival space without operative complications. Six laser applications were required using 8 W of power per pulse and 0.

Ab interno sclerostomy with a high-powered argon endolaser.

We used a high-energy argon blue-green laser (15-W maximum power output) to create full-thickness sclerostomies from the region of the anterior chamber angle to the subconjunctival space in pigmented rabbits using an ab interno approach. One to four laser pulses delivered through a 300-micron noncontact fiberoptic probe produced patent sclerostomies in all 20 eyes treated using 0.1-second pulse duration and 5 to 14 W of power.

Visual-field function in pseudophakia.

An automated perimeter (Octopus 2000) was used to examine visual-field function in 52 pseudophakic eyes. Threshold sensitivity was reduced throughout the visual field by from 0.4 to 20.

A comparison of betaxolol and timolol in open angle glaucoma and ocular hypertension.

In a randomized, double-masked study, 41 patients with primary open-angle glaucoma or ocular hypertension were treated with betaxolol 0.5% or timolol 0.5% drops for 26 weeks.

Anatomy of the optic nerve head and glaucomatous optic neuropathy.

The mechanism of axon damage in eyes with glaucomatous optic neuropathy remains undefined. Interestingly, it has been observed that, although the entire nerve cross-section may be involved by the nerve damage, in many instances, the superior and inferior axon bundles are preferentially affected by the pressure insult. Thus, recent studies by many investigators have stressed a re-examination of the optic nerve head anatomy, including the nerve head microcirculation, the glial and connective tissue elements within the nerve head, and the morphology of the axons themselves.

Background illumination and automated perimetry.

Visual field function in the right and left eyes of 31 normal volunteers was evaluated with an automated projection perimeter (OCTOPUS). Serial visual field evaluations were repeated in these same eyes with neutral filters of increasing optical density. We compared the results of threshold determinations with the different neutral filters in place before the examined eye.

Axon morphology at the lamina cribrosa in monkey eyes.

The eyes of 8 monkeys (Aotus trivirgatus) were studied. The mean cross-section area and the least diameter of axon cylinders were calculated from measurements made by computer assisted planimetry of electron photomicrographs of sections through the optic nerve head at the level of the lamina cribrosa. The density of intrabundle connective tissue and glial cell elements in nerve fiber bundles was also calculated.

Laser-induced primate glaucoma. II. Histopathology.

A sustained, moderate pressure elevation was produced in 15 nonhuman primate eyes by application of laser energy to the trabecular meshwork. By light and electron microscopy, the trabecular beams were blunted, and scattered synechiae were present. Backward bowing of the lamina cribrosa, partial loss of the myelin sheath surrounding axonal segments just posterior to the lamina, and diffuse axonal loss involving the entire nerve cross section were noted.

Pseudophakia and intraocular pressure.

We studied the change in intraocular pressure in 373 consecutive eyes undergoing cataract extraction with intraocular lens implantation between Jan. 1, 1981, and May 31, 1982. There was a mean increase in intraocular pressure of 0.

Use of betaxolol in the reduction of elevated intraocular pressure.

Forty eyes in 20 patients with elevated intraocular pressure were treated with either a 0.125% betaxolol ophthalmic solution or a placebo. After 2, 4, and 6 weeks of twice-daily therapy, the eyes receiving the betaxolol had a mean percent reduction in IOP greater than that in the eyes treated only with the drug vehicle (placebo).

Pressure-induced fast axonal transport abnormalities and the anatomy at the lamina cribrosa in primate eyes.

In ten owl monkey eyes (Aotus trivirgatus) the location of pressure-induced (perfusion pressure 35 mmHg) axonal transport abnormalities was determined by the examination of serial step cross-section tissue radio autographs from the optic nerve head. The degree of the local transport interruption did not correlate with the fiber bundle cross-section area, the shape of the laminar pores or the density of the inter-bundle septa in that region.

Axonal transport interruption and anatomy at the lamina cribrosa.

Pressure-induced, focal axonal transport abnormalities were studied in 14 cat eyes by the examination of serial step-section tissue radioautogram. Although the patterns of the transport interruption at the lamina cribrosa varied from eye to eye, the temporal sectors of the nerve head were most often involved by this abnormality. The anatomy at the lamina cribrosa was studied in adjacent (6 micrometers) cross-sectional specimens.

The anatomy at the lamina cribrosa in the normal cat eye.

In normal cat eyes, the mean cross-sectional area of the nerve fiber bundles is greater in the temporal than in the nasal lamina cribrosa. The area occupied by the interbundle trabeculae is less in the temporal sectors than in the nasal sectors of the nerve. The number and the shape of the laminar pores are similar in all nerve sectors.

Pressure-induced optic nerve axonal transport interruption in cat eyes.

After intravitreal injection of tritiated leucine, optic nerve axonal transport was studied in 30 cat eyes by tissue radioautography. Twenty-five experimental eyes were examined after four hours of acute pressure elevation with perfusion pressures maintained at 20 to 70 mm Hg. In five control specimens, intraocular pressures were maintained at 10 mm Hg for the four-hour interval.

Anatomy of the lamina cribrosa in human eyes.

Light microscopy of specimens of human eyes cut in cross section at the level of the lamina cribrosa showed variation in structural anatomy, as demonstrated previously in certain primate eyes. Connective tissue and glial cell structural elements were greater in nasal-temporal as compared with inferior and superior quadrants of the disc. This regional variation suggests a hypothesis for the specificity of early patterns of optic nerve dysfunction characteristic of glaucomatous optic neuropathy.

Anatomy of the retinal nerve fiber layer.

Anatomy of the retinal nerve fiber layer in rabbit eyes is studied by light microscopy, transmission electron microscopy, and scanning electron microscopy. It is demonstrated that retinal striations noted ophthalmoscopically in these eyes represent individual fiber bundles, Axon bundles are compartmentalized within tissue tunnels comprised of elongated processes of glial cell origin.

Morphology of axonal transport abnormalities in primate eyes.

The ultrastructure of the retina and optic nerve head was studied in primate eyes after central retinal artery occlusion. Within 2 hours of the vascular occlusion the inner retinal layers undergo watery (isosmotic) swelling. This watery swelling of axons and astroglia extends into the nerve head as far back as the anterior boundary of the scleral lamina cribrosa.

Distribution of pressure-induced fast axonal transport abnormalities in primate optic nerve. An autoradiographic study.

The distribution of transport abnormalities in primate optic nerve from eyes subjected to five hours of pressure elevation (perfusion pressure of 35 mm Hg) was studied. Tissue autoradiography and electron microscopy were used to localize regions of the lamina cribrosa with increased transport interruption. A preferential involvement by this transport abnormality involved the superior, temporal, and inferior portions, to the exclusion of the nasal portion, of the optic nerve head.

Effects of timolol on bovine corneal endothelial cultures.

The chronic use of timolol (Timoptic) maleate to control glaucoma may produce cytotoxic complications in the cornea. We have therefore compared the relative toxic effects of the commercial ophthalmic preparation with that of the pure compound. Commercial vehicle, either with or without 16 mM timolol maleate, killed cultures within the first five minutes of exposure.

Rapid axonal transport in primate optic nerve. Distribution of pressure-induced interruption.

Six primate eyes were studied after four hours of elevated intraocular pressure. Tissue specimens from the region of the lamina cribrosa were examined in cross section by transmission electron microscopy. Interruption in fast orthograde and retrograde axonal transport was identified in individual axons by noting accumulation of membraneous microorganelles, such as mitochondria and microvesicles within axon cylinders.

Regional specificity in anatomy at the lamina cribrosa.

Specimens cut in cross section at the level of the lamina cribrosa in normal primate eyes are examined by light microscopy. The density of structural elements, consisting of crosswise-oriented connective-tissue trabeculae, is examined in different regions of the nerve head. It is noted that nasal more than temporal more than superior or inferior regions of the lamina cross section contain increased connective-tissue elements.

Optic nerve fast axonal transport abnormalities in primates. Occurrence after short posterior ciliary artery occlusion.

Fast axonal transport abnormalities in primate (Aotus trivirgatus) optic nerve were studied in ten eyes at various intervals after occlusion of the lateral short posterior ciliary circulation. Evidence of focal axonal ischemia, as indicated by swelling of mitochondria and dissolution of cytoplasmic detail, was noted as early as one hour after occlusion. Accumulation of mitochondria, microvesicles, and dense bodies, indicating focal interruption of axonal transport mechanisms, was noted in eyes examined at 2, 4, and 6 hours.