Severe Visual Field Defects Research Articles

Peripapillary Scleral Deformation and Retinal Nerve Fiber Damage in High Myopia Assessed With Swept-Source Optical Coherence Tomography

To study peripapillary morphologic changes in highly myopic eyes using swept-source optical coherence tomography at a longer wavelength. Prospective cross-sectional study. Peripapillary regions of 196 eyes of 107 patients with high myopia (refractive error, <-8.0 diopters or axial length, >26.0 mm) were analyzed quantitatively and qualitatively with an swept-source optical coherence tomography prototype system that uses a tunable laser light source operated at a 100,000-Hz A-scan repetition rate in the 1-μm wavelength region. The visual field was evaluated by standard automated perimetry. Area of peripapillary atrophy β and presence of scleral protrusion temporal to the optic disc were assessed. Peripapillary atrophy β area, but not disc area, was significantly larger in eyes with visual field defect (3.16 ± 2.70 mm(2); range, 0.00 to 12.85 mm(2)) than those without visual field defect (2.31 ± 2.83 mm(2); range, 0.00 to 17.70 mm(2)). Temporal scleral protrusion was detected by color stereo disc photography in 22 (19.5%) of 113 eyes with visual field defect and in 4 (4.8%) of 83 eyes without visual field defect. Scleral bending demonstrated a wide range of angles (mean, 31.0 ± 21.1 degrees; range, 2 to 80 degrees). The angle of scleral bending, but not the distances from scleral bend to disc margin or foveal center, correlated significantly with retinal nerve fiber layer thickness above the bend (r = -0.557, P = .007) and visual field defect severity (r = -0.445, P = .038). Swept-source optical coherence tomography visualizes peripapillary deep structures in high myopia. Some cases of high myopia may be affected by direct scleral compression or stretching at the peripapillary region.

There is a trend for the diagnosis of glaucoma to be made at an earlier stage in 2010 compared to 2008 in Oxford, United Kingdom

New guidelines on glaucoma diagnosis and management were published by the National Institute of Clinical Excellence (NICE) in 2009. The aim of this study was to determine whether these guidelines on glaucoma referral have changed the numbers of patients diagnosed with glaucoma in Oxford and whether the severity of disease at presentation has altered between 2008 and 2010. A retrospective study was undertaken of patients referred to a glaucoma case-finding clinic at the Oxford Eye Hospital in 2008 and 2010. Severity of glaucoma was assigned on the basis of the worse eye and defined according to mean deviation (MD) on 24-2 Humphrey visual field testing, with early glaucomatous visual field defects defined as MD less than -6 dB, moderate defects as MD between -6 and -12 dB and severe defects as MD more than -12 dB. Statistical analysis was undertaken using Chi squared and Mann Whitney tests. The number of referrals to this clinic increased from 521 patients in 2008, to 895 patients in 2010. 85 (16.3%) patients were diagnosed with ocular hypertension in 2008, compared to 144 (16.1%) in 2010. The number of patients diagnosed with glaucoma increased from 94 cases in 2008 to 113 cases in 2010, although the percentage of referrals diagnosed with glaucoma fell from 18.1% to 12.6%. More patients diagnosed with glaucoma in 2010 had early disease (61.9% in 2010 vs 48.8% in 2008, p = 0.03). Patients found to have glaucoma in 2010 had less severe visual field defects than in 2008: patients presented with a lower mean deviation (-6.36 dB in 2010, -7.95 dB in 2008, p = 0.03) and lower pattern standard deviation (5.44 dB in 2010, 6.64 dB in 2008, p = 0.02). However, there was no significant difference between age of presentation (65.1 years in 2010, 65.2 years in 2008, p = 0.82), and IOP (21.62 mmHg in 2010, 23.15 mmHg in 2008, p = 0.22). There has been a significant increase in number of referrals to the glaucoma case-finding clinic in Oxford between 2008 and 2010. The introduction of NICE referral guidelines in 2009 has had the benefit of increasing the absolute number of patients detected with glaucoma and has resulted in more patients being diagnosed with early disease. More effort needs to be made to reduce the number of false positive referrals. In addition, the guidelines on referral of individuals with ocular hypertension need to be reconsidered.

How Does Glaucoma Look?: Patient Perception of Visual Field Loss

To explore patient perception of vision loss in glaucoma and, specifically, to test the hypothesis that patients do not recognize their impairment as a black tunnel effect or as black patches in their field of view. Clinic-based cross-sectional study. Fifty patients (age range, 52-82 years) with visual acuity better than 20/30 and with a range of glaucomatous visual field (VF) defects in both eyes, excluding those with very advanced disease (perimetrically blind). Participants underwent monocular VF testing in both eyes using a Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Dublin, CA; 24-2 Swedish interactive threshold algorithm standard tests) and other tests of visual function. Participants took part in a recorded interview during which they were asked if they were aware of their VF loss; if so, there were encouraged to describe it in their own words. Participants were shown 6 images modified in a variety of ways on a computer monitor and were asked to select the image that most closely represented their perception of their VF loss. Forced choice of an image best representing glaucomatous vision impairment. Participants had a range of VF defect severity: average HFA mean deviation was -8.7 dB (standard deviation [SD], 5.8 dB) and -10.5 dB (SD, 7.1 dB) in the right and left eyes, respectively. Thirteen patients (26%; 95% confidence interval [CI], 15%-40%) reported being completely unaware of their vision loss. None of the patients chose the images with a distinct black tunnel effect or black patches. Only 2 patients (4%; 95% CI, 0%-14%) chose the image with a tunnel effect with blurred edges. An image depicting blurred patches and another with missing patches was chosen by 54% (95% CI, 39%-68%) and 16% (95% CI, 7%-29%) of the patients, respectively. Content analysis of the transcripts from the recorded interviews indicated a frequent use of descriptors of visual symptoms associated with reported blur and missing features. Patients with glaucoma do not perceive their vision loss as a black tunnel effect or as black patches masking their field of view. These findings are important in the context of depicting the effects of glaucomatous vision loss and raising awareness for glaucoma detection. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Oximetry in glaucoma: correlation of metabolic change with structural and functional damage

To determine whether retinal vessel oxygen saturation in patients with glaucoma is associated with structural optic disc and retinal nerve fibre layer (RNFL) changes and visual field (VF) defects. Fifty-nine patients with confirmed glaucoma were recruited at University Hospitals Leuven. Retinal oxygen saturation in patients with glaucoma was measured with a noninvasive spectrophotometric retinal oximeter (Oxymap ehf, Reykjavik, Iceland). VF and Heidelberg retinal tomographies (HRTs) were performed on the same day. Statistical analysis was performed using Student's t-test and Pearson's or Spearman correlation coefficient. The mean oxygen saturation in venules was higher in patients with severe VF defects compared to those patients with mild VF defects (69 ± 3% versus 65 ± 6% respectively; p = 0.0003; n = 59). Accordingly, the arteriovenous (AV) difference in oxygen saturation was lower in patients with worse VF compared to those with better VF (29 ± 3% versus 33 ± 6% respectively; p = 0.002). The oxygen saturation in venules correlated with the VF mean defects (r = -0.42; p = 0.001; n = 59) as well as with the structural HRT parameters rim area and RNFL thickness (r = -0.39; p = 0.008 and r = -0.26; p = 0.05 respectively; n = 53). The AV difference decreased significantly as the VF defect worsened (r = 0.38; p = 0.003), as the rim area diminished (r = 0.29; p = 0.03) and as the RNFL thickness decreased (r = 0.27; p = 0.05). No correlation was found between the oxygen saturation in retinal arterioles and either of these parameters. Severe glaucomatous damage is associated with increased oxygen saturation in retinal venules and decreased AV difference in oxygen saturation. These data suggest that in eyes with severe glaucomatous damage, reduced retinal oxygen consumption is consistent with tissue loss.

Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis

Context:Retinal nerve fiber layer (RNFL) thinning has been demonstrated in cases of optic neuritis (ON) and multiple sclerosis (MS) in Caucasian eyes, but no definite RNFL loss pattern or association with visual functions is known in Indian eyes.Aim:To evaluate RNFL thickness in cases of ON and MS, and to correlate it with visual function changes in Indian patients.Settings and Design:Cross-sectional case-control study at a tertiary level institution.Materials and Methods:Cases consisted of patients of (i) typical ON without a recent episode (n = 30:39 ON eyes and 21 fellow eyes), (ii) MS without ON (n = 15;30 eyes) while the controls were age-matched (n = 15; 30 eyes). RNFL thickness was measured using the Stratus 3°CT. The visual functions tested included the best-corrected visual acuity (BCVA), contrast sensitivity, stereopsis, visual evoked responses, and visual fields.Statistical analysis used:Intergroup analysis was done using ANOVA and Pearson's correlation coefficient used for associations.Results:RNFL thickness was reduced significantly in the ON and MS patients compared to the controls (P-0.001). Maximum loss is in the temporal quadrant. Lower visual function scores are associated with reduced average overall RNFL thickness. In ON group, RNFL thinning is associated with severe visual field defects while contrast sensitivity has strongest correlation with RNFL in the MS group.Conclusions:RNFL thickness is reduced in ON and MS cases in a pattern similar to Caucasians and is associated with the magnitude of impairment of other visual parameters. Contrast sensitivity and stereoacuity are useful tests to identify subclinical optic nerve involvement in multiple sclerosis.

Macular Retinal Thickness in Glaucoma With Superior or Inferior Visual Hemifield Defects

To elucidate the relationship between macular retinal thickness and corresponding superior or inferior visual hemifield defects in glaucoma patients. Thirty-nine eyes of 39 patients with open-angle glaucoma showed superior or inferior hemifield defects (superior hemifield defects, 27 eyes; inferior hemifield defects, 12 eyes). We measured the retinal thickness of the parafovea and fovea centralis corresponding to a defect or an apparently normal hemifield by spectral domain optical coherence tomography. We then analyzed the relationship between the retinal thickness corresponding to an apparently normal hemifield and the severity of the glaucomatous visual field defect on the other side of the same eye. We found that the retinal thickness of the parafovea and fovea centralis significantly decreased, as the hemifield defect increased. The retinal thickness of the parafovea, the inner sector, outer sector, and inner and outer sectors, corresponding to the apparently normal hemifields significantly decreased with the progression of the hemifield defect on the other side. The mean±SD age of patients was 66.5±9.1 years and the refraction was -1.3±2.4 D. Macular retinal thickness decreases with a corresponding visual hemifield defect in glaucoma patients. Retinal structural changes precede the loss of the visual field in the apparently normal side.

Determinants of severity at presentation among young patients with early onset glaucoma

Aim:The aim of this study was to evaluate the clinical, socio-economic, and demographic factors associated with the severity at presentation among juvenile primary open angle glaucoma (JOAG) patients.Materials and Methods:Age at diagnosis, family history, baseline intraocular pressure (IOP), access to health-care, socio-economic status, and glaucoma awareness among 80 unrelated JOAG patients presenting between 10 years and 40 years of age were analyzed for their association with the severity at presentation. Severity at presentation was graded based on worse eye visual field using the advanced glaucoma intervention study score and on binocular visual field defects at presentation.Results:Patients with a positive family history presented 4 years earlier (P = 0.045, confidence interval [CI]: 0.09-8.8) compared to those without a family history. Lower socio-economic status (Odds ratio [OR] 5.7, P = 0.01, CI: 1.5-22), and higher baseline IOP (OR 7, P = 0.003, CI: 1.9-26) were associated with severe glaucomatous visual field defect at presentation. A negative family history was associated with a 10 times likelihood of presenting with a severe glaucomatous field defect (OR 0.1, P = 0.007, CI: 0-0.5).Conclusions:Clinical, socio-economic, and demographic factors are contributory to the severity at presentation among young patients with early onset glaucoma. Presence of a family history is associated with an earlier presentation among these patients and a reduced risk of the severe presentation.

Reevaluation of presentation and course of idiopathic intracranial hypertension - a large cohort comprehensive study

We analyzed the clinical and ophthalmological findings in a large group of patients with idiopathic intracranial hypertension (IIH) trying to find factors that might influence the course of the disease. Medical records of patients with IIH were retrospectively reviewed. The patients included were women after menarche and men older than 18 years of age who were followed up for at least 1 year. Eighty-two patients (89% women) with a mean age of 30.2 ± 12.0 years were included. The prevailing complaint was headache and transient visual obscurations followed by tinnitus and double vision. Eighty-two percent of patients were overweight at the time of diagnosis. Overweight patients had higher opening cerebrospinal fluid (CSF) pressure than patients with normal weight did. The grade of papilledema correlated with the CSF opening pressure. Inverse correlation was found between the depression of the visual field sensitivity and the grade of papilledema. The mean follow-up time was 61.3 ± 62.3 months. Eighty-four percent of the patients have improved while in 22% CSF diversion procedures or optic nerve decompression was required. The mean body mass index (BMI) at the end of follow-up decreased significantly. Sixty-seven percent of the patients suffered a recurrence of IIH. The number of recurrences inversely correlated with weight loss. Visual field defects on presentation were encountered more frequently in patients with recurrence. Women with recurrence had a history of more pregnancies. Our results confirm the strong association between overweight and IIH. The recurrence rate seemed to be influenced by the obstetrical history and the severity of visual field defects at presentation. In contrast to some previous studies, we have found an interrelation between the CSF opening pressure, grade of papilledema and depression of the visual field sensitivity.

Pituitary apoplexy associated with an inverted papilloma of sphenoid sinus

A 42-year-old man had a severe progressive headache and visual field defects due to pituitary apoplexy. Transsphenoidal resection of a pituitary tumor (measuring approximately 8.7 cm 3 ) resulted in the complete relief of his symptoms. Histological examination revealed the presence of a pituitary adenoma and an inverted papilloma of the sphenoid sinus.This communication emphasizes the following: (1) mucosal thickening and an inverted papilloma of the sphenoid sinus can be a precipitating factor in pituitary apoplexy; (2) an inverted papilloma of the sphenoid sinus may increase intrasellar pressure and therefore increase the risk of acute pituitary apoplexy; (3) if imaging shows thickening of the sphenoid sinus mucosa, then a partial resection of the sphenoid sinus mucosa for histological evaluation should be performed during the transsphenoidal resection of the pituitary tumor.

The water-drinking test: a review

The water-drinking test (WDT) was first described as a diagnostic tool for glaucoma, which was later abandoned due to its poor diagnostic accuracy. This test has gained significant interest in recent years as different studies have shown its use as a surrogate for detecting patients who have intraocular pressure (IOP) spikes not detected during regular office hours. According to peer-reviewed literature, IOP peak detected by the WDT positively correlates with the severity of visual field defects in glaucoma and may be predictive of visual field progression. It was demonstrated that IOP peaks during the WDT are correlated and are in agreement with IOP peaks that normally occur during the day. The WDT has also been used to evaluate the quality of different clinical and surgical treatment options in glaucoma. The main objective of this article is to present and discuss these evidences and the applicability of the WDT as an assessment tool for glaucomatous disease.

Treatment of Acute Visual Loss in Giant Cell Arteritis

Treatment of Acute Visual Loss in Giant Cell Arteritis

Eye movements during visual search in patients with glaucoma

BackgroundGlaucoma has been shown to lead to disability in many daily tasks including visual search. This study aims to determine whether the saccadic eye movements of people with glaucoma differ from those of people with normal vision, and to investigate the association between eye movements and impaired visual search.MethodsForty patients (mean age: 67 [SD: 9] years) with a range of glaucomatous visual field (VF) defects in both eyes (mean best eye mean deviation [MD]: –5.9 (SD: 5.4) dB) and 40 age-related people with normal vision (mean age: 66 [SD: 10] years) were timed as they searched for a series of target objects in computer displayed photographs of real world scenes. Eye movements were simultaneously recorded using an eye tracker. Average number of saccades per second, average saccade amplitude and average search duration across trials were recorded. These response variables were compared with measurements of VF and contrast sensitivity.ResultsThe average rate of saccades made by the patient group was significantly smaller than the number made by controls during the visual search task (P = 0.02; mean reduction of 5.6% (95% CI: 0.1 to 10.4%). There was no difference in average saccade amplitude between the patients and the controls (P = 0.09). Average number of saccades was weakly correlated with aspects of visual function, with patients with worse contrast sensitivity (PR logCS; Spearman’s rho: 0.42; P = 0.006) and more severe VF defects (best eye MD; Spearman’s rho: 0.34; P = 0.037) tending to make less eye movements during the task. Average detection time in the search task was associated with the average rate of saccades in the patient group (Spearman’s rho = −0.65; P < 0.001) but this was not apparent in the controls.ConclusionsThe average rate of saccades made during visual search by this group of patients was fewer than those made by people with normal vision of a similar average age. There was wide variability in saccade rate in the patients but there was an association between an increase in this measure and better performance in the search task. Assessment of eye movements in individuals with glaucoma might provide insight into the functional deficits of the disease.

Lack of spontaneous venous pulsation: possible risk indicator in normal tension glaucoma?

Recently, the absence of spontaneous venous pulsation (SVP) has been suggested as a vascular risk factor for primary open-angle glaucoma (POAG). As the mechanism behind this phenomenon is still unknown, the authors have studied this vascular component using colour Doppler imaging (CDI). A total of 236 patients were divided into three diagnostic groups: healthy controls (81), POAG (86) and normal tension glaucoma (NTG; 69). All subjects were submitted to CDI studies of the retrobulbar circulation, intraocular pressure measurements and assessment of SVP existence. Mann-Whitney, chi-square contingency tables and Spearman correlations were used to explore differences and correlations between variables in the diagnostic groups. Eighty-two percent of healthy controls had SVP (66/81), while a smaller numbers were registered in both glaucoma groups: POAG - 50% (43/86); NTG - 51% (35/69). In NTG patients, but not in POAG patients, the prevalence of the SVP phenomenon decreases with increased glaucoma damage (p = 0.04; p = 0.55, respectively). Overall glaucoma patients from both groups had lower central retinal vein (CRV) velocities than the healthy controls (p < 0.05). NTG patients with SVP had less severe visual field defects (mean defect -6.92 versus -11.1, p < 0.05), higher [correction added after online publication 21 September 2012; the word 'higher' has been inserted to replace the word 'lower'] peak systolic and mean flow velocities in the central retinal artery (p < 0.01; p < 0.05, respectively) as well as higher [correction added after online publication 21 September 2012; the word higher has been inserted to replace the word lower] maximal velocities and RI of the CRV (p < 0.02; p < 0.05, respectively). Glaucoma patients have a decrease in CRV velocities. SVP is less prevalent in glaucoma patients than in healthy individuals. This phenomenon apparently reflects different hemodynamic patterns in the central retinal vessels. This variable may be of particular importance in NTG patients, where it may be associated with more advanced functional damage.

Optic Nerve Head, Retinal Nerve Fiber Layer, and Macular Thickness Measurements in Young Patients with Retinitis Pigmentosa

Purpose: To evaluate optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular thickness by using Cirrus HD spectral-domain optical coherence tomography (OCT) in young patients with retinitis pigmentosa (RP).Methods: ONH parameters, RNFL thickness, and macular thickness were measured and compared between 36 eyes from 36 young RP patients (RP group; mean age, 23.08 years) and 70 eyes from 70 healthy young subjects (control group; mean age, 22.66 years) using Cirrus HD-OCT. The effects of the presence of optic disc pallor and the severity of visual field (VF) defects on OCT parameters were also evaluated.Results: The RP group had a greater rim area, smaller cup-to-disc ratio, smaller cup volume, thicker RNFL, and thinner macula than the control group (p ≤ 0.024). ONH parameters were not affected by the presence of optic disc pallor (p ≥ 0.239). Eyes with more severe VF defects (mean deviation ≤ −13.88 dB) had thinner average macular areas than eyes with less severe VF defects (mean deviation ≥ −13.88 dB; p = 0.002). Meanwhile, the ONH parameters and average peripapillary RNFL thickness were not significantly different between the two groups (p ≥ 0.275).Conclusions: Young eyes with RP exhibited different OCT parameters compared to healthy eyes. Among the various OCT parameters, only macular thickness was associated with disease severity. These findings should be considered when evaluating young RP patients.

Predictive factors for visual outcome after resection of spheno‐orbital meningiomas: a long‐term review

Editor, T he purpose of our study was to assess ophthalmological results in terms of visual acuity, reduction in visual field and proptosis and to compare this outcome to the radiological data and extent of surgical procedure in a retrospective cohort of 37 consecutive patients suffering from sphenoorbital meningiomas (SOMs) between 1 January 1986 and 31 December 2006. Data were collected from 37 women and three men aged between 33 and 76 years (mean age, 50 ± 9 years at diagnosis), with a mean follow-up of 7 ± 4 years. Mean preoperative visual acuity of the 37 patients was 0.31 ± 0.45 LogMAR, which did not significantly differ following surgery (0.25 ± 0.47 LogMAR) (p = 0.5). Visual acuity was observed to be normal in 15 patients (40.5%) for whom it remained stable during follow-up, with none of these patients experiencing any decrease in visual acuity following surgery. Among the 22 patients with initially altered visual acuity, 12 improved after surgery, five stabilized and five deteriorated. Neither initial proptosis nor initial visual acuity was a predictive factor for poor evolution of visual acuity. Similarly, no correlation was observed between initially altered visual acuity and final visual acuity (r = 0.11, p = 0.14). In terms of radiology, the initial effect on visual acuity signficantly correlated anatomically with involvement of the optic canal (p = 0.0033). The only negative factor identified for improved visual acuity during follow-up was the extension to the periorbit (Table 1). Initial proptosis and initial visual acuity were found to be negative predictive factors for final visual field defect. Preoperative integrity of the optic canal and cavernous sinus, as observed radiologically, was a predictive factor for having no final visual field defect. Finally, invasion of the optic canal and the presence of an intracranial soft-tissue component were both prodictors for severe final visual field defects. Proptosis was improved by surgical treatment, decreasing from 5.6 ± 3.6 mm preoperatively to 2.2 ± 2.7 mm postoperatively (p 2 mm,

Trabeculectomy for advanced glaucoma

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3years (13-80years). The mean follow-up time was 41.1months (3-120months). Preoperatively the mean IOP was 28.4±13.1mmHg, and the mean postoperative IOP was 14.8±5.0mmHg (P=0.001). Preoperatively the mean VA was 0.87±80, and the mean value of the MD was -24.5±6.7dB. At the latest follow-up there was no significant difference in VA (0.89±79, P=0.699) and MD (-23.9±6.7, P=0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.

Visual Fields, Visual Acuity, and Driving Performance in Patients with Pituitary Adenoma before and after Surgery

We evaluated the prognosis of visual fields, visual acuity, and fitness to drive and the phenomenon of statokinetic dissociation in patients with pituitary adenoma who undergo surgery. In patients with pituitary adenoma, visual requirements for on road driving performance and the role of statokinetic dissociation have not been evaluated previously. Twenty-eight patients (56 eyes) with pituitary adenoma were included in the study over a period of 5 years and consecutively examined before and after surgery by the same ophthalmologist. Preoperatively, out of 56 eyes, we found visual field defects in 31 eyes (55%) and visual acuity impairment in 23 eyes (41%). Postoperatively, 24 out of 28 patients (86%) met the legal binocular visual requirements for driving a car in Germany. In 31 eyes with visual field defects (VFD), 64% of VF improved after surgery. Visual acuity impairment was reduced postoperatively in 75%, 10% remained unchanged, and 15% deteriorated, but 2/3 of these improved after second surgical intervention. All 28 patients were legally fit to drive postoperatively. Statokinetic dissociation was evaluated in 22 eyes with reliable static and kinetic double examination, performed on the same day. In 16 eyes (73%), computerised static perimetry (Octopus perimetry, central 30°, full threshold strategy) showed considerably more severe VFD than kinetic perimetry (i.e., statokinetic dissociation was ascertained). From this study we conclude that 60% of patients with pituitary adenoma can hope for significant improvement of visual function (64% in VF, 75% in visual acuity) after surgery, and driving permission can often be regained. Due to statokinetic dissociation, kinetic perimetry should be complemented by automated static perimetry.

Eyelid arteriovenous malformation treated with embolization leading to a branch retinal artery occlusion

Background Arteriovenous malformations (AVMs) are serious vascular abnormalities that rarely affect the eye. However, documented cases of eyelid AVMs have been reported to occur spontaneously or after trauma. Treatment for AVMs, which generally include embolization and resection, can also pose a risk to a patient's life and vision. Case Report This report describes a 21-year-old man who experienced multiple branch artery occlusions resulting in severe visual field defects after treatment for an eyelid AVM. Conclusion Eyelid AVM is a rare but potentially serious condition that should be considered a differential when a patient presents with a new-onset swollen lid. Physicians and patients must also be aware of potential risks involved in the treatment of this condition, especially if select embolization is to be performed.

Comparison of the corneal biomechanical properties with the Ocular Response Analyzer® (ORA) in African and Caucasian normal subjects and patients with glaucoma

To compare corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer(®) tonometer (ORA) between (i) African normals and treated primary open-angle glaucoma (POAG) patients and (ii) between normals and treated POAG Caucasians. To analyse the correlation of CH and CRF with visual field (VF) defects in the two groups. This comparative study included 59 African (29 (POAG), 30 normals) and 55 Caucasians (30 POAG and 25 normals) subjects. Goldmann applanation tonometry (GAT) and ORA measurements were performed in a randomized sequence. Visual field was tested with the Swedish interactive threshold algorithms standard strategy of the Humphrey perimeter. Hoddap classification was used to estimate the severity of VF defects. Primary open-angle glaucoma Africans were younger than POAG Caucasians (p < 0.001). Goldmann applanation tonometry and central corneal thickness (CCT) did not differ significantly between the four subgroups. African normals had lower CH than Caucasian controls (p < 0.001). CH was 9.2 ± 1.1 and 8.3 ± 1.7 mmHg respectively in POAG Caucasians and Africans (p < 0.001). African controls had higher ORA corneal-compensated intraocular pressure (IOPcc) than Caucasian controls (p < 0.001). Primary open-angle glaucoma Africans had higher IOPcc values than Caucasian POAGs (p < 0.001). CH and IOPcc were associated with race (p < 0.001) but not with CCT. Based on mean deviation values (MD), POAG Africans had more severe VF defects. CH was correlated with MD (r = 0.442; p = 0.031) and severity of VF defects only in POAG Africans (r = -0.464; p = 0.013). African normal subjects and POAG patients had an altered CH, which is associated with a significant underestimation of GAT IOP. This may potentially contribute to the earlier development and greater severity of glaucoma damage in Africans compared with Caucasians at diagnosis.

Complex Visual Hallucinations Accompanying Severe Visual Field Defect

65 歳, 女性, 右利き。199X 年, 右側頭葉と頭頂葉の皮質下の脳出血により左同名性半盲を生じた際には幻視は出現しなかった。12 年後の 200X 年, 左後頭葉の脳塞栓により右同名性半盲が加わり著しい視野狭窄をきたした後, 人と動物を中心とした複雑幻視が生じ, これは2 年以上続いた。複雑幻視に対する病識は乏しく, 病識が得られるようになったのは再発より 1 年 4 ヵ月後のことであった。本症例で, 複雑幻視に対する病識が乏しかった理由としては, 幻視が非常に現実味を帯びたものであったこと, 残存視野が狭くて周辺のみであったため対比する現実の視覚像がなかったこと, 視野障害の病識が減弱していたことなどが考えられた。本症例の複雑幻視の発現機序としては, 既存の左同名性半盲に新しく右同名性半盲が加わり著しい視野狭窄となったことと, 損傷を免れた左の側頭葉と頭頂葉の働きで視覚イメージが自発的に喚起され複雑幻視の素材となったことの両者が関与したものと考えられた。