Pub Date : 2003-08-01DOI: 10.1034/J.1600-0420.2003.00107.X
P. Åsman
From the combination of knowledge and actions, someone can improve their skill and ability. It will lead them to live and work much better. This is why, the students, workers, or even employers should have reading habit for books. Any book will give certain knowledge to take all benefits. This is what this textbook of clinical ophthalmology tells you. It will add more knowledge of you to life and work better. Try it and prove it.
{"title":"A Textbook of Clinical Ophthalmology","authors":"P. Åsman","doi":"10.1034/J.1600-0420.2003.00107.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2003.00107.X","url":null,"abstract":"From the combination of knowledge and actions, someone can improve their skill and ability. It will lead them to live and work much better. This is why, the students, workers, or even employers should have reading habit for books. Any book will give certain knowledge to take all benefits. This is what this textbook of clinical ophthalmology tells you. It will add more knowledge of you to life and work better. Try it and prove it.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86668560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-06-01DOI: 10.1034/J.1600-0420.2003.00087.X
A. Heijl
{"title":"Ophthalmologica and the Net","authors":"A. Heijl","doi":"10.1034/J.1600-0420.2003.00087.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2003.00087.X","url":null,"abstract":"","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83434416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-04-01DOI: 10.1034/J.1600-0420.2003.00086.X
P. J. Nielsen
{"title":"Complications in phacoemulsification","authors":"P. J. Nielsen","doi":"10.1034/J.1600-0420.2003.00086.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2003.00086.X","url":null,"abstract":"","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79233051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1034/j.1600-0420.2003.00176.x
R. Degenring, B. Kamppeter, I. Kreissig, J. Jonas
{"title":"Morphological and functional changes after intravitreal triamcinolone acetonide for retinal vein occlusion.","authors":"R. Degenring, B. Kamppeter, I. Kreissig, J. Jonas","doi":"10.1034/j.1600-0420.2003.00176.x","DOIUrl":"https://doi.org/10.1034/j.1600-0420.2003.00176.x","url":null,"abstract":"","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87377628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1034/J.1600-0420.2002.800410.X
H. Kıratlı, S. Bilgiç
PURPOSE To report the case of a patient who developed considerable subretinal pigment/debris dispersion following transpupillary thermotherapy (TTT). This type of tumour response is extremely rare with this relatively new therapeutic modality. METHODS A 50-year-old man with a left juxtapapillary choroidal melanoma measuring 8 x 6 x 4.3 mm was treated with 810 nm diode laser TTT administered in two sessions. Spot size was 3 mm and the power setting was 450 mW. RESULTS Four months after the first treatment session, a considerable amount of pigment/debris was seen to have dispersed in the subretinal space, accumulating mainly in the macular area. Over a 12-month follow-up, the tumour showed progressive shrinkage without any change in the amount or location of the shed pigment/debris. No new tumour formation, recurrence or systemic metastases were detected. CONCLUSION Subretinal pigment/debris dispersion is an unusual complication after TTT and requires close follow-up. There has been no short-term compromise on the life or visual acuity of this patient.
{"title":"Subretinal pigment dispersion following transpupillary thermotherapy for choroidal melanoma.","authors":"H. Kıratlı, S. Bilgiç","doi":"10.1034/J.1600-0420.2002.800410.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2002.800410.X","url":null,"abstract":"PURPOSE\u0000To report the case of a patient who developed considerable subretinal pigment/debris dispersion following transpupillary thermotherapy (TTT). This type of tumour response is extremely rare with this relatively new therapeutic modality.\u0000\u0000\u0000METHODS\u0000A 50-year-old man with a left juxtapapillary choroidal melanoma measuring 8 x 6 x 4.3 mm was treated with 810 nm diode laser TTT administered in two sessions. Spot size was 3 mm and the power setting was 450 mW.\u0000\u0000\u0000RESULTS\u0000Four months after the first treatment session, a considerable amount of pigment/debris was seen to have dispersed in the subretinal space, accumulating mainly in the macular area. Over a 12-month follow-up, the tumour showed progressive shrinkage without any change in the amount or location of the shed pigment/debris. No new tumour formation, recurrence or systemic metastases were detected.\u0000\u0000\u0000CONCLUSION\u0000Subretinal pigment/debris dispersion is an unusual complication after TTT and requires close follow-up. There has been no short-term compromise on the life or visual acuity of this patient.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84331700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1034/J.1600-0420.2002.800408.X
S. Crafoord, L. Geng, S. Seregard, P. Algvere
PURPOSE To investigate photoreceptor survival in transplantation of non-cultured iris pigment epithelial (IPE) cells to the subretinal space in a prospective experimental study. METHODS Upper iridectomies were carried out in the right eyes of 37 pigmented rabbits. Suspensions of freshly harvested autologous IPE cells (without culturing) were prepared and injected into the subretinal space of the same eye. Follow-up examinations were carried out using ophthalmoscopy and colour fundus photography. The rabbits were killed at 1, 2, 3 and 6 months, respectively, and the eyes examined with light and electron microscopy. RESULTS On histological examination, the photoreceptor cells were found to be well-preserved in grafted areas at 1-3 months. At 6 months, the photoreceptors generally disclosed a normal nuclear layer and long outer segments when overlying areas with single cells or clusters of transplanted IPE cells. Multilayers of cells in abundance, including native RPE cells and macrophages (stained with RAM 11), particularly under microfolds of the neural retina, were occasionally associated with photoreceptor damage and nuclear drop out from the outer retinal layer. There was no inflammatory response in the choroid and the choriocapillaris remained patent. CONCLUSION The experiments show that grafting freshly harvested autologous IPE cells to the subretinal space is feasible and that the photoreceptors generally survive for at least 6 months when overlying the transplanted areas. Multilayers of abundant cells in the subretinal space may induce adverse focal effects on adjacent photoreceptors.
{"title":"Photoreceptor survival in transplantation of autologous iris pigment epithelial cells to the subretinal space.","authors":"S. Crafoord, L. Geng, S. Seregard, P. Algvere","doi":"10.1034/J.1600-0420.2002.800408.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2002.800408.X","url":null,"abstract":"PURPOSE\u0000To investigate photoreceptor survival in transplantation of non-cultured iris pigment epithelial (IPE) cells to the subretinal space in a prospective experimental study.\u0000\u0000\u0000METHODS\u0000Upper iridectomies were carried out in the right eyes of 37 pigmented rabbits. Suspensions of freshly harvested autologous IPE cells (without culturing) were prepared and injected into the subretinal space of the same eye. Follow-up examinations were carried out using ophthalmoscopy and colour fundus photography. The rabbits were killed at 1, 2, 3 and 6 months, respectively, and the eyes examined with light and electron microscopy.\u0000\u0000\u0000RESULTS\u0000On histological examination, the photoreceptor cells were found to be well-preserved in grafted areas at 1-3 months. At 6 months, the photoreceptors generally disclosed a normal nuclear layer and long outer segments when overlying areas with single cells or clusters of transplanted IPE cells. Multilayers of cells in abundance, including native RPE cells and macrophages (stained with RAM 11), particularly under microfolds of the neural retina, were occasionally associated with photoreceptor damage and nuclear drop out from the outer retinal layer. There was no inflammatory response in the choroid and the choriocapillaris remained patent.\u0000\u0000\u0000CONCLUSION\u0000The experiments show that grafting freshly harvested autologous IPE cells to the subretinal space is feasible and that the photoreceptors generally survive for at least 6 months when overlying the transplanted areas. Multilayers of abundant cells in the subretinal space may induce adverse focal effects on adjacent photoreceptors.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72856503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1034/J.1600-0420.2002.800407.X
A. Sjöstrand, L. Tomic, L. Larsson, C. Wadelius
PURPOSE To investigate whether variants of the polymorphic GT/CA-repeat in the regulatory sequences of the gene for GLC1A are associated with glaucoma. Mutations in the protein coding region of this gene are known to cause juvenile autosomal dominant glaucoma and are also found in a subset of cases with primary open-angle glaucoma (POAG). METHODS Samples were collected from 197 patients with exfoliation glaucoma and 157 patients with POAG as well as from 92 healthy blood donors. The variable repeat located 342 base pairs upstream of the translational initiation site, was analysed by polymerase chain reaction (PCR) and detected on an ABI 377 DNA sequencer. RESULTS Five alleles were detected, ranging in size from 13 to 17 repeat units, the most common of which was 14 repeat units. This was present in 63.7%, 66.6% and 61.4% of the two cohorts of cases and the control group, respectively. There was no significant difference in the distribution of the alleles between the control group and the two patient groups, respectively. CONCLUSION The present investigation provides no evidence that the variable repeat located in the regulatory sequences of the glaucoma gene GLC1A is associated with the risk of developing POAG or exfoliation glaucoma.
{"title":"No evidence of association between GT/CA-repeat polymorphism in the GLC1A gene promoter and primary open-angle or exfoliation glaucoma.","authors":"A. Sjöstrand, L. Tomic, L. Larsson, C. Wadelius","doi":"10.1034/J.1600-0420.2002.800407.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2002.800407.X","url":null,"abstract":"PURPOSE\u0000To investigate whether variants of the polymorphic GT/CA-repeat in the regulatory sequences of the gene for GLC1A are associated with glaucoma. Mutations in the protein coding region of this gene are known to cause juvenile autosomal dominant glaucoma and are also found in a subset of cases with primary open-angle glaucoma (POAG).\u0000\u0000\u0000METHODS\u0000Samples were collected from 197 patients with exfoliation glaucoma and 157 patients with POAG as well as from 92 healthy blood donors. The variable repeat located 342 base pairs upstream of the translational initiation site, was analysed by polymerase chain reaction (PCR) and detected on an ABI 377 DNA sequencer.\u0000\u0000\u0000RESULTS\u0000Five alleles were detected, ranging in size from 13 to 17 repeat units, the most common of which was 14 repeat units. This was present in 63.7%, 66.6% and 61.4% of the two cohorts of cases and the control group, respectively. There was no significant difference in the distribution of the alleles between the control group and the two patient groups, respectively.\u0000\u0000\u0000CONCLUSION\u0000The present investigation provides no evidence that the variable repeat located in the regulatory sequences of the glaucoma gene GLC1A is associated with the risk of developing POAG or exfoliation glaucoma.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72834122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1034/J.1600-0420.2002.800405.X
G. Wendt, K. Heikkilä, P. Summanen
PURPOSE To compare the effectiveness of one- and two-field 45 degrees and 60 degrees fundus photography for detection of retinal neovascularizations (NVEs); to compare the detection of NVEs in macular 45 degrees fields centred on the fovea, between the fovea and the disc and with the nasal border along the nasal disc margin with that in standard 60 degrees one- and two-fields. METHODS Two ophthalmologists assessed red-free, black and white screening and follow-up photographs of 58 out of a total 72 patients referred for treatment for NVEs over the 3 year period 1997-99. The assessment included analysis of the numbers, sizes and locations of NVEs identified in different photographic fields defined by a transparent grid placed over two standard 60 degrees fields. RESULTS Testing of 45 degrees macular fields disclosed 59/81 (73%), 50/81 (62%) and 64/81 (79%), respectively, of NVEs detected in a 60 degrees fovea-centred photograph. Kappa values for detecting at least one NVE, when present, were 0.62 (95% CI 0.40-0.83), 0.38 (95% CI 0.19-0.57) and 0.83 (95% CI 0.62-0.99). The corresponding figures when compared with two-field 60 degrees photography were 59/111 (53%), 50/111 (45%) and 64/111 (58%), respectively. One macula-centred 60 degrees field disclosed 81/111 (73%) of NVEs detected by 60 degrees two-field photography with an additional optic disc-centred field. Two-field 45 degrees photography disclosed 86/111 (77%) of NVEs detected by two-field 60 degrees photography. A total of 90% of NVEs detected in the optic disc-centred 60 degrees field only were also detected in the corresponding 45 degrees field. CONCLUSION One-field 45 degrees photography cannot be recommended as a screening method for diabetic retinopathy. Two-field 45 degrees photography (macula-centred and disc-centred fields) disclosed 77% of NVEs detected by the corresponding two-field 60 degrees photography.
目的比较单视野、双视野45度和60度眼底摄影检测视网膜新生血管(NVEs)的有效性;比较以中央窝为中心的45度视场、中央窝与椎间盘之间以及沿鼻盘边缘的鼻缘与标准60度一视场和二视场的NVEs检测。方法两名眼科医生评估了1997- 1999年3年间72例NVEs患者中58例的无红、黑、白筛查和随访照片。评估包括分析在两个标准60度视场上放置的透明网格界定的不同摄影视场中确定的NVEs的数量、大小和位置。结果在45度黄斑视野检测中，60度中央凹中心照片检测到的NVEs分别为59/81(73%)、50/81(62%)和64/81(79%)。检测至少一种NVE的Kappa值为0.62 (95% CI 0.40-0.83)、0.38 (95% CI 0.19-0.57)和0.83 (95% CI 0.62-0.99)。与双视场60度摄影相比，相应的数据分别为59/111(53%)、50/111(45%)和64/111(58%)。一个以黄斑为中心的60度视场显示了81/111(73%)的nve，这些nve是通过60度双视场摄影和附加的视盘为中心的视场检测到的。双视野45度摄影揭示了86/111(77%)双视野60度摄影检测到的NVEs。仅在视盘中心的60度视场中检测到的nve，在相应的45度视场中也检测到90%。结论单视场45度摄影不能作为糖尿病视网膜病变的筛查方法。双视野45度摄影(以黄斑为中心和盘状为中心的视野)显示了77%的nve被相应的双视野60度摄影检测到。
{"title":"Detection of retinal neovascularizations using 45 ° and 60 ° photographic fields with varying 45 ° fields simulated on a 60 ° photograph","authors":"G. Wendt, K. Heikkilä, P. Summanen","doi":"10.1034/J.1600-0420.2002.800405.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2002.800405.X","url":null,"abstract":"PURPOSE To compare the effectiveness of one- and two-field 45 degrees and 60 degrees fundus photography for detection of retinal neovascularizations (NVEs); to compare the detection of NVEs in macular 45 degrees fields centred on the fovea, between the fovea and the disc and with the nasal border along the nasal disc margin with that in standard 60 degrees one- and two-fields. METHODS Two ophthalmologists assessed red-free, black and white screening and follow-up photographs of 58 out of a total 72 patients referred for treatment for NVEs over the 3 year period 1997-99. The assessment included analysis of the numbers, sizes and locations of NVEs identified in different photographic fields defined by a transparent grid placed over two standard 60 degrees fields. RESULTS Testing of 45 degrees macular fields disclosed 59/81 (73%), 50/81 (62%) and 64/81 (79%), respectively, of NVEs detected in a 60 degrees fovea-centred photograph. Kappa values for detecting at least one NVE, when present, were 0.62 (95% CI 0.40-0.83), 0.38 (95% CI 0.19-0.57) and 0.83 (95% CI 0.62-0.99). The corresponding figures when compared with two-field 60 degrees photography were 59/111 (53%), 50/111 (45%) and 64/111 (58%), respectively. One macula-centred 60 degrees field disclosed 81/111 (73%) of NVEs detected by 60 degrees two-field photography with an additional optic disc-centred field. Two-field 45 degrees photography disclosed 86/111 (77%) of NVEs detected by two-field 60 degrees photography. A total of 90% of NVEs detected in the optic disc-centred 60 degrees field only were also detected in the corresponding 45 degrees field. CONCLUSION One-field 45 degrees photography cannot be recommended as a screening method for diabetic retinopathy. Two-field 45 degrees photography (macula-centred and disc-centred fields) disclosed 77% of NVEs detected by the corresponding two-field 60 degrees photography.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78503855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1034/J.1600-0420.2002.800403.X
S. Hayreh, B. Zimmerman, R. Kardon
OBJECTIVES (1) To report the incidence and extent of visual improvement achieved by high-dose systemic corticosteroid treatment in eyes with visual loss due to giant-cell arteritis (GCA). (2) To understand the cause of the discrepancies between visual improvement revealed by routine visual acuity (VA) and by the central visual field in kinetic perimetry. (3) To review critically the contradictory literature on the effectiveness of corticosteroid therapy on visual recovery in GCA and to attempt to reconcile differences in the reported results. METHODS Clinical data were collected systematically on 84 consecutive patients (114 eyes) with visual loss, all of whom had GCA confirmed by temporal artery biopsy and treated by us with high-dose systemic corticosteroid therapy. The patients were treated between 1974 and 1999 and data were compiled retrospectively. All patients underwent a detailed visual and ophthalmic evaluation at the initial visit and at every follow-up. This included visual field testing (with a Goldmann perimeter). All were treated with systemic corticosteroid therapy (intravenous followed by oral in 41 patients and oral only in 43 patients). RESULTS Visual loss was due to anterior ischaemic optic neuropathy (91%), central retinal artery occlusion (10.5%), cilioretinal artery occlusion (10%), and/or posterior ischaemic optic neuropathy (4%), either alone or in different combinations. Improvement in both VA (>or= 2 lines) and central visual field was found in only five (4%) eyes of five patients (three treated with intravenous and two with oral steroid therapy). Improvement in VA >or= 2 lines but not in the central visual field was found in seven eyes (in six patients). Visual improvement was seen in 7% of 41 patients treated initially with intravenous steroids versus 5% (p = 0.672) of 43 patients treated with oral steroids only. Comparison of patients with visual improvement in both VA and fields versus those with no improvement suggested a shorter interval (p = 0.065) between onset of visual loss and start of therapy in the improved patients. CONCLUSIONS In our study, only 4% of eyes with visual loss due to GCA improved, as judged by improvement in both VA and central visual field (by kinetic perimetry and Amsler grid). The data also suggest that there is a better (p = 0.065) chance of visual improvement with early diagnosis and immediate start of steroid therapy. Improvement in VA without associated improvement in the central visual field or Amsler grid may simply represent a learned ability to fixate eccentrically with more effective use of remaining vision: this factor could help explain a number of reported cases in the literature of improved VA after steroid treatment for GCA. To prevent further visual loss in either eye and for management of systemic manifestations of GCA, all patients must be treated on a long-term basis with adequate amounts of systemic corticosteroids.
{"title":"Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature.","authors":"S. Hayreh, B. Zimmerman, R. Kardon","doi":"10.1034/J.1600-0420.2002.800403.X","DOIUrl":"https://doi.org/10.1034/J.1600-0420.2002.800403.X","url":null,"abstract":"OBJECTIVES\u0000(1) To report the incidence and extent of visual improvement achieved by high-dose systemic corticosteroid treatment in eyes with visual loss due to giant-cell arteritis (GCA). (2) To understand the cause of the discrepancies between visual improvement revealed by routine visual acuity (VA) and by the central visual field in kinetic perimetry. (3) To review critically the contradictory literature on the effectiveness of corticosteroid therapy on visual recovery in GCA and to attempt to reconcile differences in the reported results.\u0000\u0000\u0000METHODS\u0000Clinical data were collected systematically on 84 consecutive patients (114 eyes) with visual loss, all of whom had GCA confirmed by temporal artery biopsy and treated by us with high-dose systemic corticosteroid therapy. The patients were treated between 1974 and 1999 and data were compiled retrospectively. All patients underwent a detailed visual and ophthalmic evaluation at the initial visit and at every follow-up. This included visual field testing (with a Goldmann perimeter). All were treated with systemic corticosteroid therapy (intravenous followed by oral in 41 patients and oral only in 43 patients).\u0000\u0000\u0000RESULTS\u0000Visual loss was due to anterior ischaemic optic neuropathy (91%), central retinal artery occlusion (10.5%), cilioretinal artery occlusion (10%), and/or posterior ischaemic optic neuropathy (4%), either alone or in different combinations. Improvement in both VA (>or= 2 lines) and central visual field was found in only five (4%) eyes of five patients (three treated with intravenous and two with oral steroid therapy). Improvement in VA >or= 2 lines but not in the central visual field was found in seven eyes (in six patients). Visual improvement was seen in 7% of 41 patients treated initially with intravenous steroids versus 5% (p = 0.672) of 43 patients treated with oral steroids only. Comparison of patients with visual improvement in both VA and fields versus those with no improvement suggested a shorter interval (p = 0.065) between onset of visual loss and start of therapy in the improved patients.\u0000\u0000\u0000CONCLUSIONS\u0000In our study, only 4% of eyes with visual loss due to GCA improved, as judged by improvement in both VA and central visual field (by kinetic perimetry and Amsler grid). The data also suggest that there is a better (p = 0.065) chance of visual improvement with early diagnosis and immediate start of steroid therapy. Improvement in VA without associated improvement in the central visual field or Amsler grid may simply represent a learned ability to fixate eccentrically with more effective use of remaining vision: this factor could help explain a number of reported cases in the literature of improved VA after steroid treatment for GCA. To prevent further visual loss in either eye and for management of systemic manifestations of GCA, all patients must be treated on a long-term basis with adequate amounts of systemic corticosteroids.","PeriodicalId":7152,"journal":{"name":"Acta ophthalmologica Scandinavica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81910337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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