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The pilocarpine test for the early diagnosis of glaucoma
230
Surv Ophtholmol 20 (3) November-December,
1975
further incriminate H. capsdatum in the pathogen& of the disciform macular lesion so typical of this syndrome. It has been my experience, after seeing 900 cases, that these patients, at the time of their disciform macular syndrome, are not exposed to more H. cupsdatum in the air than is the population at large. A certain type of person may be predisposed to histoplasmic
The Pilocarpine
CURRENTOPHTHALMOLOGY
choroiditis. In three separate studies we have found that patients with ocular histoplasmosis hyperreact to: 1) delayed skin test antigens (Am J Ophthalmol, 67:732, 1969); 2) atypical mycobacteria by serologic testing (Am J Ophthalmol, 72: 167- 170, 1973); and 3) serum virus testing (in preparation). TF SCHLAEGEL
Test for the Early Diagnosis of Glaqcoma,
Monatsbl Augenheilkd
163:115-124,
by F Hollwich.
Klin
1973
Intraocular pressure (I.O.P.) fluctuates according to individual sinusoidal circadian rhythm. Diurnal differences do not exceed 2-3 mm Hg in healthy eyes, and may reach 20 mm Hg in glaucomatous eyes. The individual curve can be established with Goldmann’s applanation tonometer, taking 5 diurnal measurements at 8 AM, 11 AM, 2 PM, 5 PM and 8 PM on the same day, or as a substitute, at 8 AM, 12 Noon and 6 PM on 5 different days. Additional measurements are indicated if all measurements are below 20 mm Hg, but the fluctuations exceed 3mm Hg, or if the highest measurement exceeds 22 mm Hg. The provocative glaucoma tests are not sufficiently sensitive to detect very early stages of glaucoma and are more selective for the detection of acute narrow-angle glaucoma than for the detection of simple wide-angle glaucoma. The pilocarpine test is a valuable procedure for the early detection of glaucoma. This test consists of the instillation of 1% pilocarpine on a day following the measured peak of the diurnal sinus. A drop of more than 4 mm Hg within an hour after pilocarpine instillation indicates pilocarpine sensitivity or glaucoma susceptibility. In case of
doubt, the Yz%pilocarpine test will reduce the circadian sinus amplitude and reduce the average I.O.P. Even repeated instillations of 1% pilocarpine will not affect the diurnal sinus or the average I.O.P. of eyes not affected with glaucoma. The pharmacologic effect of pilocarpine is twofold: it reduces the scotoma and lowers the I.O.P. The effect of adrenaline on the other hand consists only of the reduction of the I.O.P. The author discusses the importance of hemodynamic effects and of the blood supply to the optic nerve in the treatment of glaucoma. Comment This “simple” test requires determination of the measured peak of the diurnal curve and a reduction of 4 mm Hg within an hour of 1 percent pilocarpine instillation. It is important to realize that when we are dealing with borderline cases with pressures under 24 mm Hg, such a reduction may occur in a certain percent of normal eyes. Further studies by other investigators are anticipated. SAULSUGAR
Retinal Detachment in Cases of Occlusion of the Central Retinal Vein or its Branches, by U Metzler, R Hijhmann and D Kaskel. Klin Monatsbl Augenheilkd 164:
25 l-254,
1974
Most reports in the literature on retinal detachment with occlusion of the central retinal vein describe associated tears of the retina, i.e. a mechanism similar to idiopathic retinal detachment. However, Kliiti (Mod Prob Ophthalmol 10~236, 1972) and Barsewich (Mod Pro61 Oph-
thalmol 10:294, 1972) have reported on retinal detachments with thrombosis of the central retinal vein without retinal tears or tractions of the vitreous. Among 35 patients with occlusion of the central retinal vein or its branches, 9 were found to have
Surv Ophtholmol 20 (3) November-December,
1975
further incriminate H. capsdatum in the pathogen& of the disciform macular lesion so typical of this syndrome. It has been my experience, after seeing 900 cases, that these patients, at the time of their disciform macular syndrome, are not exposed to more H. cupsdatum in the air than is the population at large. A certain type of person may be predisposed to histoplasmic
The Pilocarpine
CURRENTOPHTHALMOLOGY
choroiditis. In three separate studies we have found that patients with ocular histoplasmosis hyperreact to: 1) delayed skin test antigens (Am J Ophthalmol, 67:732, 1969); 2) atypical mycobacteria by serologic testing (Am J Ophthalmol, 72: 167- 170, 1973); and 3) serum virus testing (in preparation). TF SCHLAEGEL
Test for the Early Diagnosis of Glaqcoma,
Monatsbl Augenheilkd
163:115-124,
by F Hollwich.
Klin
1973
Intraocular pressure (I.O.P.) fluctuates according to individual sinusoidal circadian rhythm. Diurnal differences do not exceed 2-3 mm Hg in healthy eyes, and may reach 20 mm Hg in glaucomatous eyes. The individual curve can be established with Goldmann’s applanation tonometer, taking 5 diurnal measurements at 8 AM, 11 AM, 2 PM, 5 PM and 8 PM on the same day, or as a substitute, at 8 AM, 12 Noon and 6 PM on 5 different days. Additional measurements are indicated if all measurements are below 20 mm Hg, but the fluctuations exceed 3mm Hg, or if the highest measurement exceeds 22 mm Hg. The provocative glaucoma tests are not sufficiently sensitive to detect very early stages of glaucoma and are more selective for the detection of acute narrow-angle glaucoma than for the detection of simple wide-angle glaucoma. The pilocarpine test is a valuable procedure for the early detection of glaucoma. This test consists of the instillation of 1% pilocarpine on a day following the measured peak of the diurnal sinus. A drop of more than 4 mm Hg within an hour after pilocarpine instillation indicates pilocarpine sensitivity or glaucoma susceptibility. In case of
doubt, the Yz%pilocarpine test will reduce the circadian sinus amplitude and reduce the average I.O.P. Even repeated instillations of 1% pilocarpine will not affect the diurnal sinus or the average I.O.P. of eyes not affected with glaucoma. The pharmacologic effect of pilocarpine is twofold: it reduces the scotoma and lowers the I.O.P. The effect of adrenaline on the other hand consists only of the reduction of the I.O.P. The author discusses the importance of hemodynamic effects and of the blood supply to the optic nerve in the treatment of glaucoma. Comment This “simple” test requires determination of the measured peak of the diurnal curve and a reduction of 4 mm Hg within an hour of 1 percent pilocarpine instillation. It is important to realize that when we are dealing with borderline cases with pressures under 24 mm Hg, such a reduction may occur in a certain percent of normal eyes. Further studies by other investigators are anticipated. SAULSUGAR
Retinal Detachment in Cases of Occlusion of the Central Retinal Vein or its Branches, by U Metzler, R Hijhmann and D Kaskel. Klin Monatsbl Augenheilkd 164:
25 l-254,
1974
Most reports in the literature on retinal detachment with occlusion of the central retinal vein describe associated tears of the retina, i.e. a mechanism similar to idiopathic retinal detachment. However, Kliiti (Mod Prob Ophthalmol 10~236, 1972) and Barsewich (Mod Pro61 Oph-
thalmol 10:294, 1972) have reported on retinal detachments with thrombosis of the central retinal vein without retinal tears or tractions of the vitreous. Among 35 patients with occlusion of the central retinal vein or its branches, 9 were found to have