Third International Visual Field Symposium - Imaging and Perimetry ...

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Note: A report ‘on atypical chiasmal visual field defects’ by E.L. Greve and M.A.C. Rakkman has been published in Documenta Ophthalmologica Proceedings Series vol 14: 315-326 (1977). (Second Int. Visual Field Symposium, Tiibingen 1976). A paper by F. Dannheim related to this subject is published in this volume. Author’s address: Department of Ophthalmology School of Medicine, Kobe University Kusunoki-cho, 7-chome, Ikuta-ku Kobe, Japan 42
Docum. Ophthal. Proc. Series, Vol. 19 VISUAL FIELDS BEFORE AND AFTER TRANSNASAL REMOVAL OF A PITUITARY TUMOR Correlation of topographical features with sensorial disturbance for liminal and supraliminal stimuli F. DANNHEIM, D. LUEDECKE & D. KUEHNE (Hamburg, GFR) ABSTRACT In 111 patients with pituitary tumors, central visual fields were obtained preoperatively, in halve of them postoperatively as well. Kinetic perimetry as well as supraliminal stimuli have been applied. The correlation of the radiologically (skull x-ray, PEG, CT) and surgically evaluated extent of tumor and visual fields is good. Deviations occur only towards more functional damage than to be expected. 11 patients showed sensorlal alterations with intrasellar tumors, some of them as changes of sensation, but normal kinetic fields. Those findings - never observed in normal subjects - seem to represent the first functional damage produced by a ‘compressing’ lesion, and they are the last to disappear after decompression. Recovery of visual function may show a rapid and a slow phase, complete recovery from even those minimal changes is not frequent. An affection of the nasal field is more frequent than generally accepted, sometimes following a nerve tibre pattern. Classical nerve fibre defects are observed with large tumors. Binasal or homonymous changes of sensation - however - occur especially with small tumors. INTRODUCTION Conventional perimetry is based on perception of light by means of threshold measurements as in kinetic and static perimetry. The application of supraliminal stimuli for an assessment of sensation proved valuable especially in chiasmal syndromes with discrete functional damage (Chamlin 1949, Frisen 1973, Dannheim 1977, 1978). This study was made to find out the accuracy and limitations of this second method by correlating it’s results with patho-anatomical features of pituitary tumors and by observing the characteristics of visual recovery following removal of the compressing lesion. MATERIAL AND METHOD 111 patients of 15 - 7 5 years of age suffering from a pituitary tumor have been evaluated before transnasal removal both ophthalmologically and radiologically within the last 2 years. The central visual fields were performed with a Tuebinger or a modified Rodenstock perimeter using a background 43
Page 1 and 2: Third International Visual Field Sy
Page 3 and 4: Third International visual i: ii~,d
Page 5 and 6: CONTENTS E.L. Greve: Introduction .
Page 7 and 8: Session IV. Methodology Chairman: H
Page 9 and 10: of the R.N.L. may not be accompanie
Page 11 and 12: Docum. Ophthal. Proc. Series, Vol.
Page 13 and 14: conduction disturbances. Their caus
Page 15 and 16: Sofue 1975, Sommer, Miller, Pollack
Page 17 and 18: areas but they can occur also in ot
Page 19 and 20: ut only thinning of the arcuate bun
Page 21 and 22: metric strategies, it affords an ob
Page 23 and 24: Docum. Ophthal. Proc. Series, Vol.
Page 25 and 26: Table 1. Atrophic stages of maculop
Page 27 and 28: VS=20/60 Fig. 3. Red-free fundus ph
Page 29 and 30: I 20/20 l- 1.0 1.2- 20/25 ,- 20/30
Page 31 and 32: It could be observed, in red-free f
Page 33 and 34: VISUAL FIELD DEFECTS DUE TO TUMORS
Page 35 and 36: 1. FIRST GROUP: THE SYMMETRIC TYPE
Page 37 and 38: Table 4. Visual field defects due t
Page 39 and 40: chiasm and above either of the opti
Page 41 and 42: and 20/40 for the respective eyes t
Page 43 and 44: advantages of applying other perime
Page 45 and 46: Fig. 7. The pseud-macular sparing:
Page 47: defect due to central integration o
Page 51 and 52: disturbance of perception is visibl
Page 53 and 54: Supraliminal stimuli still show a b
Page 55 and 56: tion (Dannheim 1977, 1978). These f
Page 57 and 58: Huber, A. Chiasmasyndrome - Klinik.
Page 59 and 60: Table 1. Incidence of age, sex and
Page 61 and 62: Table 3. Time interval between the
Page 63 and 64: Table 5. Initial and final visual a
Page 65 and 66: Table 7. State of the optic disc at
Page 67 and 68: Visual field defects. Table 12 summ
Page 69 and 70: Effect of the time lag between the
Page 71 and 72: Table IS. Effect of systemic cortic
Page 73 and 74: In contrast to Group I, usually no
Page 75 and 76: series. The following case vividly
Page 77 and 78: Docum. Ophthal Proc. Series, Vol. 1
Page 79 and 80: well as cases due to Diabetes. As c
Page 81 and 82: a- b - ht:Mii,H Fig. 4. Typical def
Page 83 and 84: of both diseases, just as the infer
Page 85 and 86: of minor ONH therefore include a de
Page 87 and 88: Fig. 2. Visual field defect due to
Page 89 and 90: less complete lesions certainly are
Page 91 and 92: probably congenital hydrocephalus w
Page 93 and 94: area was involved as well. In 4 fie
Page 95 and 96: chiasma. Although transient papillo
Page 97 and 98: REFERENCES Bynke, H. & Heijl, A. Au
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*U. y: R-• 01.. 1Q69. V..T DY.ST
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98 y=’ -’ 40 cl.0 ,,' .4 ,' 3'
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REFERENCES Matsuda, H. & Nakabayash
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Perhaps we can bring this up in a c
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there have been no visual symptoms
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could understand supra-se&r meningi
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I found in pituitary adenoma and in
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Docum. Ophthal. Proc. Series, Vol.
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tided to compare the two eyes to se
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Fig. 4. (Lichter). Nucleus of a def
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Fig. 6. (Lichter). Nucleus of a def
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THE EARLY VISUAL FIELD DEFECT IN GL
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central tests were done with the be
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Fig, 4. Earliest field defect showi
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ences were normally distributed aro
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was found. The first patients of th
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fibre bundle. This group has been f
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On the one hand the w.s.d. may be r
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REFERENCES Armaly, M.F. Selective p
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followed over a one-year period. So
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RESULTS Forty-nine out of 49 open a
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DISCUSSION AND CONCLUSIONS 1. 1. Al
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Table I. JR OD Month I.O.P. mm HG 1
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was almost always abnormal if the s
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perties. II. Dichoptic properties o
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until now had to watch for the appe
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In the following time pressure cont
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matous perimetric changes (Aulhorn
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genital or closed angle glaucoma or
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60 50 40 30 20 10 0 MEDIANS bsx OHn
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those who developed glaucoma with t
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that did not yet show a break-throu
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CASE REPORTS Case 1.: a 52-year-old
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172 Goldmann-field Tiibinger nasal
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174 Friedman-fidd New Front Plate f
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Leblanc, R. Peripheral nasal field
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types of defects described, Goldman
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similar areas of the field. Additio
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Fig. 2. Visual field of the right e
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Table 1. The same type of defects s
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tion tonometer) at time of initial
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treated eyes (5/61 or 8.2%) than in
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was not quite statistically signifi
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early, disappeared entirely. Howeve
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The results of this investigation e
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30’ a) asb 32 10 32 100 320 1000
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OVER-ALL CONCLUSIONS Some degree of
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eye with a modified Goldmann-Weeker
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flow of axoplasm in the optic nerve
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Vanderburg, D. & Drance, S.M. Studi
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naga, Endo & Matsuo 1976). We initi
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up examinations. AU the eyes withou
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41 among 69 (59%), were located in
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oped relative field defects. In the
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utilizing the static method of peri
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CASE PRESENTATIONS For the first tw
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DISCUSSION As a bundle of nerve fib
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REVERSIBILITY OF VISUAL FIELD DEFEC
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glaucoma with use of some agents bu
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lyzer showed paracentral slight spo
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no disappearance. In 9 eyes progres
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closure glaucoma, in early stage id
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(Isayama & Tagami, 1977) in order t
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fiber bundle defects did not corres
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However, after the ocular pressure
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FllE3UENCY of FIWDIN6 EMly 6LAUCOYA
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gression. Each visual field was div
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DISCUSSIONS AND COMMENTS Aulhom dev
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we 10 - 8- 0 eye 10 - 5- J-J o4 10
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REFERENCES Aulhom, E. & Harms, H. E
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no major effect of the water drinki
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Case b, right eye, 45" meridian +-+
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REFERENCES Aoyama, T. Pupillographi
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These authors of the second group d
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The behaviour of type 1) must be co
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isolated defect of the Bjerrum area
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choosing the direction of your prof
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How does one explain contraction on
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adequate way if we could understand
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analyse, you can see how well they
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(L. Ron&i and L. Barca. biological
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with a way to teach the clinician t
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The relevant quantities are defined
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The average number n of false scoto
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criteria will suffice for the separ
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Let us consider the two arrangement
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esults of an initial low-resolution
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practical applications, for patholo
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examination phase also provides inf
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Section: 1. Characters ‘READY’
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In order not to disturb the subject
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A B Fig. 5. Result with the semi-au
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3 Fig. 2. Left visual field in a pa
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In the remaining 8 fields of 5 case
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Docum. OphthaI. Proc. Series, Vol.
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ROLE OF STANDARDISATION IN AUTOMATE
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REFERENCES Aulhorn, E Ueber die Aut
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Matsuo. Any other comment on Dr. Fa
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need an infinite number; I don’t
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not separate clearly between normal
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SUMMARY OF SESSION III: AUTOMATION
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RESULTS Visual fields were measured
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etinal edema was seen. The visual a
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DISCUSSION In the new fundus contro
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Fig. 8. Occlusion of arterial branc
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ACKNOWLEDGEMENTS The authors would
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NEW FUNOUS PHOTO PERIMITER-OPTICAL
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354 Fig. 4. Heredodegeneration of m
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_No. 9 Diag.NeuritiS optica retrobu
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Fig. 7 shows caecocentral scotoma p
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360 Fig. 1. (See text) Fig. 2. (See
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were obtained from several cases of
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significance of eye-rotation in per
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through an actual change in sensiti
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Docum. Ophthal. Proc Series, Vol 19
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angiography (FFA) and differential
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Fig. 2a. Results of FFA of case 2 (
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Case 4: A woman of 68 years was see
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-.. 378 Fig. 4.5. Results of FFA in
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3. indicating very sensitively the
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added distorting components are pre
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INVERSION Fig. 1. A tangent screen
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Case History VC is a 42-year-old Ca
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a=# 0 OTHERS * REDUCED SENSITIVITY
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gential errors has been made. In es
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that a functional anomaly is prefer
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In the cases of this group, hemorra
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399
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are mainly represented by the PCS g
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oquine retinopathy, 2 eyes of centr
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Table 2. FVFA Profiles of PRD. 406
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REFERENCES Friedmann, AL The assesm
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stimulus used by Verriest and Israe
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In Figure 3, threshold gradients ar
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Matsuo: I would like to proceed to
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SUMMARY OF SESSION IV: METHODOLOGY
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puts in work all the processus inhe
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to the luminous conditions of backg
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MEASURES OF HOW WELL A PROCEDURE DI
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A general idea or model about the c
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enough to understand the test. Fig.
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visual function is normal. Therefor
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ackground field up to 50’ of visu
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clearly isolated with this perimete
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15’ nasal IO 5’ 0’ 5” tempo
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Fig 2, A new attachment (left) and
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and 6000 asb. in rabbit No. 2. Fig.
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Case 2. Cihoretinal occlusion. Male
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detected by kinetic perimetry were
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Fig. 6. The thresholds of two prese
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Docum. Ophthal. PIOC. Series, Vol.
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peripheral parts of the retina, the
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2. Characteristics of Vertex Potent
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Regarding the characteristics of th
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changes could be detected without P
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An isolated nasal PVF defect in the
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Docum. Ophthal. PIOC. Series, Vol.
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determination of the achromatic inc
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field ‘and also other methods, fo
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REPORT OF THE IPS RESEARCH GROUP ON
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white or colour perimetry. Lakowski
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heard. I am not a neophyte in Japan
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T. Aoyama, 265 M.F. Armaly, 177 E.
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