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Scanning Laser Polarimetry - is it Beneficial in the Diagnosis of Glaucoma? Examples

1Niederdräing N., 1Kremmer S., 1Selbach J. M., 2Steuhl K. P.,
1Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde (Essen)
2Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde, Abt. für Erkrankungen des vorderen Augenabschnitts (Essen)

Background: In the last years, scanning laser polarimetry (SLP) has become increasingly interesting in glaucoma diagnosis. Classical standard glaucoma diagnostic methods such as perimetry are dependent on patient cooperation and experience of the investigator. In addition to retinal nerve fiber layer photography (RNP) with a green filter, SLP allows an objective measurement of the retinal nerve fiber layer (RNFL). With various clinical examples we show possibilities and limits of SLP.
Patients and methods: We show examples from patients of our glaucoma service. Besides ophthalmological standard examinations, 30° automated perimetry (P) (Tübinger Automatic Perimeter,Oculus), and RNP, we performed SLP with GDx (software version 1.0.14 and 2.0.10, LDT,USA).
Results: some case reports are shown: 1.Examination of 5 year follow-up: between first and last SLP a cataract operation on both eyes was performed. Scotomas in P were markedly less but RNFL was stable or even reduced. 2.After trabeculectomy improvement in P and SLP, but again decreasing after two years. 3.NTG suspect: big atypical optic discs, no scotomas, normal RNFL. 4.Big atypical optic discs, beginning scotomas, markedly reduced RNFL. 5.Small optic discs, normal P, high IOP and reduced RNFL. 6.High IOP, progressive optic nerve damage, inconstant perimetric results, well reproducable reduction of RNFL. 7.Suspect for aggravation: IOP 15 mmHg, CDR 0,6, absolute scotomas, reduced RNFL; vascular dysregulation and sleep apnoe syndrom detected. 8. CDR asymmetry, normal RNFL in both eyes 9. CDR asymmetry, reduced RNFL in the eye with the big atypical optic disc 10. Follow up examinations 11. Examination of children, in which P is often difficult or impossible. Better use of SLP because of short duration (>1 sec) of each measurement.
Conclusions: SLP is a fast, objective and well reproducable method which provides important additional information in glaucoma diagnosis.