Optische Schnittbild-Vermessung des vorderen Augenabschnittes nach Scheimpflug: Möglichkeiten und Grenzen - eine Übersicht[1] [2]

 

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Zusammenfassung

Hintergrund Hornhaut und Linse des Auges besitzen Lichtstreuungseigenschaften, die sich mit dem Alter verändern. Dieser Vorgang wird von Schadensfaktoren beeinflusst, die die Ausbildung von Katarakten induzieren können. Zur Dokumentation und Vermessung der Lichstreuung im Auge sind 4 verschiedene Spezialkameras nach dem Scheimpflugschen Abbildungsprinzip entwickelt worden (Topcon SL-45, Zeiss SLC, Oxford CASE 2000, Nidek EAS 1000). In der klinischen und experimentellen Anwendung haben sich die SL-45 und die EAS 1000 durchgesetzt.

Material und Methoden Die Dokumentation des Auges mit einem Scheimpflug-System erfolgt im abgedunkelten Raum in Mydriasis. Orientierungshilfen ermöglichen eine Ausrichtung der Rotationsachse der Kamera in der optischen Achse des Auges. Vier Meridiane haben sich als ausreichend erwiesen. Die Bildauswertung berücksichtigt Unterschiede in Peakhöhe und Abstand von 2 Schichten in der Hornhaut und 10 Schichten in der Linse. Eichvorsätze ermöglichen eine Abgleichung von technischen Schwankungen des Aufnahmeverfahrens.

Ergebnisse Die Vermessung des Alterungsverhaltens der Linse hat typische Dichteverläufe für einzelne Linsenschichten aufgezeigt, die Rindenschicht nimmt früher an Dichte zu als der Kernbereich. Bei der Kataraktklassifikation erlaubt die Scheimpflug-Fotografie eine objektive Bewertung von Katarakttypus und Progredienz. Die chirurgische Korrektur von refraktiven Fehlern lässt sich ebenfalls mit der Scheimpflug-Kamera vermessen. Am Beispiel der Gyrase- und HMG-CoA-Reduktase-Hemmer konnte gezeigt werden, dass die Scheimpflug-Fotografie die Methode der Wahl zur Etablierung eines Sicherheitsprofils einer Substanz ist.

Schlussfolgerungen Die reproduzierbare Dokumentation und Bildauswertung mit der Scheimpflug-Fotografie erfordert fachliche Expertise. Trotzdem hat sie sich als überlegenes Verfahren zur objektiven Vermessung des vorderen Augenabschnittes bei humanen und tierischen Augen erwiesen.

Background Light scattering properties of the cornea and lens change in relation to age. This process is influenced by noxious factors which may induce the formation of cataracts. Four different camera types based on the Scheimpflug principle have been developed for documentation and evaluation of light scattering in the eye, Topcon SL-45, Zeiss SLC, Oxford CASE 2000, Nidek EAS 1000. Only the SL-45 and EAS 1000, however, have found a wider application in clinical and experimental studies.

Material and Methods Documentation of the eye with a Scheimpflug system is performed in a dark room after mydriasis induction.The rotating axis of the camera is aligned to the optical axis of the eye with fixation devices. Four meridians have been found appropriate for routine documentation. Image analysis is based on peak height and distance evaluation of 2 layers in the cornea and 10 layers in the lens. Standardization devices allow correction of technical differences in the recording process.

Results Evaluation of the ageing properties of the lens has evidenced typical density developments for each individual layer, the cortex increasing in density earlier than the nucleus. Cataract classification using a Scheimpflug camera provides an objective characterization of cataract type and progression. The outcome of surgical procedures changing the refractive power of the eye can be evaluated with a Scheimpflug camera as well. Its application in studies dealing with the ocular effects of Quinolones and HMG-CoA-reductase inhibitors, has demonstrated that Scheimpflug photography is the method of choice for establishment of a safety profile for a new drug.

Conclusions Scheimpflug photography has proven to be ideal for objective documentation of the anterior eye segment in human and animal eyes, although both documentation and image analysis demand technical expertise to be reproducible.

01 Manuskript erstmalig eingereicht am 29. 11. 00 und in der vorliegenden Form angenommen.

02 Herrn Prof. Dr. rer. nat. Dr. med. h. c. Otto Hockwin zum 75. Geburtstag gewidmet.

Literatur

01 Manuskript erstmalig eingereicht am 29. 11. 00 und in der vorliegenden Form angenommen.

02 Herrn Prof. Dr. rer. nat. Dr. med. h. c. Otto Hockwin zum 75. Geburtstag gewidmet.

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