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Purpose:To evaluate pathogenetic m echanisms and fre-quency distribution of visual field defects(VFDs )in pa-tients with chiasmal lesions.Secon dly,to reconsider the existence of“Wilbrand’s knee”as far as referable to the anterior junction syndrome.Method s:Consecutive visual field records related to chiasmal le sions were retrieved from the Tuebingen Perimetric Database.In all cases,at least one eye was examined with the Tuebingen Automated Perimeter using a standardized grid of 191static targets within the central 30°visual field,and a threshold-related,slightly supraliminal strategy.VFDs were classified ac-cording to standard neuro-ophthalm ological categories.Results:Results from 153consecutive patients(65male,88female)were evaluable.The majority(65%)of chi-asmal lesions was due to pituitary ad enoma,followed by craniopharyngioma (12%),astrocytoma (9%),and meningioma (8%).Vascular lesions in this region oc-curred rarely(2%).Three percent of all patients had no final diagnosis.The majority(22%)of scotomas was at-tributable to involvement of the tem poral hemifield in both eyes,with true bitemporal hemianop ia being a very rare event (1%).Anterior junction syndrome,chara cterized by advanced visual field loss affectin g the visual field centre in one eye and(possibly subtle)defects respecting the verti-cal midline in the fellow eye,was the second most frequent classifiable VFD(13%).Homonymous hemianopic VFDs occurred in 11%of all cases.Nine percent of all patients exhibited monocular VFDs which did n ot respect the verti-cal midline,whereas in 3%of the subj ects the monocular VFDs did not cross the vertical merid ian.Binasal defects and posterior junction syndrome also oc curred seldom(<1%).Nineteen percent of all visual field records of patients with chiasmal lesions had results,which could not be classified unequivocally,and an identical portion was rated normal.Conclusion:In patients with chiasm al lesions,incomplete involvement of the temporal hemifie lds in both eyes was the most frequent event (22%),followed by anterior junction syndrome (13%).The latter entity at least clinically in-dicates the proximity of the prechia smal ipsilateral optic nerve and decussating fibres emanating from the inferior nasal hemiretina of the fellow eye.However,this cannot provide conclusive evidence for the existence of anterior Wilbrand’s knee.
Purpose: To evaluate pathogenetic m echanisms and fre-quency distribution of visual field defects (VFDs) in pa-tients with chiasmal lesions. Secon dly, to reconsider the existence of “Wilbrand’s knee” as far as referable to the anterior junction syndrome. Method s: Consecutive visual field records related to chiasmal le sions were retrieved from the Tuebingen Perimetric Database.In all cases, at least one eye was examined with the Tuebingen Automated Perimeter using a standardized grid of 191 static targets within the central 30 ° visual field, and a threshold-related, slightly supraliminal strategy. VFDs were classified ac-cording to standard neuro-ophthalmological categories. Results: Results from 153 concutives (65male, 88female) were evaluable. to pituitary ad enoma, followed by craniopharyngioma (12%), astrocytoma (9%), and meningioma (8%). Vascular lesions in this region oc- curred rarely The majority (22%) of scotomas was at-tributable to involvement of the tem poral hemifield in both eyes, with true bitemporal hemianop ia being a very rare event (1%). Anterior junction syndrome, chara cterized by advanced visual field loss affectin g the visual field center in one eye and (possibly subtle) defects respecting the verti-cal midline in the fellow eye, was the second most frequent classifiable VFD (13%). Homonymous hemianopic VFDs occurred in 11% of all cases. Nine percent of all patients exhibiting monocular VFDs which did n ot respect the verti-cal midline, while in 3% of the subj ects the monocular VFDs did not cross the vertical merid ian.Binasal defects and posterior junction syndrome also oc curred seldom (< 1%) Nineteen percent of all visual field records of patients with chiasmal lesions had results, which could not be classified unequivocally, and an identical portion was rated normal. Conlusion: In patients with chiasm al lesions, incomplete involvement of the temporal hemifie l ds in bThe latter entity at least clinically in-dicates the proximity of the prechia smal ipsilateral optic nerve and decussating fibers emanating from the inferior nasal hemiretina of the fellow eye .However, this can not provide conclusive evidence for the existence of anterior Wilbrand’s knee.