Hans Goldmann (1899–1991)

Hans Goldmann (1899–1991), born in Komotau in Bohemia, studied medicine in Prague. He was trained in physiology by A.V. Tchermak-Seysenegg and in ophthalmology by A. Elschnig in Prague and by A. Siegrist in Berne. He succeeded Siegrist as chairman of the Department of Ophthalmology in Berne in 1935. He was granted Swiss citizenship in 1936. For almost 70 years, Hans Goldmann has influenced, and continues to influence, the daily practice of ophthalmology. In 1933, he and W. Haag and H. Papritz produced the Haag-Streit-Slitlamp 320. This instrument, together with contact lenses that he developed, enabled the whole eye from the surface of the cornea to the fundus to be examined with the patient in the seated position. In 1945, the Goldmann Cupola-Perimeter followed, which allowed the standardization of background and target luminance. The applanation tonometer was introduced in 1954 and, in 1958, the Haag-Streit Slitlamp 900. The presentation of every new instrument was accompanied by a clinical article demonstrating its value. Goldmann's research culminated in the understanding of the production and outflow of the aqueous. He determined the volume of the anterior chamber in 1941, detected the aqueous veins in 1945, proved that these contain aqueous in 1949, measured aqueous production by fluorescein dilution curves in 1950, and coined the formula that determines outflow facility. This article is to remind the current generation of ophthalmologists of an outstanding man who developed our understanding of disease and who created the many of the instruments that still determine the daily practice of ophthalmology worldwide.

A history of primary angle closure glaucoma

The satisfactory control and cure of attacks of primary angle closure glaucoma spans one hundred years following von Graefe's iridectomy in 1856. Gonioscopy was required to validate the theories of shallow anterior chamber and pupillary obstruction, but the gonioscopists looked for the causes of angle closure in their own territory at the angle in the periphery of the anterior chamber and disregarded the center. General agreement of the importance of pupil block was thereby delayed for over ten years. Advances in pharmacology and the invention of laser surgery gave opthalmologists a comfortable control of a formerly distressing, blinding disease.

[Indications for the location of trabeculotomy in simple glaucoma. I. The blood contents of Schlemm's canal]

Following trabeculotomy, about 30% of glaucomatous eyes are not normalized in pressure without additional therapy. In these cases, it was not possible to remove the resistance of outflow completely. Before deciding to perform trabeculotomy it is, therefore, necessary to localize the resistance of outflow. The inspection of the blood pattern in Schlemm's canal gives no indication where to localize the resistance of outflow. The same holds true for the haemorrhage deriving from Schlemm's canal, in the operating field (trabeculotomy window), which appears in 19.2% of cases. After trabeculotomy the blood outflow into the anterior chamber is significantly higher (63.6%) using the suction cup, then following pressure of the gonioscopy lens (28.1%). The differences between these findings are discussed. Our results indicate the necessity to search for other methods in localizing the resistance of outflow pre-operatively.

Historical notes on gonioscopy

The evolution of gonioscopy is reviewed, beginning with the first in vivo examination of the angle of the anterior chamber in 1867. The people and events responsible for the successful development of this important technique are discussed.

Gonioscopic differences between primary open-angle glaucoma and normal subjects over 40 years of age

Gonioscopy was performed on 110 patients with primary open-angle glaucoma over 40 years of age and an equal number of normal sugjects, matched by race and age. The frequency distribution of various angle features differed in the two groups: in the glaucoma group, there were more iris processes at all levels of insertion, a higher insertion of the iris root and more trabecular pigmentation. A congenital angle anomaly is one important factor in the pathogenesis of the elevated pressure.

Significance of goniohaemorrhage in heterochromic cyclitis

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Anatomical studies of the trabecular meshwork of the normal human eye

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