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PubMed2002

Confocal microscopy in Meretoja syndrome.

PURPOSE: To study the correlation between severity of clinical systemic symptoms and the degree of stromal haze and visibility of epithelial and stromal nerves on scanning slit confocal microscopy examination in Meretoja syndrome. METHODS: Three patients with Meretoja syndrome were examined by slit-lamp microscopy and scanning slit confocal microscopy. RESULTS: Increased symptoms and abnormal slit-lamp findings correlated positively with confocal microscopic stromal haze intensity and inversely with visibility of epithelial and stromal nerves on confocal examination. A prominent deposit, presumably amyloid, was observed contiguous to a stromal nerve of an affected cornea. In a severely affected cornea, no stromal or epithelial nerves were seen. CONCLUSION: The results of this study suggest that Meretoja syndrome causes corneal nerve damage and eventual degeneration that correlates with the degree of clinical involvement.

Adolescent↗
PubMed2005

Imaging the microstructural abnormalities of meesmann corneal dystrophy by in vivo confocal microscopy.

PURPOSE: To delineate the microstructural features of Meesmann corneal dystrophy using in vivo confocal microscopy. METHOD: Three subjects with clinically diagnosed Meesmann corneal dystrophy were examined by slit-lamp biomicroscopy and slit-scanning in vivo confocal microscopy. RESULTS: On slit-lamp biomicroscopy, all subjects demonstrated large bilateral multiple epithelial cystic lesions extending to the midperiphery. On in vivo confocal microscopy, these lesions appeared as hyporeflective areas in the basal epithelial layer. The majority were circular, oval or teardrop shaped and ranged between 48 mum and 145 mum in diameter. Large elongated intraepithelial clefts were also seen. Reflective spots were visible within most of the lesions and these may represent the fibrillogranular material (termed peculiar substance) and tonofilament bundles observed in electron microscopy studies. An additional finding was the fragmented appearance of the subbasal nerve plexus. CONCLUSION: We present the first case series of Meesmann corneal dystrophy imaged by in vivo confocal microscopy and describe the associated microstructural features. Delineation of these features facilitates the use of the confocal microscope to aid diagnosis and management of corneal dystrophies.

Corneal Dystrophies, Hereditary↗
PubMed1989

Lens opacities classification system II (LOCS II)

The Lens Opacities Classification System, version II (LOCS II), uses a set of colored slit-lamp and retroillumination transparencies to grade different degrees of nuclear, cortical, and subcapsular cataract. The system uses four nuclear standards for grading nuclear opalescence and color, five cortical standards, and four subcapsular standards. The LOCS II can be used to grade patients' cataracts at the slit lamp or to grade slit-lamp and retroillumination photographs; it is easy to learn and can be applied consistently by different observers. We obtained very good interobserver reproducibility of the clinical gradings at the slit lamp, excellent intraobserver reproducibility, very good to excellent interobserver reproducibility of photographic gradings, and good agreement between clinical and photographic gradings. The LOCS II is potentially useful for both cross-sectional and longitudinal studies of cataract.

Cataract↗
PubMed1992

Selenite nuclear cataractogenesis: a scanning electron microscope study.

The sequential changes during selenite nuclear cataractogenesis were examined with a scanning electron microscope (SEM) and correlated with slit lamp observations. A posterior opacity, visible with the slit lamp 1-2 days after injection of sodium selenite, was found to consist of masses of vacuoles in the superficial posterior cortex by SEM. 2-3 days post injection, a biomicroscopic refractile ring around the nucleus was represented by SEM abnormalities suggesting membrane damage and possible loss of cytosol in the perinuclear region. All normal structure in this region was lost by 5 days after injection when the central nucleus had become opaque. SEM also showed evidence for damage in areas which were still clear by slit lamp examination. Changes, characteristic of aging, were found near selenite induced damage in peripheral (younger) fibers.

Animals↗
PubMed1970

Early recognition of heterozygotes for the gene for dystrophia myotonica.

A study has been performed on 124 first degree relatives of 38 index patients with dystrophia myotonica in order to assess means of detecting heterozygotes before neurological complaints. Some or all of the following tests have been performed on the relatives: clinical examination, electromyography, slit-lamp examination, radiography of the skull, electrocardiography, serum insulin, and serum immunoglobulin levels. There is evidence that abnormalities in symptomless heterozygotes may be detected by slit-lamp examination, electromyography, and immunoglobulin concentration, and this is probably the order of usefulness of the test in early recognition of the disease. In this study 13 previously undetected heterozygotes have been identified: six as a result of neurological examination, four by both electromyography and slit-lamp examination, and three by slit-lamp examination alone. Abnormalities detected by these tests appear to be independently manifest, so that they will probably be more useful in combination than singly. The family data give a maximum estimate for incidence of mutations among index cases of one quarter, lower than previously suggested. The estimation of immunoglobulins in 45 patients showed significant deficiency, as compared with controls, not only of IgG but also of IgM, and there was an insignificant trend for IgA to be low too. This suggests that the abnormally rapid catabolism of immunoglobulin, previously reported, is not specific for IgG.

Adolescent↗
PubMed1999

Iris transillumination defects in the pigment dispersion syndrome as detected with infrared videography: a comparison between a group of blacks and a group of nonblacks.

BACKGROUND: Infrared image analysis has been reported to be the most sensitive method to detect iris transillumination defects (ITDs) associated with the pigment dispersion syndrome (PDS). Although a common sign of PDS in patients with lighter irides, ITDs that are demonstrated with standard slit lamp examination are frequently absent in blacks with the disease. This absence may lead to confusion in diagnosis; therefore improved methods of evaluation could be beneficial. Although infrared image analysis has been investigated in nonblacks, it has not been applied to a group of blacks with the condition. METHODS: Six blacks (11 eyes, all irides brown) with PDS and eight nonblacks (15 eyes, 10 blue irides, 5 brown irides) with PDS underwent analysis. ITDs were searched for with traditional slit lamp examination and with infrared videography. RESULTS: Among the blacks, 2 of 11 eyes (18%) showed ITDs via infrared analysis, a frequency that was significantly lower (p < 0.001) than the frequency exhibited among the nonblacks (100%) when examined with the same technique. Standard slit lamp examination also showed a significantly lower frequency of ITDs among the blacks compared to the nonblacks (p < 0.001). Infrared videography detected ITDs at least one grade higher in 1 of 11 eyes (9%) among the black group and in 7 of the 15 eyes (47%) among the nonblacks. Using the Wilcoxon signed ranks test, the difference in the ability of infrared videography to detect and rank the iris defects in the nonblack PDS group was significantly greater when compared to standard slit lamp examination (p = 0.011), but infrared analysis did not increase detection or change the mean ranking of those in the black group (p = 0.317). CONCLUSION: In this group of patients, infrared videography did not significantly improve the detection and visibility of ITDs in blacks, as it did in the nonblacks. The frequency that ITDs were detected with standard slit lamp examination and with infrared videography was significantly greater in the group of nonblacks compared to the blacks who exhibited PDS.

Adolescent↗
PubMed1979

[Biomicroscopy of the fundus in retinal detachment surgery (author's transl)].

Biomicroscopy of the fundus during retinal detachment surgery has the same advantages as indirect ophthalmoscopy. In addition to this, it offers three main advantages over indirect ophthalmoscopy: the observation of the fundus, in an optical cross section of the tissues, the high variation of magnification available, and the observation of the fundus without switching off the light of the operating room. Since 1976--biomicroscopy of the fundus during retinal detachment surgery has been easily performed with the surgical mobile slit lamp manufactured by the firm Zeiss. The angle of the surgical slit lamp can be reduced to 5 degrees. The slit lamp can be used either with the Zeiss OPMI 1 operating microscope or with the Zeiss OPMI 6 operating microscope. The microscope, the contact lens and the surgical instrumentation specialy fitted for biomicroscopy of the fundus during retinal detachment surgery are described. The surgical technique is dealt with, pointing out the practical details which allow for overcoming the own difficulties of biomicroscopy of the fundus during surgery.

Fundus Oculi↗
PubMed1978

[30 SL/M-conception of a general utility instrument for ophthalmology (author's transl)].

In respect to the instrument practice the slit lamp holds an eminent place in ophthalmology. The 6th generation of slit lamps after Gullstrand is now presented as a new development. The slit lamp 30 SL/M has been designed as a basic instrument which can be used with accessories to measure characteristics of the eye and to document actual shapes. With that the increasing demand for quantity and objectivity has been answered.

Humans↗
PubMed1992

Ciprofloxacin and prednisolone therapy for experimental Pseudomonas keratitis.

Rabbit corneas were injected intrastromally with Pseudomonas aeruginosa. Sixteen hours after injection, the rabbits were divided randomly into four treatment groups (3 rabbits/6 eyes per group: 1, ciprofloxacin and prednisolone; 2, ciprofloxacin only; 3, prednisolone only; 4, untreated. Ocular signs of inflammation were graded in a masked fashion by slit lamp examination before injection and 16 and 27 hours after injection. Slit lamp examination scores were significantly lower in eyes receiving ciprofloxacin and prednisolone or prednisolone alone, compared with scores in untreated eyes. Slit lamp examination scores were not significantly lower in eyes receiving ciprofloxacin alone, compared with untreated controls. The numbers of viable bacteria in the corneas treated with ciprofloxacin and in the corneas treated with ciprofloxacin and prednisolone were similar and were significantly less (P less than 0.0001) than those in untreated corneas, indicating that the presence of the steroid did not interfere with the bactericidal action of ciprofloxacin.

Administration, Topical↗
PubMed1999

Combined system of biomicroscopic vitreous videography and photography.

PURPOSE: To combine the techniques of biomicroscopic vitreous videography and vitreous photography when examining patients with age- or disease-related vitreous changes. METHODS: We performed biomicroscopic vitreous videography and photography using the newly developed digital photo camera (one-half-inch three-charged coupled device camera with high resolution of 800 x 800 television lines) connected to a slit-lamp biomicroscope and compared it with conventional 35-mm slit-lamp photography in 24 consecutive eyes of 19 patients with idiopathic macular breaks. RESULTS: Stage 1 macular breaks were found in three eyes, stage 2 in four eyes, stage 3 in 11 eyes, and stage 4 in six eyes. Both vitreous videographs and still photographs were recorded and reviewed rapidly in one system. Using this system, dynamic vitreous changes and still vitreous images were documented clearly with real-time television monitoring without using flash illumination. The still images obtained from this system were better than those obtained using conventional 35-mm slit-lamp photography in cases with stage 1, 2, and 3 macular breaks (P = 0.0000000001 by Fisher's exact test). CONCLUSION: This combined system of biomicroscopic vitreous videography and photography may become the standard system of biomicroscopic vitreous examination.

Aged↗
PubMed2004

Impact factors on intraocular pressure measurements in healthy subjects.

AIM: To evaluate whether intraocular pressure (IOP) calculation by applanation tonometry is determined more essentially by the subject's neck position or by neck constriction. METHODS: 23 right eyes of 23 healthy subjects (12 male, 11 female) were included. IOP was measured by applanation tonometry with the TonoPen on sitting participants under four different conditions: with open collar upright (A) or with the head in the headrest of a slit lamp (B), with a tight necktie upright (C) or in slit lamp position (D). All measurements with neck constriction were performed 3 minutes after placing the necktie. RESULTS: Mean IOP was 16.9 (SD 2.3) mm Hg (range 11-21 mm Hg) (A), 18.1 (SD 2.2) mm Hg (range 14-22 mm Hg) (B), 17.9 (SD 2.9) mm Hg (range 12-25 mm Hg) (C) and 18.7 (SD 2.7) mm Hg (range 13-24 mm Hg) (D). Mean IOP increased by 1.3 (SD 2.6) mm Hg (p = 0.028, paired t test, range +0.2 to +2.4 mm Hg) if subjects changed position from A to B. There was no statistically significant difference between measurements with or without neck constriction. CONCLUSION: Applanation tonometry may be inaccurate if performed in slit lamp position. In contrast, tight neckties do not significantly affect IOP evaluation in healthy subjects.

Adult↗
PubMed2003

A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy.

AIMS: To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. METHODS: A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n=586; graded manually), colour slides (n=586; graded manually), and slit-lamp examination by specially trained optometrists (n=485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. RESULTS: Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52-88) and a specificity of 90% (87-93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82-98) and a specificity of 87% (84-90), and for colour slides, a sensitivity of 96% (87-100) and a specificity of 89% (86-91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77-89) and a specificity of 71% (66-75) and diabetic macular oedema with a sensitivity of 76% (53-92) and a specificity of 85% (82-88). CONCLUSIONS: Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening.

Adolescent↗
PubMed2006

Optimization of anterior eye fluorescein viewing.

PURPOSE: To optimize anterior eye fluorescein viewing and image capture. DESIGN: Prospective experimental investigation. METHODS: The spectral radiance of ten different models of slit-lamp blue luminance and the spectral transmission of three barrier filters were measured. Optimal clinical instillation of fluorescein was evaluated by a comparison of four different instillation methods of fluorescein into 10 subjects. Two methods used a floret, and two used minims of different concentration. The resulting fluorescence was evaluated for quenching effects and efficiency over time. RESULTS: Spectral radiance of the blue illumination typically had an average peak at 460 nm. Comparison between three slit-lamps of the same model showed a similar spectral radiance distribution. Of the slit-lamps examined, 8.3% to 50.6% of the illumination output was optimized for >80% fluorescein excitation, and 1.2% to 23.5% of the illumination overlapped with that emitted by the fluorophore. The barrier filters had an average cut-off at 510 to 520 nm. Quenching was observed for all methods of fluorescein instillation. The moistened floret and the 1% minim reached a useful level of fluorescence in on average approximately 20s ( approximately 2.5x faster than the saturated floret and 2% minim) and this lasted for approximately 160 seconds. CONCLUSIONS: Most slit-lamps' blue light and yellow barrier filters are not optimal for fluorescein viewing and capture. Instillation of fluorescein using a moistened floret or 1% minim seems most clinically appropriate as lower quantities and concentrations of fluorescein improve the efficiency of clinical examination.

Adult↗
PubMed1992

Ophthalmological screening in juvenile arthritis: should the frequency of screening be based on the risk of developing chronic iridocyclitis?

Chronic iridocyclitis (CI) may complicate juvenile chronic arthritis (JCA) and if left untreated may cause significant ocular impairment. It is usually not symptomatic and diagnosis relies on slit lamp biomicroscopy. It is unclear how often children with JCA should be screened for this complication. From a review of the literature, the following recommendations could be made, although these require scientific validation. All children with JCA should have at least one adequate slit lamp examination as soon as possible after diagnosis of the arthritis. If CI is detected then appropriate treatment and follow up should be determined by the ophthalmologist. If CI is not detected initially, all children with JCA should be screened by slit lamp examinations every 3-4 months for the first 5 years after arthritis onset. After 5 years, CI screening could be stopped. The only exceptions would be arthritic children at low risk for CI, including systemic onset JCA, juvenile spondyloarthropathy and juvenile onset rheumatoid arthritis, who do not need to be screened if the initial slit lamp examination is normal.

Arthritis, Juvenile↗
PubMed2002

Ultrasonographic biomicroscopic study of an intracorneal hematoma.

PURPOSE: To demonstrate the importance of ultrasonographic biomicroscopy for following the clinical course of an intracorneal hematoma of unknown origin. METHODS: A 64-year-old woman was referred to the Nagoya University Hospital because of a decrease in vision in her left eye. Her visual acuity was 20/70 (uncorrectable) in the left eye and the slit-lamp biomicroscopic examination showed a dark red-colored intracorneal hematoma in the central area of the left eye at the pre-Descemet's membrane level. Because the hematoma was small without any epithelial involvement and ultrasonographic biomicroscopy (UBM) and slit-lamp biomicroscopy showed a low risk of a pupillary block, she was followed without surgical treatment. RESULTS: The hematoma turned yellow and grew smaller, and UBM images showed an internal liquified cyst 10 months after her initial visit. The cystic legion was detected as a low-echoic cavity by UBM 2 months before it was observed by slit-lamp biomicroscopy. The hematoma was almost resolved 2.5 years after the onset, and the visual acuity OS improved to 20/30. CONCLUSION: The intracorneal hematoma occurred without any obvious cause and should be classified as spontaneous. UBM combined with slit-lamp biomicroscopy was useful in estimating the extent of the hematoma and thus the risk of pupillary block. It was also helpful in deciding whether surgical treatment was necessary.

Corneal Diseases↗
PubMed2006

[The different opacity patterns of Lisch corneal dystrophy].

BACKGROUND: Lisch corneal dystrophy is an epithelial corneal dystrophy where diffuse gray corneal opacifications are seen in direct illumination that appear in different patterns. Examination in retroillumination shows that these gray changes do consist of multiple densely crowded clear microcysts according to the opacity units. We wanted to investigate if one single case of Lisch corneal dystrophy can be differentiated easily from the other epithelial corneal dystrophies by exact analysis of the opacity units. PATIENTS AND METHODS: We examined three non-related patients with Lisch corneal dystrophy at the slit-lamp. The epithelial corneal opacities were documented photographically with direct slit-lamp illumination and retroillumination. RESULTS: All three patients showed the characteristic intraepithelial densely crowded clear microcysts in retroillumination. Diffuse gray radial opacities were noted in both corneas of a 15-year-old female patient. A club-shaped opacity was noted in one cornea of a 35-year-old female patient and a feathery gray opacity pattern was found in one cornea of a 49-year-old male patient. All three patients showed the characteristic densely crowded clear microcysts of Lisch corneal dystrophy in retroillumination. CONCLUSION: Taking the previous literature into account, five different opacity patterns can be summarised: radial, band, flame/feathery, whorled and club-shaped gray epithelial corneal opacities. A single case of Lisch corneal dystrophy can be differentiated from other epithelial corneal dystrophies by means of an exact analysis of the opacity pattern and units by slit-lamp examination.

Adolescent↗
PubMed2004

[Quantitative determination of aqueous flare and cells in the eyes of patients with inflammation of anterior uvea].

OBJECTIVE: To quantify aqueous flare and cells in the eyes of patients with inflammation of anterior uvea by FC-2000 laser flare cell meter (LFCM), and to compare these results with those obtained with slit lamp microscopy. METHODS: Aqueous flare and cells of 194 eyes of 110 patients with inflammation of anterior uvea and 52 eyes of 52 healthy subjects were graded into 0, 1+, 2+, 3+ and 4 + scale based on a previously described system using slit lamp microscopy. LFCM was also used for evaluation of aqueous flare and cells. RESULTS: All eyes in normal individuals were graded as "0" scale of both flare and cells by silt lamp microscopy. Flare of grade 0, 1+ and 2+ were noted in 74, 98 and 18 eyes, and cell of grade 0, 1+, 2+, 3+ and 4+ were noted in 124, 26, 19, 14 and 11 eyes in uveitis patients, respectively. LFCM examination revealed that the mean flare values in uveitis eyes with flare of grade 0, 1+ and 2+ were 7.9, 29.5 and 189.0 photon count/ms, respectively. In patients with flare of grade 3+ and 4+, LFCM readings were unreliable because of increased background noise. There was significant correlation between slit lamp examination and the laser flare measurement for flare of grade 0, 1+ and 2+ (r = 0.75, P < 0.001). The mean flare values were significantly higher in patients with flare of grade 0, 1+ and 2+ than that in normal controls (5.3 pc/ms) (t = 5.872, P < 0.05). The mean cell numbers in the eyes with cell of grade 0, 1+, 2+, 3+ and 4+ were 1.5, 12.1, 33.9, 84.9 and 193.1 count/0.5 mm(3), respectively. The results of slit lamp examination showed significant correlation with laser cell counts measurement (r = 0.72, P < 0.001). The mean cell numbers were significantly higher in uveitis patients than that in normal controls (0.9 count/0.5 mm(3)) (t = 7.351, P < 0.05). CONCLUSIONS: Our results indicate that LFCM is able to evaluate precisely the mild and moderate breakdown of blood aqueous barrier and inflammation of the anterior uvea tract, therefore it provides an important parameter for the treatment of anterior uveitis.

Adolescent↗
PubMed2002

[A case of secondary glaucoma studied by optical coherence tomography of the anterior ocular segment].

PURPOSE: To compare slit lamp biomicroscopy or gonioscopy with optical coherence tomography (OCT) and to assess the efficacy of OCT in a case of anterior segment disease. CASE: A 74-year-old male who had bilateral keratoconus. The left eye was aphakic, and a penetrating keratoplasty was performed on it, as well as Nd:YAG laser capsulotomy. The prognosis was good in the early postoperative stage. But 6 months postoperatively, we could not control the intraocular pressure and judged that a second operation might be needed. Before the operation, we tried to get images of the anterior segment of this eye using slit lamp biomicroscopy, gonioscopy, and OCT. RESULTS: Findings obtained by OCT were more useful than those obtained by slit lamp biomicroscopy or gonioscopy to determine the method of operation. DISCUSSION: This case substantiates the view that observation of the anterior ocular segment by OCT is useful for such cases, because in cases of corneal disease we can not get much information about the deep and endothelial side of the cornea from slit lamp biomicroscopy.

Aged↗