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PubMed2004

An experimental model of mycobacterial infection under corneal flaps.

In order to develop a new experimental animal model of infection with Mycobacterium chelonae in keratomileusis, we conducted a double-blind prospective study on 24 adult male New Zealand rabbits. One eye of each rabbit was submitted to automatic lamellar keratotomy with the automatic corneal shaper under general anesthesia. Eyes were immunosuppressed by a single local injection of methyl prednisolone. Twelve animals were inoculated into the keratomileusis interface with 1 microl of 10(6) heat-inactivated bacteria (heat-inactivated inoculum controls) and 12 with 1 microl of 10(6) live bacteria. Trimethoprim drops (0.1%, w/v) were used as prophylaxis for the surgical procedure every 4 h (50 microl, qid). Animals were examined by 2 observers under a slit lamp on the 1st, 3rd, 5th, 7th, 11th, 16th, and 23rd postoperative days. Slit lamp photographs were taken to document clinical signs. Animals were sacrificed when corneal disease was detected and corneal samples were taken for microbiological analysis. Eleven of 12 experimental rabbits developed corneal disease, and M. chelonae could be isolated from nine rabbits. Eleven of the 12 controls receiving a heat-inactivated inoculum did not develop corneal disease. M. chelonae was not isolated from any of the control rabbits receiving a heat-inactivated inoculum, or from the healthy cornea of control rabbits. Corneal infection by M. chelonae was successfully induced in rabbits submitted to keratomileusis. To our knowledge, this is the first animal model of M. chelonae infection following corneal flaps for refractive surgery to be described in the literature and can be used for the analysis of therapeutic responses.

Animals↗
PubMed1999

Fluorophotometric assessment of rabbit corneal epithelial barrier function after rigid contact lens wear.

PURPOSE: The effect of overnight wear of graded rigid gas-permeable (RGP) contact lenses on the rabbit corneal epithelial barrier function was assessed by fluorophotometry. METHODS: RGP lenses with optimal fitting were worn by rabbits for 24 h. The values of oxygen transmissibility (Dk/L) of lenses used were 0, 10, 27, 43, 84, and 109 x 10(-9) (cm/s)(ml O2/ml mm Hg); lens thickness (0.15 mm) and diameter (14.0 mm) were standardized. Corneal epithelial barrier function was measured by a slit-lamp fluorophotometer. Corneal surface lesions by fluorescein staining were observed by a slit-lamp biomicroscope with the aid of fluorescein filter paper and were scored. Corneal epithelial structure was observed by scanning electron microscopy (SEM). RESULTS: After 24-h wear of RGP lenses, fluorescein uptake by the cornea increased, and this increase depended on the Dk/L value of lenses worn; mean +/- standard error, 1,601+/-454 (Dk/L 0), 347+/-226 (Dk/L 10), 144+/-42 (Dk/L 27), 100+/-25 (Dk/L 43), 56+/-18 (Dk/L 84), 51+/-15 (Dk/L 109), and 49+/-4 ng/ml (control). There was a significant correlation between the fluorophotometric value and the biomicroscopic scores of corneal lesions. SEM showed progressive desquamation of epithelial superficial and wing cells for lower-value Dk/L lens groups. CONCLUSION: This study demonstrated for the first time that overnight wear of Dk/L 84 and 109 lenses does not alter the barrier function of the rabbit corneal epithelium. In contrast, wear of a PMMA lens greatly alters the corneal epithelial barrier function. It is suggested that RGP lenses with a Dk/L >80 can provide safe overnight wear, based on the epithelial barrier function.

Animals↗
PubMed2000

Laser photocoagulation spot-size errors stemming from the refractive state of the surgeon's eye.

PURPOSE: Meaningful errors in photocoagulation spot size may result from several factors. In this article we discuss one major factor, namely, fluctuations in the surgeon's accommodative state, coupled with an inaccurate setting of the slit-lamp oculars. DESIGN: Experimental study. METHODS: We analyzed and tested the optics of slit-lamp mounted lasers. Varying the ocular setting is correlated with measurements of the actual spot size obtained with each system. MAIN OUTCOME MEASURE: The spot size obtained. RESULTS: Three distinct, but related, phenomena that may lead to spot size errors are defined: (1) focusing the laser spot as opposed to focusing the retinal image; (2) instrument misalignment; (3) inadvertent accommodation. CONCLUSION: The ocular setting must be meticulously calibrated to produce a true spot-sized burn. At the 50 microm setting, each diopter of induced accommodation, or erroneous ocular setting, almost doubles the actual spot size obtained. With large (500 microm) spot size settings, the defocused delivery system is more prone to spot-size errors in contrast with parfocal lasers.

Accommodation, Ocular↗
PubMed1998

Epithelial permeability reflects subclinical effects of contact lens wear.

AIMS: Recently, it was reported by the authors that a single drop fluorophotometric technique for estimating corneal epithelial permeability (Pde) to fluorescein is not sufficiently precise for monitoring permeability changes in individual patients., but may be useful for evaluating mean differences in Pdc in population based research. To determine whether this technique provides a more sensitive index of epithelial integrity compared with conventional clinical assessments, the effects of mild corneal trauma on Pdc, the slit lamp appearance of the cornea, and corneal thickness (CT) were assessed. METHODS: After baseline slit lamp examinations (SLE) and CT measurements, one randomly chosen eye of each of 32 normal subjects underwent 1 hour of closed eye soft contact lens (CL) wear while the fellow eye served as a control (no CL). After removing the CL, the SLE and CT measurements were repeated. Then, Pdc to fluorescein was assessed using a single drop fluorophotometric method refined to enhance feasibility, precision, and accuracy. RESULTS: The mean (95% confidence interval) difference in natural log (Pdc) between 32 pairs of eyes (CL minus no CL) was 0.341 (0.069, 0.613), p = 0.016. By contrast, none of the 32 subjects exhibited corneal epithelial disruption upon SLE with white light following the closed eye period. Also, no substantial differences were apparent in the corneal swelling response between paired eyes, mean delta CT (95% CI) = -2.31(-7.53, 2.91) microns, p = 0.37. CONCLUSIONS: Pdc measurements, used in studies of modest sample size, appear capable of detecting average differences in corneal barrier function that remain undetectable by SLE or pachymetry.

Adult↗
PubMed1985

Posterior polymorphous corneal dystrophy: a disease characterized by epithelial-like endothelial cells which influence management and prognosis.

This thesis contains a clinical and laboratory summary of findings in PPMD and, for the first time, reports the results of a large series of patients who underwent keratoplasty surgery. Posterior polymorphous dystrophy is bilateral and autosomal dominantly inherited. Slit lamp findings include corneal edema in the more advanced cases, calcific and lipid degenerative changes in severe cases, band-like lesions at the level of Descemet's membrane, localized or diffuse thickenings of Descemet's membrane, posterior corneal vesicular-like lesions, islands of abnormal cells surrounded by normal-appearing endothelial cells. Iridocorneal adhesions ranged in severity from fine or broad-based adhesions seen only on gonioscopy to large iridocorneal adhesions often associated with a glass-like membrane that are seen easily by slit lamp examination. All patients with broad-based iridocorneal adhesions have elevated intraocular pressure. Some patients have elevated pressure but no adhesions. Laboratory examination of corneal, iris, and trabecular meshwork tissue from patients undergoing penetrating keratoplasty and filtering operations reveals an abnormal endothelial cell layer covering the posterior cornea and growing across the trabecular meshwork and onto the iris. Although this tissue contains a variety of cells, the most prominent type is an epithelial-like cell. Extensive laboratory studies demonstrate features in common between the epithelial-like cells and normal epithelium. These include a multilaminar pattern, desmosomal junctions, microvillous projections, cytoplasmic keratin, sparse mitochondria, and rapid growth in tissue culture. These cells appear to determine the management and prognosis of patients with PPMD undergoing surgery. Twenty-two corneal transplants were performed on 20 eyes of 13 patients with PPMD. Their ages ranged from 11 to 77 years. The follow-up time after keratoplasty averaged 4.75 years. Nine grafts (41%) failed. Two failed because of an endothelial rejection, three because of glaucoma, one because of a retrocorneal membrane, two from both a retrocorneal membrane and glaucoma, and one from both an endothelial rejection and glaucoma. Thus, glaucoma was involved in six of the nine failures (27% of all grafts). Clinically visible retrocorneal membranes formed in 4 of the 22 grafts. All four eyes had preoperative slit lamp-visible iridocorneal adhesions. The factor that most prominently influences keratoplasty prognosis is the presence of iridocorneal adhesions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Prevalence of primary cornea guttata and morphology of corneal endothelium in aging Japanese and Singaporean subjects.

The purpose of the present study was to examine, in the aging people, racial and gender differences in the morphology of corneal endothelium as well as the incidence of cornea guttata in two Asian subject groups, one in Singapore and the other in Japan. Four hundred and sixty-five Chinese Singaporeans and 299 Japanese subjects (residents of Monzen-machi, Ishikawa Prefecture) aged 50 years and older were recruited for the study. Corneal endothelial abnormalities were diagnosed with slit-lamp biomicroscopy and specular microscopy. Primary cornea guttata appeared as beaten metal appearance in slit-lamp images and dark regions in specular images. In addition to cornea guttata, corneal endothelial morphology was also analysed with specular microscopy. The mean cell density was 2,808/mm(2) in the Japanese subjects which was significantly higher than the 2,718/mm(2) seen in the Singaporeans (p < 0.001). The incidence of cornea guttata was significantly higher in the Singaporeans than in the Japanese individuals and also higher in women than in men of both racial groups. These differences support not only a racial and a gender factor but also a possible environmental influence.

Cell Count↗
PubMed2002

Planning low vision services in India : a population-based perspective.

OBJECTIVE: To assess the prevalence and causes of low vision in a population in southern India for planning low vision services. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 10,293 persons of all ages from 94 clusters representative of the population of the Indian state of Andhra Pradesh. METHODS: The participants underwent a detailed eye examination, including measurement of visual acuity with logarithm of the minimum angle of resolution charts, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and stereoscopic dilated fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were done when indicated using predefined criteria. MAIN OUTCOME MEASURES: Low vision was defined as permanent visual impairment that was not correctable with refractive error correction or surgical intervention. The participants with best-corrected distance visual acuity <6/18 to perception of light or central visual field <10 degrees because of an untreatable cause in both eyes were considered as having low vision. RESULTS: Low vision was present in 144 participants, an age, gender, and urban-rural distribution adjusted prevalence of 1.05% (95% confidence interval, 0.82%-1.28%). The most frequent causes of low vision included retinal diseases (35.2%), amblyopia (25.7%), optic atrophy (14.3%), glaucoma (11.4%), and corneal diseases (8.6%). Multivariate analysis showed that the prevalence of low vision was significantly higher with increasing age, and there was a trend for higher prevalence with decreasing socioeconomic status. Extrapolating these data to the estimated 1014 million population of India in the year 2000, 10.6 (95% confidence interval, 8.4-12.8) million people would have low vision. CONCLUSIONS: These data imply that there is a significant burden of low vision in this population, suggesting the need for low vision services.

Adolescent↗
PubMed1998

Analysis of the repeatability of tear break-up time measurement techniques on asymptomatic subjects before, during and after contact lens wear.

This study assessed the repeatability of various methods of measuring tear break-up time (TBUT) with and without soft contact lenses (CLs). TBUT was measured on 22 subjects with the tearscope, videokeratoscope and slit-lamp before and after 30 min of soft CL wear, and immediately after CL removal. Slit-lamp corneal TBUT was measured with fluorescein and without fluorescein while wearing CLs. TBUT was measured three times on the right eye only, using each technique in randomised order. TBUT measurements on CLs were repeated a second day. TBUT measurements were highly variable under all conditions and our results indicated a lack of correlation between techniques. The videokeratoscope was the least repeatable; while the tearscope was the most repeatable technique.

Journal Article↗
PubMed2000

Prevalence and pattern of retinal diseases at the Guinness Eye Hospital, Onitsha, Nigeria.

OBJECTIVES: To determine the prevalence and pattern of retinal diseases at the Guinness Eye Hospital, Onitsha, Nigeria. MATERIALS AND METHODS: This was a prospective study. All new patients seen by the author at the outpatients clinic of the Guinness Eye Hospital, Onitsha, Nigeria were examined for evidence of retinal diseases, using the Snellen chart, tonometry, indirect ophthalmoscopy after full mydriasis, slit-lamp examination with a 78D non-contact fundus lens, fundus contact lens examination, and slit-lamp examination of the anterior segment. Ancillary tests performed, as applicable, included Mantoux, skin-snip, hemoglobin genotype, urinalysis, fasting blood sugar, oral glucose tolerance test, full blood count, platelet count, ESR, VDRL, and HIV tests. RESULTS: 8.1% of the patients had retinal diseases. The leading retinal diseases were age-related macular degeneration (ARMD), diabetic retinopathy, retinal vein occlusion, retinal tears/detachment, retinitis pigmentosa and retinochoroiditis with epiretinal membrane. ARMD, diabetic retinopathy, and retinitis pigmentosa often caused bilateral lesions. Bilateral blindness was present in 14% and bilateral visual impairment in 16%, with macular degeneration, retinitis pigmentosa and retinal vascular diseases as major causes. CONCLUSIONS: Retinal diseases may be a significant cause of blindness and visual impairment in this part of Nigeria. Since most of the diseases are treatable with laser and vitrectomy techniques, it is recommended that these facilities be provided in all major eye hospitals in the area.

Adolescent↗
PubMedDate not supplied

Ultrasound biomicroscopic findings of ciliary body malignant melanoma.

BACKGROUND: Malignant melanoma of the uveal tract occurs rarely in Asian populations, and melanoma of the ciliary body is extremely rare. We treated an Asian man with uveal melanoma, relying on ultrasound biomicroscopy (UBM) findings for diagnosis and evaluation of the tumor. CASE. A 65-year-old man with uveal melanoma was examined by slit-lamp microscopy, UBM, and magnetic resonance imaging (MRI), and histopathological examinations were performed as well. OBSERVATIONS: Slit-lamp examination and MRI gave rough images of the tumor, but the exact origin and margin of the mass could not be determined. UBM clearly characterized the tumor as a medium echoic solid mass with acoustic hollowing attached to the ciliary body by a thin stem. Ciliary body detachment at the pars plicata was also found by UBM. Histopathological examination confirmed that the tumor was an epithelioid cell malignant melanoma of the ciliary body. CONCLUSIONS: UBM is useful in detecting, diagnosing, and evaluating a malignant melanoma of the ciliary body.

Aged↗
PubMed2003

Optic disc imaging in conscious rats and mice.

PURPOSE: To determine whether useful images of the optic discs of conscious rats and mice can be obtained by using a photo slit lamp and a modified Goldmann-type fundus contact lens. METHODS: Testing was performed with a photo slit lamp equipped with two 2x teleconverters and a digital camera through a Goldmann-type fundus contact lens that was fabricated for the rodent eye. RESULTS: Images of the rat and mouse optic discs were obtained that are comparable to those used by ophthalmologists to assess optic neuropathy in glaucoma, a key part of the standard of care and of clinical investigation of this disease. The cup in the optic disc image of these rodents is darker than the neural rim of the disc, rather than lighter, as it is in humans. CONCLUSIONS: In addition to the application of this imaging method to studies of the effect on optic disc cupping of induced increased intraocular pressure in rats and mice, by detecting and documenting the onset and the course of optic neuropathy, it should be valuable in identifying animal models of glaucoma, in studying neuropathogenic mechanisms, and in assessing the effects of experimental therapies.

Animals↗
PubMed1998

Correlates of lens thickness: the Beaver Dam Eye Study.

PURPOSE: To evaluate the relationships of lens thickness to age, to the presence of a nuclear, cortical, or posterior subcapsular cataract, and to other personal characteristics in participants in the Beaver Dam Eye Study. METHODS: Slit lamp photographs taken during a population-based prevalence study were measured for lens thickness. In addition, slit lamp photographs were graded for nuclear cataracts, and retroillumination photographs were graded for cortical and posterior subcapsular cataracts. A questionnaire was administered, and height, weight, and blood pressure were measured by protocol. RESULTS: Lens thickness increased systematically with age in men and women. In multivariate analysis, age, sex (male), cortical cataract, diabetes, nuclear cataract, and former cigarette smoking were related significantly to lens thickness. CONCLUSIONS: Age was the most significant personal characteristic associated with lens thickness among those subjects considered. In addition, other characteristics, including specific cataract types and risk factors for cataracts, also were associated with thickness. Whether lens thickness among people of the same age is associated prospectively with these characteristics requires a longitudinal follow-up.

Adult↗
PubMed1999

Burden of moderate visual impairment in an urban population in southern India.

OBJECTIVE: To assess the prevalence and causes of moderate visual impairment in an urban population in southern India. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 2522 (85.4% of the eligible) persons of all ages, including 1399 persons 30 years of age or older, from 24 clusters representative of the population of Hyderabad city. TESTING: The eligible subjects underwent a detailed ocular evaluation, including logarithm of the minimum angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, cataract grading, and stereoscopic dilated fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were done when indicated by standardized criteria. MAIN OUTCOME MEASURE: Moderate visual impairment was defined as presenting distance visual acuity less than 20/40 to 20/200 or visual field loss by predefined standardized conservative criteria in the better eye. RESULTS: In addition to the 1% prevalence of blindness in this sample reported earlier, moderate visual impairment was present in 303 subjects, an age-gender-adjusted prevalence of 7.2% (95% confidence interval [CI], 4.5%-9.9%; design effect, 2.7). The major cause of moderate visual impairment was refractive error (59.4%, 95% CI, 52.3%-66.5%) followed by cataract (25.3%, 95% CI, 19%-31.6%). Multivariate analysis showed that the prevalence of moderate visual impairment was significantly higher in those 40 years of age or older (odds ratio, 10.9; 95% CI, 8-15) and females (odds ratio, 1.89; 95% CI, 1.41-2.53) and lower in those belonging to the highest socioeconomic status (odds ratio, 0.27; 95% CI, 0.14-0.51). However, because of the pyramidal age distribution of the population, 38.1% of the total moderate visual impairment was present in those younger than 40 years of age. The proportion of moderate visual impairment caused by refractive error was higher in the younger than in the older age groups (P < 0.0001). CONCLUSIONS: Projecting the results to the 26.5% urban population of India, there would be 18.4 million (95% CI, 11.5-25.2 million) persons with moderate visual impairment in urban India alone. Refractive error was the major cause of moderate visual impairment in the population studied. The absolute proportion of moderate visual impairment in those younger than 40 years of age was considerable. The eyecare policy of India, apart from dealing with blindness, should address the issue of the relatively easily treatable uncorrected refractive error as the cause of moderate visual impairment in an estimated 10.9 million persons in urban India.

Adolescent↗
PubMed1986

[Simultaneous fluo-angioscope: a method for laser treatment close to the macula].

The Simultaneous Fluo-Angioscope is a compact optical device developed in clinical work as ancillary equipment for laser slit lamps. Both binocular and stereoscopic fluorescein angiograms can be directly overlaid onto the patient's fundus in the slit lamp in a 1-to-1 juxtaposition of angiographic data and fundus topography. In this way precise paramacular laser coagulation is achievable with a minimum of scotoma. The overlaying of earlier photos onto the present fundus also makes objective diagnosis of tumors, vessels, and other pathologically significant areas possible.

Fluorescein Angiography↗
PubMed2000

Retroillumination versus reflected-light images in the photographic assessment of posterior capsule opacification.

PURPOSE: To investigate the relative merit of retroillumination and of reflected light slit-lamp-derived photographs in the assessment of the opacification of the posterior lens capsule. METHODS: Retroillumination and slit-lamp-derived reflected-light photographs were taken on 23 consecutive eyes with posterior capsule opacification (PCO) in uncomplicated pseudophakia. Subjective grading was performed on both types of photographs to evaluate the extent and density of posterior capsular opacification. Best-corrected visual acuity (BCVA) before and after YAG laser capsulotomy was used to assess the impact of capsular opacification on visual function. RESULTS: After capsulotomy all patients attained a BCVA > or = 46 letters (> or =20/32) with a mean increase of 25 letters, indicating that PCO was the cause of visual impairment in these patients. The relative capacity of retroillumination and of reflected-light photographs to adequately capture the extent and the severity of posterior capsule opacification varied considerably. Reflected-light images, in addition to frequently producing higher severity scores for the opacity than retroillumination photographs, in 4 of 23 eyes (17.4%) proved to be the only technique able to document the presence of PCO. CONCLUSIONS: Our results indicate that, with respect to retroillumination images, reflected-light photography has an increased ability to adequately capture the presence and the severity of PCO and that the use of only retroillumination images may lead to its underestimation. This may be relevant to clinical studies aiming to evaluate incidence and progression of this condition.

Adult↗
PubMed1990

A multipurpose dye laser photocoagulation system.

We modified a single argon/dye laser photocoagulator by adding two optical fibers so that it could be used with a slit-lamp microscope, an operating microscope, and with an endophotocoagulation probe. One fiber is attached to a nearby slit-lamp microscope; the other extends approximately 70 m and can be connected to either an operating microscope or an endophotocoagulation probe. An electrically-operated mirror inside the machine controls which of the two fibers the laser beam passes through. Separate control boxes for each fiber permit direct regulation of the photocoagulation process in all situations.

Argon↗
PubMed2003

Corneal complications of vernal catarrh.

OBJECTIVE: To identify the magnitude and types of corneal complications of vernal catarrh and the extent of visual impairment caused by them. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Khyber Institute of Ophthalmic Medical Sciences (KIOMS), Hayatabad Medical Complex (HMC), Peshawar, from March, 1999 to May, 2000. SUBJECTS AND METHODS: All cases of vernal catarrh who agreed to an informed consent were included in the study. Patients who were difficult to be examined by a slit lamp were excluded from the study. The diagnosis was made mainly on the basis of history and clinical examination. Slit lamp examination was done in every case together with fluorescein staining of cornea. The variables were recorded and statistically analyzed. RESULTS: Superficial punctate keratitis (45%) was the most common corneal complication. Visual impairment was more pronounced in cases with shield ulcers (14%) and corneal plaques (8%). A strong association with keratoconus (15%) was also noted. Corneal opacification (9%), hydrops (6%) and pseudogerentoxon (3%) were also found. CONCLUSION: Corneal complications in VKC are common, potentially serious and may cause marked visual impairment.

Adolescent↗
PubMed1991

Influence of lens cortex on postoperative inflammation and cellular deposits on surface of intraocular lenses in rabbit eye.

An animal model was used to evaluate the influence of residual lens cortex on postoperative inflammation and cellular deposits on intraocular lenses (IOLs). Eighteen New Zealand white rabbits underwent bilateral endocapsular phacoemulsification with placement of a one-piece polymethylmethacrylate (PMMA) IOL in the capsular bag. A predetermined amount (15 mg, 30 mg or 60 mg) of homogenized lens cortex was injected into the anterior chamber of one of the eyes of each rabbit after bilateral IOL implantation. The contralateral eye served as the control. The animals underwent slit-lamp examination postoperatively, and the anterior segment of each eye was examined by gross and light microscopy. On slit-lamp examination, the eyes which had received a 60-mg injection of cortex showed a significantly higher amount of posterior synechiae than their contralateral, control eyes. After 2 weeks of observation, the rabbits were sacrificed, the eyes were enucleated, and the IOLs were removed and examined by light microscopy and scanning electron microscopy (SEM). The number of cellular deposits on the IOLs removed from the eyes receiving a 30-mg injection of cortex was significantly larger than that found in their contralateral, control eyes (P less than 0.05), but the eyes in the 60-mg and 15-mg injection groups showed no significant difference between control eyes and IOL eyes in the number of cellular deposits on explanted IOLs. Observation by SEM determined that the filopodia on the epithelioid cells found on the IOLs removed from the eyes in the 60-mg injection group showed an increased number and length compared to their controls. The epithelioid cells on the IOLs of the 30-mg injection group showed an increased number of filopodia compared to their controls.

Animals↗