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PubMed1990

Tonometer utilization, accuracy, and calibration under field conditions.

A field survey conducted in 94 ophthalmologists' offices in our immediate area assessed the accuracy of tonometers in daily use. One hundred eighty-five instruments were examined: 127 were slit lamp mounted, 48 were hand held, and 10 were noncontact devices. Nineteen percent of applanation tonometers were outside the manufacturers' specifications (1 mm Hg of the calibration) and 4.5% were more than 2 mm Hg in error. The error was constant across the scale. Hand-held applanators were less accurate than those on slit lamps (P less than .02); the latter demonstrated an association between accuracy and age (P less than .05) and heavier use (P less than .01). Annual recalibration was performed in 86% of instruments. Those practitioners who themselves performed the calibration had the most accurate instruments. Less than 15% knew how to perform the calibration check.

Calibration↗
PubMed1997

[Detection of morphological corneal changes caused by chloroquine therapy using confocal in vivo microscopy].

BACKGROUND: Chloroquine keratopathy is known as a disease with epithelial deposits in the cornea. The appearance of corneal changes does not seem to be related to dose and duration of treatment. Chloroquine accumulates in lysosomes. The purpose of this study was to investigate microscopic changes of corneal morphology in patients treated with chloroquine in vivo. PATIENTS AND METHODS: Using the confocal slit scanning microscope, we examined 16 patients during chloroquine treatment and 4 patients after treatment. The patients' age was between 33 and 75 years. They were treated with chloroquine over a minimum period of 2 months up to a maximum period of 10 years. RESULTS: In 12 of 20 patients, corneal changes were visible. An atypical inverse reflectivity of basal cells in comparison to healthy volunteers was found. There were also deposits in the wing cell layer. We saw a higher density in the anterior stroma before the appearance of epithelial opacities, as well as in cases of keratopathy on slit-lamp examination and also after the cessation of chloroquine treatment. In one patient with long-term therapy, there were atypically shaped and branched nerves in the anterior stroma. CONCLUSIONS: Using confocal microscopy, it was in some cases possible to detect changes in the corneal morphology before these changes could be detected by slit-lamp examination. As a result of this study we found that chloroquine keratopathy is not limited to the epithelium but can affect the anterior stroma and possibly neural structures.

Adult↗
PubMedDate not supplied

Progression of pellucid marginal degeneration and higher-order wavefront aberration of the cornea.

PURPOSE: To report the time course of changes in corneal wavefront aberrations in a patient with pellucid marginal degeneration. CASE: A 59-year-old man with pellucid marginal degeneration was followed-up annually with slit-lamp microscopy and videokeratography for 11 years. The anterior corneal height data of the videokeratography were expanded into the set of orthogonal Zernike polynomials to calculate wavefront aberrations for the central 3-mm cornea. OBSERVATIONS: Although the patient complained of gradual deterioration of vision, there was no evident sign of disease progression on slit-lamp examination and visual acuity measurement. Color-coded maps of videokeratography showed slight deterioration over time, but no remarkable and decisive changes were seen. Coma-like aberration displayed a gradual, but apparent increase with a 1.67-fold worsening (0.473 microm to 0.792) during the 11-year follow-up period. Spherical-like aberration remained almost stable throughout the observation period. There were no obvious changes in crystalline lens and retina. CONCLUSIONS: The results suggest that increases in coma-like aberrations of the cornea reflect the subclinical progression of pellucid marginal degeneration over the years.

Corneal Diseases↗
PubMed1977

Bullous keratopathy (Fuchs' endothelial dystrophy) treated systemically with 4-trans-amino-cyclohexano-carboxylic acid.

Twenty patients with bullous keratopathy (Fuchs' endothelial dystrophy) were treated systemically with the antifibrinolytic drug tranexamic acid. The effect was evaluated by slit-lamp biomicroscopy, measurement of central corneal thickness and determination of visual acuity. The patients subjective complaints were also registered. The duration of the treatment varied from 3 to 16 months. In most cases the treatment was given over several periods with intervening free intervals. In all cases the central corneal thickness decreased and slit-lamp biomicroscopy revealed an improvement. The visual acuity improved and all patients became free of pain. A possible mechanism involving the complement system is discussed and preliminary studies on the composition of the aqueous humour in cases of bullous keratopathy are mentioned.

Aged↗
PubMedDate not supplied

Central focal interface opacity after laser in situ keratomileusis.

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded. METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASIK). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids. RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slit-lamp biomicroscopy, corneal topography, and vision. Etiology was uncertain. CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASIK.

Acute Disease↗
PubMed1988

The quantitative effect of 0.5% ketorolac tromethamine solution and 0.1% dexamethasone sodium phosphate solution on postsurgical blood-aqueous barrier.

Anterior chamber fluorophotometry was performed after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of 0.5% ketorolac tromethamine solution (ketorolac solution) eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as compared with 0.1% dexamethasone sodium phosphate solution (dexamethasone solution) eye drops at each period, as measured by fluorophotometry. A single injection below Tenon's capsule of a short-acting corticosteroid had been given to each patient at the end of each surgical procedure. Slit-lamp observations of postoperative ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. Ketorolac solution was more effective than dexamethasone solution in facilitating reestablishment of the blood-aqueous barrier after surgery, as measured by fluorophotometry, and was equal to dexamethasone solution as observed by slit-lamp observations. This study suggests that ketorolac ophthalmic solution may be effective and safe as a nonsteroidal anti-inflammatory agent for topical use after cataract surgery and intraocular lens implantation in place of topically administered corticosteroids.

Adult↗
PubMed1998

Segmental denervation and reinnervation of the iris sphincter as shown by infrared videographic transillumination.

OBJECTIVE: This study aimed to analyze the denervation and reinnervation history of individual segments of the iris sphincter in patients with Adie's syndrome. DESIGN: The irises of these patients were retroilluminated by shining an infrared-rich light through the lower eyelid and sclera and viewing the transilluminated iris from the front with an infrared-sensitive video camera. The irises of the same group of patients also were videotaped through a slit-lamp camera using routine frontal illumination. Both of these techniques also were used to examine a series of normal subjects. PARTICIPANTS: A total of 61 patients with Adie's syndrome or Adie's-like denervation of the iris sphincter (from surgery, trauma, or radiation) and 10 normal subjects were studied. MAIN OUTCOME MEASURES: Slit-lamp examination results of the segmental movement of the iris were compared to the infrared transillumination pattern of the iris sphincter before and during the light reflex, before and during the near-vision reaction, before and during eye movement, and before and after the application of dilute pilocarpine and 1% pilocarpine. RESULTS: Whenever an iris sphincter segment contracted, it also became denser by using these techniques. Reinnervated iris segments failed to contract to light but did contract and became denser with a near effort or with eye movement. Segments supersensitive to pilocarpine became denser than adjacent segments without supersensitivity, but atrophic-appearing segments looked translucent and thin, failing to become denser, even with 1% pilocarpine. CONCLUSIONS: The innervational history and current status of each clock-hour segment of the iris sphincter can be determined using this technique of videographic infrared transillumination, and the progression and pattern of iris denervation and reinnervation can be determined in patients with Adie's pupil. A miotic Adie's pupil that is "tonic," even in darkness, was found to be associated with a dense pattern of infrared transillumination in sphincter segments, which the authors interpret as being associated with a rich reinnervation from accommodative fibers. Segments that become densely reinnervated appear to lose their cholinergic supersensitivity.

Adie Syndrome↗
PubMed1999

Digital image capture and automated analysis of posterior capsular opacification.

PURPOSE: To develop and validate a digital imaging and analysis technique for assessing the extent of posterior capsular opacification after cataract surgery. METHODS: Retroillumination images of the posterior capsule were obtained by using a digital camera mounted on a slit lamp. The images were analyzed using an available image analysis software program. The image acquisition and analysis techniques were tested for face validity, reproducibility, and the ability to detect progression of capsular opacity over time. RESULTS: Digital retroillumination images were obtained without patient discomfort. Automated analysis of images correlated well with clinical grading both at slit lamp examination and when looking at the images themselves (Spearman's correlation coefficient >0.7). Analysis of images taken at different times showed high reproducibility (intraclass correlation >0.9), and the system was able to identify progression of capsular opacity over a 2-year period with a mean increase of 15.8% in progressors versus an increase of 0.6% in nonprogressors (P < 0.05). CONCLUSIONS: Digital retroillumination images of the posterior capsule can be obtained reliably, and automated analyses correlate well with clinical assessment. The system presented here uses commercially available instruments and software, and it is practical for use in longitudinal studies of posterior capsule opacification. It is reliable, easy to use, and can detect small changes in the percentage area covered by posterior capsule opacification over time.

Cataract↗
PubMed2002

Targeted genomic deletion of the lens-specific intermediate filament protein CP49.

PURPOSE: To deduce the function of the lens-specific cytoskeletal structure, the beaded filament, by blocking expression of the fiber cell-specific beaded filament protein CP49. METHODS: The first exon of the mouse CP49 gene was deleted by using targeted genomic deletion techniques. Gene deletion was assessed through Southern blot analysis and PCR. Translation and protein expression were characterized by Northern and Western blot analysis of both CP49 and its assembly partner filensin. The architecture of knockout lenses was compared with that of wild-type lenses at the histologic level by light microscopy. Lens clarity was assessed in situ by direct ophthalmic examination and slit lamp microscopy. RESULTS: Transcription and translation of CP49 were successfully negated in knockout animals. Lenses homozygous for the CP49 deletion showed no obvious changes in lens architecture at the light microscope level. Filensin levels were sharply reduced, although filensin mRNA levels appeared unchanged. Direct examination of lenses showed no obvious loss of lens clarity, but slit lamp examination revealed the emergence of opacification in even the youngest animals. The opacification worsened with age. CONCLUSIONS: The absence of CP49 causes a subtle loss of optical clarity in the ocular lens, a loss that worsens with age. However, CP49 is not essential for the assumption or maintenance of overall fiber cell shape or long-range order of fiber cells. CP49 appears to regulate the protein levels of its assembly partner filensin, suggesting a mechanism for the regulation of beaded filament protein stoichiometry.

Aging↗
PubMed2005

[Ocular toxicity caused by chloroquine: case report].

To report a case of ocular toxicity due to chloroquine. The best visual acuity was measured in both eyes with the Snellen chart. Slit-lamp examination of anterior segment, refraction, dilated fundus examination, fluorescein angiography and retinography was done in a 53-year-old patient, female, with rheumatoid arthritis. She had used chloroquine during 6 years and had stopped for 1 year when she came to our service. She had best corrected visual acuity of 20/200 and 20/40. Slit-lamp examination showed intraocular lens in right eye and nuclear cataract (1+/4) in the other, and bilateral corneal subepithelial opacity inferior to the visual axis. Fundus examination showed macular area with retinal pigment epithelium atrophy. Fluorescein angiography showed a bull's eye maculopathy. Report of a typical keratopathy and maculopathy caused by chloroquine.

Antirheumatic Agents↗
PubMedDate not supplied

Evaluation of pentoxifylline in the prevention of haze after photorefractive keratectomy in the rabbit.

BACKGROUND: Pentoxifylline (PTX) is a methylxanthine derivative that, besides its hemorrheologic properties, possesses multiple physiologic effects at the cellular level. It has been used in keloid prevention due to its ability to inhibit the secretion of collagen and glycosaminoglycans from activated fibroblasts. METHODS: Ten New Zealand White (NZW) rabbits underwent a -7.00 diopters, 6.0 mm diameter photorefractive keratectomy after laser ablation of the epithelium with a VISX 20/20 excimer laser. The bare stroma was stained with fresh 0.5% dichlorotriazinyl aminofluorescein (DTAF). The procedure was performed on both eyes, 4 days apart. One eye received 1% Pentoxifylline qid and the other balanced salt solution qid as a control for 4 weeks, starting the same day of surgery. Two masked observers graded the amount of haze at 2, 4, 6, and 8 weeks after surgery using slit-lamp biomicroscopy. Three rabbits were sacrificed at 2 and 4 weeks followed by two rabbits at 6 and 8 weeks. The area between the DTAF-stained collagen to the base of the epithelium was measured using a digital image analyzer. RESULTS: There was no statistically significant difference in the amount of haze either by slit-lamp microscopy or by histological analysis between the pentoxifylline-treated eyes and the controls at any time interval (Student's t-test: 0.16 to 0.92) CONCLUSION: Pentoxifylline did not seem to affect haze formation in a PRK rabbit model. As no signs of toxicity were observed, further studies might examine higher concentrations or dose frequencies.

Animals↗
PubMed1996

Scanning electron microscopic characteristics of small-incision intraocular lenses.

PURPOSE: To evaluate the surface characteristics of commonly used, small-incision, intraocular lenses (IOLs). METHODS: Representative samples of five groups of foldable IOLs (4 silicone and 1 acrylic) underwent surface and edge-finish examination using a slit lamp. The IOLs were folded using a folding block and forceps. All the IOLs then were examined using a scanning electron microscope. A one-piece polymethylmethacrylate IOL was used for comparing surface-finish characteristics. The IOLs were examined for optic surface quality, edge finish, haptic, haptic/optic junction, and possible post-folding modifications. RESULTS: Slit-lamp evaluation of the surface quality of all of the silicone lenses demonstrated a smooth finish of the optic surface, edge, and haptics. Scanning electron microscopic analysis of the IOLs demonstrated adequately finished haptics or footplates and optics. Excess molding flash was seen on the edges of the some of the silicone IOLs, and no molding flash was observed on others. The acrylic IOL had a somewhat sharper optic edge. Irregular finish of the haptic/optic junctions of some of the IOLs (both silicone and acrylic) was noted. CONCLUSIONS: Currently available foldable IOLs have demonstrated adequate lens finish. However, irregularities of the haptic/optic junctions and molding flash are present on most IOLs evaluated, indicating room for improvement in the finish of foldable IOLs. Phacoemulsification with capsular bag IOL placement may decrease the clinical significance of these relatively subtle lens finish irregularities.

Acrylamide↗
PubMed1985

Ocular infection with herpes simplex virus (HSV-1) in vitamin A-deficient and control rats.

An experimental model was developed for studying ocular infections with herpes simplex virus (HSV) type 1 in vitamin A-deficient (-A) and pair-fed control (+A) rats. The severity and course of the disease was evaluated by clinical examination, slit lamp biomicroscopy and histopathologic observations. Experimental animals were in good health and were infected in the early stages of vitamin deficiency (either prior to or at the beginning of the weight plateau). In all trials the onset of herpetic keratitis was more rapid and the clinical disease more severe in -A rats compared to +A controls. Mean slit lamp scores (which assessed the severity of the corneal disease) increased from 3 to 10 d after infection and were higher (P less than 0.002) in -A rats at all time points and doses of virus tested. The inflammatory response in the cornea and uveal tract of -A rats was significantly higher than that of +A animals. Since ocular HSV disease is a common cause of blindness, the availability of a rat model should be valuable in studies of the role of nutritional factors in host susceptibility and response to viral challenge. Mild vitamin A deficiency increased the severity of experimental corneal HSV infections and resulted in a high incidence of epithelial ulceration and necrosis.

Animals↗
PubMed1977

The management of choroidal tumors.

TWe have outlined a systematic approach to the management of choroidal lesions which might appear to be choroidal melanoma: 1. When a solid, elevated mass is suspected of being a malignancy, first complete a thorough examination of both eyes, including a detailed history. Arrange for a general medical evaluation to detect sources of metastatic lesions or early metastases from the eye. 2. Eliminate the possibility of flat choroidal lesions by slit-lamp and indirect ophthalmoscopic examination. These are considered benign and can be followed at routine intervals with simple sketches or color fundus photographs. Fluorescein angiography is not essential, but can confirm the benign appearance and help in following overlying secondary changes such as pigment epithelial defects. 3. Rule out serous or cystic lesions by the use of slit lamp and fundus contact lens, and indirect ophthalmoscope with transillumination. Fluorescein angiography again can help confirm the benign nature of these lesions, but the serial fundus examinations are definitive in 99 percent cases. 4. Document the appearance of the lesion with drawings, stereo-photographs, and stereo angiography. Follow the evolution of the lesion with these modalities for a sufficient time to be certain of the diagnosis. 5. Follow lesions in the peripapillary area with particular care.

Choroid Neoplasms↗
PubMedDate not supplied

Confocal microscopy of stage 4 diffuse lamellar keratitis with spontaneous resolution.

PURPOSE: To report confocal microscopic findings at the onset of stage 4 diffuse lamellar keratitis and after its resolution. Stage 4 is the most severe form of diffuse lamellar keratitis. Its incidence is approximately 1 in 5000 and is associated with stromal melting, deep flap folds, central haze, hyperopic shift, irregular astigmatism, and severe decrease in visual acuity. METHODS: A 22-year-old woman underwent bilateral uncomplicated laser in situ keratomileusis (LASIK) for myopia. Postoperative course in the right eye was uneventful; however, in the left eye, stage 4 diffuse lamellar keratitis developed. Confocal microscopy examination was performed in both eyes at the onset of the syndrome and after its resolution. Findings in the eye with diffuse lamellar keratitis (left eye) were compared with the uninvolved (right) eye. RESULTS: The condition improved spontaneously and 2 years later, slit-lamp microscopy showed resolution of the folds and haze with subsequent improvement of visual acuity. However, confocal microscopic examination in the left eye revealed a persistent stromal subclinical haze on both sides of the lamellar cut and prominent folds that extended into the anterior stroma. CONCLUSION: Confocal microscopy revealed that in spite of normal appearance on slit-lamp microscopy, micromorphological alterations persisted after spontaneous resolution of stage 4 diffuse lamellar keratitis.

Adult↗
PubMed1997

Management of eye emergencies in the accident and emergency department by senior house officers: a national survey.

OBJECTIVE: To assess the training that accident and emergency (A&E) senior house officers (SHOs) receive in dealing with eye emergencies, their own perceived level of confidence and competence in managing such cases, and the availability of appropriate equipment in their departments. METHODS: Prospective telephone survey using a standardised structured questionnaire. One SHO from each United Kingdom A&E department listed in the BAEM directory of 1993 was chosen at random and interviewed. RESULTS: 226 A&E departments were contacted and 192 SHOs were successfully interviewed (response rate 84.9%); 26.0% received no training in the management of eye emergencies, 68.8% had only a little or no confidence in dealing with these cases, and 42.2% worked in A&E departments which had no slit lamp. CONCLUSIONS: There is a lack of adequate basic ophthalmic training for A&E SHOs, leading to a lack of confidence on their part in the management of eye emergencies. In just over 40% of A&E departments in the United Kingdom, the management of these cases may be less than optimal because of the absence of a slit lamp.

Clinical Competence↗
PubMed1989

The effect of ketorolac tromethamine in reducing postoperative inflammation: double-mask parallel comparison with dexamethasone.

Anterior chamber fluorophotometry was done after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of ketorolac solution 0.5% eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as much as did dexamethasone sodium phosphate solution 0.1% (dexamethasone solution) eye drops at each postoperative time period as measured by fluorophotometry. Slit-lamp observations of postoperative anterior ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. No additional corticosteroids were given to any patients during the study. Therefore, ketorolac solution was as effective as dexamethasone solution in suppressing postoperative inflammation after cataract surgery as measured by fluorophotometry and as observed by slit-lamp examinations. This study confirms prior studies that suggest ketorolac ophthalmic solution 0.5% may be effective and safe as a nonsteroidal antiinflammatory agent for topical use after cataract surgery and intraocular lens implantation and as a substitute for topically applied corticosteroids.

Adult↗
PubMed1997

Pseudomonas deficient in protease IV has significantly reduced corneal virulence.

PURPOSE: The role of protease IV in the pathogenesis of Pseudomonas aeruginosa keratitis was investigated by comparing a mutant strain completely deficient in protease IV activity with its protease IV activity-producing parent. METHODS: A protease IV-deficient Pseudomonas strain PA103-29::Tn9 was generated by mutagenesis of strain PA103-29, which produces protease IV, through transposon insertion. Protease IV activity was determined by a casein agar assay, zymography, and cleavage of the chromogenic substrate, Chromozym PL. Corneal virulence was evaluated by slit lamp examination and bacterial cultures in both a rabbit intrastromal model and a mouse topical model of keratitis. RESULTS: The protease IV-deficient strain PA103-29::Tn9 had significantly reduced corneal virulence relative to its parent strain PA103-29 in both a rabbit intrastromal model and a mouse topical model of infection. In the rabbit model, ocular damage (slit lamp examination score) mediated by the parent strain was severe at 32 hours after infection, whereas damage mediated by the mutant was minimal at both 32 and 55 hours after infection. This difference in virulence was not a result of differences in growth in vivo, because both strains grew equally. In the mouse model, eyes inoculated with the protease IV-producing parent strain had significant corneal damage as early as 24 hours after infection, whereas the protease IV-deficient mutant strain produced no significant corneal damage during 6 days of infection. CONCLUSIONS: The ability to produce active protease IV was the determining factor in the severity of corneal virulence. Protease IV appears to mediate corneal virulence and should be considered as a target in the development of medications designed to minimize corneal damage during Pseudomonas keratitis.

Animals↗