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The effects of nuclear magnetic resonance imaging on ocular tissues.

Nuclear magnetic resonance, an imaging technique with great promise for detecting cerebral abnormalities, was studied to determine its possible deleterious effects on the mammalian eye. Young (3.5-week-old) Columbia-Sherman rats were exposed simultaneously to a constant magnetic field of 2.7 tesla and radio frequency pulses of 29 MHz at 800-ms intervals for six hours at field strengths representing the maximum used in a clinical setting. The six-hour exposure is many times greater than the four to six minutes currently employed in most diagnostic protocols. The animals were examined by slit-lamp biomicroscopy and ophthalmoscopy at regular intervals. Autoradiograms of lenses from animals injected with tritiated thymidine prior to exposure did not reveal any disturbances in cell-cycle kinetics. Eyes from rats not previously injected with the isotope were processed for cytopathologic analysis at various intervals. A two-year follow-up has indicated that at both the slit-lamp biomicroscopic and the light microscopic levels, there were no discernable effects on the rat eye.

Animals↗

Iridocorneal adhesions in patients with the Marfan syndrome.

Marfan syndrome is an autosomal dominant connective tissue disorder characterized by skeletal, cardiovascular, and ocular anomalies. Ectopia lentis is the most common ocular manifestation. We report an ocular sign not previously described in Marfan syndrome, iridocorneal adhesions secondary to anterior lens subluxation. Three patients with the Marfan syndrome had iridocorneal adhesions on slit-lamp examination. One patient developed adhesions following treatment with pilocarpine. She underwent pars plana vitrectomy and lensectomy in both eyes due to progression of the iridocorneal adhesions. Treatment with miotics rotates the lens-iris diaphragm anteriorly and may contribute to the formation of such adhesions. The two other patients remained stable and did not received lensectomy or vitrectomy. Careful slit-lamp examination of the anterior segment should be conducted in patients with dislocated lenses.

Adolescent↗

A telemedical approach to the screening of diabetic retinopathy: digital fundus photography.

OBJECTIVE: The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We report on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists. RESEARCH DESIGN AND METHODS: A total of 129 diabetic inpatients were screened for diabetic retinopathy by slit-lamp biomicroscopy performed by an ophthalmologist and by two-field 50 degrees non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the reference method for detection of diabetic retinopathy. Slit-lamp biomicroscopy was the reference method for the detection of macular edema. RESULTS: The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sight-threatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-threatening diabetic retinopathy. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading reports. An additional seven reports referred the patients for further investigation because of concurrent diabetic retinopathy. CONCLUSIONS: Telescreening for diabetic retinopathy by an assessment of two-field 50 degrees non-stereo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed.

Computer Communication Networks↗

Polychromasia capsulare (multicolored capsule): report of three families.

PURPOSE: To describe the familial occurrence of a peripheral ring of anterior lens capsule discoloration and iridescence in three families. METHODS: Clinical ophthalmologic examination with visual acuity, slit-lamp biomicroscopy, and dilated ophthalmoscopy. Pedigree construction and evaluation for possible mode(s) of inheritance. RESULTS: In family 1, 25 members from four generations were available for examination. Twelve had identical findings consisting of a peripheral circumferential polychromatic band of anterior lens capsule. The band was predominantly iridescent green but exhibited a rainbow of colors on direct illumination with the slit-lamp beam. There were affected individuals in all four generations. The proband, one of her sons, and her granddaughter had no clinical, serologic, or other laboratory evidence of Wilson's disease, hypercupremia, or myotonic dystrophy. In family 2, three individuals in three generations were similarly affected. In family 3, a man and his son and daughter had identical peripheral lens capsule discoloration. CONCLUSIONS: Polychromasia capsulare is a rare benign autosomal dominant ocular trait that does not appear to be associated with ophthalmologic or systemic disease. The occurrence in consecutive generations and the presence of male-to-male transmission are consistent with autosomal dominant inheritance.

Adult↗

Laser in situ keratomileusis in a patient with presumed central cloudy corneal dystrophy of Francois.

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) surgery performed in a patient with likely central cloudy corneal dystrophy of Francois (CCDF). DESIGN: Observational case report. METHODS: A 48-year-old woman with likely CCDF had myopic LASIK to establish monovision. Outcome measures included visual acuity, manifest refraction, and slit-lamp examination. RESULTS: At 5-year follow-up, the patient had uncorrected visual acuity of 20/100, J1, in the right eye (OD) and 20/20 in the left eye (OS), consistent with monovision correction. Manifest refraction was -1.50 OD and -0.25 OS postoperatively; after retreatment at 1 year for regression, the left eye remained stable over the subsequent 4-year period. Slit-lamp examination revealed no progression of corneal opacities in either eye. CONCLUSIONS: LASIK may be safe and effective in patients with CCDF. Further observations of a greater number of patients are required to confirm these findings.

Corneal Dystrophies, Hereditary↗

Real-time telemedicine in the clinical assessment of the ocular surface.

PURPOSE: To report the feasibility of real-time video and audio transmission of slit-lamp images of the eye using conventional telephone systems. METHOD: We analyzed the feasibility and benefits of telemedicine in the diagnosis and follow-up of ocular surface disorders in referral patients using a real-time audio-video system that functions through integrated services digital network lines at a transmission speed of 384 kilobytes per second. RESULTS: Real-time slit-lamp images obtained through integrated services digital network lines offered satisfactory visual resolution of the ocular surface for the diagnosis and follow-up of ocular surface and corneal disease, while simultaneous audio transmission allowed for direct communication with the patient and attending physician when necessary. CONCLUSION: Telemedicine using conventional telecommunication infrastructures offers sufficient information for the diagnosis and follow-up of ocular surface disorders in referral patients.

Computer Communication Networks↗

Technique of area measurement of epithelial defects.

PURPOSE: To compare two commonly used methods of area measurement of corneal epithelial defects, namely, estimation of the area of an equivalent rectangle and use of image analysis software, the gold standard. METHODS: Thirty-eight patients with corneal epithelial defects were evaluated. The largest linear dimension of the epithelial defect and its largest possible perpendicular within the confines of the epithelial defect were measured using a slit lamp. The area was then measured using digital photographs and image analysis software. A paired sample t test was used to compare the results. RESULTS: The two measurements of area correlated well (P = 0.84); their difference was insignificant (P = 0.063) and a linear regression relation between the two could be derived with an r2 value of 0.71, which was significant. CONCLUSIONS: Accurate slit-lamp measurements with estimation of the area of an equivalent rectangle can safely be used as a measure of the epithelial defect size when sophisticated image analysis software is not available.

Adult↗

Effect of curcumin on galactose-induced cataractogenesis in rats.

PURPOSE: Curcumin, the active principle of turmeric, has been shown to have both antioxidant and hypoglycemic activity in vitro and in vivo. The purpose of this study was to investigate the effect of curcumin on the onset and maturation of galactose induced cataract. METHODS: Sprague-Dawley rats (21 days old) were divided into 5 groups. The control group (A) received an AIN-93 diet, the galactose group (B) received 30% galactose in the diet, the test groups (C and D) received the B group diet plus 0.002% and 0.01% curcumin respectively, and group (E) received the control diet plus 0.01% curcumin, all for a period of 4 weeks. Cataract progression due to galactose feeding was monitored by slit lamp microscope and classified into 4 stages. At the end of the experiment biochemical parameters such as lipid peroxidation, aldose reductase (AR), sorbitol dehydrogenase (SDH), reduced glutathione, protein content, and protein carbonyls were measured in the lens. Advanced glycated end products (AGE) and protein oxidation were measured by AGE and tryptophon fluorescence respectively. Crystallin profile was analyzed by size exclusion chromatography (HPLC). RESULTS: Slit lamp microscope observations indicated that curcumin at 0.002% (group C) delayed the onset and maturation of cataract. In contrast even though there was a slight delay in the onset of cataract at the 0.01% level (group D), maturation of cataract was faster when compared to group B. Biochemical analysis showed that curcumin at the 0.002% level appeared to exert antioxidant and antiglycating effects, as it inhibited lipid peroxidation, AGE-fluorescence, and protein aggregation. Though the reasons for faster onset and maturation of cataract in group D rats was not clear, the data suggested that under hyperglycemic conditions higher levels of curcumin (0.01%) in the diet may increase oxidative stress, AGE formation, and protein aggregation. However, feeding of curcumin to normal rats up to a 0.01% level did not result in any changes in lens morphology or biochemical parameters. CONCLUSIONS: These results suggest that curcumin is effective against galactose-induced cataract only at very low amounts (0.002%) in the diet. On the other hand at and above a 0.01% level curcumin seems to not be beneficial under hyperglycemic conditions, at least with the model of galactose-cataract.

Aldehyde Reductase↗

Retinal evaluation after 810 nm Dioderm laser removal of eyelashes.

BACKGROUND: When operating hair removal lasers on the face or in the periorbital region, even with an ocular shield in place, patients often report seeing "flashing lights" each time the laser is fired. This phenomenon suggests stimulation of retinal photoreceptors and raises laser safety issues. OBJECTIVE: To perform retinal electrophysiologic studies to evaluate the safety of hair removal lasers in the periorbital region. METHODS: Five patients with severe trichiasis secondary to trachoma were studied. The 810 nm Dioderm laser (Cynosure, Inc., Chelmsford, MA) was used to treat the eyelash follicles on the lower eyelid of each patient. Cox III metal eye shields (Oculo-Plastik, Inc., Montreal, Canada) were placed behind the eyelids of both eyes during the laser procedure. Prior to irradiation, a comprehensive ophthalmic evaluation including pupillary and slit-lamp examination, funduscopy, and full-field electroretinograms (ERGs) was performed. A comprehensive ophthalmic evaluation including ERG testing was repeated 30 minutes and 3-6 months after completion of treatment. An independent blinded assessor evaluated the ERG studies. Subjective reports of laser light sensation, pain, and discomfort during and after the laser procedure were also assessed. RESULTS: There was no detectable change in slit-lamp, pupillary, or funduscopic evaluations after periorbital laser irradiation. Similarly the pre- and posttreatment ERGs were unchanged. Three patients reported seeing flashing lights during the procedure. CONCLUSION: We found no ERG evidence of retinal damage after laser hair removal in the periorbital region, with Cox III-type ocular shields over the eyes, even when patients subjectively reported "flashing lights" during laser irradiation.

Aged↗

Optical coherence tomography findings in the macula after treatment of rhegmatogenous retinal detachments with spared macula preoperatively.

PURPOSE: To present the postoperative optical coherence tomography (OCT) findings of the macula in rhegmatogenous retinal detachment with spared macula preoperatively. METHODS: Eleven of 46 patients who underwent surgery for rhegmatogenous retinal detachment had an uninvolved macula preoperatively. Scleral buckling without intravitreous gas injection was the operation used in all eyes. All 11 patients were examined before and after treatment with slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and OCT. RESULTS: In 3 of the 11 patients with rhegmatogenous retinal detachment and uninvolved macula preoperatively, fluid was identified with OCT in the macula after successful treatment. OCT showed that the fluid gradually diminished and finally disappeared 5 to 7 months after the scleral buckling procedure. The fluid in the macula became visible with slit-lamp biomicroscopy in only one of the three patients. CONCLUSION: Subretinal fluid in a preoperatively uninvolved macula can be found after successful treatment of rhegmatogenous retinal detachment. If the fluid is located in the fovea, the visual acuity decreases and does not reach the preoperative levels. OCT identifies the presence of fluid and contributes to the study of the fluid's evolution.

Adult↗

Beyond retinal screening: digital imaging in the assessment and follow-up of patients with diabetic retinopathy.

Many screening methods are available for detecting diabetic retinopathy. However, once patients develop retinopathy, it is unclear as to what method should be used for their review. We describe a novel and integrated system for the screening and treatment of diabetic retinopathy using high street optometrists for primary screening and digital imaging as a secondary screening tool, with referral to a joint retinal clinic only where ophthalmological intervention may be required. Of 3586 patients screened by optometrists, 328 were classified as having moderate/severe pre-proliferative retinopathy or diabetic maculopathy. Patients with proliferative retinopathy (1% of the total) were recalled directly to the joint retinal clinic. A consecutive sample (281) of these patients, together with a further 100 classified by the optometrists as having no or background retinopathy were compared using digital images and standard 35 mm colour transparencies. These, together with the original optometrist reports, were reviewed independently and individually by an ophthalmologist. A further sample of 124 patients who had undergone both digital imaging and ophthalmologist slit-lamp examination were also compared. Comparison of 35 mm colour transparencies with optometrist reports showed the latter had a sensitivity for detecting sight-threatening retinopathy (STR) of 62%, a specificity of 84%, and a kappa score of 0.62. The results for digital images were 90%, 97%, and 0.90, respectively, although the extent of retinopathy was under-reported in 10 patients. With ophthalmologist slit-lamp examination as the gold standard, the sensitivity of digital imaging was 90% with a substantial level of agreement between them (kappa 0.61). We conclude that digital images provide an efficient method for the follow-up of patients with established or previously treated retinopathy.

Adult↗

Functional visual acuity in Stevens-Johnson syndrome.

PURPOSE: To evaluate the correlation of functional visual acuity (FVA) measurement with ocular surface findings in patients with Stevens-Johnson syndrome (SJS). DESIGN: Prospective comparative study. METHODS: Sixty-nine eyes of 38 patients with chronic SJS assessed at the Tokyo Dental College, Tokyo Medical Center, and the Kyoto Prefectural University of Medicine, Department of Ophthalmology, Kyoto, Japan, were studied. Twenty eyes of 10 normal subjects and 40 eyes of 20 patients with Sjögren syndrome (SS) were also studied. Conventional Landolt visual acuity (VA) and FVA examinations and slit-lamp examinations were performed. FVA was measured continuously by the FVA measurement system during a 30-second blink-free period in one eye. The visual maintenance ratio (VMR) was calculated as follows: VMR = [(2.7 - FVA)/(2.7 - baseline VA)], where logarithm of minimal angle of resolution values of FVA were entered into the formula and 2.7 represented the lowest visual acuity in this series. Slit-lamp examinations, Schirmer test, and fluorescein vital stainings were also performed in all subjects. RESULTS: VMR was markedly lower in patients with SJS compared with patients with SS and controls. FVA values showed a relation with the presence of corneal opacity and vascularization. CONCLUSIONS: The FVA measurement system is not only a useful tool in the evaluation of dynamic VA changes, but also reflects the ocular surface clinical findings in SJS.

Adult↗

Epithelial basement membrane dystrophy: evaluation with the HRT II Rostock Cornea Module.

PURPOSE: To describe corneal changes in patients with epithelial basement membrane dystrophy (EBMD) using a new in vivo confocal microscope. DESIGN: Observational case series. METHODS: A retrospective chart review of 22 consecutive patients with EBMD at the Quinze-Vingts National Ophthalmology Hospital from April 2004 to March 2005 was conducted. Gender, age, history of painful episodes suggestive of recurrent erosions, best-corrected visual acuity, slit lamp findings, and in vivo confocal microscopy images were analyzed. RESULTS: There were 8 male (36.4%) and 14 female (63.6%) subjects. Eighteen patients (81.2%) had a history of recurrent erosions in 1 or in both eyes. In 37 eyes of 19 patients (86.4%), map and/or dot and/or fingerprint changes were observed biomicroscopically. In 3 patients (13.6%) with recurrent erosions, the cornea had a normal structure on slit lamp examination and the diagnosis of EBMD was made after in vivo confocal microscopy examination. Four patients (18%), despite basement membrane abnormalities, reported no corneal symptoms suggesting recurrent erosions. In vivo confocal microscopy images showed that all patients had an abnormal epithelial basement membrane protruding into the corneal epithelium, epithelial cell abnormalities, and microcysts. No abnormalities were observed in superficial epithelial cells or the stroma. CONCLUSION: Epithelial basement membrane dystrophy is characterized by an abnormal basement membrane protruding toward the epithelium and epithelial microcysts. In vivo confocal microscopy using the HRT II Rostock Cornea Module provides better resolution and therefore outlines distinctively in vivo microstructural characteristics of EBMD. It assists in the diagnosis of EBMD in patients suffering from recurrent erosion syndrome, particularly in patients with no corneal change visible biomicroscopically.

Adult↗

Confocal microscopy and corneal sensitivity in a patient with corneal manifestations of Tangier disease.

PURPOSE: Tangier disease is an autosomal recessive disorder in which cholesterol-rich lipids are deposited at various tissues of the body including the cornea. In this case report, the corneal changes in a patient with Tangier disease are described. METHODS: A 72-year-old patient who was diagnosed with Tangier disease 25 years before received a complete eye examination including confocal microscopy and Cochet-Bonnet esthesiometry. RESULTS: Slit-lamp biomicroscopy and confocal microscopy showed bilateral corneal opacifications caused by lipid accumulation. Confocal microscopy showed that pathologic changes in the cornea in Tangier disease are limited to the stroma. Neither a reduced corneal sensation nor lid abnormalities as previously described in Tangier disease were found. CONCLUSION: Confocal microscopy helps to identify corneal changes in the stroma caused by Tangier disease easily missed in a slit-lamp examination. The ocular manifestations of Tangier disease do not necessarily include a reduced corneal sensitivity and lid abnormalities.

Aged↗

Corneal guttata associated with the corneal dystrophy resulting from a betaig-h3 R124H mutation.

AIMS: To investigate the frequency of corneal guttata in patients with a corneal dystrophy resulting from an Arg124His (R124H) mutation of betaig-h3 gene. METHODS: Slit lamp examination was performed on 30 eyes with corneal dystrophy from a genetically confirmed betaig-h3 R124H mutation and on 50 age matched control eyes. The stage of the corneal dystrophy was classified as stage 0, I, or II and the degree of guttata was classified as none, mild, or severe. Specular microscopic examinations were performed to evaluate the morphology of the corneal endothelium. RESULTS: Slit lamp examination disclosed the presence of corneal guttata in 21 eyes (70%) of the 30 eyes with the corneal dystrophy, but in only one (2%) of the 50 eyes in the age matched control group (p<0.001, chi(2) with Yates's correction). Of the 12 eyes with stage I betaig-h3 R124H corneal dystrophy, seven had no corneal guttata and five had a mild degree of guttata. Of the 18 eyes with stage II, the degree of guttata was none in two, mild in nine, and severe in seven. The degree of corneal guttata was significantly related to the stage of the corneal dystrophy (p<0.0001, Kruskul-Wallis test ANOVA on ranks). There was no significant differences between eyes with betaig-h3 R124H corneal dystrophy and normal eyes in cell density, coefficient of variation, and cell hexagonality of corneal endothelium. CONCLUSION: Corneal guttata are one of the characteristics of the corneal dystrophy resulting from betaig-h3 R124H mutation.

Aged↗

Comparison between graticule and image capture assessment of lower tear film meniscus height.

PURPOSE: To compare graticule and image capture assessment of the lower tear film meniscus height (TMH). METHODS: Lower tear film meniscus height measures were taken in the right eyes of 55 healthy subjects at two study visits separated by 6 months. Two images of the TMH were captured in each subject with a digital camera attached to a slit-lamp biomicroscope and stored in a computer for future analysis. Using the best of two images, the TMH was quantified by manually drawing a line across the tear meniscus profile, following which the TMH was measured in pixels and converted into millimetres, where one pixel corresponded to 0.0018 mm. Additionally, graticule measures were carried out by direct observation using a calibrated graticule inserted into the same slit-lamp eyepiece. The graticule was calibrated so that actual readings, in 0.03 mm increments, could be made with a 40x ocular. RESULTS: Smaller values of TMH were found in this study compared to previous studies. TMH, as measured with the image capture technique (0.13+/-0.04 mm), was significantly greater (by approximately 0.01+/-0.05 mm, p=0.03) than that measured with the graticule technique (0.12+/-0.05 mm). No bias was found across the range sampled. Repeatability of the TMH measurements taken at two study visits showed that graticule measures were significantly different (0.02+/-0.05 mm, p=0.01) and highly correlated (r=0.52, p<0.0001), whereas image capture measures were similar (0.01+/-0.03 mm, p=0.16), and also highly correlated (r=0.56, p<0.0001). CONCLUSIONS: Although graticule and image analysis techniques showed similar mean values for TMH, the image capture technique was more repeatable than the graticule technique and this can be attributed to the higher measurement resolution of the image capture (i.e. 0.0018 mm) compared to the graticule technique (i.e. 0.03 mm).

Adolescent↗

Do injections of 5-fluorouracil after trabeculectomy have toxic effects on the anterior segment?

OBJECTIVE: To discourage fibrosis of the filtering bleb, 5 fluorouracil (5-FU) may be injected after trabeculectomy. 5-FU is an antimetabolite that also can damage extraocular tissues at concentrations as low as 0.5%. This study ascertained whether repeated injection of 5-FU has toxic effects on intraocular structures. METHODS: After unilateral trabeculectomy in anesthetized New Zealand rabbits, 5-FU (5.0 mg/0.1 mL) was injected at the trabeculectomy site every 5 days for 15 days. Evaluation included slit-lamp examination, confocal microscopy, and intraocular pressure (IOP). After sacrifice, aqueous humor (AH) was drawn and eyes excised for scanning electron microscopy (SEM) and light microscopy. RESULTS: The 5-FU injection not decrease IOP beyond trabeculectomy alone. Bleb height remained constant, thickness increased, and vascularity decreased. No changes in cornea or anterior segment were observed. No inflammation was observed in the bleb or surrounding tissues by slit-lamp or histologic examination. Protein in AH increased from 0.6 +/- 0.5 microg/mL at baseline to 19.8 +/- 4.4 microg/mL after trabeculectomy but only to 0.9 +/- 0.6 microg/mL after trabeculectomy plus 5-FU. Both in vivo confocal microscopy and SEM revealed deleterious effects on corneal epithelial and endothelial cells with a minor shift toward smaller cells. CONCLUSIONS: In this study 5-FU did not provoke an intraocular inflammatory response and had minimal effect on extraocular structures. Changes in corneal epithelium and endothelium detectable by confocal microscopy suggest a small toxic effect. These in vivo measurements by confocal microscopy were confirmed by SEM. Repeated administration did not cause additional cumulative toxic effects in the anterior segment. Therefore, multiple injections of 5- FU into the filtering bleb pose minimal risk to intraocular structures.

Animals↗

Intravitreal toxicity of moxifloxacin.

PURPOSE: To assess the retinal toxicity of various concentrations of intravitreally administered moxifloxacin, a fourth-generation fluoroquinolone. METHODS: Ten New Zealand albino rabbits were divided into five groups. The initial concentration of moxifloxacin (400 mg/250 mL) was titrated using 5% dextrose solution to concentrations (320 microg/0.1 mL, 160 microg/0.1 mL, 100 microg/0.1 mL, and 50 microg/0.1 mL) that were injected intravitreally into 1 eye of each rabbit. Two control eyes were injected intravitreally with 0.1 mL of 5% dextrose solution. All animals were examined before and after injection by indirect ophthalmoscopy and slit-lamp biomicroscopy; electroretinography (ERG) was performed on all animals. The animals were killed, and their eyes were enucleated and examined with light microscopy. RESULTS: Remarkable decreases in ERG findings were noted in the group injected with moxifloxacin at a concentration of 320 microg/0.1 mL. No meaningful ERG changes were observed in eyes injected with moxifloxacin at other concentrations. There were no signs of retinal toxicity during slit-lamp examination, indirect ophthalmoscopy, or light microscopy in any eyes injected with moxifloxacin concentrations of < or =160 microg/0.1 mL. CONCLUSIONS: Intravitreal injection of moxifloxacin at a concentration of < or =160 microg/0.1 mL appeared nontoxic in the rabbit eye.

Animals↗