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PubMedDate not supplied

Damage to the corneal endothelium from anterior chamber intraocular lenses in phakic myopic eyes.

The use of minus power anterior chamber intraocular lenses to correct myopia in phakic eyes has been demonstrated previously to produce a more accurate and predictable correction than corneal refractive surgery techniques. We have examined 15 such eyes by specular microscopy and 10 such eyes by Scheimpflug slit-lamp micrography. One year after surgery, in 5 (36.3%) eyes, there was a decrease of more than 20% in the central endothelial density. Paracentral endothelial damage was present in 13 eyes (86.6%). On the specular micrograph, this damage appeared as an overall decrease in the number of the cells, abnormal cell shape with marked pleomorphism, dark zones, and acellular zones that corresponded to endothelial defects. The slit-lamp anterior segment measurements showed a distance between the edges of the IOL optic and the endothelium which ranged from 0.71 to 1.50 mm. We discuss the criteria for intraocular lens removal.

Adult↗
PubMed1991

Ocular trauma. Triage and treatment.

Many types of ocular trauma can be diagnosed and treated in the primary care office, particularly if a slit lamp is available. Treatment for corneal abrasions consists of applying a cycloplegic medication, antibiotic ointment, and a patch (unless a corneal ulcer is suspected). Iritis can be treated with cycloplegics and topical corticosteroids; the prescribing physician should be familiar with the potential ocular side effects and complications. Hyphemas are treated with bed rest, topical atropine sulfate drops and topical corticosteroids, as well as measures to prevent rebleeding. A slit lamp, topical anesthesia, and a foreign-body spud greatly facilitate the removal of foreign bodies from the cornea. Acid and alkali burns should be irrigated until the pH is normal and then should be treated like a corneal abrasion. Lid lacerations must be repaired with care to preserve proper functioning of the lid. Ruptures of the globe are serious injuries requiring surgical repair and long-term follow-up.

Burns, Chemical↗
PubMed2005

LASIK induces minimal regrowth and no haze development in rabbit corneas.

PURPOSE: To quantify central corneal regrowth and haze development after LASIK in rabbits. METHODS: New Zealand White rabbits received an 89 microm (-8 diopters) myopic LASIK and were evaluated during 4 months using slit-lamp and in vivo confocal microscopy to monitor changes in central corneal morphology, epithelial and stromal thickness, flap and bed thickness, and corneal light backscattering (haze). At various time-points, corneas were processed for histology. RESULTS: Using in vivo confocal microscopy, LASIK induced no detectable morphological changes besides a slightly elevated light backscattering at the interface. Correspondingly, all corneas remained clear with no haze development by slit-lamp biomicroscopy. Corneal thickness was stable by 8 weeks after an increase of 17 +/- 4 microm that consisted of a 13 +/- 3 microm stromal regrowth and a 4 +/- 2 microm epithelial hyperplasia. At the LASIK interface, less than 4 microm new extracellular matrix was deposited. Accordingly, all LASIK flaps were easily pulled off by 6 months. CONCLUSIONS: LASIK induces a minimal wound healing response in rabbit corneas with no haze development and a regrowth (regression) of only 17 microm of an 89-microm photoablation. Three main factors contributed to the observed regrowth: epithelial hyperplasia (approximately 4 microm), matrix deposition at the LASIK interface (approximately 4 microm), and stromal growth outside the interface within the flap and wound bed (approximately 9 microm).

Actins↗
PubMed1978

Vital staining properties of neutral red. Vital staining of cornea and conjunctiva.

Vital staining by instillation in the conjunctival sac of 1% neutral red in 54 normal and 153 differently affected eyes was studied by slit lamp examination. Of these, 134 eyes were after-stained by a mixture of 1% tetrazolium and 1/4% alcian blue and 73 eyes were after-stained by a mixture of 1% rose bengal and 1% fluorescein. Microscopy of a further 10 conjunctival scrapings and 40 mucous conjunctival threads disclosed neutral-red-stained inclusion bodies in the cytoplasm of the epithelial cells and the granulocytes. In the slit lamp the cornea and the conjunctiva were seen to be stained only rarely and, if so, poorly by neutral red, both in normal and affected eyes. Better staining was obtained with tetrazolium, and the best with rose bengal. The plica semilunaris, Marx' line, and the mucous thread were stained by neutral red, more intensely by rose bengal, and the least by tetrazolium. The inferior fornix and the tarsus were rarely stained by any of the three dyes. Neutral red seems to offer no diagnostic advantages over the vital stains with which the dye has been compared in the present study. More particularly we found no pathological processes that were stained more intensely by neutral red than by the other vital stains.

Cataract↗
PubMedDate not supplied

Quantification of simulated corneal haze by measuring back-scattered light.

The Scheimpflug anterior eye segment analysis system EAS-1000 was modified to specifically quantitate the degree of corneal haze. In order to confirm the basic measurement performance of the new system, TSPC-3 hazemeter, in vitro experiments were conducted. Using white latex microsphere solutions, tests were performed for the linearity of the measurements, the influence of slit lamp illuminance and the influence of the length of the light path through the latex solution. The validity of Beer's law was confirmed, indicating that a sufficiently wide range of latex concentrations (haze intensities) can be covered by the hazemeter. The scattering intensity measured with the hazemeter showed a significant linear correlation with the latex concentration. The obtained scattering intensity was directly proportional to the illuminance of the slit lamp. The ratio of integrated scattering values was proportional to that of the light path length. It was shown that the TSPC-3 hazemeter possesses sufficient capability for a quantitative evaluation of corneal haze.

Calibration↗
PubMed1984

Specular microscopy of hard contact lens wearers.

Wide-field specular microscopy, slit-lamp examination, and pachometry were performed on 22 successful hard contact lens wearers and 22 controls matched for age, race, sex, and refractive error. A minimum of 600 cells per control and 1200 per contact lens wearer were manually digitized from the specular photomicrographs. Frequency distributions of cell areas were compared between the two groups using the parameters of mean, median, standard deviation, coefficient of variation, skewness and kurtosis. Slit-lamp examination was normal and there was no significant difference in corneal thickness between the patient group and the control group. Comparison of mean, median, and standard deviation also revealed no significant difference, but skewness (P less than .001), kurtosis (P less than .001) and coefficient of variation (P less than .004) were greater in the hard contact lens wear group. Hard contact lens wearing time correlated with increasing pleomorphism (P less than .05). Specular microscopy also revealed morphologic changes including deep stromal striae, intra- and extracellular "blackout" areas, and clustering of extremely small and large cells. The possible relationship between endothelial hypoxia and structural stromal changes are discussed.

Adult↗
PubMed2004

Study of the effect of involuntary user movement on the potential light hazards from some ophthalmic instruments.

A study was undertaken to determine whether involuntary user movement provides a basis for relaxing the measurement conditions for evaluating the potential optical radiation hazards to the eye from slit lamps and indirect ophthalmoscopes. This was accomplished by assessment of the extent to which light from these devices can be maintained in focus on a 1-mm-diameter fiber-optic cable for 45 s. The results suggest that, although involuntary user movements can be significant, they do not provide a basis for relaxing the measurement conditions for evaluating the potential optical radiation hazards to the cornea and lens from slit lamps and indirect ophthalmoscopes.

Diagnostic Techniques, Ophthalmological↗
PubMed2003

Conjunctival hyperemia in healthy subjects after short-term dosing with latanoprost, bimatoprost, and travoprost.

PURPOSE: To evaluate conjunctival hyperemia after short-term use of latanoprost 0.005%, bimatoprost 0.03% and travoprost 0.004% in normal adults. DESIGN: Prospective, randomized, double-masked crossover active controlled comparison. METHODS: We evaluated conjunctival hyperemia by a standard photographic measure at the slit lamp and by anterior segment photographs in healthy subjects after dosing for 5 days with latanoprost, bimatoprost, or travoprost. Conjunctival hyperemia was evaluated at 24-hour trough (hour 0) and at hour 1 after dosing. Each subject was crossed over between periods after a 1-week washout interval. RESULTS: Twenty-eight subjects (mean age 26 +/- 9 years) completed this study. Several comparisons were noted to be significant between groups by slit-lamp biomicroscopy: first, at hour 0 latanoprost had significantly less hyperemia than bimatoprost; second, at hour 0 latanoprost showed significantly less change than bimatoprost compared with the study baseline (visit 2); third, at hour 1 latanoprost had significantly less hyperemia than travoprost; fourth, at hour 1 latanoprost demonstrated significantly less change from baseline in hyperemia than travoprost (visit 2); fifth, at hour 1 latanoprost had less change in hyperemia than bimatoprost or travoprost between the study and the nonstudy eye (P = .03); and last, at hour 1 latanoprost showed significantly less change than bimatoprost and travoprost compared with hour 0 (P = .04). Additionally, similar grades were observed by photographs with latanoprost demonstrating the lowest levels of hyperemia. Subjects complained less about other people noticing their red eye with latanoprost than bimatoprost or travoprost (P = .048). No serious adverse events were noted. CONCLUSIONS: This study suggests that latanoprost may cause significantly less short-term conjunctival hyperemia on average than bimatoprost or travoprost in healthy subjects.

Adult↗
PubMed1989

Inter-familial variability and intra-familial similarities of granular corneal dystrophy Groenouw type I with respect to biomicroscopical appearance and symptomatology.

140 patients from 8 countries with granular corneal dystrophy Groenouw type I are described, and 21 slit-lamp photographs demonstrate inter-familial differences and intra-familial similarities. The clinical appearance varied from mild, with only a few granules on the cornea, to a monstrous course with an almost opaque cornea. The following diagnostic criteria are suggested for the disease, as these signs are described in extensively quoted key references and meet the descriptions in most papers on this subject: Dominant inheritance, as well as 1) typical slit-lamp appearance and/or 2) granules that stain with Masson trichrome histologically, and/or 3) rod-shaped bodies seen electron microscopically.

Adolescent↗
PubMed1979

The management of patients with intraocular lenses. Guidelines for those who do not perform this operation.

The management of patients with intraocular lenses can be done quite well by any knowledgeable ophthalmologist. Every examination must include the measurement of intraocular pressure and a thorough slit-lamp examination, specifically noting: Corneal edema, local or diffuse; Increasing corneal guttata; Touch of lens or iris suture to the cornea; Aqueous ray or cells, KP, LP (lens precipitates); Lens displacement; Iris suture problems; Pupil margin erosion; Secondary cataract; Vitreous face: loss or thickening; Retrolenticular membrane formation; Vitreous cells. Ophthalmoscopy should include examination of the peripheral retina for detachment, but visual fields should be done whenever detachment is suspected. Contact lens--slit-lamp examination of the macula for cystoid edema should be supplemented by Flourescein angioscopy when needed. Lens removal should be done only after careful consideration. The damage induced by such surgery must be weighed against the problems of leaving the lens in place. Consultation is mandatory. When in doubt, refer.

Edema↗
PubMed2003

Noninvasive technique for monitoring chorioretinal temperature during transpupillary thermotherapy, with a thermosensitive liposome.

PURPOSE: To develop a technique for noninvasive and real-time monitoring of chorioretinal temperature in transpupillary thermotherapy (TTT). METHOD: A modified slit lamp, which was equipped with two laser wavelengths (490 nm for illumination and fluorescein excitation and 810 nm for hyperthermia), was developed for TTT and temperature monitoring. Five types of liposomes were prepared, and their phase-transition temperatures were 40 degrees C, 46 degrees C, 47 degrees C, 48 degrees C, and 52 degrees C, respectively. Carboxyfluorescein was encapsulated in each liposome. After intravenous injection of each liposome, TTT with the modified slit lamp was performed on normal rat choroid or tissue with choroidal neovascularization (CNV). During TTT, chorioretinal temperature was monitored by observing release of fluorescein from circulating liposomes. RESULTS: Fluorescence from liposomes was initially observed around the heated lesion immediately after TTT began and disappeared rapidly when irradiation stopped. Choroidal and retinal temperatures were monitored separately. TTT for normal retina required higher power than that for normal choroid to observe fluorescence from a 40 degrees C, 46 degrees C, and 47 degrees C liposome. Retinal whitening was observed after TTT at a high-power setting. TTT for CNV required higher laser power than that for the normal choroid and retina. CONCLUSIONS: The results demonstrate the potential use of a noninvasive monitoring technique of chorioretinal temperature during TTT. The method should be useful to establish the TTT setting and achieve the optimal temperature increase in CNV.

Animals↗
PubMed1992

Early diagnosis of infectious keratitis with in vivo real time confocal microscopy.

The tandem scanning confocal microscope (TSM) was adapted for in vivo examination of the cornea in rabbits with experimental bacterial and fungal keratitis. Compared to slit lamp biomicroscopy, the TSM provides superior lateral and axial resolution and serial optical sectioning capability, which may be useful for identification of corneal pathogens in the early stages of infection. We used the TSM to examine normal rabbit eyes infected with bacteria (Bacillus cereus) and a filamentous fungus (Aspergillus). We also examined a human cornea removed by penetrating keratoplasty after a clinical diagnosis of amoebic keratitis. In the early stages of bacterial infection, slit lamp examination revealed a nonspecific minimal stromal haze and limbal injection indistinguishable from sterile ulcers and epithelial defects. With the TSM, bacteria were visible as highly refractile bodies in the epithelium and superficial stroma. Branching fungal hyphae were also easily identified by the TSM, as were Acanthamoeba cysts and parasites in the subepithelial stroma. Our results indicate that this technique may provide a new modality for quickly and accurately identifying the agent of corneal infection, thereby facilitating prompt and appropriate treatment.

Acanthamoeba Keratitis↗
PubMed1991

Clinical experience with the laser indirect ophthalmoscope.

Laser delivery through a binocular indirect ophthalmoscope is a relatively recent addition to the armamentarium in vitreoretinal work. Hitherto to our experience, it had not been used in this region. This paper documents our initial experience with a laser indirect ophthalmoscope used successfully in the retinal photocoagulation of patients with diabetic retinopathy, venous occlusions, peripheral retinal holes and lattice degenerations and in post-vitrectomy cases. We found that this mode of laser delivery offered the advantages of an increased field of view of the retina, improved access to the retinal periphery and better patient comfort. It enabled laser treatment of patients with physical or mental handicaps who are unable to sit at the slit-lamp. It is the first system that can deliver laser treatment to patients in the pediatric age-group. It may also be valuable in Stage III retinopathy of prematurity, Coats disease, pneumatic retinopexy, and anterior hyaloidal neovascular proliferations. The chief drawback with this system are the lower magnification and sensitivity to inadvertent movement by the patient or surgeon. We concluded that this mode of laser delivery is a useful adjunct to the slit lamp system and can in some cases be the preferred mode of laser therapy.

Diabetic Retinopathy↗
PubMed1990

Conjunctival allergen challenge. A clinical approach to studying allergic conjunctivitis.

To evaluate antiallergic agents, we conducted five allergen challenge studies of increasing refinement. The final study design that evolved included two baseline visits, when skin test-positive subjects were administered a bilateral ocular allergen challenge. At the first visit, the threshold dose of reactivity was determined by increasing allergen doses at 10-minute intervals. At the second baseline visit, 3 days later, the responsive subjects were challenged with the final, highest dose used on visit 1 to assure that the allergic reaction was reproducible and not a cumulative effect of multiple allergen doses. The responsive subjects then returned 3 days later for the drug efficacy evaluation. After a slit-lamp examination, subjects were pretreated with the test drug in one eye and the placebo in the fellow eye in a randomized, double-masked fashion. After 10 minutes, subjects were challenged bilaterally with the allergen dose identified on the previous visits. Postchallenge evaluations of hyperemia, itching, chemosis, eyelid swelling, and tearing were performed at 3, 10, and 20 minutes. Subjects were rechallenged 4 hours after drug administration to assess duration of action. Slit-lamp examinations were again performed at the same intervals as after the initial challenge. A total of 396 subjects were given a baseline allergen challenge; 83.6% responded with a moderate (2+) ocular allergic reaction. Of the 266 given a second baseline challenge, 87.2% responded positively again, suggesting that ocular challenge was highly correlated with skin reactivity and reproducible with a second challenge. No statistically significant difference in redness and itching was found when both eyes were challenged with the same dose of allergen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

[Corneal topography of the partner eye in unilateral keratoconus].

PURPOSE: To study the incidence and shape of subclinical keratoconus with corneal topography in the fellow eye in the case of clinically, slit-lamp biomicroscopically and topographically diagnosed unilateral disease. METHODS: Eighty patients with keratoconus were fitted with contact lenses. Twelve of them revealed clinical features of unilateral disease. In these patients we performed a computed topographic analysis in the clinically normal fellow eye. We measured quantitative parameters (central corneal power, I-S value) and qualitative parameters (localization and shape of corneal steepening). RESULTS: In all 12 patients we found in the fellow eye no slit-lamp evidence for keratoconus. Nine patients were emmetropic in the fellow eye, three patients myopic between -1.5 and -4.0 D. The myopia in these patients was corrected with contact lenses and the investigation was performed 5 days after discontinuance of contact lenses. The corneal topography showed the typical keratoconus pattern in 11 patients with a steepening of the inferior cornea and in 1 case a superior steepening of the cornea; range of I-S values -1.0 to +5.0 D. All patients revealed a configuration of oval type cone keratoconus in the corneal topography. CONCLUSION: Keratoconus occurs with a high degree of bilaterality, but with onset of the disease at different times in the two eyes. Corneal topography seems to be a sufficient method to detect early keratoconus.

Adolescent↗
PubMed2005

Baseline donor characteristics in the Cornea Donor Study.

PURPOSE: The Cornea Donor Study (CDS) is an ongoing study that is being conducted to determine whether donor age is related to long-term corneal graft survival. Characteristics of the donor population have been evaluated with respect to donor age, endothelial cell density, and death to preservation interval. METHODS: Within the context of a prospective, double-masked, controlled trial, 1101 donor corneas were assigned without regard to donor age. RESULTS: Slit-lamp characteristics of the donor corneas showed little variation with donor age, except for the presence of corneal arcus. As death to preservation time decreased, fewer epithelial abnormalities and a lower frequency of stromal edema and Descemet folds were observed. There was little change in the mean of the endothelial cell density with donor age beyond age 60, despite variation. CONCLUSION: With respect to donor age, there was little difference in either the slit-lamp characteristics or endothelial cell density of the donor corneas. Fewer epithelial abnormalities were observed with shorter death to preservation time.

Adolescent↗
PubMed1989

An independent evaluation of the Lens Opacities Classification System II (LOCS II). The Italian-American Cataract Study Group.

The Lens Opacities Classification System II (LOCS II) has been offered for use in clinical studies of cataract. The system uses slit lamp and retroillumination photographic standards to grade lens opacities into classes of increasing severity. The authors evaluated the reproducibility and validity of LOCS II before its possible use in a natural history study of age-related cataract. The authors found excellent inter- and intraobserver reproducibility when the LOCS II standard photographs were used for clinical or photographic gradings of cataract. There was a tendency to underestimate posterior subcapsular cataracts on photographic gradings compared with slit-lamp gradings. The accuracy of the photographic gradings of posterior subcapsular opacities tended to decrease as the severity of coexisting opacities increased.

Aged↗
PubMed1995

The use of Scheimpflug photography in the documentation of clinical states and in the biometry of the anterior eye segment.

From the start of our collaboration with the Institut für Experimentelle Ophthalmologie in the early 1980s, the scientist Otto Hockwin has always taken the greatest interest in the clinical use of Scheimpflug photography. I became a student of Hockwin's through my work on the effects of Verapramil. The straightforwardness and purposeful approach with which Hockwin persued any subject, once he had taken it up, served me as example and thereby helped me repeatedly to regain courage and patience in my own work. The Scheimpflug apparatus developed by Hockwin's team has proven its superiority over the conventional slit lamp photography through its excellent depth of focus. Further to the clinical applications of the Scheimpflug photography worked out by us and summed up once again in this paper, it also presents a widening of the scope hence available within ophthalmological teaching methods, which we can hardly do without these days. The students benefit from the far superior spatial image conveyed by the optical section through the anterior eye segment, compared to that obtained by the conventional slit lamp photography alone. The precision of the reproducible image of the anterior segment furthermore represents a vital supplementary aid in the solution of pre- and postoperative, as well as specialist diagnostic problems.

Adult↗