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PubMed2004

Pterygia with deep corneal changes.

PURPOSE: To report a series of patients with pterygia associated with deep corneal marks at the level of the endothelium and Descemet membrane previously unreported. METHODS: Clinical presentations of 7 patients (11 eyes) with pterygia and underlying deep corneal changes were reviewed for age, duration of pterygium, size of pterygium, and location of pterygium. Slit-lamp photos were obtained. Specular microscopy was performed on both eyes of 6 of these patients to evaluate the central endothelium and measure central corneal pachymetry. RESULTS: All patients were elderly (mean age 75 years, range 64-91) with long-standing nasal pterygia (average duration 43 years). The average size of the pterygium was 2.3 mm (range 0.75-4.25 mm). All patients had significant ultraviolet-B exposure based on outdoor employment or hobbies. None of the patients had a family history of pterygia. Slit-lamp photos document marks at the level of the endothelium and Descemet membrane. All the deep corneal changes were underlying or directly adjacent to the pterygium. Pachymetry measurements of the central involved corneas averaged 531 +/- 41 microm. Central endothelial cell counts of the 9 eyes with endothelial changes averaged 1580 +/- 412 cells/mm2. CONCLUSIONS: Long-standing nasal pterygia in elderly patients may rarely induce deep corneal changes at the level of the endothelium and Descemet membrane. Endothelial cell density may be lower in eyes with pterygia with deep corneal changes.

Aged↗
PubMedDate not supplied

A quantitative corneal topography index for detection of keratoconus.

BACKGROUND: Detection of keratoconus has become a critical issue in patients who are potential candidates for refractive surgical procedures. In eyes with early stages of keratoconus, slit-lamp corneal changes are either absent or too subtle for detection, and keratometry may be normal. Videokeratography systems have greater sensitivity for detection of such cases, but interpretation of the topographic map is sometimes difficult, especially when pathologies with similar topographic patterns are suspected. We introduce an index using corneal topography for detection of keratoconus. METHODS: From March 1994 to December 1995, a total of 513 unoperated eyes, with no pathology other than keratoconus, from 283 consecutive patients were categorized into three groups based on slit-lamp examination and corneal topographic findings. Those with clinically obvious keratoconus were placed in the first group (53 eyes [10.3%]), those with keratoconus suspect comprised the second group (17 eyes [3.3%]), and the third group was that of normal eyes (443 eyes [86.4%]). In all videokeratographs of these eyes, the highest rate of corneal power changes (in diopters per millimeter) away from the apex (the point of maximum power) to the periphery was measured along its semimeridian. This index, called the "highest rate of steepening (HRS)", was statistically analyzed in the three groups. RESULTS: The mean +/- SD of highest rate of steepening was 3.60 +/- 1.70 D/mm (range 1.59 to 7.53 D/mm) in the clinically obvious keratoconus group, 1.59 +/- 0.21 D/mm (range 1.35 to 1.98 D/mm) in the keratoconus suspect group, and 0.72 +/- 0.31 D/mm (range 0.18 to 1.63 D/mm) in normal eyes. There was a highly statistically significant difference in the means of highest rate of steepening in the three groups (p < 0.0001). A small overlap in the highest rate of steepening ranges was shown among the three groups. Considering the first and second groups as cases of keratoconus, and 1.40 D/mm as the optimum cut-off value for highest rate of steepening, a sensitivity of 95.7% (67 out of 70 cases were detected), a specificity of 96.4% (16 false-positive cases), and an accuracy of 96.3% was obtained. CONCLUSION: The highest rate of steepening may be a useful measure for keratoconus screening with videokeratography. Validation is needed to evaluate its accuracy.

Adult↗
PubMed2006

The effect of moxifloxacin on the normal human cornea.

OBJECTIVE: To investigate the effects of moxifloxacin on the cornea of normal human eyes using confocal microscopy and slit-lamp biomicroscopy. METHODS: This study enrolled adult volunteers who had a normal baseline ophthalmic examination. The dose regimen, similar to that of patients undergoing cataract extraction, was one drop of moxifloxacin in one eye four times a day for 3 days. The untreated fellow eye served as the control. Subjects had a baseline examination (Visit 1), started moxifloxacin the next day, and were examined 24 h (Visit 2) and 72 h (Visit 3) after starting medication. At each visit, visual acuity and adverse effects were recorded, slit-lamp examination with fluorescein was used to measure tear break-up time, and endothelial and epithelial cell counts were determined using confocal microscopy. RESULTS: Fifteen volunteers (mean age 37 +/- 7 years) enrolled. No significant difference in visual acuity, tear break-up time, endothelial or epithelial cell counts was noted between the treated and fellow eye. Subjects experienced no significant decrease in visual acuity, tear break-up time, or endothelial cell counts during the 3-day treatment period in either eye. Epithelial cell counts were stable at Visits 1 and 2, and decreased similarly in the treated and control eye at Visit 3. CONCLUSIONS: Moxifloxacin was safe for use during the 3-day treatment period. Moxifloxacin causes no significant epithelial or endothelial toxicity, and has no effect on visual acuity or ocular surface integrity in healthy subjects treated using a dosing regimen that simulated prophylactic use following cataract surgery.

Administration, Topical↗
PubMed2001

Randomized clinical trial of Surodex steroid drug delivery system for cataract surgery: anterior versus posterior placement of two Surodex in the eye.

OBJECTIVE: To evaluate safety and antiinflammatory efficacy of placing two Surodex (Oculex Pharmaceuticals, Inc., Sunnyvale, CA) in the eye after cataract surgery in comparison with steroid eyedrops and to compare anterior versus posterior chamber placement. DESIGN: Randomized, masked, controlled trial. PARTICIPANTS: One hundred four eyes of 104 Asian patients undergoing extracapsular cataract extraction with intraocular lens implantation were examined. Of these, 33 eyes of 33 patients served as control eyes (group A). INTERVENTION: Two Surodex pellets were inserted in the anterior chamber (AC) of 35 eyes (group B), and two Surodex pellets were inserted in the ciliary sulcus of 36 eyes (group C) at the conclusion of surgery. Control eyes received neither Surodex nor a placebo implant, but were prescribed conventional 0.1% dexamethasone eyedrops four times daily for 4 weeks. MAIN OUTCOME MEASURES: Anterior chamber flare and cells were graded clinically at the slit lamp. Anterior chamber flare was assessed objectively with the Kowa FC500 Laser Flare Meter (Kowa Co. Ltd, Tokyo, Japan). Intraocular pressure and corneal endothelial specular microscopy with morphometric cell analysis were performed for up to 1 year after surgery. RESULTS: Lower flare meter readings occurred in both Surodex groups at all postoperative visits, as compared with the dexamethasone eyedrop group, with statistical significance at days 4 (P = 0.001), 8 (P = 0.001), and 15 (P = 0.02). No difference in flare occurred between AC and ciliary sulcus placement. Clinical slit-lamp assessment of anterior chamber flare and cells showed no difference between Surodex-treated eyes and dexamethasone-treated eyes. Nine of 33 eyes (27.3%) in group A required steroid augmentation, as opposed to 4 of 71 eyes (5.6%) in groups B and C. Inflammatory symptoms were reduced in the Surodex-treated eyes, with statistical significance for ocular discomfort (P = 0.001), photophobia (P = 0.04), and lacrimation (P = 0.01). No complications occurred with Surodex-treated eyes, and no significant difference in endothelial cell loss was noted between Surodex-treated eyes and dexamethasone-treated eyes up to 1 year after surgery. CONCLUSIONS: Intraocular placement of two Surodex is a safe and effective treatment method to reduce intraocular inflammation after cataract surgery and clearly is superior to eyedrops in reducing inflammatory symptoms and aqueous flare as measured with the laser flare meter. No difference in efficacy between AC placement and ciliary sulcus placement of Surodex was detected in this study.

Aged↗
PubMed2002

Corneal laceration and intraocular foreign body in a post-LASIK eye.

PURPOSE: To describe a case of full-thickness corneal laceration and intraocular foreign body in an eye that underwent laser-assisted in situ keratomileusis (LASIK). METHODS: A 43-year-old man underwent uneventful bilateral LASIK. Seventeen months after LASIK, the patient suffered penetrating trauma to the right eye while hammering metal without safety glasses. Examination on the night of the injury showed an uncorrected visual acuity of 20/30 in the right eye. Slit-lamp biomicroscopy showed a 2.4-mm full-thickness peripheral corneal laceration at the 11-o'clock position extending over the edge of the previous LASIK flap and a foreign body partially embedded in the superior iris. He was started on prophylactic topical and intravenous antibiotics. Under general anesthesia, the corneal laceration was repaired, and the intraocular foreign body was removed without any complications. RESULTS: At the follow-up visit 9 months after the surgery, the uncorrected visual acuity was 20/25 in the right eye. On slit-lamp examination, the corneal sutures and the well-positioned LASIK flap were in place. CONCLUSION: Penetrating trauma of the cornea did not lead to flap-related complications in this post-LASIK eye. Repair of the corneal laceration and removal of the intraocular foreign body after LASIK were managed without complications. Care must be taken to try not to manipulate or lift the LASIK flap during corneal laceration repair.

Adult↗
PubMed2000

Photochemical injury to the foveomacula of the monkey eye following argon blue-green panretinal photocoagulation.

PURPOSE: Visual loss following panretinal photocoagulation was found in the Diabetic Retinopathy and the Early Treatment Diabetic Retinopathy Studies. This study was designed to test the hypothesis that light scattered in the monkey eye during a procedure designed to mimic a clinical panretinal photocoagulation (PRP) can produce a photochemical injury to the foveomacula. METHODS: Ten eyes of 5 adult cynomologous monkeys underwent a PRP using an argon blue-green laser. Three eyes in 2 monkeys underwent a sham PRP, and an additional eye had a PRP with blue filtered slit-lamp illumination. The animals had baseline fundus photographs and fluorescein angiograms that were repeated 24 hours after the experimental procedure. Forty-eight hours after the experimental procedure, the eyes were removed and processed for light and electron microscopy. RESULTS: There were no observable changes in the macula on fundus photography or fluorescein angiography 24 hours following PRP. Light and electron microscopy demonstrated changes in the retinal pigment epithelium and the outer photoreceptors, which were confined to the foveola. The control eyes showed no apparent effect from the slit lamp illumination used during the PRP. CONCLUSIONS: The presence of histologic evidence of retinal injury in the foveomacula of the monkey eye after a procedure designed to mimic clinical PRP supports the hypothesis that photochemical retinal damage in the foveola may be associated with this procedure.

Animals↗
PubMed1998

Intrafamilial variability of the ocular phenotype in a Polish family with a missense mutation (A63D) in the Norrie disease gene.

PURPOSE: To describe the phenotypic variability in a Polish Norrie disease (ND) family associated with the missense mutation A63D. METHODS: A patient with spared vision from a Polish ND family underwent detailed ophthalmological examinations including slit-lamp biomicroscopy, ultrasound (USG), angiography, Goldmann kinetic visual field, and electroretinography (ERG). Mutation screening was carried out using the single-strand conformation polymorphism (SSCP) technique and subsequent DNA sequencing of the coding part of the ND gene. RESULTS: A mutation was detected (exon 3, A63D) in a large Polish family with 12 affected males, all but one presenting with classical ND symptoms. In one male, partially preserved vision was observed up to 40 years of age (distance acuity of the right eye 1/50 and left eye 2/50). Slit-lamp examination revealed remnants of a persistent primary vitreous and hyaloid artery. Upon angiography, the retina was vascularized within the posterior pole but not in the periphery. The ERG revealed pathological changes characteristic for chorioretinal degenerations. CONCLUSION: Within one family, individuals with identical sequence alterations in the ND gene can show remarkable phenotypic variability of the ocular symptoms. These findings indicate the involvement of additional factors (epigenetic or genetic) in ocular pathogenesis of ND.

Adult↗
PubMed1987

Adrenergically induced recurrent HSV-1 corneal epithelial lesions.

Herpes simplex virus type 1 (HSV-1) ocular shedding and recurrent HSV-1 corneal epithelial lesions were assessed after ocular iontophoresis of 0.1% 6-hydroxydopamine followed by topical ocular instillation of 0.1% Propine in ten rabbits latently infected with HSV-1 strain McKrae. Iontophoresis was performed once at 0.5 mAmp for five minutes and 0.1% Propine drops were instilled four times a day beginning three days after iontophoresis and continuing for five consecutive days. Over an eight day period beginning three days after iontophoresis, ocular tear film samples were collected on Dacron swabs with care taken to avoid contact with the corneal epithelium. The corneas were examined daily for the presence of epithelial lesions using a slit-lamp biomicroscope. Three types of lesions were observed: deep punctate lesions, dendritic lesions, and geographic epithelial defects. The ratio of positive HSV-1 eye swabs to total eye swabs was 36/157 (23%). The ratio of total positive days of corneal lesions to total days was 40/160 (25%). There were 23 deep punctate lesions, 13 dendritic lesions, and four geographic epithelial defects. There were 24/36 (67%) positive HSV-1 eye swabs associated with concurrent HSV-1 corneal epithelial lesions. There were 105/121 (87%) negative eye swabs with concurrent negative slit-lamp examinations. Chi square analysis showed significant (p less than 0.001) association of HSV-1 positive eye swabs and HSV-1 corneal lesions. These results suggest that adrenergic ocular treatment may induce both HSV-1 ocular shedding (reactivation) and HSV-1 corneal epithelial lesions (recurrence) in rabbits latently infected with HSV-1 strain McKrae.

Animals↗
PubMed1998

Effects of perfluorophenanthrene on the human corneal endothelium.

PURPOSE: To evaluate long term effects of perfluorophenanthrene (C12F24), a perfluorocarbon fluid, in the anterior chamber of the human eye, where residual perfluorophenanthrene was retained in the eye postoperatively. METHODS: Slit-lamp microscopic and specular microscopic examinations of 4 eyes of 4 patients were performed. All the eyes were operated for complicated retinal detachment and they were aphakic at the end of the operations. Mean follow-up period was 10 months (6-16 months). RESULTS: Perfluorophenanthrene was seen in the anterior chamber in the first or second day postoperatively as a single drop. In the third week, postoperatively, the first signs of splitting the perfluorophenanthrene (fish egging phenomena) was observed. There was no sign of corneal or anterior segment toxicity with the slit lamp microscopic examinations and the intraocular pressure was within normal limits during the follow-up period in all eyes. However, some structural changes of the corneal endothelium were shown by specular microscopy. Decreased endothelial cell density, a reversed illumination pattern in which the normally dark cellular boundaries appear bright and intracytoplasmic light reflecting bodies were signs of cellular damage at the contact sites whereas no significant changes were seen at non contact sites. CONCLUSION: Residual perfluorophenanthrene in the anterior chamber does not induce gross corneal damage or ocular inflammation, although structural changes indicating the damage of the corneal endothelium, can be shown by specular microscopy at the contact sites. Corneal endothelial changes seem to arise from a contact-dependent effect of the perfluorophenanthrene.

Adult↗
PubMed1987

Ocular inflammatory effects of intravitreal interleukin 1.

Locally injected endotoxin induces potent inflammatory changes in the rabbit eye. To clarify the possible role of interleukin 1 (Il-1), an endotoxin-induced monokine, in rabbit eye inflammation, we injected rabbits with recombinant Il-1 (rIl-1). Twelve and a half to 200 U of intravitreally injected rIl-1 consistently induced inflammation, which was documented using slit-lamp biomicroscopy, histologic methods, or direct quantitation of protein in the aqueous humor. Responses including a cellular infiltrate in the anterior chamber, protein extravasation, and iris vessel dilatation became evident within six hours, peaked at 24 hours, and began to recede by 48 to 72 hours after the injection. Pathologic changes primarily occurred in the anterior chamber and included edema, hemorrhage, and cellular infiltration. Locally injected corticosteroid reduced but did not prevent rIl-1-induced changes in vascular permeability. Heat-inactivated rIl-1 induced minimal changes, as determined by histologic methods, slit-lamp examination, or direct protein measurement. These data support the conclusion that Il-1 should be considered as a potential mediator of ocular inflammation.

Animals↗
PubMed1996

Corneal endothelial changes in schizophrenic patients with long-term administration of major tranquilizers.

PURPOSE: To examine corneal endothelial changes in schizophrenic patients who underwent long-term administration of major tranquilizers. METHODS: We performed slit-lamp examination and endothelial specular microscopy on 100 eyes of 50 schizophrenic patients (range, 31 to 68 years old; mean, 54 years) who underwent long-term (12 to 44 years) treatment with major tranquilizers. We also studied 50 eyes of 25 patients (range, 31 to 65 years old; mean, 53 years) with no history of corneal disease, as a control group of similar age. Mean cell density, coefficient of variation, and percentage of hexagonal cells were calculated and statistically compared between patients and controls using an unpaired t-test. RESULTS: Slit-lamp examination disclosed pigmentation of the cornea in nine eyes of five patients and pigmentation of the lens in 25 eyes (25%) of 35 patients. Corneal pigmentary changes were seen only in patients with lenticular changes. No eyes showed corneal edema. In contrast, no corneal abnormalities were seen in any control eye. Specular microscopic analysis showed mean cell density of 3,484.4 +/- 462.6 cells/mm2, coefficient of variation of 0.31 +/- 0.06 and percentage of hexagonal cells to be 60.2% +/- 7.5% in the patient group, and 3,291.3 +/- 384.4 cells/mm2, 0.32 +/- 0.07, and 60.6% +/- 7.0%, respectively, in the control subjects. There were no statistically significant differences between patient and control eyes in these three factors. The nine eyes with corneal pigmentation showed no significant differences in these three factors as compared with the control subjects. CONCLUSIONS: These results indicate that long-term treatment with major tranquilizers is not associated with morphometric abnormalities of the corneal endothelium.

Adult↗
PubMed2003

Ambulatory photographic screening for diabetic retinopathy in nursing homes.

PURPOSE: To evaluate the feasibility and cost of screening for diabetic eye disease in homebound nursing home residents not attending a systematic screening programme. METHODS: Postal survey identification of residents with diabetes in all nursing homes in Liverpool. An ophthalmologist and nurse performed Bailey-Lovie logmar visual acuity (VA), portable slit-lamp examination, fundus photography, and subjective assessment of ability to cooperate with treatment in a sample of homes. Modified Wisconsin photographic grading was performed. Screen-positive patients were invited to a dedicated assessment clinic. Sight-threatening diabetic eye disease (STED) was defined as any of: moderate preproliferative retinopathy or worse, circinate maculopathy, or exudate within 1 disc diameter of fixation. RESULTS: A total of 54 (78%) nursing homes responded reporting 199/2427 (8.2%) residents with diabetes. Of these, 64/80 (80%) residents in 17 homes were examined: VA possible in 50 (78%); slit-lamp examination in 56 (88%); gradable photographs in at least one eye in 34 (53%); STED in 12 (35%) patients. In all, 35 (70%) patients had Snellen-equivalent VA worse than 6/12 in the better eye, of whom 13 (26%) were worse than 6/60. Of 29 screen positive patients, 12 attended the assessment clinic: one was unable to cooperate outside the home; 11 continue under ophthalmic review, four for previously undetected STED of which one listed for laser photocoagulation. Total cost pound 16,980; cost per screen event pound 60.30. CONCLUSIONS: Systematic eye screening in homebound patients with diabetes detects disease but follow-up and treatment is only feasible in a small proportion and at high cost. Alternative targeted assessment is recommended.

Aged↗
PubMed2001

Triple anterior chamber after full-thickness lamellar keratoplasty for lattice corneal dystrophy.

PURPOSE: To report a patient with lattice corneal dystrophy type I (LCDI) who developed a triple anterior chamber after full-thickness lamellar keratoplasty (LKP). METHODS: A 46-year-old woman underwent a full-thickness LKP in her right eye for visual disturbances caused by LCDI. Her visual acuity was 20/200 OD before surgery. A complete ophthalmic examination, including slit lamp biomicroscopy and optical coherence tomography (OCT), was performed before and after surgery. Molecular genetic analysis was performed on DNA extracted from the peripheral leukocytes. RESULTS: The surgery was performed uneventfully; however, extra spaces posterior to the graft, along with the severe graft edema, were observed to form a triple anterior chamber a few days after surgery. The extra spaces resolved in 3 weeks with no surgical treatment, and her visual acuity improved to 20/20 OD without correction 3 months after surgery. The triple anterior chamber was clearly demonstrated by OCT, but not by slit lamp biomicroscopy. A heterozygous single base-pair transition (CGC to TGC, arginin to cysteine) was detected in codon 124 of the TGFBIgene in the patient. CONCLUSION: The separation of the graft and the host's deep corneal tissue and a Descemet's membrane detachment in the host's cornea caused the triple anterior chamber. The Descemet's membrane detachment demonstrated the weak adhesion of the stroma and the Descemet's membrane, probably resulting from a dysfunction of the TGFBI protein caused by the mutation of the TGFBIgene. OCT is useful for the objective documentation of the posterior corneal region even with severe corneal edema.

Anterior Chamber↗
PubMed2002

[Evaluation vitreous body in idiopathic macular holes--biomicroscropic and ultrasonographic picture].

AIM OF THE STUDY: The aim of our study was to estimate the state of the vitreous body and the vitreoretinal interface in patients with idiopathic macular holes. MATERIAL AND METHODS: We examined 36 patients (41 eyes), 34 women and 2 men aged 65-72 with idiopathic macular holes. State of the hole (classified by Gass) was established on the biomicroscopical examination using Goldmann lens and double aspheric Volk lenses (+60.0, +90.0 D), ultrasonography Compuscan UAB 1000 Storz and fluorescein angiography. RESULTS: We classified stage 2 macular hole in 7 eyes (17%), stage 3 in 28 eyes (68%) and stage 4 in 6 eyes (15%). In the slit lamp examination we revealed partial posterior hyaloid detachment with posterior hyaloid membrane still attached at optic nerve head in 5 eyes, vitreomacular separation in 3 eyes, and vitreofoveal separation of posterior hyaloid membrane with the presence of focal condensation of the posterior hyaloid membrane in front of the fovea--operculum in 11 eyes, in stage 3 macular hole. In 8 eyes we observed lacunaes, and vitreoretinal tractions in 6. Ultrasonography was slightly more effective in revealing vitreomacular and partial PVD separation than biomicroscopical examination. In the case of vtireoretinal tractions or lacunaes, ultrasonography was worse than slit lamp examination. CONCLUSIONS: The exact evaluation of condition of the vitreous body and vitreo-retinal relationships are crucial for a further surgical treatment.

Aged↗
PubMed2004

[Macular corneal dystrophy including histologic and ultrastructural changes].

PURPOSE: The study reports the results of a histological and ultrastructural examination of the corneal button, obtained during penetrating keratoplasty from patient with clinically recognized macular corneal dystrophy. MATERIAL AND METHODS: 34-year-old male patient suffering from macular corneal dystrophy (MCD) has been treated on corneal epithelium defect and photophobia since his early childhood. Visual acuity was decreased on the Snellen test chart to 0.02. Slit-lamp examination, and ultrasonographical measurement of the cornea's thickness were performed. Removed during penetrating keratoplasty corneal button was divided into two pieces. One of them was prepared in standard procedure for histological examination in the light microscopy after having been stained with hematoxylin and eosin, alcian blue and paS-method. From the other part, slides for ultrastructural examination in the transmission electron microscopy were prepared with the use of standard method. The family history from the patient was also taken, and available relatives have undergone examination in search of typical MCD symptoms. RESULTS: Slit-lamp examination findings revealed diffuse, from limbus to limbus, stromal opacification. In measurement by pachymeter cornea's thickness was reduced. In the light microscopy, in typical stained slides, delaminations within stroma and deficit of endothelial cells were observed. After being stained with alcian blue, dark blue deposits in the places of delamination became visible. By transmission electron microscopic examination, intracellular and extracellular deposits were detected in the stroma, Descemet membrane and endothelium. Distended keratocytes with enormous vacuoles containing abnormal material were found. Pedigree was typical for autosomal recessive inherited disease. CONCLUSIONS: Histological and ultrastructural diagnosis is a basis of recognition of macular corneal dystrophy. Analysis of the pedigree as well as ultrasonographical measurement of the cornea's thickness is very helpful to establish the right diagnosis.

Adult↗
PubMed1998

Topography of diabetic macular edema with optical coherence tomography.

OBJECTIVE: This study aimed to develop a protocol to screen and monitor patients with diabetic macular thickening using optical coherence tomography (OCT), a technique for high-resolution cross-sectional imaging of the retina. DESIGN: A cross-sectional pilot study was conducted. PARTICIPANTS: A total of 182 eyes of 107 patients with diabetic retinopathy, 55 eyes from 31 patients with diabetes but no ophthalmoscopic evidence of retinopathy, and 73 eyes from 41 healthy volunteers were studied. INTERVENTION: Six optical coherence tomograms were obtained in a radial spoke pattern centered on the fovea. Retinal thickness was computed automatically from each tomogram at a total of 600 locations throughout the macula. Macular thickness was displayed geographically as a false-color topographic map and was reported numerically as averages in each of nine regions. MAIN OUTCOME MEASURES: Correlation of OCT with slit-lamp biomicroscopy, fluorescein angiography, and visual acuity was measured. RESULTS: Optical coherence tomography was able to quantify the development and resolution of both foveal and extrafoveal macular thickening. The mean +/- standard deviation foveal thickness was 174 +/- 18 microns in normal eyes, 179 +/- 17 microns in diabetic eyes without retinopathy, and 256 +/- 114 microns in eyes with nonproliferative diabetic retinopathy. Foveal thickness was highly correlated among left and right eyes of normal eyes (mean +/- standard deviation difference of 6 +/- 9 microns). Foveal thickness measured by OCT correlated with visual acuity (r2 = 0.79). A single diabetic eye with no slit-lamp evidence of retinopathy showed abnormal foveal thickening on OCT. CONCLUSIONS: Optical coherence tomography was a useful technique for quantifying macular thickness in patients with diabetic macular edema. The topographic mapping protocol provided geographic information on macular thickness that was intuitive and objective.

Adult↗
PubMed1996

A comparative study of eyelid cleaning regimens in chronic blepharitis.

PURPOSE: Blepharitis, an intrinsic eyelid inflammation with crusting and irritation, presents a great problem for patients wearing contact lenses. An important part of blepharitis therapy is eyelid hygiene, including the use of either soap, dilute baby shampoo, or commercial lid scrubs. In this study, a comparison was made between these three cleaning regimens in a group of 25 patients, 80% of whom (20/25) wore contact lenses. METHODS: Patients used commercial eyelid scrub on right eyelids and a hypo-allergenic bar soap on left eyelids. Patient symptoms, slit lamp findings, and overall preferences were determined at the end of 4 months. A subgroup of 10 patients using lid scrub on right eyelids and dilute baby shampoo on left eyelids was followed for an additional 3 months. RESULTS: At the end of 4 months, 24% (6/25) of the patients noted no difference between soap and lid scrub, but 89% (17/19) of the others preferred the lid scrub. In the group using baby shampoo, 50% (5/10) noted no difference in 3 months, but 80% (4/5) of the remaining patients preferred the lid scrub. CONCLUSIONS: All patients improved in slit lamp findings with all three regimens, and patient preference was overwhelmingly in favor of the lid scrub regimen for convenience and ease of use.

Adult↗
PubMed1995

Quantitative assessment of macular edema with optical coherence tomography.

OBJECTIVE: To evaluate optical coherence tomography, a new technique for high-resolution cross-sectional imaging of the retina, for quantitative assessment of retinal thickness in patients with macular edema. DESIGN: Survey examination with optical coherence tomography of patients with macular edema. SETTING: Referral eye center. PATIENTS: Forty-nine patients with the clinical diagnosis of diabetes or diabetic retinopathy and 25 patients with macular edema secondary to retinal vein occlusion, uveitis, epiretinal membrane formation, or cataract extraction. MAIN OUTCOME MEASURES: Correlation of optical coherence tomograms with slit-lamp biomicroscopy, fluorescein angiography, and visual acuity. RESULTS: Optical coherence tomograms of cystoid macular edema closely corresponded to known histopathologic characteristics. Quantitative measurement of retinal thickness is possible because of the well-defined boundaries in optical reflectivity at the inner and outer margins of the neurosensory retina. Serial optical coherence tomographic examinations allowed tracking of both the longitudinal progression of macular thickening and the resolution of macular edema after laser photocoagulation. In patients with diabetic retinopathy, measurements of central macular thickness with optical coherence tomography correlated with visual acuity, and optical coherence tomography was more sensitive than slit-lamp biomicroscopy to small changes in retinal thickness. CONCLUSIONS: Optical coherence tomography appears useful for objectively monitoring retinal thickness with high resolution in patients with macular edema. It may eventually prove to be a sensitive diagnostic test for the early detection of macular thickening in patients with diabetic retinopathy.

Adult↗