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PubMed1999

Primary CNS lymphoma: findings outside the brain.

In addition to the brain parenchyma and the leptomeninges, primary central nervous system lymphoma (PCNSL) can involve the posterior parts of the eye with ocular lymphoma in up to 20% of patients and lead to systemic dissemination of lymphoma in 7-8% of patients. Ocular lymphoma is diagnosed by slit lamp examination and requires treatment by ocular irradiation. However, the clinical significance of systemic dissemination, which occurs mainly in the end stage of the disease, appears to be disputable. Extensive systemic staging at the time of initial presentation proved to be unrewarding in the vast majority of studies. So far, only 10 patients have been reported with occult systemic lymphoma at time of initial presentation, and systemic lymphoma determined the course of the disease in none of them. Thus, initial staging procedures for patients with biopsy-confirmed PCNSL can be restricted to regular blood tests, including HIV testing, and slit lamp examination of the eye.

Central Nervous System Neoplasms↗
PubMed2006

Evaluation of 0.4% ketorolac tromethamine ophthalmic solution versus 0.5% ketorolac tromethamine ophthalmic solution after phacoemulsification and intraocular lens implantation.

PURPOSE: The aim of this study was to compare the effectiveness and patient tolerance of 0.4% ketorolac tromethamine ophthalmic solution and 0.5% ketorolac tromethamine ophthalmic solution after routine phacoemulsification and lens implantation. SETTING: The setting for this study was the Storm Eye Institute and Magill Research Center for Vision Correction, Medical University of South Carolina (Charleston, SC). METHODS: This work was a prospective, double-masked study that included 40 eyes of 40 patients randomly assigned to receive topical treatment with 0.4% ketorolac or 0.5% ketorolac, starting 15 min prior to routine phacoemulsification and foldable posterior chamber intraocular lens implantation. Following the procedure, patients were instructed to use the assigned treatment agent 4 times a day after surgery for 1 week and twice a day for 3 weeks, when drops were discontinued. Slit-lamp examination, intraocular pressure (IOP), laser cell and flare measurements, and subjective patient tolerance were evaluated postoperatively at 1, 7, and 30 d. Comparisons between the 2 groups were made at each visit, as well as comparisons to baseline. A P=value less than .05 was considered statistically significant. RESULTS: At day 1, a higher percentage of patients (70% vs. 40%) reported symptoms (mainly foreign body sensation and stinging/burning) in the 0.5% ketorolac group, compared to the 0.4% ketorolac group. No significant differences were found between the 2 groups over time regarding best-corrected visual acuity (BCVA), IOP, slit-lamp assessment of cells, and cell and flare measured using the laser cell/flare meter. CONCLUSIONS: Treatment with 0.4% ketorolac tromethamine ophthalmic solution is as effective as 0.5% ketorolac tromethamine ophthalmic solution in reducing inflammation after routine cataract surgery. Patients reported less discomfort using 0.4% ketorolac.

Aged↗
PubMed1993

The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group.

OBJECTIVE: To develop the Lens Opacities Classification System III (LOCS III) to overcome the limitations inherent in lens classification using LOCS II. These limitations include unequal intervals between standards, only one standard for color grading, use of integer grading, and wide 95% tolerance limits. DESIGN AND RESULTS: The LOCS III contains an expanded set of standards that were selected from the Longitudinal Study of Cataract slide library at the Center for Clinical Cataract Research, Boston, Mass. It consists of six slit-lamp images for grading nuclear color (NC) and nuclear opalescence (NO), five retroillumination images for grading cortical cataract (C), and five retroillumination images for grading posterior subcapsular (P) cataract. Cataract severity is graded on a decimal scale, and the standards have regularly spaced intervals on a decimal scale. The 95% tolerance limits are reduced from 2.0 for each class with LOCS II to 0.7 for nuclear opalescence, 0.7 for nuclear color, 0.5 for cortical cataract, and 1.0 for posterior subcapsular cataract with the LOCS III, with excellent interobserver agreement. CONCLUSION: The LOCS III is an improved LOCS system for grading slit-lamp and retroillumination images of age-related cataract.

Aging↗
PubMed2004

Characterization of a mutation in the lens-specific CP49 in the 129 strain of mouse.

PURPOSE: The 129 strain of mouse carries a mutation in the gene for CP49 (phakinin), an intermediate filament protein thus far demonstrated only in the lens fiber cell. As such, these mice represent naturally occurring mutants of interest in the study of the lens cytoskeleton. However, this strain of mouse is also widely used as a source of embryonic stem cells in gene-targeting studies. The presence of a mutation in a lens-specific gene can confound interpretation of studies in which lens genes have been knocked out. In the present study, both the genotype and phenotype of these mice were characterized, to permit an evaluation of the biological impact of this mutation and to facilitate the discrimination between wild-type and mutant animals that have been derived from this strain in gene-targeting studies. METHODS: The CP49 cDNA and, when relevant, the genomic DNA sequences were determined for the 129/SvJ and C57BL/6J mice and from a commercially available 129/OLa P1 genomic clone. PCR primers were screened for their capacity to discriminate between the mutant and wild-type CP49 genes. Northern blot analysis was used to assess mRNA levels for CP49, filensin, and gammaS-crystallin (control). Western blot analysis was used to identify changes in protein size and abundance. The impact of the mutation on lens architecture was evaluated at the light-microscope level. Lens fiber cell ghosts from mutant and wild-type mice were examined in the electron microscope for the presence of beaded filaments. Lens clarity was assessed by slit lamp. RESULTS: The 129 strain of mice exhibited a 6303-bp deletion from the end of intron B, and the beginning of exon 2. This deletion results in the loss of the exon 2 splice acceptor site, absence of exon 2 from the CP49 mRNA, and dramatically reduced levels of CP49 mRNA. The CP49 protein was undetectable by Western blot analysis. Messenger RNA levels for filensin, CP49's assembly partner, were normal, but protein levels were sharply reduced. Light microscopy established that the initial differentiation and elongation of the fiber cells proceeded normally. Electron microscopy showed the absence of beaded filaments, whereas slit lamp microscopy showed a slowly emerging and progressive loss of optical clarity. CONCLUSIONS: The 129/SvJ and 129/OLa strains of mice harbor a mutation that sharply reduces CP49 mRNA levels and essentially eliminates both CP49 and the beaded filament. These lenses exhibited a slow but progressive loss of optical clarity with age. Thus, the 129 strain of mouse behaves as a functional CP49 knockout. The loss of clarity in the lenses of these animals and the absence of beaded filaments (and any attendant interactions that may exist between beaded filaments and other lens proteins/structures) suggest that gene-targeting studies of lens proteins in which the 129 strain was used as a source of embryonic stem cells may need reevaluation.

Amino Acid Sequence↗
PubMed1992

[Surgery of retinal detachment of patients with pseudophakia using the panfunduscope].

Examination of the extreme periphery of the fundus of patients with pseudophakic retinal detachment is difficult due to poor pupil dilatation, optical aberrations from the intraocular lens, opacification of the posterior capsule or peripheral capsular remnants. Fifty-one patients with pseudophakic retinal detachment were operated on with using the wide angle panfunduscope of Rodenstock. It allows a very satisfactory pre- or intraoperative view of the extreme periphery of the fundus using the slit-lamp of the operative microscope combined with a scleral indentation. In only 3 cases no break was found in spite of pre- and intraoperative examination of the fundus periphery with the panfunduscope. Anatomic success was achieved in 47 out of 48 patients with a minimum of 6 months of follow-up; 3 patients were lost to follow-up. The mean postoperative visual acuity was 0.5. Unlike other methods of fundus examination, such the 3 mirror Goldmann lens or the indirect binocular ophthalmoscope, the panfunduscope allows good visualization of the peripheral retina of patients with pseudophakic retinal detachment using the slit-lamp of the operative microscope combined with a scleral indentation. Thus, small peripheral retinal breaks, often associated with pseudophakic retinal detachment, can be identified.

Adult↗
PubMed2002

Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.

PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.

Aged↗
PubMed2002

Screening for hydroxychloroquine toxicity by Texas ophthalmologists.

OBJECTIVE: To determine current practice patterns for screening for hydroxychloroquine (HCQ) toxicity by Texas ophthalmologists. METHODS: A survey was sent to all comprehensive ophthalmologists and retina specialists in the state of Texas. Questions included need for baseline examinations, frequency of followup, tests used to monitor for toxicity, and influences on monitoring regimen. RESULTS: Two hundred ninety of 577 surveys were returned correctly completed (response rate = 50.3%). Two hundred fifty-seven respondents (88.6%) felt a baseline examination was necessary prior to beginning HCQ therapy, and 223 (76.9%) followed patients every 6 months during HCQ therapy. Visual acuity, slit lamp examination, and dilated fundus examination were performed on almost all patients, and about three-quarters of respondents also checked visual fields and color vision. While 183 ophthalmologists (63.1%) used the Ishihara pseudoisochromatic plates to check color vision, there was no consensus on the preferred visual field test. One hundred twenty-two respondents (42.1%) stated they had diagnosed a patient with HCQ ocular toxicity. CONCLUSION: Most ophthalmologists in Texas continue to perform baseline examinations and follow HCQ patients semiannually for the development of ocular toxicity despite recent recommendations questioning the need for such close followup. The majority check visual acuity, perform slit lamp and dilated fundus examinations, and test color vision and visual fields, although there is no consensus on the preferred method to test visual fields.

Antirheumatic Agents↗
PubMed1989

[Quantitative assessment of aqueous flare intensity and cell count in uveitis].

In an attempt to evaluate the validity of the laser flare-cell meter in in iridocyclitis, we conducted a comparative study of slit-lamp examination and flare-cell meter measurements in 251 eyes of uveitis patients. A significant correlation was observed between the two methods both in the measurement of flare intensity (Kendall tau = 0.580, p less than 0.001) and cell count (tau = 0.390, p less than 0.001). However, there were wide variations in grading within groups and large overlaps in scores between groups. These results were thought to be attributable to differences in the two examination methods. Flare-cell meter demonstrated high sensitivity for flare measurements, while there were some cases where low numbers of cells, which could be observed by a slit-lamp, were undetectable by the flare-cell meter. Patients with Behçet's disease were divided into three groups based on the interval from an ocular attack episode. Flare-cell meter examination revealed that flare intensity values remained abnormally high even in patients free from an attack episode for more than six months prior to the examination (p less than 0.001). It was considered that disruption of the blood-aqueous barrier exists permanently in patients with Behçet's disease.

Adult↗
PubMed2004

Efficacy and tolerability of ophthalmic epinastine: a randomized, double-masked, parallel-group, active- and vehicle-controlled environmental trial in patients with seasonal allergic conjunctivitis.

BACKGROUND: Epinastine hydrochloride is an antihistamine with mast cell-stabilizing and anti-inflammatory activity. OBJECTIVE: The aim of this study was to assess the efficacy and tolerability of ophthalmic epinastine in patients with seasonal allergic conjunctivitis (SAC) exposed to environmental allergens. METHODS: This randomized (age-stratified), double-masked, parallel-group, active- and vehicle-controlled, environmental, Phase III clinical trial was conducted at 6 ophthalmology clinics in the United States. Patients aged >or=9 years diagnosed with SAC and who had a positive reaction in a conjunctival allergen challenge were enrolled. Patients were randomly assigned in a 2:2:1 ratio to receive 1 drop/eye BID of epinastine hydrochloride 0.05% ophthalmic solution, levocabastine hydrochloride 0.05% ophthalmic suspension, or vehicle of epinastine, respectively, for 8 weeks. The primary end point was ocular itching, and secondary end points included ocular hyperemia, chemosis, ocular mucous discharge (all assessed on a 5-point scale), eyelid swelling (assessed on a 4-point scale), and tearing (present or absent). Efficacy analyses used assessments from the two 1-week periods with the highest pollen counts. For tolerability assessment slit-lamp biomicroscopy and visual acuity examinations were conducted at each study visit (weeks 0, 2, 4, 6, and 8). RESULTS: Two-hundred ninety-eight patients (159 females, 139 males; mean [SD] age, 32.7 [14.6] years [range, 9-71 years]) entered the study; 118 received epinastine, 118 received levocabastine, and 62 received vehicle. Epinastine-treated patients reported significantly less ocular itching than those receiving vehicle (P=0.045); scores for hyperemia were similar between these 2 groups. Ocular itching and hyperemia scores were similar between the epinastine and levocabastine groups. No clinically or statistically significant between-group differences were seen in slit-lamp biomicroscopy findings, changes in visual acuity from baseline, or the incidence of treatment-related adverse effects. CONCLUSIONS: In this study of patients with SAC, ophthalmic epinastine instilled twice daily was more effective than vehicle for the control of ocular itching and was similar in efficacy to levocabastine for control of ocular itching and hyperemia. Epinastine was well tolerated.

Adolescent↗
PubMed1990

[The simultaneous video fluoangioscope].

The present paper describes the video simultaneous fluoangioscope. It is based on the Rodenstock simultaneous fluoangioscope, an accessory for use with the laser slit-lamp. It has been proving its clinical usefulness since 1984. Hitherto, its optical superimposition of the corresponding fluorescein angiograph onto the actual fundus view was based on angiographic film as an information carrier. Digital fluorescein angiography (videoangiography) has meanwhile made film superfluous while at the same time opening up new possibilities. The video simultaneous angioscope superimposes a selected video half-frame onto the fundus, thus transferring angiographic data and facilitating safe and easy coagulation. The advantages and new possibilities arising from them are discussed and the system peripherals are described. An illustration shows the superimposition of the images when looking through the slit-lamp.

Equipment Design↗
PubMed1999

Quantitative analysis of diabetic macular edema after scatter laser photocoagulation with the scanning retinal thickness analyzer.

PURPOSE: To define the effect of scatter laser photocoagulation on foveal retinal thickness. METHODS: A commercial scanning retinal thickness analyzer was used to measure retinal thickness. The foveal retinal thickness was measured at the central area of the fundus (0.4 x 0.4 mm). The method was applied to 20 consecutive patients (mean age, 52.4 +/-16.9 years) with diabetic retinopathy. Measurements were performed before and 6 weeks after scatter photocoagulation. Patients were examined by fluorescein angiography and slit-lamp biomicroscopy to detect macular edema. RESULTS: Mean foveal thickness before scatter photocoagulation was 187+/-45 microm, increasing to 221+/-46 microm after the treatment (P = 0.0001). The foveal thickness increased in 12 eyes (60%). Laser treatment increased macular permeability in two eyes (10%). Biomicroscopic examination revealed central macular thickening in one eye (5%). Visual acuity was reduced in four eyes (20%). CONCLUSIONS: Our results suggest that subclinical macular edema occurs after scatter laser photocoagulation. The retinal thickness analyzer is a sensitive tool for early detection of macular edema after laser treatment, because increases in retinal thickness as small as 34 microm cannot be assessed by slit-lamp biomicroscopy.

Capillary Permeability↗
PubMed1998

In vivo confocal imaging of corneal neovascularization.

PURPOSE: To investigate the cellular dynamics of vessel formation during corneal neovascularization in the living eye by confocal microscopy. METHODS: Corneal neovascularization was initiated by placing a 7-0 silk suture through the corneal stroma 3 mm from the limbus at the 12 o'clock position in both eyes of 10 New Zealand white rabbits. The corneas were examined for vessel ingrowth at intervals from 1 to 15 days after suture placement using a tandem scanning confocal microscope with a 20X water immersion objective, as well as a slit-lamp biomicroscope. Changes in the limbal vessels were recorded on videotape for later analysis. As early vessel growth appeared to be associated with corneal nerves, the total number of sprouts and the number of sprouts along nerves were counted in confocal images, and the results analyzed for statistical significance. Vessel growth and the structural relationship between vascular buds and the deep stromal nerves were examined by light and transmission electron microscopy. RESULTS: The early events of cell migration from the limbal microvessels were found to be associated with the deep stromal nerves; although this association was easily visualized by confocal microscopy, it could not be documented by slit-lamp biomicroscopy. By 18 h after suture placement, the limbal vessels were dilated and the first vascular buds appeared as short, pointed, or flat-topped protrusions from the deep limbal capillaries. By 96 h, the capillary buds had increased in density and had begun to form lumens. Movement of red blood cells was established between 72 and 80 h after the first signs of bud formation, at the same time that cells of immune origin were seen. Confocal microscopy revealed and transmission electron microscopy verified that new bud formation began with the formation of vascular tubes by endothelial migration along the deep stromal nerves. The total number of sprouts and the number of sprouts associated with stromal nerves were similar on days 1 and 2 but differed on days 3-7, suggesting an association between sprouts and nerves in the early stages of neovascularization. CONCLUSION: Using real-time white light confocal microscopy, we were able, for the first time, to observe the process of corneal neovascularization in the living eye, from the earliest stages within hours after initiation to 2 weeks. The deep stromal nerves appear to serve as a focus for the growth of new vessels, by attracting and supporting vessel growth and/or by providing a potential space for movement of the endothelial cells. Confocal microscopy may provide a new approach to achieving a better understanding of the mechanisms involved in corneal neovascularization.

Animals↗
PubMed2004

Excessive maternal caffeine exposure during pregnancy is cataractogenic for neonatal crystalline lenses in rats: a biomicroscopic and histopathologic study.

PURPOSE: To investigate histologically the influence of maternal caffeine exposure during pregnancy in vivo on crystalline lenses in neonatal rats. METHODS: Experimentally naive, female Wistar-albino rats (200-220 g) were mated with adult male rats over 2 days for copulation. After confirming pregnancy with a vaginal smear method, 50 gravid rats (dams) were randomly divided into five groups (n = 10 in each), consisting of one control and four experimental groups. Groups 1, 2 and 3 experimental dams were treated with intraperitoneal (i.p.) caffeine at doses of 25, 50 and 100 mg/kg/day, respectively, during pregnancy from gestational day 9 through to day 21. Group 4 dams were treated with caffeine in distilled water in a gavage at a dose of 50 mg/kg/day. Group 5 control dams were given i.p. saline solution daily for the same period. After normal delivery, the eyes were examined by slit-lamp biomicroscopy. The neonates were then killed by decapitation at postnatal days 1 or 30 and the eyes removed for histopathologic investigation of the lenses. RESULTS: Group 1 and control eyes had normal anterior lens capsules with a single layer of anterior cuboidal epithelial cells, regularly oriented cortical and nuclear lens fibres, and a clear posterior lens capsule with no lining epithelial cells behind the equator. In the remaining groups, histopathologic findings suggesting cataractogenesis included eosinophilic degeneration, lens fibre cell swelling and liquefaction, central lens fibres with retained nuclei, and prominent epithelial cells lining the posterior lens capsule behind the equator. Moreover, some lenses in group 3 had immature cataract on slit-lamp biomicroscopic examination at postnatal day 30. CONCLUSION: Excessive maternal caffeine exposure during pregnancy had cataractogenic effects on developing crystalline lenses in newborn rat eyes, both macroscopically and histopathologically. If an appropriate dose of caffeine can be identified, caffeine-induced cataract formation may be used as a new experimental cataract model in animal studies.

Animals↗
PubMedDate not supplied

Screening for diabetic retinopathy by one-field, non-mydriatic, 45 degrees digital photography is inadequate.

PURPOSE: To evaluate the sensitivity and specificity of one-field, non-mydriatic, 45 degrees digital photography for screening for diabetic retinopathy compared to indirect ophthalmoscopy using a slit-lamp, the reference standard. METHODS: A total of 100 consecutive diabetic patients (200 eyes) who underwent digital fundus photography and ocular examinations from June 2002 to November 2002 were included in this retrospective study. The patients, recruited from a hospital-based, retina referral practice, underwent 45 degrees, non-mydriatic, digital fundus photography using a non-mydriatic fundus camera. One image was obtained focusing the mid fundus between the optic disc and the macula. The fundus images were printed and graded by endocrinologists and a retinal specialist separately. The patients also underwent complete standard ocular examinations as the reference method for determining diabetic retinopathy, including dilation of their pupils and slit-lamp biomicroscopy done by ophthalmologists. The sensitivity and specificity of the digital photographic method were calculated by comparison to the reference method. RESULTS: The sensitivity and specificity of the retinal specialist's diabetic retinopathy grades were 53.8 and 89.0%, respectively. The sensitivity and specificity of the endocrinologists' grades were 45 and 75.3%, respectively. The false negative rates were 22 and 21.5% for endocrinologists and the retinal specialist, respectively. CONCLUSIONS: Screening for diabetic retinopathy using one-field, non-mydriatic, 45 degrees digital photography is inadequate.

Adult↗
PubMed2001

Ocular blood flow tonometer reproducibility: the effect of operator experience and mode of application.

OBJECTIVE: The purpose of this study was to investigate whether the effect of learning and the reproducibility of measurements varied between the two methods of application (hand-held or slit-lamp mounted) of the ocular blood flow (OBF) tonometer. METHOD: Five consecutive measurements by each method were taken at one examination session on one eye of 35 healthy adults (mean age 36.6 years and range 17-84 years). The subjects were seated for all measures and the sequence of tonometer method was randomised between subjects. RESULTS: A new operator does exhibit a significant learning effect and this learning effect is of a greater magnitude for the hand-held technique. No significant difference was found between methods for pulsatile ocular blood flow (POBF), IOP, pulse amplitude and heart rate. Both methods of application had a high coefficient of reliability for POBF: 0.91 for slit-lamp and 0.89 for hand-held. CONCLUSIONS: We conclude that results from both methods of OBF tonometer application are reliable and either method can be used for clinical and research studies. However it is important that new operators gain sufficient experience with the OBF tonometer to avoid initial operator-induced variability.

Adolescent↗
PubMed1997

[Early diagnosis of pseudoexfoliation syndrome. A clinical electron microscopy correlation of the central, anterior lens capsule].

BACKGROUND: The intraocular manifestations of pseudoexfoliation (PEX) syndrome, with rising incidence with ageing, represent risk factors for patients undergoing intraocular surgery. Therefore we correlated our clinical assessment to transmission-electron microscopy. PATIENTS AND METHODS: 150 consecutive patients before extracapsular cataract surgery were examined for the occurrence of deposition of PEX material and other clinical alterations like PEX-phako,-irido,-corneopathy and melanin-dispersion by slit-lamp biomicroscopy. These findings were compared with the electron-microscopic examination of the anterior lens capsules. RESULTS: In clinically manifest Mini- or classic PEX the clinical diagnosis was supported in all cases except one by electron microscopy. In EM classic PEX syndrome and precapsular layer was found in 37.3% of the cataract patients in this study group. The patients with the precapsular layer were significantly younger than the patients with classical PEX. The incidence of nuclear cataract, open angle glaucoma, corneal endotheliopathy and phacodonesis were more frequent in eyes where PEX was found on the anterior lens capsule in EM. In 14 of 92 (15.2%) patients the precapsular layer and PEX was not suspected with slit-lamp biomicroscopy. In 15 of 35 (42.8%) patients with suspected PEX the samples of EM of anterior lens capsules did not reveal PEX. CONCLUSIONS: PEX and its early forms seem to be found more frequently than expected in eyes with cataracts. Although biomicroscopy is a very valuable tool to detect early PEX syndrome, we have to improve the clinical criteria for the early diagnosis.

Adult↗
PubMed2003

Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale.

PURPOSE: To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology. MATERIALS AND METHODS: The Indiana Bleb Appearance Grading Scale contains a set of photographic standards illustrating a range of filtering bleb morphology selected from the slide library of the Glaucoma Service at the Indiana University Department of Ophthalmology. These standards consist of slit lamp images for grading bleb height, extent, vascularity, and leakage with the Seidel test. For grading, the morphologic appearance of the filtration bleb is assessed relative to the standard images for the 4 parameters and scored accordingly. Fifty-one clinical bleb photographs were evaluated and scored by 3 glaucoma subspecialists in a masked fashion according to the scale. RESULTS: For all of the grading scales, high interobserver agreement was found using the scale to classify the appearance of filtering blebs (height +0.76; extent +0.78; vascularity +0.90, interclass correlation coefficient for consistency using a 2-way mixed effect model). CONCLUSION: The Indiana Bleb Appearance Grading Scale is a simple, reproducible, yet comprehensive system for classifying the morphologic slit lamp appearance of filtration blebs.

Filtering Surgery↗
PubMedDate not supplied

Evaluation of an opacity lensometer for determining corneal clarity following excimer laser photoablation.

The appearance of haze in the central cornea following photoablation with a 193 nm excimer laser is an important factor in the postoperative course of this procedure. Data from 37 human eyes treated with photorefractive keratectomy, 4 eyes treated with phototherapeutic keratectomy, and 5 untreated eyes were used to evaluate the ability of a commercially available opacity lensometer to provide an objective measure of corneal clarity. We found that the opacity lensometer was able to detect light scattered from the cornea but was not sufficiently sensitive to distinguish reliably among excimer-treated eyes with degrees of corneal haze evaluated as clear, trace, or 1+ by slit-lamp microscope examination. In untreated, clear corneas, the values obtained with the opacity lensometer in eyes measured with and without a clear contact lens were within one unit of each other for any given eye, but values from eye to eye varied over a range of six units. In a test simulating different amounts of corneal haze using contact lenses evenly coated with nail polish enamel, the log-transformed opacity lensometer values varied directly with percent light scattering as determined by spectrophotometry. These results suggest that the opacity lensometer measurements are reliable and reproducible, but that in the human cornea something is being measured by the opacity lensometer that is not taken into account in clinical slit-lamp microscope evaluation. Overall, it appears that, in its present form, this instrument is not useful to measure corneal clarity after excimer laser photoablation.

Contact Lenses↗