Slit lamp ophthalmodynamometry.
A short clinical trial of the 'Dynoptor' Slit Lamp Ophthalmodynamometer has shown it to be a practical instrument. A mean O.A.P. of 52.3 mm/hg has been recorded.
Humans↗
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Corneal astigmatism measuring module for slit lamps.
We have developed an automatic keratometer module for slit lamps that provides automatic measurements of the radii of the corneal curvature. The system projects 72 light spots displayed in a precise circle at the examined cornea. The displacement and deformation of the reflected image of these light spots are analysed providing the keratometry. Measurements in the range of 26.8-75 D can be obtained and a self-calibration system has been specially designed in order to keep the system calibrated. Infrared LEDs indicate automatically which eye is being examined. Volunteer patients (492) have been submitted to the system and the results show that our system has a high correlation factor with the commercially available manual keratometers and the keratometry measurements from a topographer. Our developed system is 95% in agreement with the corneal topographer (Humphrey--Atlas 995 CZM) and the manual keratometer (Topcon OM-4). The system's nominal precision is 0.05 mm for the radii of curvature and 1 degree for the associated axis.
Astigmatism↗
Television slit-lamp biomicroscopy.
The basic requirements for performing television slit-lamp biomicroscopy are outlined, and the methods of demonstrating particular features of ocular anatomy and ocular disease are discussed. The technique has a particular role in teaching in the clinical setting.
Eye↗
Slit lamp reformation of the anterior chamber following trabeculectomy.
Out of 50 consecutive trabeculectomies performed over a 10-month period, 13 flat or shallow anterior chambers were reformed immediately following surgery a total of 19 times without complication at the slit lamp, using hyaluronic acid. Three months after surgery, there was no significant difference between the reformed and nonreformed eyes in terms of intraocular pressure or visual acuity change. We conclude that reformation at the slit lamp using hyaluronic acid is a safe, effective means of restoring anterior chamber anatomy following trabeculectomy.
Aged↗
[Pathologically reduced endothelial cell number despite normal slit-lamp microscopic corneal findings. An important result before cataract surgery].
BACKGROUND: A reduced number of endothelial cells increases the risk of corneal decompensation after cataract surgery. It is difficult to quantify the number of endothelial cells using slit-lamp microscopy since normal corneas may also show a reduced number of endothelial cells. MATERIALS AND METHODS: We compared the number of endothelial cells pre- and postoperatively in a group of 500 consecutive patients. RESULTS: Corneas diagnosed preoperatively with corneae guttata by slit-lamp microscopy may reveal more than 1800 endothelial cells/mm2. These corneas may decompensate after surgery. CONCLUSION: We consider the routine use of endothelial microscopy to be a helpful diagnostic tool prior to cataract surgery.
Aged↗
A new contact glass for slit-lamp examination of the cornea, especially in specular reflection.
A new contact glass of 2.2X magnification for the examination of the cornea is described. With it, all three types of illumination provided by the slit lamp can be used to advantage: specular reflection, optical section, and indirect light. A precorneal chamber filled with liquid abolishes the surface reflex of the tear film, and a built-in orange filter suppresses most of the light scattered by the corneal stroma. In specular examination the necessity for a large angle between the illumination and observation beams no longer exists, so that quite small angles can be used. Since at the same time such a glass considerably widens the usable field, epi- and endothelioscopy are greatly facilitated. Handling of the glass is as easy as in routine biomicroscopy. It is shown that a contact glass of power M increases the resolution in depth by a factor of M2. Image distortion introduced by the glass is measured and found to be tolerable within the area of photographic records usable for cell density determinations. Some modifications made on the Nikon FS-2 photo slit lamp in order to improve its suitability for endotheliography are described. Clinical application of the method is documented by several examples.
Adolescent↗
Intraoperative PAR corneal topography system (CTS): comparison of its keratometric readings to manual keratometer, auto-keratometer, EyeSys Corneal Analysis system, and slit lamp PAR CTS in healthy eyes.
PURPOSE: To compare the keratometric readings obtained from Intraoperative PAR Corneal Topography System (IOPAR) to those produced by manual keratometer (Mnl-Km), autokeratometer (Auto-Km), EyeSys CAS (EyeSys Corneal Analysis System) and slit lamp PAR CTS in healthy eyes. METHODS: All instruments were calibrated prior to use and only data from the best image obtained was used for statistical analysis. Simulated keratometry readings obtained from the central 3-mm zone of the corneas by IOPAR, including flat (K1) and steep (K2) keratometry readings, average keratometric power (AK), astigmatism (As) (difference between steep and flat keratometry readings) and the axis of the steep meridian (Ax) were compared to those from four other units. The latter units were also compared among themselves. Statistical analysis was done for right and left eyes separately. For each variable, average differences between the measurements taken from pairs of instruments were estimated, with corresponding 95% confidence intervals. The degree of agreement between pairs of instruments on individual measurements was additionally assessed, via the use of "Bland-Altman"-type plots, and estimates of the proportion of cases achieving satisfactory agreement. Additionally, for every variable, the average of the measurements taken from the different instruments were compared. RESULTS: Forty-five (22 right and 23 left) normal corneas of 26 volunteers were examined. On the average, IOPAR tended to measure K1 higher than slit lamp PAR CTS system. Because K2 measurements taken by the IOPAR were higher than that of all other instruments, the As measurements, on the average, were also higher than that of others, with the exception of the PAR CTS. For the same reasons, the IOPAR produced average AK readings that were higher than those taken by EyeSys CAS and PAR CTS. When the individual measurements taken by the IOPAR were compared with each of the other units, according to the arbitrary designation of satisfactory agreement within +/-0.5 D (for K1, K2, AK, and As) and +/-20 degrees (for Ax), for almost all parameters, proportion of differences that were within the agreement range varied from 0.33 to 0.82, with wide confidence intervals (confidence interval lower limits ranging from 0.20 to 0.61 and upper limits ranging from 0.62 to 0.94). CONCLUSIONS: IOPAR is a clinically useful topographic system, producing qualitative and quantitative data in the operating environment that, in normal corneas, on the average, matches those produced by the other units in the clinic. When individually analyzed, its keratometric measurements may show greater variations with respect to other units. Further studies with multiple examiners, in corneas with high or irregular astigmatism are required to establish its reproducibility and efficacy.
Adult↗
Advanced slit lamp techniques with an understanding of pathology.
1. Knowledge of slit lamp illumination techniques along with solid concepts of the disease processes can allow an understanding of the visible morphologic structures seen in the disease process during examination with the biomicroscope. 2. Inflammation can be defined as the interaction between a stimulus and a host, frequently resulting in some degree of structural change within the host. 3. The cellular responses include a predictably sequential order of events. The four cardinal signs of inflammation are redness, swelling, heat, and pain, phenomena explained at the cellular level.
Eye Diseases↗
Direct ophthalmoscopy versus slit lamp biomicroscopy in diagnosis of the acute red eye.
The causes of red eye range from trivial to life-threatening, and many general practitioners are uncertain of their ability to diagnose them with the aid of an ophthalmoscope. We tested the hypothesis that, in the assessment of a patient with red eye, a doctor using a slit lamp biomicroscope would not differ in diagnostic accuracy from a doctor using a direct ophthalmoscope. A cross-over study was conducted in 98 patients newly attending an eye casualty department. 71% of diagnoses agreed exactly, and all potentially sight-threatening lesions were either diagnosed correctly or managed appropriately by doctors using an ophthalmoscope. We conclude that the initial diagnosis and management of patients with an acute red eye is not prejudiced by the lack of a slit lamp biomicroscope.
Acute Disease↗
[A simple and rapid method for photographic documentation of findings using the slit lamp].
UNLABELLED: The objective photographic documentation and follow-up examination of changes in the eye's anterior segment is gaining importance as part of the daily practice. Until now, however, it has been linked with specially designed and expensive photographic equipment. A large number of ophthalmic units around the world do not have access to any form of photography. The advances in videographics do not offer an adequate alternative concerning both fineness of the grain and price per picture. MATERIAL AND METHODS: After installation of a new slit-lamp camera adapter, it was possible to produce color prints and slides. A 35-mm SLR camera with a spot-metering system, a clear view-finder focusing screen, highly sensitive slide film (ISO 640/29 degrees) and a standard 50 mm lens was used. No additional light sources or flashes were necessary in this camera-slit-lamp combination. CONCLUSION: This system is suitable to take color photographs of good quality and makes ophthalmic photography readily available, particularly in circumstances where more sophisticated photographic equipment is not available. Because of the fast and easy installation and the additional use for gonioscopic or fundus photography this combination is profitable even for inexperienced photographers.
Anterior Eye Segment↗
On slit-lamp microscopy.
Theoretically the contact lens with a refractive power of -64 dioptres is superior to the concave pre-set lens (Hruby lens) or the convex lens (Bayadi). In practice the results are as follows: With the convex lens the examination of the vitreous is unsatisfactory. The reversed image with the convex lens will become familiar with some experience as one will also get used to the mirror images of the three-mirror contact lens. However, the abnormal curvature of the image is really a nuisance. On the other hand the large field of view is an advantage. The convex lens is only practically useful when it can be firmly attached to the slit-lamp microscope, as otherwise the new adjustment necessary for searching the fundus is too difficult. Attachment to the microscope is also of advantage with the Hruby lens. The concave contact lens of 64 dioptres is best suited for detailed examination of vitreous and fundus and for measurements. When no value is placed on a minute examination and a quick simple orientation suffices, the concave pre-set lens (Hruby lens) has the advantage that the lens does not have to be placed on the eye. If it is centred to the middle axis of the microscope, it facilitates especially quick observation. There will be cases where the pre-set lens will be the only answer, especially shortly after an operation or with very sensitive patients. Furthermore, the Hruby lens is preferable to the Bayadi lens because the vitreous can be better examined. The Hruby lens is also advantageous for examination of the region in the middle, lateral periphery of the fundus, 30 degrees - 60 degrees, and is superior in this area to the simple concave contact lens. The Bayadi lens seems to us only indicated for fundus examination of extremely high myopes. There it definitely offers advantages over and above the concave lens. For the most peripheral fundus, expecially below and above, the three-mirror lens with its modification is so far the best method. Especially for examination of the vitreous good brightness of the slit image is required for stereoscopic examination with as large an angle as possible between microscope and illumination. The lateral parts of the most peripheral fundus cannot be examined with the vertical slit in connection with the three-mirror lens. However, this is possible with the horizontal and tilted position of the slit and intermediate positions with an oblique slit. The slit must form an angle with the microscope in order to examine vitreous and fundus in optical section. With the indentation contact lenses ciliary processes and pars plana are now accessible to slit-lamp microscopy.
Fundus Oculi↗
Enhanced models for teaching slit-lamp skills.
This article describes enhancements to models previously devised for demonstrating slit-lamp findings to students and physicians. The models can simulate the optical appearance of the anterior segment, "flare" and "cells" in the anterior chamber, hypopyon, gross and microscopic hyphema, the red reflex, cataract, corneal epithelial defects (including fluorescein staining) and superficial corneal foreign bodies, whose removal can be practised.
Clinical Competence↗
Slit-lamp needle revision for aqueous misdirection after trabeculectomy.
PURPOSE: To describe a slit-lamp needle procedure for the management of aqueous misdirection after trabeculectomy in which more conventional therapies have failed. The pathophysiology of aqueous misdirection and explanation for the efficacy of this procedure are reviewed. METHODS: Two patients in whom aqueous misdirection developed after trabeculectomy refractory to standard medical and laser therapy underwent transcorneal needling to disrupt the anterior vitreous face and reform the anterior chamber. RESULTS: In both cases there was immediate resolution of clinical signs, with normalization of intraocular pressure throughout the 9-month follow-up period. One of the two eyes showed a slow but progressive advance in preexisting peripheral anterior synechia; however, intraocular pressure and axial anterior chamber depth remained normal in both eyes. CONCLUSION: Transcorneal needle disruption of the anterior hyaloid through the peripheral iridectomy was effectively managed two cases of aqueous misdirection. Even if only transiently useful, this simple intervention may serve to minimize corneal damage from iris and lens trauma due to a flat anterior chamber.
Aged↗
Slit-lamp studies of the rhesus monkey eye. I. Survey of the anterior segment.
Slit-lamp photographic studies of 144 caged rhesus monkeys, aged 2 months to 35 years, show age-related changes in anterior-chamber depth, lens thickness, anterior and posterior curvatures of the lens, and location of the posterior lens surface relative to the anterior corneal surface. For these parameters, as well as for those measured by other techniques, a difference in slope magnitude and (or) slope sign was found between the growth phase which lasts for 5-6 years, and the adult phase (greater than 5-6 years). Age-related changes in the adult rhesus eye are qualitatively similar in almost all aspects to those observed in the human eye, indicating that the rhesus is a good animal model for the study of human loss of accommodative amplitude.
Aging↗
A fixation aid for slit-lamp biomicroscopic examination of the optic nerve.
The traditional articulated fixation light used on slit lamps is somewhat inconvenient, requiring repositioning for each eye. A simple, inexpensive fixation aid is described, which allows examination of both optic nerves without repositioning.
Equipment Design↗
Anterior segment fluorescein angiography: a simple modification of the Zeiss stereo slit lamp camera.
The addition of a small metal housing containing a rechargeable flash to a Zeiss stereo slit lamp camera provides a simple, inexpensive method for obtaining excellent quality anterior segment fluorescein angiograms. By placing a splice in the slit illumination cord the fluorescein flash unit can be hooked up to be existing Zeiss power pack. The easy insertion of the proper excitation and barrier filters completes the temporary conversion. Utilizing this equipment, rapid sequence photographs of high resolution can be achieved. In addition, stereophotography, variable magnification, color photography and a simultaneous combination of fluorescein and infrared angiography for pigmented lesions are possible.
Anterior Chamber↗
[Photographic documentation with the Haag-Streit slit lamp (author's transl)].
A report on a simple adapter for the Haag-Streit slit lamp, by means of which a standard SLR camera can be attached to one of the eyepieces. Using highspeed film it is thus easily possible to obtain satisfactory photographs of the anterior segment, the refractive media and the fundus without flash.
Ophthalmology↗
[A new slit-lamp fluorophotometer for the clinical evaluation of corneal epithelial barrier function].
A new objective slit-lamp fluorophotometer was developed to examine corneal epithelial barrier function. This instrument has several new characteristics. The photodetector system is placed directly in front of the cornea and the focal diamond is accurately positioned at the corneal surface, permitting measurement of the barrier function of peripheral parts of the cornea. Due to the filter characteristics, measurement can be done even in a relatively bright room. Only one second is needed for measurement, eliminating blink interruption. Linear relationships were found between measurement count and fluorescein concentration. 0.5% and 3 microliters of fluorescein was applied to the eyes of healthy volunteers. In non-washed eyes, the concentration changes were consistent with tear turnover, and in washed eyes, the changes reflected the barrier function of the corneal epithelium and showed correlation with age. This instrument is also useful for determining autofluorescence. A significant relation was seen between autofluorescence and age.
Adolescent↗