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PubMed1992

[Clinical study of venous abnormalities in diabetic retinopathy].

The authors studied 304 eyes (248 cases) affected by diabetic retinopathy in relation to venous abnormalities by ophthalmoscopy, slit lamp examination with contact lens and fluorescein angiography. The posterior pole and surrounding mid-peripheral area were examined. The subjects consisted of 225 eyes with pre-proliferative and 79 eyes with proliferative retinopathy. Fifty-six eyes (18%) had venous abnormalities: 17 of the 225 eyes (8%) with pre-proliferative retinopathy and 39 of the 79 eyes (49%) with proliferative retinopathy. In the 56 eyes with venous abnormalities. 39 (96%) showed beading. 14 (25%) showed looping and 2 (4%) showed duplication. All eyes which showed looping or duplication had proliferative retinopathy. The locations of the venous abnormalities were analyzed: 42% were in secondary branches, 27% in tertiary branches, 18% in primary branches, 10% in fourth branches and 3% in fifth branches. The portion of the fundus affected was upper temporal, lower temporal, upper nasal and lower nasal in 28%, 22%, 29% and 21%, respectively. Based on our results, eyes with looping or duplication on ophthalmoscopic or slit lamp examination, have an extremely high probability of being in some stage of proliferative retinopathy. Retinopathy should be confirmed by fluorescein angiography and photocoagulation should be performed as quickly as possible.

Diabetic Retinopathy↗
PubMed2005

[The effect of interleukin-1alpha on intraocular pressure in rabbit eyes and its focal side effects].

OBJECTIVE: To investigate the efficiency of interleukin-1alpha on intraocular pressure reduction and its safety. METHODS: 35 New Zealand female rabbits were randomized into seven groups. In group-A, one eye was randomly selected to receive sub-conjunctival injection of 15 ng IL-1alpha, and in group B-D, one eye was injected intracamerally with IL-1alpha 1.5 ng, 15 ng and 40 ng respectively, and the other eye was injected intracamerally with equivalent volume of 0.1% PBS as control. In group-E, one eye was treated with 0.5% timolol eye drops and the other eye was given artificial tear. Groups F and G were treated as group D, and specifically in group-G, both eyes were given IL-1alpha. In group-A to D, the examination of tonometry, slit-lamp biomicroscopy and direct ophthalmoscope were taken before treatment and 24 hours after the treatment and were repeated everyday for 4 days. In group-E, tonometry was applied before treatment and 7 days after treatment. In group-F, aqueous humor of two eyes was aspirated for smear examination 24 and 48 hours after treatment, and corneal endothelium microscope and flash-ERG were done in group-G before and 30 to 40 hours after treatment, and then the eyes were enucleated for histology analysis. RESULTS: IOP of the eyes received IL-1alpha was decreased significantly compared with that of contralateral control eyes in group A to D (P < 0.05). Peaking time of IOP reduction was 72 - 96 hours after treatment, and IOP reduction was continued for over 96 hours. The IOP reduction efficiency in group C and D was more significant than those of group E (P < 0.05). No significant abnormal was found with the examinations of slit-lamp biomicroscopy, ophthalmoscope, corneal endothelium microscopy, flash-ERG, smear and histological observation, except for mild focal conjunctival congestion. CONCLUSION: Intraocular reduction were demonstrated with IL-1alpha treatment, charactered by its strong hypotensive effect, long duration and safety.

Animals↗
PubMed1994

[Anatomical risk factors of angle-closure glaucoma. A 10-year study of limbal and axial anterior chamber depths in a risk population].

The present follow up study was undertaken in order to evaluate the predictive value of a low limbal chamber depth (LCD) and axial anterior chamber depth (ACD) over ten years. A population of 539 Greenlanders had been examined in 1979, using LCD estimations and ACD re-measurements by Haag Streit slit lamp pachymetry. ACD had also been measured in the same population 1969. Persons above age 40 in 1989, who were without glaucoma in 1979 and had shown an LCD value < or = 0.25 of corneal thickness (= CT), and an ACD value of < or = 2.70 mm (CT included) were selected as probands. A total of 75 such persons (= 84% of those alive and eligible) were examined in 1989. Five had developed PACG during the ten year period. At the survey seven more PACG cases were detected, yielding a PACG prevalence of 12/75 = 16%. LCD and ACD did not show significant association with eventual PACG status within the sample while gonioscopical status did so (p < 0.02). Creeping, synechial angle-closure was frequent. Among probands not examined, mostly due to death, 5/54 had developed PACG during the ten year period. Non-probands had their records scrutinized for PACG; yet among the 258 persons above age 40 no PACG case was found. Thus a fairly simple, anatomical slit lamp evaluation/measurement of limbal and axial anterior chamber depths was found to effectively select a subgroup which over ten years proved to be at risk of PACG-development.

Adult↗
PubMed1982

Ocular albumin fluorophotometric quantitation of endotoxin-induced vascular permeability.

Bacterial endotoxin (lipopolysaccharide; LPS) is known to alter systemic vascular permeability, but this effect is difficult to monitor and quantitate in vivo. The ocular vessels of the rabbit are particularly sensitive to LPS. Using a slit lamp equipped with a fluorophotometer, we have adapted a method to quantitate endotoxin-induced ocular vascular permeability by measuring the accumulation of fluorescein isothiocyanate-conjugated albumin into the anterior chamber of the eye. After intravenous administration of Salmonella typhimurim LPS, the anterior chamber fluorescence and blood fluorescence were measured at intervals of 15 min and 1 h, respectively, over 4 h. In controls, maximal fluorescence in the anterior chamber was 3.1 +/- 0.8% of blood fluorescence. Doses of LPS as low as 0.25 mug/kg produced an ocular/serum fluorescence ratio of 17.6 +/- 4.9. A dose of 2.5 mug of LPS per kg tended to produce a higher ratio (68.0 +/- 7.1) than a larger dose of 50 mug/kg (30.5 +/- 16.6). Permeability changes began within 30 min after LPS, and the rate of dye accumulation varied over time, with maximal leakage usually occurring 90 min after LPS, but occasionally occurring much later. Repeated doses produced tolerance. By conjugating albumin to rhodamine and utilizing a second filter with the slit lamp to measure accumulation of this dye, we demonstrated the persistence of marked permeability during a period when intraocular fluorescein isothiocyanate and albumin levels were relatively constant. This methodology indicates that extremely low doses of LPS induce ocular permeability changes and that neither the time course nor the dose response of this effect is linear. Ocular fluorophotometry is a sensitive, noninvasive technique to study the dynamics and pharmacology of LPS-induced permeability changes.

Animals↗
PubMed2005

Effects of a 0.9% sodium chloride ophthalmic solution on the ocular surface of symptomatic contact lens wearers.

BACKGROUND: Ocular surface-related discomfort is the main reason for stopping contact lens wear. We carried out a study to evaluate the efficacy of preservative-free artificial tears containing 0.9% sodium chloride on ocular surface signs and symptoms in contact lens wearers experiencing discomfort and its possible influence on the duration of contact lens wear. METHODS: We studied 49 contact lens wearers experiencing discomfort who had normal results of slit-lamp biomicroscopy, a fluorescein tear film break-up time (BUT) of 10 seconds or more, and wetting greater than 5 mm in 5 minutes on the Schirmer 1 test with and without anesthesia. Twenty-nine subjects (16 men and 13 women with a mean age of 32.5 years [standard deviation (SD) 8.7 years]) received one instillation of the 0.9% sodium chloride solution four times daily in the lower conjunctival fornix for 21 days. Twenty subjects (12 men and 8 women with a mean age of 35.1 [SD 6.2] years) received no drops and served as a control group. The overall comfort and duration of contact lens wear, results of tear film analysis and adverse events were recorded on days 7 and 21. Patients rated their symptoms (while not receiving any medications or hydrating solutions) on a 100-mm visual analogue scale with "Excellent (lenses not felt)" at the left and "Very uncomfortable (lenses cause irritation or discomfort)" at the right. Measurement of corrected visual acuity, slit-lamp examination, determination of the tear film BUT, the Schirmer 1 test with and without anesthesia, and assessment of the colour and surface of the lens were performed at baseline and at day 21. We analysed the data for the more uncomfortable eye or, if the eyes were equally uncomfortable, the right eye. RESULTS: Significant lessening of ocular discomfort was observed in the treatment group during the study: the mean rating on the visual analogue scale at baseline was 60.2 mm (SD 12.7 mm), compared with 35.8 mm (SD 18.0 mm) at day 21 (p < 0.001, Student's t test). The duration of contact lens wear was significantly longer at day 21 than at baseline (7.0 [SD 2.6] hours vs. 6.4 [SD 2.6] hours, p < 0.05, Student's t test), and the proportion of subjects with conjunctival hyperemia was significantly lower at day 21 (48.3% vs. 82.8%, p < 0.05, chi2 test). No statistically significant changes were observed in tear film BUT, results of the Schirmer 1 test, corneal punctate staining by fluorescein or results of tear film analysis. The treatment was well tolerated by all patients. No significant differences in any of the variables studied were observed in the control group. INTERPRETATION: Treatment with a preservative-free 0.9% sodium chloride ophthalmic solution reduced ocular surface discomfort and extended the duration of contact lens wear without interfering with the tear film or contact lens materials. Long-term studies are needed to confirm the role of this solution in reducing discomfort experienced by contact lens wearers.

Adult↗
PubMed2000

Methods for detecting age-related maculopathy: a comparison between photographic and clinical assessment.

PURPOSE: To examine the sensitivity, specificity and overall agreement between photographic and clinical assessment in detecting age-related maculopathy (ARM) features in the context of an epidemiological study, the Vitamin E, Cataract and Age-related Maculopathy Study (VECAT). METHODS: A total of 1204 volunteers aged between 55 and 80 years of age, who were enrolled in the VECAT Study, had both slit-lamp biomicroscopy examination and fundus photos taken as part of the baseline ophthalmic examination. The Nidek 3-DX fundus camera (Nidek, Gamagori, Japan) was used to produce paired, one-framed, coloured, 15 degrees stereoslides of the macular area at a fixed angle. An International Classification and Grading System for Age-related Maculopathy and Age-related Macular Degeneration was used to grade the stereoslides. Agreement in the detection of drusen, pigment abnormalities, and late stage ARM features was assessed using unweignted kappa statistic. Cases of disagreement were verified using clinical data records, grading documentation and the review of stereoslides. RESULTS: Macula status was available for 2386 eyes. For drusen of size < 63 microm, sensitivity was 47%, specificity was 68% with a kappa value of 0.20. For drusden > or = 125 microm, sensitivity and specificity were > or =81%. Kappa values ranged from 0.56 to 0.71. Levels of agreement for pigment abnormalities and late ARM were in the substantial range (i.e. kappa values from 0.70 to 1.00). CONCLUSIONS: Slit-lamp biomicroscopy was found to be comparable to photograding (using the Nidek 3-DX fundus camera) for detecting features pertaining to ARM. However, given the objectivity and permanency of stereoslides, photograding is still the more reliable and the preferred system of assessing ARM in the context of an epidemiological study.

Aged↗
PubMed1987

Cataracts and hypertension in salt-sensitive rats. A possible ion transport defect.

In previous unrelated studies, we observed a 35 to 50% incidence of cataract formation in several groups of Dahl salt-sensitive hypertensive rats (DS) over a 4-year period. In the present study we evaluated longitudinal changes in blood pressure in DS in which cataracts eventually developed and those in which cataracts did not develop when all animals were maintained on a high sodium diet. Lenses were evaluated by slit-lamp microscopy to determine if cataractous lesions were similar among rats, to classify lesion types, and to define the age at which cataracts were detectable in DS. The possible participation of several cataractogenic risk factors as major influences on cataract formation also was evaluated. Finally, aqueous humor concentrations and lenticular content of sodium and potassium were determined to evaluate the possibility that a defect in ion transport at the lens epithelium and ciliary body might play a role in cataractogenesis in DS, since ion transport defects have been shown to lead to lens opacification in other models of genetic and experimental cataracts. Parallel studies were performed in Dahl salt-resistant control rats (DR). A high incidence of cataract formation was found in DS. Although systolic blood pressure was not consistently greater in adult DS with cataracts compared with values in age-matched DS without cataracts, the initial pressor response to a high salt diet was greatest in weanling DS in which cataractous lesions later developed. Slit-lamp analysis revealed that cataracts in this genetic model were cortical, with one mixed cortical, nuclear lesion. Posterior subcapsular lesions were not observed, suggesting that lesions were not steroid-induced.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1977

[Eugenic significance of linkage between the gene loci for dystrophia myotonica (Steiner's disease) and ABH-secretor].

36 relatives of 2 patients with myotonic dystrophy (M.d.) were investigated during a field study. All were neurologically examined at home and their ABO blood groups and ABH-secretor phenotypes in parotid saliva were determined for linkage analyses. Additional investigations such as EMG or slit-lamp examinations were carried out by specialists in doubtful cases. Nine additional patients presenting with varying clinical manifestations of M.d. were found. In most of the secretor-positive individuals the corresponding genotypes could be identified as heterozygotes (Sese) through the segregation pattern of their first-degree relatives. In both families the allele for M.d. was linked to the dominant allele Se, the probability being greater than 99%. A recombination was observed in 1 patient of either family. This is, however, fairly consistent with the expected recombination fraction of 0.08. No further linkage information was obtained from determinations of the Lutheran blood groups carried out in family no. 1 only, since all individuals were of the most frequent type Lu (a-/b+). In 5 out of 8 matings between M.d. patients and healthy spouses the secretor genoypes were potentially informative for the estimation of risk of their children being affected or for prenatal diagnoses. The secretor analyses and special tests for the detection of preclinical cases (e.g. by slit-lamp) and their practical value for genetic counseling are discussed, especially with regard to the limitations, which derive partly from low probabilities in the predictions even in some of the so-called informative matings, and partly also from the recombinations to be expected.

ABO Blood-Group System↗
PubMed1982

Fluorescein kinetics in perilymph and blood: a fluorophotometric study.

A modified slit lamp fluorophotometer was used to determine fluorescein concentration changes in the perilymph, cerebrospinal fluid and blood of chinchillas after intravenous injection of 0.2 ml of fluorescein sodium. This new technique provides a means of determining quantitative changes of fluorescein concentration in the perilymph without the need to withdraw fluid samples through the round window membrane of cochlear wall. Fluorescein was observed to enter the perilymph between 1 and 2 minutes after injection, and it reached its peak concentration in the mean time of 23 minutes. The mean peak concentration was 4.20 X 10-6 g/ml. Both increasing and decreasing fluorescein concentration changes in the perilymph followed an exponential time course. Although the observations of cerebrospinal fluid fluorescence were thought to represent a composite of the fluorescence of the cerebrospinal fluid itself and the underlying brain stem blood vessels, the peak fluorescence did not exceed that observed in the perilymph. These observations support the view that most of the perilymph is produced in the cochlea by ultrafiltration from the cochlear blood vessels. The slit lamp fluorophotometer appears to be a satisfactory means of recording fluorescein concentration changes in the perilymph without disturbing the cochlear physiology by penetrating the labyrinth to obtain fluid samples.

Animals↗
PubMed2002

Artisan phakic intraocular lens for myopia:short-term results of a prospective, multicenter study.

PURPOSE: To evaluate the safety and efficiency of the Artisan iris-supported phakic intraocular lens (Ophtec BV, Groningen, Netherlands) for the correction of high myopia. STUDY DESIGN: Nonrandomized, prospective, multicenter trial conducted under a United States Food and Drug Administration (FDA) Investigational Device Exemption. PARTICIPANTS: One hundred fifty-five eyes of 155 patients with myopia from -5.5 to -22.5 diopters (D) underwent implantation of an Artisan lens, as part of a phase I, II, or III FDA trial. METHODS: Eyes were examined at 1 day (154 eyes), 2 weeks (142 eyes), 2 months (130 eyes), and 6 months (84 eyes). Intraocular pressure and presence of flare and cell on slit-lamp biomicroscopy were recorded at each visit. MAIN OUTCOME MEASURES: Achieved correction, stability of spherical equivalent refraction, change in astigmatism, postoperative uncorrected vision, change in best spectacle-corrected acuity, and change in endothelial cell count. RESULTS: Mean spherical equivalent manifest refraction stabilized on postoperative day 1. Mean difference between attempted and achieved correction at 2 months was -0.32 +/- 0.95 D (mean +/- standard deviation; range, -4.42 to +2.2 D). At 6 months, 85% of eyes saw 20/40 or better uncorrected, and 90% of eyes were within 1 D of the attempted correction. Refractive astigmatism increased in 4.8% of eyes and decreased in 17% of eyes at 6 months. At 2 months, six eyes (4.8%) lost two or more lines of best spectacle-corrected visual acuity; by 6 months, no eyes lost two or more lines of best-corrected visual acuity. Endothelial cell count was unchanged at 6 months compared with the preoperative count. Nonprogressive lens opacities developed in four eyes as a result of surgical trauma. Chronic inflammation was not detected in any eye by slit-lamp biomicroscopy, nor did any eye develop angle closure or glaucoma. CONCLUSIONS: Short-term results suggest that the Artisan lens is an accurate and safe method for the correction of high myopia. Surgical skill is important in avoiding lens opacities. Longer-term data are needed to assess the impact of the lens on the endothelium, the crystalline lens, and the iris.

Adult↗
PubMed1998

In vivo confocal microscopic analysis of corneal allograft rejection in rabbits.

PURPOSE: To demonstrate in vivo confocal microscopic features of corneal allograft rejection that may be useful for differentiating graft rejection from other conditions. METHODS: Corneal donor buttons from Dutch Belted (DB) pigmented rabbits were transplanted orthotopically into New Zealand White (NZW) recipient corneal beds. Slit-lamp and confocal microscopic examinations were performed every 3 days thereafter until the time of graft failure. RESULTS: Allograft-rejection signs began to appear during the fourth postoperative week. In epithelial rejection, small inflammatory cells were visualized forming a linear rejection line mixed with larger damaged epithelial cells. Subepithelial infiltrates (SEIs) could be discerned as aggregates of small and highly refractile inflammatory cells within the extracellular matrix. An area of stromal rejection showed increased reflectivity of stromal edema with numerous small infiltrated inflammatory cells. Keratic precipitate (KP) was visualized to be protruding into the anterior chamber with surrounding normal polygonal endothelial cells at its base. Endothelial rejection lines were formed by cellular aggregates of small inflammatory cells and damaged larger endothelial cells with pyknotic highly reflective nuclei. With the progression of endothelial rejection, damaged endothelial cells decreased in number, increased in size, and extended pseudopod-like cytoplasmic structures. CONCLUSION: In vivo confocal microscopy can provide us with detailed histopathology of corneal graft rejection, which might be useful for differentiating immune rejection from other graft conditions and may provide a technique for early diagnosis of rejection before slit-lamp findings.

Animals↗
PubMed1995

Ophthalmoscopic measurement of the optic disc.

PURPOSE: The authors evaluated whether the optic disc dimensions can be measured directly by ophthalmoscopy without the use of a fundus camera or special ophthalmoscope. MATERIALS AND METHODS: The horizontal and vertical disc diameters were measured ophthalmoscopically in 158 eyes of 95 subjects using a standard Goldmann three-mirror contact lens and a commercial slit lamp with adjustable length of the beam. The refractive error ranged from -7.25 to 3.5 diopters. Based on these direct measurements, the authors calculated the disc area by applying a modified formula for an ellipse, where area = pi/4 x the horizontal diameter x the vertical diameter. Additionally, the authors determined by planimetry the diameters and area of the disc on color photographs after correcting the ocular and photographic magnification. RESULTS: The values of the disc diameters as determined by photography were x1.27 larger than those measured with the Goldmann contact lens. Taking into account this constant correction factor of 1.27 for all eyes examined, the disc diameters, as measured by the Goldmann lens, varied by 0.11 +/- 0.06 mm or 5.8% +/- 3.5% from the values measured on the photographs. This error decreased slightly (P = 0.04) with increasing disc size. It was independent of the refractive error. The calculated disc area based on the ophthalmoscopically determined disc diameters differed by 9.4% +/- 6.6% from the disc area as measured by planimetry on the photographs. CONCLUSIONS: For clinical purposes, the optic disc and other structures of the posterior fundus can be measured by ophthalmoscopy using a Goldmann contact lens and a slit lamp with adjustable beam length. The optic disc area can be calculated by the formula: horizontal disc diameter x vertical disc diameter x pi/4.

Adult↗
PubMed2001

The effect of degree of refractive error on hydrogel contact lens-induced complications and patient self-management behaviors.

INTRODUCTION: Although many aspects of hydrogel lens wear have been explored over the last 20 years, little attention has been paid to the role of refractive error magnitude in determining patients' ocular responses or associated contact lens behaviors. METHODS: A cross-sectional study was conducted in 32 optometric and ophthalmologic practices. We enrolled 2161 spherical soft contact lens-wearing patients. High ametropes were defined as those with at least +/- 5.00 D spherical equivalent refractive error in the right eye. Data on current contact lenses, prescribed care regimens, and slit lamp biomicroscopic signs were provided by the eye care practitioners, and information on actual lens care behaviors and attitudes toward contact lens wear were gathered by survey directly from the patients. All differences between high and low ametropes were compared using the chi-square test. RESULTS: Compared with low ametropes, high ametropes were more satisfied with their vision with contact lenses (p < 0.001). More high ametropes wore their lenses on an extended-wear schedule (p = 0.015). Both groups of patients reported a similar degree of lens awareness and lens-associated pain, but fewer high ametropes reported foreign body sensation (p = 0.002). In managing contact lens discomfort, high ametropes were more likely to use an old spare lens (p = 0.01) and more likely to continue wearing their lenses (p = 0.016)--indicators of a propensity for self-management. In response to a damaged lens, high ametropes were less likely to remove both of their lenses (p = 0.002). High ametropes showed more conjunctival staining (p = 0.001) and more corneal scars (p = 0.033). High ametropes also presented with more corneal fluorescein staining (p = 0.001) and more corneal vascularization (p < 0.001). These relations between the degree of ametropia and slit lamp signs of contact lens wear were not significantly affected by daily- vs. extended-wear status. CONCLUSIONS: In summary, practitioners should consider the implications of the patient's degree of ametropia when prescribing contact lenses. These results indicate the need for closer observation and specific advice concerning management of contact lens-related problems when caring for patients with high refractive errors.

Adult↗
PubMed2006

Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography.

BACKGROUND: To describe the use of anterior segment optical coherence tomography (OCT) in imaging intrableb morphology after trabeculectomy. METHODS: 14 post-trabeculectomy eyes from 11 primary open angle glaucoma and 3 primary angle closure glaucoma subjects were studied. The blebs were classified with reference to slit lamp morphology and bleb function. They included diffuse filtering (n = 7), cystic (n = 2), encapsulated (n = 2) and flattened (n = 3) bleb types. One eye in each patient was imaged with the Visante anterior segment OCT. A vertical scan line of 10 mm consisting of 512 A-scans was positioned at the centre of the bleb. The images were then analysed by built-in software. Intrableb morphologies and structures, including bleb wall thickness, subconjunctival fluid collections, suprascleral fluid space, scleral flap thickness, intrableb intensity (low, medium or high) and the route under the scleral flap were characterised and measured. RESULTS: Diffuse filtering blebs were found by subconjunctival fluid collections. Suprascleral fluid space and the route under the scleral flap were identified in four of the seven cases. Cystic blebs were composed of a large hyporeflective space with multiloculated fluid collections covered by a thin layer of conjunctiva. Encapsulated blebs had a thick bleb wall with high reflectivity and an enclosed fluid filled space. Flattened blebs demonstrated high scleral reflectivity and no bleb elevation. CONCLUSIONS: Visante anterior segment OCT can be used for bleb imaging. The different patterns of intrableb morphology identified by OCT were related to slit lamp appearance and bleb function. This information may be useful to study the different surgical outcomes and the process of wound healing in trabeculectomised eyes.

Adult↗
PubMed2000

Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva.

OBJECTIVE: To evaluate the effects of oleoresin capsicum (OC) on the human cornea and conjunctiva and to test the effectiveness of topical anesthetics for relief of pain. DESIGN: Prospective, randomized clinical trial. METHODS: Forty-seven subjects were examined before and at 10 minutes and 1 hour after exposure to pepper spray during a training exercise. Eleven subjects were reexamined at 1 week after exposure. A short, subjective questionnaire was given asking subjects to rate their pain, blurring of vision, and tearing. After exposure, subjects were randomly given a placebo, a topical nonsteroidal antiinflammatory agent, or a topical anesthetic. MAIN OUTCOME MEASURES: Visual acuity and corneal sensitivity with a Cochet-Bonnet aesthesiometer (scale of 1-6 cm) was measured and the eyes were examined with a portable slit lamp using fluorescein. Symptoms of pain, blurring of vision, and tearing were recorded in a ranking of 0 to 10. RESULTS: Visual acuity was unaffected by exposure to pepper spray. Corneal sensitivity was reduced from a pretest mean of 5.7 cm to a posttest mean of 0.6 cm 10 minutes after exposure. At 1 hour, the mean corneal sensitivity had recovered to 2.9 cm. Twenty-one percent of eyes had evidence of punctate epithelial erosions, but no corneal abrasions were found. All subjects reported significant pain, blurring of vision, and tearing at 10 minutes that was much improved by 1 hour. Topical flurbiprofen 0.03% improved symptoms in two of 11 subjects, whereas topical proparacaine hydrochloride 0.5% improved symptoms in 16 of 29 eyes. At 1 week after exposure, corneal sensation returned to baseline, and no corneal abnormalities were noted. CONCLUSIONS: The predominant symptom after exposure to OC was pain. Topical flurbiprofen was not helpful in reducing symptoms of exposure, whereas topical proparacaine was effective in relieving pain in most subjects. Corneal sensitivity was dramatically reduced at 10 minutes after exposure and was improved after 1 hour. At 1 week, corneal sensation had returned to normal, as had slit-lamp appearance on all subjects examined.

Adult↗
PubMed2007

In vivo laser confocal microscopy findings for Bowman's layer dystrophies (Thiel-Behnke and Reis-Bücklers corneal dystrophies).

OBJECTIVE: To investigate microstructures in patients with genetically confirmed Bowman's layer dystrophies (Thiel-Behnke or Reis-Bücklers corneal dystrophy) using an in vivo laser scanning confocal microscope. DESIGN: Single-center, prospective, comparative small case series. PARTICIPANTS: Two patients from one pedigree (a 29-year-old woman and 58-year-old man) with Thiel-Behnke corneal dystrophy (Arg555Gln [R555Q] heterozygous missense mutation of human transforming growth factor beta-induced [TGFBI] gene) and 3 patients from one pedigree (a 70-year-old woman, 58-year-old man, and 14-year old man) with Reis-Bücklers corneal dystrophy (Arg124Leu [R124L] heterozygous missense mutation of the TGFBI gene) were examined. Two patients with Reis-Bücklers corneal dystrophy exhibited recurrence after corneal transplantation. TESTING: All patients were examined by slit-lamp biomicroscopy. The center and the peripheral cornea of both eyes also were examined by in vivo laser scanning confocal microscopey. Image analysis was used to identify the corneal epithelial and stromal deposits correlated with each disorder. MAIN OUTCOME MEASURES: Selected images of the corneal layers were evaluated qualitatively for the shape and degree of light reflection of the deposits. RESULTS: In each dystrophy, distinct characteristic deposits were observed in the epithelium and Bowman's layer, respectively, by in vivo laser scanning confocal microscopy. In Thiel-Behnke corneal dystrophy, the deposits in the epithelial basal cell layer showed homogeneous reflectivity with round edges accompanying dark shadows. In contrast, deposits in Reis-Bücklers corneal dystrophy in the same cell layer showed extremely high reflectivity from small granular materials without any shadows in all cases. In each dystrophy, Bowman's layer was replaced totally with pathological materials; the reflectivity of those materials is much higher in Reis-Bücklers corneal dystrophy than in Thiel-Behnke corneal dystrophy. CONCLUSIONS: In vivo laser scanning confocal microscopy is capable of identifying in vivo corneal microstructural changes related to Thiel-Behnke and Reis-Bückler corneal dystrophy with a higher resolution than is available with slit-lamp biomicroscopy or in vivo white-light confocal microscopy. As a result, this device may enable differentiation of Thiel-Behnke and Reis-Bücklers corneal dystrophy in vivo. In vivo laser scanning confocal microscopy also may be a valuable tool for further research into the corneal dystrophies, especially to follow the natural course.

Adolescent↗
PubMedDate not supplied

Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach.

We determined the "normal" central corneal thickness (CCT) value in human corneas based on reported literature values for within-study average CCT values, and used this as a reference to assess the reported impact of physiological variables (especially age and diurnal effects), contact lens wear, pharmaceuticals, ocular disease, and ophthalmic surgery on CCT. With the expected CCT and its variance defined, it should be possible to determine the potential impact of differences in CCT in intraocular pressure (IOP) assessments, especially by applanation tonometry, using a meta-analysis approach. Some 600 sets of CCT data were identified from the worldwide literature over the period of 1968 through mid-1999, of which 134 included IOP measures as well. The within-study average CCT values and reported variance (SD) was noted along with the number of eyes and any special characteristics, including probable ethnic origin of the study subjects. Various sets of data were subjected to statistical analyses. From 300 data sets from eyes designated as normal, the group-averaged CCT was 0.534 mm. From 230 data sets where interindividual variance was reported, the group-averaged CCT was 0.536 mm (median 0.536 mm; average SD of 0. 031 mm, average coefficient of variation = 5.8%). Overall, studies using slit-lamp-based pachometry have reported marginally lower CCT values (average 0.530 mm, average SD 0.029 mm) compared to ultrasound-based studies (average 0.544, average SD 0.034 mm), which perhaps reflects the type of individual studied (non-surgical vs. pre-surgical patients) rather than the technique itself. A slight chronological increase in reported average CCT values (approximately 0.006 mm/decade) was evident, but a substantial chronological increase was evident for ultrasound pachometry studies (approximately 0.015 mm/decade). Within the meta-analysis-generated average and variance, age had no obvious impact on CCT measures for *whites, although an age-related decline in CCT is evident for non-whites. Any diurnal effects are likely concealed within the expected variance in CCT. Contact lens wear and pharmaceuticals generally produced changes in CCT that were well within the expected variance in CCT. Of the ocular diseases, only those associated with collagen disorders (including keratoconus) or endothelial-based corneal dystrophies (e.g., Fuchs) were likely to result in decreases or increases, respectively, of CCT beyond the normal variance. Routine contact lens wear and diseases such as diabetes seem unlikely to produce changes in CCT of a magnitude that would justify pachometry as a monitoring method beyond routine slit-lamp evaluation. Increases in CCT beyond the expected variance were reported after a range of intraocular surgeries (cataract operations, penetrating keratoplasty), whereas photorefractive surgery produces a measurable decrease in CCT. A meta-analysis of possible association between CCT and IOP measures of 133 data sets, regardless of the type of eyes assessed, revealed a statistically significant correlation; a 10% difference in CCT would result in a 3. 4 +/- 0.9 mm Hg difference in IOP (P </= 0.001, r = 0.419). The observed phenomenon was much smaller for eyes designated as healthy (1.1 +/- 0.6 mm Hg for a 10% difference in CCT, P = 0.023, r = 0. 331). For eyes with chronic diseases, the change was 2.5 +/- 1.1 mm Hg for a 10% difference in CCT (P = 0.005, r = 0.450), whereas a substantial but highly variable association was seen for eyes with acute onset disease (approximately 10.0 +/- 3.1 mm Hg for a 10% difference in CCT, P = 0.004, r = 0.623). Based on the meta-analysis, normal CCT in white adults would be expected to be within +/-11.6% (+/-2 SD) of 0.535 mm, i.e., 0.473-0.597 mm (95% CI, 0.474-0.596). The impact of CCT on applanation tonometry of healthy eyes is unlikely to achieve clinical significance, but for corneas of eyes with chronic disease, pachometry should be performed if the tonometry reveals IOP readi

Aging↗
PubMed2003

Long-term progression of astigmatism after penetrating keratoplasty for keratoconus: evidence of late recurrence.

PURPOSE: To study changes in astigmatism throughout a 20-year period using keratometry and refraction in patients who underwent penetrating keratoplasty (PKP) for keratoconus. METHODS: We reviewed the charts of patients who underwent PKP for keratoconus from 1975 to 1979 and recorded preoperative refraction, stage of keratoconus, laterality of surgery, graft size, suture technique, time of suture removal, keratometry, subjective refraction at 1, 3, 5, 7, 10, 15, 20, and 25 years after suture removal, and slit-lamp findings. RESULTS: Eighty eyes with a mean follow-up of 20 years (range, 15-25) were included in the study. Graft size, suture technique, and time of suture removal had no significant influence on the astigmatism at the last examination. We observed a stabilization of keratometric astigmatism in the first 7 years (4.05 +/- 2.29 D 1 year after suture removal, 3.90 +/- 2.28 D at year 3, 4.03 +/- 2.49 D at year 5, 4.39 +/- 2.48 D at year 7) followed by a progressive increase from 10 years after suture removal until the last follow-up visit (5.48 +/- 3.11 D at year 10, 6.43 +/- 4.11 D at year 15; 7.28 +/- 4.21 D at year 20, and 7.25 +/- 4.27 D at year 25). The mean absolute value of the difference vector (DV) calculated by vector analysis was 7.17 +/- 4.35 D (0-18.33). In 70% of cases, progression of the astigmatism was evident with mean absolute DV of 9.10 +/- 3.65 D. There was a significant correlation between the preoperative and final axis of astigmatism (Pearson r = 0.39, p = 0.0008). There was also a slight positive correlation coefficient between the DV of the eyes in bilateral cases, but it was not significant (Spearman's r = 0.2226, p = 0.34). The major late slit-lamp finding was a peripheral crescent-shaped thinning at the graft-host junction with absence of Bowman's layer on histopathology. CONCLUSION: In spite of refractive stability obtained during the first years after PKP for keratoconus, increasing astigmatism thereafter suggests that there is a progression of the disease in the host cornea.

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