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PubMed1991

Clinical experience with the laser indirect ophthalmoscope.

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

Diabetic Retinopathy↗
PubMed1990

[The relationship between ophthalmoscopic changes and classification of toxemia in toxemia of pregnancy].

Based on ophthalmoscopic findings, 30 toxemic patients were divided into three types: R-type; retinal vascular occlusion type, C-type; choroidal vascular occlusion type, R + C-type; mixed vascular occlusion type. R-type (5 cases) and R + C-type (7 cases) significantly correlated to superimposed preeclampsia. C-type (18 cases) significantly correlated to preeclampsia (pregnancy-induced hypertensive disorder: PIH). Clinical examinations (urine protein, platelet, fibrinogen, fibrin degradation product, partial thromboplastin time and prothrombin time) had no relation to the types of ophthalmoscopic classification. It was concluded that preeclampsia (PIH) and superimposed preeclampsia have different influences on the ocular fundus.

Adult↗
PubMed1986

Pseudopapilledema secondary to optic nerve drusen: ophthalmoscopic differentiation.

Two cases of pseudopapilledema secondary to optic nerve drusen were presented. The first case demonstrated the difficulty of ophthalmoscopic differentiation in children and the possible misapplication of invasive neurologic procedures. The second case report demonstrated the relatively greater ease of ophthalmoscopic differentiation in adults and the familial and progressive nature of optic nerve drusen. Also presented were some of the possible sequelae of this condition.

Adult↗
PubMed1982

Ophthalmoscopic model of nerve fiber bundle defects in monkey eyes produced by intraocular retinal coagulation.

The development of nerve fiber bundle defects in monkey eyes by means of intraocular retinal coagulation, such as endodiathermy, intraocular cryotherapy or endophotocoagulation was confirmed by ophthalmoscopy. Two to 4 days after the application of intraocular retinal coagulation, the findings could be already observed. Endodiathermy especially could provide the typical ophthalmoscopic findings of nerve fiber bundle defects without any abnormal fluorescein angiographic findings, while endophotocoagulation and intraocular cryotherapy induced hyperfluorescence due to window defect at the coagulation site. Therefore, endodiathermy in monkey eyes can provide an excellent ophthalmoscopic model of the nerve fiber bundle defects. Histological findings 8 weeks after the coagulation showed thinning of the retinal nerve fiber layer and gliosis occurring in the retinal portion corresponding to the lesion.

Animals↗
PubMed1993

Planned combined I-125 plaque irradiation and indirect ophthalmoscope laser therapy for choroidal malignant melanoma.

We studied the short-term impact of planned sequential episcleral I-125 plaque irradiation and indirect ophthalmoscope laser therapy in a series of 25 patients with choroidal or ciliochoroidal malignant melanoma. In a case-by-case matched comparison study, we evaluated the relative local regression of tumors which did and did not receive planned supplemental laser therapy following plaque treatment. The tumors treated with supplemental laser regressed substantially faster and more completely than those treated by plaque alone. Planned sequential I-125 plaque irradiation combined with indirect ophthalmoscope laser therapy appears to be a more effective local-tumor treatment than plaque radiotherapy alone.

Aged↗
PubMedDate not supplied

Ophthalmoscopic observation of the retinal nerve fiber layer.

Alterations of the retinal nerve fiber layer occur as a result of diseases affecting the anterior visual pathway. Optimal viewing conditions, familiarity with the appearance of the normal nerve fiber layer, precise focus, and a high index of suspicion are necessary for the ophthalmoscopic observation of pathologic alteration in the nerve fiber layer. The observer must learn to differentiate pseudodefects (reflexes) from true defects (areas of nerve fiber layer atrophy). Nerve fiber layer changes appear ophthalmoscopically as generalized attrition, slit defects, sector defects (all types of atrophic change), or changes in the appearance of the nerve fiber layer itself. These alterations, which occur in numerous conditions including congenital hemianopia, ocular hypertension and glaucoma, multiple sclerosis, acute Leber optic neuropathy, trauma, severe hypertension, congenital and heredity optic atrophy, toxic amblyopia, papilledema, retinochoroiditis, and following photocoagulation, may be of critical diagnostic importance.

Adult↗
PubMed1977

The Fuchs' spot: an ophthalmoscopic and fluorescein angiographic study.

A correlation of funduscopic and fluorescein angiographic findings in the Fuchs' spot of high myopia is presented. A variety of ophthalmoscopic changes indicate that both serous and hemorrhagic detachments of the retinal pigment epithelium and neurosensory retina are associated with this lesion. Fluorescein angiography, however, reveals subretinal reovascularization from the choroid as the basic underlying disease in most cases reviewed. Wide variations in the ophthalmoscopic appearance of the pigmented maculopathy of high myopia necessitate a more descriptive approach than that indicated by the term "Fuchs' spot." Fluorescein angiography becomes a necessity to delineate neovascular lesions as paracentral tufts may possibly be treated with laser photocoagulation to reduce progression.

Adult↗
PubMed1998

[The differential diagnosis of a prominent papilla nervi optici--the ophthalmoscopic and angiofluorographic aspects].

In the beginning, the paper presents an up-to-date of the theoretical concepts about the structure, vascularisation, ophthalmoscopical and angiographical appearance of the optic disc. The next part reveals the most important situations in which the optic disc become prominent, sustained by ophthalmoscopic and fluorescein angiographic images. The final part contains the practical conclusions.

Diagnosis, Differential↗
PubMed1998

Simultaneous indocyanine green and fluorescein angiography using a confocal scanning laser ophthalmoscope.

BACKGROUND: Fluorescein and indocyanine green (ICG) angiography are both useful in the diagnosis and treatment of many retinal diseases. In some cases, both tests must be performed for diagnosis and treatment; however, performing both is time-consuming and may require multiple injections. METHODS: We designed a compact digital confocal scanning laser ophthalmoscope to perform true simultaneous fluorescein and ICG angiography. We report our experience using the instrument to perform 169 angiograms in 117 patients. RESULTS: There were no unexpected adverse effects from mixing the dyes and administering them in 1 injection. An entire examination, including fundus photography, fluorescein angiography, and ICG angiography, could be performed in 45 minutes. It was possible to study differences in fluorescein patterns by comparing identically timed frames and to find cases in which ICG or fluorescein was optimal in visualizing retinal and subretinal structures. Confocal optical sections in the depth (z) dimension allowed viewing in different planes. It was possible to overlay ICG and fluorescein images or compare them side-by-side using a linked cursor. Digital transmission of the images was also performed. CONCLUSIONS: Simultaneous ICG and fluorescein angiography can be performed rapidly, safely, and conveniently. The availability of simultaneous angiography will allow critical determination of the relative advantages and disadvantages of both types of angiography.

Choroid↗
PubMed2000

Scanning laser ophthalmoscope correlations with biomicroscopic findings and foveal function after macular hole closure.

OBJECTIVE: To investigate the relation between foveal findings and visual function in eyes with a resolved idiopathic macular hole after vitreous surgery. METHODS: We divided 28 eyes with postoperative idiopathic macular hole resolution into 3 groups based on postoperative biomicroscopic foveal findings of complete closure, partial closure, or atrophic closure. To evaluate foveal retinal function, scanning laser ophthalmoscope (SLO) microperimetry was performed preoperatively and 6 months postoperatively. RESULTS: Postoperatively in 18 eyes (64%), the foveal images became normal or almost normal and were classified as having complete closure, 6 eyes (21%) were classified as having partial closure, and 4 eyes (14%) as having atrophic closure. The corresponding visual acuity levels 6 months postoperatively were, respectively, 0.10, 0.35, and 0.64 (P<.01) based on LogMAR analysis. Preoperative SLO microperimetry detected an absolute scotoma at the bottom of all macular holes; postoperatively, the absolute scotoma disappeared in the 18 eyes with complete hole closure, but a relative scotoma was detected in 6 eyes. Of 6 eyes with partial closure, 1 had an absolute scotoma and 5 had a relative scotoma. An absolute scotoma was detected in 4 eyes with atrophic closure. CONCLUSIONS: After macular hole closure, SLO findings correlate both with biomicroscopic findings and foveal function. Better anatomical foveal recovery in eyes after macular hole closure results in better improvement of vision than in eyes in which the foveal anatomical findings are not as good.

Aged↗
PubMed2001

Clinical investigation of a true color scanning laser ophthalmoscope.

OBJECTIVE: To show true color scanning laser ophthalmoscope (SLO) images produced by simultaneously imaging the retina with red, green, and blue lasers. METHODS: Low-power red, green, and blue lasers were combined using fiber optics. By rapidly pulsing the lasers, each point on the fundus is illuminated by the 3 colors in quick succession, with the total power level being similar to that from a single laser. The reflected light is then decoded to extract the red, green, and blue color information and the true color fundus image is displayed live on a computer monitor. RESULTS: Comparison was made between the color SLO images from 5 patients and their digitized fundus photographs. The background fundus and retinal vasculature showed a similar appearance. The SLO gave better quality information in patients with ocular histoplasmosis, macular dystrophy, and optic disc drusen. By operating the color SLO in the indirect mode, macular edema could be clearly seen as lines and ridges surrounding the fovea. CONCLUSION: The color SLO offers all the advantages of the present commercially available monochromatic device, with the added advantage of true color representation of the fundus without increasing either imaging time or the level of exposure.

Adult↗
PubMed2002

Identifying live nematodes in diffuse unilateral subacute neuroretinitis by using the scanning laser ophthalmoscope.

OBJECTIVE: To describe use of the scanning laser ophthalmoscope (SLO) to identify live nematodes in patients with diffuse unilateral subacute neuroretinitis. METHODS: Infrared, red, and blue illumination (780, 633, and 488 nm, respectively) in an SLO were used to image and evaluate functional retinal status in patients with late-stage diffuse unilateral subacute neuroretinitis. An examination to identify live nematodes was performed in the affected eyes. RESULTS: Using blue illumination, the ocular fundus appeared dark and provided a high-contrast background for the white image of the worm. The red laser was used to perform red-on-red perimetry. We also used perimetry stimulus to stimulate the worm's movement and pinpoint its location. We precisely defined the relation between the fixation point and the worm to plan accurate laser treatment. The infrared laser is safe and comfortable for prolonged examination. Using the SLO, several physicians simultaneously visualized the ocular fundus. Video output from the SLO provided temporal information, excellent for enhancing detection of worms, which was displayed dynamically on video. CONCLUSIONS: Although examination with a fundus contact lens by skilled ophthalmologists is the method of choice, the SLO provides a new examination modality with distinct advantages for identifying live worms in young patients with diffuse unilateral subacute neuroretinitis.

Adolescent↗
PubMed2003

Imaging a child's fundus without dilation using a handheld confocal scanning laser ophthalmoscope.

Images of the fundus were acquired in children without pupil dilation using a prototype handheld confocal scanning laser ophthalmoscope (SLO). A 780-nm laser beam imaged a 20 degrees x 20 degrees area of the fundus while a 645-nm beam scanned a fixation target. Scorable images of the optic nerve, macula, and vessels were obtained in 67 (72%) of 93 eyes from pediatric patients with nystagmus, amblyopia, media opacities, or optic nerve or macular abnormalities. Images were obtained in all eyes of pediatric and adult controls. Unsuccessful imaging was associated with media opacities, high refractive error, and poor cooperation. Disadvantages of the SLO were the inability to detect optic nerve pallor or consistently image the periphery. Advantages of the SLO were seen in children with nystagmus, photophobia, eccentric fixation, cone dystrophy, and mild papilledema.

Adolescent↗
PubMed1977

A hand-held, two-channel stimulator-ophthalmoscope.

A hand-held optical system for presenting focused stimuli on known retinal areas by direct ophthalmoscopy is described. The optical system provides a time-modulated stimulus beam of variable dimension, retinal illuminance, wave-length, and polarization, and a steady background beam of variable retinal illuminance and wavelength. Both beams enter the patient's eye in maxwellian-view for precise control of the ratio of stimulus to background retinal illuminance. The stimulator-ophthalmoscope allows the examiner to compensate easily for variable fixation.

Child↗
PubMed1997

150 years since Babbage's ophthalmoscope.

The discovery of the ophthalmoscope in 1851 is rightly attributed to Hermann von Helmholtz. However, 4 years earlier, in 1847, Charles Babbage nearly invented the instrument that was to revolutionize ophthalmological examination so dramatically.

England↗
PubMed1999

Simultaneous three wavelength imaging with a scanning laser ophthalmoscope.

BACKGROUND: Various imaging properties of scanning laser ophthalmoscopes (SLO) such as contrast or depth discrimination, are superior to those of the traditional photographic fundus camera. However, most SLO are monochromatic whereas photographic systems produce colour images, which inherently contain information over a broad wavelength range. METHODS: An SLO system has been modified to allow simultaneous three channel imaging. Laser light sources in the visible and infrared spectrum were concurrently launched into the system. Using different wavelength triads, digital fundus images were acquired at high frame rates. RESULTS: Favourable wavelengths combinations were established and high contrast, true (red, green, blue) or false (red, green, infrared) colour images of the retina were recorded. The monochromatic frames which form the colour image exhibit improved distinctness of different retinal structures such as the nerve fibre layer, the blood vessels, and the choroid. CONCLUSIONS: A multi-channel SLO combines the advantageous imaging properties of a tunable, monochrome SLO with the benefits and convenience of colour ophthalmoscopy. The options to modify parameters such as wavelength, intensity, gain, beam profile, aperture sizes, independently for every channel assign a high degree of versatility to the system.

Color↗