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Slit-lamp Examination (slit-lamp + examination)
Selected AbstractsA comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathyDIABETIC MEDICINE, Issue 7 2003J. A. Olson Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source] Tubulointerstitial nephritis and uveitis (TINU) syndrome: a case report and review of the literatureACTA OPHTHALMOLOGICA, Issue 6 2009Veronica Holm Thomassen Abstract. Purpose:, We aim to describe the first case of tubulointerstitial nephritis and uveitis (TINU) syndrome reported in Scandinavia and to underline the importance of the syndrome, which should be better known among ophthalmologists. Methods:, We report an 11-year-old boy who was admitted to hospital because of general fatigue and weight loss. Blood tests showed renal insufficiency and a renal biopsy revealed acute tubulointerstitial nephritis. One week after admission the patient developed transitory blurred vision and flickering shadows in the left eye. Slit-lamp examination revealed bilateral anterior non-granulomatous uveitis and TINU syndrome was diagnosed. Results:, Because of renal insufficiency the patient was treated with systemic prednisone 50 mg/day for 3 weeks. Evolution was favourable, and prednisone was tapered over 10 weeks. Uveitis was treated with topical steroid with good effect. The only complication after 18 months of follow-up was transitory cushingoid aspect. Conclusions:, Tubulointerstitial nephritis and uveitis syndrome is a rare syndrome that is probably underdiagnosed in clinical practice. Co-operation between ophthalmologists and nephrologists/paediatricians is crucial for early diagnosis and instigation of treatment. Uveitis may occur before tubulointerstitial nephritis or the renal symptoms may be so mild that the patient is unaware of them. Therefore, ophthalmologists play an important role in the initial discovery of patients with TINU syndrome. Tubulointerstitial nephritis tends to be self-limiting, whereas uveitis tends to relapse and recurrences tend to be more severe than the initial uveitis. Therefore, the patient must be ophthalmologically monitored very carefully. [source] Prevalence and associations of cataract in indigenous Australians within central Australia: the Central Australian Ocular Health StudyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 4 2010John Landers MBBS MPH PhD Abstract Purpose:, To determine the prevalence and associations of cataract within the indigenous Australian population living in central Australia. Methods:, 1884 individuals aged ,20 years, living in one of 30 remote communities within the statistical local area of ,central Australia' were recruited for this study. This equated to 36% of those aged ,20 years and 67% of those aged ,40 years within this district. Slit-lamp examination was performed. The degree and subtype of cataract was graded using the Lens Opacities Classification System III criteria. A cataract was defined as a nuclear opalescence ,4.0, a cortical opacity ,3.0, a posterior subcapsular opacity ,2.0, a visual acuity worse than 6/12 or a visual acuity worse than 6/60 due to cataract. The prevalence of cataract in one or both eyes was presented for each of the definitions. Results:, Nuclear opalescence cataract was present in 13.5% (18.5% of those ,40 years); cortical opacity cataract was present in 13.1% (17.7% of those ,40 years); and posterior subcapsular cataract was present in 15.8% (21.0% of those ,40 years). 12.6% of patients (17.3% of those ,40 years) and 4.4% of patients (5.9% of those ,40 years) had a cataract that resulted in a visual acuity of worse than 6/12 and worse than 6/60, respectively. All cataracts were associated with advancing age. Posterior subcapsular cataract was associated with self-reported diabetes. Conclusion:, There is a higher prevalence of cataract among indigenous Australians living within remote central Australia compared with the non-indigenous population. Services for this population need to be designed with this in mind when planning resource allocation. [source] In vivo confocal microscopy in recurrent granular dystrophy in corneal graft after penetrating keratoplastyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2006Claudio Traversi MD Abstract Two case reports of recurrent granular dystrophy in corneal grafts after penetrating keratoplasty are presented. Slit-lamp examination and confocal microscopy (HRT II) were performed in two patients with recurrent granular dystrophy. All confocal microscopic findings of granular dystrophy were evaluated in the graft. Dystrophic lesions of the donor cornea presented the same confocal microscopic aspects in both eyes, and were similar to granular dystrophy lesions. Confocal microscopy is an imaging method that may provide new information on corneal microanatomy in dystrophies. It may be particularly useful in improving the early diagnosis of dystrophic lesions in corneal grafts. [source] Retinal Evaluation After 810 nm Dioderm Laser Removal of EyelashesDERMATOLOGIC SURGERY, Issue 9 2002Randal T. H. Pham MD background. When operating hair removal lasers on the face or in the periorbital region, even with an ocular shield in place, patients often report seeing "flashing lights" each time the laser is fired. This phenomenon suggests stimulation of retinal photoreceptors and raises laser safety issues. objective. To perform retinal electrophysiologic studies to evaluate the safety of hair removal lasers in the periorbital region. methods. Five patients with severe trichiasis secondary to trachoma were studied. The 810 nm Dioderm laser (Cynosure, Inc., Chelmsford, MA) was used to treat the eyelash follicles on the lower eyelid of each patient. Cox III metal eye shields (Oculo-Plastik, Inc., Montreal, Canada) were placed behind the eyelids of both eyes during the laser procedure. Prior to irradiation, a comprehensive ophthalmic evaluation including pupillary and slit-lamp examination, funduscopy, and full-field electroretinograms (ERGs) was performed. A comprehensive ophthalmic evaluation including ERG testing was repeated 30 minutes and 3,6 months after completion of treatment. An independent blinded assessor evaluated the ERG studies. Subjective reports of laser light sensation, pain, and discomfort during and after the laser procedure were also assessed. results. There was no detectable change in slit-lamp, pupillary, or funduscopic evaluations after periorbital laser irradiation. Similarly the pre- and posttreatment ERGs were unchanged. Three patients reported seeing flashing lights during the procedure. conclusion. We found no ERG evidence of retinal damage after laser hair removal in the periorbital region, with Cox III-type ocular shields over the eyes, even when patients subjectively reported "flashing lights" during laser irradiation. [source] A national retinal screening programme for diabetes in ScotlandDIABETIC MEDICINE, Issue 12 2003G. P. Leese Abstract The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the ,Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article. [source] A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathyDIABETIC MEDICINE, Issue 7 2003J. A. Olson Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source] Comparison of indices of vitamin A status in children with chronic liver disease,HEPATOLOGY, Issue 4 2005Andrew P. Feranchak Malabsorption of fat-soluble vitamins is a major complication of chronic cholestatic liver disease. The most accurate way to assess vitamin A status in children who have cholestasis is unknown. The goal of this study was to assess the accuracy of noninvasive tests to detect vitamin A deficiency. Children with chronic cholestatic liver disease (n = 23) and noncholestatic liver disease (n = 10) were studied. Ten cholestatic patients were identified as vitamin A,deficient based on the relative dose response (RDR). Compared with the RDR, the sensitivity and specificity to detect vitamin A deficiency for each test was, respectively: serum retinol, 90% and 78%; retinol-binding protein (RBP), 40% and 91%; retinol/RBP molar ratio, 60% and 74%; conjunctival impression cytology, 44% and 48%; slit-lamp examination, 20% and 66%; tear film break-up time, 40% and 69%; and Schirmer's test, 20% and 78%. We developed a modified oral RDR via oral coadministration of d-alpha tocopheryl polyethylene glycol-1000 succinate and retinyl palmitate. This test had a sensitivity of 80% and a specificity of 100% to detect vitamin A deficiency. In conclusion, vitamin A deficiency is relatively common in children who have chronic cholestatic liver disease. Our data suggest that serum retinol level as an initial screen followed by confirmation with a modified oral RDR test is the most effective means of identifying vitamin A deficiency in these subjects. (HEPATOLOGY 2005;42:782,792.) [source] Implantable Imaging System for Visual ProsthesisARTIFICIAL ORGANS, Issue 6 2010Chuanqing Zhou Abstract In order to propose a method of intraocular imaging system for the visual prosthesis, an implantable microcamera was developed and evaluated in vivo. The microcamera was specially developed and shaped to fit the rabbit's lens capsule and encapsulated with the biocompatible silicone. To evaluate the feasibility of this novel approach, the custom-built device was implanted following the surgical extraction of rabbit's lens. And clinical examinations were performed 1 day, 3 days, 1 week, 2 week, and 1 month postoperatively, including slit-lamp examination, intraocular pressure, wound status, anterior chamber depth, the presence of the iris fibrosi of neovascularization, and the position of the implant. Real-time imaging was performed in vivo 1 month after the operation, and the acquired images were processed with the software and hardware that were specially developed for generating the stimulating pulses. Short-term results showed the novel approach is promising. [source] Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysisACTA OPHTHALMOLOGICA, Issue 1 2010Robert Ritch Abstract. Purpose:, To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. Methods:, Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. Results:, A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45,75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. Conclusion:, In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS. [source] Use of heavy silicone oil (Densiron-68®) in the treatment of persistent macular holesACTA OPHTHALMOLOGICA, Issue 8 2009Alexandra Lappas Abstract. Purpose:, In this retrospective case series, we studied the effect of ,heavy' silicone oil on persisting macular holes. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade Densiron-68®. Methods:, Twelve patients with primary macular holes that persisted after pars plana vitrectomy, peeling of the internal limiting membrane and internal gas tamponade with SF6 (sulphur hexafluoride) were retreated with heavy silicone oil, Densiron-68®, in the University Eye Hospital, Cologne. After 1.5,4 months the Densiron-68® was removed. Best corrected visual acuity (VA), slit-lamp examination, binocular fundus examination and optical coherence tomography (OCT) were used for evaluation pre- and postoperatively. The follow-up period was 3,7 months. Results:, Preoperatively, all patients displayed full-thickness macular holes, with a mean size of 502.25 ,m (± 129.39 ,m). Postoperatively, 11 of 12 macular holes were closed. One patient experienced a reopening of the macular hole. Mean VA was 20/250 (1.07 ± 0.22 logMAR) prior to treatment with Densiron-68® and 20/160 (0.84 ± 0.24 logMAR) postoperatively. Visual acuity increased from baseline in nine patients and decreased in one. Conclusions:, Retreatment of persisting macular holes with the heavy, longterm tamponade Densiron-68® resulted in anatomical closure of the hole in 11 of 12 cases. This result was accompanied by a functional improvement in VA in nine of 12 patients. [source] Atrial septal defect with interatrial aneurysm and Axenfeld-Rieger syndromeACTA OPHTHALMOLOGICA, Issue 1 2000Necdet A. Bekir ABSTRACT. Purpose: The aim of this presentation is to report a rare association between interatrial aneurysm and Axenfeld-Rieger syndrome. Methods: We present a 20-year-old girl with Axenfeld-Rieger syndrome, in whom the diagnosis was confirmed by the facial dysmorphic appearance, slit-lamp examination, applanation tonometer, gonioscopy, and cardiovascular examination. Results: The patient had prominent Schwalbe's line in all quadrants, iris atrophy, and secondary glaucoma in both eyes. The echocardiogram revealed an atrial septal defect with interatrial aneurysm. Conclusion: This is the first case report of coexisting Axenfeld-Rieger syndrome and interatrial aneurysm. We would like to stress that aneurysm can be a potential occult source of cerebral embolism. [source] Risk factors for primary open-angle glaucoma in a Burmese population: the Meiktila Eye StudyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2007Robert J Casson FRANZCO Abstract Purpose:, To report the risk factors associated with primary open-angle glaucoma (POAG) in the Burmese population. Methods:, The Meiktila Eye study, a population-based cross-sectional study, included inhabitants 40 years of age and over from villages in the Meiktila District. Of 2481 eligible participants identified, 2076 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1997 participants. The ophthalmic examination included slit-lamp examination, tonometry, gonioscopy and dilated stereoscopic fundus examination. Definitions adhered to the International Society for Geographic and Epidemiological Ophthalmology's recommendations. Univariate and multivariate analyses of potential risk factors were performed. Results:, The overall prevalence of POAG was 2.0% (95% CI 0.9,3.1). In the univariate analysis, increasing age (P = 0.024), spherical equivalent (P = 0.01), axial length (P = 0.023) and intraocular pressure (IOP; P < 0.001) were significantly associated with POAG. And in the multivariate analysis, myopia <0.5 D (P = 0.049), increasing age and IOP (P < 0.001) were significant risk factors for POAG. Conclusion:, POAG in this Burmese population was associated with increasing age, axial myopia and IOP. [source] | ||||||||||