Adaptation of slitlamp to indirect ophthalmoscopy.
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We devised a new binocular indirect ophthalmoscope and a complimentary examination technique that provide enhanced fundus magnification and optimum stereopsis through a wide range of patient pupillary apertures. The lightweight, mechanically simple instrument uses a variable focus Galilean telescopic observation system to enlarge the condensing lens image of the fundus seen by the examiner. The present device is capable of about X 1.5 fundus magnification with negligible stereopsis through a 20-mm patient pupil, continuously increasing to X 8.5 with greatly enhanced stereopsis through an 8-mm pupil. A zoom focusing capability considerably extends the magnification, stereopsis, and small pupip penetrating characteristics of a given condensing lens by allowing the examiner to binocularly observe the telescopically magnified fundus image throughout the 30-cm to 60-cm focusing range of the ophthalmoscope.
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PURPOSE: To visualize retinal pigment epithelial cells in vivo by fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope. DESIGN: Experimental study and observational case report. METHODS: Digital in vivo autofluorescence images were recorded with a confocal scanning laser ophthalmoscope (excitation, 488 nm; emission, >500 nm) and compared with confocal scanning laser ophthalmoscope and fluorescence microscopic recordings from human donor eyes. RESULTS: A uniform pattern of the polygonal retinal pigment epithelial cell layer was visualized in vivo outside of absorbing retinal vessels and macular pigment. Autofluorescence intensities of individual cells showed marked variation. The pattern corresponded to in vitro findings. Visualization is based on the topographic distribution of autofluorescent lipofuscin granules and melanin granules in apical retinal pigment epithelium cytoplasm. CONCLUSIONS: High-resolution autofluorescence imaging may be useful to determine morphologic and lipofuscin-dependent alterations in retinal diseases and may be applicable for monitoring effects of therapeutic interventions targeting the retinal pigment epithelium.
PURPOSE: To describe retinal changes in active multifocal and serpiginous chorioretinitis seen with en-face optical coherence tomography (OCT). DESIGN: Observational case report. METHODS: Two patients, presenting with active multifocal chorioretinitis (MFC) and serpiginous chorioretinitis (SC), respectively, were scanned with a prototype en face OCT ophthalmoscope. RESULTS: The OCT scan in the patient with the active MFC lesion showed a transretinal hyperreflectivity at the site of lesion. The OCT scan in the patient with the active SC lesion showed hyper-reflectivity in the outer retina at the site of the lesion. CONCLUSIONS: OCT allows for better evaluation of intraretinal changes in patients with white dot syndromes. In these two cases, OCT showed different morphologic changes in active lesions. OCT may be helpful in identifying the location of involvement in various white dot syndromes. This may have prognostic and therapeutic significance.
We evaluated fundus imaging using a modified confocal scanning laser ophthalmoscope (cSLO) in mice. Examinations were performed in conscious, untrained mice. The largest field of view measured 1,520 x 1,520 mu, with a significant interindividual variability, itself correlated to biometric variability. The composite field of view extended up to the ora serrata. The reflectance imaging associated light reflection from nerve fiber bundles and vessel walls, and absorption by hemoglobin and melanin. Light absorption by the pigment epithelium indeed increased the contrast of the nerve fiber layer, but impaired viewing of the choroid. Due to the confocal mode, fluorescence angiograms with clear separation of retinal and choroidal fluorescence could be obtained even in albino mice. Micrometric-scale transverse resolution and several planes of optical sectioning within the retina were obtained. This permitted for instance tridimensional, subcellular viewing of gfp-expressing retinal microglial cells in CX(3)CR1 mice. We concluded that cSLO is a promising tool for noninvasive, multimodal intravital microscopy of the fundus in the mouse.
PURPOSE: To compare measurements of optic nerve topography of ocular hypertensive patients with those of normal subjects and primary open-angle glaucoma patients. METHODS: Three age-matched study groups of 46 ocular hypertensive patients, 46 primary open-angle glaucoma patients, and 46 normal subjects were recruited from patients and volunteers of a glaucoma referral practice. Optic nerve topography was measured using a confocal scanning laser tomograph, the Heidelberg Retina Tomograph. The following optic nerve parameters were evaluated: disk area, cup/disk area ratio, cup shape, height in contour, rim area, rim volume, maximum cup depth, cup area, cup volume, retinal height, and retinal cross-section area. For this cross-sectional study, analysis of variance was used to evaluate overall differences among the three subject groups and the Tukey-Kramer multiple comparison test to evaluate differences between the means of two groups. RESULTS: Statistically significant differences among study groups were found for all topographic optic nerve parameters evaluated. Despite considerable overlap in optic nerve parameter measurements among the study groups, mean values of ocular hypertensive eyes were intermediate between those for normal and primary open-angle glaucoma eyes. Statistically significant differences were found between ocular hypertensive and glaucomatous eyes for all optic nerve parameters measured, and between ocular hypertensive and normal eyes for disk area, height in contour, rim area, and rim volume. CONCLUSIONS: In age-matched groups, mean measurements of certain topographic optic nerve parameters of ocular hypertensive eyes differ from those of normal and glaucomatous eyes.
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We examined 19 patients (41 +/- 7.5 years old) with central serous chorioretinopathy and symptoms that ranged from one day to 24 months. Fluorescein and indocyanine green angiographies were performed with a scanning laser ophthalmoscope. Focal exudation was found in all patients with fluorescein and in 15 patients (79%) with indocyanine green. We found a more widespread exudation of indocyanine green into the choroid around the focal hyperfluorescent spot in seven patients (37%). Perfusion with fluorescein was delayed in the area of focal exudation in two patients (11%) and with indocyanine green in 12 patients (63%). Exudation of both dyes stopped with clinical improvement, whereas the perfusion deficits remained unchanged. These results further indicate that central serous chorioretinopathy is primarily a choroidal disease.
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PURPOSE: To develop a quantitative method for analysis of the topographic relationship between structural and functional damage in patients with glaucoma. METHODS: We studied 26 patients with primary open-angle glaucoma, focal optic disk damage, and focal visual field loss. The visual field was evaluated with automated perimetry, and the optic disk topography was assessed with a confocal scanning laser ophthalmoscope. Topographic measurements were calculated in 10-degree sectors and compared with a normative database (n=52). The topographic relationship of structural damage and functional loss was analyzed. RESULTS: Rim area ratio was defined as the ratio of rim area in each 10-degree sector divided by the total rim area. This ratio resulted in the identification of one (46%) or more (54%) clusters of optic disk sectors as outside normal limits in all 26 patients (12 and 14 patients, respectively). Twenty-two patients (84%) with superior hemifield sensitivity loss tended to have inferior rim defects, and vice versa. Nasal visual field defects close to the horizontal midline were matched with damaged rim areas close to the vertical midline. CONCLUSIONS: This mapping method allows an objective and quantitative evaluation of the optic disk and visual field in patients with glaucoma and focal damage. Although the topographic relationship between structure and function is characterized by considerable interindividual variability, the identification of certain patterns may be useful to aid in the evaluation of glaucomatous damage.
BACKGROUND: The purpose of this study was to examine and compare menstrual-cycle-dependent topographic changes in the optic nerve head of normally menstruating women with different grades of type 2 diabetes mellitus. METHODS: We studied the right eyes of 123 normally menstruating women (36 with severe nonproliferative diabetic retinopathy [NPDR], 42 with mild NPDR and 45 healthy subjects). All subjects underwent a complete ocular examination at baseline. At 4 hormonally distinct phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), we analysed the topography of the optic nerve head, using a confocal scanning laser ophthalmoscope, and measured the serum levels of estradiol, progesterone and luteinizing hormone. RESULTS: We excluded from analysis the data for 8 patients with severe NPDR, 10 patients with mild NPDR and 15 control subjects who were lost to follow-up examinations during the menstrual cycle. The mean age and optic disc area did not differ significantly among the 3 groups. The duration of diabetes was significantly longer in the patients with severe NPDR than in those with mild NPDR (p < 0.05). The women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup/disc ratio, cup/disc area ratio and cup area in the late luteal phase compared with the other phases of the menstrual cycle (p < 0.05). Those with mild NPDR or a normal retina had no significant topographic changes in the optic nerve head during the menstrual cycle. INTERPRETATION: Severe NPDR is associated with significant topographic changes in the rim and cup of the optic nerve head during the menstrual cycle. This must be considered in the evaluation of women with both diabetes and glaucoma. The normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seem to affect the optic nerve head more when the disease is advanced.
PURPOSE: To describe a method for making morphometric analysis of the pores in the lamina cribrosa with a confocal scanning laser ophthalmoscope (SLO). METHODS: Sixteen consecutive images were acquired with an SLO from the retinal surface to the bottom of the optic disc in +0.25-diopter increments. An He-Ne laser (633 nm) with a 20 degrees field of view was used. The images from each section were processed and combined with the aid of Macintosh software. RESULTS: Eyes with physiological cupping showed uniformly round or nearly round pores, whereas eyes with primary open-angle glaucoma frequently had compressed pores. CONCLUSIONS: In vivo morphometry of the surface of the internal lamina cribrosa can be performed by this technique, which should be useful for evaluating the progression of glaucomatous changes of the optic nerve head.
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