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Results for “OPHTHALMOSCOPY”

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PubMed2001

[Indocyanine green angiography in angioid streaks].

PURPOSE: To define the findings of an indocyanine green angiographic study of angioid streaks and compare them with the ophthalmoscopic and fluorescein angiographic findings. PATIENTS AND METHODS: Twelve eyes of six patients with bilateral angioid streaks were examined by ophthalmoscopy, fluorescein angiography, and indocyanine green angiography. RESULTS: In the ophthalmoscopy, the streak colors ranged from brown in the early phases to orange in severe stages. The streaks already presented a hyperfluorescent pattern from the arterial phases in all of the eyes with the fluorescein angiography. Using the indocyanine green angiography filling of the choroidal veins, a hyperfluorescent pattern was observed in eight eyes with severe lesional changes and a hypofluorescent pattern in four eyes with an early stage of the disease. The angioid streaks were more clearly visualized by indocyanine green angiography. CONCLUSION: The indocyanine green angiography contributes to the diagnosis of angioid streaks. The indocyanine patterns seems to be correlated with the ophthalmoscopic features and degree of evolution of the disease. The indocyanine green angiography allows for the early detection of angioid streaks and diagnosis in young patients.

Adult↗

PubMed1975

[Early diagnosis of microangiopathy in infantile diabetes (author's transl)].

The authors have carried out fluorescein angiography in infantile diabetics--negative by ophthalmoscopy,--looking for the earliest symptoms of microangiopathy. The study concerned 161 diabetics in the age between 3-18, and 50 non-diabetic children in the same age. There is no significant difference between diabetics and control-group in the frequency of symptoms, described in literature as early signs of microangiopathy, as multiple capillary-, and peripapillary-filling and early venous dilatation. Increased capillary filling was found at anxious children with strained cervical muscles during the examination. In 54% of the 161 diabetic patients-negative by ophthalmoscopy,-solitary or multiple microaneurysms were found fluorescence angiographically. The increase of number of the microaneurysms is correlated to the duration of the diabetics and advance in age. In the authors opinion the presence of microaneurysms is in some cases due to genetic factors and is independent from the metabolic changes of diabetes.

Adolescent↗

PubMed1975

Retinal detachment surgery.

Retinal surgery commences with careful ophthalmoscopy. The surgeon must be familiar with indirect monocular and binocular ophthalmoscopy, but biomicroscopy is most essential. Buckling procedures can be produced by different techniques and should be adapted to the case. Drainage of subretinal fluid is crucial. One should avoid it if possible, but if it has to be done, care has to be taken to avoid complications. The sealing of retinal holes and tears can be performed by diathermy, cryo- and light coagulation. Each technique has its indication and should be available at the time of surgery. Vitreous surgery is still in the experimental stage, but seems to be very promising, although its main use will most probably lie outside the field of retinal detachment.

Argon↗

PubMedDate not supplied

[Pathomorphological features of proliferative vitreoretinopathy in intravitreal administration of blood mononuclear cells (experimental study)].

The role of blood mononuclears in the pathogenesis of proliferative vitreoretinopathy (PVR) was studied on 25 Wistar rats (200-250 g). Intravitreal injections of 0.05 ml normal saline containing mononuclears (3000/mm@3) into one eye and 0.05 ml normal saline into the other were made through the flat part of the ciliary body under ether narcosis. Mononuclears were isolated using the ficoll-hypaque gradient. Indirect ophthalmoscopy was carried out on days 1, 3, 5, 7, 14, and 21 after injection. After each ophthalmoscopy (except day 1) 5 animals were sacrificed and both eyes were removed. The material was fixed for optic and electron microscopy. Ophthalmoscopic and histological studies showed the development of preretinal adhesions, the main sign of PVR. Bearing in mind the unidirectional flow of liquid in ocular tissues, created by the pressure gradient, the authors suggest that blood mononuclears are involved in the development of vitreoretinal proliferation.

Animals↗

PubMed2003

[Electrophysiological and histopathological study on visual toxicity of clioquinol].

OBJECTIVE: To evaluate the effect of clioquinol on the optic nerve and retina of rhesus monkeys by ophthalmoscopy, electrophysiology and histopathology. METHODS: Clioquinol was given orally to 5 monkeys, gradually increasingly from 100 mg/kg/day up to 14 months(total dosage 227 g/kg). Ophthalmoscopy, erectroretinogram(ERG), visual evoked potential(VEP) and histopathological examination of enucleated eyeballs were done periodically up to 10 years. RESULTS: The margin of the optic disc was not clear at the early stage, but the colour became atrophic at the late stage. VEP maximum amplitude decreased quickly at the early stage and the amplitude of ERG a and b waves and oscillatory potential decreased gradually. 37 months after the discontinuation of administration of VEP, ERG amplitude increased gradually. Swelling of axons and disorganization of the myelin sheath were noticed 2.5 months after beginning treatment. Swelling of the peripapillary nerve fiber layer was seen 5.5 months after beginning treatment. Karyorrhexis was seen in the inner layer of the retina after 12.5 months. Axonal swelling disappeared and the myelin sheath became reorganized 9 months after the discontinuation of treatment. CONCLUSIONS: Clioquinol produced an early decrease of electrophysiological function, but recovery of function was seen after discontinuation of treatment. The degeneration of axons and myelin sheath continued during treatment, and interruption of the degeneration was seen after discontinuation of treatment.

Animals↗

PubMed1992

Fluorescein angiography in systemic hypertension.

This study evaluates the role of fluorescein angiography (FA) in detecting changes in the retinal and choroidal capillary bed in hypertension and defines its advantages over direct ophthalmoscopy. 37 patients with varying degree of severity of hypertension were studied. Direct ophthalmoscopy and FA was done in all cases. No significant difference was found in documenting vessel calibre and arteriovenous crossing changes with either of the methods. Hard exudates were not visualized on FA. Capillary bed and choroidal abnormalities could be better studied on FA which can be employed in selected patients of hypertension but its use is not advocated as a routine in all hypertensives.

Adult↗

PubMed2001

When should children and young adults with sickle cell disease be referred for eye assessment?

Children and young adults who suffer from sickle cell disease (SCD) are at risk of blindness from retinopathy and other complications. The incidence of proliferative retinopathy in SCD patients varies from 5 to 10% depending on the genotype, being commoner in SC than SS and S-thal. 'Sudden' blinding sequelae such as vitreous haemmorrhage and tractional retinal detachment can eventuate from vasculo-proliferative retinal lesions, known as sea fans, in otherwise 'quiet' eyes. This risk can be minimised considerably if the lesions are detected in a timely fashion and treated, usually with laser photocoagulation and possibly with cryotherapy. This communication aims, by a review of relevant literature and through our original data, to highlight a time frame for the development of proliferative sickle retinopathy to enable paediatricians decide on an appropriate time of referral for ophthalmic assessment. Ninety patients with SCD (88 SS, 2 SC) aged 5-36 years were examined for anterior and posterior ocular signs of SCD using dilated binocular indirect ophthalmoscopy. Other relevant literature was reviewed. Twenty-four percent of these patients had some form of SCD related posterior pathology, 5.6% of which was pre-proliferative or proliferative. This included a 14-year-old SS patient with arterio-venous anastomosis. The literature reveals that patients begin to exhibit evidence of proliferative retinopathy from about the age of 10 and the frequency tends to increase with age. However, though rare, vitreous haemmorhage has been known to occur below the age of 20. Children with SCD should, from about the age of ten, be referred for at least biennial dilated binocular indirect ophthalmoscopy preferably with fluorescein angiography if such facilities are available, so that neovascular lesions can be treated before blinding sequelae occur. From the age of 20, the frequency of eye examination should increase to yearly. Antisickling remedies, such as NIPRISAN may be beneficial in prophylaxis.

Adolescent↗

PubMed2006

Single dose of 1% tropicamide and 10% phenylephrine for pupil dilation.

OBJECTIVE: To compare the efficacy of pupil dilation between a single dose and three doses of 1% tropicamide and 10% phenylephrine for binocular indirect ophthalmoscopy. MATERIAL AND METHOD: A prospective randomized double-blind clinical controlled trial was conducted. All patients underwent the binocular indirect ophthalmoscopy and met the inclusion criteria were randomized into two groups using block randomization. Group A received a single dose of 1% tropicamide and 10% phenylephrine eye drops, and Group B received three doses of the same drugs. The primary outcome was the horizontal pupil diameter measured by slit-lamp biomicroscope (Haag-Streit model 900) before and at 10, 15, 20, 25 and 30 minutes after eye drop instillation. The clinical equivalence of the efficacy of pupil dilation between the two groups was defined as the difference of less than or equal to 1 mm (-1 mm to + 1 mm). RESULTS: Eighty patients (160 eyes) were randomized into 40 patients (80 eyes) in group A and 40 patients (80 eyes) in group B. The mean pupil sizes at baseline of group A were 3.51 +/- 0.63 mm in the right eye and 3.39 +/- 0.67 mm in the left eye. Those in group B were 3.61 +/- 0.67 mm in the right eye and 3.66 +/- 0.72 mm in the left eye. The mean pupil diameters at 30 minutes of group A were 7.34 +/- 0.51 mm in the right eye and 7.41 +/- 0.56 mm in the left eye, whereas those of group B were 7.49 +/- 0.45 mm in the right eye and 7.51 +/- 0.40 mm in the left eye. The mean difference of the pupil size between the two groups was 0.15 mm (p = 0.175) in the right eye and 0.l0 mm (p = 0.362) in the left eye. The 95% confidence intervals of the difference in pupil size were -0.36 to 0.07 mm in the right eye and -0.32 to 0.12 mm in the left eye. CONCLUSION: The 95% confidence interval of the difference in pupil size lay entirely within the range of equivalence. The single dose of 1% tropicamide and 10% phenylephrine was clinically equivalent to the three doses of the same drugs.

Adult↗

PubMedDate not supplied

[Early detection of diabetic retinopathy in adult-onset diabetes patients].

The frequency of early diabetic retinopathy by using ophthalmoscopy and intravenous fluorescein angiography in adult-onset diabetics with short duration of diabetes was examined, and the findings are presented. The authors studied 103 insulin dependent and non-insulin dependent diabetics ranging in age from 38 to 55 years, mean 47.7 years. The duration of diabetes was up to 10 years, mean 5.3 years. All diabetic patients included in this study underwent a detailed ophthalmoscopic examination and in 71 patients with normal ophthalmoscopic finding intravenous fluorescein angiography was performed. Both methods revealed signs of early diabetic retinopathy in 2/3 (60.2%) of cases; among insulin dependent diabetics in 3/4 (75.5%) of cases and among non-insulin dependent diabetics in 1/2 (51.5%) of cases. Compared with regular ophthalmoscopy, fluorescein angiography doubled the frequency of diagnosis of early diabetic retinopathy. Early detection of diabetic retinopathy enables better evaluation of the disease, early treatment and better diabetic control.

Adult↗

PubMed1983

Early signs of diabetic retinopathy by fluorescein angiography.

The initial sign of diabetic retinopathy is considered to be microaneurysm, determined by ophthalmoscopy. To elucidate early vascular changes in diabetes, fluorescein angiography was performed in 272 eyes of 166 patients who had shown no evidence of diabetic retinopathy by ophthalmoscopy. Early retinal vascular changes shown by fluorescein angiography were seen in 181 eyes (66.5%) out of 272 eyes. These angiographic findings embraced dye leakage, dilatation of capillaries, filling defect of capillaries, microaneurysm-like spot dilatation and microaneurysm. Statistical analysis and follow-up studies for 1 to 5 years revealed that, with progression of the disease, the angiographic changes progressed in the following order: dye leakage, dilatation of capillaries, filling defect of capillaries, microaneurysm-like spot dilatation and microaneurysm.

Adult↗

PubMed1982

Funduscopic systems: a comparison of magnification.

The magnification properties of several funduscopy techniques are compared. These techniques include direct and indirect ophthalmoscopy, and slitlamp funduscopy with accessory lenses, such as the Hruby lens and fundus contact lens. Two new approaches are taken in the determination of funduscopic magnification. As a standard, the magnification of direct ophthalmoscopy is assumed to be 1.0X. The magnification provided by other methods is compared to this to yield relative magnification.

Fundus Oculi↗

PubMed1994

Toxicologic and pharmacokinetic analysis of intravitreal injections of foscarnet, either alone or in combination with ganciclovir.

PURPOSE: The retinal toxicity of single and repeated intravitreal injections of foscarnet was investigated. In addition, the effects of a combination of foscarnet and ganciclovir were studied, and a pharmacokinetic study to determine the ocular pharmacokinetics of foscarnet after intravitreal injection was carried out. METHODS: Forty rabbits (both albino and pigmented) were used in this study. The electroretinographic (ERG) a-waves and b-waves and oscillatory potentials (OP) were used as as indicators of retinal toxicity. Potential toxicity was also assessed by ophthalmoscopy and histologic studies (light and electron microscopy). RESULTS: The a-wave and b-wave were not deteriorated with 2.4 mg foscarnet after single or repeated injections. The OP remained unchanged. There was no ERG change after intravitreal injection of a combination of both drugs. No evidence of retinal toxicity was observed by indirect ophthalmoscopy in any case. Light and electron microscopy on semithin sections of retina failed to demonstrate any adverse effects, and showed normal organization and cytoarchitecture of all the layers of the retina without evidence of cytopathology. The ocular pharmacokinetics of foscarnet determined by noncompartmental analysis showed a 34-hour terminal elimination half-life and an apparent volume of distribution of 1.9 ml. CONCLUSIONS: Based on these results, high doses of foscarnet were not judged toxic to the rabbit retina, with single or repeated injections. Moreover, concomitant injection of the two drugs did not induce any retinal toxicity. These findings suggest that when systemic treatment is to be stopped in patients with AIDS for toxic side effects, either ganciclovir or foscarnet may be used intravitreally as an alternative. Because a combination of the two drugs has been shown to be synergistic, both ganciclovir and foscarnet might be simultaneously injected into the vitreous cavity to block progression of cytomegalovirus retinitis.

Animals↗

PubMed1993

[Is fundus photography useful in screening for diabetic retinopathy in patients with type II diabetes mellitus?].

OBJECTIVE: To determine the value of a screening programme with fundus photography for diabetic retinopathy in diabetes mellitus type II patients. DESIGN: Prospective. SETTING: General practices in the region Zwolle, The Netherlands. METHOD: 650 Patients from 50 general practices were photographed after dilating both eyes. Of these 215 were examined by an ophthalmologist. Data of patients who did not join the study were analysed in 13 general practices. Any symptom of retinopathy and/or photographs of poor quality implied referral to an ophthalmologist. RESULTS: Of a total of 1300 photographs 208 (16%) could hardly or not at all be assessed. The agreement in the group of 215 patients between photography and ophthalmoscopy was statistically significant at classification level (Cohen's kappa 0.41). The advice given to patients after photography did not differ from that after ophthalmoscopy (kappa: 0.50); photography did not miss any high-risk characteristics, it yielded more warnings, and underestimated the level of retinopathy in 8 out of 215 cases. With current ophthalmologic rates in the Netherlands fundus photography was not financially advantageous as 71 (33%) out of 215 patients needed to be referred to an ophthalmologist. However, in the other 144 (67%) patients photography sufficed. This may offer a solution where ophthalmic care is in short supply. Of 168/420 patients who did not apply for photography 116 (69%) were either under ophthalmic supervision already or too disabled to be screened. CONCLUSION: The use of a fundus camera is equivalent to funduscopy by an ophthalmologist in screening for retinopathy of type II diabetic patients. There are no financial benefits, but it reduces the work load of ophthalmologists.

Aged↗

PubMed1996

Comparison of the effectiveness of a nondilated versus dilated fundus examination in the pediatric population.

BACKGROUND: A study was performed to compare the clinical effectiveness of a nondilated fundus examination to a dilated fundus examination. METHODS: The population consisted of 90 pediatric patients aged 5 to 16 years. Subjects were randomly selected from patients presenting for a routine eye examination at the Eye Institute of the Pennsylvania College of Optometry. Direct ophthalmoscopy was performed on the subjects before pupillary dilation while direct and binocular indirect ophthalmoscopy were performed post-dilation. RESULTS: Twenty-three patients (25.5 percent) had one or more posterior pole anomalies not detected by the nondilated pupil examination. A total of 30 posterior pole anomalies were not detected by the nondilated pupil examination. Forty-six patients (51 percent) had one or more peripheral anomalies not detected by the nondilated pupil examination. Sixty-nine total peripheral anomalies were not detected by the nondilated pupil examination. CONCLUSIONS: A dilated fundus examination provides a more effective clinical method for evaluating intraocular health in a pediatric population.

Adolescent↗

PubMed1997

Retinoschisislike alterations in the mouse eye caused by gene targeting of the Norrie disease gene.

PURPOSE: To investigate the retinal function and morphology of mice carrying a replacement mutation in exon 2 of the Norrie disease gene. METHODS: Recently, Norrie disease mutant mice have been generated using gene targeting technology. The mutation removes the 56 N-terminal amino acids of the Norrie gene product. Ganzfeld electroretinograms (ERGs) were obtained in five animals hemizygous or homozygous for the mutant gene and in three female animals heterozygous for the mutant gene. As controls, three males carrying the wild-type gene were examined. Electroretinogram testing included rod a- and b-wave V-log I functions, oscillatory potentials, and cone responses. The fundus morphology has been visualized by scanning laser ophthalmoscopy. RESULTS: Rod and cone ERG responses and fundus morphology were not significantly different among female heterozygotes and wild-type mice. In contrast, the hemizygous mice displayed a severe loss of ERG b-wave, leading to a negatively shaped scotopic ERG and a marked reduction of oscillatory potentials. The a-wave was normal at low intensities, and only with brighter flashes was there a moderate amplitude loss. Cone amplitudes were barely recordable in the gene-targeted males. Ophthalmoscopy revealed snowflakelike vitreal changes, retinoschisis, and pigment epithelium irregularities in hemizygotes and homozygotes, but no changes in female heterozygotes. CONCLUSIONS: The negatively shaped scotopic ERG in male mice with a Norrie disease gene mutation probably was caused by retinoschisis. Pigment epithelial changes and degenerations of the outer retina are relatively mild. These findings may be a clue to the embryonal retinoschisislike pathogenesis of Norrie disease in humans or it may indicate a different expression of the Norrie disease gene defect in mice compared to that in humans.

Animals↗

PubMed1997

Occurrence of birefringent retinal inclusions in cynomolgus monkeys after high doses of canthaxanthin.

PURPOSE: To reproduce and investigate in a primate animal model the phenomenon of the red carotenoid canthaxanthin (beta, beta-carotene-4'4'-dione) to induce crystal-like retinal deposits as they have been observed in the ocular fundus of humans after high canthaxanthin intake (i.e., more than 30 mg/day). METHODS: Groups of four cynomolgus monkeys (Macaca fascicularis) per gender and dose were administered 5.4, 16.2, or 48.6 mg canthaxanthin/kg body weight daily by oral gavage for 2.5 years. Eight control animals received placebo. In vivo ophthalmoscopy was performed at intervals of 3 months along with electroretinography after 12 and 24 months and retinal biomicroscopy just before the monkeys were killed. Retinal wholemounts or frozen sections were investigated postmortem by polarization, bright field, and differential interference contrast microscopy. Retinal and preterminal plasma canthaxanthin concentrations were determined by high-performance liquid chromatography (HPLC). RESULTS: By ophthalmoscopy and retinal biomicroscopy in vivo, no crystals or other light-reflecting particles were observed in the central paramacular retina. However, postmortem polarization microscopy of all 24 canthaxanthin-treated animals showed a circular zone in the peripheral retina containing birefringent, polymorphous red, orange, or white inclusions. The density of these inclusions was diminished within 1 to 8 mm posterior to the ora serrata. These inclusions were located mainly in the inner retinal layers, that is the nerve fiber layer and ganglion cell layer, inner plexiform layer, and inner nuclear layer. Twelve of the 24 canthaxanthin-treated animals showed yellow, golden birefringent inclusions in the macula. Retinas of placebo-treated monkeys were free of birefringent, crystal-like inclusions. The HPLC confirmed the presence of all-trans canthaxanthin, and 4-OH-echinenone and isozeaxanthin as well, in the retinas of all canthaxanthin-treated animals. Neither electroretinography nor histopathology indicated any adverse effects of the canthaxanthin-induced retinal inclusions seen in this study. CONCLUSIONS: A high intake of canthaxanthin for 2.5 years led to the deposition of crystal-like birefringent inclusions in the inner layers of the peripheral retina and, to some extent, the central retina of cynomolgus monkeys. The presence of these deposits did not interfere with morphology nor with retinal function.

Animals↗

PubMed1997

Ultrasound-guided cryotherapy for retinal tears in patients with vitreous hemorrhage.

BACKGROUND AND OBJECTIVE: The goal was to utilize ultrasound-guided cryotherapy as an immediate, low-risk, noninvasive, precise method of treating retinal tears obscured by vitreous hemorrhage. PATIENTS AND METHODS: Eleven patients with sudden onset of vitreous hemorrhage were referred for diagnosis and management. Ophthalmoscopy with scleral depression was unsuccessful at localizing peripheral retinal tears, and all of the patients were examined with ultrasound using the techniques of standardized echography. The cryoprobe was positioned for cryotherapy using both transverse and longitudinal B-scan approaches following the indentation of the globe as it appeared on the oscilloscope. RESULTS: On follow-up examination after the vitreous hemorrhage cleared, 10 of the 11 tears were examined by ophthalmoscopy and were thought to have been adequately treated. One patient had a retinal detachment after remaining stable for 3 months. Two patients were treated with laser to enhance the cryotherapy seal. One patient was observed by another physician and underwent vitrectomy due to vitreous hemorrhage that persisted 2 months following cryotherapy. After vitrectomy, the physician reported a successful cryotherapy reaction at the treated tear. One final patient in the series required vitrectomy and scleral buckle before the hemorrhage had cleared, and the treatment did not appear to be complete. CONCLUSION: Ultrasound-guided cryotherapy provides a noninvasive, inexpensive treatment alternative for retinal tears obscured by vitreous hemorrhage.

Aged↗

PubMed1998

Ocular vascular thrombosis following tin ethyl etiopurpurin (SnET2) photodynamic therapy: time dependencies.

BACKGROUND AND OBJECTIVES: To evaluate the optimal time from the end of photosensitizer injection to the commencement of light application for creating characteristic fundus lesions and the time to vascular occlusion following photodynamic therapy (PDT) with tin ethyl etiopurpurin (SnET2). MATERIALS AND METHODS: Following intravenous injection of SnET2 0.5 mg/kg or lipid emulsion alone, the fundus of rabbits was irradiated at different times (5 to 240 minutes) after photosensitizer injection using 664 +/- 7-nm laser light with an irradiance of 354 mW/cm2 and fluence of 20 J/cm2. Ophthalmoscopy and fluorescein angiography were performed 1 day after SnET2 PDT. In separate groups of rabbits, treated areas of the fundus were imaged within 30 minutes following PDT using fluorescein vesicle and microsphere angiography with scanning laser ophthalmoscopy to document time of vascular occlusion. All animals were killed 1 day following treatment and eyes were examined by histopathology. RESULTS: Areas of hypofluorescence (indicating vascular occlusion) were seen when activating laser light was applied 5 to 20 minutes after SnET2 injection. Retinal vessels remained perfused in all cases. The time to vascular occlusion was 70 to 120 and 40 to 90 minutes in nonpigmented and pigmented rabbits, respectively. No safety issues were seen. CONCLUSION: PDT with SnET2 was effective in occluding the choriocapillaris. Activating light needs to be applied within a specific time frame after photosensitizer injection to achieve vascular occlusion.

Animals↗