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PubMed2006

Diagnosis of serous neuroretinal detachments of the macula in severe preeclamptic patients with optical coherence tomography.

OBJECTIVE: Visual symptoms are common in patients with preeclampsia, and are caused by various underlying pathological changes in the retina. Blurred vision may be one of these symptoms. We describe three cases in which the underlying retinal pathology of blurred vision was clarified using optical coherence tomography (OCT), a novel, non-invasive ophthalmic imaging technique that provides micrometer-scale resolution images of the human retina. METHODS: Three patients with preeclampsia complained of blurred vision postpartum. In all cases, ophthalmoscopy was performed at the bedside, followed by the assessment of best corrected visual acuity, slit-lamp biomicroscopy, fluorescein angiography (FLA), and OCT. In all cases, the presence of central visual defects was examined by an Amsler-grid. RESULTS: In one case, the symptoms were bilateral. In all affected eyes, the patients complained of a relative central scotoma. Ophthalmoscopy showed edema in the affected maculae, while OCT examination clarified a serous neurosensory detachment of the macula. In one case, a neurosensory detachment was also detected in the papillomacular region of a fellow eye with no symptoms. In two cases, FLA was performed, but only in one case could we detect late leakage and subretinal exudates. The serous detachments observed showed total resolution in all cases within 5 to 10 weeks, with restoration of visual acuity. CONCLUSION: In patients with preeclampsia, OCT may provide a useful method for the precise assessment of retinal changes, distinguishing retinal edema from serous neurosensory detachments. This finding may help to clarify the pathophysiological circulatory changes seen in preeclampsia.

Adult↗

PubMed2006

Accuracy and reliability of teleophthalmology for diagnosing diabetic retinopathy and macular edema: a review of the literature.

Using teleophthalmology for the delivery of routine eye care for patients with diabetes mellitus is becoming an increasingly common practice. Paramount in the consideration of any new diagnostic test is an analysis of its diagnostic accuracy and reliability and how that compares with conventional care. This review summarizes existing data on the diagnostic accuracy and reliability of teleophthalmology and conventional clinic-based eye care for detecting diabetic retinopathy and diabetes mellitus. The sensitivity of ophthalmoscopy for detecting diabetic retinopathy performed by eye care clinicians has varied widely, with point estimates ranging from 0% to 96%. Alternatively, specificity has been universally high. The sensitivity of teleophthalmology for detecting diabetic retinopathy has been shown to be comparable, if not better, than clinic-based examinations. Sensitivity values have ranged from 50% to 93%. The specificity of teleophthalmology, like clinic-based examinations, has been consistently high. High levels of diagnostic reliability, analyzed by both simple agreement and kappa values, have been found between ophthalmoscopy and teleophthalmology for detecting and classifying diabetic retinopathy. Evaluating the accuracy of macular edema detection requires the use of dual gold standards, the clinical examination using slit-lamp biomicroscopy and stereoscopic photography. Teleophthalmology, compared with both gold standards, has, overall, been a highly sensitive and specific test. Reliability studies that compared the two gold standards with one another have found moderate to substantial levels of agreement. Based on existing data, teleophthalmology appears to be an accurate and reliable test for detecting diabetic retinopathy and macular edema.

Diabetic Retinopathy↗

PubMed2006

A comparative analysis of the effects of the fixed combination of timolol and dorzolamide versus latanoprost plus timolol on ocular hemodynamics and visual function in patients with primary open-angle glaucoma.

AIMS: The aim of this study was to assess the effects of fixed combination of timolol and dorzolamide and latanoprost plus timolol on retinal, choroidal, and retrobulbar hemodynamics and visual function in primary open-angle glaucoma (OAG) subjects. METHODS: Sixteen (16) OAG patients (age, 63.5 +/- 10.8 years; 9 male) were evaluated in a randomized, crossover, double-blind study design after 4 weeks of treatment of latanoprost with timolol and fixed combination of timolol and dorzolamide. After randomization, 9 right eyes and 7 left eyes were included in the hemodynamic portion of the study. Measurements included: adverse events check, visual acuity, contrast sensitivity, blood pressure, heart rate, intraocular pressure (IOP), and fundus examination. Ocular blood flow was assessed using confocal scanning laser Doppler flowmetry, color Doppler imaging, and scanning laser ophthalmoscopy. RESULTS: Both therapies were effective at lowering IOP, whereas there was no statistically significant difference between latanoprost plus timolol and the fixed combination of timolol and dorzolamide (13.9% and 12.2% reduction, respectively; P = 0.5533). Fixed combination of timolol and dorzolamide significantly increased central retinal artery end diastolic blood flow velocity (P = 0.0168) and lowered resistance to flow (P = 0.0279). Temporal posterior ciliary artery peak systolic and end diastolic velocities were significantly increased with the fixed combination of timolol and dorzolamide (P = 0.0125 and 0.0238, respectively). Latanoprost plus timolol had no significant effects on ocular blood flow during 4 weeks of treatment. There were no statistically significant differences in adverse events, blood pressure, heart rate, visual acuity, contrast sensitivity scanning laser ophthalmoscopy, or Heidelberg Retinal Flowmeter for any treatment period. CONCLUSIONS: Fixed combination of timolol and dorzolamide therapy might increase blood flow in OAG patients while attaining a similar IOP reduction compared to latanoprost plus timolol. Visual function, however, was not different in this short-term comparison between the two treatments.

Adrenergic beta-Antagonists↗

PubMed1983

Tropicamide-induced mydriasis in densely pigmented eyes.

Clinically effective diameters (CED's) corresponding to illumination intensities used in direct ophthalmoscopy were determined in 30 young adults with densely pigmented irides after instillation of 1 drop of 0.5% tropicamide. All subjects were of Asian, Pacific Island, or Hispanic origin. The maximum CED was attained by 30 min and was maintained without significant change for the next 60 min. Ninety percent of the subjects had maximum CED's of 6.0 mm or more, and 57% had CED's of 7.0 mm or more. These figures correspond to the entrance pupil diameters and are free from the effects of corneal magnification. The average CED's for these densely pigmented eyes did not differ in a statistically significant manner from corresponding mean CED's for 97 less densely pigmented Caucasian eyes during the interval of 30 to 90 min after instillation of tropicamide. Tropicamide at 0.5% concentration appears to be an effective mydriatic for use in these densely pigmented eyes with procedures requiring intensities of illumination similar to those used in direct ophthalmoscopy.

Adult↗

PubMed2003

Mouse model of subretinal neovascularization with choroidal anastomosis.

PURPOSE: To characterize the phenotype and report a reliable genetic model of retinal angiogenesis and subretinal neovascularization in the mouse. METHODS: The mouse phenotype was characterized using ophthalmoscopy, fundus photography, fluorescein angiography, electroretinography, histology, gene sequencing, and linkage analysis. RESULTS: Scattered pink-gray retinal lesions were found on ophthalmoscopy and were confirmed to be subretinal neovascularization on fluorescein angiography. On histologic examination, outer plexiform retinal neovascularization with growth into the subretinal space was found as early as postnatal Day 15. On genetic analysis, homozygosity of the Vldlr mutation always segregated with the retinal angiogenesis, whereas normal and heterozygous mice had no neovascularization. The histologic studies 15 to 18 days consistently showed new outer plexiform neovascular vessels drawn to the subretinal space by 20 days, and by 30 to 50 days, subretinal hemorrhages and choroidal anastomoses were common. Mice by 8 months had increased vascularity of the iris and ciliary body. CONCLUSIONS: The Vldlr mutation in the mouse provides a good model for retinal angiogenesis and subretinal neovascularization. Finding a strong association between retinal angiogenesis and a very low density lipid receptor mutation is new, and study of lipid receptor physiology may broaden the understanding of retinal angiogenesis.

Animals↗

PubMedDate not supplied

Serous macular detachment in central retinal vein occlusion.

PURPOSE: To describe serous macular detachment in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography (OCT). METHODS: This study included 22 eyes of 22 consecutive patients with CRVO. The patients underwent complete ophthalmic examination, including corrected visual acuity measurement, slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, fluorescein angiography, and OCT. RESULTS: Twenty-two patients (22 eyes) with cystoid macular edema associated with CRVO (10 women and 12 men; age range, 48-75 years [average, 62.5 years]) made up the study population. Angiographically, all patients had typical cystoid macular edema. At the time of initial examination, no patient was suspected of having a serous macular detachment associated with CRVO. The mean foveal thickness as determined by OCT was 567.4 microm. In all cases, the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. A serous macular detachment composed of retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues was seen in 18 eyes (81.8%). CONCLUSION: OCT findings in this study showed that serous macular detachment in patients with CRVO occurs more often than previously thought. Our data also showed that noncontact fundus ophthalmoscopy and fluorescein angiography were not sufficient to diagnose serous macular detachment in CRVO.

Aged↗

PubMed1997

Congenital optic pits and central serous chorioretinopathy.

PURPOSE: The reporting of the occurrence of central serous chorioretinopathy in a patient with congenital optic pits. METHODS: A 31-year-old man complained of blurred vision in the right eye for 1 week. He had a visual acuity of 20/25 in the right eye. He underwent ophthalmoscopy and fluorescein angiography. RESULTS: Ophthalmoscopy revealed serous detachment of macula with its margin not adjacent to the margin of optic disc. Fluorescein angiography showed a typical ink blot appearance of dye leakage. CONCLUSIONS: Central serous chorioretinopathy can occur in the patient with congenital optic pits. Detailed ophthalmoscopic and fluorescein angiographic studies are necessary to establish the diagnosis of optic pits associated with macular detachment. Various mechanisms have been reported to explain the serous macular detachment in patients with optic pits including vitreous and cerebrospinal fluid leakage through the optic pit and from there into the subretinal space. The present case further denotes that central serous chorioretinopathy in the presence of optic pits can be due to leakage from the retinal pigment epithelium.

Adult↗

PubMed1991

Screening for treatable diabetic retinopathy: a comparison of different methods.

The results of the screening of 3318 diabetic patients for sight-threatening diabetic retinopathy in three UK centres are reported. The aims of the study were to determine the extent of diabetic retinopathy in the screened population and to assess the relative effectiveness of different screening methods in appropriately referring cases from a diabetic population, in a context very close to a routine clinical service. Patients were assessed by ophthalmoscopic examination by an ophthalmological clinical assistant. The clinical assistants' referral grades formed the reference standard against which to assess the effectiveness of other screening methods including ophthalmoscopy by primary screeners who were general practitioners (GPs), ophthalmic opticians and hospital physicians, and the assessment by consultant ophthalmologists of non-mydriatic Polaroid fundus photography. The performance of primary screeners based on ophthalmoscopy ranged from a sensitivity of 0.41, with a specificity of 0.89, for one of the GP groups, to a sensitivity of 0.67, with a specificity of 0.96, for the hospital physician group. The performance of the non-mydriatic camera ranged from a sensitivity of 0.35, with a specificity of 0.95, to a sensitivity of 0.67, with a specificity of 0.98.

Aged↗

PubMed1980

Fluorescein angiography in diabetic children.

In 63 diabetic children, aged 10--14 years, with normal ophthalmoscopy, fluorescein angiography revealed slight diabetic retinopathy in maximally three, aged 12--14 years. These findings are discussed in relation to the controversial results published in a few other fluorescein angiographic studies on diabetic children. It is concluded that normal ophthalmoscopy does not exclude the presence of diabetic retinopathy and that fluorescein antiography is a valuable method in the early diagnosis of diabetic retinopathy.

Adolescent↗

PubMed1991

Comparison of fluconazole and amphotericin B for treatment of disseminated candidiasis and endophthalmitis in rabbits.

We compared the efficacy of intravenous fluconazole (80 mg/kg of body weight per day) with that of amphotericin B (1 mg/kg/day) for the long-term treatment of endophthalmitis in rabbits with disseminated candidiasis. After 17 days of therapy, fluconazole decreased the fungal colony counts of the choroid-retinas significantly more than did the saline control (P less than 0.05); however, after 24 days of fluconazole therapy, this treatment effect was lost and fluconazole was no more effective than saline. In contrast, treatment for 24 days with amphotericin B reduced the vitreous and choroid-retina fungal colony counts significantly more than either fluconazole or saline (P less than 0.05 for both treatment groups). After 17 days of therapy, indirect ophthalmoscopy revealed less severe eye involvement in both antifungal treatment groups than in saline controls; however, this difference reached statistical significance only for the amphotericin B-treated rabbits (P less than 0.05). Also, there was a trend towards worsening eye lesions, as seen by indirect ophthalmoscopy, in the fluconazole-treated rabbits after 24 days of therapy, which roughly paralleled the quantitative culture results. Despite the presence of negative choroid-retina cultures, some rabbits in all treatment groups had persistently visible eye lesions, indicating that ophthalmoscopic resolution of Candida endophthalmitis may lag behind lesion sterilization. Amphotericin B was superior to fluconazole in the treatment of Candida endophthalmitis in this model.

Amphotericin B↗

PubMed2004

Visual outcomes in children in Malawi following retinopathy of severe malaria.

AIM: To investigate whether retinal changes in children with severe malaria affect visual acuity 1 month after systemic recovery. METHODS: All children with severe malaria admitted to a research ward in Malawi during one malaria season were examined by direct and indirect ophthalmoscopy. Visual acuity was tested in those attending follow up by Cardiff cards, Sheridan-Gardiner single letters, or Snellen chart. RESULTS: 96 (68%) children attended follow up, of whom 83 (86%) had visual acuity measured. Cardiff cards were used in 47 (57%) children, and Sheridan-Gardiner letters or Snellen chart in 29 (35%). There was no significant difference in the mean logMAR visual acuity between groups with or without macular whitening (0.14 versus 0.16, p = 0.55). There was no trend for worse visual acuity with increasing severity of macular whitening (p = 0.52) including patients in whom the fovea was involved (p = 0.32). Six (4.2%) children had cortical blindness after cerebral malaria, and all six had other neurological sequelae. Ophthalmoscopy during the acute illness revealed no abnormalities in four of these children. CONCLUSION: Retinal changes in severe malaria, in particular macular whitening, do not appear to affect visual acuity at 1 month. This supports the hypothesis that retinal whitening is due to reversible intracellular oedema in response to relative hypoxia, caused by sequestered erythrocytes infected by Plasmodium falciparum. Impaired visual functioning after cerebral malaria is not attributable to retinal changes and appears to be a cortical phenomenon.

Blindness, Cortical↗

PubMed1988

Evaluation of a non-mydriatic camera in Indian and European diabetic patients.

The value of the Canon CR3-45NM non-mydriatic fundus camera in screening for diabetic retinopathy has been assessed in two ethnic groups, namely, 45 Indian and 40 European diabetic patients. There was 72% agreement between ophthalmoscopy by an ophthalmologist and the photographic assessment, and 100% agreement on clinically important lesions requiring treatment. However, peripheral retinal lesions, seen on ophthalmoscopy but lying outside the photographic field, occurred in 4% of eyes. 6% of photographs were totally unassessable and an additional 12% were only partially assessable. The prevalence and severity of retinopathy was similar in Indian and European patients. The advantages and disadvantages of the non-mydriatic camera in screening for diabetic retinopathy are discussed.

Diabetic Retinopathy↗

PubMed1999

Hypofluorescent spots on indocyanine green angiography at the recovery stage in multiple evanescent white dot syndrome.

PURPOSE: To evaluate the fundus lesions in a young woman. METHODS: Visual function, ophthalmoscopy, electrophysiology, fluorescein angiography, and indocyanine green angiography were performed. RESULTS: A 24-year-old woman had decreased visual acuity (0.2), granularity in the macula, and multiple yellow-white patches in the fundus, reduced a wave on electroretinography, hyperfluorescence on fluorescein angiography, and hypofluorescence on indocyanine green angiography in the left eye. When visual acuity improved to 1.0, the white dots disappeared ophthalmoscopically, and fluorescein angiography showed normal findings. Hypofluorescent spots were found, however, on indocyanine green angiography. CONCLUSION: It is possible that signs of multiple evanescent white dot syndrome may remain longer during examination by indocyanine green angiography than by visual function, ophthalmoscopy, or fluorescein angiography.

Adult↗

PubMedDate not supplied

Establishment of the mouse as a model animal for the study of diabetic cataracts.

The purpose of the present study was to investigate the suitability of using the mouse, a species known to have a low lens aldose reductase activity, as a model animal for studying the pathogenesis of diabetic cataract. Earlier studies with diabetic rats whose cataract development is much faster can only partially explain the etiology of cataracts in humans where lens aldose reductase is substantially low. CD-1 mice were injected intraperitoneally with streptozotocin according to Rossini's method. Blood glucose levels were estimated after 7 days, and animals having blood glucose between 300 and 400 mg/dl were selected for further experiments. Development of lenticular opacity was followed by examining the animals every 3-4 weeks by direct ophthalmoscopy, slitlamp examination and Scheimpflug photography. Additionally, the animals were sacrificed at appropriate intervals, eyes enucleated and subjected to morphological studies. The presence of refractive changes and early cataract in the diabetic mice was initially ascertained by the distorted appearance of the grid pattern when seen through the isolated lenses. Early cataracts were visible on slitlamp examination and by ophthalmoscopy as early as 3-4 weeks after the establishment of diabetes. Advanced opacity was clearly documentable by photography after 5-6 months. Similar to that in other species, a single layer of anterior epithelial cells abutting the anterior capsule was seen in the histological sections of normal mouse lenses. On the contrary, the epithelium in the diabetic lens was multilayered, and numerous nucleated cells were visible in the superficial anterior cortex. These studies therefore suggest that further studies with mice may throw additional light on the contribution of diabetes in the pathogenesis of cataracts in low lens aldose reductase models.

Animals↗

PubMed1990

Retinal infarction during sleep and wakefulness.

Brain and retinal infarctions during sleep have been attributed to focal hypoperfusion caused by systemic hypotension combined with underlying arterial stenosis, rather than to embolism. Because some retinal emboli may be visualized on ophthalmoscopy, we studied 24 consecutive patients (18 men and six women) aged 26-78 (mean 58) years with recent retinal infarction and determined whether the infarction had occurred during sleep or wakefulness. All patients underwent dilated ophthalmoscopy and a carotid artery study (arteriography in 20, duplex ultrasound in the remaining four), and 12 had echocardiography. Retinal infarction occurred during sleep at an unexpectedly rate (14 of 24 observed compared with eight of 24 expected, p = 0.02). Retinal cholesterol emboli were seen in one half of the patients regardless of whether the retinal infarction had occurred during sleep or wakefulness. Carotid artery disease was found in seven of the 14 patients in whom infarction had occurred during sleep and in eight of the 10 patients in whom infarction had occurred during wakefulness (p = 0.21). Cerebrovascular occlusive disease was not found in the five patients aged less than 50 years. Our findings suggest that embolism is a common mechanism of retinal infarction during sleep or wakefulness, that in patients aged greater than 50 years extracranial carotid artery disease is a common source of retinal emboli, and that the retina may be especially susceptible to infarction during sleep.

Cerebral Infarction↗

PubMed1992

Cost-effectiveness of alternative methods for diabetic retinopathy screening.

OBJECTIVE: To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy. RESEARCH DESIGN AND METHODS: Comparison of 45-degrees fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use. The study included 352 patients attending outpatient diabetes and general-medicine clinics at VA and DOD facilities. RESULTS: Medical system costs per true positive were: 45-degrees photos with dilation, $295; 45-degrees photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degrees photos with dilation, $139; 45-degrees photos without dilation, $171; ophthalmologist, $306; and technician, $1009. Cost-effectiveness is sensitive to program size due to high fixed cost of the camera methods but not to prevalence. Cost-effectiveness of the technician exam is strongly affected by its sensitivity. CONCLUSIONS: Primary-care screening with retinal photographs through pharmacologically dilated pupils for diabetic retinopathy is an appropriate and cost-effective alternative to screening by an ophthalmologist in this setting. Ophthalmologists are scarce, primary-care physicians are extremely busy, and large clinics allow fixed equipment costs to be spread across many patients.

Cost-Benefit Analysis↗

PubMed1995

Biodegradation and tissue reaction to intravitreous biodegradable poly(D,L-lactic-co-glycolic)acid microspheres.

We studied the biodegradation of and the tissue reaction to microspheres of 50:50 poly(D,L-lactic-co-glycolic)acid (PLGA) (viscosity-average MW: 3000 d), injected intravitreous in rabbits. These microspheres are under investigation as injectable devices for intravitreous sustained drug delivery. The rate of intravitreous degradation of PLGA microspheres has not been well documented in the literature. Twenty two pigmented rabbits underwent gas vitrectomy in one eye: 19 eyes received 2.5 mg of PLGA microspheres in 1 ml of balanced salt solution (BSS) and 3 control eyes received 1 ml of BSS only. Slit lamp exam and indirect ophthalmoscopy were performed periodically from day 1 to 6 months after surgery. The eyes were enucleated and studied by light microscopy and immunohistochemistry at various time points. The electroretinogram (ERG) was recorded in a subgroup of rabbits before injection and after 1 and 6 months. The amount of microspheres in the vitreous cavity progressively decreased. At 6 months microspheres were found in 1/4 rabbits at indirect ophthalmoscopy and in 4/4 rabbits histopathologically. A mild localized, non progressive foreign body reaction was observed. The cell reaction was composed mostly of vimentin and glial fibrillary acidic protein positive cells which probably represent glial cells and fibroblasts. The choroid and retina were normal. The ERG showed no abnormalities. No clinical inflammatory signs were observed 4 days postoperatively and thereafter.

Animals↗

PubMed1990

Optic disc and early glaucomatous visual field loss.

In the early stages of glaucoma, the disc changes prior to visual field loss, so assessment of the optic disc is very important for the evaluation of the glaucoma patient. The aim of this study is to assess the glaucomatous disc and to look for the features of the optic disc that are commonly associated with early visual field loss. Forty-three eyes of 28 patients were included in this investigation. The criteria for inclusion were a cup/disc(C/D) ratio of more than 0.4 by direct ophthalmoscopy, no visual field defect with Goldmann perimetry, and open anterior chamber angle. Each optic disc was photographed with a Canon fundus camera with Polaroid 600 Plus film. Each photographic set was then examined stereoscopically for morphologic parameters: 1) comparison of vertical versus horizontal C/D ratio; 2) presence of nasal cupping; 3) presence of overpassing vessels; 4) presence of baring of circumlinear vessels; 5) presence of peripapillary atrophy; 6) ratio of the thinnest neuroretinal rim(NRR) width in the vertical sectors of the NRR width of the temporal sector. All subject's central visual fields were examined with an automated static perimeter, Humphrey program C30-2 with STATPAC. The C/D ratio estimated by direct ophthalmoscopy consistently showed a smaller C/D ratio than that found by the stereophotographic method. The parameter with the highest probability value to differentiate between the optic disc of the early visual field loss and the optic disc of normal subjects was "Ratio of the thinnest NRR width in the vertical sectors to the NRR width of the temporal sector less than or equal to 85%". Although it has less resolving power than slide film, a stereo disc photograph with Polaroid film is a quick and simple method of recording changes, and the ratio of the thinnest NRR width in the vertical sectors to the temporal sector is a good predictive parameter for detection of early visual field loss.

Adolescent↗