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PubMedDate not supplied

The problem of cycloplegia in the pediatric age group: a combination formula for refraction.

Cycloplegic refraction and indirect ophthalmoscopy are essential to evaluation of the pediatric patient. Unfortunately, along with this practice occur the attendant risks of toxicity and the unpleasantness of instillation. The literature that documents the development of cycloplegic agents is often contradictory regarding efficacy and side effects. It is presented for perspective. We have found that efficacy and discomfort are inseparable; however, as with efficacy and toxicity they are directly related to the concentration used. The case is therefore made to use each agent in its minimal effective concentration and thereby minimize both discomfort and toxicity. Our combination of 1.3% cyclogyl, .167% mydriacil, and 1.6% phenylephrine accomplishes effective cycloplegia for refraction and indirect ophthalmoscopy, has a rapid onset and short duration, works reliably in dark irides, is accomplished in a single encounter with the patient, and exhibits none of the side effects of the individual agents in our series.

Age Factors↗

PubMed2005

Relationship between clinical presentation and visual outcome in postoperative and posttraumatic endophthalmitis in south central India.

PURPOSE: To determine risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis in a large referral center in south central India. METHODS: In this prospective observational series the authors examined 388 patients of postoperative (n= 206) and posttraumatic (n= 182) endophthalmitis at the L V Prasad Eye Institute in Hyderabad, India between 1991 and 1997. The analysis was confined to 236 patients-128 (62.1%) postoperative and 108 (59.3%) posttraumatic patients who were followed for a minimum period of 3 months. A detailed protocol was followed. Chi-square and logistic regression analysis were used to determine risk factors for visual outcome worse than 6/18 and worse than 6/120. RESULTS: Postoperative endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included intracapsular cataract surgery, poor presenting visual acuity, presence of vitreous cells, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In the multivariate analysis, visual acuity of less or equal light perception (LP) at presentation was associated with a 3-month postoperative visual acuity of < 6/18, with an odds ratio of 5.85 [1.25 - 27.42, 95% CI], and vitreous membranes seen on ultrasonography was associated with a final visual acuity of < 6/120, with an odds ratio of 2.47 [1.05 - 5.83, 95% CI]. Posttraumatic endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included a retained intraocular foreign body (IOFB), trauma by needle (hypodermic or sewing), poor presenting visual acuity, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In multivariate analysis, IOFB was associated with a 3-month follow-up visual acuity of < 6/18, with an odds ratio of 5.90 [1.85 - 18.78, 95% CI], and trauma by a needle (hypodermic or sewing) and retained IOFB was associated with a final visual acuity of < 6/120, with an odds ratio of 4.47 [1.22 - 16.38, 95%CI] and 3.76 [1.36 - 10.37, 95% CI] respectively. CONCLUSION: This is the largest, single-centre, prospective study on risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis. The independent risk factor for 3-month follow-up visual acuity of < 6/18 was the presenting visual acuity of < or =LP in postoperative endophthalmitis and a retained IOFB in posttraumatic endophthalmitis. The independent risk factor for 3-month visual acuity of < 6/120 was the presence of vitreous membranes on ultrasonography in postoperative endophthalmitis, and trauma by a needle (hypodermic/ sewing) and retained IOFB in posttraumatic endophthalmitis.

Adolescent↗

PubMed1999

Severe ocular abnormalities in C57BL/6 but not in 129/Sv p53-deficient mice.

PURPOSE: To demonstrate the importance of genetic background interaction on the development of ocular phenotypes in p53-deficient mice. METHODS: Eyes of adult mice, homozygous and heterozygous for the p53 gene disruption in the 129/SvJ and C57BL/6J (B6) genetic backgrounds, and their F1 progeny were examined by indirect ophthalmoscopy and by light microscopy. RESULTS: Indirect ophthalmoscopy revealed unilateral or bilateral vitreal opacities, fibrous retrolental tissue, and retinal folds in adult B6 mice but not in 129/Sv mice homozygous for a p53 null mutation. In B6 p53-/- mice, blood vessels extended from the peripapillary inner retina through the posterior vitreous and into the retrolental membrane. Optic nerves were hypoplastic. CONCLUSIONS: These findings indicate that alleles from the B6 background contribute to the aberrant ocular phenotypes observed in p53 deficiency. They also suggest that p53 or the pathway in which it functions may be important for normal eye development.

Abnormalities, Multiple↗

PubMed2001

Autosomal dominant cone and cone-rod dystrophy with mutations in the guanylate cyclase activator 1A gene-encoding guanylate cyclase activating protein-1.

OBJECTIVE: To describe the phenotype in 3 families with dominantly inherited cone and cone-rod dystrophy with mutations in guanylate cyclase activator 1A (GUCA1A), the gene-encoding guanylate cyclase activator protein-1 (GCAP-1). METHODS: Phenotypic characterization with psychophysical and electrophysiological evaluation and confocal laser scanning ophthalmoscopy was performed in 2 families with a Tyr99Cys mutation and 1 family with a Pro50Leu mutation. Haplotype analysis was performed in the families with Tyr99Cys mutation. RESULTS: The families with a Y99C mutation were shown to be ancestrally related. Decreased visual acuity and loss of color vision occurred after the age of 20 years, followed by progressive atrophy of the central 5 degrees to 10 degrees. Electrophysiological testing revealed generalized loss of cone function, with preservation of rod function. Abnormal rod and cone sensitivities were confined to the central 5 degrees to 10 degrees. Confocal laser scanning ophthalmoscopy imaging showed abnormalities of autofluorescence in early disease. Subjects with a Pro50Leu mutation demonstrated marked variability in expressivity from minimal abnormalities of macular function to cone-rod dystrophy. CONCLUSIONS: The phenotype associated with the Y99C mutation in GUCA1A is distinctive, with little variation in expression. By contrast, that associated with the P50L mutation demonstrates variable expressivity. CLINICAL RELEVANCE: Phenotype-genotype correlation in these 2 mutations demonstrates 2 different phenotypes.

Adolescent↗

PubMed2001

[The formation and involution of the optociliary vein during the course of central retinal vein occlusion].

BACKGROUND: Formation of collateral pathways by veins on the optic nerve head is sometimes observed during the resolution of a central retinal vein occlusion (CRVO). However, no cases have been reported which documented the formation and involution of these collateral pathways during the resolution of a CRVO. CASE: A 56-year-old man with a non-ischemic CRVO was followed over a 10-year period by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (IA). Initial examination revealed only mild arteriosclerosis and absence of the optociliary vein (OCV) in the right eye. Approximately 9 years later, the patient returned with non-ishemic CRVO, and FA demonstrated a prolongation of the retinal circulation time to 12.1 seconds (normal < 11.0 seconds). Monitoring of this patient during treatment disclosed development of an OCV on the optic nerve head and gradual decrease in the retinal hemorrhage. In FA, the retinal circulation time was shortened and returned to normal. IA verified an outflow through the OCV into choroidal veins. Later, ophthalmoscopy showed a narrowing of the diameter of the OCV. CONCLUSION: We suggest that the OCV developed to drain blood from retinal veins to the vortex veins through choroidal veins to compensate for the slowing of retinal blood outflow. The reperfusion of the central retinal vein was accompanied by the narrowing of the OCV.

Collateral Circulation↗

PubMed2002

HGF regulation of RPE proliferation in an IL-1beta/retinal hole-induced rabbit model of PVR.

PURPOSE: To understand molecular events that lead to retinal pigment epithelial (RPE) cell proliferation and migration during the early phases of proliferative vitreoretinopathy (PVR) in a rabbit model. METHODS: Retinal holes were created and interleukin-1beta(IL-1beta) was injected intravitreally. Eyes were examined by indirect ophthalmoscopy and eyecup pieces containing retinal holes were analyzed at different times after the surgery up to 4 weeks. RPE proliferation and migration were examined by immunohistochemistry. Tyrosine phosphorylation of extracellular signal regulated kinase (ERK) and hepatocyte growth factor receptor (HGFR or c-met) was determined by immunoprecipitation and western blot analysis. Tyrosine phosphorylation of c-met and morphological studies was performed on vitreous treated ARPE-19 cells. Expression of c-jun was determined by Northern blot analysis. Matrix metalloproteinase (MMP) content in vitreous was assessed by zymography. RESULTS: Indirect ophthalmoscopy identified formation of epiretinal membrane and immunohistochemistry identified proliferative and migratory RPE and other cells in the posterior segment containing retinal holes at 4 weeks post-surgery. Tyrosine phosphorylation of ERK and c-met occurred in this segment within 30 min of surgery. ARPE-19 cells treated with vitreous from the 24 h post-surgical eyes, but not with control vitreous or IL-1beta, showed morphological changes and tyrosine phosphorylation of c-met. Northern blot analysis in this segment identified upregulation of c-jun within 30 min of surgery and the expression peaked at 72 h. Zymographic analysis of vitreous identified MMP-9 in 12-72 h post-surgery. CONCLUSIONS: These data suggest that the presence of retinal holes and IL-1beta may lead to activation of HGF, mitogen activated protein kinases (MAPK), c-jun and extracellular matrix remodeling, resulting in proliferative and migratory cells in the wounded retina.

Animals↗

PubMed1979

[Biomicroscopy of the fundus in retinal detachment surgery (author's transl)].

Biomicroscopy of the fundus during retinal detachment surgery has the same advantages as indirect ophthalmoscopy. In addition to this, it offers three main advantages over indirect ophthalmoscopy: the observation of the fundus, in an optical cross section of the tissues, the high variation of magnification available, and the observation of the fundus without switching off the light of the operating room. Since 1976--biomicroscopy of the fundus during retinal detachment surgery has been easily performed with the surgical mobile slit lamp manufactured by the firm Zeiss. The angle of the surgical slit lamp can be reduced to 5 degrees. The slit lamp can be used either with the Zeiss OPMI 1 operating microscope or with the Zeiss OPMI 6 operating microscope. The microscope, the contact lens and the surgical instrumentation specialy fitted for biomicroscopy of the fundus during retinal detachment surgery are described. The surgical technique is dealt with, pointing out the practical details which allow for overcoming the own difficulties of biomicroscopy of the fundus during surgery.

Fundus Oculi↗

PubMedDate not supplied

The positive prognostic implications of crying during exam on threshold ROP.

INTRODUCTION: Most infants cry with lid speculum, scleral depression and indirect ophthalmoscopy. This simple observation, "did the infant cry?" during the initial 31-week ROP screening exam was prospectively studied. METHODS: From Fall 1989 through Summer 2003, all Alaskan infants with birthweight < or = 1500 grams were examined by RWA. After 1992, at the 31-week initial ROP screening, we recorded whether the infant was able to cry (cry), did not cry (quiet), or was intubated (vent) during indirect ophthalmoscopy with lid speculum and scleral depression. RESULTS: ROP was classified as to threshold in 873 infants. Infants who were able to cry during their 31-week GA screening exam were less likely to progress to threshold (Chi square 600, 2 = 36, p < .001). Using a logistic fit of Threshold, the increased risk of ROP in infants unable to cry persisted independent of gestational age or birthweight. CONCLUSIONS: Respiratory and neurologic co-morbidity may render those infants unable to cry during the first screening examination at increased risk to progress to threshold ROP.

Alaska↗

PubMed2006

A new microsurgical technique to correct retinal detachment.

PURPOSE: To evaluate the efficacy of a new technique to repair retinal detachments (RD) under the microscope. METHODS: Thirty-six consecutive patients (36 eyes) who presented to our clinic with rhegmatogenous RD without severe proliferative vitreoretinopathy (< or =C1) were included. The sutures for buckling and/or encircling bands were preplaced according to the preoperative location of the breaks using a three-mirror contact lens. Drainage of subretinal fluid, retinal cryotherapy, buckling, locating the retinal breaks, and intravitreal gases injection were performed under surgical microscopy. The surgical effects were compared with those in 37 consecutive patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmoscopy. RESULTS: The simultaneous intraoperative observation of fundus details and the sclera through the microscope was excellent in all cases. The effect of retinal cryotherapy was clearly visible. Mild opacity of the refractive media did not interfere with observing cryotherapy and locating the breaks. Retinal reattachment was obtained in 31 eyes (86%) during the primary surgery and in three eyes after a second surgery (94% total). The best-corrected visual acuity was < 0.1 in 6 eyes (16.7%), 0.1-0.4 in 15 eyes (41.7%) and > or = 0.5 in 15 eyes (41.7%). The results were similar to that of RD surgery performed under indirect ophthalmoscopy. CONCLUSIONS: This microsurgical procedure to correct RD is simple, convenient, reliable, provides an upright image, and facilitates good recovery similar to conventional RD surgery.

Adolescent↗

PubMed2006

Ultrasonic assessment in pre-operative cataract patients.

INTRODUCTION: The ability to examine the posterior segment of the eye accurately in patients with opaque media is essential to good surgical care of the cataract patient. In dense cataracts, the posterior segment is inaccessible to direct and indirect ophthalmoscopy and so adequate evaluation of posterior segment to exclude abnormalities become difficult. There is a risk of poor prognosis in eyes of patients with cataracts who may also have co-existing posterior segment abnormalities. Ultrasonography provides a method of assessing the structural changes in the posterior segment of the eye in such patients. OBJECTIVE: To determine the relevance and prevalence of posterior segment abnormalities in patients with dense cataracts prior to surgery by ultrasonography. METHOD: A 12- month prospective study of patients with clinically diagnosed dense cataracts in either or both eyes, in which the posterior segment cannot be evaluated properly during ophthalmoscopy, and therefore were sent for ocular ultrasonography. B-scan ultrasound was done on 116 eyes of 80 patients. RESULTS: Eighty patients were involved in the study, 116 eyes demonstrated dense cataract. One hundred and ten eyes (94.8%) had a normal posterior segment. Total retinal detachment was noted in 3 eyes (2.59%), a left partial retinal detachment was observed in 1 eye (0.87%), 2 eyes with total retinal detachment in conjunction with vitreous haemorrhage were noted in a single patient, 1.72% CONCLUSION: Posterior segment assessment with ultrasound is advisable and important in the preoperative evaluation of patients with dense cataract prior to surgery.

Aged↗

PubMedDate not supplied

[Vitreo-retinal biomicroscopy using bilaterally aspherical Volk lenses (+78 D, +90 D)].

Aspherical+ Volk lenses allow a full realization of El Bayadi conception of use of a great power a positive lens for the indirect ophthalmoscopy by means of a biomicroscope. The authors compared the techniques of ophthalmoscopy with utilization of a biomicroscope pointing to following advantages of the Volk lens: the lack of contact with the patient's eye (avoidance of eventual transmission of infection), possibility of examination of the entire area of the fundus, a detailed evaluation of the vitreous, possibility of examination even by narrow pupil, a high comfort of examination for the patient. These advantages were confirmed during the examination of 51 eyes with retinal detachment, pathological changes of the macula and the optic disc and with intraocular tumors.

Equipment Design↗

PubMed1991

[Fluorescence angiography image of erythrocytes with the scanning laser ophthalmoscope].

Erythrocytes bind fluorescein to their surface, but they do not take up the dye intracellularly during fluorescein angiography. The cells are therefore hypofluorescent compared to blood plasma. Due to the high velocity of red blood cells in retinal vessels, this phenomenon has not been observed during conventional angiography. Scanning laser ophthalmoscopy, however, allows imaging of the retina with a very high temporal resolution. The exposure time of the scanning laser beam for a single erythrocyte is in the range of only 100 ns. Therefore, scanning laser ophthalmoscopy permits imaging of fast-moving red blood cells in large retinal vessels. Pathologically reduced blood flow is clearly visible and can be measured with digital image analysis. The values found in three patients with vascular occlusions were between 0.1 and 1.8 mm/s. In cases with intact circulation, digital image analysis was not sufficient to measure red blood cell velocity. Even if a velocimeter that permits semiquantitative comparison between erythrocytes and moving black dots is used, superimposed on the angiogram, reliable results can only be obtained in cases with reduced red cell velocity. Nevertheless, for the clinician observation of erythrocyte flow during scanning laser angiography is a new and fascinating tool.

Blood Flow Velocity↗

PubMed1989

[Observation of erythrocyte flow in retinal vessels during fluorescein angiography].

Erythrocytes do not take up fluorescein intracellularly during angiography, they are hypofluorescent compared to blood plasma. This negative staining phenomenon has not been observed in the human retina. Scanning Laser Ophthalmoscopy permits imaging of the retina with a higher temporal and a higher spatial resolution than a conventional funduscamera. Thus, the retinal erythrocyte flow can be observed during fluorescein angiography. The red blood cells are seen as multiple black dots in a superficial layer of the intravasal blood column. A pathologically reduced blood flow can be recognized by simple observation. The velocity of the red blood cells is estimated with an erythrocyte velocimeter, that permits an optical comparison between the velocity of black dots and the velocity of the cells in the retinal vessel. The measured values fit well to the data obtained with the laser doppler technique. Therefore, the negative staining phenomenon in association with scanning laser ophthalmoscopy gives us a new tool in retinal microcirculation research.

Erythrocytes↗

PubMed1987

Screening for diabetic retinopathy--comparison of a nurse and a doctor with retinal photography.

The efficacy of diabetic retinal screening by a nurse trained in ophthalmoscopy and of a diabetologist was assessed by comparison with fundal photography. The study was performed in 282 subjects, 59 with known diabetes and 223 participating in a screening survey, of whom 13 had diabetes and 43 impaired glucose tolerance. The prevalence of retinopathy in the diabetic subjects was 36.8% and serious retinopathy 9.5% while in the screened subjects it was 3.5% and 0.9% respectively. The characteristics of nurse examination as a test to detect retinopathy was: sensitivity 50.0% +/- CL16.8%, specificity 99.2% +/- CL0.9%, which compared with 51.3% +/- CL15.7% and 98.7% +/- CL1.2% for the doctor. The nurse failed to detect serious retinopathy as accurately as the doctor, although new vessels were missed in 5 of 6 cases by the doctor. Screening for retinopathy requires either ophthalmoscopy by an observer trained to a higher level than is common in doctors, or non-mydriatic retinal photography.

Adult↗

PubMed1983

The relationship between diabetic control and retinopathy in a group of diabetic teenagers.

Twenty insulin-dependent diabetic teenagers from the Oxford pediatric diabetic clinic were recruited to study the relationship between diabetic control and retinal microvascular disease. Two patients (10%) had evidence of minimal background diabetic retinopathy on careful ophthalmoscopy. Retinal color photography and fluorescein angiography each revealed retinopathy in 5 patients (25%) and together revealed retinopathy in 7 patients (35%). Color photography demonstrated retinopathy which had not been discovered on ophthalmoscopy. The presence of retinopathy was related to the duration of diabetes (p less than 0.02) and the glycosylated hemoglobin level (p less than 0.01). It is concluded that multiple field color photography is a useful method of assessing patients with minimal or no ophthalmoscopic retinopathy.

Adolescent↗

PubMed1982

Comparative ocular pathogenicity of Cryptococcus neoformans, Candida glabrata, and Aspergillus fumigatus in the rabbit.

In a previous study, 88% of rabbits with disseminated infection caused by Candida albicans developed ophthalmoscopically visible, hematogenous endophthalmitis (chorioretinitis) over a 2 week period. To determine the incidence of this ocular complication in disseminated infection caused by Cryptococcus neoformans, Candida glabrata, and Aspergillus fumigatus compared with that caused by C. albicans, the first three species of fungi were injected intravenously (between 10(5) and 10(9) organisms per animal) into 36 New Zealand white rabbits. No chorioretinal lesions were seen by indirect ophthalmoscopy over a 2 week period. C. glabrata and A. fumigatus were not cultured from chorioretinas despite positive cultures from brains and kidneys at 1 and 2 weeks. In contrast, C. neoformans was cultured from 12 of 18 chorioretinas. (mean Log10 3.45 colony forming units/gm of tissue) as well as from the brains and kidneys. The less intense inflammatory cell response to C. neoformans compared with that 10 C. albicans seen on histopathologic examination most likely explains the nondetectability of the cryptococcal chorioretinitis by indirect ophthalmoscopy. These data suggest that C. glabrata. A. fumigatus, and possibly C. neoformans have less ocular pathogenicity than C. albicans in rabbits and correlate with the small number of documented human cases of ophthalmoscopically visible hematogenous endophthalmitis caused by fungi other than C. albicans.

Animals↗

PubMed1995

The introduction of new condensing lenses for fundus examination.

BACKGROUND: Examination of the inner eye is an important part of any comprehensive eye examination. There are a number of instruments used for examination of the ocular fundus; each has its advantages and disadvantages. Many of these instruments rely on hand-held lenses of which there are a number of options. METHODS: A doublet design lens consisting of two aspheric, plano-convex lenses, which have their convex sides facing toward each other and are separated by an air space, was evaluated and compared with other commercially available condensing lenses. RESULTS: A + 13.5 and +16 diopter doublet lens can be a valuable lens for binocular indirect ophthalmoscopy when compared with currently available, commercially available lenses. CONCLUSIONS: Innovative designs in lenses used with binocular indirect ophthalmoscopy may add considerably to the enhancement of the examination of the ocular fundus.

Equipment Design↗

PubMedDate not supplied

[Diagnostic methods in retinal detachment].

Important diagnosis methods are anamnesis, visual acuity determination, visual field determination, anterior segment biomicroscopy, tonometry, gonioscopy. Great attention must be paid to the ophthalmoscopy with scleral indentation. The paper compare the advantages and disadvantages of direct ophthalmoscopy using Goldmann contact lens. A great importance has the graphical representation of the eye fundus pathology, and also applying Lincoff rules in the localisation of the retinal breaks in retinal detachment. As special methods in examination are revealed the diaphanoscopy, the angiofluorography, the computerized tomography, the tomography in magnetic resonance field, and also the utilization of the electrophysiological and echographic exams in retinal detachment diagnosis.

Acute Disease↗