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Ford MM. A method for teaching depth of corneal lesions using a portable slit lamp (biomicroscope). Vet Ophthalmol 2024; 27:286-289. [PMID: 38409733 DOI: 10.1111/vop.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
A novel, simple, and inexpensive model for teaching depth of lesions within the cornea using slit lamp biomicroscopy to veterinary students, ophthalmology residents, and general clinicians with access to a slit lamp biomicroscope is described. Using common laboratory items, this method can be created in any clinic and can be used to teach and quiz students through independent study with objective self-testing achieved.
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Affiliation(s)
- Marnie M Ford
- Pacific Animal Eye Specialty Services, New Westminster, British Columbia, Canada
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2
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Xu Q. A corneal stroma circular ring captured by smartphone adaptor slit lamp camera after small incision lenticule extraction. Clin Case Rep 2024; 12:e8690. [PMID: 38562576 PMCID: PMC10982112 DOI: 10.1002/ccr3.8690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
A corneal stroma circular ring has captured by smartphone adaptor slit lamp camera after smile for 1 week.
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Affiliation(s)
- Qi‐Bin Xu
- Department of Ophthalmology, Zhejiang Hospital of Integrated Traditional Chinese and Western MedicineHangzhou Red‐Cross HospitalHangzhouChina
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3
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Borselli M, Toro MD, Rossi C, Taloni A, Khemlani R, Nakayama S, Nishimura H, Shimizu E, Scorcia V, Giannaccare G. Feasibility of Tear Meniscus Height Measurements Obtained with a Smartphone-Attachable Portable Device and Agreement of the Results with Standard Slit Lamp Examination. Diagnostics (Basel) 2024; 14:316. [PMID: 38337832 PMCID: PMC10855891 DOI: 10.3390/diagnostics14030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE We aimed to evaluate the feasibility of using a novel device, the Smart Eye Camera (SEC), for assessing tear meniscus height (TMH) after fluorescein staining and the agreement of the results with measurements obtained using standard slit lamp examination. METHODS TMH was assessed using both SEC and conventional slit lamp examination. The images were analyzed using the software ImageJ 1.53t (National Institutes of Health, Bethesda, MD, USA). A common measurement unit scale was established based on a paper strip, which was used as a calibration marker to convert pixels into metric scale. A color threshold was applied using uniform parameters for brightness, saturation, and hue. The images were then binarized to black and white to enhance the representation of the tear menisci. A 2 mm area around the upper and lower meniscus in the central eye lid zone was selected and magnified 3200 times to facilitate manual measurement. The values obtained using SEC were compared with those obtained with a slit lamp. RESULTS The upper and lower TMH values measured using the SEC were not statistically different from those obtained with a slit lamp (0.209 ± 0.073 mm vs. 0.235 ± 0.085, p = 0.073, and 0.297 ± 0.168 vs. 0.260 ± 0.173, p = 0.275, respectively). The results of Bland-Altman analysis demonstrated strong agreement between the two instruments, with a mean bias of -0.016 mm (agreement limits: -0.117 to 0.145 mm) for upper TMH and 0.031 mm (agreement limits: -0.306 to 0.368 mm) for lower TMH. CONCLUSIONS The SEC demonstrated sufficient validity and reliability for assessing TMH in healthy eyes in a clinical setting, demonstrating concordance with the conventional slit lamp examination.
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Affiliation(s)
- Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Mario Damiano Toro
- Department of Ophthalmology, Federico II University Hospital, 80131 Naples, Italy;
- Department of Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Rohan Khemlani
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Yokohama Keiai Eye Clinic, Yokohama 240-0065, Japan
| | - Shintato Nakayama
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Hiroki Nishimura
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Eisuke Shimizu
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Collis S, Yung M, Parikh N. Evaluation of an Instructional Video and Simulation Model for Teaching Slit Lamp Examination to Medical Students. J Acad Ophthalmol (2017) 2023; 15:e215-e222. [PMID: 37766880 PMCID: PMC10522417 DOI: 10.1055/s-0043-1775577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Purpose This article assesses the efficacy of an instructional video and model eye simulation for teaching slit lamp exam to medical students as compared to traditional preceptor teaching. Methods First through 4th year students from the University of California, San Francisco School of Medicine were recruited via email to participate in the study. Students were randomized into two groups. The experimental "model eye" group watched an instructional video on slit lamp exam, spent 10 minutes practicing on the model eye, then practiced for 25 minutes with a student partner. The control "preceptor teaching" group received 25 minutes of in-person preceptor teaching on slit lamp exam, then spent 25 minutes practicing with a student partner. Students were objectively assessed by a blinded grader who scored their examination skills with a 31-item checklist. Qualtrics surveys that measured student perceptions were distributed before and after the intervention. Results Seventeen medical students participated in the study. Students in the model eye group achieved higher mean objective assessment scores than students in the preceptor teaching group on skills relating to slit lamp set up (1.75, standard deviation [SD] = 0.50 and 1.50, SD = 0.80 out of 2 points, p = 0.03) and on the total score (1.69, SD = 0.6 and 1.48, SD = 0.8 out of 2 points, p < 0.01). Both groups reported a significant increase in their understanding of what a slit lamp is used for ( p < 0.01) and in their confidence using a slit lamp ( p < 0.01). All students felt their skills improved with the workshop, 94% found the workshop to be useful, and 88% enjoyed the workshop, with no intergroup differences on these metrics. Conclusion An instructional video combined with a simulation model is as effective as traditional preceptor teaching of the slit lamp exam. Such a teaching module may be considered as an adjunct to traditional methods.
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Affiliation(s)
- Sophia Collis
- University of California San Francisco School of Medicine, San Francisco, California
| | - Madeline Yung
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Neeti Parikh
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
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Bhirud A, Chandrakanth P, Agrawal M, Mishra A. Universal slit-lamp-mounted mobile adapter with 20 D lens for fundus photography: "Litter to glitter". Indian J Ophthalmol 2023; 71:2222-2224. [PMID: 37202954 PMCID: PMC10391469 DOI: 10.4103/ijo.ijo_3226_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand. Similarly, with a 20 D lens, the filming distance is adjusted by moving the lens or mobile forward or backward, which makes it difficult to adjust and focus the image in busy ophthalmology outpatient departments (OPDs). Moreover, fundus camera costs thousands of dollars. Authors describe a novel technique of performing fundus photography with a 20 D lens and a universal slit-lamp-mounted mobile adapter made from trash. By the use of this simple, yet frugal innovation, primary care physicians or ophthalmologists without a fundus camera can easily snap a fundus photo and subject it to digital analysis by retina specialists across the world. This will help in simultaneous ocular examination and fundus photos taken via mounted 20 D on a slit lamp itself and also reduce the need for unnecessary retina referrals to tertiary eye care centers.
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Affiliation(s)
- Atul Bhirud
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Prithvi Chandrakanth
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Mohini Agrawal
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Avinash Mishra
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
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Muth DR, Blaser F, Foa N, Scherm P, Mayer WJ, Barthelmes D, Zweifel SA. Smartphone Slit Lamp Imaging-Usability and Quality Assessment. Diagnostics (Basel) 2023; 13:diagnostics13030423. [PMID: 36766528 PMCID: PMC9913954 DOI: 10.3390/diagnostics13030423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To assess the usability and image quality of a smartphone adapter for direct slit lamp imaging. METHODS A single-center, prospective, clinical study conducted in the Department of Ophthalmology at the University Hospital Zurich, Switzerland. The smartphone group consisted of 26 medical staff (consultants, residents, and students). The control group consisted of one ophthalmic photographer. Both groups took images of the anterior and the posterior eye segment of the same proband. The control group used professional photography equipment. The participant group used an Apple iPhone 11 mounted on a slit lamp via a removable SlitREC smartphone adapter (Custom Surgical GmbH, Munich, Germany). The image quality was graded independently by two blinded ophthalmologists on a scale from 0 (low) to 10 (high quality). Images with a score ≥ 7.0/10 were considered as good as the reference images. The acquisition time was measured. A questionnaire on usability and experience in smartphone and slit lamp use was taken by all of the participants. RESULTS Each participant had three attempts at the same task. The overall smartphone quality was 7.2/10 for the anterior and 6.4/10 for the posterior segment. The subjectively perceived difficulty decreased significantly over the course of three attempts (Kendall's W). Image quality increased as well but did not improve significantly from take 1 to take 3. However, the image quality of the posterior segment was significantly, positively correlated (Spearman's Rho) with work experience. The mean acquisition time for anterior segment imaging was faster in the smartphone group compared to the control group (156 vs. 206 s). It was vice versa for the posterior segment (180 vs. 151 s). CONCLUSION Slit lamp imaging with the presented smartphone adapter provides high-quality imaging of the anterior segment. Posterior segment imaging remains challenging in terms of image quality. The adapter constitutes a cost-effective, portable, easy-to-use solution for recording ophthalmic photos and videos. It can facilitate clinical documentation and communication among colleagues and with the patient especially outside normal consultation hours. Direct slit lamp imaging allows for time to be saved and increases the independence of ophthalmologists in terms of patient mobility and the availability of photographic staff.
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Affiliation(s)
- Daniel Rudolf Muth
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-255-87-94; Fax: +41-44-255-44-72
| | - Frank Blaser
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Nastasia Foa
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Pauline Scherm
- Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Wolfgang Johann Mayer
- Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
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Li F, Zhu Z, Fan L, Yi G, Zhu X, Li N. A Simple Repair Algorithm for Descemet's Membrane Detachment Performed at the Slit Lamp. J Clin Med 2022; 11. [PMID: 36498576 DOI: 10.3390/jcm11237001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Our study aims to investigate a simple repair algorithm for Descemet's membrane detachment (DMD) following phacoemulsification with Pentacam and anterior segment optical coherence tomography (AS-OCT). Twelve patients with DMD were included in this retrospective study. All cases had persistent corneal edema after phacoemulsification and no improved response to conservative treatment. The repair algorithm consisted of delineating the DMD with the Pentacam and AS-OCT, paracentesis, and intracameral air bubble performed at the slit lamp, followed by immediate supine position. At one month, the final status of Descemet's membrane (DM), best-corrected visual acuity, and incidence of complications were noted. DMD was involved in the visual axis in all cases. The mean interval between phacoemulsification and repair was 5.3 ± 1.2 days. Complete reattachment of DM and corneal clarity occurred in all 12 eyes. Eleven (91.7%) eyes underwent one repair procedure, while one eye (8.3%) underwent a repeat procedure. No adverse events were found. Minor post-intervention complications included temporary increased intraocular pressure due to pupillary block in one eye (8.3%). In conclusion, our modified and simplified repair algorithm for DMD can be performed safely as an outpatient procedure, with accurate delineation using a Pentacam and AS-OCT. It may provide new insight into the timely diagnosis, evaluation, and management of DMD.
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Gagné S, Yuen D, Cohen S. Transconjunctival XEN45 Implantation for Glaucoma Performed at the Slit Lamp: A Pilot Study. J Glaucoma 2022; 31:675-81. [PMID: 35773233 DOI: 10.1097/IJG.0000000000002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/12/2022] [Indexed: 02/04/2023]
Abstract
PRCIS This pilot study of ab externo implantation of a gel microstent is a novel, minimally invasive glaucoma surgery performed at the slit lamp that is effective for lowering intraocular pressure in patients with uncontrolled glaucoma. PURPOSE To evaluate the intraocular pressure (IOP)-lowering effect of gel microstent (XEN Gel Stent, Allergan, Irvine, CA) implantation using an ab externo approach in an office setting. PATIENTS AND METHODS This retrospective, multicenter chart review examined outcomes in patients with uncontrolled glaucoma receiving maximally tolerated medical therapy, who underwent slit lamp ab externo gel stent implantation. At postoperative visit, the IOP, the number of glaucoma medications, the final position of the stent, and the needling rate were analyzed. Assessments were conducted 1 day, 1 week and 1, 3, 6, and 12 months after the implantation. Treatment success was defined as IOP ≥6 mm Hg and ≤18 mm Hg with ≥20% reduction from presurgical IOP, with or without medications. RESULTS Thirty-four eyes from 28 patients were included. Mean preoperative IOP was 24.1±8.0 mm Hg on 3.2±0.9 glaucoma medications. At 12 months postoperative, IOP was reduced to 15.4±4.7 mm Hg on 0.6±1.0 medications; 46.9% and 81.3% of eyes achieved complete and partial success, respectively. The gel stent was properly positioned in 94.1% of eyes after 1 attempt at implantation and in 100% of eyes after a second attempt. In addition to malpositioning, observed complications included occlusion, erosion, and endophthalmitis following anterior chamber reformation. Adjunctive needling was required in 21% of implanted eyes. CONCLUSION Slit-lamp-based transconjunctival XEN45 implantation reduced intraocular pressure in glaucoma patients in the first year of this pilot study and was most commonly associated with wound leak and hypotony among other adverse events.
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Hafezi F, Hillen M, Kollros L, Tan J, Awwad ST. A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface. J Clin Med 2022; 11:4109. [PMID: 35887874 DOI: 10.3390/jcm11144109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement.
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Xu QB, Hu ZY, Wu SQ. Renal cell carcinoma choroidal metastasis recorded by smartphone with interface eyepiece adapter mounted on slit lamp: A case report. Medicine (Baltimore) 2021; 100:e24910. [PMID: 33725849 PMCID: PMC7969302 DOI: 10.1097/md.0000000000024910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Ocular metastasis of renal cell carcinoma (RCC) is rare, and mainly located on the choroid. We report a choroidal metastasis from RCC, which was recorded by a smartphone with an interface eyepiece adapter mounted on a slit lamp. PATIENT CONCERNS A 45-year-old female presented with 1-month history of painless occlusion of the vision field on the left eye, who had undergone right nephrectomy for RCC 19 months ago. DIAGNOSES A smooth, hemispherical and brown protrusion was found behind the pupil nasally. An enhanced computed tomography scan of the orbit showed a slightly high-density hemispherical nodule involving the nasal portions of the left eyeball, the enhancement of the lesion was obvious and homogeneous. A metastatic choroidal space-occupying lesion from RCC was highly suspected according to the clinical and radiological findings. INTERVENTIONS The patient was advised to undergo further treatment, such as radiotherapy. OUTCOMES The images of choroid metastasis were recorded by the smartphone with the interface eyepiece adapter mounted on the slit lamp handily. CONCLUSIONS The smartphone with an interface eyepiece adapter mounted on the slit lamp can be widely used to record the precious images in the clinic in a timely manner.
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Affiliation(s)
- Qi-bin Xu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
| | - Zhi-yi Hu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuang-qing Wu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
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Kocamış Ö, Örnek K, Aşıkgarip N, Hızmalı L, Sezgin FM, Şahin Y. Evaluation of Nasopharyngeal and Conjunctival Swab Samples of Hospitalised Patients with Confirmed COVID-19. Ocul Immunol Inflamm 2021; 29:634-637. [PMID: 33661070 DOI: 10.1080/09273948.2020.1838558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the results of conjunctival and nasopharyngeal swab tests in patients with confirmed COVID-19. METHODS This prospective study included 45 patients who were hospitalized for confirmed COVID-19. Nasopharyngeal swab samples were obtained from the patients before hospitalization. Only one eye of each patient was randomly selected for-conjunctival sampling. All participants underwent a complete slit-lamp examination. Conjunctival and nasopharyngeal swab samples were analyzed by reversetranscriptase-polymerase-chain reaction (RT-PCR). RESULTS Twenty seven (60%) of the patients were male and 18 (40%) were female. Conjunctival swab was positive in only one (2.22%) patient. None of the COVID-19 patients showed ocular changes and symptoms. There were no abnormalities of the ocular surface, anterior chamber or posterior segment at slit-lamp examination. CONCLUSIONS The RT-PCR was not high positive in the conjunctiva as in nasopharyngeal swabs. Ocular changes were not common in COVID-19 patients.
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Affiliation(s)
- Özkan Kocamış
- Department of Opthalmology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Kemal Örnek
- Department of Opthalmology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Nazife Aşıkgarip
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey
| | - Lokman Hızmalı
- Department of Infectious Disease and Clinical Microbiology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Fikriye Milletli Sezgin
- Department of Medical Microbiology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Yahya Şahin
- Department of Emergency Medicine, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
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González-Márquez F, Luque-Romero L, Ruiz-Romero MV, Castillón-Torre L, Hernández-Martínez FJ, Olea-Pabón L, Moro-Muñoz S, García-Díaz RDM, García-Garmendia JL. Remote ophthalmology with a smartphone adapter handled by nurses for the diagnosis of eye posterior pole pathologies during the COVID-19 pandemic. J Telemed Telecare 2021:1357633X21994017. [PMID: 33599527 DOI: 10.1177/1357633x21994017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The use of smartphones to provide specialist ophthalmology services is becoming a more commonly used method to support patients with eye pathologies. During the COVID-19 pandemic, demand for telehealth services such as tele-ophthalmology, is increasing rapidly.Methods: In 2019, the agreement between diagnostic tests was investigated by comparing the diagnostic performance for eye posterior pole pathologies of the images obtained by a smartphone coupled to a medical device known as open retinoscope (OR), handled by a nurse and subsequently assessed by an ophthalmologist versus the images obtained by an ophthalmologist using a slit lamp associated to a 76 diopter indirect ophthalmic lens (Volk Super FieldVR ) (SL-IOL) at the outpatient department of a hospital. The OR used in this study worked with a 28 diopter indirect lens.Results: An examination of 151 dilated eyes (79 adult patients, mean age of 66.7 years, 59.5% women) was conducted. Sensitivity was 98.9%, specificity was 89.8%, the positive predictive value was 93.8% and the negative predictive value was 98.2%. The kappa index between both tests was 0.90 (95% CI: 0.83-0.97) in basic diagnosis, 0.81 (95% CI: 0.74-0.89) in syndromic diagnosis (13 categories) and 0.70 (95% CI: 0.62-0.77) in advanced diagnosis (23 categories).Discussion: Images obtained by a nurse using a smartphone coupled to the OR and subsequently assessed by an ophthalmologist showed a high diagnostic performance for eye posterior pole pathologies, which could pave the way for remote ophthalmology systems for this patient group.
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Affiliation(s)
- Florencio González-Márquez
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Luis Luque-Romero
- Department of Investigation Primary Healthcare District Aljarafe-Sevilla Norte, Mairena del Aljarafe, Seville, Spain
| | - María Victoria Ruiz-Romero
- Department of Quality and Investigation, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Luis Castillón-Torre
- Department of Ophthalmology, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | | | - Luna Olea-Pabón
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Serafín Moro-Muñoz
- Department of Information Systems, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | | | - José Luis García-Garmendia
- Department of Critical Care and Emergency, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
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Yang J, Zhu X, Liu Y, Jiang X, Fu J, Ren X, Li K, Qiu W, Li X, Yao J. TMIS: a new image-based software application for the measurement of tear meniscus height. Acta Ophthalmol 2019; 97:e973-e980. [PMID: 31044537 DOI: 10.1111/aos.14107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To present a new automated image recognition software for the measurement of tear meniscus height (TMH) and investigate its correlation and efficacy compared with an open-source software (NIH ImageJ) and manual evaluation. METHODS A total of 520 slit lamp photographs, among which 276 were in ×16 magnification and 244 were ×40 magnified, captured from 138 eyes of 69 healthy subjects were assessed for TMH by the new automated Tear Meniscus Identification Software (TMIS), ImageJ and human graders. Images processing of TMIS included filtration, recognition and measurement of slit lamp photographs under certain algorithm, which output two measurement patterns, TMISM ax and TMISM ean . TMH measured by ImageJ software, considered as the reference value, was conducted by a masked observer while four masked ophthalmologists performed the manual evaluation. RESULTS In both magnifications, TMH measured by TMISM ean showed similar values with ImageJ while manual evaluation demonstrated underestimated results, and a strong correlation was detected between TMIS and ImageJ. In ×16 magnified photographs, manually obtained TMH revealed a higher correlation with ImageJ, whereas a notably stronger correlation of TMIS with ImageJ was observed in ×40 photographs. Correspondingly, the accuracy for both TMISM ax and TMISM ean appeared to be lower than most doctors in ×16 slit lamp images, in contrast to a better precision of TMISM ean in ×40 ones. CONCLUSION The new software displayed high accuracy and efficacy in ×40 magnification and TMISM ean pattern, suggesting the possibility of this automated TMH measurement platform to be a valid tool in dry eye screening and follow-up practice.
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Affiliation(s)
- Jiarui Yang
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Xingyu Zhu
- Research Centre of Multiphase Flow in Porous Media China University of Petroleum (East China) Qingdao China
| | - Yushi Liu
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Xiaodan Jiang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing key laboratory of restoration of damaged ocular nerve Beijing China
| | - Jiayu Fu
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Xiaotong Ren
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Kaixiu Li
- Burns and Plastic Department Miyun Teaching Hospital of Capital Medical University Beijing China
| | - Weiqiang Qiu
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Xuemin Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing key laboratory of restoration of damaged ocular nerve Beijing China
| | - Jun Yao
- Research Centre of Multiphase Flow in Porous Media China University of Petroleum (East China) Qingdao China
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14
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Yen CH, Wang GQ, Lin TY, Liu CH. Semi-permanent smartphone adapter for microscopes: Design demonstration and workflow testing using a slit-lamp biomicroscope. Taiwan J Ophthalmol 2019; 9:111-117. [PMID: 31198670 PMCID: PMC6557070 DOI: 10.4103/tjo.tjo_19_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: A smartphone microscope adapter is an alternative to a permanently mounted camera, which often requires a specially designed light path as well as a computer system for data storage and network connectivity. A common disadvantage of these adapters is that they need to be repeatedly mounted and dismounted; this is inconvenient during serial observations. PURPOSE: The study purpose is to develop and test a semi-permanent microscope adapter. METHODS: Our prototype was designed using three-dimensional (3D) computer-aided design software and was 3D printed for testing. Two tests were designed to quantify the workflow improvement by measuring the time required to complete specific movements, which simulated the actions of capturing photographs by using an adapter and a slit-lamp biomicroscope. Our prototype was the experimental adapter, and two commercially available products were used as references. A single-shot test measured the average time required to complete a photographing cycle, in which a single photograph was recorded. A multiple-shot test measured the time required to complete cycles in which a different number of photographs were captured; thus, the time required specifically for the preparation phase of photographing was determined. Both tests were performed by 4 researchers. RESULTS: The average time required to complete a cycle using our prototype in single-shot test was significantly shorter than that using one of the references. For the other reference, significances were shown in 2 testers’ results. In the multiple-shot test, the linear regression analysis also showed that the preparation phase of our prototype was significantly shorter than the preparation phase of the two commercially available products (P < 0.001). CONCLUSIONS: The semi-permanent design may improve the workflow of photography using smartphone adapters, thereby reducing the time and effort required for preparing devices, particularly when making multiple consecutive observations or when the targets disappear fast.
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Affiliation(s)
- Chieh-Hung Yen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Ophthalmology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Guo-Quan Wang
- Department of Life Sciences, National Cheng-Kung University, Tainan, Taiwan
| | | | - Chun-Hsiu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Ophthalmology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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15
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Alabi RO, Ansin A, Clover J, Wilkins J, Rao NK, Terry MA, Tran KD, Sales CS. Novel Use of Telemedicine for Corneal Tissue Evaluation in Eye Banking: Establishing a Standardized Approach for the Remote Evaluation of Donor Corneas for Transplantation. Cornea 2019; 38:509-514. [PMID: 30614904 PMCID: PMC6403003 DOI: 10.1097/ico.0000000000001848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the feasibility of using telemedicine consultations in the evaluation of recovered donor corneas for transplant suitability. METHODS This study aims to establish and test the minimum imaging requirements for telemedical consultations of corneal tissue by remote eye bank medical directors. Digital images from the slit lamp, optical coherence tomography, and/or specular microscope were assembled into telemedical consults and emailed to 4 eye bank medical directors (M.A.T., J.W., C.S.S., N.K.R.). Feedback on the minimum image requirements for each corneal finding was collected. After establishing a standardized imaging and presentation protocol, test cases were presented to the medical directors to examine the validity of these remote consults. To establish a benchmark for the study's parameters, one medical director (J.W.) examined each case in person after his initial remote review. Examiners were masked to each other's responses. RESULTS Minimum image requirements for determination of corneal findings were defined and were specific to each anatomic layer of the cornea (epithelial, stromal, or endothelial). Using a defined set of digital images for a set of common corneal findings, the rate of agreement between remote evaluators, eye bank staff, and the in-person evaluator was 100% (11 of 11 examples). For ambiguous test cases, remote evaluators agreed on 80% of the cases (4 of 5). CONCLUSIONS Results from this pilot study suggest that telemedical review of corneal tissue using high-quality digital images may be adequate for accurate identification of specific corneal findings commonly encountered by eye banks.
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Affiliation(s)
- Rolake O. Alabi
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Amy Ansin
- Vision Research Laboratory, Lions VisionGift, Portland, OR
| | - Jameson Clover
- Vision Research Laboratory, Lions VisionGift, Portland, OR
| | | | | | - Mark A. Terry
- Vision Research Laboratory, Lions VisionGift, Portland, OR
- Devers Eye Institute, Portland, OR
| | - Khoa D. Tran
- Vision Research Laboratory, Lions VisionGift, Portland, OR
| | - Christopher S. Sales
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
- Vision Research Laboratory, Lions VisionGift, Portland, OR
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16
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Nankivil D, Gonzalez A, Rowaan C, Lee W, Aguilar MC, Parel JMA. Robotic Remote Controlled Stereo Slit Lamp. Transl Vis Sci Technol 2018; 7:1. [PMID: 29977662 PMCID: PMC6028985 DOI: 10.1167/tvst.7.4.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/08/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Our purpose was to develop a robotic remotely operated stereo slit lamp system allowing three-dimensional stereo viewing and recording of the patient's examination via local area network, Internet, and satellite. Methods A commercial slit lamp was modified to accept motors and servos to permit control of all optical and mechanical components of the device. The custom graphical user interface with dual high-resolution real-time stereoscopic imaging, control/position indicators, overview video, and audio were transmitted via local area network, Internet, and satellite. Under University of Miami Institutional Review Board authorization, Internet connectivity enabled multiple examiners to simultaneously view and control the slit lamp and to collaboratively discuss diagnosis and treatment options. The remote clinicians used a tablet, laptop, or desktop computer to view and control the slit lamp. Results The network, Internet, satellite-connected system was controllable from the United States, Europe, and Canada while acquiring high-resolution, real-time video in all subjects. Control of the slit lamp through Ethernet, WiFi, and 4G exhibited total system latencies of 464 ± 58, 483 ± 64, and 870 ± 66 milliseconds when transmitting within the continent, and Ethernet control exhibited a latency of 606 ± 130 milliseconds when transmitting between continents. High- and low-magnification images of healthy volunteers were acquired by a remote clinician. Conclusions The robotic remotely operated stereo slit lamp system allows three-dimensional stereo viewing and recording of the patient's examination via local area network, Internet, and satellite. Translational Relevance The robotic remotely controlled stereo slit lamp system enables remote examination of human subjects.
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Affiliation(s)
- Derek Nankivil
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alex Gonzalez
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cornelis Rowaan
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William Lee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean-Marie A Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA.,Brien Holden Vision Institute, University of New South Wales, Sydney, Australia.,University of Liège, Department of Ophthalmology, CHU Sart-Tillman, Liège, Belgium
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17
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van den Berg TJTP. Intraocular light scatter, reflections, fluorescence and absorption: what we see in the slit lamp. Ophthalmic Physiol Opt 2018; 38:6-25. [PMID: 29265476 DOI: 10.1111/opo.12426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Much knowledge has been collected over the past 20 years about light scattering in the eye- in particular in the eye lens- and its visual effect, called straylight. It is the purpose of this review to discuss how these insights can be applied to understanding the slit lamp image. RESULTS The slit lamp image mainly results from back scattering, whereas the effects on vision result mainly from forward scatter. Forward scatter originates from particles of about wavelength size distributed throughout the lens. Most of the slit lamp image originates from small particle scatter (Rayleigh scatter). For a population of middle aged lenses it will be shown that both these scatter components remove around 10% of the light from the direct beam. For slit lamp observation close to the reflection angles, zones of discontinuity (Wasserspalten) at anterior and posterior parts of the lens show up as rough surface reflections. All these light scatter effects increase with age, but the correlations with age, and also between the different components, are weak. For retro-illumination imaging it will be argued that the density or opacity seen in areas of cortical or posterior subcapsular cataract show up because of light scattering, not because of light loss. NOTES: (1) Light scatter must not be confused with aberrations. Light penetrating the eye is divided into two parts: a relatively small part is scattered, and removed from the direct beam. Most of the light is not scattered, but continues as the direct beam. This non-scattered part is the basis for functional imaging, but its quality is under the control of aberrations. Aberrations deflect light mainly over small angles (<1°), whereas light scatter is important because of the straylight effects over large angles (>1°), causing problems like glare and hazy vision. (2) The slit lamp image in older lenses and nuclear cataract is strongly influenced by absorption. However, this effect is greatly exaggerated by the light path lengths concerned. This obviates proper judgement of the functional importance of absorption, and hinders the appreciation of the Rayleigh nature of what is seen in the slit lamp image.
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Affiliation(s)
- Thomas J T P van den Berg
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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18
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Abstract
The therapeutic effects of hydrogen-rich saline (HRS) have been reported for a wide range of diseases mainly via selectively reducing the amount of reactive oxygen species. Oxidative stress plays an important role in the pathogenesis of uveitis and endotoxin-induced uveitis (EIU). In this study, we investigated whether HRS can mitigate EIU in rats. Sprague-Dawley rats were randomly divided into Norm group, Model group, HRS group, dexamethasone (DEX) group, and rats in the latter three groups were injected with equal amount of lipopolysaccharide (LPS) to induce EIU of different severities (by 1 mg/kg of LPS, or 1/8 mg/kg of LPS). Rats in HRS group were injected with HRS intraperitoneally at three different modes to purse an ameliorating effect of EIU (10 mL/kg of HRS immediately after injection of 1 mg/kg of LPS, 20 mL/kg of HRS once a day for 1 week before injection of 1 mg/kg of LPS and at 0, 0.5, 1, 2, 6, 8, 12 hours after LPS administration, or 20 mL/kg of HRS once a day for 1 week before injection of 1/8 mg/kg of LPS, and at 0, 0.5, 1, 2, 6, 8, 12, 24 hours and once a day for 3 weeks after LPS administration). Rats of DEX group were injected with 1 mL/kg of DEX solution intraperitoneally immediately after LPS administration. Rats in Norm and Model groups did not receive any treatment. All rats were examined under slit lamp microscope and graded according to the clinical signs of uveitis. Electroretinogram, quantitative analysis of protein in aqueous humor (AqH) and histological examination of iris and ciliary body were also carried out. Our results showed that HRS did not obviously ameliorate the signs of uveitis under slit lamp examination and the inflammatory cells infiltration around iris and cilliary body of EIU induced by 1 mg/kg or 1/8 mg/kg of LPS (P > 0.05), while DEX significantly reduced the inflammation reflected by the above two indicators (P < 0.05). The impaired retinal function of mild EIU induced by 1/8 mg/kg of LPS, showed by delay of peak time of b-wave of Dark adapted 3.0 electroretinogram, was not significantly restored by HRS (P > 0.05), while DEX had an obvious therapeutic effect (P < 0.05). However, HRS exerted an inhibition trend on elevation of protein in AqH of EIU induced by 1 mg/kg of LPS, and significantly reduced the increasing amount of protein in AqH of mild EIU induced by 1/8 mg/kg of LPS (P < 0.05). In conclusion, HRS could not obviously mitigate EIU in rats, while it could inhibit the elevation of AqH protein.
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Affiliation(s)
- Wei-Ming Yan
- Department of Clinical Medicine, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
| | - Lei Zhang
- Department of Clinical Medicine, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
| | - Tao Chen
- Department of Health Service, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
| | - Guan-Hua Zhao
- Department of Clinical Medicine, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
| | - Pan Long
- Department of Clinical Medicine, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
| | - Jing An
- Institute of Neurobiology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zuo-Ming Zhang
- Department of Clinical Medicine, Faculty of Aerospace Medicine, Key Laboratory of Aerospace Medicine of the National Education Ministry, Fourth Military University, Xi'an, Shaanxi Province, China
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19
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Abstract
We are describing a simple and affordable design to pack and carry the slit lamp to the field. Orbis staff working on the Flying Eye Hospital (FEH) developed this design to facilitate mobilization of the slit lamp to the field during various FEH programs. The solution involves using a big toolbox, a central plywood apparatus, and foam. These supplies were cut to measure and used to support the slit lamp after being fitted snuggly in the box. This design allows easy and safe mobilization of the slit lamp to remote places. It was developed with the efficient use of space in mind and it can be easily reproduced in developing countries using same or similar supplies. Mobilizing slit lamp will be of great help for staff and institutes doing regular outreach clinical work.
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Affiliation(s)
| | | | - Ahmed Gomaa
- Flying Eye Hospital, Orbis International, New York, NY, USA
- Department of Ophthalmology, Cairo University, Cairo, Egypt
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20
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Abstract
A 64-year-old Mexican fisherman with a history of syphilis is diagnosed with panuveitis of the right eye after presenting with unilateral blurry vision, redness, and pain. A PPD was 35X30mm, and chest X-ray suggested tuberculosis. The patient's pain and vision improved with 4-drug anti-tuberculous therapy, topical steroids, and cycloplegic eye drops.
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Affiliation(s)
- Read G Pierce
- UCSF Internal Medicine and Ophthalmology, San Francisco VA Medical Center, 4150 Clement St, Rm 1A-81, Bldg 203, San Francisco, CA 94121, USA.
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