A comparative study on efficacy of different dilutions of phenylephrine and tropicamide combination eye drops on pupil dilatation

Background: In ophthalmology (OPD), cycloplegics or mydriatics were needed for doing correct refraction and evaluation of fundus on a daily basis. Aims and Objectives: The objectives of this study were to compare the clinical efficacy and systemic side effects of different dilutions of phenylephrine and tropicamide combinations drops on pupil dilatation and to measure and compare pulse rate and blood pressure before and after giving the drug. Materials and Methods: The present study is a hospital-based interventional study conducted among patients attending to OPD of Regional Eye hospital, Visakhapatnam during April 2012–August 2012. Eighty-one patients randomly allocated to two groups (41 patients in Group 1 and 40 patients in Group 2). Dilution of phenylephrine 5% and Tropicamide 0.8% mixture was applied to patients of Group A in both eyes and dilution of phenylephrine 2.5% and Tropicamide 0.4% mixture was applied to Group B patients in both eyes. Pupil diameter and pulse rate BP were measured and compared. Results: Mean age of Group 1 patients was 55.39 ± 11.47 and Group 2 was 49.95 ± 13.71. Among 36 males, 50% in Group 1 and 50% in Group 2 and among 45 females 51.1% in Group 1 and 48.9% in Group 2. Among both Group 1 and Group 2 patients, both left and right pupil size was significantly increased after application of dilutions, but there was more increase in the pupil size among Group 1 patients compared to Group 2 patients 15 min after and 30 min after application of drug. Conclusions: The combination of 0.8% tropicamide and 5% phenylephrine was effective compared to alternate application of 0.4% tropicamide and 2.5% phenylephrine for rapid and sustainable pupil dilatation for indirect ophthalmoscopy.

Comparison of patient satisfaction with red-free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination

Purpose: Comparison of patient satisfaction with red?free (green) versus yellow light using binocular indirect ophthalmoscope for retinal examination. Methods: This is an observational questionnaire?based study of 100 myopes in the age group of 18–40 years coming for a routine check?up or for refractive surgery workup. The examination was done using an indirect ophthalmoscope and a 20D lens with green or yellow light and was assigned in two groups randomly using the coin toss method, following which, a questionnaire was used to assess the following parameters: a) level of comfort, b) any complaints of discomfort during examination, d) preference of the used light source in future, e) grading of discomfort on a linear scale, and f) patient cooperation and duration of examination. Results: Patients were randomized for observation with IDO using either green light (n = 55) or yellow light (n = 45) filter. In the study, 46 patients (83.6%) were very comfortable and only 9 patients (16.4%) experienced mild discomfort when using red?free (green) light, while only 3 patients (6.7%) were very comfortable and 31 (68.9%) had mild discomfort when using yellow light. The complaints of watering with yellow and green light were noted in 36 patients (80.0%) and 15 patients (27.3%), pain in 13 patients (28.9%) and 3 patients (5.5%), light sensitivity in 29 patients (64.4%) and 4 patients (7.3%), respectively, all being significantly more in yellow light category (P < 0.001). The time of examination was significantly more in yellow light category with 83 ± 10.75 seconds (P < 0.001). Conclusion: Retinal examination using the green filter of indirect ophthalmoscope is more comfortable in examining the patients as compared to routine yellow light with decreased number of complaints, lesser examination time, and better patient cooperation.

Clinical Study Of Fundal Changes In Myopia

Background: Aim: Study fundal changes in different age groups & degrees of myopia.Measure ocular parameters (Corneal Curvature, Axial Length, Intraocular Pressure,Central Corneal Thickness) associated with myopia. Material And Methods: Study included 150 patients out of which 50 were low, 50 medium and 50 high myopia.Examination included best corrected visual acuity, slit lamp examination, keratometry, axial length, central corneal thickness and intraocular pressure, ultrasound B scan, dilated fundus with indirect ophthalmoscope. Result: All fundus findings had correlation with high myopia except choroidal neovascularization which did not differwith degree. All degree showed highest percentage of Keratometry K1 between 42 to 43.99 D and K2 between 44 to 45.99 D with lowest percentage K1 between 46 to 48 D and K2 between 48 to 50 D.Axial lengthincreased with severity. Highest percentage ofcentral corneal thickness in all degree was between 500 to 549 microns.100% of high myopic had tessalation,it did not differ with age. Temporal crescent was common in higher age group. Peripheral retinal degeneration was common between 20 to 29 years.Posterior staphyloma was associated between 30 to 39 years. Retinal detachment did not vary with age.Conclusion: Visual impairmentdue to myopia may be prevented by early detection of cause by appropriate investigations and treatment.

Relationship between fundus screening and intraocular pressure changes in children with ROP in Retcam3 system / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the ability of Retcam3 in screening the retinopathy of prematurity(ROP)and its relationship with the change of intraocular pressure.<p>METHODS: A total of 80 premature infants who met the screening criteria admitted to our hospital from August 2017 to August 2019 were selected as subjects. They were screened by binocular indirect ophthalmoscope and Retcam3 system respectively. The former method was chosen as the gold standard, the sensitivity, specificity, positive and negative predictive values of Retcam3 system screening was calculated, the intraocular pressure changes before and after screening was compared. <p>RESULTS:A total of 37 children with ROP were examined by binocular indirect ophthalmoscopy. 35 infants with ROP were screened by Retcam3 system. The sensitivity of Retcam3 was 100%, the specificity was 95.8%, and the positive predictive value was 94.2%, the negative predictive value is 100%. The intraocular pressure of left eye and right eye after Retcam3 screening was higher than that before dilation, and the difference was statistically significant(<i>P</i><0.05).<p>CONCLUSION: The Retcam3 system can accurately screen patients with ROP, while it can cause an increase in intraocular pressure after screening.

The subjectivity of objective evaluation of torsion on fundus photographs by practicing strabismologists

Purpose: To assess the variability of assessing the ocular torsion on fundus photographs among strabismus surgeons. Methods: This was a prospective, noninterventional, clinical trial involving 16 trained and experienced squint surgeons participated in the study. Two videos were prepared of a total of 10 fundus pictures with or without lines for disc foveal angle. The first video had a 4 s viewing time for each fundus image. The second video had the disc foveal lines drawn and a similar 4 s viewing time for each image. The participants were asked to grade the torsion. The primary outcome measure was to assess the agreement between the raters for ocular torsion measurement. Difference in the response of observers from the standard response was the secondary outcome measure. Results: A 4 s viewing time was given to mimic the exposure time in the clinic while assessing torsion in a patient. Large variability was found among the responses. The kappa test was done for comparing the agreement between various observers which ranged from slight to fair (<0.40). There was no difference in torsion grading in 30.6% and 26.3% responses in the first and second video from the standard response, respectively. When a limit of ±1 grade was taken as acceptable for the responses, 66.2% for the first and 68.7% for the second video respectively were similar to standard response. Conclusion: There is wide variability in assessing ocular torsion by fundus photography. The level of accuracy does increase with marking the line on photographs but still remains unreliable.

Unconventional techniques of fundus imaging: A review.

The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand‑held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost‑effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist’s armamentarium.

Smartphone Indirect Ophthalmoscopy: For Screening, and Documentation of the Ocular Fundus.

Purpose: The purpose of this study is to describe in detail the procedure of performing indirect ophthalmoscopy using any smartphone along with instruments that are readily available in ophthalmic practice. Materials and Methods: The procedure was performed with a smartphone and a 20D or 28D lens. Using the flashlight of the phone as a coaxial light source, the system works as an indirect ophthalmoscope where the camera creates a digital image of the ocular fundus on the phone screen through the condensing lens. High definition videos of the fundus were recorded using the inbuilt video recorder of the phone, and subsequently good quality fundus images were extracted from the video clips. Results: With the described technique of smartphone indirect ophthalmoscopy, we were able to carry out basic screening of the ocular fundus without using a direct ophthalmoscope, slit lamp biomicroscopy or indirect ophthalmoscope. It also proved to be an excellent tool for documentation of fundus pathologies through good quality images. Conclusion: The described technique is an easy and inexpensive way to photograph the fundus in patients using readily available portable instruments. Commercially available fundus cameras are outside the reach of many practitioners and institutes. Hence, the method seems to be a good tool for basic screening and documentation of fundus pathologies. With a small learning curve, it is relatively simple to master and takes advantage of the expanding mobile-telephone networks for telemedicine.

Video indirect ophthalmoscopy using a hand-held video camera.

Fundus photography in adults and cooperative children is possible with a fundus camera or by using a slit lamp-mounted digital camera. Retcam™or a video indirect ophthalmoscope is necessary for fundus imaging in infants and young children under anesthesia. Herein, a technique of converting and using a digital video camera into a video indirect ophthalmoscope for fundus imaging is described. This device will allow anyone with a hand-held video camera to obtain fundus images. Limitations of this technique involve a learning curve and inability to perform scleral depression.

Comparison of Results of Cryopexy and Laser Indirect Ophthalmoscopy in Rhegmatogenous Retinal Detachment

PURPOSE: To compare the efficacy and safety of intraoperative laser indirect ophthalmoscopy and cryopexy for rhegmatogenous retinal detachment through the use. METHODS: We retrospectively analyze the clinical results of 60 patients (61 eyes) with rhegmatogenous retinal detachment. All eyes had an attached macula and were scheduled for conventional scleral buckling surgery with cryopexy (25 eyes) or laser indirect ophthalmoscopy (36 eyes) from March 2001 to August 2007. The visual acuities of the two groups at the first postoperative day, 1 week, 1 month, and 3 months were compared. Retinal reattachment, macular pucker, cystoid macular edema, and proliferative vitreoretinopathy were confirmed 3 months after surgery. RESULTS: The visual recovery was faster in patients who received laser indirect ophthalmoscopy (1 day, P=0.044; 1 week, P=0.017). During the follow-up period, anatomical failure in the laser indirect ophthalmoscopy group did not develop, but there were two anatomical failures in the cryopexy group. In addition, 1 PVR was detected in the cryopexy group. However, neither group exhibited macular pucker or cystoid macular edema. Postoperative additional laser photocoagulation was performed on 7 eyes (19.4%) in thelaser indirect ophthalmoscopy group and 2 eyes (4.0%) in the cryopexy group. CONCLUSIONS: Although intraoperative laser indirect ophthalmoscopy causes less chorioretinal scar formation than cryopexy, it has a higher anatomical success rate and allows for faster visual recovery.

Retinopatía del prematuro: principales factores de riesgo / Retinopathy in premature newborn: main risk factors

Tipo de Estudio: retrospectivo, descriptivo. Objetivo: identificar los factores de riesgo y su influencia en la retinopatía del prematuro (ROP). Método: Se tomaron 74 recién nacidos pretérmino en el hospital Gineco-Obstétrico “Enrique C. Sotomayor” con factores de riesgo conocidos y se les realizó el examen de fondo de ojo mediante oftalmoscopía indirecta entre la cuarta y octava semanas de vida extrauterina; y sus respectivos controles hasta el alta oftalmológica. Resultados: de la población estudiada, 48 pacientes completaron los controles sin presentar la patología, y los 25 pacientes restantes (34) presentaron ROP en distintos grados. Tomando en cuenta los factores de riesgo estudiados y su repercusión sobre la patología: -La edad gestacional promedio de neonatos afectos fue de 32.8 semanas. -Tiempo promedio de exposición a oxigenoterapia de 10 días. -Promedio de peso al nacer 1325.5 gramos. Conclusiones: en este estudio la inmadurez neonatal fue el factor más determinante en la incidencia de esta patología, seguido del bajo peso al nacer y del tiempo de exposición a oxigenoterapia; y dado el gran numero de nacimientos pretérmino en el mundo y mayor aun en países en desarrollo como el nuestro, es menester hacer hincapié en la necesidad de una correcta implementación y organización interhospitalaria del programa de detección temprana de Retinopatía del Prematuro en nuestra ciudad, y de esta manera evitar el inicio de una vida en penumbra.

Type of study: Retrospective, descriptive. Objective: Identify the risk factors and its influence in retinopathy in premature patients. Method: A total of 74 preterm newborn at the “Enrique C. Sotomayor” Gineo-Obstetric Hospital” with known risk factors were included in the study. They underwent an indirect ophtalmoscopy between the fourth and eight week of life and were monitored. Results: From the total population, 48 patients did not have symptoms of the pathology while being monitored and 25 patients left (34) had different stages of retinopathy. Our findings were: The average gestational age of the neonates was 32.8 weeks, the average time of oxygen therapy was 10 days and the average weight was 1325.5 grams. Conclusions: In this study prematurity was the factor that determined the incidence of the pathology, followed by low birth weight and the period received oxygen therapy. Due to the high incidence of premature births in the world and even higher in third world countries like ours it is important to organize a program for the early detection of retinopathy in premature newborns.

Whole Layer Photocoagulation on the Rabbit Retina with Indirect Diode Laser Ophthalmoscopy

In the treatment of retinopathy of prematurity, it is necessary to coagulate retina including inner retinal layer to achieve regression. However, diode laser has long wavelength, thus damage to bruch`s membrane or choroid can occur when one attempts to coagulate whole retinal layers. We evaluated whether or not we could coagulate whole retinal layer without damage to Bruch`s membrane or choroid in rabbit eyes with indirect diode laser ophthalmoscopy. We palaced laser spots on retina of pigmented rabbits with various laser powers(150, 300, 500mW) and durations(0.3, 0.5, 1.0 second). Fundus photographs were taken immediately after photocoagulation. then we took fundus photographs and enucleated the eyes at one day, one week, 3 weeks, and 5 weeks after photocoagulation to perform pathologic examination. With laser setting of 150mW and 0.3 second, the coagulated retina revealed damaged outer layer but inner retinal layer was spared. We could coagulate whole retinal layer without any damage to Bruch`s membrane or choroid with laser power of 300mW and 0.3 second duration. In 300mW, 0.5 second laser burns and 500mW, 0.3 second burns, internal limiting membrane remained intact while Bruch`s membrane and whole retinal layers were damaged We found whole layer rabbit retina could be coagulated without damage to Bruch`s membrane and choriocapillaries with indirect diode laser opthalmoscopy. and we think it would be necessary to adjust laser power and duration in clinical situation to minimize possible deep tissue injury by diode laser.

The Role of Preoperative Indirect Ophthalmoscopy Under General Anesthesia for Diagnosis of Torsional Strabismus

The purpose of this study is to evaluate the status of fundus torsion in 48 patients with unilateral inferior oblique overaction(IOOA) and the results were compared with that in 182 patients who showed normal inferior oblique function by an indirect ophthalmoscope under general anesthesia before strabismic surgery. In 48 eyes with unilateral IOOA, 35 eyes(72.9%) showed extorsion in the same eye. We could also find extorsion in 9 normal fellow eyes(18.7%). Among 182 horizontal strabismic patients(364 eyes) with normal inferior oblique function, there were 23 eyes(6.3%) of extorsion and 1 eye (0.3%) of intorsion. We compared the degree of extorsion with that of IOOA in 48 patients with unilateral IOOA: a mild extorsion were observed in 2 of 10 eyes with IOOA+1. A mild and moderate extorsion were observed in 13(72.2%) and 3 (16.7%) of 18 eyes with IOOA+2, respectively. A mild and moderate extorsion were observed in 9(45%) and 8(40%) of 20 eyes with IOOA+3 respectively. These findings showed that the greater IOOA produces the greater extorsion(p<0.01). On our results the fundus indirect ophthamoscopy before strabismic surgery seems to be helpful in the diagnosis of cyclotorsion.