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Purpose: Diseases affecting the cornea are a major cause of corneal blindness globally. The pressing issue we are facing today is the lack of diagnostic devices in rural areas to diagnose these conditions. The aim of the study is to establish sensitivity and accuracy of smartphone photography using a smart eye camera (SEC) in ophthalmologic community outreach programs. Methods: In this pilot study, a prospective non?randomized comparative analysis of inter?observer variability of anterior segment imaging recorded using an SEC was performed. Consecutive 100 patients with corneal pathologies, who visited the cornea specialty outpatient clinic, were enrolled. They were examined with a conventional non?portable slit lamp by a cornea consultant, and the diagnoses were recorded. This was compared with the diagnoses made by two other consultants based on SEC videos of the anterior segment of the same 100 patients. The accuracy of SEC was accessed using sensitivity, specificity, PPV, and NPV. Kappa statistics was used to find the agreement between two consultants by using STATA 17.0 (Texas, USA). Results: There was agreement between the two consultants to diagnosing by using SEC. Above 90% agreements were found in all the diagnoses, which were statistically significant (P?value < 0.001). More than 90% sensitivity and a negative predictive value were found. Conclusion: SEC can be used successfully in the community outreach programs like field visits, eye camps, teleophthalmology, and community centers, where either a clinical setup is lacking or ophthalmologists are not available.
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@#AIM: To investigate the necessity of visual acuity, intraocular pressure(IOP)and slit lamp microscope examination on the same day after cataract surgery, and to explore a safe and effective method for postoperative observation.<p>METHODS: We collected cataract patients receiving day surgery from October to November 2018. They underwent phacoemulsification combined with intraocular lens(IOL)implantation. 149 patients(149 eyes)were included. Before the surgery, and 2h, 1d, 1wk after the surgery, we measured and compared their best corrected visual acuity(BCVA)and IOP, observing whether they had the corneal edema, IOL dislocation or other complications with slit lampmicroscope. We also compared the percentage of high IOP, low IOP before and after surgery.<p>RESULTS: BCVA before and 2h after surgery, BCVA 2h and 1d after surgery, and BCVA 1d and 1wk after surgery were statistically different, showing a gradually improving trend(<i>P</i><0.05). There was no significant difference between IOP before surgery and 2h after surgery or 1d after surgery(<i>P</i>>0.05), but the IOP 1wk after surgery was lower than that before surgery, 2h after surgery and 1d after surgery(<i>P</i><0.05). The percentage of high IOP 2h after surgery was significantly higher than that before surgery, 1d after surgery and 1wk after surgery. No ocular complication was found 1wk after surgery.<p>CONCLUSION: The visual acuity, IOP and corneal edema of the patients recovered 1wk after day cataract surgery, and high IOP was easy to happen 2h after surgery. Visual acuity, IOP and slit lamp microscope examination were safe, and corresponding treatment could be given to patients with high IOP.
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@#AIM: To describe the application of image acquisition function of smart phone with slit lamp examination in the ophthalmology residency training program.<p>METHODS: The supporting set for smart phone can be securely connected to the ocular lens of slit lamp microscopy. The anterior or fundus photos and dynamic videos were obtained through slit lamp examination with non-contact lens, three-mirror lens or gonio lens. Acquired images or recorded videos were transmitted to ophthalmology trainee by using wireless local area network(WLAN), WeChat and other software.<p>RESULTS: High quality images and dynamic video could be successfully taken with smart phone and supporting set by slit lamp examination, which could clearly display tissue details and pathological features. The fast transmission of image data can enable more trainees to access clinic education resource simultaneously and communicate with each other timely and effectively.<p>CONCLUSION: High resolution smart phones are wildly used and supporting sets are very accessible; thus high quality of images could be easily obtained for clinical teaching purpose. Furthermore, it enriches the clinical teaching resources. So the application of image acquisition function of smart phone with slit lamp examination is worthy in the standardized training of ophthalmology residents.
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Objective To investigate the imaging manifestations of different filamentous fungal strains under the confocal laser scanning microscope and slit-lamp microscope,and evaluate the feasibility of rapid diagnosis and therapeutic efficacy judgment for fungal culture negative patients.Methods A diagnosis trail was performed.Nine hundred and ninety-three patients with fungal keratitis (FK) which were varified by fungal culture were included in Henan Eye Hospital from September 2013 to January 2014.Distribution of fungi strains and positive rate of fungal strains by fungal culture and corneal confocal laser scanning microscopy were compared.The imaging characteristics of different filamentous fungi and different stages of one filamentous fungi under the slit-lamp microscope and confocal laser scanning microscopy were summarized.Results In the 993 FK patients,the diagnostic positive rate of fungal culture and confocal laser scanning microscopy was 43.20％ and 82.07％,respectively,showing a significant difference between them (x2 =45.323,P =0.000).In 429 culture-positive patients,the diagnostic positive rate of confocal laser scanning microscopy was 92.31％;while in 564 culture-negative patients,the diagnostic positive rate of confocal laser scanning microscopy was 74.29％.In 429 culture-positive patients,Aspergillus was the most common genus,accounting for 50.12％,and followed by Fusarium sp.and Altemaria sp.(18.18％ and 10.49％).There were no significant differences in fungal species distributions between fungal culture and confocal laser scanning microscopy examination in 429 cases (all at P＞0.05).The imaging characteristics under the slit-lamp microscope and confocal laser scanning microscope were different in different fungi stains.Aspergillus infection showed a plume-like corneal ulcer,and the Aspergillus sp.hyphae were thin and line-shaped with high reflective light and less branched under the confocal laser scanning microscope.Toothpaste-like corneal infiltration was seen in Fusarium sp.-infectious lesions under the slit lamp microscope,and mycelium showed a high-reflective long rod-like image with less branch in the image of confocal laser scanning microscope.Alternaria alternate sp.corneal infection showed nevus lesions,and hyphae characterized by high-reflective long rod or string beads in shape with less branches in the image of confocal laser scanning microscope.The mycelium was ruptured,shorter,thinner with weak reflective light following drug therapy.The differential diagnosis could be easily obtained between hyphae and corneal nerve fibers by confocal laser scanning microscope.Hyphae intertwined,or had branches with diffuse distribution,which surrounded by highreflective inflammatory cells and destructed matrix fiber and were located in stroma.The corneal nerve fibers located between epithelium layer and stroma layer,surrounded by normal epithelium or stroma structure.The diameter of the thicker nerve fibers in the stroma layer was obviously thicker than that of the hyphae.Conclusions The diagnosis rate of confocal laser scanning microscope combined with slit-lamp microscope for filamentous fungi-infectious FK is higher than that of fungal culture.The combination procedure of confocal laser scanning microscope and slit lamp microscope examination provides a rapid evaluation for fungi strains and therapeutic efficacy in the FK patients with negative results by fungal culture.
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PURPOSE: We present a new simple technique to remove subconjunctival cyst under the slit lamp microscope. CASE SUMMARY: A cotton swab was used to verify whether or not the cyst was freely movable under the conjunctiva. After topical anesthesia, we incised the conjunctiva near the cyst using a 30-gauge needle and extracted the cyst through the wound using forceps under the slit lamp microscope. Four cases of subconjunctival cyst were successfully removed with our new technique. During the average five month (2-10 month) follow-up period, there was no recurrence or procedure-related complications. CONCLUSIONS: Some subconjunctival cysts such as an epithelial inclusion cyst which is freely movable without attachment to surrounding tissues can be easily removed with a 30-gauge needle and forceps under the slit lamp microscope. This could be considered as the primary procedure instead of simple aspiration.
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Anesthesia , Conjunctiva , Follow-Up Studies , Needles , Recurrence , Surgical InstrumentsABSTRACT
Objective:To examine the quality of the donor corneal tissue preserved with Optisol.Methods:An auto-designed bottle underprop was installed on the chin underprop of slit lamp microscope,and it was applied to examine the quality of donor corneal tissue preserved in bottle with Optisol.Results:The donor corneal layers preserved in bottle with Optisol could be observed clearly from endothelial layer to epithelial layer by improved slit lamp microscope.Conclusion:An effective examining method is supplied to assure the quality of donor corneal tissue from eye bank.