ABSTRACT
OBJECTIVE: To compare the diagnostic properties of a nonmydriatic 200° ultra-widefield scanning laser ophthalmoscope (SLO) versus mydriatic Early Treatment of Diabetic Retinopathy Study (ETDRS) 7-field photography for diabetic retinopathy (DR) screening. RESEARCH DESIGN AND METHODS: A consecutive series of 212 eyes of 141 patients with different levels of DR were examined. Grading of DR and clinically significant macular edema (CSME) from mydriatic ETDRS 7-field stereo photography was compared with grading obtained by Optomap Panoramic 200 SLO images. All SLO scans were performed through an undilated pupil, and no additional clinical information was used for evaluation of all images by the two independent, masked, expert graders. RESULTS: Twenty-two eyes from ETDRS 7-field photography and 12 eyes from Optomap were not gradable by at least one grader because of poor image quality. A total of 144 eyes were analyzed regarding DR level and 155 eyes regarding CSME. For ETDRS 7-field photography, 22 eyes (18 for grader 2) had no or mild DR (ETDRS levels ≤ 20) and 117 eyes (111 for grader 2) had no CSME. A highly substantial agreement between both Optomap DR and CSME grading and ETDRS 7-field photography existed with κ = 0.79 for DR and 0.73 for CSME for grader 1, and κ = 0.77 (DR) and 0.77 (CSME) for grader 2. CONCLUSIONS: Determination of CSME and grading of DR level from Optomap Panoramic 200 nonmydriatic images show a positive correlation with mydriatic ETDRS 7-field stereo photography. Both techniques are of sufficient quality to assess DR and CSME. Optomap Panoramic 200 images cover a larger retinal area and therefore may offer additional diagnostic properties.
Subject(s)
Diabetic Retinopathy/diagnosis , Ophthalmoscopy/methods , Photography/methods , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
PURPOSE: To evaluate the efficacy and safety of hyaluronidase as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, and Eye Center Munich East, Munich-Haar, Germany. METHODS: Eyes having cataract surgery at 1 of the 2 centers were included in this prospective randomized double-blind placebo-controlled clinical trial. Retrobulbar anesthesia was administered by the surgeon using a solution of 5 mL mepivacaine 1% with additional hyaluronidase (Hylase Dessau) 75 IU (40 eyes) or additional placebo (40 eyes). The main target parameter was akinesia 5 minutes after administration of the study medication. Secondary parameters were akinesia at later times, additional injections, ptosis of the upper eyelid, time to reach complete anesthesia, assessment of pain using a visual analog scale, assessment of efficacy and tolerability by the patient and the surgeon, and adverse events. RESULTS: Complete akinesia 5 minutes after retrobulbar injection was reached in significantly more cases in the hyaluronidase group (29) than in the placebo group (13) (P < .001). Additional injections were necessary in 5 placebo-treated eyes. The administration of hyaluronidase yielded significantly better results than the placebo in terms of ptosis, time to reach complete anesthesia, assessment of efficacy, tolerability, and postoperative pain. No adverse events occurred in either group. CONCLUSION: The addition of hyaluronidase to mepivacaine for retrobulbar anesthesia in cataract surgery enhanced the safety of the surgical procedure due to more complete akinesia and quicker onset of complete anesthesia.
