Binocular Indirect Ophthalmoscopy Research Articles

Телемедицина в скрининге, диагностике и лечении активной ретинопатии недоношенных

The literature review provides information on the use of special research and clinical tool – telemedicine in ophthalmology. The importance of telemedicine services for the early detection and timely treatment of such diseases as retinopathy of prematurity (ROP) is shown based on the data of a number of studies. Many studies indicate the value of retinal pediatric system RetCam and digital images of the fundus obtained with their help for screening, diagnosis and tactics of patients with ROP via telemedicine technologies. This, according to many researchers, promotes the timely detection of children with the stages of the disease, requiring the consultation of ophthalmologists, treatment, and referring them to specialized clinics. Thereat this demonstrates a high accuracy of the interpretation of fundus images during the telemedicine screening. Foreign authors note a significant economic efficiency of ROP telemedicine compared with the standard diagnostic methods, such as the indirect binocular ophthalmoscopy during the direct consultation of the patient by an ophthalmologist, they also noted that the use of this technology promotes to reduce time-consuming of ophthalmologists involved in the management of patients with ROP. According to various authors, the incidence of ROP worldwide continues to grow, and the use of telemedicine for screening, diagnosis, and training of medical personnel will become increasingly important in the organization of eye care in preterm infants. Nowadays the subject of ROP telemedicine is reflected in the national pediatric ophthalmology only in a few publications. However, this trend begins to develop rapidly and is one of the most promising tools to solve the problem of retinopathy of prematurity in Russian pediatric ophthalmic practice.

Using a +20D lens for non-contact slit lamp biomicroscopy of ocular fundus

Noncontact slit lamp examination of the ocular fundus has been classically done using high power convex lenses like +90D, +78D, and +60D. A real and inverted image of the fundus is formed in between the high power convex lens and the slit lamp. The +20D lens is commonly used for binocular indirect ophthalmoscopy. The authors use this +20D lens for slit lamp biomicroscopy examination of the fundus.

Signs and symptoms of uveitis

SummaryUveitis can be a sight‐threatening disease. Inflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Blurred vision, ocular pain, photophobia and floaters are some of the symptoms complained by those who are affected by uveitis. The onset of uveitis can be either acute or insidious, bilateral rather than unilateral. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to evaluate the severity of vitritis. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be present. Uveitis might be complicated by anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia.

Cost analysis of remote telemedicine screening for retinopathy of prematurity

Abstract Objective To compare costs of 2 screening modalities for retinopathy of prematurity (ROP): telemedicine imaging with remote interpretation versus in-person binocular indirect ophthalmoscopy (BIO). Design Retrospective chart review. Participants Infants from an existing telemedicine screening program at 2 cities in Ontario, Canada. Methods We conducted a cost analysis comparison from the perspective of the Ministry of Health. Patient level data was used for the telemedicine group. A hypothetical control group consisted of the minimum number of BIO and interhospital transfers if the existing patients were screened in person. Costs included in-person examinations, transfers, setting up, and ongoing costs of telemedicine screening. Costs were compared using the Mann–Whitney U test and are reported in 2014 Canadian dollars. Results A total of 102 and 72 infants were screened from Sudbury and Barrie, respectively; 3% and 2% of infants in the telemedicine group were transferred for BIO from Sudbury and Barrie, respectively. All infants in the control group would have required at least one transfer for BIO. The average total cost per eye examination was $4855 ± $5616 and $4540 ± $3129 for the telemedicine group and $19 834 ± $13 814 and $2429 ± $1664 for the control group from Sudbury and Barrie, respectively (p Conclusions Telemedicine appears to be an economically attractive option depending on the location and number of infants screened. This information is useful for planning similar ROP screening programs.

Screening and treatments using telemedicine in retinopathy of prematurity.

Several studies have validated the role of telemedicine as a new powerful screening and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.

Incidence and Risk factors of Retinopathy of Prematurity in Tertiary Care Centre of Western India

Aim: This study is aimed to estimate the incidence of retinopathy of prematurity and to identify the risk factors which predispose to retinopathy of prematurity. Material & Methods: The present prospective study was conducted at Ophthalmology department of tertiary care centre in Aurangabad, India from September 2010 to May 2013. Total 150 preterm infants admitted to the neonatal intensive care unit or discharged were included in this study. Diagnosis of ROP was done by binocular indirect ophthalmoscopy and graded into stages and zones as per the international classification of ROP. The data was analysed by using the SPSS-23 program and applying the chi-square test. Results: Of the total 150 infants screened, ROP was seen in 71 infants with the overall incidence of 47.33 %. The stage I ROP was with the highest incidence (22%), followed by decreased incidence pattern in stages II, III, IVa. There were no patients with stage V. The highest percentage of retinopathy of prematurity was seen in infants with gestational age < 28 weeks and extremely low birth weight (<1000 g) infants. The oxygen administration for more than 2 days (p= 0.0001), sepsis (p=0.001), intraventricular haemorrhage (p=0.001), blood transfusion (p=0.001) and respiratory distress syndrome (p=0.01) were found to be statistically significant for the development of retinopathy of prematurity. Conclusion: All high risk babies should be screened for ROP as early screening and intervention can help to increase the child’s chances of better vision and hence better quality of life and also reduce the load of paediatric blindness due to ROP.

Diagnostic Discrepancies in Retinopathy of Prematurity Classification

To identify the most common areas for discrepancy in retinopathy of prematurity (ROP) classification between experts. Prospective cohort study. A total of 281 infants were identified as part of a multicenter, prospective, ROP cohort study from 7 participating centers. Each site had participating ophthalmologists who provided the clinical classification after routine examination using binocular indirect ophthalmoscopy (BIO) and obtained wide-angle retinal images, which were independently classified by 2 study experts. Wide-angle retinal images (RetCam; Clarity Medical Systems, Pleasanton, CA) were obtained from study subjects, and 2 experts evaluated each image using a secure web-based module. Image-based classifications for zone, stage, plus disease, and overall disease category (no ROP, mild ROP, type II or pre-plus, and type I) were compared between the 2 experts and with the clinical classification obtained by BIO. Inter-expert image-based agreement and image-based versus ophthalmoscopic diagnostic agreement using absolute agreement and weighted kappa statistic. A total of 1553 study eye examinations from 281 infants were included in the study. Experts disagreed on the stage classification in 620 of 1553 comparisons (40%), plus disease classification (including pre-plus) in 287 of 1553 comparisons (18%), zone in 117 of 1553 comparisons (8%), and overall ROP category in 618 of 1553 comparisons (40%). However, agreement for presence versus absence of type 1 disease was >95%. There were no differences between image-based and clinical classification except for zone III disease. The most common area of discrepancy in ROP classification is stage, although inter-expert agreement for clinically significant disease, such as presence versus absence of type 1 and type 2 disease, is high. There were no differences between image-based grading and clinical examination in the ability to detect clinically significant disease. This study provides additional evidence that image-based classification of ROP reliably detects clinically significant levels of ROP with high accuracy compared with the clinical examination.

Wide-field fundus fluorescein angiogram assisted photocoagulation on familial exudative vitreoretinopathy

Objective To observe the application value and therapeutic efficacy of wide-field digital pediatric retinal imaging system (Retcam Ⅲ) fundus fluorescein angiograms (FFA) assisted photocoagulation on familial exudative vitreoretinopathy (FEVR). Methods The study included 46 eyes of 34 patients with staging 2 FEVR. All patients received color fundus photography and FFA under general anesthesia. The blood vessel reliability of color fundus photography and FFA was comparatively determined. Binocular indirect ophthalmoscope laser photocoagulation was applied to peripheral retina with abnormal leakage as indicated by FFA, the wavelength was 532nm, the duration was 0.25 s and the energy was 200 - 280 mW. After laser photocoagulation, fundus imaging and FFA was repeated. Further laser photocoagulation was immediately added to areas with vessel leakage but missing the photocoagulation. After treatment, the mean follow-up duration was 14.4 months. The follow up focused on neovascularization, exudative lesions, vitreous traction and merging of photocoagulation spots within 3 months, and on fibrosis membrane resulting in macular traction, tractional retinal detachment, vitreous hemorrhage or Coats disease-like retinal exudates after 3 months. Results It was hard to identify the blood vessels based on the color fundus images and some avascular zone maybe missed. Neovascularization can't be determined by shape of the blood vessels. On the other hand, those new blood vessels can be easily recognized by FFA as leakage sites at the boundary of avascular zone. The surgeon could quickly and accurately locate the FEVR area guided by the color fundus images and FFA from same angle under binocular indirect ophthalmoscope. During the treatment, there was no retinal FEVR area missed laser photocoagulation for all patients. There was no neovascularization, exudative lesions, vitreous traction within 3 months, and no fibrosis membrane, tractional retinal detachment, vitreous hemorrhage or Coats disease-like retinal exudates after 3 months. There were no ocular and systemic complications during and after the FFA and laser photocoagulation. Conclusion Wide-field Retcam Ⅲ FFA can help retinal specialists to identify abnormal neovascularization, locate the lesion area, and thus increase the success rate of laser photocoagulation, reduce the ocular and systemic complications for FEVR. Key words: Retinal diseases/congenital; Retinal diseases/diagnosis; Fluorescein angiography; Retinal diseases/therapy; Laser coagulation

Clinical effects of gas tamponade followed by scleral cryotherapy on rhegmatogenous retinal detachment

To evaluate the effects of intravitreal injection of sterile air followed by scleral cryotherapy on simple rhegmatogenous retinal detachment (RRD). Retrospective study. Thirty-five cases (thirty-five eyes) with RRD were collected from Oct 2013 to Mar 2014. Among them, macular detachment was observed in 31cases, all accompanied with obvious synchesis. All retinal breaks were horseshoe shaped and holes located above 9 o'clock to 3 o'clock position, with size ranged from 0.5 to 1.5 PD. Subretinal fluid was drained by scleral puncture, after that 0.5-2.0 ml sterile air was injected into the vitreous cavity. Cryotherapy was done under binocular indirect ophthalmoscope followed by scleral buckling. Retina reattachment was seen in 32 cases at the first day after operation. A small amount of subretinal fluid was found in 2 cases, which absorbed completely in one week after the surgery. Vitrectomy was done in 1 case because of aggravation of vitreous opacity and failure of retinal reattachment. The success rate of single operation and final operation was 97.1% and 100.0%, respectively. Visual improvement was observed in 33 cases. Ocular hypertension was seen in 6 cases and was controlled by topical antiglaucomatous eyedrops. No recurrence of RRD was found in all cases during the 5-10 months follow-up visit. Gas tamponade followed by scleral cryotherapy can improve the success rate of operation for simple rhegmatogenous retinal detachment with obvious synchesis and retinal holes located at the upper quadrant.

Comparison of the effectiveness of three retinal camera technologies for malarial retinopathy detection in Malawi.

The purpose of this study was to test the suitability of three available camera technologies (desktop, portable, and i-phone based) for imaging comatose children who presented with clinical symptoms of malaria. Ultimately, the results of the project would form the basis for a design of a future camera to screen for malaria retinopathy (MR) in a resource challenged environment. The desktop, portable, and i-phone based cameras were represented by the Topcon, Pictor Plus, and Peek cameras, respectively. These cameras were tested on N=23 children presenting with symptoms of cerebral malaria (CM) at a malaria clinic, Queen Elizabeth Teaching Hospital in Malawi, Africa. Each patient was dilated for binocular indirect ophthalmoscopy (BIO) exam by an ophthalmologist followed by imaging with all three cameras. Each of the cases was graded according to an internationally established protocol and compared to the BIO as the clinical ground truth. The reader used three principal retinal lesions as markers for MR: hemorrhages, retinal whitening, and vessel discoloration. The study found that the mid-priced Pictor Plus hand-held camera performed considerably better than the lower price mobile phone-based camera, and slightly the higher priced table top camera. When comparing the readings of digital images against the clinical reference standard (BIO), the Pictor Plus camera had sensitivity and specificity for MR of 100% and 87%, respectively. This compares to a sensitivity and specificity of 87% and 75% for the i-phone based camera and 100% and 75% for the desktop camera. The drawback of all the cameras were their limited field of view which did not allow complete view of the periphery where vessel discoloration occurs most frequently. The consequence was that vessel discoloration was not addressed in this study. None of the cameras offered real-time image quality assessment to ensure high quality images to afford the best possible opportunity for reading by a remotely located specialist.

Toxoplasmose ocular com reação em cadeia da polimerase positiva em sangue periférico – relato de dois casos, estado de São Paulo, Brasil

Aims: To describe the use of polymerase chain reaction (PCR) in peripheral blood and demonstrate its importance in the clinical follow-up of patients with ocular toxoplasmosis. Case description: Two immunocompetent patients were clinically diagnosed with acute ocular toxoplasmosis. The routine clinical evaluation consisted of fundus examination using binocular indirect ophthalmoscopy, color fundus photography, fluorescein angiography, and spectral domain optical coherence tomography. The serological diagnosis was made by ELISA (IgM, IgG) and confirmed by ELFA (IgG, IgM). The molecular diagnosis was made by PCR in peripheral blood using the B1 gene of Toxoplasma gondii as marker. The younger patient was male, had previous lesion in the right eye, complained of low visual acuity in the left eye and was under treatment. The older patient was male, had retinal detachment, and presented with sudden loss of acuity in the right eye. The fundus examination revealed chorioretinal scar in the left eye. IgG was reactive, IgM was non-reactive, and PCR was positive in the peripheral blood of both patients. New blood samples were collected for serological and molecular monitoring and PCR remained positive in both cases. Six weeks after treatment with oral sulfadiazine and pyrimethamine, the PCR yielded negative results. Conclusions: The results show that T. gondii antigens may be found in peripheral blood during ocular reactivations and that PCR may be a good tool for the follow-up of patients with ocular toxoplasmosis.

The efficacy of intravitreal interferon alpha-2b for the treatment of experimental endotoxin-induced uveitis.

Purpose:To study the efficacy of intravitreal interferon alpha-2b for endotoxin-induced uveitis.Materials and Methods:A total of 36 rabbits were randomly allocated to one of the three groups: (1) received interferon plus balanced-salt solution; (2) received lipopolysaccharide (LPS) plus interferon; and (3) received LPS plus balanced-salt solution. Intraocular inflammation was evaluated by slit-lamp biomicroscopy (standardization of uveitis nomenclature grading), binocular indirect ophthalmoscopy (BIO) score, and histopathology.Results:Group 2 showed significantly lower mean (±standard deviation) anterior chamber reaction than Group 3 (3.1 ± 0.9 vs. 3.8 ± 0.4) on day 1 postinjection, lower vitreous cells on days 1 through 7 (day 1: 3.1 ± 0.9 vs. 3.8 ± 0.4; day 3: 2.1 ± 1.6 vs. 3.8 ± 0.4; day 7: 1.9 ± 1.3 vs. 3.6 ± 0.7), and lower BIO score on days 1–7 (day 1: 3.3 ± 1.2 vs. 4.4 ± 0.7; day 3: 3.0 ± 1.4 vs. 4.3 ± 0.9; day 7: 2.4 ± 1.4 vs. 3.7 ± 1.2). The protein content of anterior and vitreous aspirates was lower in Group 2 than 3 (1618.5 ± 411.4 vs. 2567.3 ± 330.8 and 2157.0 ± 283.3 vs. 3204.6 ± 259.5, respectively).Conclusion:Intravitreal interferon alpha-2b was effective in controlling endotoxin-induced uveitis.

Retinopatia da prematuridade

This study discusses current aspects regarding retinopathy of prematurity (ROP), a clinical disorder that leads to the highest number of children in the world becoming blind. This emphasizes the importance of screening for the disease in all preterm infants with a very low birth weight, identifying retinopathy at a proper time, and treating it using laser at about 37 weeks post-conception while there is still a chance for treatment, which should preferably be conducted during the child stay at the Neonatology Center. The first ophthalmic examination should be performed using binocular indirect ophthalmoscopy, with dilated pupils, between 4 and 6 weeks after birth in all newborns weighing 1,500 g or less and/or at the gestational age of 32 weeks or less, as proposed by the Brazilian Guidelines for ROP Screening and Detection. The follow-up of children with or without retinopathy should be conducted periodically until vascularization of Zone 3 temporal retina is normalized, and this normalization should be maintained during the first years of life for the prevention of amblyopia and strabismus and for the correction of refractive errors related to prematurity.

Ophthalmological pre-clinical research about essential oil from the Origanum vulgare L., Lamiaceae

Objective: To evaluate acute eye irritation in rabbits following topical administration of essential oil. Methods: animals were divided into three groups, each containing three rabbits, with a total of 6 eyes per group. The difference between them was the concentration used (1, 3 and 9%). A single dose of 0.1 ml of the product was applied into the conjunctival sac of one eye of the animal, and the contralateral eye was used as control. The effects caused by the essential oil in the conjunctiva, iris and cornea were analyzed after 1, 24, 48 and 72 hours and at the end of the seventh day after topical application. Ophthalmologic evaluations were performed with the aid of a binocular indirect ophthalmoscope fluorescein and with and without the observed responses, before being graded according to the Draize scale. Pathological examinations were performed on all eyes studied at the end of the experiment. Results: in the group of animals subjected to the ocular instillation of 1% essential oil, there was no change. For treatment with 3% oil, conjunctival changes were found to be decreasing during the examination after 1 hour. Administration of the 9%essential oil induced conjunctival injection, without any change in the other ophthalmologic evaluation times. Conclusion: the evaluation contributed to meet the clinical changes in the ocular surface. Thus, it was possible to classify the oil at 1% as non-irritating and the concentration of 3% and 9 as mildly irritating, making it possible for clinical studies to establish the oil as an alternative therapy in bacterial conjunctivitis.

Comparison between binocular indirect ophthalmoscopy and digital retinography for diabetic retinopathy screening: the multicenter Brazilian Type 1 Diabetes Study.

BackgroundDiabetic retinopathy is the main cause of preventable blindness in the economically active population in western countries. Diabetic retinopathy screening is effective in preventing blindness and can be performed through various diagnostic methods. Our objective is to compare binocular indirect ophthalmoscopy (BIO) to telemedicine protocols of digital retinography for diabetic retinopathy screening in a large and heterogenous type 1 diabetes population in a developing country.MethodsData from 1266 Type 1 Diabetes Mellitus patients from a Brazilian multicenter study were analyzed. Patients underwent BIO and digital retinography, non-mydriatic and mydriatic. Images were sent to a reading center in a telemedicine protocol. Agreement between the different methods was calculated with kappa statistic for diabetic retinopathy and maculopathy classification. Clinical outcome was either observation or referral to specialist.ResultsAgreement between BIO and mydriatic retinography was substantial (kappa 0.67–0.74) for diabetic retinopathy observation vs referral classification. Agreement was fair to moderate (kappa 0.24–0.45) between retinography and BIO for maculopathy. Poor mydriasis was the main obstacle to image reading and classification, especially on the non-mydriatic strategy, occurring in 11.9 % of right eyes and 16.9 % of left eyes.ConclusionMydriatic retinography showed a substantial agreement to BIO for diabetic retinopathy observation vs referral classification. A significant amount of information was lost on the non-mydriatic technique because of poor mydriasis. We recommend a telemedicine-based diabetic retinopathy screening strategy with digital mydriatic retinography, preferably with 2 fields, and advise against non-mydriatic retinography in developing countries.

Signs and symptoms of uveitis

SummaryInflammation of uveal tract can be divided into: anterior, intermediate, posterior, and panuveitis. Uveitis can be a sight‐threatening disease. The commonest ocular symptoms are: blurred vision, ocular pain, photophobia and floaters, depending on the type of uveitis. The onset of uveitis can be either acute or insidious, involving one or both eyes. Posterior uveitis is usually associated with vitritis. Anterior chamber cells and flare should be graded according to standardized uveitis nomenclature (SUN) working group. Binocular indirect ophthalmoscopy (BIO) score is used to grade vitreous involvement. Vitreous changes may comprehend: vitreous hemorrhage, vitreous strands, and vitreous traction. A further classification of posterior uveitis depends on the primary site of inflammation, which can identify: retinitis, choroiditis, retinochoroiditis, and chorioretinitis. Posterior pole uveal involvement can be: focal, multifocal, and placoid. Retinal vasculitis can be associated with several sub‐types of posterior uveitis. Uveitis can present several complications such as, anterior and posterior synechiae, which can lead to uveitic glaucoma, cystoid macular oedema, retinal and choroidal neovascularizations, and retinal ischemia.

Direct Ophthalmoscopic Indirect Ophthalmoscopy (DIDO) and Estimation Dynamic Distance Direct Ophthalmoscopy (E-DDDO). The Two Novel Uses of Direct Ophthalmoscope!

Aim: To describe two novel uses of a direct ophthalmoscope. 1) Direct ophthalmoscopic indirect ophthalmoscopy (DIDO) for the evaluation of the posterior pole of the eye from a distance using a direct ophthalmoscope and 2) estimation dynamic distance direct ophthalmoscopy (E-DDDO) for the objective measurement of accommodation in children. Subjects and Methods: In this prospective observational study, DIDO and E-DDDO were performed on children < 16 years and compared with the current gold standard, the binocular indirect ophthalmoscopy (BIDO) and dynamic retinoscopy (DR), respectively. Results: Of 31 consecutive cases, DIDO identified all 5 patients who had retinal pathology diagnosed by BIDO. Seventeen children, aged 9.6±3.1 years underwent the E-DDDO and DR. The accommodative amplitude with E-DDDO was 8±2.3D, (range 4-11D) and that with DR was 8.5±2.7 D, (range 4-14D). One patient with asthenopia & hypo-accommodation was identified on both DR and E-DDDO. The Pearson r for E-DDDO & DR was 0.9. There was no statistical difference between the values obtained on two different techniques (Paired t test – p = 0.6). Conclusion: DIDO and E-DDDO are two valid techniques; DIDO can be used for a rapid screening of the posterior pole of the fundus especially in uncooperative children and E-DDDO can be used to objectively assess the amplitude of accommodation in preverbal children and uncooperative children or adults.

Safety of Retinopathy of Prematurity Examination and Imaging in Premature Infants

To describe adverse events (AEs) and noteworthy clinical or ocular findings associated with retinopathy of prematurity (ROP) evaluation procedures. Descriptive analysis of predefined AEs and noteworthy findings reported in a prospective observational cohort study of infants <1251g birth weight who had ROP study visits consisting of both binocular indirect ophthalmoscopy (BIO) and digital retinal imaging. We compared infant characteristics during ROP visits with and without AEs. We compared respiratory support, nutrition, and number of apnea, bradycardia, or hypoxia events 12hours before and after ROP visits. A total of 1257 infants, mean birth weight 802g, had 4263 BIO and 4048 imaging sessions (total 8311 procedures). No serious AEs were related to ROP visits. Sixty-five AEs were reported among 61 infants for an AE rate of 4.9% infants (61/1257) or 0.8% total procedures (65/8311 BIO+imaging). Most AEs were due to apnea, bradycardia,and/or hypoxia (68%), tachycardia (16%), or emesis (8%). At ROP visit, infants with AEs, compared with those without, were more likely to be on mechanical ventilation (26% vs 12%, P=.04) even after adjustment for weight and postmenstrual age. Noteworthy clinical findings were reported during 8% BIO and 15% imaging examinations. Respiratory and nutrition support were not significantly different before and after ROP evaluations. Retinal imaging by nonphysicians combined with BIO was safe. Noteworthy clinical findings occurred during both procedures. Ventilator support was a risk factor for AEs. Monitoring rates of AEs and noteworthy findings are important to the safe implementation of ROP imaging protocols. Clinicaltrials.gov: NCT01264276.

Comparative study of RetCamRetCam II vs. binocular ophthalmoscopy in a screening program for retinopathy of prematurity

ObjectiveTo determine the performance of RetCam vs. binocular ophthalmoscopy (BIO) in a screening program for retinopathy of prematurity (ROP). MethodsObservational comparative study with prospective data collection. Examinations with RetCam (n=169) were performed on 83 infants included in a screening program for ROP and stored for analysis at a later stage. An experienced ophthalmologist examined the ocular fundus with binocular indirect ophthalmoscopy (BIO). The RetCam images were assessed for the presence of ROP, zone, grade, and presence of plus disease. RetCam and BIO data were compared by visually to estimate sensitivity, specificity, positive (VPP) and negative (VPN) predictive values. ResultsROP disease was detected in 108 eyes with BIO, and in 74 with RetCam. Out of 306 eyes examined with RetCam, false negative results were found in 34 eyes, with no false positives. Sensitivity of RetCam exam vs. BIO was 0.68, and specificity was 0.99. Positive predictive value was 0.93 and negative predictive value was 0.85. All 34 ROP cases not detected with RetCam were in zone III or outer zone II. They were all mild and regressed spontaneously. No threshold ROP was missed with RetCam. ConclusionBinocular indirect ophthalmoscopy is the reference method for the diagnosis of ROP. RetCam may be used as an alternative for ROP screening.

Application value of RetCam III in the diagnosis of retinoblastoma

Objective To observe the application value of RetCam Ⅲ in the diagnosis of retinoblastoma (RB). Methods The clinical data of 125 eyes from 94 patients with RB were retrospectively analyzed. According to the International Intraocular Retinoblastoma Classification, the results of binocular indirect ophthalmoscope and RetCam Ⅲ was compared. The consistency between RetCam Ⅲ and binocular indirect ophthalmoscope was analyzed by Kappa test. The detectable rates of tumor between binocular indirect ophthalmoscope, RetCam Ⅲand B scan ultrasound were comparatively analyzed. Results By binocular indirect ophthalmoscope, there were 18 eyes (14.4%) in stage A, 15 eyes (12.0%) in stage B, 10 eyes (8.0%) in stage C, 28 eyes (22.4%) in stage D, and 54 eyes (43.2%) in stage E. Using RetCam Ⅲ, the classification was 18 eyes (14.4%) in stage A, 16 eyes (12.8%) in stage B, 11 eyes (8.8%) in stage C, 27 eyes (21.6%) in stage D, and 53 eyes (42.4%) in stage E. The RB classification of RetCam Ⅲ was quite consistent with binocular indirect ophthalmoscope (Weighted Kappa Coefficient=0.979 8, 95% confidence interval=0.960 1 - 0.999 5). A total of 150 tumors from stage A - D were observed by binocular indirect ophthalmoscope. In which, 147 tumors (98.0%) were found by RetCam Ⅲ, 122 tumors (81.3%) were found by B scan ultrasound. No serious complication was found in these patients. Conclusions RetCam Ⅲ can detect RB of different stage in clinic. It is quite consistent with binocular indirect ophthalmoscope. Key words: Retinoblastoma/diagnosis; Ophthalmoscopy; Ultrasonography