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Ординатура / Офтальмология / Английские материалы / Ocular Periphery and Disorders_Dartt, Bex, Amore_2011

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246 Structure and Function of the Tear Film, Ocular Adnexa, Cornea and Conjunctiva in Health

S/W version: 1.1.2.1987 Patient ID: 20048609 Gender: male Age: 58

High res. corneal

OD

OS

180°

0°

(e)

Figure 19 Fifty-eight-year-old male with misdiagnosed Fusarium keratitis. (a) Moderately dense full-thickness central corneal infiltrate (black arrow) and small hypopyon (white arrow). (b) Confocal microscopy shows multiple linear structures with branching at 45 , consistent with Fusarium species (later culture proven). (c–e) OCT showed a remarkable funnel of fibrin (white arrow) from the base of the ulcer to the pupil. From Steinert, R. E. and Huang, D. (2008). Anterior Segment Optical Coherence Tomography. Thorofare, NJ: SLACK Incorporated. Reprinted with permission from SLACK Incorporated.

Figure 20 Continued

Corneal Imaging: Clinical

247

S/W version: 1.0.12.1896 Patient ID: 19663061 Gender: unknown Age: 54

High res corneal

OD OS

271°

91°

(b)

S/W version: 1.0.12.1896 Patient ID: 19663061 Gender: unknown Age: 54

High res corneal

OD OS

271°

91°

0.27 mm

(c)

Figure 20 Continued

248 Structure and Function of the Tear Film, Ocular Adnexa, Cornea and Conjunctiva in Health

S/W version: 1.0.12.1896 Patient ID: 19663061 Gender: unknown Age: 54

High res. corneal quad

OD OS

270°

90°

0.32 mm

(d)

S/W version: 1.0.12.1896 Patient ID: 19663061 Gender: unknown Age: 54

High res. corneal quad

180°

OD

0° 225°

OD

 

45°

270°

OD

90° 315°

OD

 

135°

 

0.50 mm

 

 

(e)

Figure 20 Fifty-four-year-old female with severe infectious keratitis. Gram stain of the corneal scrapings showed gram-negative rods, and cultures were positive for Pseudomonas. (a) Large infiltrate with large hypopyon. (b) Vertical orientation of OCT shows 60–70% anterior chamber hypopyon. Note white arrow representing interface between cornea (anterior) and hypopyon (posterior). (c) Significant stromal thinning with 270 mm shown by caliper tool (blue bar). Note that normal corneal thickness is about 540 mm. (d) The patient was admitted and treated aggressively; 1 week later, the thinning was nonprogressive. (e) Over a 2-month period, the area of corneal thinning gradually improved to nearly normal thickness and the anterior chamber hypopyon regressed as shown in this high-resolution corneal quadrant image. Each image represents a corneal section through a particular axis which is shown above the image. From Steinert, R. E. and Huang, D. (2008). Anterior Segment Optical Coherence Tomography. Thorofare, NJ: SLACK Incorporated. Reprinted with permission from SLACK Incorporated.

Corneal Imaging: Clinical

249

S/W version: 2.0.1.88 Patient ID: Gender: unknown Age: 60 Enhanced high res> corneal

180°

0.56 mm

2.73 mm

451 m

203 m

483 m

1 74 m

OD OS

0°

0.95 mm

486 m

221 m

Figure 21 DSEK (note attached graft with flap tool showing thickness of DSEK lenticule and compact overlying stroma).

S/W version: 2.0.1.88 Patient ID: Gender: unknown Age: 59

Enhanced high res. corneal

OD OS

180°

0°

Figure 22 Dislocated DSEK (note fluid cleft in interface (white arrow) and relative thickness of overlying stroma and DSEK lenticule).

250 Structure and Function of the Tear Film, Ocular Adnexa, Cornea and Conjunctiva in Health

S/W version: 1.1.2.1987 Patient ID: 1827371 Gender: male Age: 65

High res. corneal

OD OS

180°

0°

(c)

S/W version: 1.1.2.1987 Patient ID: 1827371 Gender: male Age: 65

 

High res. corneal

OS

OD

180°

0°

(d)

Figure 23 Continued

Corneal Imaging: Clinical

251

S/W version: 1.1.2.1987 Patient ID: 1827371 Gender: male Age: 65

 

High res. corneal

OS

OD

180°

0°

(e)

S/W version: 1.1.2.1987 Patient ID: 1827371 Gender: male Age: 65

High res. corneal

OD

OS

180°

0°

Suture at 50% depth

(f)

Figure 23 Zig-zag shaped PKP femtosecond laser incisions. (a) Slit lamp photo showing well-aligned incision with smooth transition from donor to host. (b) Angled anterior incision is clearly visible (black arrow). (c) OCT at 1 month postoperatively

shows excellent alignment of donor and host, both at the anterior and posterior surfaces (white arrows). (d) OCT at 3 months shows higher signal return at incision indicating stronger wound healing as compared to postop month one. (e) The rainbow color image highlights the zig-zag incision. (f) Suture depth is noted at 50% depth with perfect posterior tissue alignment and apposition. From Steinert, R. E. and Huang, D. (2008). Anterior Segment Optical Coherence Tomography. Thorofare, NJ: SLACK Incorporated. Reprinted with permission from SLACK Incorporated.

252 Structure and Function of the Tear Film, Ocular Adnexa, Cornea and Conjunctiva in Health

S/W version: 1.1.2.1987 Patient ID: 1707051 Gender: female Age: 41 High res. corneal quad

270°

(a)

OD OS

90°

0.44 mm

S/W version: 1.1.2.1987 Patient ID:1707051 Gender: female Age:41

 

High res. corneal quad

OS

OD

225°

45°

0.40 mm

(b)

Figure 24 Continued

Corneal Imaging: Clinical

253

S/W version: 1.1.2.1987 Patient ID: 1707051 Gender: female Age: 41

High res. corneal quad

180°

OS

0° 225°

OS

 

45°

270°

OS

90° 315°

OS

 

135°

(c)

Figure 24 Forty-one-year-old patient with a corneal melt. (a) Left eye showing superior corneal thinning (vertical orientation) as shown by the caliper tool (blue bar). Normal corneal thickness is about 540 mm. (b) Left eye showing supero-temporal thinning (oblique orientation). (c) Corneal quad scan of left eye showing a generalized superior corneal thinning (white arrows).

S/W version: 2.0.1.88 Patient ID: Gender: unknown Age: 68

Enhanced anterior segment single

OD OS

180°

0°

(a)

Figure 25 Continued

254 Structure and Function of the Tear Film, Ocular Adnexa, Cornea and Conjunctiva in Health

S/W version: 2.0.1.88 Patient ID: Gender: unknown Age: 68

Enhanced anterior segment single

OD OS

180°

0°

38.9°

38.4°

(b)

S/W version: 2.0.1.88 Patient ID: Gender: unknown Age: 68

Enhanced anterior segment single

OD OS

180°

0°

(c)

Figure 25 Sixty-eight-year-old male with normal angle configuration. (a) Horizontal meridian scan showing open angles. (b) Horizontal meridian scan with angle degree markers. (c) High resolution of angle at 180 .

Corneal Imaging: Clinical

255

(a)

(b)

Synechiae

(c)

Figure 26 (a–c) Peripheral anterior synechiae (white arrows). From Steinert, R. E. and Huang, D. (2008). Anterior Segment Optical Coherence Tomography. Thorofare, NJ: SLACK Incorporated. Reprinted with permission from SLACK Incorporated.

See also: Penetrating Keratoplasty; Refractive Surgery.

Further Reading

Chiou, A. G., Kaufman, S. C., Kaufman, H. E., et al. (2006). Clinical confocal microscopy. Survey of Ophthalmology 51: 482–500.

Dhaliwal, J. S., Kaufman, S. C., and Chiou, A. G. (2007). Current applications of clinical confocal microscopy. Current Opinion in Ophthalmology 18: 300–307.

Jalbert, I., Stapleton, F., Papas, E., et al. (2003). In vivo confocal microscopy of the human cornea. British Journal Ophthalmology 87: 225–236.

Kaufman, S. C. and Kaufman, H. E. (2006). How has confocal helped us in refractive surgery? Current Opinion in Ophthalmology 17: 380–388.

Konstantopoulous, A., Hossain, P., and Anderson, D. F. (2007). Recent advances in ophthalmic anterior segment imaging: A new era for ophthalmic surgery? British Journal of Ophthalmology

91: 551–557.

Lim, L. S., Aung, H. T., and Tan, D. T. (2008). Corneal imaging with anterior segment optical coherence tomography for lamellar keratoplasty procedures. American Journal of Ophthalmology

145: 81–90.

Patel, D. V. and McGhee, C. N. (2007). Contemporary in vivo confocal microscopy of the living human cornea using white light and laser scanning techniques: A major review. Clinical Experiment Ophthalmology 35: 71–88.

Schallhorn, J. M., Tang, M., Song, J. C., et al. (2008). Optical coherence tomography of clear corneal incisions for cataract surgery. Journal of Cataract and Refractive Surgery 34: 1561–1565.

Steinert, R. F. and Huang, D. (2008). Anterior Segment Optical Coherence Tomography. Thorofare, NJ: SLACK.

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