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Claes H. Dohlman, Rony R. Sayegh; Wide-angle Fundus Imaging Through The Boston Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1169.
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Examination of the peripheral retina through the Boston keratoprosthesis is challenging with indirect ophthalmoscopy. Feasibility and comparison of 3 wide-angle fundus imaging systems, Optos, RetCam, and Panoret is explored.
Four eyes with a type I keratoprosthesis were imaged. The failure-to-image-rate, ease of acquisition and quality was noted. Fields were compared. Interpretation of the images, limitations and complications were recorded.
Optos could be performed on all 4 eyes, RetCam on 3, Panoret on 2. With Optos, an opaque grayish ring was observed surrounding the photo and limiting the field of view. Retcam images showed circular light reflections that in some cases obscured underlying retinal details. The external illumination of the Panoret made it impossible to image the darkly pigment individual. Image quality was better with contact methods. Media opacity affected image quality the most with RetCam.Fields (standardized in reference to disc diameter) were comparable between the 3 different cameras at a maximum of 19.2×17.7 for Optos, 20.5×18.5 for RetCam, and 16.3x14.9 for Panoret.Failure to image with both contact devices in one patient was due to agitation. No readable image was obtained with Panoret on another patient who was African American. One patient had persistent ocular irritation from the coupling agent that resolved with replacement of the contact lens.
Wide-angle fundus imaging through the Boston keratoprosthesis is possible and all 3 cameras performed similarly. Although better quality pictures were obtained with the contact methods in our series, the ease-of-use, comfort and safety of the non-contact Optos make it a preferred choice. As a general observation however, the quality of these images seemed inferior to previously obtained non-wide-field photos using a regular fundus camera.
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