Evisceration with implantation of an intrascleral silicone prosthesis in dogs: A retrospective study of 107 cases (2010-2019).

OBJECTIVE: To retrospectively analyze the preoperative clinical characteristics and surgical outcomes of evisceration with implantation of an intrascleral silicone prosthesis (EIISP) procedures in dogs and evaluate whether brachycephalic dogs are more prone than non-brachycephalic dogs to develop postoperative complications after EIISP. ANIMAL STUDIED: Ninety-One dogs (19 of which were brachycephalic) were included. PROCEDURES: Medical records from 2010 to 2019 were reviewed. Signalment, reason for EIISP, postoperative complications, follow-up time, and postoperative eye appearance were analyzed. RESULTS: The most frequently represented breeds were French Bulldog [11/91 (12%) dogs], Jack Russell Terrier [6/91 (7%)], and Shih Tzu [6/91 (7%)]. Brachycephalic dogs were statistically younger than non-brachycephalic dogs at the time of EIISP (p = 1.61 × 10-5 ). Uncontrolled glaucoma was the most common reason for EIISP in both groups. Short-term complications (from D0 to D15) seen in 7/91 (8%) dogs included epithelial corneal ulcers (n = 3), keratoconjunctivitis sicca (KCS) (n = 2), and prosthesis extrusion (n = 2). Long-term complications seen in 26/91 (29%) dogs included KCS (n = 11), epithelial corneal ulcers (n = 7), stromal ulcers (n = 3), entropion (n = 4), and prosthesis extrusion (n = 1). Extrusion of the prosthesis occurred twice in eyes that had undergone diode laser transscleral cyclophotocoagulation. The risk of postoperative complications was not significantly different between brachycephalic and non-brachycephalic dogs (p = .3). CONCLUSIONS: Brachycephalic status in dogs does not appear to influence the risk of complications from EIISP. Nevertheless, the present study is a reminder that EIISP focuses on esthetics, and considering the possible complications associated with it, it does not provide a benefit to the patient compared to enucleation.

Eye trauma from a cat scratch with retention of the claw in the anterior chamber in a dog.

Background: Cat scratches and ocular foreign bodies are frequent reasons for consultation in veterinary ophthalmology. Case Description: We here present an unusual case combining trauma to the cornea and lens by a cat scratch with retention of the claw in the anterior chamber. Management consisted of the removal of the claw, reconstruction of the cornea, and mechanized ablation of the lens by phacoemulsification with implantation of an artificial lens. Conclusion: The progression during the follow-up period was considered satisfactory, with positive responses to visual tests and intraocular pressure within the norms. Only dyscoria and a tear of the endothelium and Descemet membrane, secondary to the trauma, remained.

Multidirectional corneoconjunctival transposition in the treatment of large keratomalacia in 7 dogs and 5 cats.

OBJECTIVE: To describe the use of multidirectional corneoconjunctival transposition (CCT) as a surgical treatment for large keratomalacia. METHOD: A prospective study including dogs and cats initially presenting with keratomalacia larger than 6 × 6 mm and affecting more than half of the corneal thickness. Signalment, concurrent eye diseases, ulcer size, bacterial culture and susceptibility testing results, follow-up, and outcome were recorded. The surgery consisted of harvesting of two or three opposite corneoconjunctival grafts, after removal of the malacic tissue using a square-edge keratectomy. The medical treatment consisted of administration of topical and systemic antibiotics, topical atropine, and N-acetylcysteine. Follow-up examinations were performed at D7, D14, D21, and D28, and then at various time points. The corneal clarity score (CCS) was recorded upon completion of the follow-up period. RESULTS: Seven dogs and five cats were included. Brachycephalic dogs were overrepresented, with no breed predisposition in cats. Concurrent eye diseases were corneal pigmentation in three dogs, hypopyon in two dogs, nictitating membrane wound in one dog, and corneal perforation in one cat. The size of the keratomalacia ranged from 6 × 6 to 9.5 × 11.5 mm. The short-term complications were suture dehiscence (two of 12) and progression of the keratomalacia (one of 12). The long-term complications were corneal pigmentation (10 of 12), corneal epithelial inclusion cyst (two of 12), and marginal synechiae (one of 12). All animals were sighted at the last follow-up. The median CCS was G3 (range G2-G4). CONCLUSION: Multidirectional CCT is an effective surgical treatment for large keratomalacia in dogs and cats.

Ocular dermoids in 13 cats: a multicentre retrospective study.

OBJECTIVES: The aim of this multicentre retrospective study was to review the clinical data, outcomes and histopathological features of cats that had been treated for ocular surface dermoids. METHODS: Thirteen cats from various private practices in France with a clinical diagnosis of ocular surface dermoid were included in the study. RESULTS: The mean age of the study population at the time of diagnosis was 5 months. There were nine males and four females. Three different breeds were domestic shorthair (n = 7), Birman (n = 4) and Havana Brown (n = 2). Two of the four Birmans were related (same sire). The two Havana Browns were also related (same sire). All of the dermoids were unilateral. Five of the dermoids were strictly conjunctival. Four affected both the conjunctiva and the cornea. Three affected both the conjunctiva and the eyelid, and one was strictly corneal. They were located in various positions: temporal (n = 9), inferonasal (n = 1), dorsonasal (n = 1) and dorsotemporal (n = 1). The last dermoid was heterogeneous and involved the nasal, dorsal and temporal quadrants. Concurrent eye diseases were observed in five patients: four cats exhibited associated eyelid agenesis and one cat exhibited persistent iris-to-iris pupillary membranes. Ten dermoids were surgically excised with no recurrences. Surgery was not performed for three cats: one cat died a few days after diagnosis and two cats were lost to follow-up after initial presentation. CONCLUSIONS AND RELEVANCE: Ocular surface dermoids are a rare condition in cats that can be treated successfully by surgical excision. Although our study reports only a small number of cases, the observation of ocular surface dermoids in two related cats in two different breeds indicates that genetic transmission is likely.

Ectopic cilia in 112 dogs: A multicenter retrospective study.

OBJECTIVE: The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered ectopic cilium (EC). ANIMALS STUDIED: One hundred and twelve dogs from multiple private practices in France, with a clinical diagnosis of EC were included in the study. RESULTS: The mean age of affected dogs was 2.3 years. There were 64 females and 48 males. The most represented breeds were the Shi Tzu, the French Bulldog, the English Bulldog and the Chihuahua. Eleven dogs were affected bilaterally. The upper eyelid was implicated in 93.5% of the cases, with the median portion being the most affected. No statistical difference was observed between the right and the left eye. EC were associated with distichiasis in 50% of the cases. Pigmentation of the conjunctiva at the point of exit of the EC was present in 58% of the cases. EC were short in 75% and long in 25% of the cases. Corneal complications were statistically associated with short EC. The corneal lesions associated with EC were keratitis (94%), corneal granuloma (0.8%), corneal fibrosis (2.7%), corneal degeneration (0.8%), superficial corneal ulcer (68.7%), deep corneal ulcer (8%) and perforating corneal ulcer (0.8%). The surgeries which consisted of the removal of the hair follicle was successful in 88.4% of the cases. CONCLUSION: EC is a rare condition which can be treated successfully by the removal of the hair follicles. It must be suspected in cases of corneal lesions unresponsive to medical treatment.

Corneal bee sting in a Bengal cat.

CASE SUMMARY: A 6-month-old female Bengal cat was referred for a suspected vegetal foreign body (FB) in the mid-stroma of the right cornea. A small dark linear FB was identified in the dorsal aspect of the cornea, with associated cell infiltrate. Ophthalmic examination was otherwise normal, with no inflammatory reaction of the anterior uvea, and no abnormalities of the lens or fundus. Surgical removal was performed under general anesthesia. The FB, as observed under an optic microscope, was a worker bee stinger without the venom sac. Medical treatment consisted of topical and systemic antibiotics and steroids, and topical administration of atropine. Follow-up was uneventful. RELEVANCE AND NOVEL INFORMATION: Ocular bee stings have been described in humans, with several consequences ranging from mild conjunctivitis to severe lesions affecting the cornea, iris, lens and retina. Most severely affected cases have been observed when the venom sac was found with the stinger, with a likely greater amount of venom being delivered into the ocular structures. The relatively benign presentation of this case was probably due to the lack of the venom sac within the bee sting. To our knowledge, this is the first documented case of a corneal bee sting in a cat.

Corneal epithelial inclusion cysts in 12 dogs (13 eyes) from 2010 to 2019: A multicentric retrospective study.

OBJECTIVE: The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered corneal epithelial inclusion cysts (CEIC). Animals studied Thirteen eyes from 12 dogs from multiple private practices in France and Belgium, with a strong clinical of CEIC were included in the study. RESULTS: The mean age of affected dogs was 9 years. There were 9 females and 3 males. Two out of 12 dogs were Shih Tzus. Where identified, etiology was traumatic. Eleven dogs were affected unilaterally, 1 bilaterally. The cysts were single, bi-lobulated, or tri-lobulate, and cyst size ranged from 1 to 6 mm in diameter. Keratectomy alone was performed in seven cases, in conjunction with a conjunctival graft in three cases, a porcine small intestine mucosa graft in two cases, or an amniotic membrane graft in one case. Histopathologic findings were consistent in all eyes with a cyst located in the corneal stroma, composed of a nonkeratinized squamous epithelium delineating a lumen filled with neutrophils and desquamated epithelial cells. Surgery was curative in all cases but one, where the removal was incomplete and recurrence occurred several weeks after the surgery. CONCLUSION: Corneal epithelial inclusion cysts is a rare condition, secondary to corneal trauma, which can be treated successfully with conventional keratectomy alone or in conjunction with graft procedures.

Inter-individual differences in foveal shape in a scavenging raptor, the black kite Milvus migrans.

Birds, and especially raptors, are believed to forage mainly using visual cues. Indeed, raptors (scavengers and predators) have the highest visual acuity known to date. However, scavengers and predators differ in their visual systems such as in their foveal configuration. While the function of the foveal shape remains unknown, individual variation has never been quantified in birds. In this study, we examined whether foveal shape differs among individuals in relation to eye size, sex, age, eye (left or right) and genetic proximity in a scavenging raptor, the black kite Milvus migrans. We assessed foveal shape in 47 individuals using spectral domain optical coherence tomography (OCT) and geometric morphometric analysis. We found that foveal depth was significantly related to eye size. While foveal width also increased with eye size, it was strongly related to age; younger individuals had a wider fovea with a more pronounced rim. We found no relationship between foveal shape and genetic proximity, suggesting that foveal shape is not a hereditary trait. Our study revealed that the shape of the fovea is directly linked to eye size and that the physical structure of the fovea may develop during the entire life of black kites.

Phenotype of macular corneal dystrophy in Labrador Retrievers: A multicenter study.

OBJECTIVE: To describe the phenotype of canine macular corneal dystrophy (MCD) including the clinical presentation, multimodal ocular imaging, histopathology, and ultrastructural analysis in ten Labrador Retrievers. PROCEDURE: Multicentered data collection. RESULTS: Labrador Retrievers affected by MCD were presented between the age of 4.5 and 6 years of age with a history of cloudy eyes and/or visual impairment. Findings on ophthalmic examination included a diffuse haze of the corneal stroma and multiple, well-demarcated, off-white to yellow-brown, punctate corneal opacities heterogeneous in size. Corneal vascularization developed in most dogs as the disease progressed. Disease progression was associated with increased density of the corneal haze as well as increased number and size of the focal opacities and dogs developed significant visual impairment. Spectral domain-optical coherence tomography revealed multifocal hyper-reflective regions within the stroma. In vivo confocal microscopy revealed marked alterations in reflectivity throughout the entire stroma. Normal keratocytes could not be identified in affected areas. Histopathology showed stromal collagen fibers separated by acidophilic granular material on hematoxylin and eosin stain. The material stained with periodic acid-Schiff and colloidal iron stain but not with Masson trichrome stain, confirming the accumulation of glycosaminoglycans. On electron microscopic ultrastructural examination, keratocytes presented with vacuolated rough endoplasmic reticulum and multiple electron dense cytoplasmic inclusions. In areas keratocytes appeared ruptured, with cell organelles and proteinaceous material grouped together between collagen fibers. CONCLUSION: MCD in Labrador Retrievers has similarities with the human counterpart of the condition and is an important differential diagnosis in dogs with corneal disease.

High intensity focused ultrasound cyclocoagulation in dogs with primary glaucoma: a preliminary study.

The objective was to assess the effect of high intensity focused ultrasound (HIFU) on intraocular pressure (IOP) in dogs with primary glaucoma (PG). Seven dogs (13 eyes) presenting with PG as diagnosed by a raised IOP (> 20 mm Hg) associated with consistent gonioscopy and ultrasound biomicroscopy of the ciliary cleft, with no other ocular disease. Patients were divided into 3 groups, corresponding to their pre-operative IOP (group 1 ranging from 21 to 30 mm Hg, group 2 from 31 to 40 and group 3 for 40 and above). Ciliary process sonication was achieved with a probe containing one high-frequency transducer operating at 21 MHz during 5 seconds. Six sites were treated in patients from group 1, 8 in group 2, 10 in group 3, under general anesthesia. Post-operative treatment consisted of systemic meloxicam and topical carbonic anhydrase inhibitors, beta-blockers and prostaglandins analogues. No intraoperative complications were observed. Conjunctival hyperaemia occurred in eyes from group 2 (66%) and 3 (100%). Conjunctival burns were visible in 2 patients from group 3. One patient from group 3 experienced a hypertensive spike during the first hours post-op with associated pain. The hypotensive effect of HIFU was observed in all groups. Normotensive IOP (≤20 mm Hg) was reached in all patients until the last recheck at 6 months post op. Despite the small number of patients included in the study, HIFU appears to be a promising option for the management of PG in dogs.

Eye Size, Fovea, and Foraging Ecology in Accipitriform Raptors.

Birds with larger eyes are predicted to have higher spatial resolution because of their larger retinal image. Raptors are well known for their acute vision, mediated by their deep central fovea. Because foraging strategies may demand specific visual adaptations, eye size and fovea may differ between species with different foraging ecology. We tested whether predators (actively hunting mobile prey) and carrion eaters (eating dead prey) from the order Accipitriformes differ in eye size, foveal depth, and retinal thickness using spectral domain optical coherence tomography and comparative phylogenetic methods. We found that (1) all studied predators (except one) had a central and a temporal fovea, but all carrion eaters had only the central fovea; (2) eye size scaled with body mass both in predators and carrion eaters; (3) predators had larger eyes relative to body mass and a thicker retina at the edge of the fovea than carrion eaters, but there was no difference in the depth of the central fovea between the groups. Finally, we found that (4) larger eyes generally had a deeper central fovea. These results suggest that the visual system of raptors within the order Accipitriformes may be highly adapted to the foraging strategy, except for the foveal depth, which seems mostly dependent upon the eye size.

The association of a lip commissure to eyelid transposition flap with a frontal transposition flap for reconstructive eyelid surgery following squamous cell carcinoma resection in a European short-haired cat.

The surgical resection of a squamous cell carcinoma in a cat was performed on both the palpebral and nasal aspects of the OD medial canthus. A two-stage surgical technique was employed, involving two different transposition flaps, taking care to maintain eyelid function and estheticism, with a long follow-up.

Assessment of a smartphone-based camera for fundus imaging in animals.

OBJECTIVE: To assess the use of an optical device (D-EYE; Si14 S.p.A.) attached to a modern smartphone (iPhone 5; Apple Inc.) for imaging the fundus in small animals. ANIMALS STUDIED: Five dogs, five cats, and five rabbits with clear media were imaged using a prototype of the D-EYE. PROCEDURE: The optical device was composed of lenses, polarizing filters, a beam splitter, a diaphragm, and mirrors, attached to a smartphone via a metal shell. Images were obtained 20 min after pupil dilation with topical 0.5% tropicamide in a darkened room, to ensure maximum pupillary dilation. Focus was set to the infinite when the autofocus was overwhelmed. Light intensity was adapted to each animal via the application (minimum light intensity for imaging the tapetal region, maximum light intensity for imaging the nontapetal region). Both still images and video sequences were recorded for each animal. RESULTS: Posterior segment structures were visible in all animals: optic nerve head, tapetum lucidum (when present), nontapetal region, retinal vessels, and choroidal vessels (when the retinal pigment epithelium and the choroidal pigmentation were discreet). Focal light artifacts were common when photographing the tapetum lucidum. Recording videos allowed the visualization of dynamic phenomena. CONCLUSIONS: The D-EYE assessed appears to be an easy means of obtaining images of the posterior segment structures.

Visual abilities in two raptors with different ecology.

Differences in visual capabilities are known to reflect differences in foraging behaviour even among closely related species. Among birds, the foraging of diurnal raptors is assumed to be guided mainly by vision but their foraging tactics include both scavenging upon immobile prey and the aerial pursuit of highly mobile prey. We studied how visual capabilities differ between two diurnal raptor species of similar size: Harris's hawks, Parabuteo unicinctus, which take mobile prey, and black kites, Milvus migrans, which are primarily carrion eaters. We measured visual acuity, foveal characteristics and visual fields in both species. Visual acuity was determined using a behavioural training technique; foveal characteristics were determined using ultra-high resolution spectral-domain optical coherence tomography (OCT); and visual field parameters were determined using an ophthalmoscopic reflex technique. We found that these two raptors differ in their visual capacities. Harris's hawks have a visual acuity slightly higher than that of black kites. Among the five Harris's hawks tested, individuals with higher estimated visual acuity made more horizontal head movements before making a decision. This may reflect an increase in the use of monocular vision. Harris's hawks have two foveas (one central and one temporal), while black kites have only one central fovea and a temporal area. Black kites have a wider visual field than Harris's hawks. This may facilitate the detection of conspecifics when they are scavenging. These differences in the visual capabilities of these two raptors may reflect differences in the perceptual demands of their foraging behaviours.

Use of a porcine urinary bladder acellular matrix for corneal reconstruction in dogs and cats.

OBJECTIVE: To describe the use of a porcine urinary bladder acellular matrix for surgical reconstruction of the cornea in cases of canine and feline deep corneal ulcers, and feline corneal sequestra. MATERIALS AND METHODS: Twenty-seven dogs and three cats with deep corneal ulcers and seven cats with corneal sequestra were included in the study with overall 38 eyes. For each patient, the necrotic material (ie corneal sequestrum or collagenolytic tissue) was removed by circular lamellar keratectomy. The collagen graft was then cut and prepared to match the stromal defect and then sutured into the lamellar keratectomy bed using interrupted and continuous patterns of absorbable polyglactin 9-0 sutures. Postoperative medical treatment consisted of topical and systemic administration of antibiotics, combined with topical administration of atropine sulfate. The animals were examined 18, 45, and 90 days after the surgery. RESULTS: Postoperative examination revealed complete integration of the biomaterial in 93.5% of ulceration cases in both species and in 100% of feline corneal sequestrum cases. In two cases of ulceration (1 dog and 1 cat), progression of the collagenolytic process at the graft periphery required an additional conjunctival graft 7 days after the first surgery. At 90 days post-op, 100% of the eyes were sighted. CONCLUSION: Use of a porcine urinary bladder acellular matrix appears to be effective in the surgical management of deep corneal ulcers and feline corneal sequestra.

Scanning laser ophthalmoscopy and optical coherence tomography imaging of spectacular ecdysis in the corn snake (Pantherophis guttatus) and the California king snake (Lampropeltis getulus californiae).

PURPOSE: One of the singularities of the eyes of snakes is the presence of the spectacle, a transparent and vascularized integument covering the cornea. The spectacle is completely renewed during ecdysis. Combined scanning laser ophthalmoscopy (SLO), optical coherence tomography (OCT), and conventional macrophotography were used to image this phenomenon. MATERIAL AND METHODS: A spectral OCT/SLO examination and macrophotography were performed in four healthy adult corn snakes (Pantherophis guttatus) and one healthy adult California king snake (Lampropeltis getulus californiae) the day before the start of ecdysis and then daily during ecdysis. RESULTS: In all animals, ecdysis lasted 5 days. The spectacle was hardly visible at baseline, but became obvious at day one, while the subspectacular space became larger and the superficial cornea presented a hyperechoic band. At day two, eye surface became translucent, and at the same time, vascularization of the spectacle was visible using SLO. At day 3, the vascularization was no longer visible, while the subspectacular space increased and the eye surface remained translucent. At day 4, the eye surface was transparent and the superficial hyperechoic band started to become less bright. At day 5, the old spectacle was shed and all the parameters returned to baseline. CONCLUSION: We hypothesize that the echogenicity modifications of the anterior cornea correspond to major metabolic activity associated with new spectacle formation. This increased metabolic activity may contribute to the neovascularization and play an important role in the accumulation of fluid in the subspectacular space, facilitating the shedding of the old spectacle.

Anterior segment morphology and morphometry in selected reptile species using optical coherence tomography.

OBJECTIVE: To provide new and original images of the anterior segment (AS) of the eye of selected Ophidian, Chelonian, and Saurian species and to compare the AS architecture among and within these three groups. ANIMALS STUDIED: 17 Saurians, 14 Ophidians, and 11 Chelonians with no concurrent systemic or eye disease were included in the study. PROCEDURE: Age, weight, nose-cloaca distance (NCD), and pupil shape were collected for each animal. The AS was examined by optical coherence tomography (OCT). After gross description of the appearance of the AS, the central and peripheral corneal thickness (CCT, PCT) and anterior chamber depth (ACD) were measured using the software provided with the OCT device. The ratio CCT/ACD was then calculated for each animal. RESULTS: Pupil shape was a vertical slit in all the crepuscular or nocturnal animals (except for 1 chelonian and 1 ophidian). Each group had its own particular AS architecture. Saurians had a regularly thin cornea with a flat anterior lens capsule and a deep anterior chamber. Ophidians had a thick cornea with a narrow anterior chamber due to a very anteriorly anchored spherical lens. The spectacle was difficult to identify in all ophidians except in Python molurus bivitattus in which it was more obvious. Chelonians displayed an intermediate architecture which more closely resembled the Saurian type than the Ophidian type. CONCLUSION: Despite grossly similar AS architecture, the three groups of reptiles in the study demonstrated differences that are suggestive of a link between anatomical disparities and variations in environment and lifestyle.

Determination of morphological, biometric and biochemical susceptibilities in healthy Eurasier dogs with suspected inherited glaucoma.

In both humans and dogs, the primary risk factor for glaucoma is high intraocular pressure (IOP), which may be caused by iridocorneal angle (ICA) abnormalities. Oxidative stress has also been implicated in retinal ganglion cell damage associated with glaucoma. A suspected inherited form of glaucoma was recently identified in Eurasier dogs (EDs), a breed for which pedigrees are readily available. Because of difficulties in assessing ICA morphology in dogs with advanced glaucoma, we selected a cohort of apparently healthy dogsfor the investigation of ICA morphological status, IOP and plasma concentrations of oxidative stress biomarkers. We aimed to establish correlations between these factors, to identify predictive markers of glaucoma in this dog breed. A cohort of 28 subjects, volunteered for inclusion by their owners, was selected by veterinary surgeons. These dogs were assigned to four groups: young males, young females (1-3 years old), adult males and adult females (4-8 years old). Ocular examination included ophthalmoscopy, tonometry, gonioscopy, biometry and ultrasound biomicroscopy (UBM), and the evaluation of oxidative stress biomarkers consisting of measurements of plasma glutathione peroxidase (GP) activity and taurine and metabolic precursor (methionine and cysteine) concentrations in plasma. The prevalence of pectinate ligament abnormalities was significantly higher in adult EDs than in young dogs. Moreover, in adult females, high IOP was significantly correlated with a short axial globe length, and a particularly large distance between Schwalbe's line and the anterior lens capsule. GP activity levels were significantly lower in EDs than in a randomized control group of dogs, and plasma taurine concentrations were higher. Hence, ICA abnormalities were associated with weaker antioxidant defenses in EDs, potentially counteracted by higher plasma taurine concentrations. This study suggests that EDs may constitute an appropriate canine model for the development of glaucoma. This cohort will be used as a sentinel for longitudinal monitoring.

Conversion of the Kowa RC-2 camera to a digital version, instructions for use, and postprocessing of the images.

OBJECTIVE: To describe a means of converting the Kowa RC-2 camera to a digital version. PROCEDURE: The optic (OP) and the film portions (FP) of the Kowa RC-2 were separated. The lateral rails were unscrewed from the front plate of the FP. The front plate was detached from the FP. The plate was fixed to an anodized aluminum plate (AAP). The rails were screwed back onto the front plate. This system was reattached to the OP by means of the rails. A T2-E mount ring was screwed onto the AAP and fixed to a digital camera body (DCB). A flash sync extension cord was used to connect the flash cable of the Kowa to the DCB. The images obtained with the converted Kowa were inverted horizontally and vertically using image processing software. RESULTS: The images obtained with the converted Kowa RC-2 were identical in format to those using the film version with a circular image surrounded by a black rectangle. The imaged ocular structures were accurately depicted, appearing upside down and reversed on the LCD screen. The DCB was set to manual mode and focus. The shutter speed was initially set to 1/250 s, and the ISO was adjusted based on the ocular structure being photographed. An extra filter had to be placed over the light source to dim the light when imaging reflective fundi. CONCLUSION: The converted digital version of the Kowa RC-2 as described provides an affordable means of obtaining high-quality images of various ocular structures.