|Year : 1985 | Volume
| Issue : 5 | Page : 331-332
The use of ultrasound jelly as gonioscopic fluid
M Mahabaleswara, DP Edward
Dept of Ophthalmology, St. John's Medical College Hospital, Bangalore, India
Dept of Ophthalmology, St. John's Medical College Hospital, Bangalore-560034
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mahabaleswara M, Edward D P. The use of ultrasound jelly as gonioscopic fluid. Indian J Ophthalmol 1985;33:331-2
The use of diagnostic lenses for gonioscopy and posterior segment study at the slit-lamp is an important part of Ophthalmic examination. However, the fluids used presently (normal saline, methyl cellulose and recently K-Y jelly) have certain drawbacks. An ideal fluid must be innocuous, nonirritant, transparent, non-greasy, water soluble and must not harm the lenses or equipment with which it comes in contact. The fluid should also be sterile and stable.
It was observed that during ocular contact ultrasound scanning, the jelly used did not produce any adverse effects if it spilled into the conjunctival cul-de-sac. It was then that we decided to try the jelly as a gonioscopy fluid.
| Material and methods|| |
Ultrasound jelly is available commercially as Aqua-2000 (manufactured by Medical Disposables Ltd, Madras). The contents are thickeners, preservatives and deionised water. The fluid is sterile, water soluble and has a neutral pH. It is bottled in a plastic container with a nozzle tip. The gel form of the fluid has a blue tinge, but this does not interfere with its transparency.
During gonioscopy or 3 mirror examinations, the jelly was squeezed over the contact lens surface of the Goldmann 3 mirror lens, and the lens inserted over the eye. On removal, the patients were instructed to wash their eyes with tap water and the lens cleaned, with sterile cotton.
| Observations|| |
Gonioscopic and 3 mirror examination were carried out in fifty patients at the Ophthalmology Department of St. John's Medical College Hospital Bangalore.
The following factors were assessed during examination.
i. Transparency : The jelly remained transparent throughout the examination procedure without drying. The bluish colour of the gel did not, in any way interfere with the visibility of the anterior chamber angle or the posterior segment. In a few patients minute air bubbles were entrapped in the jelly, but this was avoided by squeezing the jelly uniformly over the contact lens surface.
ii. Viscocity : It was observed that on application of the jelly on the contact lens surface of the 3-mirror, the jelly did not spill even when the contact lens was inverted [Figure - 1]. All other gels, including K-Y jelly have been found to drip, confirming the excellent viscocity of ultrasound jelly.
iii. Local reactions
(a) Subjective : All patients were comfortable during the procedure. There was no irritation or pain in the eye on introduction of the jelly. Following the procedure, the gel was easily washed off by tap water and did not produce stickiness of the lid margins.
(b) Objective : No signs of abnormal conjunctival hyperemia or discharge were noted after the procedure. Corneal examination on follow up did not reveal any abnormality.
No damage to the contact lens or slit lamp head rest was observed.
| Discussion|| |
Many practical difficulties are faced with the common gonioscopic fluids like normal saline and methyl cellulose, the most annoying being the frequent entry of an air bubble in the cornea-contact lens interface. Recently, methods of avoiding this difficulty have been a subject of correspondence,.
The main advantage of ultrasound jelly lies in its viscocity. It was noted that the lens was easily placed in all eyes examined and the problem of an airbubble interfering with visibility was not encountered even in patients with narrow palpebral apertures or those who were apprehensive. Moreover, the lens could be left unheld for sometime with the patient at the slit lamp. This was useful when different clinicians needed to see the patient at one sitting [Figure - 2].
Another useful application of ultrasound jelly is its application over an exposed cornea during xenon are photocoagulation. The gel film over the corneal surface ensures its clarity over long periods.
The packaging of ultrasound jelly has a definite advantage over K-Y jelly (available in tubes). The sterile plastic container with nozzle, helps in maintaining sterility of the geland avoids waste of material which occurs while squeezing a tube.
The gel also works out to be quite economical and a single container could be used for a over a hundred examinations. It is also easily available from the manufacturers.
| Summary|| |
Ultrasound jelly (Aqua-2000) has been found to be an eflective, convenient and economical gonioscopic fluid that can be safely used for diagnostic contact lens procedures. It is also useful in maintaining corneal clarity during xenon arc photocoagulation.
| References|| |
Mehta H.K. 1984, Brit Ophthalmol 68 :765767.
Girard L.J., 1982, Amer J. Ophthalmol 94 :187.
Kaushik N., 1983, Amer. J. Ophthalmol. 95 : 570.
[Figure - 1], [Figure - 2]