Papillary Changes Research Articles

Myopic (Peri)papillary Changes and Visual Field Defects.

Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed. These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey® Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath's sector (A-F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately. Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations (p < 0.001). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations (p = 0.011). The mean OI was significantly lower (p < 0.001) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI (p < 0.001) was the only statistically significant factor discriminating PICCs and combinations. Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.

Immediate implant placement with or without immediate provisionalization: A systematic review and meta-analysis.

To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes, and clinical parameters following single immediate implant placement (IIP). Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized controlled trials (RCTs) comparing IIP with IP (test) and IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow-up, marginal bone-level changes, probing depth at final follow-up, and bleeding on probing at final follow-up. Of the 8213 records, 7 RCTs reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP: 162 implants in 162 patients) were selected with a mean follow-up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for five RCTs and high risk for two RCTs. Meta-analysis on the cases with intact alveoli demonstrated 0.87 mm (95% confidence interval [CI] [0.57; 1.17], p< .001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone-level changes, probing depth, and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes and PES. IP may contribute to midfacial soft tissue stability at immediate implants. However, high-quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines.

Retrograde trans-synaptic axonal degeneration in post-geniculate lesions

: The concept of retrograde axonal degeneration is well studied for visual pathway lesions upto lateral geniculate body. Since clinically evident optic nerve head changes and papillary changes are usually absent in post geniculate lesions, very few studies have been reported to look for the presence of retrograde axonal degeneration in these lesions.To analyse RNFL and GCC thickness in patients with retrogeniculate lesions using Spectral Domain OCT and to determine any characteristic thinning pattern corresponding to the visual field defect.: Patients attending Ophthalmology OPD as diagnosed cases of unilateral retrochiasmal lesions were included in the study. Those who showed homonymous hemianopia corresponding to the retrochiasmal lesions were subjected to OCT RNFL and GCC. Spectral domain OCT was performed on all patients using ZEISS Cirrus HD-OCT Model 400.: Mean age of the study population was 55.5±14.02 years. 21(70%) patients were males, 9(30%) were females. Ipsilateral eyes have superior RNFL thinning, contralateral eyes have inferior, nasal and temporal quadrants thinning. Average RNFL thickness and GCC thickness was reduced in the contralateral eyes. In ipsilateral eyes, temporal GCC was thinner compared to nasal, whereas in contralateral eyes, nasal GCC was thinner compared to temporal. : The pattern of RNFL and GCC thinning corresponds with pattern of visual field loss. The thinning of RNFL and GCC is in accordance to the known trajectories of the crossed and uncrossed projections arising in the nasal and temporal hemiretinae respectively. Our study substantiates that retrograde axonal degeneration occurs in post geniculate lesions also.

Inhibition of FGF10-ERK signal activation suppresses intraductal papillary neoplasm of the bile duct and its associated carcinomas

Evidence regarding intraductal papillary neoplasm of the bile duct (IPNB) as a type of precancerous lesion of cholangiocarcinoma is limited. Moreover, a reproducible invivo model is lacking, and IPNB pathogenesis remains unclear. Here, we use a doxycycline-inducible tetracycline (Tet)-on mice model to control fibroblast growth factor 10 (FGF10) expression, which regulates branching and tubule formation. FGF10-induced IPNB mimics the multifocal and divergent human IPNB phenotypes via the FGF10-FGF receptor 2 (FGFR2)-RAS-extracellular-signal-regulated kinase (ERK) signaling pathway. A paracrine/autocrine growth factor is sufficient to initiate and maintain IPNB originating from the peribiliary glands, including biliary stem/progenitor cells. With KrasG12D, p53, or p16 mutations or both, Fgf10-induced IPNB shows stepwise carcinogenesis, causing associated invasive carcinoma. Fgf10-induced papillary changes and progression are suppressed by the inhibition of the FGF10-FGFR2-RAS-ERK signaling pathway, demonstrating that the signal is a therapeutic target for IPNB and associated carcinoma.

FGF10/FGFR2/ERK Signal Activation is Required for the Initiation, Maintenance and Progression of Intraductal Papillary Neoplasm of the Bile Duct

Evidence regarding intraductal papillary neoplasm of the bile duct (IPNB) as a new type of precancerous lesion of cholangiocarcinoma is limited. Moreover, a reproducible in vivo model is lacking and IPNB pathogenesis remains unclear. Here, we used a doxycycline-inducible Tet-on mice model facilitating the control of fibroblast growth factor 10 (FGF10) expression which contributes to branching and tubule formation. FGF10-induced IPNB mimicked the multifocal and divergent human IPNB phenotypes via the FGF10–FGFR2–RAS–ERK signalling pathway. A paracrine/autocrine growth factor was sufficient for the initiation and maintenance of IPNB originating from the peribiliary glands, including the biliary stem/progenitor cells. With KrasG12D, p53 and/or p16 gene alterations, Fgf10-induced IPNB showed stepwise carcinogenesis, causing associated invasive carcinoma. Fgf10-induced papillary changes were suppressed by FGF10–FGFR2–RAS–ERK signalling inhibition, which was inhibited with a MEK inhibitor, demonstrating that the signal is a novel therapeutic target for IPNB and associated carcinoma.

Clinical Predictors of outcome in Isolated Traumatic Acute Subdural Hematoma

Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma.&#x0D; All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome.&#x0D; Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorable outcome. GCS score, papillary changes, midline shift and hematoma volume were found to have significant association with the outcome in isolated traumatic acute subdural hematoma.&#x0D; Clinical parameters and radiological parameters can gauge the outcome in isolated traumatic brain injury.

Lubricity comparison of a silicone hydrogel contact lens material, the human cornea, and a wetting agent

Purpose: Narafilcon A (daily disposable, silicone hydrogel) has been previously shown to be equivalent to no lens wear after one year in several key areas of physiology including corneal staining and papillary changes (Morgan et al., CLAE 2013). The material contains a high molecular weight wetting agent, polyvinylpyrrolidone (PVP), which has individual repeating units similar in function to ocular mucins in providing a lubricious (low friction) surface. It is hypothesized this lubricious interface helps to minimize the interaction between the contact lens (CL) and the eye. The purpose of this study was to evaluate the coefficient of friction (CoF) of PVP, narafilcon A and human corneal tissue in vitro to help elucidate the previously published clinical performance findings.

Modifications papillaires en tomographie par cohérence optique dans l’œdème papillaire à Lomé

To study the influence of optic disc edema (ODE) on the dimensions of the disc and the thickness of the retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT) in Lomé. This was a retrospective study which took place in a general ophthalmology office in the city. Twenty-six eyes were examined for ODE (cases) between January 2013and May 2015, and 26healthy eyes (control group) were considered in this study. The control group was recruited taking age into account with a variation not exceeding 5years compared to the ODE cases. Topcon 3D-OCT 2000software was used to analyze the disc and to measure the thickness of the peripapillary RNFL. The results were compared with software integrated into the OCT device, to the normal range of databases (normative basis) of RNFL thickness. The variables studied were age, gender, etiology of the edema, disc dimensions (optic disc surface area, vertical cup to disc ratio [CDR]), and the thickness of the peripapillary RNFL. Chi2tests were used for comparison of proportions with a significance level less than or equal to 0.05. Twenty-six eyes of 16patients with ODE (mean age 25.88±14.35years) and 26eyes of 16control group patients (mean age 25.73±15.90years) were recruited. The ODE was caused by inflammatory optic neuropathies in 10cases, malignant hypertension in 8cases and intracranial hypertension in 8cases. The surface area of the disc was 3.77±1.82mm2for the ODE group vs. 2.74±0.57mm2for the control group (P=0.009). The vertical CDR was 0.11±0.15for the ODE group vs. 0.50±0.15for the control group (P=0). The mean RNFL thickness was 117.12±18.30μm for the ODE group vs. 95.77±2.52μm for the control group (P=0.006). This study reveals an increase in RNFL in all quadrants (superior, P=0.027; inferior, P=0.007; nasal, P=0.026; temporal, P=0.032). Of the 26ODE cases, we noted an increase beyond the normative base; superiorly (in 9cases), inferiorly (in 12cases), nasally (in 10cases) and temporally (in 11cases). The study of papillary changes with OCT in ODE has allowed us to note an increase in the surface area of the disc, a reduction of the vertical CDR, and an increase in the thickness of the average RNF in all quadrants.

Epiretinal membrane as a source of errors during the measurement of peripapillary nerve fibre thickness using spectral-domain optical coherence tomography (SD-OCT).

We aimed to examine the extent to which measurement errors in the determination of retinal nerve fibre layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) occur in cases of epiretinal membrane and whether systematic deviations are found in the values obtained. A macular scan and a circumpapillary scan were performed on 97 eyes of 97 patients using SD-OCT. Group 1 comprised 53 patients with epiretinal membrane at an age of 70 ± 4.8years (median ± average absolute deviation). Group 2 consisted of 44 patients without any macular pathologies (median age 70 ± 5.8years). Differences in the thickness of the RNFL and segmentation errors in the detection of the RNFL were recorded quantitatively in both groups and checked for statistical significance using non-parametric tests. The median central retinal thickness in Group 1 was 357 ± 79μm (median ± average absolute deviation), and in Group 2 it was 270 ± 11μm (p < 0.001). The result of the quadrant-by-quadrant measurement of the average RNFL in Group 1 and Group 2, respectively, was: temporal 88 ± 17 and 73 ± 9μm, inferior 121 ± 17 and 118 ± 15μm, nasal 87 ± 15 and 89 ± 14μm and superior 115 ± 15 and 114 ± 9μm. Temporally, the difference was statistically significant (p < 0.001). Segmentation errors of the RNFL were found in 19 of 53 eyes (35.8%) in Group 1 and in no eyes (p < 0.001) in Group 2. In eyes with epiretinal membrane, measuring errors in the SD-OCT occur significantly more frequently than in eyes without any retinal pathologies. If epiretinal membrane and glaucoma are present simultaneously, the results of the automated RNFL measurement using SD-OCT should be critically scrutinised, even if no papillary changes are visible clinically.

Ocular Papillary Changes on the Caruncle Surface in Allergic Conjunctivitis

Rationale: The caruncle is located in the nasal corner of the eye and can be easily viewed. Prior reports have associated papillary changes on the caruncle surface as diagnostic sign of allergic conjunctivitis. We examined the caruncle and the rest of the palpebral conjunctiva under magnification and fluorescein dye to determine surface roughness in this multi-site, non-interventional, retrospective chart review.

Treatment of vitreomacular traction with ocriplasmin in a non‐reimbursed setting

AbstractPurpose Vitreomacular adhesion can lead to vitreomacular traction (VMT) and macular hole (MH) formation. Intravitreal ocriplasmin provides a non‐surgical solution to release VMT with or without macular hole. A series of 37 patients treated with ocriplasmin is presented. Since ocriplasmin was used in a non‐reimbursed setting, the injection was only recommended when a high success chance was anticipated (e.g. excluding patients with a concomitant epiretinal membrane).Methods An observational trial was conducted on 37 patients with VMT +/‐ MH treated with ocriplasmin with a minimal follow up time of 28 days. Patients had OCT scans of the macular and papillary region prior to the treatment and regularly in the following month. Data on papillary changes were also recorded by Heidelberg Retinal Tomography.Results Overall, 38 eyes of 37 patients were treated (27 with VMT and 11 with VMT+MH). VMT resolved in 28 cases (74%) and macular holes closed in 4 cases (36%). The cup/disc ratio transiently became smaller, associated with a small increase in retinal nerve fiber layer thickness. Interestingly, formation of transient subretinal fluid was observed in the subfoveal and peripapillar region in some patients and a subfoveal drusenoid deposit disappeared in two patients after injection.Conclusion A high success rate of VMT release can be obtained after injection of ocriplasmin when patients are carefully selected. Further research on observed transient changes in the appearance of subretinal fluid and the peripapillary nerve fiber layer thickness is needed.

Astigmatism and soft torics–the challenge or is it?”

Astigmatism and soft torics–the challenge or is it?”

And it was all going so well! Dealing with complications in contact lens wear

Contact lens wear can be associated with a wide range of complications ranging from corneal infection to papillary changes to the eyelid. Both the prevalence and severity of these conditions vary widely. Potential consequences in the most severe cases can be permanent loss of vision while discomfort, redness and cessation of wear frequently occur. It is important therefore that practitioners are able to recognise each potential condition and be in a position to take the appropriate action in terms of management and patient counselling. This presentation will explore the features of infectious, inflammatory, mechanically and chemically related conditions occurring during contact lens wear. In addition to learning how to recognize and differentiate these events, attendees will also be introduced to the aetiological factors responsible and be given guidance on management approaches.

Contact lenses–what to expect in your pre- reg year

Contact lenses–what to expect in your pre- reg year

Strukturelle Diagnostik der Verlaufsbeobachtung der Glaukome

Imaging of the structural progression of glaucoma enables measurement of the neuroretinal rim of the optic disc, retinal nerve fibre layer and thickness of the ganglion layer. High resolution disc photography, laser scanning tomography, scanning laser polarimetry and optical coherence tomography (OCT) are the current methods of choice to document and measure progression of this chronic degenerative disease. Loss of the neuroretinal rim is only a few mm(2) or mm(3) per year and has to be differentiated from age-related loss which shows less change over the years. The most pronounced loss is temporal both superior and inferior. Thinning of the retinal nerve fibre layer follows the same pattern with significant annual changes of only 6-7 µm. Modern OCT devices deliver measurements of the macula ganglion cell complex which can be even more sensitive than the thickness of the retinal nerve fibre layer. Qualitative criteria for structural progression are papillary hemorrhage, rarification of papillary vessels and specific changes of the retinal pigment epithelium. Structural loss due to glaucoma can be imaged and measured with different methods in different tissues. The evaluation of significant changes is still the responsibility of the ophthalmologist by taking all findings into account.

Comparaison de la morbidité de 2 prélèvements des tendons de la patte d’oie pour la reconstruction de ligament croisé antérieur

To determine the prevalence of papillary changes of the upper palpebral conjunctiva and folliculosis of the lower palpebral conjunctiva in Chinese children with no history of contact lens wear.Ninety-nine subjects (aged 6–15 years old) who were interested in a myopia control study were screened for papillary changes and folliculosis of the palpebral conjunctiva. Photodocumentation was performed under white and blue light (after the application of fluorescein) with a yellow filter and the photographs were graded by a group of practitioners according to a pre-set grading scale. Analysis was performed with the subjects divided into groups according to gender and age.More than 48% of the subjects had clinically significant (≥Grade 3) papillary changes in the upper palpebral conjunctiva. The prevalence of significant folliculosis in the lower lid was about 33%. The prevalence of significant papillary changes and folliculosis were similar between genders. No differences were observed between younger (age ≤ 10 years old) and older (age > 10 years old) in papillary changes but younger subjects showed a higher prevalence of folliculosis.The prevalences of clinically significant papillary changes and folliculosis of unknown aetiology are high in Chinese children.

Pathological characteristics of posterior echo attenuation of papillary thyroid microcarcinoma and cystic degeneration of cervical lymph node metastasis

The aim of our study was to evaluate the pathological features of posterior echo attenuation of papillary thyroid microcarcinoma (PTMC) and cystic degeneration of cervical lymph node metastasis. We retrospectively evaluated the ultrasound results from 36 cases of PTMC with 20 nodules of cystic degeneration of cervical lymph node metastasis and correlated the results with the histopathologic findings. The preliminary study indicated certain correlation between histopathologic findings and ultrasound results of posterior echo attenuation of papillary thyroid microcarcinoma and cystic degeneration of cervical lymph node metastasis. Posterior echo attenuation detected by ultrasound was associated with fibrous structures in PTMC nodules, while cystic degeneration and papillary changes of cervical lymph node metastasis in PTMC showed liquefactive necrosis, degenerative changes and enlarged follicular of nodular structures.

Placental Transmogrification of the Lung

Placental transmogrification is a very rare lung disease, where the alveoli resemble the chorionic villi of placenta, and this change is a characteristic finding. A 31-year-old female patient presented with cough and dyspnea that had begun 2 weeks prior to admission. Along with giant bulla found in the left upper lung field, subsegmental consolidation was also identified in the lingular segment on plain chest radiograph and CT scan. Wedge resection was performed to remove the bulla. Pathologic examination of the resected bulla revealed destruction of the normal structures and characteristic villous and papillary changes. These changes led to a diagnosis of placental transmogrification. We made an encounter of an unusual placental transmogrification which had different image findings from other reported transmogrification cases. Thus, we report an atypical placental transmogrification case where both consolidation and giant bulla coexist.

Prevalence of papillary changes and folliculosis of the palpebral conjunctiva in asymptomatic Chinese children

To determine the prevalence of papillary changes of the upper palpebral conjunctiva and folliculosis of the lower palpebral conjunctiva in Chinese children with no history of contact lens wear. Ninety-nine subjects (aged 6-15 years old) who were interested in a myopia control study were screened for papillary changes and folliculosis of the palpebral conjunctiva. Photodocumentation was performed under white and blue light (after the application of fluorescein) with a yellow filter and the photographs were graded by a group of practitioners according to a pre-set grading scale. Analysis was performed with the subjects divided into groups according to gender and age. More than 48% of the subjects had clinically significant (≥Grade 3) papillary changes in the upper palpebral conjunctiva. The prevalence of significant folliculosis in the lower lid was about 33%. The prevalence of significant papillary changes and folliculosis were similar between genders. No differences were observed between younger (age≤10 years old) and older (age>10 years old) in papillary changes but younger subjects showed a higher prevalence of folliculosis. The prevalences of clinically significant papillary changes and folliculosis of unknown aetiology are high in Chinese children.

Xp11.2 translocations in adult renal cell carcinomas with clear cell and papillary features.

4613 Background: Xp11.2 translocation renal cell carcinoma (RCC) is a rare tumor with unpredictable clinical course and prognosis in adults. Recognition of these tumors depends on the identification of a RCC with unique histology, particularly clear cell and papillary (CCP) features. Our objectives were to determine the incidence of Xp11.2 translocations in adult RCCs with clear cell and papillary features, and to characterize the clinicopathological features and prognosis of adult Xp11.2 RCCs. Methods: Slides for 1047 RCCs in adults (1999-2009) were retrieved from multiple institutions. Cases were reviewed histologically in order to detect any degree of clear cell and papillary change. Tissue microarrays were constructed from the clear cell and papillary RCCs as well as 40 non-papillary clear cell, 5 papillary, 3 chromophobe and 2 unclassified RCCs. Immunohistochemistry using TFE3, a marker highly sensitive (97.5%) and specific (99.6%) for Xp11.2 translocations was performed. Four pathologists independently reviewed the TFE3 results. Clinical and pathologic data were also retrieved. Results: Out of 1047 RCCs, 140 (13%) exhibited clear cell and papillary features. Four out of these 140 (3%) were positive for TFE3. All of the non-papillary clear cell, papillary, chromophobe and unclassified RCCs were negative for TFE3. Mean follow up for TFE3+ RCCs was 55 months. Conclusions: Xp11.2 translocation RCCs diagnosed by TFE3 immunohistochemistry were identified in 3% of adult RCCs that had clear cell and papillary changes. These tumors appear to present with smaller tumour size, lower stage and better prognosis in comparison to non-Xp11.2 CCPRCC and clear cell RCCs. In addition to Xp11.2 translocation carcinoma, coexistence of clear cell and papillary features may be present in other subsets of tumors that have yet to be characterized. [Table: see text]