Optical Coherence Tomography Results Research Articles

Optical Coherence Tomography Can Be Used to Assess Glaucomatous Optic Nerve Damage in Most Eyes With High Myopia.

It is generally assumed that optical coherence tomography (OCT) cannot be used to diagnose glaucomatous optic neuropathy (GON) in high myopes. However, this study presents evidence that there is sufficient information in OCT scans to allow for accurate diagnosis of GON in most eyes with high myopia. The purpose of this study was to test the hypothesis that glaucomatous damage can be accurately diagnosed in most high myopes via an assessment of the OCT results. One hundred eyes from 60 glaucoma patients or suspects, referred for OCT scans and evaluation, had corrected spherical refractive errors worse than -6 D and/or axial lengths ≥26.5 mm. An OCT specialist judged whether the eye had GON, based upon OCT circle scans of the disc and cube scans centered on the macula. A glaucoma specialist made the same judgement using all available information (eg, family history, repeat visits, intraocular pressure, 10-2 and 24-2 visual fields, OCT). A reference standard was created based upon the glaucoma specialist's classifications. In addition, the glaucoma specialist judged whether the eyes had peripapillary atrophy (PPA), epiretinal membrane (ERM), tilted disc (TD), and/or a paravascular inner retinal defect (PIRD). The OCT specialist correctly identified 97 of the 100 eyes using the OCT information. In 63% of the cases, the inner circle scan alone was sufficient. For the rest, additional scans were requested. In addition, 81% of the total eyes had: PPA (79%), ERM (18%), PIRD (26%), and/or TD (48%). For most eyes with high myopia, there is sufficient information in OCT scans to allow for accurate diagnosis of GON. However, the optimal use of the OCT will depend upon training to read OCT scans, which includes taking into consideration myopia related OCT artifacts and segmentation errors, as well as PPA, ERM, PIRD, and TD.

Karakteristik Ketebalan Makula Sentral Sebelum dan Sesudah Injeksi IntravitrealBevacizumab di RSKM Padang Eye Center Periode Januari 2018 – Januari 2019

Macular edema is a common cause of vision disturbing. Fluid accumulation in the retina and increased thickness of the retina cause damage to the blood retinal barrier. Intravitreal anti-VEGF (bevacizumab) injection aims to reduce VEGF activity, where retinal vein occlusion (RVO) induces an increase in VEGF levels which causes an increase in vascular permeability and results in macular edema. The aim of this study was to determine the central macular thickness before and after intravitreal injection of bevacizumab in patients with central retinal vein occlusion and branch retinal vein occlusion through observing the results of OCT (Optical Coherence Tomography) examination. This research is a retrospective descriptive study based on the results of medical records tracing of 8 RVO patients in the Padang Eye Center Hospital for the period January 2018 to January 2019. The study was conducted in March to April 2020. The study subjects consisted of 8 people (8 eyes) consisting of 2 men (25.0%) and 6 women (75.0%). The age range ranges from 41-80 years. The thickness of the central macula at the start was found to be majority > 300 μm, as many as 7 people (87.5%), while ≤ 300 μm was 1 person (12.5%). One month after injection found the majority of central macular thickness ≤ 300 μm by 5 people (62.5%), while> 300 μm is as many as 3 people (37.5%). All patients experienced a decrease in central macular thickness in 8 subjects (100%).

Accuracy of Physicians in Differentiating Type 1 and Type 2 Myocardial Infarction Based on Clinical Information

BackgroundPhysicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. MethodsWe performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. ResultsThe response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. ConclusionsPhysician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology.

Progressive Multiple Sclerosis Is Associated with Faster and Specific Retinal Layer Atrophy.

Therapeutic development in progressive multiple sclerosis (PMS) has been hampered by a lack of reliable biomarkers to monitor neurodegeneration. Optical coherence tomography (OCT)-derived retinal measures have been proposed as promising biomarkers to fulfill this role. However, it is unclear whether retinal atrophy persists in PMS, exceeds normal aging, or can be distinguished from relapsing-remitting multiple sclerosis (RRMS). 178 RRMS, 186 PMS, and 66 control participants were followed with serial OCT for a median follow-up of 3.7 years. The estimated proportion of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell + inner plexiform layer (GCIPL) thinning in multiple sclerosis (MS) attributable to normal aging increased from 42.7% and 16.7% respectively at age 25 years, to 83.7% and 81.1% at age 65 years. However, independent of age, PMS was associated with faster pRNFL (-0.34 ± 0.09%/yr, p < 0.001) and GCIPL (-0.27 ± 0.07%/yr, p < 0.001) thinning, as compared to RRMS. In both MS and controls, higher baseline age was associated with faster inner nuclear layer (INL) and outer nuclear layer (ONL) thinning. INL and ONL thinning were independently faster in PMS, as compared to controls (INL:-0.09 ± 0.04%/yr, p = 0.03; ONL:-0.12 ± 0.06%/yr, p = 0.04), and RRMS (INL:-0.10 ± 0.04%/yr, p = 0.01; ONL:-0.13 ± 0.05%/yr, p = 0.01), whereas they were similar in RRMS and controls. Unlike RRMS, disease-modifying therapies (DMTs) did not impact rates of retinal layer atrophy in PMS. PMS is associated with faster retinal atrophy independent of age. INL and ONL measures may be novel biomarkers of neurodegeneration in PMS that appear to be unaffected by conventional DMTs. The effects of aging on rates of retinal layer atrophy should be considered in clinical trials incorporating OCT outcomes. ANN NEUROL 2020;87:885-896.

2D Spatially-Resolved Depth-Section Microfluidic Flow Velocimetry Using Dual Beam OCT.

A dual beam optical coherence tomography (OCT) instrument has been developed for flow measurement that offers advantages over microscope derived imaging techniques. It requires only a single optical access port, allows simultaneous imaging of the microfluidic channel, does not require fluorescent seed particles, and can provide a millimetre-deep depth-section velocity profile (as opposed to horizontal-section). The dual beam instrument performs rapid re-sampling of particle positions, allowing measurement of faster flows. In this paper, we develop the methods and processes necessary to make 2D quantitative measurements of the flow-velocity using dual beam OCT and present exemplar results in a microfluidic chip. A 2D reference measurement of the Poiseuille flow in a microfluidic channel is presented over a spanwise depth range of 700 μm and streamwise length of 1600 μm with a spatial resolution of 10 μm, at velocities up to 50 mm/s. A measurement of a more complex flow field is also demonstrated in a sloped microfluidic section.

Optical coherence tomography characterizes the roughness and thickness of the heterogeneous layer on cortical bone surface induced by Er:YAG laser ablation at different moisture contents.

As an innovative bone ablation tool, pulsed erbium: yttrium-aluminum-garnet (Er:YAG) laser is being used in clinical practice. It faces the same problems as traditional tools: the water content of bone usually changes with the position, while the amount of water spray in the process of laser irradiation is also uncertain. Real-time monitoring of the effects of laser bone ablation is necessary, but effective tools are still lacking. In this study, we examined the feasibility of rapidly and non-destructively evaluating the surface properties of bone after Er:YAG laser irradiation at different moisture contents by optical coherence tomography (OCT). Bone specimens (n=90) collected from pig cortical bone were used in this study. All bone specimens had similar volume and surface characteristics after machining. To display the baseline level before Er:YAG laser ablation, a control group (n=10) without dehydration or Er:YAG laser ablation was examined with OCT, scanning electron microscopy (SEM), and energy dispersive X-ray (EDX) spectroscopy. The remaining specimens were randomly divided into four groups (n=20/group) with different moisture content: dried (Group 2 and Group 4) or not dried (Group 1 and Group 3). Pulsed Er:YAG laser (120 mJ/pulse, 20 Hz, 100 µs) was used for perpendicular irradiation with (Group 1 and Group 2) or without (Group 3 and Group 4) water spray. The treated specimens were subjected to SEM, EDX spectroscopy, OCT, and then processed for histological evaluation. After Er:YAG laser ablation, the melting effect was obvious in the SEM results of the dry groups and non-sprayed groups (Groups 2-4). EDX spectroscopy showed that the content of calcium and phosphorus and their ratios remained unchanged in the undried and with water spray group (Group 1) were the closest to the control group. Three-dimensional (3D) OCT could evaluate the depth and shape of ablation grooves. The roughness of the laser-ablated surface could be visualized by extracting the surface lines from cross-sectional OCT images. The results illustrated that the laser ablation with water spray could achieve a smoother surface. Furthermore, OCT results demonstrated that a layer with high image intensity was generated on the bone surface after laser irradiation. The thickness of these layers showed a correlation with whether or not the laser irradiation was sprayed with water. Histology showed that thin eosin-stained layers were created in all experimental groups, which matched well with OCT results of the layers with high image intensity. No denatured layer was observed in the non-irradiated areas of bone tissues. OCT could rapidly and non-destructively visualize the bone surface before and after Er:YAG laser ablation at four different moisture contents. The morphology of ablation grooves, as well as the roughness and thickness of the heterogeneous layer on the bone surface, could be characterized quantitatively with good correlation with SEM and histology. This study will promote the development of OCT as an efficient and accurate tool for evaluating laser ablation of bone.

Optical Coherence TomographyStudy of peripapillary Nerve Fiber layer ThicknessinThyroid Associated Ophthalmopathy

Abstract Background Thyroid Associated Ophthalmopathy (TAO) or Graves Opthalmopathy (GO) is a very common autoimmune disorder of the thyroid gland which activates the gland function and result in hyperthyroidism. Some patients with graves disease(GD) develop localized manifestations including GO and dermopathy. Dysthyroid optic neuropathy (DON) is impairment of optic nerve function due to GO, the most serious complication of GO which occurs in about 4–8% of patients, it occurs due to ischemia and inflammation of the optic nerve, also compression of the optic nerve due to enlargement of extraocular muscles at the apex of orbit. Objective To assess peripapillary retinal nerve fiber layer (pRNFL) thickness in GD and to correlate it with the severity of the disease. Patients and Methods This study was conducted on 40 eyes of 21 recently diagnosed GO patients (two patients were single eyed) recruited from Endocrinology clinic and examined at Ophthalmology clinic, Ain Shams University Hospital in the period from March 2018 to September 2018. Complete ophthalmologic examination, proptosis assessment of direction and degree, Visual Field (VF) examination, clinical activity score (CAS), severity score assessment and Optical Coherence Tomography (OCT) were performed to all patients . Results In the whole group of patients; the mean average pRNFL was 109.53 um ± 12.33 SD (range: 86 – 140), median MD was -4.53 (range:-0.66 to-18.95) and -8.04 ± -2.15 SD, mean PSD was 5.55 ± 3.8 SD (range: 1.11 to 12.73). Normal average pRNFL thickness (according to normative data base included in the OCT program) was found in 15 eyes (37.5%) and those had abnormal increase in thickness was 12 eyes (30%). Abnormal decrease in thickness was detected in 13 eyes (32.5%). Conclusion PRNFL thickness abnormalities were detected in 25 eyes (62%) of recently diagnosed GO patients. This might be associated with localized visual field defects. Regular follow up of intra ocular pressure (IOP), serial VF examinations, are required to decide further management of those patients, as OCT results were correlated with degree of eye protrusion and the severity of the disease (CAS and severity score).

Патогенетические факторы формирования морфологических форм диабетического макулярного отека (обзор литературы)

Diabetic macular edema (DME) is a pathological accumulation of fluid in the subretinal or intraretinal spaces of the macular area in patients with diabetic retinopathy and leads to a significant decrease in Central vision. Various types of technical equipment for retinal imaging have led to significant advances in the study of diabetic macular edema. In particular, optical coherence tomography (OCT) can provide linear and structural analysis of macular layers in great detail. The important role of inflammation in the development of changes in the macular region, based on OCT classification, associated with characteristic changes in the retina, has been studied. In this review, we will describe the pathogenesis of diabetic macular edema and discuss its types based on the results of OCT and identify the relationship of various types of (DME) with inflammation. Inflammation plays an important role in the pathogenesis of diabetic macular edema, but its role differs depending on the type of changes detected on OCT.

Early detection of enamel demineralization by optical coherence tomography

Enamel is the outermost layer of the tooth that protects it from invasion. In general, an acidic environment accelerates tooth demineralization, leading to the formation of cavities. Scanning electron microscopy (SEM) is conventionally used as an in vitro tool for the observation of tooth morphology changes with acid attacks. Yet, SEM has intrinsic limitations for the potential application of in vivo detection in the early demineralization process. In this study, a high-resolution optical coherence tomography (OCT) system with the axial and transverse resolutions of 2.0 and 2.7 μm in teeth has been utilized for characterizing the effect of the acidic environment (simulated by phosphoric acid) on the enamel topology. The scattering coefficient and the surface roughness of enamel can be directly derived from the OCT results, enabling a quantitative evaluation of the topology changes with demineralization. The dynamic process induced by the acid application is also recorded and analyzed with OCT, depicting the evolution of the demineralization process on enamel. Notably, the estimated enamel scattering coefficient and surface roughness significantly increase with the application time of acid and the results illustrate that the values of both parameters after demineralization are significantly larger than those obtained before the demineralization, illustrating both parameters could be effective to differentiate the healthy and demineralized teeth and determine the severity. The obtained results unambiguously illustrate that demineralization of the tooth surface can be successfully detected by OCT and further used as an indicator of early-stage cavity formation.

P5614The association between tissue morphology assessed with optical coherence tomography and mid and late-term results after percutaneous coronary intervention for in-stent restenosis lesions

Abstract Background It was reported that tissue morphology of in-stent restenosis (ISR) lesions assessed with optical coherence tomography (OCT) had an effect on midterm results including ISR and target lesion revascularization (TLR) rates after percutaneous coronary intervention (PCI). However, little was known about the association between tissue morphology assessed with OCT and late-term results. Methods We performed PCI treated with paclitaxel coated balloon (PCB) or drug-eluting stent (DES) for 452 ISR lesions (260 lesions with fibrous plaque and 192 lesions with lipid-laden plaque) using OCT between May 2008 and July 2016. Six- to eight-month (midterm) angiographic follow-up was performed on 422 of the 452 ISR lesions (follow-up rate: 93.4%). Furthermore, eighteen- to twenty-month (late-term) angiographic follow-up was performed on 337 of the 361 ISR lesions (follow-up rate: 93.4%) which were free from midterm TLR. We examined the association between tissue morphology, midterm-results and late-term results including ISR and TLR rates. Fibrous plaque was defined as homogeneous, signal-rich regions with low attenuation. Lipid-laden plaque was defined as diffuse border, signal poor regions with high attenuation. Results The patients were 353 men and 69 women, and the mean age was 68.8±9.6 years. PCI were performed with PCB in 285 lesions (PCB group) and DES in 137 lesions (DES group). The figure shows the angiographic midterm results of the 422 lesions and late-term results of the 337 lesions with respect to each tissue morphology and each PCI device. There was no difference in ISR and TLR rates of lesions with both fibrous and lipid-laden plaque at midterm between the two groups. ISR and TLR rates of lesions with lipid-laden plaque at late-term were significantly higher in the PCB group than in the DES group, while there was no difference in ISR and TLR rates of lesions with fibrous plaque at late-term between two groups. Figure 1 Conclusion Tissue morphology of ISR lesions might have an impact on outcomes after PCI. Morphological assessment of ISR tissue using OCT might suggest favorable types of PCI for ISR lesions.

Clinical and OCT outcomes of a universal adhesive in a randomized clinical trial after 12 months

ObjectivesTo assess the performance of a universal adhesive in different application modes in non-carious cervical lesions clinically and by optical coherence tomography (OCT). Methods55 adult patients with three non-carious cervical lesions (NCCL) each participated in the study. Lesions were restored with Scotchbond™ Universal (SBU, 3 M) applied in the self-etch (SBU-SE) and the selective-enamel-etch mode (SBU-SEE) in combination with Filtek™ Supreme XTE (3 M). OptiBond™ FL (OFL, Kerr) was used as a control. Restorations were clinically assessed (FDI criteria) after 14 days, 6 and 12 months and in parallel imaged by OCT (interfacial adhesive defects), starting immediately after filling placement. Cumulative failure rates (CFR) and means of interfacial adhesive defect were statistically evaluated. ResultsAfter 12 months, CFRs were lower in the SBU groups (0.0% each) than in the OFL group (20.0%, p = 0.001). Clinically, small marginal fractures occurred three times more often in the SBU-SE than in the SBU-SEE group (p = 0.001). Immediately after filling placement and at each reassessment OCT revealed more interfacial defects at enamel interfaces for SBU/SE compared to SBU/SEE and OFL (pi ≤ 0.044). At dentin/cement more defects were seen with OFL compared to SBU/SE and SBU/SEE (pi ≤ 0.001). Before restoration loss, more interfacial defects appeared compared to remaining restorations (pimmediately/6M = 0.132/0.002). ConclusionsClinical evaluation and OCT imaging revealed higher interfacial integrity for SBU in both application modes compared to OFL. OCT detected interfacial bond failures prior to clinical deterioration or restoration loss. Clinical significanceScotchbond Universal showed an equivalent or improved bonding performance compared to the reference adhesive. Selective enamel etching is recommended. The parameter interfacial adhesive defect seems to be a valuable predictor for evaluation of adhesive restoration systems.

Relationship between neointimal strut bridge and jailed side-branch ostial area

Our study analyzed the relationship between the neointimal strut bridge and jailed side-branch (SB) ostial area in patients with coronary heart disease (CHD) who had asingle drug-eluting stent (DES) crossover of the left anterior descending coronary artery (LAD)/diagonal branch(D) bifurcation. Atotal of 64CHD patients with an LAD/D bifurcation treated by optical coherence tomography (OCT)-guided single-DES implantation and followed up at 1year after primary percutaneous intervention (pPCI) were enrolled in our study. According to the two-dimensional OCT results, patients were divided into anon-neointimal bridge group (n = 44) and aneointimal bridge group (n = 20). Basic clinical, angiographic, 2D and 3D OCT, and DES results were analyzed. The blood lipid levels of the two groups after the 1‑year follow-up were lower than the levels 1year earlier (p < 0.05). There was a notable decrease in the SB ostial minimum lumen diameter and area directly after pPCI vs. before pPCI in both groups. The diameter stenosis directly after pPCI showed a clear increase compared with the pre-pPCI value in both groups (p < 0.05 or p < 0.01, respectively). The strut distance of the neointimal bridges in the neointimal bridge group was greater than in the non-neointimal bridge group (p < 0.05). A clearly short strut distance of the neointimal bridge was observed compared with the strut distance of the non-neointimal bridge in the neointimal bridge group (p < 0.05). A larger neointimal bridge area and a smaller SB ostial area were found in the neointimal bridge group compared with the non-neointimal bridge group (p < 0.05 or p < 0.01, respectively). Ashort strut distance facilitated formation of a neointimal bridge, which significantly influenced the SB ostial area after single crossover stenting of the SB orifice at the 1‑year follow-up.

Structural validation of facial skin using optical coherence tomography: A descriptive study.

In this immediate ex vivo study, we aimed to identify the structures of normal and pathological facial skin using optical coherence tomography (OCT) and compared them to the gold standard histopathology. A total of 53 patients, with 57 suspicious facial lesions, participated in this study. A set of variables have been highlighted by the pathologist to represent the minimum unique features that could be used to diagnose a skin pathology have been included in a checklist. One pathologist used this checklist while examining the histopathology slides and one clinician while examining the OCT images. The data from both checklists have been reviewed and compared. Optical coherence tomography's overall accuracy in diagnosing AK was 83%. Best accuracy was achieved in diagnosing BCC and was 97%, while it was 85% for cutaneous SCC. OCT failed to diagnose LM with an accuracy of 33.3% based on the two parameters of the pathology checklist, while it was 81% for malignant melanoma. This study proved the success of OCT in identifying structural changes in normal and pathological facial skin. Further studies to prove its usefulness in vivo are recommended.

Comparison of vascular–function and structure–function correlations in glaucomatous eyes with high myopia

Background/aimsTo determine the usefulness of peripapillary retinal vessel density (VD) measured using optical coherence tomography (OCT) angiography (OCTA) in the evaluation of glaucomatous visual field damage in highly myopic eyes...

Prevalence of macular abnormalities identified only by optical coherence tomography in Brazilian patients with cataract

To assess the prevalence of macular abnormalities not suspected by the biomicroscopic fundus examination and identified only by macular optical coherence tomography (OCT) in the preoperative evaluation for cataract surgery in a large series of Brazilian patients. Private practice, Recife, Brazil. Retrospective case series. All eyes that had cataract surgery by the same physician between August 2014 and July 2016 were eligible. Excluded were eyes with a previous diagnosis of macular abnormalities, with a suspicious biomicroscopic fundus examination, and without OCT results. Based on the preoperative macular OCT, patients were divided into the following 2 groups: those with a normal OCT and those with an abnormal OCT. Nine hundred fifty-two eyes (614 patients) were included in the study. Macular OCT identified abnormalities in 47 eyes (4.9%) of 44 patients (7.2%). Thirty-one eyes (3.3%) had epiretinal membrane, 7 (0.7%) had age-related macular degeneration, 4 (0.4%) had intraretinal cysts, 4 (0.4%) had a lamellar hole, and 1 (0.1%) had a macular hole. Patients with an abnormal OCT had a statistically significant higher mean age (P=.004). In the preoperative evaluation for cataract surgery in Brazilian patients, 7.2% of those with a normal biomicroscopic fundus examination had macular abnormalities that were identified only by OCT.

Factors Related to Superior and Inferior Hemifield Defects in Primary Open-Angle Glaucoma.

Purpose We aimed to investigate factors related to superior and inferior hemifield defects in primary open-angle glaucoma (POAG). Methods Sixty-seven subjects with newly diagnosed, untreated POAG underwent optical coherence tomography (OCT) of the disc area, macular ganglion cell complex (mGCC), and circumpapillary retinal nerve fiber layer (cpRNFL) thickness within 6 months of the visual field (VF) test. Based on the VF and OCT results, 40 subjects had a superior and 27 an inferior hemifield defect. Clinical data including visual acuity, refractive error, disc hemorrhage, VF indexes, and medical history were recorded. Results Average mGCC thickness corresponding to the defective hemifields was thinner in the superior VF defect group than in the inferior VF defect group (P=0.003). Average total deviation (TD) was comparable between the two groups. However, the superior VF defect group had a higher prevalence of defects (P=0.001) and lower TD (P=0.002) within central 5 degrees of VF than the inferior VF defect group. In multivariate regression analyses, the temporal-lower and inferior-temporal cpRNFL thicknesses were significant contributing factors to the inferior mGCC thickness in the superior VF defect group. In the inferior VF defect group, the disc area, family history of glaucoma, and temporal-upper cpRNFL thickness contributed to the superior mGCC thickness. Conclusion The inferior mGCC thickness corresponding to the superior hemifield defect group was significantly thinner than the superior mGCC thickness corresponding to the inferior hemifield defect group. The factors related to the reduction of the corresponding mGCC thickness may differ between superior VF defect and inferior VF defect groups.

Comparison of Coronary Culprit Lesion Morphology Determined by Optical Coherence Tomography and Relation to Outcomes in Patients Diagnosed with Acute Coronary Syndrome During Winter –vs– Other Seasons

Patients diagnosed with acute coronary syndrome (ACS) during winter have worse outcomes; however, mechanisms driving this trend are unclear. We examined coronary culprit lesion morphologies using optical coherence tomography (OCT). Features and outcomes were retrospectively compared between patients admitted with ACS in winter (W-ACS; n = 390) and in other seasons (O-ACS; n = 1,027). Angiography and OCT results were analyzed in patients who underwent OCT examination (173 patients in W-ACS and 450 in O-ACS). On initial angiography, minimum lumen diameter was smaller (median; 0.12 mm vs 0.25 mm, p = 0.021) and Thrombolysis in myocardial infarction flow grade was worse (Thrombolysis in myocardial infarction 0/1; 57% vs 44%, p = 0.005) in W-ACS. OCT performed before coronary interventions or just after intracoronary thrombectomy showed that plaque rupture (56% vs 46%) and calcified nodules (8% vs 5%) were more prevalent, and plaque erosion (37% vs 49%) was less prevalent in W-ACS (p = 0.039 for all 3 variables). At 2-year follow-up for all admitted ACS patients, Kaplan-Meier estimates showed higher cardiac mortality in W-ACS (11.8% vs 8.3%, p = 0.043). Multivariate Cox proportional hazard analysis showed that patients in W-ACS group had a 1.5-fold increased risk of cardiac death within 2 years after adjusting for traditional cardiovascular risk factors (hazard ratio, 1.54 [95% confidence interval, 1.06 to 2.23]; p = 0.024). In conclusion, patients diagnosed with ACS during winter had worse angiographic results and OCT revealed less plaque erosion (more plaque rupture or calcified nodules) at the culprit lesions, which may be partly associated with worse cardiac mortality within 2 years.

Transorbital ultrasonography in acute optic neuritis: Can it be a supportive diagnostic tool?

BackgroundBecause of limitations of conventional tools for diagnosing optic neuritis (ON), transorbital ultrasonography (TOUS) was introduced as a promising tool to evaluate the optic nerve. However, studies demonstrating its utility are scarce. ObjectiveTo assess the practical diagnostic value of TOUS in patients with ON along with other diagnostic tools such as visual evoked potential (VEP), MRI, and optical coherence tomography (OCT). MethodsSeventeen patients with first-attack unilateral acute ON were enrolled. Clinical characteristics, visual acuity, TOUS, MRI, VEP, and OCT results were evaluated. Bilateral optic nerves were scanned using TOUS to obtain axial images showing the optic nerve and the disc in the longitudinal plane. ResultsTOUS revealed thickening of the optic nerve sheath and optic nerve diameter with sheath on the affected side compared with the unaffected side (p = 0.002 and p = 0.003, respectively). Time since onset of initial symptoms was inversely correlated with optic nerve diameter (ρ = −0.517, p = 0.040) and retinal nerve fiber layer thickness (ρ = −0.831, p < 0.001). ConclusionTOUS could be a cost-effective tool for morphologically evaluating acute ON showing a significant thickening of the optic nerve and sheath, although only a limited retrobulbar area could be explored.

Evaluation of early changes of macular function and morphology by multifocal electroretinograms in patients with nasopharyngeal carcinoma after radiotherapy.

To assess the role of multifocal electroretinograms (mfERGs) and optical coherence tomography (OCT) for detecting early changes in macular functions of patients with nasopharyngeal carcinoma (NPC) after radiotherapy. mfERGs and OCT were used to examine a NPC group (36 NPC patients after radiotherapy without clinically visible radiation retinopathy, 36 eyes) and a normal control group (25 healthy individuals, 25 eyes) with the same procedure and parameters. The two groups of mfERG were summarized by calculating ring averages, response density, N1 amplitude and P1 and N1 latencies were analysed. OCT scan thickness was summarized into ETDRS regions for comparison. Compared with controls, the NPC group had significantly decreased P1 response densities in 1-4 ring regions and N1 amplitudes in 1-3 rings (P < 0.01). P1 latencies were obviously prolonged in rings 1 (P < 0.01). In four quadrants (inferonasal, superonasal, inferotemporal and superotemporal) of the mfERG response waveforms, the NPC group had significantly decreased P1 response densities and N1 amplitudes mainly in the inferonasal and inferotemporal quadrants, showing statistically significant differences from the control group (P < 0.0125). But for the OCT results, there is no statistically significant difference between the NPC group and the control group. In NPC patients after radiotherapy, there may be changes in the mfERGs before any visible fundus lesions appeared as radiation macular oedema. Since the global OCT macular thickness analysis cannot reveal early changes, the mfERGs can objectively and quantitatively assess the earlier changes in macular function in NPC patients.

Factors Associated With Visual Acuity and Central Subfield Thickness Changes When Treating Diabetic Macular Edema With Anti–Vascular Endothelial Growth Factor Therapy

Identifying the factors that are associated with the magnitude of treatment benefits from anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) may help refine treatment expectations. To identify the baseline factors that are associated with vision and anatomic outcomes when managing DME with anti-VEGF and determine if there are interactions between factors and the agent administered. This post hoc analysis of data from the Diabetic Retinopathy Clinical Research Network multicenter randomized clinical trial , Protocol T, was conducted between December 2016 and December 2017. Between August 22, 2012, and August 28, 2013, 660 participants were enrolled with central-involved DME and vision impairment (approximate Snellen equivalent, 20/32-20/320). Repeated 0.05-mL intravitreous injections of 2.0-mg aflibercept (201 eyes), 1.25-mg bevacizumab (185 eyes), or 0.3-mg ranibizumab (192 eyes) per protocol. Change in visual acuity (VA) and optical coherence tomography (OCT) central subfield thickness at 2 years and change in VA over 2 years (area under the curve [AUC]). Among 578 participants, the median age (interquartile range) was 61 (54-67) years. Across anti-VEGF treatment groups, each baseline factor was associated with mean improvement in VA and a reduction in central DME compared with the baseline. For every decade of participant age, the mean VA improvement was reduced by 2.1 letters (95% CI, -3.0 to -1.2; P < .001) in the VA and 1.9 letters (95% CI, -2.4 to -1.3; P < .001) in the VA AUC analyses. For each 1% increase in hemoglobin A1c levels, VA improvement was reduced by 1 letter in the VA (95% CI, -1.5 to -0.5; P < .001) and 0.5 letters (95% CI, -0.9 to -0.2; P < .001) in the VA AUC analyses. Eyes with no prior panretinal photocoagulation (PRP) and less than severe nonproliferative diabetic retinopathy had an approximately 3-letter improvement in the VA (95% CI, 0.9-5.4; P = .007) and VA AUC (95% CI, 1.3-4.2; P < .001) analyses compared with eyes with prior PRP. On average, African American participants had greater reductions in central subfield thickness compared with eyes of white participants (-27.3 μm, P = .01), as did eyes with central subretinal fluid compared with eyes without this OCT feature (-22.9 μm, P = .01). There were no interactions between the predictive factors and the specific anti-VEGF agent that was administered for any VA or OCT outcome. Lower hemoglobin A1c levels were associated with the magnitude of vision improvement following anti-VEGF therapy, providing further evidence to encourage glycemic control among persons with diabetes. Younger patients and those without prior PRP might expect greater improvement in VA than older patients or those with prior PRP.