Rim Volume Research Articles

Partially de-epithelialized postauricular flap for ear reconstruction

SURGICAL CHALLENGE The ear presents unique challenges in reconstruction, including the need to recreate distinct subunits of a complex 3-dimensional structure and cartilaginous framework. The postauricular flap is a workhorse flap for reconstruction of the scapha with exposed cartilage. A modification of the postauricular flap with distal de-epithelization can be used to reconstruct large defects of the scapha and augment helical rim volume.

Hypofractionated Stereotactic Radiation Therapy/ Radiosurgery Results in Patients With Uveal Melanoma

bi-directional product (BP), volume of the post-surgical cavity including surrounding enhancement (Vol), and volume of T1+C enhanced rim (Rim) with the cavity subtracted. We first sought to determine if a 25% increase between PO and 1 or 3 month T1+C MRIs was predictive of worsened OS and PFS for each technique. If significant, we planned to determine if a 5% increase, or any increase were also predictive. Results: Median age was 61.8 years. Median OS and PFS were 18.6 and 11.7 months. A relative increase in Rim volume of 25% at 3 months was a poor prognostic factor for OS (15.2 vs 31.3 months pZ0.001) and for PFS (10.0 vs 15.5 months pZ0.011). Even at 1 month, Rim increase of 25% was a poor prognostic factor for OS and for PFS. Vol and BP change did not statistically significantly predict for OS. Rim increase of only 5% at 1 month also predicted for worse OS (15.2 vs 26.9 months pZ0.010). Further, at 1 month, any increase in Rim enhancement was associated with worse OS (15.2 vs 21.3 months pZ0.025). Conclusion: Even minor change in the relative amount of enhancement surrounding the post-surgical cavity is an early prognostic factor for OS and PFS. Changes of Vol or BP were not significant predictors of OS. These findings suggest that either a lack of early response or underappreciated progression portends a significantly worse prognosis and raises the question of whether salvage therapies should be considered earlier in these patients. Author Disclosure: J. Molitoris: None. S. Aggarwal: None. C. Gzell: None. T. Diwanji: None. M.P. Mehta: Consultant; Elekta, Novocure, Novartis. Member, Board of Directors; Pharmacyclics. Chair, Brain Tumor Committee; NRG.

Retinal Nerve Fiber and Optic Disc Morphology in Patients with Human Immunodeficiency Virus Using the Heidelberg Retina Tomography 3.

PurposeTo use novel confocal scanning ophthalmoscopy technology to test hypothesis that HIV-seropositive patients without history of retinitis with a history of a low CD4 count are more likely to have damage to their retinal nerve fiber layer (RNFL) when compared to patients with high CD4 count. In addition, we compared optic disc morphologic changes with glaucoma.DesignCross-sectional study.Participants and Controls171 patients were divided into four groups. The control group consisted of 40 eyes of 20 HIV-seronegative patients. The second group consisted of 80 eyes of 41 HIV-positive patients whose CD4 cell count never dropped below 100 (1.0 x 109/L). The third group consisted of 44 eyes of 26 HIV-positive patients with a history of low CD4 counts <100. Fourth group consisted of 79 eyes of 79 patients with confirmed glaucoma who served as positive controls.TestingConfocal scanning laser ophthalmoscopy was performed with the Heidelberg Retina Tomograph (HRT3) and data were analyzed with HRT3, software (Heyex version 1.5.10.0).Main Outcome MeasuresDisc area, cup area, cup volume, rim volume, mean cup depth, maximum cup depth, cup-to-disc ration, mean RNFL thickness, and RNFL cross-sectional area.ResultsAnalysis of the global optic nerve and cup parameters showed no difference in disk area among the four groups. There was also no difference in cup, rim volume, mean cup depth, or maximum cup depth among the first three groups but they were all different from glaucoma group. The RNFL was thinner in glaucoma and both HIV-positive groups compared to HIV-seronegative subjects. The cross sectional RNFL area was thinner in both high and low CD4 HIV-positive groups compared to HIV-seronegative group in the nasal and temporal/inferior sectors, respectively. Glaucoma group showed thinning in all sectors.ConclusionsHIV retinopathy results in retinal nerve fiber layer loss without structural optic nerve supportive tissue change. RNFL damage may occur early in HIV disease by mechanism different than in glaucoma.

Flicker defined form, standard perimetry and Heidelberg retinal tomography: Structure-function relationships

ObjectiveTo compare flicker defined form (FDF) perimetry using the Heidelberg edge perimeter (HEP) with standard automated perimetry (SAP) on the Humphrey visual field (HVF) analyzer and to compare their relationship to structural measurements acquired with the Heidelberg retina tomograph. DesignProspective, observational study. ParticipantsThirty-one glaucomatous eyes with varying severity and 13 normal control eyes were included in this analysis. MethodsAll subjects underwent FDF testing on the HEP using the 24-2 protocol by the adaptive staircase thresholding algorithm standard strategy and SAP on the HVF analyzer 750 II using the SITA-Standard 24-2 test. Heidelberg retina tomography (HRT) testing was obtained for each patient. Spearman correlation coefficient, mean deviation (MD), and pattern standard deviation measurements by both machines were compared. ResultsFDF and SAP MD were significantly correlated (r = 0.81, p < 0.001). FDF and SAP MD were significantly correlated with HRT cup/disc ratio (FDF MD: p < 0.001; SAP MD: p = 0.003), disc area (FDF MD: p = 0.005; SAP MD: p = 0.059), rim volume (FDF MD: p < 0.001; SAP MD: p < 0.001), and retinal nerve fibre layer (FDF MD: p < 0.001; SAP MD: p < 0.001). ConclusionsThis pilot study shows that the MD parameter of FDF correlated with SAP results. FDF and SAP had significant correlations with HRT parameters in glaucomatous and healthy eyes. The potential utility of FDF in the clinical management of glaucoma requires further investigation.

Characterization of Abnormal Optic Nerve Head Morphology in Albinism Using Optical Coherence Tomography.

To characterize abnormalities in three-dimensional optic nerve head (ONH) morphology in people with albinism (PWA) using spectral-domain optical coherence tomography (SD-OCT) and to determine whether ONH abnormalities relate to other retinal and clinical abnormalities. Spectral-domain OCT was used to obtain three-dimensional images from 56 PWA and 60 age- and sex-matched control subjects. B-scans were corrected for nystagmus-associated motion artefacts. Disc, cup, and rim ONH dimensions and peripapillary retinal nerve fiber layer (ppRNFL) thickness were calculated using Copernicus and ImageJ software. Median disc areas were similar in PWA (median = 1.65 mm2) and controls (1.71 mm2, P = 0.128), although discs were significantly elongated horizontally in PWA (P < 0.001). In contrast, median optic cup area in PWA (0.088 mm2) was 23.7% of that in controls (0.373 mm2, P < 0.001), with 39.4% of eyes in PWA not demonstrating a measurable optic cup. This led to significantly smaller cup to disc ratios in PWA (P < 0.001). Median rim volume in PWA (0.273 mm3) was 136.6% of that in controls (0.200 mm3). The ppRNFL was significantly thinner in PWA compared with controls (P < 0.001), especially in the temporal quadrant. In PWA, ppRNFL thickness was correlated to ganglion cell thickness at the central fovea (P = 0.007). Several ONH abnormalities, such as cup to disc ratio, were related to higher refractive errors in PWA. In PWA, ocular maldevelopment is not just limited to the retina but also involves the ONH. Reduced ppRNFL thickness is consistent with previous reports of reduced ganglion cell numbers in PWA. The thicker rim volumes may be a result of incomplete maturation of the ONH.

Structural Changes in Pseudoexfoliation Syndrome Evaluated with Spectral Domain Optical Coherence Tomography

ABSTRACTPurpose: To detect early structural changes of macular ganglion cell complex (GCC), peripapillary nerve fiber layer (pNFL), and optic nerve head (ONH) topography in subjects with pseudoexfoliation (PEX) using 3-D spectral domain optical coherence tomography (SD-OCT, Topcon 3D-2000).Materials and Methods: Thirty-five participants with PEX and 29 healthy control subjects were included in the study. All study participants underwent SD-OCT imaging. Macular NFL, ganglion cell layer and inner plexiform layer (GCL + IPL), pNFL, and ONH parameters were measured in each participant. The results were compared within the two groups.Results: In eyes with PEX, the superior and total mNFL thickness; superior, and total GCL + IPL thickness; superior, inferior, and total GCC thickness; and inferior, temporal, nasal, and total pNFL thickness were significantly thinner than the control subjects. In the topographic evaluation of ONH, there was no significant difference in optic disc area (ODA), cup area, rim area, cup to disc ratio (CDR), cup volume, rim volume, linear CDR and vertical CDR between the two groups.Conclusions: In PEX syndrome, similar decreases of the GCC and NFL occurred, and a high correlation existed between the two. Therefore, GCC can potentially be used to detect the early stages of PEX glaucoma.

Ipsilateral renal function preservation after robot-assisted partial nephrectomy (RAPN): an objective analysis using mercapto-acetyltriglycine (MAG3) renal scan data and volumetric assessment.

To objectively assess ipsilateral renal function (IRF) preservation and factors influencing it after robot-assisted partial nephrectomy (RAPN). Our database was queried to identify patients who had undergone RAPN from 2007 to 2013 and had complete pre- and postoperative mercapto-acetyltriglycine (MAG3) renal scan assessment. The estimated glomerular filtration rate (eGFR) for the operated kidney was calculated by multiplying the percentage of contribution from the renal scan by the total eGFR. IRF preservation was defined as a ratio of the postoperative eGFR for the operated kidney to the preoperative eGFR for the operated kidney. The percentage of total eGFR preservation was calculated in the same manner (postoperative eGFR/preoperative eGFR × 100). The amount of healthy rim of renal parenchyma removed was assessed by deducting the volume of tumour from the volume of the PN specimen assessed on pathology. Multivariable linear regression was used for analysis. In all, 99 patients were included in the analysis. The overall median (interquartile range) total eGFR preservation and IRF preservation for the operated kidney was 83.83 (75.2-94.1)% and 72 (60.3-81)%, respectively (P < 0.01). On multivariable analysis, volume of healthy rim of renal parenchyma removed, warm ischaemia time (WIT) > 30 min, body mass index (BMI) and operated kidney preoperative eGFR were predictive of IRF preservation. Using total eGFR tends to overestimate the degree of renal function preservation after RAPN. This is particularly relevant when studying factors affecting functional outcomes after nephron-sparing surgery. IRF may be a more precise assessment method in this setting. Operated kidney baseline renal function, BMI, WIT >30 min, and amount of resected healthy renal parenchyma represent the factors with a significant impact on the IRF preservation. RAPN provides significant preservation of renal function as shown by objective assessment criteria.

Parameters measurement of the optic nerve head and macular ganglion cell complex in patients with preperimetric glaucoma

Objective To observe the changes of glaucoma optic nerve head (ONH) parameters and macular ganglion cell complex (GCC) structure in preperimetric glaucoma (PPG) patients.Methods Eighteen PPG patients (18 eyes,PPG group),22 primary open-angle glaucoma (POAG) patients (22 eyes,POAG group),and 20 patients (20 eyes) with physiologic large optic cup (physiological big optic cup group) were included in this study.Seventeen healthy volunteers (17 eyes) were the normal control.The optic nerve head and macular was scanned by fourier-domain optic coherence tomography (FD-OCT) for all subjects.The following 15 parameters,including nerve fiber layer thickness (RNFL),the optic disk rim volume (RV),optic nerve head volume (NHV),optic disc area (ODA),rim area (RA),cup volume (CV),cup/disc area ratio (CDAR),vertical cup/disc ratio (VCDR),horizontal cup/disc ratio (HCDR) and optic cup area (CA),macular GCC,superior GCC,inferior GCC thickness,focal loss of volume (FLV) and global loss of volume (GLV),were measured at 10 different quadrants.The relationship between macular GCC thickness or optic disc RNFL thickness and RA was analyzed by simple linear regression analysis.Results The RNFL thickness of PPG patients was (99.29±19.93) μm (superior quadrant),(97.29±22.86) μm (inferior),(114.61±15.64) μm (superior temporal,ST),(119.22±26.19) μm (inferior temporal,IT),(116.11±39.32) μm (superior nasal,SN),(111.33±37.65) μm (inferior nasal,IN),(77.56±17.22) μm (temporal upper,TU),(76.78±10.34) μm (temporal lower,TL),(88.94± 42.54) μm (nasal upper,NU),and (82.33±43.83) μm (nasal lower,NL) respectively,which was thinner than normal control group and physiologic large cup group,but thicker than POAG patients.Compared to normal controls and physiologic large cup patients,PPG patients also had 4 parameters reduced (RV,NHV,ODA and RA),and 5 parameters increased (CV,CDAR,VCDR,HCDR and CA),the differences are statistically significant (P＜0.05).However,these parameters were similar to POAG patients (P＞ 0.05).For macular GCC parameters,PPG patients also had 3 parameters reduced (average GCC,superior and inferior GCC thickness),and 2 parameters increased (GLV and FLV) compared to normal control group and physiologic large cup patients (P＜0.05).However,these parameters were similar to POAG patients (P＞0.05).Simple linear regression analysis showed that,with the GCC macular thinning,reducing the number of ganglion cells reduced,optic disc RNFL thickness became thinner (regression coefficient=1.25,P=0.00) and RV reduced (regression coefficient =0.037,P =0.00).Conclusions PPG patients and normal control had a similar distribution of optic disc RNFL.Five parameters (RV,NHV,ODA,RA,macular GCC thickness) were less than normal control and physiological big optic cup group,but had no significant differences compared with POAG group. Key words: Glaucoma/diagnosis; Retinal ganglion cells; Macula lutea; Optic disk; Tomography, optical coherence

A comparison between amblyopic and fellow eyes in unilateral amblyopia using spectral-domain optical coherence tomography.

PurposeTo compare the macular retinal thickness and characteristics of optic nerve head (ONH) parameters in amblyopic and fellow eyes in patients with unilateral amblyopia.Patients and methodsA total of 21 patients with unilateral amblyopia (14 patients with anisometropic amblyopia, four patients with strabismic amblyopia, and three patients with both) were examined using spectral-domain optical coherence tomography. The mean age of the patients was 8.5±3.5 years. The examined parameters included the mean macular (full, inner, and outer), ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) thicknesses, and ONH parameters (rim volume, nerve head volume, cup volume, rim area, optic disc area, cup area, and cup-to-disc area ratio).ResultsThe amblyopic eyes were significantly more hyperopic than the fellow eyes (P<0.001). Among the macular retinal thickness parameters, the cpRNFL thickness (P<0.01), macular full retinal thickness (3 mm region) (P<0.01), and macular outer retinal thickness (1 and 3 mm regions) (P<0.05) were significantly thicker in the amblyopic eyes than in the fellow eyes, while the ganglion cell complex thickness, macular full retinal thickness (1 mm region), and macular inner retinal thickness (1 and 3 mm regions) were not significantly different. Among the ONH parameters, the rim area was significantly larger and the cup-to-disc area ratio was smaller in the amblyopic eyes than in the fellow eyes (P<0.05). None of the other ONH parameters were significantly different between the investigated eyes. The differences in the cpRNFL thickness and macular outer retinal thickness in the 1 mm region were significantly correlated with the difference in axial length (P<0.05, r=−0.48; P<0.01, r=−0.59, respectively) and refractive error (P<0.05, r=0.50; P<0.01, r=0.60, respectively). The other parameters were not significantly related to the difference in axial length, refractive error, or best corrected visual acuity.ConclusionWe found significant differences in some of the morphological measurements between amblyopic and fellow eyes that appear to be independent of abnormalities in the visual cortex.

Confocal scanning laser tomography of the optic nerve head on the patients with Alzheimer's disease compared to glaucoma and control.

The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer's disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 ± 0.07 in AD, 0.22 ± 0.09 in glaucoma and 0.24 ± 0.07 in the control group (p = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control (p < 0.05). There was no statistically significant difference between AD and control for the optic disc parameters tested (p > 0.05). We observed a negative correlation of the age with RNFL in all of the groups (p < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age.

Megalopapilla in children: a spectral domain optical coherence tomography analysis.

To compare various optic nerve head (ONH) parameters and peripapillary retinal nerve fibre layer (pRNFL) thickness between megalopapilla cases and normal control using spectral domain optical coherence tomography (SD-OCT) in children. Fifty eyes with megalopapilla and 80 normal control eyes of totally 130 children between the ages of 6 and 15 were examined using SD-OCT. Optic nerve head parameters including disc diameter, cup-to-disc ratio, disc area, cup area, rim area, cup volume and rim volume, and pRNFL thickness were analysed and compared between two groups. Megalopapilla group presented larger optic disc diameter, disc and cup area, cup-to-disc and cup-to-disc area ratio, when compared with normal control group. However, there is no difference in rim area (p = 0.25) and rim volume (p = 0.48) between the two groups. Average pRNFL thickness was higher in the megalopapilla group (p < 0.001). Rim area, rim volume and pRNFL, which reflect the number of retinal nerve fibres, were preserved in children with megalopapilla. Various ONH parameters obtained with SD-OCT may be useful in the differential diagnosis of megalopapilla in children.

Dewetting film dynamics inside a capillary using a micellar nanofluid.

An experimental study was performed in which hexadecane was displaced by a micellar nanofluid in a glass capillary. Experiments have shown that a thick film was formed on the capillary wall after hexadecane was displaced by the nanofluid. The thick hexadecane film is unstable, and over time it breaks and forms a thin film. Once the thick film ruptures, it retracts and forms an annular rim (liquid ridge) that collects liquid. As the volume of the annular rim increases over time, it forms a double-concave meniscus across the capillary and dewetting stops. The thin film on the right side of the double-concave meniscus then breaks and the contact angle increases. The process repeats until the droplets build up all along the capillary wall. Finally, the droplets are displaced from the capillary wall by the nanofluid and spherical droplets appear inside the capillary. This is a novel phenomenon because we did not observe any film formation when we used a solution without micelles. The theoretical model based on the lubrication approximation using the capillary pressure gradient was developed to estimate the annular rim dewetting velocity. The predicted dewetting velocity is found to be in fair agreement with the experimentally measured value.

Age-associated changes in the retinal nerve fiber layer and optic nerve head.

Optical coherence tomography (OCT) measures of the retinal nerve fiber layer (RNFL) thickness and neuroretinal rim (NRR) parameters are often used as a surrogate for retinal ganglion cell content. The purpose of this study was to investigate the relationship between these morphological measures and the aging effects on these structures. One hundred thirteen healthy individuals, aged 19 to 76 years, with no prior history of retinal of optic nerve head pathology were recruited. A circumpapillary and radial OCT scan centered on the optic nerve head (ONH) was used for data analysis. Transverse scaling was calculated for each subject using measures from optical biometry. Custom algorithms were used for morphological analysis of the ONH NRR and RNFL that included quantification of major retinal vascular contribution. There was a significant age-related loss of RNFL thickness (-0.23 μm/y, R(2) = 0.24, P < 0.01), major retinal vascular contribution (-0.03 μm/y, R(2) = 0.07, P = 0.01, neural rim volume (NRV, -0.004 mm(3)/y, R(2) = 0.15, P < 0.01), and minimum rim width (MRW, -1.77 μm/y, R(2) = 0.23, P < 0.01) before, and after, incorporating the Bruch's membrane opening size (sMRW, -1.86 μm/y, R(2) = 0.22, P < 0.01). When normalized, the rates of change for ONH NRR parameters (NRV, 0.69%/y and sMRW, 0.50%/y) exceeded that of RNFL thickness (0.19%/y, P < 0.01). Although both RNFL and ONH NRR parameters contain axons of retinal ganglion cells, there are differences in age-related changes in these measures that should be considered in clinical application.

Robotic Partial Nephrectomy for Cystic Renal Masses: A Comparative Analysis of a Matched-paired Cohort

To compare the outcomes of robotic partial nephrectomy (RPN) for cystic and solid renal neoplasms. Our RPN database was queried to identify consecutive patients who underwent RPN for cystic and solid renal masses in the period between July 2007 and July 2013. Cystic renal masses were diagnosed on cross-sectional imaging (computed tomography or magnetic resonance imaging). Matching was done between the patients with cystic renal masses and patients with solid renal masses (1:1 matching) by age, gender, tumor size, and nephrometry score. Of 647 cases, 55 patients with cystic masses (group 1) were matched with 55 patients with solid tumors (group 2). There was no cyst rupture or positive surgical margin observed in group 1. The volume of resected rim of healthy renal parenchyma surrounding the tumor was the same for both groups (P=.9). There was no difference between the groups in terms of percentage of glomerular filtration rate preservation postoperatively (85% vs 86%; P=.94). There was no difference in term of overall complications between the 2 groups. Thirty patients (54.5%) in group 1 and 47 patients (85.5%) in group 2 had renal cell carcinoma (P=.0001). RPN can be safely and effectively performed when treating a suspicious cystic renal neoplasm with outcomes resembling those obtained for solid masses. Thus, when a cystic renal mass in encountered, nephron-sparing surgery can be offered and RPN represents an effective tool for this approach.

Optic Neuropathy Induced by Experimentally Reduced Cerebrospinal Fluid Pressure in Monkeys

To examine the influence of experimentally reduced cerebrospinal fluid pressure (CSFP) on retinal nerve fiber layer (RNFL) thickness and neuroretinal rim area of the optic nerve head. This experimental study included nine monkeys that underwent implantation of a lumbar-peritoneal cerebrospinal fluid (CSF) shunt. In the study group (n = 4 monkeys), the shunt was opened to achieve a CSF of approximately 40 mm H2O, while the shunt remained closed in the control group (n = 5 monkeys). At baseline and in monthly intervals thereafter, optical coherence tomographic and photographic images of the optic nerve head and RNFL were taken of all monkeys. Two out of four monkeys in the study group showed bilaterally a progressive reduction in RNFL thickness between 12% and 30%, reduction in neuroretinal rim area and volume, and increase in cup-to-disc area ratios. A third monkey developed a splinter-like disc hemorrhage in one eye. The fourth monkey in the study group did not develop morphologic changes during follow-up, nor did any monkey in the control group. Experimental and chronic reduction in CSF in monkeys was associated with the development of an optic neuropathy in some monkeys.

Comparing Optic Nerve Head Analysis Between Confocal Scanning Laser Ophthalmoscopy and Spectral Domain Optical Coherence Tomography

Purpose/aim of the study: Confocal scanning laser ophthalmoscopy, HRT3, and spectral domain optical coherence tomography (OCT), RTVue-100, are able to give 3-dimensional (3D) topography images of optic nerve head (ONH) and to derive stereometric parameters and sectorial analysis. The purpose of the study is to evaluate the agreement of these two devices and their diagnostic accuracy to discriminate eyes with glaucoma from those without.Materials and methods: Glaucoma patients and healthy control subjects were included. All of them underwent a complete ophthalmological examination, including slit lamp evaluation and visual field (VF) test. After pupil dilatation, HRT3 and RTVue-100 were performed. The following stereometric parameters were recorded: disc area, rim area, rim volume, cup volume, cup area, cup/disk ratio, and the following sectors, superotemporal, superonasal, inferotemporal, inferonasal.Results: Forty-six eyes of 46 glaucoma patients and 58 eyes of 58 healthy subjects were included in the study. In both groups, HRT3 rim area and rim volume were statistically higher than RTVue-100 (glaucomas: 0.95 ± 0.38 versus 0.44 ± 0.33 and 0.19 ± 0.13 versus 0.02 ± 0.03, p < 0.01. controls: 1.41 ± 0.30 versus 1.08 ± 0.37 and 0.37 ± 0.13 versus 0.14 ± 0.11, p < 0.01), while cup area was statistically higher by RTVue-100 (glaucomas: 1.42 ± 0.57 versus 1.14 ± 0.58, p < 0.01. controls: 1.05 ± 1.35 versus 0.65 ± 0.48). Bland and Altman plots confirmed the presence of a fixed bias. The parameters with largest AUROC were rim volume, rim area and cup/disk ratio for both instruments. HRT3 inferotemporal sector had the highest sensitivity (80.43%, at 75.9% specificity), while for RTVue-100, the superotemporal sector had the highest sensitivity (76.1%, at 81% specificity). The agreement was moderate for inferotemporal sector and fair for the others.Conclusions: HRT3 and RTVue-100 are not interchangeable for ONH analysis. They both have good diagnostic accuracy, but RTVue-100 shows slightly better performance, at least with regard to rim area volume.

Assessment of the Optic Nerve Head Parameters Using Heidelberg Retinal Tomography III in Preterm Children

BackgroundVariations in optic nerve head morphology and abnormal retinal vascular pattern have been described in preterm children using digital image analysis of fundus photograph, optical coherence tomograph and serial funduscopy. We aimed to compare the optic nerve head parameters in preterm and term Malay children using Heidelberg Retinal Tomograph III.DesignA cross sectional study.Methodology/Principal FindingsThirty-two preterm Malay children who were born at up to 32 weeks postconception, and 32 term Malay children aged 8–16 years old were recruited into this cross sectional study, which was conducted in the Hospital Universiti Sains Malaysia, Malaysia from January to December 2011. Their optic nerves were scanned and analyzed using a Heidelberg Retinal Tomography (HRT) III (Heidelberg Engineering, Germany). Preterm children showed an increased rim volume (SD) (0.56 (0.26) vs 0.44 (0.18) mm3, respectively), smaller cup shape (SD) (0.18 (0.07) vs 0.25 (0.06) mm, respectively), increased height variation contour (SD) (0.44 (0.14) vs 0.35 (0.08) mm, respectively), and increased cup depth (SD) (0.24 (0.11) vs 0.17 (0.05) mm3, respectively) when compared to their normal peers (p<0.05). There were no significant differences in the mean disc area, cup area, cup to disc ratio or rim area between the preterm and term children (p>0.05) in our study.Conclusions/SignificancePreterm children exhibit different characteristics of optic nerve head parameters with HRT III analysis. Increased cup depth in preterm children suggests a need for close observation and monitoring. It may raise suspicion of pediatric glaucoma when proper documentation of intraocular pressure and clinical funduscopy are unsuccessful in uncooperative children.

Decreased retinal nerve fiber layer thickness in patients with congenital isolated growth hormone deficiency.

To evaluate the optic disc topography parameters of children with congenital isolated growth hormone deficiency (GHD) using the Heidelberg retina tomograph (HRT) in a controlled study. This prospective study included 32 eyes of 32 patients with congenital isolated GHD and 36 eyes of 36 healthy subjects. The topographic optic disc parameters (mean cup volume, rim volume, cup area, disc area, rim area, mean cup-to-disc ratio and cup depth, retinal nerve fiber layer thickness [RNFL]) were imaged in all subjects with HRT-III (software 3.01 a-M). Pearson correlation analysis was used to investigate the correlation between right and left eyes regarding the optic disc parameters. Differences between the 2 groups were evaluated by independent t test, Mann-Whitney U test, and chi-square test. The mean RNFL thickness in children with congenital isolated GHD was found to be statistically significantly thinner than in healthy subjects (p&lt;0.05). However, no statistically significant differences were found between the mean cup volume, rim volume, cup area, disc area, rim area, mean cup-to-disc ratio and cup depth, and mean sectorial RNFL thickness (p&gt;0.05). The results suggest that congenital GHD may lead to thinner RNFL thickness when compared with healthy subjects. This indicates that GH has an important role in the development of the neural retina.

Heidelberg retina tomography II parameters in evaluating high- and normal-pressure glaucoma progression

Heidelberg retina tomography II (HRT II) haves been employed to quantitatively assess the topography of optic discs in eyes with high-pressure glaucoma (HPG) and normal-pressure glaucoma (NPG), in order to determine which of global and segmental optic disc parameters will prove to be most suitable for monitoring the progression of these two conditions. The results of 73 eyes of 73 patients with HPG and NPG were analyzed in relation to age, refractive error, quality of HRT images and stereometric parameters. A statistically significant difference (p < 0.05) between the global baseline and follow-up results was found in: rim volume, maximum cup depth and cup shape measure (in the HPG group), and C/D ratio, cup volume, rim volume and cup shape measure (in the NPG group). The baseline and follow-up results of the retinal nerve fiber layer in the temporal and inferotemporal sectors show a significant difference in both groups. Several HRT stereometric parameters are useful for monitoring the progression of changes of the optic disc and local retina in eyes with HPG and NPG. Both segmental and global scanning is of importance in glaucoma progression analysis.

Comparison of Normal- and High-Tension Glaucoma: Nerve Fiber Layer and Optic Nerve Head Damage

Purpose: The aim of this study was to investigate differences in the nerve fiber layer and glaucoma-induced structural optic nerve head (ONH) damage in patients with normal- (NTG) and high-tension (HTG) glaucoma. Methods: In this retrospective pair-matched comparative study, 22 NTG and 22 HTG eyes were matched according to the same glaucomatous damage based on rim volume, rim area and disk size, as measured by Heidelberg retinal tomography (HRT III). Visual fields (VF) were assessed by Humphrey perimetry, and nerve fiber layer thickness was determined both by scanning laser polarimetry (GDxVCC) and spectral-domain optical coherence tomography (SD-OCT). Comparisons of all measured parameters were made between NTG and HTG groups. Results: Based on HRT results, both NTG and HTG eyes displayed comparable structural damage to the ONH (NTG/HTG, mean: disk area, 2.30/2.31 mm², p = 0.942; rim area, 1.02/0.86 mm², p = 0.082; rim volume, 0.19/0.17 mm³, p = 0.398). NTG eyes had significantly less VF damage than HTG eyes (NTG/HTG, mean deviation: -4.23/-12.12 dB, p = 0.002; pattern standard deviation: 5.39/8.23 dB, p = 0.022). The inferior nerve fiber layer of NTG patients was significantly thicker than that of HTG patients (NTG/HTG, mean: GDx inferior: 53.5/46.3 µm, p = 0.046). SD-OCT revealed a significantly thicker nerve fiber in NTG compared with HTG patients in all quadrants (NTG/HTG, total mean: 72.72/58.45 µm, p = 0.002). Conclusion: At comparable glaucomatous stages, nerve fiber loss was more advanced in HTG patients compared with NTG patients.