Relación entre la perimetría automatizada convencional y la topografía papilar realizada con el tomógrafo Heidelberg

espanolObjetivo: Determinar las correlaciones entre los parametros de la cabeza del nervio optico (CNO) obtenidos mediante el laser confocal de barrido (HRT), y los resultados de la perimetria automatizada convencional (PA) en sujetos normales, hipertensos oculares (HTO), sospechosos de glaucoma y glaucomatosos. Metodos: Cuatrocientos veintitres ojos fueron incluidos en el estudio y clasificados segun la presion intraocular basal, morfologia papilar y los resultados de la PA en 4 grupos: 87 normales, 192 hipertensos oculares, 70 sospechosos de glaucoma y 74 glaucomatosos. En los diferentes grupos diagnosticos, se calcularon los coeficientes de correlacion de Pearson entre los parametros de la CNO y la desviacion media (DM), la desviacion estandar de la media (DSM), el numero de puntos alterados en cada cuadrante del campo visual (superior-nasal, inferior-nasal, superior-temporal e inferior-temporal), el numero de puntos alterados segun los niveles de probabilidad y los valores umbral en cada punto de la PA. Resultados: En el grupo normal y de hipertensos oculares, se encontraron pocas correlaciones debiles entre los parametros del HRT y los resultados de la PA. La fuerza y el numero de correlaciones significativas aumentaron en el grupo de sospechosos de glaucoma. En el grupo de glaucomas, las correlaciones fueron mas fuertes, especialmente entre los cocientes excavacion/disco y anillo/disco con la DM (r=0,479) y entre el area de anillo con la DSM (r=0,444). Conclusiones: Se encontraron correlaciones debiles o moderadas entre algunos parametros de la CNO medidos con el HRT y los resultados de la PA, en el grupo de glaucomas. EnglishPurpose: To determine the correlations between optic nerve head (ONH) parameters measured with the Heidelberg Retina Tomograph (HRT), and the main outcomes of standard automated perimetry (SAP) in normal, ocular hypertensive, glaucoma suspects and glaucomatous subjects. Methods: Four hundred and twenty-three patients were enrolled in the study and classified into four groups depending on baseline intraocular pressure, optic nerve head morphology, and SAP results: 87 normal eyes, 192 ocular hypertensive eyes, 70 glaucoma suspects and 74 glaucomatous eyes. In the different diagnostic groups, Pearson's correlation coefficients were calculated between ONH parameters and mean deviation, pattern standard deviation (PSD), number of altered points in each quadrant of the visual field (superior-nasal, inferior-nasal, superior-temporal and inferior-temporal), number of points altered at different probability levels, and threshold values at each point of SAP. Results: In the normal and ocular hypertensive groups, only a few weak correlations were found between HRT and SAP parameters. The strength and number of significant correlations increased in the suspected glaucoma group. The glaucoma group had the strongest correlations, particularly between cup/disc ratio and rim/disc ratio with MD (r=0.479) and between rim area and PSD (r=0.444). Conclusions: Weak to moderate correlations were found between some ONH parameters obtained with the HRT and SAP results in the glaucoma grou

The Underestimated Role of Platelets in Severe Infection a Narrative Review

Beyond their role in hemostasis, platelets have emerged as key contributors in the immune response; accordingly, the occurrence of thrombocytopenia during sepsis/septic shock is a well-known risk factor of mortality and a marker of disease severity. Recently, some studies elucidated that the response of platelets to infections goes beyond a simple fall in platelets count; indeed, sepsis-induced thrombocytopenia can be associated with—or even anticipated by—several changes, including an altered morphological pattern, receptor expression and aggregation. Of note, alterations in platelet function and morphology can occur even with a normal platelet count and can modify, depending on the nature of the pathogen, the pattern of host response and the severity of the infection. The purpose of this review is to give an overview on the pathophysiological interaction between platelets and pathogens, as well as the clinical consequences of platelet dysregulation. Furthermore, we try to clarify how understanding the nature of platelet dysregulation may help to optimize the therapeutic approach

The circadian curve of intraocular pressure : can we estimate its characteristics during office hours?

PURPOSE: To verify whether office-hour measurements in patients in different body positions can estimate the characteristics of 24-hour intraocular pressure (IOP). METHODS: The 24-hour IOP curves of 29 healthy subjects (10 young adults, 19 elderly) and 30 patients with untreated glaucoma were analyzed. Measurements were taken at 9 AM; 12, 3, 6, and 9 PM; and 12, 3, and 6 AM, both in the supine and sitting (Goldmann tonometer) positions. Peak, mean, and fluctuation of 24-hour IOP curves were compared with office-hour measurements obtained in subjects in the sitting position alone and with combined pressures obtained in the sitting and supine positions (four measurements in each body position from 9 AM to 6 PM). The percentage of subjects with estimates of all IOP parameters within a cutoff of +/-1 (peak and mean) and +/-2 mm Hg (fluctuation) was calculated. RESULTS: Office-hour sitting measurements correctly identified peak, mean, and IOP fluctuation in 10% of the young adults, 32% of the elderly control subjects, and 20% of the patients with glaucoma, whereas the combination of supine and sitting measurements correctly identified them in 30%, 85%, and 46% of cases, respectively. It is noteworthy that office-hour measurements did not characterize any 24-hour parameter in 20% of patients with glaucoma. CONCLUSIONS: Compared with sitting measurements alone, the collection of supine and sitting office-hour measurements may enhance the correct identification of 24-hour IOP characteristics in both control subjects and untreated patients with glaucoma, thus reducing the need for obtaining 24-hour curves to a minority of patients

Optical coherence tomography angiography in Purtscher-like retinopathy associated with dermatomyositis : a case report

Purpose: To describe a multimodal imaging diagnosis of retinopathy in dermatomyositis. Case presentation: A 21-year-old white woman with a history of fatigue and a cutaneous rash complained of visual impairment in her left eye. A funduscopic examination showed multiple confluent cotton-wool spots in both eyes. Swept source-optical coherence tomography presented macular edema in both eyes; optical coherence tomography angiography revealed superficial and deep capillary occlusion in all areas affected by cotton-wool spots; and fluorescein angiography showed vascular walls enhancement, veins dilatation, and capillary leakage. After large doses of intravenously administered glucocorticoid therapy, followed by a cyclophosphamide regimen, best corrected visual acuity returned to 20/20 in both eyes. Conclusions: This case report presents optical coherence tomography angiography clinical findings in a rare case of dermatomyositis-associated retinopathy, remarking the importance of a multi-imaging approach for a correct diagnosis and treatment of eye injuries, in order to avoid serious complications and permanent sequelae

Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it.</p> <p>Case presentation</p> <p>A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radiographs revealed an inter-trochanteric fracture of the femur. A dynamic hip screw fixation was planned for the fracture but the dilemma was on how to position the patient on the fracture table for the surgery. Special attention was needed in positioning the patient and in surgical fixation of the fracture.</p> <p>Conclusion</p> <p>Hip fracture fixation in patients with below-knee amputations poses a special problem in positioning for fracture reduction and fixation. In this case report, we share our experience and suggest techniques to use when encountering this difficult problem.</p

A Comparison between the Compass Fundus Perimeter and the Humphrey Field Analyzer

Purpose: To evaluate relative diagnostic precision and test–retest variability of 2 devices, the Compass (CMP, CenterVue, Padova, Italy) fundus perimeter and the Humphrey Field Analyzer (HFA, Zeiss, Dublin, CA), in detecting glaucomatous optic neuropathy (GON). Design: Multicenter, cross-sectional, case-control study. Participants: We sequentially enrolled 499 patients with glaucoma and 444 normal subjects to analyze relative precision. A separate group of 44 patients with glaucoma and 54 normal subjects was analyzed to assess test–retest variability. Methods: One eye of recruited subjects was tested with the index tests: HFA (Swedish interactive thresholding algorithm [SITA] standard strategy) and CMP (Zippy Estimation by Sequential Testing [ZEST] strategy), 24-2 grid. The reference test for GON was specialist evaluation of fundus photographs or OCT, independent of the visual field (VF). For both devices, linear regression was used to calculate the sensitivity decrease with age in the normal group to compute pointwise total deviation (TD) values and mean deviation (MD). We derived 5% and 1% pointwise normative limits. The MD and the total number of TD values below 5% (TD 5%) or 1% (TD 1%) limits per field were used as classifiers. Main Outcome Measures: We used partial receiver operating characteristic (pROC) curves and partial area under the curve (pAUC) to compare the diagnostic precision of the devices. Pointwise mean absolute deviation and Bland–Altman plots for the mean sensitivity (MS) were computed to assess test–retest variability. Results: Retinal sensitivity was generally lower with CMP, with an average mean difference of 1.85±0.06 decibels (dB) (mean ± standard error, P < 0.001) in healthy subjects and 1.46±0.05 dB (mean ± standard error, P < 0.001) in patients with glaucoma. Both devices showed similar discriminative power. The MD metric had marginally better discrimination with CMP (pAUC difference ± standard error, 0.019±0.009, P = 0.035). The 95% limits of agreement for the MS were reduced by 13% in CMP compared with HFA in participants with glaucoma and by 49% in normal participants. Mean absolute deviation was similar, with no significant differences. Conclusions: Relative diagnostic precision of the 2 devices is equivalent. Test–retest variability of MS for CMP was better than for HFA

Evidence for alterations in fixational eye movements in glaucoma

BACKGROUND: Fixation changes in glaucoma are generally overlooked, as they are not strikingly evident as in macular diseases. Fundus perimetry might give additional insights into this aspect, along with traditional perimetric measures. In this work we propose a novel method to quantify glaucomatous changes in fixation features as detected by fundus perimetry and relate them to the extent of glaucomatous damage. METHODS: We retrospectively analysed fixation data from 320 people (200 normal subjects and 120 with glaucoma) from the Preferred Retinal Locus (PRL) detection of a Compass perimeter. Fixation stability was measured as Bivariate Contour Ellipse Area (BCEA), and using two novel metrics: (1) Mean Euclidean Distance (MED) from the Preferred Retinal Locus, and (2) Sequential Euclidean Distance (SED) of sequential fixation locations. These measures were designed to capture the spread of fixation points, and the frequency of position changes during fixation, respectively. RESULTS: In the age corrected analysis, SED was significantly greater in glaucomatous subjects than controls (P = 0.002), but there was no difference in BCEA (P = 0.15) or MED (P = 0.054). Similarly, SED showed a significant association with Mean Deviation (P  0.14 for both). CONCLUSION: Changes in the scanning pattern detected by SED are better than traditional measures of fixation spread (BCEA) for describing the changes in fixation stability observed in glaucoma

Compass : clinical evaluation of a new instrument for the diagnosis of glaucoma

Aims: To evaluate Compass, a new instrument for glaucoma screening and diagnosis that combines scanning ophthalmoscopy, automated perimetry, and eye tracking. Materials and Methods: A total of 320 human subjects (200 normal, 120 with glaucoma) underwent full ophthalmological evaluation and perimetric evaluation using the Humphrey SITA standard 24\ub0 test (HFA), and the Compass test that consisted of a full-threshold program on the central 24\ub0with a photograph of the central 30\ub0 of the retina. A subgroup of normal subjects and glaucoma patients underwent a second Compass test during the same day in order to study test-retest variability. After exclusion of 30 patients due to protocol rules, a database was created to compare the Compass to the HFA, and to evaluate retinal image quality and fixation stability. Results: The difference inmean sensitivity between Compass and HFA was -1.02 \ub1 1.55 dB in normal subjects (p65% of cases; Image-based diagnosis was in accordance with the initial diagnosis in 85%of the subjects. Conclusions: Based on preliminary results, Compass showed useful diagnostic characteristics for the study of glaucoma, and combined morphological information with functional data