Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

PURPOSE: To evaluate posterior capsule opacification (PCO) in humans after cataract surgery with intraocular lens (IOL) implantation, by using optical coherence tomography (OCT-1). METHODS: Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 microm. Results were compared with visual acuity (VA) and PCO type. RESULTS: Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88-20.41) and 11.9 (8.58-14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 microm; range, 46.33-115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 microm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (r(o) = 0.66; P = 0.01). CONCLUSIONS: OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation

Retinal thickness study with optical coherence tomography in patients with diabetes

To quantitatively assess retinal thickness by optical coherence tomography (OCT) in normal subjects and patients with diabetes. This study was intended to determine which retinal thickness value measured with OCT best discriminates between diabetic eyes, with and without macular edema. METHODS: OCT retinal thickness was measured by a manual technique in a total of 26 healthy volunteers (44 control eyes) and 85 patients with diabetes (148 eyes) with the clinical diagnosis of no diabetic retinopathy (45 eyes), nonproliferative diabetic retinopathy without clinically significant macular edema (CSME; 54 eyes), proliferative diabetic retinopathy without CSME (21 eyes), and 28 eyes with diabetic retinopathy with CSME. Independent predictors of the presence of CSME were quantified by using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to evaluate and compare the predictor variables. The correlation of retinal thickness measurements and visual acuity was calculated. RESULTS: There were statistically significant differences in foveal thickness between control eyes and all the other eye groups (P = 0.001). Diabetic eyes with CSME had a statistically significant greater thickness in each of the areas compared with the other groups. In a multivariate logistic regression model, foveal thickness was a strong and independent predictor of CSME (odds ratio [OR], 1.037; 95% confidence interval [CI] 1.02-1.05). The area under the ROC curve of this predictor variable was 0.94 (P = 0.001). For a cutoff point of 180 microm, the sensitivity was 93%, and specificity was 75%. Foveal thickness correlated with visual acuity in a log minimum angle of resolution (logMAR) scale (Spearman's rho = 0.9, P = 0.001). CONCLUSIONS: These results suggest that foveal thickening over 180 microm measured by OCT may be useful for the early detection of macular thickening and may be an indicator for a closer follow-up of the patient with diabetes

Reproducibility and clinical relevance of the ocular response analyzer in nonoperated eyes: corneal biomechanical and tonometric implications

To assess the reproducibility of the ocular response analyzer (ORA) in nonoperated eyes and the impact of corneal biomechanical properties on intraocular pressure (IOP) measurements in normal and glaucomatous eyes. METHODS: In the reliability study, two independent examiners obtained repeated ORA measurements in 30 eyes. In the clinical study, the examiners analyzed ORA and IOP-Goldmann values from 220 normal and 42 glaucomatous eyes. In both studies, Goldmann-correlated IOP measurement (IOP-ORAg), corneal-compensated IOP (IOP-ORAc), corneal hysteresis (CH), and corneal resistance factor (CRF) were evaluated. IOP differences of 3 mm Hg or greater between the IOP-ORAc and IOP-ORAg were considered outcome significant. RESULTS: Intraexaminer intraclass correlation coefficients and interexaminer concordance correlation coefficients ranged from 0.78 to 0.93 and from 0.81 to 0.93, respectively, for all parameters. CH reproducibility was highest, and the IOP-ORAg readings were lowest. The median IOP was 16 mm Hg with the Goldmann tonometer, 14.5 mm Hg with IOP-ORAg (P < 0.001), and 15.7 mm Hg with IOP-ORAc (P < 0.001). Outcome-significant results were found in 77 eyes (29.38%). The IOP-ORAc, CH, and CRF were correlated with age (r = 0.22, P = 0.001; r = -0.23, P = 0.001; r = -0.14, P = 0.02, respectively), but not the IOP-ORAg or IOP-Goldmann. CONCLUSIONS: The ORA provides reproducible corneal biomechanical and IOP measurements in nonoperated eyes. Considering the effect of ORA, corneal biomechanical metrics produces an outcome-significant IOP adjustment in at least one quarter of glaucomatous and normal eyes undergoing noncontact tonometry. Corneal viscoelasticity (CH) and resistance (CRF) appear to decrease minimally with increasing age in healthy adults

Azoor. Tras una lesión por latigazo cervical

Purpose/Method: To present a case of a 30 years old woman that suffered a car accident one year ago, diagnosed of cervical sprain. One month after the accident, the patient saw a black stein in the outer side of the visuald field on the left eye.Results/Conclusions: Brain CAT, evocated visual potencials, color test and MRI were within of the normality. Acording with the ophtalmic examination, visual field test and OCT (optical coherence tomography), the diagnosis was acute zonal occult outer retinopathy (AZOOR).Objetivo/Metodo: Se presenta un caso clínico de una paciente de 30 años que sufrió un accidente de tráfico en el cual fue diagnosticada de contractura cervical. Aproximadamente un mes después, la paciente percibe un escotoma en la región externa del campo visual del ojo izquierdo. Resultado/Conclusiones: La TAC craneal, potenciales visuales evocados, test de los colores y RNM fueron normales. El estudio mediante oftalmoscopía, campimetría y OCT, sirvió para realizar el diagnósti- co de retinopatía zonal externa aguda oculta (AZOOR)

Measurable Residual Disease by Next-Generation Flow Cytometry in Multiple Myeloma

PURPOSE: Assessing measurable residual disease (MRD) has become standard with many tumors, but the clinical meaning of MRD in multiple myeloma (MM) remains uncertain, particularly when assessed by next-generation flow (NGF) cytometry. Thus, we aimed to determine the applicability and sensitivity of the flow MRD-negative criterion defined by the International Myeloma Working Group (IMWG). PATIENTS AND METHODS: In the PETHEMA/GEM2012MENOS65 trial, 458 patients with newly diagnosed MM had longitudinal assessment of MRD after six induction cycles with bortezomib, lenalidomide, and dexamethasone (VRD), autologous transplantation, and two consolidation courses with VRD. MRD was assessed in 1, 100 bone marrow samples from 397 patients; the 61 patients without MRD data discontinued treatment during induction and were considered MRD positive for intent-to-treat analysis. The median limit of detection achieved by NGF was 2.9 × 10-6. Patients received maintenance (lenalidomide ± ixazomib) according to the companion PETHEMA/GEM2014MAIN trial. RESULTS: Overall, 205 (45%) of 458 patients had undetectable MRD after consolidation, and only 14 of them (7%) have experienced progression thus far; seven of these 14 displayed extraosseous plasmacytomas at diagnosis and/or relapse. Using time-dependent analysis, patients with undetectable MRD had an 82% reduction in the risk of progression or death (hazard ratio, 0.18; 95% CI, 0.11 to 0.30; P < .001) and an 88% reduction in the risk of death (hazard ratio, 0.12; 95% CI, 0.05 to 0.29; P < .001). Timing of undetectable MRD (after induction v intensification) had no impact on patient survival. Attaining undetectable MRD overcame poor prognostic features at diagnosis, including high-risk cytogenetics. By contrast, patients with Revised International Staging System III status and positive MRD had dismal progression-free and overall survivals (median, 14 and 17 months, respectively). Maintenance increased the rate of undetectable MRD by 17%. CONCLUSION: The IMWG flow MRD-negative response criterion is highly applicable and sensitive to evaluate treatment efficacy in MM

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Objective Quantification of Posterior Capsule Opacification after Cataract Surgery, with Optical Coherence Tomography

PURPOSE: To evaluate posterior capsule opacification (PCO) in humans after cataract surgery with intraocular lens (IOL) implantation, by using optical coherence tomography (OCT-1). METHODS: Sixty-six eyes with PCO and 20 eyes with a normal posterior capsule were analyzed. A 3-mm-long horizontal scan of the posterior capsule was obtained. Measurements at three points and their average were recorded. Intraoperator and interoperator reliabilities were assessed. Investigated was peak intensity (PI) and posterior capsule thickening (PCT), with PCT indicating the distance between two reflectivity spikes, with an approximate axial resolution of 10 microm. Results were compared with visual acuity (VA) and PCO type. RESULTS: Intraoperator reliability was 0.59 and 0.97 for average PI and PCT, respectively. The interoperator concordance correlation coefficient was 0.70 and 0.82 for average PI and PCT, respectively. Median (interquartile range) intensities of the reflectivity spike were 16.88 (dB) (range, 12.88-20.41) and 11.9 (8.58-14.28), respectively, in the PCO and control eyes (P = 0.001). PCT was found in PCO eyes (median: 86.13 microm; range, 46.33-115.33), whereas no second spike appeared in control eyes (P = 0.001). The area under the receiver operating characteristic curve of the average PCT for differentiating pearl-type from fibrosis-type PCO was 0.87 (P = 0.001). For a cutoff point of 55.3 microm, the sensitivity was 97.5%, and the specificity was 69%. Worse VA correlated significantly only with larger PCT (r(o) = 0.66; P = 0.01). CONCLUSIONS: OCT-1 appears useful to quantitate PCO. In addition, this system seems to discriminate between different types of PCO. PCT may be a previously unrecognized factor in VA degradation

Bilateral ischemic optic neuropathy after transurethral prostatic resection: a case report

Background: Nonarteritic ischemic optic neuropathy affects the anterior portion of the optic nerve and is characterized by sudden, painless visual loss. The affected eye has a relative afferent pupillary defect. The typical funduscopic appearance includes optic disc edema, with associated nerve fiber layer hemorrhage. Risk factors include advanced age, systemic hypertension, nocturnal hypotension, diabetes mellitus, and a small cup-to-disc ratio. Bilateral presentation is rare. Postoperative optic neuropathy has been associated with nonocular surgery; risk factors include a combination of prolonged surgical times, acute systemic hypotension, anemia due to blood loss, or prone positioning. We report for the first time a patient with bilateral, simultaneous anterior ischemic optic neuropathy after elective transurethral prostatic resection. Case presentation: A 66-year old man underwent surgery for benign prostatic hyperplasia. The preoperative blood pressure was 140/85 mmHg, hemoglobin 15.9 g/dL, and hematocrit 48.6%. Two hours postoperatively, the blood pressure, hemoglobin, and hematocrit dropped dramatically. One day later, transient horizontal diplopia developed. Funduscopy showed a congenitally small cup-todisc ratio without papillary edema. Other ocular findings were unremarkable. By 4 days postoperatively, sudden and painless amaurosis bilaterally developed when the patient awoke with nausea and vomiting. Visual acuity was no light perception bilaterally. The optic discs were swollen with small hemorrhages. Scans of the head and orbits and electrolyte levels were normal. There were no responses on visual evoked potentials bilaterally. The blood pressure was 90/50 mm Hg, the hemoglobin 7.0 g/dL, and the hematocrit 22.9%, necessitating infusion of three units of packed red blood cells. The blood pressure, hematocrit, and hemoglobin increased to normal levels. Three months later the visual acuity remained no light perception. The pupils were unreactive and there was marked optic disc atrophy bilaterally. Conclusion: Bilateral and simultaneous acute ischemic optic neuropathy may be a rare but devastating surgical complication. The combination of anemia and hypotension may increase the risk of anterior ischemic optic neuropathy postoperatively after transurethral prostatic resection