Choroidal pigmented lesions imaged by ultra-wide-field scanning laser ophthalmoscopy with two laser wavelengths (Optomap)

Marcus Kernt, Ulrich C Schaller, Carmen Stumpf, Michael W Ulbig, Anselm Kampik, Aljoscha S NeubauerDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, GermanyPurpose: Clinical differentiation of choroidal pigmented lesions is sometimes difficult. ­Choroidal melanoma is the most prevalent primary neoplasia among malignant ocular tumors, and metastasis often occurs before the primary tumor is diagnosed. Therefore, early detection is essential. We investigated the imaging properties of clinically diagnosed melanocytic choroidal tumors using a nonmydriatic ultra-wide-field scanning laser ophthalmoscope (SLO) with two laser wavelengths to distinguish benign from malignant lesions. Repeated standardized ultrasound (US) evaluation provided reference standard.Methods: In a consecutive series of 49 patients with clinically diagnosed melanocytic ­choroidal tumors in one eye, 29 had established melanoma (defined by proven growth on repeated US follow-up) and 20 had nevi (defined by no malignancy according to clinical, US, and growth ­characteristics for at least 2 years). All patients underwent clinical examination, undilated Optomap? (Optos PLC, Dunfermline, Fife, Scotland, UK) imaging, standardized US ­examination, and standard retinal photography. Measurements of the tumor base using the Optomap software were compared with US B-scan measurements. Imaging characteristics from the SLO images were correlated with the structural findings in the two patient groups.Results: Measurements of tumor base correlated well between SLO and US with r = 0.61 (T-direction) and r = 0.51 (L-direction). On SLO imaging, typical malignant lesions appeared dark on the red laser channel and bright on the green laser channel. Based on those simple binary characteristics, a sensitivity of 76% at a specificity of 70% was obtained for a correct classification of lesions. When analogous to clinical examination lesion size, margin touching the optic disc, and existence of subretinal fluid were additionally considered, 90% sensitivity at 82% specificity was obtained.Conclusions: In this first, limited series, nonmydriatic SLO imaging with two laser wavelengths permitted to differentiate malignant ocular tumors from nonmalignant lesions with high ­diagnostic accuracy. Additional parameters may further enhance diagnostic properties, but larger patient series are required to validate our findings and prove the diagnostic properties.Keywords: choroidal melanoma, nevus, imaging, ultra-wide-field scanning laser ophthal­moscop

Impairment of vascular strain in patients with obstructive sleep apnea

<div><p>Background</p><p>Obstructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular diseases. Aim of this present study was to evaluate and extend recent research on the influence of obstructive sleep apnea on vascular strain.</p><p>Methods</p><p>A total number of 98 patients were integrated in the study. Patients were grouped according to the Apnea-Hypopnea-Index (AHI) in patients with mild-to-moderate OSA (5/h ≤ AHI < 30/h), severe OSA (AHI ≥ 30/h) and controls (AHI < 5/h). Groups were matched in age, body-mass-index and cardiovascular risks. Vascular strain of common carotid arteries was assessed by ultrasound speckle-tracking. A minor group of 30 patients and controls further underwent assessment of vascular strain of brachial and femoral arteries. Additionally, all patients underwent blood testing to reveal potential influences of inflammatory markers on arterial stiffness. In additional analysis we examined the effect of statin therapy on vascular strain.</p><p>Results</p><p>Patients with OSA showed significantly reduced values of vascular strain of common carotid arteries. Radial and circumferential strains were significantly lower in both patients with mild-to-moderate (p = .05) and patients with severe OSA (p = .001) compared to control. Vascular strain parameters of brachial and femoral arteries showed no consistent results. There were no significant correlations of inflammatory markers with vascular strain parameters. No significant differences in vascular strain were detected between statin and non-statin groups.</p><p>Conclusion</p><p>Patients with OSA show significantly reduced vascular strain assessed by ultrasound-based speckle-tracking. Vascular stiffness increases with the severity of the disease. Target vessels to assess vascular strain in patients with OSA are common carotid arteries, whereas other sites of the arterial tree are not reliable. No significant impact of current statin therapy on vascular strain was found. Further studies are needed to evaluate potential benefit of statins in secondary prevention of atherosclerosis in OSA.</p></div