Search

Resume Introduction L’etendue de la chirurgie pancreatique pour cancer rend la survenue de fuites chyleuses (FC) assez frequente. Recemment une definition consensuelle de FC a ete etablie par l’International Study Group of Pancreatic Surgery (ISGPS). Le but de cette etude etait d’analyser les facteurs de risque et le traitement des FC apres chirurgie pancreatique. Methodes Au total, 228 patients ayant un drainage sereux ou chyleux apres chirurgie pancreatique ont ete inclus dans cette etudes de donnees collectees prospectivement entre janvier 2014 et decembre 2016. Les facteurs de risque et les traitements des FC etaient compares. Une analyse du sous-groupe de patients ayant eu l’ablation des drains malgre une FC persistante etait effectuee avec une etude de la necessite d’un drainage percutane ou une reintervention dans les 3 mois postoperatoires. Resultats Soixante patients ayant eu une FC etaient analyses. Parmi eux, 41 ont eu un regime pauvre en graisses pendant une duree mediane de 12 jours. Le type de traitement n’avait pas d’effet sur la duree du drainage (p = 0,29) et la morbidite (p = 0,15). De plus la morbidite postoperatoire n’etait pas augmentee chez les patients ayant eu une ablation des drains malgre une FC persistante (p = 0,84). Aucun de ces patients n’avait eu un drainage percutane ou une reintervention pour collection postoperatoire. Conclusions Le regime pauvre en graisse n’est probablement pas un traitement efficace des FC. De futures etudes sont necessaires pour explorer l’effet et la necessite d’un traitement des FC.

Summary Purpose With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle leak (CL) has become a more commonly observed complication. Recently, a new consensus definition was established by the International study group of pancreatic surgery (ISGPS). The aim of the present analysis was to evaluate risk factors and treatment options of patients with CL after pancreatic surgery. Methods Two hundred and twenty-eight patients with serous or chylous drainage after pancreatic surgery were included in this analysis of a prospectively collected database between 01/2014 and 12/2016. Risk factors for CL and treatment options were compared. A subgroup analysis on those patients, who had drain removal despite of persistent CL with respect to the need of subsequent percutaneous drainage or reoperation within three months postoperatively, was performed. Results Sixty patients with CL were identified. Of those, 41 patients were treated with medium-chain triglyceride-diet, with a median duration of therapy of 12 days. In patients with CL, the type of treatment had no effect on time to drain removal (P = 0.29) and morbidity (P = 0.15). Furthermore, morbidity was not increased in patients who had their drains removed despite persistent CL (P = 0.84). None of the latter patients had percutaneous drainage or reoperation for CL after removal of the surgical drains. Conclusions Dietary treatment may not be very effective in treating CL. Further research is warranted to explore the effect and necessity of CL treatment.

Heinrich Muller was a nineteenth-century German retinal anatomist who, during his short career, was one of the discoverers of the rod photopigment rhodopsin and neuroglia in the retina, now known as Muller cells. He also described the ocular muscles and double foveae of some birds. An important, but largely neglected, insight by Muller was to combine careful psychophysical measurements and geometrical optics to find the location of the photosensitive layer of the retina in the living eye. Here, we provide translated passages from Muller's (1855) publication and compare his entoptic observations with retinal imaging using optical coherence tomography. Muller correctly deduced from his careful experiments that vision is initiated in the photoreceptors located in the back of the retina.

Optical and neural changes in the aging human visual system are reviewed in terms of factors that can influence the study of light-mediated effects on circadian physiology. All aspects of early stage visual mechanisms change continuously from the first days of life, and these changes must be understood when investigating both conscious and unconscious visual responses to light throughout the life span.

Im aktuellen klinischen Alltag haben zystische Pankreaslasionen (PCNs) einen zunehmend relevanten Stellenwert, da sie aufgrund der sich stetig verbessernden Bildgebung haufig als Zufallsbefund diagnostiziert werden. Man unterscheidet zwischen nichtneoplastischen und neoplastischen Pankreaszysten, wobei letztere in unterschiedlicher Auspragung zur malignen Entartung neigen und damit als Vorlauferlasionen des duktalen Adenokarzinoms des Pankreas (PDAC) gelten. Zur Differenzialdiagnose werden neben einer genauen Anamnese und Untersuchung vor allem bildgebende Verfahren wie die Computertomographie (CT) und Magnetresonanztomographie (MRT) sowie der endoskopische Ultraschall mit Feinnadelaspiration herangezogen. Die Indikationen zur chirurgischen Resektion dieser Lasionen richten sich nach den aktuellen europaischen Leitlinien, deren Inhalte sind jedoch nicht evidenzbasiert, sondern stutzen sich auf Erkenntnisse und Empfehlungen von Experten. Gemas den Konsensusempfehlungen kann die asymptomatische seros-zystische Neoplasie (SCN) als serose Lasion mit niedriger Tendenz zur Entartung beobachtet werden. Im Gegensatz dazu sollten alle muzinos-zystischen Neoplasien (MCN) >4 cm sowie alle solid-pseudopapillaren Neoplasien (SPN) reseziert werden. Intraduktal papillar-muzinose Neoplasien (IPMNs), die aufgrund ihres Bezugs zum Pankreasgangsystem in Haupt(MD)- oder Seitengang(BD)-IPMNs unterteilt werden, sollten als MD-IPMN und als Mixed-type(MT)-IPMN reseziert werden. Das Entartungsrisiko der BD-IPMN ist variabler und abhangig von Risikofaktoren, die klinisch und bildmorphologisch definiert werden. Das therapeutische Management erfolgt daher individuell nach Risikoabschatzung. Um die Indikationsqualitat bei PCNs quantifizieren zu konnen und damit auch zu einer optimierten Versorgung beizutragen, werden dringend prospektive Langzeitstudien benotigt.

Die Implementierung technologischer Innovationen in der Chirurgie wie roboterassistierte Eingriffe, neuartige Implantate, Navigation oder moderne Visualisierungstechniken stellen fur Klinken eine okonomische Herausforderung dar, da sie selten per se kostendeckend sind. Im deutschen DRG(„diagnosis related groups“)-System sind die Kosten zahlreicher neuartiger Technologien und Innovation in der Chirurgie kurzfristig und auch oft mittel- und langfristig nicht oder nicht ausreichend gedeckt. Dieser Ubersichtsartikel beschreibt die okonomischen Aspekte chirurgischer Innovationen und zeigt mogliche Wege fur Kliniken auf, die Kosten zu decken. In einem simulierten Fallbeispiel wird veranschaulicht, inwieweit das aktuelle deutsche DRG-Tarifsystem die Kosten minimal-invasiver Techniken (laparoskopisch, roboterassistiert) im Rahmen einer elektiven Sigmaresektion bei benigner Indikation widerspiegelt.

Brown is a contrast color that depends on complex combinations of chromatic and achromatic signals. We measured brown perception with variations in chromaticity and luminance in center-surround configurations. In Experiment 1, the dominant wavelength and saturation in terms of S -cone stimulation were tested with five observers in a fixed surround luminance ( 60 c d / m 2 ). A paired-comparison task required the observer to select the better exemplar of brown in one of two, simultaneously presented, stimuli (1.0° center diameter; annulus of 9.48° outer-diameter). In Experiment 2, the same task was tested with five observers in which surround luminance was varied (from 13.1 to 99.6 c d / m 2 ) for two center chromaticities. The results were a set of win–loss ratios for each stimulus combination and converted to Z -scores. An ANOVA did not reveal a significant main effect of the observer factor but revealed a significant interaction with red/green ( a ∗ ) [but not with the dominant wavelength and the S -cone stimulation (or b ∗ )]. Experiment 2 revealed observer variation in interactions with surround luminance and S -cone stimulation. The averaged data plotted in 1976 L ∗ a ∗ b ∗ color space indicate that high Z -score values widely distribute in the area of a ∗ from 5 to 28 and b ∗ over 6. The balance of the strength between yellowness and blackness differs among observers owing to the amount of induced blackness required for the best brown.

In vivo functional imaging of human photoreceptors is an emerging field, with compelling potential applications in basic science, translational research, and clinical management of ophthalmic disease. Measurements of light-evoked changes in the photoreceptors has been successfully demonstrated using adaptive optics (AO) coherent flood illumination (CFI), AO scanning light ophthalmoscopy (SLO), AO optical coherence tomography (OCT), and full-field OCT with digital AO (dAO). While the optical principles and data processing of these systems differ greatly, and while these differences manifest in the resulting measurements, we believe that the underlying physiological processes involved in each of those techniques are likely the same. AO-CFI and AO-SLO systems are more widely used than OCT systems. However, those systems produce only two-dimensional images and so, less can be said about the anatomical and physiological origins of the observed signal. OCT signal, on the other hand, provides 3D imaging but at a cost of high volume of data, making it impractical to clinical purposes. In light of this, we employed a combined AO-OCT-SLO system–with point-for-point correspondence between the OCT and SLO images–to measure functional responses simultaneously with both and investigate SLO retinal functional biomarkers based on OCT response. The resulting SLO images reveal reflectance changes in the cones which are consistent with those previously reported using AO-CFI and AO-SLO. The resulting OCT volumes show phase changes in the cone outer segment (OS) consistent with those previously reported by us and others. We recapitulate a model of the cone OS previously proposed to explain AO-CFI reflectance changes, and show how this model can be used to predict the signal in AO-SLO. The limitations of the model is also discussed in this manuscript.

Accurate and reproducible OCT angiography (OCTA) measurements are highly dependent on the overall phase stability of the sample. Raster-scanning OCT systems are vulnerable to eye motion, which makes phase correlation impossible if the retinal displacement is too large. Numerical methods exist to correct components of phase shifts due to the axial movement, but that due to lateral movement bigger, then imaging spot are not generally correctable. Real-time eye tracking provides a method to reduce the phase shifts caused by lateral eye movement. Here we report the advancements on monitoring ocular metrics during OCTA acquisition and its effects on image quality.

Background An increasing body of evidence suggests that microbiota may promote progression of pancreatic ductal adenocarcinoma (PDAC). It was hypothesized that gammaproteobacteria (such as Klebsiella pneumoniae) influence survival in PDAC, and that quinolone treatment may attenuate this effect. Methods This was a retrospective study of patients from the Massachusetts General Hospital (USA) and Ludwig-Maximilians-University (Germany) who underwent preoperative treatment and pancreatoduodenectomy for locally advanced or borderline resectable PDAC between January 2007 and December 2017, and for whom a bile culture was available. Associations between tumour characteristics, survival data, antibiotic use and results of intraoperative bile cultures were investigated. Survival was analysed using Kaplan-Meier curves and Cox regression analysis. Results Analysis of a total of 211 patients revealed that an increasing number of pathogen species found in intraoperative bile cultures was associated with a decrease in progression-free survival (PFS) (-1·9 (95 per cent c.i. -3·3 to -0·5) months per species; P = 0·009). Adjuvant treatment with gemcitabine improved PFS in patients who were negative for K. pneumoniae (26·2 versus 15·3 months; P = 0·039), but not in those who tested positive (19·5 versus 13·2 months; P = 0·137). Quinolone treatment was associated with improved median overall survival (OS) independent of K. pneumoniae status (48·8 versus 26·2 months; P = 0·006) and among those who tested positive for K. pneumoniae (median not reached versus 18·8 months; P = 0·028). Patients with quinolone-resistant K. pneumoniae had shorter PFS than those with quinolone-sensitive K. pneumoniae (9·1 versus 18·8 months; P = 0·001). Conclusion K. pneumoniae may promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.

Noninvasive, objective measurement of rod function is as significant as that of cone function, and for retinal diseases such as retinitis pigmentosa and age-related macular degeneration, rod function may be a more sensitive biomarker of disease progression and efficacy of treatment than cone function. Functional imaging of single human rod photoreceptors, however, has proven difficult because their small size and rapid functional response pose challenges for the resolution and speed of the imaging system. Here, we describe light-evoked, functional responses of human rods and cones, measured noninvasively using a synchronized adaptive optics optical coherence tomography (OCT) and scanning light ophthalmoscopy (SLO) system. The higher lateral resolution of the SLO images made it possible to confirm the identity of rods in the corresponding OCT volumes.

Neuroendocrine tumors (NETs) are rare neoplasms, which represent complex challenges in diagnosis and treatment. Even in the metastatic stage there are important differences in the type of tumor in comparison to gastrointestinal and pancreatic adenocarcinomas. Therefore, the disease courses are substantially different depending on the grade of differentiation. Even in the metastatic stage the 5‑year survival rates of G1 tumors is up to 83%. Approximately 20% of small intestine NETs additionally show hormone activity, which can compromise survival and the quality of life. For individual treatment decisions the special tumor biology of these tumors must be taken into consideration more so than for other tumor entities. Surgery always becomes important for these tumors when a R0 resection appears possible. Oligometastasis of the liver and the lymph drainage system can be meaningfully approached by surgical treatment. In selected patients with an isolated liver involvement, a liver transplantation can be considered; however, even tumor debulking can lead to improvement in the quality of life and survival, especially for hormone active tumors with a carcinoid syndrome which cannot be conservatively controlled. The aim of this review is to present the value of surgical treatment options in the case of (oligo)metastasized NETs.

We present noninvasive depth-resolved imaging of human retinal and choroidal microcirculation with an ultrahigh-speed (1.7 MHz A-scans/s), Fourier-domain mode locked (FDML) swept-source optical coherence tomography (SS-OCT) system having a central wavelength of 1065 nm. Three OCT angiography (OCTA) motion based contrast methods, namely phase variance (PV), amplitude decorrelation (AD) and Joint Spectral and Time domain OCT (STdOCT) were implemented. The OCTA imaging was performed with a field of view of 16° (5 mm × 5 mm) and 30° (9 mm × 9 mm), on the retina. A qualitative comparison of images obtained with all three OCTA methods is demonstrated using the same eye of a healthy volunteer. Different parameters, namely acquisition time, scanning area, and scanning density, are discussed. The phase-variance OCTA (PV-OCTA) method produced relatively better results than the other two. Different features regarding the retinal and choroidal vessels are described in different subjects.

We describe the details of a multimodal retinal imaging system which combines adaptive optics (AO) with an integrated scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT) imaging system. The OCT subsystem consisted of a swept-source, Fourier-domain mode-locked (FDML) laser, with a very high A-scan rate (1.6MHz), whose beam was raster scanned on the retina by two scanners-one resonant scanner and one galvanometer. The high sweep rate of the FDML permitted the SLO and OCT to utilize the same scanners for in vivo retinal imaging and, unlike existing multimodal systems, concurrently acquired SLO frames and OCT volumes with approximate en face correspondence at a rate of 6Hz. The AO provided diffraction-limited cellular resolution for both imaging channels.

Objective optical assessment of photoreceptor function may permit earlier diagnosis of retinal disease than current methods such as perimetry, electrophysiology, and clinical imaging. Recent work with adaptive optics (AO) flood imaging, conventional OCT and phase-sensitive full-field OCT have revealed apparent changes in photoreceptor outer segment (OS) length in response to visible stimuli. In this work, we describe an AO-OCT system designed to measure these stimulus-evoked OS length changes. The OCT subsystem consisted of a Fourier-domain mode-locked laser that acquires A-scans at 1.64MHz and an AO subsystem providing diffraction-limited imaging with a closed-loop correction rate of 20Hz. To our knowledge this is the highest-speed AO-OCT system developed to date. Visible stimuli were delivered using a LED-based Maxwellian view channel incorporated into the system. In a dark-adapted healthy subject, 1-deg square volumetric images were acquired at a rate of 32Hz. Images were acquired for 10s, with a 10ms bleaching stimulus flash with variable intensity. Strip-based registration was used to track individual cones in the volume series, and time series of the resulting depth-resolved complex signal were analyzed. Stimulus-evoked changes in the morphology of OS and RPE were observed in the M-scan amplitude. In the M-scan phase, the difference between the IS/OS and COST was shown to increase in response to the stimulus flash, and the magnitude of the phase change depended upon flash intensity. These results suggest that cone OS elongates in response to visible stimuli, and that the length change scales with stimulus intensity.

For over 150 years, spectrally selective filters have been proposed to improve the vision of observers with color vision deficiencies [1]. About 6% of males and

Impulse response functions for an incremental luminous pulse (ON flash) or a decremental luminous pulse (OFF flash) were derived for twelve young (19–24 years old) and ten old (65–84 years old) observers. Thresholds were measured for two pulses separated by stimulus-onset-asynchronies from 13.3 to 186.7 ms. The pulses had a spatial Gaussian shape and were presented as increments or decrements on a 15 cd/m2 equal-energy white background, having the same chromaticity as the pulse. A spatial four-alternative forced-choice method was combined with a staircase procedure. Retinal illuminance was equated individually by heterochromatic flicker photometry and using a 2.3-mm exit pupil in a Maxwellian-view optical system to reduce the effects of age-related changes and individual variations in lens density and pupil size. Luminance ON- and OFF-impulse response functions calculated from the threshold data revealed significant age-related changes in the response amplitude of both first excitatory and first inhibitory phases. However, there were no significant changes in the time to the first peak or the second peak. These age-related changes in luminance varying ON- and OFF-impulse response functions (IRFs), reflecting putative properties of the magnocellular pathway, are discussed in relation to motion detection and the balance of ON and OFF pathways across the life span.

This feature issue of the Journal of the Optical Society of America A (JOSA A) reflects the basic and applied research interests of members of the color vision community. Most of the articles stem from presentations at the 24th Biennial Symposium of the International Colour Vision Society (ICVS).

We have designed and implemented a dual-mode adaptive optics (AO) imaging system that combines spectral domain optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) for in vivo imaging of the human retina. The system simultaneously acquires SLO frames and OCT B-scans at 60Hz with an OCT volume acquisition time of 4.2s. Transverse eye motion measured from the SLO is used to register the OCT B-scans to generate three-dimensional (3-D) volumes. Key optical design considerations include: minimizing system aberrations through the use of off-axis relay telescopes, conjugate pupil plane requirements, and the use of dichroic beam splitters to separate and recombine the OCT and SLO beams around the nonshared horizontal scanning mirrors. To demonstrate system performance, AO-OCT-SLO images and measurements are taken from three normal human subjects ranging in retinal eccentricity from the fovea out to 15-deg temporal and 20-deg superior. Also presented are en face OCT projections generated from the registered 3-D volumes. The ability to acquire high-resolution 3-D images of the human retina in the midperiphery and beyond has clinical importance in diseases, such as retinitis pigmentosa and cone-rod dystrophy.

Hintergrund Das Pankreaskarzinom ist weiterhin mit einer sehr schlechten Prognose verbunden. Die chirurgische Resektion ist der einzige kurative Therapieansatz. Gleichwohl wurden in den letzten Jahren zunehmende Fortschritte im Bereich neuer onkologischer Therapiekonzepte gemacht, welche nachfolgend detailliert dargestellt werden sollen.

In retinal raster imaging modalities, fixational eye movements manifest as image warp, where the relative positions of the beam and retina change during the acquisition of single frames. To remove warp artifacts, strip-based registration methods-in which fast-axis strips from target images are registered to a reference frame-have been applied in adaptive optics (AO) scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT). This approach has enabled object tracking and frame averaging, and methods have been described to automatically select reference frames with minimal motion. However, inconspicuous motion artifacts may persist in reference frames and propagate themselves throughout the processes of registration, tracking, and averaging. Here we test a previously proposed method for removing movement artifacts in reference frames, using biases in stripwise cross-correlation statistics. We applied the method to synthetic retinal images with simulated eye motion artifacts as well as real AO-SLO images of the cone mosaic and volumetric AO-OCT images, both affected by eye motion. In the case of synthetic images, the method was validated by direct comparison with motion-free versions of the images. In the case of real AO images, performance was validated by comparing the correlation of uncorrected images with that of corrected images, by quantifying the effect of motion artifacts on the image power spectra, and by qualitative examination of AO-OCT B-scans and en face projections. In all cases, the proposed method reduced motion artifacts and produced more faithful images of the retina.

Macular degeneration (MD) affects the central retina and leads to gradual loss of foveal vision. Although, photoreceptors are primarily affected in MD, the retinal nerve fiber layer (RNFL) and central visual pathways may also be altered subsequent to photoreceptor degeneration. Here we investigate whether retinal damage caused by MD alters microstructural properties of visual pathways using diffusion-weighted magnetic resonance imaging.Six MD patients and six healthy control subjects participated in the study. Retinal images were obtained by spectral-domain optical coherence tomography (SD-OCT). Diffusion tensor images (DTI) and high-resolution T1-weighted structural images were collected for each subject. We used diffusion-based tensor modeling and probabilistic fiber tractography to identify the optic tract (OT) and optic radiations (OR), as well as nonvisual pathways (corticospinal tract and anterior fibers of corpus callosum). Fractional anisotropy (FA) and axial and radial diffusivity values (AD, RD) were calculated along the nonvisual and visual pathways.Measurement of RNFL thickness reveals that the temporal circumpapillary retinal nerve fiber layer was significantly thinner in eyes with macular degeneration than normal. While we did not find significant differences in diffusion properties in nonvisual pathways, patients showed significant changes in diffusion scalars (FA, RD, and AD) both in OT and OR.The results indicate that the RNFL and the white matter of the visual pathways are significantly altered in MD patients. Damage to the photoreceptors in MD leads to atrophy of the ganglion cell axons and to corresponding changes in microstructural properties of central visual pathways.

We demonstrate OCT angiography (OCTA) and Doppler OCT imaging of the choroid in the eyes of two healthy volunteers and in a geographic atrophy case. We show that visualization of specific choroidal layers requires selection of appropriate OCTA methods. We investigate how imaging speed, B-scan averaging and scanning density influence visualization of various choroidal vessels. We introduce spatial power spectrum analysis of OCT en face angiographic projections as a method of quantitative analysis of choroicapillaris morphology. We explore the possibility of Doppler OCT imaging to provide information about directionality of blood flow in choroidal vessels. To achieve these goals, we have developed OCT systems utilizing an FDML laser operating at 1.7 MHz sweep rate, at 1060 nm center wavelength, and with 7.5 μm axial imaging resolution. A correlation mapping OCA method was implemented for visualization of the vessels. Joint Spectral and Time domain OCT (STdOCT) technique was used for Doppler OCT imaging.

Author(s): Panorgias, Athanasios; Tillman, Megan; Sutter, Erich E; Moshiri, Ala; Gerth-Kahlert, Christina; Werner, John S | Abstract: PurposeTo investigate the topographic changes of the dark-adapted multifocal electroretinogram (mfERG) across adulthood in the central retina and compare the topography between macular versus extramacular, nasal versus temporal, and inferior versus superior retinal areas.MethodsSixty-five subjects (18-88 years) received a comprehensive dilated eye examination to ensure the health of their retina and were tested with a dark-adapted mfERG protocol using a 61-hexagon pattern. The lens absorption of each subject was also estimated using a heterochromatic flicker photometry (HFP) paradigm.ResultsThe response amplitude and latency of the dark-adapted mfERG showed a significant change with age, which was best described with a linear model. All the retinal areas examined demonstrated similar aging effects. The extramacular and temporal retina showed higher response amplitude and faster response latency when compared with the macular and nasal retinae, respectively. No difference was found in response amplitude and latency between the inferior and superior retina. The HFP results also showed a significant correlation with age, consistent with senescent increases in short wavelength absorption by the crystalline lens. However, the change in lens absorption did not exceed the magnitude of the change in response amplitude and latency.DiscussionOur results indicate that there is a decline in dark-adapted retinal activity as measured with the mfERG. These aging processes affect rods and rod-bipolar cells. Their decrease in response can be attributed to both optical and neural factors.

Eye Movements, Strabismus, Amblyopia, and Neuro-Ophthalmology Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial, Part II: Correlations and Relationship to Clinical Features OCT Sub-Study Committee for the NORDIC Idiopathic Intracranial Hypertension Study Group Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, New York, New York, United States Correspondence: Mark J. Kuper- smith, Departments of Neurology and Ophthalmology, Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, 1000 10th Avenue, New York, NY 10019, USA; mkuper@chpnet.org. See the appendix for the members of the OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group. Submitted: June 5, 2014 Accepted: September 8, 2014 Citation: OCT Sub-Study Committee; for the NORDIC Idiopathic Intracra- nial Hypertension Study Group. Base- line OCT measurements in the Idiopathic Intracranial Hypertension Treatment Trial, part II: correlations and relationship to clinical features. Invest Ophthalmol Vis Sci. 2014;55:8173–8179. DOI:10.1167/ iovs.14-14961 P URPOSE . The accepted method to evaluate and monitor papilledema, Fris´en grading, uses an ordinal approach based on descriptive features. Part I showed that spectral-domain optical coherence tomography (SD-OCT) in a clinical trial setting provides reliable measurement of the effects of papilledema on the optic nerve head (ONH) and peripapillary retina, particularly if a 3-D segmentation method is used for analysis. 1 We evaluated how OCT parameters are interrelated and how they correlate with vision and other clinical features in idiopathic intracranial hypertension (IIH) patients. M ETHODS . A total of 126 subjects in the IIH Treatment Trial (IIHTT) OCT substudy had Cirrus SD-OCT optic disc and macula scans analyzed by using a 3-D segmentation algorithm to derive retinal nerve fiber layer (RNFL) thickness, total retinal thickness (TRT), retinal ganglion cell layer plus inner plexiform layer (GCLþIPL) thickness, and ONH volume. The SD-OCT parameter values were correlated with high- and low-contrast acuity, perimetric mean deviation, Fris´en grading, and IIH features. R ESULTS . At study entry, the average RNFL thickness, TRT, and ONH volume showed significant strong correlations (r ‡ 0.90) with each other. The same OCT parameters showed a strong (r > 0.76) correlation with Fris´en grade and a mild (r > 0.24), but significant, correlation with lumbar puncture opening pressure. For all eyes at baseline, neither visual acuity (high or low contrast) nor mean deviation correlated with any OCT measure of swelling or GCLþIPL thickness. C ONCLUSIONS . In newly diagnosed IIH, OCT demonstrated alterations of the peripapillary retina and ONH correlate with Fris´en grading of papilledema. At presentation, OCT measures of papilledema, in patients with newly diagnosed IIH and mild vision loss, do not correlate with clinical features or visual dysfunction. (ClinicalTrials.gov number, NCT01003639.) Keywords: papilledema, intracranial hypertension, OCT, lumbar puncture n the preceding report, 1 we have shown that spectral-domain optical coherence tomography (SD-OCT) can provide high- quality data in patients with papilledema due to idiopathic intracranial hypertension (IIH), from multiple clinical sites working with an experienced OCT reading center. Optical coherence tomography imaging reliably and reproducibly demonstrates alterations in the optic nerve head (ONH) and retinal layers in IIH, which includes measurement of the average peripapillary retina nerve fiber layer (RNFL) thickness, average total peripapillary retinal thickness (TRT), ONH volume, and the ganglion cell plus inner plexiform layer thickness (GCLþIPL) in the macular region. Moreover, inter- ocular comparisons for all OCT parameters reflecting swelling of the ONH or peripapillary retina were significant and highly correlated. As expected, 90% of eyes (220/244 with Zeiss algorithm–derived RNFL thickness values) of the enrolled subjects exhibited significant (>95th percentile) thickening of the RNFL. Only 7% of the study eyes showed significant thinning (