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AimTo compare the repeatability of peripapillary perfusion density and flux index measurements on referenced and non-referenced optical microangiography (OMAG) scans in normal, glaucoma suspect and glaucoma eyes.MethodsIn a cross-sectional study, 48 eyes (33 subjects) underwent three repeat, non-referenced peripapillary OMAG scans in the same session and 43 eyes (25 subjects) underwent three referenced peripapillary OMAG scans. In the referenced scan group, repeat scans (second and the third scan) were acquired exactly on the baseline (first) scan using the ‘track to prior scan’ option on the device. Repeatability estimates of the mean and four-sector (temporal, superior, nasal and inferior) OMAG measurements on the non-referenced and referenced scans were assessed using within-subject coefficient of repeatability (CRw) and variation (CVw).ResultsCRw (%) of peripapillary perfusion density measurements (range: 2.0–4.1) on non-referenced scans were significantly higher than that on referenced scans (range: 1.4–2.7). CVw (%) on non-referenced and referenced scans ranged from 1.7 to 3.1 and from 1.2 to 2.1, respectively . CRw of flux index on non-referenced and referenced scans ranged from 4.4 to 5.8 and from 3.6 to 4.8, respectively. CVw on non-referenced and referenced scans ranged from 4.1 to 5.2 and from 3.3 to 4.5, respectively.ConclusionsRepeatability estimates of OMAG measurements were better on referenced scans compared with non-referenced scans. Perfusion density measurements had lower variability than flux index. OCTA-measured perfusion density of referenced scans is preferable for monitoring vascular change in glaucoma.

Precis: Lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) on optical coherence tomography angiography (OCTA) were significantly associated with faster rate of mean deviation (MD) decline. Purpose: To evaluate the association between OCTA features and prior visual field (VF) progression in primary angle closure glaucoma (PACG). Methods: In a cross-sectional study, 46 eyes of 31 PACG patients with 5 reliable VF examinations performed over >= 3 years of follow-up underwent OCTA imaging. Effect of clinical (age, sex, number of antiglaucoma medications, mean, and SD of intraocular pressure during follow-up), optical coherence tomography (average retinal nerve fiber layer and ganglion cell complex thickness) and OCTA (whole enface vessel density of disc and macular scan, deep-layer microvascular dropout) parameters on the rate of MD change was evaluated using linear mixed models. Results: Average (+/- SD) MD of the baseline VF was -7.4 +/- 7.3 dB, and rate of MD change was -0.32 +/- 0.29 dB/y. Whole enface vessel density of disc and macular scans was 39.5%+/- 8.1% and 38.7%+/- 4.4%, respectively. Microvascular dropout was noted in 33.3% of the eyes. Multivariate mixed models showed that lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) were significantly associated with faster rate of MD decline. Other factors significantly associated with faster progression in multivariate models were older age (coefficient: -0.02, P

Purpose: To compare the visual field (VF) parameters of the new Swedish Interactive Thresholding Algorithm (SITA), SITA Faster (SFR) with that of SITA Standard (SS) on the Humphrey Field Analyzer. Methods: Ninety-seven eyes of 97 subjects (63 glaucoma, 26 glaucoma suspects, and 8 normal eyes) underwent VF examination with SFR and SS strategies on the same day in random order. Agreement in VF parameters between SFR and SS strategies was assessed by Bland and Altman plots. In addition, some subjects underwent a second VF examination with SFR strategy to evaluate its test-retest variability. Results: The median test duration of SS strategy was 6 minutes 14 seconds, whereas SFR was 2 minutes 49 seconds (55% shorter, P

Optical coherence tomography angiography (OCTA) is a relatively new, noninvasive, dye-free imaging modality that provides a qualitative and quantitative assessment of the vasculature in the retina and optic nerve head. OCTA also enables visualization of the choriocapillaris, but only in areas of parapapillary atrophy. With OCTA, the movement of red blood cells is used as a contrast to delineate blood vessels from static tissues. The features seen with OCTA in eyes with glaucoma are reduction in the superficial vessel density in the peripapillary and macular areas, and complete loss of choriocapillaris in localized regions of parapapillary atrophy (called deep-layer microvascular dropout). These OCTA changes correlate well topographically with the functional changes seen on visual field examination and structural changes seen on optical coherence tomography (OCT) (ie, parapapillary retinal nerve fiber layer changes and inner retinal layer thickness changes at macula). The OCTA measurements also have acceptable test-retest variability and well differentiate glaucomatous from normal eyes. OCTA measurements can be affected by various subject-related, eye-related, and disease-related factors. Vessel density reduction on OCTA reaches a base level (floor) at a more advanced disease stage than the structural changes on OCT and therefore has the potential to monitor progression in eyes with advanced glaucomatous damage. OCTA also adds information about glaucoma patients at risk of faster progression. OCTA, therefore, complements visual field and OCT examinations to diagnose glaucoma, detect progression, and assess risk of progression.

While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.

PURPOSE: To identify longitudinal changes in peripapillary and parafoveal vessel density (VD) measured by OCT angiography (OCTA) in primary open-angle glaucoma (POAG) eyes with disc hemorrhages (DHs).DESIGN: Prospective cohort study conducted from August 2016 through August 2020 PARTICIPANTS: Eighteen Asian-Indian participants with POAG (18 eyes) who sought treatment at the clinic with a single DH in the peripapillary region were recruited consecutively.METHODS: The study was conducted at a tertiary eye care center. All participants who were recruited underwent a baseline OCT and OCTA, which were repeated every 4 to 6 months.MAIN OUTCOME MEASURES: Peripapillary VD and retinal nerve fiber layer (RNFL) thickness, parafoveal VD and ganglion cell-inner plexiform layer (GCIPL) thickness in the DH sector, and the corresponding mirror-image sector across the horizontal meridian (control) were evaluated over time using linear mixed-effects models.RESULTS: The baseline average RNFL thickness was 79 ± 9 μm. Mean duration of follow-up was 2.6 ± 0.7 years. In the DH sector, all VD and structural parameters showed a significant negative slope (P < 0.01). In the control sector, the slopes of the structural parameters (RNFL and GCIPL thickness) were not significant (P > 0.05), but the rate of change of the peripapillary and parafoveal VDs were significant (P < 0.01). The rate of change of peripapillary VD was greater in the DH sector compared with the non-DH sector (-2.86 ± 0.6%/year vs. -1.71 ± 0.7%/year; P < 0.01). However, the parafoveal VD slopes did not differ significantly between DH and control sectors (-2.9 ± 0.17%/year vs. -2.8 ± 0.8%/year; P = 0.51).CONCLUSIONS: Eyes with POAG harboring a DH showed not only progressive RNFL and GCIPL loss in the DH sector, but also progressive peripapillary and parafoveal VD reduction in the DH and non-DH regions as documented on OCTA.

The main purpose of this study was to compare the prevalence of choroidal microvascular dropout (CMvD) in primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH).In a cross-sectional study, 44 eyes of 44 control subjects, 32 eyes of 32 POAG patients with DH, and 41 eyes of 41 POAG patients without DH underwent visual fields (VFs), optical coherence tomography (OCT) and OCT angiography (OCTA). Presence of CMvD was evaluated on the choroidal OCTA slab. VF defect in the glaucoma eyes were classified into initial nasal defect, initial parafoveal scotoma, and combined nasal and parafoveal defect.CMvD was detected in 17 POAG eyes with DH (53.1%) and 13 POAG eyes without DH (31.7%; P=0.06). On univariate analysis, CMvD in POAG eyes was associated with DH [odds ratio (OR): 2.44, P=0.06] and measures of glaucoma severity: VF mean deviation (OR: 0.85, P=0.02), retinal nerve fiber layer thickness (OR: 0.95, P=0.03), and peripapillary vessel density (OR: 0.94, P=0.09). On multivariate models that accounted for the measures of glaucoma severity, CMvD in POAG eyes was statistically significantly associated with DH (OR≥3, P0.05). CMvD was more frequently seen in eyes with initial parafoveal scotoma than initial nasal defect both in POAG eyes with DH (P=0.06) and POAG eyes without DH (P0.001).Prevalence of CMvD was significantly greater in POAG eyes with DH compared with POAG eyes without DH. CMvD in POAG eyes was also significantly associated with central VF defects and greater severity of glaucomatous damage.

PURPOSE: To determine the prevalence and factors associated with the presence of choroidal microvascular dropout (CMvD) in primary angle-closure glaucoma (PACG) eyes compared to primary open-angle glaucoma (POAG) eyes.DESIGN: Cross-sectional study.METHODS: Thirty-six POAG eyes (36 patients) and 28 PACG eyes (28 patients) underwent optical coherence tomography angiography (OCTA). Presence of CMvD was evaluated on choroidal OCTA slabs. Visual field (VF) defects in the glaucoma eyes were classified into initial nasal defect (IND), initial parafoveal scotoma (IPFS), and combined nasal and parafoveal defect, and the association between type of VF defect and CMvD was evaluated.RESULTS: CMvD was detected in 21 POAG (58.3%) and 10 PACG (35.7%) eyes (P = .07). CMvD in POAG eyes was associated with pretreatment intraocular pressure (odds ratio [OR] = 0.91/mm Hg higher intraocular pressure, P = .06), VF mean deviation (MD, OR = 0.75/dB higher MD, P = .007), retinal nerve fiber layer thickness (OR = 0.92/mu m increase in thickness, P = .02), and peripapillary vessel density (OR = 0.80/ unit increase in density, P = .01). CMvD in PACG eyes was associated only with VF MD (OR = 0.90/dB higher MD, P = .05). When analyzed in the entire cohort of glaucoma patients (64 eyes), CMvD was significantly associated with POAG (OR > 3.5, P CONCLUSIONS: Prevalence of CMvD was significantly lower in PACG compared to POAG. As in POAG, CMvD in PACG was associated with advanced VF damage and with IPFS on VF. (C) 2018 Elsevier Inc. All rights reserved.

PurposeTo compare the corneal biomechanical parameters between pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma (POAG) and healthy controls using Corvis ST.MethodsA prospective, cross-sectional study was conducted which included 132 treatment-naïve eyes which underwent Corvis ST. The study cohort comprised of 44 eyes with PXG, 42 eyes with POAG and 46 healthy controls. Corneal biomechanical parameters, which included corneal velocities, length of corneal applanated surface, deformation amplitude (DA), peak distance and radius of curvature, were compared between the groups using analysis of variance models.ResultsThe 3 groups were demographically similar. The mean IOP was 15.7 ±3 mmHg in the control group, 21.3 ±5 mmHg in the POAG group and 25.8 ±7 mmHg in the PXG group (pConclusionCorneal biomechanical parameters measured on Corvis ST are not different between eyes with PXG, POAG and healthy controls after adjusting for IOP.

PRECIS The agreement between a head-mounted perimeter [GearVision (GV)] and Humphrey field analyzer (HFA) for total threshold sensitivity was a mean difference of -1.9 dB (95% limits of agreement -5 to 1). GV was the preferred perimeter in 68.2% of participants. PURPOSE The purpose of this study was to compare reliability indices and threshold sensitivities obtained using a novel, smartphone-based, head-mounted perimeter (GV) with the HFA in normal, glaucoma suspect and glaucoma patients. A secondary objective was to evaluate the subjective experience participants had with both perimeters using a questionnaire. METHODS In a prospective, cross-sectional study; 107 eyes (34 glaucoma, 18 glaucoma suspect, and 55 normal) of 54 participants underwent HFA and GV in random order. The main outcome measure was the agreement of threshold sensitivities using Bland and Altman analysis. Participants also completed a questionnaire about their experience with the devices. RESULTS Median false-positive response rate for GV was 7% (4% to 12%), while for HFA it was 0% (0% to 6%, P

Purpose To determine if the presence of disc hemorrhage (DH) causes any artifactual change in peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness as measured by OCT. Design Cohort study. Participants Glaucoma patients having a single peripapillary DH. Methods Fifteen glaucoma patients having a single peripapillary DH underwent OCT and OCT angiography. Patients were reviewed every 2 months and scans were repeated on disappearance of the DH. Peripapillary VD and RNFL thickness were evaluated at these 2 time points in the DH sector to determine whether the presence of a DH affects these measurements. The mirror-image sector (e.g., superotemporal sector if DH is inferotemporal) was used as a control. Statistical analysis was carried out using the paired t test. Additionally, the analysis of covariance test was used to determine if there was any difference in the measurements between the visits after controlling for signal strength index (SSI). Main Outcome Measures Peripapillary VD and RNFL thickness were measured in the presence of a DH, and then after DH resolution. Results The mean ± standard deviation (SD) interval between scans was 4.0±0.4 months. The inferotemporal sector was the most common site of DH (66.6%). The mean ± SD intraocular pressure was reduced medically from 16.1±4.7 mmHg at the time of DH to 13.4±4.2 mmHg at the time of DH resolution (P = 0.001). The mean ± SD VD in the DH sector was 52.5±9.7% at the time of DH and 51.1±8.7% on DH resolution (P = 0.30). The mean ± SD RNFL thickness in the DH quadrant was 91±20 μm in the presence of DH and 92±21 μm after DH resolution (P = 0.26). There was no significant difference between the mean VD or the mean RNFL thickness in the DH and control quadrants at these 2 time points after controlling for change in SSI (P > 0.05). Conclusions The presence of a DH does not artifactually alter the VD or RNFL thickness measurements. Therefore, OCT scans obtained in the presence of a DH may be included in series used for studying progression.

Purpose:To study sectoral vessel density (VD) and structural alterations in the peripapillary and parafoveal hemiretina corresponding to perimetrically intact regions of glaucomatous eyes with hemifield defects and to compare these with healthy eyes using optical coherence tomography.Methods:This cross-sectional study included 37 eyes with open-angle glaucoma having visual fields defects restricted to 1 hemifield and 45 age-matched controls. Peripapillary VD and retinal nerve fiber layer (RNFL) thickness were measured in 8 sectors. Parafoveal VD and ganglion cell complex thickness were measured in the superior and inferior hemispheres of the macula. These parameters were compared between the intact hemiretinae of glaucomatous eyes and corresponding sectors of healthy eyes using the t test.Results:Within the perimetrically intact regions of glaucomatous eyes, the mean VD and RNFL thickness were significantly reduced in inferotemporal, superonasal, and nasal upper peripapillary sectors as compared with healthy eyes (P

Purpose:To evaluate the diagnostic abilities of macular vessel length and perfusion densities measured with optical microangiography (OMAG) over a 3x3mm and a 6x6mm region, and to compare these with macular ganglion cell-inner plexiform layer (GCIPL) thickness in eyes with primary open-angle glaucoma (POAG).Methods:In a cross-sectional study, 96 eyes of 57 control subjects and 88 eyes of 57 POAG patients underwent macular imaging with optical coherence tomography. Area under receiver operating characteristic curves (AUC) and sensitivities at 90% specificity of OMAG and GCIPL parameters were evaluated.Results:Most OMAG parameters of the 3x3mm macular scan and all inner sector parameters of the 6x6mm scan were similar (P>0.05) in the POAG and control eyes. All outer sector OMAG parameters of the 6x6mm scan were significantly less (P0.05) to that of the 6x6mm scan (outer inferior vessel length density; 0.72% and 30%, respectively). AUC and sensitivity of the best GCIPL thickness parameter (inferotemporal GCIPL thickness, 0.84% and 67%) were significantly better (P

Purpose:The purpose of this article was to evaluate the relationship between macular optical microangiography (OMAG), ganglion cell-inner plexiform layer (GCIPL) thickness, and visual sensitivity measurements of different macular sectors in primary open-angle glaucoma.Methods:In a cross-sectional study, 39 eyes of 26 primary open-angle glaucoma patients underwent optical coherence tomography imaging and 10-2 visual field examination of the macula in the same session. Linear regression models were used to evaluate the relationships between OMAG, GCIPL thickness, and visual sensitivity measurements in different macular sectors. Strength of relationship was reported as coefficient of determination (R-2).Results:R-2 values for the associations between OMAG and GCIPL thickness measurements ranged from 0.37 in the temporal sector to 0.56 in the inferior macular sector. R-2 values for the association between OMAG and visual sensitivity measurements ranged from 0.23 in the superior to 0.53 in the inferior macular sector. R-2 values for the association between GCIPL thickness and visual sensitivity measurements ranged from 0.15 in the superior to 0.62 in the temporal sector.Conclusions:The strongest associations between OMAG, GCIPL thickness, and visual sensitivity measurements were found in the inferior macular sector. The association of OMAG with GCIPL thickness measurements was as strong as the association between OMAG and visual sensitivity measurements in the inferior macular sector.

Purpose: To compare the vessel density measurements of optic nerve head, peripapillary and macular regions in severity-matched primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH) using optical coherence tomography (OCT) angiography, and to compare their diagnostic abilities with that of the rim area, retinal nerve fiber layer and the ganglion cell complex thickness measurements on OCT.Methods: In a cross-sectional study, 66 eyes of 46 control subjects, 34 eyes of 33 POAG patients with DH (median mean deviation=-3.7 dB) and 63 eyes of 43 POAG patients without DH (median mean deviation=-3.8 dB) underwent imaging with spectral domain OCT. Area under receiver operating characteristic curves (AUC) and 5sensitivities at 90% specificity of vessel density and structural measurements in POAG eyes with DH were compared with those in POAG eyes without DH.Results: Most of the vessel density and structural measurements were similar (P>0.05) in POAG eyes with and without DH. Whole enface vessel density of the disc scan and inferotemporal peripapillary vessel density showed the best AUC and sensitivity at 90% specificity both in POAG eyes with DH (0.82, 56% and 0.75, 59%) and without DH (0.91, 73% and 0.83, 67%). AUCs and sensitivities of vessel density and structural measurements of POAG eyes with and without DH were statistically similar (P>0.05).Conclusions: OCT angiography measured vessel densities and their diagnostic abilities in POAG eyes with and without DH were similar. This suggests that the cause of DH in POAG is unlikely to be vascular abnormality.

Aims To evaluate the diagnostic ability of peripapillary vessel density measurements on optical coherence tomography angiography (OCTA) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and to compare these with peripapillary retinal nerve fibre layer (RNFL) thickness measurements.Methods In a cross-sectional study, 48 eyes of 33 healthy control subjects, 63 eyes of 39 patients with POAG and 49 eyes of 32 patients with PACG underwent OCTA (RTVue-XR, Optovue, Fremont, California, USA) and RNFL imaging with spectral domain OCT. Diagnostic abilities of vessel density and RNFL parameters were evaluated using area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities.Results AUCs of peripapillary vessel density ranged between 0.48 for the temporal sector and 0.88 for the inferotemporal sector in POAG. The same in PACG ranged between 0.57 and 0.86. Sensitivities at 95% specificity ranged from 13% to 70% in POAG, and from 10% to 67% in PACG. AUCs of peripapillary RNFL thickness ranged between 0.51 for the temporal sector and 0.91 for the inferonasal sector in POAG. The same in PACG ranged between 0.61 and 0.87. Sensitivities at 95% specificity ranged from 8% to 68% in POAG, and from 2% to 67% in PACG. AUCs of all peripapillary vessel density measurements were comparable (p>0.05) to the corresponding RNFL thickness measurements in both POAG and PACG.Conclusions Diagnostic ability of peripapillary vessel density parameters of OCTA, especially the inferotemporal sector measurement, was good in POAG and PACG. Diagnostic abilities of vessel density measurements were comparable to RNFL measurements in both POAG and PACG.

To evaluate the sectoral and global structure-structure (vessel density-retinal nerve fiber layer thickness) and structure-function (vessel density-visual sensitivity loss) relationships of peripapillary vessel density measurements on optical coherence tomography angiography in primary open-angle glaucoma and to determine if fractional polynomial (FP) models characterize the relationships better than linear models.In a cross-sectional study, structure-structure and structure-function relationships of peripapillary vessel densities were determined in 227 eyes of 143 subjects (63 control and 164 primary open-angle glaucoma eyes) who had undergone standard automated perimetry and optical coherence tomography testing within 6 months of each other, using linear and FP models. FP model evaluates the relationship between the dependent and the best-fitting fractional powers of the independent variable. Strength of relationship was reported as coefficient of determination (R).R values for structure-structure associations using linear models (0.53 for superotemporal sector, 0.61 for inferotemporal, and 0.53 for average measurements) were significantly less (P0.05) than that determined using FP models (0.57, 0.65, and 0.55, respectively). R values for structure-function associations using linear models (0.35 for superotemporal vessel density-inferotemporal visual sensitivity loss, 0.49 for inferotemporal vessel density-superotemporal visual sensitivity loss, and 0.39 for average vessel density-average visual sensitivity loss) were significantly less than that determined using FP models (0.43, 0.58, and 0.47, respectively).The inferotemporal peripapillary vessel density showed the strongest association with the corresponding retinal nerve fiber layer thickness and visual sensitivity loss in the global and sectoral regions studied. The FP models were significantly better than linear models in describing these relationships.

PURPOSE To predict the magnitude of functional damage [mean deviation (MD) on visual field examination] and structural damage [retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness on spectral domain optical coherence tomography] in glaucoma from monocular pupillary light response measurements using automated pupillography. METHODS In total, 59 subjects (118 eyes) with either a confirmed or suspected diagnosis of glaucoma underwent automated pupillography, along with visual fields and spectral domain optical coherence tomography examinations. Association between pupillary light response measurements of each eye [amplitude of constriction, latency of onset of constriction (Loc), latency of maximal constriction (Lmaxc), velocity of constriction and velocity of redilation] and corresponding MD, average RNFL, and average GCC measurements were evaluated using univariate and multivariate regression analysis after accounting for the multicollinearity. Goodness of fit of the multivariate models was evaluated using coefficient of determination (R). RESULTS Multivariate regression models that contained Loc and Lmaxc showed the best association with MD (R of 0.30), average RNFL thickness (R=0.18) and average GCC thickness (R=0.26). The formula that best predicts the MD could be described as: MD=-14.06-0.15×Loc+0.06×Lmaxc. The formula that best predicts the average RNFL thickness could be described as: Average RNFL thickness=67.18-0.22×Loc+0.09×Lmaxc. CONCLUSIONS Glaucomatous damage as estimated by MD, RNFL, and GCC thickness measurements were best predicted by the latency parameters (Loc and Lmaxc) of pupillography. Worsening of glaucomatous damage resulted in a delayed onset of pupillary constriction and a decreased Lmaxc.

Purpose To evaluate the reliability indices [fixation losses, false negative response rates (FN) and false positive response rates] and threshold sensitivities obtained from glaucoma patients with a Compass perimeter and to compare the same with the Humphrey field analyzer (HFA). Methods In a cross-sectional study, 97 eyes of 58 subjects (64 glaucoma and 33 glaucoma suspect eyes) underwent visual field examination with Compass and HFA. Any test with a fixation losses, FN or FP of >20% was considered unreliable. Reliability indices and threshold sensitivities between the 2 instruments were compared and the agreement evaluated using Bland and Altman analysis. Results In total, 37 tests (38%) with Compass and 17 (18%) with HFA were unreliable. The number of unreliable tests due to high FN (>20%) was significantly more (P=0.005) with Compass (n=27) than HFA (n=3). The mean difference [95% limits of agreement (LoA)] in mean sensitivity between Compass and HFA in the 51 eyes with reliable Compass and HFA results was -0.7 dB (-5.6, 4.3 dB). The point-wise threshold sensitivities with Compass were lower than that with HFA in central and temporal but higher in the nasal field. The 95% LoA ranged from -8 to +5 dB at one of the central points to -20 to +20 dB at one of the peripheral points. Conclusions The numbers of unreliable tests were higher with Compass compared with HFA. The LoA between Compass and HFA for point-wise threshold sensitivities as well as the global indices were wide, implying that the instruments cannot be used interchangeably.

AimsTo compare the peripapillary vessel density (VD) measurements of high-density (HD) and non-HD optical coherence tomography angiography (OCTA) scans in normal and glaucoma eyes, and to evaluate the intrasession repeatability of VD measurements of HD scans.MethodsIn a cross-sectional study, 46 normal (33 subjects) and 89 glaucoma (64 patients) eyes underwent 3 HD and 1 non-HD optic nerve head OCTA scans in the same session. Agreement in VD measurements between HD and non-HD scans was assessed using Bland and Altman analysis. Repeatability of the VD measurements of HD scans was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw).ResultsThe mean difference in the VDs ranged between 0.7% (temporal sector VD) and 2.0% (inferonasal sector VD), with HD scans showing significantly greater VD values than non-HD scans. The 95% limits of agreement (LoA) in glaucoma eyes ranged between −2.0% and 5.0% for whole enface VD and between −4.8% and 9.6% for superotemporal VD. CRw (%) and CVw (%) of VD measurements of HD scans ranged from 3.0 to 4.9 and from 2.0 to 3.1 in normal eyes. The same ranged from 3.2 to 6.7 and from 2.6 to 4.8, respectively, in glaucoma eyes.ConclusionsVD of HD scans was higher than that of non-HD scans. The wide 95% LoA indicates that the VD measurements of HD and non-HD scans cannot be used interchangeably. Test–retest repeatability of VDs on HD scans was as high as 6%. These results should be considered while using OCTA for longitudinal evaluation of glaucoma.

Population explosion, availability of life saving drugs and perusal of healthier life styles is leading to rising life expectancy worldwide. This indirectly translates to increasing prevalence of open angle glaucoma1 worldwide and Pakistan is no exception to these myriad factors of population increase and related healthcare issues. Studies have in general shown increased glaucoma severity corelating with direct and indirect costs associated with the progression of disease2. Hence there is a wide spread tendency to treat suspicious optic nerve heads, mild to moderate high intraocular pressures or even documented but non progressive glaucoma damage without comprehensive structural, visual function, local and systemic risk assessment. This has in turn led to plethora of adverse clinical, socioeconomic and financial concerns triggering chain of adversities at individual and as well as national level.

Splenic hamartoma, also known as splenoma, splenic adenoma or nodular hyperplasia, is a rare benign splenic tumor. It is composed of disordered vascular channels with abnormal mixture of red or white splenic pulp. Mostly it is asymptomatic and encountered incidentally at imaging, surgery or autopsy. Radiologically hamartomas are almost identical to hemangioma. In such circumstances radiolabelled blood pool imaging and radiocolloid scintigraphy helps to differentiate the two entities. We present a case of asymptomatic splenic lesion on hybrid radionuclide imaging with SPECT-CT, findings suggestive of hamartoma. Key Words: Splenic hamartoma, SPECT-CT, Radiocolloid scintigraphy

Purpose To compare the diagnostic abilities of the vessel densities in optic nerve head (ONH), peripapillary, and macular regions measured using optical coherence tomography angiography (OCTA) in eyes with primary open-angle glaucoma (POAG), and to evaluate the effect of glaucoma severity (based on the mean deviation, MD), optic disc size, and pretreatment intraocular pressure (IOP). Design Cross-sectional study. Methods Seventy-eight eyes of 53 control subjects and 64 eyes of 39 POAG patients underwent OCTA imaging. Area under receiver operating characteristic (ROC) curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary, and macular regions were analyzed. ROC regression was used to evaluate the effect of covariates on the diagnostic abilities. Results The AUCs of ONH vessel densities ranged between 0.59 (superonasal sector) and 0.73 (average inside disc), peripapillary between 0.70 (nasal, superonasal and temporal) and 0.89 (inferotemporal), and macular between 0.56 (nasal) and 0.64 (temporal). AUC of the average peripapillary vessel density was significantly better than the average inside disc ( P = .05) and macular ( P = .005) measurement. MD showed a negative association with the AUCs of the vessel densities of all regions. Pretreatment IOP (coefficient: 0.09) showed a significant ( P Conclusions Diagnostic ability of the vessel density parameters of OCTA was only moderate. Macular and inside disc densities had significantly lower diagnostic abilities in POAG than the peripapillary density. Diagnostic abilities of vessel densities increased with increasing severity of glaucoma and that of ONH vessel density with higher pretreatment IOPs.

Purpose To describe a technique to manage corneal perforations between 3 and 6 mm in size using autologous Tenons tissue with cyanoacrylate glue and a bandage contact lens. Methods A thin layer of Tenons capsule harvested from the patient's own eye is used to seal the perforation and act as a scaffold. The Tenons patch graft is spread over the perforation and held in place by the application of cyanoacrylate glue. A bandage contact lens is then placed on the eye. Results A 6-year retrospective review of 28 patients who underwent this procedure was performed. One patient was lost to follow-up. Of the 27 patients who were followed up, 20 healed completely, with an adherent leucoma and preservation of the anterior chamber. The condition of one patient (with a perforated Pseudomonas corneal ulcer) progressively worsened despite maximum medical therapy and had to undergo evisceration. Conclusions This procedure makes use of easily available autologous Tenons tissue in patients with corneal perforations too large to be managed with cyanoacrylate glue alone, to preserve eyeball morphology. A corneal transplant can then be done when the cornea has healed.

Detection of primary tumor site in patients with carcinoma of unknown primary (CUP) syndrome has always been a diagnostic dilemma, necessitating extensive workup. Early detection of primary tumor site coupled with specific therapy improves prognosis. The low detection rate of the primary tumor site can be attributed to the biological behavior or the small size of the primary tumor to be detected by conventional imaging. The objective of this study was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting CUP.A retrospective, cross-sectional analysis of 100 PET-CT scans of patients with CUP syndrome between November 2009 and December 2013 was performed. Eighteen patients whose final histopathology results could not be obtained for correlation were excluded from analysis. The hypermetabolic sites were assessed in correlation with histopathology. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values were assessed for PET-CT.Out of the 82 patients, primary tumor was correctly identified in 57.3% patients by 18F-FDG PET-CT (true positive). The PET-CT scan results were negative for primary site localization in 15% of patients (false negative). While 21% had true negative results, 7.3% displayed false positive results. PET-CT scan upstaged the disease in 27% cases. Overall, the diagnostic accuracy was found to be 78%, sensitivity 80%, specificity 74%, positive predictive value 88.7% and negative predictive value 59%.Our data supports the utility of 18F-FDG PET-CT scan in the localization and staging of CUP syndrome.Amaç: Primeri bilinmeyen karsinom (PBK) sendromu olan hastalarda primer tümör yerleşiminin bulunması tanısal bir zorluk oluşturmuş ve detaylı incelemeyi gerektirmiştir. Primer tümör yerleşiminin bulunması ile spesifik tedavinin birleşimi prognozu iyileştirir. Primer tümör yerinin bulunmasındaki düşük oranlar primer tümörün biyolojik davranışına veya konvansiyonel görüntüleme ile saptanamayacak kadar küçük çapta olmasına bağlanabilir. Bu çalışmanın amacı PBK’nın değerlendirilmesinde F-18 florodeoksiglükoz ( 18 F-FDG) pozitron emisyon tomografisi/bilgisayarlı tomografinin (PET-BT) tanısal doğruluğunu değerlendirmektir. Yöntem: Kasım 2009 ve Aralık 2013 tarihleri arasında PBK nedeniyle PET-BT uygulanmış 100 hasta retrospektif, kesitsel olarak analiz edildi. Histopatolojik değerlendirme sonuçlarına ulaşılamayan 18 hasta çalışma dışı bırakıldı. Hipermetabolik alanlar histopatoloji ile karşılaştırıldı. PET-BT için tanısal doğruluk, duyarlılık, özgüllük, pozitif öngörü değeri ve negatif öngörü değeri belirlendi. Bulgular: Seksen iki hastadan %57,3’ünde primer tümör 18 F-FDG PET-BT ile doğru olarak tespit edildi (gerçek pozitif). PET- BT sonuçları primer tümör lokalizasyonunu belirlemede %15 hastada negatif idi (yanlış negatif). Hastaların %21’inde gerçek negatif sonuç, %7,3’ünde yanlış pozitif sonuç saptandı. PET-BT ile %27 hastada evre daha ileri olarak bulundu. Genel olarak, tanısal doğruluk %78, duyarlılık %80, özgüllük %74, pozitif öngörü değeri %88,7 ve negatif öngörü değeri %59 olarak saptandı. Sonuç: Sonuçlarımız 18 F-FDG PET-BT görüntülemenin PBK sendromunda lokalizasyon ve evreleme amacıyla kullanılabilirliğini desteklemektedir.

Purpose: To compare the corneal biomechanical parameters among pseudoexfoliation syndrome (PXF), pseudoexfoliation glaucoma (PXG), and healthy controls using Corvis Scheimpflug Technology (ST). Methods: A prospective, cross-sectional study of 141 treatment-naive eyes that underwent Corvis ST was conducted. These included 42 eyes with PXF, 17 eyes of PXF with ocular hypertension (PXF + OHT) defined as intraocular pressure (IOP) >21 mmHg without disc/field changes, 37 eyes with PXG, and 45 healthy controls. Corneal biomechanical parameters, which included corneal velocities, length of corneal applanated surface, deformation amplitude (DA), peak distance, and radius of curvature, were compared among the groups using analysis of variance models. Results: The four groups were demographically similar. The mean IOP was lower in the controls (15.6 +/- 3 mmHg) and PXF group (16.0 +/- 3 mmHg) compared to the other two groups (>24 mmHg). Corneal pachymetry was similar across the four groups. Mean DA was significantly lower (P < 0.0001) in the PXG group (0.91 +/- 0.18 mm) and the PXF + OHT group (0.94 +/- 0.13 mm) when compared to the PXF (1.10 +/- 0.11 mm) and control groups (1.12 +/- 0.14 mm). Corneal velocities were also found to be statistically significantly lower in PXG and PXF + OHT compared to the PXF and control groups. However, after adjusting for age and IOP, there was no difference in any of the biomechanical parameters among the four groups. Conclusion: Corneal biomechanical parameters measured on Corvis ST are not different between healthy controls and eyes with PXF and PXG. Since PXG is a high-pressure glaucoma, corneal biomechanics may not play an important role in its diagnosis and pathogenesis.

Purpose:The aim of this study was to evaluate the diagnostic abilities of peripapillary optical microangiography (OMAG) measurements in eyes with primary open-angle glaucoma (POAG) and to evaluate the relationship of these measurements with retinal nerve fiber layer (RNFL) thickness and visual sensitivities in different peripapillary sectors.Methods:In a cross-sectional study, 97 eyes of 57 control subjects and 101 eyes of 66 POAG patients underwent OMAG and RNFL imaging with optical coherence tomography. POAG was diagnosed on the basis of the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves and sensitivities at 90% specificity of the OMAG and RNFL thickness measurements in different peripapillary sectors were evaluated. Association between OMAG, RNFL thickness, and visual sensitivity measurements were evaluated using fractional polynomial regression models.Results:All OMAG and RNFL measurements were significantly less in the POAG compared with the control eyes. Diagnostic abilities of the best OMAG measurement (inferior sector vessel length density, area under receiver operating characteristic curves: 0.84, sensitivity at 90%, specificity: 65%) were significantly less (P

AimsTo compare the intrasession repeatability of peripapillary and macular vessel density measurements of optical coherence tomography angiography (OCTA) in normal and glaucoma eyes, and to evaluate the effect of signal strength of OCTA scans on the repeatability.MethodsIn a cross-sectional study, three optic nerve head scans each of 65 eyes (30 normal, 35 glaucoma eyes) and three macular scans each of 69 eyes (35 normal, 34 glaucoma eyes) acquired in the same session with OCTA were analysed. Repeatability was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw). Effect of signal strength index (SSI) on repeatability was evaluated with repeated-measures mixed-effects models.ResultsCRw (%) and CVw (%) of peripapillary measurements in normal eyes ranged between 3.3 and 7.0, and 2.5 and 4.4 respectively, and that in glaucoma eyes between 3.5 and 7.1, and 2.6 and 6.6. For the macular, these measurements ranged between 4.1 and 6.0, and 3.3 and 4.7 in normal eyes and 4.3 and 6.9, and 3.7 and 5.6 in glaucoma eyes. Repeatability estimates of most measurements were similar in normal and glaucoma eyes. Vessel densities of both peripapillary and macular regions significantly increased with increase in SSI of repeat scans (coefficients ranging from 0.15 to 0.38, pConclusionsRepeatability estimates of OCTA measured peripapillary and macular vessel densities were similar in normal eyes and eyes with glaucoma. SSI values of the scans had a significant effect on the repeatability of OCTA with the vessel density values increasing in scans with higher SSI values.

We report a case of secondary pigmentary glaucoma due to Soemmerring rings in a patient with retinitis pigmentosa and describe the histopathologic findings. Unlike other cases of pseudophakic pigmentary glaucoma that are usually due to malpositioned intraocular lenses (IOLs) or bent haptics, this case had a well-positioned IOL in the capsular bag. The prominent Soemmerring ring appears to be the cause of the pigment release. Although Soemmerring rings have been associated with angle-closure glaucoma, they have not previously been shown to cause any form of open-angle glaucoma. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To evaluate the vessel density measurements of the optic nerve head (ONH), peripapillary, and macular regions on optical coherence tomography (OCT) angiography in eyes with primary angle closure (PAC) and primary angle closure glaucoma (PACG), and to compare their diagnostic abilities with the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness, and the macular ganglion cell complex (GCC) thickness measurements on OCT in PACG.DESIGN: Cross-sectional study.METHODS: Seventy-seven-eyes of 50 control subjects, 65 eyes of 45 patients with PACG, and 31 eyes of 22 PAC patients with a history of high intraocular pressure underwent imaging with OCT. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities were compared with structural measurements.RESULTS: All the vessel density and structural measurements were significantly lower (P .05) to that of the controls; the superotemporal RNFL, however, was significantly thinner in the PAC group (127 mu m vs 135 P = .01). The AUC and sensitivity at 95% specificity of vessel densities within the ONH (0.76 and 42%) and macular region (0.69 and 18%) in PACG were significantly lower P CONCLUSIONS: These results suggest that structural changes in PACG occur earlier than the reduction in retinal vessel densities. (C) 2017 Elsevier Inc. All rights reserved.

Author(s): Rao, Harsha L; Pradhan, Zia S; Weinreb, Robert N; Riyazuddin, Mohammed; Dasari, Srilakshmi; Venugopal, Jayasree P; Puttaiah, Narendra K; Rao, Dhanaraj AS; Devi, Sathi; Mansouri, Kaweh; Webers, Carroll AB | Abstract: PurposeTo compare the diagnostic abilities of vessel density measurements of the optic nerve head (ONH), peripapillary and macular regions on optical coherence tomography (OCT) angiography in eyes with primary open angle glaucoma (POAG) with that of the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (GCC) thickness measurements.MethodsIn a cross sectional study, 78 eyes of 50 control subjects and 117 eyes of 67 POAG patients underwent vessel density and structural measurements with spectral domain OCT. POAG was diagnosed based on the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary and macular regions were compared with rim area, RNFL and GCC thickness.ResultsThe AUC (sensitivity at 95% specificity) of average vessel densities within the ONH, peripapillary and macular region were 0.77 (31%), 0.85 (56%) and 0.70 (18%) respectively. The same of ONH rim area, average RNFL and GCC thickness were 0.94 (83%), 0.95 (72%) and 0.93 (62%) respectively. AUCs of vessel densities were significantly lower (pl0.05) than that of the corresponding structural measurements. Pre-treatment IOP (coefficient: 0.08) affected (pl0.05) the AUC of ONH vessel density but not of any other vessel density or structural measurements.ConclusionsDiagnostic abilities of ONH, peripapillary and the macular vessel densities in POAG were significantly lower than ONH rim area, peripapillary RNFL and macular GCC measurements respectively. At fixed levels of glaucoma severity, the diagnostic ability of the ONH vessel density was significantly greater in eyes with higher pre-treatment IOP.

PURPOSE The aim of this study was to investigate the usefulness and tolerance of rigid gas-permeable (RGP) contact lenses in the visual rehabilitation of children postocular trauma. METHODS In this retrospective case series, children below 15 years of age with ocular trauma were included. The best-corrected visual acuity with RGP contact lenses was compared with that of spectacle correction. The factors affecting visual improvement were analyzed, and problems caused by contact lens use were identified. RESULTS Twelve eyes of 12 boys were included. The mean best-corrected visual acuity was 0.81 ± 0.29 (LogMar equivalent) with spectacles and 0.47 ± 0.27 (LogMar equivalent) with contact lenses (P 2 line increase in visual acuity with contact lens correction as compared with that using spectacle correction. The mean astigmatism in eyes that achieved this improvement in vision was 5.45 ± 1.6 diopters, whereas the mean astigmatism in the eyes that did not improve was 2.6 ± 1.2 diopters, which was statistically significant (P = 0.009). No other factors (age, corneal scar location/density, grade/zone of injury, lens status, and occlusion) seemed to affect visual improvement with contact lenses. The mean follow-up duration was about 15 months during which 91% of the patients continued their contact lens usage. CONCLUSIONS RGP contact lenses offer a useful refractive treatment alternative in traumatized eyes of children. Eyes with high degrees of astigmatism were found to benefit the most. RGP contact lenses were found to be well tolerated in this population.

In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

To evaluate the diagnostic ability of automated pupillography measurements in glaucoma and study the effect of inter-eye asymmetry in glaucomatous damage on the diagnostic ability.In an observational, cross-sectional study, 47 glaucoma patients and 42 control subjects underwent automated pupillography using a commercially available device. Diagnostic abilities of the pupillary response measurements were evaluated using area under receiver operating characteristic (ROC) curves (AUC) and sensitivities at fixed specificities. Influence of inter-eye asymmetry in glaucoma [inter-eye mean deviation (MD) difference on visual fields (VF)] on the diagnostic ability of pupillography parameters was evaluated by ROC regression approach.The AUCs of automated pupillography parameters ranged from 0.60 (amplitude score with peripheral blue stimulus) to 0.82 (amplitude score with full field white stimulus, Amp-FF-W). Sensitivity at 95% specificity ranged between 5% (amplitude score with full field blue stimulus) and 45% (amplitude score with full field green stimulus). Inter-eye MD difference significantly affected the diagnostic performance of automated pupillography parameters (p0.05). AUCs of Amp-FF-W at inter-eye MD difference of 0 dB, 5 dB, 10 dB and 15 dB were 0.71, 0.80, 0.87 and 0.93, respectively, according to the regression model. The corresponding sensitivities at 95% specificity were 20%, 34%, 50% and 66%, respectively.The diagnostic abilities of even the best automated pupillography parameters were only moderate in glaucoma. The performance of these pupillography measurements in detecting glaucoma significantly increased with greater inter-eye asymmetry in the glaucomatous damage.

Osseous haemangiomas are benign skeletal tumours, usually identi ed as incidental ndings on different imaging modalities. Bone scan is the most frequent radionuclide procedure performed as metastatic workup in patients with various malignancies. Not every hotspot on a staging bone scan is malignant. Haemangiomas with variable degree of radiotracer uptake on technetium-99m (Tc-99m) bone scintigraphy may be falsely labelled as metastases in background of known malignancy. The addition of single-photon emission computed tomography computed tomography (SPECT-CT) enhances the specificity of bone scan which allows accurate detection and anatomical localisation of scintigraphic findings. We present a case series as pictorial review of osseous haemangiomas identi ed on Tc-99m methylene diphosphonate SPECT CT at our department. Key words: Haemangioma, methylene diphosphonate, bone scan, single-photon emission computed tomography- computed tomography

Purpose To predict the intereye asymmetry in functional (mean deviation, MD on visual field, VF) and structural (retinal nerve fibre layer, RNFL and ganglion cell complex, GCC thickness on spectral domain optical coherence tomography, SDOCT) measurements in glaucoma using the automated pupillography parameters. Methods Fifty-nine subjects with a diagnosis of either glaucoma or glaucoma suspect underwent automated pupillography along with VF and SDOCT examinations. Association between pupillography and the absolute intereye difference in MD, RNFL and GCC measurements was evaluated using regression analysis after accounting for the multicollinearity. Results Univariate regression analysis showed statistically significant associations (p

Objectives: To evaluate the efficacy of ultrasound (US) and US-guided fine-needle aspiration (US-FNA) for axillary nodal staging in breast cancer patients. Methods: A retrospective study of breast cancer patients at our institution from January 2007 to December 2009 revealed 449 cases in which axillary US was performed. The US appearance of the axillary lymph nodes was divided into 4 categories: suspicious, borderline, benign, and not visible. The results were compared with the final pathologic outcome and correlated with the tumor size on US and the pathologic nodal stage (pN). Results: Among the 449 patients, the lymph nodes were: not visualized in 124, suspicious in 180, borderline in 39, and benign in 106 cases. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US alone and combined US/US-FNA was 69.1%, 83.3%, 86.8%, 63%, and 74.6% and 69.1%, 100%, 100%, 67.2%, and 81.1%, respectively. The sensitivity of US increased with increasing tumor size and pN. A negative or benign US (combined n = 230) was associated with the pN0, pN1, pN2, and pN3 stage in 146, 66, 13, and 5 cases, respectively. Conclusions: Axillary staging using US criteria is about 70% sensitive and its sensitivity increases with increasing tumor size and pN stage.

Purpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomo graphy/computed tomography, recurrence

Post-operative Nocardia endophthalmitis has an aggressive course and poor visual prognosis. It often masquerades as severe post-operative uveitis or toxic anterior segment syndrome due to the absence of vitreous involvement resulting in a delay in diagnosis. The poor prognosis in Nocardia endophthalmitis is due to severe intra-ocular inflammation which may lead to phthisis. Therefore, treatment with corticosteroids after appropriate antibiotics have been initiated may improve the outcome. This is an interventional case report highlighting the typical features of Nocardia endophthalmitis, which when diagnosed early and managed medically with antibiotics and steroids, resulted in an excellent visual outcome in our patient.

Purpose To determine whether the ISNT rule (Inferior>Superior>Nasal>Temporal) or the "IST" rule (Inferior>Superior>Temporal) can be applied to the peripapillary retinal nerve fiber layer (RNFL) thickness as measured using Heidelberg Retinal Tomography (HRT) and Optical Coherence Tomography (OCT). Materials and methods This was a cross-sectional study of 189 normal and 42 glaucomatous eyes. RNFL thicknesses measured in different quadrants using HRT and OCT were compared to determine the percentage of eyes obeying the ISNT and IST rule. Results The HRT-measured mean RNFL thickness in normal eyes showed that 25.9% obeyed the ISNT rule and 70.4% conformed to the "IST" rule. The "IST" rule was able to identify normal eyes better (P=0.040), but had a poor sensitivity (45%) and specificity (70%) to diagnose glaucoma. The OCT-measured average RNFL thickness showed that 47.1% of normal eyes obeyed the ISNT rule and 58.7% conformed to the "IST" rule. Exclusion of the nasal sector also increased the number of glaucomatous eyes conforming to the IST rule (31% obeyed the ISNT rule and 50% obeyed the IST rule). Sensitivities and specificities of the ISNT and the IST rules for OCT-quantified RNFL ranged from 42% to 77%. Conclusions A larger number of normal eyes obeyed the IST rule compared with the ISNT rule for the RNFL thickness measured by HRT and OCT. Exclusion of the nasal sector from the analysis (IST rule) marginally improved the specificity in diagnosing glaucoma at the cost of the sensitivity, making neither of these parameters (ISNT and IST) likely to be useful clinically.

Household poisons can cause serious damage to the health of children. Turpentine oil, used chiefly as a solvent in paints, varnishes, and waxes; is often placed within easy reach of children during polishing or painting work. It is capable of causing serious toxicity, whether ingested or inhaled. Pulmonary aspiration can lead to lung parenchymal damage and turpentine-associated pneumonia. We report a case of exploratory ingestion and inhalation of turpentine oil in an 18-month-old boy, leading to extensive lung parenchymal damage, formation of multiple abscess cavities, and necrosis treated with decortication and segmental resection.

Idiopathic elevated episcleral venous pressure is characterized by dilated episcleral veins and open angle glaucoma. Trabeculectomies in these eyes are often complicated by uveal effusions (intraoperative or postoperative) at nonhypotonous pressures. We highlight the ability to avoid the need for sclerostomies by preventing intraoperative shallowing of the anterior chamber and the use of tight scleral sutures which should be adjusted postsurgery to gradually reach the target intraocular pressure in a step-wise manner.

Objectives. Campylobacter jejuni enteritis can lead to musculoskeletal, neuropathic or other health sequelae. We investigated the coexistence, seasonal occurrence, strain-type associations and impact on work capacity of different health problems following C. jejuni enteritis in a Lancashire population during 1999 and 2001. Methods. A semistructured questionnaire was used to characterize health problems that occurred in the community after laboratory-confirmed episodes of C. jejuni enteritis. The questionnaire was posted to all adults in the Preston and Chorley area who developed C. jejuni enteritis in 1999 or 2001. All Campylobacter isolates from this population were serotyped. Results. Several types of sequelae occurred consistently in both years, including the coexistence of musculoskeletal and neuropathic problems. There was no evidence of C. jejuni strain-type associations or seasonal preponderance for any type of sequela. The overall health impact of C. jejuni enteritis, as measured by workdays lost, was high in this population. Conclusions. A variety of health problems occur consistently following C. jejuni enteritis and substantially increase morbidity due to campylobacteriosis in the community.

Purpose: To generate normative data for optical coherence tomography (OCT) estimated macular thickness in Indian eyes and to establish its determinants. Materials and Methods: In this cross-sectional, observational, hospital-based study, 189 healthy Indian individuals underwent a fast macula OCT scan. Macular thickness was measured in nine ETDRS (Early Treatment Diabetic Retinopathy Study) regions, and the effect of gender, age, laterality, diabetes, and hypertension status on it was determined. Results: Females had a significantly thinner fovea (176.71 ± 23.32 μm v/s. 193.24 ± 20.95 μm) and inner macula (p < 0.001) as compared to males. With advancing age, foveal thickness increases (p = 0.012) while the superior and inferior outer macula thins (p = 0.018-0.027). Diabetes in the absence of any clinical retinopathy did not affect macular thickness. Hypertensive individuals had a thinner macula in all regions except the fovea and nasal macula. Conclusions: The thinner macula in females and age-related thinning should be considered when interpreting OCT scans of the macula. Diabetics with good visual acuity and no evidence of clinical retinopathy had normal macular thickness. Sub-clinical attenuation of vessels might account for the thinner macula in individuals with hypertension.

A rapid test for the detection of pregnancy has been evaluated. The test has been found to be simple to perform and gives a result within 3 minutes. The reliability and sensitivity of the test correlated well with the Friedman test. During the late stage of pregnancy when clinical signs are usually unmistakable, the sensitivity of the test decreases with the lower level of chorionic gonadotropin.

Extracorporeal photopheresis (ECP) was given to 23 patients with steroid-refractory acute GVHD (aGVHD, grade II (n=10), III (n=7) or IV (n=6)). The median duration of ECP was 7 months (1-33) and the median number of ECP cycles in each patient was 10. Twelve patients (52%) had complete responses. Eleven patients (48%) survived and 12 died, 10 of GVHD with or without infections and two of leukaemia relapse. The average grade of GVHD was reduced from 2.8 (on the first day of ECP) to 1.4 (on day +90 from ECP) (P=0.08), and the average dose of i.v. methylprednisolone from 2.17 to 0.2 mg/kg/d (P=0.004). Complete responses were obtained in 70, 42 and 0% of patients, respectively, with grades II, III and IV aGVHD; complete responses in the skin, liver and gut were 66, 27 and 40%. Patients treated within 35 days from onset of aGVHD had higher responses (83 vs 47%; P=0.1). A trend for improved survival was seen in grade III-IV aGVHD treated with ECP as compared to matched controls (38 vs 16%; P 0.08). ECP is a treatment option for patients with steroid refractory aGVHD and should be considered early in the course of the disease.