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Richter GM, Takusagawa HL, Sit AJ, Rosdahl JA, Chopra V, Ou Y, Kim SJ, WuDunn D. Trabecular Procedures Combined with Cataract Surgery for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:370-382. [PMID: 38054909 DOI: 10.1016/j.ophtha.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To determine the intraocular pressure (IOP) reduction of various trabecular procedures (a form of minimally invasive glaucoma surgery [MIGS]) combined with cataract surgery compared with cataract surgery alone, to compare the safety of the various trabecular procedures, and to highlight patient characteristics that may favor one trabecular procedure over another. METHODS A search of English-language peer-reviewed literature in the PubMed database was initially conducted in February 2021 and updated in April 2023. This yielded 279 articles. Twenty studies met initial inclusion and exclusion criteria and were assessed for quality by the panel methodologist. Of these, 10 were rated level I, 3 were rated level II, and 7 were rated level III. Only the 10 level I randomized controlled trials (RCTs) were included in this assessment, and all were subject to potential industry-sponsorship bias. RESULTS The current analysis focuses on the amount of IOP reduction (in studies that involved medication washout) and on IOP reduction with concurrent medication reduction (in studies that did not involve medication washout). Based on studies that performed a medication washout, adding a trabecular procedure to cataract surgery provided an additional 1.6 to 2.3 mmHg IOP reduction in subjects with hypertensive, mild to moderate open-angle glaucoma (OAG) at 2 years over cataract surgery alone, which itself provided approximately 5.4 to 7.6 mmHg IOP reduction. In other words, adding a trabecular procedure provided an additional 3.8% to 8.9% IOP reduction over cataract surgery alone, which itself provided 21% to 28% IOP reduction. There was no clear benefit of one trabecular procedure over another. Patient-specific considerations that can guide procedure selection include uveitis predisposition, bleeding risk, metal allergy, and narrowing of Schlemm's canal. There are no level I data on the efficacy of trabecular procedures in subjects with pretreatment IOP of 21 mmHg or less. CONCLUSIONS Trabecular procedures combined with cataract surgery provide an additional mild IOP reduction over cataract surgery alone in hypertensive OAG subjects. Additional research should standardize outcome definitions, avoid industry sponsorship bias, and study the efficacy of these procedures in normotensive OAG. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
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Chopra V, Takusagawa HL, Rosdahl JA, Sit AJ, Richter GM, Ou Y, Kim SJ, WuDunn D. Aqueous Shunts with Extraocular Reservoir for Open-Angle Adult Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:227-239. [PMID: 38069945 DOI: 10.1016/j.ophtha.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate the recently published literature on the efficacy and safety of the use of aqueous shunts with extraocular reservoir for the management of adult open-angle glaucomas (OAGs). METHODS A search of peer-reviewed literature was last conducted in April 2023 of the PubMed database and included only articles published since the last aqueous shunt Ophthalmic Technology Assessment, which assessed articles published before 2008. The abstracts of these 419 articles were examined, and 58 studies were selected for full-text analysis. After inclusion and exclusion criteria were applied, 28 articles were selected and assigned ratings by the panel methodologist according to the level of evidence. Twenty-five articles were rated level I and 3 articles were rated level II. There were no level III articles. RESULTS Implantation of aqueous shunts with extraocular reservoir can lower intraocular pressure (IOP) by between one-third and one-half of baseline IOP, depending on whether it is undertaken as the primary or secondary glaucoma surgery. Success rates for aqueous shunts were found to be better than for trabeculectomies in eyes with prior incisional surgery. Conversely, in eyes without prior incisional surgery, implantation of aqueous shunts was found to have an overall lower success rate as the primary glaucoma procedure compared with trabeculectomy. Although both valved and nonvalved aqueous shunts with extraocular reservoir were effective, the nonvalved device generally achieved slightly lower long-term IOPs with fewer glaucoma medications and less need for additional glaucoma surgery. Both devices slow the rates of visual field progression with efficacy comparable with that of trabeculectomy. Early aqueous humor suppression after aqueous shunt implantation is recommended for the management of the postoperative hypertensive phase and long-term IOP control. No strong evidence supports the routine use of mitomycin C with aqueous shunt implantation for OAG. CONCLUSIONS Implantation of aqueous shunts with extraocular reservoir, including valved or nonvalved devices, has been shown to be an effective strategy to lower IOP. Strong level I evidence supports the use of aqueous shunts with extraocular reservoir by clinicians for the management of adult OAG. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
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WuDunn D, Takusagawa HL, Rosdahl JA, Sit AJ, Chopra V, Ou Y, Richter GM, Knight OJ, Solá-Del Valle D, Kim SJ. Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:240-248. [PMID: 38069944 DOI: 10.1016/j.ophtha.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than -6 decibels (dB). METHODS A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English-language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed. RESULTS The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing. CONCLUSIONS Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatable defect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - O'Rese J Knight
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | | | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Richter GM, Lee JC, Khan N, Vorperian A, Hand B, Burkemper B, Zhou X, Chu Z, Wang R, Varma R, Kashani AH. Ocular and systemic determinants of perifoveal and macular vessel parameters in healthy African Americans. Br J Ophthalmol 2023; 107:540-546. [PMID: 34740885 DOI: 10.1136/bjophthalmol-2021-319675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine the relationship of various systemic and ocular characteristics with perifoveal and macular vessel density in healthy African American eyes. DESIGN A population-based cross-sectional study of prospectively recruited African Americans ≥40 years of age. Participants underwent 3×3 mm and 6×6 mm macula scans using spectral-domain optical coherence tomography angiography (OCTA), clinical examinations and clinical questionnaires. Participants with glaucoma, severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular oedema were excluded. Custom MATLAB based software quantified vessel area density (VAD) and vessel skeleton density (VSD) in the superficial retinal layer of the macula. Multivariable regression analysis, controlling for inter-eye correlation, was performed to determine systemic and ocular determinants of macular vessel metrics using stepwise selection. Candidate variables included: age, gender, body mass index, history of smoking, history of diabetes, diabetes duration, history of stroke or brain haemorrhage, systolic blood pressure, diastolic blood pressure (DBP), pulse pressure, mean arterial pressure, central subfield thickness (CSFT), visual field mean deviation, intraocular pressure, axial length (AL), mean ocular perfusion pressure and signal strength (SS). RESULTS A total of 2221 OCTA imaged eyes from 1472 participants were included in this study. Reduced perifoveal and macular VAD and VSD were independently associated with longer AL, reduced SS, reduced CSFT and older age. Male gender and lower DBP were also associated with reduced perifoveal and macular VSD. CONCLUSIONS When interpreting OCTA images in a clinical setting, it is important to consider the effects ocular and systemic characteristics may have on the macular microcirculation.
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Affiliation(s)
- Grace M Richter
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jae Chang Lee
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nasir Khan
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alexander Vorperian
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Brennan Hand
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Bruce Burkemper
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Xiao Zhou
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Zhongdi Chu
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ruikang Wang
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Rohit Varma
- Southern California Eye Institute, Los Angeles, California, USA
| | - Amir H Kashani
- Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA
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Sit AJ, Chen TC, Takusagawa HL, Rosdahl JA, Hoguet A, Chopra V, Richter GM, Ou Y, Kim SJ, WuDunn D. Corneal Hysteresis for the Diagnosis of Glaucoma and Assessment of Progression Risk: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:433-442. [PMID: 36529572 DOI: 10.1016/j.ophtha.2022.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To review the current published literature on the utility of corneal hysteresis (CH) to assist the clinician in the diagnosis of glaucoma or in the assessment of risk for disease progression in existing glaucoma patients. METHODS Searches of the peer-reviewed literature in the PubMed database were performed through July 2022. The abstracts of 423 identified articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 19 articles were selected, and the panel methodologist rated them for level of evidence. Eight articles were rated level I, and 5 articles were rated level II. The 6 articles rated level III were excluded. RESULTS Corneal hysteresis is lower in patients with primary open-angle glaucoma, primary angle-closure glaucoma, pseudoexfoliative glaucoma, and pseudoexfoliation syndrome compared with normal subjects. Interpretation of low CH in patients with high intraocular pressure (IOP) or on topical hypotensive medications is complicated by the influence of these parameters on CH measurements. However, CH is also lower in treatment-naïve, normal-tension glaucoma patients compared with normal subjects who have a similar IOP. In addition, lower CH is associated with an increased risk of progression of glaucoma based on visual fields or structural markers in open-angle glaucoma patients, including those with apparently well-controlled IOP. CONCLUSIONS Corneal hysteresis is lower in glaucoma patients compared with normal subjects, and lower CH is associated with an increased risk of disease progression. However, a causal relationship remains to be demonstrated. Nevertheless, measurement of CH complements current structural and functional assessments in determining disease risk in glaucoma suspects and patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Arthur J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - Teresa C Chen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye & Ear, Glaucoma Service, Boston, Massachusetts
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon; Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Ambika Hoguet
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | | | - Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute Keck Medicine of University of Southern California Los Angeles, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, UCSF Medical Center, San Francisco, California
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darrell WuDunn
- University of Florida College of Medicine, Jacksonville, Department of Ophthalmology, Jacksonville, Florida
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LeTran VH, Burkemper B, O'Fee JR, Souverein EA, Lee JC, Phillips MJ, Dinh-Dang D, Song BJ, Xu BY, Wong BJ, Richter GM. Wedge Defects on Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma: Prevalence and Associated Clinical Factors. J Glaucoma 2022; 31:242-249. [PMID: 35089892 DOI: 10.1097/ijg.0000000000001991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Among subjects with glaucoma, wedge-shaped defects on optical coherence tomography angiography (OCTA) were associated with disc hemorrhages (DH), paracentral visual field (VF) defects, increased cup-to-disc ratio (CDR), and thinner retinal nerve fiber layer (RNFL). PURPOSE To examine determinants of wedge defects on peripapillary OCTA in glaucoma. MATERIALS AND METHODS A total of 278 eyes of 186 subjects with mild to severe primary open-angle glaucoma underwent 6×6 spectral-domain OCTA imaging of the superficial peripapillary retina from 2016 to 2020 at an academic practice. Wedge defects were defined as focal microvasculature loss that extends outward from the optic nerve in an arcuate, wedge shape. Logistic regression models controlling for intereye correlation identified variables significantly associated with wedge defects. Eyes with profound microvasculature loss in both hemispheres were excluded. Candidate variables included: age, sex, race or ethnicity, diabetes, hypertension, follow-up duration, baseline untreated intraocular pressure, intraocular pressure at time of imaging, DH history, paracentral VF defects, CDR, central corneal thickness, spherical equivalent, VF mean deviation, RNFL thickness, and glaucoma stage. RESULTS Of 278 eyes, 126 (45.3%) had wedge defects in at least 1 hemisphere. In our multivariable logistic regression model, wedge defects were associated with DH history [odds ratio (OR): 3.19, 95% confidence interval (CI): 1.05-9.69, P=0.041], paracentral VF defects [OR: 4.38 (95% CI: 2.11-9.11), P<0.0001], larger CDR [OR: 1.27 (95% CI: 1.03-1.56), P=0.024, per 0.1 increase], and thinner RNFL [OR: 1.71 (95% CI: 1.25-2.34), P=0.0009, per 10 μm decrease]. CONCLUSION DH history and paracentral VF defects were independently associated with wedge defects on OCTA, which was present in 45.3% of primary open-angle glaucoma patients. These findings may provide insight into glaucoma pathogenesis.
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Affiliation(s)
- Vivian H LeTran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - John R O'Fee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Erik A Souverein
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jae C Lee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark J Phillips
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Brian J Song
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brandon J Wong
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Shan J, Pardeshi A, Jiang X, Richter GM, McKean-Cowdin R, Varma R, Xu BY. Optimal number and orientation of anterior segment OCT images to measure ocular biometric parameters in angle closure eyes: the Chinese American Eye Study. Br J Ophthalmol 2022; 107:795-801. [DOI: 10.1136/bjophthalmol-2021-319275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022]
Abstract
PurposeTo assess the optimal number and orientation of anterior segment optical coherence tomography (AS-OCT) images for accurately measuring ocular biometric parameters in angle closure eyes.MethodsSubjects with angle closure, defined as >3 quadrants of non-visible pigmented trabecular meshwork on static gonioscopy, were selected from the Chinese American Eye Study. Mean angle opening distance (AOD500) was calculated using four images (0°−180°, 45°−225°, 90°−270° and 135°−315° meridians) from one eye per subject. Ten eyes from each quartile of AOD500 measurements were randomly selected for detailed 32-image analysis of 10 biometric parameters, including AOD500, iris curvature (IC), anterior chamber depth (ACD), lens vault (LV), and anterior chamber area (ACA). Mean and range of measurements from 1, 2, 4, 8 or 16 images were compared with 32-image values for all parameters.Results40 out of 335 eyes with angle closure were selected for 32-image analysis. Deviation from the 32-image mean was between 0.44% and 19.31% with one image, decreasing to 0.08% to 4.21% with two images for all parameters. Deviation from the 32-image range of measurements was between 54.67% to 88.94% with one image, decreasing to <7.00% with eight images for all parameters except ACD and ACA. Orienting the first image analysed along the 25°−205° meridian better approximated the range of measurements when four or fewer images were analysed.ConclusionsSectoral anatomical variations in angle closure eyes are easily misrepresented based on current AS-OCT imaging conventions. A revised multi-image approach can better capture the mean and range of biometric measurements.
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Phillips MJ, Dinh-Dang D, Bolo K, Burkemper B, Lee JC, LeTran VH, Chang BR, Grisafe DJ, Chu Z, Zhou X, Song BJ, Xu BY, Wong B, Wang RK, Richter GM. Steps to Measurement Floor of an Optical Microangiography Device in Glaucoma. Am J Ophthalmol 2021; 231:58-69. [PMID: 34051173 DOI: 10.1016/j.ajo.2021.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare dynamic ranges and steps to measurement floors of peripapillary and macular metrics from a complex signal-based optical microangiography (OMAGC) optical coherence tomography angiography (OCTA) device for glaucoma with those of OCT measurements. DESIGN Cross-sectional study. METHODS Imaging of 252 eyes from 173 patients with glaucoma and 123 eyes from 92 subjects without glaucoma from a glaucoma clinic was quantified using custom and commercial software. Metrics from OCT (retinal nerve fiber layer [RNFL], ganglion cell/inner plexiform layer [GCIPL]) and OCTA (custom: peripapillary vessel area density [pVAD], macular vessel area density [mVAD], and macular vessel skeleton density [mVSD]; commercial: peripapillary perfusion density [pPDZ], macular perfusion density [mPDZ], and macular vessel density [mVDZ]) were plotted against visual field mean deviation (MD) with linear change-point analyses, measurement floors, and steps to floors. RESULTS Mean MD (dB) for glaucomatous eyes was -5.77 (-6.45 to -5.10). The number of eyes with mild glaucoma (MD >-6), moderate glaucoma (MD -6 to -12), and severe glaucoma (MD <-12) were 164, 50, and 38, respectively. pPDZ yielded the lowest estimated floor at -26.6 dB (standard error [SE] 1.53), followed by OCTA macular metrics (-25 to -21 dB; SE 1.03) and pVAD (-17.6 dB, SE 1.06). RNFL and GCIPL produced floors at -17.8 (SE 0.927) and -23.6 dB (SE 1.14). The highest number of steps to measurement floor belonged to RNFL (7.20) and GCIPL (7.33), followed by pPDZ (4.25), mVAD (3.87), and mVSD (3.81), with 2.5 or fewer steps for pVAD, mPDZ, and mVDZ. CONCLUSIONS pPDZ, mVAD, and mVSD had approximately 4 steps within their dynamic ranges, without true measurement floors, and thus may be useful in evaluating advanced glaucomatous progression. Improving OCTA test-retest repeatability could augment number of steps for OCTA metrics, increasing their clinical utility.
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Hong KL, Burkemper B, Urrea AL, Chang BR, Lee JC, LeTran VH, Chu Z, Zhou X, Xu BY, Wong BJ, Song BJ, Jiang X, Wang RK, Varma R, Richter GM. Hemiretinal Asymmetry in Peripapillary Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes. Am J Ophthalmol 2021; 230:156-165. [PMID: 34102157 DOI: 10.1016/j.ajo.2021.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate hemiretinal asymmetry in radial peripapillary capillary vessel area density (VAD) of healthy, glaucoma suspect, and glaucoma eyes of varying severity and its diagnostic utility for glaucoma. DESIGN Population-based, cross-sectional study. METHODS Optic disc scans (6 × 6 mm) were collected on optical coherence tomography angiography (OCTA) to obtain VAD and on optical coherence tomography (OCT) to measure circumpapillary retinal nerve fiber layer (RNFL) thickness. Hemiretinal difference in VAD (hdVAD) was defined as the absolute difference between superior and inferior hemiretinal VAD. Age-adjusted multivariable linear regression of hdVAD on glaucoma severity was performed. Areas under curves (AUCs) were calculated from predicted probabilities generated by multiple logistic regression of glaucoma severity on age-adjusted single and combined parameters. RESULTS A total of 1,043 eyes of 1,043 participants (587 healthy, 270 suspect, 67 mild, 54 moderate, 65 severe glaucoma) were included. After age adjustment, mean hdVAD was similar between healthy and suspect (P = .225), higher in mild vs suspect (P < .001), and higher in moderate vs mild (P = .018), but lower in severe vs moderate (P = .001). AUCs of hdVAD were highest for discriminating mild (0.685) and moderate (0.681) glaucoma from healthy. Combining hdVAD and global RNFL (gRNFL) yielded the highest AUCs of all parameters for mild (0.818) and any POAG (0.859) and resulted in significantly better diagnostic accuracy than either hdVAD or gRNFL alone (P < .05 for all comparisons). CONCLUSIONS hdVAD is higher in early glaucoma and may help with early detection when damage is focal, but its diagnostic ability appears less robust in advanced glaucoma when damage is diffuse.
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Richter GM, Wagner G, Reichenmiller K, Staufenbiel I, Martins O, Löscher BS, Holtgrewe M, Jepsen S, Dommisch H, Schaefer AS. Exome Sequencing of 5 Families with Severe Early-Onset Periodontitis. J Dent Res 2021; 101:151-157. [PMID: 34515563 PMCID: PMC8807999 DOI: 10.1177/00220345211029266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Periodontitis is characterized by alveolar bone loss leading to tooth loss. A small proportion of patients develop severe periodontitis at the juvenile or adolescent age without exposure to the main risk factors of the disease. It is considered that these cases carry rare variants with large causal effects, but the specific variants are largely unknown. In this study, we performed exome sequencing of 5 families with children who developed stage IV, grade C, periodontitis between 3 and 18 y of age. In 1 family, we found compound heterozygous variants in the gene CTSC (p.R272H, p.G139R), 1 of which was previously identified in a family with prepubertal periodontitis. Subsequent targeted resequencing of the CTSC gene in 24 patients <25 y of age (stage IV, grade C) identified the known mutation p.I453V (odds ratio = 4.06, 95% CI = 1.6 to 10.3, P = 0.001), which was previously reported to increase the risk for adolescent periodontitis. An affected sibling of another family carried a homozygous deleterious mutation in the gene TUT7 (p.R560Q, CADD score >30 [Combined Annotation Dependent Depletion]), which is implicated in regulation of interleukin 6 expression. Two other affected siblings shared heterozygous deleterious mutations in the interacting genes PADI1 and FLG (both CADD = 36), which contribute to the integrity of the environment-tissue barrier interface. Additionally, we found predicted deleterious mutations in the periodontitis risk genes ABCA1, GLT6D1, and SIGLEC5. We conclude that the CTSC variants p.R272H and p.I453V have different expressivity and diagnostic relevance for prepubertal and adolescent periodontitis, respectively. We propose additional causal variants for early-onset periodontitis, which also locate within genes that carry known susceptibility variants for common forms. However, the genetic architecture of juvenile periodontitis is complex and differs among the affected siblings of the sequenced families.
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Affiliation(s)
- G M Richter
- Department of Periodontology and Synoptic Dentistry, Institute for Dental and Craniofacial Sciences, Charité-University Medicine Berlin, Berlin, Germany
| | - G Wagner
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | | | - I Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover, Germany
| | - O Martins
- Institute of Periodontology, Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - B S Löscher
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Holtgrewe
- Core Unit Bioinformatics-CUBI, Berlin Institute of Health, Charité-University Medicine Berlin, Berlin, Germany
| | - S Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - H Dommisch
- Department of Periodontology and Synoptic Dentistry, Institute for Dental and Craniofacial Sciences, Charité-University Medicine Berlin, Berlin, Germany
| | - A S Schaefer
- Department of Periodontology and Synoptic Dentistry, Institute for Dental and Craniofacial Sciences, Charité-University Medicine Berlin, Berlin, Germany
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11
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Cano J, Rahimi M, Xu BY, Richter GM, Tan O, Huang D, Shahidi M. Relationship Between Macular Vessel Density and Total Retinal Blood Flow in Primary Open-angle Glaucoma. J Glaucoma 2021; 30:666-671. [PMID: 33979111 PMCID: PMC8373641 DOI: 10.1097/ijg.0000000000001880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/21/2021] [Indexed: 01/12/2023]
Abstract
PRECIS An association between macular vessel density (VD) and total retinal blood flow (TRBF) was demonstrated in subjects with primary open-angle glaucoma (POAG) and visual field (VF) loss. PURPOSE The purpose of this study was to report relationships of macular VD metrics and TRBF in POAG. MATERIALS AND METHODS A total of 24 POAG and 19 healthy control subjects participated in the study. Subjects underwent optical coherence tomography and angiography for measurements of inner retinal thickness (IRT), VD, and spacing between large vessels (SLV) and small vessels (SSV). Doppler optical coherence tomography imaging was performed for TRBF measurement. In POAG subjects, automated perimetry was performed and VF loss expressed as mean deviation was measured. RESULTS Compared with the control group, POAG group had decreased VD, TRBF, IRT, and increased SLV (P<0.0001). Decreased VD (Pearson correlation, r=0.51; P<0.0001; N=43) and increased SLV (Spearman correlation, rs=-0.47; P=0.001) were correlated with decreased TRBF. Decreased VD and SSV (r≥0.39; P≤0.001; N=43) and increased SLV (rs=-0.71; P<0.0001) were associated with decreased IRT. Decreased VF mean deviation was correlated with decreased VD, SSV, IRT (r≥0.53; P≤0.001; N=24), and with increased SLV (rs=-0.84; P<0.0001). CONCLUSIONS The finding of an association between macular VD and TRBF supports the role of vascular factors in the pathophysiology of POAG and potential conduct of future studies aimed at identifying multiple image-based vascular metrics for disease diagnosis.
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Affiliation(s)
- Jennifer Cano
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Mansour Rahimi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Benjamin Y. Xu
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Grace M. Richter
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Ou Tan
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
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12
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Juliano J, Burkemper B, Lee J, Nelson A, LeTran V, Chu Z, Zhou G, Jiang X, Wang RK, Varma R, Richter GM. Longer Axial Length Potentiates Relationship of Intraocular Pressure and Peripapillary Vessel Density in Glaucoma Patients. Invest Ophthalmol Vis Sci 2021; 62:37. [PMID: 34311470 PMCID: PMC8322720 DOI: 10.1167/iovs.62.9.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate how axial length (AL) changes the relationship of intraocular pressure (IOP) with peripapillary vessel density (pVD) in glaucoma versus non-glaucomatous eyes. Methods A population-based, cross-sectional study of 2127 African Americans aged 40 years and older in Inglewood, California, were imaged with 6 × 6-mm optic disc optical coherence tomography angiography scans. There were 1028 healthy subjects (1539 eyes) and 65 subjects with glaucoma (86 eyes) who met inclusion criteria. A multivariable linear mixed effects regression model investigated the relationship of IOP on pVD after controlling for signal strength, retinal nerve fiber layer thickness, and age. These results were stratified by AL groups. Results Higher IOP was a significant predictor of lower pVD among subjects with glaucoma (P = 0.009), but not among healthy subjects (P = 0.26). After stratifying by the sample median AL (23.46 mm), higher IOP was associated with lower pVD among subjects with glaucoma with longer AL (≥ 23.46 mm, P = 0.005), but not among those in the shorter AL (< 23.46 mm, P = 0.45). IOP was not significantly associated with pVD among healthy subjects in either AL stratum. Conclusions Among subjects with glaucoma with longer AL, IOP was significantly associated with pVD. This relationship was not seen among subjects with glaucoma with shorter AL or non-glaucomatous subjects in either AL group. These findings support the hypothesis that disturbed retinal autoregulation may be present in subjects with glaucoma with longer AL. Longitudinal studies are needed to further investigate whether axial elongation increases glaucoma risk by compromising retinal autoregulation.
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Affiliation(s)
- Joseph Juliano
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Bruce Burkemper
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Jae Lee
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Andrew Nelson
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Vivian LeTran
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Gabriella Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Xuejuan Jiang
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, United States
| | - Grace M Richter
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
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13
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Sommer CM, Pieper CC, Offensperger F, Pan F, Killguss HJ, Köninger J, Loos M, Hackert T, Wortmann M, Do TD, Maleux G, Richter GM, Kauczor HU, Kim J, Hur S. Radiological management of postoperative lymphorrhea. Langenbecks Arch Surg 2021; 406:945-969. [PMID: 33844077 DOI: 10.1007/s00423-021-02094-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. METHOD A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. RESULTS Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. CONCLUSION The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.
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Affiliation(s)
- C M Sommer
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany.
- Clinic of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany.
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
| | - C C Pieper
- Clinic of Diagnostic and Interventional Radiology, Bonn University Hospital, Venusberg-Campus 1, 53105, Bonn, Germany
| | - F Offensperger
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - F Pan
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - H J Killguss
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - J Köninger
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - M Loos
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T Hackert
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - M Wortmann
- Clinic of Vascular and Endovascular Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - G Maleux
- Department of Radiology, Leuven University Hospitals, Herestraat 49, 3000, Leuven, UZ, Belgium
| | - G M Richter
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - J Kim
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - S Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Ihwa-dong, Jongno-gu, Seoul, Republic of Korea
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14
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Xu BY, Lifton J, Burkemper B, Jiang X, Pardeshi AA, Moghimi S, Richter GM, McKean-Cowdin R, Varma R. Ocular Biometric Determinants of Anterior Chamber Angle Width in Chinese Americans: The Chinese American Eye Study. Am J Ophthalmol 2020; 220:19-26. [PMID: 32730913 DOI: 10.1016/j.ajo.2020.07.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE We sought to investigate anatomic mechanisms of angle narrowing by assessing ocular biometric determinants of anterior chamber angle width. DESIGN Population-based cross-sectional study. METHODS Subjects ≥50 years of age from the Chinese American Eye Study underwent a comprehensive ocular examination, including anterior segment optical coherence tomography imaging and ultrasound A-scan. Independent variables, including anterior chamber depth (ACD), lens vault (LV), iris curvature (IC), anterior chamber width, lens thickness, vitreous cavity depth, and axial length, and dependent variables, including angle opening distance, were measured in 1 randomly selected eye per subject. Univariable and multivariable regression models with standardized regression coefficients (SRCs) and semipartial correlation coefficients squares (SPCC2) were used to assess relative and unique contributions by independent variables to angle width. RESULTS Two thousand two hundred twenty-five subjects (1433 women and 834 men) were included in the analysis. All biometric parameters except lens thickness differed between men and women (age-adjusted P < .001). In model 1A (R2 = 0.66), which included ACD, lens thickness, and vitreous cavity depth, ACD (SRC = 0.64, SPCC2 = 0.19) and IC (SRC = -0.26, SPCC2 = 0.041) were the strongest determinants of angle opening distance. In model 1B (R2 = 0.58), which included LV and axial length, LV (SRC = -0.46, SPCC2 = 0.1) and IC (SRC = -0.3, SPCC2 = 0.047) were the strongest determinants of angle opening distance. Determinants of angle width were similar in separate multivariable models for men and women. CONCLUSIONS ACD, LV, and IC are the strongest determinants of angle width in Chinese Americans. Sex-related differences in angle width are explained by differences among biometric measurements. These results provide insights into anatomic mechanisms of angle narrowing and have important implications for quantitative assessments of angle closure eyes.
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Affiliation(s)
- Benjamin Y Xu
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA.
| | - Jacob Lifton
- Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Bruce Burkemper
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Xuejuan Jiang
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Anmol A Pardeshi
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla California, USA
| | - Grace M Richter
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Roberta McKean-Cowdin
- University of Southern California Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA; Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, USA
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15
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Nousome D, Mckean-Cowdin R, Richter GM, Burkemper B, Torres M, Varma R, Jiang X. Retinal Nerve Fiber Layer Thickness in Healthy Eyes of Black, Chinese, and Latino Americans: A Population-Based Multiethnic Study. Ophthalmology 2020; 128:1005-1015. [PMID: 33217471 DOI: 10.1016/j.ophtha.2020.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare peripapillary retinal nerve fiber layer (RNFL) thickness among healthy adults by race and ethnicity and to identify determinants of RNFL thickness. DESIGN Population-based cross-sectional study. PARTICIPANTS Data from 6133 individuals (11 585 eyes) from 3 population-based studies in Los Angeles County, California, 50 years of age or older and of self-described African, Chinese, or Latin American ancestry. METHODS We measured RNFL thickness and optic nerve head parameters using the Cirrus HD-OCT 4000. Multivariate linear mixed regression was used to evaluate factors associated with RNFL thickness among participants without ocular diseases. MAIN OUTCOME MEASURES Determinants and modifiers of RNFL thickness. RESULTS The mean age of the participants was 60.1 years (standard deviation, 7.4 years). Black Americans showed the lowest RNFL thickness and smallest cup-to-disc ratio (CDR), and Chinese Americans showed the largest CDR and disc area after adjusting for age and gender (all P < 0.05). Per each 10-year older age group, the average RNFL thickness was 2.5 μm (95% confidence interval [CI], 1.8-3.1 μm), 2.8 μm (95% CI, 2.3-3.3 μm), and 3.5 μm (95% CI, 2.9-4.1 μm) thinner for Black, Chinese, and Latino Americans, respectively (age trend P < 0.05 and interaction P = 0.041). Black Americans compared with Chinese Americans, older age, male gender, hypertension, diabetes, greater axial length (AL), bigger disc area, and lower scan signal strength were associated with thinner average RNFL. Race, age, AL, disc area, and scan signal strength consistently were associated with RNFL thickness in all quadrants, whereas gender, hypertension, and diabetes were associated with RNFL thickness in select quadrants. Age and race explained the greatest proportion of variance of RNFL thickness. CONCLUSIONS Clinically important differences in RNFL thickness are present in healthy adults 50 years of age or older from different racial and ethnic groups of the same age, with the thinnest measures observed in Black Americans. This difference remains after accounting for disc size and AL. Furthermore, age-related RNFL thinning differs by race and ethnicity. Longitudinal studies are needed to verify our findings and to assess the influence of race and ethnicity in the clinical application of RNFL thickness.
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Affiliation(s)
- Darryl Nousome
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Roberta Mckean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Bruce Burkemper
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California.
| | - Xuejuan Jiang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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16
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Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM. Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp 2020; 4:60. [PMID: 33135104 PMCID: PMC7604276 DOI: 10.1186/s41747-020-00188-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/01/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). METHODS A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. RESULTS In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1-100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8-99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. CONCLUSIONS Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.
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Affiliation(s)
- F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
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17
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Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM. The roles of iodized oil-based lymphangiography and post-lymphangiographic computed tomography for specific lymphatic intervention planning in patients with postoperative lymphatic fistula: a literature review and case series. CVIR Endovasc 2020; 3:79. [PMID: 33085018 PMCID: PMC7578215 DOI: 10.1186/s42155-020-00146-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
In the management of patients with postoperative lymphatic fistula (LF) in different locations, iodized oil-based lymphangiography (LAG) from trans-pedal or intranodal route is an established diagnostic approach with the potential to plan further interventional treatments. However, specific lymphatic interventions are indicated depending on different locations and morphologies of the LF. After a systematic literature review, four types of interventions can be considered, including direct leakage embolization/sclerotherapy (DLE/DLS), percutaneous afferent lymphatic vessel embolization (ALVE), percutaneous afferent lymphatic vessels disruption/sclerotherapy (ALVD/ALVS), and trans-afferent nodal embolization (TNE). In the iodized oil-based LAG, three potential lymphatic targets including confined leakage, definite afferent LVs, and definite closest afferent LNs should be comprehensively assessed. For optimal prospective treatment planning for LF, iodized oil-based post-lymphangiographic computed tomography (post-LAG CT) is a useful complement to the conventional iodized oil-based LAG, which can be performed easily after LAG. This review article summarized the current evidence of the specific lymphatic interventions in patients with postoperative LF and explored the potential benefits of post-LAG CT in the intervention planning from a case series.
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Affiliation(s)
- F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
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Lee JC, Grisafe DJ, Burkemper B, Chang BR, Zhou X, Chu Z, Fard A, Durbin M, Wong BJ, Song BJ, Xu BY, Wang R, Richter GM. Intrasession repeatability and intersession reproducibility of peripapillary OCTA vessel parameters in non-glaucomatous and glaucomatous eyes. Br J Ophthalmol 2020; 105:1534-1541. [PMID: 32917629 DOI: 10.1136/bjophthalmol-2020-317181] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare intrasession repeatability versus intersession reproducibility of the peripapillary vessel parameters using optical microangiography-based optical coherence tomography angiography (OCTA) in non-glaucomatous and glaucomatous eyes. METHODS In an observational, longitudinal study, peripapillary OCTA scans were collected to evaluate intrasession repeatability and intersession reproducibility using within-eye coefficient of variation (CVW) and intraclass correlation coefficient (ICC). Images were quantified using a custom research-oriented quantification software calculating vessel area density (VAD) and flux and a commercially developed, clinic-oriented quantification software (Cirrus 11.0, Carl Zeiss Meditec) calculating perfusion density (PD) and flux index (FI). Effect of signal strength on the reliability of OCTA parameters was also evaluated. RESULTS Among 120 non-glaucomatous eyes, intrasession CVW were 4.2% for VAD, 5.3% for flux, 1.5% for PD and 2.0% for FI. The intersession CVW were 6.5% for VAD, 8.0% for flux, 2.0% for PD and 3.2% for FI. The intrasession ICC ranged from 0.928 to 0.945, and intersession ICC ranged from 0.811 to 0.866. From 118 glaucomatous eyes, intrasession CVW was 9.0% for VAD, 10.3% for flux, 1.7% for PD and 2.3% for FI. The intersession CVW was 12.1% for VAD, 14.2% for flux, 2.3% for PD and 3.5% for FI. The intrasession ICC ranged from 0.904 to 0.972, and intersession ICC ranged from 0.855 to 0.955. Signal strength was significantly positively associated with OCTA vessel parameters (p<0.0001) for both groups. CONCLUSION Peripapillary OCTA vessel parameters had greater intrasession repeatability compared to intersession reproducibility in both non-glaucomatous and glaucomatous eyes. The built-in commercially developed quantification software demonstrated greater agreement than the custom research-oriented quantification software.
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Affiliation(s)
- Jae Chang Lee
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Dominic J Grisafe
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Bruce Burkemper
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Brenda R Chang
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Xiao Zhou
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Zhongdi Chu
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ali Fard
- Carl Zeiss Meditec Inc, Dublin, California, USA
| | - Mary Durbin
- Carl Zeiss Meditec Inc, Dublin, California, USA
| | - Brandon J Wong
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Brian J Song
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Benjamin Y Xu
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ruikang Wang
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Grace M Richter
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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19
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Chang R, Nelson AJ, LeTran V, Vu B, Burkemper B, Chu Z, Fard A, Kashani AH, Xu BY, Wang RK, Varma R, Richter GM. Systemic Determinants of Peripapillary Vessel Density in Healthy African Americans: The African American Eye Disease Study. Am J Ophthalmol 2019; 207:240-247. [PMID: 31229463 DOI: 10.1016/j.ajo.2019.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the relationship between systemic factors and radial peripapillary capillary (RPC) vessel density (VD) in healthy African American (AA) participants of the African American Eye Disease Study. DESIGN A population-based, cross-sectional study. METHODS A total of 4135 eyes from 2127 AA participants aged 40 years and older in Inglewood, California, were imaged for 6×6-mm optic disc scans on a spectral-domain optical coherence tomography angiography (OCTA) device. Of these, 1029 eyes from 1029 participants who met the inclusion and exclusion criteria were analyzed, including only 1 eye per participant. Custom software was used to quantify RPC VD. Multivariate linear regression was used to identify systemic factors associated with RPC VD with a significance level set at 0.05. The contribution of each variable to the final model was estimated with the magnitude of standardized regression coefficients (SRCs). The fit of the final model was measured by R2. RESULTS The average RPC VD was 0.346±0.045. Controlling for signal strength, the systemic variables in the final multivariate model associated with reduced RPC VD were older age (β = -0.0123 per decade; SRC = -0.2733; P < .0001), male sex (β = -0.0067; SRC = -0.0716; P = .0060), and longer diabetes duration (β = -0.0022 per 5 years; SRC = -0.0527; P = .0427). The model R2 was 0.3689. CONCLUSIONS Age, sex, and systemic influences, such as diabetes duration, need to be considered when assessing changes in RPC VD in glaucoma and other ocular diseases. Longitudinal studies are needed to investigate whether reduced RPC VD and the factors that affect it are associated with an increased risk of developing glaucomatous nerve damage.
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Affiliation(s)
- Ryuna Chang
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Andrew J Nelson
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Vivian LeTran
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Brian Vu
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Bruce Burkemper
- Southern California Eyecare and Vision Research Institute, Los Angeles, California, USA
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ali Fard
- Carl Zeiss Meditec, Inc, Dublin, California, USA
| | - Amir H Kashani
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Benjamin Y Xu
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, Los Angeles, California, USA
| | - Grace M Richter
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California, USA.
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20
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Wang P, Shen J, Chang R, Moloney M, Torres M, Burkemper B, Jiang X, Rodger D, Varma R, Richter GM. Machine Learning Models for Diagnosing Glaucoma from Retinal Nerve Fiber Layer Thickness Maps. Ophthalmol Glaucoma 2019; 2:422-428. [PMID: 32672575 DOI: 10.1016/j.ogla.2019.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/16/2019] [Accepted: 08/14/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of multiple machine learning models using full retinal nerve fiber layer (RNFL) thickness maps in detecting glaucoma. DESIGN Case-control study. PARTICIPANTS A total of 93 eyes from 69 patients with glaucoma and 128 eyes from 128 age- and sex-matched healthy controls from the Los Angeles Latino Eye Study (LALES), a large population-based, longitudinal cohort study consisting of Latino participants aged ≥40 years residing in El Puente, California. METHODS The 6×6-mm RNFL thickness maps centered on the optic nerve head (Cirrus 4000; Zeiss, Dublin, CA) were supplied to 4 different machine learning algorithms. These models included 2 conventional machine learning algorithms, Support Vector Machine (SVM) and K-Nearest Neighbor (KNN), and 2 convolutional neural nets, ResNet-18 and GlaucomaNet, which was a custom-made deep learning network. All models were tested with 5-fold cross validation. MAIN OUTCOME MEASURES Area under the curve (AUC) statistics to assess diagnostic accuracy of each model compared with conventional average circumpapillary RNFL thickness. RESULTS All 4 models achieved similarly high diagnostic accuracies, with AUC values ranging from 0.91 to 0.92. These values were significantly higher than those for average circumpapillary RNFL thickness, which had an AUC of 0.76 in the same patient population. CONCLUSIONS Superior diagnostic performance was achieved with both conventional machine learning and convolutional neural net models compared with circumpapillary RNFL thickness. This supports the importance of the spatial structure of RNFL thickness map data in diagnosing glaucoma and further efforts to optimize our use of this data.
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Affiliation(s)
- Peiyu Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Jian Shen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California
| | - Ryuna Chang
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Maemae Moloney
- Department of Neuroscience, University of Southern California, Los Angeles, California
| | - Mina Torres
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
| | - Bruce Burkemper
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Damien Rodger
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
| | - Grace M Richter
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
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21
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Nelson AJ, Chang R, LeTran V, Vu B, Burkemper B, Chu Z, Fard A, Kashani A, Xu B, Wang R, Varma R, Richter GM. Ocular Determinants of Peripapillary Vessel Density in Healthy African Americans: The African American Eye Disease Study. Invest Ophthalmol Vis Sci 2019; 60:3368-3373. [PMID: 31917454 PMCID: PMC6681862 DOI: 10.1167/iovs.19-27035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose The African American (AA) population has unique ocular anatomic characteristics and a disproportionately high incidence of glaucoma, which is associated with lower peripapillary vessel density (VD). This study aimed to identify ocular determinants of peripapillary VD in healthy AAs. Methods This was a cross-sectional, population-based study of 1029 AAs, ages 40 and older. Participants underwent examination to obtain axial length (AL), IOP, central corneal thickness (CCT), mean retinal nerve fiber layer (RNFL) thickness, visual field mean deviation (MD), and 6 × 6-mm optical coherence tomography angiography scans of the optic nerve. Participants with glaucoma, vision-threatening diabetic retinopathy, or other relevant ocular disease were excluded. Prototype software was used to quantify VD. A multivariable regression model, controlling for age and signal strength, identified the ocular variables that predicted peripapillary VD. The contribution of each variable was assessed with the magnitude of standardized regression coefficients (SRC). Results Based on univariate regressions, AL, RNFL thickness, and MD had significant associations with peripapillary VD (all P < 0.001). In the final multivariate model, lower mean RNFL thickness (β = 0.0022, P < 0.001, SRC = 0.542) and longer AL (β = -0.0055, P < 0.001, SRC = -0.118) were associated with lower peripapillary VD, controlling for age and signal strength, with model R2 of 0.69. Conclusions Thinner RNFL and longer AL were the most influential ocular determinants of lower peripapillary perfusion in healthy AA eyes. Additional research is needed to clarify whether longer AL increases risk of glaucoma by affecting capillary perfusion.
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Affiliation(s)
- Andrew J. Nelson
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ryuna Chang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Vivian LeTran
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Brian Vu
- University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Bruce Burkemper
- Departments of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Washington, United States
| | - Ali Fard
- Carl Zeiss Meditec, Dublin, California, United States
| | - Amir Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Benjamin Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Washington, United States
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, United States
| | - Grace M. Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States
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22
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study. Transl Vis Sci Technol 2019; 8:5. [PMID: 30941263 PMCID: PMC6438105 DOI: 10.1167/tvst.8.2.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans. Methods Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists. Results Seven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants. Conclusions Gonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease. Translational Relevance AS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
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23
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Quantitative Evaluation of Gonioscopic and EyeCam Assessments of Angle Dimensions Using Anterior Segment Optical Coherence Tomography. Transl Vis Sci Technol 2018; 7:33. [PMID: 30619653 PMCID: PMC6314106 DOI: 10.1167/tvst.7.6.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the relationship between angle dimensions assessed by gonioscopy or EyeCam and anterior segment optical coherence tomography (AS-OCT). Methods Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES). Each subject underwent a complete ocular exam, including gonioscopy, AS-OCT, and EyeCam. Angle closure was defined as three or more quadrants in which pigmented trabecular meshwork could not be visualized. Angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA) were measured in each AS-OCT image. Results 709 eyes (272 angle closure, 437 open angle) from 709 subjects were analyzed. Mean gonioscopy and EyeCam grades tended to increase as AS-OCT measurements increased. There were strong correlations overall between AS-OCT measurements and gonioscopy (r > 0.73) and EyeCam (r > 0.68) grades. However, correlations with AS-OCT measurements were weak for gonioscopy (r < 0.38) and EyeCam (r < to 0.27) among eyes with angle closure. Mean AS-OCT measurements differed for eyes with Shaffer grade 0 in all four quadrants among eyes with varying degrees of angle closure on gonioscopy (P < 0.01) but did not differ among eyes with varying degrees of angle closure on EyeCam (P > 0.27). Conclusions Angle assessments by gonioscopy and EyeCam are weakly related to angle dimensions in eyes with angle closure. Translational Relevance AS-OCT imaging raises concerns about current clinical methods that rely on direct visualization of ACA structures to assess the degree of angle closure.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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24
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Richter GM, Chang R, Situ B, Chu Z, Burkemper B, Reznik A, Bedrood S, Kashani AH, Varma R, Wang RK. Diagnostic Performance of Macular Versus Peripapillary Vessel Parameters by Optical Coherence Tomography Angiography for Glaucoma. Transl Vis Sci Technol 2018; 7:21. [PMID: 30564510 PMCID: PMC6284470 DOI: 10.1167/tvst.7.6.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/16/2018] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare the diagnostic ability of the vessel parameters in macular and peripapillary regions measured using spectral-domain optical coherence tomography angiography (SD-OCTA) in differentiating primary open-angle glaucoma (POAG) from healthy eyes. METHODS POAG patients and healthy subjects underwent 6 × 6-mm scans centered on the macula and optic nerve head. Commercially available automatic segmentation created en face images from SD-OCTA of the superficial retinal layer (SRL) of the macular (m) and peripapillary (cp) regions. Vessel area density (VAD), vessel skeleton density (VSD), vessel complexity index (VCI), and flux were calculated. Area under curve (AUC) statistics controlled for age and intereye correlation. RESULTS Of 126 eyes from 79 patients who underwent SD-OCTA macula and peripapillary imaging, 50 eyes from 35 POAG patients and 37 healthy eyes from 25 control subjects had good quality imaging and were studied. Diagnostic accuracies of four perfusion parameters, VAD, VSD, VCI, and flux, were significantly greater in the peripapillary compared with the macular regions. For VAD, the cpAUC was 0.84 and mAUC was 0.73 (AUC difference: P = 0.026). For VSD, the cpAUC was 0.84 and mAUC was 0.72 (ΔP = 0.015). For VCI, the cpAUC was 0.80 and mAUC was 0.70 (ΔP = 0.045). For flux, the cpAUC = 0.87 and mAUC was 0.76 (ΔP = 0.0091). CONCLUSIONS Peripapillary perfusion parameters performed better than macular perfusion parameters for glaucoma diagnosis, supporting the idea that glaucomatous superficial retinal vascular changes are more pronounced in the peripapillary region. TRANSLATIONAL RELEVANCE The diagnostic accuracy of OCTA perfusion parameters of the superficial retinal microcirculation was greater for the peripapillary region than the macular region in the diagnosis of glaucoma.
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Affiliation(s)
- Grace M. Richter
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ryuna Chang
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Betty Situ
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Bruce Burkemper
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Alena Reznik
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Sahar Bedrood
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Amir H. Kashani
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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25
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Richter GM, Sylvester B, Chu Z, Burkemper B, Madi I, Chang R, Reznik A, Varma R, Wang RK. Peripapillary microvasculature in the retinal nerve fiber layer in glaucoma by optical coherence tomography angiography: focal structural and functional correlations and diagnostic performance. Clin Ophthalmol 2018; 12:2285-2296. [PMID: 30510397 PMCID: PMC6231432 DOI: 10.2147/opth.s179816] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To quantify peripapillary microvasculature within the retinal nerve fiber layer (RNFL) in primary open-angle glaucoma (POAG) and normal eyes, determine association of perfusion parameters with structural and functional measures, and report diagnostic accuracy of perfusion parameters. Patients and methods POAG and normal patients underwent 6×6 mm2 optic nerve head scans (Angioplex optical coherence tomography angiography [OCTA]; Cirrus HD-OCT 5000) and Humphrey Field Analyzer II-i 24-2 visual field (VF) testing. Prototype software performed semiautomatic segmentation to create RNFL en face images and quantified vessel area density (VAD), vessel skeleton density (VSD), and vessel complexity index (VCI) in the optic nerve head globally and focally. Generalized estimating equations models assessed association of OCTA parameters with VF mean deviation (MD) and RNFL thickness. Results Thirty-eight POAG and 17 normal eyes were studied. Global VAD, VSD, and VCI were reduced in mild POAG vs normal (P<0.02) and moderate-severe vs mild POAG (P<0.04). Stepwise focal reductions across disease stage were demonstrated for OCTA parameters in the inferior hemisphere (P<0.05); reduction in OCTA parameters in mild POAG vs normal was demonstrated in inferior and superior quadrants (P<0.05). Reduced global VF MD was associated with reduced VAD, VSD, and VCI (P=0.0007, 0.0013, <0.0001; R2=0.449, 0.312, 0.399, respectively), and global RNFL thickness was associated with VAD, VSD, and VCI (P<0.0001; R2=0.499, 0.524, 0.542), superior and inferior hemifield MD were associated with corresponding VAD, VSD, and VCI (P≤0.001; R2 from 0.208 to 0.513). RNFL thickness in all quadrants was associated with corresponding OCTA parameters (P<0.05; R2 from 0.213 to 0.394), except temporal VAD and VCI. Area under curves for VAD, VSD, and VCI demonstrated good diagnostic ability (0.868, 0.855, 0.868; P<0.0001). Conclusion Glaucomatous eyes showed stepwise reductions in RNFL microcirculation across severity; focal reductions in the inferior hemisphere and inferior and superior quadrants were most significant. OCTA parameters had stronger associations with structural rather than functional measures of glaucoma.
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Affiliation(s)
- Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Beau Sylvester
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ingy Madi
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ryuna Chang
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Alena Reznik
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Rohit Varma
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA,
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Chow A, Burkemper B, Varma R, Rodger DC, Rao N, Richter GM. Comparison of surgical outcomes of trabeculectomy, Ahmed shunt, and Baerveldt shunt in uveitic glaucoma. J Ophthalmic Inflamm Infect 2018; 8:9. [PMID: 29915970 PMCID: PMC6006003 DOI: 10.1186/s12348-018-0150-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/08/2018] [Indexed: 01/02/2023] Open
Abstract
Background Uveitis is defined as a collection of syndromes involving intraocular inflammation which can lead to pain, tissue damage, and vision loss. Ophthalmic surgery in uveitis patients can be challenging due to inflammation-induced fibrosis and scarring. Trabeculectomy and implantation of glaucoma drainage devices (aqueous shunts) have been used in surgical management of uveitic glaucoma, however there is a paucity of literature examining the comparative results of these entities in this unique setting. The purpose of this retrospective comparative study is to compare clinical outcomes of trabeculectomy with MMC, Ahmed shunt, and Baerveldt shunt surgery specifically in uveitic glaucoma. Results Median IOP, IOP reduction, glaucoma medication use, and visual acuity at 6- and 12-month follow-up were similar across groups. Postoperative hypotony rate was significantly different across trabeculectomy (53%), Baerveldt (24%), and Ahmed (18%) groups (p = 0.027); other complication rates were similar. Baerveldt eyes had a lower failure rate compared to trabeculectomy (p = 0.0054) and Ahmed (p = 0.0008) eyes. Conclusions While there was no difference in IOP reduction between trabeculectomy, Ahmed, and Baerveldt, Baerveldt eyes had the lowest failure rate.
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Affiliation(s)
- Audrey Chow
- Department of Ophthalmology, USC Roski Eye Institute, Keck Medicine of University of Southern California, 1450 San Pablo Street, Suite 4700, Los Angeles, CA, 90033, USA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck Medicine of University of Southern California, 1450 San Pablo Street, Suite 4700, Los Angeles, CA, 90033, USA
| | - Rohit Varma
- Department of Ophthalmology, USC Roski Eye Institute, Keck Medicine of University of Southern California, 1450 San Pablo Street, Suite 4700, Los Angeles, CA, 90033, USA
| | - Damien C Rodger
- Department of Ophthalmology, Kaiser Permanente Los Angeles Medical Center, 1515 N. Vermont Ave, 7th floor, Los Angeles, CA, 90027, USA
| | - Narsing Rao
- Department of Ophthalmology, USC Roski Eye Institute, Keck Medicine of University of Southern California, 1450 San Pablo Street, Suite 4700, Los Angeles, CA, 90033, USA
| | - Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck Medicine of University of Southern California, 1450 San Pablo Street, Suite 4700, Los Angeles, CA, 90033, USA.
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Richter GM. The Promise of Optical Coherence Tomography Angiography in Glaucoma. Ophthalmology 2018; 124:1577-1578. [PMID: 29055364 DOI: 10.1016/j.ophtha.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 07/26/2017] [Accepted: 08/07/2017] [Indexed: 11/24/2022] Open
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Sommer CM, Vollherbst DF, Richter GM, Kauczor HU, Pereira PL. [What can/should be treated in kidney tumors and when]. Radiologe 2017; 57:80-89. [PMID: 28130580 DOI: 10.1007/s00117-016-0202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE In the treatment of localized renal cell carcinoma, the lack of randomization in controlled trials on thermal ablation is a major limitation. The latter leads to significant study bias and it ultimately remains unclear whether the improved overall survival in favor of partial nephrectomy can actually be attributed to the treatment method. STANDARD RADIOLOGICAL METHODS For T1a (≤4 cm) renal cell carcinoma without lymph node and distant metastases, excellent technical and clinical results have been described after imaging-guided radiofrequency ablation and cryoablation. METHODICAL INNOVATIONS Low major complication rates, preservation of renal function and three-dimensional confirmation of negative ablation margins (A0 ablation) are the advantages of computed tomography (CT)-guided thermal ablation. PERFORMANCE According to the results of controlled (non-randomized) trials on T1a renal cell cancer, the cancer-specific survival rates are comparable between ablative and surgical techniques. ACHIEVEMENTS It is high time for prospective randomized controlled trials to define the actual value of percutaneous thermal ablation and partial nephrectomy in the treatment of T1a renal cell carcinoma. PRACTICAL RECOMMENDATIONS Apart from localized renal cell carcinoma, angiomyolipoma and oncocytoma can be treated by thermal ablation. Transarterial embolization extends the radiological spectrum for the treatment of renal tumors, either as complementary embolization (e. g. before thermal ablation of T1a and T1b renal cell carcinoma), prophylactic embolization (e. g. angiomyolipoma >6 cm), preoperative embolization (e. g. before laparoscopic partial nephrectomy) or palliative embolization (e. g. in patients with symptomatic macrohematuria due to renal cell carcinoma).
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Affiliation(s)
- C M Sommer
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. .,Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland.
| | - D F Vollherbst
- Abteilung Neuroradiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G M Richter
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland
| | - H U Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - P L Pereira
- Klinik für Radiologie, minimal-invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
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Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, Shi Y, Wang RK. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res 2017; 60:66-100. [PMID: 28760677 PMCID: PMC5600872 DOI: 10.1016/j.preteyeres.2017.07.002] [Citation(s) in RCA: 559] [Impact Index Per Article: 79.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
OCT has revolutionized the practice of ophthalmology over the past 10-20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA demonstrates many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.
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Affiliation(s)
- Amir H Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States.
| | - Chieh-Li Chen
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
| | - Jin K Gahm
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Fang Zheng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Ruikang K Wang
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
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Richter GM, Wang M, Jiang X, Wu S, Wang D, Torres M, Choudhury F, Varma R. Ocular Determinants of Refractive Error and Its Age- and Sex-Related Variations in the Chinese American Eye Study. JAMA Ophthalmol 2017; 135:724-732. [PMID: 28520882 DOI: 10.1001/jamaophthalmol.2017.1176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Uncorrected refractive error (RE) is a leading cause of visual impairment, and variations in ocular anatomy determine RE. The unique ocular determinants of RE in Chinese American individuals have not been studied previously. Objective To report ocular determinants of RE in a Chinese American population 50 years and older in Monterey Park, California. Design, Setting, and Participants The Chinese American Eye Study, a population-based, cross-sectional study, was conducted from February 1, 2010, through October 31, 2013, in Monterey Park, with this particular data analysis performed from January 1 through December 31, 2016. This study included data from 4582 participants who underwent an eye examination to obtain axial length (AL), central corneal thickness, vitreous chamber depth (VCD), anterior chamber depth (ACD), lens thickness (LT), corneal power (CP), noncycloplegic subjective refraction, and lens nuclear opalescence (NOP) grading. Data from the right phakic eye of each participant were used. Multiple regression models (standardized regression coefficients [SRCs] and semipartial correlation coefficients squared [SPCCs2]) identified key determinants of RE. Main Outcomes and Measures Ocular determinants of RE. Results Among the 4071 participants eligible for analysis (1496 men [36.7%] and 2575 women [63.3%]; mean [SD] age, 60.5 [8.1] years), mean (SD) RE was -0.52 (2.95) diopters (D), with no sex-related difference. A hyperopic shift occurred in women from -0.62 (2.95) D at 50 to 59 years to 0.60 (1.62) D at 80 years or older and in men from -0.69 (3.00) D at 50 to 59 years to 0.40 (2.29) D at 80 years or older (P < .001 for both). Compared with men, women had shorter AL (mean [SD], 23.62 [1.34] vs 24.14 [1.27] mm; P = .006), shorter ACD (mean [SD], 3.33 [0.34] vs 3.44 [0.34] mm; P < .001), and steeper CP (mean [SD], 43.50 [1.52] vs 42.88 [1.45] D; P = .02), after adjusting for age and height. No sex differences were found in VCD, LT, and NOP after height adjustment. Compared with younger individuals, older individuals had shallower ACD, thicker LT, and more NOP compared with younger individuals (P < .001 for both), even after adjustment for height. Axial length was the strongest determinant of RE (SRC = -0.92; SPCC2 = 0.55), followed by CP (SRC = -0.43; SPCC2 = 0.15). When individual components of AL were evaluated, VCD had the greatest contributing effect (SRC = -0.99; SPCC2 = 0.52), followed by CP (SRC = -0.47; SPCC2 = 0.15) and LT (SRC = -0.29; SPCC2 = 0.06). Conclusions and Relevance These data suggest that Chinese American individuals have longer AL and greater contribution of AL to RE than do Latino and other Chinese populations. Future studies should explore risk factors for increased AL in Chinese Americans and potential interventions that may ultimately prevent myopia-related disease.
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Affiliation(s)
- Grace M Richter
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Mingwu Wang
- Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson
| | - Xuejuan Jiang
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles3Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Shuang Wu
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Dandan Wang
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Mina Torres
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Farzana Choudhury
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Rohit Varma
- USC Gayle and Edward Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles
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Maus V, Kurz P, Sommer CM, Massmann A, Hatopp A, Erpenbach S, Thomas K, Saalmüller T, Meißner H, Hupp T, Richter GM. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm. ROFO-FORTSCHR RONTG 2016; 188:746-52. [PMID: 27388996 DOI: 10.1055/s-0042-105764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors' institution's experience. MATERIALS AND METHODS Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2 ± 5.4 months. RESULTS Eighteen iliac side branch devices were implanted with a branch patency of 100 % and a primary technical success rate of 94.4 % (n = 17). Perioperative 30 days mortality was 0 %. The mean diameter of treated abdominal aorta and common iliac artery was 41 ± 14 and 30 ± 8 mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15 %) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation. CONCLUSION Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm. KEY POINTS • Implantation of iliac side branch devices is a feasible technique.• Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm.• Carefully patient selection is necessary to avoid complications and re-interventions. Citation Format: • Maus V, Kurz P, Sommer CM et al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr Röntgenstr 2016; 188: 746 - 752.
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Affiliation(s)
- V Maus
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - P Kurz
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - C M Sommer
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - A Massmann
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - A Hatopp
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - S Erpenbach
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - K Thomas
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
| | - T Saalmüller
- Clinic of Vascular Surgery, Katharinenhospital Stuttgart, Germany
| | - H Meißner
- Clinic of Vascular Surgery, Katharinenhospital Stuttgart, Germany
| | - T Hupp
- Clinic of Vascular Surgery, Katharinenhospital Stuttgart, Germany
| | - G M Richter
- Clinic of Diagnostic and Interventional Radiology, Katharinenhospital Stuttgart, Germany
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Cerasuolo M, Richter GM, Richard B, Cunniff J, Girbau S, Shield I, Purdy S, Karp A. Development of a sink-source interaction model for the growth of short-rotation coppice willow and in silico exploration of genotype×environment effects. J Exp Bot 2016; 67:961-77. [PMID: 26663471 PMCID: PMC4737082 DOI: 10.1093/jxb/erv507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Identifying key performance traits is essential for elucidating crop growth processes and breeding. In Salix spp., genotypic diversity is being exploited to tailor new varieties to overcome environmental yield constraints. Process-based models can assist these efforts by identifying key parameters of yield formation for different genotype×environment (G×E) combinations. Here, four commercial willow varieties grown in contrasting environments (west and south-east UK) were intensively sampled for growth traits over two 2-year rotations. A sink-source interaction model was developed to parameterize the balance of source (carbon capture/mobilization) and sink formation (morphogenesis, carbon allocation) during growth. Global sensitivity analysis consistently identified day length for the onset of stem elongation as most important factor for yield formation, followed by various 'sink>source' controlling parameters. In coastal climates, the chilling control of budburst ranked higher compared with the more eastern climate. Sensitivity to drought, including canopy size and rooting depth, was potentially growth limiting in the south-east and west of the UK. Potential yields increased from the first to the second rotation, but less so for broad- than for narrow-leaved varieties (20 and 47%, respectively), which had established less well initially (-19%). The establishment was confounded by drought during the first rotation, affecting broad- more than narrow-leaved canopy phenotypes (-29%). The analysis emphasized quantum efficiency at low light intensity as key to assimilation; however, on average, sink parameters were more important than source parameters. The G×E pairings described with this new process model will help to identify parameters of sink-source control for future willow breeding.
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Affiliation(s)
- M Cerasuolo
- Sustainable Soils and Grassland Systems Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - G M Richter
- Sustainable Soils and Grassland Systems Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - B Richard
- Sustainable Soils and Grassland Systems Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - J Cunniff
- Agroecology Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - S Girbau
- Agroecology Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - I Shield
- Agroecology Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
| | - S Purdy
- Institute of Biological Environmental and Rural Sciences (IBERS), Aberystwyth University, Plas Gogerddan, Aberystwyth, Ceredigion SY23 3EE, UK
| | - A Karp
- Agroecology Department, Rothamsted Research, Harpenden, Herts AL5 2JQ, UK
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Abstract
Minimally invasive glaucoma surgery aims to provide a medication-sparing, conjunctival-sparing, ab interno approach to intraocular pressure reduction for patients with mild-to-moderate glaucoma that is safer than traditional incisional glaucoma surgery. The current approaches include: increasing trabecular outflow (Trabectome, iStent, Hydrus stent, gonioscopy-assisted transluminal trabeculotomy, excimer laser trabeculotomy); suprachoroidal shunts (Cypass micro-stent); reducing aqueous production (endocyclophotocoagulation); and subconjunctival filtration (XEN gel stent). The data on each surgical procedure for each of these approaches are reviewed in this article, patient selection pearls learned to date are discussed, and expectations for the future are examined.
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Affiliation(s)
- Grace M Richter
- UCLA Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA; USC Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Anne L Coleman
- UCLA Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA
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Sommer SA, Geissler R, Stampfl U, Wolf MB, Radeleff BA, Richter GM, Kauczor HU, Pereira PL, Sommer CM. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology. ROFO-FORTSCHR RONTG 2015; 188:353-8. [PMID: 26716403 DOI: 10.1055/s-0041-108198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology--with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. KEY POINTS •On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. •Regarding a physician's liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent. •Forensic practice shows that patients frequently enforce both offences concurrently.
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Affiliation(s)
- S A Sommer
- Kapp & Geissler Lawyers, Stuttgart, Germany
| | - R Geissler
- Kapp & Geissler Lawyers, Stuttgart, Germany
| | - U Stampfl
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - M B Wolf
- Radiology (E010), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B A Radeleff
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Germany
| | - H-U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - P L Pereira
- Radiology, Minimally-invasive Therapies and Nuclearmedicine, SLK Kliniken, Heilbronn, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
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Hupp T, Jost D, Kurz P, Richter GM. Endovaskuläre Therapie abdominelle Aorta - EVAR im OP. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hupp T, Jost D, Richter GM. Klinischer Einsatz operativer Therapieverfahren. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Richter GM, Torres M, Choudhury F, Azen SP, Varma R. Risk factors for cortical, nuclear, posterior subcapsular, and mixed lens opacities: the Los Angeles Latino Eye Study. Ophthalmology 2011; 119:547-54. [PMID: 22197433 DOI: 10.1016/j.ophtha.2011.09.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/22/2011] [Accepted: 09/02/2011] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To identify sociodemographic and biological risk factors associated with having cortical, nuclear, posterior subcapsular (PSC), and mixed lens opacities. DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 5945 Latinos aged ≥ 40 years from 6 census tracts in Los Angeles, California. METHODS Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity. MAIN OUTCOME MEASURES Odds ratios for sociodemographic and biological risk factors associated with cortical only, nuclear only, PSC only, and mixed lens opacities. RESULTS Of the 5945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities, and 364 had mixed lens opacities. Older age, higher hemoglobin A(1c), and history of diabetes mellitus were independent risk factors for cortical only lens opacities. Older age, smoking, and myopic refractive error were independent risk factors for nuclear only lens opacities. Higher systolic blood pressure and history of diabetes were independent risk factors for PSC lens opacities. Older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender, and presence of large drusen were independent risk factors for mixed lens opacities. CONCLUSIONS The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention, and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss.
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Affiliation(s)
- Grace M Richter
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
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Stampfl U, Hackert T, Radeleff B, Sommer CM, Stampfl S, Werner J, Büchler MW, Kauczor HU, Richter GM. Percutaneous management of postoperative bile leaks after upper gastrointestinal surgery. Cardiovasc Intervent Radiol 2011; 34:808-15. [PMID: 21301846 DOI: 10.1007/s00270-011-0104-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 09/20/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE This study was designed to investigate the benefit of percutaneous interventional management of patients with postoperative bile leak on clinical outcome. Primary study endpoints were closure of the bile leak and duration of percutaneous transhepatic biliary drainage (PTBD) treatment. Secondary study endpoints were necessity of additional CT-guided drainage catheter placement, course of serum CRP level as parameter for inflammation, and patients' survival. METHODS Between January 2004 and April 2008, all patients who underwent PTBD placement after upper gastrointestinal surgery were analyzed regarding site of bile leak and previous attempt of operative bile leak repair, interval between initial surgery and PTBD placement, procedural interventional management, course of inflammation parameters, duration of PTBD therapy, PTBD-related complications, and patients' survival. RESULTS Thirty patients underwent PTBD placement for treatment of postoperative bile leaks. In 12 patients (40%), PTBD was performed secondary to a surgical attempt of bile leak repair. Additional percutaneous drainage of bilomas was performed in 14 patients (47%). CRP serum level decreased from 138.1 ± 73.4 mg/l before PTBD placement to 43.5 ± 33.4 mg/l 30 days after PTBD placement. The mean duration of PTBD treatment was 55.2 ± 32.5 days in the surviving patients. In one patient, a delayed stenosis of the bile duct required balloon dilation. Two PTBD-related complications (portobiliary fistula, hepatic artery aneurysm) occurred, which were successfully treated by embolization. Overall survival was 73% (22 patients). CONCLUSIONS PTBD treatment is an effective therapy. PTBD treatment and additional CT-guided drainage of bilomas helped to reduce intraabdominal inflammation, as shown by reduction of inflammation parameters.
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Affiliation(s)
- U Stampfl
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Bauen AW, Dunnett AJ, Richter GM, Dailey AG, Aylott M, Casella E, Taylor G. Modelling supply and demand of bioenergy from short rotation coppice and Miscanthus in the UK. Bioresour Technol 2010; 101:8132-8143. [PMID: 20624602 DOI: 10.1016/j.biortech.2010.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 04/21/2010] [Accepted: 05/04/2010] [Indexed: 05/29/2023]
Abstract
Biomass from lignocellulosic energy crops can contribute to primary energy supply in the short term in heat and electricity applications and in the longer term in transport fuel applications. This paper estimates the optimal feedstock allocation of herbaceous and woody lignocellulosic energy crops for England and Wales based on empirical productivity models. Yield maps for Miscanthus, willow and poplar, constrained by climatic, soil and land use factors, are used to estimate the potential resource. An energy crop supply-cost curve is estimated based on the resource distribution and associated production costs. The spatial resource model is then used to inform the supply of biomass to geographically distributed demand centres, with co-firing plants used as an illustration. Finally, the potential contribution of energy crops to UK primary energy and renewable energy targets is discussed.
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Affiliation(s)
- A W Bauen
- Centre for Environmental Policy, Imperial College London, London SW7 2AZ, UK.
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Varma R, Richter GM, Torres M, Foong AWP, Choudhury F, Azen SP. Four-year incidence and progression of lens opacities: the Los Angeles Latino Eye Study. Am J Ophthalmol 2010; 149:728-34.e1-2. [PMID: 20181327 DOI: 10.1016/j.ajo.2009.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 11/04/2009] [Accepted: 11/05/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To estimate the 4-year incidence and progression of lens opacities. DESIGN Population-based longitudinal study. METHODS A total of 4658 adult Latinos from Los Angeles County were examined at baseline and 4-year follow-up. Examination included assessment of lens opacities using the Lens Opacities Classification System II (LOCS II). Incidences of cortical, nuclear, and posterior subcapsular opacities (with LOCS II scores >or=2) were defined as opacity development in persons without that opacity at baseline. Single and mixed opacities were defined in persons without any opacity at baseline. Incidence of all lens changes included development of at least 1 opacity or cataract surgery among those without any opacity at baseline. Four-year progressions were defined as increase of >or=2 in LOCS II score. RESULTS The 4-year incidence of all lens opacities was 14.2%. Four-year incidence of cataract surgery was 1.48%. The incidences were 4.1% for cortical-only, 5.8% for nuclear-only, 0.5% for PSC-only, and 2.5% for mixed. The incidences for any opacities were 7.5% for cortical, 10.2% for nuclear, and 2.5% for PSC. Incidence increased with age (P < .0001 for all). The progressions were 8.5% for cortical, 3.7% for nuclear, and 2.9% for PSC opacities. CONCLUSIONS Our Latino population had a higher incidence of nuclear than cortical opacities, but a greater progression of cortical than nuclear opacities. Incidence and progression of PSC was low. Additional understanding of the natural history and progression of various lens opacities will give us a better understanding of the pathogenesis and management of lens opacities.
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Affiliation(s)
- Rohit Varma
- Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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López-Benítez R, Barragán-Campos HM, Richter GM, Sauer P, Mehrabi A, Fonouni H, Golriz M, Schmidt J, Hallscheidt PJ. Interventional radiologic procedures in the treatment of complications after liver transplantation. Clin Transplant 2010; 23 Suppl 21:92-101. [PMID: 19930322 DOI: 10.1111/j.1399-0012.2009.01115.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study is to report our interventional radiologic procedures (IRP) in liver transplant (LTX) patients. These include procedures for biliary, arterial, venous, and portal complications, as well as the treatment of infected and non-infected fluid collections. This retrospective study covered 583 patients (mean age: 44 +/- 14 yr) in whom a total of 685 LTX were performed from August 1987 to April 2005. Overall, 182 LTX patients underwent a total of 428 IRP, including digital subtraction angiography (n = 152/35.51%), percutaneous transluminal angioplasty (PTA) (n = 4/0.93%) and PTA + stent (n = 7/1.63%) of arterial anastomosis, PTA + stent of the celiac trunk (n = 2/0.46%), transjugular intrahepatic portosystemic shunt (TIPS) (n = 2/0.46%), arterial lysis (n = 4/0.93%), venous lysis (n = 2/0.46%), inferior vena cava stenting (n = 2/0.46%), percutaneous biliary drainage (n = 34/7.94%), percutaneous transluminal dilatation (PTD) of the choledocho-enteric anastomosis (n = 16/3.73%), biliary stent (n = 5/1.16%), intrahepatic biliary flushing treatment, stone and cast biliary extraction (n = 27/6.30%), other interventions (e.g., embolization in other regions, transjugular liver biopsies, lymphangiographies) (n = 9/2.10%), and ultrasound- and computer tomography-guided biopsies and percutaneous drainage (n = 153/35.74%). The overall success rate was 85.7%. Technical improvements in LTX and interventional radiology permit vascular and biliary complications to be treated successfully by interventional radiology.
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Affiliation(s)
- R López-Benítez
- Department of Diagnostic Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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Schaefer AS, Richter GM, Nothnagel M, Laine ML, Rühling A, Schäfer C, Cordes N, Noack B, Folwaczny M, Glas J, Dörfer C, Dommisch H, Groessner-Schreiber B, Jepsen S, Loos BG, Schreiber S. A 3' UTR transition within DEFB1 is associated with chronic and aggressive periodontitis. Genes Immun 2009; 11:45-54. [PMID: 19829306 DOI: 10.1038/gene.2009.75] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Periodontal diseases are complex inflammatory diseases and affect up to 20% of the worldwide population. An unbalanced reaction of the immune system toward microbial pathogens is considered as the key factor in the development of periodontitis. Defensins have a strong antimicrobial function and are important contributors of the immune system toward maintaining health. Here, we present the first systematic association study of DEFB1. Using a haplotype-tagging single nucleotide polymorphism (SNP) approach, including described promoter SNPs of DEFB1, we investigated the associations of the selected variants in a large population (N=1337 cases and 2887 ethnically matched controls). The 3' untranslated region SNP, rs1047031, showed the most significant association signal for homozygous carriers of the rare A allele (P=0.002) with an increased genetic risk of 1.3 (95% confidence interval: 1.11-1.57). The association was consistent with the specific periodontitis forms: chronic periodontitis (odds ratio=2.2 (95% confidence interval: 1.16-4.35), P=0.02), and aggressive periodontitis (odds ratio=1.3 (95% confidence interval 1.04-1.68), P=0.02). Sequencing of regulatory and exonic regions of DEFB1 identified no other associated variant, pointing toward rs1047031 as likely being the causative variant. Prediction of microRNA targets identified a potential microRNA-binding site at the position of rs1047031.
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Affiliation(s)
- A S Schaefer
- Institute for Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Kiel, Germany.
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Richter GM, Chung J, Azen SP, Varma R. Prevalence of visually significant cataract and factors associated with unmet need for cataract surgery: Los Angeles Latino Eye Study. Ophthalmology 2009; 116:2327-35. [PMID: 19815276 DOI: 10.1016/j.ophtha.2009.05.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/10/2009] [Accepted: 05/29/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To estimate the prevalence of visually significant cataract in a US Latino population and to report predisposing, enabling, need, and health behavior characteristics associated with the unmet need for cataract surgery (UNCS). DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 6142 Latinos 40 years and older from 6 census tracts in Los Angeles County, California. METHODS Participants completed an in-home interview and a comprehensive eye examination that included assessment of lens opacification, using the slit lamp-based Lens Opacities Classification System II (LOCS II), and best-corrected visual acuity. Visually significant cataract was defined by any LOCS II grading >or=2, best-corrected visual acuity <20/40, cataract as the primary cause of vision impairment, and self-reported vision of fair or worse. Because cataract surgery is not needed in all persons, participants with a visually significant cataract or prior cataract surgery in at least 1 eye composed the at-risk cohort needing cataract surgery. Unmet need for cataract surgery was defined as any person in the at-risk cohort who had at least 1 eye with a visually significant cataract. Univariate and stepwise logistic regression analyses were used to identify predisposing, enabling, need, and health behavior characteristics associated with UNCS. MAIN OUTCOME MEASURES Prevalence of visually significant cataract and odds ratios (ORs) for factors associated with UNCS. RESULTS Of 6142 participants who completed the interview and clinical examination, 118 (1.92%) had visually significant cataract in at least 1 eye. Of the 344 participants who have needed cataract surgery, 118 (34.3%) had UNCS. Independent factors associated with UNCS included health behavior: having last eye examination >or=5 years ago compared with <1 year ago (OR, 3.76; 95% confidence interval [CI], 1.71-8.25), and enabling factors: being uninsured (OR, 2.79; CI, 1.30-5.19), income less than $20,000 (OR, 2.60; CI, 1.40-5.56), and self-reported barriers to eye care (OR, 2.41; CI, 1.14-5.13). CONCLUSIONS Latinos in our study had a substantial UNCS. Because Latinos with specific health behavior and enabling characteristics were more likely to have UNCS, interventions aimed at modifying these characteristics may be beneficial in reducing the unmet need and thus reducing the burden of visual impairment related to cataract in the United States.
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Affiliation(s)
- Grace M Richter
- Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
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Richter GM, Williams SL, Starren J, Flynn JT, Chiang MF. Telemedicine for retinopathy of prematurity diagnosis: evaluation and challenges. Surv Ophthalmol 2009; 54:671-85. [PMID: 19665742 DOI: 10.1016/j.survophthal.2009.02.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/13/2009] [Indexed: 10/20/2022]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder affecting low birth weight infants. Although timely diagnosis and treatment can significantly reduce the risk of severe complications, ROP remains a leading cause of childhood blindness worldwide. Limitations of current disease management strategies include extensive travel and logistical coordination requirements for ophthalmologists and neonatologists, decreasing availability of adequately trained ophthalmologists at the point of care, variability in how retinal findings are diagnosed and documented, and a growing need for ROP care worldwide. Store-and-forward telemedicine is an emerging technology by which medical data are captured for subsequent interpretation by a remote expert. This has potential to improve accessibility, quality, and cost of ROP management. In this article, we summarize the current evaluation data on applications of telemedicine for ROP, particularly involving the diagnostic accuracy and reliability of remote image interpretation by experts. We also address challenges such as the cost-effectiveness of telemedicine, and highlight potential barriers to implementation of these systems. Understanding these principles is essential to determine future directions in research and development of telemedicine systems for ROP, as well as for other ophthalmic diseases.
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Affiliation(s)
- Grace M Richter
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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Klauss M, Alt CD, Welzel T, Werner J, Buchler MW, Richter GM, Kauffmann GW, Kauczor HU, Grenacher L. Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy. Pancreatology 2009; 9:621-30. [PMID: 19657217 DOI: 10.1159/000212096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/07/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A prospective study to determine the value of multidetector CT (MD-CT) in assessing the course of nonresectable pancreatic carcinoma during therapy. MATERIAL AND METHODS 26 patients with nonresectable pancreatic carcinoma underwent MD-CT before and after therapy. The examinations were evaluated with regard to tumor size and vascular invasion using an invasion score (IS) by 2 radiologists independently (kappa analysis). Diagnosis was confirmed surgically, by biopsy or clinical course. RESULTS Sensitivity for the assessment of irresectability was 100%. Following therapy, 54% of all the tumors were smaller (14/26), 42% had increased in volume (11/26), and one tumor remained stable (1/26). The IS (veins) during follow-up changed in 26 patients (portal vein: 5 higher (mean score 10.4/16.2), 4 lower (mean score 17.5/11.5); superior mesenteric vein: 12 higher (11/14.4), 5 lower (16.2/14.6); p = 0.026). The IS (arteries) changed in 13 patients (celiac trunk: 3 higher (3.3/10); hepatic artery: 4 higher (5.7/10.2), 3 lower (11.6/10.3); superior mesenteric artery: 2 higher (4.5/9.5), 1 lower (12/11)). The kappa values were calculated between 0.56 and 0.87. CONCLUSION MD-CT is suitable for evaluating tumor spread during therapy for nonresectable pancreatic carcinoma. The IS is useful for assessing the degree of change in vessel invasion.
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Affiliation(s)
- M Klauss
- Department of Diagnostic Radiology, University of Heidelberg, Heidelberg, Germany.
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Richter GM, Sun G, Lee TC, Chan RP, Flynn JT, Starren J, Chiang MF. Speed of telemedicine vs ophthalmoscopy for retinopathy of prematurity diagnosis. Am J Ophthalmol 2009; 148:136-42.e2. [PMID: 19376496 PMCID: PMC2820880 DOI: 10.1016/j.ajo.2009.02.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the speed of retinopathy of prematurity (ROP) diagnosis using standard indirect ophthalmoscopy with that of telemedicine. DESIGN Prospective, comparative study. METHODS Three study examiners (2 pediatric retinal specialists [R.V.P.C., T.C.L.] and 1 pediatric ophthalmologist [M.F.C.]) conducted ROP diagnosis via standard indirect ophthalmoscopy and telemedicine. Each examiner performed: 1) standard ophthalmoscopy on 72 to 150 consecutive infants at his respective institution and 2) telemedical diagnosis on 125 consecutive deidentified retinal image sets from infants from an at-risk population. Time for ophthalmoscopic diagnosis was measured in 2 ways: 1) time spent by the examiner at the infant's bedside and 2) mean total time commitment per infant. Time for telemedicine diagnosis was recorded by computer time stamps in the web-based system. For each examiner, nonparametric statistical analysis (Mann-Whitney U test) was used to compare the distribution of times for examination by ophthalmoscopy vs telemedicine. RESULTS Mean (+/- standard deviation [SD]) times for ophthalmoscopic diagnosis ranged from 4.17 (+/- 1.34) minutes to 6.63 (+/- 2.28) minutes per infant. Mean (+/- SD) times for telemedicine diagnosis ranged from 1.02 (+/- 0.27) minutes to 1.75 (+/- 0.80) minutes per infant. Telemedicine was significantly faster than ophthalmoscopy (P < .0001). The total time commitment by ophthalmologists performing bedside ophthalmoscopy for ROP diagnosis, including travel and communication with families and hospital staff, was 10.08 (+/- 2.53) minutes to 14.42 (+/- 2.64) minutes per infant. CONCLUSIONS The ophthalmologist time requirement for telemedical ROP diagnosis is significantly less than that for ophthalmoscopic diagnosis. Additional time requirements associated with bedside ROP diagnosis increased this disparity. Telemedicine has potential to alleviate the time commitment for ophthalmologists who manage ROP.
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Affiliation(s)
- Grace M. Richter
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY
- Columbia University Mailman School of Public Health, New York, NY
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Thomas C. Lee
- The Vision Center, Childrens Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | - R.V. Paul Chan
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - John T. Flynn
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Justin Starren
- Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, WI
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Michael F. Chiang
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, NY
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Stampfl U, Radeleff B, Stampfl S, Sommer C, Lopez-Benitez R, Bellemann N, Thierjung H, Berger I, Kauczor HU, Richter GM. Myomembolisation mit Embozene™: 1 Jahres-Ergebnisse einer Single-Center Studie mit 121 Patientinnen. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stampfl U, Hackert T, Werner J, Stampfl S, Sommer C, Radeleff B, Kauczor HU, Richter GM. Diagnostik und interventionelle Therapie von Komplikationen nach Pankreaskopfresektion. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Radeleff B, Sommer CM, Stampfl U, Ramsauer S, Lopez-Benitez R, Kauczor HU, Richter GM. Interventionelle Therapie des akut blutenden Patienten. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Stampfl U, Radeleff B, Lopez-Benitez R, Sommer C, Stampfl S, Böckler D, Kauczor HU, Richter GM. Ischämische Komplikationen bei akuter Aortendissektion: interventionell-radiologische Therapie. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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