Background
Optic nerve head drusen (ONHD) are calcific deposits buried or at the surface of the optic disc. Although ONHD may be associated with progressive visual field defects, the mechanism of drusen-related field loss is poorly understood. Methods for detecting and imaging disc drusen include B-scan ultrasonography, fundus autofluorescence, and optical coherence tomography (OCT). These modalities are useful for drusen detection but are limited by low resolution or poor penetration of deep structures. This review was designed to assess the potential role of new OCT technologies in imaging ONHD.
Evidence Acquisition
Critical appraisal of published literature and comparison of new imaging devices to established technology.
Results
The new imaging modalities of enhanced depth imaging optical coherence tomography (EDI-OCT) and swept source optical coherence tomography (SS-OCT) are able to provide unprecedented in vivo detail of ONHD. Using these devices it is now possible to quantify optic disc drusen dimensions and assess integrity of neighboring retinal structures, including the retinal nerve fiber layer.
Conclusions
EDI-OCT and SS-OCT have the potential to allow better detection of longitudinal changes in drusen and neural retina and improve our understanding of drusen-related visual field loss.
Purpose
To evaluate and compare the diagnostic accuracy of the global and sector analyses for detection of early visual field damage using the retinal nerve fiber layer (RNFL) reference databases of the Spectralis and Cirrus spectral-domain optical coherence tomography (SD-OCT) devices.
Methods
Healthy subjects and glaucoma suspects from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) with at least 2 years of follow-up were included. Global and sectoral RNFL measures were classified as within normal limits, borderline and outside normal limits based on the device reference databases. The sensitivity of outside normal limits classification was estimated in glaucoma suspect eyes that developed repeatable visual field (VF) damage.
Results
353 glaucoma suspect eyes and 279 healthy eyes were included. 34 (9.6%) of glaucoma suspect eyes developed VF damage. In glaucoma suspect eyes, Spectralis and Cirrus outside normal limits classification was present in 47 eyes (13.3%) and 24 eyes (6.8%), respectively. The sensitivity of the global RNFL outside normal limits classification among eyes that developed VF damage was 23.5% for Cirrus and 32.4% for Spectralis. The specificity of within normal limits global classification in healthy eyes was 100% for Cirrus and 99.6% for Spectralis. There was moderate to substantial agreement between Cirrus and Spectralis classification as outside normal limits.
Conclusions
The Spectralis and Cirrus reference databases have a high specificity for identifying healthy eyes, and good agreement for detection of eyes with early glaucoma damage.
Breast masses frequently present after autologous reconstruction. Fat necrosis is the most common cause. Recurrent carcinoma can occur in the reconstructed breast and presents later. A higher index of suspicion for recurrence should accompany any mass in which prior lymphovascular invasion was present or if original margins were <1 cm. Radiographic imaging accurately identifies the cause of these masses.
This article summarizes the initial management of acute burn injuries to the hand, in addition to treatment and reconstructive options. The goal of treatment for a burn injury to the hand is primarily a functional hand. This is best achieved by appropriate early treatment, the right selection from a wide range of possible reconstructive procedures, and focused occupational hand therapy.
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