Micropulse diode laser seems to be as effective as modified Early Treatment Diabetic Retinopathy Study laser photocoagulation in the treatment of clinically significant diabetic macular edema. Micropulse diode laser treatment does not determine any change on FAF showing (at least) nonclinically visible damage of the retinal pigment epithelium. Microperimetry data encourage the use of a new, less aggressive laser therapeutic approach in the treatment of clinically significant diabetic macular edema.
Abstract.Purpose: To determine the validity of scanning laser ophthalmoscopy in the retromode (RM‐SLO) versus other imaging modalities in the diagnosis of diabetic macular oedema (DME).Methods: Two hundred and sixty‐three eyes were examined. Inclusion criteria were any stage of untreated or treated diabetic retinopathy and four imaging modalities of the macula carried out on the same day: time domain optical coherence tomography (OCT), fundus autofluorescence (FAF), RM‐SLO and fluorescein angiography (FA). Two masked retinal specialists independently graded all images. Agreement between RM‐SLO and OCT, FA and FAF in evaluating the presence and patterns of DME was evaluated by kappa statistics, sensitivity, specificity, observed proportional agreement, and proportional agreement in positive and negative cases.Results: The agreement in evaluating the presence/absence of DME between RM‐SLO and OCT, FA and FAF was good: κ = 0.73 (confidence interval; CI, 0.64–0.83), κ = 0.71 (CI, 0.61–0.81) and κ = 0.73 (CI, 0.63–0.83), respectively. The agreement in evaluating cystoid pattern of DME was almost perfect between RM‐SLO and OCT, RM‐SLO and FA, κ > 0.8; and good between RM‐SLO and FAF, κ > 0.7. The agreement in evaluating the presence/absence of subfoveal neuroretinal was almost perfect between RM‐SLO and OCT (κ = 0.83; 95% CI, 0.70–0.96). Subfoveal neuroretinal detachment did not show any specific pattern on FA or FAF. Sensitivity and specificity of RM‐SLO in evaluating DME was 97.7% and 71.9% versus OCT, 97.4% and 68.1% versus FA and 96.1% and 73.3% versus FAF. Retinal thickness of 233 μm represented the cut‐off value to define DME by RM‐SLO.Conclusions: The combined use of non‐invasive imaging techniques can improve the diagnostic interpretation of different aspects of DME.
Microperimetry shows that fixation location and stability in patients with diabetic macular edema are independent of edema characteristics, except when subfoveal hard exudates are present. Location of pseudofovea may influence treatment strategy.
Objective: To investigate the influence of the inverted flap technique compared with traditional internal limiting membrane (ILM) peeling in the postoperative remodelling of outer retinal layers of idiopathic macular holes (MHs) > 450 µm. Methods: We analyzed medical records and imaging studies of all patients with an idiopathic MH > 450 µm who underwent vitrectomy at the
The NF-kB family of transcription factors is up-regulated in inflammation and different cancers. Recent data described heterozygous deletions of the NF-kB Inhibitor alpha gene (NFKBIA) in about 20% of glioblastomas (GBM): deletions were mutually exclusive with epidermal growth factor receptor (EGFR) amplification, a frequent event in GBM. We assessed the status of NFKBIA and EGFR in 69 primary GBMs and in corresponding neurospheres (NS). NFKBIA deletion was investigated by the copy number variation assay (CNV); EGFR amplification by CNV ratio with HGF; expression of EGFR and EGFRvIII by quantitative PCR or ReverseTranscriptase PCR. Heterozygous deletions of NFKBIA were present in 3 of 69 primary GBMs and, surprisingly, in 30 of 69 NS. EGFR amplification was detected in 36 GBMs: in corresponding NS, amplification was lost in 13 cases and reduced in 23 (10 vs 47 folds in NS vs primary tumors; p < 0.001). The CNV assay was validated investigating HPRT1 on chromosome X in females and males. Results of array-CGH performed on 3 primary GBMs and 1 NS line were compatible with the CNV assay. NS cells with NFKBIA deletion had increased nuclear activity of p65 (RelA) and increased expression of the NF-kB target IL-6. In absence of EGF in the medium, EGFR amplification was more conserved and NFKBIA deletion less frequent point to a low frequency of NFKBIA deletions in GBM and suggest that EGF in the culture medium of NS may affect frequency not only of EGFR amplifications but also of NFKBIA deletions.
The PowerRefractor is accurate, but not as precise for measuring refractive error as compared to the Canon R-50 autorefractor, especially for high hyperopia.
Purpose Clinically significant diabetic macular edema (CSME) shows variable retinal structural and functional impairment. The aim of this study was to assess the correlation between different macular parameters, mainly fundus autofluorescence (FAF) and macular sensitivity, in diabetics with CSME.
Methods Sixty diabetic patients with untreated CSME (104 eyes) underwent: best corrected visual acuity determination (BCVA, logMAR), slit lamp biomicroscopy, fluorescein angiography, OCT, FAF and microperimetry.
Results Thirty eyes had normal FAF , whereas 74 increased (IFAF) pattern. Retinal sensitivity over areas with IFAF was significantly lower than over areas with normal FAF (p<0.001). Cystoid OCT‐pattern correlated to both presence and dimension of IFAF (p<0.05), whereas sponge‐like and subfoveal neuroretinal detachment did not. BCVA did not correlate either to FAF pattern or area of IFAF.
Conclusion Functional impact of CSME correlate with IFAF and is better determined with macular microperimetry rather than VA. Increased FAF seems to be a relevant characteristic of cystoid CSME. New structural and functional parameters should be used to better predict the prognosis of (treated and untreated) eyes affected by CSME.
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