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.
Both standard and bolus PDT induce regression of symptomatic CCH. Bolus PDT may cause RPE and retinal changes associated with reduced retinal sensitivity.
Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.
Objectives: The British Association of Dermatologists Biologic Interventions Register (BADBIR) is a long-term pharmacovigilance register of patients with psoriasis treated with biologic therapies. The objectives were to describe patterns of use of index biologics for biologic-naïve psoriasis patients in BADBIR by: (i) country; and (ii) comorbid psoriatic arthritis (PsA). MethOds: 7495 patients receiving biologics were recruited from 153 dermatology centres across the United Kingdom and the Republic of Ireland (ROI). Registrations from 01/09/2007 (cohort inception) to 01/01/2016 were included. Patients receiving their first biologic therapy (infliximab, etanercept, adalimumab or ustekinumab) were classified as "biologic-naïve" at registration. Proportions of registrations to each therapy by country and PsA were examined. Results: 6140 biologic-naïve patients (82%) registered to BADBIR (median age 45 years, inter-quartile range 36-54; 60% male). Adalimumab (57%) was the most common index biologic (23% etanercept; 18% ustekinumab; 2% infliximab). 76% registrations were in England (9% Scotland; 5% Northern Ireland (NI); 5% ROI; 5% Wales). Adalimumab registrations were highest (73%) in NI (56% England; 48% ROI; 69% Scotland; 46% Wales); etanercept accounted for 46% registrations in ROI (22% England; 15% NI; 21% Scotland; 34% Wales); ustekinumab registrations were highest (20%) in England (11% NI; 6% ROI; 9% Scotland; 18% Wales). PsA was recorded as a comorbidity in 18% of patients at registration. For patients with concomitant PsA, 62% were commenced on adalimumab (25% etanercept; 10% ustekinumab). From 2009 to 2015, registrations for patients with concomitant PsA to ustekinumab and adalimumab increased (4% to 30% and 51% to 61%, respectively), while etanercept registrations decreased (42% to 9%). cOnclusiOns: Adalimumab was the most commonly prescribed index biologic drug across the United Kingdom and ROI. The availability of biologics has influenced prescribing practices. Future work will explore the influence of guidelines for biologic use on prescribing patterns.
This paper reports a case of late vitreomacular traction in a young patient secondary to toxoplasma retinochoroiditis resolved by vitrectomy. A 17-year-old female with chronic inflammatory bowel disease developed severe vitreomacular traction 8 months after resolution of ocular toxoplasmosis with medical therapy. Best-corrected visual acuity, full ophthalmic slit-lamp examination, colour fundus photography, spectral domain optical coherence tomography, and fluorescein angiography were performed. The patient underwent vitrectomy with removal of the clinically evident posterior hyaloid. Vitrectomy was rapidly successful in resolving the vitreomacular traction, with full recovery in best-corrected visual acuity of 20/20. Vitreoretinal traction in patients with previous toxoplasma retinochoroiditis may appear several months after resolution of the inflammatory condition. We suggest observing carefully for possible development of late vitreoretinal traction during follow-up of such patients.
Modified (enlarged) enucleation via lateral orbitotomy for selectd choroidal melanomas with massive, circumscribed perioptic/posterior extrascleral extension allows complete tumor removal and placement of an orbital implant, avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.
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