Purpose
To evaluate the performance of ganglion cell/inner plexiform layer (GC/IPL) measurements with spectral-domain optical coherence tomography (Cirrus HD-OCT) for detection of early glaucoma and to compare results to retinal nerve fiber layer (RNFL) measurements.
Design
Cross-sectional prospective diagnostic study.
Methods
Fifty-nine glaucoma eyes (47 subjects) (mean deviation >–6.0dB) and 91 normal eyes (52 subjects) were enrolled. Patients underwent biometry and peripapillary and macular OCT imaging. Performance of the GC/IPL and RNFL algorithms was evaluated with area under receiver operating characteristic curves (AUC), likelihood ratios, and sensitivities/specificities adjusting for covariates. Combination of best parameters was explored.
Results
Average (SD) mean deviation in the glaucoma group was –2.5 (1.9) dB. On multivariate analyses, age (p<0.001) and axial length (p=0.03) predicted GC/IPL measurements in normal subjects. No significant correlation was found between average or regional GC/IPL thickness and respective outer retina (OR) thickness measurements (p>0.05). Average RNFL thickness performed better than average GC/IPL measurements for detection of glaucoma (AUC=0.964 vs. 0.937; p=0.04). The best regional measures from each algorithm (inferior quadrant RNFL vs. minimum GC/IPL) had comparable performances (p=0.78). Entering GCIPL/OR ratio into prediction models did not enhance performance of the GC/IPL measures. Combining the best parameters from each algorithm improved detection of glaucoma (p=0.04).
Conclusions
Regional GC/IPL measures derived from Cirrus HD-OCT performed as well as regional RNFL outcomes for detection of early glaucoma. Using GCIPL/OR ratio did not enhance the performance of GC/IPL parameters. Combining the best measures from the two algorithms improved detection of glaucoma.
Correction of RNFL measurements for ocular magnification did not improve prediction limits in normal subjects or enhance the performance of SD-OCT in this group of eyes in which the axial length did not deviate significantly from average values. The cross-sectional area of the RNFL was not related to the optic disc area.
Of all the spontaneous fistulas that occur between the extrahepatic biliary system and the intestine, a choledochoduodenal fistula is rarely seen. When it does occur, it is most often secondary to a perforated duodenal ulcer, choledocholithiasis, or cholelithiasis. It may also be seen following complications related to iatrogenic injury or tuberculosis. Generally, choledochoduodenal fistulas are asymptomatic, but may present with vague abdominal pain, fever, and other symptoms related to cholangitis. As a result, they can be difficult to diagnose clinically before imaging is obtained. We present a case of a 74 year old, asymptomatic, female with a past medical history significant for Crohn's disease who was found to have a choledochoduodenal fistula demonstrated on MRCP, possibly secondary to her underlying inflammatory bowel disease.
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