Stratifying indeterminate cytology thyroid nodules by combining Thyroid Imaging Reporting and Data Systems (TI-RADS) and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)

Objective@#To determine the risk of malignancy of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) indeterminate Thyroid Nodules (Bethesda III, IV and V) by combining cytologic (TSBRTC) and Thyroid Imaging Reporting and Data Systems (TI-RADS) ultrasonographic features based on final histopathology.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Private Training Hospital. Participants: 551 records. @*Results@#Among 81 eligible participants, 59 out of 84 nodules (70.24%) wer malignant on histopathology. The malignancy risk of Bethesda classification was 60.87% (28 out of 46) for Bethesda III, 57.14% (8 out of 14) for Bethesda IV and 95.83% for Bethesda V. The malignancy risk for TI-RADS categories was 0 % (0/1) for TI-RADS 2, 50% (10 out of 20) for TI-RADS 3, 71.05 % for TI-RADS 4 and 91.67 % for TI-RADS 5. The highest risk of malignancy (100%) was associated with [Bethesda IV/TI-RADS 1, 2, and 3], [Bethesda V/TI-RADS 1, 2 and 3 [Bethesda IV and V/TI-RADS 1, 2 and 3] and [Bethesda IV/TI-RADS 5]. The lowest risk of malignancy (33.33%) was associated with [Bethesda III/TI-RADS1, 2 and 3]. A high Bethesda classification (Bethesda V) was almost 5x more likely to have a malignant anatomorphology compared with Bethesda III (p = .05) while a TI-RADS 4 or 5 category was almost 5x more likely to have a malignant anatomorphology compared to TI-RADS 1, 2 or 3 (p = .026).@*Conclusion@#This study showed that TI-RADS scoring is a sensitive diagnostic classification in recognizing patients with thyroid cancer and combining Bethesda classification and TI-RADS scoring increases the sensitivity in the diagnosis of malignant thyroid nodules. A higher likelihood of malignancy is associated with higher Bethesda classification and TI-RADS scoring.

Comparison of the clinical profile of patients with glaucoma between private and government clinics in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.</p><p style="text-align: justify;"><strong>METHODS</strong>: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.</p><p style="text-align: justify;"><strong>RESULTS</strong>: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.</p><p style="text-align: justify;"><strong>CONCLUSION</strong>: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.</p>

Short wavelength automated perimetry and peripapillary retinal nerve fiber layer in early diabetes

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR). <br /><br /> <strong>METHODS:</strong> This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed. <br /><br /> <strong>RESULTS:</strong> There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000). <br /><br /> <strong>CONCLUSION:</strong> SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.</p>

Safety of Intracameral Moxifloxacin/Dexamethasone fixed-dose formulation on the Corneal Endothelium in a rabbit model

Objective@#To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin. @*Methods@#This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.@*Results@#In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation. @*Conclusion@#Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.

Safety of intracameral moxifloxacin/dexamethasone fixed-dose formulation on the corneal endothelium in a rabbit model

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.</p>

Current Clinical Status and Vascular Complications among Patients with Type 2 Diabetes Mellitus at Tertiary Hospitals in Malaysia.

Objective: To assess the prevalence of diabetic vascular complications and cardiovascular risk factors control in type 2 diabetic patients at tertiary settings. Methods: This cross-sectional study was conducted among 313 patients diagnosed with type 2 diabetes mellitus (T2DM) at two tertiary referral hospitals in Malaysia. Data regarding socio-demographics, macro- and microvascular complications, family health history, blood pressure, anthropometric indices, glycaemic control, and lipid profile were obtained from medical records, face-to-face interview and physical examination. Results: The mean age of patients was 55.7±9.2 years, mean diabetes duration was 10.1±8.1 years, and 52.1% were females. Approximately 36.1% patients had cardiovascular disease (CVD). There were high prevalence of established coronary artery disease (30.7%), cerebrovascular disease (10.2%), and peripheral vascular disease (5.1%). Peripheral neuropathy, diabetic nephropathy and retinopathy were present in 41.5%, 17.6% and 15.0% patients respectively. Only 14.1% of the patients reached optimal HbA1c level and 21.1% patients achieved target fasting plasma glucose. The overall prevalence of dyslipidemia was 89.1%, hypertension was 80.2%, and obesity was 35.9% (BMI) and 86.5% (waist-to-hip ratio). Conclusions: Diabetic vascular complications were highly prevalent among the type 2 diabetic patients. Cardiovascular risk factors control was suboptimal. Both awareness and application of recommended guidelines need to be reinforced.

The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus

<p><b>INTRODUCTION</b>The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients.</p><p><b>METHODS</b>This study was an analytical cross-sectional study involving 313 patients aged 30-78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients' sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument - a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure.</p><p><b>RESULTS</b>T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their nonCVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898-28.167). Age (OR 1.095, 95% CI 1.054-1.137), duration of T2DM (OR 1.085, 95% CI 1.032-1.140), ethnicity (OR 0.411, 95% CI 0.187-0.903), body mass index (OR 1.074, 95% CI 1.006-1.148), and physical activity level (OR 3.506, 95% CI 1.415-8.689) were also significant predictors of HRQoL.</p><p><b>CONCLUSION</b>In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.</p>

Comparison of the in-vitro effects of bevacizumab, mitomycin-C, 5-fluorouracil,and triamcinolone acetonide on the viability of cultured human tenon's fibroblasts

@#<p style="text-align: justify;"><strong>Objective:</strong> To evaluate and compare the effects of bevacizumab, mitoinycin-C (MMC), 5-fluorouracil (5-FU), and triamcinolone acetonide (TA) on the viability of cultured human Tenon's capsule fibroblasts (cHTF) in vitro.</p> <p style="text-align: justify;"><strong>Methods:</strong> Human Tenon's fibroblasts (HTF) were harvested and cultured in a Roswell-Park-Memorial 1-Institute (RPMI) media. MMC, 5-FU, bevaciz. umab, and TA were administered to the cHTF at 3-fold decreasing concentrations starting from 20 ug, 5 mg, 25 mg, and 4 mg respectively. A negative control/untreated group containing RPMI media only was included in the study. Fibroblast cell viability was assessed using resazurin fluorim etric assay. Half¬maximal inhibitory concentration (IC50) was computed for agents which showed significant decrease in cHTF viability compared to the untreated group.</p> <p style="text-align: justify;"><strong>Results:</strong> There was no significant difference in cH IF viability between the untreated control group compared to 5-FU (p=0.97), bevacizumab (p=0.10), and TA (p=0.06) groups. Mitomycin-C showed a significant decrease in cHTF viability (p<0.001) which was dose dependent. The IC50 of MMC was computed at 12.16 ug using the prism software.</p> <p style="text-align: justify;"><strong>Conclusion:</strong> Mitomycin-C demonstrated dose-dependent decrease in viability of cultured human Tenon's fibroblasts. 5-FU, bevacizumab, and triamcinolone did not show this effect.</p> <p style="text-align: justify;"><strong>Key Words:</strong> Mitomycin-C, 5-fluorouracil, Bevaciz. umab, Tria. mcinolone acetonide, Fibroblast, Trabeculectomy</p>

Correlation between average retinal nerve fiber layer thickness and rim area of the spectral-domain OCT with the Humphrey visual field index in eyes with glaucoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the correlation between the average retinal nerve fiber layer (RNFL) thickness and optic nerve head rim area (RA) measured with a spectral-domain optical coherence tomography (OCT) with the visual field index (VFI) using the Humphrey Visual Field Analyzer in glaucoma patients.<br /><strong>METHODS:</strong> Eighty-five consecutive patients diagnosed with glaucoma underwent spectral-domain OCT of the optic disc and Humphrey perimetry. A glaucoma specialist confirmed the presence of glaucomatous optic neuropathy based on findings in the optic nerve head photographs, OCT measurements of the RNFL and optic disc, and standard automated perimetry. The correlation of the average RNFL thickness and rim area with the VFI was determined using the Spearman's correlation coefficient analysis.<br /><strong>RESULTS:</strong> A total of 121 glaucomatous eyes of 85 patients were included in the study. There were 47 males and 38 females, ages ranging from 12 to 94 years. The average RNFL thickness, RA, and VFI were 67.9 ± 12.3 ?m, 0.65 ± 0.3 mm2, and 56 ± 32%, respectively. The average RNFL thickness (r = 0.35) showed a stronger positive correlation with VFI than RA (r = 0.15), but the difference was not statistically significant.<br /><strong>CONCLUSION:</strong> The average RNFL thickness and rim area of the spectral-domain OCT demonstrated a positive correlation with the VFI of the Humphrey Visual Field Analyzer. The OCT parameters, exemplified by average RNFL and RA, were not good indicators for VFI.</p>

Correlation of average RNFL thickness using the STRATUS OCT with the perimetric staging of glaucoma

Objective@#To determine the correlation between average peripapillary retinal nerve fiber layer (RNFL) thickness measured with time domain optical coherence tomography (TD-OCT) in normal and glaucoma eyes. @*Methods@#This was a cross-sectional study of 281 eyes randomly selected from a previous study. Assessment of glaucomatous damage was done by glaucoma specialists who based their diagnosis on the visual field tests and optic disc photos, independent of OCT results. Eyes were classified into the following groups: normal, mild, moderate, or severe glaucoma. Severity of glaucoma was based on visual field abnormalities following a modified HodappAnderson-Parish criteria for staging. Average RNFL thickness of normal and glaucoma subgroups, as measured with STRATUS–OCT, were analyzed using single ANOVA test. Association between average RNFL thickness and severity of glaucomatous visual field loss was evaluated using the Pearson’s correlation coefficient analysis. @*Results@#183 eyes had no glaucoma; 27 had mild, 32 had moderate, and 39 had severe glaucoma. Mean average peripapillary RNFL thickness (μm) in the normal, mild, moderate, and severe glaucoma groups were 98.05(±13.46), 76.27(±11.79), 76.42(±16.01), and 56.17(±14.92) respectively. Significant differences were seen in the average RNFL thickness among the groups (P<0.05), except in eyes with mild to moderate glaucoma. A moderately strong correlation of -0.57 (P<0.05) was observed between average RNFL thickness and the stage of glaucoma. @*Conclusion@#TD-OCT showed moderately strong correlation between the average RNFL thickness and perimetric stages of glaucoma. Average RNFL thickness is a good parameter to discriminate normal from glaucoma eyes.

Diagnostic accuracy of the optical coherence tomography in assessing glaucoma among Filipinos. Part 2: Optic nerve head and retinal nerve fiber layer parameters

Objective@#To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in the diagnosis of glaucoma and to determine the validity of these measurements. @*Methods@#Glaucoma suspects undergoing glaucoma diagnostic tests were recruited consecutively. The numerical results of the Stratus OCT fast optic disc and fast RNFL protocols were analyzed against an independent assessment by glaucoma experts who were blinded as to the results of the OCT. An ROC curve analysis was applied to derive estimates of diagnostic accuracy and multi-level likelihood ratios.@*Results@#A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included. All ONH and RNFL OCT parameters showed statistically significant differences in mean values between the 2 groups. The ROC curve identified the vertical integrated rim area (AUC: 0.822), the cup-disc area ratio (AUC: 0.816), and the horizontal integrated rim width (AUC: 0.794) as the best optic disc parameters; and the RNFL average thickness (AUC: 0.827), the superior quadrant (AUC: 0.807), and the inferior quadrant (AUC: 0.804) as the best RNFL parameters. Multi-level likelihood ratios for ONH and RNFL parameters were calibrated using a projected posttest probability of 70% for a positive test result (therapeutic threshold) and a 10% posttest probability for a negative result (diagnostic threshold). @*Conclusion@#The results showed that statistically significant mean differences in ONH and RNFL parameters did not translate into a high predictive ability for each individual parameter. Single cut-off value for each OCT parameter based on the best sensitivity and specificity combination did not result in high predictive values for any single parameter. Multi-level likelihood ratios for the best ONH and RNFL parameters were derived to increase the diagnostic capability of the Stratus OCT.

Diagnostic accuracy of the optical coherence tomography in assessing glaucoma among Filipinos. Part 1: Categorical outcomes­ based on a normative database

Objective@#To determine the accuracy of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) parameters using the Stratus OCT in diagnosing glaucoma among Filipino patients and to determine the validity of the OCT measurements compared with a reference standard. @*Methods@#Glaucoma suspects were recruited consecutively from patients undergoing diagnostic tests. The results of the Stratus OCT fast RNFL protocol were analyzed against the independent assessment by glaucoma experts who were blinded. Outcomes included RNFL thickness values of ≤5 percentile and ≤1 percentile of the normative database for each RNFL sector, quadrant, and for the average RNFL thickness. Estimates of diagnostic accuracy with 95% confidence intervals were calculated.@*Results@#A total of 119 subjects assessed as glaucoma and 397 subjects assessed as normal were included in the analysis. Using the best categorical criterion for abnormality (average RNFL thickness of ≤1 percentile of the normative database), the OCT had a specificity of 98% (95% CI 96 - 99) and a sensitivity of 37% (95% CI 28 - 46). The criterion with the highest sensitivity was the presence of at least one sector with thickness at ≤5 percentile. @*Conclusion@#The Stratus OCT demonstrated a specificity of 98% and a sensitivity of 37% for the diagnosis of glaucoma using as a criterion an average RNFL thickness of ≤1 percentile of the normative database. It was a poor screening test for glaucoma suspects, although it showed some promise as a confirmatory test.

Tuberculous abscess of the thyroid / Journal of the ASEAN Federation of Endocrine Societies

Tuberculosis (TB) of the thyroid gland is rare, with acute abscess formation being the least common form of presentation. As such, TB of the thyroid may be overlooked as an initial clinical impression. A careful approach by history, physical examination, laboratory testing and radiologic imaging may aid in defining the etiology of the thyroid abscess, but these remain nonspecific. An accurate diagnosis may only be made by histologic examination. We present a case of a tuberculous abscess of the thyroid gland in a 37-year-old female. TB of the thyroid should also be considered when evaluating patients presenting with a painful thyroid nodule.

Effect of brimonidine on anterior-chamber angle in patients with narrow angles

Objective@#This study investigated the effect of brimonidine on the anterior-chamber angle in eyes with narrow angles using noncontact three-dimensional anterior-segment analyzer Pentacam.@*Methods@#Nine eyes with narrow angles were distributed to one of three treatment groups—single topical dose of 0.15% brimonidine tartrate, 0.5% timolol maleate (positive control), or balanced salt solution (negative control)—in a prospective, single-masked, crossover, comparative trial. The primary outcome measure was anterior-chamber angle at baseline, and 2 and 4 hours after instillation of the treatment drug. Secondary outcome measures were pupil diameter, intraocular pressure (IOP), and anterior-chamber depth and volume. After a two-week washout period, eyes were crossed over to the other treatment modes. All baseline and posttreatment measurements were taken. Repeated analysis of variance (ANOVA) was used for statistical analysis.@*Results@#Anterior-chamber angle, depth, and volume did not differ significantly for all treatment groups. Brimonidine caused a significant decrease in pupil diameter, most notably 2 hours after instillation, from baseline of 2.36 ± 0.37 mm to 2.17 ± 0.35 mm. (p = 0.03). There was a significant decrease in IOP from baseline to hour 4 after treatment for both brimonidine (11.4 ± 2.2 to 9 ± 1.8 mm Hg, p < 0.001) and timolol (11.9 ± 2.3 to 9.4 ± 2.1 mm Hg, p = 0.003).@*Conclusions@#Brimonidine produced a miotic trend with no significant opening of the anterior-chamber angle in patients with narrow angles.

Understanding structure and function in glaucoma

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.

Biphasic tricalcium phosphate spheres with muscle resection in primary enucleation

Purpose: To combine the advantage of porosity and biocompatibility of Biphasic Tricalcium Phosphate implant with Muscle Resection Methodology: Non-randomized, uncontrolled clinical case series Results: No migration or extrusion was observed. With improved muscle resection, socket and prosthesis mobility were noted. (Author)