In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration

A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as 揳typical� osteoma caused by failure to identify their extrachoroidal location.

Validation of the surgical APGAR score among patients undergoing major surgery at the Chinese General Hospital

Objective: This study sought to validate Surgical APGAR Score in predicting major postoperative complications 30 days after surgery in our hospital setting. Methods: All patients undergoing major general surgery in Chinese General Hospital and Medical Center from March to October 2009 were enrolled. Three intraoperative variables were measured: estimated blood loss (EBL), lowest mean arterial pressure (LMAP) and lowest heart rate (LHR). Base on these three variables, Surgical APGAR Scores were obtained. Resulting data were analyzed and the relationship between the scores and the incidence of major complications evaluated. Results: Eighty patients were enrolled in this study. There was a significant association of incidence of major complications decreased monotonically. The optimum cutoff point was <= 6. At this cutoff point, sensitivity was 80%, specificity was 78.57%, positive predictive value was low at 34.8%, while negative predictive value was high at 96.5%. Conclusion: Results showed that a simple surgical score can be derived from intraoperative data alone that are readily available. It validated that this 10-point scoring system based on estimated blood loss (EBL), lowest mean arterial pressure (LAMP) and lowest heart rate (LHR) can predict group of patients at higher risk of major complications within 30 days of surgery. This system can be a significant tool for prognostification and clinical guide for early intervention of postoperative care in surgery. Key words: estimated blood loss, lowest mean arterial pressure