ABSTRACT
Objective To analyze the diagnostic value of multicolor scanning laser imaging (confocal scanning laser ophthalmoscopy, cSLO) combined with swept-source optical coherence tomography (SS-OCT) for lacquer cracks (LC) and myopia stretch lines (MSL) of pathological myopia.Methods A observational study. A total of 83 eyes of 58 patients with pathological myopia were recruited from May 2017 to January 2018 in Department of Ophthalmology of The First People's Hospital Affiliated to Shanghai Jiao Tong University. Among 58 patients, 20 were males (30 eyes) and 38 were females (53 eyes). The mean age was 50.65±12.02 (range from 24 to 70) years old; the average BCVA was 0.37±0.32; the average diopter was?11.38±4.96 D; and the average axial length was 28.91±2.15 mm. All participants underwent FFA and ICGA examination to obtain FFA, ICGA, infrared light reflection (IR) and autofluorescence (AF) images. SS-OCT was applied for scanning macular and optic disc at 9 mm× 9 mm range. cSLO was performed with macular as the center. All images were inspected carefully by three independent observers and the consistency test was detect. LC were diagnosed as hyperreflective line in FFA and hypofluorescent linear lesions in late ICGA. MSL were defined as both hypofluorescent linear lesions in FFA and late ICGA. The accuracy of each inspection item in the diagnosis of LC was detected. The optimal technique was applied with SS-OCT to further explore the detection rate of LC.Results The intra-observer reproducibility was good to excellent for all measurements (Kappa=0.938,P<0.01). The positive detection rate of LC and MSL was highest in the standard images of cSLO (77.1％), followed by SS-OCT red free (73.1％), fundus photography (72.3％), IR (72.3％) and AF (49.4％). The cSLO was optimal in the test consistency (Kappa=0.520,P<0.01) and accuracy (the area under the receiver operating characteristic was 0.750). SS-OCT and cSLO were jointly applied to diagnosis of LC and MSL in high myopia. The positive detection rate of LC, MSL and LC+MSL were 91.7％, 91.2％ and 93.3％respectively. The characteristics of LC in SS-OCT were irregularities and discontinuous of the RPE-Bruch membrane line, discontinuous inner ellipsoid zone, thinner choroid, an increased light penetrance into deeper tissues, and RPE fracture in severe cases. MSL was mainly manifested as RPE clumps, visible large choroidal vessels protruding and pushing the overlying RPE toward the vitreous.Conclusions The diagnosis rate of LC in pathological myopia by cSLO is 77.1％. The standard images of cSLO combined with SS-OCT can diagnose LC, MSL and LC+MSL at rates of 91.7％, 91.2％ and 93.3％ respectively.
ABSTRACT
Objective Ticagrelor-related dyspnea may affect the medication adherence of patients with coronary artery disease.This study aims to assess the impact of ticagrelor adherence on 1-year cardiovascular outcomes in pateints with stable coronary artery diseases (SCAD).Methods This study includes the patients with SCAD from Fuwai hospital who discharged with ticagrelor between Jan.2015 to Jun.2015.We collected data of clinical characteristics and ticagrelor adherence from these patients by reviewing the electronic medical records and personnel interview.Follow-up was performed at 6 and 12 months by telephone interview or office visits.Results A total of 155 patients with SCAD were enrolled,of whom 122 (78.7％) were males with a mean age (57.0 ± 10.0) years.Among them,50 (32.3％) patients have a history of myocardial infraction and 106 (68.4％) patients had angiographic confirmed left main and/or multivessel disease.Forty-six patients (29.7％) with SCAD prematurely stopped ticagrelor within 12 months,while 25 (16.1％) patients switched from ticagrelor to clopidogrel.Hemorrhagic events and locally unavailable ticagrelor were the major reasons causes of the premature discontinuation of ticagrelor.Univariate analysis showed age,body mass index (BMI),hypertention and locally unavailable ticagrelor as relative factors for early ticagrelor discontinuation after discharge.Multivariate analysis revealed unavailable drug locally (OR 0.25,95％ CI 0.09-0.69) and elderly patients (OR 4.13,95％ CI 1.40-12.19) were risk factors for low persientence or premature ticagrelor discontinuation.Conclusion This study showed poor ticagrelor adherence in patients with SCAD after discharge.Locally unavailable ticagrelor and elderly patients were strong predictors of poor ticagrelor adherence.Discontinuation to ticagrelor prematurely may not have impact on adverse cardiovascular outcomes.