Coronary artery calcium score: we know where we are but not where we may be.

Cardiac computed tomography angiography (CCTA) has emerged as a cost-effective and time-saving technique for excluding coronary artery disease. One valuable tool obtained by CCTA is the coronary artery calcium (CAC) score. The use of CAC scoring has shown promise in the risk assessment and stratification of cardiovascular disease. CAC scores can be complemented by plaque analysis to assess vulnerable plaque characteristics and further refine risk assessment. This paper aims to provide a comprehensive understanding of the value of the CAC as a prognostic tool and its implications for patient risk assessment, treatment strategies, and outcomes. CAC scoring has demonstrated superior ability in stratifying patients, especially asymptomatic individuals, compared to traditional risk factors and scoring systems. The main evidence suggests that individuals with a CAC score of 0 have a good long-term prognosis, while an elevated CAC score is associated with increased cardiovascular risk. Finally, the clinical power of CAC scoring and the development of new models for risk stratification could be enhanced by machine learning algorithms.

Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries.

The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries. While ASO has significantly improved survival rates, a subset of patients develop a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial, as altered mechanics can have profound consequences for cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamics, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.

Cardiac magnetic resonance imaging of arrhythmogenic cardiomyopathy: evolving diagnostic perspectives.

Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disease characterized by fibro-fatty myocardial replacement, clinically associated with malignant ventricular arrhythmias and sudden cardiac death. Originally described a disease with a prevalent right ventricular (RV) involvement, subsequently two other phenotypes have been recognized, such as the left dominant and the biventricular phenotypes, for which a recent International Expert consensus document provided upgrade diagnostic criteria (the 2020 "Padua Criteria"). In this novel workup for the diagnosis of the entire spectrum of phenotypic variants of ACM, including left ventricular (LV) variants, cardiac magnetic resonance (CMR) has emerged as the cardiac imaging technique of choice, due to its capability of detailed morpho-functional and tissue characterization evaluation of both RV and LV. In this review, the key role of CMR in the diagnosis of ACM is outlined, including the supplemental value for the characterization of the disease variants. An ACM-specific CMR study protocol, as well as strengths and weaknesses of each imaging technique, is also provided. KEY POINTS: • Arrhythmogenic cardiomyopathy includes three different phenotypes: dominant right, biventricular, and dominant left. • In 2020, diagnostic criteria have been updated and cardiac magnetic resonance has emerged as the cardiac imaging technique of choice. • This aim of this review is to provide an update of the current state of art regarding the use of CMR in ACM, with a particular focus on novel diagnostic criteria, CMR protocols, and prognostic significance of CMR findings in ACM.

Filamin-C variant-associated cardiomyopathy: A pooled analysis of individual patient data to evaluate the clinical profile and risk of sudden cardiac death.

BACKGROUND: Mutations in filamin-C (FLNC) are involved in the pathogenesis of arrhythmogenic cardiomyopathy (ACM) and dilated cardiomyopathy (DCM), and have been associated with a left ventricular (LV) phenotype, characterized by nonischemic LV fibrosis, ventricular arrhythmias, and sudden cardiac death (SCD). OBJECTIVE: The purpose of this study was to investigate the prevalence of FLNC variants in a gene-negative ACM population and to evaluate the clinical phenotype and SCD risk factors in FLNC-associated cardiomyopathies. METHODS: ACM probands who tested negative for mutations in ACM-related genes underwent FLNC genetic screening. Clinical and genetic data were collected and pooled together with those of previously published FLNC-ACM and FLNC-DCM patients. RESULTS: In a cohort of 270 gene-elusive ACM probands, 12 (4.4%) had FLNC variants, and 13 additional family members carried the same mutation. Eighteen FLNC variant carriers (72%) had a diagnosis of ACM (72% male; mean age 45 years). On pooled analysis, 145 patients with FLNC-associated cardiomyopathies were included. Electrocardiographic (ECG) low QRS voltages were detected in 37%, and T-wave inversion (TWI) in inferolateral/lateral leads in 24%. Among 67 patients who had cardiac magnetic resonance (CMR), LV nonischemic late gadolinium enhancement (LGE) was found in 75%. SCD occurred in 28 patients (19%), 15 of whom showed LV nonischemic LGE/fibrosis. Compared with patients with no SCD, those who experienced SCD more frequently had inferolateral/lateral TWI (P = .013) and LV LGE/fibrosis (P = .033). CONCLUSION: Clinical phenotype of FLNC cardiomyopathies is characterized by late-onset presentation and typical ECG and CMR features. SCD is associated with the presence of LV LGE/fibrosis but not with severe LV systolic dysfunction.

OCT retinal angiography features in patients with rheumatoid arthritis: A pilot study.

PURPOSE: To evaluate the superficial (SCP) and deep retinal capillary plexus (DCP) by mean of optical coherence tomography angiography (OCTA) in treatment-naïve patients affected by rheumatoid arthritis (RA). METHODS: Between March 2019 and January 2020, patients with recent diagnosis of "definite RA" based on 2010 Rheumatoid Arthritis Classification Criteria were included in a Prospective, observational single center case-control study carried out at G.B. Bietti Foundation. Data were compared with those of 16 healthy age- and sex-matched subjects. Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) were collected by mean of OCTA. Main outcome measure was the VD alteration of SCP and DCP in treatment-naïve RA-patients. RESULTS: No difference in age, sex-distribution, best-corrected visual acuity, CFT was registered between the two groups. OCTA data analysis showed in RA-patients a statistically significant reduction in the VD in the mean global area, inner ring, especially in the superior quadrant of the SCP. A trend of VD reduction was also registered in temporal, nasal, and inferior quadrants, respectively, although it did not reach a statistically significant value. Assessment of VD of DCP and FAZ area did not evidence any difference among the groups. CONCLUSIONS: OCTA allows to highlight the vascular remodeling of the retinal microcirculation in RA-patients, even in early stages of the disease, demonstrating a reduction of VD. Outcomes of the current investigation can provide new insight in the pathogenetic mechanism of RA and extend the potential applications of this diagnostic tool.

The Role of Imaging in Planning Treatment for Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSC) is a controversial disease both in terms of clinical classification and choice of therapeutic strategy. Choroidal layers, retinal pigment epithelium (RPE), photoreceptors, and retina are involved to varying degrees. Beyond well-known symptoms raising the clinical suspect of CSC and slit-lamp fundus examination, multimodal imaging plays a key role in assessing the extent of chorioretinal structural involvement. Subretinal fluid (SRF) originating from the choroid leaks through one or multiple RPE defects and spreads into the subretinal space. Spontaneous fluid reabsorption is quite common, but in some eyes, resolution can be obtained only after treatment. Multiple therapeutic strategies are available, and extensive research identified the most effective procedures. Imaging has carved a significant role in guiding the choice of the most appropriate strategy for each single CSC eye. Multiple biomarkers have been identified, and all of them represent a diagnostic and prognostic reference point. This review aims to provide an updated and comprehensive analysis of the current scientific knowledge about the role of imaging in planning the treatment in eyes affected by CSC.

Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy.

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

Anti-VEGF and Retinal Dystrophies.

The therapeutic approach based on anti-vascular endothelial growth factor (anti-VEGF) molecules can be used to treat two important complications of retinal dystrophies: choroidal neovascularization and macular edema. The macular involvement in retinal dystrophies can lead to further visual deterioration in patients at a young age and already affected by functional limitations. The study reports the effect of anti-VEGF treatment in several subforms of retinal dystrophies, critically discussing advantages and limitations.

Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization.

AIM: To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. METHODS: Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. RESULTS: At baseline, FA and SD-OCT agreed in 26/34 cases (κ=0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. CONCLUSIONS: Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.

Comparing applanation tonometry and rebound tonometry in glaucomatous and ocular hypertensive eyes.

PURPOSE: To describe Goldmann applanation tonometer (GAT) and rebound tonometer (RT) agreement in measuring intraocular pressure (IOP) in glaucomatous and ocular hypertensive (OH) eyes and to evaluate central corneal thickness (CCT) influence on RT readings. METHODS: A total of 347 eyes were enrolled and IOP measured between 9 and 11 am. Rebound tonometry was performed first (RT1), followed by 3 consecutive GAT measurements and by a second RT reading (RT2), within a 5-minute span. Mean IOP (±SD) values were compared by means of paired t-test. Agreement between GAT and RT1 (test 1) and RT2 (test 2) was evaluated with Bland-Altman method, whereas a linear function described the relationship between CCT and IOP taken with RT. RESULTS: Mean IOP (±SD) taken with RT1, GAT, and RT2 was 18.1±4.3, 15.6±3.3, and 16.3±3.9 mmHg, respectively. Readings were within ±3 mmHg in 63.7% and 86.7% of eyes for test 1 and 2, respectively. A significant (p<0.001) proportional bias was noted on both tests (95% limits of agreement: -2.3/7.4 and -3.6/5.0 mmHg for test 1 and 2, respectively). Agreement between instruments decreased for increasing IOP. Rebound tonometry readings increased by 4.6 and 4.1 mmHg for RT1 and RT2, respectively, for each 100-µm CCT increase. CONCLUSIONS: When used first, RT significantly overestimated IOP compared with GAT. Differences became clinically negligible when RT was used immediately after GAT. Repeated applanation tonometry may explain this observation. Agreement between instruments was acceptable for low IOP, but worsened with increasing IOP values. RT is significantly influenced by CCT. Goldmann applanation tonometer and RT should not be used interchangeably.

Retinal nerve fibre layer of perimetrically unaffected eyes of glaucoma patients: an optical coherence tomography study.

PURPOSE: The aim of this study is to evaluate whether optical coherence tomography (StratusOCT) may detect early changes in perimetrically unaffected (PU) fellow eyes of glaucomatous patients by assessing retinal nerve fibre layer (RNFL) thickness parameters. METHODS: Thirty-seven glaucomatous patients with unilateral field loss and 34 age-matched controls were recruited. In glaucoma patients, PU and perimetrically affected fellow eyes were analysed separately. For each group, mean values (+/-SD) of RNFL thickness parameters were calculated and comparisons between fellow eyes of glaucoma patients and between healthy and PU eyes of glaucoma patients conducted with paired t-test and Mann-Whitney U-test, respectively. Proportion of clock-hour sectors flagged with probability <5% or <1% was collected and differences between healthy and PU eyes were evaluated on Fisher exact test. RESULTS: Global (Average Thickness) and sectoral parameters (Inferior and Nasal Average), Maximum thickness-minimum thickness (Max-min), as well as 2-o'clock (nasal side) and 6-o'clock sectors resulted significantly thinner in PU eyes than in control group. Proportion of eyes with clock-hour position flagged with probability <5% or <1% was not significantly different between healthy and PU eyes. CONCLUSION: Despite a standard automated perimetry within normal limits, the StratusOCT detected both localized and diffuse RNFL thinning in PU eyes of glaucoma patients. These eyes should be considered at risk of developing functional damage over time and consequently require thorough monitoring for detecting any sign of progression.

Scanning laser polarimetry - a review.

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia.

PURPOSE: To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). METHODS: We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. RESULTS: The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. CONCLUSIONS: After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome.

Correlation between optic disc area and retinal nerve fiber layer thickness: a study on scanning laser polarimetry with variable corneal compensation.

PURPOSE: To evaluate if a significant increase of the peripapillary retinal nerve fiber layer (RNFL) thickness can be measured in a sample of healthy eyes by means of scanning laser polarimetry with variable corneal compensation (GDx-VCC) as the optic disc (OD) area increases. METHODS: One eye each of 232 healthy subjects (mean age: 57.8 years; range:40-70) was considered. Temporal-superior-nasal-inferior-temporal average (TSNIT Avg) and OD area (area within the ellipse placed on inner border of peripapillary scleral ring) values were collected. Ellipse horizontal and vertical diameters provided on printout were used to estimate OD area using the equation: OD area = pi x horizontal radius x vertical radius. TSNIT Avg values were plotted against OD area and a multiple linear regression including age calculated. RESULTS: Mean OD area was 2.19 mm(2)+/-0.45 (range: 1.23-3.59) and mean TSNIT Avg was 54.3 micro +/- 3.2 (range: 45.8-61.8). Multiple linear regression equation was TSNIT Avg=57.7-0.096 x OD Area-0.055 x Age (Pearson r=-0.146: p=0.086) CONCLUSION: In our sample of healthy eyes, no significant correlation was found between TSNIT Avg and OD area. In spite of a shorter distance between OD and measurement ellipse margins, larger discs did not necessarily show a thicker RNFL. Probably the large inter-subject variability for RNFL thickness, and then for axonal count, was a predominant factor over OD area.

Intersession reproducibility of retinal nerve fiber layer thickness measurements by GDx-VCC in healthy and glaucomatous eyes.

BACKGROUND: To assess intersession reproducibility of retinal nerve fiber layer (RNFL) thickness measurements on scanning laser polarimetry with variable corneal compensation (GDx-VCC) in a sample of healthy subjects and glaucoma patients. METHODS: One eye each from 29 healthy and 29 glaucomatous subjects was selected and underwent RNFL scanning by the same operator at baseline and 1 week later. Glaucoma diagnosis relied on the presence of a reproducible defect on automated perimetry. GDx-VCC parameters considered were those available on page 1 of the printout [TSNIT average and standard deviation (SD), superior and inferior average (SA, IA), Nerve Fiber Indicator]. Reproducibility was assessed by calculating coefficient of variation and intraclass correlation coefficient separately for the two groups and for each parameter. The percentage of eyes with an intersession difference in thickness parameters of more than 5% was also calculated. RESULTS: Coefficient of variation was <6% for TSNIT average, SA and IA in both groups. Corresponding values for TSNIT SD in healthy subjects and in glaucoma patients were 13.7 and 11.4%, respectively, whereas for Nerve Fiber Indicator they were 82.9 and 13.3%. Intraclass correlation coefficient ranged from 0.794 to 0.907 in healthy subjects and from 0.924 to 0.972 in glaucoma patients. In healthy subjects, TSNIT average, SA and IA intersession difference was 5% or less in 55-69% of eyes, whereas the value for TSNIT SD was 34.5%. Corresponding values in glaucomatous eyes ranged from 69 to 79.3% for TSNIT average, SA and IA and was 37.9% for TSNIT SD. CONCLUSIONS: Intersession reproducibility of RNFL thickness measurements on GDx-VCC is high, both in healthy and in glaucomatous eyes. In a few cases, however, intersession variation may be larger than 10%. Caution is necessary while interpreting these changes during follow-up, in order to separate physiological variability from real RNFL thickness variations.

The effect of ageing on retinal nerve fibre layer thickness: an evaluation by scanning laser polarimetry with variable corneal compensation.

PURPOSE: To evaluate whether a significant age-related thinning of the retinal nerve fibre layer (RNFL) is measurable by means of scanning laser polarimetry with variable corneal compensation (GDx-VCC) in a sample of healthy eyes. METHODS: A sample of 324 eyes of 324 healthy subjects (mean age 56 +/- 14 years, range 21-85 years) underwent a complete ophthalmic evaluation, standard automated perimetry and RNFL scan with the GDx-VCC. Temporal-superior-nasal-inferior-temporal (TSNIT), superior and inferior average (SA and IA) values provided on the printout were collected and their mean value averaged from all eyes and also after separating the eyes by gender and by age decades. The values of the three parameters were plotted against age and linear regression was calculated. RESULTS: Ageing is associated with a significant RNFL thinning (0.08 micro, 0.16 micro and 0.12 micro per year for TSNIT, SA and IA, respectively; p < 0.001). Analysis showed a similar association with age decade (p < 0.001 on anova). For the TSNIT average, a 9.5% thinning from baseline values was estimated for a 65-year lifespan. Corresponding values for SA and IA were 16.2% and 11.7%, respectively. CONCLUSIONS: Analysis by GDx-VCC confirmed previous reports about significant age-related RNFL thinning. However, a lower rate per year was found, probably because GDx-VCC measurements are much more reliable than those obtained with the previous generation of polarimeters.

GDx-VCC performance in discriminating normal from glaucomatous eyes with early visual field loss.

BACKGROUND: To evaluate the ability of scanning laser polarimetry with variable corneal compensation (GDx-VCC) in separating healthy from glaucomatous patients with early visual field (VF) loss. METHODS: Sixty-two healthy and 48 glaucomatous age-matched patients with early glaucoma [mean deviation (MD): -1.74dB +/-1.69] underwent complete ophthalmological evaluation, automated achromatic perimetry (AAP) and retinal nerve fiber layer (RNFL) measurement with GDx-VCC. One randomly selected eye from each subject was considered. Glaucomatous VF defects had either Glaucoma Hemifield Test (GHT) outside normal limits or pattern standard deviation (PSD) outside 95% confidence limits. Mean (+/-SD) MD, PSD and GDx-VCC parameters in the two groups were compared by t-test. For each GDx-VCC parameter, area under receiver operating characteristics (AUROC) curve and sensitivity at predetermined specificity > or =80% and > or =95% were calculated. Moreover, the parameter with largest AUROC was evaluated by likelihood ratios (LRs). RESULTS: Mean values for MD, PSD and ten of 14 GDx-VCC parameters were significantly different between the two groups (P<0.001). The three parameters with largest AUROCs were the nerve fiber indicator (NFI) (0.870), superior average (0.817) and normalized superior area (0.816) (P=0.08 for differences between AUROCs). NFI displayed sensitivity values of 80.2% and 60.4% for specificity > or =80% and > or =95%, respectively. At NFI cutoff value of 30, positive LR was 34.9 (95% CI: 4.9-247.6) and negative LR was 0.45 (95% CI: 0.32-0.61). Interval LRs showed large effect on post-test probability for NFI values < or =18 or > or =31. CONCLUSIONS: In our sample of eyes with early VF loss, GDx-VCC showed moderate-to-good discriminating ability. Among the best performing parameters, NFI had the largest AUROC, but several glaucomatous eyes (21, 43.8%) had NFI <30. This suggests that algorithm for NFI calculation requires some refinement when eyes with early VF loss are evaluated.

Scanning laser polarimetry of nerve fiber layer thickness in normal eyes after cataract phacoemulsification and foldable intraocular lens implantation.

PURPOSE: To assess the effect of cataract phacoemulsification and intraocular lens (IOL) implantation on retinal nerve fiber layer (RNFL) thickness using scanning laser polarimetry (SLP). SETTING: Eye Clinic, Trieste University, Italy. METHODS: Forty-eight eyes were evaluated prospectively the day before and 30 days after cataract phacoemulsification and foldable IOL implantation. In each eye, lens opacity grading according to the Lens Opacities Classification System III (LOCS III), and axial length (AL) measurements were performed. Retinal nerve fiber layer thickness was quantified at baseline by means of SLP and anterior segment birefringence compensation was evaluated acquiring macular retardation map (MRM). Acrylic and silicone IOLs were implanted randomly. After surgery, RNFL thickness was reevaluated, and MRM was reacquired. Macular retardation map pattern variations regarding baseline profile were classified into 3 groups: no variation, bow-tie profile enhancement, or attenuation. Distribution of IOL power, AL, and cataract type in the 3 groups was assessed, as were presurgery and postsurgery SLP parameters with mean values (+/-SD) compared by paired t test. RESULTS: Twenty-two eyes (Group 1, 45.8%) showed no MRM variation, 14 (Group 2, 29.2%) an enhancement, and 12 (Group 3, 25%) an attenuation. In Group 1, no significant RNFL thickness variation occurred. In Group 2, variation 10% to 15% was measured, whereas thickening a 8% to 15% thinning appeared in Group 3. Variations occurred irrespective of IOL material, AL, or cataract type. CONCLUSIONS: Cataract surgery with IOL implantation was associated with an MRM profile change and RNFL thickness variations in 54.2% of eyes. Variations are probably related to opacified lens removal. A new baseline SLP reading is mandatory after cataract surgery.

Scanning laser polarimetry with variable corneal compensation and detection of glaucomatous optic neuropathy.

BACKGROUND: The aim of this study was to evaluate the ability of scanning laser polarimetry (SLP) parameters provided by commercially available GDx with variable corneal compensator (VCC) to discriminate between healthy and glaucomatous eyes. METHODS: Sixty-five healthy and 59 glaucomatous age-matched patients underwent a complete ophthalmological evaluation, an achromatic automated perimetry (AAP), and SLP with GDx-VCC. One randomly selected eye from each subject was considered. All glaucomatous eyes had reproducible visual field defects. Mean values (+/- SD) of all SLP-VCC parameters measured in the two groups were compared. Area under receiver operating characteristics (AUROC) curve and sensitivities at predetermined specificities of >or=80% and >or=95% for each single parameter were calculated. Moreover, the nerve fiber indicator (NFI) diagnostic accuracy was evaluated calculating positive, negative, and interval likelihood ratios (LRs) at different cutoff values. RESULTS: All SLP parameters were significantly different between the two groups (p<0.001). The NFI showed the best AUROC curve (0.938, SE 0.02) whereas temporal, superior, nasal, inferior, temporal (TSNIT) average was second best (0.897, SE 0.03), and normalized superior area was third (0.879, SE 0.04). At fixed specificity >or=95%, sensitivities ranged from 22% to 79.7% whereas for values >or=80%, sensitivities were in the 44.1-89.8% range. At a cutoff NFI value of 30, positive LR was 17.6 (95% CI: 5.8-53.6) and negative LR was 0.19 (95% CI: 0.11-0.33). Interval LRs for NFI showed that values 40 were associated with large effects on posttest probability. CONCLUSIONS: SLP-VCC allows good discrimination between healthy and glaucomatous eyes. New software-provided parameters NFI, TSNIT average, and normalized superior and inferior areas appear to be reliable in the evaluation of glaucomatous disease. In particular, after evaluation on interval LRs, the NFI showed a high diagnostic accuracy for values 40.

Photodynamic therapy for choroidal neovascularization associated with pattern dystrophy.

PURPOSE: To report the results of photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) associated with nine eyes affected by pattern dystrophy of the retinal pigment epithelium. METHODS: Each patient underwent an ophthalmologic examination complete with electroretinogram, electrooculogram, fluorescein angiography, and indocyanine green angiography to define the characteristics of the CNV. PDT was administered according to the TAP protocol. Re-treatment was decided on the basis of the detection of leakage on fluorescein angiography. RESULTS: Classic subfoveal CNV was associated with four cases of reticular dystrophy, one case of butterfly-shaped dystrophy, and one case of pattern dystrophy simulating fundus flavimaculatus. Moreover, three cases of adult-onset foveomacular vitelliform dystrophy showed occult subfoveal CNV. The mean follow-up was 15.6 +/- 2.1 months. Adult-onset foveomacular vitelliform dystrophy has the worst visual outcome, passing from 20/59 to 20/640 (mean variation, -10.7 lines), whereas the other forms of pattern dystrophy overall retain their baseline best-corrected visual acuity of 20/51 (mean variation, +0.17 lines). CONCLUSIONS: Photodynamic therapy for subfoveal CNV associated with pattern dystrophy of the retinal pigment epithelium can stabilize visual acuity, except for occult CNV associated with adult-onset foveomacular vitelliform dystrophy.