Keratoconus: Diagnosis and Staging.

ABSTRACT: The advent of refractive surgery and corneal cross-linking for ectatic disease has further highlighted the need to recognize early or subclinical ectatic disease. Historical systems depend on anterior corneal changes that occur late in the disease course and are commonly associated with visual loss. Tomographic imaging allows for the acquisition of posterior corneal surface data and corneal thickness distribution. This led to the development of modalities to diagnose early or subclinical keratoconus and to screen patients for refractive surgery.This article reviews the modern methods for assessing changes in posterior corneal surface and pachymetric distribution, now accepted by the major cornea societies to be the hallmarks of ectatic disease. Screening tools utilized by the commonly used tomographic imaging devices are discussed, and the difference between screening for ectasia and diagnosing keratoconus is highlighted. The Belin ABCD staging and classification system and the ABCD Progression Display are reviewed as a new grading and monitoring system that can be used for earlier intervention and prevention of visual loss in keratoconus.

Telemedicine distance and near visual acuity tests for adults and children.

We describe a set of distance and near, adult and child, visual acuity tests for home use. The five charts are packaged in a PDF document and are also available as JPEG images that can be printed on standard letter paper or displayed on a monitor or handheld device. Adult distance visual acuity is tested using a modified ETDRS Chart R; child distance vision is tested using a similarly formatted HOTV logMAR chart. Testing distance is 5 or 10 feet, appropriate for home use. Near visual acuity is displayed in the range of J16 to J1 using random words (for adults) or in HOTV matching format (for young children). An Amsler Grid and HOTV matching card are included. The charts include a calibration circle. For those without a printer, sending a JPEG image as an email attachment initiates onscreen testing with a single click. Devices with smaller screens require an assistant to scroll through the display. The test can performed without assistance from a printed page.

The protective mechanism of QGC in feline esophageal epithelial cells by interleukin-1ß treatment.

In a previous study, Quercetin-3-O-ß-D-glucuronopyranoside (QGC) has anti-oxidative and anti-inflammatory effects in vivo. QGC is a flavonoid glucoside extracted from Rumex Aquaticus. We investigated the downstream target proteins involved in IL-1ß-stimulated ROS production and the ability of QGC to inhibit ROS production. Cell viability was determined using the MTT reduction assay. Western blot analysis was performed with antibodies to investigate the activation of three MAPKs, NF-κB, and phosphorylated IκB-α (pIB), and the expression of COX-2. 2',7'-dichlorofluorescin diacetate was used to detect the generation of intracellular ROS species. When the cells were exposed to media containing IL-1ß for 18 h, cell viability was not affected. QGC did not reduce the COX-2 expression induced by IL-1ß. However; QGC attenuated the production of intracellular ROS induced by IL-1ß. IL-1ß increased the expression of ERK, p38 MAPK, and pIB, and nuclear translocation of NF-κB were recovered by the ROS scavenger N-acetyl-L-cysteine (NAC) and QGC, but not by the NADPH oxidase inhibitor diphenylene iodonium. Pretreatment of cells with the ERK inhibitor PD98059, the p38 MAPK inhibitor SB202190, NAC, and QGC attenuated nuclear translocation of NF-κB and activation of pIB. QGC has a scavenging effect on cytokine-induced ROS production, thereby preventing its downstream effects, nuclear translocation of NF-κB, and activation of pIB is mediated by activation of ERK and p38 MAPK, although QGC does not inhibit IL-1ß-stimulated COX-2 expression in feline esophageal epithelial cells. The data suggest that QGC exerts anti-oxidative effects and inhibitory effects against esophageal epithelial cells signals by the action of IL-1ß treatment.

Retinal sensitivity is a valuable complementary measurement to visual acuity--a microperimetry study in patients with maculopathies.

PURPOSE: To evaluate changes in macular sensitivity, as measured with microperimetry, among patients with maculopathy and stable visual acuity (VA). METHODS: Macular sensitivity was assessed using the Spectral OCT/SLO™ microperimetry (OCT/SLO, Optos Plc., Dunfermline, UK) in 25 eyes (16 patients) with maculopathy and stable VA (<5 letters change in ETDRS score) at two consecutive clinic visits. To take the limits of the test-retest repeatability of the OCT/SLO into account, coefficient of repeatability (CoR) was employed to estimate the probability of the sensitivity changes being secondary to measurement noise. RESULTS: The point sensitivity changes were statistically significant (Wilcoxon signed-rank test, P < 0.001). Seventy-seven points (11 %) out of a total of 700 sensitivity points had a genuine sensitivity change, with a mean increase of 8.6 ± 2.6 dB in 35 points and a mean decrease of 7.9 ± 2.2 dB in 42 points. CONCLUSIONS: Point-to-point change in macular sensitivity can be used as a biomarker of changes in disease activity in patients with maculopathy, and can be more accurate than either mean sensitivity or BCVA in detection of changes in macular function. The measurement variability should be considered when observing the local sensitivity changes.

Cytologic features in vitreous preparations of patients with suspicion of intraocular lymphoma.

Intraocular lymphoma may occur, primarily with or without overt parenchymal CNS lymphoma or secondarily from a variety of other lymphomas. The diagnosis is frequently based on cytologic features and/or a limited panel of ancillary techniques. Twenty-seven cytology samples from the vitreous preparations of 20 patients with clinical suspicion or histopathologic diagnoses of lymphoma were retrospectively reviewed (2007-2011). Floaters and decreased visual acuity were the most common ocular symptoms. Sixteen (of 20) patients had at least one cytology that was "positive" or "suspicious" for lymphoma (F = 10; M = 6, median age = 71 years, range = 52-82). Involvement was limited to the eye in half of the cases (n = 8). Seven patients had CNS involvement, and three had systemic lymphoma. Cytologic specimens were classified as large B cell lymphoma (LBCL) (n = 13), suspicious for LBCL (n = 5), atypical/negative (n = 5), and consistent with NK-T cell lymphoma (n = 1). Three cytologic samples were acellular. Cytologic findings included increased cellularity (high n = 7, moderate n = 7), large to medium (n = 19) cell size, marked nuclear irregularities (n = 12), frequent apoptosis (n = 7), lymphoglandular bodies (n = 12), and necrosis (n = 12). Easily identifiable mitotic figures were present in two cases. CD20 immunocytochemistry performed in 15 cases with available cell blocks/destained cytospins preparations, was confirmatory in 8 cases. Cytologic evaluation of intraocular lymphoma is possible in vitreous specimens. Extraocular involvement was not present in half of the cases. The most useful cytologic features include increased cellularity, necrosis, and nuclear enlargement. Ancillary immunocytochemical studies are useful and support the morphologic impression in a subset of cases.

Longitudinal spectral domain optical coherence tomography changes in eyes with intraocular lymphoma.

BACKGROUND: Cases of patients with primary intraocular lymphoma (PIOL) were retrospectively analyzed to describe the longitudinal intra-retinal morphological changes in PIOL as visualized on images obtained by spectral domain optical coherence tomography (SD-OCT). RESULTS: In a retrospective case series, Heidelberg Spectralis SD-OCT images obtained in the longitudinal evaluation of patients with biopsy-proven PIOL were analyzed and assessed. The images were graded for the presence of macular edema (ME), pigment epithelial detachment (PED), subretinal fluid (SRF), and hyperreflective signals. SD-OCT scans of five eyes from five patients were assessed. Patients showed signs of inflammation, such as ME and SRF, which were resolved with treatments in some cases. Hyperreflective signals were found in all eyes in the form of nodules or bands across the retina, with the highest frequency of appearance in the ganglion cell layer, inner plexiform layer, photoreceptor layer, and retinal pigment epithelium; such signals increased with the progression of PIOL. CONCLUSION: SD-OCT may be employed to monitor the progression of PIOL. Hyperreflective signals on OCT may correspond with increase in disease activities, along with other findings such as ME, PED, and SRF.

Cardiac arrest from intravenous indigo carmine during laparoscopic surgery -A case report-.

Indigo carmine (sodium indigotindisulfonate) is a safe, biologically inactive blue dye routinely administered intravascularly during urologic and gynecologic procedures to localize the ureteral orifices and to identify severed ureters and fistulous communications. We report a case of hypotension, cardiac arrest, and cerebral ischemia after the administration of indigo carmine in a patient under total laparoscopic hysterectomy.

Sensitive DNA biosensor based on a long-period grating formed on the side-polished fiber surface.

We demonstrate a sensitive DNA biosensor based on a long period grating (LPG) formed by a photolithograph process on the surface of a side-polished fiber. The biomolecules of the biosensor were immobilized on the silica surface between LPG patterns. The resonance wavelength was red-shifted after the binding of the poly-L-lysine, probe ssDNA and target ssDNA to the sensor surface. The overall wavelength shift after the successful DNA hybridization was 1.82 nm. The proposed LPG-based DNA biosensor is approximately 2.5 times more sensitive than the previously reported fiber grating-based DNA biosensors.

Incidental diagnosis of multiple myeloma during the treatment of low back pain: A case report.

A 49-year-old male patient presented at our clinic with back pain due to an insignificant injury that had occurred approximately 7 months earlier. Although the patient had been treated at primary clinics, the pain had gradually become aggravated and characterized by resting and night pain. We initially diagnosed the patient with myofascial pain syndrome and began treatment comprised of trigger point injection (TPI) on the back muscles to control the pain. His symptoms improved after the first treatment (TPI), but he complained of back pain again several days later. At that time he also reported that he had lost 10 kg over the 4 months preceding his initial visit. Plain radiographs of the thoracolumbar spine revealed L1-L5 compression fractures and generalized osteopenia. The patient was then diagnosed with multiple myeloma based on the results of a bone marrow biopsy. This case demonstrates the importance of using comprehensive diagnostic approaches when the patient manifests symptoms that are unresponsive to conventional treatment.

Characterization of tunable photonic crystal fiber directional couplers.

We present a tunable photonic crystal fiber (PCF) directional coupler fabricated by a side-polishing method. The PCF directional coupler was modeled as a typical single-mode fiber-based directional coupler and analyzed using the improved effective-index method (IEIM). The characteristics of the PCF directional coupler such as the coupling coefficient and the coupling ratio were measured and found to be in good agreement with those predicted by the theoretical model. The PCF directional coupler exhibited an insertion loss of approximately 2 dB for a 3 dB coupler and was able to tune the coupling ratio between 0% and 100% by tilting the angle of the top side-polished quartz block against the fixed-bottom quartz block.