ABSTRACT
Purpose: To compare the efficacy of optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) for detecting nonexudative macular neovascularization (MNV) in age-related macular degeneration (AMD). Methods: In this prospective study, patients with a new diagnosis of exudative AMD in 1 eye were imaged using OCTA, fluorescein angiography (FA), and ICGA in both eyes. The rates at which these imaging modalities detected nonexudative MNV in the nonexudative fellow eye were then compared. Results: This study comprised 41 eyes with a mean follow-up was 14 months. Nonexudative MNV was found in 3 eyes using OCTA and ICGA. No MNV exudation was detected on FA or structural OCT. One of 3 eyes with MNV progressed to exudative disease 6 months after the initial visit. During the follow-up, 5 of the 38 eyes without MNV developed exudation at 4 to 18 months. Conclusions: OCTA is similarly effective as ICGA at detecting nonexudative MNV patterns.
ABSTRACT
PURPOSE OF REVIEW: The aim of this review is to provide the information necessary for recognizing scleritis in rheumatology patients, recognize associated systemic diseases in scleritis patients referred to rheumatology, and choose the best conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic therapy, based on the most recent data. RECENT FINDINGS: Scleritis is most often associated with systemic conditions, particularly autoimmune conditions. Rheumatologists should be most vigilant about rheumatoid arthritis and ANCA-associated vasculitis. A recent systemic association has been found with IgG4-related disease as well. Most of the therapeutic decisions are based on observational data. Most recently, there is increasing evidence of the role of rituximab for refractory disease. Scleritis is a severe inflammatory ocular condition that leads to complications including vision loss. It can precede a systemic autoimmune disease diagnosis, especially in the case of vasculitis. Prompt recognition and adequate therapy are needed in order to avoid serious ocular complications. There is an unmet need for (1) head-to-heat trials on csDMARDs and biologic drugs for the treatment of idiopathic scleritis and (2) randomized controlled trials on the treatment of refractory cases.
Subject(s)
Autoimmune Diseases , Scleritis , Antirheumatic Agents/therapeutic use , Autoimmune Diseases/diagnosis , Autoimmune Diseases/drug therapy , Autoimmune Diseases/etiology , Humans , Rituximab/therapeutic use , Scleritis/diagnosis , Scleritis/drug therapy , Scleritis/etiologyABSTRACT
PURPOSE: To report on whole body positron emission tomography/computed tomography (PET/CT) screening for metastasis at diagnosis of primary uveal melanoma. METHODS: Since August 2003, 333 consecutive patients were diagnosed with uveal melanoma and underwent whole body screening for metastatic disease with PET/CT along with liver function tests and physical examination. Abnormal findings prompted further biopsies, blood tests, imaging, or clinical evaluations for confirmation. The presence of metastatic disease and second cancers were evaluated. RESULTS: Using the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) 7th edition criteria, 104 tumors were classified T1 (31%), 162 T2 (49%), 37 T3 (11%), and 30 T4 (9%). Seven of 333 (2.1%; 95% confidence interval [CI] 0.8-4.3) patients had metastatic melanoma. One tumor was a T3 and 6 were T4. Thus, 3% of T3 and 20% of T4 melanomas were found to have metastases at the time of initial diagnosis. Ten patients (3.3%; 95% CI 0.9-5.5) had synchronous second cancers and 28 (8.4%) concurrent benign lesions. The most common metastatic sites were liver (7/7) and bone (2/7). DISCUSSION: This study suggests that PET/CT improves the yield of detecting both extrahepatic metastases, especially from tumors defined as AJCC-T4, and synchronous primary cancers, irrespective of the size of the uveal melanoma. With respect to liver metastases, PET/CT demonstrated high sensitivity and positive predictive values, indicating an overall better performance than conventional screening procedures.
