Coarsening of choriocapillaris on optical coherence tomography angiography as a sign of acute idiopathic blind spot enlargement.

Purpose: Acute idiopathic blind spot enlargement is a rare syndrome that is classified within a spectrum of primary inflammatory choriocapillaropathies with circumscribed outer retinal dysfunction. Observations: We observed coarsening of the choriocapillaris on en-face optical coherence tomography angiography when compared to the fellow eye in a patient with suspected acute idiopathic blind spot enlargement. Conclusions and Importance: Increased granularity of the choriocapillaris as imaged by optical coherence tomography angiography may assist in the diagnosis of acute idiopathic blind spot enlargement, particularly during a global pandemic when access to electrodiagnostics is limited. This finding supports the current evidence of choriocapillaris hypoperfusion in the pathogenesis of acute idiopathic blind spot enlargement.

The utility of multichannel intraluminal impedance-pH testing in tailoring the management of paediatric gastro-oesophageal reflux disease.

AIM: To determine whether combined multichannel intraluminal impedance and pH (MII-pH) testing led to a change in management of children with gastro-oesophageal reflux disease (GORD). METHODS: Retrospective chart review was done in all patients who underwent MII-pH testing for GORD symptoms at Sydney Children's Hospital between 2008 and 2016. Changes to anti-reflux medications and referral for anti-reflux surgery were evaluated. RESULTS: There were 365 patients, 260 (71.2%) of whom were on acid-suppressing therapy. The median age was 4.1 ± 4.8 years, 205 patients (56%) were males, 83 (22.7%) were infants (<1 year of age) and 145 (39.7%%) had comorbid conditions. We found 72.1% had abnormal MII-pH results, of which 17.5% had abnormal acid reflux, 8.2% had abnormal number of retrograde bolus movements and 46.3% had hypersensitive oesophagus (positive symptom association only). Infants were significantly more likely to have abnormal MII-pH results compared to older children (P = .04). Results of MII-pH testing led to medication changes in 44.7% and referral for anti-reflux surgery in 6.8% of patients. CONCLUSION: Combined multichannel intraluminal impedance and pH testing is clinically useful in the management of children with symptoms of GORD and over half the patients had changes to their medical treatment or referral for anti-reflux surgery based on the results of MII-pH testing. It resulted in a treatment change in an additional 32% of patients over traditional pH-metry.