Diagnostic capability of macular parameters of Stratus OCT 3 in detection of early glaucoma.

AIM: To report the diagnostic capability of Stratus OCT macular parameters in early glaucoma. MATERIAL AND METHODS: In a cross-sectional observational study, two groups of subjects (early glaucoma and normals) who satisfied the inclusion and exclusion criteria were recruited. The diagnosis of early glaucoma was based on a glaucomatous appearance of the optic disc correlating with visual-field defects (fulfilling at least two of three Anderson and Patella criteria, with a mean deviation better than or equal to -6 dB. All patients underwent a complete ophthalmic evaluation including visual-field examination (24-2/30-2 SITA standard programme) and imaging with Stratus OCT 3. The macular thickness map in Stratus OCT includes the fovea, inner macula and outer macula, with diameters of 1, 3 and 6 mm, a total of nine sectors. Sensitivity, specificity, area under the receiving operating characteristic curve (AUROC) and likelihood ratio were calculated for volume and thickness parameters in these nine sectors. RESULTS: 56 eyes (56 patients) with early glaucoma and 75 eyes (75 normals) were analysed. Only two parameters, the outer inferior average volume (p = 0.003) and the outer inferior average thickness (p = 0.002), were statistically significantly lower in the glaucoma group. Outer inferior average volume had a "best combination" of sensitivity and specificity (56% and 79% respectively). Both outer inferior average volume and thickness parameters yielded the best AUROCs of 0.66. CONCLUSIONS: Outer inferior macular thickness and volume parameters in early glaucoma are significantly different from normals. The moderate sensitivity and specificity suggest that the role of macular parameters in the diagnosis of early glaucoma is limited.

Retinal nerve fibre layer imaging compared with histological measurements in a human eye.

PURPOSE: A feasibility study comparing retinal nerve fibre layer (RNFL) thickness values obtained with imaging devices against RNFL thickness measurements obtained histologically in a human eye. DESIGN: A single patient scheduled for orbital exenteration, who still possessed a healthy functioning eye. METHODS: Before surgery, the eye was imaged using optical coherence tomography (OCT) and scanning laser polarimetry (SLP). After orbital exenteration, the globe was sectioned, and 100 equidistant RNFL thickness measurements were obtained for each of four concentric rings centred on the optic disc, with diameters of 3.0, 3.5, 4.0, and 4.5 mm. RESULTS: RNFL thickness was found to be inversely related to the distance from the centre of the optic disc along each radial meridian. Peripapillary RNFL thickness was found comparable for histology, OCT, and SLP. RNFL thickness measured histologically confirmed a 'double hump' pattern, peaking at the superior and inferior poles. Histologically derived RNFL thickness (microm), at 3.0 and 3.5 mm diameter ring ranged between 30-135 and 25-115 respectively. In comparison, the 3.0 mm diameter GDx data ranged between 25 and 100, and the 3.4 mm diameter OCT data between 40 and 175. CONCLUSIONS: Imaging data appear qualitatively similar when compared to the histologically derived data. Quantitative differences may be partly due to scaling differences and histological artefacts. The histological analysis approach demonstrated in this study can potentially serve to validate imaging-derived data, as well as help improve our understanding of RNFL loss in glaucoma.

Self-adhesive drape (Opsite) for management of leaking abdominal wounds.

BACKGROUND: Leaking abdominal wounds (LAW) are associated with high patient morbidity. OBJECTIVES: To evaluate the efficacy of a self-adhesive drape (Opsite) with suction drains for the management of LAW. METHODS: Twenty patients with LAW (14 intestinal fistula, 4 biliary fistula, 2 ascites leak) were subjected to the use of a self-adhesive drape with a Romovac suction drain. Conventional wound management was used for the first 5 days, followed by the application of Opsite drape. The parameters evaluated were quantity of the effluent, skin integrity, ease of application, patient comfort and cost effectiveness. A discomfort score (based on four parameters: mobility, skin excoriation, wetness and unpleasant odor) was recorded on day 1 (pre conventional), day 5 (post conventional-pre Opsite), and day 5 after Opsite application. Opsite drape was changed whenever required. RESULTS: The discomfort score was not altered with conventional therapy but was lower following Opsite application: mobility (0 vs 2), skin excoriation (0 vs 2), wetness (0.5 vs 2) and odor (0 vs 1). Opsite drape allowed accurate measurement of the effluent in all patients. The drape required change after a median of 14 days (range 10 to 18). CONCLUSIONS: Opsite drape is easy to apply on LAW, is effective in containing the effluent, and is associated with low patient morbidity.

Bilioma secondary to choledocholithiasis.

Bilioma secondary to choledocholithiasis is rare. We report a patient in whom a large common bile duct stone was responsible for leak from the infraduodenal segment of the bile duct. Choledochotomy with extraction of stone followed by T-tube drainage of the bile duct and evacuation of the bilioma resulted in complete recovery.

Superior orbital fissure syndrome: current management concepts.

The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.