Optical coherence tomography angiography of the macular microcirculation in acute primary angle closure treated with phacoemulsification.

PURPOSE: To measure the changes of macular microcirculation in cases with unilateral acute primary angle closure (APAC) who were managed by phacoemulsification. METHODS: Patients with unilateral APAC and managed by phacoemulsification were enrolled. The contralateral unaffected eyes were served as fellow group, and normal individuals were recruited as control group. Optical coherence tomography angiography (OCT-A) was performed to analyze the macular whole image vessel density (wiVD) and parafoveal vessel density (pfVD). The retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses were assessed using spectral-domain optical coherence tomography. RESULTS: A total of 36 APAC patients and 35 eyes from 35 normal individuals were recruited. In the APAC eyes, the mean wiVD (42.1% ± 3.7%) and pfVD (45.2% ± 3.8%) in the superficial layers (wiVD-SL and pfVD-SL) were both significantly reduced, compared to fellow eyes (45.7% ± 3.1%, 48.7% ± 3.1%) and control eyes (44.4% ± 4.7%, 47.4% ± 5.1%) (P < 0.05). They were all statistically correlated with RNFL, GCC, visual field pattern standard deviation (PSD), and mean deviation (MD). CONCLUSION: The macular OCT-A parameters including wiVD-SL and pfVD-SL were significantly reduced in the eyes with APAC compared to the fellow unaffected eyes and normal control eyes. They were correlated well with RNFL, GCC, PSD and MD. The macular vessel density parameters may help monitor the progression of APAC.

[Clinical values and optimal cut-off points of basic vital signs in early identification of critical hand, foot, and mouth disease].

OBJECTIVE: To study the clinical values of basic vital signs in early identification of critical hand-foot-mouth disease (HFMD). METHODS: The clinical data of 358 children with severe HFMD [212 cases in stage 2 (central nervous system involvement) and 146 cases in stage 3 (earlier stage of cardiopulmonary failure, critical type)] were reviewed. The diagnostic values of peak temperature and duration of fever, as well as the heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in different age groups, for critical HFMD (stage 3) were analyzed using the receiver operating characteristic (ROC) curve. RESULTS: HFMD might progress to critical type in case of HR≥148.5 beats/minutes, RR≥36.5 times/minutes, SBP≥95 mm Hg, and DBP≥59 mm Hg among children aged 0-1 year. HR≥142.5 times/minutes, RR≥31.5 times/mintes, SBP≥103 mm Hg, and DBP≥60.5 mm Hg in children aged 1-2 years had a certain diagnostic value for critical HFMD. HFMD might progress to critical type in case of HR≥139.5 times/minutes, RR≥29.5 times/minutes, and SBP≥103 mm Hg among children≥3 years of age. The sensitivity and specificity of every indicator were higher than 0.517 and 0.769, respectively. The area under the ROC curve (AUC) for peak temperature was 0.507 (P=0.816, compared with AUC=0.5). When the duration of fever was ≥5.5 days, the sensitivity and specificity were 0.589 and 0.571, respectively. CONCLUSIONS: HR, RR, and BP are good indicators to identify critical HFMD (stage 3) early. The optimal cut-off points conform to the age characteristics of children. DBP in children≥3 years of age, peak temperature, and duration of fever have a low value in early identification of critical HFMD.