Percentage signal intensity recovery: A step ahead of rCBV in DSC MR perfusion imaging for the differentiation of common neoplasms of brain.

CONTEXT: Relative cerebral blood volume (rCBV) and percentage signal recovery (PSR) obtained from T2* dynamic susceptibility contrast magnetic resonance imaging are important parameters for brain tumor assessment. AIM: To study the accuracy of PSR in the differentiation of low-grade glioma, high-grade glioma, lymphoma, and metastases particularly in comparison to rCBV. SETTINGS AND DESIGN: Retrospective observational study. SUBJECTS AND METHODS: Study included pathologically confirmed cases of 10 low-grade glioma, 22 high-grade glioma, 6 lymphoma, and 12 metastases (Total 50). PSR, relative PSR (rPSR), and rCBV were calculated. STATISTICAL ANALYSIS USED: Accuracy of these parameters studied statistically using analysis of variance and ROC (Receiver operating characteristic) curves. RESULTS: rCBV was higher in metastases (3.45 ± 2.82) and high-grade glioma (3.47 ± 1.62), whereas was low in lymphoma (1.03 ± 0.74) and low-grade glioma (1.43 ± 0.47) with P value of 0.030. PSR was low in metastases (48 ± 16.18), intermediate in glioma (73.24 ± 6.39 and 88.26 ± 6.05, high and low grade), and high in lymphoma (112.16 ± 10.57) with P value < 0.000. rPSR was higher for lymphoma (1.73 ± 0.57) than high-grade glioma (0.85 ± 0.11) and metastasis (0.69 ± 0.19) with P value <.000. Area under ROC for PSR was greater than rCBV in differentiating metastases from lymphoma (1.00 vs 0.13), high-grade glioma from lymphoma (1.00 vs 0.38), high-grade glioma from metastases (0.89 vs 0.58), and high-grade glioma from low-grade glioma (0.96 vs 0.03) with excellent curve characteristics. F values for PSR and rPSR from ANOVA analysis were 71.47 and 36.77, was better than rCBV (3.84) in differentiating these groups. CONCLUSIONS: Percentage of signal recovery shows low recovery values in metastases, intermediate recovery values in glioma, and overshoot in lymphoma. PSR values show lower overlap than rCBV between lymphoma and metastases; and between high grade glioma and metastases. PSR difference is also higher than rCBV between low- and high-grade gliomas. Hence, PSR can potentially help as an additional perfusion parameter in the preoperative differentiation of these tumors.

Incomplete capsular bag distension syndrome after neodymium:YAG capsulotomy.

We report a 60-year-old man with incomplete capsular bag distension syndrome 2 years after neodymium:YAG (Nd:YAG) laser capsulotomy for capsule opacification, which developed from extracapsular cataract extraction with intraocular lens (IOL) implantation performed 4 years before presentation to our clinic. The patient reported floaters of 15 days duration. Slitlamp examination showed shallowing of the inferior and medial anterior chamber. Dilated pupil examination showed a peripheral capsular bag inferiorly and medially behind the IOL. The bag was distended and filled with turbid fluid. The central and superior capsule was absent as a result of the previous Nd:YAG treatment. The IOL lie over the anterior capsule, and peripheral capsule leaves' edges were adhered. An Nd:YAG laser puncture of the incomplete capsular bag resolved the condition.

Vitrectomy as a treatment for elevated intraocular pressure following intravitreal injection of triamcinolone acetonide.

PURPOSE: To report control of intravitreal triamcinolone acetonide-induced elevated intraocular pressure (IOP) by vitrectomy-assisted corticosteroid removal. DESIGN: Interventional case series. METHODS: Of the 26 eyes that had intravitreal injection of triamcinolone acetonide for various causes, 11 eyes (42.5%) developed elevated IOP. In nine eyes IOP was controlled by antiglaucoma medication. Two eyes of two patients developed uncontrolled IOP despite maximal antiglaucoma medication. These eyes underwent vitrectomy and removal of triamcinolone acetonide. RESULTS: IOP returned to normal in 3 weeks and 1 week, respectively, after vitrectomy. CONCLUSIONS: Elevated IOP associated with intravitreal injection of triamcinolone acetonide that is not controlled by maximal antiglaucoma medication can be effectively treated by vitrectomy-assisted removal of triamcinolone acetonide.

Orbital cysticercosis-associated scleral indentation presenting with pseudo-retinal detachment.

PURPOSE: To report a clinical picture similar to retinal detachment caused by orbital myocysticercosis-associated scleral indentation. DESIGN: Interventional case series. METHODS: Of the 49 cases of orbital myocysticercosis, four eyes of four patients had pseudoretinal detachment presentations that are detailed. RESULTS: Of the four patients with pseudoretinal detachment, three were found to have orbital myocysticerci in lateral and one in inferior recti muscles, mechanically indenting the eyeball, causing scleral indentation, evidenced by ultrasonography or computed tomography. Associated signs of myocysticercosis were orbital inflammation, restricted ocular motility or proptosis. In 2 to 10 days, the cysts traveled forward and came to lie in a sub-Tenon position. Three cysts were removed surgically and one extruded spontaneously. CONCLUSIONS: Patients presenting with a clinical picture similar to retinal detachment in the presence of symptoms and signs of orbital cysticercosis, with a history of exposure to an endemic area, should be considered to have orbital myocysticerci causing scleral indentation.

Conjunctival ulceration following triamcinolone injection.

PURPOSE: To report conjunctival ulceration as a complication of periocular triamcinolone acetonide injection. Interventional case series. METHODS: Conjunctival ulceration was found in three patients who had anterior subtenon's or subconjunctival deposition of triamcinolone. Cultures from the ulcer edges were negative. RESULTS: Most of the triamcinolone extruded, and the conjunctival ulcers healed with minimal scarring. CONCLUSIONS: Conjunctival ulceration was a potential complication of periocular triamcinolone injection in three patients who had anterior subtenon's or subconjunctival deposition of the corticosteroid.

Silicone sleeve of extrusion cannula as an intraocular foreign body.

An unusual intraocular foreign body--the silicone sleeve of a soft-tipped extrusion cannula left behind accidentally in the vitreous cavity following a vitreoretinal surgical procedure for complex retinal detachment--is reported. The silicone sleeve remained within the eye for a year without causing any problem.