Exploring the gap between diagnostic research outputs and clinical use of OCT for diagnosing glaucoma.

AIMS: To explore the gap between diagnostic research outputs and clinical use of optical coherence tomography (OCT) in glaucoma and assess the reliability of a specific reference database when applied to a morphological imaging parameter for diagnostic purposes. METHODS: Consecutive subjects enrolled in the Multicenter Italian Glaucoma Imaging Study (MIGIS) have been included in this cross-sectional, comparative evaluation of diagnostic tests study. Patients underwent measurement of global and sectorial peripapillary retinal nerve fibre thickness (pRNFL) and minimum rim width (MRW) by OCT. The sensitivity and specificity of reference-database categorical classifications were calculated by means of 2×2 tables and sensitivity was compared with that of the corresponding continuous parameter extracted from the receiver operating characteristic (ROC) curves by matching the specificity. RESULTS: 280 Caucasian subjects have been included. At matched specificities, the sensitivity of pRNFL categorical classifications was statistically similar to that of the corresponding continuous parameters, whereas the sensitivity of the MRW categorical classifications was significantly lower than that of the corresponding continuous parameters. CONCLUSIONS: The diagnostic accuracy of reference database classifications might be lower than that extrapolated from the ROC curves of continuous parameters used in diagnostic research. The gap between the accuracy of these two approaches may be used to estimate the reliability of a specific reference database when applied to a continuous parameter for diagnostic purposes.

Macular versus nerve fibre layer versus optic nerve head imaging for diagnosing glaucoma at different stages of the disease: Multicenter Italian Glaucoma Imaging Study.

PURPOSE: To compare the diagnostic accuracy of minimum rim width (MRW), peripapillary retinal nerve fibre layer (pRNFL) and multilayered macular analysis by Spectralis SD-OCT (Heidelberg Engineering, Germany) in discriminating perimetric glaucoma at different stages of the disease from healthy eyes. METHODS: In this multicentre, prospective, evaluation of diagnostic tests study, multilayered macular analysis and MRW and pRNFL were obtained from one eye of 197 glaucoma (76 early, 68 moderate and 53 advanced) and of 83 healthy controls from the Multicenter Italian Glaucoma Imaging Study (MIGIS). The reference standard for classifying eyes as glaucomatous and for staging the disease was the visual field. The main outcome measures were area under the ROC curve (AUC) and sensitivity at fixed specificity (95%). RESULTS: Average MRW and average pRNFL showed the highest and similar diagnostic accuracy in both the whole study population (AUC 0.968 and 0.939) and early glaucoma (AUC 0.956 and 0.929). Among the macular parameters, the three innermost retinal layers combined as the Ganglion Cell Complex provided the highest diagnostic accuracy (AUC 0.931) in the whole population, which was statistically similar to that of average pRNFL but inferior to that of average MRW. Compared to both average MRW and pRNFL, all macular parameters showed statistically significant lower accuracy in early glaucoma, but accuracy in moderate and advanced glaucoma showed no statistically significant differences among three protocols. CONCLUSION: The diagnostic accuracy of MRW, pRNFL and macular analysis by Spectralis SD-OCT is overall good. MRW and pRNFL analysis performs statistically and clinically better than macular analysis to discriminate early glaucoma from healthy eyes.

Hypobaric hypoxia: effects on intraocular pressure and corneal thickness.

OBJECTIVE: The purpose of this study focused on understanding the mechanisms underlying ocular hydrodynamics and the changes which occur in the eyes of subjects exposed to hypobaric hypoxia (HH) to permit the achievement of more detailed knowledge in glaucomatous disease. METHODS: Twenty male subjects, aged 32±5 years, attending the Italian Air Force, were enrolled for this study. The research derived from hypobaric chamber, using helmet and mask supplied to jet pilotes connected to oxygen cylinder and equipped with a preset automatic mixer. RESULTS: The baseline values of intraocular pressure (IOP), recorded at T1, showed a mean of 16±2.23 mmHg, while climbing up to 18,000 feet the mean value was 13.7±4.17 mmHg, recorded at T2. The last assessment was performed returning to sea level (T4) where the mean IOP value was 12.8±2.57 mmHg, with a significant change (P<0.05) compared to T1. Pachymetry values related to corneal thickness in conditions of hypobarism revealed a statistically significant increase (P<0.05). CONCLUSIONS: The data collected in this research seem to confirm the increasing outflow of aqueous humor (AH) in the trabecular meshwork (TM) under conditions of HH.

Amblyopia treatment strategies and new drug therapies.

Amblyopia is a unilateral or bilateral reduction of visual acuity secondary to abnormal visual experience during early childhood. It is one of the most common causes of vision loss and monocular blindness and is commonly associated with strabismus, anisometropia, and visual deprivation (in particular congenital cataract and ptosis). It is clinically defined as a two-line difference of best-corrected visual acuity between the eyes. The purpose of this study was to understand the neural mechanisms of amblyopia and summarize the current therapeutic strategies. In particular, the authors focused on the concept of brain plasticity and its implication for new treatment strategies for children and adults with amblyopia.

Cancer of the rectum: comparison of two different surgical approaches.

Surgical treatment of rectal cancer is still controversial as regards the type of operation and the extent of lymphadenectomy. Four hundred and fifty-eight patients with rectal cancer operated on at two different hospitals (206 patients, Surgical Department, S. Martino General Hospital and 252 patients, Surgical Department, Galliera General Hospital) in the decade 1980-1989 were studied. None of the patients were submitted to adjuvant or neoadjuvant therapy. The operations opted for were anterior resection for carcinoma of the upper rectum, anterior resection or abdominoperineal resection for carcinoma of the middle rectum, and abdominoperineal resection for lower rectal cancer. At the S. Martino General Hospital, anterior resection comprised ligation of the inferior mesenteric artery at its origin, with subsequent preaortic lymphadenectomy. In abdominoperineal resection, the pelvis was left open and was closed later. At the Galliera General Hospital, preaortic lymph node dissection was not performed, and abdominoperineal resection comprised a one-stage pelvic floor closure. Survival was no different in the two patient populations. Extended lymphadenectomy was of no benefit in terms of survival in operated rectal cancer patients. Abdominoperineal resection may still be useful for selected patients.

[Anterior resection in rectal cancer: the role of lymphadenectomy. Comparison of 2 surgical experiences]. / La resezione anteriore nel cancro del retto: il ruolo della linfoadenectomia. Due diverse esperienze chirurgiche a confronto.

Of great interest today is the debate regarding the benefits and limitations of extended lymphadenectomy in rectal cancer, particularly with regard to patient survival. In the present report we review the experience of two different surgical departments: a total of 458 patients with rectal cancer were operated on in the 1st Surgical Department of S. Martino Hospital, Genoa, and in the 1st Surgical Department of Galliera Hospital, Genoa over the period from 1980 to 1989. Anterior rectal resection was performed in 137 rectal tumours at the S. Martino Hospital and in 146 at the Galliera Hospital. The mean follow-up was 48 months (range: 24-120 months). In the first group of patients, ligation at the origin of the mesenteric vessels (with subsequent peri-aortic lymphadenectomy) (D2-D3) was performed, while in the second group the mesenteric vessel ligation was done at the level of the origin of the left colic vessels (D1). There were no complementary therapies (radio or chemotherapy) either before or after surgery, because these were only introduced later. The data obtained from analysis of the long-term survival curves showed that there were no statistical differences between the two surgical experiences. The execution of extended lymphadenectomy would not appear to afford any additional benefit in terms of the survival of patients with rectal cancer. The well-matched starting conditions in the two groups allowed effective comparison between the two experiences and evaluation of the "pure" surgical aspect.