Macular Vascular Density Analysis Using Adobe Photoshop Software In Diabetic Eyes: Optical Coherence Tomography Angiography Study.

BACKGROUND: Optical Coherence Tomography Angiography (OCTA) is dye less microvascular visualizing technique. In study we binaries OCTA images of macular vessels in healthy and diabetic subjects without macular oedema using Adobe Photoshop CS3 extended version. METHODS: Prospective, single centered, observational study total of 58 eyes of 108 Diabetic Retinopathy (DR) subjects and 20 eyes of 40 normal subjects with mean age of 58.3±10.5 range (40-82) were included in our study. Ten eyes with Non-Diabetic Retinopathy (NDR), twenty-nine eyes with Non-Proliferative Diabetic Retinopathy (NPDR) (mild-10, moderate-7 and severe-12) and nineteen eyes with Proliferative Diabetic Retinopathy (PDR)are studied with images obtained using OCTA between September 2016 to June 2017. Scan area of 6×6 mm was selected to find morphological changes in the superficial retinal layers and deep retinal layers. Captured OCTA images were binarized using automated thresholding algorithm. Macular Vessel Density (MVD) (%) and Foveal Avascular Zone area (mm2) measured for superficial and deep retinal vessel arcade. For comparison, analysis of variance and Kruskal-Wallis test are applied. RESULTS: Diabetic eyes were grouped according to their severity level. MVD and FAZ are compared in all groups. Results are significantly lower in all groups except in controls and NDR. Significant decrease is observed in vascular density of most layers with progress in retinopathy. CONCLUSIONS: Adobe Photoshop CS3 extended version is an excellent tool for image binarization. Calculating FAZ area and MVD using OCTA images agreed closely with clinical grading system. Application of this method can be helpful in monitoring disease progression.

Management of cognitive impairment in bipolar disorder: a systematic review of randomized controlled trials.

Cognitive impairment is common in bipolar disorder and is emerging as a therapeutic target to enhance quality of life and function. A systematic search was conducted on PubMed, PsycInfo, Cochrane, clinicaltrials.gov, and Embase databases for blinded or open-label randomized controlled trials evaluating the pro-cognitive effects of pharmacological, neurostimulation, or psychological interventions for bipolar disorder. Twenty-two trials were identified, evaluating a total of 16 different pro-cognitive interventions. The methodological quality of the identified trials were assessed using the Cochrane Risk of Bias tool. Currently, no intervention (i.e., pharmacologic, neurostimulation, cognitive remediation) has demonstrated robust and independent pro-cognitive effects in adults with bipolar disorder. Findings are preliminary and methodological limitations limit the interpretation of results. Methodological considerations including, but not limited to, the enrichment with populations with pre-treatment cognitive impairment, as well as the inclusion of individuals who are in remission are encouraged. Future trials may also consider targeting interventions to specific cognitive subgroups and the use of biomarkers of cognitive function.