The value of dual time-point fluorine-18 fluorodeoxyglucose PET/computed tomography imaging in predicting lymph node metastasis in non-small cell lung cancer patients.

OBJECTIVE: The purpose of this study was to analyze the correlation between specified dual time-point fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) imaging parameters and pathological characteristics in non-small cell lung cancer (NSCLC) patients. METHODS: This study retrospectively analyzed 47 patients with NSCLC. All patients underwent dual time-point 18 F-FDG PET/CT imaging. We obtained the metabolic parameters, standardized uptake value (SUV) maximum, SUV mean , delayed standardized uptake value (DSUV) maximum, DSUV mean , delay index standardized uptake value (DISUV) maximum, and DISUV mean , of the primary tumor. The tumor size was measured by CT. All lymph nodes had a definite pathological diagnosis. We next evaluated the status of the lymph node metastases (LNM) and the correlations between metabolic parameters and clinical characteristics. Receiver operating characteristic curves were drawn for the prediction of LNM. RESULTS: We found that the DSUV max , DISUV max , DSUV mean , and tumor size were significantly related to LNM ( P  = 0.036, 0.009, and 0.049, respectively). Multivariate analysis revealed that tumor size and DISUV max were independent risk factors for LNM in lung cancer patients. According to the receiver operating characteristic curve analysis, the optimal cutoff values for DISUV max and tumor size were 0.33 and 2.8 cm, respectively. When these two parameters were combined, the area under the curve for predicting LNM in NSCLC was 0.768, and the sensitivity was 95.7% for predicting LNM in lung cancer patients. We further allocated the patients to three groups: the high-risk group (tumor size ≥ 2.8 cm, DISUV max  ≥ 0.33), the moderate-risk group (tumor size ≥ 2.8 cm, DISUV max  < 0.33, or tumor size < 2.8 cm, DISUV max  ≥ 0.33), and the low-risk group (tumor size < 2.8 cm, DISUV max  < 0.33). The rates of LNM were 70, 50, and 0%, respectively. CONCLUSION: Tumor size and DISUV max are risk factors for predicting LNM, and they are more useful in combination. Compared with standard PET/CT imaging, dual time-point PET/CT imaging has added value in predicting LNM in NSCLC patients.

Pediatric Glaucoma-From Screening, Early Detection to Management.

Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.

Risk of Normal Tension Glaucoma Progression From Automated Baseline Retinal-Vessel Caliber Analysis: A Prospective Cohort Study.

PURPOSE: To determine the relationship between baseline retinal-vessel calibers computed by a deep-learning system and the risk of normal tension glaucoma (NTG) progression. DESIGN: Prospective cohort study. METHODS: Three hundred and ninety eyes from 197 patients with NTG were followed up for at least 24 months. Retinal-vessel calibers (central retinal arteriolar equivalent [CRAE] and central retinal venular equivalent [CRVE]) were computed from fundus photographs at baseline using a previously validated deep-learning system. Retinal nerve fiber layer (RNFL) thickness and visual field (VF) were evaluated semiannually. The Cox proportional-hazards model was used to evaluate the relationship of baseline retinal-vessel calibers to the risk of glaucoma progression. RESULTS: Over a mean follow-up period of 34.36 ± 5.88 months, 69 NTG eyes (17.69%) developed progressive RNFL thinning and 22 eyes (5.64%) developed VF deterioration. In the multivariable Cox regression analysis adjusting for age, gender, intraocular pressure, mean ocular perfusion pressure, systolic blood pressure, axial length, standard automated perimetry mean deviation, and RNFL thickness, narrower baseline CRAE (hazard ratio per SD decrease [95% confidence interval], 1.36 [1.01-1.82]) and CRVE (1.35 [1.01-1.80]) were associated with progressive RNFL thinning and narrower baseline CRAE (1.98 [1.17-3.35]) was associated with VF deterioration. CONCLUSION: In this study, each SD decrease in the baseline CRAE or CRVE was associated with a more than 30% increase in the risk of progressive RNFL thinning and a more than 90% increase in the risk of VF deterioration during the follow-up period. Baseline attenuation of retinal vasculature in NTG eyes was associated with subsequent glaucoma progression. High-throughput deep-learning-based retinal vasculature analysis demonstrated its clinical utility for NTG risk assessment.

Relationship between macular intercapillary area measured by optical coherence tomography angiography and central visual field sensitivity in normal tension glaucoma.

PURPOSE: To investigate the relationship of macular intercapillary area (ICA) with macular ganglion cell-inner plexiform layer (GCIPL) thickness and central visual field sensitivity (CVFS) in normal tension glaucoma (NTG). METHODS: Seventy-eight early NTG eyes, 33 moderate-to-severe NTG eyes and 75 normal control eyes were cross-sectional evaluated. All participants underwent swept-source optical coherence tomography angiography (OCT-A; DRI-OCT, Topcon, Tokyo, Japan). A customised MATLAB program was used to quantify macular OCT-A metrics at central 3×3 mm macular region including vascular density (VD), foveal avascular zone (FAZ) area, 10 largest ICA including FAZ area (ICA10_IncFAZ) and excluding FAZ area (ICA10_ExcFAZ). Generalised estimating equation regression models were performed to determine the relationships of OCT-A vascular metrics with GCIPL thickness in the macular region and CVFS. RESULTS: NTG eyes had lower global VD, larger ICA10_IncFAZ, and larger ICA10_ExcFAZ than normal controls (all p≤0.016). In the multivariable analyses, decreased VD (ß=-0.304, p=0.006) and increased ICA (ß=-0.231 for ICA10_IncFAZ and ß=-0.259 for ICA10_ExcFAZ, all p≤0.042) were significantly associated with decreased GCIPL thickness in early NTG eyes but not in moderate-to-severe NTG eyes. ICA enlargement was associated with CVFS in early NTG eyes (ß=-0.310, p=0.009), while VD was associated with CVFS in moderate-to-severe NTG eyes (ß=-0.272, p=0.038). CONCLUSION: ICA enlargement could be a potentially important disease marker of early NTG as reflected by its association with GCIPL thinning and decrease CVFS specifically for early NTG eyes.

Longitudinal change of peripapillary vessel density and retinal nerve fibre layer thickness in normal tension and primary angle closure glaucoma.

PURPOSE: To compare the rates of peripapillary vessel density (pVD) loss and retinal nerve fibre layer (RNFL) thinning in normal tension glaucoma (NTG) and primary angle closure glaucoma (PACG). METHODS: Baseline age and severity-matched NTG and PACG eyes (75 eyes of 60 patients for each subtype) were observed longitudinally. All participants' RNFL thickness were measured by optical coherence tomography (OCT); pVD were measured by swept-source OCT-angiography (OCT-A) and quantified by a customised MATLAB program. The rate of pVD loss and RNFL thinning were estimated by linear mixed-effects models. RESULTS: NTG eyes had significant pVD loss in all sectors (p≤0.05) while PACG eyes' pVD loss was borderline significant in the global region (p=0.05). Significant RNFL thinning was detected in the inferotemporal and superonasal regions of both groups, and the superotemporal region in the NTG group (all p≤0.02). NTG had faster rate of pVD loss in the global (difference (95% CI) -1.08 (-1.90 to -0.27) %/year), temporal (-1.57 (-2.91 to -0.23) %/year) and superotemporal (-1.46 (-2.65 to -0.26) %/year) regions than PACG (all p≤0.02), without significant difference of the rate of RNFL thinning. A lower baseline mean deviation (MD) was associated with a faster rate of global pVD loss, while a lower baseline pVD was associated with a slower rate of global pVD loss in multivariable analyses (both p≤0.04). CONCLUSIONS: NTG had more extensive and faster rate of pVD loss than PACG. Baseline global pVD and MD were independently associated with the rate of pVD loss in NTG.

Prevalence and Ocular Biometric Characteristics of Myopia in Primary Angle Closure Disease in Rural China: The Handan Eye Study.

Purpose: The purpose of this study was to determine the prevalence of myopia among patients with primary angle closure disease (PACD) in rural China and their ocular biometric characteristics. Methods: Study subjects were recruited from the Handan Eye Study. A/B-mode scan (Cine Scan, Quantel Medical, Cedex, France) was used to measure the axial length, anterior chamber depth (ACD), and lens thickness (LT). PACD was defined as the anterior chamber angle being considered closed when 180 degrees or more of the posterior pigmented trabecular meshwork were not visible on the gonioscopy. Myopia was defined as a spherical equivalent (SE) refractive error ≤-0.5 diopter (D). Persons who did not meet PACD definition were classified as the open-angle (OA) group. Results: The overall prevalence of myopia in persons with PACD was 13.7% (11.6% in primary angle closure suspect [PACS], 21.6% in primary angle closure [PAC], 62.5% in primary angle closure glaucoma [PACG]). The age-specific prevalence of myopia in PACD eyes was 41.7% at 30 to 39 years old, 12.3% at 40 to 49 years old, 8.7% at 50 to 59 years old, 10.7% at 60 to 69 years old, and 31.7% at age 70 years and over. PACD had shorter AL (22.2 ± 0.8 vs. 22.9 ± 0.9 mm, P < 0.001), shallower ACD (2.3 ± 0.3 vs. 2.8 ± 0.4 mm, P < 0.001), and greater LT (5.0 ± 0.5 vs. 4.7 ± 0.5 mm, P < 0.001). PACD had even thicker lenses and deeper ACD with age than those with OA (all P ≤ 0.025) from 30 years to 70 years of age and over. Conclusions: Myopia was common among persons with PACD who were less than 40 years of age in this rural Chinese population, and over half of those with PACG were myopic.

Comparison of optical coherence tomography angiography metrics in primary angle-closure glaucoma and normal-tension glaucoma.

To investigate the peripapillary vascular metrics in early normal tension glaucoma (NTG) and early primary angle closure glaucoma (PACG) eyes using optical coherence tomography angiography (OCT-A). One or both eyes of each subject were imaged for a 3 × 3 mm peripapillary region by swept-source OCT-A (DRI-OCT Triton, Topcon, Japan) and assessed by an automated MATLAB program. OCT-A metrics including circumpapillary vessel density (cpVD) and fractal dimension (cpFD) were compared. Their association with visual field (VF) parameters and retinal nerve fiber layer (RNFL) thickness were determined. Sixty-eight eyes of 51 PACG, 68 eyes of 48 NTG, and 68 eyes of 49 control subjects were cross-sectionally analyzed. NTG eyes had significantly lower global cpVD (52.369 ± 0.781%) compared with PACG eyes (55.389 ± 0.721%, P = 0.004) that had comparable disease severity and average RNFL thickness. Multivariable analysis revealed that, for PACG and NTG eyes, decreased cpVD ([PACG] ß = -4.242; CI: -8.120, -0.363 vs [NTG] ß = -5.531; CI: -9.472, -1.590) and cpFD ([PACG] ß = -8.894;CI: -11.925, -5.864 vs [NTG] ß = -12.064; CI: -17.095, -6.932) were associated with decreased RNFL thickness (all P ≤ 0.032); with a stronger association between decrease cpFD and decreased RNFL thickness in NTG eyes (P = 0.028). Decreased cpVD was associated with decrease mean deviation (MD) in NTG eyes (ß = -0.707; CI: -1.090, -0.324; P ≤ 0.001) and not associated with the visual field parameters in PACG eyes. Early NTG had lower global cpVD compared with early PACG, despite similar disease severity and average RNFL thickness.