Macular thickness assessment in healthy eyes based on ethnicity using Stratus OCT optical coherence tomography.

PURPOSE: To assess the variation in macular thickness measurements in healthy Caucasian and African American men and women through Stratus OCT optical coherence tomography (OCT-3). METHODS: One hundred sixty-six eyes of 83 healthy patients underwent complete ophthalmologic examination in this prospective study. Exclusion criteria included a diagnosis of diabetes mellitus, hypertension, intraocular pressure (IOP) greater than 21 mm Hg, history of eye surgery or trauma, or evidence of eye disease. For analysis purposes, the authors excluded those participants in whom OCT signal strength was <7 in each eye. A fast macular thickness protocol consisting of a 6-mm radial scan centered on the fovea was used for the analysis, and the data were analyzed using the t-test for independence and linear regression. Both eyes of each patient were analyzed using the OCT-3, and analysis showed a statistically significant correlation between right and left eyes. Therefore, only one eye from each patient was randomly selected for final correlation and analysis. RESULTS: Mean foveal thickness (MFT) for Caucasians was 32 microm greater than for African Americans (217 vs. 185 microm, respectively; P < 0.001). The MFT was significantly thicker in males than in females (220 vs. 197 microm, respectively; P < 0.001). CONCLUSIONS: The fovea is significantly less thick in African Americans and females than in Caucasians and males. Racial and sexual differences should be considered when interpreting an OCT scan.

Can effect of finasteride on prostate-specific antigen be used to decrease repeat prostate biopsy?

OBJECTIVES: Patients often undergo multiple prostate biopsies for persistently elevated prostate-specific antigen (PSA) levels. Finasteride decreases serum PSA by approximately 50%. We performed a pilot study to examine the correlation among finasteride, PSA, and PSA density (PSAD) to identify patients who could be excluded from repeat prostate biopsy. METHODS: We performed a prospective study from 2001 to 2002 on 25 men with elevated PSA levels. These patients had prior negative prostate biopsy findings. At study onset, the patients' PSA level and PSAD were measured. Patients were instructed to take finasteride 5 mg for 6 months. PSA and PSAD determination and prostate biopsies were repeated at 6 months and the findings compared with the initial results. RESULTS: The mean patient age was 67.2 years (median 62). The median PSA level was 8.3 ng/dL at study entry (mean 9.34) and 4.6 ng/dL (mean 5.09) at 6 months. The median PSAD was 0.18 (mean 0.20) at study entry and 0.09 (mean 0.12) at 6 months. Of the 23 patients who completed the study, 6 (26%) were diagnosed with prostate cancer. At study entry, the median PSA level in those with prostate cancer was 9.6 ng/dL and was 5.8 ng/dL at 6 months. Patients without prostate cancer on repeat biopsy had a 44% decrease in PSAD. Patients with prostate cancer had a 5% decrease in PSAD. CONCLUSIONS: The results of our study have demonstrated that patients without prostate cancer have a greater decrease in PSAD when taking finasteride than those with prostate cancer. This pilot study had a small population with limited power, and a repeat prospective study with a larger population is warranted.

Indocyanine green staining of anteriorly placed zonules.

The anatomy of the capsules and zonules varies with each patient, particularly in the zonule-free zone. We present a case in which indocyanine green dye highlighted the anterior lens capsule and centrally encroaching zonular fibers within a 2.0 mm zonule-free zone. We suggest technique modifications to reduce the risk for capsule extensions and related complications.

Obstructive nephropathy secondary to sulfasalazine calculi.

The incidence of drug-induced stone disease is 0.44%. A 57-year-old woman with ulcerative colitis presented with obstructive nephropathy and pyelonephritis. She underwent cystoscopy, bilateral retrograde pyelography, and bilateral ureteral stent placement. A 6-cm bladder calculus and two 3-mm right distal ureteral calculi were discovered. Later, cystolithotomy was performed. The stone analysis demonstrated sulfapyridine, a sulfasalazine metabolite. Patients with inflammatory bowel disease can develop urolithiasis owing to acidic urine and low-volume urine production. Patients receiving aminosalicylates are at an increased risk of urolithiasis and may benefit from oral hydration and urinary alkalization.