Screening and Follow-Up of Acute ROP: Reproducibility of Fluorescein Angiography.

INTRODUCTION: Binocular indirect ophthalmoscopy (BIO) is fundamental for screening of retinopathy of prematurity (ROP). Digital retinal imaging devices with fluorescein angiography (FA) proved to be useful in screening and management of ROP. FA provides valuable additional information that is not detectable through ophthalmoscopy. FA images are relatively easy to interpret even by personnel without specific experience in ROP. The aim of this study is to evaluate reproducibility of FA for the screening and follow-up of ROP. METHODS: A total of 106 pairs of FA images of 30 eyes of 15 premature infants with stage II ROP were evaluated by 5 ophthalmologists: 2 experts, 2 non-experts, and 1 expert in reading FA in adult patients. Each operator gave a score to each of following parameters: leakage, ischemic areas, peripheral plus disease and vascular anomalies. The images were reviewed twice. Intra- and inter-concordance between the readers of the FA findings was evaluated by the means of Cohen's kappa coefficient (κ). RESULTS: The intra-operator concordance was very good (κ > 0.81) for all FA findings. Inter-operator concordance was good (κ > 0.41) for all operators and all FA findings. Global concordance was: substantial (intra-inter readers: κ > 0.61) for leakage, ischemic areas, and plus disease; almost perfect (κ > 0.81) for vascular anomalies; and moderate (κ = 0.41-0.60) for continuity/discontinuity of the ischemic areas. Total FA score was directly correlated to the percentage of treatment: a score ≥ 7 was correlated with 100% treatment and a score ≤ 3 with no treatment. Treatment timing was inversely correlated to FA score: a score ≥ 8 was correlated with a timely treatment (≤ 6 days), and a score ≤ 7 was correlated with a delayed treatment (< 10 days). CONCLUSION: This study showed that FA represents a reproducible imaging technique. It is useful for detecting ROP progression, and to define the treatment timing and type.

The Challenge of Planning Conservation Strategies in Threatened Seascapes: Understanding the Role of Fine Scale Assessments of Community Response to Cumulative Human Pressures.

Assessing the distribution and intensity of human threats to biodiversity is a prerequisite for effective spatial planning, harmonizing conservation purposes with sustainable development. In the Mediterranean Sea, the management of Marine Protected Areas (MPAs) is rarely based on explicit consideration of the distribution of multiple stressors, with direct assessment of their effects on ecosystems. This gap limits the effectiveness of protection and is conducive to conflicts among stakeholders. Here, a fine scale assessment of the potential effects of different combinations of stressors (both land- and marine-based) on vulnerable rocky habitats (i.e. lower midlittoral and shallow infralittoral) along 40 km of coast in the western Mediterranean (Ionian Sea) has been carried out. The study area is a paradigmatic example of socio-ecological interactions, where several human uses and conservation measures collide. Significant differences in the structure of assemblages according to different combinations of threats were observed, indicating distinct responses of marine habitats to different sets of human pressures. A more complex three-dimensional structure, higher taxon richness and ß-diversity characterized assemblages subject to low versus high levels of human pressure, consistently across habitats. In addition, the main drivers of change were: closeness to the harbour, water quality, and the relative extension of beaches. Our findings suggest that, although efforts to assess cumulative impacts at large scale may help in individuating priority areas for conservation purposes, the fact that such evaluations are often based on expert opinions and not on actual studies limits their ability to represent real environmental conditions at local scale. Systematic evaluations of local scale effects of anthropogenic drivers of change on biological communities should complement broad scale management strategies to achieve effective sustainability of human exploitation of marine resources.

Fluorescein angiography-based diagnosis for retinopathy of prematurity: expert-non expert comparison.

PURPOSE: To evaluate accuracy and inter-rater reliability of RetCam fundus images and digital camera fluorangioscopic images in acute retinopathy of prematurity (ROP) by comparing diagnoses given by trainee ophthalmologists with those provided by expert ophthalmologists. 
 METHODS: This is a multicenter retrospective observational study of diagnostic data from 48 eyes of 24 premature infants with classical ROP, stage II, as evaluated by RetCam 3 and fluorescein angiography (FA). Average gestational age was 25.4 weeks, average weight 804.7 g. A staging grid (with ocular fundus divided into 3 concentric zones) and 24 15° sectors centered around the optic papilla were superimposed on 360° retina photomontages (Photoshop) made from RetCam and FA images. Non expert vs expert diagnosis agreement was measured for each sector by means of Cohen kappa (Fleiss, 1981).
 RESULTS: A high degree of concordance was found. Inter-rater agreement between expert and non expert interpretations of retinal photomontages was greater for fluorangiographic images than for RetCam images, with κ = 0.61-1 for 120/152 (78.9%) sectors examined on the RetCam images and κ = 0.61-1 for 168/198 (84.8%) sectors examined on the FA images.
 CONCLUSIONS: The FA images appear to be easier to interpret than RetCam images, both by expert and non expert ophthalmologists. The results confirm that FA is a good examination technique with a high degree of reliability, even where trainee practitioners are involved. This suggests that retinopathy management can be improved by entrusting diagnostic responsibilities to trainee ophthalmologists, in order to extend access to correct diagnosis, recognition of threshold lesions, and prompt treatment.