Analysis of deep optic nerve head structures with spectral domain and swept-source optical coherence tomography.

PURPOSE: Histological evidence indicates that the earliest structural changes to the optic nerve head (ONH) in glaucoma occur in the lamina cribrosa (LC) and its interface with the sclera. However, clinical imaging of these structures remains challenging. We compared the visibility of deep ONH structures with newer iterations of spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT). METHODS: Twelve patients with open-angle glaucoma were imaged with SD-OCT with 24 radial B-scans centred on Bruch's membrane opening (BMO) and SS-OCT with a horizontal and vertical raster scan pattern containing five lines each, centred on the ONH. Single best-matched horizontal and vertical scans from the two modalities were selected and exported. Three independent observers masked to modality determined if BMO, posterior choroid surface, anterior scleral canal opening and anterior and posterior LC insertions into the sclera were detectable in the matched B-scan images. We determined the interobserver agreement and concordance in detecting each structure with the two OCT imaging modalities. RESULTS: There was a high interobserver agreement with both SS-OCT and SD-OCT (inter-item correlations: 0.81-0.93 and 0.77-0.82, respectively). There was a consistent tendency for higher overall detection rates with SS-OCT, however, the differences failed to reach statistical significance. With respect to individual structures, only the posterior LC insertion in the nasal quadrant was statistically different, with a detection rate of 13 and 6 (pooled out of a total of 36 across the three observers) with SS-OCT and SD-OCT, respectively (p=0.04). CONCLUSION: Overall, both SS-OCT and SD-OCT showed statistically equivalent visualisation of ONH structures, however, SS-OCT tended to have higher visualisation rates.

Recipient race modifies the association between obesity and long-term graft outcomes after kidney transplantation.

Donor and recipient obesity (defined using body mass index [BMI]) are associated with worse outcomes after kidney transplant (KT). In adult KT recipients identified using the Scientific Registry of Transplant Recipients (2000-2017), we examined the modifying effect of recipient race on recipient obesity (BMI > 30 kg/m2) and combined donor and recipient (DR) obesity pairing, with death-censored graft loss (DCGL), all-cause graft loss (ACGL), and short-term graft outcomes using multivariable Cox proportional hazards models and logistic regression. Obesity was associated with a higher risk of DCGL in White (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.25-1.35) than Black (aHR, 1.13; 95% CI, 1.08-1.19) recipients. White, but not Black, recipients with obesity were at higher risk for ACGL (aHR, 1.08; 95% CI, 1.05-1.11, for White recipients; aHR, 0.99; 95% CI, 0.95-1.02, for Black recipients). Relative to nonobese DR, White recipients with combined DR obesity experienced more DCGL (aHR, 1.38; 95% CI, 1.29-1.47 for White; aHR, 1.19; 95% CI, 1.10-1.29 for Black) and ACGL (aHR, 1.12; 95% CI, 1.07-1.17 for White; aHR, 1.00; 95% CI, 0.94-1.07 for Black) than Black recipients. Short-term obesity risk was similar irrespective of race. An elevated BMI differentially affects long-term outcomes in Black and White KT recipients; uniform BMI thresholds to define transplant eligibility are likely inappropriate.

Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation.

Background: As the prevalence of obesity increases globally, appreciating the effect of donor and recipient (DR) obesity on graft outcomes is of increasing importance. Methods: In a cohort of adult, kidney transplant recipients (2000-2017) identified using the SRTR, we used Cox proportional hazards models to examine the association between DR obesity pairing (body mass index (BMI) >30 kg/m2), and death-censored graft loss (DCGL) or all-cause graft loss, and logistic regression to examine risk of delayed graft function (DGF) and ≤30 days graft loss. We also explored the association of DR weight mismatch (>30 kg, 10-30 kg (D>R; D

Eyelid-Cheek Junction Soft-Tissue Perineurioma: Case Report and Controversies.

Perineurioma is a rare soft-tissue tumor with characteristic histologic and immunohistochemical features. The diagnosis; however, can be met with certain challenges. A 71-year-old woman presented with an enlarging painless mass in the right lower eyelid-cheek junction. The lesion presented as a raised overhanging trunk-shaped mass. An excisional biopsy and local reconstruction were performed. The overall morphology and immunohistochemical findings were most supportive of a cellular soft-tissue perineurioma, with differential diagnoses including dermatofibroma. To the authors' knowledge, this is the first histopathologically reported case of a superficially occurring soft-tissue perineurioma in the eyelid-cheek junction. The authors discuss the presentation, relevant literature, and controversies associated with this diagnosis.

Clinical relevance of protruded retinal layers in minimum rim width measurement of the optic nerve head.

BACKGROUND/AIMS: Optical coherence tomography (OCT) imaging of the optic nerve head minimum rim width (MRW) has recently been shown to sometimes contain components besides extended retinal nerve fibre layer (RNFL). This study was conducted to determine whether excluding these components, termed protruded retinal layers (PRLs), from MRW increases diagnostic accuracy for detecting glaucoma. METHODS: In this cross-sectional study, we included 123 patients with glaucoma and 123 normal age-similar controls with OCT imaging of the optic nerve head (24 radial scans) and RNFL (circle scan). When present, PRLs were manually segmented, and adjusted MRW measurements were computed. We compared diagnostic accuracy of adjusted versus unadjusted MRW measurement. We also determined whether adjusted MRW correlates better with RNFL thickness compared with unadjusted MRW. RESULTS: The median (IQR) visual field mean deviation of patients and controls was -4.4 (-10.3 to -2.1) dB and 0.0 (-0.6 to 0.8) dB, respectively. In the 5904 individual B-scans, PRLs were identified less frequently in patients (448, 7.6%) compared with controls (728, 12.3%; p<0.01) and were present most frequently in the temporal sector of both groups. Areas under the receiver operating characteristic curves and sensitivity values at 95% specificity indicated that PRL adjustment did not improve diagnostic accuracy of MRW, globally or temporally. Furthermore, adjusting MRW for PRL did not improve its correlation with RNFL thickness in either group. CONCLUSION: While layers besides the RNFL are sometimes included in OCT measurements of MRW, subtracting these layers does not impact clinical utility.

Impact of Head Tilt on Optical Coherence Tomography Image Orientation.

PURPOSE: Head tilt can have an impact on the orientation of posterior pole images. We conducted this study to determine the effect of head tilt on image orientation measured by the fovea-Bruch's membrane opening (FoBMO) angle with optical coherence tomography (OCT) imaging. METHODS: The study included 56 healthy subjects with mean (range) age of 33 (18 to 61) years. The dominant eye was first determined. To measure head tilt, a smartphone with a built-in gyroscope was affixed to the subject's head with adjustable straps. OCT imaging was performed in both eyes (in randomized order) at 0, 5, and 10 degrees of head tilt in the direction of the imaged eye (ipsilateral head tilt), and then in the opposite direction (contralateral head tilt). For each image, the device software determined Bruch's membrane opening center and the foveal pit from which the FoBMO angle was derived. RESULTS: Thirty-eight (68%) subjects were right eye dominant and 18 (32%) were left eye dominant. Each 1 degree head tilt resulted in a mean change of 0.76 degree in the FoBMO angle (P<0.01), with no significant difference in effect between the 2 eyes (P=0.72). The magnitude of the effect increased from 5 to 10 degrees, and was similar for both ipsilateral and contralateral head tilt. Ocular dominance did not modulate the effect of head tilt (P=0.42). CONCLUSIONS: Head tilt significantly affects OCT image orientation as measured by the FoBMO angle, presumably because cyclotorsion is not fully compensatory. The magnitude and direction of the effect does not depend on the dominant eye.

Protruded retinal layers within the optic nerve head neuroretinal rim.

PURPOSE: To determine the frequency with which retinal tissues other than the nerve fibre layer, hereafter referred to as protruded retinal layers (PRL), are a component of optical coherence tomography (OCT) neuroretinal rim measurements. METHODS: Ninety healthy (30 White, Black and Japanese, respectively) subjects were included in the study. A radial scan pattern (24 B-scans centred on Bruch's membrane opening [BMO]) was used. For each of the 48 minimum rim width (MRW) measurement points, we determined whether PRL were present, absent or indeterminate. When present, the proportion of PRL within the MRW was quantified. RESULTS: Protruded retinal layers were present in 503 (11.6%), absent in 3805 (88.1%) and indeterminate in 12 (0.3%) measurement points. Overall, 69 (76.6%) subjects had ≥1 points with PRL, with White subjects having the highest frequency and Japanese the lowest (29 [97%] and 18 [60%], respectively; p < 0.01). PRL were present in one-third of points in the temporal sector, but ≤5% in other sectors. When present, the median PRL thickness was 53.0 (interquartile range [IQR]: 33.0 to 78.5) µm, representing 20.6 (IQR: 13.0 to 28.5)% of MRW. Globally, the median PRL thickness comprised 1.3 (IQR: 0.2 to 3.5)% of the MRW; however, in the temporal sector, it exceeded 30% of MRW in some subjects. CONCLUSIONS: Protruded retinal layers are a component of MRW measurements in most normal subjects, occurring in almost 12% of all measurement points analysed. There were racial variations in the presence of PRL and a significantly higher frequency of PRL in the temporal sector.