The disc damage likelihood scale: Diagnostic accuracy and correlations with cup-to-disc ratio, structural tests and standard automated perimetry.

Our objective was to compare the diagnostic accuracies of and to determine the correlations between the disc damage likelihood scale (DDLS) and anatomical and functional tests used for glaucoma detection. A total of 54 healthy subjects (54 eyes) and 47 primary open-angle glaucoma patients (47 eyes) were included in this cross-sectional observational study. DDLS scores and cup-to-disc (C/D) ratios were evaluated. Subjects underwent standard automated perimetry (SAP), optic disc and retinal nerve fiber layer (RNFL) imaging with time and spectral-domain optical coherence tomography (TD and SD-OCT), Heidelberg Retina Tomograph (HRT II), and scanning laser polarimetry (GDx-VCC). Areas under the receiver operating characteristic curves (AROCs) for DDLS and diagnostic tests parameters were calculated. DDLS correlations (Spearman's rank) among these parameters were analyzed. Fifty-four eyes were healthy and 47 had glaucoma, including 16 preperimetric glaucoma. DDLS, vertical and horizontal C/D ratios had the largest AROCs (0.92, 0.94 and 0.91, respectively). DDLS diagnostic accuracy was better than the accuracies of HRT II parameters, TD and SD-OCT RNFL thicknesses, and SAP mean deviation (MD) index. There were no significant differences between the accuracies of the DDLS and the C/D ratios, TD-OCT vertical (0.89) and horizontal (0.86) C/D ratios, TD-OCT C/D area ratio (0.89), and GDx-VCC NFI (0.81). DDLS showed significant strong correlations with vertical (r = 0.79) and horizontal (0.74) C/D ratios, and with the parameters vertical C/D ratio and C/D area ratio from HRT II (both 0.77) and TD-OCT (0.75 and 0.72, respectively). DDLS had significant moderate correlations with most of the other structural measurements and SAP MD. The optic disc clinical evaluation with DDLS system and C/D ratio demonstrated excellent accuracy in distinguishing glaucomatous from healthy eyes. DDLS had moderate to strong correlations with most structural and functional parameters. These findings stress the importance of optic disc clinical examination to detect glaucoma in a clinical scenario.

Fetal ocular measurements by three-dimensional ultrasound.

PURPOSE: To establish a reference range for normal fetal eye volume (FEV) by three-dimensional ultrasound using Virtual Organ Computer-aided AnaLysis (VOCAL) method and compare the reproducibility between the two trace modes (manual and sphere). METHODS: This prospective, longitudinal observational study was performed at a single center and involved 71 eyes of 37 fetuses between 17 and 40 weeks of gestational age. Only pregnancies without fetal growth restriction, diabetes mellitus, hypertension, or major fetal malformation were included. Fetuses' eye measurements were obtained by a single observer during routine ultrasonographic examination. RESULTS: Mean FEV manual mode ranged from 309.5 ± 80.1 mm(3) at 17-18 weeks to 2552.1 ± 384.9 mm(3) at 39-40 weeks. Mean FEV sphere mode ranged from 394.8 ± 71.8 mm(3) at 17-18 weeks to 2682.1 ± 343.4 mm(3) at 39-40 weeks. Correlations ranged from R² = 0.85 (transversal diameter and gestational age) to R² = 0.91 (FEV sphere mode and gestational age). All correlations were statistically significant (P < 0.001). Although highly correlated (R² = 0.97, P < 0.001), there was a fixed bias between manual and sphere measurements. The agreement between these measurements showed no proportional bias (P = 0.89). CONCLUSIONS: The present study establishes reference values for FEV using the VOCAL method manual mode. These normal growth parameters can be used in routine ultrasound assessment of the fetal eye, especially in families at risk of genetic diseases that affect ocular growth, such as congenital glaucoma.

Spectral-domain optical coherence tomography for early glaucoma assessment: analysis of macular ganglion cell complex versus peripapillary retinal nerve fiber layer.

OBJECTIVE: We sought to compare the glaucoma discrimination ability of macular inner retinal layer (MIRL) thickness with that of conventional peripapillary retinal nerve fiber layer (pRNFL) thickness as measured by spectral-domain optical coherence tomography (SD-OCT) in patients with early glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: We studied 67 patients with early glaucoma (visual field mean deviation index ≥-6 dB), and 56 healthy subjects were prospectively enrolled. METHODS: All patients underwent MIRL thickness measurement (ganglion cell complex [GCC] scan) and pRNFL thickness measurement (3.45 mm scan) by SD-OCT. Whenever both eyes were eligible, one was randomly selected. Receiver operating characteristic curves and sensitivities at fixed specificities were generated for different parameters. The areas under the receiver operating characteristic curves (AUCs) of each parameter were compared. RESULTS: The average mean deviation for the glaucomatous eyes was -2.5 ± 1.6 dB. The AUCs for average (0.815); superior (0.807); and inferior (0.788) MIRL thicknesses were not significantly different (p ≥ 0.18). The AUCs for average (0.735); superior (0.728); and inferior (0.697) pRNFL thicknesses were also similar (p ≥ 0.15). Average MIRL thickness had a significantly larger AUC compared to average pRNFL thickness analysis (0.815 vs 0.735; p = 0.03). Sensitivities at 80% specificity for average MIRL and pRNFL thicknesses were 66.7% (cutoff, 89.9 µm) and 62.9% (cutoff, 111.8 µm), respectively. CONCLUSIONS: The GCC scan showed a similar or even a slightly better ability to discriminate between healthy and early glaucomatous eyes compared to the pRNFL scan. Different from previous analyses considering total macular thickness, the GCC macular scan seems to be a useful tool for identification of early structural damage in patients with glaucoma.

Dimethyl sulfoxide as a block to the deleterious effect of nicotine in a random skin flap in the rat.

BACKGROUND: In plastic surgery, a causal relationship between heavy smoking and flap necrosis has been shown. The deleterious effect of nicotine in random skin flaps in rats has also been proven, being related to vasoconstriction and possibly reactive oxygen species. This study aimed to verify the capacity of dimethyl sulfoxide, an antioxidant, to block the deleterious effect of nicotine in a random skin flap. METHODS: Fourteen adult male Wistar-EPM rats were distributed at random into two groups of seven animals. The nicotine group received this drug subcutaneously (1.2 mg/kg/day), for 1 week before flap elevation. The nicotine plus dimethyl sulfoxide group followed the same routine. Five minutes before the surgical procedure, rats in the nicotine group received distilled water orally and rats in the nicotine plus dimethyl sulfoxide group received dimethyl sulfoxide orally (2 ml/kg). Blood and skin tissue samples were collected to allow determination of malondialdehyde levels. RESULTS: The nicotine group had a mean value of 40.2 percent and the nicotine plus dimethyl sulfoxide group had a mean value of 20.6 percent necrosis (p = 0.009). Malondialdehyde levels in both serum and skin samples were lower in the animals that received dimethyl sulfoxide. CONCLUSION: The deleterious effect of nicotine was effectively blocked by dimethyl sulfoxide.