Comparison of Drusen Volume Assessed by Two Different OCT Devices.

To compare drusen volume between Heidelberg Spectral Domain (SD-) and Zeiss Swept-Source (SS) PlexElite Optical Coherence Tomography (OCT) determined by manual and automated segmentation methods. Thirty-two eyes of 24 patients with Age-Related Macular Degeneration (AMD) and drusen maculopathy were included. In the central 1 and 3 mm ETDRS circle drusen volumes were calculated and compared. Drusen segmentation was performed using automated manufacturer algorithms of the two OCT devices. Then, the automated segmentation was manually corrected and compared and finally analyzed using customized software. Though on SD-OCT, there was a significant difference of mean drusen volume prior to and after manual correction (mean difference: 0.0188 ± 0.0269 mm3, p < 0.001, corr. p < 0.001, correlation of r = 0.90), there was no difference found on SS-OCT (mean difference: 0.0001 ± 0.0003 mm3, p = 0.262, corr. p = 0.524, r = 1.0). Heidelberg-acquired mean drusen volume after manual correction was significantly different from Zeiss-acquired drusen volume after manual correction (mean difference: 0.1231 ± 0.0371 mm3, p < 0.001, corr. p < 0.001, r = 0.68). Using customized software, the difference of measurements between both devices decreased and correlation among the measurements improved (mean difference: 0.0547 ± 0.0744 mm3, p = 0.02, corr. p = 0.08, r = 0.937). Heidelberg SD-OCT, the Zeiss PlexElite SS-OCT, and customized software all measured significantly different drusen volumes. Therefore, devices/algorithms may not be interchangeable. Third-party customized software helps to minimize differences, which may allow a pooling of data of different devices, e.g., in multicenter trials.

The Effect of Speaking Valves on ICU Mobility of Individuals With Tracheostomy.

BACKGROUND: Early mobilization is part of the rehabilitation process for critically ill patients and is currently considered a means of preventing ICU-acquired muscle deterioration and worsening of physical function. We sought to determine whether the use of speaking valves in tracheostomized patients would improve their mobility. We evaluated the changes in mobility performance with the use of speaking valves in tracheostomized subjects. METHODS: We performed a cohort study of a series of subjects who were tracheostomized and were being weaned from mechanical ventilation between April 2016 and May 2018. The subjects were those able to tolerate a speaking valve for a minimum of 30 min. Demographic data, comorbidities, cause of ICU admission, days in the ICU, duration of mechanical ventilation before tracheostomy, and days free from mechanical ventilation before tracheostomy were collected. Mobility status was evaluated using daily measurements of the Perme Intensive Care Unit Mobility Score. RESULTS: During the study period, 63 patients were tracheostomized. Patients with deficiencies in language (n = 2) or cognitive deficits (n = 36) and patients in exclusive palliative care (n = 7) were excluded. Eighteen subjects were enrolled in the study. The mean age of the subjects was 64.6 ± 14.2 y (55.5% were male), and the most common reason for ICU admission was pneumonia (n = 7; 38.8%). Perme scores increased from 11.3 (interquartile range 10.1-12.0) on the day before initiation of the speaking valve to 18.2 (IQR 16.2-20.1) immediately after the initiation of a speaking valve (P < .01). These changes were maintained during all periods of speaking valve use. CONCLUSIONS: The use of speaking valves in tracheostomized subjects improved mobility.

Quantification of retinal layer thickness changes in acute macular neuroretinopathy.

PURPOSE: To quantitatively evaluate retinal layer thickness changes in acute macular neuroretinopathy (AMN). METHODS: AMN areas were identified using near-infrared reflectance (NIR) images. Intraretinal layer segmentation using Heidelberg software was performed. The inbuilt ETDRS -grid was moved onto the AMN lesion and the mean retinal layer thicknesses of the central grid were recorded and compared with the corresponding area of the fellow eye at initial presentation and during follow-up. RESULTS: Eleven patients were included (mean age 26±6 years). AMN lesions at baseline had a significantly thinner outer nuclear layer (ONL) (51±21 µm vs 73±17 µm, p=0.002). The other layers, including inner nuclear layer (37±8 µm vs 38±6 µm, p=0.9) and outer plexiform layer (OPL) (45±19 µm vs 33±16 µm, p=0.1) did not show significant differences between the study eyes and fellow eyes. Adjacent to NIR image lesions, areas of OPL thickening were identified (study eye: 50±14 µm vs fellow eye: 39±16 µm, p=0.005) with corresponding thinning of ONL (study eye: 52±16 µm vs fellow eye: 69±16 µm, p=0.002). CONCLUSIONS: AMN presents with characteristic quantitative retinal changes and the extent of the lesion may be more extensive than initially presumed from NIR image lesions.

Retinal Ganglion Cell Layer Change in Patients Treated With Anti-Vascular Endothelial Growth Factor for Neovascular Age-related Macular Degeneration.

PURPOSE: To evaluate macular retinal ganglion cell thickness in patients with neovascular age-related macular degeneration (AMD) and intravitreal anti-vascular endothelial growth factor (VEGF) therapy. DESIGN: Retrospective case series with fellow-eye comparison. METHODS: Patients with continuous unilateral anti-VEGF treatment for subfoveal and juxtafoveal neovascular AMD and a minimum follow-up of 24 months were included. The retinal nerve fiber (RNFL) and retinal ganglion cell layer (RGCL) in the macula were segmented using an ETDRS grid. RNFL and RGCL thickness of the outer ring of the ETDRS grid were quantified at baseline and after repeated anti-VEGF injections, and compared to the patients' untreated fellow eye. Furthermore, best-corrected visual acuity (BCVA), age, and retinal pigment epithelium (RPE) atrophy were recorded and correlated with RNFL and RGCL. RESULTS: Sixty eight eyes of 34 patients (23 female and 11 male; mean age 76.7 (SD ± 8.2) with a mean number of 31.5 (SD ± 9.8) anti-VEGF injections and a mean follow-up period of 45.3 months (SD ± 10.5) were included. Whereas the RGCL thickness decreased significantly compared to the noninjected fellow eye (P = .01), the decrease of the RNFL was not significant. Visual acuity gain was significantly correlated with RGCL thickness (r = 0.52, P < .05) at follow-up and negatively correlated (r = -0.41, P < .05) with age. Presence of RPE atrophy correlated negatively with the RGCL thickness at follow-up (r = -0.37, P = .03). CONCLUSION: During the course of long-term anti-VEGF therapy there is a significant decrease of the RGCL in patients with neovascular AMD compared to the fellow (untreated) eye.

Capacidade funcional e qualidade de vida entre sujeitos saudáveis e pacientes com apneia obstrutiva do sono / Functional capacity and quality of life between healthy subjects and patients with obstructive sleep apnea

Caso-controle. Objetivos do estudo: Comparar a capacidade funcional, parâmetros respiratórios e qualidade de vida entre sujeitos saudáveis e pacientes com apneia obstrutiva do sono. Metodologia: Em 19 pacientes com apneia obstrutiva do sono e 19 sujeitos saudáveis foram avaliadas a qualidade de vida (The Medical Study 36-item Short-Form Health Survey), capacidade funcional (teste de caminhada de seis minutos), função pulmonar (espirometria) e força muscular respiratória(manovacuometria). Resultados: Os pacientes apresentaram declínio na qualidade de vida pelos domínios capacidade funcional, estado geral de saúde e saúde mental. A distância percorrida no teste de caminhada de seis minutos foi menor nos pacientes com apneia obstrutiva do sono. Os parâmetros respiratórios não diferiram entre os grupos. Conclusão: Pacientes com apneia obstrutiva do sono apresentam comprometimento da qualidade de vida e da capacidade funcional...

To compare the functional capacity, respiratory parameters and quality of life between healthy subjects and patients with obstructive sleep apnea. Methodology: 19 patients with obstructive sleep apnea and 19 healthy subjects were evaluated regarding their quality of life (The Medical Study 36-Item Short-Form Health Survey), their functional capacity (six-minute walk test), pulmonary function (spirometry) and their strength respiratory muscle(manovacuometer). Results: Patients showed a decline in the quality of life concerning functional capacity domains, general state of health and mental health. The distance walked in the six-minute walktest was shorter for patients with obstructive sleep apnea. Respiratory parameters did not differ between groups. Conclusion: Patients with obstructive sleep apnea present impairment regarding their quality of life and functional capacity...

Obesidade e variáveis polissonográficas empacientes com apneia obstrutiva do sono / Obesity and polysomnographic variables on patients with obstructivesleep apnea

Apneia Obstrutiva do Sono (AOS) e a obesidade, são condições que vem ganhando importância devido à alta prevalênciae influência na saúde dos indivíduos. Dessa forma, o objetivo do estudo foi comparar variáveis polissonográficas entrepacientes com apneia obstrutiva do sono (AOS) classificados como eutróficos, com sobrepeso ou obesos. Foram avaliados88 pacientes divididos em grupo eutrófico (GE; n=21; IMC=23,4±1,3kg/m2), sobrepeso (GS; n=34; IMC=27,5±1,4kg/ m2)e obeso (GO; n=33; IMC=33,6±2,9kg/m2) que realizaram polissonografia basal de noite inteira para diagnóstico da AOS.Foram analisadas as seguintes variáveis: estágios 1, 2 e 3 do sono (N1, N2 e N3), sono REM, índice de movimentos periódicosde membros inferiores (MPMI), índice de apneia e hipopneia (IAH), IAH no sono REM (IAHREM) e índice demicrodespertares (IMD). O GO apresentou elevação do N2 (p=0,036), do IAHREM (p=0,001) e do IMD (p=0,004) emcomparação ao GE. O IAH foi maior no GO do que no GE (p<0,001) e no GS (p=0,014). O GO apresentou redução doN3 em relação ao GE (p=0,016) e ao GS (p=0,003). Houve correlação significativa do IMC com o N2 (r=0,30), com oIAH (r=0,49), com o IAHREM (r=0,37), com o IMD (r=0,37) e com o N3 (r=-0,38). A obesidade esteve associada à elevaçãono número de apneias e hipopneias, microdespertares e tempo do estágio N2, assim como à redução no tempo doestágio N3 do sono. A combinação destas alterações demonstra baixa qualidade do sono em sujeitos obesos, em relaçãoaos eutróficos ou com sobrepeso.

Obstructive Sleep Apnea (OSA) and obesity are conditions that are gaining importance due to the high prevalence andinfluence on individuals’ health. Therefore, the aim of the study was to compare polysomnographic variables among ObstructiveSleep Apnea (OSA) patients classified as eutrophic, overweight or obese. Eighty eight patients were evaluateddivided in eutrophic (EG; n=21; BMI=23.4±1.3kg/m2), overweight (OWG; n=34; BMI=27.5±1.4kg/m2) and obese group(OG; n=33; BMI=33.6±2.9kg/m2) that carried out all-night basal polysomnography for the diagnosis of Obstructive SleepApnea (OSA). The following variables were analyzed: stages 1, 2 and 3 of sleep (N1, N2 and N3), REM sleep, index periodicmovements of the lower limbs (PLMS), apnea and hypopnea (AHI), AHI in REM sleep (AHIREM) and micro-arousalrates (MAR). The OG presented an increase of the N2 (p=0,036), of the AHIREM (p=0.001) and of the MAR (p=0.004), incomparison to EG. The AHI was larger in the OG than in the EG (p<0.001) and in the SG (p=0.014). The OG presentedreduction in the N3 in relation to the EG (p=0.016) and SG (p=0.003). There was a significant correlation of the BMI withthe N2 (r=0.30), with the AHI (r=0.49), with the AHIREM (r=0.37), with the MAR (r=0.37) and with the N3 (r=-0.38). Theobesity has been associated with the increase in the number of apneas and hypopneas, micro-arousals, and time of stage 2,and the reduction in time of stage 3 of sleeping. The combination of these changes demonstrates low quality of sleep onobese individuals, in relation to eutrophic or overweight individuals.

Obstructive sleep apnea: acute effects of CPAP on polyssonographic variables / Apneia obstrutiva do sono: efeitos agudos do CPAP sobre variáveis polissonográficas

Introduction The use of non-invasive ventilation in the form of continuous positive airway pressure (CPAP) is among the main therapeutic options for patients with obstructive sleep apnea (OSA). Yet the effects of CPAP obtained on the first night of use are underreported. Objective To evaluate the acute effects of CPAP on polysomnographic variables in patients with OSA. Materials and methods This study is a case series with 31 patients (55.8 ± 11.4 years; 22 men) in the initial phase of CPAP treatment. The subjects were evaluated by means of polysomnography with and without CPAP (10.2 ± 3.1 cmH2O) and without CPAP, on different days, by means of the following variables: sleep stages 1, 2 and 3 (N1, N2 and N3), rapid eye movement (REM) sleep, apnea and hypopnea index (AHI), AHI in REM sleep (AHIREM) and the micro-arousal index (MAI). Results The use of CPAP resulted in a reduction of N2 (p < 0.001), AHI (p < 0.001), AHIREM (p < 0.001) and MAI (p = 0.001). There was an increase in N3 (p = 0.006) and REM sleep (p < 0.001) during the night with use of CPAP. Conclusion This study demonstrated that, from the first night of use by patients with OSA, CPAP promotes greater balance between sleep phases, and improves sleep quality. These results should be presented to patients and their families in order to encourage greater adherence in the initial phase of treatment with CPAP. .

Introdução O uso de ventilação não invasiva sob a forma de Continuous Positive Airway Pressure (CPAP) está entre as principais opções terapêuticas no manejo de pacientes com apneia obstrutiva do sono (AOS). No entanto, os efeitos obtidos logo na primeira noite de uso do CPAP ainda são pouco relatados. Objetivo Avaliar os efeitos agudos do CPAP sobre variáveis polissonográficas em pacientes com AOS. Materiais e métodos Trata-se de uma série de casos, com um total de 31 pacientes (55,8 ± 11,4 anos; 22 homens) em fase inicial de tratamento com o CPAP no Instituto do Sono de Santa Maria (RS). Os sujeitos foram avaliados pela polissonografia sem e com CPAP (10,2 ± 3,1 cmH2O), em dias diferentes, por meio das seguintes variáveis: estágios do sono 1, 2 e 3 (N1, N2 e N3), sono REM (rapid eyes moviment), índice de apneia e hipopneia (IAH), IAH no sono REM (IAHREM) e índice de microdespertares (IMD). Resultados Houve diminuição com o uso do CPAP no N2 (p < 0,001), IAH (p < 0,001), IAHREM (p < 0,001) e IMD (p = 0,001). O N3 (p = 0,006) e o sono REM (p < 0,001) aumentaram durante a noite com o CPAP. Conclusão Este estudo demonstrou que o CPAP, logo na primeira noite de sua utilização, promove um maior equilíbrio entre as fases e melhora na qualidade do sono de pacientes com AOS. Esses resultados devem ser apresentados aos pacientes e aos seus familiares, visando estimular maior adesão na fase inicial do tratamento com o CPAP. .

Evaluation of scleral and corneal thickness in keratoconus patients.

PURPOSE: To determine whether the scleral stroma is affected as much as the corneal stroma in keratoconus. SETTING: University Eye Clinic, Bern, Switzerland. DESIGN: Comparative case-control study. METHODS: Eyes with keratoconus (keratoconus group) and eyes of age-, sex-, and axial length-matched controls (control group) were analyzed. Corneal videokeratometry and pachymetry were performed using a Scheimpflug tomographer (Pentacam). For measurements of the peripheral cornea and the anterior sclera, a spectral-domain anterior segment optical coherence tomography device (Spectralis) was used. RESULTS: The study group comprised 51 eyes and the control group, 50 eyes. The mean central corneal thickness in the keratoconus group was statistically significantly lower than in the control group (447.8 µm ± 57.8 [SD] versus 550.5 ± 35.5 µm) (P < .0001). No significant difference in the mean anterior scleral thickness was found between the keratoconus group and the control group (479.1 ± 43.7 µm versus 474.2 ± 43.0 µm) (P =.57). CONCLUSION: Although corneal thinning was observed in keratoconus patients, the anterior scleral stroma thickness in these patients seemed to be similar to that in healthy control eyes.

Senile scleral plaques imaged with enhanced depth optical coherence tomography.

PURPOSE: Senile scleral plaques (SSP) are sharply demarcated greyish areas located just anterior to the insertions of the horizontal rectus muscles and thus are frequently encountered during transscleral intravitreal injections. The aim of this study was to characterize SSP using enhanced depth imaging spectral domain anterior segment optical coherence tomography (OCT) in a cohort of patients attending intravitreal injection clinics. METHODS: Prospective cross-sectional study of 380 patients attending the clinic for intravitreal injections at the Department of Ophthalmology at the Bern University Hospital. Thirty-two patients with SSP were identified and the anatomical features were assessed using anterior segment OCT. RESULTS: In our patient cohort, we found a SSP prevalence of 8.2%. Senile scleral plaques were easily identifiable using anterior segment OCT and were found at the insertion sites of the horizontal recti muscles. The mean horizontal diameter was 2.2 mm (±760 µm SD), the mean vertical diameter was 3.3 mm (±144 µm SD), and the average surface area was 5.3 mm(2) (±0.4 mm(2) SD). The mean senile scleral plaque thickness was 0.6 mm (±149 µm SD). The mean distance from the limbus was 2.24 mm for nasally located SSP and 3.22 mm for temporally located SSP. CONCLUSION: SSP are frequently encountered during intravitreal injections as they are located just anterior to the insertion sites of the horizontal recti muscles. Because the scleral stroma is rarefied and due to calcifications within SSP, these areas should be avoided when performing multiple intravitreal injections as this may result in rupture of the sclera.