Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy.

At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients (n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippocampus and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippocampus with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli.Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857.

Management of bacterial postoperative endophthalmitis and the role of vitrectomy.

Management of postoperative bacterial endophthalmitis was explored in the Endophthalmitis Vitrectomy Study37 in 1995, which has underpinned the core protocols in treatment ever since. While surgical techniques have continued to evolve, little has changed in the overall clinical management as no further large randomized controlled trials have taken place. We review the literature addressing the incidence of endophthalmitis, pathogens, antibiotic therapies, and the role of vitrectomy. We suggest an update to management protocols based on available evidence. While vitreous culture remains the gold standard for diagnosis, new techniques allow bacterial identification after antibiotic administration, so injection should be initiated immediately. Current antibiotic regimes are comprehensive and do not need changing. Intravitreal antibiotics should not be repeated at 48 hours after initial treatment. Vitrectomy should be considered instead if the clinical picture is not improving.

Idiopathic bilateral retinal dialyses complicated by posterior retinal tear after blunt trauma.

PURPOSE: The purpose of this study was to present a case of posterior rupture in a previously detached retina after blunt trauma. METHOD: This is a case report. RESULT: A child with idiopathic bilateral retinal dialyzes sustained accidental blunt trauma to the left eye while awaiting surgery. This caused a posterior rupture of the retina in an already preexisting retinal detachment. The right eye underwent uneventful cryopexy and a buckle procedure. The left eye was managed conservatively while awaiting spontaneous posterior vitreous separation. Unfortunately, the retina detached further to involve the macula with progression of proliferative vitreoretinopathy. The child required three subsequent vitrectomies in the left eye to stabilize the retina. CONCLUSION: This case highlights the etiology of retinal dialyzes and the dilemmas in the management of complicated retinal detachment.

Day 1 postoperative intraocular pressure spike in vitreoretinal surgery (VDOP1).

PURPOSE: To classify the clinical characteristics that might identify patients who may not require next-day follow-up following routine vitreoretinal intervention. METHODS: Prospective case series. RESULTS: The only statistically significant factors for raised intraocular pressure (IOP) were gas tamponade and preoperative raised IOP. 44.7% (17/38) of patients with preoperative IOP ≥ 20 mmHg had postoperative IOP ≥ 30 mmHg while 8.6% (17/197) of patients with preoperative IOP < 20 mmHg had postoperative IOP ≥ 30 mmHg (p = 0.0001). Phacoemulsification did not increase risk for a postoperative IOP spike. There was a 20-21% risk of postoperative IOP > 30 mmHg for patients with gas tamponade. All patients with no tamponade with IOP > 30 mmHg had preoperative IOP ≥ 20 mmHg. CONCLUSION: Uncomplicated vitreoretinal procedures with preoperative IOP of< 20 mmHg and no gas tamponade are unlikely to have uncontrolled IOP spike at day 1.

Automatic detection of diabetic retinopathy exudates from non-dilated retinal images using mathematical morphology methods.

Diabetic retinopathy is a complication of diabetes that is caused by changes in the blood vessels of the retina. The symptoms can blur or distort the patient's vision and are a main cause of blindness. Exudates are one of the primary signs of diabetic retinopathy. Detection of exudates by ophthalmologists normally requires pupil dilation using a chemical solution which takes time and affects patients. This paper investigates and proposes a set of optimally adjusted morphological operators to be used for exudate detection on diabetic retinopathy patients' non-dilated pupil and low-contrast images. These automatically detected exudates are validated by comparing with expert ophthalmologists' hand-drawn ground-truths. The results are successful and the sensitivity and specificity for our exudate detection is 80% and 99.5%, respectively.