Purpose To investigate the structur e-function relationship between optical coherence tomograp hy(OCT)macular retinal and peripapillary nerve fib er layer(NFL)thick-ness and automated visual field(VF)findings.Design C...Purpose To investigate the structur e-function relationship between optical coherence tomograp hy(OCT)macular retinal and peripapillary nerve fib er layer(NFL)thick-ness and automated visual field(VF)findings.Design Cross-sectional observational stu dy.Methods Retrospective institutional study where 150conse cutive eyes(101sub-jects)from a glaucoma service were included.All the participants had full ophthalmic ev aluation,VF testing and prototype OCT scanning at the sam e visit.Orthogonal OCT macular analysis was obtained to maximize the sam-pling of the area of interest.Pearso n age-adjusted corre-lation was determined between macul ar retinal thickness and peripapillary NFL thickness.Ar ea under the receiver operator characteristics(AROC)curves for the association between macular retinal thickness a nd peripapillary NFL thickness and VF findings were calcu lated in a subgroup of eyes without VF defect and eyes wit h VF defect con-fined to one hemifield.Results The c orrelation between macular retinal and peripapillary N FL measurements ranged between r=0.27to 0.54for quadrants,0.44to0.55for hemiretina,and 0.52for the overall mean.Areas under the receiver operator characteristics for macular thickness were higher in areas corre sponding to the VF defect location than the noncorresp onding locations.Areas under the receiver operator characteristics for peripapillaryNFL thickness were higher than for th e macular retinal thickness.Including both macular r etinal thickness and peripapillary NFL thickness measur ements in the logistic regression model yielded AROCs (range:0.69-0.77)similar to those found for the peripapillary NFL alone.Conclusion Macular retinal thickness,as measured by OCT,was capable of detecting glaucomatous damage and corresponded with peripapillary NFL thickness;however,peripapillary NFL thickness had hig her sensitivity and specificity for the detection of VF a bnormalities.展开更多
Purpose: To present clinical manifestations of eyes with peculiar looped/coiled peripapillary retinal vessels. Methods: Seven patients with looped/coiled retinal vessels on or near the optic disc were enrolled. All pa...Purpose: To present clinical manifestations of eyes with peculiar looped/coiled peripapillary retinal vessels. Methods: Seven patients with looped/coiled retinal vessels on or near the optic disc were enrolled. All patients went through detailed ophthalmologic examinations and fluorescein angiography (FAG). Results: There were two men and five women. Patients’ age ranged from 15 to 71 years (mean: 39 years). The followup period ranged from 3 to 74 months (average: 27 months). One patient had bilateral involvement. Five of the seven patients noticed sudden onset of floaters in one eye. The colour fundus photography revealed looped/coiled retinal vessels on or near the optic disc, and most of the vessels were arteries. Accompanied retinal, preretinal, or vitreous haemorrhage was noted in all five patients who had sudden onset of floaters. Fluorescein angiography showed no leakage from the looped/ coiled retinal vessels. No specific underlying diseases were noted in any patients. Follow-up examination revealed reabsorption of haemorrhage, and no change of the abnormal vessel patterns in any eyes. Conclusions: The peculiar fundus lesion of looped/coiled peripapillary retinal vessels is likely a benign congenital retinal vascular anomaly that does not progress. Floaters secondary to preretinal or vitreous haemorrhage is the most frequent complaint. The prognosis is excellent.展开更多
Background: Access to the pancreatic or the bile duct is paramount to the success of diagnostic and therapeutic ERCP. Selective cannulation may be difficult because of the small size of the papilla and anatomic factor...Background: Access to the pancreatic or the bile duct is paramount to the success of diagnostic and therapeutic ERCP. Selective cannulation may be difficult because of the small size of the papilla and anatomic factors such as peripapillary diverticulum and gastrectomy with Billroth-II anastom osis. Currently, one of the techniques for gaining access in such cases is the pre-cut technique with a catheter that has a thin wire at the tip (needle knife) . A less well described pre-cut technique involves initial cannulation of the pancreatic duct with a “traction-type”papillotome and then incision through the“septum”toward the bile duct. The aim of this randomized trial was to compare the success and the complication rates of needleknife sphincterotomy and tran spancreatic sphincterotomy in achieving cannulation of an otherwise inaccessible bile duct. Methods: Sixty-three consecutive patients with inaccessible bile ducts underwent pre-cut sphincterotomy either by needleknife sphincterotomy (n = 34) or transpancreatic septotomy (n = 29). In patients with an accessible pancre atic duct who undergo needle-knife sphincterotomy, a short (2-3 cm) stent (5F -7F) was placed in the pancreatic duct to act as a guide and to reduce the risk of post-procedure pancreatitis. All patients were hospitalized overnight for observation after pre-cut sphincterotomy. The outcomes measured were success rate and complications. Indications for pre-cut sphincterotomy were the following: suspected choledocholithiasis, 11 patients (17.5%); obstructive jaundice with negative CT findings, 19 patients (29.2%), or with positive CT findings, 13 patients (20.6%); abdominal pain with elevated biochemical tests of liver function , 15 patients (23.8%); and miscellaneous, 5 patients (7.9%). Results: In 55 of 63 (87%) patients, the bile duct was selectively cannulated after pre-cut sphincterotomy. On a pre-protocol basis, the bile duct was cannulated in 29 of 29 (100%) patients randomized to transpancreatic septotomy sphincterotomy and 26 o f 34 (77%) patients who underwent needle-knife sphincterotomy (p = 0.01). There were 7 complications, including bleeding (n = 2) and acute pancreatitis (n = 5 ). Complications were less frequent in the transpancreatic septotomy sphincterotomy group (1/29; 3.5%) compared with the needle-knife sphincterotomy group (6/ 34; 17.7%). Conclusions: Transpancreatic pre-cut sphincterotomy can be performed with a high degree of success in patients with inaccessible obstructed bile ducts. Compared with standard needle-knife sphincterotomy, transpancreatic septo tomy sphincterotomy has a significantly higher rate of bile duct cannulation and a lower complication rate.展开更多
文摘Purpose To investigate the structur e-function relationship between optical coherence tomograp hy(OCT)macular retinal and peripapillary nerve fib er layer(NFL)thick-ness and automated visual field(VF)findings.Design Cross-sectional observational stu dy.Methods Retrospective institutional study where 150conse cutive eyes(101sub-jects)from a glaucoma service were included.All the participants had full ophthalmic ev aluation,VF testing and prototype OCT scanning at the sam e visit.Orthogonal OCT macular analysis was obtained to maximize the sam-pling of the area of interest.Pearso n age-adjusted corre-lation was determined between macul ar retinal thickness and peripapillary NFL thickness.Ar ea under the receiver operator characteristics(AROC)curves for the association between macular retinal thickness a nd peripapillary NFL thickness and VF findings were calcu lated in a subgroup of eyes without VF defect and eyes wit h VF defect con-fined to one hemifield.Results The c orrelation between macular retinal and peripapillary N FL measurements ranged between r=0.27to 0.54for quadrants,0.44to0.55for hemiretina,and 0.52for the overall mean.Areas under the receiver operator characteristics for macular thickness were higher in areas corre sponding to the VF defect location than the noncorresp onding locations.Areas under the receiver operator characteristics for peripapillaryNFL thickness were higher than for th e macular retinal thickness.Including both macular r etinal thickness and peripapillary NFL thickness measur ements in the logistic regression model yielded AROCs (range:0.69-0.77)similar to those found for the peripapillary NFL alone.Conclusion Macular retinal thickness,as measured by OCT,was capable of detecting glaucomatous damage and corresponded with peripapillary NFL thickness;however,peripapillary NFL thickness had hig her sensitivity and specificity for the detection of VF a bnormalities.
文摘Purpose: To present clinical manifestations of eyes with peculiar looped/coiled peripapillary retinal vessels. Methods: Seven patients with looped/coiled retinal vessels on or near the optic disc were enrolled. All patients went through detailed ophthalmologic examinations and fluorescein angiography (FAG). Results: There were two men and five women. Patients’ age ranged from 15 to 71 years (mean: 39 years). The followup period ranged from 3 to 74 months (average: 27 months). One patient had bilateral involvement. Five of the seven patients noticed sudden onset of floaters in one eye. The colour fundus photography revealed looped/coiled retinal vessels on or near the optic disc, and most of the vessels were arteries. Accompanied retinal, preretinal, or vitreous haemorrhage was noted in all five patients who had sudden onset of floaters. Fluorescein angiography showed no leakage from the looped/ coiled retinal vessels. No specific underlying diseases were noted in any patients. Follow-up examination revealed reabsorption of haemorrhage, and no change of the abnormal vessel patterns in any eyes. Conclusions: The peculiar fundus lesion of looped/coiled peripapillary retinal vessels is likely a benign congenital retinal vascular anomaly that does not progress. Floaters secondary to preretinal or vitreous haemorrhage is the most frequent complaint. The prognosis is excellent.
文摘Background: Access to the pancreatic or the bile duct is paramount to the success of diagnostic and therapeutic ERCP. Selective cannulation may be difficult because of the small size of the papilla and anatomic factors such as peripapillary diverticulum and gastrectomy with Billroth-II anastom osis. Currently, one of the techniques for gaining access in such cases is the pre-cut technique with a catheter that has a thin wire at the tip (needle knife) . A less well described pre-cut technique involves initial cannulation of the pancreatic duct with a “traction-type”papillotome and then incision through the“septum”toward the bile duct. The aim of this randomized trial was to compare the success and the complication rates of needleknife sphincterotomy and tran spancreatic sphincterotomy in achieving cannulation of an otherwise inaccessible bile duct. Methods: Sixty-three consecutive patients with inaccessible bile ducts underwent pre-cut sphincterotomy either by needleknife sphincterotomy (n = 34) or transpancreatic septotomy (n = 29). In patients with an accessible pancre atic duct who undergo needle-knife sphincterotomy, a short (2-3 cm) stent (5F -7F) was placed in the pancreatic duct to act as a guide and to reduce the risk of post-procedure pancreatitis. All patients were hospitalized overnight for observation after pre-cut sphincterotomy. The outcomes measured were success rate and complications. Indications for pre-cut sphincterotomy were the following: suspected choledocholithiasis, 11 patients (17.5%); obstructive jaundice with negative CT findings, 19 patients (29.2%), or with positive CT findings, 13 patients (20.6%); abdominal pain with elevated biochemical tests of liver function , 15 patients (23.8%); and miscellaneous, 5 patients (7.9%). Results: In 55 of 63 (87%) patients, the bile duct was selectively cannulated after pre-cut sphincterotomy. On a pre-protocol basis, the bile duct was cannulated in 29 of 29 (100%) patients randomized to transpancreatic septotomy sphincterotomy and 26 o f 34 (77%) patients who underwent needle-knife sphincterotomy (p = 0.01). There were 7 complications, including bleeding (n = 2) and acute pancreatitis (n = 5 ). Complications were less frequent in the transpancreatic septotomy sphincterotomy group (1/29; 3.5%) compared with the needle-knife sphincterotomy group (6/ 34; 17.7%). Conclusions: Transpancreatic pre-cut sphincterotomy can be performed with a high degree of success in patients with inaccessible obstructed bile ducts. Compared with standard needle-knife sphincterotomy, transpancreatic septo tomy sphincterotomy has a significantly higher rate of bile duct cannulation and a lower complication rate.
