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Purpose: To assess the feasibility and the diagnostic accuracy of the new tool, DEvice© (AI, Rome, Italy), for screening patients with dry eye disease (DED). Methods: This study was performed at the University Magna Græcia of Catanzaro. Enrolled patients were classified as affected by DED (group 1) or not (group 2) using an already validated tool (Keratograph 5M, Oculus, Germany), evaluating the noninvasive keratograph breakup time (NIKBUT), tear meniscus height (TMH), meibomian gland loss (MGL), and bulbar redness. All the patients were then examined by means of DEvice©, which allowed the measurement of the relative humidity (RH) and temperature of the ocular surface. Symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. Results: Overall, 40 patients (17 males and 23 females, mean age 38.0 ± 17.1 years) were included: of these, 20 belonged to group 1 and the remaining 20 to group 2. Using Keratograph 5M, significant differences between groups 1 and 2 were detected for NIKBUT-first (respectively, 4.97 ± 1.85 vs. 13.95 ± 4.8 s; p < 0.0001) and for NIKBUT-average (10.55 ± 4.39 vs. 15.96 ± 4.08 s; p = 0.0003). No statistically significant changes were detected for TMH (p = 0.565), MGL (p = 0.051), and bulbar redness (p = 0.687). Using Device©, a statistically significant higher value of RH was found in group 1 compared to group 2 (respectively, 85.93 ± 10.63 vs. 73.05 ± 12.84%; p = 0.0049). A statistically significant correlation was found between RH and OSDI (r = 0.406; p = 0.009). The value RH showed a discriminating power to detect DED with an AUC = 0.782 (standard error 0.07264; 95% CI 0.6401–0.9249; p = 0.0022). Conclusions: The DEvice© can effectively discriminate DED patients from healthy subjects. The parameter RH showed good sensitivity, making this tool ideal for a fast and noninvasive DED screening. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a multifactorial disease that represents one of the most common ophthalmologic conditions encountered in everyday clinical practice. Traditional diagnostic tests for DED, such as subjective questionnaires, tear film break-up time and the Schirmer test, are often associated with poor reproducibility and reliability, which make the diagnosis, follow-up, and management of the disease challenging. New advances in imaging technologies enable objective and reproducible measurements of DED parameters, thus making the diagnosis a multimodal imaging-based process. The aim of this review is to summarize all the current and emerging diagnostic tools available for the diagnosis and monitoring of DED, such as non-invasive tear breakup time, thermography, anterior segment optical coherence tomography, meibography, interferometry, in vivo confocal microscopy, and optical quality assessment. Although there is not a gold standard imaging technique, new multi-imaging-integrated devices are precious instruments to help clinicians to better cope with the diagnostic complexity of DED. [ABSTRACT FROM AUTHOR]

Background: To evaluate macular changes in fellow eyes of patients diagnosed with lamellar macular hole (LMH) using spectral-domain optical coherence tomography (SD-OCT) and blue fundus autofluorescence (B-FAF). Methods: Fellow eyes of patients diagnosed with a LMH were retrospectively evaluated on OCT. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were recorded. Corresponding B-FAF images, vitreo-macular relations, and type of epiretinal membranes (ERMs) were also examined. Results: Thirty-five patients were included. At baseline, six fellow eyes (17%) showed a normal foveal profile, 26 (74%) had a tractional ERM, and three cases (9%) revealed a bilateral LMH, one of them with a lamellar hole-associated epiretinal proliferation (LHEP). A posterior vitreous detachment (PVD) was present in 29 patients (83%), four (11%) had only a vitreo-papillary adhesion (VPA), and two (6%) had both vitreo-macular adhesion (VMA) and VPA. After a mean follow-up of 4.6 ± 1.9 years, one eye (3%) developed a vitreous detachment from the macula with persistent VPA, and one developed a PVD from a VPA with subsequent ERM formation. BCVA and mean CFT remained stable in 35 eyes (100%). Likewise, no B-FAF signal variations were detected. One patient developed a LMH during the 3rd year of follow-up. Conclusions: Our data suggest that the presence of a LMH in one eye does not increase significantly the risk of developing the same condition in the fellow eye after 4 years. Bilateral condition is uncommon, and an ERM is often detected in the fellow eye. LHEPs were not observed in fellow eyes with foveal integrity, and all LHEPs observed (in main and fellow eyes) were always associated with LMHs; this supports the hypothesis that LHEP is a consequence and not a causative factor for LMHs. The occurrence of a LMH in one fellow eye after 3 years follow-up may suggest that a higher incidence of bilateral disease could develop in a longer time span. [ABSTRACT FROM AUTHOR]

Objective: To assess eyes with unilateral choroidal melanocytosis using enhanced depth imaging (EDI) optical coherence tomography (OCT). Design: Retrospective, observational case series. Participants: Fifteen patients with unilateral choroidal melanocytosis. Methods: Each patient was evaluated with EDI-OCT, and comparison was made of involved versus uninvolved foveal retinal and choroidal layers. Main Outcome Measures: Enhanced depth imaging OCT features of choroidal melanocytosis. Results: The mean patient age was 28 years (median, 23 years; range, 5–76 years). There were 9 male and 6 female patients. Best-corrected visual acuity ranged from 20/20 to 20/30. All patients had subfoveal involvement with choroidal melanocytosis. Associated features included dermal (n = 6), scleral (n = 9), iris (n = 3), and palate (n = 1) melanocytosis. Spectral domain EDI-OCT revealed normal inner retina (n = 15) and normal outer retina (n = 14). The only retinal abnormality was a defect in both the myoid zone and the ellipsoid junction (n = 1). The affected choroid showed smooth anterior contour (n = 15) and thinned or compressed choriocapillaris (n = 2), thinned (n = 3) or thickened (n = 3) medium vessels, and thinned large vessels (n = 2). The subfoveal choroid was a mean 23% thicker in the involved eye, with a mean thickness of 326.4 μm (median, 326 μm; range, 120–459 μm) compared with 264.4 μm (median, 260 μm; range, 94–462 μm) in the uninvolved eye (P = 0.15). The choroidal perivascular interstitial tissue was 51% thicker in the study eye, enwrapping and silhouetting the medium and large vessels (P = 0.01). The ratio between the perivascular stromal tissue and the subfoveal choroidal thickness was 66% in the study eye and 54% in the normal eye (P = 0.0001). Deep partial (n = 5) or complete (n = 2) tissue shadowing was noted. Conclusions: Enhanced depth imaging OCT revealed that choroidal melanocytosis shows increased subfoveal choroidal thickness with an apparent increase in the choroidal perivascular stromal tissue and minimal effect on the overlying retina. [ABSTRACT FROM AUTHOR]

Objective: To describe the imaging characteristics of congenital hypertrophy of the retinal pigment epithelium (CHRPE). Design: Retrospective, observational case series. Participants: Eighteen eyes of 18 patients with CHRPE. Methods: Review of chart, fundus photography, ultrasonography, fundus autofluorescence, infrared reflectance (IR) imaging, and enhanced-depth imaging optical coherence tomography (EDI-OCT). Main Outcome Measures: Features of CHRPE as analyzed by EDI-OCT. Results: The mean age at diagnosis was 48 years (range, 13–73 years). There were 5 males and 13 females, and 17 Caucasian and 1 African American patients. The mean best-corrected visual acuity was 20/22 (range, 20/20–20/40). The CHRPE was located in the retinal periphery (n = 16) with intralesional lacunae (n = 14) and surrounding nonpigmented (n = 4) and pigmented (n = 14) halo. By ultrasonography, the mean CHRPE thickness was 1.0 mm (range, 0.9–1.4 mm). Fundus autofluorescence disclosed hypoautofluorescence (n = 18) with lacunae (n = 14) showing isoautofluorescence (n = 10) or hypoautofluorescence (n = 4). Infrared reflectance imaging displayed hyporeflectivity in the area of pigmentation (n = 16) and hyperreflectivity within lacunae (n = 14). On EDI-OCT, all 18 lesions were flat with a mean basal diameter of 4529 μm (median, 3707 μm; range, 697–11 617 μm). The mean central sublesional choroidal thickness (126.4 μm) was not different compared with thickness 50 μm outside the margin (126.8 μm; P = 0.99). The retinal pigment epithelium (RPE) was absent (n = 2), thickened (n = 16), or irregular (n = 15). Of 9 lesions in which lacunae were imaged, 8 showed absent RPE. The overlying retinal findings included thinning or absence of the outer retina beginning at the ganglion cell layer (n = 1), outer plexiform layer (n = 4), outer nuclear layer (n = 12), or inner segment/outer segment junction (n = 1). Additional retinal findings included hyperreflective spots (n = 11), cystoid edema (n = 5), and subretinal cleft (n = 6). Subretinal cleft specifically occurred at the site of absent photoreceptors. Conclusions: Generally, CHRPE displays hypoautoflouorescence and hyporeflectivity with hyperreflective lacunae on IR imaging. On EDI-OCT, CHRPE seems flat with thickened, irregular RPE and absent RPE within lacunae. A prominent feature is outer retinal loss, generally involving the outer nuclear layer to photoreceptors, occasionally with a characteristic subretinal cleft. [ABSTRACT FROM AUTHOR]

The article discusses developments in retinal and chloroidal examination. Particular focus is given on a technique that employs simultaneous taking of different types of images by spectral-domain optical coherence tomography and retinal imaging. This technique produces images with increased resolution and reduced signal noise. These features lead to better visualization of fine structures and easier and more accurate diagnosis.

Neutrophil gelatinase-associated lipocalin (NGAL) has been described in chronic heart failure (HF) as marker of tubular damage and renal dysfunction; however, less data are available in patients with acute HF. Because of high rate of acute kidney injury (AKI) development, we aimed to investigate the role of NGAL in predicting early AKI development; second, we compared NGAL with respect to cystatin C, B-type natriuretic peptide (BNP), renal function, and blood urea nitrogen (BUN) for outcome prediction. We measured admission serum NGAL, cystatin C, and BNP in 231 patients affected to acute HF; all patients were submitted to daily creatinine, estimated glomerular filtration rate, and measurement to identify inhospital AKI defined by Risk, Injury, Failure, Loss, End-Stage Kidney Disease and Acute Kidney Injury Network criteria. We also measured admission and discharge estimated glomerular filtration rate, creatinine, and BUN to evaluate their prognostic role during a 6-month follow-up period; 78 patients developed AKI during hospitalization. In these subjects, NGAL levels were significantly increased respect to patients without AKI (295 ± 228 vs 129 ± 108 ng/ml, p <0.001). A cutoff of 134 ng/ml has been related to AKI with good sensibility and specificity (85% and 80%, respectively; area under the curve 0.81, p <0.001). BNP was also mildly increased (1,000 ± 906 vs 746 ± 580 pg/ml, p = 0.03) but not cystatin C. Patients with chronic kidney disease demonstrated higher NGAL levels compared with subjects with preserved renal function (258 ± 249 and 120 ± 77 ng/ml, p <0.001). The receiver-operating characteristic curve analysis demonstrated that increased NGAL values were associated with increased mortality (cutoff 170 ng/ml, sensibility 60%, specificity 82%, accuracy 71%, area under the curve 0.77, p <0.001). The same significant correlation was also found for BUN at discharge (cutoff 100 mg/dl, sensibility 65%, specificity 85%, accuracy 71%, area under the curve 0.77, p <0.001). Multivariable Cox regression analysis showed that cutoff 170 ng/ml was related with adverse outcome (hazard ratio 1.77, confidence interval 1.24 to 2.83, p = 0.01). In conclusion, NGAL measurement is a sensible tool to predict AKI during hospitalization. Elevated NGAL levels appear to be related to BUN increase and post-discharge outcome. This suggests a prognostic role of tubular damage beyond renal dysfunction. [ABSTRACT FROM AUTHOR]

Abstract: In recent years there has been growing interest in the development of new diagnostic tools and particularly in laboratory tests for the identification of heart failure (HF) patients. Because of the rise in HF occurrence, it is necessary to use simple and reliable method to recognize those patients at risk before the onset of the clinical symptoms. To date HF diagnosis remains difficult: its symptoms and signs are often non specific as well as being poor sensitive indicators for HF severity. Throughout the last 10years published literature has highlighted a boom in the use of biomarkers for HF. Both B-type and N-terminal pro-B-type natriuretic peptides have demonstrated specific role in heart failure diagnosis, as well as risk assessment. A single determination of BNP at any time during the development of chronic heart failure (CHF) provides a clinically useful tool to establish the outcome. Renal dysfunction is often associated with heart failure and predicts adverse clinical outcomes. Many studies have recently suggested the clinical use of serum neutrophil gelatinase‐associated lipocalin (NGAL) levels in patients admitted to the hospital for acute HF can be used to estimate the risk of early worsening renal function. This could be potentially applied in clinical practice for early identification of renal dysfunction development in patients with HF. NGAL levels appear also to predict renal dysfunction in patients with chronic HF and preserved renal function. For all these reasons, BNP and NGAL are two emerging tools useful for diagnosis and prognosis in HF. The combination of two laboratory biomarkers could potentially identify patients with more elevated risks of both cardiac hemodynamic impairment and kidney dysfunction. [Copyright &y& Elsevier]

Purpose To survey Friedman lipid globules by high-resolution histologic examination and to compare with multimodal imaging of hyporeflective caverns in eyes with geographic atrophy (GA) secondary to age-related macular (AMD) and other retinal diseases. Design Histologic survey of donor eyes with and without AMD. Clinical case series with multimodal imaging analysis. Participants Donor eyes (n = 139; 26 with early AMD, 13 with GA, 40 with nAMD, 52 with a healthy macula, and 8 with other or unknown characteristics) and 41 eyes of 28 participants with GA (n = 16), nAMD (n = 8), Stargardt disease (n = 4), cone dystrophy (n = 2), pachychoroid spectrum (n = 6), choroidal hemangioma (n = 1), and healthy eyes (n = 4). Methods Donor eyes were prepared for macula-wide epoxy resin sections through the foveal and perifoveal area. In patients, caverns were identified as nonreflective spaces on OCT images. Multimodal imaging included color and red-free fundus photography; fundus autofluorescence; fluorescein and, indocyanine green angiography; OCT angiography; near-infrared reflectance; and confocal multispectral (MultiColor [Spectralis, Heidelberg Engineering, Germany]) imaging. Main Outcome Measures Presence and morphologic features of globules, and presence and appearance of caverns on multimodal imaging. Results Globules were found primarily in the inner choroidal stroma (91.0%), but also localized to the sclera (4.9%) and neovascular membranes (2.1%). Mean diameters of solitary and multilobular globules were 58.9±37.8 μm and 65.4±27.9 μm, respectively. Globules showed morphologic signs of dynamism including pitting, dispersion, disintegration, and crystal formation. Evidence for inflammation in the surrounding tissue was absent. En face OCT rendered sharply delimited hyporeflective areas as large as choroidal vessels, frequently grouped around choroid vessels or in the neovascular tissue. Cross-sectional OCT revealed a characteristic posterior hypertransmission. OCT angiography showed absence of flow signal within caverns. Conclusions Based on prior literature documenting OCT signatures of tissue lipid in atheroma and nAMD, we speculate that caverns are lipid rich. Globules, with similar sizes and tissue locations in AMD and healthy persons, are candidates for histologic correlates of caverns. The role of globules in chorioretinal physiologic features, perhaps as a lipid depot for photoreceptor metabolism, is approachable through clinical imaging. [ABSTRACT FROM AUTHOR]