Reproducibility of retinal nerve fiber layer measurements across the glaucoma spectrum using optical coherence tomography

Purpose:

The purpose was to determine intra-session and inter-session reproducibility of retinal nerve fiber layer (RNFL) thickness measurements with the spectral-domain Cirrus optical coherence tomography (OCT)^® (SD-OCT) in normal and glaucomatous eyes, including a subset of advanced glaucoma.

Materials and Methods:

RNFL measurements of 40 eyes of 40 normal subjects and 40 eyes of 40 glaucomatous patients including 14 with advanced glaucoma were obtained on the Cirrus OCT^® (Carl Zeiss Meditec, Dublin, CA, USA) five times on 1-day (intra-session) and on five separate days (inter-session). Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) values were calculated for mean and quadrant RNFL in each group separately. Reproducibility values were correlated with age and stage of glaucoma.

Results:

For intra-session reproducibility, the ICC, COV, and TRT values for mean RNFL thickness in normal eyes were 0.993, 1.96%, and 4.02 µm, respectively, 0.996, 2.39%, and 3.84 µm in glaucomatous eyes, and 0.996, 2.41%, and 3.70 µm in advanced glaucoma. The corresponding inter-session values in normal eyes were 0.992, 2.16%, and 4.09 µm, 0.995, 2.62%, and 3.98 µm in glaucoma and 0.990, 2.70%, and 4.16 µm in advanced glaucoma. The mean RNFL thickness measurements were the most reproducible while the temporal quadrant had the lowest reproducibility values in all groups. There was no correlation between reproducibility and age or mean deviation on visual fields.

Conclusions:

Peripapillary RNFL thickness measurements using Cirrus OCT^® demonstrated excellent reproducibility in normal and glaucomatous eyes, including eyes with advanced glaucoma. Mean RNFL thickness measurements appear to be the most reproducible and probably represent the best parameter to use for longitudinal follow-up.     

Correction to: The quadriceps active ratio: a dynamic MRI-based assessment of patellar height

European Journal of Orthopaedic Surgery & Traumatology - In the online version of the original article, one of the white lines was not accurately drawn in Fig. 1.     

Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors

Background

Although partial nephrectomy (PN) has been associated with improved renal function compared with radical nephrectomy (RN) for renal cell carcinoma, the impact on overall survival (OS) remains controversial.

Objective

To evaluate comparative OS and renal function in patients following PN and RN for a renal mass where malignancy was not a confounding factor.

Design, setting, and participants

Using the Mayo Clinic Nephrectomy Registry, we retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with PN or RN between 1980 and 2008.

Outcome measurements and statistical analysis

The primary outcome measures were OS and the incidence of new-onset stage IV chronic kidney disease (CKD), determined using the Kaplan-Meier method. Cox models were used to test the association of nephrectomy type with these outcomes.

Results and limitations

Overall, 206 and 236 patients with benign renal masses were surgically treated with RN and PN, respectively. Patients who underwent RN were older (median age: 67 vs 64 yr; p = 0.02) and had larger tumors (median size: 5.0 vs 2.7 cm; p < 0.001). Median follow-up for patients still alive at last follow-up was 8.3 yr (range: 0.1–27.9 yr). Estimated OS (95% confidence interval [CI]) rates at 10 and 15 yr were 69% (62–76%) and 53% (45–62%) for RN compared with 80% (73–87%) and 74% (65–83%) following PN (p = 0.032). After adjusting for covariates of interest, patients treated with RN were significantly more likely to die from any cause (hazard ratio [HR]: 1.75; 95% CI, 1.08–2.83; p = 0.023) or develop stage IV CKD (HR: 4.23; 95% CI, 1.80–9.93; p < 0.001) compared with patients who underwent PN. Limitations include the retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.

Conclusions

Our data suggest that PN may confer a clinical benefit for improved renal function and better OS compared with RN after excluding the confounding effect of malignancy.     

Use of Combination Chemotherapy for Treatment of Granulomatous and Lymphocytic Interstitial Lung Disease (GLILD) in Patients with Common Variable Immunodeficiency (CVID)

Purpose

A subset of patients with common variable immunodeficiency (CVID) develops granulomatous and lymphocytic interstitial lung disease (GLILD), a restrictive lung disease associated with early mortality. The optimal therapy for GLILD is unknown. This study was undertaken to see if rituximab and azathioprine (combination chemotherapy) would improve pulmonary function and/or radiographic abnormalities in patients with CVID and GLILD.

Methods

A retrospective chart review of patients with CVID and GLILD who were treated with combination chemotherapy was performed. Complete pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans of the chest were done prior to therapy and >6 months later. HRCT scans of the chest were blinded, randomized, and scored independently (in pairs) by two radiologists. The differences between pre- and post-treatment HRCT scores and PFT parameters were analyzed.

Results

Seven patients with CVID and GLILD met inclusion criteria. Post-treatment increases were noted in both FEV1 (p?=?0.034) and FVC (p?=?0.043). HRCT scans of the chest demonstrated improvement in total score (p?=?0.018), pulmonary consolidations (p?=?0.041), ground-glass opacities (p?=?0.020) nodular opacities (p?=?0.024), and both the presence and extent of bronchial wall thickening (p?=?0.014, 0.026 respectively). No significant chemotherapy-related complications occurred.

Conclusions

Combination chemotherapy improved pulmonary function and decreased radiographic abnormalities in patients with CVID and GLILD.