Kutane zystische Läsionen (n = 35) wurden mit optischer Kohärenztomographie untersucht. Zysten waren sichtbar als hyporeflektive rundliche Raumforderung mit klarer Abgrenzung unter teils verdünnter Epidermis. Epidermalzysten, trichilemmale Zysten und Hidrozystome hatten einen linearen Rand, der das Zystenepithel darstellt, während mukoide Pseudozysten keinen linearen Rand aufwiesen. Trichilemmal- und Epidermoidzysten wiesen zudem einen hyperreflektiven Inhalt auf, welcher Keratin entspricht. Durch die Visualisierung des Randsaums und des Inhalts der Zyste war es möglich, zwischen verschiedenen Entitäten von Zysten zu differenzieren. / Cutaneous cystic lesions (n= 35) were examined with optical coherence tomography. Cysts were visible as a hyporeflective roundish area with a clear margin; in some cases, the epidermis was thinned. Epidermal cysts, trichilemmal cysts, and hidrocystomas had a linear margin representing the epithelium of the cyst, whereas mucoid pseudocysts showed no linear margin. Trichilemmal and epidermal cysts presented with hyperreflective content that corresponds to keratin. By visualizing the margin and the content of the cyst, it was possible to differentiate between different types of cysts.

Background Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) can yield improved diagnostic accuracy of nonmelanoma skin cancer (NMSC) in comparison with dermoscopy alone. Objectives The aim of this study was to compare the diagnostic performance of OCT and RCM together and individually with that of dermoscopy. Methods Patients with lesions suspicious for NMSC were randomized into two groups in a prospective, single-centre study. In the intervention group (IG), every lesion was examined with dermoscopy, OCT and RCM, while in the control group (CG), every lesion was examined with dermoscopy alone. Results A total of 365 lesions of 250 patients (105 female, 145 male) were included in the study. A total of 208 basal cell carcinomas (BCCs), 65 squamous cell carcinomas (SCCs) and 31 SCCs in situ were examined histologically. The IG involved significantly fewer biopsies than the CG (14 vs. 27, p = 0.029) and required fewer additional inpatient stays due to positive biopsy results (2 vs. 12, p = 0.001). For the diagnosis of BCC, diagnostic accuracy was 81% with dermoscopy, 84% with OCT, 83% with RCM and 85% with the combination of OCT and RCM (OCT/RCM). The diagnostic accuracy of OCT for BCC subtypes was as follows: superficial, 89%; nodular, 79%; sclerodermiform, 82%; and nodular-cystic BCC, 75%. For the diagnosis of SCC, diagnostic accuracy was 85% with dermoscopy, 87% with OCT, 89% with RCM and 87% with OCT/RCM. For the diagnosis of in situ SCC, diagnostic accuracy was 87% with dermoscopy, 89% with OCT, 89% with RCM and 91% with OCT/RCM. Conclusions Diagnostic accuracy increased with OCT and RCM and was even higher when both methods were used together. OCT and RCM could facilitate optimization of lesion management by reducing the number of punch biopsies and reducing additional inpatient stays due to positive biopsy results.

This work is devoted to one of the urgent problems today - automation of diagnostics of ophthalmological diseases on optical coherence tomography (OCT) images. It is known that automation of diagnostics solves a number of existing problems and reduces the time of evaluation and interpretation of OCT images, and also eliminates the subjectivity of the assessment, thereby improving the quality of diagnostics.The object of the study is optical coherence tomography images of the eye with early and intermediate forms of age-related macular degeneration. The subject of the study is the development of a deep learning algorithm for multiclass segmentation of the "dry" form of age-related macular degeneration. The aim of the work is to develop and test a neural network model capable of multi-class segmentation of early and intermediate forms of age-related macular degeneration in optical coherence tomography images of the eye. Scientific novelty: within the framework of the work, multi-class segmentation of the "dry" form of AMD was carried out for the first time on the open OCTDL dataset using the UNet3+ convolutional deep neural network. The architecture of the neural network solving the problem of multi-class segmentation was developed based on the UNet3+ convolutional deep neural network and trained on the open OCTDL dataset. The practical significance of the work lies in the fact that the use of deep learning methods for segmentation of OCT images and classification of AMD forms will allow diagnosing the disease at an early stage and preventing its transition to a more severe form. Also, the use of deep neural networks will reduce the time of patient examination by a doctor and reduce the influence of the specialist's subjective assessment on the diagnosis. / Данная работа посвящена одной из актуальных на сегодняшний день проблем – автоматизации диагностики офтальмологических заболеваний на снимках оптической когерентной томографии (ОКТ). Известно, что автоматизация диагностики решает ряд существующих проблем и сокращает время оценки и интерпретации снимков ОКТ, а также устраняет субъективность оценки, тем самым повышая качество диагностики. Объектом исследования являются снимки оптической когерентной томографии глаза с ранней и промежуточной формами возрастной макулярной дегенерации. Предмет исследования – разработка алгоритма глубокого обучения для мультиклассовой сегментации «сухой» формы возрастной макулярной дегенерации. Цель работы – разработать и протестировать модель нейронной сети, способную проводить мультиклассовую сегментацию ранней и промежуточной форм возрастной макулярной дегенерации на снимках оптической когерентной томографии глаза. Научная новизна: в рамках работы впервые проведена мультиклассовая сегментация «сухой» формы ВМД на открытом наборе данных OCTDL с использованием сверточной глубокой нейронной сети UNet3+. Архитектура нейронной сети, решающая задачу мультиклассовой сегментации, была разработана на основе сверточной глубокой нейронной сети UNet3+ и обучена на открытом наборе данных OCTDL. Практическая значимость работы заключается в том, что использование методов глубокого обучения для сегментации снимков ОКТ и классификации форм ВМД позволит диагностировать заболевание на ранней стадии и предотвратить его переход в более тяжелую форму. Также использование глубоких нейронных сетей сократит время обследования пациента врачом и снизит влияние субъективной оценки специалиста на постановку диагноза.

Indiana University-Purdue University Indianapolis (IUPUI) / Adaptive-optics optical coherence tomography (AOOCT) is a technology that has been rapidly advancing in recent years and offers amazing capabilities in scanning the human eye in vivo. In order to bring the ultra-high resolution capabilities to clinical use, however, newer technology needs to be used in the image reconstruction process. General purpose computation on graphics processing units is one such way that this computationally intensive reconstruction can be performed in a desktop computer in real-time. This work shows the process of AOOCT image reconstruction, the basics of how to use NVIDIA's CUDA to write parallel code, and a new AOOCT image reconstruction technology implemented using NVIDIA's CUDA. The results of this work demonstrate that image reconstruction can be done in real-time with high accuracy using a GPU.

Cette thèse porte sur l’étude de l’anatomie de la cornée après 3 techniques de greffe soient, la greffe totale traditionnelle (GTT) et des techniques de greffe lamellaire postérieur (GLP) telles que la greffe lamellaire endothéliale profonde (DLEK) et la greffe endothélium/membrane de Descemet (EDMG) pour le traitement des maladies de l’endothélium, telles que la dystrophie de Fuchs et de la kératopathie de l’aphaque et du pseudophaque. Dans ce contexte, cette thèse contribue également à démontrer l’utilité de la tomographie de cohérence optique (OCT) pour l’étude de l’anatomie des plaies chirurgicales la cornée post transplantation. Au cours de ce travail nous avons étudié l'anatomie de la DLEK, avant et 1, 6, 12 et 24 mois après la chirurgie. Nous avons utilisé le Stratus OCT (Version 3, Carl Zeiss, Meditec Inc.) pour documenter l’anatomie de la plaie. L'acquisition et la manipulation des images du Stratus OCT, instrument qui à été conçu originalement pour l’étude de la rétine et du nerf optique, ont été adaptées pour l'analyse du segment antérieur de l’oeil. Des images cornéennes centrales verticales et horizontales, ainsi que 4 mesures radiaires perpendiculaires à la plaie à 12, 3, 6 et 9 heures ont été obtenues. Les paramètres suivants ont été étudiés: (1) Les espaces (gap) entre les rebords du disque donneur et ceux du receveur, (2) les dénivelés de surface postérieure (step) entre le les rebords du disque donneur et ceux du receveur, (3) la compression tissulaire, (4) le décollement du greffon, 6) les élévations de la surface antérieure de la cornée et 7) la pachymétrie centrale de la cornée. Les mesures d’épaisseur totale de la cornée ont été comparées et corrélées avec celles obtenues avec un pachymètre à ultra-sons. Des mesures d’acuité visuelle, de réfraction manifeste et de topographie ont aussi été acquises afin d’évaluer les résultats fonctionnels. Enfin, nous avons comparé les données de DLEK à celles obtenues de l’EDMG et de la GTT, afin de caractériser les plaies et de cerner les avantages et inconvénients relatifs à chaque technique chirurgicale. Nos résultats anatomiques ont montré des différences importantes entre les trois techniques chirurgicales. Certains des paramètres étudiés, comme le sep et le gap, ont été plus prononcés dans la GTT que dans la DLEK et complètement absents dans l’EDMG. D’autres, comme la compression tissulaire et le décollement du greffon n’ont été observés que dans la DLEK. Ceci laisse entrevoir que la distorsion de la plaie varie proportionnellement à la profondeur de la découpe stromale du receveur, à partir de la face postérieure de la cornée. Moins la découpe s’avance vers la face antérieure (comme dans l’EDMG), moins elle affecte l’intégrité anatomique de la cornée, le pire cas étant la découpe totale comme dans la GTT. Cependant, tous les paramètres d’apposition postérieure sous-optimale et d’élévation de la surface antérieure (ce dernier observé uniquement dans la GTT) finissent par diminuer avec le temps, évoluant à des degrés variables vers un profil topographique plus semblable à celui d’une cornée normale. Ce processus paraît plus long et plus incomplet dans les cas de GTT à cause du type de plaie, de la présence de sutures et de la durée de la cicatrisation. Les valeurs moyennes d’épaisseur centrale se sont normalisées après la chirurgie. De plus, ces valeurs moyennes obtenues par OCT étaient fortement corrélées à celles obtenues par la pachymétrie à ultra-sons et nous n’avons remarqué aucune différence significative entre les valeurs moyennes des deux techniques de mesure. L’OCT s’est avéré un outil utile pour l’étude de l’anatomie microscopique des plaies chirurgicales. Les résultats d’acuité visuelle, de réfraction et de topographie des techniques de GLP ont montré qu’il existe une récupération visuelle rapide et sans changements significatifs de l’astigmatisme, contrairement à la GTT avec et sans suture. La GLP a permis une meilleure conservation de la morphologie de la cornée, et par conséquence des meilleurs résultats fonctionnels que la greffe de pleine épaisseur. Ceci nous permet d’avancer que la GLP pourrait être la technique chirurgicale à adopter comme traitement pour les maladies de l’endothélium cornéen. / This thesis aims to study the anatomy of the corneal wound following 3 techniques of corneal graft: traditional penetrating keratoplasy (PK) and two techniques of posterior lamellar keratoplasy (PLK) which are deep lamellar endothelial keratoplasy (DLEK) and Endothelial-Descemet’s Membrane Graft (EDMG) for the treatment of the endothelial corneal diseases, such as Fuch’s dystrophy and aphakic and pseudopakic bullous keratopathy. In this context, this thesis also contributes to show the utility of the time domain optical coherence tomography (TD-OCT) for studying the anatomy of surgical wounds after corneal transplantation. In this work we studied the anatomy of DLEK, before and 1,6,12 and 24 months after surgery. We used the Stratus OCT. (Version 3, Carl Zeiss, Meditec Inc.) to document the anatomy of the wound. The acquisition and the handling of the images of the Stratus OCT, an instrument originally designed for the study of the retina and the optic nerve, were adapted to analyse the anterior segment of the eye. Vertical and horizontal central images of the cornea, in addition to 4 radial measurements perpendicular to the wound at 12, 3, 6 and 9 hours were obtained. The following parameters were studied: (1) the gap between the edges of the donor disc and those of the recipient, (2) posterior surface mismatch (step) between the edges of the disc donor and those of the recipient, (3) tissue compression, (4) graft detachment, 6) elevations of the anterior corneal surface and 7) the central pachymetry of the cornea. Measurements of the total thickness were compared and correlated with those obtained with an ultrasound pachymeter. Measurements of visual acuity, manifest refraction and topography were also acquired in order to evaluate the functional results. Lastly, we compared the data of DLEK with those obtained from the EDMG and the PK, in order to characterize the wounds and to highlight the advantages and disadvantages relative to each surgical technique.Our anatomical results showed important differences between the three surgical techniques. Some of the studied parameters, like the step and the gap, were more pronounced in PK than in DLEK and completely absent in the EDMG group. Others, like tissue compression and graft detachment were observed only in the DLEK group. This let us predict that the distortion of the wound varies proportionally with the depth of recipient posterior stromal dissection. The less dissection towards the anterior surface (as in EDMG), the less it affects the anatomical integrity of the cornea, the worst case being full thickness trephination as in PK. However, all the parameters of sub-optimal posterior surface apposition and anterior surface elevation (this last only observed in PK) ended up decreasing with time, evolving with variable degrees to a topographic profile more similar to that of a normal cornea. This process appears longer and more incomplete in the cases of PK because of the type of wound, the presence of sutures and the longer healing period. The mean values of central thickness were normal after surgery. Moreover, these mean values obtained by OCT. were strongly correlated with those obtained by ultrasound pachymetry and we did not notice any significant difference between the mean values of the two measurement techniques. OCT proved to be a useful tool for the study of the microscopic anatomy of the corneal surgical wounds. The results of vision, refraction and topography of the techniques of posterior lamellar grafts showed that there was a fast visual recovery and without significant changes in astigmatism, contrary to PK with and without sutures. Posterior lamellar grafts allowed a better conservation of the morphology of the cornea, and consequently better functional results than PK. This enabled us to conclude that posterior lamellar corneal grafts could be the surgical technique of choice for the treatment of corneal endothelial diseases.

OBJETIVO: Investigar a correlação entre as espessuras da mácula e da camada de fibras nervosas da retina (CFNR), medidas pelas tomografias de coerência óptica de domínio Fourier (FD - OCT) e de domínio do tempo (TD - OCT) e a perda de sensibilidade no campo visual (CV) em pacientes com atrofia em banda do nervo óptico. Comparar a habilidade diagnóstica dos dois instrumentos. MÉTODOS: 36 olhos de 36 pacientes com perda de CV permanente por compressão do quiasma óptico e 36 controles normais foram submetidos ao exame de CV pela perimetria automatizada padrão (Humphrey Field Analyzer TM; Carl Zeiss Meditec, Dublin, CA), ao FD - OCT (3 D OCT-1000TM Topcon Corp., Tokyo, Japan) e ao TD - OCT (StratusTM ;Carl Zeiss Meditec Inc, Dublin, California, USA). Foram comparados os protocolos análogos de ambos os equipamentos para avaliação da espessura macular.Foi realizado a divisão macular em quatro quadrantes e em metades, sendo calculado a média da espessura macular global, a média da espessura dos quadrantes e a média da espessura das metades maculares. A média global e setorial da medida da espessura da CFNR peripapilar também foi analisada. A perda de sensibilidade no CV foi inicialmente avaliada pelo defeito temporal médio. O CV foi ainda dividido em 6 setores de acordo com a distribuição da CFNR e em 16 pontos centrais para a realização da correlação estrutura-função entre os parâmetros medidos pelo FD - OCT e a perda de sensibilidade no CV em decibéis e 1/Lambert. Foi calculado o coeficiente de correlação de Sperman e a análise de regressão linear. As áreas sobre a curva ROC e valores fixos de sensibilidade e especificidade foram calculados para cada parâmetro estudado. RESULTADOS: As medidas da espessura macular e da CFNR pelo FD - OCT e TD - OCT foram capazes de discriminar olhos com atrofia em banda do nervo óptico dos controles normais. A espessura global e setorial dos parâmetros maculares e da CFNR mostraram diferenças significativas (p<0,001) entre os doentes e os controles e os dois aparelhos tiveram desempenho semelhante na discriminação entre pacientes e controles. Em ambos existiram correlações significativas entre a perda de sensibilidade do CV e as medidas da espessura macular e da CFNR. As medidas de espessura nos quadrantes e nas metades nasais da macula, avaliadas pelo FD - OCT tiveram os melhores desempenhos nas correlações com os defeitos de CV, sendo o parâmetro com a melhor correlação, a medida do quadrante infero-nasal da mácula e a perda de sensibilidade do CV central do quadrante temporal superior central (r = 0.78, R2 = 61%, p<0,001). CONCLUSÕES: A espessura macular e a espessura da CFNR medidas pelo FD - OCT e pelo TD - OCT se correlacionaram topograficamente com a perda de sensibilidade no CV de pacientes com hemianopsia temporal por compressäo quiasmática. A correlação entre os quadrantes maculares e a perda de sensibilidade no CV, foram melhores do que aquelas entre o CV e as medidas da CFNR, principalmente nas medidas realizadas pelo FD - OCT. Este estudo demonstrou a importância clínica das medidas maculares na correlação estrutura-função e na quantificaçäo do dano neural em pacientes com compressão quiasmática, podendo ser útil na monitorização destes pacientes / PURPOSE: To investigate the relationship between fourier-domain optical coherence tomography (FD - OCT) measured macular and retinal nerve fiber layer thickness (RNFL) and visual field sensitivity loss on standard automated perimetry in eyes with permanent temporal hemianopia from chiasmal compression and compare the ability of FD - OCT and time-domain optical coherence tomography (TD - OCT) to detect axonal loss in eyes with band atrophy of the optic nerve. METHODS: One eye of each of 36 patients with permanent temporal visual field defects and 36 age- and sex-matched healthy subjects. Subjects underwent standard automated perimetry and macular and RNFL thickness measurements with FD - OCT (3 D OCT-1000® Topcon Corp., Tokyo, Japan) and TD - OCT (Stratus; Carl Zeiss Meditec Inc, Dublin, California, USA). Macular thickness measurements as a global average, divided in four quadrants and in two halves as well as average and sectoral RNFL thickness around the optic disc were calculated. Visual field sensitivity loss was evaluated by the temporal mean defect; as deviations from normal in six sectors of the visual field and in 16 central visual field test points. Relationship between visual field sensitivity loss in decibel and 1/Lambert units and optical coherence tomography measurements were evaluated using Spearman correlation coefficients and by linear regression analysis. Receiver operating characteristic curves and sensitivities at fixed specificities were calculated for each parameter. RESULTS: Global and sectoral macular and RNFL thickness parameters showed a significant difference in eyes with band atrophy compared with controls. The strongest correlations were seen between visual field sensitivity loss and quadrantic or hemianopic nasal macular thickness measurements than with sectoral retinal nerve fiber layer thickness measurements. The highest correlation was observed between the inferonasal quadrant macular thickness and the visual field sensitivity loss in the superior temporal central visual field quadrant (r = 0.78, R2 = 61%, p <0.001). CONCLUSION: Both RNFL thickness and macular thickness FD - OCT and TD - OCT measurements were related topographically with visual field sensitivity loss in patients with temporal hemianopia from chiasmal compression and there is a stronger relationship in quadrantic macular compared to RNFL thickness measurements with FD - OCT. Macular thickness measurements could potentially be used to quantify neuronal loss in patients with chiasmal compression and could prove clinically useful for detection of damage and for monitoring these patients

Fundamentos: A caracterização precisa da interação da placa aterosclerótica no momento do implante do stent é crucial para o entendimento da complacência e da cicatrização vasculares. Objetivamos investigar se a composição da placa avaliada pela tomografia de coerência óptica (OCT), influencia as alterações agudas no procedimento índice do implante do stent e na cicatrização vascular no seguimento tardio. Métodos: Os pacientes tratados com um único tipo de stent eluidor de fármaco (cromo cobalto, eluidor de sirolimus e polímero bioabsorvível) foram incluídos prospectivamente, seguindo um protocolo com etapas de dilatações progressivas do vaso. As imagens de OCT sequenciais foram realizadas no procedimento índice (basal e a cada etapa do protocolo) e no seguimento tardio, co-registradas e analisadas a cada 0,6mm. A avaliação semiquantitativa da placa foi realizada dividindo-se secções transversas em 4 quadrantes, com cada quadrante rotulado de acordo com o seu componente mais prevalente (fibrótico, calcificado, lipídico, normal). A interação stent-vaso avaliada pela OCT foi utilizada como indicador substituto para lesão e cicatrização vasculares após o implante do stent. Resultados: Um total de 22 lesões (1stent/lesão) de 20 pacientes e 2298 seções transversas de OCT foram analisadas no procedimento índice. O reestudo com OCT foi realizado em 17 pacientes e 19 lesões (86%). O componente de placa predominante foi fibrótico (fibrótico = 46.84 ± 16%; lipídico = 17.63 ± 10.72%; calcificado = 4.63 ± 5.9%; normal = 29.16 ± 12.24; não analizável=1.74 ± 5.35%). Houve um aumento nas áreas da luz (10atm = 5.5 (4.5 - 7.4) mm2, 14-16atm = 6.0 (4.7 - 7.70) mm2, 20atm = 6.7 (5.5 - 8.2) mm2; P < 0.001) e do stent (10atm = 5.2 (4.3 - 7.0) mm2, 14-16atm = 5.7 (4.5 - 7.5) mm2, 20atm = 6.5 (5.3 - 7.9) mm2; P < 0.001), com um aumento na área do prolapso tecidual (10atm =0.09 (0.06 - 0.12) mm2, 14-16atm =0.10 (0.06 - 0.15) mm2, 20atm =0.15 (0.08 - 0.20) mm2; P < 0.01). Segmentos com muito tecido fibrocalcificado tiveram áreas luminais menores ao longo das etapas da intervenção. Por outro lado, placas com muito conteúdo lipídico ou vaso normal tiveram maiores ganhos nas medidas das áreas luminais mínimas ao longo das dilatações sequenciais. Além disso, placas com muito tecido fibrocalcificado no momento basal apresentaram menor crescimento neointimal no seguimento tardio, enquanto que o grau de conteúdo lipídico e de vaso normal não tiveram impacto sobre a formação do tecido neointimal. Os indicadores substitutos de lesão vascular após o implante do stent correlacionaram-se significativamente com o crescimento neointimal no seguimento tardio. Conclusões: A composição tecidual das placas subjacentes influencia significativamente o comportamento mecânico agudo e a longo prazo dos vasos coronarianos submetidos ao implante de stent. Além disso, a lesão vascular após o implante do stent está potencialmente ligada ao futuro crescimento neointimal no seguimento tardio / Background Accurate characterization of atherosclerotic plaque interaction during stent deployment is crucial to understand vascular compliance and healing. We sought to determine whether plaque composition assessed by optical coherence tomography (OCT), influences acute changes at index procedure and vascular healing at follow up. Methods Patients treated with a single drug-eluting stent type (cobalt chromium with bioabsorbable polymer eluting sirolimus stent) were prospectively included, following a pre-defined step-by-step progressive vessel dilatation. Sequential OCT imaging were performed at the index procedure (baseline and at each time point of the protocol) and at follow up, co-registered and analyzed every 0.6mm for quantitative measurements. Semi-quantitative plaque assessment was performed at baseline by dividing cross-sections into 4 quadrants, with each quadrant labeled according to its most prevalent component (fibrotic, calcific, lipid). OCT assessments of stent-vessel interactions were used as a surrogate for vessel injury and healing after stent implantation. Results A total of 22 lesions (1stent/lesion) of 20 patients and 2298 OCT crosssections were analyzed at the index procedure. For an average of 19.7 months (591.88 ± 60.52 days), 17 of the patients and 19 lesions (86%) underwent OCT imaging at follow up. The predominant percentage plaque component was fibrotic (fibrotic = 46.84 ± 16%; lipid = 17.63 ± 10.72%; calcific = 4.63 ± 5.9%; normal = 29.16 ± 12.24; non-analyzable = 1.74 ± 5.35%). There was an increase in lumen (10atm = 5.5 (4.5 - 7.4) mm2, 14-16atm = 6.0 (4.7 - 7.70) mm2, 20atm = 6.7 (5.5 - 8.2) mm2; P < 0.001) and stent (10atm = 5.2 (4.3 - 7.0) mm2, 14-16atm = 5.7 (4.5 - 7.5) mm2, 20atm = 6.5 (5.3 - 7.9) mm2; P < 0.001) areas, with an increase in tissue prolapse area (10atm =0.09 (0.06 - 0.12) mm2, 14-16atm =0.10 (0.06 - 0.15) mm2, 20atm =0.15 (0.08 - 0.20) mm2; P < 0.01). Segments with high fibrocalcific content tended to have decreased minimal luminal areas along the intervention time-points. Conversely, plaques with high lipid content had increased minimal luminal areas during sequential dilatations. Moreover, plaques with high fibrocalcific tissue at baseline had significantly smaller neointimal growth at follow-up, whereas the degree of lipid content or normal tri-layered vessel had no impact on neointimal formation. OCT surrogates of vessel injury after coronary stenting significantly correlated with neointimal growth at follow-up. Conclusions: Tissue composition of underlying plaques significantly influences the acute mechanical and the long-term behavior of coronary vessels undergoing stent implantation. In addition, vessel injury after coronary stenting is potentially linked to future neointimal growth at follow-up

Pacientes com compressão quiasmática apresentam perda das fibras nervosas da retina nasal que decussam no quiasma óptico. Por conseguinte, ocorre perda das fibras nervosas, predominantemente, no setor nasal e temporal do disco óptico, que se manifesta por atrofia em banda do nervo óptico ao exame oftalmoscópico e hemianopsia temporal ao exame de campo visual. Trabalhos anteriores mostraram que o tomógrafo de coerência óptica é capaz de diferenciar pacientes com atrofia em banda do nervo óptico associada à hemianopsia temporal completa de indivíduos normais através da análise da camada de fibras nervosas peripapilar. Estudos em glaucoma têm sugerido que a avaliação da espessura macular poderia ser útil na quantificação da perda neural como um método alternativo ou complementar ao estudo da camada de fibras nervosas da retina. No presente estudo, a espessura macular e da camada de fibras nervosas foram avaliadas pelo tomógrafo de coerência óptica em pacientes com atrofia em banda do nervo óptico e graus variados de hemianopsia temporal. O desempenho dos parâmetros maculares para detecção da atrofia em banda do nervo óptico foi avaliado pela área sob a curva ROC (AROC) e sensibilidades para especificidades fixas e os resultados foram comparados aos parâmetros da camada de fibras nervosas peripapilar. Para identificar os parâmetros do Stratus OCT que apresentaram melhor desempenho para diferenciar pacientes com AB do nervo óptico de indivíduos normais, modelos de regressão logística foram utilizados. A correlação estrutura-função foi realizada entre o grau do defeito temporal e os valores de espessura macular e da camada de fibras peripapilar através do coeficiente de correlação de Spearman. A categorização diagnóstica dos parâmetros da camada de fibras nervosas através do banco de dados normativos foi avaliada pelos valores de sensibilidade e especificidade calculados pelo teste exato de Fisher. Quarenta e quatro olhos com atrofia em banda e 47 olhos normais foram avaliados no estudo. Entre os parâmetros maculares, os parâmetros da retina nasal apresentaram melhor desempenho para detectar atrofia em banda do nervo óptico comparados aos parâmetros da retina temporal. Não houve diferença significante (p=0,32) entre as áreas sob a curva ROC do melhor parâmetro macular (AROC=0,97) e do melhor parâmetro da camada de fibras nervosas retiniana (AROC=0,99). Na avaliação da correlação estrutura-função, os parâmetros da retina nasal apresentaram maior correlação com o defeito campimétrico comparados aos parâmetros da camada de fibras nervosas da retinal. Entre os parâmetros maculares, a espessura nasal média apresentou a maior correlação (rs=0,618). Entre os parâmetros da camada de fibras nervosas da retina, a espessura média apresentou a maior correlação (rs=0,479). Os parâmetros espessura média, espessura nasal e espessura temporal da camada de fibras nervosas da retina apresentaram melhor desempenho diagnóstico baseado na categorização diagnóstica do banco de dados normativos. Os resultados obtidos no estudo mostraram que os parâmetros maculares discriminam olhos com atrofia em banda do nervo óptico em pacientes com graus variados de defeito temporal. Além disso, os parâmetros da retina nasal podem colaborar com o exame perimétrico e os parâmetros da camada de fibras nervosas para o seguimento dos pacientes com compressão quiasmática. / Patients with chiasmal compression present damage of crossed fibers of nasal retina. Therefore, retinal nerve fiber layer loss occurs predominantly on the nasal and temporal sides of the optic disc, a pattern that can be identified on ophthalmoscopy as band atrophy of the optic nerve and on visual field as temporal hemianopia. Previous studies have been demonstrated that optical coherence tomography is able to detect retinal nerve fiber layer loss in patients with lesions of the optic chiasm and complete temporal hemianopia. Studies in glaucoma have been suggested that macular thickness measurements could be useful in quantification of optical nerve axonal loss as alternative or complement method to evaluate the retinal nerve fiber layer. The purpose of the present study was to compare macular thickness and retinal nerve fiber thickness measurements in patients with band atrophy of the optic nerve and different severities of visual field defect using optical coherence tomography. Area under the receiver operating characteristic curve (AROC) and sensitivities at fixed specificities were performed for evaluation of diagnostic accuracy of macular and retinal nerve fiber layer parameters. To identify the best optical coherence tomography measurements to differentiate band atrophy of the optic nerve patients from normal individuals, logistic regression models were performed. Association between optical coherence tomography parameters and temporal field defect were examined by Spearman coefficient of correlation. Fisher\'s exact test was performed to evaluate diagnostic ability of retinal nerve fiber parameters by optical coherence tomography in eyes with band atrophy using comparison with its internal normative database. A total of 44 eyes with band atrophy of the optic nerve and 47 normal eyes were studied. Among macular parameters, nasal retina measurements showed diagnostic accuracy better than temporal retina measurements. No statistically significant difference (p=0.32) was found between areas under ROC curve for the best macular parameter (AROC=0.97) and the best retinal nerve fiber layer parameter (AROC=0.99). Nasal retina parameters correlations were higher than retinal nerve fiber parameters. The highest correlation was observed for the mean nasal thickness (rs=0.618) for macular parameters. In retinal nerve fiber parameters, the highest correlation was observed for the average thickness (rs=0.479). In evaluation of diagnostic ability of normative database, the average thickness parameter demonstrated the highest sensitivity for detection of abnormalities in eyes with band atrophy, followed by the parameters related to the nasal and temporal quadrants. These results suggest that macular thickness measurements discriminate eyes with band atrophy of the optic nerve with different severities of temporal field defect. Results also suggest that nasal retina thickness measurements could potentially be used to evaluate retinal ganglion cell loss in patients with chiasmal compression.

Introdução: a ataxia espinocerebelar tipo 7 (SCA7) é um distúrbio neurodegenerativo autossômico dominante causado por uma repetição CAG expandida (CAGexp) no gene ATXN7, resultando na inserção de uma poliglutamina (poliQ) alongada na proteína ataxina-7. Em consequência, pacientes com SCA7 desenvolvem ataxia, espasticidade e outros sintomas neurológicos. A SCA 7 se destaca de outras SCAs por se associar à distrofia retiniana, causando deficiências visuais que podem levar à cegueira. Sendo uma das mais raras SCAs, pequenas séries de casos têm aparecido na literatura. Poucas delas buscaram correlacionar os achados neurológicos com os oftalmológicos; e a fase pré-clínica jamais foi sistematicamente investigada. Objetivo: descrever os achados neurológicos e oftalmológicos de uma coorte de casos de SCA 7, comparando as manifestações encontradas em sujeitos sintomáticos com as encontradas em portadores assintomáticos e em parentes não portadores, em uma abordagem exploratória que buscou levantar potenciais biomarcadores de progressão da doença. Métodos: trata-se de um estudo transversal onde pacientes com diagnóstico molecular de SCA7 realizado na nossa instituição foram identificados em nossos arquivos protegidos. Tanto eles como seus parentes foram convidados a participar da presente investigação. Sujeitos em risco de 50% foram incluídos se tivessem mais de 18 anos. Após o consentimento, dados clínicos e demográficos foram coletados entre junho de 2016 e setembro de 2017. A seguir, todos os participantes realizaram uma bateria de escalas clínicas voltadas à medida da ataxia (SARA, CCFS, PATA e 8 MW) e das manifestações neurológicas (NESSCA e INAS); um questionário de qualidade de vida relacionada à visão (NEI-VFQ 25); avaliação da acuidade visual melhor corrigida (AVMC), desvio médio em campimetria computadorizada (MD) e espessuras da mácula e da camada de células ganglionares na tomografia de coerência óptica (OCT). A escala SARA e a AVMC foram escolhidas como as variáveis de referência para a gravidade dos quadros. A análise molecular do ATXN7 foi feita, mas participantes do estudo e avaliadores foram mantidos cegos para seus resultados; os indivíduos em risco interessados em receber seus resultados foram enviados para o programa de testes pré-sintomáticos. Como não houve critérios a priori para estimar tamanhos de efeito e como a SCA7 é uma condição rara, não houve como decidir um tamanho de amostra. O estudo foi exploratório e por isso não foram feitas correções para múltiplas testagens. Um p de 0,05 foi eleito para definir significância, e testes estatísticos foram aplicados de acordo com as características das variáveis em estudo. Resultados: 12 portadores sintomáticos (grupo 2) e 8 indivíduos em risco (3 portadores - grupo 1 - e 5 não-portadores - grupo 0) foram incluídos neste estudo. Todas as variáveis contínuas à exceção da CAGexp tiveram distribuição 4 normal. A AVMC estava reduzida em todos os participantes sintomáticos e claramente diferente entre estes e os outros dois grupos (p <0,0001, ANOVA), enquanto os portadores assintomáticos e os não portadores tiveram resultados semelhantes. A AVMC média foi 20/143, 20/18 e 20/20 nos grupos 2, 1 e 0, respectivamente. Não surpreendentemente, o NEI-VFQ 25 também demonstrou uma diferença estatisticamente significativa, mas o que foi inesperado foi a forma progressivamente diferente entre os 3 grupos (grupo 0 = 92,76 ± 6,7; grupo 1 = 74,9 ± 55,5; grupo 2 = 58,0 ± 21,3) (p= 0,012, ANOVA com Tukey) O MD mostrou um padrão linear estatisticamente significativo para piorar do grupo controle (-1,34 ± 1,15dB) para o assintomático (-2,81 ± 1,66dB) e do grupo assintomático para sintomático (-10,54 ± 6,95dB) (p = 0,027, ANOVA com Tukey). Além disso, o MD correlacionou-se com a AVMC (p = 0,020; r = 0,660) e apresentou tendência de correlação com a SARA (p= 0,073; r= -0,535). As medidas de espessura macular distinguem completamente os 3 grupos (grupo 0 = 243,6 ± 22,2 μ; grupo 1 = 204,5 ± 14,1 μ; grupo 2 = 137,95 ± 34,6 μ) (p = 0,0001, ANOVA) e também se correlacionou significativamente com os dois critérios planejados de gravidade, SARA (p = 0,050; r = -0,577) e AVMC (p = 0,007; r = 0,730). Discussão: alterações oftalmológicas estavam presentes já nas fases pré-clínicas da doença, quando os escores obtidos das escalas neurológicas ainda não distinguem portadores assintomáticos de não portadores: a espessura macular medida por OCT e o MD medido pela campimetria computadorizada. Esses achados demonstram que o processo neurodegenerativo já se encontra em curso e é detectável por essas medidas anatômicas e funcionais da retina. Além disso, ambas as alterações detectadas em fases pré-clínicas, ao serem estudadas no grupo total de portadores sintomáticos e assintomáticos, se correlacionaram com os nossos padrões-ouro da gravidade da doença, SARA e AVMC. Os dois achados - início em fase pré-clínica e correlação com a progressão da doença medida por escores independentes - sugerem que a espessura macular medida por OCT e o MD medido pela campimetria computadorizada são potenciais candidatos a biomarcadores de estado (de progressão da doença) desde fases pré-manifestas na SCA7. / Background: spinocerebellar ataxia type 7 (SCA7) is an autosomal dominant neurodegenerative disorder caused by an expanded CAG repeat (CAGexp) at ATXN7 gene, resulting in the insertion of an elongated polyglutamine (polyQ) into the ataxin-7 protein. As a consequence, patients with SCA7 develop ataxia, spasticity and other neurological symptoms. SCA7 stands out from other SCAs by associating it with retinal dystrophy, causing visual deficiencies that can lead to blindness. Being one of the rarest SCAs, small series of cases appear in the literature. Few of them sought to correlate neurological findings with ophthalmologic findings; and the preclinical stage has never been systematically investigated. Objective: to describe the neurological and ophthalmological findings of a cohort of cases of SCA7, comparing the manifestations found in symptomatic subjects with those found in asymptomatic carriers and in non-carrier relatives in an approach exploratory study that sought to raise potential biomarkers of disease progression. Methods: patients with a molecular diagnosis of SCA7 performed at our institution were identified in our protected files. Both they and their relatives were invited to participate in the present investigation. Subjects at risk of 50% were included if they were older than 18 years. After consent, clinical and demographic data were collected between June 2016 and September 2017. All participants then performed a battery of clinical scales aimed at the measurement of ataxia (SARA, CCFS, PATA and 8 MW) and neurological manifestations (NESSCA and INAS); a visual function questionnaire (NEI-VFQ 25); assessment of better corrected visual acuity (AVMC), mean deviation in computerized campimetry (MD), and thickness of the macula and ganglion cell layer on OCT. The SARA and AVMC scale were chosen as the reference variables for the severity of the frames. Molecular analysis of ATXN7 was done, but study participants and evaluators were kept blind to their results; the individuals at risk interested in receiving their results were sent to the presymptomatic testing program. As there were no a priori criteria for estimating effect sizes and because SCA7 is a rare condition, there was no way to decide on a sample size. The study was exploratory and therefore no corrections were made for multiple tests. A p of 0.05 was chosen to define significance, and statistical tests were applied according to the characteristics of the variables under study. Results: 12 symptomatic carriers (group 2) and 8 individuals at risk (5 carriers - group 1 - and 3 non-carriers - group 0) were included in this study between June 2016 and September 2017. All continuous variables with the exception of CAGexp had normal distribution. AVMC was reduced in all symptomatic participants and clearly different between these and the other two groups (p <0.0001, ANOVA), while asymptomatic and non-carriers had similar results. The mean BCVA was 20/143, 20/18 and 20/20 in groups 2,1 and 6 0, respectively. Not surprisingly, NEI-VFQ 25 also showed a statistically significant difference, but what was unexpected was the progressively different form between the 3 groups (group 0 = 92.76 ± 6.7, group 1 = 74.9 ± 55, 5, group 2 = 58.0 ± 21.3) (p = 0.012, ANOVA with Tukey). The MD showed a statistically significant linear pattern to worsen from the control group (-1.34 ± 1.15dB) to the asymptomatic (-2.81 ± 1.66dB) and from the asymptomatic to the symptomatic group (-10.54 ± 6, 95dB) (p = 0.027, ANOVA with Tukey). In addition, MD correlated with AVMC (p = 0.020; r = 0.660) and showed a correlation tendency with ARDS (p = 0.073; r = -0.535). The macular thickness scores completely distinguish the 3 groups (group 0 = 243.6 ± 22.2 μ, group 1 = 204.5 ± 14.1 μ, group 2 = 137.95 ± 34.6 μ) (p = 0.0001, ANOVA ...) and also correlated significantly with the two planned criteria of severity, SARA (p = 0.050, r = -0.577) and AVMC (p = 0.007, r = 0.730). Conclusion: ophthalmologic changes were present already in the preclinical stages of the disease, when the scores obtained from the neurological scales did not yet distinguish asymptomatic non-carrier patients: macular thickness measured by OCT and MD measured by computerized campimetry. These findings demonstrate that the neurodegenerative process is already underway and is detectable by these anatomical and functional measures of the retina. In addition, both changes detected in preclinical stages, when studied in the total group of symptomatic and asymptomatic carriers, correlated with our gold standard of disease severity, SARA and AVMC. The two findings - pre-clinical onset and correlation with disease progression measured by independent scores - suggest that the macular thickness measured by OCT and MD as measured by computerized campimetry are potential candidates for disease biomarkers (disease progression) from pre-manifest stages in SCA7.

Made available in DSpace on 2014-07-29T15:25:16Z (GMT). No. of bitstreams: 1 Tese Rosana Zacarias Honnouche.pdf: 1939926 bytes, checksum: d4fdb3cd4d741d0cf72b9b9269fceb63 (MD5) Previous issue date: 2011-11-29 / Diabetic macular edema (DME) is the main cause of visual loss in diabetic patients and is characterized by retinal thickening, whose evaluation is important for the diagnosis and management of diabetic retinopathy. The aim of this research was to measure the central subfield thickness (CST), the best-corrected visual acuity (BCVA) and the macular volume, and compare these data to those of diabetic patients without DME, using spectral-domain optical coherence tomography (SD-OCT), for quantitative analysis of DME.Two hundred patients with nonproliferative diabetic retinopathy (NPDR) were enrolled in a transversal study, from which 55 eyes with macular edema were detected by fundus biomicroscopy. Twenty seven diabetic patients without DME and with normal ophthalmological exam served as control group. Measurements of CST (main variable), BCVA and macular volume were taken, considering the variables age, gender, NPDR classification, external limitant membrane (ELM) integrity and type of DME. Biomicroscopy with noncontact lens, fluorescein angiography and spectral optical coherence tomography were performed using Cirrus SD-OCT. Besides descriptive statistics, additional tests were applied to analyze the results, such as variance analysis, t-Student, chisquare, Fischer s exact test, Mann-Whitney and Kruskall-Wallis. The relation between CST and BCVA was studied by linear regression, with logarithmic scale of minimal angle of resolution (logMAR). It was found that there is no significant difference between case and control groups for the variables age and gender. However, there was significant difference for variables CST, BCVA and macular volume. It was found significant correlation between retinopathy severity according to NPDR classification and the mean value of CST,which is the greater the retinopathy severity, the greater the CST. Most of the patients presented moderate NPDR. A strong correlation between macular volume and CST was found. Patients with serous retinal detachment presented higher mean value of CST, and those with CME presented worse BCVA. Patients with disrupted ELM showed greater mean value of CST and worse BCVA. It was concluded that SD-OCT allows quantitative measurement of CST in DME and, for identifying the retinal layers individually, also detects retinal structural changes and correlates them to visual functions. / O edema macular diabético é a principal causa de perda visual em diabéticos e é caracterizado pelo espessamento retiniano, cuja avaliação é importante para o diagnóstico e conduta da retinopatia diabética. O objetivo deste trabalho foi comparar as medidas da espessura do subcampo central (ESCC), a acuidade visual e o volume macular de pacientes com edema macular diabético (EMD) com diabéticos sem EMD, usando tomografia de coerência óptica de domínio espectral (SD-OCT) para análise quantitativa do EMD. Foi realizado um estudo transversal em que foram avaliados 55 pacientes com EMD, selecionados pela biomicroscopia de fundo, de um grupo de 200 pacientes com retinopatia diabética não proliferativa (RDNP). Um grupo de 27 pacientes diabéticos sem edema macular e com exame oftalmológico normal serviu como controle. Mediu-se a espessura do subcampo central (principal variável), a acuidade visual , o volume macular e avaliou-se a idade, o sexo, a classificação RDNP, a integridade da membrana limitante externa (MLE) e a morfologia do edema macular. Realizou-se biomicroscopia com lente de não contato, angiofluoresceinografia e tomografia de coerência óptica de domínio espectral com Cirrus SD-OCT. Além da estatística descritiva, utilizou-se testes para análise dos resultados: análise de variância, t-Student, qui-quadrado, teste exato de Fisher, Mann-Whitney e Kruskall-Wallis. A relação entre a ESCC e a acuidade visual foi estuda da através de análise de regressão linear com escala logarítmica de mínimo ângulo de resolução (logMAR). Registrou-se não haver diferença significativa entre casos e controles nas variáveis idade e sexo. Entretanto, houve diferença significativa para as variáveis ESCC, acuidade visual e volume macular. Foi encontrada correlação significativa entre a gravidade da retinopatia na classificação RDNP e a média da ESCC, sendo que quanto maior a gravidade da retinopatia, maior a ESCC. A maior parte dos pacientes apresentou RDNP moderada. Foi encontrada correlação significativa entre o volume e a ESCC. Pacientes com descolamento seroso apresentaram maior média da ESCC; e aqueles com EMC apresentaram pior acuidade visual. Pacientes com MLE descontínua apresentaram maior média da ESCC e pior acuidade visual. Concluiu-se que o SD-OCT mede quantitativamente a ESCC no EMD e, por identificar individualmente as camadas retinianas, detecta suas mudanças estruturais. Estas medidas podem ser correlacionadas com a função visual e auxiliar na conduta de pacientes com retinopatia diabética.