Visual acuity outcomes in Coats disease by classification stage in 160 patients

2019 ◽  
Vol 104 (3) ◽  
pp. 422-431 ◽  
Author(s):  
Carol L Shields ◽  
Sanika Udyaver ◽  
Lauren A Dalvin ◽  
Li-Anne S Lim ◽  
Hatice T Atalay ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Laser Photocoagulation ◽  
Disease Stage ◽  
Final Visit ◽  
Advanced Stage ◽  
Snellen Visual Acuity ◽  
Stage 4 ◽  
Before And After ◽  
Coats Disease ◽  
Stage 1

PurposeTo assess visual outcomes of Coats disease by classification stage.MethodsA retrospective review was conducted on consecutive patients with Coats disease, classified according to Shields classification and with available Snellen visual acuity before and after treatment.ResultsThere were 160 eyes with Coats disease (stage 1 (n=2) vs stage 2A (n=17) vs stage 2B (n=22) vs stage 3A1 (n=26) vs stage 3A2 (n=40) vs stage 3B (n=42) vs stage 4 (n=9) vs stage 5 (n=2)). By comparison, more advanced stage showed greater frequency of poor presenting visual acuity (<20/200) (0% vs 0% vs 50% vs 35% vs 38% vs 83% vs 100% vs 100%, p<0.001) and higher mean intraocular pressure (17 vs 15 vs 15 vs 15 vs 15 vs 15 vs 37 vs 26, p<0.001). More advanced stage was less likely managed with laser photocoagulation (100% vs 87% vs 48% vs 62% vs 74% vs 35% vs 0% vs 0%, p<0.001) and more likely with cryotherapy (0% vs 47% vs 81% vs 81% vs 82% vs 88% vs 50% vs 100%, p=0.001). More advanced stage was associated with lower frequency of visual acuity ≥20/40 (100% vs 71% vs 5% vs 42% vs 23% vs 5% vs 0% vs 0%, p<0.001) and greater frequency of visual acuity <20/200 (0% vs 12% vs 36% vs31 % vs 45% vs 88% vs 0% vs 100%, p<0.001).ConclusionVisual acuity in eyes with Coats disease parallels staging with more advanced stage demonstrating poorer visual acuity at presentation and final visit.

scholarly journals Anatomical and functional significance of ectopic inner foveal layer (EIFL) in epiretinal membrane (ERM)

2021 ◽  
Vol 7 (2) ◽  
pp. 366-371
Author(s):  
Sunil Ganekal ◽  
Varun Ganekal
Keyword(s):  
Visual Acuity ◽  
Epiretinal Membrane ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Chi Square ◽  
Epiretinal Membranes ◽  
Stage 4 ◽  
Before And After ◽  
Chi Square Test ◽  
Stage 1

To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL). : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables.: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes.: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.

Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study

2020 ◽  
Vol 4 (6) ◽  
pp. 467-471
Author(s):  
Pukhraj Rishi ◽  
Ekta Rishi ◽  
Yamini Attiku ◽  
Mahesh Uparkar ◽  
Pramod Bhende ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Subretinal Fluid ◽  
Vitreous Hemorrhage ◽  
Disease Stage ◽  
Final Visit ◽  
Kaplan Meier ◽  
Coats Disease ◽  
End Stage ◽  
Anatomical Outcome

Purpose: This work studies outcomes of external subretinal fluid (SRF) drainage in management of eyes with advanced Coats disease. Methods: Patients with advanced-stage Coats disease (≥stage 3B), who were younger than 12 years and underwent external SRF drainage from 1996 to 2016, were included in this retrospective study. Surgical intervention involved external drainage of SRF and cryotherapy. SRF drainage was performed by lamellar scleral dissection or by external needle drainage. Favorable anatomical outcome was defined as retinal reattachment with normal intraocular pressure (IOP). IOP greater than 24 mm Hg was considered raised. Univariate and multivariate analyses were performed to measure the association between preoperative or intraoperative factors and retinal status at final follow-up. Outcome measures evaluated included visual acuity, IOP, retinal status, globe status, and complications of surgery. Kaplan-Meier analysis was performed for globe salvage without pain. Results: Thirty-two eyes of 32 patients were included in the study. Mean age at surgery was 3.8 ± 3 years. The mean duration of follow-up was 7 years (range, 6 months-15.7 years). Improvement in visual acuity was seen in 5 eyes. Retina was attached at final visit in 6 eyes. IOP in the range of 8 to 24 mm Hg was noted in 16 eyes. Favorable anatomical outcome was achieved in 3 (9%) eyes. Globe salvage was achieved in 84% of eyes. Complications included intraoperative vitreous hemorrhage (n = 1) and postoperative inflammation (n = 1). Kaplan-Meier ocular survival rate without pain at 10 years was 76%. Conclusions: SRF drainage and cryotherapy in eyes with advanced Coats disease favorably alter the natural history of the disease and prevent end-stage complications. Visual outcomes remain poor.

scholarly journals Epiretinal membrane surgery outcome in eyes with abnormalities of the central bouquet

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Max P. Brinkmann ◽  
Stephan Michels ◽  
Carolin Brinkmann ◽  
Felix Rommel ◽  
Mahdy Ranjbar ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Internal Limiting Membrane ◽  
Surgical Removal ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Morphological Appearance ◽  
Surgery Outcome ◽  
Stage 4 ◽  
Before And After ◽  
Stage 1

Abstract Background Clinical studies have shown that epiretinal membranes (ERM) as well as abnormalities of the central foveal bouquet (CB) can be classified in different stages according to their morphological appearance. Furthermore, visual acuity correlates with the different stages of these features. The present study evaluated how these findings change after the surgical removal of the ERM and their impact on functional outcomes. Methods In this retrospective study eyes with ERM were evaluated by SD-OCT scans before and after pars plana vitrectomy (PPV) with macular ERM and internal limiting membrane (ILM) peeling. CB abnormalities were classified according to their morphological appearance from stage 0 (no abnormalities) to stage 3 (acquired vitelliform lesion). ERMs were classified ranging from stage 0 (absence of ERM) to stage 4 (ERM with significant anatomic disruption of macula). Changes in morphology were correlated with visual acuity before and after surgery. Results 151 eyes were included into the study. Before surgery 27.2% (n = 41) of eyes showed CB abnormalities with stage 1 being the most common (11.9%, n = 18). Before surgery ERM was seen in all patients. The most common form was stage 1 (28.5%, n = 43), followed by stage 3 (27.8%, n = 42) and 2 (25.2%, n = 38). Only 18.5% (n = 28) presented with stage 4 ERM. The mean BCVA was 0.42 (logMAR) before and increased to 0.19 (logMAR) 8 weeks after vitrectomy (95% CI 0.20–0.28; p < 0.001). Patients who suffered from CB abnormalities had less increase in BCVA than patients who had no evidence of CB (0.28 vs. 0.14 logMAR; p < 0.001). Of all the patients with CB abnormalities at baseline, 68% had lower CB grading after the surgery (n = 28; 95% CI; p < 0.001). All patients showed an improvement of their ERM grading, with 98.7% reaching stage 0 (n = 151 vs. n = 149; 95% CI; p < 0.001). Conclusions The study indicates that the presence of CB abnormalities correlates with worse visual function. They are furthermore associated with worse visual outcomes after PPV with ERM and ILM peeling. These findings are valuable for deciding on PPV in patients with ERM.

scholarly journals Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Jianbo Mao ◽  
Hanfei Wu ◽  
Chenyi Liu ◽  
Chenting Zhu ◽  
Jimeng Lao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Thickness ◽  
Final Visit ◽  
Central Macular Thickness ◽  
Epiretinal Membranes ◽  
Stage 4 ◽  
Significant Difference ◽  
Three Stages ◽  
B Scan Images

Purpose. To observe the changes in metamorphopsia, visual acuity, and central macular thickness (CMT) in patients undergoing vitrectomy for idiopathic epiretinal membranes (iERM); all of which were preoperatively stratified into 4 stages according to the anatomical structure of the macula seen on the optical coherence tomography (OCT) b-scan images. Methods. A total of 108 eyes of 106 patients were included. We evaluated and classified the severity of each preoperative ERM based on OCT. Changes in the best-corrected visual acuity (BCVA), metamorphopsia, and CMT were studied by comparing the pre- and postoperative measurements. The follow-up time was at least 6 months. Results. There were 41 eyes at stage 2, 35 at stage 3, 32 at stage 4, and none at stage 1. BCVA and metamorphopsia significantly improved at the final visit in all patients (P<0.01). However, comparing the pre- and postoperative measurements at each stage, only the BCVA and CMT improved significantly for all stages (P<0.001). For stages 2 and 3 ERMs, the horizontal (MH) and vertical (MV) metamorphopsia scores decreased significantly after surgery (P<0.05). No significant difference was found in either MH or MV for stage 4 ERMs (P both >0.05). The preoperative BCVA, MH, and CMT had significant difference among the three stages (P<0.05). Similarly, the postoperative values in the three variables mentioned above also had significant difference among the three stages (P<0.05). For stage 2 ERMs, the baseline MH and MV were positively correlated with the baseline CMT. The MH and MV at the final follow-up also presented a significant positive correlation with the baseline CMT. For stage 3 ERMs, only the baseline MV showed significant correlation with the CMT. Conclusion. Categorization of the preoperative ERMs is a useful method to predict the postoperative improvement in metamorphopsia, which would aid in surgical decisions for patients with ERMs.

An administrative stage inference algorithm for use in patients receiving chemotherapy for colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18121-e18121 ◽  
Author(s):  
Gabriel A. Brooks ◽  
Mary Beth Landrum ◽  
Nancy Lynn Keating
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Metastatic Cancer ◽  
Cancer Stage ◽  
Fee For Service ◽  
Inference Algorithm ◽  
Stage 4 ◽  
Before And After ◽  
Care Outcomes ◽  
Stage 1

e18121 Background: Claims data are often used for evaluating cancer care outcomes; however, such data lack information about cancer stage. We developed a claims-based stage inference algorithm to classify chemotherapy-treated patients with localized vs. metastatic colorectal cancer (CRC). Methods: We used the SEER-Medicare linked data (2010-‘11) to develop and validate an algorithm to predict cancer stage (localized vs. metastatic) among patients receiving chemotherapy within 6 months of CRC diagnosis. We used claims to identify treatments received (surgery, radiation, and chemotherapy agents) during the 6 months before and after the first dose of chemotherapy. The sample was split 1:1 into development and validation cohorts. After testing in the development cohort, the final algorithm was evaluated in the validation cohort. SEER data served as the gold standard for cancer stage. Results: We identified 25,258 patients with fee-for-service Medicare and a new diagnosis of CRC. 6,907 patients (27%) received chemotherapy for CRC within 6 months of diagnosis. The median age of chemotherapy-treated patients was 73, 49% were female, and 76% were white; 69% had localized cancer (AJCC stage 1-3) and 31% had metastasis at diagnosis (stage 4). Split-sample validation of the final classification algorithm demonstrated sensitivity and specificity of 87% (95% CI 86-89%) and 76% (73-78%) for localized cancer and 73% (70-75%) and 91% (90-92%) for metastatic cancer. The overall accuracy of classification was 83%. Stratified analyses demonstrated preserved algorithm performance across subgroups of age, sex, race, geography, and comorbidity. Misclassification was most common among patients with metastatic disease who were treated with surgery followed by fluoropyrimidine chemotherapy with or without oxaliplatin. 2-year overall survival was 79.8% (stage 1-3) and 35.4% (stage 4) for SEER stage groups, vs. 79.6% and 35.8% for predicted stage groups. Conclusions: A claims-based algorithm can classify extent of disease in chemotherapy-treated CRC patients with an accuracy of 83%. This algorithm will allow more clinically-relevant patient stratification for claims-based evaluations of cancer care outcomes.

scholarly journals Surgical Approach to Control Advanced Coats Disease

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Şengül Özdek ◽  
Ahmet Yücel Üçgül
Keyword(s):  
Pediatric Population ◽  
Neovascular Glaucoma ◽  
Surgical Approaches ◽  
Exudative Retinal Detachment ◽  
Ablative Therapies ◽  
Stage Disease ◽  
Stage 4 ◽  
Coats Disease ◽  
End Stage ◽  
Stage 1

Coats disease, first described by George Coats in 1908, is commonly a unilateral clinical entity characterized by leaky telangiectatic vessels leading to progressive subretinal exudation and exudative retinal detachment (ERD).1 It is generally seen in pediatric population and has a distinct male predilection of over 90%. Shields et al.2 classified Coats disease into five stages as follows: Stage 1: presence of retinal telangiectasia only, Stage 2: telangiectasia and exudation (2A: extrafoveal exudation, 2B: foveal exudation), Stage 3: exudative RD (3A: subtotal RD, 3B: total RD), Stage 4: total RD and neovascular glaucoma, Stage 5: advanced end-stage disease.       Disease progression can be controlled with ablative therapies such as laser photocoagulation (LFK) and cryotherapy in the early stages of Coats disease. However, ablative therapies are not effective in the late stages (Stage 3 – 4) due to excessive subretinal exudation and ERD. Therefore, adjunctive surgical approaches have become popular in the treatment of advanced Coats disease. This helps in effective ablation of leaky abnormal vessels.

Fovea-sparing coats disease: A rare clinical entity

2020 ◽  
pp. 112067212097428
Author(s):  
Matteo Maria Girolamo ◽  
Sonia De Francesco ◽  
Federica Salvoldi ◽  
Matteo Barchitta ◽  
Cristina Menicacci ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Early Stage ◽  
Argon Laser ◽  
Disease Stage ◽  
Early Management ◽  
Good Visual Acuity ◽  
Retinal Screening ◽  
Excellent Control ◽  
Coats Disease ◽  
The University

Purpose: To evaluate the rarity, clinical features and management of Coats disease characterized by fovea-sparing enhancing the importance of pediatric retinal screening and early management to maintain a good visual acuity. Methods: Retrospective analysis of approximately 40 patients affected by Coats disease between 2000 and 2020 at the Retinoblastoma Referral Center and Ophthalmology unit of the University of Siena in Italy. Results: Two patients with fovea sparing Coats disease were included. Both presented an extrafoveal Coats disease (stage 2A by Shields classification) when they were 5 and 6 years old respectively. They had no anterior findings and a presenting visual acuity of 20/20 reflecting the early stage and a milder phenotype of the disease which are indeed more likely to be found in patients older than 3 years at presentation. Both presented telangiectasia and retinal exudation in the affected eye. Standard Argon laser photocoagulation and subsequently Cryotherapy were performed in the telangiectatic retinal periphery of both patients obtaining an excellent control and regression of the disease. Conclusions: Careful pediatric retinal screening and early management are crucial to ensure a good visual prognosis in such an early feature of Coats disease as fovea sparing since this condition unfortunately tends to recall the physician’s attention in more advanced stages. Due to the extremely poor number of articles regarding such a rare feature of Coats disease like fovea sparing, we report our experience.

scholarly journals Laser photocoagulation for patients with chronic central serous chorioretinopathy

2015 ◽  
Vol 96 (4) ◽  
pp. 514-517
Author(s):  
A A Gilyazova ◽  
A N Samoylov ◽  
R Kh Khafiz’yanova
Keyword(s):  
Visual Acuity ◽  
Central Serous Chorioretinopathy ◽  
Laser Photocoagulation ◽  
Wave Length ◽  
Field Testing ◽  
Functional Results ◽  
Chronic Central Serous Chorioretinopathy ◽  
Corrected Visual Acuity ◽  
Before And After ◽  
Best Corrected Visual Acuity

Aim. To assess the efficacy of laser photocoagulation treatment for patients with chronic central serous chorioretinopathy. Methods. The study included 17 eyes of 15 patients with relapse of central serous chorioretinopathy of different etiology, including 9 men. Patient’s age ranged from 34 to 55 years. Mean disease duration ranged from 3 months to 8 years. All study subjects underwent a standard ophthalmic examination including best-corrected visual acuity testing, intraocular pressure measurement, bioophthalmoscopy, color vision testing, visual field testing, optical coherence tomography, fluorescent angiography of the retina before and after the treatment. Fluorescein sodium salt (100 mg/ml, ampules of 5 ml, «Novartis Pharma» was used as a contrast. Before the treatment, neuroepithelial layer detachment height was 385.09±14.1 µm, the best-corrected visual acuity ranged from 0.41 to 0.82. The study group did not include the patients with secondary choroidal neovascularization. Diode laser with wave length of 532 nm («Carl Zeiss») was used for laser photocoagulation. The laser photocoagulation procedure was done using the following parameters: exposure time 0.05-0.1 sec, the spot diameter 100-200 µm, and the impulse energy of 100-200 mJ. Results. Significant improvement of visual acuity, disappearance of relative central scotoma proven by instrumental methods was seen in all patients. Best-corrected visual acuity was 0.91, decrease of neuroepithelial layer detachment height with adherence of all layers of the retina was reduced to 171.12±11.5 µm on the 3-5 day after laser photocoagulation. Patients were followed up from 1 to 6 months, with treatment results staying stable. Conclusion. Laser photocoagulation of a retina in treatment of chronic central serous chorioretinopathy allows to achieve encouraging morphologic and functional results.

scholarly journals Neopterin and CXCL-13 in Diagnosis and Follow-Up of Trypanosoma brucei gambiense Sleeping Sickness: Lessons from the Field in Angola

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Julien Bonnet ◽  
Philippe Vignoles ◽  
Natalia Tiberti ◽  
Vatunga Gedeão ◽  
Alexandre Hainard ◽  
...  
Keyword(s):  
Human African Trypanosomiasis ◽  
Intermediate Stage ◽  
Disease Stage ◽  
Advanced Stage ◽  
Trypanosoma Brucei Gambiense ◽  
Neopterin Concentration ◽  
Stage Disease ◽  
Stage 1 ◽  
Work Supports

Human African Trypanosomiasis may become manageable in the next decade with fexinidazole. However, currently stage diagnosis remains difficult to implement in the field and requires a lumbar puncture. Our study of an Angolan cohort of T. b. gambiense-infected patients used other staging criteria than those recommended by the WHO. We compared WHO criteria (cell count and parasite identification in the CSF) with two biomarkers (neopterin and CXCL-13) which have proven potential to diagnose disease stage or relapse. Biological, clinical, and neurological data were analysed from a cohort of 83 patients. A neopterin concentration below 15.5 nmol/L in the CSF denoted patients with stage 1 disease, and a concentration above 60.31 nmol/L characterized patients with advanced stage 2 (trypanosomes in CSF and/or cytorachia higher than 20 cells) disease. CXCL-13 levels below 91.208 pg/mL denoted patients with stage 1 disease, and levels of CXCL-13 above 395.45 pg/mL denoted patients with advanced stage 2 disease. Values between these cut-offs may represent patients with intermediate stage disease. Our work supports the existence of an intermediate stage in HAT, and CXCL-13 and neopterin levels may help to characterize it.

PREGNANCY MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4

2019 ◽  
Vol 23 (2) ◽  
pp. 109-116
Author(s):  
N. L. Kozlovskaya ◽  
Y. V. Korotchaeva ◽  
K. A. Demyanova ◽  
M. M. Engibaryan ◽  
M. S. Mikulyak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Advanced Stage ◽  
Healthy Baby ◽  
Stage 4 ◽  
Calcium Phosphorus ◽  
History Of ◽  
Rare Situation

Pregnancy in patients with an advanced stage of chronic kidney disease (CKD) remains a rather rare situation to date. This observation demonstrates our own experience of successfully management of pregnancy in a patient with chronic kidney disease stage 4. A special feature of this observation is an unclear diagnosis that led to CKD. Based on a combination of advanced CKD in a young patient with no kidney history, no changes in urine tests, increased blood pressure, hyperuricemia, and small cysts of both kidneys, a diagnosis of autosomal dominant tubulo-interstitial kidney disease was suggested, despite the lack of family history of renal disease. Since the kidney disease was first identified during pregnancy, the main areas of care were the correction of complications (anemia, calcium-phosphorus disorders), caused by the advanced stage of CKD and the prevention of pre-eclampsia as one of the most frequent complications of pregnancy in this cohort of patients. In order to timely diagnose preeclampsia, the patient was regularly monitored for angiogenesis markers. Conducting pregnancy was carried out by an interdisciplinary team of specialists (nephrologists, obstetrician-gynecologists). Pregnancy ended with the birth of healthy baby. After childbirth renal failure progressed.

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