Alay Banker

PURPOSE: To evaluate choroidal vascularity index (CVI) in eyes with central serous chorioretinopathy (CSC) using an image binarization tool on enhanced depth imaging using spectral domain optical coherence tomography scans. METHODS: In this retrospective cohort study, enhanced depth imaging optical coherence tomography scans of both eyes of patients with CSC were taken at baseline; they were segmented and compared with enhanced depth imaging optical coherence tomography scans of fellow eyes without CSC as well as age-matched healthy subjects. Subfoveal choroidal area (1,500 μm) was segmented into luminal area and stromal area using image binarization. Choroidal vascularity index was defined as the proportion of luminal area to the total circumscribed subfoveal choroidal area. RESULTS: Eyes with acute CSC (32 eyes) had significantly higher CVI compared with their fellow eyes (27 eyes) (P < 0.0001), 19 eyes with resolved CSC (P < 0.0001) and with 30 eyes of age-matched healthy eyes (P < 0.0001). Fellow eyes of subjects with acute CSC also had significantly higher CVI compared with eyes with resolved CSC (P < 0.0001) and age-matched healthy eyes (P < 0.0001). CONCLUSION: Increased CVI suggests increased vascular component compared with the stromal component in acute CSC. Increased CVI was noted in fellow eye of the subjects with acute CSC in comparison with age-matched healthy subjects. The CVI could be a useful index for early diagnosis of CSC and to assess the treatment response after laser photocoagulation or photodynamic therapy.

BACKGROUND: The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS: We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS: We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension. CONCLUSIONS: The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.