Prevalence and clinical characteristics of Charles Bonnet syndrome in Madrid, Spain

Purpose: Charles Bonnet syndrome (CBS) is a condition characterized by development of visual hallucinations in patients with no cognitive impairment and significant loss of vision mainly caused by age-related macular degeneration (AMD) or glaucoma. Methods: This was a study of prevalence and characteristics of CBS diagnosed at the Neuroophthalmic Unit within the Ophthalmology Department of Hospital Clínico San Carlos (HCSC), Madrid, Spain. Results: The CBS prevalence in patients from HCSC Madrid is 0.47%, rising to 15% in patients with low vision. Women over 80 years of age comprised 58.3% of the patients, who mainly had AMD (58.3%). Main characteristics of hallucinations included animals (50%), color (58.3%), moving (75%), 6- to 12-month evolution (50%), three times a day frequency (75%), and 3- to 5-minute duration (50%). Conclusions: Charles Bonnet syndrome is a complex process that must be treated jointly by ophthalmologists, neurologists, and psychiatrists in order to ensure accurate diagnosis and adequate management. New studies are needed in order to improve awareness of clinical manifestation of this condition, the incidence of which is underestimated due to patients' fear of being branded mentally ill, as well as physicians' lack of knowledge about CBS

Anatomical characterization of central, apical and minimal corneal thickness

<b>AIM:</b> To anatomically locate the points of minimum corneal thickness and central corneal thickness (pupil center) in relation to the corneal apex.<b>METHODS:</b> Observational, cross-sectional study, 299 healthy volunteers. Thickness at the corneal apex (AT), minimum corneal thickness (MT) and corneal thickness at the pupil center (PT) were determined using the pentacam. Distances from the corneal apex to MT (MD) and PT (PD) were calculated and their quadrant position (taking the corneal apex as the reference) determined:point of minimum thickness (MC) and point of central thickness (PC) depending on the quadrant position. Two multivariate linear regression models were constructed to examine the influence of age, gender, power of the flattest and steepest corneal axes, position of the flattest axis, corneal volume (determined using the Pentacam) and PT on MD and PD. The effects of these variables on MC and PC were also determined in two multinomial regression models.<b>RESULTS:</b> MT was located at a mean distance of 0.909 mm from the apex (79.4% in the inferior-temporal quadrant). PT was located at a mean distance of 0.156 mm from the apex. The linear regression model for MD indicated it was significantly influenced by corneal volume (B=-0.024; 95%CI:-0.043 to -0.004). No significant relations were identified in the linear regression model for PD or the multinomial logistic regressions for MC and PC.<b>CONCLUSION:</b> MT was typically located at the inferior-temporal quadrant of the cornea and its distance to the corneal apex tended to decrease with the increment of corneal volume

Correlations between corneal and optic nerve head variables in healthy subjects and patients with primary open angle glaucoma

AIM: To correlate corneal variables (determined using the Pentacam) with optic nerve head (ONH) variables determined using the Heidelberg retina tomograph (HRT) in healthy subjects and patients diagnosed with primary open angle glaucoma (POAG). METHODS: Measurements were made in 75 healthy eyes and 73 eyes with POAG and correlations examined through Pearson correlation coefficients between the two sets of variables in the two subject groups. The corneal variables determined were corneal volume (CVol), central corneal thickness (CCT), overall corneal thickness (OvCT), the mean thickness of a circular zone centered at the corneal apex of 1 mm radius (zone I) and the mean thickness of several concentric rings, also centered at the apex until the limbus, each of 1 mm width (zones II to VI respectively). The ONH variables were determined using the HRT. RESULTS: The following pairs of variables were correlated in the control group: CCT-disc area (DAr) (-0.48; P<0.0001), Zone I-DAr (-0.503; P<0.0001) and Zone II-DAr (-0.443; P<0.0001); and in the POAG group: CCT-cup-to-disc area ratio (CDRa) (-0.402; P<0.0001), Zone I-CDRa (-0.418; P<0.0001), Zone II-CDRa (-0.405; P=0.006), Zone I-cup shape measure (CSM) (-0.415; P=0.002), Zone II-CSM (-0.405; P=0.001), Zone IV-height variation contour (HVC) (0.378; P=0.002); Zone V-HVC (0.388, P<0.0001). CONCLUSION: AS-OCT-derived lens thickness measurement is valid and comparable to the results obtained by A-scan US. It can be used as a reliable noncontact method for measuring lens thickness in adults with or without significant cataract

Corneal Properties in Primary Open Angle Glaucoma Assessed Through Scheimpflug Corneal Topography and Densitometry

Purpose: To compare corneal topography and densitometry measurements in patients with primary open angle glaucoma (POAG) and healthy subjects. Patients and Methods: 200 eyes of 75 patients with POAG and 125 healthy controls underwent corneal topography and densitometry (Oculus Pentacam HR). The data compared in the two groups were: anterior chamber angle (ACA), depth (ACD) and volume (ACV), keratometry (K minimum, K maximum and K mean), central corneal thickness (CCT), central anterior elevation (CAE), anterior elevation apex (AEA), maximum anterior elevation (MAE) and posterior elevation apex (PEA). Densitometry measurements were made at three depths on a 12▒mm-diameter circle divided into 4 concentric rings (0-2▒mm, 2-6▒mm, 6-10▒mm and 10-12▒mm). The diagnostic capacity of the corneal variables was assessed through the areas under the receiver operator characteristics (ROC) curve (AUC). Results: The corneal density of practically all depth layers and total corneal density were significantly higher in the POAG than control group (P<0.05). Total corneal density was positively correlated with age (r=0.623; P<0.001) and also showed a good diagnostic capacity for glaucoma (AUC=0.617; IC 95% [0.541-0.697]; P<0.001). In a multiple linear regression designed to assess its relationship with age, gender, CCT and Km, age emerged as a significant confounder both in controls (coef. 0.315; P<0.001; 95% CI [0.246-0.384]) and patients (coef. 0.370; P<0.001; 95% CI [0.255-0.486]). Conclusion: Corneal densitometry measurements showed a good diagnostic capacity for POAG suggesting this type of examination could have clinical applications in the diagnosis and management of glaucoma

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake