PURPOSE: To investigate the treatment of severe bacterial endophthalmitis. METHODS:The curative effects of vitrectomy after intravitreal antibiotics and steroids (IVAS)for the treatment of 23 patients with bacterial endophthalmitis (group I)and vitrectomy and IVA at the same time for the treatment of 28 patients with bacterial endopbthalmitis (group I)were analyzed retrospectively. RESULTS: The rate of curative effects of two groups were similar,while the marked curative effects in group I (47.8% )was significantly higher than that of the group I (17.9%). The average period of eliminating infiamation of group I was longer than that of group I , and the incidence of postoperative retinal detachment of group Ⅱ was 3 times more than that of group I . CONCLUSION :It was indicated that vitrectomy after IVAS may increase the security of vitrectomy and the curative effects of severe bacterial ndophthalmitis.
ObjectiveTo investigate the characteristics, pathogenesis and treatment of steroid-induced diseases. MethodsThe clinical data of one patient with steroid-induced disease diagnosed and treated on October 20th, 2015 were analyzed retrospectively. ResultsThis patient was admitted to the hospital because of "20 years of pain in the left lower limb and 6 months after the recurrence of the muscle atrophy". After previous diagnosis of sciatica, the patient abused hormone therapy (triamcinolone), and had limb muscle weakness, atrophy, proximal limb muscle strength of grade 5-, creatine kinase 53 U/L, and electromyography suggested neurogenic damage of the limbs. We considered steroid myopathy, and required immediate stop of hormone. The patient's symptoms gradually improved. ConclusionSteroid myopathy and the pathogenesis of glucocorticoid abuse are closely related. Regulating the use of hormone, timely detection of complication of steroid myopathy and stopping the use of sugar cortical hormone are the most important measures to avoid the disease and improve the prognosis.
Pharmaceutical therapy, including anti-vascular endothelial growth factor treatment and intravitreal corticosteroids, is the most common treatment for branch retinal vein occlusion (BRVO) and its complications, however there are confusing ideas about the protocol, patient selection, timing and endpoint of this treatment. The disease is easy to relapse with these drugs therapy. Collateral vessel formation was found in patients receiving intravitreal injection of ranibizumab or triamcinolone for BRVO and secondary macular edema. The mechanism of collateral vessel formation has not been carefully investigated. In the past thrombolysis, arteriovenous fasciostomy and laser choroidal retinal vascular anastomosis were used to reconstruct the retinal circulation, but their rationality, effectiveness and safety need to be further were studied. In recent years, because of the key technology is still immature, the artificial vascular bypass surgery experiment is not yet practical, but provides us a new idea worth looking forward to for the treatment of BRVO.
ObjectiveTo investigate the clinical, laboratory and imaging evaluation, treatment and prognosis of patients with idiopathic hypertrophic pachymeningitis (IHP) with ophthalmic manifestations as the first symptom.MethodsA retrospective case analysis. Eight patients displaying symptoms of IHP were recruited from the Neuro-ophthalmology Department in the First Medical Center of Chinese PLA General Hospital from January 2016 to April 2019 were inculed in this study. There were 6 males and 2 females, aged from 11 to 65 years, with an average age of 48.00±19.08 years. The course of disease ranged from 30 days to 7.5 years, with an average course of 17.00±30.08 months. The age, symptoms and signs of all patients were recorded. All patients underwent ophthalmic examination, orbit or brain MRI or CT examinations, blood routine examination, biochemistry, tumor markers, immunity, hepatitis B, syphilis, HIV, thyroid function and other laboratory tests, and lumbar puncture was performed to measure the cerebrospinal fluid (CSF) pressure and indicators. The clinical manifestations, orbital or brain MRI imaging and laboratory examination characteristics were summarized. Treatment and prognosis were also observed.ResultsIn total of 8 patients, visual loss was presented in 6 patients, visual loss and diplopia were presented in 1 patient, and diplopia was presented in 1 patient. Binocular involvement in 7 patients and monocular involvement in 1 patient. Other symptoms including headache and hear loss and so on. Optic disc edema in 1 eye and optic disc pallor in 6 eyes were reviewed by fundus examination. The laboratory examination showed that the angiotensin converting enzyme abnormal in 4 patients, the anti-thyroid peroxidase antibody abnormal in 3 patients and immunoantibodies positive in 3 patients. CSF measurements showed that the protein level elevated in all patients. Orbit and/or brain MRI and CT examination showed that optic nerve involvement in 6 patients, oculomotor nerve involvement in 1 patient, and cavernous sinus region involvement in 2 patients. Glucocorticoid was effective in all patients, and the visual acuity significantly improved in 4 patients, the diplopia was completely resolved in 2 patients, and the disease modifying therapy (DMT) was combined to prevent recurrence in 7 patients. No recurrence was observed in an average follow-up time of 26.63±16.55 months.ConclusionsIHP patients may be first visit an ophthalmologist due to vision loss in bilateral eyes simultaneous or sequentially. IHP patients are often associated with headache and other cranial nerve paralysis symptoms. Definitive diagnosis of IHP depends on imaging examination. Glucocorticoid treatment is effective in early phase, but it is tendency to progress and relapse, suggesting combined with DMT as early as possible.
ObjectiveTo evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).MethodsGlucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.ResultsAn initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions.ConclusionThe efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.
ObjectiveTo observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION).MethodsA prospective clinical study. From December 2017 to June 2020, 40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination of optic disc; 35 eyes (BCVA≥0.1) underwent visual field examination at the same time. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation (MD) value. The thickness of peripapillary retinal nerve fire layer (pRNFL) around the optic disc of the affected eye was measured with an OCT instrument. According to the wishes of patients, they were divided into hormone treatment group and control group. All were given vitamin B1 and methylcobalamin orally; the hormone treatment group was given oral prednisone acetate treatment, 60 mg/d (regardless of body weight); after 2 weeks, the dose was reduced by 5 mg every 5 days, and the dose was reduced to 40 mg and maintained until optic disc edema subsides; thereafter, the dose was quickly reduced until the drug was stopped. Three and 6 months after treatment, the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA, MD, and pRNFL. The thickness of BCVA, MD, and pRNFL between the two groups was compared by Mann-Whitney U test. The thickness of BCVA, MD, and pRNFL before and after treatment within the group was compared by rank analysis of variance. ResultsAmong 40 eyes of 40 cases, 21 eyes were in the hormone treatment group, and 19 eyes were in the control group. There were differences in age, sex composition, course of disease, associated systemic risk factors, BCVA, MD, and pRNFL thickness between the two groups. There was no statistical significance (P＞0.05). At 3 and 6 months after treatment, the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32, 0.26±0.34, 0.28±0.30, 0.25±0.32, respectively. The visual field MD were －15.52±6.87, －15.55±6.04 dB and －14.82±7.48, －15.18±6.40 dB; pRNFL thickness was 70.38±10.22, 73.79±11.82 μm and 65.67±10.07, 69.26±10.85 μm. LogMAR BCVA (Z=－0.014, －0.315; P=1.000, 0.768), visual field MD (Z=－0.041, －0.068; P=0.979, 0.957), pRNFL thickness (Z= －0.965, －1.112; P=0.347, 0.270), the difference was not statistically significant. ConclusionCompared with the control group, oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.