ObjectiveTo observe and analyze the clinical features and prognosis of proliferative diabetic retinopathy (PDR) with chronic myeloid leukemia.MethodsA retrospective case series study. From May 2011 to December 2020, 5 patients (10 eyes) were included in this study in Eye-ENT Hospital of Fudan University. Basic information about the patient's age, gender, diabetes history and CML history were collected. The endocrine and hematological indexes of all patients were evaluated. All the patients were undertaken visual acuity, intraocular pressure, slit lamp and fundus examination and other examinations to observe the eye conditions. Ophthalmic treatments included panretinal laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor, vitrectomy. During the follow up period from 5 months to 6 years, prognosis was observed at each office visit. During the follow up period, patients' vision, intraocular pressure, anterior segment and retinal status were observed.ResultsThere were 4 males and a female in 5 patients. The ages were from 27 to 49 years, with the mean age of 39 years. All patients were bilateral. All patients suffered type 2 diabetes for 3 months to 13 years. Four of them were diagnosed as chronic myeloid leukemia before visiting to ophthalmologists, while the other visited to ophthalmology first due to poor vision. The initial visual acuity ranged from light perception to 0.4 and 6 eyes were less than 0.1. In addition to the typical manifestations of diabetic retinopathy, such as venous tortuous dilation, exudation, microaneurysm and neovascularization, patients also presented with Roth spot as leukemic fundus manifestations. All eyes developed to PDR stage. Abnormal thickening of the neovascular membranes may occur in the lower part of the retina, with secondary traction retinal detachment. All the eyes were treated with pan retinal photocoagulation and 9 eyes underwent pars plana vitrectomy. After treatment, retina of 8 eyes kept flat. The best corrected visual acuity ranged from no light perception to 1.0, and only 4 eyes reached more than 0.2. Unfortunately, one eye lost vision because of secondary neovascular glaucoma.ConclusionsPDR patients with CMLof fundus not only have venous tortuous dilation, exudation, microaneurysm and neovascularization, also present with Roth spot as leukemic fundus manifestations. Diabetic retinopathy combined with CML could progress rapidly, and its aggravating complications such as hyperplastic membrane, vitreous hemorrhage and traction retinal detachment may result in poor visual prognosis. Early screening and treatment can help improve the prognosis of patients.
ObjectiveTo observe the clinical features and prognosis of eyes with corneal suture-related infective endophthalmitis. MethodsA retrospective interventional case series. From January 2020 to December 2021, 5 patients (5 eyes) with corneal suture-related infectious endophthalmitis diagnosed by ophthalmic examination at Department of Ophthalmology of the Eye-ENT Hospital of Fudan University were included in the study. Among them, there were 3 males and 2 females; all had unilateral disease; the mean age was 30.80±21.98 years. Sutures of 4 cases were secondary to lens related surgery and of 1 case was secondary to penetrating keratoplasty. Average retention time of corneal suture was 20.00±7.41 months. Of the 5 eyes, corneal sutures were removed in 1 eye due to redness and eye pain in another hospital; 3 eyes were loosened of the sutures in the remaining 4 eyes. The patients were given standard treatment for infectious endophthalmitis, including systemic and local anti-infective therapy; corneal suture removal, intraocular injection, and vitrectomy (PPV). In PPV, it was decided whether to give silicone oil filling according to the situation. The follow-up time after treatment was 11.00±7.38 months. The best corrected visual acuity (BCVA), B-mode ultrasound and microbial culture results of the affected eye before and after surgery were observed and analyzed.ResultsInfiltrates, ulcers, or abscesses surrounding the suture may be seen on the cornea of the affected eye. B-mode ultrasonography showed vitreous opacity, preretinal cords, and spherical wall edema in the entire segment of the affected eye. The results of vitreous humor culture were positive in 3 eyes, which were Streptococcus viridis, Staphylococcus hominis subspecies, Staphylococcus epidermidis. After treatment, all the intraocular infections in the affected eyes were successfully controlled, and there were no cases of enucleation of ocular contents or enucleation. Before treatment, the BCVA of the affected eye was from no light perception to counting fingers; after treatment, 2 eyes had BCVA＞0.3. ConclusionsInfiltration, ulcers or abscesses around the sutures can be seen in the cornea of corneal suture-related infective endophthalmitis patients, which are related to the long-term retention of the sutures in the eye. Most of the affected eyes have loose sutures when they go to the doctor; timely treatment can effectively control the infection, and some eyes have good visual prognosis.
ObjectiveTo observe the changes of varicella zoster virus (VZV)-DNA load in aqueous humour samples in VZV-induced acute retinal necrosis (ARN) in the early stages of antiviral treatment. MethodsA retrospective observational clinical study. From April 2016 to April 2018, 24 patients with 24 eyes of VZV-induced ARN who were diagnosed by Department of Ophthalmology, Eye and ENT Hospital of Fudan University and received complete aqueous humor sampling were included in the study. Among them, there were 13 males with 13 eyes, 11 females with 11 eyes; 12 left eyes and 12 right eyes; the age was 52.0±9.5 years old (39-71 years old). The time from the onset of ocular symptoms to the diagnosis of ARN was 16.6±6.1 days (7-30 days). Best-corrected visual acuity (BCVA) and ultra-wide-field fundus imaging were performed in all affected eyes. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. All patients were given intravitreal injection of 40 mg/ml ganciclovir 0.1 ml (including 4 mg of ganciclovir), 2 times a week, until the active necrotizing retinal lesions subsided, at most after the diagnosis 4 weeks, with a maximum of 9 injections. The follow-up period was 12.8±5.6 months. The aqueous humor samples were collected at presentation and 4, 7, 14, 21, 28 days after the initiation of antiviral therapy, and the VZV-DNA load was detected by real-time quantitative polymerase chain reaction. A plateau phase and a logarithmic reduction phase of the DNA load changes were observed after antiviral treatment began. Wilcoxon rank sum test was used to compare and analyze the differences in BCVA between the eyes at baseline and last follow-up. ResultsThe mean viral load at presentation was 8.6×107±1.3×108 copies/ml. The initial plateau phase last for an average of 7.4±2.4 days. In the following logarithmic reduction phase, the mean slope of the decline in viral load was －0.13±0.04 log/day, and the expected time for half reduction of the initial viral load was 2.5±0.7 days. After 28 days antiviral treatment, the viral load decreased to 1.7×105±1.8×105 copies/ml. In the course of the disease, rhegmatogenous retinal detachment occurred in 16 eyes. Before treatment and at the last follow-up, the logMAR BCVA of the affected eye was 1.1±0.6 and 0.8±0.7, respectively. The results of correlation analysis showed that the logMAR BCVA at the last follow-up was correlated with the initial VZV-DNA load (r=0.467, P=0.033). ConclusionThe VZV-DNA load in the aqueous humor of eyes with VZV-induced ARN is significantly decreased after antiviral treatment, which is closely related to the clinical process of ARN.