In recent years, more and more new diagnostic and examining techniques are popularized, which improves the level of ocular fundus disease diagnosis and treatment. Because of the uneven distribution of diagnostic and therapeutic instruments resources, low level of application techniques, and different professional level of the doctors, the improvement and development of the application of the equipments and level of the diagnosis and treatment were inhibited. Appropriate understanding and applying basic diagnostic techniques of ocular fundus disease and comprehensive promoting the professionalsprime; levels are an urgent problem needs to be solved.
ObjectiveTo analyze the increased risks of nursing due to expansion of ophthalmic day surgery indications, and the countermeasures. MethodsWe collected the information in the last three years from January 2012 to December 2014 in the Department of Ophthalmology, including the number of operations, the proportion of cataract patients, patients aged over 70 and under 12 years old, patients with high-risk fall, the number of general anesthesia operations, adverse events, and the data from the satisfaction survey of the patients. All the data were analyzed by statistical method. ResultsDuring the last three years, the relaxation of ophthalmic day surgery indications led to an increased admission rate of high-risk patients, and caused more nursing risk factors. Through the efforts of prevention and care, during the last three years, there were no adverse events, and patients had a satisfaction rate over 90%. ConclusionAlthough the ophthalmic day surgery indication has been relaxed, through the establishment of nursing risk response system by pre-hospital guidance, admission assessment, peri-operative education and follow-up visit, with the continuous improvement of nursing management system and convenient workflow, we can not only improve the work efficiency, but also ensure nursing safety.
ObjectiveTo investigate and analyze the ophthalmic resource distribution and service ability of Leshan City, and provide scientific basis for development of ophthalmology and prevention of blindness. MethodsWe statistically analyzed all departments of ophthalmology in 17 general hospitals of Leshan, including numbers of beds, numbers of health technicians, professional title structure, ophthalmic instruments, levels of operation and service ability in 2012. ResultsThere were 186 ophthalmic beds, 84 ophthalmologists, 6 technicians, 64 nurses, 16 professors, 28 doctors with medium-level title, and 40 residents in the 17 general hospitals of Leshan. There were 184 300 out-patients and 9 920 in-patients with 12 320 operations including 6 211 cataract operations in the year of 2012. ConclusionThe ophthalmic resources and service ability are not equally distributed in Leshan. Most resources are distributed in big hospitals of the urban district. Meanwhile, hospitals in remote areas do not have ophthalmologists or ophthalmologic instruments. We should develop our service ability and work efficiency by continuous learning in order to improve the three-level primary blindness prevention system.
ObjectiveTo comparatively analyze for the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR) between first-visit and non-first-visit in ophthalmology.MethodsA retrospective study was performed for 22 patients (41 eyes) diagnosed as CMVR with AIDS by ophthalmology in the Affiliated Municipal Hospital of Xuzhou Medical University from July 2004 to September 2017. The patients were divided into two groups: one with the first-visit in ophthalmology (FVO) and the other with the first-visit in non-ophthalmology (FVNO). All patients underwent visual acuity, intraocular pressure, slit lamp microscope and indirect ophthalmoscope examinations. Thirty-nine eyes of 21 patients with clear refractive media were examined by color fundus photography, of which 5 patients were examined by FFA. Five patients examined by OCT and B-mode ultrasound. The CMVR were characterized as fulminant type or indolent type. All the 22 patients (41 eyes) except 2 patients (4 eyes) accepted highly active antiroviral therapy, and all patients were treated with ganciclovir intravenously. Nine patients (12 eyes) received intravitreal injection of ganciclovir, 7 patients (10 eyes) underwent vitrectomy because of retinal detachment, 6 patients (7 eyes) gave up surgery because of extensive retinal detachment, and the other 12 eyes did not undergo any eye surgery. All patients were followed for 6-58 months (average 23±39 months). The incidences and fundus characteristics of the patients with fulminant or indolent CMVR were compared and analyzed. Between the two groups, the difference of visual acuity and CD4+T cell count at the first vist and the last follow-up were analyzed by a t-test, and the macular involvement and spread of the two groups were compared by a chi-square test.ResultsFulminant CMVR showed dense yellow-white necrotic lesions along the great vessels with or without satellite lesions, while indolent CMVR showed sparse yellow-white granular lesions with a little bleeding. The concomitant signs included frost-like dendritic vascular sheath, retinal artery occlusion and optic disc edema. Fourteen eyes of 7 patients in FVO group were fulminant, including 2 patients (2 eyes) with retinal artery occlusion and 1 patient (two eyes) with optic disc edema. In FVNO group, there were 27 eyes of 15 patients, including 21 eyes of 13 cases identified as fulminant type and 6 eyes of 4 patients as indolent type. In the fulminant type, there were 4 patients (6 eyes) with frost-like dendritic vascular sheath, 10 patients (12 eyes) with retinal artery occlusion and 4 patients (4 eyes) with optic disc edema. There was no significant difference in initial visual acuity (t=－1.534, P=0.133), but there was a significant difference in visual acuity at the last follow-up (t=－3.420, P=0.001). There was no significant difference in CD4+ T cells between the two groups at the first visit (t=－0.902, P=0.378). The proportions of macular involvement and 3-4 quadrant involvement in FVO group were significantly higher than those in FVNO group (χ2=7.552, 7.865; P=0.006, 0.005).ConclusionFor AIDS patients with CMVR, the first-visit in ophthalmology showed more dense necrotic lesions involving macular and a wider range of lesions than the first-visit in non-ophthalmology.
With the development of ophthalmic optical coherence tomography (OCT) and OCT angiography (OCTA), including the improving of light source, resolution, scanning depth and upgrade of analysis softwares, they can more accurately display the structure of retinal layers and give accurate quantitative measurement. In neuro-ophthalmic diseases, the OCT indicators (the thickness of retinal nerve fiber layer around optic disc and plexus layer in macular gangle cells) and OCTA indicators (the blood flow density of capillaries around optic disc, superficial and deep capillaries in macular area, and the area of foveal avascualr zone) had special changes. It has important value in the differential diagnosis of central nervous system diseases and retinal diseases with visual dysfunction as the first symptom, the diagnosis and differential diagnosis of neuro-ophthalmic disease, the evaluation of progression of neurodegenerative diseases. Neuro-ophthamologists should pay more attention to the exploration and application of OCT and OCTA in the field of neuro-ophthalmology.
Currently, coronavirus disease 2019 (COVID-19) is still widely prevalent around the world, leading to a major threat to the global public health. COVID-19 mainly involves the respiratory system, but extrapulmonary manifestations including that of the nervous system also exist in the setting of COVID-19. Misdiagnosis and delayed treatment of the disease may easily cause when ocular, especially neuro-ophthalmological symptoms are the first symptoms in early COVID-19, as the neuroophthalmological manifestations are rarely reported. First-line clinicians need to ask about not only respiratory symptoms such as fever, cough and sore throat, but also diplopia, impaired vision, eye motion pain, abnormal gait or other neurological deficits at the first reception, as these extrapulmonary manifestations are often signs of serious infection. The neuroophthalmological manifestations and possible underlying etiology of COVID-19 were summarized in this review, hoping to provide an early identification and effective treatment of COVID-19 for clinicians. More extensive studies are needed in the future to confirm the causal relationship between COVID-19 and neuroophthalmological disease to provide a sufficient basis for a comprehensive understanding of COVID-19.
ObjectiveTo investigate the clinical characteristics of vascular neuro-ophthalmology in patients with central retinal artery occlusion (CRAO). MethodsA single-center, prospective clinical study. From January 2018 to December 2020, 49 eyes of 49 CRAO patients of The Neuro-ophthalmology Department of Xi'an First Hospital were included in the study. Data on patient demographic characteristics, vascular risk factors, disease characteristics, digital subtraction angiography (DSA) imaging characteristics of internal carotid arteries, treatment, treatment-related adverse events, and 1-month follow-up vascular events were collected. All patiens were examined by visual acuity, head CT and or magnetic resonance imaging. At the same time, 35 cases of internal carotid artery vascular DSA were examined; 14 cases of head and neck CT angiography were examined. The anatomical variation of the extracranial segment of the internal carotid artery was divided into tortuous, tortuous, and coiled; the aortic arch was divided into type Ⅰ, type Ⅱ, type Ⅲ, and bovine type. Intravenous thrombolysis, arterial thrombolysis, conservative treatment were performed. The follow-up time was 1 month after treatment. Functional vision was defined as vision ≥20/100. Vascular events were strokes, cardiovascular events, deaths and neovascular glaucoma during follow-up. ResultsAmong 49 eyes of 49 cases, 40 eyes were male (81.6%, 40/49), and 9 eyes were female (18.4%, 9/49); the average age was 60.7±12.9 years. There were 33, 17, and 16 cases with hypertension, type 2 diabetes, and cerebrovascular disease, respectively; 27 and 34 cases had a history of smoking and tooth loss, respectively. Taking antihypertensive, hypoglycemic, antiplatelet aggregation/anticoagulation, and hypolipidemic drugs were 15, 5, 8, and 5 patients, respectively. There were 11 cases of transient amaurosis before the onset, and 17 cases of CRAO after waking up. There were 33 cases (67.3%, 33/49) with infarction of the affected side of the brain tissue. DSA was performed in 35 cases, and the stenosis rate of the internal carotid artery on the affected side was 70%-99% and 100% were 3 (8.6%, 3/35) and 4 (11.4%, 4/35) cases, respectively. The ophthalmic artery on the affected side originated from the external carotid artery in 5 cases (14.3%, 5/35). There were 17 (54.8%, 17/31) and 2 (6.5%, 2/31) cases of tortuousity and kinking in the extracranial segment of the internal carotid artery. There were 15 (42.9%, 15/35), 6 (17.1%, 6/35), and 2 (5.7%, 2/35) cases of aortic arch type Ⅱ, type Ⅲ, and bovine type, respectively. Intravenous thrombolysis and arterial thrombolysis were performed in 13 and 29 cases, respectively. Complications occurred in 2 cases during treatment; 3 cases of symptoms fluctuated after treatment, and 10 cases of asymptomatic new infarcts occurred in imaging studies. Forty-eight cases were treated with antiplatelet aggregation/anticoagulation and hypolipidemic treatment. At discharge and 1 month after treatment, the recovery of functional vision was 7 and 17 cases, respectively. One month after treatment, 1 case died because myocardial infarction; 2 cases of neovascular glaucoma occurred. ConclusionThe proportion of CRAO patients with vascular risk factors and internal carotid artery abnormalities on the affected side is relatively high; the prognosis is relatively good after intravenous thrombolysis and/or arterial thrombolysis and secondary stroke prevention.
Poly(styrene-block-isobutylene-block-styrene) (SIBS) and its crosslinked product crosslinked polyisobutylene (xPIB) are a kind of novel thermoplastic elastomer. They have excellent biocompatibility and stability, which are suitable for long-term implantation in human body. At present, SIBS is widely used in cardiovascular diseases, and also has preliminary application in ophthalmology. This article reviews the application and research progress of SIBS and xPIB in ophthalmic glaucoma minimally drainage tube material, intraocular lens material, new sclera buckle material and orbital defect filler, with a view of providing reference for the clinical application of such biomedical materials in ophthalmology.
Idiopathic cranial hypertension (IIH) is a neurological disorder that causes an unexplained increase in intracranial pressure. Its symptoms are chronic headache and visual impairment with typical unilateral or bilateral disk edema. The diagnostic procedure is mainly based on the exclusion of diagnostic thinking, which requires the imaging examination of the whole body and nervous system. Current treatment strategies for IIH include a combination of weight loss, medication, and surgery to reduce intracranial pressure and relieve associated symptoms, maximize visual function preservation, and improve prognosis. In the future, it is necessary to further improve the diagnostic process and criteria of IIH, guide personalized treatment and prognosis judgment, and effectively use artificial intelligence segmentation and combined imaging omics technology to improve the intelligent diagnosis rate of the disease.