Objective::To analyze the accuracy of the SPOT vision screener in detecting hyperopic reserve in preschool children, and calculate the optimal referral criteria for screening myopia and pre-myopia.Methods::In this cross-sectional study, children who visited the Yuhuatai District Maternal and Child Health Clinic from January 2022 to April 2023 were included consecutively. Refraction was obtained using SPOT and cycloplegic retinoscopy. The data were analyzed using the Wilcoxon signed-rank test and the receiver operating characteristic curves.Results::A total of 812 children (mean age 4.2 ±1.0 years) were included in this study, including 404 boys and 408 girls. Among them, 94 children had myopia (11.6%) and 232 children had pre-myopia (28.6%). SPOT underestimated spherical equivalent (SE) compared to cycloplegic retinoscopy (+0.25 D vs. +1.12 D, Z=-20.22, P<0.001). The optimal referral criterion for screening myopia was ≤-0.50 D, sensitivity 91.49%, specificity 88.58%, Youden index 0.80, and for screening pre-myopia was ≤0 D, sensitivity 69.63%, specificity 81.07%, Youden index 0.51. Conclusions::The SPOT vision screener may underestimate the hyperopic reserve in preschool children. The optimal referral criteria for screening myopia and pre-myopia were ≤-0.50 D and ≤0 D, respectively.
患者，女，7岁，因"戴镜1年后视力矫正不良"于2020年10月在天津市眼科医院就诊。患者曾在2019年6月因视力下降于外院就诊，复方托比卡胺睫状肌麻痹验光示：右眼最佳矫正视力（BCVA）-3.50=0.6，左眼BCVA-2.50+0.50×105°=0.4。诊断：屈光不正。左眼弱视，给予框架眼镜全矫屈光不正联合遮盖治疗。患者戴镜1年，矫正视力无提高。患者无全身疾病、外伤、激光笔照射及视力突然降低史。我院眼科检查示：双眼裸眼视力0.1，角膜映光正位，外眼及眼前节无异常；眼底检查示：左眼黄斑区月牙状瘢痕，边界清晰（图1）；光学相干断层扫描血管成像（Optical coherence tomography angiography，OCTA）示：左眼黄斑区色素上皮层隆起，椭圆体带缺失（图2）；复方托比卡胺睫状肌麻痹验光示：右眼BCVA-5.00=0.8，左眼BCVA-4.00+0.75×95°=0.4。右眼调节幅度9.50 D，调节灵敏度5 cpm，左眼调节幅度7.50 D，调节灵敏度3 cpm，双眼均为负镜片通过困难。诊断：双眼屈光不正，调节不足，左眼黄斑陈旧病变。给予框架眼镜矫屈光不正，遮盖右眼4 h/d联合海丁格刷（YGS光刷治疗仪，北京同明尚业医疗器械有限责任公司）和红光闪烁（YHY弱视治疗仪，北京同明尚业医疗器械有限责任公司）治疗，以及翻转拍进行视觉训练。患者于2020年12月复查，复方托比卡胺睫状肌麻痹验光示：右眼BCVA-6.50=1.0，左眼BCVA-5.00+1.00×90°=0.6；微视野（MAIA，意大利CenterVue公司）检查示：左眼旁中心注视，注视位点在黄斑鼻上方，注视稳定性较差。2021年3月检查结果：右眼BCVA 1.0，左眼BCVA 0.6；微视野检查示：左眼旁中心注视，注视位点位于黄斑鼻上方，注视稳定性较差。2021年5月检查结果：小瞳验光示右眼BCVA-6.5=1.0，左眼BCVA-5.0+1.0×90°=0.9；微视野检查示左眼黄斑中心凹旁注视点，注视稳定性明显改善（图3B）；双眼调节幅度及调节灵敏度均提升至正常，分别为13.50 D和13 cpm，其后间隔3~4个月随访（图3C-D），直至2022年3月，患者左眼BCVA均为0.9，并保持稳定的旁中心注视。
Objective::To compare the effects of bifocal toric intraocular lens (IOL) implantation and standard nontoric bifocal IOL implantation combined with peripheral corneal limbal relaxing incisions (LRI) in cataract patients with moderate preexisting corneal astigmatism.Methods::A prospective non-randomized controlled study was conducted between July 2019 and June 2022 in Fushun Eye Hospital. Totally of 67 patients with corneal astigmatism between 0.75-2.50 diopters (D) who were scheduled for cataract surgery were included. All patients underwent unilateral cataract surgery and based on the voluntary principle, 32 patients underwent ultrasonic emulsification cataract aspiration followed by implantation of AcrySof IQ ReSTOR Toric IOL (ART group), while other 35 patients received AcrySof IQ ReSTOR IOL implantation combined with LRIs (LRIs group). The uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), residual astigmatism analysis, contrast sensitivity, reading function, and quality of life were evaluated 3 months after surgery. Reading function was measured using the Radner-Vissum test, and postoperative quality of life was assessed using the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire. Independent sample t-tests were used to analyze the data. Generalized linear models were used to calculate the scores of NEI-RQL for both groups. Results::Compared with the ART group, the LRIs group had smaller difference vector (0.52±0.45 D vs. 0.79±0.53 D, t=-3.30, P=0.003), magnitude of error (-0.17±0.68 D vs. -0.37±0.74 D, t=5.24, P<0.001), absolute value of angle of error (-3.39±38.62° vs. -2.86±24.71°, t=-2.10, P=0.036), and correction index (0.79±0.71 vs. 0.64±0.73, t=2.04, P=0.045). The success index of the ART group was significantly lower than that of the LRIs group (0.47±0.36 and 0.63±0.49, t=-2.31, P=0.023), while the successful rate of not wearing glasses after surgery was significantly higher than LRIs group (87.49±15.56 and 78.98±16.03, t=2.02, P=0.048). The postoperative comparison between the two groups showed no statistically significant differences in contrast sensitivity (both photopic and scotopic) or reading ability (all P>0.05). Conclusions::Both ART implantation and ReSTOR combined with LRIs can effectively correct patients' astigmatism and address their postoperative need for not wearing glasses. ART implantation showed better efficiency in correcting astigmatism, while the two therapies exhibited comparable efficacy in improving patients' subjective visual quality, especially in terms of near vision.
角膜交联术（Corneal cross-linking，CXL） [1]以核黄素（维生素B 2）作为光敏剂，应用紫外线A（Ultraviolet A，UVA）照射角膜（含扩张区域），诱导角膜基质内部结构形成光化学交联，从而提高角膜生物力学性能。治疗性CXL能够有效阻止或延缓角膜扩张的进展，主要用于治疗圆锥角膜（Keratoconus，KC）、角膜屈光手术后继发角膜扩张等扩张性角膜疾病，近年来已在国内外临床上逐步推广并具有广泛开展的趋势，为了规范CXL的临床应用，保障医疗质量和医疗安全，结合中国实际情况，经过充分讨论达成以下共识，以供临床医师参考使用。
The global incidence of myopia is increasing at an alarming rate, and the World Health Organization (WHO) has listed myopic as one of the blinding eye diseases to be urgently addressed. Myopia is a complex disease with multiple genes and factors interacting with heredity and environment. The treatment of myopia has limited effects and some disadvantages, and there is no consensus on clinical management strategies at present. Risk assessment of myopia to identify the population in need of intervention (such as high-risk factors for myopia, preclinical myopia, early myopia, advanced myopia) is the most important initial step in prevention and control of myopia. The purpose of this review is to provide the latest clinical management strategies for the prevention and control of myopia, address the health problems associated with myopia and alleviate the burden of myopia.
患者，女，52岁。因发现右眼上睑皮肤红肿20 d，于2022年5月就诊于山东第一医科大学附属眼科医院。患者20 d前无明显诱因出现右眼上睑皮肤红肿，就诊于外院，诊断为睑板腺囊肿，给予妥布霉素地塞米松眼膏治疗，未见明显好转。患者有甲减病史10余年，否认重大全身性疾病，否认药物过敏史，否认家族性遗传病史。眼部检查：右眼最佳矫正视力1.0，眼压11 mmHg（1 mmHg=0.133 kPa），右眼上睑近中央睑缘处见一直径约5 mm半球形隆起（图1A），质韧，局部皮肤稍有淤青、淤血，压痛阴性，结膜无明显充血，角膜透明，前房中等深浅，瞳孔圆，晶状体透明；左眼检查未见明显阳性体征。血常规、C反应蛋白、尿常规、即刻血糖、凝血功能、乙型肝炎病毒、丙型肝炎病毒、梅毒螺旋体、人类免疫缺陷病毒检查均正常。临床诊断：右眼眼睑肿物、右眼睑板腺囊肿？完善术前相关检查，患者于2022年6月8日在局部浸润麻醉下行"右眼眼睑肿物切除术"，术中平行睑缘切开肿物表层的眼睑组织，分离周围组织充分暴露肿物，剥离过程中见肿物内有大量白色干酪样及肉芽组织状内容物流出，剪除囊壁及肉芽，压迫止血。术后结膜囊及切口处涂氧氟沙星眼膏1次/d，左氧氟沙星滴眼液4次/d，持续1周。病理检查：送检囊壁组织约6 mm×3 mm×2 mm，灰白色，质地中等，主要成分为增生的纤维结缔组织伴慢性炎细胞浸润；内容物约5 mm×3 mm×2 mm，黄白色，呈颗粒状，主要由蓝染的嗜碱性细胞和嗜酸性的影细胞组成（图1B），病理学诊断：右眼睑钙化上皮瘤。术后右眼上睑切口对合好，无渗血、渗液，上眼睑无明显红肿。患者随访3个月，未见肿物复发。
Myopia is a common eye disease that has become the main cause of vision loss among Chinese children and adolescents. In 2020, the overall myopia rate of Chinese children and adolescents was 52.7%. The problem of low myopia age is still prominent, and the number of high myopia is increasing year by year. Although the country has raised myopia prevention and control to a strategic level, the current situation has not been completely changed. There are still many difficulties and bottlenecks that have not been solved. The etiology of myopia is complex, and there is no universal prevention and control strategy. In view of the current situation of myopia prevention and control, the author starts from the concept of children and adolescents' eye development and myopia cognition, thinks about the way of medical and industrial cross assistance, takes refractive development profile as guidance, establishes a standard system for data collection of refractive development archives, establishes longitudinal data prediction, so as to provide means for early warning and early prevention of children and adolescents' eye health. In order to provide solutions to break through the bottleneck of myopia prevention and control.
Objective::To investigate the synergistic effect of 0.05% atropine on the regulation of the defocus ring in patients who have progressive myopia with an orthokeratology lens.Methods::This prospective randomized control study was conducted from June 2021 to January 2023 in Chongqing Wodi Ophthalmology Department and 90 patients who had progressive myopia with an axial length increase of 0.34 mm after wearing orthokeratology lens were enrolled. Patients were randomly divided into two groups: control group included 45 eyes treated with orthokeratology lens combined with 0.01% atropine eye drops, and combination group included 45 eyes treated with orthokeratology lens combined with 0.05% atropine eye drops. The axial length, photopic and mesopic pupil diameter, change in the position of the defocus ring relative to the pupil (the defocus ring was outside, matched, or inside the pupil), and the occurrence of adverse reactions were compared between groups, t-test and chi-square test were used for analysis between two groups. Results::After 1 year of treatment, a significant increase was observed in the axial length ( P<0.001), photopic and mesopic pupil diameters ( P<0.001) of both groups, and less axial length changes in the combination group ( P<0.001). In addition, the combination group with a photopic pupil showed significant changes in the position of the defocus ring relative to the pupil ( P<0.001), whereas no significant difference was observed in the control group ( P>0.05). During the treatment period, no difference in the occurrence of adverse reactions was observed between the two groups ( P>0.05). Conclusions::Combining orthokeratology lens with 0.05% and 0.01% atropine can enhance myopia control in adolescents with good safety. In particular, when combined with an orthokeratology lens, 0.05% atropine was better at controlling progressive myopia than 0.01% atropine.
Objective::To assess the predictive value of inflammation markers in predicting the development of infective endophthalmitis following ocular trauma, this study examined the inflammation markers in patients with and without infective endophthalmitis.Methods::This was a retrospective case-control study. In this study, 12 516 patients with ocular trauma (12 558 eyes) hospitalized in the Eye Hospital, Wenzhou Medical University from January 1st, 2013 to June 1st, 2021 were collected. The study identified 235 patients with traumatic endophthalmitis (236 eyes) as the endophthalmitis group, following specified inclusion and exclusion criteria. Concurrently, 235 patients without endophthalmitis following ocular trauma (237 eyes) were divided into the control group. Additionally, 235 preoperative patients from the department of plastic surgery during the same period were selected as the normal group. To assess the predictive value of inflammation markers in the diagnosis of traumatic endophthalmitis, various preoperative parameters including peripheral white blood cell count (WBC), neutrophil count (NEUT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), among others were analyzed using Mann-Whitney U test. The diagnostic efficacy of inflammation markers in traumatic endophthalmitis was evaluated using receiver operating characteristic curves, and binary logistic regression was used to analyze the prognostic factors associated with visual outcomes following ocular trauma. Results::The inflammation markers of patients with ocular trauma were significantly higher than those of healthy individuals, while the lymphocyte count (LYM) was lower. Specifically, WBC ( Z=-8.26, P<0.001), NEUT ( Z=-8.67, P<0.001), NLR ( Z=-7.91, P<0.001), monocyte-to-lymphocyte ratio ( Z=-4.47, P<0.001), platelet-to-lymphocyte ratio ( Z=-3.60, P<0.001), CRP ( Z=-3.83, P<0.001), and serum amyloid A ( Z=-2.97, P=0.003) were all significantly higher in the endophthalmitis group compared to the control group, while LYM ( Z=3.64, P<0.001) was lower. CRP exhibited a specificity of 99.32% with 6.73 mg/L of cut-off. Risk factors for adverse visual outcomes included WBC>8.41×10 9/L ( OR=2.23, 95% CI:1.42-3.51, P<0.001), NLR>3.66 ( OR=1.78, 95% CI: 1.07-2.98, P=0.027), intraocular foreign body ( OR=2.14, 95% CI: 1.41-3.23, P<0.001), and positive culture ( OR=6.56, 95% CI: 3.54-12.16, P<0.001). Conclusions::WBC, NEUT, and NLR proved to be valuable in identifying traumatic endophthalmitis. CRP exhibited a high specificity. WBC>8.41×10 9/L, NLR>3.66, intraocular foreign body, and positive culture were risk factors of visual outcomes. An independent risk factor for visual outcomes was the present of a positive culture of the eye contents.
Active eye health service refers to the adoption of proactive measures to minimize the impact of eye diseases on the vision and quality of life, and to provide better eye health services for the elderly. The National Key Research and Development Program project about "Evaluation and Intervention Techniques for Visual Dysfunction in the Elderly" has successfully implemented an active eye health service system for the elderly through the primary healthcare service system by integrating appropriate active eye health technologies into the annual physical examinations of the elderly population, and has achieved substantial results. This paper presents the good foundation laid by the primary health care service system in China for more than 20 years for the advancement of active eye health. Combined with the development path in the field of eye health, it elaborates on the construction and key elements of the primary active eye health model, and explores the further consolidation and promotion of the model in practice.
Objective::To study on the agreement between the Howell phoria card and the Maddox rod test and to access the repeatability of measuring near horizontal heterophoria with the Howell phoria card.Methods::This cross-sectional study was conducted from March to September 2023. A total of 1 450 students were randomly selected by simple sampling from Huantai County, located in Shandong Province. The near horizontal heterophoria was measured using both Howell phoria card and Maddox rod test, and remeasured using the Howell phoria card on the following day. Then the agreement and repeatability of the test methods were analyzed through Bland-Altman analysis.Results::A total of 1 436 pieces of subjects data were included in the analysis, aged from 6 to 17 (10.6±2.3) years old, showing a strong level of agreement (Kappa=0.76, P<0.001), revealing near heterophoria of -3.82±4.93 △ and -3.97±4.73 △ measured by the Howell phoria card and the Maddox rod test, respectively, and no significantly different between the two methods was found ( P>0.05). The Bland-Altman plot showed a mean difference of -0.15 △ between the two methods, with 95% limits of agreement (LOA) ranging from -8.02 △ to 7.72 △, and 96.45% (1 385/1 436) of the data points fell within the clinically acceptable agreement limits. Specifically, the Howell phoria card demonstrated good repeatability. The Bland-Altman plot demonstrated a mean difference of 0.07 △ between the two measurements of the Howell phoria card, with a 95% limits of agreement of -6.01 △~6.14 △, and 96.87% (1 391/1 436) of the data points fell within the clinically acceptable agreement limits. Conclusions::The Howell phoria card results demonstrate a high level of agreement with the Maddox rod test in the measurement of near horizontal heterophoria, and indicated good repeatability.
Objective::To investigate the effects on corneal nerve regeneration and early ocular surface pain index in moderate myopia undergoing transepithelial photorefractive keratectomy with smart pulse technology (SPT-TransPRK) combined with 0.01% or 0.02% mitomycin C (MMC).Methods::Prospective self controlled study. Thirty patients (60 eyes) with preoperative spherical equivalent -6.00 to -3.00 D who voluntarily underwent binocular refractive surgery from October 2022 to January 2023 in the ophthalmic laser center of Dalian Third People's Hospital were included. The study used an invitro pairing design, with one eye randomly using 0.01% MMC for the MMC0.01 group (30 eyes), and the other eye using 0.02% MMC for the MMC0.02 group (30 eyes). Confocal microscopy was used to observe the repair of subepithelial nerves in different areas of the cornea before and 14 days, 1 month and 3 months after surgery. Image J software was used to analyze the changes in central corneal nerve fiber density (CNFD) and nerve fiber length (CNFL). The visual acuity and the degree of pain scored by visual analogue scale (VAS) were recorded before and 1, 3, 7, 14 days after surgery.Results::There was no statistically significant difference in CNFD and CNFL in the central corneal region between the MMC0.01 group and the MMC0.02 group before and 14 days, 1 month and 3 months after surgery ( P>0.05). Compared with preoperative values, CNFD and CNFL in both groups decreased at 14th days postoperatively, and gradually increased at 1 and 3 months postoperatively. The differences at each time point were statistically significant compared to preoperative values ( P<0.001). The postoperative pain levels in both the MMC0.01 and MMC0.02 groups were within a mild to moderate range, and decreased with recovery time. On the first day after surgery, the VAS of the two groups were 4.15±0.83 and 5.39±1.18, respectively. And on the third day after surgery, they were 2.31±0.84 and 3.07±0.83, respectively. The differences were statistically significant ( P<0.001, P=0.001). But there was no statistically significant difference in VAS scores between the two groups on the 7th and 14th day after surgery. There were statistically significant differences in UCVA between the two groups on the 1st, 3rd, and 7th day after surgery (all P<0.001), with the MMC0.01 group having a better UCVA. Within 3 months after surgery, two patients (7%) showed a grade 0.5 haze in both eyes. Conclusions::The combination of 0.01% and 0.02% MMC during surgery has a similar promoting effect on nerve regeneration in the early postoperative period (within 3 months) of SPT-TransPRK. At 3 months after surgery, the central nerve fibers in the ablation area of both groups of corneas did not return to preoperative levels. The use of 0.01% MMC during surgery has better eye pain relief and faster visual recovery in the early postoperative period.
Objective::To investigate differences in macular choroid thickness and volume between primary open-angle glaucoma (POAG), primary chronic angle-closure glaucoma (CPACG), and normal controls.Methods::This was a case-controlled study. Patients admitted to Shijiazhuang People's Hospital from October 2018 to October 2021 were selected in this study. A total of 77 patients (77 eyes) with POAG were included as the POAG group, 80 patients (80 eyes) with CPACG were included as the CPACG group, and 79 normal subjects (79 eyes) with matched age, intraocular pressure, and axial length were selected as the control group. Thickness and volume of choroid in 9 macular regions of all subjects measured by Enhanced depth imaging optical coherence tomography (EDI-OCT) was analyzed by one-way variance measurement. And Pearson correlation analysis was used to analyze the correlation between macular choroid thickness and visual field mean defect (MD) in glaucoma patients.Results::The choroidal thicknesses of the average macula, central sub?eld macula, nasal inner macula, superior inner macula, temporal inner macula, inferior inner macula, nasal outer macula, superior outer macula, temporal outer macula and inferior outer macula regions between the POAG group, the CPACG group, and the normal control group were statistically significant ( F=9.87, P<0.001; F=7.23, P<0.001; F=9.90, P<0.001; F=8.16, P<0.001; F=6.56, P=0.002; F=10.69, P<0.001; F=7.89, P<0.001; F=8.51, P<0.001; F=6.61, P=0.002; F=9.93, P<0.001). The choroidal volume of the average macula, central sub?eld macula, nasal inner macula, superior inner macula, temporal inner macula, inferior inner macula, nasal outer macula, superior outer macula, temporal outer macula and inferior outer macula regions between three groups were statistically significant ( F=9.80, P<0.001; F=7.03, P<0.001; F=11.39, P<0.001; F=7.85, P<0.001; F=5.59, P=0.004; F=10.01, P<0.001; F=6.55, P=0.002; F=8.44, P<0.001; F=6.43, P=0.002; F=9.94, P<0.001). There were no significant differences in the thickness and volume of choroid in 9 macular regions and average thickness and volume of choroid between POAG group and control group (all P>0.05). Compared with POAG group and control group, the thickness and volume of choroid in 9 macular regions and average choroidal thickness and volume in CPACG group were thicker and larger, and the differences were statistically significant (all P<0.05). The macular choroidal thickness of various macular regions was not correlated with MD in POAG group and CPACG group (all P>0.05). Conclusions::The choroidal thickness and volume of macular area in CPACG patients were thicker and larger than those in POAG patients and normal controls. The choroid may play an important role in the pathogenesis of CPACG patients.
患者，女，19岁，因"右眼视物不清10余年"于2022年1月3日就诊于新疆医科大学第一附属医院眼科。患者自幼无明显诱因下出现右眼视物不清，无视物变形，无眼红、眼痛、畏光、流泪等，多次配镜视力不能提高。曾于2009年就诊于外院，给予药物治疗（具体不祥），未见明显好转，为进一步诊治，就诊于我院眼科门诊。患者无高血压、糖尿病等全身病史，否认眼部外伤、感染及射线接触史，否认家族遗传及同类病史。眼部检查：右眼：裸眼视力0.06，矫正视力：-3.75 D=0.15，左眼：裸眼视力0.25，矫正视力：-3.50 D=1.0；眼压：右眼13 mmHg（1 mmHg=0.133 kPa），左眼16 mmHg。双眼角膜映光正位，交替遮盖无运动。裂隙灯显微镜检查：右眼：结膜未见明显充血，角膜透明，前房深，房水清，虹膜纹理清晰，瞳孔大小3 mm×3 mm，直接及间接光反应灵敏，晶状体旁中央区域可见一点状混浊，余透明，玻璃体呈轻度混浊，视盘边界清晰，C/D约0.3，黄斑区反光未见，视网膜未见明显出血及渗出；左眼：结膜未见明显充血，角膜透明，前房深，房水清，虹膜纹理清晰，瞳孔大小3 mm×3 mm，直接及间接光反应灵敏，晶状体透明，玻璃体呈轻度混浊，视盘边界清晰，C/D约0.3，黄斑区反光未见，视网膜未见明显出血及渗出。Scheimpflug摄像（Pentacam三维眼前节分析仪，德国欧科路光学仪器有限公司）行角膜分析示：双眼角膜近视散光，均无圆锥角膜。眼科B超：双眼玻璃体呈轻度混浊，双眼眼底未见明显异常。光学相干断层扫描（OCT）示：双眼黄斑区未见明显异常。全身检查未见异常。散瞳至瞳孔直径7 mm后进一步检查，裂隙灯、眼前段照相（图1）及Scheimpflug断层扫描（图2）均可见右眼晶状体后囊膜偏颞侧的旁中央区域，呈圆锥形向玻璃体腔方向膨出，膨出的后囊膜下可见一点状混浊。明确诊断为：右眼晶状体后圆锥，右眼弱视，双眼屈光不正。
患儿，女，7岁，因"双眼视力下降"于2020年6月8日就诊于潍坊眼科医院。家属诉患儿自幼双眼视力差。患儿4年前于外地医院行"双眼白内障摘除联合一期人工晶状体（IOL）植入术"；3年前无明显诱因下出现双眼眼压高，外地医院就诊，给予酒石酸溴莫尼定滴眼液、布林佐胺滴眼液、布林佐胺噻吗洛尔滴眼液、贝美前列素滴眼液滴眼治疗3个月后眼压控制正常。患儿足月剖宫产，智力正常，父母非近亲结婚。患儿父亲自幼视力差，有"双眼先天性白内障"病史，其父亲2020年7月27日来院时眼部检查：右眼视力无光感，右眼眼压60 mmHg（1 mmHg=0.133 kPa）。左眼外伤后眼球摘除，义眼片在位；右眼眼部检查见图1。患儿曾祖父有青光眼病史。否认家族内其余成员眼部及其他遗传病史、类似病史。
Objective::To investigate and analyze the detection condition and influencing factors of diabetic retinopathy (DR) in middle-aged and elderly type 2 diabetic patients in rural areas of Qujiang, Shaoguan, Guangdong.Methods::This was a cross-sectional survey study. Totally, 1, 694 middle-aged and elderly type 2 diabetic patients aged 55 years or above who participated in basic public health chronic disease management in rural areas of Qujiang, Shaoguan were screened for DR between September 2019 to December 2019, and the examinations included vision examination, slit-lamp examination, fundus films, questionnaires, laboratory examination, etc. Participants were divided into the no DR (NDR) group and the DR group based on fundus films. The Wilcoxon rank sum test and χ2 test were used to analyze differences between groups on basic information and laboratory variables, and logistic regression was used to analyze the influencing factors of DR. Results::Among 1 694 diabetic patients, the detection rate of DR was 41.6%, 95% confidence interval ( CI) : 39.21%-43.91%. The results of the logistic analysis showed that the duration of diabetes mellitus (DM) (≥5-≤10 years: odds ratio ( OR)=1.628, 95% CI: 1.280-2.070; >10-≤15 years: OR=2.295, 95% CI: 1.670-3.153; >15 years: OR=3.609, 95% CI: 2.512-5.183; all P<0.001), and hemoglobin A1c ( OR=1.184, 95% CI: 1.105-1.268, P<0.001) were risk factors for DR in patients with type 2 diabetes mellitus and age was a protective factor (>65-≤75 years: OR=0.711, 95% CI: 0.569-0.889, P=0.003; >75 years: OR=0.408, 95% CI: 0.286-0.582, P<0.001). Conclusions::The detection rate of DR was high among diabetic patients in rural areas in Qujiang, Shaoguan, Guangdong, which was associated with diabetes mellitus duration, hemoglobin A1c, and age.
Objective::To evaluate the retinal and choroidal capillary alternations in patients with juvenile systemic lupus erythematosus (JSLE) using optical coherence tomography angiography (OCTA).Methods::This was a case series study. Eighteen patients (18 eyes) who were diagnosed with JSLE by the Second Affiliated Hospital of Wenzhou Medical University from January to June 2023 were included in this study as the JSLE group. Eighteen healthy children (18 eyes) of similar age and gender from the eye clinic were included as the control group. All subjects had a 4.5 mm×4.5 mm area of the macula scanned by OCTA to obtain vessel density of superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), choriocapillaris (CC), and area of foveal avascular zone (FAZ). Data analysis was performed by a t test and Spearman correlation analysis. Results::The vessel density of ICP, DCP, and CC in the JSLE group were significantly lower than those in the control group ( t=2.37, P=0.024; t=3.25, P=0.003; t=3.17, P=0.003, respectively). And vessel density of CC was positively correlated with the duration of the disease ( r=0.76, P<0.001). There was no statistically significant difference in vessel density of SCP and area of FAZ between the two groups (all P>0.05). Conclusion::At subclinical stage, OCTA could detect damage to the deep retinal and choriocapillaris layers in patients with JSLE.
Objective::To investigate the relationship between corneal thickness and surgically induced astigmatism (SIA) after clear corneal incision in phacoemulsification.Methods::This was a retrospective case series study. A total of 69 patients (69 eyes) who underwent phacoemulsification cataract extraction combined with intraocular lens implantation at Xi'an No. 1 Hospital's day surgery center from September 2021 to March 2022 were included in this study. Participants were divided into a right eye group and a left eye group based on their first surgery. Central corneal thickness, average corneal thickness, and alternations of the average corneal thickness in upper, lower, nasal, and temporal directions within the 5 mm were observed and recorded pre- and postoperative 3 months. Simulate keratometric power (SimK) and 3 mm SIA of the anterior and posterior surfaces were calculated to analyze the influence of corneal thickness changes on SIA by using vector analysis method. Data analysis was conducted using independent sample t-test and partial correlation analysis. Results::There was no significant difference in corneal thickness and alternations in each quadrant between eyes pre- and postoperative 3 months ( P>0.05). SimK-Y SIA and corneal anterior surface Y SIA had statistically difference between two groups ( t=2.47, P=0.016; t=3.25, P=0.002), but no difference in SIA of corneal posterior surface ( P>0.05). The changes in corneal thickness in the center and various quadrants of the right eye were significantly positively correlated with the posterior surface SIA ( r=0.39-0.49, all P<0.05), while the rest were not correlated ( P>0.05). The alternations of corneal thickness above the left eye were negatively correlated with SimK, anterior and posterior surface Y SIA ( r=-0.50, P=0.005; r=-0.53, P=0.002; r=-0.55, P=0.001). Except for the alternation of upper corneal thickness, other alternations of corneal thickness were positively correlated with SimK-X SIA ( r=0.37, P=0.040; r=0.46, P=0.010; r=0.44, P=0.013), while the alternations of nasal and temporal thickness were negatively correlated with Y SIA of the anterior surface ( r=-0.46, P=0.009; r=-0.38, P=0.036). Conclusions::Three months after cataract surgery, the corneal thickness returned to the preoperative level. There is a correlation between alternations of corneal thickness and SIA. The increase in corneal thickness of the left eye can cause SIA to rotate more clockwise.
Objective::To establish the initial prediction model for myopia progression in adolescents, providing decision support for myopia control.Methods::A prospective observational study. Four hundred and fifty myopic adolescents who visited Eye Hospital, Wenzhou Medical University during January 2022 to March 2023 were enrolled. All agreed to take a questionnaire survey for prediction of myopia control efficacy. Axial growth ≥0.2 mm was defined as myopia progression, and the progression time was calculated. Predictors were screened according to least absolute shrinkage and selection operator (LASSO) regression, optimal subset regression, stepwise regression and clinical significance, and then a Cox prediction model for myopia progression was established. Receiver operating characteristic (ROC) curve and calibration plot were used to evaluate this model' s performance. Cross-validation method was used for internal validation, and decision curves analysis (DCA) was to evaluate the clinical usefulness of the model.Results::Four hundred and twenty nine subjects were finally enrolled for analysis, among which 175 subjects had axial growth of more than 0.2 mm. The prediction model was initially established with 12 predictors. The discrimination ability of this model was 0.78 [95% confidence interval ( CI): 0.75-0.81]. The area under ROC curve (AUC) for 6 months, 9 months and 1 year was 0.872 (95% CI: 0.831-0.912) and 0.812 (95% CI: 0.759-0.866), 0.806 (95% CI: 0.742-0.870) and the average AUC of the cross-validation was 0.853, 0.789 and 0.792, respectively, suggesting this model has good calibration ability. The area under the DCA was 0.058, 0.152 and 0.263 for 6 months, 9 months and 1 year, showing the model has good clinical net benefit. Conclusion::The initial prediction model of myopia progression in adolescents has good clinical usefulness and could provide supportive decision-making for myopia control.
患者1，女，65岁，因"左眼眼周突发肿胀、疼痛5 d"入院，患者否认眼部及头部外伤史，否认高血压、糖尿病史及血液病病史。既往左眼曾因"年龄相关性白内障"行白内障超声乳化联合人工晶状体（IOL）植入术，自诉术后视力恢复可。眼科专科检查见：右眼裸眼视力（UCVA）0.1，左眼0.3，右眼矫正视力-2.75-1.25×90°=0.7（自然晶状体），左眼-0.75=0.6（人工晶状体）。右眼眼前节仅见晶状体混浊，玻璃体轻度混浊，余（-）；左眼眼睑皮肤轻度肿胀，内眦周围皮肤稍红，压痛（+），结膜充血（+），角膜透明，瞳孔圆，直径约4 mm，直接对光反射稍稍迟钝，间接对光反射可，人工晶状体在位，眼底见视盘稍肿胀，色淡，C/D约0.3，视网膜血管纤细，动静脉管径之比约1：3，视网膜平伏（图1）。眼球向各方向运动均无明显异常，眼球突出度：右眼13 mm，左眼15 mm。入院抽血检查发现血常规、C反应蛋白、凝血功能均在正常值范围内。眼眶CT检查提示：左眼上方及眶骨膜可见一稍高密度的肿物，肿物外围密度稍高。同侧额窦、筛窦均可见与眼眶肿物内相同密度的内容物填充，与此同时，左眼眼眶眶内侧壁还可见部分骨质呈缺损状态，左侧视神经轻度受压移位。眼眶MRI示：左侧额窦-筛窦-眼眶内可见不规则软组织肿块影，边界清楚、信号均匀一致，以稍长T2、短T1信号为主，左眼眼球突出，视神经轻度受压推挤（图2A-C）。
