Purpose: To develop and validate an artificial intelligence framework for identifying multiple retinal lesions at image level and performing an explainable macular disease diagnosis at eye level in optical coherence tomography images. Methods: A total of 26,815 optical coherence tomography images were collected from 865 eyes, and 9 retinal lesions and 3 macular diseases were labeled by ophthalmologists, including diabetic macular edema and dry/wet age-related macular degeneration. We applied deep learning to classify retinal lesions at image level and random forests to achieve an explainable disease diagnosis at eye level. The performance of the integrated two-stage framework was evaluated and compared with human experts. Results: On testing data set of 2,480 optical coherence tomography images from 80 eyes, the deep learning model achieved an average area under curve of 0.978 (95% confidence interval, 0.971-0.983) for lesion classification. In addition, random forests performed accurate disease diagnosis with a 0% error rate, which achieved the same accuracy as one of the human experts and was better than the other three experts. It also revealed that the detection of specific lesions in the center of macular region had more contribution to macular disease diagnosis. Conclusion: The integrated method achieved high accuracy and interpretability in retinal lesion classification and macular disease diagnosis in optical coherence tomography images and could have the potential to facilitate the clinical diagnosis.

报告一例陈旧性视网膜中央静脉阻塞6年后发生视网膜中央动脉阻塞的病例,讨论视网膜血管阻塞性疾病全身治疗的重要性.

目的:观察玻璃体内注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿的短期疗效及其临床表现,探讨可能对该类患者视力恢复及黄斑水肿的消退有影响的因素.方法:回顾性病例分析70例70眼非缺血型RVO继发黄斑水肿的患者,给予玻璃体内注射康柏西普0.5mg(0.05ml),遵循1+PRN的原则,必要时重复治疗,从初次治疗开始随访观察3个月.收集所有研究对象的详细病史以及最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心视网膜厚度(central retinal thickness,CRT)等随访数据.根据患者治疗后的CRT恢复情况,对患者的年龄、病程、RVO类型、基线视力、基线CRT、是否合并SRF、糖尿病及高血压等病史情况的因素进行多因素Logistic回归分析,探讨可能影响黄斑水肿消退的因素.结果:在治疗前BCVA为(0.96±0.53)LogMAR,治疗后3个月BCVA为BCVA为(0.53±0.43)LogMAR,差异有统计学意义(t=-10.252,P=0.000);CRT从治疗前的基线(552.6±231.8)μm降低至治疗后3个月的CRT为(249.8±96.7)μm,差异有统计学意义(t=-10.640,P=0.000);logistic多因素回归分析结果显示,病程、年龄、RVO分类、是否合并SRF等因素与治疗预后无关(P>0.05),基线CRT是影响治疗后3个月CRT的主要因素(P<0.05).结论:康柏西普对于non-iRVO-ME具有很好地安全性,短期内可以明显提高BCVA、改善ME的程度,基线CRT是判断其短期疗效的重要参数.

AIM: To investigate the differences of the choroidal vascularity index between type 2 diabetes with diabetic retinopathy and non-diabetes patients.METHODS: A retrospective cross-sectional study was performed at Beijing Friendship Hospital. Enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT)scans of 68 eyes of 68 type 2 diabetes who with diabetic retinopathy were compared with those of right eyes of 34 age- and gender-matched healthy controls. The choroidal images were binarized into luminal areas(LA)and stromal areas(SA). CVI was defined as the ratio of LA to total circumscribed subfoveal choroidal area. Mean choroidal thickness, mean retinal thickness and mean CVI between patients and controls were compared using t-test. RESULTS: There were no significant differences in total circumscribed subfoveal choroidal area(0.53±0.14mm2 vs 0.49±0.15mm2), LA(0.35±0.09mm2 vs 0.32±0.10mm2), SA(0.17±0.05mm2 vs 0.17±0.06mm2), or subfoveal choroidal thickness(347.9±76.9μm vs 325.9±92.9μm)between patients with DR and controls(P>0.05). However, there was a significantly lower CVI in patients with diabetes as compared to controls(64.33%±3.25% vs 67.04%±2.46%, P<0.001). The critical value was 63.59%.CONCLUSION: CVI is a kind of biological indicators which can directly reflect the changes of choroidal internal structure, and it is more stable and reliable than SFCT. For type 2 diabetic patients who with diabetic retinopathy, CVI is lower than that of healthy people.

目的 本文主要对昌平区城区学龄前期及学龄期儿童的视力发育特点进行初步研究.方法 入选2016年3月—2017年12月在昌平区医院眼科门诊筛查视力的儿童,共计123人246眼进行屈光发育健康档案的建立,全部儿童均进行视力、屈光度、眼轴测量,分析筛查结果 .结果发现裸眼视力低常者共计45人90眼;其中近视的儿童为24人,占裸眼视力低常者的53.3％,远视的儿童为21人,占裸眼视力低常者的46.7％.其中弱视的儿童为6人,占所有受检儿童的4.9％;24人近视的儿童中,儿童的眼轴长度平均为(23.30±1.14)mm,21人远视的儿童中，儿童的眼轴长度平均为（21.86±0.53）mm.结论 昌平区城区低龄儿童的视力存在一定问题，应建立屈光健康档案，定期进行视力监测，并给予相应的防治措施.

目的:探讨全视网膜光凝对糖尿病视网膜病变玻璃体手术术中、术后并发症的影响.方法:2016年2月-2018年6月收治糖尿病视网膜病变患者30例,将其按照是否进行全视网膜光凝分为未光凝组14例和光凝组16例.结果:术中出血和手术时间方面,光凝组优于未光凝组(P<0.05).并发症发生率方面,光凝组6.25％,未光凝组21.42％,差异有统计学意义(P<0.05).结论:对糖尿病视网膜病变患者在玻璃体切除术前行全视网膜光凝治疗,可减少术中出血量,降低术后并发症发生率,此方案推广意义大.

患者女性,64岁.主因双眼干涩,于2010年4月26日就诊于北京友谊医院眼科.既往史:患者于1963年曾患肺门淋巴结结核,抗结核治疗后好转.2004年行右卵巢畸胎瘤切除术.2009年曾患三叉神经走行处带状疱疹,导致右眼疱疹性角膜炎、虹膜炎,右眼视力下降仅余光感,予激素类滴眼液局部用药后视力逐步恢复.目前眼部检查:双眼裸眼视力均为0.8,矫正视力为1.0.右眼瞳孔偏鼻上方可见虹膜粘连,左限于鼻侧、上方及颞侧球结膜下可见粉红色"鲑鱼肉"样肿物(图1).B超检查提示:双眼玻璃体后脱离,除此,双眼外直肌、内直肌、下直肌的肌腹及肌止端均有不同程度的增粗,且肌肉表面回声欠光滑;除此之外,患者右眼球壁下可探及无回声缝隙状暗区,其边界清晰;于左眼眶内亦可探及多个类圆形无回声小暗区,与视神经邻近,边界清晰(图2,3).

患者男性,20岁.因左眼不适伴眼红1年,左眼“变小”及肿物生长3个月,于2009年11月4日到首都医科大学附属北京友谊医院眼科就诊.患者否认眼部慢性炎症和角膜接触镜佩戴史,否认眼外伤及手术史.家族成员无相关病史及遗传史.眼科检查:双眼视力1.0,眼前节与后节检查均未见异常。

<正>Terson综合征是一种眼和脑的综合征,即眼内出血合并任何形式的颅内或蛛网膜下腔出血,因患者就诊时仅表现为玻璃体出血,故容易忽略颅内出血病史而误诊。本文通过报道1例Terson综合征病例,对本病的临床表现、诊断依据及治疗

Objective To observe the effect of sub-Tenon injection of triamcinolone acetonide(STTA) on retinal thickness after panretinal photocoagulation(PRP) in Brown Norway(BN) rats.Methods Laser photocoagulation of nasal retinal in the right eyes of male BN rats were performed,with the rats being randomly divided into experimental group and control group(n= 6).The experimental group was injected 2 mg of triamcinolone acetonide(TA,50 μL) in posterior sub-Tenon space,and the control rats were injected the same amount of saline immediately after PRP.The retinal thickness was evaluated by optical coherence tomography(OCT).The temporal retinal thickness in the right eyes before and after PRP was compared.Results The retinal thickness in the control group at 24-hour after PRP was significantly thicker than that of before injection[(223.9 ± 7.7) μm vs(197.6 ± 7.2) μm](P 0.05).The retinal thickness in the experimental group was significantly suppressed as compared with that in the control group(P 0.05).Conclusion It is demonstrated that the retinal thickness could increase shortly after PRP and the STTA could significantly decrease the retinal thickness induced by the laser-induced photocoagulation.