Objective: To optimize the follow-up approach for patients with ophthalmic genetic diseases through informational technology, reduce the loss rate of cases, and facilitate the efficient operation of the clinical laboratory. Methods: Using the SWOT analysis method to collect requirements, ‘Pediatric Genetics of Zhongshan Ophthalmic Center’, an ophthalmic genetics information management system for ophthalmic genetic diseases was established on the Wechat public platform. Based on whether the ophthalmic genetic disease information management system was used and there were personnel mobility restrictions, patients who underwent genetic testing in the hospital for genetic testing from July 1, 2017, to November 30, 2023, were divided into four groups: traditional group, traditional+ lockdown group, Wechat+ lockdown group, and Wechat group. Te chi-square test was used to evaluate the performance of the ophthalmic genetic information management system. Results:The ophthalmic genetic disease information management system, which is based on open-source sofware and hosted on the Alibaba Cloud e-government platform, interacts with the hospital network through encrypted communication. Te system was divided into three modules: gene detection business, data management, and system management. By the system, patients or relatives can upload medical records, sign informed consent, inquire about genetic test reports at any time and anywhere, and conduct one-on-one communication to achieve long-term follow-up if necessary. In this process, the patient's clinical information was digitized. A total of 10,662 patients were included in the study to evaluate the performance of the system. The loss rate of cases was decreased from 12.2%to 2.7%, and the rate of second visits was reduced from 70% to 11.7%, which were statistically different, respectively (P< 0.001). Conclusion: Te application of the ophthalmic genetic information management system has signifcantly reduced the loss rate of cases and the rate of second visits in patients with ophthalmic genetic diseases.
Aim: The objective of this study was to investigate the prognosis of massive vitreous hemorrhage(VH) secondary to polypoidal choroidal vasculopathy(PCV) after vitrectomy.
Methods: Forty-nineeyes in 48 patients with PCV and breakthrough VH who underwent 23-gauge pars plana vitrectomy between January 2015 and December 2020 were enrolled. The main outcome parameters were best-corrected visual acuity, postoperative adverse events, and reoperation.
Results:The average follow-up time was 20.0±15.82 months. The average preoperative best-corrected visual acuity (BCVA) was 2.12±0.65 logarithm of the minimum angle of resolution (logMAR), the BCVA at six monthswas 1.65±0.64 logMAR, and the six-month follow-up BCVA was 1.67±0.76 logMAR. Compared to the average preoperative BCVA, the six-months and last follow-up BCVA after vitrectomy improved (P<0.05). The BCVAat the fnal follow-up was better than 1.3logMAR only in 14 eyes (28.6%). Postoperative complications were observed in 10 eyes (20.4%), including recurrent retinal detachment, recurrent vitreous hemorrhage, macular hole, hyphema and lens dislocation. Fourteen eyes(28.6%) underwent cataract surgery procedure an average of 10.16±5.14 months after vitrectomy. BCVAone week and three monthsafter cataract surgery improved compared toBCVAbefore cataract surgery (P<0.05). Hypertension was associated with BCVAsix months after vitrectomy (P=0.017). The BCVA at baseline and three months after PPV were worse in patients who underwent vitrectomy combined with silicone oil filling (P<0.05). Eyes with postoperative complications had worse BCVA at six months, 12 months, and at the final follow-up after PPV (P<0.05).The duration of VH is related to the BCVA12 months after PPV visual acuity after surgery. Patients who underwent vitrectomy within one month of the onset of vitreous hemorrhage had better BCVA 12 months after vitrectomy than those who underwent vitrectomy surgery one month later (P=0.015).
Conclusions: Although the prognosis of vitrectomy varies greatly, cataract surgery could be considered to improve BCVAif polypoidal lesions are inactive six months after vitrectomy.
Objective: To demonstrate the clinical characteristics and surgical effects of glaucoma in Hallermann-Streiff syndrome (HSS). Methods: Observational case series and literature review. The results of ophthalmic examinations of three patients diagnosed as glaucoma with HSS were recorded, including visual acuity, intraocular pressure (IOP), slit-lamp microscopy, ultrasound biomicroscopy, optical coherence tomography, corneal topography, A-scan and B-scan ultrasonography, and orbital size measurement by X-ray. Peripheral iridectomy, glaucoma drainage device implantation or trabeculectomy, were performed in these patients. Results: Three HSS patients were 9, 29 and 47 years old, respectively, including 2 females and 1 male. The best corrected visual acuity was 6/150 to 6/12. The mean spherical equivalent refraction was +12.1 DS. The average IOP was 37.7 mm Hg, and the average corneal diameter was 9.1 mm. The average central anterior chamber depth was 2.43mm. The average axial length was 18.13mm. Keratometry showed average K1 of 56.97 degrees, and K2 of 60.65 degrees. Two younger patients were aphakic bilaterally with uveitis, pupillary fibrous membrane and peripapillary choroidal atrophy. The older patient showed blue sclera, cataract, and anterior chamber angle closure. The horizontal orbital diameter was 28.76-31.40 mm, and vertical orbital diameter was 30.16-32.90 mm. All patients were proportionate nanism, with an average height of 143 cm. Craniofacial manifestations included dyscephalia and “bird-like” face, hypotrichosis, dental anomalies, and mandibular hypoplasia. They were followed up for 47.7 (11-84) months after surgery. The IOPs were all controlled, and the visual acuities remained unchanged. No treatment-related complications occurred. Conclusions: HSS patients with glaucoma may present as small orbit, microphthalmia, microcornea, blue sclera, aphakia, pupillary fibrous membrane, uveitis, with atrophic chorioretinal changes. For these patients, personalized treatment may help to achieve better therapeutic effects.
Macular edema refers to the formation of edema in the macular area, the most sensitive part of the retina to light, and fluid infiltration, resulting in serious visual impairment. Macular edema is basically not present after intraocular lens surgery, but it is not immune to this situation. We report a case of rapid, severe, and rare macular edema after ICL surgery. Now combined with the literature reports as follows.
OBJECTIVE:To explore the influencing factors of ophthalmology surgery time under general anesthesia relying on previous surgery information, and to construct a machine learning model to predict the surgery time for better scheduling of next day surgery. METHODS: A total of 4859 general anesthesia surgery cases in the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2019 to June 2021 were extracted and included in this study to establish a database. Prediction with machine learning modeling: decision tree analysis and plain Bayesian analytic classifier were used to do classification model prediction; linear regression, random forest, neural network, and support vector machine were used to do regression model prediction. Prediction accuracy, Mean Square Error (MSE), and Root Mean Squared Error (RMSE) were used to evaluate the model prediction effectiveness. RESULTS: The Random Forest model had the smallest RMSE and MSE; the Linear Regression model was the largest of the four models and relatively less effective. CONCLUSION: Age, gender, body mass index, ASA classification, eye type, type of surgery, and surgeon are predictors of ophthalmic surgery time. Machine learning for predicting surgical time can probably predict the start and end time of surgery, which contributes to the efficiency of surgery, increases patient turnover, and plays an important role in social benefits and economic improvement of hospitals.
A 16-year-old girl presented to the hospital because of recurrent transient visual loss on the left eye for nearly a month. The corrected visual acuity of both eyes is 1.0 for the right eye and 1.2 for the left eye. Color fundus photographs, Fundus fluorescence angiography(FFA) and optical coherence tomography(OCT) showed left eye optic disc edema. No abnormality was found in brain magnetic resonance imaging and magnetic resonance angiography. Contrast-enhanced transcranial doppler ultrasound(cTCD) indicates positive foaming test, supporting right to left shunt. Cardiac ultrasound indicates patent foramen ovale(PFO). Combined with the medical history and examination results, the diagnosis was PFO and left eye optic disc edema. Transient visual loss of the left eye disappears after catheter-based patent foramen ovale closure, but there was still optic disc edema in the left eye.
Optical coherence Tomography (OCT) is a type of tomography that measures the light reflection of biological tissue to reflect the deep structure, which mainly uses low-coherence light interference. The damage of retinal ganglion cells (RGCs) can be reflected by changes in parameters such as the macular ganglion cell complex (GCC), to a certain extent, reflecting the damage of the optic nerve. OCT is evaluated by non-invasive and repeatable characteristics, which is regarded as a "window" for the discovery of central nervous system diseases in neuroophthalmology. OCT is widely used to study neurodegenerative diseases such as multiple sclerosis, Alzheimer's disease and Parkinson's disease. In this paper, the application of OCT to detect the thickness changes of ganglion cell complex in macular area in different neuroophthalmic diseases is aimed at providing clinical ideas for diagnosis, differentiation and prognosis assessment of neuroophthalmic diseases.
Sterile marginal corneal infiltrates is a relatively rare postoperative complication after corneal refractive surgery. The key is to differentiate between infectious and non-infectious corneal infiltrates. This article reports 3 cases of sterile marginal corneal infiltrates after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Topical tobramycin and dexamethasone eye drops and eye ointment were used for treatment. After treatment, the patient's pain, foreign body sensation, and tearing symptoms were significantly relieved. Most of the peripheral corneal infiltrates lesions improved in 1 week, and gradually healed to form interlaminar scars in 2 weeks. Observation after treatment found no significant impact on visual acuity. No glucocorticoid-induced intraocular hypertension occurred.
Objective To investigate the safety and efficacy of "double lacrimal tubular catheterization and absorbable lacrimal duct anastomosis" in the treatment of lacrimal duct rupture surgery. Methods A retrospective analysis was performed on the treatment effect of 24 patients (24 cases) with primary lacrimal tubule rupture who applied "double lacrimal tubular catheterization with absorbable lacrimal anastomosis".According to the location of the tear duct rupture and the degree of medial canthus and lower eyelid laceration, different surgical plans were adopted, and the silicone tube was removed after 3~6 months after surgery. Results The lacrimal canalicular laceration and anastomosed in 100.00% during operation.There were 16 cases of 24 patients with silicone catheter removed at 3 months after surgery, and 8 cases with silicone catheter removed at 6 months after surgery.The follow-up period after extubation was 3 to 6 months. At 3-6 months after surgery, 22 (91.67%) were cured, 2 (8.33%) were improved, and 0 (0.00%) were ineffective. During the follow-up period, one patient had a small lower tear spot, and one case had poor healing at the broken end of the tear duct to form a fistula. There were 9 cases of nasal allergy in the early stage, all patients had no serious epistaxis, and all patients did not have eyelids, medial canthus, and lacrimal punctal deformities after surgery.The complication rate was 8.33%. Conclusion "Double lacrimal tubular catheterization with absorbable lacrimal anastomosis" is safe and effective in the treatment of lacrimal duct rupture.
