Retinal neurovascular characteristics for the diagnosis and staging of nondiabetic chronic kidney disease: a diagnostic study

Retinal neurovascular characteristics for the diagnosis and staging of nondiabetic chronic kidney disease: a diagnostic study

:371-388
 
Aims: To identify the characteristic retinal neurovascular changes in patients in different stages of nondiabetic chronic kidney disease (CKD) and to develop a model for the accurate diagnosis of nondiabetic CKD.
Methods: Peripapillary retinal nerve fiber layer (pRNFL) thickness and average macular ganglion cell-inner plexiform layer (GC-IPL) thickness of nondiabetic CKD patients and healthy controls (HC) were evaluated by spectral-domain optical coherence tomography (OCT). The vessel density (VD) and perfusion density (PD) of the macula were obtained from optical coherence tomography angiography (OCTA). The estimated glomerular filtration rate (eGFR) was obtained to access the kidney function of CKD patients. Multiple linear regression models were used to adjust for confounding factors in statistical analyzes. The diagnostic capabilities of the parameters were evaluated by logistic regression models.
Results: 131 nondiabetic CKD patients and 62 HC 
entered the study. eGFR was found significantly associated with parafoveal VD and PD (average PD: β = 0.000 4, Padjusted < 0.001) in various sectors. Thinning of pRNFL (β = -6.725, Padjusted0.001) and GC-IPL (β = -4.542, Padjusted < 0.001), as well as decreased VD (β = -2.107, P- adjusted0.001) and PD (β = -0.057, Padjusted = 0.032 8) were found in CKD patients. Thinning of pRNFL and deteriorated perifoveal vasculature were found in early CKD, and the parafoveal and foveal VD significantly declined in advanced CKD. Logistic regression models were employed, and selected neurovascular parameters showed an AUC of 0.853 (95% Confidence Interval [CI]: 0.795 to 0.910) in distinguishing CKD patients from HC.
Conclusions: Distinctive retinal neurovascular 
characteristics could be observed in nondiabetic CKD patients of different severities. Our results suggest that retinal manifestations could be valuable in the screening, diagnosis, and follow-up evaluation of patients with CKD.
Aims: To identify the characteristic retinal neurovascular changes in patients in different stages of nondiabetic chronic kidney disease (CKD) and to develop a model for the accurate diagnosis of nondiabetic CKD.
Methods: Peripapillary retinal nerve fiber layer (pRNFL) thickness and average macular ganglion cell-inner plexiform layer (GC-IPL) thickness of nondiabetic CKD patients and healthy controls (HC) were evaluated by spectral-domain optical coherence tomography (OCT). The vessel density (VD) and perfusion density (PD) of the macula were obtained from optical coherence tomography angiography (OCTA). The estimated glomerular filtration rate (eGFR) was obtained to access the kidney function of CKD patients. Multiple linear regression models were used to adjust for confounding factors in statistical analyzes. The diagnostic capabilities of the parameters were evaluated by logistic regression models.
Results: 131 nondiabetic CKD patients and 62 HC 
entered the study. eGFR was found significantly associated with parafoveal VD and PD (average PD: β = 0.000 4, Padjusted < 0.001) in various sectors. Thinning of pRNFL (β = -6.725, Padjusted < 0.001) and GC-IPL (β = -4.542, Padjusted < 0.001), as well as decreased VD (β = -2.107, Padjusted < 0.001) and PD (β = -0.057, Padjusted = 0.032 8) were found in CKD patients. Thinning of pRNFL and deteriorated perifoveal vasculature were found in early CKD, and the parafoveal and foveal VD significantly declined in advanced CKD. Logistic regression models were employed, and selected neurovascular parameters showed an AUC of 0.853 (95% Confidence Interval [CI]: 0.795 to 0.910) in distinguishing CKD patients from HC.
Conclusions: Distinctive retinal neurovascular 
characteristics could be observed in nondiabetic CKD patients of different severities. Our results suggest that retinal manifestations could be valuable in the screening, diagnosis, and follow-up evaluation of patients with CKD.
眼科麻醉专题

全身麻醉在青光眼日间手术中的应用分析

The application of general anesthesia in the ambulatory glaucoma surgery

:541-546
 
目的:分析全身麻醉在青光眼日间手术中的应用特点。方法:回顾性收集2023年1月—6月于中山大学中山眼科中心在全身麻醉下接受青光眼日间手术患者71例(全麻组),并选择同时期在局部麻醉下接受青光眼手术患者154例(局麻组),同时以年龄为配对因素行倾向评分匹配分析。主要观察指标为患者术后离院时间,并对患者的手术时间、手术前后眼压、视力、中央前房深度、周边前房深度、甘露醇使用情况以及术后较术前眼压降低差值进行分析。结果:与局麻组比较,全麻组患者术后离院时间未有延长(P>0.05);全麻组患者术前眼压较高(P<0.001)、中央前房深度浅(P=0.018)、周边前房深度浅(P<0.001);且全麻组患者在术后较术前眼压降低差值更大(P=0.002)。组间术后中央前房深度、术后使用甘露醇者比例及术后视力提高者比例比较差异均无统计学意义(P>0.05)。结论:术前眼部条件较差的青光眼患者能在全身麻醉下完成日间手术,且不延长术后离院时间。
Objective: To analyze the application of general anesthesia in the ambulatory glaucoma surgery. Methods: This retrospective study collected 71 patients who underwent ambulatory glaucoma surgery with general anesthesia at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2023 to June 2023, and 154 patients who underwent similar glaucoma surgery with local anesthesia during the same period. Age differences between the two groups were balanced by propensity score-matched analysis. The main outcome measures were the patients' post-operative discharge time, and the secondary end points included the duration of surgery, the patients' preoperative and postoperative intraocular pressure (IOP), visual acuity status, central anterior chamber depth, peripheral anterior chamber depth, mannitol use, the difference in IOP reduction after surgery compared to preoperative. Results: After propensity score-matched analysis, as compared with group L, general anesthesia did not prolong the patients' post-operative discharge time(P>0.05).Patients in the group G displayed significant higher IOP (P<0.001), shallower central anterior chamber depth (P=0.018), and shallower peripheral anterior depth (P<0.001). The dramatic reductions in IOP after surgery were exhibited in group G as compared with group L(P=0.002). There were no statistically significant differences in postoperative central anterior chamber depth, incidences in postoperative mannitol use, as well as incidences in visual acuity improvement on the first day after surgery. Conclusion: Glaucoma patients with poor preoperative ocular conditions were able to complete the complex glaucoma surgery under general anesthesia without prolonging their post-operative discharge time.
论著

微创玻璃体切割术后急性眼内炎的临床分析

Clinical analysis of endophthalmitis after minimally invasive vitrectomy

:113-119
 
目的:分析23G/25G微创玻璃体切割术后发生眼内炎的危险因素。方法:回顾性分析2014年6月—2023年5月于中国人民解放军中部战区总医院行微创玻璃体切割术后,临床诊断为眼内炎患者(开放性眼外伤患者除外)的临床特征。结果:纳入8 955例行微创玻璃体切割术患者,其中11例微创玻璃体切割术后患眼发生眼内炎,发生率为0.12%。平均年龄(60.8±7.6)岁。11例其中,5例(45.4%)患者合并糖尿病;原发眼疾构成情况:黄斑疾病7例(63.6%)、增殖期糖尿病性视网膜病变继发玻璃体积血2例(18.2%),视网膜裂孔继发玻璃体积血1例(9.1%)、视网膜脱离1例(9.1%);术中联合行白内障手术3例(27.3 %);术毕8例(72.7%)患眼玻璃体腔填充无菌空气,3例(27.3%)填充平衡盐溶液,术毕所有患者均未缝合巩膜穿刺切口;术后低眼压3例(27.3 %)。术后发生眼内炎的时间为(2.8±1.1)d。11例患者经过局部和全身抗感染治疗后炎症控制不佳,均再次行玻璃体切割术联合术中配置万古霉素液灌注,其中9例术毕玻璃体腔填充硅油,术后所有眼内炎得到控制,10例(91.0%)患者最终矫正视力有所提高。结论:微创玻璃体切割术后,免缝合的巩膜切口可能是病原微生物侵入眼内导致眼内炎的潜在途径。尤其要重视黄斑手术中玻璃体不全切除引起巩膜切口处发生玻璃体束综合征可能是术后发生眼内炎的危险因素之一。


Objective: To analyze risk factors for endophthalmitis occurred after 23G/25G minimally invasive vitrectomy. Methods: Retrospective analysis of the clinical characteristics of patients with endophthalmitis (except patients with open eye trauma) after minimally invasive vitrectomy in General Hospital of Central Theater Command(Wuhan,430064) from June 2014 to May 2023. Results: This study included 8,955 patients, of which 11 cases occurred endophthalmitis after minimally invasive vitrectomy, with an incidence rate of 0.12%. The average age was (60.8±7.6) years, and 5 patients (45.4%) were complicated with diabetes; The composition of primary eye diseases: 7 cases (63.6%) of macular disease, 2 cases (18.2%) of vitreous hemorrhage secondary to proliferative diabetic retinopathy and 1 case (9.1%) vitreous hemorrhage secondary to retinal fissure, 1 case (9.1%) of retinal detachment; During the operation, 3 cases (27.3%) underwent combined cataract surgery; After the operation, 8 cases (72.7%) were filled with sterile air in the vitreous cavity of affected eye, the other 3 cases (27.3%) were filled with equilibrium liquid,and sclera puncture incision was not sutured in all patients; 3 cases (27.3%) had low intraocular pressure after operation. The time for postoperative endophthalmitis to occur after operation was 2.8±1.1day. 11 patients had poor inflammation control after local and systemic anti-inflammatory treatments, and all underwent vitrectomy combined with intraoperative injection of vancomycin solution. Among them, 9 patients were filled with silicone oil in the vitreous cavity after the surgery. After the operation, all the endophthalmitis were controlled and final corrected visual acuity of 10 patients improved. Conclusions: Minimally invasive vitrectomy and suture-free scleral incision may be a potential way for pathogenic microorganisms to invade the eye and cause endophthalmitis. Particular attention should be paid to the ‘Vitreous Wick Syndrome’ at the scleral incision caused by incomplete vitrectomy in macular surgery, which may be one of the risk factors for postoperative endophthalmitis.

BJO专栏

角膜塑形镜对近视儿童脉络膜厚度和脉络膜轮廓的长期影响

Long-term effect of orthokeratology on choroidal thickness and choroidal contour in myopic children

:63-74
 
目的:调查角膜塑形镜对近视儿童脉络膜厚度和脉络膜轮廓的长期影响。方法:受试者来自一项2年的随机对照试验。研究对象为年龄8~12岁、等效球镜在-1.00~-6.00 D的儿童(n=80),这些研究对象被随机分配到对照组(n=40)和角膜塑形镜组(n=40)。本研究在基线和1、6、12、18、24个月的随访中收集光学相干断层扫描图像(optical coherence tomography,OCT),然后基于OCT图像计算脉络膜厚度和脉络膜轮廓。在这些随访点也同时测量了眼轴长度(axial length,AL)和其他眼生物学参数。结果:在2年内,对照组的脉络膜厚度随时间变薄,脉络膜轮廓变得更加后凸(均P<0.001)。角膜塑形镜可以改善脉络膜厚度(均P<0.001),并在所有随访中维持脉络膜轮廓不后凸(均P<0.05)。在角膜塑形镜组中,脉络膜轮廓在颞侧的变化小于鼻侧(P=0.008),而脉络膜厚度在颞侧以黄斑中心凹为中心、直径3 mm线性扫描区域的增厚更明显(P<0.001)。2年内脉络膜厚度的变化与对照组中2年内AL变化呈负相关(r=-0.52,P<0.001),然而,这一规律被角膜塑形镜打破(r=-0.05 P=0.342)。在多变量回归模型中校正其他变量后,角膜塑形镜对脉络膜厚度的影响是稳定的。结论:角膜塑形镜可以改善脉络膜厚度并维持脉络膜轮廓,但这种效果在长期内趋于减弱。
Objective: To investigate the long-term effect of orthokeratology on the choroidal thickness and choroidal contour in myopic children. Methods:Subjects were from a conducted 2-year Randomized Clinical Trial. Children (n=80) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were randomly assigned to the control group (n=40) and ortho-k group (n=40). OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits, then the choroidal thickness and choroid contour were calculated. Axial length (AL) and other ocular biometrics were also measured. Results: During two years, in the control group, the choroidal thickness became thinning and the choroidal contour became prolate with time at all visits (all P<0.001). Ortho-k can improve the choroidal thickness (all P<0.001) and maintain the choroidal contour at all visits (all P<0.05). In the ortho-k group, the choroidal contour was less changed in the temporal than nasal (P=0.008), and the choroidal thickness was more thickening in the temporal 3 mm (P<0.001). Two-year change in choroidal thickness was significantly associated with the two-year AL change in the control group (r=-0.52, P<0.001), however, this trend was broken by ortho-k (r=-0.05, P=0.342). After being adjusted by other variables in the multivariable regression model, the effect of ortho-k on choroidal thickness was stable. Conclusions: In a short term, ortho-k can improve the choroidal thickness and maintain the choroidal contour, but this effect diminished in a long term. Further study with larger sample size and longer follow-up is warranted to refine this issue.
论著

人工智能在人工晶状体屈光力计算的应用

Application of artificial intelligence in intraocular lens power calculation

:790-799
 
目的:评估新一代基于人工智能(artificial intelligence,AI)的人工晶状体(intraocular lens,IOL)计算公式的准确性。方法:本研究为回顾性研究,纳入因白内障行晶状体超声乳化联合IOL植入术的262例患者262眼。在术前,通过IOLMaster700获取角膜曲率、角膜白到白、中央角膜厚度、前房深度、晶状体厚度以及眼轴长度。使用第三代公式(SRK/T、Holladay 1和Hoffer Q)、Barrett UniversalⅡ(BUⅡ)、新一代AI公式(Kane、Pearl-DGS、Hill-RBF 3.0、Hoffer QST和Jin-AI)对术后屈光状态进行计算,并与术后实际的屈光状态进行比较。在将预测误差(prediction error,PE)归零后,分析了各公式的标准差(standard deviation,SD)、绝对误差均值(mean absolute error,MAE)、绝对误差中位数(median absolute error,MedAE)以及PE在±0.25、±0.50、±1.00、±2.00 D范围内的百分比。结果:基于AI的IOL屈光力计算公式的SD、MAE和MedAE的范围分别为0.37 D(Kane和Jin-AI)至0.39 D(Hoffer QST)、0.28 D(Hill-RBF 3.0和Jin-AI)至0.31 D(Hoffer QST)以及0.21 D(Hill-RBF3.0和Jin-AI)至0.24 D(HofferQST);均低于第三代公式(SD:0.43 D~0.45 D;MAE:0.34 D;MedAE:0.25 D~0.28 D)。在所有公式中,Jin-AI公式预测误差在±0.50 D的比例最高,为84.73%,Kane(84.35%)和BUⅡ(83.97%)公式次之。结论:在IOL屈光力预测上,与传统第三代公式相比,新一代基于AI的公式表现出更高的准确性,可以使更多的患者在术后获得预期的屈光状态。
Objective: To evaluate the accuracy of new generation artificial intelligence (AI)-based intraocular lens (IOL)power calculation formulas. Methods: This retrospective study included a total of 262 eyes from 262 patients with cataract who underwent uneventful phacoemulsification combined with IOL implantation. Keratometry, corneal white-to-white, central corneal thickness, anterior chamber depth, lens thickness, and axial length were measured by the IOL Master 700 before surgery. Predicted refractive errors were calculated by the third-generation formulas (SRK/T, Holladay 1, and Hoffer Q), Barrett UniversalⅡ (BUⅡ), and the newer-generation AI formulas (Kane, Pearl-DGS, Hill-RBF 3.0, Hoffer QST, and Jin-AI), and were compared with the actual postoperative refractive value. After adjusting the prediction error (PE) to zero, the standard deviation (SD), mean absolute error (MAE), median absolute error (MedAE), and the percentage of a PE within the range of ±0.25 diopter (D), ±0.50 D, ±1.00 D, and ±2.00 D were analyzed. Results: The SD, MAE, and MedAE of the AI-based formulas ranged from 0.37 D (Kane and Jin-AI) to 0.39 D (Hoffer QST), 0.28 D (Hill-RBF 3.0 and Jin-AI) to 0.31 D (Hoffer QST), and 0.21 D (Hill-RBF 3.0 and Jin-AI) to 0.24 D (Hoffer QST), respectively. These values were all lower than those of the third-generation formula (SD: 0.43 D to 0.45 D; MAE: 0.34 D; MedAE: 0.25 D to 0.28 D). Among all the formulas, the Jin-AI formula had the highest proportion of a PE within ±0.50 D (84.73%), followed by Kane (84.35%) and BUⅡ (83.97%) formulas. Conclusion: The new AI-based IOL formulas show higher accuracy compared with the traditional third-generation ones in predicting IOL power. thereby enabling more patients to achieve the expected refractive outcomes after surgery
综述

神经退行性疾病的眼部病理改变

Ocular pathological changes in neurodegenerative diseases

:225-238
 
视网膜是中枢神经系统的一部分。在胚胎起源上,视网膜和大脑均由神经管发育而来。因此,许多发生在大脑的神经退行性疾病往往会同时累及视网膜。而神经退行性疾病过程中相关的特征性病理改变,如病理性蛋白聚集和神经血管单元破坏也常能在视网膜组织中被检测到。在一些神经退行性疾病中,眼部的病理改变甚至在临床症状出现之前就已发生;其次视网膜易于观察且局部治疗操作便捷,因此近年来视网膜在中枢神经退行性疾病发病机制研究、早期诊断和新型治疗方式探究等方面备受关注。该文对常见神经退行性疾病的眼部病理改变进行综述,旨在为大脑和视网膜神经退行疾病的发病机制、诊断以及治疗研究提供新的见解。
The retina is a part of the central nervous system. Developmentally, both retina and brain are derived from the neural tube. Therefore, many neurodegenerative diseases that occur in the brain tend to involve both the retina. In the process of neurodegenerative diseases, related characteristic pathological changes, such as pathological protein aggregation, neurovascular unit impairment can often be detected in retinal tissue. In some neurodegenerative diseases, pathological changes in the eye occur even before clinical symptoms appear. In addition, the retina are easy to observe and local treatments are convenient. In recent years, the manifestations of the retina have attracted much attention in the study of pathogenesis, early diagnosis, and new treatments of systemic central neurodegenerative diseases. In this way, this article reviews the ocular pathological changes of common neurodegenerative diseases, aiming to provide new insights into the pathogenesis, diagnosis, and treatment of brain and retinal neurodegenerative diseases.
综述

区块链在药物临床试验中的应用

Application of blockchain technology in clinical drug trial

:46-49
 
当前,药物临床试验面临着两大难题:数据真实性及相关人员操作规范性。现阶段国内外在药物临床试验方面的监管主要以事后监查为主,在数据质量管理以及操作规划标准的监查方面存在一定的时延性。而区块链通过非对称加密、哈希算法及智能合约等技术,可以在保证受试者隐私信息的前提下,提高政府相关监督机构的监管效率,提升药物临床试验数据管理的透明度;同时,与物联网的紧密结合可以实现对标准操作规范的进一步核查,与人工智能的结合有望实现受试者的自动招募。
Clinical drug trials are confronted with two major issues: first, data authenticity, for instance, if any data falsification is conducted during the whole trial; second, whether the standard of procedure is accordingly conducted throughout the whole trial or not. Currently, both domestic and overseas clinical drug trials are not supervised without delay (ex-post inspection). Blockchain technology can improve the efficiency of Food and Drug Administration and the transparency of trials while the rights and safety of human research subjects are guaranteed by the integrated technology such as chained structure, asymmetry key algorithm, hash algorithm, and smart contract. Furthermore, with the assistance of internet of things (IoT) and artificial intelligence (AI), the actual supervision over the whole trial and automatic recruitment of human research subjects are expected to achieve.
综述

机器人辅助系统在眼底手术中的应用

Application of robot auxiliary system in fundus surgery

:194-199
 
传统的眼底手术要求眼科医生具备精细的操作技术,但即便拥有再精湛的操作技术,眼底手术还是存在很大的风险性。因此,为了减少手术风险,提高手术质量,对传统眼底手术进行改进是十分必要的。近年来,在我国对于人工智能产业的大力支持之下,应用于各类行业的机器人随之诞生。机器人辅助系统(robot auxiliary system,RAS)在医学领域,特别是眼科学中应用广泛。对近几年RAS应用于眼底手术的案例进行整理总结,并将RAS参与的眼底手术以及传统的眼底手术进行对比,可以发现RAS在眼底手术中的应用可以显著提高手术效率,并降低手术风险。未来RAS的发展趋势可能着重聚焦于与深度学习算法的紧密结合。通过算法对手术中的视野图像进行预测、优化,从而让高精度的眼底手术更加高效、安全。
Traditional fundus surgery requires ophthalmologists to be equipped with sophisticated operating techniques, but even with the most sophisticated operating techniques, fundus surgery still has great risks. Therefore, in order to reduce the risk of surgery and improve the quality of surgery, it is very necessary to improve the traditional fundus surgery. In recent years, with China’s strong support for the artificial intelligence industry, robots used in various industries have been born. Robot auxiliary system (RAS) is widely used in the medical field, especially in ophthalmology. By summarizing the cases of fundus surgery with RAS in recent years and comparing the fundus surgery involving RAS with traditional fundus surgery, it can be found that the application of RAS in fundus surgery can significantly improve the efficiency of surgery and reduce the risk of surgery. The future development trend of RAS may focus on the close integration with deep learning algorithms, which can predict and optimize the field of view images during surgery so that high-precision fundus surgery can be more efficient and safer.

Point-wise correlations between 10-2 visual field and regional macular vessel density in early open-angle glaucoma

Point-wise correlations between 10-2 visual field and regional macular vessel density in early open-angle glaucoma

:389-397
 
Aims: To explore the point-wise correlations between 10-2 visual field (VF) metrics and macular vessel density, as measured by optical coherence tomography angiography (OCTA), in patients with early open-angle glaucoma (OAG) and healthy controls. Methods: This is a cross-sectional study that retrospectively analyzed data from 54 participants (18 eraly OAG patients and 36 healthy controls) from the Zhongshan Ophthalmic Center. All participants underwent comprehensive ophthalmic examinations, 10-2 VF, and macular OCTA imaging. The correlation between capillary density (CD) in macular subregions and light sensitivity (LS) at corresponding VF test points was analyzed using Pearson's correlation coefficients. Results: The analysis revealed a significant reduction in CD within the inferior macular regions of glaucomatous eyes. Notably, there were strong point-wise correlations between CD and 10-2 VF, particularly in the inferior region of outer ring (peak r = 0.534, P < 0.001). Conclusion: The point-wise correlation between 10-2 VF and macular CDdemonstrates the potential for using CD to predict central VF damage in glaucoma, emphasizing theimportance of macular microcirculation in early disease screening.
Aims: To explore the point-wise correlations between 10-2 visual field (VF) metrics and macular vessel density, as measured by optical coherence tomography angiography (OCTA), in patients with early open-angle glaucoma (OAG) and healthy controls. Methods: This is a cross-sectional study that retrospectively analyzed data from 54 participants (18 early OAG patients and 36 healthy controls) from the Zhongshan Ophthalmic Center. All participants underwent comprehensive ophthalmic examinations, 10-2 VF, and macular OCTA imaging. The correlation between capillary density (CD) in macular subregions and light sensitivity (LS) at corresponding VF test points was analyzed using Pearson's correlation coefficients. Results: The analysis revealed a significant reduction in CD within the inferior macular regions of glaucomatous eyes. Notably, there were strong point-wise correlations between CD and 10-2 VF, particularly in the inferior region of outer ring (peak r = 0.534, P < 0.001). Conclusion: The point-wise correlation between 10-2 VF and macular CDdemonstrates the potential for using CD to predict central VF damage in glaucoma, emphasizing theimportance of macular microcirculation in early disease screening.
眼科麻醉专题

可弯曲喉罩在经鼻内镜眼科日间手术中的应用观察

Application of flexible laryngeal mask in endoscopic ophthalmic day surgery

:547-553
 
目的:探究可弯曲喉罩在经鼻内镜眼科日间手术中应用的安全性。方法:收集2023年1月—2024年1月在全身麻醉(全麻)下行经鼻内镜眼科日间手术成年患者资料,分析可弯曲喉罩使用的成功率,观察患者入室时、插管后、手术开始时、手术结束时的血流动力学变化情况;并记录喉罩置入后、手术开始5 min、手术开始30 min和手术结束时的呼吸参数及患者在麻醉恢复室(post-anesthesia care unit,PACU的停留期间的并发症。结果:共635例患者纳入分析,其中619例患者选用喉罩,607例患者喉罩置入成功,成功率98.1%,喉罩置入失败12例,均为诱导期间置入失败,占1.9%,无术中发生喉罩通气失败改气管插管病例。喉罩通气能满足经鼻内镜手术需求,表现为各时点通气量无显著变化及平稳的心率和平均动脉压。患者均顺利复苏,PACU停留时间为(34.6±11.2) min,喉罩拔除时间为(14.3±4.3) min,无二次气管内插管事件发生。结论:置入成功的可弯曲喉罩可安全应用在经鼻内镜眼科日间全麻手术中。
Objective: To investigate the safety of flexible laryngeal masks in the application of endoscopic ophthalmic ambulatory surgery. Methods: Data of adult patients undergoing endoscopic day ophthalmic surgery under general anesthesia from January 2023 to January 2024 were collected; the changes in hemodynamics at T1 (entry into the operating room), T2 (after intubation), T3 (before surgery), and T6 (after surgery) time points and the respiratory parameters at T2 (after intubation), T4 (5 minutes after surgery), T5 (30 minutes after surgery), and T6 (after surgery) time points were analyzed; meanwhile, the complications during the PACU stay were also analyzed. Results: A total of 635 patients were included in the retrospective analysis, of whom 619 patients were initially used FLMA, FLMA were successfully inserted in 607 patients with a rate of 98.1% while 12 patients suffered insertion failure during the period of anesthesia induction. Importantly, none of patients displayed FLMA ventilation failure and required tracheal intubation during the period of surgery. General anesthesia via FLMA ventilation can provide high quality of surgical field for endoscopic ophthalmic surgery, as evidenced by stable heart rates and mean arterial pressure and no significant change in minute ventilation at each time points. All patients recovered uneventfully with a PACU stay time of 34.6±11.2 min and FLMA removal time of (14.3±4.3) min. None of patients exhibited subsequently endotracheal intubation after FLMA removal. Conclusion: FLMA with successful placement can be safely used for endoscopic ophthalmic ambulatory surgery under general anesthesia.
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