The training of qualified ophthalmologists is important to help our country prevent eye diseases and visual impairment more effectively and to provide quality eye care services to the people according to their needs. This article focuses on comparing the details of the standardized ophthalmology residency training system in the Mainland and Hong Kong, and analyzing the similarities and differences in ophthalmology education in the Mainland and Hong Kong. The comparison of ophthalmology education between the Mainland and Hong Kong will help us to improve the ophthalmology residency education and training system in the Mainland in the light of our own actual situation. Relevant reference information is provided for medical educators.
【Abstract】 Objective To analyze the application and testing of clinical diagnosis and treatment involving non-surgical routine test items in a tertiary ophthalmology specialty hospital in the south of China in the past five years, and to provide a basis for ophthalmologists to understand the overview of test-assisted diagnosis, laboratory project management in specialty hospitals, and the development of new projects. Methods From the hospital laboratory information management system, 22,453 blood samples (a total of 94,081 test items) of 12,866 patients attending Sun Yat-sen University Zhongshan Ophthalmology Center during the period from January 1, 2018, to December 31, 2022, were exported from the relevant test records. The departments and specialists applying for testing were classified into 10 subspecialties according to the recommendations of the Chinese Medical Association Ophthalmology Branch, and the information on diseases and test items was statistically analyzed and described in the form of text, bar graphs and line graphs. Results A total of 12,866 patients applied for blood testing during the five-year, including 6,356 male patients (49.4%) and 6,510 female patients (50.6%). Based on the first ophthalmic specialty classification, the top three ophthalmic diseases were oculoplastic/ophthalmic oncology diseases in 5214 cases (40.5%), fundus diseases in 3487 cases (27.1%), and keratoconus diseases in 1711 cases (13.3%). The volume of specimens requested for testing increased from 3,163 in 2018 to 5,903 in 2022, with a general upward trend. Analyzing the application samples from specialists, oculoplastic/orbital disease specialists had the largest number of application slips, with 6,751 (30.1%), of which autoimmune disease testing accounted for the largest proportion of 49.1%, and thyroid disease-related testing accounted for 41.9%; ocular immunity specialists applied for 4,214 tests (18.8%), with autoimmune disease testing accounting for 55.7% of the total and 32.5% for infectious item testing; fundus specialists applied for a total of 3,629 tests (16.2%), with autoimmune disease testing and infectious item testing accounting for 47.8% and 39.6%, respectively; and cornea specialists applied for 1,436 tests, with the proportion of allergic disease testing accounting for 41.2%. Based on the fact that one application form can test multiple items at the same time, oculoplastic/orbital specialists applied for the most testing items with 33,513 items, thyroid disease testing accounted for 65.0%, keratoconus specialists applied for 16,482 items, and allergic disease testing accounted for 83.4%, and fundus specialists and ocular immunity specialists applied for 8,794 items and 8,047 items, respectively, and all of them were dominated by autoimmune disease testing, which accounted for 42.5% and 40.4% respectively. Conclusion The number of applications for clinical diagnosis and treatment involving non-surgical routine tests in ophthalmology specialty hospitals has increased year by year, with the number of applications for each subspecialty being significantly uneven, and the composition of the items being influenced by the disease characteristics of the subspecialty. Specialized hospitals should strengthen the publicity and management of non-surgical routine testing items.
【Abstract】 Objective To analyze the application and testing of clinical diagnosis and treatment involving non-surgical routine test items in a tertiary ophthalmology specialty hospital in the south of China in the past five years, and to provide a basis for ophthalmologists to understand the overview of test-assisted diagnosis, laboratory project management in specialty hospitals, and the development of new projects. Methods From the hospital laboratory information management system, 22,453 blood samples (a total of 94,081 test items) of 12,866 patients attending Sun Yat-sen University Zhongshan Ophthalmology Center during the period from January 1, 2018, to December 31, 2022, were exported from the relevant test records. The departments and specialists applying for testing were classified into 10 subspecialties according to the recommendations of the Chinese Medical Association Ophthalmology Branch, and the information on diseases and test items was statistically analyzed and described in the form of text, bar graphs and line graphs. Results A total of 12,866 patients applied for blood testing during the five-year, including 6,356 male patients (49.4%) and 6,510 female patients (50.6%). Based on the first ophthalmic specialty classification, the top three ophthalmic diseases were oculoplastic/ophthalmic oncology diseases in 5214 cases (40.5%), fundus diseases in 3487 cases (27.1%), and keratoconus diseases in 1711 cases (13.3%). The volume of specimens requested for testing increased from 3,163 in 2018 to 5,903 in 2022, with a general upward trend. Analyzing the application samples from specialists, oculoplastic/orbital disease specialists had the largest number of application slips, with 6,751 (30.1%), of which autoimmune disease testing accounted for the largest proportion of 49.1%, and thyroid disease-related testing accounted for 41.9%; ocular immunity specialists applied for 4,214 tests (18.8%), with autoimmune disease testing accounting for 55.7% of the total and 32.5% for infectious item testing; fundus specialists applied for a total of 3,629 tests (16.2%), with autoimmune disease testing and infectious item testing accounting for 47.8% and 39.6%, respectively; and cornea specialists applied for 1,436 tests, with the proportion of allergic disease testing accounting for 41.2%. Based on the fact that one application form can test multiple items at the same time, oculoplastic/orbital specialists applied for the most testing items with 33,513 items, thyroid disease testing accounted for 65.0%, keratoconus specialists applied for 16,482 items, and allergic disease testing accounted for 83.4%, and fundus specialists and ocular immunity specialists applied for 8,794 items and 8,047 items, respectively, and all of them were dominated by autoimmune disease testing, which accounted for 42.5% and 40.4% respectively. Conclusion The number of applications for clinical diagnosis and treatment involving non-surgical routine tests in ophthalmology specialty hospitals has increased year by year, with the number of applications for each subspecialty being significantly uneven, and the composition of the items being influenced by the disease characteristics of the subspecialty. Specialized hospitals should strengthen the publicity and management of non-surgical routine testing items.
Objective: To explore the application of Optical Coherence Tomography Angiography (OCTA) in non proliferative diabetic retinopathy (NPDR) in Kashi area. Methods: Thirty two patients with non proliferative diabetes and 50 normal controls were selected from the ophthalmology department of our hospital. OCTA data of the areas of the Superficial Retinal Vascular Plexus (SVP), the Deep Retinal Vascular Plexus (DVP) and the Deep Capillary Free Zone (FAZ) were obtained from the two groups. Results: In the NPDR group, there were 11 males (34.375%) and 21 females (65.625%), with an average age of 58 ± 9.89 years, an average age of 13.39 ± 7.2 years of diabetes, an average glycosylated hemoglobin value of 9.48 ± 2.28 mmol/L, and an optimal corrected visual acuity (BCVA) of 0.54 ± 0.3. There are 50 cases in the normal control group, with 21 males (42%) and 29 females (58%). The best corrected visual acuity (BCVA) is 0.97 ± 0.12. The SVP blood flow density (%) in the NPDR group was (21.65 ± 5.38), while the normal control group was (26.36 ± 6.23). The DVP blood flow density (%) in the NPDR group was (19.12 ± 4.3), while the normal control group was (27.51 ± 2.95). The FAZ area (mm2) in the NPDR group was (0.51 ± 0.15), while the normal control group was (0.41 ± 0.14). Compared with the normal control group, the SVP blood flow density and DVP blood flow density in the NPDR group were significantly reduced, while the FAZ area was significantly increased, And it has statistical significance (P=0.001, P=0.000, P=0.003, respectively). Conclusion: OCTA is helpful for the diagnosis of non proliferative diabetes patients in Kashi area, and may be able to detect the retinal blood flow changes of diabetes retinopathy earlier.
A 5 years old girl complained of “right eye exotropia and poor vision of the right eye for 4 years” visited to the Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine on November 15, 2023. The child had a full-term vaginal delivery, and there was no abnormality in her personal and family history. Eye examination showed normal palpebral fissures in both eyes and no obvious ptosis. Both eyes had clear corneas, normal anterior chamber depth, and clear lenses. The pupil of the right eye was approximately 6mm dilated and unresponsive to direct light reflection, and the pupil of the left eye was approximately 2.5mm and sensitive to direct light reflection. Fundus examination showed clear optic disc border in both eyes and no obvious abnormality in retina. The visual acuity of both eyes was 0.3 in the right eye and 0.7 in the left eye. The cycloplegic refraction of compound tobicamide eye drops was +1.25D=0.3 in the right eye and +1.25D=0.7 in the left eye. The intraocular pressure was normal in both eyes. Eye movement examination showed a normal eyelid position, dilated pupil, weakened response to light, and the exotropia was increased lasted for about 2 minutes of the right eye in paralysis stage. While during the spasm period, the eyelid position of the right eye was normal, and the eye position of the right eye gradually changed from exotropia to esotropia. The pupil of the right eye was constricted and the response to light weakened for about 15s (Video 1). Brain and orbit enhanced magnetic resonance imaging showed no abnormal lesions. We diagnosed “periodic oculomotor nerve palsy and right amblyopia in the right eye.”
Dominant optic atrophy (DOA) is an inherited optic neuropathy and more than 75% of DOA patients harbor pathogenic mutations in OPA1. We reported a 39-year-old female harboring c.2119G>T mutation of OPA1 and manifested progressive visual impairment after hydroxychloroquine (HCQ) therapy. The patient’s visual impairment remained stable for 10 years until she began to take HCQ 13 months ago. She complained about progressively decreased vision in both eyes. Bilateral pale temporal optic disc was similar with that of 11 years ago. Optical coherence tomography showed bilateral moderate retinal nerve fiber layer thinning other than the nasal quadrant and general thinning of the inner retina in the macular. Microcystic macular edema was noted in nasal macular in both eyes. Visual field testing showed paracentral scotoma and microperimetry showed decrease sensitivity in the macular in both eyes. After the patient stopped taking HCQ, her functional tests including visual acuity, field testing and microperimetry testing was stable compared with those of 2 years ago. However, progressive inner macular and RNFL thinning was shown by OCT. OPA1 c.2119 G>T found in this patient was a mutation that had been rarely reported in previous studies. The patient has been followed up for over 10 years and her visual acuity stayed stable for decades long until she took HCQ for 13 months. Her vision decline terminated after she stopped taking HCQ. Although HCQ toxicity is highly related to the duration and daily dose, HCQ may aggravate visual impairment in certain individuals harboring OPA1 mutation. Patients with DOA should avoid using neurotoxic HCQ and other medications that may interfere mitochondrial metabolism.
Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm2 to postoperative (2 472.54±394.32)/mm2 (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia
Polypoidal choroidal vasculopathy (PCV) is a common blinding disease in Asian populations. Massive hemorrhage secondary to PCV includes subretinal hemorrhage (SRH) and vitreous hemorrhage (VH). The risk factors for SRH include a long duration, clustered PCV, and non-regression of polyp lesions. The treatments for SRH including anti-vascular endothelial growth factor drugs, photodynamic therapy, laser, vitreous pneumatic displacement, intravenously injected tissue plasminogen activator, vitrectomy and combination therapy. Whether macular fovea is involved and the time since bleeding onset are the main factors affecting the choice of treatment for SRH. Older age of onset, history of hypertension, retinal pigment epithelium detachment, photodynamic therapy history and larger SRH area were associated with higher risk of VH. PCV patients with massive VH should be treated with vitrectomy, while the timing and technique of operation should be paid attention to. At present, the risk factors of PCV massive bleeding are not completely clear, and its treatment methods are diverse, which requires a large number of studies to prove its effectiveness and establish expert diagnosis and treatment consensus.
This paper raises questions on the article titled Expert consensus on the application of retrobulbar block issued by Eye Science, Vol. 38, No. 9, 2023. We consider that there are objections to the contraindications, operating steps, and causes of postoperative ptosis and contralateral amaurosis of retrobulbar block anesthesia.
