Diabetes mellitus causes diabetic retinopathy (DR) and diabetic macular edema (DME), which are important causes of blindness and low vision in adults.With the improvement of living standard, the innovation of diagnostic technology and the awareness of medical consultation, the incidence of DR and DME is gradually increasing, which has become an important public health problem for human beings in the world. Studies have shown that dietary intake can affect DR and DME. Tea, coffee,olive oil, crocin, coreopsis tinctoria nutt, lutein, have protective effects on DR.Smoking is an independent risk factor for DR. Higher dietary choline, rice, unsweetened soda and unsweetened carbonated beverages also exacerbate DR. Micronutrients such as zinc and selenium are protective factors for DR, the effect of iron and copper on DR is debated. Deficiencies of vitamins A, B, C, D, and E can exacerbate DR progression. Exploring the effect of diet on DR aims to provide a new way of the treatment of DR.
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
Meibomian gland dysfunction (MGD) is a common ophthalmic disease, which is the main cause of evaporative dry eye. Population-based studies have suggested that the prevalence of MGD is high in Asia, with a reported incidence of 46.2% to 69.3%. Current modalities of MGD treatment include lid hygiene, warm compresses,massage, artificial lubricants, systemic and topical antibiotics, etc., among which warm compress is a common at-home treatment. Due to different eyelid warming methods, temperature, durations of heat application, frequency and compliance, there is no uniform standard for the application of warm compress to the treatment of MGD.In addition, adverse events of warm compress, such as blurred vision and thermal damage, have not attracted enough attention in clinical practice. Therefore, in order to improve the clinical efficacy of warm compress and reduce its adverse events, it is necessary to conduct standardized guidance or treatment of warm compress in the future. Based on the above considerations, this article will briefly review the application of warm compress to the treatment of MGD.
Ocular myasthenia gravis (OMG) is an autoimmune disease involving the postsynaptic membrane of the neuromuscular junction. The fluctuation of OMG and the clinical characteristics of fatigue easily lead to a high rate of missed diagnosis and misdiagnosis, which seriously affects the quality of life of patients. Therefore, detection methods play an important role in the early diagnosis of OMG. In this paper, OMG detection methods were reviewed in clinical examination, neostigmine test, autoantibody detection, electrophysiological detection, and other aspects, in order to provide useful guidance for the early diagnosis of OMG.
Primary acquired nasolacrimal duct obstruction (PANDO), which mainly occurs in the middle-aged and elderly women, is the most common type of obstructive diseases of the lacrimal duct, and it is also a common and frequently-occurring disease in ophthalmology. It constantly occurs secondary to various symptoms and signs of acute or chronic dacryocystitis, which seriously affects the daily work and life of patients. This article summarizes the research progress on the possible pathogenesis of PANDO in recent years, the urgent problems to be solvedand the hot research directions in the future, aiming to further deepen the understanding of the occurrence and development of lacrimal obstructive diseases.
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
Laser assisted in situ keratomileusis (LASIK) is one of the important surgical procedures for corneal refractive surgery. It is difficult to calculate IOL power for some patients with cataract and eccentric corneal ablation. This article reports a case of cataract after LASIK with eccentric corneal ablation. The ophthalmologist determined the centrality of corneal ablation and corrected the keratometry (K value), which was then substituted into the Barrett True K formula to calculate the IOL power. After cataract phacoemulsification combined with intraocular lens implantation, the visual acuity of the patient was improved.
Objective To explore the application and teaching effect of clinical guidelines combined with TBL courses in resident standardized training of ophthalmology. Methods 15 residents who received standardized training in the ophthalmology department of XX Hospital were recruited from January 2022 to June 2023. Self-study teaching and TBL teaching were successively used to study the clinical guidelines of ophthalmology. Then the teaching effect was evaluated by satisfaction questionnaire, passing rate of phase examination, achievement of academic?proficiency test and passing rate of final examination. Results The residents spoke highly of the clinical guidelines and did not perceive it as an additional learning burden. After the residents studied clinical guidelines, their passing rate of the phase exam, academic proficiency test and final examination were all 100%. In terms of cultivating teamwork ability and study atmosphere, the satisfaction of TBL lectures was significantly higher than that of self-study lectures (P < 0.001). 93.3% (14/15) of the residents preferred TBL lectures. Conclusion The combination of ophthalmology clinical guidelines and TBL teaching proved to be an effective teaching model. The residents achieved excellent teaching results in the subjective satisfaction questionnaire and objective examination scores. The successful application of our study will further provide reference to improve the standardized training courses for residents of ophthalmology.
Objective: To investigate and analyze the effect of He-Ne laser, recombinant human interferon α-2b ointment and gabapentin on skin lesion healing, sleep, pain and disease course in acute herpes zoster ophthalmicus. Methods: Sixty patients with acute herpes zoster ophthalmicus were collected from January 2017 to January 2020 in our hospital. According to the different treatment, they were divided into an experimental group (32 cases) and a control group (28 cases). The patients in the control group received routine basic treatment including antiviral, neurotrophic therapy, interferon α-2b ointment and gabapentin, and the experimental group was treated with He-Ne laser on the basis of control group treatment. The time of detumescence, blister stopping, scab formation, scab removal and pain relief, Visual Analogue Scale (VAS) score, sleep time, adverse reactions, and postherpetic neuralgia were collected and analyzed. Results: Before treatment, there was no significant difference in the observation indexes between the two groups (P>0.05); after treatment, the observation indexes of skin rash (detumescence, blister stopping, scab formation, scab removal) and pain relief time in the experimental group were significantly less than those in the control group, and the scab removal rate on the 4th and 7th days post-treatment in the experimental group was significantly higher than that in the control group; after treatment, the sleep duration was prolonged, and the VAS score was decreased. For pain relief and prolonging sleep time, the experimental group was better than the control group, and the difference was statistically significant P<0.05).There was no significant difference in scab removal rate on 2, 14 and 28 days post-treatment (P>0.05). The effective rate in the experimental group (93.75%) was significantly higher than that in the control group (75%), and the difference was statistically significant (P=0.047); there was no significant difference in PHN and adverse reactions between the two groups (P>0.05). Conclusion: He-Ne laser combined with interferon α-2b ointment and gabapentin is safe and effective in the treatment of acute herpes zoster ophthalmicus. It can significantly relieve the acute pain, promote the recovery of rash, improve sleep quality, shorten the disease course, and can be actively promoted in clinical usage.
objective: to analyze the occurrence regularity, clinical features and pathogenesis of perifoveal exudative vascular abnormal complex (PEVAC) in order to improve clinicians' understanding of the disease and prevent misdiagnosis and missed diagnosis. Methods: the case reports included in CNKI, VIP, Wan-FangData, PubMed, Medline, Elsevier and other domestic and foreign literature databases were searched, and the general condition, clinical characteristics and outcome of the patients were analyzed. Results: 19 effective case reports were selected, involving 54 patients, 55 eyes, including 32 males and 22 females; the age was 44-90 years old, with an average of (69.07 ±13) years; clinical features: 1 Visual acuity: from 0.05 to 1.0, 11 cases (20%) from 0.05 to 0.3, 27 cases (50%) from 0.4 to 0.6, and 16 cases (30%) from 0.8 to 1.0. 2 concomitant systemic condition: 46 cases had no systemic disease (85%), 8 cases (15%) had systemic disease and the systemic disease was well controlled. 3 concomitant with other eye diseases: there were 24 cases of ophthalmopathy (45%), 17 cases of AMD and / or other macular lesions (30%), 5 cases of myopia (including 2 cases with anterior macular membrane), 1 case of macular epiretinal membrane with macular lamellar foramen and 2 cases of vitreous macular adhesion. 4 treatment measures and effect statistics: 34 cases were followed up (7 cases improved, 12 cases unresponsive, 15 cases lost), 11 cases were treated with simple medication (5 cases effective, 6 cases unresponsive), 6 cases were treated with combined laser (5 cases effective, 1 case unresponsive), 1 case was treated with simple laser (1 case was effective), 1 case was treated with diclofenac sodium eye drops (1 case was effective). Conclusion: PEVAC is a newly diagnosed disease, which is characterized by abnormal isolated peri-foveal aneurysms, rigid exudation and peripheral retinal edema, mostly moderate visual impairment, mostly in healthy individuals, and can also occur in patients with diabetes, hypertension and even eye diseases such as AMD, myopia, epimacular membrane and so on. Clinicians should pay more attention to the possibility of this special perifoveal disease in differential diagnosis. Generally choose follow-up, can also try to use laser, anti-VEGF, local non-steroidal anti-inflammation and other treatment methods, and realize its relatively poor prognosis or very long recovery time. With the deepening of the study of the disease, the formulation of the pathogenesis and effective treatment strategy of PEVAC is worthy of further study.
