Background: Dyop® is a dynamic optotype with a rotating and segmented visual stimulus. It can be used for visual acuity and refractive error measurement. The objective of the study was to compare refractive errormeasurement using the Dyop® acuity and LogMAR E charts.
Methods: Fifty subjects aged 18 or above with aided visual acuity better than 6/12 were recruited. Refractive error was measured by subjective refraction methods using the Dyop® acuity chart and LogMAR E charts and the duration of measurement compared. Thibo’s notation was used to represent the refractive error obtained for analysis.
Results: There was no significant difference in terms of spherical equivalent (M) (P=0.96) or J0 (P=0.78) and J45 (P=0.51) components measured using the Dyop® acuity and LogMAR E charts. However, subjective refraction measurement was significantly faster using the Dyop® acuity chart (t=4.46, P<0.05), with an average measurement time of 419.90±91.17 versus 452.04±74.71 seconds using the LogMAR E chart.
Conclusions: Accuracy of refractive error measurement using a Dyop® chart was comparable with use of a LogMAR E chart. The dynamic optotype Dyop® could be considered as an alternative fixation target to be used in subjective refraction.
Background: Dyop® is a dynamic optotype with a rotating and segmented visual stimulus. It can be used for visual acuity and refractive error measurement. The objective of the study was to compare refractive errormeasurement using the Dyop® acuity and LogMAR E charts.
Methods: Fifty subjects aged 18 or above with aided visual acuity better than 6/12 were recruited. Refractive error was measured by subjective refraction methods using the Dyop® acuity chart and LogMAR E charts and the duration of measurement compared. Thibo’s notation was used to represent the refractive error obtained for analysis.
Results: There was no significant difference in terms of spherical equivalent (M) (P=0.96) or J0 (P=0.78) and J45 (P=0.51) components measured using the Dyop® acuity and LogMAR E charts. However, subjective refraction measurement was significantly faster using the Dyop® acuity chart (t=4.46, P<0.05), with an average measurement time of 419.90±91.17 versus 452.04±74.71 seconds using the LogMAR E chart.
Conclusions: Accuracy of refractive error measurement using a Dyop® chart was comparable with use of a LogMAR E chart. The dynamic optotype Dyop® could be considered as an alternative fixation target to be used in subjective refraction.
Ahmed青光眼引流阀植入术作为难治性青光眼的主要治疗方案，能很大程度控制眼压，且疗效和预后均优于常规滤过性手术。但是远期引流盘周围被纤维包裹后会阻塞房水流出，引起术后高眼压，导致手术失败。因此，解决引流盘纤维包裹能很大程度地提高青光眼阀植入术后远期成功率，这也是目前的研究热点。目前临床上主要采用术前预防及术后二次操作对纤维包裹进行干预，但长期效果欠佳。本文就青光眼引流阀纤维包裹发生的组织病理学及分子机制、临床目前解决方案、前沿研究进展以及对Ahmed青光眼阀门的材料改造的探索进行综述。
Ahmed glaucoma valve implantation, as the main treatment option for refractory glaucoma, can control intraocular pressure (IOP) to a large extent. And its efficacy and prognosis are superior to those of conventional filtration surgery. IOP is well-controlled in the early postoperative stages. However, long-term fibrosis of encapsulated bleb inhibits fluid exchange and causes elevated IOP, leading to surgical failure. Therefore, treating fibrosis of encapsulated bleb can improve the long-term success rate after glaucoma valve implantation, which is also a research hotspot. Currently, the main clinical interventions are preoperative prophylaxis and postoperative secondary operations for fiber wrapping, but its long-term efficacy is not satisfactory. This article reviews the occurrence, histopathology and molecular mechanism of fibrous encapsulation, treatment in a clinical setting, cutting-edge research progress, and exploration on material modification of Ahmed glaucoma valve.
目的：探讨外伤性视神经病变(traumatic optic neuropathy，TON)患者内镜下经蝶筛径路视神经管减压术(endoscopic trans-ethmosphenoid optic canal decompression，ETOCD)的整体护理。方法：选取中山大学中山眼科中心2020年1月至2021年3月收治的80例TON患者，回顾总结患者 ETOCD期间的护理措施及手术疗效。结果：所有患者经过综合护理后均顺利完成手术，未发生感染，出血、疼痛情况经治疗和护理后均改善，68.8%患者术后视力有提高。结论：针对TON患者ETOCD的特点，采取个体化的整体护理具有重要意义，有利于帮助患者顺利完成手术，降低并发症的发生率，促进患者康复。
Objective: To investigate the holistic nursing care of patients with traumatic optic neuropathy undergoing endoscopic trans-ethmosphenoid optic canal decompression (ETOCD). Methods: A total of 80 patients with traumatic optic neuropathy admitted to Zhongshan Ophthalmology Center of Sun Yat-sen University from Jan 2020 to Mar 2021 were selected as the subjects, and the nursing measures and surgical effect during ETOCD were reviewed and summarized. Results: All 80 surgical patients successfully completed the operation after comprehensive nursing without infection. The bleeding and pain were improved after treatment and nursing, and 68.8% patients presented with vision improvement. Conclusion: According to the characteristics of ETOCD in patients with traumatic optic neuropathy, it is of great significance to take individualized overall care, which is beneficial to help patients successfully complete the operation, reduce the incidence of complications, and promote the recovery of the patient’s healthy.
目的：评价丙泊酚-阿芬太尼-利多卡因混合剂在成人白内障日间手术中的麻醉镇静效果与不良反应。方法：回顾性分析2021年1月至2021年6月中山大学中山眼科中心接受丙泊酚-阿芬太尼-利多卡因静脉镇静下白内障日间手术的患者(静脉镇静组，n=30)，并匹配同一主刀医师、诊断相似且在丙美卡因表面麻醉下白内障手术患者(表麻组，n=30)。比较两组患者围手术期血流动力学变化、手术中眼位评级、手术中断的次数、手术时间、手术后苏醒时间、出院时间、术中手术体验以及术后不良事件等指标。结果：所有患者均在原麻醉方式下顺利完成手术；与表麻组相比，静脉镇静组手术中断次数显著降低(P<0.05)，围手术期血压更平稳，且术后满意度评价明显升高(P<0.05)。结论：丙泊酚-阿芬太尼-利多卡因静脉镇静能显著提升白内障日间手术患者的就医体验，而不影响手术进程。
Objective: The aim of this study is to observe the efficacy and safety of propofol-alfentanil-lidocaine mixture in adult patients for cataract ambulatory surgery. Methods: Thirty adult patients undergoing cataract ambulatory surgery sedated by propofol-alfentanil-lidocaine mixture from January 2021 to June 2021 were enrolled in this retrospective study (sedation group, n=30). Meanwhile, another thirty patients with similar diagnosis performed by the same surgeons under topical anesthesia were matched in this study (topical anesthesia group, n=30). The scores of intraoperative eye position, the number of surgical interruptions due to poor cooperation, surgical time, emergence time, time to discharge, changes in blood pressure, surgical experience, as well as any adverse events were compared between the two groups. Results: The surgeries were successfully completed in all patients in both groups. Compared to topical anesthesia group, patients under sedation showed less surgical interruptions and more stable hemodynamics during the surgery, as well as better surgical experience (all P<0.05). Conclusion: Sedation with propofol-alfentanil-lidocaine mixture can significantly improve the surgical experience of patients undergoing cataract ambulatory surgery without prolonging duration of the surgery.
本文根据上海鹰瞳医疗科技有限公司的创新产品《糖尿病视网膜病变眼底图像辅助诊断软件》在国家药品监督管理局(NMPA，原CFDA)历时两年半的上市前创新申报与注册申报经历，介绍了人工智能类医疗器械产品的产品研发、注册申报流程及相关重点难点，并且列明了在整个过程中需要遵循和参考的法律法规，为此类产品的上市前注册工作提供参考。
Based on the NMPA premarket application through two and a half years for the computer aided diagnosis software using fundus images of diabetic retinopathy, which is an innovative medical device of Shanghai EagleVision Medical Technology Co., Ltd. (Airdoc), this article introduced the development process, the premarket application, and the key points in the application of this artificial intelligence device, also lists the related regulations and guidelines as references to provide some ideas for the follow-up premarketing application of such kind of products.
手术前常规检查在临床诊疗中被广泛应用，但在一些低风险择期手术前对患者进行常规检查，对提高医疗质量并无帮助，反而降低了医疗效率，增加了医疗费用。为提高效率，一些地区、机构和专家学者陆续通过宣传教育、发表共识、制定指南等方式控制无指征术前常规检查，但效果仍依赖于执业者的重视程度和专业水平。大数据机器学习方法以其标准化、自动化的特点为解决这一问题提供了新的思路。在回顾已有研究的基础上，我们抽取2017至2019年在中山大学中山眼科中心进行眼科手术的3.4万名患者的病史和体格检查资料大数据，涵盖年龄、性别等口学信息，诊断、既往疾病等病史信息，视功能、入院时身体质量指数(BMI)等体格检查信息。并以此为基础使用机器学习方法预测术前胸部X线检查是否存在异常，受试者操作特性曲线(receiver operating characteristic curve，ROC)曲线下面积达到0.864，预测准确率可达到81.2%，对大数据机器学习精简术前常规检查的新方式进行了先期探索。
Preoperative routine tests are widely prescribed in clinical settings. However, these tests do not help improving the quality of medical care in low-risk elective surgery. Instead, they are associated with lower efficiency and increasing fees. To improve the efficiency, many regions, institutions, and scholars have attempted to reduce preoperative routine tests without indications through propaganda, education, consensus, and guidelines. Nevertheless, the effects are still highly dependent on the expertise and emphasis of practitioners. Machine learning based on big data provide a new solution with its standardization and automation. Through literature review, we extracted the big data, including demographic features such as sex and age, histories including diagnosis and chronic diseases, and physical examination features such as visual function and body mass index. A total of 34 000 patients undergone ocular surgeries in Zhongshan Ophthalmic Center, Sun Yat-sen university from 2017 to 2019. Machine learning was adopted to predict the risk of finding abnormalities in chest X-ray examination, with an accuracy of 81.2%. Area under the Receiver Operating Characteristic curve was 0.864. The study could be an early exploration into the field of simplifying preoperative tests by machine learning.
建立标准化的数据中心有利于收集高质量数据资源与促进医学人工智能的发展，在医疗大数据的基础上建立不同应用场景的医疗人工智能系统，整合、搭建可满足多种疾病诊疗需求的智能服务云平台，全面提升智能医疗管理的效率。本文以眼科为研究基础，对眼科数据中心和智能服务云平台的建设经验进行总结分析，为眼科及其他专科开展人工智能研究、建立数据中心、搭建智能服务云平台等方面提供参考。
The establishment of standardized data center can promote the accumulation of high-quality data resources and the development of medical artificial intelligence. On the basis of medical big data, medical artificial intelligence systems in different application scenarios can be established and integrated into an intelligent service cloud platform, which improves the management efficiency of intelligent medical systems. This article takes ophthalmology as a prototype to summarize the experience of the establishment of ophthalmic data center and intelligent service cloud platform, aiming to provide reference and guidance for ophthalmology and other specialties to carry out artificial intelligence research, establish data center and build an intelligent service cloud platform.
目的：通过在血管灌注尸头标本上模拟经鼻内镜下鼻泪管-泪囊切除术探讨该术式的基本操作以及在经鼻内镜下鼻泪管-泪囊和其周围结构的解剖关系，以期为临床开展该术式提供解剖学依据。方法：采用5个动、静脉双灌注成人尸头标本(共10侧)进行解剖学研究。在标本上进行经鼻内镜下暴露全程鼻泪管及泪囊，观察鼻泪管-泪囊切除过程的解剖标志和毗邻关系。结果：10侧泪囊-鼻泪管的解剖显示全部泪囊均位于鼻丘的前方稍外侧，泪囊顶基本和鼻丘顶平齐，泪囊体大部分位于中鼻甲腋窝水平线上方。泪囊窝后内壁由泪骨构成，泪骨后内方与鼻丘气房相邻。泪囊底向下移行为膜性鼻泪管进入骨性鼻泪管，鼻泪管在鼻腔外侧壁的投影位于钩突垂直部前缘前方约3~7mm。鼻泪管下鼻道开口距离下鼻甲前端的距离为(16±3)mm。泪囊长度为(13.8±1.8)mm，鼻泪管长度为(23.2±3.6)mm。结论：经鼻内镜入路可充分暴露和切除全程鼻泪管和泪囊。本解剖研究展示的基本操作过程和解剖标志可为临床开展经鼻内镜鼻泪管-泪囊切除术提供解剖学参考。
Objective: By simulating transnasal endoscopic resection of nasolacrimal duct and lacrimal sac on cadaveric specimens with vascular perfusion, the basic process of this procedure and the anatomical relationship between nasolacrimal duct and lacrimal sac were explored, providing anatomical basis for clinical application. Methods: Five adult cadaver head specimens (10 sides in total) were used for anatomical study. The nasolacrimal duct and lacrimal sac were exposed under transnasal endoscopy, and the anatomical landmarks and their relationship with adjacent areas during the resection of nasolacrimal duct and lacrimal sac were observed. Results: Ten sides of nasolacrimal duct and lacrimal sac showed that all lacrimal sacs were located anterior and slightly lateral to the nasal mound. The roof of lacrimal sac was almost the same height as the roof of nasal mound. The body of lacrimal sac was almost located above the horizontal line of the middle turbinate axilla. The posterior inner wall of the lacrimal fossa was composed of lacrimal bone. The posterior inner side of the lacrimal bone was adjacent to the agger nasi cell. The bottom of the lacrimal sac moved downward as the membranous part of the nasolacrimal duct located in the bony part of the nasolacrimal duct. The projection of the nasolacrimal duct on the lateral nasal wall was located about 3–7 mm in front of the anterior edge of the vertical part of the uncinate process. The distance between the inferior meatus opening of the nasolacrimal duct and the anterior end of the inferior turbinate was (16±3) mm. The length of the lacrimal sac was (13.8±1.8) mm, and the length of the nasolacrimal duct was (23.2±3.6) mm. Conclusion: The transnasal endoscopic approach can fully expose and resect the nasolacrimal duct and lacrimal sac. The basic operation process and anatomical landmarks demonstrated in this anatomical study provide an anatomical reference for the clinical development of transnasal endoscopic resection of nasolacrimal duct and lacrimal sac.
目的：探讨医用自交联透明质酸钠凝胶对鼻内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryocystorhinostomy，En-DCR)后的影响。方法：将219例单侧慢性泪囊炎(chronic dacryocystitis CD)患者随机分为医用自交联透明质酸钠凝胶组(A组)和对照组(B组)。所有患者行En-DCR。A组将医用自交联透明质酸钠凝胶填充吻合口，B组不做任何处理。随访12个月。比较创面黏膜上皮化、肉芽形成情况、渗血情况及吻合口通畅成功率。结果：A组98例，B组102例。随访2周，A组86例患者鼻腔吻合口黏膜上皮完整，B组77例患者鼻腔吻合口黏膜上皮完整。随访12个月，A组有7例患者存在瘢痕(7.1%)，8例患者出现肉芽肿(8.2%)，而B组有17例患者存在瘢痕(16.7%)，18例患者出现肉芽肿(17.6%)。两组瘢痕形成及出现肉芽肿差异均有统计学意义(P<0.05)。A组的吻合口通畅成功率达到90.8%(89/98)，而B组的成功率为78.4%(80/102)(P<0.05)。B组患者术后渗血情况A组相当(P>0.05)。结论：医用自交联透明质酸钠凝胶填充吻合口可通过促进En-DCR术后吻合口黏膜上皮愈合和降低伤口瘢痕及肉芽肿生成率，提高En-DCR治疗CD的成功率。
Objective: To investigate the effect of medical self-crosslinking sodium hyaluronate gel on endonasal endoscopic dacryocystorhinostomy (En-DCR). Methods: A total of 219 patients with unilateral chronic dacryocystitis (CD) were selected and randomly divided into two groups: medical self-crosslinking sodium hyaluronate gel group (group A) and control group (group B). All patients underwent En-DCR. Group A received medical self-crosslinking sodium hyaluronate gel filling the ostium at the end of En-DCR, whereas group B received no treatment. Patients were followed-up for 12 months. The mucosal epithelialization of the wound, the granulation formation, bleeding, and the success rate of ostial patency were compared in the two groups. Results: Our study included 98 patients in group A and 102 patients in group B. After 2 weeks, the number of absorbable hemostatic patients who had intact mucosal epithelium lining the ostia was 86 in group A and 77 in group B. At 12 months follow up, there were 7 patients with scar (7.1%) and 8 patients with granuloma (8.2%) in group A, compared with 17 patients with scar (16.7%) and 18 patients with granuloma (17.6%) in group B. There were significant differences in scar formation and granuloma between the two groups (P<0.05). The success rate of anastomotic patency reached 90.8% (89/98) in group A whereas the success rate was 78.4% (80/102) in group B (P<0.05). The situation of postoperative bleeding in group B was similar to that in group A (P>0.05). Conclusion: The medical self-crosslinking sodium hyaluronate gel can improve the success rate of En-DCR treatment of CD through promoting the healing of anastomotic mucosa and reducing the rate of wound scar and granuloma formation.
