论著

高效液相色谱法测定曲伏前列素滴眼液中曲伏前列素含量

Determination of content of travoprost in travoprost eye drops by HPLC

:600-607
 
目的:建立高效液相色谱法(high-performance liquid chromatography, HPLC)测定曲伏前列素滴眼液中曲伏前列素含量。方法:采用Dikma C18色谱柱(50 mm×4.6 mm, 3 μm);以磷酸溶液(取磷酸1.0 mL,用水稀释至1 000 mL,用1 mol/L氢氧化钠溶液调节pH至2.8)-乙腈(67:33)为流动相;流速为每分钟3.0 mL;柱温为25℃;检测波长为220 nm;进样体积30 μL。结果:曲伏前列素在20.28~70.98 μg /mL(= 0.999 5)范围内线性关系良好,平均回收率为100.3%,相对标准偏差(relative standard deviatio, RSD)为2.0% (= 9),该方法重现性好。对照品溶液和供试品溶液在室温放置48 h基本稳定。结论:该方法可用于曲伏前列素滴眼液中的曲伏前列素含量测定。
Objective: To establish a high-performance liquid chromatography (HPLC) method for the determination of content of Travoprost in Travoprost Eye Drops. Methods: The analytic column was Dikma C18 (50 mm×4.6 mm, 3 μm) . Using phosphoric acid solution (take 1.0 mL of phosphoric acid, dilute with water and make up to 1 000 mL, adjust the pH to 2.8 with 1 mol/L sodium hydroxide solution)-acetonitrile (67:33) as mobile phase. The flow rate is 3.0 mL/min. The column temperature is 25 ℃; The detection wavelength is 220 nm. The injection volume is 30 μL. Results: The linear range of travoprost showed were well shown within 20.28-70.98 μg/mL(r=0.998). The average recovery rate of travoprost was 100.3% with relative standard deviation (RSD) 2.0% (n=9). The method had high reproducibility. The reference solution and the test solution remain stable at room temperature for 48 hours. Conclusion: The method can be used for the determination of content of travoprost in Travoprost Eye Drops.
论著

囊袋张力环植入对新一代 IOL 计算公式在高度近视患者中预测准确性的影响

Predictive accuracy and effect of capsular tension ring implantation with new generation intraocular lens calculation formulas in high myopia patients

:782-789
 
目的:探究囊袋张力环(CTR)植入对五种新一代人工晶状体(IOL)计算公式[Barrett Universal Ⅱ (BUⅡ), Emmetropia Verifying Optical (EVO), Kane, Pearl-DGS和Hill-RBF 2.0]在高度近视患者中预测准确性的影响。方法:前瞻性病例对照研究。观察2020年12月—2021年9月于陕西省眼科医院就诊的眼轴长度(axial length,AL)≥ 27.00 mm行白内障联合IOL(AR40E, 美国强生)植入术的患者。术眼随机分为植入CTR组(A组)和未植入CTR组(B组)。术前根据IOLMaster700测量眼部参数,使用BU Ⅱ公式计算所需IOL度数。记录术后1周、1个月及3个月实际等效球镜度(spherical equivalent,SE),计算并比较五种公式预测误差(prediction error,PE)和绝对屈光预测误差(absolute Error,AE)。将A组和B组分别分为A1组(27.00 mm ≤ AL ≤ 30.00 mm)和A2组(AL>30.00 mm);B1组(27.00 mm ≤ AL ≤ 30.00 mm)和B2组(AL >30.00 mm),分析不同AL范围内CTR植入对公式预测准确性的影响。结果:共纳入患者63例(89眼),年龄(55.93±10.17)岁,术前AL为(30.30±2.18)mm。A组、A1组及A2组术后不同时间SE值比较差异均无统计学意义(P>0.05),B组、B1组及B2组术后1周与1个月,术后1周与3月SE值分别比较差异有统计学意义(P<0.05),术后1个月与3个月比较,差异无统计学意义(P>0.05)。A组、B组、A1组、A2组、B1组和B2组各组中五种公式的AE值比较差异均无统计学意义(均P>0.05)。植入CTR后五种公式的预测误差变化比较差异无统计学意义(P>0.05)。结论:对于AL ≥27.00 mm的白内障患者,植入CTR组术后1周屈光度趋于稳定,未植入组术后1个月屈光度趋于稳定。CTR植入对五种公式预测准确性和选择无影响,五种计算公式均可正常选择。
Objective: To investigate the predictive accuracy and effect of capsular tension ring (CTR) implantation with five new generation intraocular lens (IOL) calculation formulas [Barrett Universal Ⅱ (BU Ⅱ), Emmetropia Verifying Optical(EVO), Kane, Pearl-DGS and Hill-RBF 2.0] in high myopia patients. Methods: This is a prospective case-control study. The patients were enrolled with an axial length (AL)≥27.00 mm, and underwent cataract surgery with AR40E IOL implantation at the Shaanxi Eye Hospital from December 2020 to September 2021. The patients were randomly assigned to the CTR implantation group (group A) and the non-CTR implantation group (group B). With the ocular parameters measured by the IOLMaster700, the IOL power was calculated with the BUⅡformula before surgery. The postoperative actual equivalent spherical diopter (SE) were recorded,and the predicted error (PE) and absolute error (AE) using the five formulas were recorded and compared at 1 week, 1 month, and 3 months, repsectively. Group A was divided to A1 (27.00 mm ≤ AL ≤ 30.00 mm) and A2 (AL>30.00 mm), and group B was divided to B1 (27.00 mm ≤ AL ≤ 30.00 mm) and B2 (AL>30.00 mm). The effects of CTR implantation and the accuracy of the formulas were analyzed with different AL ranges. Results: A total of 63 patients (89 eyes) were included, aged (55.93±10.17) years old, with preoperative AL (30.30± 2.18)mm. There was no statistically significant difference in SE between groups A, A1, and A2 (P>0.05) at different postoperative times. While there was a statistically significant difference in SE between groups B, B1, and B2 (P < 0.05) at 1 week and 1 month after surgery, and between 1 week and 3 months after surgery. There was no statistically significant difference between 1 month and 3 months after suergery (P>0.05). There was no significant difference in the AE using the five formulas among groups A, B, A1, A2, B1, and B2 (P>0.05). There was no statistically significant difference in prediction error changes among the five formulas after CTR implantation (P>0.05). Conclusion: For cataract patients with AL ≥ 27.00 mm, the refractionvalue in the CTR implantation group tended to stabilizeafter one week of surgery. While in the non-CTR implantation group, the refractionvalue tended to stabilize after one month. CTR implantation had no effect on the accuracy and selection of the five formula, and the five IOL calculation formulas can be normally selected.
综述

人工智能在眼底影像分析中的研究进展及应用现状

Research progress and application status of artificial intelligence in fundus image analysis

:185-193
 
近年来,眼科人工智能(artificial intelligence,AI)迅猛发展,眼底影像因易获取及其丰富的生物信息成为研究热点,眼底影像的AI分析在眼底影像分析中的应用不断深入、拓展。目前,关于糖尿病性视网膜病变(diabetic retinopathy,DR)、年龄相关性黄斑变性(age-related macular degeneration,AMD)、青光眼等常见眼底疾病的临床筛查、诊断和预测已有较多AI研究,相关成果已逐步应用于临床实践。除眼科疾病以外,探究眼底特征与全身各种疾病之间的关系并据此研发AI诊断系统已经成为当下的又一热门研究领域。AI应用于眼底影像分析将改善医疗资源紧缺、诊断效率低下的情况,为多种疾病的筛查和诊断开辟“新赛道”。未来眼底影像AI分析的研究应着眼于多种眼底疾病的智能性、全面性诊断,对复杂性疾病进行综合性的辅助诊断;注重整合标准化、高质量的数据资源,提高算法性能、设计贴合临床的研究方案。
In recent years, artificial intelligence (AI) in ophthalmology has developed rapidly. Fundus image has become a research hotspot due to its easy access and rich biological information. The application of AI analysis in fundus image is under continuous development and exploration. At present, there have been many AI studies on clinical screening, diagnosis and prediction of common fundus diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma, and related achievements have been gradually applied in clinical practice. In addition to ophthalmic diseases, exploring the relationship between fundus features and various diseases and developing AI diagnostic systems based on this has become another popular research field. The application of AI in fundus image analysis will improve the shortage of medical resources and low diagnostic efficiency, and open up a “new track” for screening and diagnosis of various diseases. In the future, research on AI analysis of fundus image should focus on the intelligent and comprehensive diagnosis of multiple fundus diseases, and comprehensive auxiliary diagnosis of complex diseases, and lays emphasis on the integration of standardized and high-quality data resources, improve algorithm performance, and design clinically appropriate research program.
论著

飞秒激光小切口基质透镜取出术和飞秒制瓣联合准分子激光原位角膜磨镶术术后有效光学区及角膜像差的比较

Comparison of effective optical zone and high order aberrations after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis

:36-43
 
目的:比较不同预设光学区组的飞秒激光小切口基质透镜取出术(small incision lenticule extraction,SMILE)和飞秒激光制瓣联合准分子激光原位角膜磨镶术(femtosecond laser-assisted in situ keratomileuses,FS-LASIK)术后有效光学区(effective optical zone,EOZ)大小与角膜高阶像差(high order aberrations,HOAs)变化以及有效光学区大小对角膜高阶像差的影响。方法:收集2019年2月 至2020年5月来佛山市第二人民医院行激光手术的患者80例,均取右眼入组,SMILE组43例,FSLASIK组37例,按预设光学区大小分为6.5 mm和6.0 mm组,分别于术前和术后1个月应用Pentacam三维眼前节分析系统测量有效光学区及总角膜高阶像差、彗差、球差,分析不同预设光学区下SMILE组和FS-LASIK组有效光学大小及与角膜高阶像差的关系。结果:在相同预设光学区下,术后1个月SMILE组的有效光学区均大于FS-LASIK组,差异均有统计学意义(均P<0.05),且SMILE组的角膜总高阶像差、球差、彗差均较FS-LASIK组低,差异均有统计学意义(均P<0.05);对于相同手术方式,预设光学区6.0 mm较6.5 mm组,术后1个月角膜总高阶像差、球差、彗差均升高,差异均有统计学意义(均P<0.05)。结论:SMILE组和FS-LASIK组术后1个月的有效光学区均小于预设光学区,SMILE组大于FS-LASIK组;术后1个月有效光学区越大,角膜高阶像差越小;在相同预设光学区下,SMILE组术后1个月角膜高阶像差小于FS-LASIK组。
Objective: To compare the effective optical zone (EOZ) and the changes in corneal high order aberrations (HOAs) after small incision lenticule extraction (SMILE) with those after femtosecond laser-assisted in situ keratomileuses (FS-LASIK). Methods: This study included 80 subjects who underwent laser refractive surgery at the Second People’s Hospital of Foshan between February 2019 and May 2020. Only data from the right eye of each subject were analyzed. A total of 43 eyes underwent SMILE while 37 eyes received FS-LASIK. The eyes were further stratified into subgroups based on different programmed optical zones: the 6.5 mm group and the 6.0 mm group. EOZ, coma, and spherical aberration were measured with Pentacam 3D anterior segment analysis system preoperatively and one month postoperatively. In addition, the relationship between EOZ and corneal HOAs was analyzed and compared between different optical-zone groups after SMILE and FS-LASIK. Results: For the same programmed optical zone, the SMILE group achieved a significantly greater EOZ than the FS-LASIK group who was measured 1-month postoperatively did (P<0.05). Meanwhile, corneal HOAs, spherical aberration, and coma in the SMILE group are significantly lower than those in the FS-LASIK group (P<0.05). For the same procedure (SMILE or FS-LASIK), the 6.0 mm group demonstrated significantly higher corneal total HOAs, spherical aberration, and coma than the 6.5 mm group did 1-month after the surgery (P<0.05). Conclusion: In both the SMILE and the FS-LASIK groups, 1-month postoperative EOZ was smaller than the programmed optical zone. EOZ in the SMILE group was larger than that in the FS-LASIK group. The larger the 1-month postoperative EOZ was, the lower corneal HOAs were. For the same programmed optical zone, 1-month postoperative corneal HOAs in the SMILE group is lower than that in the FS-LASIK group.
论著

某院眼科万古霉素使用情况调查分析及超说明书用药评价

Investigation and analysis of vancomycin use in a hospital ophthalmology department and evaluation of off-label drug use

:528-537
 
目的:调查眼科万古霉素使用情况,并对超说明书用药进行评价,为临床提供参考。方法 :采用回顾性分析法,选取郑州市第二人民医院2022年1月1日—2024年12月眼科使用万古霉素的159例住院患者为研究对象,对患者基本信息、万古霉素的使用情况、微生物送检情况及超说明书用药情况等进行评价分析。结果:159例患者中男性占比76.1%,主要分布在眼底病病区,致病因素主要为眼外伤(102/159,64.15%),其次为手术源性(36/159,22.64%)。给药途径主要为玻璃体腔注射,以治疗用药为主,多联合头孢他啶治疗眼内感染。病原菌送检率为75.47%,标本检出率为35.07%。其中革兰阳性菌33例,占80.49%,主要为表皮葡萄球菌;革兰阴性菌5例,占12.20%,有大肠埃希菌、铜绿假单胞菌等;真菌4例,占9.76%,主要为曲霉菌。超说明书用药包括玻璃体腔注射、眼内灌洗及超适应证用于眼内炎的预防。玻璃体腔注射超说明书用药推荐等级及证据强度高于眼内灌洗和超适应证。结论 :万古霉素在眼科临床应用广泛,应严格掌握适应证和用法用量。对于超说明书用药,应在充分评估其合理性和安全性后谨慎使用。本研究对万古霉素的规范化使用及药品说明书修订和个体化治疗具有重要的临床价值和现实意义。
Objective: To investigate the use of vancomycin in ophthalmology department and evaluate its off-label drug use, thereby providing references for clinical practice. Methods: A retrospective analysis was conducted, selecting 159 inpatients who received vancomycin treatment in the Department of Ophthalmology of our hospital from January 1, 2022 to December 31, 2024. The basic information of the patients, details of vancomycin, microbial testing results, and off-label drug use were evaluated and analyzed. Results: Among the 159 patients, male patients accounted for 76.1%, and there were mainly distributed in the fundus disease area. The primary pathogenic factor was ocular trauma (102/159,64.15%), followed by surgical causes (36/159,22.64%). The main route of vancomycin administration was intravitreal injection, primarily for therapeutic purposes. It was often combined with ceftazidime to treat intraocular infections. The submission rate of pathogenic bacteria was 75.47%, and the specimen detection rate was 35.07%. There were 33 cases of gram-positive bacteria, accounting for 80.49%, mainly Staphylococcus epidermidis; 5 cases of gram-negative bacteria, accounting for 12.20%, including Escherichia coli, Pseudomonas aeruginosa, etc.; and 4 cases of fungi, accounting for 9.76%, mainly Aspergillus. Off-label drug use included intravitreal injections, intraocular lavage, and the use of drugs highly suitable for the preventing endophthalmitis. Endogenous infections were mainly caused by gram-negative bacteria. The evidence-based medicine support for vancomycin intravitreal injection in the treatment of endophthalmitis is strong. The recommended grade and evidence strength of off-label use of intravitreal injection are higher than those of intraocular lavage and off-label use. Conclusions: Vancomycin is widely used in ophthalmology, and its indications, usage, and dosage should be strictly controlled. Off-label drug use should be used with caution after a comprehensive evaluation of its rationality and safety. This study holds significant clinical value and practical significance for the standardized use of vancomycin, the revision of drug instructions, and individualized treatment.
病例研究

先天性葡萄膜外翻继发性青光眼:病例系列报道与文献回顾

Glaucoma secondary to congenital ectropion uveae: case series report and literature review

:608-621
 

目的:分析先天性葡萄膜外翻(Congenital ectropion uveae, CEU)继发性青光眼的临床表现、影像学特点和治疗方法。方法:回顾分析就诊于中山大学中山眼科中心诊断为CEU继发性青光眼患者的电子病历资料,收集整理患者的一般情况、视力、眼压、裂隙灯检查、房角镜照相、超声生物显微镜等检查结果,以及手术治疗方式选择和术后随访眼压情况,并结合国内外文献回顾分析总结CEU继发性青光眼的临床特点和诊疗效果。结果:报告两例CEU继发性青光眼患者年龄分别为24岁和11岁,均为男性、单眼发病慢性病程,患眼都为右眼,都不伴有全身异常,最佳矫正视力为手动/40cm-0.16,就诊时平均眼压为37 mmHg,平均中央前房深度为3.45 mm。两例患者查体表现:均角膜透明,瞳孔大小约5-5.5mm,对光反应灵敏,瞳孔缘近360°葡萄膜外翻呈棕褐色,晶状体透明,眼底检查青光眼性视杯凹陷,视网膜平伏。其中24岁患者房角镜检查全周宽角开放,小梁网有色素沉着。超声生物显微镜(ultrasound biomicroscopy, UBM)检查提示右眼虹膜稍向后凹,7点位房角关闭,其余全周房角开放。而11岁患者房角镜检查以及UBM检查均为全周房角关闭。两例患者角膜内皮镜检查均正常。两例患者均诊断为右眼先天性葡萄膜外翻继发性青光眼,眼压高,最大量降眼压药物治疗下不能控制,对24岁患者行小梁切除联合术中使用抗代谢药物11岁患者行引流阀植入联合术中使用抗代谢药物,术中术后均无明显并发症,至今随访6个月,眼压控制良好。结论:CEU特征性改变为瞳孔缘葡萄膜外翻,常继发青光眼,可表现为开角型、房角发育异常(闭角型,降眼压药物治疗效果有限,通常需要手术治疗。由于CEU继发性青光眼人群以儿童和年轻患者为主,为难治性青光眼,因此抗青光眼术中联合使用抗代谢药物可获得较好的治疗效果。

Objective: To analyze the clinical manifestations, imaging characteristics, and treatment methods of secondary glaucoma associated with congenital ectropion uveae (CEU). Methods: Observational case series and literature review. A retrospective analysis was conducted on the electronic medical records of patients diagnosed with secondary glaucoma due to CEU at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China. Data collected included demographics, visual acuity, intraocular pressure (IOP), slit-lamp examination, gonioscopy, ultrasound biomicroscopy (UBM), and surgical treatment methods. Postoperative IOP were also collected. A literature review was conducted to summarize the clinical characteristics and treatment outcomes of secondary glaucoma due to CEU. Results: Two male patients with secondary glaucoma due to CEU were included, aged 24 and 11 years, respectively. Both patients had a chronic course of disease affecting the right eye, with no systemic abnormalities. The best-corrected visual acuity was hand motion/40 cm to 0.16, and the average IOP at presentation was 37 mmHg, with an average central anterior chamber depth of 3.45 mm. Clinical examination revealed clear corneas, pupils measuring approximately 5-5.5 mm with brisk light reflexes, and nearly 360° of brownish ectropion of the uveae. The lenses were clear, and fundus examination showed glaucomatous optic disc cupping with a normal retina. In the 24-year-old patient, gonioscopy revealed a wide-open angle with trabecular meshwork pigmentation, while UBM indicated slight posterior bowing of the iris and angle closure at the 7 o'clock position. In the 11-year-old patient, both gonioscopy and UBM showed complete angle closure. Corneal endothelial microscopy was normal in both patients. Both were diagnosed with secondary glaucoma due to CEU in the right eye, with elevated IOP that was uncontrolled by maximal medications. The 24-year-old underwent trabeculectomy with intraoperative use of antimetabolites, while the 11-year-old received a drainage valve implantation with antimetabolites. No significant intraoperative or postoperative complications were observed, and IOP was well controlled over a six-month follow-up period. Conclusions: CEU is characterized by ectropion of the uveae and is frequently associated with secondary glaucoma, which may present as open-angle or angle-closure (goniodysgenesis) glaucoma. The effectiveness of IOP-lowering medications is limited, often necessitating surgical intervention. Given that secondary glaucoma due to CEU predominantly affects children and young adults, the use of antimetabolites during glaucoma surgery can yield favorable treatment outcomes.

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
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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