ObjectiveTo comparatively analyze for the fundus characteristics of acquired immune deficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR) between first-visit and non-first-visit in ophthalmology.MethodsA retrospective study was performed for 22 patients (41 eyes) diagnosed as CMVR with AIDS by ophthalmology in the Affiliated Municipal Hospital of Xuzhou Medical University from July 2004 to September 2017. The patients were divided into two groups: one with the first-visit in ophthalmology (FVO) and the other with the first-visit in non-ophthalmology (FVNO). All patients underwent visual acuity, intraocular pressure, slit lamp microscope and indirect ophthalmoscope examinations. Thirty-nine eyes of 21 patients with clear refractive media were examined by color fundus photography, of which 5 patients were examined by FFA. Five patients examined by OCT and B-mode ultrasound. The CMVR were characterized as fulminant type or indolent type. All the 22 patients (41 eyes) except 2 patients (4 eyes) accepted highly active antiroviral therapy, and all patients were treated with ganciclovir intravenously. Nine patients (12 eyes) received intravitreal injection of ganciclovir, 7 patients (10 eyes) underwent vitrectomy because of retinal detachment, 6 patients (7 eyes) gave up surgery because of extensive retinal detachment, and the other 12 eyes did not undergo any eye surgery. All patients were followed for 6-58 months (average 23±39 months). The incidences and fundus characteristics of the patients with fulminant or indolent CMVR were compared and analyzed. Between the two groups, the difference of visual acuity and CD4+T cell count at the first vist and the last follow-up were analyzed by a t-test, and the macular involvement and spread of the two groups were compared by a chi-square test.ResultsFulminant CMVR showed dense yellow-white necrotic lesions along the great vessels with or without satellite lesions, while indolent CMVR showed sparse yellow-white granular lesions with a little bleeding. The concomitant signs included frost-like dendritic vascular sheath, retinal artery occlusion and optic disc edema. Fourteen eyes of 7 patients in FVO group were fulminant, including 2 patients (2 eyes) with retinal artery occlusion and 1 patient (two eyes) with optic disc edema. In FVNO group, there were 27 eyes of 15 patients, including 21 eyes of 13 cases identified as fulminant type and 6 eyes of 4 patients as indolent type. In the fulminant type, there were 4 patients (6 eyes) with frost-like dendritic vascular sheath, 10 patients (12 eyes) with retinal artery occlusion and 4 patients (4 eyes) with optic disc edema. There was no significant difference in initial visual acuity (t=－1.534, P=0.133), but there was a significant difference in visual acuity at the last follow-up (t=－3.420, P=0.001). There was no significant difference in CD4+ T cells between the two groups at the first visit (t=－0.902, P=0.378). The proportions of macular involvement and 3-4 quadrant involvement in FVO group were significantly higher than those in FVNO group (χ2=7.552, 7.865; P=0.006, 0.005).ConclusionFor AIDS patients with CMVR, the first-visit in ophthalmology showed more dense necrotic lesions involving macular and a wider range of lesions than the first-visit in non-ophthalmology.
Ultra-wide field fundus autofluorescence (FAF) imaging is a new noninvasive technique with an imaging range of about 200 °. It can detect peripheral retinal lesions that cannot be found in previous FAFs and more objectively reflect intracellular content and distribution of lipofuscin in the retinal pigment epithelium (RPE) and RPE cell metabolic status. The ultra-wide field FAF can find the abnormal autofluorescence (AF) in the peripheral retina of the eyes of age-related macular degeneration (AMD), and different AF manifestations may have an impact on the diagnosis and treatment of the different AMD subtypes. It is helpful to evaluate subretinal fluid in the eyes of central serous choroidal retinopathy and can accurately detect the changes in the outer retina of the eyes without subretinal fluid. It can help to determine the type of uveitis and fully display the evolution of the disease. It can also assess the peripheral photoreceptor cell layer and RPE in patients with retinal dystrophy and retinitis pigmentosa, and comprehensively evaluate their retinal function and monitor the progress of disease. It can also assist in the evaluation of the short-term efficacy and RPE cell function after the scleral buckling surgery for patients with rhegmatogenous retinal detachment. In the future, ultra-wide field FAF may change the knowledge and intervention strategy of ocular fundus diseases and promote the clinical and scientific research in this field.
At present, artificial intelligence (AI) has been widely used in the diagnosis and treatment of various ophthalmological diseases, but there are still many problems. Due to the lack of standardized test sets, gold standards, and recognized evaluation systems for the accuracy of AI products, it is difficult to compare the results of multiple studies. When it comes to the field of image generation, we hardly have an efficient approach to evaluating research results. In clinical practice, ophthalmological AI research is often out of touch with actual clinical needs. The requirements for the quality and quantity of clinical data put more burden on AI research, limiting the transformation of AI studies. The prediction of systemic diseases based on fundus images is making progressive advancement. However, the lack of interpretability of the research lower the acceptance. Ophthalmology AI research also suffer from ethical controversy due to unconstructed regulations and regulatory mechanisms, concerns on patients’ privacy and data security, and the risk of aggravating the unfairness of medical resources.
ObjectiveTo observe the demographic data, disease composition and convenience of remote consultation in ophthalmology. MethodsA retrospective study. From 2015 to 2021, the demographic data, changing trends, disease classification of teleconsultation patients, and hospitals participating in teleconsultation, and the waiting time of patients for teleconsultation was analyzed retrospectively; remote consultation physician level composition and other data was analyzed. ResultsDuring the 7-year period, 1 216 patients with remote consultation were obtained through the platform of the telemedicine center. Among them, there were 680 males and 536 females; the average age was 50.8 years. In 2016 and 2017, the number of patients participating in telemedicine consultations reached a peak of 260 and 221 cases, respectively. Among the ophthalmic diseases, there were 490 cases (40.30%, 490/1 216) of retinal and optic nerve-related diseases, 212 cases (17.43%, 212/1 216) of ocular trauma. 678 cases (56.27%, 678/1 205) of remote consultation waiting time were less than 24 hours, 991 cases (82.24%, 991/1 205) were less than 48 hours. Among the physicians who participated in the remote consultation, there were 733 chief physicians (60.3%, 733/1 216) and 466 deputy chief physicians (38.3%, 466/1 216). ConclusionsDuring the seven-year period from 2015 to 2021, there are relatively few patients with ophthalmology teleconsultation; retinal and optic nerve-related diseases accounted for a high proportion. Remote consultation has high convenience.
With the development of ophthalmic optical coherence tomography (OCT) and OCT angiography (OCTA), including the improving of light source, resolution, scanning depth and upgrade of analysis softwares, they can more accurately display the structure of retinal layers and give accurate quantitative measurement. In neuro-ophthalmic diseases, the OCT indicators (the thickness of retinal nerve fiber layer around optic disc and plexus layer in macular gangle cells) and OCTA indicators (the blood flow density of capillaries around optic disc, superficial and deep capillaries in macular area, and the area of foveal avascualr zone) had special changes. It has important value in the differential diagnosis of central nervous system diseases and retinal diseases with visual dysfunction as the first symptom, the diagnosis and differential diagnosis of neuro-ophthalmic disease, the evaluation of progression of neurodegenerative diseases. Neuro-ophthamologists should pay more attention to the exploration and application of OCT and OCTA in the field of neuro-ophthalmology.
Objective
To summarize the role and implementation effect of risk management in Ophthalmic Day Surgery Center.
Methods
Since the establishment of Ophthalmic Day Surgery Center on October 8th, 2012, risk management was implemented in the aspects of hardware management, post setting, file management, operating process, service, etc., and the adverse events occurred in the period were analyzed to find out the defectiveness and hidden dangers in the working process, and then refined intervention measures were put forward and carried out. The surgical amount, occurrence of nosocomial infections and nursing adverse events, and patients satisfaction from October 8th, 2012 to June 30th, 2015 were analyzed.
Results
During this period, 52 073 ambulatory operations were completed, with no nosocomial infection and 2 cases of nursing adverse events. The patients satisfaction in 2013, 2014, and 2015 was 98.09%, 98.22%, and 99.85%, respectively.
Conclusion
The implementation of risk management in Ophthalmic Day Surgery Center can effectively reduce the occurrence of adverse events in nursing work, improve work efficiency, help to establish and improve the nursing security environment, improve the nurse-patient relationship, and improve patients satisfaction.
Idiopathic intracranial hypertension (IIH) is a neurological disorder that causes an unexplained increase in intracranial pressure. Its main clinical manifestations include chronic headache, visual impairment, and typical unilateral or bilateral disk edema found on fundus examination. The diagnosis of IIH depends on the exclusion of other diseases that may cause increased intracranial pressure and further confirmation by systemic and neurological imaging. Current treatment strategies for IIH include lifestyle adjustments for weight loss, pharmacological interventions, and surgery if necessary to reduce intracranial pressure and relieve patient-related symptoms. Maximum protection and restoration of visual function. In the future, it is necessary to further improve the IIH diagnostic process and criteria to guide personalized treatment and prognosis judgment. The effective use of artificial intelligence technology for image segmentation and combined image omics analysis is expected to improve the accuracy of IIH intelligent diagnosis, achieve earlier and more accurate disease detection, and provide patients with a more personalized treatment path.
