眼科学报最新文献

Purpose: To explore the effects of the prevention and control of perioperative incision infection on the quality of day cataract surgery.

Methods: The nursing care and efficacy of 5087 patients undergoing day cataract surgery between October 2012 and October 2013 were retrospectively reviewed. The disinfection and isolation guidance was established for perioperative prevention and control of infection, topical administration of ocular agents, reexamination and healthcare instruction, and alternative measures were taken.

Results: All 5087 patients successfully underwent day surgery of phacoemulsification combined with intraocular lens implantation. All cases recovered without incision infection.

Conclusion: Preoperative preparation, and intraoperative and postoperative prevention and control of infection serve as vital measures for effectively avoiding the incidence of incision infection in patients undergoing day cataract surgery.

Purpose: A cross-sectional study was conducted to explore the relationship between refractive error and ocular biometrics in children from the Guangzhou twin eye study.

Methods: Twin participants aged 7-15 years were selected from Guangzhou Twin Eye Study. Ocular examinations included visual acuity measurement, ocular motility evaluation, autorefraction under cycloplegia, and anterior segment, media, and fundus examination. Axial length (AL), anterior chamber depth (ACD), and corneal curvature radius were measured using partial coherence laser interferometry. A multivariate linear regression model was used for statistical analysis.

Results: Twin children from Guangzhou city showed a decreased spherical equivalent with age, whereas both AL and ACD were increased and corneal curvature radius remained unchanged. When adjusted by age and gender, the data from 77% of twins presenting with spherical equivalent changes indicated that these were caused by predictable variables (R2 = 0.77, P < 0.001). Primary factors affecting children's refraction included axial length (β = -0.97,P < 0.001), ACD (β = 0.33, P < 0.001), and curvature radius (β = 2.10, P < 0.001). Girls had a higher tendency for myopic status than did boys (β = -0.26, P < 0.001). Age exerted no effect upon the changes in refraction (β = -0.01, P = 0.25).

Conclusion: Refraction is correlated with ocular biometrics. Refractive status is largely determined by axial length as the major factor.

Purpose: To study the clinical manifestations and the diagnostic and differential diagnostic characteristics of acute idiopathic blind spot enlargement syndrome (AIBSES).

Methods: Six patients diagnosed with AIBSES underwent complete eye examinations including fundus photography, fundus fluorescein angiography(FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), electroretinogram (ERG), and visual field examinations.

Results: All patients had enlarged blind spots of variable sizes and densities. Three eyes had mild swelling of the optic disc and one eye had peripapillary scarring that corresponded to the permanent field defect. Two patients who underwent FFA had fluorescein leakage of blood vessels around the optic disc and ICGA highlighted diffuse, small hypofluorescent spots scattering throughout the posterior pole. OCT showed that the inner and outer segment (IS/OS) line were absent in five patients and the middle cone outer segment tip line was absent in the nasal macular area in one eye.

Conclusion: AIBSES is a rare outer retinopathy. Visual field examination and OCT are the most important means of detection. ICGA and FAF can determine the range of lesions earlier, and the progress of the disease should be taken into account when making a diagnosis.

Purpose: To report a rare case of Mantle cell lymphoma in lacrimal gland and review of the literature

Case report: We report a case of a 59-year-old female who presented with an upper eyelid mass in the right eye for 3 months, without pain and irrigation. A computerized tomography (CT) scan showed a mass in the bilateral lacrimal gland region, more significant in right eye. The patient underwent a lacrimal gland mass excision surgery and diagnosis of mantle cell lymphoma by histopathology. Immunochemistry for CD20, CD79a, CD5, and CyclinD1 was positive. She was recommended to the Shantou cancer hospital for chemotherapy.

Conclusion: Mantle cell lymphoma is a rare type of malignant lymphoma, over expressing CD5 and cyclin D1 antigens, which distinguishes it from other B cell lymphomas.

Purpose: To compare postoperative pain following laser-assisted subepithelial keratectomy (LASEK) and transepithelial photorefractive keratectomy (T-PRK, two-step surgery) and alleviate postoperative subjective pain.

Methods: Thirty patients (60 eyes) with myopia or myopic astigmatism were consecutively recruited into this prospective, randomized paired study. Patients underwent LASEK in one eye, and T-PRK in the other. The degree of pain was rated on a scale of 0-10 on postoperative days 1, 2 and 3. Uncorrected visual acuity (UCVA) and subepithelial corneal haze were assessed at postoperative 1 and 3 months.

Results: The pain was relieved on the 4th postoperative day in all patients, healing of corneal epithelium was observed at 4-5 days after surgery and contact lenses were removed promptly. At postoperative 1 day, the mean subjective pain score in the LASEK group was 3.2 ± 1.88 and 4.43 ± 1.61 in T-PRK group (P = 0.008). No significant difference was found between two groups on postoperative 2 and 3 days. At postoperative 3 months, the percentage of UCVA ≥ 0.8 in the LASEK group was 100% and 96.7% in the T-PRK group (P = 0.24), 93.3% of patients in the LASEK with UCVA ≥ 1.0 and 90% in the T-PRK group (P = 0.64). In the LASEK group, the value of corneal haze was 0.26 ± 0.21 and 0.27 ± 0.25 in the T-PRK group (P = 0.877).

Conclusion: Good visual acuity was obtained in both groups at postoperative 3 months. Compared with those in the T-PRK group, patients undergoing had less discomfort in the LASEK group, which may be associated with corneal epithelial activity. The changing curve of subjective pain in the T-PRK group was relatively flat and stable at postoperative 3 days.

Purpose: To show the follow-up of a case of vitelliform macular dystrophy with morphological and visual functional tests over an 8-year period.

Methods: Retrospective review of medical records. The morphological examination included color photography, fluorescein angiography, and ocular coherence tomography (OCT). The visual functional tests included visual acuity, electro-oculogram (EOG) and multifocal electroretinography (mfERG). The patient was observed for 8 years, from 2003 to 2011.

Results: During the follow-up, the improvement of sensory retinal detachment and reduction of yellow-white deposit were observed with color photography and fluorescein angiography. OCT revealed a decrease in sensory retinal detachment and subretinal hyper-reflective deposits; both of these morphological changes were correspondent. Visual acuity was maintained throughout the follow-up. The Arden ratio of EOG was decreased. The amplitudes of mfERG were decreased but slightly increased during the follow-up.

Conclusion: The retinal morphological changes and visual function slightly improved in this case of vitelliform maculopathy. The prognosis is good.

Purpose: Our aim was to obtain a better understanding of the etiologies and characteristics of pediatric cataracts treated at a single facility in China.

Methods: Medical records accrued over a 10-year period (from August, 2003 to July, 2013) at Shengjing Hospital of China Medical University were reviewed retrospectively, identifying all patients treated for various subtypes of pediatric cataract. A database with 367 subjects under 14 years of age (598, including second-round surgeries) was generated.

Results: Of this cohort (n = 367; males: 232, 63.2%; females: 135, 36.8%), 200 patients (54.5%) had bilateral cataracts, and 258 (70.3%) were under 3 years of age. In all age groups and in all subtypes of pediatric cataract, males were most commonly affected. Congenital cataract was the most prevalent subtype, accounting for 296 patients (80.7%). Most congenital cataracts were associated with other ocular or systemic abnormalities; and in 48 patients (16.22%), they were hereditary. Traumatic cataract was the most common subtype (85.92%) of acquired cataract. The few instances of cataracts due to steroids (n = 3) or to metabolic disorders (n = 2) occurred in males and involved both eyes.

Conclusion: The majority of pediatric cataracts in this patient population were congenital in nature. A significant lag in ophthalmologic evaluation of Chinese infants was evident and should be addressed by educating both children and parents on risk factors for cataract development. Regular assessments are especially important in children subjected to long-term systemic steroid treatments.

Purpose: To evaluate the efficacy and safety of transepithelial collagen cross-linking by iontophoretic delivery of riboflavin in treatment of progressive keratoconus.

Methods: Eleven patients (15 eyes) with progressive keratoconus were enrolled. After 0.1% riboflavin-distilled water solution was deliveried via transepithelial iontophpresis for 5 min with 1 mA current, and ultraviolet radiation (370 nm, 3 mW/cm2) was performed at a 1.5 cm distance for 30 min. The follow up were 6 months in all eyes. The uncorrected visual acuity, corrected visual acuity, endothelial cell counting, corneal thickness, intraocular pressure, corneal curvature, corneal topography, OCT and corneal opacity before and 6-month after surgery were analyzed.

Results: At 6 month postoperatively, mean uncorrected visual acuity and corrected visual acuity changed from 0.36 to 0.30 and from 0.42 to 0.57 without statistical significance. The mean value of each index of corneal curvature declined without statistical significance.Kmax value dereased from 60.91 to 59.91, and the astigmatism declined from 3.86 to 3.19. Central corneal thickness decreased from 460.93 μm to 455.40 μm, and thinnest corneal thickness declined from 450.87 μm to 440.60 μm with no statistical significance. Intraocular pressure was significantly elevated from 10.85 mmHg to 12.62 mmHg. Endothelial cell count did not change significantly. No corneal haze occurred. Mean depth of corneal demarcation line was 288.46 μm at 1 month postoperatively.

Conclusion: Transepithelial corneal collagen cross-linking by iontophoresis is effective and safe in the treatment of progressive keratoconus, and yields stable clinical outcomes during 6-month follow up. However, long-term follow up is urgently required.

Purpose: To report an unusual case of retinal hernia in the central macula in an adult after iridocyclitis.

Case report: We report a case of a 46-year-old male who presented with blurred vision 2 weeks after complete resolution of acute iridocyclitis. Anterior segment and vitreous body examinations were unremarkable. Yellowish spots in the macular area were observed. Spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed loss of the inner segment/outer segment (IS/OS) photoreceptor junction, with irregularity of the retinal pigment epithelium (RPE), and a V-shaped hernia of the retina into the choroid. The macular lesions emerged as mild window defects on fluorescein angiography and were visualized as hypofluorescent patches on all-phase indocyanine green angiography. At a one month follow-up, the best-corrected visual acuity improved to 20/20, which was followed by partial restoration of the IS/OS line, but a V-shaped hernia of the retina remained unchanged on SD-OCT.

Conclusion: Ophthalmologists should be alert to the changes in OCT of the macula in patients after iridocyclitis and further research on the cause and possible predisposing factors for retinal herniation is warranted.

Pediatric ophthalmic test requires meticulous observation and precise measurement. However, children are unable to actively cooperate with the test. If they were forced to receive the examinations, it is difficult to deliver accurate diagnosis and treatment, and cause negative influence upon physical and mental health. Consequently, sedation technique plays an extremely vital role in pediatric eye examinations. This study was designed to summarize the application of chloral hydrate in pediatric eye examination and propose different methods of medicine administration for children of varying ages, aiming to improve the effect of sedation. In addition, the feasibility of use of dexmedetomidine, which had been proven to be effective in pediatric sedation examination, into pediatric ophthalmic sedation examination was evaluated, thereby offering more options for the development of pediatric ocular sedation test.