中华眼科杂志最新文献

In medical practice, intraocular space-occupying lesions are a major category of diseases that are prone to clinical misdiagnosis and mistreatment. In the process of diagnosing these lesions caused by different etiologies, special attention should be paid to the establishment of diagnostic and therapeutic thinking patterns and clinical diagnosis, and vigilance should be exercised against the negative trend of using auxiliary examination results instead of clinical diagnosis. Ophthalmologists should enhance their understanding of intraocular space-occupying lesions, make accurate diagnoses, choose appropriate treatments, and perform enucleation surgery with caution.

Optical coherence tomography (OCT), with its advantages of non-invasiveness, non-contact, rapid imaging, and high resolution, has become an indispensable core imaging tool in the diagnosis and treatment of fundus diseases. It provides clinicians with critical structural insights for accurately assessing lesion characteristics and severity, dynamically monitoring disease progression and treatment efficacy, and optimizing therapeutic strategies. However, in the era of precision medicine, the application effectiveness of OCT still faces significant challenges. Deeply understanding and acknowledging its limitations is fundamental to maximizing the value of OCT and seeking effective solutions. This article focuses on the key bottlenecks and breakthrough paths of OCT in the diagnosis and treatment of fundus diseases, systematically analyzing the core issues from three dimensions, including the physical constraints of the device itself, the physiological and pathological variations among individual patients, and the subjectivity of physician interpretation. Closely following the cutting-edge trends and development opportunities in the OCT field, the counter strategies, like continuous technological innovation, deep integration of artificial intelligence, multimodal imaging integration, optimization of patient workflows and protocols, and standardized physician training, are also discussed. The aim is to provide clinicians with a comprehensive insight into the current status and future directions of OCT applications, helping them better understand existing challenges, more effectively utilize current technologies, and grasp the opportunities brought by technological innovation and diagnostic model transformation, and thus promoting the continuous improvement of precision diagnosis and treatment levels for fundus diseases.

The management of rhegmatogenous retinal detachment (RRD) primarily relies on two core surgical modalities: scleral buckling (SB) and pars plana vitrectomy (PPV). In recent years, the rapid advancement of PPV technology has facilitated its increasingly widespread clinical application. However, due to its steep learning curve, SB has become progressively marginalized in clinical practice. In some instances, it has even been substituted for cases that were originally indicated for SB. This article systematically analyzes the unique complications and indications of both surgical approaches, highlighting the irreplaceable value of SB in specific patient populations, such as pediatric patients and those with moderately complex RRD in phakic eyes. It is proposed that the selection of surgical strategy should be based on a comprehensive evaluation of lesion characteristics, patient-specific factors, and the inherent advantages of each technique, thereby enabling individualized and precise treatment.

In recent years, therapeutic bandage contact lenses have been widely used in clinical practice. In 2019, the Society of Contact Lens Safety Monitoring and Visual Health of Chinese Health Association formulated expert consensus opinions on their standardized clinical application. Over the past five years, new progress has been achieved in the related research. Therefore, the society has conducted extensive discussions to attain an updated consensus on the indications, contraindications and usages of therapeutic bandage contact lenses based on the latest evidence-based medicine and clinical discoveries and experience, which may serve as a reference for clinical practitioners.

The clinical activity score (CAS) for the thyroid-associated ophthalmopathy (TAO) evaluation has advantages such as simplicity and practicality for clinical use, but it also has limitations. Based on the formulation and development of the CAS, this article analyzes five aspects: design limitations, ethnic differences, comparison with the VISA (vision, inflammation, strabismus, and appearance/exposure) classification, controversies regarding CAS cutoff values, and the lack of objectivity in the CAS. It emphasizes that clinicians should comprehensively and dialectically evaluate the CAS by integrating the disease course, severity, and harmfulness of TAO, so as to correctly distinguish TAO stages, provide appropriate treatments, achieve favorable therapeutic effects, and ultimately improve the clinical management of TAO.

Objective: To achieve automated lesion detection in optical coherence tomography (OCT) images based on a lightweight convolutional neural network architecture. Methods: This retrospective study employed deep learning to construct a lightweight lesion identification model using OCT images from Sichuan Provincial People's Hospital alongside datasets including OCT-C8, OCT-2017, and HD-OCT of MH. Model performance evaluation comprised two stages: firstly, testing on four independent external validation sets to assess the model's generalisability and accuracy; secondly, employing a confidence interval overlap comparison method to evaluate the classification performance of ophthalmologists at different levels of clinical experience (two per level) against the model, thereby determining the clinical experience level corresponding to the model's medical proficiency. Results: The model achieved an accuracy of 93.41% (47 054/50 374) on the validation set, with an F1 score of 88.18% (44 419/50 374) and a recall rate of 86.42% (43 533/50 374). The area under the receiver operating characteristic curve was 99.31% (50 026/50 374), with precision at 91.48% (46 082/50 374) and specificity at 99.1% (49 921/50 374). For nine categories of OCT images, namely neovascularisation, posterior vitreous detachment, epiretinal membrane, macular hole, macular schisis, subretinal fluid, normal image, vitreomacular traction, and obscured image, the precision rates were 97.48% (16 873/17 310), 90.99% (3 039/3 340), 97.62% (1 325/1 358), 97.91% (2 185/2 232), 79.23% (4 961/6 262), 81.47% (1 594/1 957), 90.55% (17 744/19 596), 88.08% (237/269), and 99.95% (19 520/19 530), respectively. The model achieved an average accuracy of 89.9% on the external validation set, whereas junior physicians demonstrated an accuracy of 74% (95%CI: 61.84%~86.16%) in interpreting OCT images, and that of mid-level physicians was 88% (95%CI: 78.99%~97.01%), indicating the model's performance approached that of mid-level physicians. Conclusions: This study marks the first successful implementation of automated recognition across nine categories of OCT images. Its clinical performance has preliminarily attained the level of a mid-career physician, and it can be deployed locally within healthcare settings to enhance diagnostic efficiency and accuracy.

Polypoidal choroidal vasculopathy (PCV) is a common subtype of neovascular age-related macular degeneration (nAMD) in Asian populations. Clinical follow-up has revealed varying degrees of activity in PCV lesions. Studies have shown that multimodal retinal imaging techniques can be used to assess the activity of PCV lesions. Abnormal branching vascular networks, polypoidal lesions, and choroidal-related features are important biological markers for predicting lesion activity. Additionally, demographic characteristics and genetic traits of patients may also serve as relevant factors for assessing the activity of PCV lesions. This review summarizes recent updates in the understanding of PCV lesion activity based on multimodal retinal imaging studies and their impact on clinical ophthalmic practice. It also explores the potential applications and prospects of lesion activity characteristics in the treatment and follow-up of PCV, aiming to provide reference for clinicians in assessing and determining the activity of PCV lesions and developing personalized treatment and follow-up plans.

Four children were treated at the Ophthalmology Department of Beijing Children's Hospital affiliated with Capital Medical University, including a female patient aged 9 years and 11 months with redness and swelling of the forehead accompanied by bilateral eyelid swelling for 3 days, a male 14-day-old infant with progressive worsening of the right eye redness and swelling accompanied by high fever, nasal congestion and a runny nose for 7 days, a boy aged 5 years and 9 months with the left eye and facial redness and swelling, black skin deposition, rupture, pus discharge and high fever for 2 days, and a 7-year-old male with the right eyelid redness and swelling accompanied by fever and acute lymphoblastic leukemia for 2 hours. The comprehensive blood routine examination showed C-reactive protein levels exceeded 140 mg/L and white blood cell counts exceeded 20×10⁹/L in all patients. Bacterial cultures of ocular secretions or pus were mainly positive for Streptococcus pyogenes, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Orbital imaging revealed orbital abscess formation (Chandler stage 4) in 2 patients and subperiosteal abscess and necrotizing fasciitis (Chandler stage 3) in 2 patients. According to the scoring criteria for the systemic inflammatory response syndrome, all four cases were diagnosed with severe orbital cellulitis. Systemic and ocular antibiotics were administered, along with local debridement and abscess incision and drainage. Four children recovered without any recurrence of infection. Two of them developed late-onset inner canthal deformity and eyelid abnormality, which were resolved by corrective surgery.