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The recommendations for pediatric vitreoretinal surgery 儿童玻璃体视网膜手术的建议
Pub Date : 2019-11-07 DOI: 10.15406/aovs.2019.09.00366
B. Turgut, T. Demir, O. Çatak
Pediatric vitreoretinal surgery (PVRS) has important differences compared to that in adults. The main indications for PVRS include rhegmatogenous retinal detachments (RRD) caused by trauma, congenital retinoschisis, Marfan, Stickler or morning-glory syndrome, peripheral retinal degenerations, fundus coloboma, retinoblastoma, myopia, previous ocular surgery and tractional retinal detachments (TRD) caused by retinopathy of prematurity (ROP), persistent fetal vasculature (PFV), familial exudative vitreoretinopathy (FEVR) and penetrating ocular trauma. RRD in the adult usually associates with the posterior vitreous detachment (PVD), while as the RRD in pediatric age is often caused by trauma or congenital abnormalities. As pediatric retinal detachments (RD) usually present in late stages and pediatric ocular anatomy is featured, PVRS is more difficult and complex and has greater complication rates. The most common and devastating complication of PVRS is proliferative vitreoretinopathy (PVR). In particular, creating an iatrogenic retinal break (IRB) during PVRS can cause PVR in children because of the strong inflammatory and proliferative response.1−5
与成人相比,儿童玻璃体视网膜手术(PVRS)具有重要的差异。PVRS的主要适应证包括外伤引起的孔源性视网膜脱离(RRD)、先天性视网膜裂、Marfan、Stickler或牵牛花综合征、周围性视网膜变性、眼底缺损、视网膜母细胞瘤、近视、既往眼部手术、早产儿视网膜病变(ROP)、持续性胎儿血管病变(PFV)、家族性渗出性玻璃体视网膜病变(FEVR)和穿透性眼外伤引起的牵引性视网膜脱离(TRD)。成人的RRD通常与玻璃体后脱离(PVD)有关,而儿童年龄的RRD通常由创伤或先天性异常引起。由于儿童视网膜脱离(RD)通常出现在晚期,且儿童眼部解剖特点,PVRS更为困难和复杂,并发症发生率更高。增生性玻璃体视网膜病变(PVR)是PVRS最常见和最具破坏性的并发症。特别是,在PVRS期间产生医源性视网膜破裂(IRB)可导致儿童PVR,因为强烈的炎症和增殖反应1−5
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引用次数: 1
Acute angle-closure glaucoma caused by topiramate–a drug complication that can lead to blindness 由托吡酯引起的急性闭角型青光眼——一种可导致失明的药物并发症
Pub Date : 2019-11-05 DOI: 10.15406/aovs.2019.09.00365
M. Duarte, Claudia Cristina Duarte
Glaucoma is the commonest pattern of optic neuropathy characterized as a gradual loss of retinal ganglion cells (RGCs) as well as classic modifications to the retinal nerve fiber layer (RNFL) and optic nerve.1 Depending on the angle appearance at gonioscopy, it is classified as open-angle or closed-angle glaucoma.1 Likewise, if an underlying cause is established, the disease is perceived as secondary glaucoma.1 Considering closed-angle glaucoma characteristics, secondary drug-induced is a rare disease with a huge potential of perpetual visual loss.1
青光眼是最常见的视神经病变,其特征是视网膜神经节细胞(RGCs)的逐渐丧失以及视网膜神经纤维层(RNFL)和视神经的经典修饰根据角度的不同,可分为开角型青光眼和闭角型青光眼同样,如果确定了潜在的病因,则认为该疾病是继发性青光眼考虑到闭角型青光眼的特点,继发性药物性青光眼是一种罕见的疾病,具有永久性视力丧失的巨大潜力
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引用次数: 0
Efficacy and quality of informed consent for Dacryocystorhinostomy–a prospective study 泪囊鼻腔造瘘术知情同意的疗效和质量——一项前瞻性研究
Pub Date : 2019-10-28 DOI: 10.15406/aovs.2019.09.00364
Ahmad Aziz
To date, consent for complex ocular procedures has not received much attention in the literature. As a specialty, ophthalmology surrenders to the ‘treadmill’ efficiency of pooled lists, assigned assessments and generic patient information sheets.7 There is an assumption that valid consent has been gained when patients may still be uninformed. Furthermore, patients may report high levels of satisfaction, yet remain to have poor levels of understanding.8 Patient retention of operation risks is poor and the capacity to provide fully informed consent is influenced by the patients level of education, literacy and language competency.9–11 The anatomy of the lacrimal system and potential for surgery is a difficult concept for patients to perceive, especially without pictorial or comprehensive written material devoid of medical jargon. Considering all these factors, it may be likely that the process we deem as valid consent is actually an uninformed one. To our knowledge no prior studies have looked at objective improvement in patient recollection and understanding during informed consent for dacryocystorhinostomy (DCR). In our survey, we aimed to evaluate the effectiveness of our current standard consenting process for dacryocystorhinostomy (DCR) at increasing understanding and comprehension in a competent patient in a specialist ophthalmology centre in London.
迄今为止,在文献中,对复杂眼科手术的同意并没有得到太多的关注。作为一门专业,眼科学屈服于“跑步机”式的合并名单、分配评估和通用患者信息表的效率有一种假设是,当患者可能仍然不知情时,已经获得了有效的同意。此外,患者可能报告高水平的满意度,但仍然有低水平的理解患者对手术风险的认知较差,提供完全知情同意的能力受到患者教育水平、文化水平和语言能力的影响。9-11泪系统的解剖结构和手术的可能性对患者来说是一个难以理解的概念,特别是在没有医学术语的图片或全面的书面材料的情况下。考虑到所有这些因素,我们认为有效的同意过程实际上可能是一个不知情的过程。据我们所知,在知情同意泪囊鼻腔造口术(DCR)过程中,没有先前的研究观察到患者回忆和理解的客观改善。在我们的调查中,我们的目的是评估我们目前的泪囊鼻腔吻合术(DCR)的标准同意过程在提高理解和理解能力方面的有效性,在伦敦的专业眼科中心。
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引用次数: 0
Reported medication adherence by glaucoma patients in a Nigeria hospital 尼日利亚一家医院青光眼患者的药物依从性报告
Pub Date : 2019-10-24 DOI: 10.15406/aovs.2019.09.00363
O AjiteKayode, O FadamiroChristianah, I AjayiIyiade, J OmotoyeOlusola
Glaucoma is a chronic disease necessitating a lifelong treatment in order to prevent the occurrence of irreversible blindness.1 Glaucoma is the second leading cause of blindness in Nigeria2 and the leading cause of irreversible blindness globally.3 The primary objective of glaucoma therapy is to prevent progressive vision loss and blindness. Lowering of intraocular pressure (IOP) is the only proven strategy that prevents the risk of glaucoma progression.4,5 Medical therapy, laser procedures, and incisional surgical treatment are reasonable options for the initial treatment of glaucoma (lowering intraocular pressure) and most patients initially receive topical ocular hypotensive drops.6 In the majority of cases topical therapy is beneficial if administered correctly. Poor patient adherence to chronic medical therapy has been well documented across the disease spectrum over the past several decades.6−8 Non adherences to medical treatments by glaucoma patients may lead to resultant visual impairment, blindness, and disabilities. Therefore, the outcome of therapy relies heavily on patient adherence to the treatment regimen.7 Successful outcomes of medical treatment for glaucoma requires proper and daily use of medication to prevent disease progression. According to the World Health Organization (WHO), adherence to long-term therapies among patients suffering from chronic diseases in the general population is around 50% and is much lower in developing countries.8 Nonadherence among glaucoma patients has been reported to range as high as 80%.9 Patients with poor adherence to medication have worse outcomes with a higher rate of visual loss and increase health care costs.10 Adherence is defined as the degree to which a patient follows the instructions to take a prescribed treatment during a defined period of time.11
青光眼是一种慢性疾病,需要终生治疗,以防止不可逆失明的发生青光眼是尼日利亚第二大致盲原因2,也是全球不可逆转失明的主要原因青光眼治疗的主要目的是防止进行性视力丧失和失明。降低眼压(IOP)是唯一被证实的预防青光眼进展风险的策略。药物治疗、激光手术和切口手术治疗是青光眼初始治疗(降低眼压)的合理选择,大多数患者最初接受局部降压药在大多数情况下,如果使用得当,局部治疗是有益的。在过去的几十年里,患者对慢性药物治疗的依从性差已经在整个疾病谱系中得到了很好的记录。6−8青光眼患者不坚持治疗可能导致视力损害、失明和残疾。因此,治疗的结果在很大程度上取决于患者对治疗方案的坚持青光眼医学治疗的成功结果需要正确和日常使用药物来预防疾病进展。根据世界卫生组织(WHO)的数据,在一般人群中,慢性病患者坚持长期治疗的比例约为50%,而在发展中国家,这一比例要低得多据报道,青光眼患者的不依从率高达80%对药物依从性差的患者预后较差,视力丧失率较高,医疗费用增加坚持治疗的定义是病人在规定的时间内遵循指示接受规定治疗的程度
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引用次数: 3
The future of ophthalmology; how will the patient with ophthalmic problems be cared for in 30 years’ time? 眼科学的未来;30年后,眼疾患者将如何得到照顾?
Pub Date : 2019-10-23 DOI: 10.15406/aovs.2019.09.00361
Housam Monla-Haidar
Looking back not many years ago, the significant change in how the patient used to be cared for compared to the current days is undeniable. Starting from surgical techniques and the machines we use, moving to how we now manage long-term conditions that were nearly impossible to be managed in the most optimistic ophthalmologist’s mind back in the days. For example, mind-blowing innovations and great efforts are now dedicated to controlling conditions causing significant sight impairment such as AMD or retinitis pigmentosa. Living in the current era where technology and innovations dominate and influence our lives, remarkable, unprecedented advances are taking place. As expected, tiny, well-designed and connected instruments and the accompanying apps make it possible to undertake eye examinations anywhere in the world – making patients the point of care. Internationally, this considerable step would provide ophthalmic service to people in unprivileged areas and people in war zones. Using smartphones and newly built lenses might be the future of out of hospital ophthalmology. One can imagine how using these remote approached would provide a quicker response to some of the most serious ophthalmic emergencies where time is vital in determining the future of the patients’ vision and the quality of their life. For instance, it is not imaginary being able to diagnose retinal artery occlusion or an acute angle closure glaucoma using criteria that does not require the patient to waste valuable time in A&Es. We have all heard about a watch being able to detect a fall or a life-threatening arrhythmia, not far from today, we might see devices and implants to identify ocular emergencies that significantly reduce the long-term complications of not having responded to an ophthalmic emergency in a timely manner.1,2
回顾几年前,与目前相比,病人的护理方式发生了重大变化,这是不可否认的。从我们使用的手术技术和机器开始,到我们现在如何治疗长期的疾病,这些疾病在过去最乐观的眼科医生看来几乎是不可能治疗的。例如,令人兴奋的创新和巨大的努力现在致力于控制导致严重视力损害的条件,如AMD或视网膜色素变性。生活在科技和创新主导并影响我们生活的当今时代,正在发生着非凡的、前所未有的进步。正如预期的那样,小巧、设计精良、联网的仪器和配套的应用程序使人们可以在世界任何地方进行眼科检查——让患者成为护理的焦点。在国际上,这一重大步骤将为贫困地区和战区的人们提供眼科服务。使用智能手机和新型镜片可能是医院外眼科的未来。可以想象,使用这些远程方法将如何为一些最严重的眼科紧急情况提供更快的反应,在这些紧急情况下,时间对决定患者未来的视力和生活质量至关重要。例如,使用不需要患者在急症室浪费宝贵时间的标准来诊断视网膜动脉闭塞或急性闭角型青光眼并不是想象出来的。我们都听说过手表能够检测到跌倒或危及生命的心律失常,在不久的今天,我们可能会看到用于识别眼部紧急情况的设备和植入物,这些设备和植入物可以显著减少由于没有及时对眼科紧急情况做出反应而导致的长期并发症
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引用次数: 0
Quality of care for chalazion surgery between nursing and medical staff 手术护理与医护人员护理质量的比较
Pub Date : 2019-10-21 DOI: 10.15406/aovs.2019.09.00362
Ahmad Aziz, Rushmia Karim, T. Lynch, V. Lee, Ahmed Alnahrawy, Rajni Jain
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引用次数: 0
Pediatric nasolacrimal duct obstruction a review of current management 小儿鼻泪管梗阻的当前治疗回顾
Pub Date : 2019-10-08 DOI: 10.15406/aovs.2019.09.00360
Ahmad Aziz, V. Lee, T. Fayers, Yassir Abourayyah, Rajni Jain
Congenital nasolacrimal duct obstruction is a condition that occurs commonly in infants22-25 and usually resolves with conservative management alone24-20. It is the most common cause of epiphora in infants1,2 70% of neonates present with congenital nasolacrimal duct obstructions at delivery3 with only 6-20% being symptomatic4,5 as the obstruction usually resolves before lacrimal secretion begins.6 The common approach in the management of this condition is lacrimal massage and observation with or without topical antibiotic treatment as most cases of nasolacrimal duct obstruction resolve without surgery.7−11 Another option is an immediate office probing approach with topical anaesthesia and restraint and this was not found to be superior to observation and massage.12 The assessment of pediatric epiphora involves looking for a high tear meniscus, recurrent mucopurulent discharge and applying pressure to the lacrimal sac contents by pressure to reflex the contents.6,13 Other conditions which may present with epiphora need to be excluded including epiblepharon, congenital entropion, congenital glaucoma, keratitis and uveitis.5 The fluorescent dye disappearance test is a non invasive test that can confirm nasolacrimal duct obstruction with 90% sensitivity8. Down’s syndrome and craniofacial malformations may be associated with a higher prevalence of congenital nasolacrimal duct obstruction which can be confirmed with imaging.9
先天性鼻泪管梗阻是一种常见于婴儿的疾病[22-25],通常仅通过保守治疗即可解决[24-20]。先天性鼻泪管梗阻是导致婴儿大哭的最常见原因,70%的新生儿在分娩时出现先天性鼻泪管梗阻,只有6-20%有症状,因为梗阻通常在泪液分泌开始前就消失了处理这种情况的常见方法是泪道按摩和观察,有或没有局部抗生素治疗,因为大多数鼻泪管阻塞不需要手术解决。7 - 11另一种选择是局部麻醉和约束下即刻探查,但没有发现这种方法优于观察和按摩评估儿童溢泪包括寻找高撕裂半月板,反复的粘液化脓性分泌物,并通过压力反射泪囊内容物对泪囊内容物施加压力。6,13其他可能伴有外翻的情况需要排除,包括外翻、先天性内翻、先天性青光眼、角膜炎和葡萄膜炎荧光染料消失试验是一种无创试验,可确诊鼻泪管阻塞,灵敏度达90% 8。唐氏综合征和颅面畸形可能与先天性鼻泪管阻塞的高发率有关,这可以通过影像学证实
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引用次数: 0
Multimodal imaging in congenital simple hamartoma of retinal pigment epithelium (CSHRPE): optical coherence tomography (OCT), autofluorescence and oct angiography, a review of the literature and case presentation 先天性视网膜色素上皮单纯性错构瘤(CSHRPE)的多模态成像:光学相干断层扫描(OCT),自身荧光和OCT血管造影,文献回顾和病例报告
Pub Date : 2019-09-24 DOI: 10.15406/aovs.2019.09.00359
A. Gurreri, A. Pazzaglia
According to Gass Retinal Pigment Epithelial Hamartoma (RPEH) is a presumed congenital pigment epithelial adenomas or primary pigment epithelial hyperplasia.1 RPEH is a non-hereditary benign retinal tumour of unknown aetiology, possibly due to translocation between the short arms of chromosomes 11 and 18, like Combined Hamartoma of the Retina and Retinal Pigment Epithelium.2 Congenital simple Hamartoma of Retinal Pigment Epithelium (CSHRPE) was first recognized in 1981 by Laqua3 and later characterized and named in 1989 by Gass, who reported ten cases.1 In 2003, Shields documented the largest subsequent case series, consisting of five patients.4 CSHRPE is a rare intraocular finding that is described as a unilateral, focal, nodular, jet black lesion. That frequently occur at or near the macula, no known association with changes in the surrounding neurosensory retina, RPE or choroid, nor have they been related with exudation or hemorrhage . Usually, involves the full thickness of the retina through the I.L.M. (Internal Limiting Membrane) with an umbrella shaped in the inner retinal surface.1 The patients are asymptomatic, and usually have normal visual acuity. For this reason though these lesions are congenital, they often are not identified until adulthood. Although, sometimes children may develop amblyopia and strabismus due to macular involvement.
根据Gass的说法,视网膜色素上皮错构瘤(RPEH)是一种先天性色素上皮腺瘤或原发性色素上皮增生RPEH是一种病因不明的非遗传性良性视网膜肿瘤,可能是由于11号和18号染色体短臂之间的易位所致。2先天性单纯性视网膜色素上皮错构瘤(CSHRPE)于1981年由laqu3首次发现,1989年由Gass鉴定并命名,报告10例2003年,希尔兹记录了随后最大的病例系列,包括5名患者CSHRPE是一种罕见的眼内发现,被描述为单侧,局灶性,结节性,黑色病变。常发生在黄斑或黄斑附近,与周围神经感觉视网膜、RPE或脉络膜的改变无已知关联,也与渗出或出血无关。通常,通过视网膜内限定膜覆盖整个视网膜,视网膜内表面呈伞状患者无症状,通常视力正常。由于这个原因,虽然这些病变是先天性的,但它们通常直到成年后才被发现。虽然,有时儿童可能发展弱视和斜视,由于黄斑受累。
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引用次数: 1
Interface vitrectomy-a savior technique for vitreoretinal surgery 界面玻璃体切除术——玻璃体视网膜手术的救星技术
Pub Date : 2019-08-30 DOI: 10.15406/aovs.2019.09.00358
B. Turgut, O. Çatak
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引用次数: 0
Chorioretinal coloboma: clinical presentation complications and treatment alternatives 绒毛膜视网膜缺损:临床表现、并发症及治疗选择
Pub Date : 2019-08-28 DOI: 10.15406/aovs.2019.09.00357
A. Altıntaş
Choroio Retinal coloboma (CRC) characterized by congenital absence of part of the retinal pigment epithelium and choroid, caused by the defective closure of the embryonic fissure, which normally develops gradually between sixth and seventh weeks of fetal life. Colobomas present various parts of ocular tissue such as iris and /or uvea, lens, optic nerve or eyelid. Since it is embriological pathology CRC may also be associated with other ocular pathologies such as cataract, microphthalmia, anophthalmia.1−4
Choroio Retinal coloboma (CRC)以先天性视网膜色素上皮和脉络膜部分缺失为特征,由胚胎裂隙闭合缺陷引起,通常在胎儿生命的第6 - 7周之间逐渐发展。结肠瘤出现在眼部组织的各个部位,如虹膜和/或葡萄膜、晶状体、视神经或眼睑。由于CRC是一种胚胎病理学,它也可能与其他眼部病变相关,如白内障、小眼症、无眼症等
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引用次数: 1
期刊
Advances in ophthalmology & visual system
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