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FLASH: A Novel Tool to Identify Vision-Threating Eye Emergencies. 闪光:一种识别威胁视力的眼部紧急情况的新工具。
Pub Date : 2020-01-01 Epub Date: 2020-10-08
Neil Jairath, Patrick Commiskey, Ariane Kaplan, Yannis M Paulus

Background: Two million patients visit emergency departments due to eye complaints annually in the United States, yet nearly one-quarter of these visits are for non-urgent ocular problems. Other patients often present a significant length of time after the onset of their symptoms, which may cause progression to irreversible vision loss. A major reason for this discrepancy is that many patients are unsure what symptoms constitute eye emergencies. The challenge is helping patients understand what constitutes a vision-threatening eye emergency, as well as the risks and complications that are associated with delaying their visit to the ophthalmologist or Emergency Department.

Objectives: To describe relevant literature on incidence, prevalence, presentation times, associated prognoses, risks, and complications of individual vision-threating eye emergencies, and present a novel acronym, FLASH (Floaters and flashes, Loss of vision, Aching pain, Second Image, Help), to better educate patients at risk for these conditions, fostering better symptom recognition and timely care. This manuscript is aimed at reaching public health departments, educational institutions, primary care offices and eye care centers as part of a dedicated patient education effort for vision-threatening eye emergencies.

Design / methods: Narrative overview of the available literature on specific eye conditions presenting with the aforementioned symptoms, synthesizing findings retrieved from searches of computerized databases and authoritative texts.

Conclusions: In each condition presented in this article, symptom interval significantly impacts treatment prognoses. The cited literature demonstrates that patients often present late in emergent eye conditions resulting in vision loss.

背景:在美国,每年有200万患者因眼部疾病前往急诊科就诊,但其中近四分之一的就诊是非紧急眼部问题。其他患者在症状出现后通常会出现相当长的时间,这可能会导致不可逆的视力丧失。造成这种差异的一个主要原因是,许多患者不确定什么症状构成眼部紧急情况。挑战在于帮助患者了解什么构成威胁视力的眼部紧急情况,以及与延迟就诊眼科医生或急诊科相关的风险和并发症。目的:描述有关发病率、患病率、就诊时间、相关预后、风险、,以及个人视力威胁眼部紧急情况的并发症,并提出了一个新的缩写词FLASH(Floaters and FLASH,Loss of vision,Aching pain,Second Image,Help),以更好地教育有这些疾病风险的患者,促进更好的症状识别和及时护理。这份手稿旨在接触公共卫生部门、教育机构、初级保健办公室和眼科护理中心,作为专门针对视力威胁性眼部紧急情况的患者教育工作的一部分。设计/方法:对出现上述症状的特定眼部疾病的现有文献进行叙述性概述,综合从计算机数据库和权威文本中检索到的结果。结论:在本文提出的每种情况下,症状间隔对治疗预后有显著影响。引用的文献表明,患者经常在突发眼部疾病中出现较晚,导致视力下降。
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引用次数: 0
Influence of Different Concentrations of Carbachol Drops on the Outcome of Presbyopia Treatment – A Randomized Study 不同浓度Carbachol滴剂对老花眼治疗效果的影响——一项随机研究
Pub Date : 2019-09-18 DOI: 10.17554/j.issn.2409-5680.2019.05.89
A. Abdelkader
Purpose: To evaluate and compare in a masked fashion the influence of using two different concentrations of carbachol drops on the outcome of presbyopia treatment. Methods: A prospective, double-masked, randomized study. 57 emmetropic and presbyopic subjects aged between 44 and 60 years with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Subjects were divided into 2 groups. Group 1 (n=32 eyes) received single dose of 2.25% carbachol plus 0.2% brimonidine eye drops. Group 2 (n=25) received single dose of 3% carbachol plus 0.2% brimonidine eye drops. The subjects’ pupil size and both near and distance visual acuities were evaluated before and after treatment at 1, 2, 4, 8 and 12 hr, by a masked examiner at the same room illumination. Results: Statistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received both concentrations of carbachol plus brimonidine drops (P < 0.0001). Significant and sustained improvement in mean NVA was reported in higher concentrations of carbachol drops than in lower concentrations (P < 0.0001). No serious adverse ocular effects were observed in any of the subjects of both groups. Conclusion: Based on the data, higher concentration of carbachol was found to be safe and provided greater efficacy in improving near visual acuity than lower concentration with prolonged duration of action.
目的:以隐蔽性的方式评价和比较使用两种不同浓度的乙醇滴剂对老花眼治疗结果的影响。方法:前瞻性、双盲、随机研究。57名年龄在44 - 60岁之间,双眼未矫正距离视力至少为20/20且无其他眼部病理的准远视和老花眼受试者符合入选条件。受试者分为两组。第1组(32只眼)给予单次剂量的2.25%氨基苯酚加0.2%溴硝定滴眼液。第2组(n=25)给予3%乙醇单剂量加0.2%溴硝定滴眼液。受试者的瞳孔大小和近距离视力分别于治疗前、治疗后1、2、4、8和12小时由蒙面审查员在相同房间照明下评估。结果:接受两种浓度的氨基酚加溴硝定滴剂治疗的所有受试者的平均近视力(NVA)均有统计学意义的改善(P < 0.0001)。据报道,高浓度的碳醇滴剂比低浓度的碳醇滴剂显著且持续地改善了平均NVA (P < 0.0001)。两组受试者均未见严重的眼部不良反应。结论:较高浓度的卡巴酚对近视力的改善是安全的,且较低浓度的卡巴酚改善近视力的效果更好,且作用时间延长。
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引用次数: 0
Conjunctival Autograft Versus Non-bare Sclera Mitomycin C in Surgery of Primary Pterygium 自体结膜移植与非裸巩膜丝裂霉素C在原发性翼状胬肉手术中的比较
Pub Date : 2019-08-04 DOI: 10.17554/j.issn.2409-5680.2019.05.88
A. Abdelkader
Objective: To evaluate and compare the efficacy of using conjunctival autograft and non-bare sclera mitomycin C (MMC) techniques as two treatment options for primary pterygium. Patients and Methods: Retrospective comparative study included 55 eyes in 55 patients with primary pterygium. 30 eyes of 30 patients (group 1) underwent pterygium excision followed by conjunctival autograft. 25 eyes of 25 patients (group 2) underwent pterygium removal followed by intraoperative application of 0.02% MMC for 2 minutes with conjunctival preservation (non-bare sclera technique). Both groups were compared in terms of surgery time, pterygium size, cosmetic effect, pterygium recurrence and complications. Results: Mean pterygium size was (3.1 ± 0.64 mm and 2.6 ± 0.94 mm) in group 1 and 2, respectively (p =0.1). Mean surgery time was significantly shorter in MMC group (26.4 ± 6.39 min) as compared  to conjunctival autograft group (47.9 ± 11.7 min) (P < 0.0001).  Pterygium recurrence was not seen in any of the patients. Mean follow up time was (14.8 ± 6 and 17.2 ± 9.6 months) in group 1 and 2, respectively (p = 0.4). Conclusion: Both conjunctival graft and non-bare sclera MMC techniques are comparable as regard of pterygium recurrence. MMC technique has significantly shorter surgery time, better cosmoses and lower incidence of complications. Preserving the conjunctiva should be considered when the patient has a history of glaucoma or there is insufficient conjunctiva.
目的:评价和比较自体结膜移植和非裸巩膜丝裂霉素C (MMC)技术治疗原发性翼状胬肉的疗效。患者与方法:回顾性比较研究55例原发性翼状胬肉患者55只眼。30例患者30眼(1组)行翼状胬肉切除后自体结膜移植。25例患者(第二组)25眼行翼状胬肉切除术,术中应用0.02% MMC保存结膜2分钟(非裸巩膜技术)。比较两组手术时间、翼状胬肉大小、美容效果、翼状胬肉复发及并发症。结果:1组和2组的平均翼状胬肉大小分别为(3.1±0.64 mm和2.6±0.94 mm),差异有统计学意义(p =0.1)。MMC组平均手术时间(26.4±6.39 min)明显短于自体结膜移植组(47.9±11.7 min) (P < 0.0001)。所有患者均未见翼状胬肉复发。1组和2组的平均随访时间分别为(14.8±6个月和17.2±9.6个月)(p = 0.4)。结论:结膜移植与非裸巩膜MMC技术在翼状胬肉复发方面具有可比性。MMC技术手术时间短,疗效好,并发症发生率低。当患者有青光眼病史或结膜不足时,应考虑保留结膜。
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引用次数: 0
A Correlative Study of Duration of Diabetes Mellitus, Microalbuminuria, Hyperlipidaemia with the Severity of Diabetic Retinopathy 糖尿病病程、微量白蛋白尿、高脂血症与糖尿病视网膜病变严重程度的相关性研究
Pub Date : 2019-05-12 DOI: 10.17554/j.issn.2409-5680.2019.05.87
P. Garg, Smriti Mishra, Ritika Mullick
AIM: The present study was carried out with an aim to study the concordance and correlation of microalbuminuria, dyslipidemia with the severity of Diabetic Retinopathy in type II diabetes mellitus patient and to provide a possible basis for explanation of mechanisms governing this relationship. MATERIAL AND METHOD: The study was conducted in a tertiary care hospital in North India.The patients underwent thorough history and ocular evaluation.The patients included in the study were advised to undergo biochemical investigations for Blood sugar, Urinary albumin to creatinine ratio in a random spot collection of urine and Lipid profile. Patients with acute or chronic renal failure, Opaque/hazy ocular media preventing fundus visualization, Co-existing ocular disorders likely to mask the findings of diabetic retinopathy, Patients with presence of any of the confounding factors, like fever, active systemic infections, exercise, high protein intake, accelerated hypertension, congestive heart failure, patients not willing to participate in the study were excluded from the study. RESULTS: 444 subjects of either gender were included in our study, out of which 236 patients were females and the rest were males. Majority of the patients lied in the age group of 41-60 years (54.73%) followed by 61-80 years (29.28%) and 20-40 years (15.09%), while only 4(0.90%) patients were aged >80 years. A statistically significant association with severity of retinopathy and the age of the patients was observed. Proportion of Group I (No retinopathy) was higher in younger patients i.e. 20- 40 (74.6%) and 41-60 (54.3%) as compared to elderly cases i.e. 61-80 (46.2%) and this difference was found to be statistically significant (p<0.001). Statistically significant association was found between the severity of retinopathy and duration of diabetes (p<0.001). Proportion of severe to very severe retinopathy and proliferative diabetic retinopathy were higher in higher grade of microalbuminuria (Grade II and Grade III). A statistically significant association between microalbuminuria grade and severity of retinopathy was observed (p<0.001). Total cholesterol was found to be high (240 mg/dl) in 13.74%patients. Prevalence of retinopathy was 60.7%, in patients having high total cholesterol levels. Proportional difference in severity of retinopathy in patients with different total cholesterol levels was found to be statistically significant (p=0.002). Trivariate analysis between severity of retinopathy, microalbuminuria and serum cholesterol levels, revealed that in microalbuminuria grade 0, difference in prevalence of retinopathy in patients with different serum cholesterol levels was not found to be statistically significant. CONCLUSION: Duration of diabetes and microalbuminuria have been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study. The findings in present study endorsed the view that mic
目的:本研究旨在探讨2型糖尿病患者微量白蛋白尿、血脂异常与糖尿病视网膜病变严重程度的一致性和相关性,并为解释这种关系的机制提供可能的依据。材料和方法:本研究在印度北部的一家三级保健医院进行。患者接受了详细的病史和眼部评估。建议纳入研究的患者进行血糖、尿白蛋白与肌酐比(随机抽取尿液)和血脂的生化检查。急性或慢性肾功能衰竭患者、妨碍眼底可视化的不透明/朦胧的眼介质、可能掩盖糖尿病视网膜病变发现的并存眼部疾病患者、存在发热、活动性全身感染、运动、高蛋白摄入、加速高血压、充血性心力衰竭等任何混淆因素的患者、不愿意参加研究的患者均被排除在研究之外。结果:我们的研究纳入了444名男女患者,其中女性236例,其余为男性。患者以41 ~ 60岁居多(54.73%),其次为61 ~ 80岁(29.28%)和20 ~ 40岁(15.09%),年龄在bb0 ~ 80岁的患者仅4例(0.90%)。观察到视网膜病变严重程度与患者年龄有统计学意义的关联。I组患者中20 ~ 40岁(74.6%)和41 ~ 60岁(54.3%)的无视网膜病变比例高于老年患者61 ~ 80岁(46.2%),差异有统计学意义(p<0.001)。视网膜病变的严重程度与糖尿病病程之间有统计学意义的关联(p<0.001)。重度至极重度视网膜病变和增长性糖尿病视网膜病变的比例在微白蛋白尿级别较高(II级和III级),微白蛋白尿级别与视网膜病变严重程度之间有统计学意义的相关性(p<0.001)。13.74%的患者总胆固醇高(240 mg/dl)。在总胆固醇水平高的患者中,视网膜病变的患病率为60.7%。不同总胆固醇水平患者视网膜病变严重程度的比例差异有统计学意义(p=0.002)。视网膜病变严重程度、微量白蛋白尿和血清胆固醇水平之间的三变量分析显示,在微量白蛋白尿0级时,不同血清胆固醇水平患者的视网膜病变患病率差异无统计学意义。结论:糖尿病病程和微量白蛋白尿是糖尿病视网膜病变的独立危险因素,但血清胆固醇水平在我们的研究中没有显示出独立的作用。本研究结果支持微量白蛋白尿具有糖尿病视网膜病变风险的观点,该风险受糖尿病病程、血糖控制水平和脂质水平的影响。
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引用次数: 2
Intraocular Pressure Changes Following the Administration of Intravitreal Dexamethasone Implant: A Mini -Review 玻璃体内注射地塞米松后眼压的变化:一项小综述
Pub Date : 2019-05-12 DOI: 10.17554/j.issn.2409-5680.2019.05.86
O. Karti, A. Osman Saatci
Intravitreal Dexamethasone Implant (IDI) (Ozurdex®, Allergan, Inc. Irvine, CA) is the sustained-release corticosteroid device approved by the US Food and Drug Administration for the treatment of macular edema resulting from diabetes mellitus, non-infectious uveitis and retinal vein occlusion. Along with its anti-inflammatory effects, the most common associated side-effects are cataract formation and intraocular pressure (IOP) elevation. Although the exact pathophysiological mechanism remains unclear, increased aqueous outflow resistance resulted from the biochemical and structural changes in the trabecular meshwork is deemed responsible for the already well-known IOP elevation. This mini-review evaluated the major clinical trials on IOP changes following the 0.7 mg IDI administration and summarized their main results on IOP changes and its management.
玻璃体内地塞米松植入物(IDI)(Ozurdex®,Allergan,股份有限公司Irvine,CA)是一种经美国食品和药物管理局批准的皮质类固醇缓释装置,用于治疗糖尿病、非感染性葡萄膜炎和视网膜静脉阻塞引起的黄斑水肿。除了抗炎作用外,最常见的相关副作用是白内障形成和眼压升高。尽管确切的病理生理机制尚不清楚,但小梁网的生化和结构变化导致的水流出阻力增加被认为是众所周知的IOP升高的原因。这篇小型综述评估了0.7 mg IDI给药后IOP变化的主要临床试验,并总结了其关于IOP变化及其管理的主要结果。
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引用次数: 1
Purtscher Retinopathy and Fat Embolism Syndrome Purtscher视网膜病变和脂肪栓塞综合征
Pub Date : 2019-02-02 DOI: 10.17554/j.issn.2409-5680.2019.05.77
Cagri Ilhan
Purtscher retinopathy and fat embolism syndrome are chorioretinopathies occurred after indirect ocular trauma. These diseases look like similar conditions but there are important differences which are help to differential diagnosis. In general, trauma is responsible from these diseases; but crush trauma play role in Purtscher retinopathy, while bone fracture play role in fat embolism syndrome. Retinal whitening is dominant funduscopic finding in these diseases; but whitening is wide and centrally in Purtscher retinopathy, while it is smaller and located more peripherally in fat embolism syndrome. These clinical findings associated with Purtscher retinopathy and fat embolism syndrome, resolve spontaneously in weeks or months but permanent visual loss can be seen in survivors. In this manuscript, we aimed to give general information about emergence and clinical course and differentiation of Purtscher retinopathy and fat embolism syndrome.
Purtscher视网膜病变和脂肪栓塞综合征是间接眼外伤后发生的脉络膜视网膜病变。这些疾病看起来相似,但有重要的差异,有助于鉴别诊断。一般来说,创伤是由这些疾病引起的;但挤压伤在Purtscher视网膜病变中起作用,而骨折在脂肪栓塞综合征中起作用。视网膜变白是这些疾病的主要眼底发现;但在Purtscher视网膜病变中,白化范围广泛且集中,而在脂肪栓塞综合征中,白化面积较小且位于外周。这些与Purtscher视网膜病变和脂肪栓塞综合征相关的临床发现在几周或几个月内自发消退,但在幸存者中可以看到永久性视力丧失。在这篇文章中,我们旨在提供有关Purtscher视网膜病变和脂肪栓塞综合征的出现、临床过程和鉴别的一般信息。
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引用次数: 0
Non-Therapeutic Laser Retinal Injury. 非治疗性激光视网膜损伤。
Pub Date : 2019-01-01 Epub Date: 2019-11-26 DOI: 10.17554/j.issn.2409-5680.2019.05.90
Patrick W Commiskey, Curtis J Heisel, Yannis M Paulus

Background: As lasers have become an increasingly important component of commercial, industrial, military, and medical applications, reported incidents of non-therapeutic laser eye injuries have increased. The retina is particularly vulnerable due to the focusing power and optical transparency of the eye. Continued innovations in laser technology will likely mean that lasers will play an increasingly important and ubiquitous role throughout the world. Critical evaluation should thus be paid to ensure that non-therapeutic injuries are minimized, recognized, and treated appropriately.

Methods: A comprehensive literature review on the PubMed database was conducted to present case reports and case series representative of the variety of laser eye injuries in different injury circumstances, tissue types, and biological damage mechanisms.

Results: A general summary of non-therapeutic laser retina injuries is presented, including information about growth of the industry, increasingly accessible online markets, inconsistent international regulation, laser classifications, laser wavelengths, and laser power, mechanisms of tissue injury, and a demonstration of the variety of settings in which injury may occur. Finally, 68 cases found in the literature are summarized to illustrate the presentations and outcomes of these patients.

Conclusions: As non-therapeutic laser eye injuries increase in frequency, there is a greater need for public health, policy, diagnosis, and treatment of these types of injuries.

背景:随着激光在商业、工业、军事和医疗应用中日益重要的组成部分,非治疗性激光眼损伤的报道也越来越多。由于眼睛的聚焦能力和光学透明度,视网膜特别脆弱。激光技术的持续创新可能意味着激光将在世界各地发挥越来越重要和无处不在的作用。因此,应该进行关键的评估,以确保非治疗性损伤被最小化、识别和适当治疗。方法:对PubMed数据库进行全面的文献综述,提出具有代表性的各种激光眼损伤在不同损伤情况、组织类型和生物损伤机制下的病例报告和病例系列。结果:对非治疗性激光视网膜损伤进行了概述,包括有关行业发展的信息,越来越多的在线市场,不一致的国际法规,激光分类,激光波长,激光功率,组织损伤机制,以及可能发生损伤的各种环境的演示。最后,我们总结了68例文献中发现的病例,以说明这些患者的表现和结果。结论:随着非治疗性激光眼损伤发生频率的增加,对这类损伤的公共卫生、政策、诊断和治疗有更大的需求。
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引用次数: 2
Advances in Retinal Laser Therapy 视网膜激光治疗进展
Pub Date : 2018-02-27 DOI: 10.17554/j.issn.2409-5680.2018.04.70
Jia Li, Y. Paulus
Since the 1960s, laser therapies have played a critical role in the treatment of numerous retinal diseases. Significant advances have been made in laser technology and the molecular understanding of laser-tissue interactions over the past 55 years to maximize the therapeutic effect while minimizing side-effects. While pharmacologic therapies (e.g., anti-vascular endothelial growth factor or anti-VEGF) are playing a larger role, laser therapy remains an important treatment modality for proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), sickle cell retinopathy, retinal vein occlusions, central serous chorioretinopathy, tumors, polypoidal choroidal vasculopathy, and retinal tears. With the development new laser technologies such as selective retinal therapy, subthreshold micropulse laser, nanosecond laser, photomediated ultrasound therapy, and navigated laser, the risk of adverse events has been significantly reduced. This review summarizes the latest developments in retinal laser therapy.
自20世纪60年代以来,激光治疗在许多视网膜疾病的治疗中发挥了关键作用。在过去的55年中,激光技术和对激光与组织相互作用的分子理解取得了重大进展,以最大限度地提高治疗效果,同时最大限度地减少副作用。虽然药物治疗(如抗血管内皮生长因子或抗vegf)正在发挥更大的作用,但激光治疗仍然是增生性糖尿病视网膜病变(PDR)、糖尿病黄斑水肿(DME)、镰状细胞视网膜病变、视网膜静脉阻塞、中央浆液性脉络膜视网膜病变、肿瘤、息肉样脉络膜血管病变和视网膜撕裂的重要治疗方式。随着选择性视网膜治疗、亚阈值微脉冲激光、纳秒激光、光介导超声治疗、导航激光等激光新技术的发展,不良事件的发生风险显著降低。本文综述了视网膜激光治疗的最新进展。
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引用次数: 10
期刊
International journal of ophthalmic research
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