Clinical effects of atorvastatin combined with conbercept in the treatment of patients with macular edema secondary to retinal vein occlusion and carotid plaque: study protocol for a prospective randomized controlled trial.

INTRODUCTION: Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs have been widely used in patients with macular edema (ME) secondary to retinal vein occlusion (RVO); however, recurrence is a major concern. This study aims to observe the clinical effects of atorvastatin and intravitreal therapy in the treatment of patients with branch or central RVO-ME and coexistent carotid plaques (CP). METHODS AND ANALYSIS: A prospective randomized controlled clinical trial will be conducted. Sixty-four patients diagnosed with branch or central RVO-ME and coexistent CP will be enrolled and randomly allocated in a 1:1 ratio to the control and experimental groups. The control group will be treated with intravitreal conbercept monthly for 3 months, followed by monthly evaluation and injection of pro re nata (PRN) for 12 months, while the experimental group will be treated with oral atorvastatin 20 mg daily combined with the control group treatment. If a drop of best-corrected visual acuity (BCVA) is more than five Early Treatment Diabetic Retinopathy Study (ETDRS) letters (one line) or an increment in central subfield thickness (CSFT) of 100 µm (or a 10% increment from the previous visit), intravitreal re-treatment will be performed. Outcome measurements include CSFT, BCVA, number of injections, and incidence of adverse events during the 12-month follow-up period. Differences between groups will be evaluated using Student's t-test, and comparisons between groups will be evaluated using repeated-measures analysis of variance. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Review Board of Nanjing Lishui People's Hospital, Nanjing, China (approval number 2023KY0418-12, dated 18 April 2023), and has been registered on chictr.org.cn. Written informed consent will be collected from each patient and the results of this trial will be submitted to a peer-reviewed journal. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300071359. Registered on 12 May 2023.

Effect of a self-developed fixation device on preventing endotracheal intubation-related pressure injury: a randomised controlled trial.

OBJECTIVE: To evaluate the effects of our self-developed endotracheal tube fixation device in mechanically ventilated patients. METHODS: In a dual-centre randomised controlled trial, patients who were expected to require mechanical ventilation for over 48 h were assigned to the observation group (using self-developed device) or the control group (using the traditional device). The primary endpoint was the incidence of endotracheal intubation-related pressure injury (EIRPI). RESULTS: Fifty-one patients in the observation group and 54 patients in the control group were analysed. The incidence of EIRPI was 7.8% in the observation group and 33.3% in the control group (p = 0.001). Lip pressure injury (PI) occurred in 0 versus 14 (25.9%) patients in the observation versus control groups (p < 0.001). Both oral-mucosal and facial PIs were similar between the two groups. CONCLUSIONS: The use of the novel device reduced the incidence of EIRPI, especially lip PI. Trial registration Chinese Clinical Trial Registry ChiCTR2300078132. Registered on 29 November 2023.

An atypical form of retinitis pigmentosa: A case report.

Key Clinical Message: This case contributes to the new knowledge of unilateral pericentral RP. Multimodal imaging provides valuable information to better understand the disease. The development is significantly slow and defines a better clinical course than typical RP. Pericentral RP presents with unremarkable night blindness, which can be easily misdiagnosed by ophthalmologists. Abstract: Unilateral pericentral retinitis pigmentosa (RP) is a rare, atypical, mild form of RP that affects the pericentral retina close to the vascular arcades and tends to spare the far-peripheral retina in one eye, while the fellow eye remains completely unaffected. A 71-year-old Chinese woman presented with blurred vision in her right eye for several decades, however, her left eye was unaffected. Fundus photography revealed bone-spicule pigmentation located at the pericentral retina of her right eye. Spectral-domain optical coherence tomography revealed significant atrophy of the outer retina and retinal pigment epithelium, and an evident absence of the ellipsoid zone in the right eye. The visual field showed a wide-range paracentral scotoma in the right eye. The full-field electroretinogram demonstrated subnormal amplitudes of dark and light adaption in the right eye. No significant changes were observed during a further 5-year follow-up. Multimodal imaging provides valuable information to better understand unilateral pericentral RP. The development of unilateral pericentral RP is significantly slow and defines a better clinical course than the typical RP. Pericentral RP presents with slight visual reduction and unremarkable night blindness, which can be easily misdiagnosis by ophthalmologists. Reasonable prevention measures, screening methods, and timely diagnosis are beneficial for RP patients.

Case report: acute isolated cilioretinal artery occlusion secondary to percutaneous coronary intervention.

INTRODUCTION: This case report aims to describe in detail the acute isolated cilioretinal artery occlusion (CLRAO) secondary to complicated therapeutic percutaneous coronary intervention (PCI). CASE DESCRIPTION: A 68-year-old Chinese man with coronary artery disease (CAD) complained of sudden, sharp chest pain. Coronary angiography revealed severe stenoses of the coronary arteries. The patient was then treated with PCI. One hour after the procedure, the patient presented with a sudden reduction in vision in the right eye. The patient was diagnosed with acute isolated CLRAO and treated with Salvia miltiorrhiza injections. CONCLUSIONS: This is the report to provide a detailed description of acute isolated CLRAO secondary to therapeutic PCI treated with Salvia miltiorrhiza. The visual prognosis of the untreated patients is poor. Suitable management and prevention are essential for interventional cardiologists to prevent these complications.

Etiological Factors and Visual Outcomes of Dense Vitreous Hemorrhage in Patients Aged 80 years and above over the Past Decade in a Tertiary General Hospital.

This study aimed to investigate the main etiological factors and visual outcomes in patients with dense vitreous hemorrhage (DVH) aged ≥80 years. We retrospectively included patients with DVH aged ≥80 years who were admitted to our ophthalmology department between January 1, 2010, and December 31, 2019. All patients underwent pars plana vitrectomy (PPV). Data regarding demographic characteristics; preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ophthalmic B-scan ultrasonography findings; intraoperative conditions; and postoperative complications were collected and analyzed. A total of 44 patients (44 eyes) were enrolled, with a median age of 82 years; among them, 25 patients (56.82%) were men. The median preoperative BCVA was 2.3 (1.1-3.0). The main etiological factors included retinal vein occlusion (RVO) (20 eyes, 45.45%), polypoidal choroidal vasculopathy (PCV) (15 eyes, 34.09%), proliferative diabetic retinopathy (PDR) (7 eyes, 15.90%), retinal arterial macroaneurysm (RAM) (1 eye, 2.27%), and posterior vitreous detachment (PVD) (1 eye, 2.27%). The median final BCVA was 1.92 (0.5-2.6). There was a significant postoperative improvement in the BCVA; moreover, branch RVO (BRVO) had a better postoperative visual prognosis than central RVO (CRVO), PCV, and PDR (P < 0.05). The final postoperative BCVA was significantly better when the initial BCVA was above hand motion (HM) than when it was HM or lower (P < 0.05). Our findings indicate that RVO, PCV, and PDR were the main causes of DVH. Microinvasive PPV is a safe and effective method that can clarify diagnosis and improve BCVA. Patients with BRVO and preoperative BCVA > HM may have a relatively good visual prognosis. For patients aged ≥80 years who have an appropriate general condition, PPV can be timely performed to treat DVH.

Clinical Characteristics and Prognosis of Pediatric Phthirus pubis Coinfestation of the Eyelashes and Scalp Hairs.

Phthirus pubis infestation is a highly infectious parasitic disease, affecting 1.3-4.6% of people globally. However, the coinfestation of P. pubis on the eyelashes and scalp hairs in children is uncommon, and the clinical characteristics and prognosis have not been fully studied. In this retrospective study, we report five pediatric patients diagnosed with eyelash and scalp coinfestation of P. pubis. The samples were obtained after treatment and sent for pathological examination. The demographic and clinical characteristics of the study participants were analyzed in detail. Numerous lice and nits were detectable on the eyelashes and scalp hairs in all enrolled patients. The ages ranged from 2 to 5 years. The duration of onset ranged from 3 to 10 days. The common clinical presentations were itching (100%) and conjunctivitis (60%). Treatment included eyelash and scalp hair trimming to the root (100%) and mechanical removal of the parasites (100%), in addition to topical tobramycin eye ointment (100%) and phenothrin shampoo (80%). Symptoms resolved by a 1-week follow-up. Pediatric P. pubis coinfestation mainly occurs on the eyelashes and temporal scalp in females, and sometimes contact tracing fails to identify the source. Phthirus pubis infestation of eyelashes can be misdiagnosed as blepharoconjunctivitis. Sexually transmitted diseases should be ruled out for patients with P. pubis infestation. Untreated or persistent cases may lead to several serious infections.

Case report: Spontaneous bilateral intraocular lens dislocation in a patient with homocystinuria.

Background: Spontaneous bilateral intraocular lens dislocation of the vitreous cavity is a rare ocular disorder. This article aims to comprehensively describe bilateral spontaneous intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis in a Chinese woman with homocystinuria. Case presentation: A 72-year-old Chinese woman with homocystinuria presented with a painless bilateral blurring of vision. The slit lamp showed the absence of lenses in both eyes. B-ultrasound and orbital computed tomography (CT) demonstrated bilateral posterior dislocation of the crystalline lenses, and spectral-domain optical coherence tomography (SD-OCT) revealed a lamellar macular hole and retinoschisis in the right eye. Biochemical examination demonstrated that the total homocysteine level was moderately elevated. Conclusion: This report is the first to present an extensive and valuable description of bilateral intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis secondary to homocystinuria. We have demonstrated that this case was spontaneous and chronic. CT is an effective diagnostic tool for patients with ectopia lentis. Early diagnosis and suitable management of patients with homocystinuria are essential to prevent these complications.

Effect of a Topical Nonsteroidal Anti-Inflammatory Drug (0.1% Pranoprofen) on VEGF and COX-2 Expression in Primary Pterygium.

Purpose: To evaluate the effect of a topical nonsteroidal anti-inflammatory drug (0.1% pranoprofen) on the expression of VEGF and Cox-2 in primary pterygium. Methods: This was a prospective, randomized study. Between January 2019 and April 2020, 120 patients diagnosed with primary pterygium were enrolled and randomly divided into three groups before operation: 1) 40 patients in group 1 received topical pranoprofen 0.1% four times daily for 4 weeks, 2) 40 patients in group 2 received topical fluorometholone 0.1% four times daily for 4 weeks, and 3) patients in group 3 did not receive treatment. For each group, the age, sex, eye type, best-corrected visual acuity (BCVA), intraocular pressure (IOP), duration of onset, combined systemic diseases, and the results regarding vascular endothelial growth factor (VEGF) and cyclo-oxygen-ase-2 (COX-2) in postoperative pterygial tissues were evaluated in detail. Results: There were no significant differences regarding age, sex, eye type, combined systemic diseases, duration of onset, IOP, and BCVA within the three groups (p > 0.05). The reduction of VEGF and CoX-2 expression of pterygial vascular endothelial cells in group 1 were statistically significant compared to group 2 and group 3 (p < 0.05). There were significant correlations between COX-2 and VEGF expression of pterygial tissues within the three groups (p < 0.05). Conclusion: The present findings suggested that the topical pranoprofen 0.1% could reduce the expression of VEGF and COX-2 in primary pterygium. We confirmed that treatment with pranoprofen offers advantages in early intervention and has therapeutic potential in reducing the postoperative recurrence of primary pterygium patients. Clinical Trial registration: The study was registered with the Chinese Clinical Trial Registry. (http://www.chictr.org.cn/index.aspx, Registration Number: ChiCTR2100047726).

Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report.

Background: Acute hypertensive retinochoroidopathy is a rare, severe ocular disease, characterized by retinal and choroidal ischaemia. Untreated cases are associated with high mortality and poor visual outcomes. Patients subjected to treatment with the anti-neoplasic drug apatinib may trigger this disease. The purpose of this article is to describe in detail an acute hypertensive retinochoroidopathy in a young Chinese woman treated with apatinib. Case Presentation: A 40-year-old young Chinese woman presented a sudden but painless reduction of visual acuity in both eyes. She was previously diagnosed with gastric cancer and metastatic ovarian adenocarcinoma. The treatment consisted radical gastrectomy, transabdominal hysterectomy, bilateral adnexectomy, and 250 mg oral apatinib per day. After 58 days of apatinib administration, the patient immediately sought consult for a sudden decrease in vision. Her blood pressure was 208/136 mmHg and, based on the clinical manifestations, the patient was diagnosed with acute hypertensive retinochoroidopathy. Conclusions: This is the first case report of an apatinib-related acute hypertensive retinochoroidopathy diagnosed using fundal photograph, fundus fluorescein angiography, and spectral-domain optical coherence tomography simultaneously. It is crucial to develop a suitable strategy for management and prevention of this adverse event.