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Objective:To study a deep learning-based dual-modality fundus camera which was used to study retinal blood oxygen saturation and vascular morphology changes in eyes with branch retinal vein occlusion (BRVO).Methods:A prospective study. From May to October 2020, 31 patients (31 eyes) of BRVO (BRVO group) and 20 healthy volunteers (20 eyes) with matched gender and age (control group) were included in the study. Among 31 patients (31 eyes) in BRVO group, 20 patients (20 eyes) received one intravitreal injection of anti-vascular endothelial growth factor drugs before, and 11 patients (11 eyes) did not receive any treatment. They were divided into treatment group and untreated group accordingly. Retinal images were collected with a dual-modality fundus camera; arterial and vein segments were segmented in the macular region of interest (MROI) using deep learning; the optical density ratio was used to calculate retinal blood oxygen saturation (SO 2) on the affected and non-involved sides of the eyes in the control group and patients in the BRVO group, and calculated the diameter, curvature, fractal dimension and density of arteriovenous in MROI. Quantitative data were compared between groups using one-way analysis of variance. Results:There was a statistically significant difference in arterial SO 2 (SO 2 -A) in the MROI between the affected eyes, the fellow eyes in the BRVO group and the control group ( F=4.925, P<0.001), but there was no difference in the venous SO 2 (SO 2-V) ( F=0.607, P=0.178). Compared with the control group, the SO 2-A in the MROI of the affected side and the non-involved side of the untreated group was increased, and the difference was statistically significant ( F=4.925, P=0.012); there was no significant difference in SO 2-V ( F=0.607, P=0.550). There was no significant difference in SO 2-A and SO 2-V in the MROI between the affected side, the non-involved side in the treatment group and the control group ( F=0.159, 1.701; P=0.854, 0.197). There was no significant difference in SO 2-A and SO 2-V in MROI between the affected side of the treatment group, the untreated group and the control group ( F=2.553, 0.265; P=0.088, 0.546). The ophthalmic artery diameter, arterial curvature, arterial fractal dimension, vein fractal dimension, arterial density, and vein density were compared in the untreated group, the treatment group, and the control group, and the differences were statistically significant ( F=3.527, 3.322, 7.251, 26.128, 4.782, 5.612; P=0.047, 0.044, 0.002, <0.001, 0.013, 0.006); there was no significant difference in vein diameter and vein curvature ( F=2.132, 1.199; P=0.143, 0.321). Conclusion:Arterial SO 2 in BRVO patients is higher than that in healthy eyes, it decreases after anti-anti-vascular endothelial growth factor drugs treatment, SO 2-V is unchanged.
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Objective:To evaluate the application of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery.Methods:An observational case series study was conducted.A total of 316 patients (316 eyes) who received vitreoretinal surgery and iOCT from January 2015 to December 2017 in Hangzhou Branch of Eye Hospital, Wenzhou Medical University were enrolled.The iOCT scanning time and result, the consistency between iOCT result and observation under the operating microscope as well as the influence of iOCT on surgical strategy were recorded.The postoperative adverse reactions and complications were observed.The study protocol was approved by an Ethics Committee of Eye Hospital, Wenzhou Medical University(No.2019-168-K-160). Written informed consent was obtained from all patients prior to any medical examination.Results:There were 85.8% (271/316) of patients who successfully completed iOCT scanning, with an average scanning time of (3.54±2.30)minutes.Among the 271 successful eyes, there were 51 with idiopathic macular hole (IMH), 95 with epiretinal membrane, 50 with dense vitreous hemorrhage (VH), 30 with macular lamellar hole, 12 with vitreous macular traction syndrome, 33 with myopic maculopathy.There were 45 eyes, accounting for 16.6%, the iOCT results of which were inconsistent with the observation of operator under the operating microscope.There were 27 eyes, accounting for 10.0%, the surgical strategy of which was changed.The iOCT results of IMH showed that intra-retinal bridge connection appeared in 2 eyes after ILM peeling, then air tamponade was used.High-reflection strips on the edge of the MH after ILM peeling, called the Hole-door phenomenon, were found in 15 eyes, accounting for 32.6%.In MH with a diameter >400 μm, the postoperative best corrected visual acuity and continuity of outer limiting membrane were better in eyes with Hole-door phenomenon than eyes without Hole-door phenomenon.There were 8 eyes, accounting for 8.4%, showing residual membrane, 3 eyes of which received extra ERM peeling.There were 56 eyes, accounting for 58.9%, showing the secondary changes after membrane peeling.For 50 eyes with dense VH, there were 17 eyes showing the normal macular structure, accounting for 34%, and 33 eyes showing the abnormal macular structure, accounting for 66.0%.In addition, the macular structures of 14 eyes, accounting for 28.0%, observed in iOCT image were inconsistent with the intraocular microscope finding, and 11 of them received extra ERM peeling.Conclusions:The application of iOCT in vitreoretinal surgery can guide the selection of reasonable surgical methods during operation, predict postoperative recovery as well as improve postoperative outcomes.
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Objective:To observe the incidence and risk factors of microcystic macular edema (MME) in patients with idiopathic macular epiretinal membrane (IMEM) preoperatively and postoperatively.Methods:A retrospective case series study. From January 2017 to May 2021, 72 eyes of 72 patients with IMEM in Eye Hospital of Wenzhou Medical University at Hangzhou were included. There were 18 male and 54 female. Average age was 64.8±7.8 years. Eyes were all monocular. All patients received the examination of best corrected visual acuity (BCVA) by standard logarithmic visual acuity chart, which was represented logarithmic of minimum angle of resolution (logMAR). Optical coherence tomography was used to measure central macular thickness (CMT). MME was defined as small, vertically bounded cystic space located outside the fovea in the inner layer of the retina. According to the presence or absence of MME before surgery, the affected eyes were divided into two groups: non-MME group (35 eyes) and MME group (37 eyes). The difference of logMAR BCVA and CMT was statistically significant between Group A and B ( t=3.117, 2.589; P=0.003, 0.012). All patients with IMEM were treated with 23G three-channels pars plana vitrectomy (PPV) with epiretinal membrane and inner limiting membrane (ILM) peeling. The two groups were further divided into four groups according to whether there was MME in the postoperative follow-up time. The group A1 was without MME before and after surgery, group A2 was without MME before surgery and with MME after surgery. The MME group was subdivided into the group with MME before surgery and without MME after surgery (group B1) and the group with MME before and after surgery (group B2). The mean follow-up time was 8.8±7.7 months. The same equipment and methods were used to exam the patients during the follow-up. Paired t test was used to compare the changes of MME, BCVA and CMT before and after surgery. The differences of CMT and BCVA among groups before and after surgery were compared by independent sample t test and one-way ANOVA. Logistic regression was used to analyze the influencing factors of MME before and after surgery, and multiple linear regression was used to analyze the influencing factors of postoperative BCVA. Results:There were 35 eyes in the non-MME group, 18 eyes (51.43%, 18/35) in the A1 group and 17 eyes (48.57%, 17/35) in the A2 group, respectively. There were 37 eyes in MME group, 6 eyes (16.22%, 6/37) in group B1 and 31 eyes (83.78%, 31/37) in group B2, respectively. At last follow-up, the logMAR BCVA was 0.10±0.12, 0.25±0.17, 0.09±0.11, 0.30±0.26 in group A1, A2, B1, and B2, respectively. Compared with the logMAR BCVA before surgery, the differences were statistically significant ( t=3.779, 4.253, 7.869, 6.668; P<0.01). There was significant difference in logMAR BCVA among the four groups ( F=4.460, P<0.01). There was a significant difference in logMAR BCVA between group A1 and group A2 ( t=-2.930, P=0.006). There was no significant difference between group B1 and group B2 ( t=-1.921, P=0.063). The CMT of group A1, A2, B1 and B2 were 371.83±73.24, 431.24±83.13, 407.00±28.07 and 425.19±70.97 μm, respectively. Compared with those before operation, the differences were statistically significant ( t=5.197, 2.465, 3.055, 6.078; P<0.05). There was no significant difference in CMT among the four groups ( F=2.597, P=0.059). Logistic regression analysis showed that pre-operation MME was correlated with pre-operation IMEM stage ( β=1.494, P=0.004). New MME after surgery was correlated with age ( β=0.153, P=0.013). Multiple linear regression analysis showed that postoperative visual acuity was significantly correlated with CMT before surgery and MME after surgery ( β=0.001, 0.134; P=0.015, 0.019). Conclusions:PPV combined with epiretinal membrane and ILM peeling surgery for IMEM can improve visual acuity and decrease CMT. MME regress or regenerate after surgery. Age is an independent predictor of the risk of newly formed MME after surgery.
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Objective:To observe the expression of vascular endothelial growth factor (VEGF) and aquaporin 4 (AQP4) in the inner limiting membrane (ILM) of diabetic retinopathy (DR) with macular edema, and analyze the correlation between VEGF and AQP4 expression.Methods:A cross-sectional study. From September 2019 to September 2020, 38 eyes of 38 patients with DR and idiopathic macular hole (iMH) who underwent vitrectomy (PPV) combined with ILM stripping at the Hangzhou campus of The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included in the study. Among them, there were 25 males and 13 females who aged 37-76 years old, average age was 59±10 years old; All eye included 15 right eyes and 23 left eyes. iMH and DR included 9 eyes in 9 cases and 29 eyes in 29 cases, respectively, and they were divided into iMH group and DR group. The DR group was divided into DME group and no DME group according to whether it was accompanied by diabetic macular edema (DME), with 14 eyes and 15 eyes respectively. After the stripped ILM tissue was fixed, immunofluorescence analysis was performed to obtain a picture of the fluorescence mode of AQP4 and VEGF, and the fluorescence intensity value of VEGF and AQP4 was measured by Image J software. The differences of VEGF and AQP4 immunofluorescence values in the specimens between groups were compared by one-way analysis of variance. The correlation between the fluorescence intensity of AQP4 and the fluorescence intensity of VEGF was analyzed by Pearson correlation analysis.Results:The average fluorescence intensity valuesof VEGF and AQP4 in ILM specimens of DME group, no DME group and iMH group were 38.96±7.53, 28.25±3.12, 30.07±4.84 and 49.07±8.73, 37.96±6.45, 38.08±5.04, respectively. The average fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DME group was significantly higher than that of the no DME group and iMH group, and the difference was statistically significant ( F=13.977, 9.454; P<0.05). The average fluorescence intensity values of VEGF and AQP4 on IML specimens in the DR group were 33.80±7.91, 43.76±9.44, respectively. The results of Pearson correlation analysis showed that the fluorescence intensity of VEGF and AQP4 in the ILM specimens of the DR group was significantly positively correlated ( r=0.597, P=0.003). Conclusions:The expressions of VEGF and AQP4 in ILM of eyes with DR and DME are significantly increased compared with those without DME. The expression of VEGF and AQP4 in ILM of eyes with DR is positively correlated.
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The 17α-hydroxylase/17, 20-lyase deficiency (17-OHD) is a rare disease. The clinical characteristics and gene mutation of 2 late-diagnosed 17-OHD patients with testicular tumor admitted to our hospital from March 2018 to February 2019 were analyzed retrospectively. The two 17-OHD patients were female (46, XY). Laparoscopic abdominal exploration found undeveloped testicles in grey-yellow or grey-red in the groin and iliac fossa. The testicles were removed and showed malignancy in pathology study. Sequencing of the CYP17A1 gene identified c.1247G>A/c.1427T>C and c.985_987delTACinsAA/c.1306G>A complex heterozygous mutations. Taking together, the possibility of 17-OHD should be considered in patients with hypertension, hypokalemia, adrenal adenomatoid hyperplasia together with 46, XY gonadal dysplasia, so as to make early diagnosis and treatment, and avoid dysplastic testicular turning to malignancy.
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Based on binocular disparity, three-dimensional (3D) display technology makes the right and left eyes see different images in a certain way, which generates a stereo image after the processing of the brain's visual cortex.Due to its high-definition stereoscopic surgical field of vision and accurate spatial positioning ability, 3D display technology has been widely used in surgery.Ophthalmic microsurgery is performed with the help of microscope because of the complex intraocular operation and small operating space, especially minimally invasive vitreoretinal surgery, which is the most difficult surgery with the longest learning curve in ophthalmology.The 3D display viewing system can improve surgical accuracy, reduce retinal phototoxicity, relieve the pressure on the neck and back of the surgeon as well as promote communication and cooperation between medical staff and so on.At present, the major 3D display systems applied in ophthalmology include the NGENUITY 3D Visualization System and TrueVision 3D Visualization System, both of which require wearing 3D glasses.The naked eye 3D display system is the main direction of future development.The combination of 3D display system and ophthalmic surgical robot system provides a new idea for the development of remote ophthalmic surgery.At the same time, broader application of 3D display system requires continuous improvement.In this article, the research and application of 3D display system in anterior segment surgery and vitreoretinal surgery were reviewed.
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Objective:To evaluate the efficacy and safety of conbercept in patients with choroidal neovascularization secondary to chronic central serous chorioretinopathy (CSC-CNV).Methods:A retrospective case study was performed.The medical records of 13 patients (14 eyes) diagnosed as chronic CSC-CNV in Hangzhou Branch of Eye Hospital of Wenzhou Medical University from September 2015 to January 2018 were collected.All the study eyes received intravitreal injection of conbercept (0.05 ml/0.5 mg) under one intravitreal injection and pro re nata (PRN) treatment.The best corrected visual acuity (BCVA) and central macular thickness (CMT) before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were measured and analyzed.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient before initial injection.The study protocol was approved by the Ethics Committee of Hangzhou Branch of Eye Hospital of Wenzhou Medical University (No.2019-029-K-28).Results:During the 6-month follow-up, the mean administration times was 1.93±0.83, and all the CNV secondary to CSC did not grow outside the retinal pigment epithelium layer.The BCVA values before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were 0.51±0.32, 0.43±0.34, 0.36±0.35, 0.31±0.28, 0.27±0.29 and 0.26±0.30, respectively, with a significant difference among different time points ( F=21.225, P<0.05). The BCVA values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). The CMT values before initial injection and 1 week and 1 month, 2, 3, 6 months after initial injection were (299.07±132.90), (216.50±70.94), (203.00±61.87), (234.29±95.70), (194.21±46.46) and (207.43±55.46) μm, respectively, and the difference was statistically significant among different time points ( F=3.768, P<0.05). The CMT values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). No severe treatment complications were observed during the follow-up period. Conclusions:Intravitreal injection of conbercept is safe and can effectively reduce the CMT and improve BCVA of chronic CSC-CNV patients in the short term.
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Objective To compared the macular blood flow parameters among myopic choroidal neovascularization (mCNV), high myopia (HM) and normal subjects.Methods Retrospective study. Forty patients (40 eyes) diagnosed as mCNV (mCNV group) in the Eye Hospital of Wenzhou Medical University at Hangzhou from June 2016 to November 2018, age-matched, sex-matched and diopter-matched 40 HM patients (40 eyes, HM group), age-matched and sex-matched 40 healthy persons (40 eyes, normal group) were enrolled in this study. Retina superficial and deep vessel density, the area of foveal avascular zone (FAZ), a-circularity index (AI) and vessel density around the 300 μm width of the FAZ region (FD) on macular 3 mm×3 mm scan on OCTA of 3 groups were compared.Results There were significant differences in the average retina superficial, deep vessel density, the area of FAZ, AI and FD among 3 groups (F=24.82, 9.18, 3.58, 7.68, 14.15;P<0.05). The average retina superficial and deep vessel density and FD in mCNV group were lower than those in HM group (P<0.05). The average retina superficial and deep vessel density and FD in HM group were lower than those in control group (P<0.05). The average area of FAZ in mCNV group was smaller than that in control group (P<0.05). The average AI in mCNV group was less than that in the other 2 groups (P<0.05). Conclusions The retina superficial, deep vessel density and FD decreased, the area and the form of FAZ remained unchanged in HM subjects comparing with normal subjects. While retina superficial, deep vessel density and FD decreased more, the area of FAZ reduced, the form of FAZ tend to be irregular in mCNV.
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Objective To observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic. Methods A prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12％ C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.Results The foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20;P<0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.Conclusions Pars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.
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Compared with age-matched controls,mild cognitive impairment (MCI) populations are at a higher risk of developing Alzheimer's disease (AD).There is no consensus that any pharmacological treatment can improve MCI,thus it is plausible to turn attention to cognitive interventions.This paper reviewed the prior researches on cognitive stimulation,cognitive training,and cognitive rehabilitation for MCI based on the categories defined by Clare and Woods in order to clarify the effect of these interventions on improving cognitive function in MCI individuals.The results indicate that cognitive interventions may improve multiple cognitive domains including memory performance,executive functions,processing speed,attention,and social functions in adults with MCI,while the mechanism remains unclear.It suggested that further studies should examine the mechanism of cognitive intervention by applying neuroscience technology and strengthening the control of heterogeneity of the etiologies and symptoms of MCI,and improve the clinical effect by combining cognitive stimulation,cognitive training,and cognitive rehabilitation.
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Objective@#To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.@*Methods@#A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males(5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.@*Results@#In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ2=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).@*Conclusions@#Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.
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Objective To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.Methods A retrospective,case-controlled study.Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study.There were 5 males (5 eyes) and 24 females (24 eyes),with an average age of 55.28 ± 11.40 years.According to the surgical method,the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes).All patients underwent BCVA,spectral domain OCT and axial length measurement before surgery.There was no significant difference between the two groups in age,gender,course of disease,hole diameter,BCVA and other baseline data.Follow-up was over 4 months after surgery.The BCVA,macular hole closure and continuity of outer retina after surgery were observed.Results In ILM peeling group,11 eyes were closed (64.7％) and 6 eyes were not closed at 3 months after surgery.In ILM flap group,12 eyes were closed (100.0％).The difference of closure rate between two groups was statistically significant (x2=5.34,P=0.028).The BCVA of inverted ILM flap group was significantly improved at 1,3 months after surgery compared with preoperative measurements,and the difference was statistically significant (F=3.813,4.667;P=0.003,0.001).The BCVA of ILM peeling group was improved at 1 month after surgery,but the difference was not statistically significant (F=1.556,P=0.139).And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements,and the difference was statistically significant (F=2.453,P=0.026).But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647,0.535;P=0.551,0.612).There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008,P=0.631).Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole.The closure rate of the hole can be improved significantly.
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Objective The aim of this study is to explore the mechanism of canonical Wnt signaling pathway in type 2 diabetes mice peripheral neuropathy. Methods Male C57BL6 mice were randomly assigned to three groups. One group treated with normal diet as control. And the rest were used to establish the diabetic model through the combination of 60 kcal% high fat diet and an administration of multipleand low dose of streptozotocin on 5 consecutive days. When the model of type 2 diabetes mice peripheral neuropathy was successfully established, one group was injected with the canonical Wnt signaling pathway inhibitor XAV 939 ( T2DM-XAV 939 group) and the other one was injected with phosphate buffer saline (PBS) as control (T2DM-PBS group). The 21stweek was the end point of the experiment, and fasting blood glucose, insulin level, homeostasis model assessment for insulin resistance (HOMA-IR), plantar test, and exercise tolerance were measured, realtime PCR were adopted to detect the related mRNA expression of the canonical Wnt signaling pathway. Results T2DM-XAV 939 group had higher total cholesterol, triglyceride, fasting blood glucose, and HOMA-IR than T2DM-PBS group, but showed no statistical difference. The enzymatic activity of glutamic oxaloacetic transaminase was lower level than that in T2DM-PBS group (P＜0.05); T2DM-XAV 939 group had significantly higher plantar test and poorer exercise tolerance than those in T2DM-PBS group (P＜0.05). The mRNA levels of genes in canonical Wnt signaling pathway such as β-catenin, c-myc, mitochondrial transcription factor A (TFAM) had slightly lower level than those in T2DM-PBS group, without statistical difference, and the protein expression of c-myc was lower than that of T2DM-PBS group (P＜0.05). The insulin receptor substeate 2 (IRS-2) mRNA expression was higher than that in T2DM-PBS group (P＜0.05). With the development of the experiment, we found that the survival rate of the T2DM-XAV 939 group was significantly reduced compared with the other groups. Conclusion Inhibition of the canonical Wnt signaling pathway may aggravate diabetic peripheral neuropathy.
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Objective To evaluate the efficacy and safety of chloral hydrate combined with dexmedetomidine for sedation during echocardiography in pediatric patients with Williams-Beuren syndrome.Methods Eighteen pediatric patients diagnosed with Williams-Beuren syndrome by genetic testing,aged 5-58 months,scheduled for elective echocardiography under sedation,received oral chloral hydrate 50 mg/kg.Vital signs were measured every 5 min,and sedation was assessed using Ramsay sedation score.When Ramsay sedation score＜4 points 20 min later,intranasal dexmedetomidine 1 μg/kg was given as rescue sedative.Medicine used,vital signs,onset time,moderate and deep sedation duration and emergence time were recorded.Results The success rate of sedation with chloral hydrate alone was 38.9％ and with chloral hydrate and dexmedetomidine 61.1％.The onset time,sedation duration and emergence time were (15.7+1.9) min,(75+26) min and (52+25) min,respectively,in pediatric patients received chloral hydrate alone.The onset time,sedation duration and emergence time were (33.2±3.4) min,(83±49) min and (61±46) min,respectively,in pediatric patients received chloral hydrate and dexmedetomidine.The onset time was significantly prolonged in pediatric patients received chloral hydrate and dexmedetomidine than in pediatric patients received chloral hydrate alone (P＜0.05).Heart rate,respiratory rate and SpO2 were stable during sedation in all pediatric patients,and nausea and mild vomiting were found in 3 pediatric patients received chloral hydrate and in 6 pediatric patients received chloral hydrate and dexmedetomidine,and no other adverse reactions were observed.Conclusion Oral chloral hydrate 50 mg/kg combined with intranasal dexmedetomidine 1 μg/kg provides reliable sedative efficacy and exerts less influence on respiratory and circulatory function with higher safety when used for echocardiography in pediatric patients with Williams-Beuren syndrome.
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Objective To evaluate the accuracy of intraocular lens (IOL) power calculation using IOL-Master in patients underwent phacoemulsification and vitrectomy for idiopathic macular epiretinal membrane (IMEM) concurrent with age-related cataract (ARC).Methods A prospective study was designed.A total of 32 patients (32 eyes) with ARC (ARC group) and 30 patients (30 eyes) with ARC and IMEM (ARC+IMEM group) were enrolled from March 2013 to July 2015 in the Hangzhou District of Eye Hospital of Wenzhou Medical University.All the surgeries were performed by the same experienced surgeon and the same IOL (Adapt-AO) was implanted.IOL power was calculated by both SRK-T and Haigis formulas.The central macular thickness was measured by OCT preoperatively and postoperatively.The mean postoperative refractive prediction error (ME),mean absolute postoperative prediction error (MAE) and percentage of eyes achieved target refraction within ± 0.25,± 0.50 and ± 1.00 D were compared between the 2 groups.The correlation between the refractive error and macular thickness change was evaluated.Results The ME and MAE calculated by Haigis were (-0.47±0.66)D and (0.63±0.44)D in ARC+IMEM group,and (-0.18±0.74)D and (0.68±0.65)D in ARC group.The ME and MAE calculated by SRK-T were (-0.60 ±0.59) D and (0.73 ±0.41) D in ARC +IMEM group,and (-0.23 ±0.85)D and (0.75 ±0.69)D in ARC group.No significant differences were found between the two groups in each formula (all at P＞0.05).There was no significant difference of MAE distribution between the two groups in Haigis formula.In SRK-T formula,the percentage of MAE≤0.25 D in the ARC+IMEM group was significantly higher than that in the ARC group (x2 =7.114,P=0.007).In the A RC+IMEM group,the change of the macular thickness was (-97.4± 115.3)μm,which was statistically correlated with the ME of H aigis and SRK-T formulas (r=0.369,P =0.045;r =0.421,P =0.021).Conclusions There is a tendency toward myopia shift in patients underwent phacoemulsification and vitrectomy compared with conventional phacoemulsification.The myopia shift shows a significant correlation with macular thickness changes.Haigis formula performs better than SRK-T formula with the condition of un-optimized parameters.
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Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF).Methods This is a retrospective case study.A total of 35 MF patients (36 eyes) were enrolled in this study.There were 5 males (5 eyes) and 30 females (31 eyes),with an average age of (60.13 ± 10.00) years.All patients were examined for best corrected visual acuity (BCVA),diopter,optical coherence tomography (OCT) and axial length.The patients were divided into a MF group (group A,10 eyes),MF with foveal detachment group (group B,12 eyes) and MF with lamellar macular hole group (group C,14 eyes) according to the OCT characteristics.There was no difference of age,gender,spherical equivalent refraction and axial length among 3 groups (F=0.020,0.624,0.009,0.195;P＞0.05).There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100,41.790;P＜ 0.05).All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade.The follow-up was more than one year.The BCVA and macular structure at the final follow-up were analyzed.The efficacy between 3 forms of MF was compared.Results At the final follow-up,the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm,which were significantly improved compared with preoperative measurements (t=5.984,5.113;P＜0.001).MF was resolved in 33 eyes.In group A,B and C,the logMAR BCVA were 0.13 ± 0.10,0.73±0.33 and 0.38± 0.52,respectively;CFT was (222.40± 57.16),(212.50 ± 150.45),(206.67 ± 55.97) μm,respectively;MF was resolved in 10,11 and 12 eyes,respectively;complete ellipsoid was observe in 8,2 and 12 eyes.The logMAR BCVA (F=6.750,P=0.003) and the rate of complete ellipsoid (x2=18.590,P＜0.001) in group B was lower than group A and C,the differences were significant.There was no difference of CFT (F=0.068,P=0.935) and the rate of MF resolving (x2=1.558,P=0.459) among the three groups.One eye (1/14) in group C suffered from full layer macular hole.Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis.The macular structures and BCVA are worst in eyes with foveal detachment.
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Objective To investigate the correlation between the vitreomacular adhesion (VMA) and exudative age-related macular degeneration (AMD).Methods A literature research was performed in PubMed,EMbase,Cochrane Library,CNKI and Wanfang database from January 2000 to December 2016.Case-control studies on the relationship between VMA or posterior vitreous detachment and exudative AMD were included in this analysis.Literature screening and data extraction were performed according to inclusion and exclusion criteria.The qualities of the literatures were evaluated according to the Newcastle-Ottawa Scale (NOS).Seven literatures were selected into meta-analysis.The NOS score was 9 points in 1 article,8 scores in 4 articles,7 points in 2 articles.A total of 947 eyes with exudative AMD,638 eyes with dry AMD,and 618 eyes with controls were included.The correlation between exudative AMD and VMA were analyzed using the software Review manager 5.3.Results The prevalence of VMA in exudative AMD eyes was higher than that in controls [odds ratio (OR)=2.14,95％ confidence interval (CI)=1.19-3.84,P=0.010] and dry AMD eyes (OR=2.24,95％CI=1.24-4.03,P=0.007).There was no difference in PVD prevalence among exudative AMD eyes,dry AMD eyes (OR=0.44,95％CI=0.16-1.20,P=0.110) and controls (OR=0.70,95％CI=0.41-1.18,P=0.180).Conclusion There is correlation between VMA and exudative AMD.
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Objective To establish a risk prediction model of diabetic retinopathy (DR) for type 2 diabetic patients (T2DM).Methods A total of 315 T2DM patients (600 eyes) were enrolled in the study.There were 132 males (264 eyes) and 183 females (366 eyes).The mean age was (67.28± 12.17) years and the mean diabetes duration was (10.86 ± 7.81) years.The subjects were randomly assigned to model group and check group,each had 252 patients (504 eyes) and 63 patients (126 eyes) respectively.Some basic information including gender,age,education degree and diabetes duration were collected.The probable risk factors of DR including height,weight,blood pressure,fasting glucose,glycosylated hemoglobin (HbAlc),blood urea,serum creatinine,uric acid,triglyceride,total cholesterol,high-density lipoprotein,low density lipoprotein cholesterol and urinary protein.The fundus photograph and the axial length were measured.Multivariate logistic regression was used to analyze the correlative factors of DR and establish the regression equation (risk model).Receiver operating characteristic (ROC) curves were used to determine the cut-off point for the score.The maximum Youden Index was used to determine the threshold of the equation.The check group was used to check the feasibility of the predictive model.Results Among 504 eyes in the model group,170 eyes were DR and 334 eyes were not.Among 126 eyes in the check group,45 eyes were DR and 81 eyes were not.Multivariate logistic regression analysis revealed that axial length [β=-0.196,odds ratio (OR)=0.822,P＜0.001],age (β=-0.079,OR=0.924,P＜0.001),diabetes duration (β=0.048,OR=1.049,P=0.001),HbAlc (β=0.184,OR=1.202,P=0.020),urinary protein (β=1.298,OR=3.661,P＜0.001) were correlated with DR significantly and the simplified calculation of the score of DR were as follows:P=7.018-0.196X 1-0.079X2+0.048X3+0.148X4+ 1.298X5 (X1=axial length,X2=age,X3=diabetes duration,X4=glycosylated hemoglobin,X5=urinary protein).The area under the ROC curve for the score DR was 0.800 and the cut-offpoint of the score was-1.485.The elements of the check group were substituted into the equation to calculate the scores and the scores were compared with the diagnostic threshold to ensure the patients in high-risk of DR.The result of the score showed 84％ sensitivity and 59％ specificity.ROC curve for the score to predict DR was 0.756.Conclusion Axial length,age,diabetes duration,HbA1c and urinary protein have significant correlation with DR.The sensitivity and specificity of the risk model to predict DR are 84.0％ and 59.0％ respectively.The area under the ROC curve was 0.756.
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Objective To evaluate the accuracy of ultrasonographic measurement of the subglottic airway diameter in selecting the cuffed endotracheal tube (ETT) size for the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes with congenital heart disease,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,aged 1 month-7 yr,undergoing elective open heart surgery,were included in this study.The subglottic airway diameter was measured by bedside ultrasonography after induction of anesthesia.The outer diameter of the cuffed ETT was determined according to the subglottic airway diameter.The air leak test was performed after intubation to determine whether or not the ETT size selected based on ultrasonography was appropriate.When the difference between the inner diameter of the finally selected ETT and the result calculated by the Motoyama formula was less than 0.2 mm,the ETT size selected based on the Motoyama formula was considered appropriate.The agreement and correlation between the subglottic airway diameter measured by age-based formula and ultrasonography and the outer diameter of the actually selected ETT were analyzed using Bland-Altman plot and Passing-Bablok regression analysis.Results The accurate rate of the ETT selected based on the ultrasonic measurement and Motoyama formula were 80％ and 55％,respectively,and there was significant difference (P＜0.05).Conclusion Ultrasonographic measurement of the subglottic airway diameter produces higher accuracy than the classical Motoyama formula in selecting the cuffed ETT size for the pediatric patients with congenital heart disease.
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Objective To evaluate the value of ultrasonographic measurement of the antral crosssectional area (CSA) in assessing the preoperative gastric content volume in preschool pediatric patients.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged ＜7 yr,undergoing elective non-gastrointestinal surgery,were fasted according to the preoperative fasting guidelines recommended by American Society of Anesthesiologists.Sedation was performed with intravenously injected midazolam or with intravenously injected midazolam and propofol after admission to the operating room.The antral CSA in the supine and right lateral decubitus positions was measured using bedside ultrasonography and free tracing method.A gastric tube was inserted after gastric sonography to collect the gastric fluid,and the total volume of the gastric fluid was considered to be the gastric content volume.Results Six pediatric patients were excluded due to the unsatisfactory ultrasound image,and 44 pediatric patients were included.Gastric content volume and gastric content volume per kilogram of body weight were positively correlated with the antral CSA in the right lateral decubitus position,and the Spearman correlation coefficients were 0.48 (P＜0.01) and 0.37 (P＜0.05),respectively.There was no correlation between gastric content volume and gastric content volume per kilogram of body weight and the antral CSA in the supine position (P＞0.05).Conclusion Ultrasonographic measurement of the antral CSA in the right lateral decubitus position can be used to assess the preoperative gastric content volume in preschool pediatric patients.