Autoimmune retinopathy (AIR) is an umbrella term for a group of rare autoimmune retinal degenerative disease presumably caused by cross-reactivity of serum autoantibodies directed against ratinal antigens, and include cancer-associated retinopathy, melanoma-associated retinopathy and non-paraneoplastic autoimmune retinopathy. Common feature of AIR include progressively painless vision loss with abnormal electrophysiology responses associated with positive anti-retinal antibodies. They present a clinical diagnosis challenge on account of the rare incidence, unobvious clinical symptoms and lack of specific and sensitive biological markers. Early diagnosis and treatment may play a critical role to avoid the irreversible immunological retinal damage.
ObjectiveTo observe the clinical characteristics of patients with visual impairment caused by fungal sphenoid sinusitis and analyze the influencing factors related to visual prognosis. Methods A retrospective clinical study. From January 2006 to December 2020, 44 patients (55 eyes) with visual impairment caused by fungal sphenoid sinusitis confirmed by imaging and pathological examination in the Department of Ophthalmology of Beijing Tongren Hospital were included in the study. Patients was first diagnosed in the Department of Ophthalmology due to monocular or binocular vision loss, or binocular diplopia, limited eye movement and ptosis. All patients underwent visual acuity examination and fundus color photography. CT examination of paranasal sinus or orbit was performed in 37 cases; magnetic resonance imaging (MRI) of paranasal sinus, brain or orbit was performed in 34 cases. All patients underwent endoscopic sinus opening combined with intrasinus lesion clearance; 14 cases were treated with antifungal drugs after operation. The average follow-up time was 59.61±37.70 months. Comparison of clinical characteristics between invasive and non-invasive fungal sphenoid sinusitis were by χ2 test or Fisher exact test. The influencing factors with P＜0.2 in univariate analysis were selected for multivariate regression analysis. ResultsAmong the 44 patients, there were 19 males and 25 females; the ratio of male to female was 1:1.3; the average age of visual symptoms was 61.48 ± 12.17 years; 23 cases (52.3%, 23/44) suffered from immune dysfunction, including 21 cases of diabetes mellitus. The visual acuity decreased in 33 cases (44 eyes) (75.0%, 33/44). There were 15 cases of binocular diplopia with eye movement disorder (34.0%, 15/44), including 6 cases with visual impairment. The visual acuity of the affected eye was no light perception-0.8. There were 35 cases with headache (79.5%, 35/44). Nasal symptoms were found in 14 cases (31.8%, 14/44). There were 40 and 4 cases of Aspergillus and Mucor infection in sphenoid sinus, respectively. Among the 37 cases who underwent CT examination of paranasal sinus or orbit, there were soft tissue filling in the sinus cavity, including 19 cases of high-density calcification in the sinus cavity (51.4%, 19/37); bone defect of sinus wall were in 24 cases (64.9%, 24/37). There were 26 cases (70.3%, 26/37) of sinus wall osteosclerosis. MRI of paranasal sinus, brain or orbit was performed in 34 cases. T1WI of sphenoid sinus lesions showed low signal, high signal and equal signal in 14, 10 and 9 cases, respectively; T2WI showed high signal, low signal and equal signal in 13, 16 and 2 cases respectively. After enhancement, the lesions were strengthened in 11 cases, no obvious enhancement in 23 cases, and the surrounding mucosa was thickened and strengthened. The lesions involved the orbital apex and cavernous sinus in 18 and 16 cases, respectively; orbital apex and cavernous sinus were involved in 12 cases. Six months after operation, visual acuity was significantly improved in 27 eyes (65.9%, 27/41); visual acuity did not improve in 14 eyes (34.1%, 14/41). Multivariate regression analysis showed that the change of sinus wall osteosclerosis was associated with higher visual acuity improvement rate (odds ratio= 0.089, 95% confidence interval 0.015-0.529, P=0.008). ConclusionsFungal sphenoid sinusitis related visual impairment is relatively common in elderly female patients with low immune function; monocular vision loss with persistent headache is the most common clinical symptom; imaging findings of sphenoid sinus lesions are an important basis for diagnosis. Sphenoid sinus opening combined with sinus lesion clearance is an effective treatment. After operation, the visual acuity of most patients can be improved. The prognosis of visual acuity was relatively good in patients with hyperplasia and sclerosis of sphenoid sinus wall bone.
ObjectiveTo observe the clinical characteristics of elderly patients with demyelinating optic neuritis (DON), and preliminarily analyze the related factors affecting their visual prognosis. MethodsA observational clinical case-control study. A total of 107 patients with DON who were diagnosed and hospitalized in Beijing Tongren Hospital and its medical alliance Department of Ophthalmology, Beijing Puren Hospital from March 2019 to October 2023 were included in this study. Detailed medical histories were recorded, including time of onset, presence of ocular pain, treatment modalities, and follow-up status. All affected eyes underwent best-corrected visual acuity (BCVA) testing, orbital magnetic resonance imaging (MRI), and laboratory tests, including erythrocyte sedimentation rate (ESR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), aquaporin-4 (AQP4) antibodies, and myelin oligodendrocyte glycoprotein (MOG) antibodies in peripheral blood. Based on age, patients were categorized into the elderly DON group (≥50 years) and the young and middle-aged DON group (＜50 years), comprising 50 and 57 cases, respectively. Furthermore, the elderly DON group was subdivided by serum-specific antibody status into the AQP4 antibody-positive ON group (AQP4-ON group), the MOG antibody-positive ON group (MOG-ON group), and the double-negative ON group (DN-ON group), with 18, 10, and 22 cases respectively. The median follow-up duration was 36 months. Follow-up assessments were conducted using the same equipment, methods, and relevant examinations as those applied at baseline. Binary logistic regression analysis was performed to identify factors associated with visual prognosis in elderly DON patients. ResultsCompared with the DON group of young and middle-aged people, the incidence of binocular disease, accelerated ESR, MRI imaging score, the incidence of combined cardiovascular and cerebrovascular diseases, diabetes, tumors, and the proportion of adverse reactions of glucocorticoids in the elderly group were higher, and the proportion of ocular pain was lower. The differences were statistically significant (P＜0.05). Six months after the treatment, the number of cases with BCVA＞0.3 in the affected eyes in the elderly DON group and the young and middle-aged DON group was 28 (56.0%, 28/50) and 42 (73.7%, 42/57), respectively. The number of patients with BCVA＞0.3 in the elderly DON group was significantly lower than that in the young and middle-aged DON group, and the difference was statistically significant (P=0.034). Moreover, with the increase of age, the degree of improvement in visual acuity showed a decreasing trend. The proportion of females in the AQP4-ON group, the proportion of optic chiasm and posterior optic pathway involvement in acute MRI, and the positive rate of ANA/ENA were significantly higher than those in the MOG-ON group and the DN-ON group, and the differences were statistically significant (P＜0.05). The rate of optic disc edema in the MOG-ON group was significantly higher than that in the AQP4-ON group, and the difference was statistically significant (P=0.031). One and six months after treatment, the BCVA in the MOG-ON group was significantly better than that in the AQP4-ON group and the DN-ON group, and the difference was statistically significant (P＜0.05). The results of binary logistic regression analysis showed that at the onset of the disease, BCVA＜0.01 [odds ratio (OR) =2.60, 95% confidence interval (CI) 1.23-5.52, P=0.013] and accelerated ESR (OR=4.68, 95%CI 1.08-20.18, P=0.039) was an independent risk factor affecting the prognosis of BCVA in elderly patients with DON. ConclusionsThere are different clinical characteristics between elderly DON patients and young and middle-aged patients. The risk of combined systemic diseases and side effects of glucocorticoids is higher, and the visual prognosis is worse. There are also differences in clinical characteristics and visual prognosis among subgroups of different serological antibodies in elderly DON. Advanced age, the lowest visual acuity at onset and immune inflammatory indicators are all factors affecting the visual prognosis of DON.
ObjectiveTo compare and analyze the changes in the diagnosis and treatment of intravitreal injection before and after the implementation of centralized management in the "one-stop intravitreal injection center", and to preliminarily explore the advantages of centralized management. MethodsA retrospective cohort study. A total of 5 954 patients (6 481 eyes) who received intravitreal anti-vascular endothelial growth factor (VEGF) injection in Department of Ophthalmology of Macula Clinic (One-stop Intravitreal Injection Center) of Dalian Third People's Hospital from January 1, 2021 to December 31, 2024 were enrolled. Data were obtained from the Hospital Information System, fundus disease database, and intravitreal injection management software of Dalian Third People's Hospital. Among the patients, there were 2 950 males (3 453 eyes) and 3 004 females (3 528 eyes); 3 163 patients lived in urban areas, and 2 791 in suburban or external areas. Regarding the affected eyes, 1 901 eyes had wet age-related macular degeneration (wAMD), 2 340 eyes had diabetic macular edema (DME), 1 874 eyes had macular edema secondary to retinal vein occlusion (RVO-ME), 580 eyes had diabetic retinopathy (DR), and 390 eyes had other fundus diseases. A total of 19 539 anti-VEGF injections were performed in 6 481 eyes. The control group comprised 2 294 patients (2 630 eyes) from January 1, 2021 to April 30, 2022 (before centralized management), and the observation group comprised 3 660 patients (4 351 eyes) from May 1, 2022 to December 31, 2024 (after centralized management). The total number of intravitreal injections, the distribution of anti-VEGF therapy in patients with wAMD, RVO-ME, DME and other fundus diseases, the completion rates of 3, 5 injections in the first year, and patients' medical experience via telephone interviews were compared between the two groups. The Chi-square test or t-test was used for inter-group comparison. ResultsThe cumulative number of injections in the observation group and the control group was 12 552 and 5 747 times, with the average number of injections per eye being (3.43±2.76) and (2.51±1.73) times. The number of eyes that completed 3 injections in the first year was 2,000 (54.64%, 2 000/3 660) and 968 (42.20%, 968/2 294), while the number of eyes that completed 5 injections in the first year was 762 (20.82%, 762/3 660) and 232 (10.11%, 232/2 294). The average number of injections per eye in the observation group (t=23.56) and the completion rates of 3 and 5 injections in the first year (χ2=87.40, 116.22) were significantly higher than those in the control group, and the differences were statistically significant (P＜0.001). The injection frequency and completion rates of 3 and 5 injections in the first year for patients with DME, RVO-ME, and wAMD in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P＜0.05). Stratified by age, the 5-year completion rates in the observation group were significantly higher than those in the control group in patients aged 41-50, 51-60, 61-70, and ＞80 years old (P＜0.05). The 3-year completion rate of injections in the first year in the observation group was significantly higher than that in the control group, but the difference in the 5-year completion rate (α=0.01) was not statistically significant after adjusting the test level (P=0.004). The total number of injections for patients in the observation group living in urban areas and other regions was significantly higher than that in the control group (P＜0.05). The total discharge time and appointment waiting time for patients in the observation group and the control group were (2.08±0.74) and (2.28±0.63) hours respectively, and the process convenience score was (4.35±0.73) and (3.87±0.98) points respectively, and the medical service satisfaction score was (4.35±0.74) and (4.30±0.84) points respectively. Compared with the control group, the total discharge time and appointment waiting time in the observation group were significantly shortened, the process convenience score was significantly improved, and the differences were statistically significant (t=2.55, 3.80, ?5.09; P＜0.05); there was no statistically significant difference in the medical service satisfaction score between the two groups (t=?0.62, P=0.535). ConclusionCentralized management can significantly enhance the operational efficiency and management level of the "one-stop intravitreal injection center", and improve the patient visit rate and treatment compliance.