Objective To assess the effectiveness and safety of fructose 1,6-diphosphate （FDP） in the treatment of hypoxic ischemic encephalopathy （HIE）patients. Methods Biomedical databases, including MEDLINE （1977 -2004 ）, EMBASE（1989- 2004） ,Cochrane Injuries Group trials register, Cochrane Controlled Trials Register, CBMdisk and CNKI （1994- 2005 ）were searched. Chnical trials were collecte＆Quality assessments of chnical trials were carried out. Randomized controlled trials （RCTs） with mortality and the incidence of cerebral palsy, epilepsy and mental defect were selected for meta-analysis. Results Nine RCTs were included, and all were done in China. None of the 9 RCTs described the method of randomization or allocation concealment. None of the 9 RCTs mentioned wether blindness was use＆ In Jadad score, 5 trials were scored by 2 and 4 trials were 1. Seven trials were included in the meta-analysis of death, which showed that the obsolute risk （OR） [95% confidence interval （CI）] of death following FDP administration was 0. 50 （95% CI 0. 21 to 1.16）. Five RCTs reported the results of follow-up. When intention to treat （ITT） analysis was adopted, the OR of FDP on cerebral palsy was 0. 36 （95% CI 0. 19 to 0. 89）, on epilepsy was 0.74 （95% CI 0. 29 to 1.88）, and on dementia was 0. 21 （95% CI 0. 06 to 0.70）. We didn＇t conduct sensitivity analysis because no RCTs were of high quality. We didn＇t identify clinical trials compared with adverse reactions between the two groups. Conclusions The quality of RCTs on FDP for HIE is poor. Because there were no RCTs of high quality available, we can＇t draw a conlusion. Well-designed RCTs with economic evaluation are urgently needed to evaluate the value of FDP in the treatment of HIE.
ObjectiveTo observe and analyze changes in macular ganglion cell complex (GCC) parameters after trabeculectomy in primary open-angle glaucoma (POAG) patients and their relationship with visual function. MethodsA retrospective clinical study. From January 2022 to June 2024, 105 POAG patients (105 eyes) diagnosed and undergoing trabeculectomy at Department of Ophthalmology, Daqing Longnan Hospital were included. All patients underwent examinations including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), visual field, and optical coherence tomography (OCT). The patients were divided into the mild group, the moderate group and the severe group according to the degree of optic nerve damage, with 36, 42 and 27 cases respectively. According to the BCVA 3 months after the operation, the patients were divided into the good visual recovery group and the poor visual recovery group, with 63 and 42 cases respectively. OCT was used to measure the average GCC thickness in the overall macular area (GCC-Avg), superior hemisphere (GCC-Sup), and inferior hemisphere (GCC-Inf). Restricted cubic splines (RCS) were used to analyze the relationship between GCC thickness and optic nerve damage severity. Multiple linear regression analyzed the relationship between GCC parameter changes and visual acuity recovery. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate the predictive value of GCC parameter changes for postoperative visual recovery in patients with different nerve damage severities. ResultsSignificant differences were found in GCC-Avg, GCC-Sup, and GCC-Inf thicknesses among the different optic nerve damage severity groups (F=5.761, 18.199, 7.529; P＜0.05). Generalized linear mixed-effects models and RCS analysis revealed a significant nonlinear dose-response relationship between GCC thickness and severe nerve damage (nonlinear test P＜0.05). Significant differences were observed between the good and poor recovery groups in preoperative and postoperative intraocular pressure (t=2.839, 3.979) and optic nerve damage severity (χ2=15.418) (P＜0.05). Preoperatively, and at 1 week and 1 month postoperatively, the poor recovery group had significantly lower GCC-Avg (t=5.089, 5.983, 6.321), GCC-Sup (t=7.513, 9.342, 9.810), GCC-Inf (t=5.499, 6.279, 7.698) thicknesses, UCVA (t=15.194, 14.852, 18.758), and BCVA (t=16.129, 16.167, 21.798) compared to the good recovery group (P＜0.05). UCVA and BCVA improved significantly at 1 week, 1 month, and 3 months postoperatively in the good recovery group (P＜0.05). Multiple linear regression showed that GCC-Avg, GCC-Sup, and GCC-Inf thicknesses were positively correlated with UCVA and BCVA in patients with different nerve damage severities (P＜0.05). ROC curve analysis showed that GCC-Avg, GCC-Sup, and GCC-Inf thicknesses had AUC ＞0.7 for predicting postoperative visual recovery in POAG patients. The combined prediction using all three parameters yielded higher AUC, sensitivity, and specificity than any single parameter, indicating superior predictive performance. ConclusionVisual recovery after trabeculectomy in patients with open-angle glaucoma correlates with the extent of optic nerve damage and the thickness of the ganglion cell complex in the macula.
ObjectiveTo analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.MethodsA total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study. Among them, 410 patients with 410 eyes were males (77.2%), 121 patients with 121 eyes were females (22.8%). The average age of the patients was 38.62±15.36 years. The relevant medical records were collected to analyze the pathogenic factors. Samples of aqueous humor, vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.ResultsOcular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1%), other factors included postoperative endophthalmitis (19.0%), suppurative keratitis-related endophthalmitis (17.1%) and endogenous endophthalmitis (3.8%). Postoperative endophthalmitis mainly occured after cataract surgery. A total of 224 strains of organisms were isolated, among which the predominant organisms isolated were gram-positive bacteria (54.0%) and staphylococcus epidermidis was the most common (25.0%). The other pathogenic organisms were fungi (29.5%) and gram-negative bacteria (16.5%). Among the fungi, aspergillus (10.7%) was the dominant genus, followed by fusarium (9.8%). For gram-positive organisms, susceptibilities were vancomycin 97.4%, gatifloxacin 91.8%, fusidate acid 77.9% and levofloxacin 54.6%. For gram-negative organisms, susceptibilities were gatifloxacin 85.7%, levofloxacin 77.8%, tobramycin 71.4% and ceftazidime 62.5%. For fungal isolates, sensitivities were voriconazole 88.2% and amphotericin B 84.8%.ConclusionsOcular trauma is the main pathogenic factor of suppurative endophthalmitis, followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis. Gram-positive bacteria are the major pathogenic organisms, especially staphylococcus epidermidis followed by fungal species, among which aspergillus and fusarium were the dominating pathogenic genus.
ObjectiveTo observe and analyze the subfoveal choroidal thickness (SFCT), large choroidal vessel layer thickness (LCVT), and their early changes, and to evaluate their prognostic value for treatment outcomes in eyes with polypoidal choroidal vasculopathy (PCV) receiving anti-vascular endothelial growth factor (VEGF) therapy. MethodsA retrospective clinical study. A total of 120 patients (120 eyes) with unilateral PCV diagnosed and confirmed at Tangshan Eye Hospital from January 2020 to August 2024 were included. All affected eyes received intravitreal anti-VEGF injections. SFCT and LCVT were measured using swept-source optical coherence tomography (SS-OCT) before treatment and at 1, 3, 6, and 12 months after treatment. Based on the 12-month follow-up outcomes, the eyes were divided into a good prognosis group (69 eyes) and a poor prognosis group (51 eyes). Subretinal fluid (SRF) absorption was assessed by SS-OCT at 1 month after the first treatment (early stage). Repeated measures ANOVA was used to compare the dynamic changes of SFCT and LCVT between the two groups. Binary logistic regression, joint modeling, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and mediation analysis were used to evaluate the predictive value of SFCT and LCVT for prognosis. ResultsCompared with the good prognosis group, the poor prognosis group had significantly greater disease duration, best-corrected visual acuity, branching vascular network area, maximum linear lesion distance, proportion of choroidal vascular hyperpermeability, pigment epithelial detachment height, and pre-treatment SFCT and LCVT (P＜0.05). The good prognosis group had significantly lower SRF height (SRFH) before treatment and at 1 month after treatment, and a greater reduction in SRFH (ΔSRFH) within the first month, compared with the poor prognosis group (P＜0.05). At 1 month after treatment, complete SRF absorption was observed in 65 eyes (94.20%, 65/69) in the good prognosis group and 32 eyes (62.75%, 32/51) in the poor prognosis group; the complete SRF absorption rate was significantly higher in the good prognosis group (χ2=18.731, P＜0.001). Repeated measures ANOVA showed that SFCT and LCVT significantly decreased after treatment at different time points in both groups (P＜0.05); at each post-treatment time point, SFCT and LCVT were significantly higher in the poor prognosis group than in the good prognosis group (P＜0.05). Cohen's d effect size analysis showed that the intergroup difference in LCVT was greater than that in SFCT. ROC curve analysis showed that pre-treatment SFCT and LCVT effectively predicted early complete SRF absorption, and LCVT had significantly better diagnostic performance than SFCT [area under the ROC curve (AUC)=0.82, 0.76; P=0.025]. Joint modeling analysis showed that longitudinal changes in SFCT and LCVT were significantly associated with the risk of poor prognosis (P＜0.01); for every 50 μm increase in LCVT and SFCT, the relative risk of poor prognosis was 1.615 and 1.512, respectively. The Akaike information criterion value of the LCVT joint model (3 719.42) was lower than that of the SFCT model (3 852.67). At 1 month after treatment, ΔLCVT and ΔSFCT were both significant predictors of poor prognosis; in all adjusted models, the odds ratio of ΔLCVT was lower than that of ΔSFCT, indicating better predictive value. ROC curve analysis showed that both ΔSFCT and ΔLCVT had significant predictive value for poor prognosis, and ΔLCVT had significantly better predictive performance than ΔSFCT (AUC=0.81, 0.74). DCA showed that both ΔSFCT and ΔLCVT provided clinical net benefit, with ΔLCVT showing higher benefit. Mediation analysis showed that ΔLCVT and ΔSFCT partially improved prognosis by promoting early SRF absorption, with the indirect effect of ΔLCVT (39.35%) being higher than that of ΔSFCT (32.70%). ConclusionsBoth SFCT and LCVT can serve as predictors of prognosis in PCV eyes treated with anti-VEGF therapy. After controlling for the effect of SFCT, LCVT maintains independent predictive value, and its predictive efficacy is superior to that of SFCT.