This article provides an interpretive review of the "2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation", which was updated and published by the American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) based on the latest clinical evidence. It delves into the classification and management strategies for atrial fibrillation (AF), grounded in the most current evidence-based medical research. The guideline offers significant updates in various aspects such as the definition and staging of AF, clinical evaluation and treatment, modification of risk factors, prevention of thromboembolism, and management of specific populations. Notably, the introduction of a new staging model for AF and corresponding management strategies stands out, underscoring the importance of prevention and early intervention. This article focuses on the three pillars of integrated AF management—stroke risk assessment, modification of risk factors, and management of specific patient groups, in addition to rate and rhythm control, analyzes their substantial significance in clinical practice and guides clinicians in providing more precise treatment.
Myasthenia gravis (MG) is an autoimmune disease characterized by autoantibody-mediated acquired neuromuscular junction transmission disorders. Based on the different muscles involved, approximately 80% MG can be classified into ocular MG (OMG) and generalized MG. Eighty percent of MG patients initially present with OMG, leading to ptosis and diplopia, which significantly impair their quality of life. Approximately 50.0% to 69.7% of OMG patients may progress to generalized MG within two years, exhibiting symptoms such as limb weakness, dysphagia, and even respiratory failure that threatens life. Due to the diverse manifestations and fluctuating symptoms of OMG, it is often prone to missed and/or misdiagnosis. To further standardize the understanding of OMG among clinicians, Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Neuro-Ophthalmology Society of Chinese Research Hospital Association, in conjunction with relevant domestic and international researches, consensuses, guidelines and based on the actual situation in China, have developed the Chinese expert consensus on the clinical diagnosis and management of ocular myasthenia gravis (2025). The consensus comprehensively covers clinical diagnosis and management of OMG, including epidemiology, mechanisms of ocular extraocular muscle involvement in MG, clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis, treatment, assessment and prevention strategies for generalized transformation of OMG, and diagnosis and management of refractory OMG, with detailed recommendations provided in nine sections. This consensus is applicable to ophthalmologists, neuro-ophthalmologists, neurologists, and medical personnel engaged in the diagnosis and management of OMG. It aims to standardize the diagnosis and management process of OMG, improve early identification and treatment capabilities, alleviate ocular symptoms of OMG and reduce the risk of generalized transformation.
Ocular ischemic syndrome (OIS) is defined as ocular ischemia and hypoxia secondary to chronic hypoperfusion of the ocular arteries, chiefly caused by internal carotid artery stenosis or occlusion. The pathophysiological evolution of OIS manifests as a dynamic continuum, including prodromal, retinopathic, and neovascular phases. However, due to the often insidious and non-specific clinical presentations during the prodromal and retinal ischemic stages, they are frequently overlooked in clinical practice. Consequently, current interventional strategies are predominantly focused on the neovascular stage, particularly on managing its complications such as neovascular glaucoma. Management strategies also remain inconsistent among physicians of different specialties. Consequently, there is a pressing need to formulate and implement a clinical consensus on OIS that aligns with the specific context of medical practice in China. The formulation of this consensus involved a structured literature retrieval and an analysis of multidisciplinary diagnostic and therapeutic experiences worldwide, consolidated with China's clinical practices to produce the initial draft. Following critical appraisal and successive revisions by a core panel of experts, the final version was established. This consensus encompasses all aspects of OIS clinical care, including its epidemiology, anatomical basis, pathogenesis, risk factors, clinical manifestations, auxiliary examinations, diagnosis, staging, differential diagnosis, and therapeutic interventions (comprising ocular, pharmacological, surgical, and physical treatments). It also evaluates associated vascular event risks (including stroke, cerebral small vessel disease, myocardial ischemia, and mortality) and provides recommendations on patient follow-up and systematic management, with the principal objective of improving the integrated diagnostic and therapeutic standards for OIS throughout China. Given variations in patient profiles and differences in healthcare resources across medical institutions, clinicians should adapt the recommendations in this consensus to individual circumstances. In the management of OIS, a patient-centered approach should always be maintained, with individualized treatment plans implemented to maximize visual function improvement and reduce the risk of neovascular glaucoma and vascular events.