ObjectiveTo observe multimodal imaging characteristics in eyes with focal choroidal excavation (FCE) and preliminarily analyze the risk factors in FCE with complications correlated with RPE.MethodsA retrospective case series. Thirty-one patients (31 eyes) with monocular FCE, first identified by spectral-domain (SD)-OCT in the Eye Center of The Second People’s Hospital of Foshan from December 2014 to December 2018, were involved in this study. There were 14 males and 17 females, with the mean age of 45.84±13.57 years. All patients underwent BCVA, optometry, and SD-OCT examinations. FFA and ICGA were simultaneously performed in 3 FCE patients with RPE complications. The subfoveal choroidal thickness (SFCT) and excavation width were measured with enhanced depth imaging OCT (EDI-OCT). The eyes with FCE were divided into two groups (FCE alone group 17 eyes vs. FCE complication group 14 eyes), based on whether complicated by RPE dysfunction. Among 14 eyes of FCE complication group, 7 (22.6%) with choroidal neovascularization, 4 (12.9%) with central serous chorioretinopathy, 1 (3.2%) with polypoidal choroidal vasculopathy, and 2 (6.5%) with RPE detachment. No significant difference was found in the mean age (t=0.87), gender composition (χ2=0.06), ocular laterality (χ2=2.58), and spherical equivalent (t=?0.81) between two groups, respectively (P＞0.05), except that the BCVA was significantly different (t=?2.11, P＜0.05). The SFCT and excavation width of eyes in both groups and the ICGA imaging characteristics of eyes in FCE complication group were analyzed. Risk factors of FCE with RPE complications were analyzed by logistic regression analysis.ResultsThirty-three excavations were identified in 31 eyes with FCE. The mean SFCT was 167.00±85.18 μm in FCE alone group vs. 228.36±67.95 μm in FCE complication group, while the excavation width was 645.00±231.93 μm vs. 901.00±420.55 μm and they were both significantly different (P＜0.05). Logistic regression analysis showed the SFCT (OR=1.016, P=0.026) and excavation width (OR=1.004, P=0.034) were risk factors for RPE complications of FCE. EDI-OCT showed the RPE at the excavation was impaired or vulnerable in all eyes of the FCE alone group, especially at the boundary area of excavation. The RPE damages were located at the boundary area of excavation in 10 eyes (71.4%) of FCE complication group. Constant choroidal hypofluorescence and filling defect were observed under the excavation in 3 eyes with ICGA imaging.ConclusionsSFCT and excavation width may be risk factors for RPE complications of FCE. Impairment of RPE at boundary area of excavation and focal choroidal ischemia or aberrant circulation under the excavation may correlate with the development of FCE complications.
ObjectiveTo investigate the clinical characteristics of 40 patients with ocular toxocariasis (OT) on the first attendance. MethodsA total of 40 consecutive patients who were clinically and serologically diagnosed with OT were retrospectively reviewed. ResultsThe mean age of patients was (12.12±10.42) years. There were 29 males and 11 females. 29 cases presented with decreased vision, 4 children with leukocoria, 2 cases with strabismus and 5 cases was found abnormal during regular eye examination. Initially 8 eyes (20%) were misdiagnosed as retinoblastoma (1 eye), Coat's disease(1 eye), cataract (2 eyes), iridocyclitis (2 eyes) and retinal detachment (2 eyes). 23 eyes had retinal detachment, 19 eyes had cataract. OT was the initial diagnosis for 15 patients (37.5%). The best corrected visual acuity (BCVA) were NLP to 0.7. Ultrasound biomicroscopy (UBM) were performed in 29 eyes, and identified peripheral granulomas in 23 eyes and adjacent tractional retinal detachment in 12 eyes. We also identified 17 cases (68.0%) with elevated IgE level among 25 patients with positive serological antibody test. ConclusionsTractional retinal detachment, vitreous opacities and cataract are the common clinical findings at the first attendance of OT patients. The adjunctive test of serum total IgE level may be helpful for the diagnosis. The application of UBM and specific IgG detection in serum and intraocular fluid, can also improve the diagnosis.
Objective To compare the axial length (AL) measured by Lenstar and contact AScan in the patients with idiopathic macular hole and study the correlation between the difference of the two measurements and the foveal thickness measured by optical coherence tomography (OCT). Methods Twenty-seven eyes of 26 idiopathic macular hole patients (IMH group) and 27 eyes of 25 patients with mild cataract (control group) were enrolled in this study. Foveal thickness was measured with 3D OCT. The AL was measured by Lenstar and contact A-Scan, and the consistency of the two measurements was determined by Bland-Altman analysis. The correlation between the difference of the two measurements and foveal thickness was analyzed by Pearson correlation analysis. Results Mean foveal thickness of IMH and control eyes were （372.85±60.02） μm and （243.44±22.50） μm, respectively. The difference between the foveal thickness of the two groups was highly significant (t=-10.490，P＜0.001). In the IMH group, the AL measured by Lenstar and contact A-Scan were (23.20±1.12) mm and (23.18±1.13) mm, respectively, the difference between the two measurements was not statistically significant (t=-0.549，P=0.588), whereas in the control group, the AL was (23.41±0.72) mm by Lenstar and (23.33±0.74) mm by contact A-Scan, the two measurements were significantly different (t=-4.832，P＜0.001). However, no correlation was found by Pearson correlation analysis between the difference of the two measurements and the foveal thickness in either IMH or control group (r=0.181，-0.141;P＞0.05). ConclusionsAlthough there is no difference of axial length measurements using Lenstar and contact A-Scan in IMH eyes, in clinical measurements the results of two instruments should be taken into comprehensive consideration.
The human sclera accounts for 95% of the surface of the eyeball, providing ample contact area which is suitable for targeted trans-scleral ocular drug delivery. Currently there are several tans-scleral sustained-release strategies, including intra-scleral delivery, episcleral delivery, as well as tans-scleral iontophoresis. Different devices and methods have their own advantages and disadvantages, for example, intra-scleral delivery is somehow invasive, and episcleral delivery device needs to be made thin to prevent erosion of conjunctiva, iontophoresis needs to be frequently repeated as of its short-term effect. With the development of bio-material engineering technology, episcleral microfilm could become an ideal drug delivery route for posterior segment ocular diseases.
ObjectiveTo analyze the sensitivity and specificity of polymerase chain reaction (PCR) tests in the detection of cytomegalovirus (CMV) in the diagnosis of patients with acquired immune deficiency syndrome (AIDS), using aqueous humor samples. Methods25 AIDS patients (including 21 men and 4 women) were studied. The age of the patients varied from 24 to 59 years, with an average of (39.2±9.3) years. The CD4+ T cell count was from 1 to 523 cells/μl, with a medium of 40 cells/μl. They were infected with human immunodeficiency virus(HIV)for a period from 15 days to 9 years with a median of 10 months. They were divided into three groups according to the fundus and treatment, including untreated cytomegalovirus retinitis (CMVR), treated CMVR and control group. There were 10 patients without anti-CMV treatment and 7 patients treated previously with foscarnet or ganciclovir whose eyes were diagnosed CMVR. Control group has 8 patients who had normal fundus or minor retinopathy excluded from CMVR. Approximately 100 μl of aqueous humor was obtained by anterior-chamber paracentesis and PCR was performed in all cases. ResultsThere were CMV DNA in 9 of 10 eyes with untreated CMVR (90.0% sensitivity). Of 7 specimens from eyes with treated CMVR, 3 were CMV PCR positive (42.9% sensitivity). All 8 samples of the control group were negative for CMV DNA, indicating the clinical specificity of our PCR was greater than 99.9% for CMVR. The anterior chamber paracentesis did not cause any complications in our patients except for a patient with subconjunctival hemorrhage. ConclusionsThe assay had an estimated sensitivity of 90.0% in detecting untreated CMVR and a sensitivity of 42.9% in detecting CMVR that had been treated. The specificity of this assay was greater than 99.9%.
ObjectiveTo discuss the impact of health education for the patients with decompensated cirrhosis and their family members on patients' family life quality, psychological conditions, medication compliance, and re-admission rates. MethodsWe selected 100 decompensated cirrhosis patients between December 2012 and December 2013, and randomized them into two groups with 50 patients in each. One week prior to discharge, we conducted a comprehensive nursing assessment for the patients and developed hospital care regimen. Patients were followed up after discharge for six months. The control group underwent routine health education and extended care, while the experimental group had an addition of health education and extended care intervention on their family members. ResultsAnxiety and depression were alleviated in both the two groups. The psychological conditions of patients in the experimental group were significantly better than the control group (P<0.01). The total scores of quality of life was significantly different compared with the scores before intervention (P<0.01). Medication compliance improved more significantly in the experimental group after intervention (P<0.05). Re-admission rates decreased more significantly in the experimental group than the control group (P<0.01). ConclusionHealth education and extended care intervention for patients and their family members can improve patients' psychological conditions, promote medication compliance, reduce readmission rates, and improve patients' quality of family life.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.