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AIM: To evaluate the macular microcirculation changes in patients with diabetic retinopathy(DR)by optical coherence tomography angiography(OCTA), and correlate the risk factors that may affect the macular microcirculation, so as to provide a clinical basis for early screening, diagnosis and therapeutic intervention for DR.METHODS: Retrospective study. A total of 75 patients(75 eyes)with type 2 diabetes mellitus(DM)who came to the ophthalmology outpatient clinic and ward of Xi'an Central Hospital from May to October 2022 were collected, and the DM patients were further divided into non-DR(NDR)group, non-proliferative DR(NPDR)group and proliferative DR(PDR)group, with 28 eyes, 25 eyes and 22 eyes in each group respectively. OCTA was applied to perform a 3mm×3mm blood flow imaging scan of the macular retina to automatically obtain the vascular density(VD)of the superficial retinal macular foveal, the parafoveal(1～3mm), as well as the macular 3mm×3mm and the area of macular foveal avascular zone(FAZ). Furthermore, the alteration of these parameters in patients with different degrees of DR was analyzed.RESULTS: Compared with the NDR group, the VD of the 3mm×3mm superficial retinal capillary(SCP)in the macular region was decreased in both PDR and NPDR group(all P<0.017), and the VD of the parafoveal was decreased in each quadrant(P<0.017), with the most significant decrease in the PDR group. The FAZ area of patients in the PDR and NPDR groups was significantly larger than that in the NDR group(P<0.017). Age, homocysteine, best corrected visual acuity(LogMAR), axial length and glycosylated hemoglobin(HbA1c)of patients with DR were negatively correlated with VD in the macular foveal(P<0.05), while homocysteine, best corrected visual acuity(LogMAR), axial length, and the duration of diabetes were negatively correlated with VD in the macular 3mm×3mm(P<0.05). Triglycerides, best corrected visual acuity(LogMAR), and HbA1c were negatively correlated with VD in the parafoveal(P<0.05), while total cholesterol and central macular thickness had no significant correlation with VD(P>0.05).CONCLUSION: The microcirculation changes in the macular area of DR patients can be monitored by OCTA, and the systemic condition of DR patients is closely related to their macular microcirculation.
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@#Visual loss after non-ocular surgery(VLNOS)includes postoperative visual loss and perioperative visual loss after non-ocular surgery. The former accident consists of the blindness during a surgery or after a surgery, and the latter accident shows the acute visual loss in perioperative period. VLNOS can be appeared in a prone spinal surgery, cardiopulmonary bypass surgery, head and neck surgery, and facial micro-plastic injection treatment, which is a rare, extremely serious complication. VLNOS is divided into predictable and unpredictable condition. Doctors of related subjects have pay attention to VLNOS, and begin to study the possible reasons, and take positive precautions.
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@#AIM:To observe the clinical effects of the small incision non phacoemusification cataract surgery in 462 Sudanese cataract cases(536 eyes). <p>METHODS:From September 2013 to August 2015, we analyzed the 462 Sudanese cataract cases(536 eyes)performed cataract surgery by the way of the small incision non phacoemusification with intraocular lens(IOL)implantation and summarized the intraoperative and postoperative complications, the eyesight and intraocular pressure(IOP)of the eyes in 1d, 1wk and 1mo after operation. <p>RESULTS: Intraoperative complications: posterior capsular ruptured and vitreous prolapsed in 18 eyes(3.4%), iris prolapsed in 10 eyes(1.9%), suspensory ligament of the lens ruptured in 7 eyes(1.3%), not implanted IOL in 5 eyes(0.9%), descent's membrane detachment in 3 eyes(0.6%), iridodialysis in 1 eye(0.2%). Postoperative complications: corneal edema in 47 eyes(8.8%), anterior chamber inflammatory reaction in 32 eyes(6.0%), pupil oval or slightly upward in 12 eyes(2.2%), the upper iris incarcerated in the tunnel incision in 3 eyes(0.6%),hyphema in 2 eyes(0.4%), infective endophthalmitis in 1 eye(0.2%). Visual acuity: uncorrected visual acuity were ≤0.1 in 52 eyes(9.7%), >0.1-<0.3 in 97 eyes(18.1%), 0.3-<0.5 in 129 eyes(24.1%), and ≥0.5 in 258 eyes(48.1%)in 1d after operation. Uncorrected visual acuity was ≤0.1 in 28 eyes(5.2%), >0.1-<0.3 in 66 eyes(12.3%), 0.3-<0.5 in 150 eyes(28.0%), and ≥0.5 in 292 eyes(54.5%)in 1wk after operation. At 1mo after operation, some patients did not follow-up on time, uncorrected visual acuity of reviewer above 0.5 in 321 eyes. IOP: in 1d after operation, IOP above 20 mmHg in 26 eyes(4.9%). In 1wk after operation, IOP above 20 mmHg in 2 eyes(0.4%). In 1mo after operation, 1 eye was still poor control with traumatic cataract surgery, and IOP returned to normal after the reoperation of trabeculectomy. <p>CONCLUSION:The small incision non phacoemusification cataract surgery with IOL implantation has the advantages of small incision, short operation time, relatively safe, easy to mastered, no-suture, quick visual function recovery and low cost. And, the operation equipments are simple and do not need many expensive medical equipments, supplies and professional staffs. So, the small incision non phacoemusification cataract surgery with IOL implantation is suitable for the anti-blind work of cataract in the foreign aid and remote areas.
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@#AIM:To discuss the clinical features and operation methods on small-diopter intermittent exotropia. <p>METHODS:Totally 206 in-patients with small-diopter intermittent exotropia(IXT)in different operation groups, from September 2013 to September 2014,were observed for the eyesight, refraction, dominant eye, exotropia degree, synoptophore and near stereopsis before and after operation. Three types were divided in 206 cases. One hundred and thirty-two cases of basic IXT were the first type, in which 52 cases underwent nondominant eye unilateral recess-resection(nondominant eye unilateral recess-resection, ndR& R), 40 cases underwent dominant eye unilateral recess-resection(dominant eye unilateral recess-resection, dR& R), 40 cases underwent bilateral lateral rectus recession(bilateral lateral rectus recession, BLR-rec). Sixty-one cases of convergence insufficiency IXT were the second type, in which 40 cases underwent ndR& R, 21 cases underwent bilateral medial rectus amputation. Thirteen cases of divergence excess IXT were the third type, in which 7 cases underwent ndR& R, 6 cases underwent BLR-rec. The rates of the orthophoria, undercorrection, overcorrection and the recovery of synoptophore and near stereopsis after surgery in 1, 6, 12, 24mo were compared in 3 types. <p>RESULTS: The clinical features of 206 cases with small-diopter IXT were: in the most cases, between 5 and 12 years old; nondominant eye was left eye; the eyesight of nondominant eye was lower than another eye; refraction status were myopia, astigmatism and anisometropia; basic IXT was the most common type; exotropia degree was between 40<sup>△</sup> and 60<sup>△</sup>; some cases owned binocular function and near stereopsis. Comparison of operation methods in 3 groups: orthophoria comparisons in basic IXT among ndR& R group, d R& R group and BLR-rec group were significant difference(<i>P</i><0.05)after operation in 12 and 24mo. Orthophoria comparison in insufficiency IXT between ndR& R group and BMR-amp group was not significant difference(<i>P</i>>0.05)after operation. The operation of divergence excess IXT was effective. Orthophoria comparison in ndR& R group between basic IXT and convergence insufficiency IXT was significant difference(<i>P</i><0.05)after operation in 6, 12 and 24mo. Synoptophore and near stereopsis of some cases were improved after operation. <p>CONCLUSION:Early surgical treatment of the pediatric patients with small-diopter IXT is benefit for the establishment of binocular function and stereopsis. Adult surgical treatment can improve the appearance and alleviated eyestrain. In 206 cases, the operation method of ndR& R is obvious curative effective in each type of small-diopter IXT. The operation methods of BMR-amp and BLR-rec are obvious effective in insufficiency intermittent and divergence excess IXT.