Translation and validation to Portuguese of a 60-item questionnaire to evaluate theoretical knowledge in fundus examination / Tradução e validação para o português de um questionário de 60 itens para avaliação do conhecimento teórico no exame de fundo de olho

ABSTRACT Purpose: To translate and validate a questionnaire that evaluates the theoretical knowledge regarding fundus examination. Methods: A 60-item multiple-choice English questionnaire that investigates various aspects of knowledge regarding fundus examination was translated into Portuguese. The process involved translation, back-translation, and evaluation by an expert committee. The resulting questionnaire was applied to final-year medical students and ophthalmology residents. Each included subject answered the questionnaire twice, with an interval of one week between each application. Internal consistency, test-retest reliability, inter-rater reliability, and percentage agreement were calculated. Results: Thirty participants were included (25 medical students and 5 ophthalmology residents). The pass-fail cutoff was calculated at 46, the theoretical false positives were 8.7% and the theoretical false negatives were 2.8%. The observed false positive and false negative rates were 0%. Among the 60 items, test-retest reliability was strong in 17 items, which one had a negative correlation, moderate in 14 items, which one had a negative correlation, and weak in 29 items; inter-rater reliability of 34 items was under 0.4, 17 items were between 0.4 and 0.6, and 8 items were above 0.6. One item had a negative kappa. Among the percent agreement, 10 items were between 40%-60% agreement, 50 were above 60% agreement, and 18 were above 80%. Cronbach's alpha was calculated as 0.674. Conclusions: The translated questionnaire provided a standard instrument for future research and interventions to improve medical education in ophthalmology.

RESUMO Objetivos: Traduzir e validar para o português um questionário para avaliar o conhecimento teórico no exame de fundo de olho. Métodos: Um questionário de múltipla escolha de 60 questões em inglês, ao qual avalia diversos aspetos do conhecimento no exame de fundo de olho, foi traduzido para o português. O processo envolveu uma tradução, re-tradução e avaliação por um comitê de especialistas. O questionário resultante foi aplicado em estudantes de medicina do último ano e médicos-residentes em oftalmologia. Cada indivíduo respondeu o questionário duas vezes, com um intervalo de uma semana entre cada aplicação. A consistência interna, a confiança teste-reteste, a confiança entre avaliadores e a porcentagem de concordâncias foram calculadas. Resultados: Trinta participantes foram incluídos (25 estudantes de medicina e 5 residentes em oftalmologia). A nota de corte para aprovação-reprovação foi calculada em 46, sendo os falsos positivos teóricos de 8,7% e os falsos negativos teóricos 2,8%. No mesmo corte, os falsos positivos e falsos negativos observados foi de 0%. Dentre os 60 itens, a confiança teste-reteste foi forte em 17 itens, sendo que um apresentou uma correlação negativa, moderada em 14 itens, sendo que um apresentou uma correlação negativa, e fraca em 29 itens; a confiança inter-examinador foi inferior a 0,4 em 34 itens, entre 0,4 e 0,6 em 17 itens, e acima de 0,6 em 8 itens. Um dos itens apresentou um valor negativo. A porcentagem de concordância foi entre 40-60% em 10 itens, superior a 60% em 50 itens e acima de 80% em 18 itens. O alfa de Crombach foi calculado com 0,674. Conclusões: O questionário traduzido propicia um instrumento padronizado para futuras pesquisas e intervenções às quais visem aprimorar o ensino em oftalmologia.

Performance analysis of pretrained convolutional neural network models for ophthalmological disease classification / Análise de desempenho de modelos de rede neural convolucional pré-treinados para classificação de doenças oftalmológicas

ABSTRACT Purpose: This study aimed to evaluate the classification performance of pretrained convolutional neural network models or architectures using fundus image dataset containing eight disease labels. Methods: A publicly available ocular disease intelligent recognition database has been used for the diagnosis of eight diseases. This ocular disease intelligent recognition database has a total of 10,000 fundus images from both eyes of 5,000 patients for the following eight diseases: healthy, diabetic retinopathy, glaucoma, cataract, age-related macular degeneration, hypertension, myopia, and others. Ocular disease classification performances were investigated by constructing three pretrained convolutional neural network architectures including VGG16, Inceptionv3, and ResNet50 models with adaptive moment optimizer. These models were implemented in Google Colab, which made the task straight-forward without spending hours installing the environment and supporting libraries. To evaluate the effectiveness of the models, the dataset was divided into 70%, 10%, and 20% for training, validation, and testing, respectively. For each classification, the training images were augmented to 10,000 fundus images. Results: ResNet50 achieved an accuracy of 97.1%; sensitivity, 78.5%; specificity, 98.5%; and precision, 79.7%, and had the best area under the curve and final score to classify cataract (area under the curve = 0.964, final score = 0.903). By contrast, VGG16 achieved an accuracy of 96.2%; sensitivity, 56.9%; specificity, 99.2%; precision, 84.1%; area under the curve, 0.949; and final score, 0.857. Conclusions: These results demonstrate the ability of the pretrained convolutional neural network architectures to identify ophthalmological diseases from fundus images. ResNet50 can be a good architecture to solve problems in disease detection and classification of glaucoma, cataract, hypertension, and myopia; Inceptionv3 for age-related macular degeneration, and other disease; and VGG16 for normal and diabetic retinopathy.

RESUMO Objetivo: Avaliar o desempenho de classificação de modelos ou arquiteturas de rede neural convolucional pré--treinadas usando um conjunto de dados de imagem de fundo de olho contendo oito rótulos de doenças diferentes. Métodos: Neste artigo, o conjunto de dados de reconhecimento inteligente de doenças oculares publicamente disponível foi usado para o diagnóstico de oito rótulos de doenças diferentes. O banco de dados de reconhecimento inteligente de doenças oculares tem um total de 10.000 imagens de fundo de olho de ambos os olhos de 5.000 pacientes para oito categorias que contêm rótulos saudáveis, retinopatia diabética, glaucoma, catarata, degeneração macular relacionada à idade, hipertensão, miopia, outros. Investigamos o desempenho da classificação de doenças oculares construindo três arquiteturas de rede neural convolucional pré-treinadas diferentes, incluindo os modelos VGG16, Inceptionv3 e ResNet50 com otimizador de Momento Adaptativo. Esses modelos foram implementados no Google Colab o que facilitou a tarefa sem gastar horas instalando o ambiente e suportando bibliotecas. Para avaliar a eficácia dos modelos, o conjunto de dados é dividido em 70% para treinamento, 10% para validação e os 20% restantes utilizados para teste. As imagens de treinamento foram expandidas para 10.000 imagens de fundo de olho para cada tal. Resultados: Observou-se que o modelo ResNet50 alcançou acurácia de 97,1%, sensibilidade de 78,5%, especificidade de 98,5% e precisão de 79,7% e teve a melhor área sob a curva e pontuação final para classificar a categoria da catarata (área sob a curva=0,964, final=0,903). Em contraste, o modelo VGG16 alcançou uma precisão de 96,2%, sensibilidade de 56,9%, especificidade de 99,2% e precisão de 84,1%, área sob a curva 0,949 e pontuação final de 0,857. Conclusão: Esses resultados demonstram a capacidade das arquiteturas de rede neural convolucional pré-treinadas em identificar doenças oftalmológicas a partir de imagens de fundo de olho. ResNet50 pode ser uma boa solução para resolver problemas na detecção e classificação de doenças como glaucoma, catarata, hipertensão e miopia; Inceptionv3 para degeneração macular relacionada à idade e outras doenças; e VGG16 para retinopatia normal e diabética.

El fondo de ojo, una ventana a la microvasculatura del paciente hipertenso / The fundus, a window to microvasculature in hypertensive patients

Introducción: La hipertensión arterial constituye una de las enfermedades más frecuentes en la población general. En la actualidad llega a una prevalencia global del 30 al 45 %. La microcirculación retiniana puede considerarse como una representación anatómica de las características fisiológicas y funcionales de la circulación coronaria y cerebral. Objetivos: Profundizar en la relación existente entre los niveles de presión arterial y el daño del órgano diana, específicamente a través del fondo de ojo, así como de las posibles complicaciones oftalmológicas derivadas de la hipertensión arterial, y la comparación de algunas de las clasificaciones existentes sobre los cambios oftalmológicos que esta provoca. Métodos: Se emplearon los métodos de análisis-síntesis y análisis bibliográfico y documental. Los motores de búsqueda utilizados fueron: Google y Google Académico, y las bases de datos Hinari, SciELO Cuba, Pubmed, entre otras. Conclusiones: La retinopatía hipertensiva es una de las complicaciones adversas de la hipertensión arterial aguda o crónica. Por su parte, las oclusiones venosas y la formación de macroaneurismas, constituyen otras de gran envergadura. Mientras más eficaz sea el diagnóstico y seguimiento de los pacientes hipertensos, menos recursos se necesitarán para su tratamiento, y se evitarán así las complicaciones de otros órganos diana como el cerebro y el riñón, lo que provocaría en los pacientes una mayor discapacidad.

Introduction: arterial hypertension is one the most frequent diseases in general population. Nowadays, it reaches a global prevalence of 30 to 45 %. Retinal microcirculation can be considered as an anatomical representation of the physiological and functional characteristics of the coronary and cerebral circulation. Objectives: to delve into the relationship between blood pressure levels and target organ damage, specifically through the fundus, as well as the possible ophthalmological complications derived from arterial hypertension, and the comparison of some of the existing classifications on the ophthalmological changes that it causes. Methods: analysis - synthesis and bibliographic- documentary analyses were the used methods. Google and Google Scholar as well as Hinari, SciELO Cuba, Pubmed and others databases were the search engines. Conclusions: hypertensive retinopathy is one of the adverse complications of acute or chronic arterial hypertension. On the other hand, venous occlusions and the formation of macroaneurysms constitute other serious ones to consider. The more effective the diagnosis and follow-up of hypertensive patients, the fewer resources will be needed for their treatment, thus avoiding complications in other target organs such as the brain and kidney, which would cause greater disability in patients.

Mapeamento de retina nas interconsultas oftalmológicas: um estudo transversal e epidemiológico em um hospital de referência do estado de São Paulo / Indirect ophthalmoscopy in ophthalmological interconsultations: a cross-sectional and epidemiological study in a reference hospital in the state of São Paulo

RESUMO Objetivo Avaliar os mapeamentos de retina realizados em interconsultas oftalmológicas, analisando as prevalências de alterações encontradas e comparando-as com o motivo da interconsulta. Métodos Estudo transversal, com dados encontrados durante exame de mapeamento de retina de pacientes internados ou em atendimento no pronto-socorro. Os dados analisados de cada paciente foram idade, sexo, especialidade médica solicitante, motivo da interconsulta e achados do exame fundoscópico. Resultados Foram avaliados 104 pacientes, com prevalência de alterações ao exame em 43,27%. Os motivos mais frequentes de solicitação de avaliação oftalmológica foram trauma (16,35%) e alterações neurológicas (15,38%). O achado com maior prevalência foi o edema de papila, presente em 17,3% das avaliações gerais. Outros achados muito prevalentes foram as retinopatias diabética e hipertensiva, ambas com 11,53% na avaliação geral, mas com 83,3% e 53,84% de prevalência nos pacientes cujos motivos da consulta foram diabetes mellitus descompensada e crise hipertensiva, respectivamente. Conclusão O edema de papila e as retinopatias diabética e hipertensiva foram as alterações mais prevalentes, o que demonstra a importância do atendimento multidisciplinar sempre que possível, com maior atenção aos pacientes hipertensos e diabéticos.

ABSTRACT Objective To evaluate the indirect ophthalmoscopy performed in ophthalmologic consultations, analyzing the prevalence of the study and comparing them with the reason for the consultation. Methods Cross-sectional study, with data found during the indirect ophthalmoscopy exam of inpatients or in emergency room care. The data analyzed for each patient was sex, the requested medical age, the reason for the consultation and the funduscopic examination findings. Results One hundred and four patients were evaluated and 43.27% of patients with a prevalence of changes in the exam. The most requested reasons for requesting ophthalmologic evaluation were trauma (16.35%) and neurological alterations (15.38%). The most prevalent finding was papillary edema, representing 17.3% of the general estimates. Other very prevalent findings were diabetic and hypertensive retinopathies, both with 11.53% in the general assessment, but with 83.3% and 53.84% prevalence in patients whose reasons for consultation were decompensated DM and hypertensive crisis, respectively. Conclusions Papillary edema and diabetic and hypertensive retinopathies were the most prevalent alterations, which demonstrates the importance of multidisciplinary care whenever possible, with greater attention to hypertensive and diabetic patients.

Manejo del desprendimiento de retina regmatógeno / Management of rhegmatogenous retinal detachment

1. INTRODUCCIÓN El desprendimiento de retina es un problema visual grave que puede ocurrir a cualquier edad, aunque suele darse en individuos de edad media o en personas de la tercera edad. La incidencia es relativamente baja considerando que las estima-ciones varían según zonas geográficas; y, se han reportado datos de entre 6,3 y 17,9 por 100 000 habitantes. Otras características im-portantes a considerar son la degeneración en encaje de 45,75% y la miopía de 47,28% que influyen en la presentación del desprendi-miento de retina. Al mismo tiempo que la edad, los cambios vítreos retinianos y la presencia de pseudofaquia1,2. Además, de los factores oculares relacionados también influyen, el seguimiento inadecuado de los factores de riesgo y el difícil acceso a médicos especialistas que se traduce en retraso en el diagnóstico certero y tratamiento tardío que implica deterioro del pronóstico visual cuando el área macular está incluida en el área desprendida con pobres resultados en adultos jóvenes y en edad productiva.El tratamiento evitará el deterioro o pérdida irreversible de la visión. El pronóstico con tratamiento quirúrgico es bueno si el des-prendimiento no incluye a la mácula.

1. INTRODUCTIONRetinal Detachment is a serious visual problem that can occur at any age, although it usually occurs in middle-aged or elderly in-dividuals. The incidence is relatively low considering that estimates vary ac-cording to geographical areas; and, data have been reported be-tween 6,3 and 17,9 per 100 000 inhabitants. Other important cha-racteristics to consider are socket degeneration of 45,75% and myopia of 47,28% that influence the presentation of retinal deta-chment, as well as age, vitreoretinal changes and the presence of pseudophakia1,2.In addition to the related ocular factors, inadequate follow-up of risk factors and difficult access to medical specialists also play a role, resulting in delayed accurate diagnosis and late treatment that implies deterioration of the visual prognosis when the macular area is included in the detached area with poor results in young adults and those of productive age.Treatment will prevent irreversible deterioration or loss of vision. The prognosis with surgical treatment is good if the detachment does not include the macula.

Barreiras para a realização de oftalmoscopia direta por médicos de família e comunidade / Barriers to performing direct ophthalmoscopy by primary care physicians / Barreras a la oftalmoscopia directa por médicos de familia y comunidade

A oftalmoscopia direta é um exame utilizado para diagnóstico e rastreamento de doenças da retina, do disco óptico e do humor vítreo no contexto da atenção primária à saúde. Estudos demonstram que é uma prática pouco utilizada regularmente por médicos de família e comunidade. O objetivo deste estudo é identificar barreiras para a realização da oftalmoscopia por médicos da referida especialidade. Este estudo utilizou metodologia qualitativa, baseada em entrevista semiestruturada com médicos de família e comunidade e posterior análise temática. Demonstrou-se que as barreiras para a realização de oftalmoscopia direta incluem dificuldade no manejo do oftalmoscópio e na dilatação pupilar, pouco conhecimento da anatomia ocular, sentimento de insegurança na realização e na interpretação de achados, percepção de que seria um exame mais bem realizado por um especialista, falta de formação e experiência prática na graduação e na residência médica, percepção de pouca utilidade ou resolutividade, dificuldade em adequar o ambiente para a realização do exame, ausência de aparelho e colírios midriáticos nas unidades de saúde, aumento no tempo de consulta, ausência de fluxos de encaminhamento mediante achados alterados, presença de serviços de teleoftalmologia e ausência de treinamento da equipe multiprofissional.

Introduction: Direct ophthalmoscopy is an examination performed for the diagnosis and screening of diseases of the retina, optic disc, and vitreous humor in the context of primary health care. Studies show that this practice is rarely used by primary care physicians. Objective: The aim of this study is to identify barriers for primary care physicians to perform ophthalmoscopy. Methods: This study used a qualitative methodology based on a semi-structured interview with primary care physicians with subsequent thematic analysis. Results: It was verified that barriers to performing direct ophthalmoscopy include difficulty in handling the ophthalmoscope and pupil dilation, little knowledge of eye anatomy, feeling of insecurity in performing and interpreting findings, perception that the examination would be better performed by a specialist, lack of training and practical experience in undergraduate program and medical residency, perception of little use or resolution, difficulty in adjusting the room environment for the examination, absence of equipment and mydriatics in health units, increase in consultation time, absence of referral flows when facing altered findings, presence of teleophthalmology services and lack of training of the multidisciplinary team. Conclusions: Barriers to performing ophthalmoscopy by primary care physicians include emotional, behavioral, cognitive, educational, and work-environment aspects.

Introducción: La oftalmoscopia directa es un examen que se utiliza para el diagnóstico y rastreo de enfermedades de la retina, el disco óptico y el humor vítreo en el contexto de la atención primaria de salud. Los estudios demuestran que es una práctica poco utilizada habitualmente por los médicos de familia y comunidad. Objetivo: El objetivo de este estudio es identificar barreras del porqué los médicos de familia y comunidad no realizan oftalmoscopias. Métodos: Esta investigación está basada en una entrevista semiestructurada com médicos de familia y comunidad con posterior análisis temático. Resultados: Se ha demostrado que las barreras para realizar oftalmoscopia directa incluyen dificultad en el manejo del oftalmoscopio y dilatación pupilar, poco conocimiento de la anatomía ocular, sensación de inseguridad en la realización e interpretación de los hallazgos, percepción de que sería un mejor examen por parte de un especialista, falta de formación y experiencia práctica en licenciatura y residencia médica, percepción de poco uso o resolución, dificultad para ajustar el ambiente para el examen, ausencia de aparatos y gotas midriáticas en las unidades de salud, aumento del tiempo de consulta, ausencia de flujo derivación a hallazgos alterados, presencia de servicios de teleoftalmología y falta de formación del equipo multidisciplinario. Conclusiones: Barreras para la oftalmoscopia directa por médicos de familia y de la comunidad incluyen aspectos emocionales, conductuales, cognitivos, educativos y del entorno laboral.

Analysis of ocular clinical features and gene mutations of Waardenburg syndrome / 中华眼底病杂志

Objective:To deeply explore the clinical features and gene mutations of Waardenburg syndrome (WS) by tested of the eyes and genes of three patients.Methods:A Case series study. From 2019 to 2021, 3 children with WS who were diagnosed at Department of Ophthalmology, West China Hospital of Sichuan University were included in the study. Among them, there were 2 males and 1 female; the ages were 3, 4, and 12 months, respectively. All children underwent external eye, anterior segment, fundus and fluorescein fundus angiography, the clinical features of the eyes were observed. The peripheral venous blood of 3 children was collected, and the whole genome DNA was extracted for whole exome sequencing to analyze the gene mutation sites.Results:All children had different degrees of iris heterochromia and fundus pigment abnormalities, and were accompanied by sensorineural hearing impairment. Case 1 had dystopia canthorum; case 2 had macular fovea hypoplasia. The sequencing results of case 1 showed that there were large fragments of heterozygous deletion in exons 2-8 of the Paired box 3 ( PAX3) gene, who was diagnosed as WS Ⅰ type. The sequencing results of of case 2 showed heterozygous mutation in exon 9 of Microphthalmia-associated transcription factor ( MITF) gene (c.1066 C >T), combined with heterozygous mutation in exon 1 of HPS6 gene (c.1417 G> T), who was diagnosed as WS Ⅱ type. The sequencing result of case 3 showed that the exon 3 of SOX10 gene had loss of heterozygosity (c.497_500 delAAGA), who was diagnosed as WS Ⅳ type. Both PAX3 and SOX10 gene mutations were newly discovered mutations. Conclusions:The ocular clinical features of Waardenburg syndrome include hypopigmentation of the iris and choroid, and dystopia canthorum, etc. Early screening of the eye and hearing will help to better diagnose the disease. The large fragments of heterozygous deletion in exons 2-8 of the PAX3 gene, the heterozygous mutation in exon 9 of MITF gene (c.1066 C> T), and the loss of heterozygosity in exon 3 of SOX10 gene are pathogenic genetic variations of 3 children.

Evaluation of fundus autofluorescence maging of diabetic patients without retinopathy / Avaliação do exame de imagem de autofluorescência do fundo do olho em pacientes diabéticos sem retinopatia

ABSTRACT Purpose: To evaluate the usefulness of fundus autofluorescence imaging of diabetic patients without retinopathy to investigate early retinal damage. Methods: Fundus autofluorescence images of patients with type 2 diabetes mellitus without retinopathy (diabetic group) and age-sex matched healthy patients (control group) were recorded with a CX-1 digital mydriatic retinal camera after detailed ophthalmologic examinations. MATLAB 2013a software was used to measure the average pixel intensity and average curve width of the macula and fovea. Results: Fifty-six eyes of 28 patients, as the diabetic group, and 54 eyes of 27 healthy patients, as the control group, were included in this study. The mean aggregation index was 168.32 ± 37.18 grayscale units (gsu) in the diabetic group and 152.27 ± 30.39 gsu in the control group (p=0.014). The mean average pixel intensity value of the fovea was 150.87 ± 35.83 gsu the in diabetic group and as 141.51 ± 31.10 gsu in the control group (p=0.060). The average curve width value was statistically higher in the diabetic group than in the control group (71.7 ± 9.2 vs. 59.4 ± 8.6 gsu, respectively, p=0.03). Conclusion: Fundus autofluorescence imaging analysis revealed that diabetic patients without retinopathy have significant fluorescence alterations. Therefore, a noninvasive imaging technique, such as fundus autofluorescence, may be valuable for evaluation of the retina of diabetic patients without retinopathy.

RESUMO Objetivo: Avaliar a utilidade da autofluorescência do fundo de olho de pacientes diabéticos sem retinopatia para investigar lesões precoces na retina. Métodos: Imagens de autofluorescência do fundo de olho de pacientes com diabetes mellitus do tipo 2 sem retinopatia (grupo diabético) e indivíduos saudáveis pareados por idade e sexo (grupo controle) foram registrados com uma câmera retiniana digital midriática CX-1 após exames oftalmológicos detalhados. O software MATLAB 2013a foi usado para medir a intensidade média do pixel e a largura média da curva da mácula e fóvea. Resultados: Cinquenta e seis olhos de 28 pacientes, como o grupo diabético, e 54 olhos de 27 indivíduos saudáveis, como grupo controle, foram incluídos neste estudo. O índice médio de agregação foi de 168,32 ± 37,18 unidades de escala de cinza (gsu) no grupo diabético e em 152,27 ± 30,39 gsu no grupo controle (p = 0,014). O valor médio da intensidade de pixel na fóvea foi de 150,87 ± 35,83 gsu no grupo diabético e de 141,51 ± 31,10 gsu no grupo controle (p=0,060). O valor médio da largura da curva foi estatisticamente maior no grupo diabético do que no grupo controle (71,7 ± 9,2 vs. 59,4 ± 8,6 gsu, respectivamente; p = 0,03). Conclusão: A análise por imagens de autofluorescência de fundo de olho revelou que pacientes diabéticos sem retinopatia apresentam alterações significativas de fluorescência. Portanto, uma técnica de imagem não invasiva, como a autofluorescência de fundo de olho, pode ser valiosa para a avaliação da retina de pacientes diabéticos sem retinopatia.

Clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion / 中国基层医药

Objective@#To investigate the clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion(RVO).@*Methods@#From June 2016 to June 2017, 98 patients with RVO secondary macular edema in the People's Hospital of Linfen were randomly divided into three groups according to the digital table: A group (30 cases) treated with simple fundus laser, B group (33 cases) treated with intravitreal injection of ranibizumab, C group(35 cases) treated with fundus laser combined with intravitreal injection of ranibizumab.The best corrected visual acuity(BCVA), macular fovea thickness(CMT), leakage rate, injection times and complications were compared among the three groups before and after treatment.@*Results@#At 3, 6, 9, 12 months after treatment, the BCVA among A group, B group and C group had statistically significant differences (F=4.165, 5.021, 6.954, all P<0.05), and the BCVA of C group was better than that of B group, the BCVA of B group was better than that of A group (t=3.985, 3.852, 3.779, 4.021, 3.624, 3.729, all P<0.05). There were statistically significant differences in CMT among A group, B group and C group at 3 months and 6 months after treatment (F=6.772, 14.025, all P<0.05), and the CMT of C group was less than that of B group, the CMT of B group was less than that of A group (t=5.325, 11.251, 3.992, 6.895, all P<0.05). At 6 months after treatment, the leakage rate in C group (2.86%) was lower than that in B group (18.18%), the leakage rate in B group was lower than that in A group (23.33%) (χ2=6.148, P<0.05). The injection times of ranibizumab in B group was (2.93±1.52), which was significantly less than that in C group (2.00±0.56)(t=3.349, P<0.05).@*Conclusion@#The short-term clinical effect of ranibizumab combined with fundus laser in the treatment of macular edema secondary to RVO is better than laser therapy and ranibizumab alone, and the injection times of ranibizumab can be reduced.

Clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion / 中国基层医药

Objective To investigate the clinical value of ranibizumab combined with fundus laser in the treatment of macular edema secondary to branch retinal vein occlusion (RVO).Methods From June 2016 to June 2017,98 patients with RVO secondary macular edema in the People's Hospital of Linfen were randomly divided into three groups according to the digital table:A group (30 cases) treated with simple fundus laser,B group (33 cases) treated with intravitreal injection of ranibizumab,C group(35 cases) treated with fundus laser combined with intravitreal injection of ranibizumab.The best corrected visual acuity (BCVA),macular fovea thickness (CMT),leakage rate,injection times and complications were compared among the three groups before and after treatment.Results At 3,6,9,12 months after treatment,the BCVA among A group,B group and C group had statistically significant differences (F=4.165,5.021,6.954,all P ＜0.05),and the BCVA of C group was better than that of B group,the BCVA of B group was better than that of A group (t =3.985,3.852,3.779,4.021,3.624,3.729,all P ＜0.05).There were statistically significant differences in CMT among A group,B group and C group at 3 months and 6 months after treatment (F =6.772,14.025,all P ＜ 0.05),and the CMT of C group was less than that of B group,the CMT of B group was less than that of A group (t =5.325,11.251,3.992,6.895,all P ＜ 0.05).At 6 months after treatment,the leakage rate in C group (2.86％) was lower than that in B group (18.18％),the leakage rate in B group was lower than that in A group (23.33％) (x2 =6.148,P ＜ 0.05).The injection times of ranibizumab in B group was (2.93 ± 1.52),which was significantly less than that in C group (2.00 ± 0.56) (t =3.349,P ＜ 0.05).Conclusion The short-term clinical effect of ranibizumab combined with fundus laser in the treatment of macular edema secondary to RVO is better than laser therapy and ranibizumab alone,and the injection times of ranibizumab can be reduced.

Effect of Cataract Grade according to Wide-Field Fundus Images on Measurement of Macular Thickness in Cataract Patients

PURPOSE: To investigate the effects of cataract grade based on wide-field fundus imaging on macular thickness measured by spectral domain optical coherence tomography (SD-OCT) and its signal-to-noise ratio (SNR). METHODS: Two hundred cataract patients (200 eyes) with preoperative measurements by wide-field fundus imaging and macular SD-OCT were enrolled. Cataract severity was graded from 1 to 4 according to the degree of macular obscuring by cataract artifact in fundus photo images. Cataract grade based on wide-field fundus image, the Lens Opacity Classification System III, macular thickness, and SD-OCT SNR were compared. All SD-OCT B-scan images were evaluated to detect errors in retinal layer segmentation. RESULTS: Cataract grade based on wide-field fundus imaging was positively correlated with grade of posterior subcapsular cataracts (rho = 0.486, p < 0.001), but not with nuclear opalescence or cortical cataract using the Lens Opacity Classification System III. Cataract grade was negatively correlated with total macular thickness (rho = −0.509, p < 0.001) and SD-OCT SNR (rho = −0.568, p < 0.001). SD-OCT SNR was positively correlated with total macular thickness (rho = 0.571, p < 0.001). Of 200 eyes, 97 (48.5%) had segmentation errors on SD-OCT. As cataract grade increased and SD-OCT SNR decreased, the percentage of eyes with segmentation errors on SD-OCT increased. All measurements of macular thickness in eyes without segmentation errors were significantly greater than those of eyes with segmentation errors. CONCLUSIONS: Posterior subcapsular cataracts had profound effects on cataract grade based on wide-field fundus imaging. As cataract grade based on wide-field fundus image increased, macular thickness tended to be underestimated due to segmentation errors in SD-OCT images. Segmentation errors in SD-OCT should be considered when evaluating macular thickness in eyes with cataracts.

An epidemiological survey of ocular fundus diseases in primary and secondary school students of Dagang Oilfield in Tianjin / 天津医药

Objective To study the fundus diseases that primary and middle school students may be susceptible to suffer, and to understand the prevalence rate and constituent ratio of these diseases. Methods A total of 9 504 students were examined from November 2015 to February 2017 to find out their ocular fundus conditions. They were from all the primary and secondary schools directly subordinate to Dagang Oilfield headquarters. Among the 9 504 participants 4 998 were male and 4 506 were female,with the age span of 5 to 23 and the average age of(13.40±3.41).Our medical examination included uncorrected visual acuity examination and fundus oculi photography. The distribution of fundus diseases was analyzed,including gender,vision acuity and age composition of patients with major diseases. Results Among the 9 504 students,4 314 had emmetropic eyes,and 5 190 had refractive errors.A total of 9 126 out of the 9 504 examined students had normal ocular fundus(96.02%),while those with abnormal ocular fundus accounted for 378(3.98%).The main types of abnormal ocular fundus included the tessellation fundus 354 (3.72%), followed by the large depression of optic disk 16 (0.17%). Among all the 354 cases with tessellation fundus, 179 were male and 175 were female. There were 257 students whose visual acuity≤0.3/0.3,and the prevalence was higher in 17-19 years old students(5.86%).Conclusion It has been revealed in this epidemiological survey that the main abnormal ocular fundus of primary and middle school students in Dagang is tessellation fundus.Most of the tessellation fundus are caused by middle and high myopia,and very few are found in emmetropic students. It has also been found that the incidence of tessellation fundus increases significantly with the increase of age. The large depression of optic disk ranks the second in the abnormal ocular fundus, which is mostly physiological.

La fotografía de fondo de ojo como método de diagnóstico en el glaucoma / Fundus photography as a diagnostic method in glaucoma

El glaucoma es una neuropatía óptica caracterizada por alteraciones en la cabeza del nervio óptico, asociada a pérdida de la visión, y constituye la segunda causa de ceguera en el mundo; aunque dicha ceguera se considera irreversible, puede ser prevenible con el diagnóstico precoz y el tratamiento adecuado de la enfermedad. Múltiples medios diagnósticos se han creado para la detección del glaucoma: la fotografía de fondo de ojo constituye uno de ellos. Usada desde tiempos inmemoriales, ha transitado por una serie de transformaciones resultantes del constante desarrollo científico técnico en el campo de la salud, las cuales han permitido su uso frecuente. Esta revisión se realizó con el objetivo de que los oftalmólogos conozcan más detalladamente las características de este medio diagnóstico a nuestro alcance, sus inicios, evolución tecnológica y su uso, para el diagnóstico precoz y la evolución de la enfermedad glaucomatosa

Glaucoma is an optic neuropathy characterized by alterations in the optic nerve head and associated to vision loss; it constitutes the second cause of blindness globally, although this blindness is considered irreversible and can be prevented with an early diagnosis and adequate treatment of the disease. Several diagnostic methods have been created to detect glaucoma and fundus photography is one of them. It has been used since immemorial times and has passed through a series of transformations resulting from the constant scientific and technical development in the health field, which have allowed their frequent use. This revision was carried out with the objective that ophthalmologists know in detail the characteristics of this diagnostic technique accessible to everyone, its beginnings, technological evolution and use in order to do an early diagnosis and evolution of glaucomatous disease

Differential analysis of blood flow parameters of ophthalmic artery by color Doppler imaging in patients with diabetes with or without retinopathy / 中国基层医药

Objective To explore the differences of blood flow parameters of ophthalmic artery by color Doppler imaging in patients with diabetes mellitus with or without retinopathy.Methods 120 patients with diabetes mellitus were collected.According to whether the patients with retinal lesions,the patients were divided into the lesion group and the non lesion group,60 cases in each group.The pulsatility index,systolic blood peak,diastolic blood peak and resistance index in posterior ciliary artery(PCA),ophthalmic artery(OA),central retinal artery(CRA) were compared between the two groups.Results (1)PCA parameters:the pulsatility index[(1.93±0.38) vs.(1.26±0.32),t=10.447],resistance index[(0.92±0.01) vs.(0.58±0.06),t=43.297]of the lesion group were higher than those of the non lesion group(all P＜0.001),and systolic blood peak,diastolic blood peak were lower,the differences were statistically significant(t=11.735,10.762,all P＜0.001).(2)OA parameters:the systolic blood peak[(27.33±8.72)cm/s vs.(35.64±6.88)cm/s,t=5.795],diastolic blood peak[(7.44±3.57)cm/s vs.(10.28±2.92)cm/s,t=4.770]of the lesion group were less than those of the non lesion group(all P＜0.001),resistance index was higher[(1.97±0.34) vs.(1.39±0.18),t=11.678,P＜0.001],but the pulsatility index had no significant difference between the two groups(t=1.732,P=0.086).(3)CRA parameters:the systolic blood peak[(7.91±2.37)cm/s vs.(10.81±2.76)cm/s,t=6.175]and diastolic blood peak[(3.17±1.99)cm/s vs.(5.04±0.66)cm/s,t=6.909]of the lesion group were less than those of the non lesion group(all P＜0.001),the pulsatility index and resistance index were higher than those of the non lesion group(t=54.222,34.293,all P＜0.001).Conclusion The analysis of the parameters of the blood flow parameters in the patients with diabetic retinopathy by fundus artery ultrasound imaging has a certain reference value.

Profesor LI Rongzhen's Academic Idea and Experience about Treating the Diseases of the Ocular Fundus / 浙江中医药大学学报

[Objective] To sum up the clinical experience of famous veteran doctor LI Rongzhen in treating the fundus oculi disease. [Methods] By learning from Professor LI Rongzhen, recording the relevant cases and analyzing the typical cases, to summarize the academic idea and the clinical experience according to the viscera syndrome differentiation and treatment characteristics, as well as list two proved cases. [Results] Professor LI Rongzhen holds that this disease is closely related with the viscera, origins from heart, involving liver, lung and kidney. In the clinical treatment, Professor LI is good at using the classical prescriptions and the therapy with syndrome differentiation with the permit addition and subtraction, according to the pattern of the fundus oculi disease, which has received the remarkable effect: patients with the deficiency of both heart and spleen of sudden blind, using the principle of nourishing qi to stop bleeding with Guipi Decoction, patients with hyper-action of liver yang, using Zhengan Xifeng Decoction to nourish yin for suppressing hyperactive yang, patients with qi stagnation and blood stasis are treated by Xuefu Zhuyu Decoction to remove stasis and stopp blood;patients with deficiency of kidney-yin of vitreous opacity, using the treatment of tonifying kidney for improving eyesight, with Six Ingredient Rehmannia Pill to nourish the liver and kidney, syndrome with the disharmony of liver and spleen, using Xiaoyao Powder to replenish vital energy ,deficiency of qi and blood, applying Bazhen Decoction to invigorate qi and blood. All of the cases verify her clinical experience. [Conclusion] While treating the fundus oculi disease, Professor LI pays attention to the relation between the eyes and the viscera, using the therapy with syndrome differentiation, with the flexible application of the ancient prescriptions and the traditional Chinese medicine, her experience in treating the fundus oculi disease is well worth learning and using.

Drusenoid retinal pigment epithelium detachments / Descolamento do epitélio pigmentar da retina tipo drusenóide

The authors make a review of drusenoid retinal pigment epithelium detachments(DPDs), a form of retinal pigment epithelium detachment(PED) that evolves from confluent and large soft drusen.Drusenoidretinal pigment epithelial detachments are a recognized element of the "dry" AMD. Until now, no treatment is indicated in drusenoid PEDs. The authors describe the clinical characteristics of drusenoid retinal pigment epithelium detachments (DPEDs) and make a review of the DPEDs related in the international literature. We related in this revision paper the multimodal advanced image exams in two cases of dusenoid retinal pigment epithelium detachments (DPEDs) and the general characteristics of thisfinding associated with Dry Macular degeneration.Upon examination of the ocular fundusDPEDs emerge as well-circumscribed yellow or yellow–white elevations of the RPE that are usually found within the macula.They may show scalloped borders and a slightly irregular surface. When visualized using fluorescein angiography (FA),DPEDs are typically described as faint hyper-fluorescent in the early phase followed by a slow increase in fluorescence throughout the transit stage of the study without late leakage. With optical coherence tomography (OCT), drusenoid PEDs usually show a smooth contour of the detached hyperreflective RPE band that may have an undulating appearance.Drusenoid PEDs encompass far above the ground possibility type of "dry" AMD that develops in relationship with large confluent soft drusen.At this point no treatment is utilized in drusenoid retinal pigment epithelium detachment(DPEDs).

Os autores fazem uma revisão do descolamento do epitélio pigmentar tipo drusenoide e apresentam dois casos desta patologiaassociada à degeneração macular relacionadaà idade descrevendo seus achados em avançados exames com imagem da retina.Neste artigo de revisão da literatura sobre os achados característicos dodescolamento do epitélio pigmentar tipodrusenoide e sua evolução descrevemos os achados de dois casosassociados à degeneração macular relacionada à idade, forma seca, utilizando exames como SD-OCT, fundusautofluorescencia e angiografia com indocianinaverde, além de retinografiacolorida e fluoresceínica. Odescolamento do epitélio pigmentar tipo druside evolui á partir de drussas moles confluentes presentes na degeneração macular relacionada à idade e é também associado a outras doenças retinianas. Até este momento não há tratamento para esta forma da doença.

Changes of serum lipids in patients with Bietti crystalline dystrophy / 中华实验眼科杂志

Background Bietti crystalline dystrophy (BCD) is a congenital and autosomal recessive hereditary eye disease characterized by multiple glistening intraretinal crystals scattered over the fundus.Studies determined abnormality of fatty acid metabolism probably is associated with BCD.However,the study on the alteration of blood lipid level in BCD patients is rare.Objective This trail was to study the change of serum lipids in BCD patients.Methods A total of 50 patients with bilateral BCD and 50 matched healthy volunteers were included from November 2011 to March 2013 in Beijing Tongren Eye Center with the approval of Ethic Committee of Beijing Tongren Hospital.Written informed consent was obtained from each subject before any medial examination.Peripheral blood of 3 ml was collected from the subjects.The serum concentrations of triglyceride (TG),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured and analyzed.The examination outcome was identified based on the criteria of China Adult Dyslipidemia Prevention Guideline (Version 2007).Results Abnormality of serum lipid content was detected in 58.00％ patients (29/50),and hypertriglyceridemia and hypercholesteremia were in 34.48％ (10/29),respectively,and mixed hyperlipidaemia was in 27.59 ％ (8/29).The serum levels of TG,TC and LDL-C were (1.63± 1.19) mmol/L,(5.10±1.05) mmol/L and (3.27±0.97) mmol/L in the BCD group,which were significantly higher than (0.93± 0.33) mmol/L,(4.33 ±0.56) mmol/L,(2.63 ±0.51) mmol/L of the normal group (t =4.036,4.496,4.095,all at P=0.000).Conclusions The serum lipid levels elevate in BCD patients,which might be related to the occurrence of BCD.

Optic neuritis complicating herpes zoster ophthalmicus in an immunocompetent patient / Zoster optic neuritis in immunocompentent

A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.

Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.

Characteristics of retinal vascularization in premature infants / 中华围产医学杂志

Objective To determine the characteristics of retinal vascularization in premature infants. Methods A prospective study was carried out which included all premature infants with birth weight<2 000 g, who were hospitalized in Guangdong Women and Children's Hospital from September 1, 2009 to August 31, 2010. Close retinal screening and follow-up were carried out in order to record retinal vascularization at different post-conceptional ages. Spearman correlation analysis was performed for statistical analysis. Results A total of 231 infants were enrolled, and follow-up was completed in 212 infants giving a follow-up rate of 91.8%. Twenty-eight infants developed retinopathy of prematurity (ROP) resulting in a ROP morbidity of 13.2%, and 184 cases had full retinal vascularization. The median birth weight was 1 600 g (1 000-1 900 g) and the median gestational age was 32.4 weeks (27.0-35.5 weeks). In the 32-week post-conceptional age group, the proportion with full vascularization in ZoneⅠ,ⅡandⅢwas 87.1%(81/93), 7.5%(7/93) and 0.0%(0/93), respectively. In the 36-week post-conceptional age group, full vascularization was observed in ZoneⅠ, and the proportion with full vascularization in ZoneⅡandⅢrose sharply at 38-week and 40-week post-conceptional age, respectively. The proportion with full vascularization in ZoneⅢwas 100.0%(24/24) at 43-week post-conceptional age. According to Spearman correlation analysis, there was a positive correlation between ZoneⅡand Zone Ⅲ retinal vascularization progression and post-conceptional age (r=0.690 and 0.720;P=0.000). In premature infants, full retinal vascularization in ZoneⅠoccurred at 36-week post-conceptional age. The median gestational age for ZoneⅡand ZoneⅢretinal vascularization was 38 weeks (32.2-40.4 weeks) and 41 weeks (36.0-42.6 weeks), respectively. Therefore, a further 2-3 weeks were required for full retinal vascularization in ZoneⅡand ZoneⅢ. The time differences for under-vascularization in ZoneⅡandⅢwere 8 to 10 weeks, and the time differences for full vascularization in ZoneⅡandⅢwere 8 weeks and 6 weeks, respectively. Conclusion Retinal vascularization varies in premature infants. Almost all premature infants complete vascularization by term gestational age and the majority of infants need to be followed up to 41 weeks. It is essential to focus on the different retinal regions during maturation.

Correlation between cup-to-disc ratio and cup/retrobulbar optic nerve diameter proportion assessed by high-resolution ultrasound in glaucomatous eyes / Correlação entre relação escavação/disco e proporção escavação/diâmetro do nervo óptico retrobulbar obtida pela ultrassonografia de alta resolução em olhos com glaucoma

PURPOSE: To investigate the correlation between the measurements of the cup/retrobulbar optic nerve diameter (C/OND) proportion obtained by high-resolution 20-MHz B-mode ultrasound (US) and those of the cup/disc ratio (C/D) obtained by fundus biomicroscopy (BIO) and optical coherence tomography (OCT). METHODS: Thirty eyes of 15 glaucomatous patients with any C/D proportion were studied. All patients underwent examination of the vertical C/D by BIO with a 78D lens and time-domain OCT analysis, as well as the vertical C/OND proportion using 20-MHz US measurements. All data were analyzed by correlation and agreement tests. RESULTS: The Spearman test showed a strong correlation between C/D results obtained by BIO and the measurements of C/OND (US) (r=0.788, p<0.0001), and with C/D obtained by OCT (r=0.8529, p<0.0001). However, comparison of C/D results obtained with OCT to those obtained by with C/OND (US) showed only a moderate correlation (r=0.6727, p<0.0001). Bland-Altman analysis did not show good agreement between C/D (BIO) and C/OND (US). CONCLUSIONS: The results demonstrate that B-mode ultrasound examination with a 20 MHz probe can be a good additional method for the evaluation of the C/D ratio in glaucomatous patients, and may be considered as an alternative gross tool in glaucomatous patients with optic media opacities.

OBJETIVOS: Verificar a correlação entre os achados da relação escavação/diâmetro do nervo óptico retrobulbar (E/DNO) obtidos pelo exame de ultrassom (US) modo B de alta resolução com sonda de 20 MHz e a relação escavação/disco (E/D) obtidos pela biomicroscopia de fundo de olho (BIO) e pela tomografia de coerência óptica (OCT). MÉTODOS: Foram analisados 30 olhos de 15 pacientes com diagnóstico de glaucoma com qualquer proporção da relação E/D. Todos os pacientes foram submetidos ao exame de BIO, com lente 78D, e de OCT, com tecnologia de domínio temporal, para a análise da relação E/D vertical e exame de US modo B, com sonda de 20 MHz, para determinação da proporção E/DNO vertical. Todos os resultados foram analisados por métodos de correlação e concordância. RESULTADOS: Observou-se forte correlação entre as medidas E/D obtidas pela BIO, e as medidas E/DNO (US) (r=0,788; p<0,0001), e com as medidas E/D obtidas pelo OCT (r=0,8529; p<0,0001). Porém, a análise entre as medidas E/DNO (US) e E/D (OCT) mostrou apenas níveis moderados de correlação (r=0,6727, p<0,0001). O teste de Bland-Altman não mostrou bons níveis de concordância entre E/D (BIO) e E/DNO (US). CONCLUSÕES: Os resultados demonstraram que o exame de US modo B com sonda de 20 MHz pode ser um bom método adicional para avaliar a relação E/D de pacientes com glaucoma, a ser considerado como uma ferramenta alternativa na avaliação de pacientes glaucomatosos com opacidades dos meios ópticos.