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.

Application progress of swept-source optical coherence tomography angiography in ophthalmology / 国际眼科杂志(Guoji Yanke Zazhi)

Swept-source optical coherence tomography angiography(SS-OCTA)is a new vascular imaging technique that was recently proposed. It has the advantages of being non-invasive, quick, high-resolution, and automated vascular stratification imaging. It is extremely helpful in the early diagnosis of ophthalmology-related diseases, as well as in the evaluation of treatment effectiveness and the tracking of disease progression. Based on the foundation of OCTA, SS-OCTA utilizes a fast-tuning laser with a wavelength of 1 050 nm for deeper penetration and non-invasive depth-resolved imaging of the retinal and choroidal microvascular systems, deepening the understanding of the characteristics of a wide range of ophthalmic diseases(fundus lesions, glaucoma, neurodegenerative diseases, etc.). The structures of the anterior segment of the eye can also be studied using SS-OCTA, including changes in the depth and density of corneal neovascularization as well as changes in iris neovascularization before and after therapy. This approach provides a novel tool for ophthalmic clinical practice. The development of the clinical use of SS-OCTA technology in ophthalmology is reviewed in this article.

Phenotypic heterogeneity in family members of patients with retinitis pigmentosa

Purpose: To describe the phenotypic variations in family members of patients with retinitis pigmentosa (RP) with different modes of inheritance and to assess the ocular abnormalities in RP families. Methods: A descriptive analysis of three types of inheritance of RP was carried out, where 64 family members were examined at a tertiary eye care center, South India. They underwent comprehensive eye examination, fundus photography, fundus autofluorescence (FAF), full?field electroretinogram (FFERG), and spectral domain optical coherence tomography (SD?OCT). Analysis was performed between mild and severe forms of abnormalities to delineate retinal structural and functional defects in RP families. Results: The mean age was 38.55 ± 17.95 years. Males were 48.4%. In autosomal recessive and X?linked recessive groups, 74.2% and 77.3%, respectively, were asymptomatic, whereas in autosomal dominant group, 27.3% were asymptomatic. The proportion of the cases with abnormalities in all three groups was higher on ERG (59.6%), followed by OCT (57.5%), visual acuity (43.7%), peripheral FAF (23.5%), and macular FAF (11.8%). However, these abnormalities and the clinical pictures of the family members had no statistical difference across the three groups of inheritance. Conclusion: Structural and functional retinal alterations were noted in four out of five asymptomatic members, suggesting the need for careful screening of RP families and the pressing need for pre?test (genetic) counseling

Universal slit-lamp–mounted mobile adapter with 20 D lens for fundus photography: “Litter to glitter”

Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand. Similarly, with a 20 D lens, the filming distance is adjusted by moving the lens or mobile forward or backward, which makes it difficult to adjust and focus the image in busy ophthalmology outpatient departments (OPDs). Moreover, fundus camera costs thousands of dollars. Authors describe a novel technique of performing fundus photography with a 20 D lens and a universal slit-lamp–mounted mobile adapter made from trash. By the use of this simple, yet frugal innovation, primary care physicians or ophthalmologists without a fundus camera can easily snap a fundus photo and subject it to digital analysis by retina specialists across the world. This will help in simultaneous ocular examination and fundus photos taken via mounted 20 D on a slit lamp itself and also reduce the need for unnecessary retina referrals to tertiary eye care centers.

Smartphone for retinal imaging – Case series in resource-limited rural settings

Purpose: There is a clinical need for a cost?effective, reliable, easy?to?use, and portable retinal photography. The use of smartphone fundus photography for documentation of retinal changes in resource?limited settings, where retinal imaging was not previously possible, is studied here. The introduction of smartphone?based retinal imaging has resulted in the increase in available technologies for fundus photography. On account of the cost, fundus cameras are not readily available in ophthalmic practice in developing countries. Because smartphones are readily available, easy to use, and also portable, they present a low?cost alternative method in resource?limited settings. The aim is to explore the use of smartphones (iphones) for retinal imaging in resource?limited settings. Methods: A smartphone (iphone) was used to acquire retinal images with the use of +20 D lens in patients with dilated pupils by activating the video mode of the camera. Results: Clear retinal images were obtained in different clinical conditions in adults and children, including branch retinal vein occlusion with fibro?vascular proliferation, choroidal neo?vascular membranes, presumed ocular toxoplasmosis, diabetic retinopathy, retinoblastoma, ocular albinism, and hypertensive retinopathy. Conclusion: New inexpensive, portable, easy?to?operate cameras have revolutionized retinal imaging and screening programs and play an innovative role in research, education, and information sharing

Impact of preoperative posterior segment evaluation on surgical intervention in camp patients: A retrospective analysis

Purpose: To retrospectively study impact of preoperative posterior segment evaluation on surgical intervention in camp patients recruited for cataract surgery in Gujarat India. Methods: Retrospective analysis of six months data collected from hospital electronic medical record (EMR) system of 9820 admitted patients recruited from screening camp for cataract surgery from 1/10/2019 to 31/3/2020 in Tertiary Eye Hospital in Gujarat, India, has been done. Comprehensive clinical evaluation, of both anterior and posterior segment which included detailed history; best corrected visual acuity (BCVA); intraocular pressure measurement with non?contact tonometer (NCT) and when required with Goldman applanation tonometer; slit lamp examination; and fundus examination with + 90 diopter lens as well as indirect ophthalmoscope as and when indicated. In case there was no view of retina, a B?scan ultrasound was done to rule out any posterior segment pathology. Immediate surgical intervention done was assessed and results analyzed in percentage. Results: Cataract surgery was advised for 8390 patients (85.43%). Surgical intervention for management of glaucoma was done for 68 patients (0.692%). Retina intervention was done for 86 patients. Posterior segment evaluation changed immediate surgical plane of management for 154 (1.57%) patients. Conclusion: Comprehensive clinical evaluation is economical and should be mandatory especially in community services as comorbid conditions like glaucoma, diabetic retinopathy, retinal vein occlusion, and other varied posterior segment diseases contribute significantly to visual disability in elderly age group. It is difficult to follow these patients later if manageable comorbidity is not informed about and if indicated dealt simultaneously for visual rehabilitation of patient.

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.

Analysis of occurrence and influencing factors of fundus arteriosclerosis in HIVAIDS patients after long-term highly active antiretroviral therapy / 中国热带医学

@#Abstract: Objective　To investigate the fundus arteriosclerosis and its influencing factors in HIV/AIDS patients after long-term highly active antiretroviral therapy (HAART). Methods　The clinical basic data and fundus examination data of 203 HIV/AIDS patients before and after HAART in the Fourth People 's Hospital of Nanning from January 2020 to June 2022 were collected to evaluate the occurrence of fundus arteriosclerosis and analyze its influencing factors. Results　Of the 203 HIV/AIDS patients, 159 patients developed fundus arteriosclerosis, with an incidence of 78.33%, including 33 patients with grade Ⅰ(20.75%), 87 patients with grade Ⅱ (54.72%), 28 patients with grade Ⅲ(17.61%), and 11 patients (6.92%) with Grade Ⅳ. Before HAART, there was no significant difference in CD4+T lymphocyte count, CD8+T lymphocyte count, viral load, white blood cell count, platelet count, hemoglobin, serum creatinine, blood urea nitrogen, triacylglycerol, total cholesterol, fasting blood glucose, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin between the atherosclerosis group and normal group (P>0.05). After 6 months of HAART, CD8+T lymphocyte count, triacylglycerol and fasting blood glucose in atherosclerosis group were significantly higher than those in normal group (P<0.05). In the stratified comparison of CD4+ and CD8+ lymphocyte counts after 6 months of HAART, the proportion of patients with CD4+ lymphocyte count (CD4+)<200 (cells/μL) in the atherosclerosis group was significantly higher than that in the normal group; the proportion of patients with CD4+ lymphocyte count (CD4+)≥500 (cells/μL) was significantly lower than that in the normal group; the proportion of patients with CD8+ lymphocyte count CD8+≥ 800/μL was significantly higher than that in the normal group (all P<0.05). Binary logistic regression analysis showed that opportunistic infection, HIV course, CD4+T, CD8+T lymphocyte count after HAART and triglyceride were independent risk factors for ocular fundus atherosclerosis in HIV/AIDS patients (all P<0.05). Conclusions　The incidence of ocular fundus arteriosclerosis is high in HIV/AIDS patients. More than 4 years of HIV course, combined opportunistic infection, Low CD4+T lymphocyte count after 6 months of HAART, high CD8+T lymphocyte count and high triglyceride level are independent risk factors for ocular fundus arteriosclerosis in HIV/AIDS patients. Fundus screening should be performed before and after HAART in such population, HAART program should be formulated for the risk of cardiovascular disease, and risk management of cardiovascular disease should be strengthened during treatment to improve patient outcomes.

Guidelines for the application of the fundus autofluorescence in age-related macular degeneration(2023) / 国际眼科杂志(Guoji Yanke Zazhi)

Fundus autofluorescence(FAF)imaging is based on the fluorescence excited by the endogenous fluorophores in the retinal pigment epithelium and choroid, mainly referring to lipofuscin(LF)and melanin. The non-invasive examination method can imply the function of retinal pigment epithelium by observing the spatial distribution of LF or melanin. This technique has unique advantages in the diagnosis and differentiation of age-related macular degeneration(ARMD). This guideline is to standardize and interpret the application of FAF in different stages and classifications of ARMD.

Screening status of neonatal fundus disease and its influencing factors in Longhua district, Shenzhen / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the screening status of neonatal fundus disease and the related influencing factors of common fundus retinal hemorrhage in Longhua District of Shenzhen, so as to provide references for the prevention, screening and intervention of neonatal fundus disease in clinical practice.METHODS: A total of 3 101 neonates who received fundus screening in the People's Hospital of Longhua, Shenzen from September 2019 to October 2022 were selected as research objects. The screening results were summarized, and the risk factors for neonatal retinal hemorrhage were analyzed by Logistic regression model.RESULTS: The detection rate of neonatal fundus abnormalities was 12.71%, and the detection rate of neonatal retinal hemorrhage was the highest(12.19%). The other types of fundus abnormalities included periretinal white focus, chromatosis, pigment shedding, choroid coloboma and nystagmus. Hemorrhage grade I accounted for the largest proportion of 378 neonates with retinal hemorrhage(75.66%). Follow-up found that different grades of retinal hemorrhage could be automatically absorbed over time without excessive intervention. Logistic analysis suggested that spontaneous delivery [OR=3.180, 95%CI(1.543～6.555)], twin pregnancy [OR=2.119, 95%CI(1.121～4.007)] and umbilical cord round the neck [OR=1.547, 95%CI(1.239～1.930)] were risk factors affecting neonatal retinal hemorrhage.CONCLUSION: Retinal hemorrhage is the most common type of fundus abnormalities in neonates. Spontaneous delivery, twin pregnancy and umbilical cord around the neck are risk factors of retinal hemorrhage. It is recommended that pay attention to the above factors and choose appropriate intervention means to avoid serious fundus complications.

Application of deep learning artificial intelligence in the auxiliary diagnosis of age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

Since the advent of artificial intelligence(AI), it has been increasingly applied and rapidly developed in various fields. In the field of medicine, image features can be automatically extracted and the performance of feature learning and classification can be completed with the help of AI. In the field of ocular fundus disease, AI can give a diagnosis of age-related maculopathy by analyzing and identifying fundus photography and optical coherence tomography with an accuracy rate similar to that of ophthalmologists. In the future, AI may assist physicians in making a diagnosis of age-related macular degeneration, aid basic hospital in screening and curb its progression in the early stage of the disease. However, the technique has problems such as uncertain model recognition performance, opaque operation process, and excessive amount of clinical data required, which still cannot be widely used in the clinic. In recent years, a lot of research has been done in China in the application of deep learning with AI to assist diagnosis of ophthalmic diseases, and the results show that AI combined with imaging analysis of ophthalmic diseases has such characteristics as objectivity, efficiency and accuracy. In this article, studies on deep learning in the auxiliary diagnosis of age-related maculopathy are reviewed, and the progress on its application and the limitations that exist are analyzed, so as to provide more information on the use and extension of AI in this disease.

Research progress on fundus examination methods and fundus image characteristics of retinopathy of prematurity / 国际眼科杂志(Guoji Yanke Zazhi)

Retinopathy of prematurity(ROP)is the primary cause of preventable childhood blindness. It is hard to screen, diagnose and objectively evaluate. There are various modalities for ROP screening, including various contact or non-contact imaging devices, smart phone-based fundus photography, and artificial intelligence-based fundus image analysis. The diagnosis of ROP is based on visualization and recording of the entire retinal fundus of ROP, which is also the basis for subsequent screening, treatment assessment. Fundus screening is critical for early recognition and facilitates early detection and prompt referral. Potential features may be found by analyzing and summarizing the characteristics of ROP fundus images. Subsequently, timely and targeted ROP prevention and treatment could be performed. Artificial intelligence promotes automatic, quantifiable and objective diagnosis of ROP. This article reviews commonly used clinical fundus examination methods and fundus image characteristics of ROP and summarizes the latest research progress on the application of artificial intelligence in the automatic diagnosis of ROP.

Research progress of fundus morphology in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

High myopia is the main cause of visual impairment in the world. With the development of society, the myopia rate is increasing year by year. The development of high myopia is closely related to the progressive extension of the eye axis, and a series of fundus changes will inevitably occur with the extension of the eye axis, such as comus, lacquer cracks, choroidal neovascularization, macular choroidal atrophy, retinal detachment, posterior scleral staphyloma, etc. At present, characterized by younger age and high degree, myopia has become the main cause of blindness in China. This paper briefly summarizes the latest research on the morphological changes of the optic disc, macula, retina, choroid and sclera of high myopia, aiming to provide references for the development of intelligent prediction models, clinical diagnosis and further research on the treatment measures in combination with the fundus morphology of high myopia.

Comparison of detection rates and time costs of different fundus imaging techniques for retinal neovascularization in optic disc and other area of proliferative diabetic retinopathy / 中华实验眼科杂志

Objective:To compare the detection rate and time cost of different imaging methods for retinal and optic disc neovascularization in proliferative diabetic retinopathy (PDR).Methods:A cross-sectional study was conducted.Thirty-eight patients (48 eyes) with PDR were enrolled in Henan Eye Hospital from October 2019 to February 2021, including 22 males (28 eyes) and 16 females (20 eyes). The average age of the patients was (51.08±13.35) years.All patients underwent ultra-widefield imaging (UWFI), fundus fluorescein angiography (FFA), optical coherence tomography angiography (OCTA), en face optical coherence tomography (OCT), near-infrared fundus imaging (IR) combined with spectral domain OCT (SD-OCT). Wide field swept-source OCTA (WF-SS-OCTA) was performed in the patients who were unsuitable for FFA.The time required for each examination in one eye and the detection rate of neovascularization at the optic disc (NVD) and retinal neovascularization elsewhere (NVE) were recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by Henan Eye Hospital (No.HNEECKY-2021[22]). All patients were informed about the method and purpose of the study and voluntarily signed the informed consent form.Results:The mean monocular examination time costs of UWFI, IR+ SD-OCT, OCTA+ en face OCT, FFA and WF-SS-OCT was (0.51±0.13), (2.08±0.57), (5.79±0.68), (17.66±1.83) and (13.38±1.23)min, respectively.There was a significant overall difference in the mean monocular examination time among the five methods ( F=2 077.960, P<0.001). The detection rates of UWFI, IR+ SD-OCT, OCTA+ en face OCT, FFA+ WF-SS-OCT for NVE and NVD were 52.1%(25/48) and 12.5%(6/48), 81.3%(39/48) and 20.8%(10/48), 83.3%(40/48) and 27.1%(13/48), 93.8%(45/48) and 29.2%(14/48), respectively.There were significant differences in the detection rates of NVE ( χ2=26.460, P<0.001) but not in the detection rates of NVD ( χ2=4.645, P=0.200) among the various methods.Five neovascular buds were detected by OCTA in 3 eyes, but not by FFA. Conclusions:UWFI and IR+ SD-OCT are faster and non-invasive methods for the screening of NVD and NVE in PDR eyes.Compared with FFA, OCTA and en face OCT can show the shape of neovascularization more clearly.FFA provides a wide-range retinal image, but it is time-consuming and invasive.WF-SS-OCTA extends the examination range of OCTA and detects neovascularization non-invasively and faster than FFA.

Relationship between posterior staphyloma and fundus structure and microcirculation in high myopia / 中华实验眼科杂志

Posterior staphyloma (PS) refers to the local abnormal bulge of the posterior wall of the eyeball, which is one of the common pathological changes in high myopia.The appearance of PS is often accompanied by changes in fundus microstructure such as sclera, choroid and Bruch membrane.The abnormality of fundus microstructure leads to the decrease of its resistance to the expansion of ocular axis, or causes the remodeling of tissue structure in the corresponding area, resulting in the change of microvascular structure, and then giving rise to abnormal blood circulation in the posterior pole.The microcirculatory changes may be followed by changes in fundus microstructure, seriously affecting the visual acuity of the affected eyes.There is still no clear conclusion on the pathogenesis of PS in the world, and there are no good preventive measures or treatment methods.This article reviewed and summarized the interaction between PS, fundus structure and microcirculation in high myopia, so as to provide a theoretical basis for exploring the pathogenesis, prevention and treatment of PS and improving the visual function of high myopia.

Efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors of gastric cardia and fundus: a multicenter study / 中华消化外科杂志

Objective:To investigate the efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors (GIST) of gastric cardia and fundus.Methods:The retrospective cohort study was conducted. The clinicopathological data of 251 patients with GIST of gastric cardia and fundus who underwent laparoscopic radical resection in 14 medical centers, including Guangdong Provincial People′s Hospital et al, from December 2007 to December 2021 were collected. There were 123 males and 128 females, aged 58(24,87)years. Observation indicators: (1) treatment; (2) clinicopathological data of patients undergoing different laparoscopic surgeries; (3) subgroup analysis for special laparoscopic techniques. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test or ANOVA. Measure-ment data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test or Kruskal-Wallis H test. Count data were described as absolute numbers or percentages. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Treatment. Of the 251 patients,202 cases underwent gastric wedge resection, 26 cases underwent special laparoscopic techniques including 10 cases with serotomy and dissection and 16 cases with transluminal gastrectomy, 23 cases underwent structural gastrectomy including 6 cases with total gastrectomy and 17 cases with proximal partial gastrectomy. There were 24 patients had postoperative complications after surgery. (2) Clinicopathological data of patients undergoing different laparoscopic surgeries. The gender (male, female), age, tumor diameter, operation time, volume of intraoperative blood loss, length of incision, time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, duration of postoperative hospital stay, cases with perioperative complications, cases with mitotic count as ≤5/50 high power field, 6?10/50 high power field, >10/50 high power field, cases be classified as very low risk, low risk, medium risk, high risk according to the National Institutes of Health risk classification, cases with tumor located at fundus and gastric cardia were 93, 109, (59±11)years, 3.50(0.40,10.00)cm, 88.00(25.00,290.00)minutes,20.00(25.00,290.00)mL, 4.00(2.00,12.00)cm, 3.00(1.00,9.00)days, 4.00(1.00,16.00)days, 5.00(1.00,18.00)days, 14, 164, 31, 7, 47, 83, 50, 22, 30, 172 in patients undergoing gastric wedge resection, respectively. The above indicators were 19, 7, (49±14)years, 2.55(0.20,5.00)cm, 101.00(59.00,330.00)minutes, 27.50(2.00,300.00)mL, 4.50(0,6.00)cm, 2.50(1.00,10.00)days, 4.00(1.00,16.00)days, 6.00(1.00,18.00)days, 3, 20, 5, 1, 15, 5, 2, 4, 24, 2 in patients undergoing special laparos-copic techniques, and 11, 12, (52±10)years, 5.00(0.80,10.00)cm, 187.00(80.00,325.00)minutes, 50.00(10.00,300.00)mL, 6.00(4.00,12.00)cm, 4.00(2.00,8.00)days, 6.00(3.00,14.00)days, 8.00(2.00,18.00)days, 7, 11, 5, 7, 2, 6, 6, 9, 13, 10 in patients undergoing structural gastrectomy. There were significant differences in the above indicators among the three groups of patients ( χ2=6.75, F=10.19, H=17.71, 37.50, 35.54, 24.68, 16.09,20.20, 13.76, χ2=13.32, Z=28.98, 32.17, χ2=82.14, P<0.05). (3) Subgroup analysis for special laparoscopic techniques. The time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, classification of tumor location (endophytic type, exophytic type, parietal type) were 4.50(1.00,10.00)days, 8.00(3.00,12.00)days, 0, 8, 2 in patients undergoing serotomy and dissection, versus 2.00(1.00,4.00)days, 3.00(1.00,6.00)days, 16, 0, 0 in patients undergoing transluminal gastrectomy. There were significant differences in time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake between them ( Z=-2.65, -3.16, P<0.05); and there was a significant difference in classification of tumor location between them ( P<0.05). Conclusions:Gastric wedge resection is the most commonly used laparoscopic technique for GIST of gastric cardia and fundus. The application of special laparoscopic techniques is focused on the GIST of cardia to preserve the function of the cardia.

Progress in imaging and functional assessment of myopic fundus tessellation changes / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia has become a serious global burden of visual impairment and blindness, and the World Health Organization has included the prevention and treatment of myopia in its global blindness prevention program. Many ocular pathological alterations that follow from advanced myopia could cause visual impairment and even blindness in severe situations. Myopia is becoming more prevalent and has a greater impact on young people. Myopia's social repercussions are becoming more widely known. One of the several fundus alterations linked to myopia is tessellated fundus, which is the earliest lesion in the natural course of myopic fundus lesions and an important clinical marker for the development of retinopathy. Currently, there are several different methods of grading fundus tessellation, all of which are graded subjectively by fundus color photography. One can investigate the morphological characteristics and functional status of the tessellated fundus with ophthalmoscope, fundus photography, optical coherence tomography, electroretinogram, microperimetry and other modal images. In this study, the imaging properties and common applications of the tessellated fundus are reviewed to provide appropriate resources for clinical ophthalmology.

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.

Clinical features of fundus lesions of 74 patients with acquired immunodeficiency syndrome in Shenyang / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical features and factors of fundus lesions in patients with acquired immunodeficiency syndrome(AIDS)in Shenyang and the relationship between fundus lesions and CD4+T cell count.METHODS: Retrospective case study. A total of 74 cases with AIDS who were treated in the Central Hospital of Liaoning Electric Power Supply Co., Ltd., from January 2021 to December 2021 were selected. The fundus manifestation and CD4+T cell count of the patients were analyzed.RESULTS: The total detection rate of fundus lesions in AIDS patients was 58%. CD4+T cell count in the patients with fundus lesions was significantly lower than that in the patients with normal fundus [29(6, 55)/μL vs. 76(35, 103)/μL, P<0.01]. The rate of fundus lesions was the highest in the patients with CD4+T cell count ≤ 50/μL(74%). Logistic regression analysis showed that as the CD4+T cell count increased, the incidence of fundus lesions decreased(OR=0.977, 95%CI 0.964～0.991, P<0.01).CONCLUSION: Fundus lesions in AIDS patients related to CD4+T cell count. Decreasing CD4+T cell count was a risk factor of fundus lesions for AIDS patients. Routine fundus examination is important for the early diagnosis of fundus lesions in AIDS patients.