Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle

●AIM:To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment(RRD)using a novel foldable capsular buckle(FCB).●METHODS:This was a series of case observation studies.Eighteen patients(18 eyes)who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included.The procedure was similar to conventional scleral buckling,while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad,external indentation instead of the silicone buckle.The retinal reattachment rate,best corrected visual acuity(BCVA),intraocular pressure(IOP),refractive dioptre and astigmatism degree,and complications were evaluated and recorded.●RESULTS:There were 7 males and 11 females aged 19-58y.The average time course of RRD was 12d,ranging from 7-20d.The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes,with macula-off detachments in 12 eyes.The patients were followed-up for at least 6mo.The final retinal reattachment rate was 100%.The BCVA was significantly improved compared with the baseline(P<0.05).There was no significant change in refractive dioptre or astigmatism degree at each follow-up(all P>0.05).Three patients had transiently high IOPs within one week after surgery.Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed.●CONCLUSION:The success rate of FCB scleral buckling for RRD is satisfactory.This procedure can be expected to be applied in new,uncomplicated cases of RRD.

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

AIM:To assess the effect of age at diabetes onset and uncontrollable high Hb A1 c levels on the development of diabetic retinopathy(DR)among Chinese type 2 diabetes mellitus(DM)patients.METHODS:This was a cross-sectional survey of diabetic patients in Subei district,China.Data covering physical measurements,fasting blood-glucose(FBG),glycosylated hemoglobin(Hb A1 c),blood lipid,urinary albumin/creatinine ratio(UACR),ocular fundus examination,and diabetes treatment records were collected.An independent sample t-test were used to analyze differences.A Logistic regression analysis was applied to study the independent risk factors of DR.RESULTS:A total of 1282 patients with type 2 DM were enrolled,and 191 cases had DR(14.9%).The age at diabetes onset,education level,alcohol consumption,Hb A1 c level,UACR level,and hypoglycemic drugs were independent influencing factors for DR.The older the onset of diabetes,the less likely to develop DR(OR:0.958,95%CI:0.942-0.975,P=0.000).Patients were then divided in terms of age at diabetes onset as follows:<50 y,50-59 y,60-69 y,and≥70 y.Compared with diabetes onset age<50 y,50-59 y(OR:0.463,95%CI:0.306-0.699,P=0.000),60-69 y(OR:0.329,95%CI:0.203-0.535,P=0.000)and≥70 y(OR:0.232,95%CI:0.094-0.577,P=0.002)were at a lower risk of DR.The prevalence of DR was highest in patients with diabetes onset age<50 y(29.5%,P<0.05).The Hb A1 c level(8.67±1.97)%and proportion of insulin injection(52.5%)in patients with diabetes onset<40 y were higher than in patients with older diabetes onset age(P<0.05).CONCLUSION:Diabetes onset at an earlier age and uncontrollable high Hb A1 c level could be independent risk factors for DR.

Safety profile of 0.0015%tafluprost eye drops in China:a post-marketing observational study

AIM:To investigate the treatment pattern and safety of tafluprost for glaucoma and ocular hypertension(OH)in clinical practice in China.METHODS:This post-marketing observational study included patients who received tafluprost to lower intraocular pressure(IOP)within 30d between September 2017 and March 2020 in 20 hospitals in China.Adverse drug reactions(ADRs)during tafluprost treatment and within 30d after the treatment were collected.RESULTS:A total of 2544 patients were included in this study,of them 58.5%(1488/2544)had primary open angle glaucoma(POAG),21.9%(556/2544)had OH and 19.7%(500/2544)used tafluprost for other reasons.Of 359 ADRs occurred in 10.1%(258/2544)patients,and no serious adverse event occurred.The most common ADR was conjunctival hyperemia(128 ADRs in 124 patients,4.9%).Totally 1670 participants(65.6%)combined tafluprost with carbonic anhydrase inhibitors(CAIs;37.1%,620/1670),sympathomimetics(33.5%,559/1670),β-blockers(33.2%,555/1670),other prostaglandin analogs(PGAs;15.6%,260/1670)and other eye drops(15.1%,253/1670).The highest incidence of conjunctival hyperemia was noted in patients who received tafluprost in combination with other PGAs(23 ADRs in 23 patients,8.8%,23/260)and the lowest was in combination with CAIs(16 ADRs in 16 patients,2.6%,16/620).Tafluprost was applied in primary angle-closure glaucoma(41.6%,208/500),after glaucoma surgery(17.8%,89/500)and after non-glaucoma surgery(15.8%,79/500).CONCLUSION:Tafluprost is safe for POAG and OH,and tolerable when combined with other eye drops and under various clinical circumstances.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

PDR行玻璃体手术前注射雷珠单抗或曲安奈德后玻璃体腔内细胞因子的变化

目的:比较增生型糖尿病视网膜病变(PDR)行玻璃体切割术前用雷珠单抗或曲安奈德玻璃体腔内注射前后玻璃体腔内细胞因子的变化。方法:前瞻性研究。将2015-05/2017-02我院收治的PDR患者88例112眼纳入研究。依照随机方法分为行玻璃体切割术前玻璃体腔注射0.5mg/0.05mL雷珠单抗组(43例57眼)、行玻璃体切割术前玻璃体腔注射4mg/0.1mL曲安奈德组(45例55眼),两组患者分别在玻璃体腔注射药物前抽取0.5mL玻璃体液后于玻璃体腔内注射雷珠单抗或曲安奈德。注药后7d行玻璃体切割术术前再次抽取玻璃体液0.5mL。采用双抗酶联免疫吸附试验(ELISA)测定玻璃体液的胎盘生长因子(PIGF)。用Luminex200液相芯片分析系统检测单核细胞趋化蛋白1(MCP-1)、单核细胞趋化蛋白3(MCP-3)、白介素-6(IL-6)、白介素-8(IL-8)、血小板源性生长因子-AB/BB(PDGF-AB/BB)和血管内皮生长因子-A(VEGF-A)浓度。结果:雷珠单抗组玻璃体腔内PIGF与VEGF-A水平注射后较注射前均明显降低,而IL-6、IL-8水平增高(PIGF:65.36±15.16 vs 19.42±6.34pg/mL;VEGF-A:315.16±14.34 vs 21.32±2.54pg/mL,IL-6:37.32±4.04 vs 52.42±5.32pg/mL;IL-8:111.723±21.32 vs 198.73±19.03pg/mL,P<0.001)。而MCP-1、MCP-3及PDGF-AB/BB的水平无明显变化(P>0.05)。曲安奈德组玻璃体腔内PIGF水平显著增加(74.28±17.34 vs 136.12±15.34pg/mL,P<0.05)。而MCP-1水平明显减少(2789.32±143.54 vs 2038.21±105.34pg/mL,P<0.05)。MCP-3、IL-6、IL-8、PDGF-AB/BB、VEGF-A表达均无明显改变(P>0.05)。两组患者治疗后进行对比,雷珠单抗注射后玻璃体中PIGF、VEGF-A含量明显低于曲安奈德注射后含量(P<0.01),IL-8、MCP-1水平则显著增加(P<0.05)。此外,雷珠单抗组术中出血情况明显低于曲安奈德组(P<0.05)。结论:玻璃体腔注射雷珠单抗能显著降低PIGF、VEGF-A表达,同时促进IL-6、IL-8水平增加;而玻璃体腔内注射曲安奈德能减少MCP-1表达,促进PIGF水平增加。

徐州市中小学生近视筛查与矫正情况分析

目的:了解江苏省徐州市6~18岁中小学生近视筛查与矫正情况。方法:横断面随机整群抽样研究,于2020-09/12以学校为单位抽取徐州市70所中小学校进行近视筛查。参与抽样63488人,剔除不合格记录后,最终纳入6~18岁中小学生58149人,并分析其不同年龄、性别、地区、近视程度下的近视及矫正情况。结果:徐州市6~18岁中小学生筛查性近视率为49.26%,近视患病率随年龄增长呈增加的趋势(P<0.01),近视程度随年龄增加逐渐加深,女生近视患病率高于男生(53.70%vs 45.67%,P<0.01),城市中小学生近视患病率高于乡镇(55.40%vs 45.10%,P<0.01)。框架眼镜矫正率为31.11%,足矫率为60.23%,同时矫正率随着年龄的增长逐渐增高(P<0.01),女生矫正率高于男生(32.45%vs 29.84%,P<0.01),但女生足矫率却低于男生(56.60%vs 63.98%,P<0.01)。城市中小学生矫正率和足矫率均高于乡镇(46.50%vs 18.33%,62.20%vs 56.07%,P<0.01)。结论:徐州市2020年中小学生筛查性近视率不容乐观,中小学生近视矫正率及矫正合格率较低,推测是近视进展的原因之一。

康柏西普联合25G玻璃体手术及小梁切除术治疗继发于PDR伴VH的NVG

目的:比较不同围手术时期给予玻璃体腔内注射康柏西普联合25G微创玻璃体手术(PPV)及小梁切除术治疗继发于增生型糖尿病视网膜病变(PDR)伴玻璃体积血(VH)的新生血管性青光眼(NVG)的手术效果及并发症。方法:前瞻性随机对照临床试验。纳入2016-11/2019-04在我院确诊的PDR伴VH的Ⅲ期NVG患者28例30眼。所有患者均接受25G PPV联合小梁切除术。将其随机分为两组:第1组12例14眼患者于术前3d玻璃体腔内注射康柏西普,第2组16例16眼于25G玻璃体手术及小梁切除术毕玻璃体腔内注射康柏西普(IVC)0.5mg/0.05mL。比较两组患者手术时间、术中出血及术后并发症的发生率。观察术后疼痛缓解、虹膜新生血管(INV)消退和最佳矫正视力(BCVA)以及眼压(IOP)控制率情况。结果:第1、2组均完成手术并分别随访12.40±2.21mo和12.23±2.11mo(P>0.05)。第1组术中出血和术后早期前房出血发生率(29%、14%)低于第2组(75%、56%,均P<0.05)。两组患者手术时间、浅前房、脉络膜脱离、玻璃体再出血的发生率无差异(P>0.05)。术后3d所有患者疼痛缓解。第1组IVC后3d(即手术日)93%的INV完全消退,第2组PPV术后7d 94%INV完全消退。末次随访两组患者各有1眼残余少许萎缩的INV。术后1wk,1、3、6mo IOP控制率,第1组依次为93%、79%、64%、57%,第2组依次为94%、75%、50%、44%,两组患者各时间段比较无差异(P>0.05)。两组术后不同时间点IOP与术前相比均明显降低(P<0.05)。末次随访时第1、2组IOP分别为20.45±10.55和22.63±7.24mmHg,与术前42.21±9.11和44.88±11.83mmHg相比明显降低(P<0.05)。两组术后不同随访时间点BCVA与术前相比无差异(P>0.05)。结论:术前IVC预处理与术毕IVC联合25G PPV及小梁切除术治疗继发于PDR伴VH的NVG相比,术中出血和术后早期前房出血的发生率较低。两种方法IOP控制率相当,虽然随着时间逐渐减低,但是经过及时处理最终可以获得较好的疗效。

低中度近视儿童中心凹脉络膜厚度相关因素分析

目的:探讨影响低中度近视儿童中心凹脉络膜厚度(SFCT)的相关因素。方法:横断面研究。选择2020-10/12在徐州医科大学附属徐州市立医院眼科就诊的6~12岁近视儿童,按睫状肌麻痹验光所得等效球镜度(SER)纳入-0.75~-3.00D的低度近视患者60例60眼,-3.25~-6.00D的中度近视患者50例50眼,测量其SFCT、中心凹视网膜厚度(SFRT)、眼轴长度(AL)、眼调节参数,调查其年龄、性别、身高、体质量、父母近视情况,分析SFCT与各参数的关系。结果:低、中度近视组SFCT分别为273.30±44.93、237.16±48.56μm(P<0.01),Pearson相关分析得出SFCT与SER、AL、身高均有相关性(r=0.35、-0.45、-0.19,均P<0.05),与其他因素均无相关性(均P>0.05),多重线性回归显示SFCT随着AL的增长而变薄(B=-19.87,P<0.01)。结论:低中度近视儿童SFCT与SER、AL、身高均有关,其中AL是影响SFCT的最主要因素,与其他因素关系不明显。