ObjectiveTo analyze the prognostic factors of vision of myelin oligodendrocyte glycoprotein (MOG) antibody positive associated optic neuritis (ON) after methylprednisolone pulse therapy. MethodsA clinical observational study. A total of 32 patients (47 eyes) with MOG antibody positive ON were observed and followed up in the ophthalmology department of Beijing Tongren Hospital Affiliated to Capital Medical University and Beijing Puren Hospital from March 2019 to January 2022. Clinical data including the best corrected visual acuity (BCVA) and orbital magnetic resonance imaging were recorded. The BCVA was examined by Snellen visual acuity chart, which was finally converted into the logarithm of the minimal angle of resolution (logMAR) for statistical analysis. There were 22 case (38 eyes) with complete image data. All patients were treated with intravenous methylprednisolone pulse (IVMP) for 3-5 days. According to the intervention time (from onset to glucocorticoid treatment), the patients were divided into three groups: ＜7 d group, 7-14 d and ＞14 d group, with 16, 13, 11 eyes, respectively. The median follow-up time was 28 months. After 1 week, 1, 3 and 6 months treatment, the same equipment and methods were used for relevant examinations to observe the changes of visual acuity and the factors influencing the prognosis of visual acuity after IVMP treatment. Logistic regression and linear regression were used to analyze the prognostic correlation factors. Receiver operating characteristic (ROC) curve was used to determine the critical cut-off point of intervention timing. ResultsAmong the patients, 16 were male and 16 were female. The median onset age was 26 years. The onset duration time was 5-60 days. There were 18 cases (56.3%, 18/32) with abnormal serum immune indexes. The initial symptom was decreased vision with unilateral or bilateral ON. Seventeen (53.1%, 17/32) cases had unilateral ON and 15 (46.9%, 15/32) cases with bilateral ON. Thirty-six eyes (76.6%, 36/47) got optic disc edema, 37 eyes (78.7%, 37/47) accompanied by pain of ocular movement. The nadir logMAR BCVA was mean 1.69±0.13. Long T2WI signals with segmental thickening in the orbital segment of the optic nerve were obtained in 27 eyes (71.1%, 27/38) and in 24 eyes (63.2%, 24/38) with optic nerve and sheath enhancement. During the follow-up period, there were 10 cases of relapse (31.3%, 10/32). The logMAR BCVA of attacked eyes were 0.52±0.09, 0.22±0.06, 0.12±0.06, 0.10±0.06 at 1 week and 1, 3 and 6 months after IVMP treatment, respectively. The rate of BCVA improvement was the fastest at 1 week after treatment, and BCVA returned to stability at 3 months. Logistic regression analysis showed that the timing of intervention was significantly correlated with the prognosis of vision in primary onset patients (odds ratio=12.17, P=0.006), with a negative linear regression relationship (r=－0.48, 95% confidence interval －0.71-－0.17, P=0.008). Comparing the logMAR BCVA between the intervention time ＞14 group with the ＜7 group and the 7-14 group, there were statistically significant difference (P=0.017, 0.037), respectively. The cut-off point of ROC curve to predict the optimal intervention time was 13.5 days. Other factors such as: gender, age, predisposing factor, pain of eye motion, edema of optic disc, bilateral ON, imaging changes, abnormal autoimmune indicators were not associated with the prognosis of visual acuity. ConclusionThe timing of hormone intervention in primary onset patients is an important factor affecting the prognosis of vision and the optimal intervention time window of IVMP is two weeks.
ObjectiveTo investigate the factors correlated with the visual outcome of idiopathic macular holes (IMH) after vitreoretinal surgery. MethodsA total of 57 eyes of 57 patients with IMH were included. There were 43 females (43 eyes) and 14 male (14 eyes), mean age was (60.46±4.79) years. All the eyes underwent best corrected visual acuity (BCVA), slit-lamp microscope, three-mirror contact-lens and optical coherence tomography (OCT) examinations. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution (logMAR) acuity. The minimum diameter and base diameter of macular holes and central retinal thickness (CRT) were detected by OCT. The average logMAR BCVA of 57 eyes was 0.98±0.41. The minimum diameter and base diameter of macular holes were (479.53±164.16) μm and (909.14±278.65) μm. All the patients underwent pars plana vitrectomy combined with phacoemulsification cataract extraction and intraocular lens implantation. The mean follow-up period was (173.44±147.46) months. The relationships between final BCVA and these parameters were examined by single and multiple regression analysis. The valuable influence factors were filtrated and formulated using multiple linear regression models. ResultsAt the final follow-up, the logMAR BCVA of 57 eyes was 0.44±0.31, the CRT was (158.79±86.96) μm. The final BCVA was positive related to minimum diameter of macular holes and preoperative BCVA (r=0.420, 0.448; P=0.001, 0.000), negative related to postoperative CRT (r=-0.371, P=0.004). There was no relationship between the final BCVA and base diameter of macular holes, age and follow-up (r=0.203, -0.015, 0.000; P=0.130, 0.913, 0.999). The incidence of preoperative BCVA for postoperative BCVA was bigger than preoperative minimum diameter of macular holes (P=0.008, 0.020). ConclusionThe preoperative minimum diameter of macular holes and BCVA are related to postoperative BCVA in IMH eyes.
ObjectiveTo analyze the status and influencing factors of awareness of diabetic retinopathy (DR) knowledge in diabetics in Funing County, Jiangsu Province. MethodsThis is a cross-sectional study. In 2021, a total of 2 125 residents with diabetes in Funing County, Jiangsu Province were recruited using cluster random sampling methods. General examinations were performed and ophthalmological evaluation were conducted including visual acuity in daily life, slit lamp microscope with preset lens, digital non-mydriatic fundus photography. Clinical assessment and classification of DR were according to the international standard clinical classifications of diabetic retinopathy in 2019. DR was classified into no obvious DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). Field questionnaire surveys were conducted to show the awareness rate of DR knowledge. Then Chi-square test and Logistic regression analysis were used to investigate influencing factors. ResultsAmong 2 125 subjects, 762 (35.86%, 762/2 125) residents were male and 1 363 (64.14%, 1 363/2 125) residents were female. A total of 444 (20.89%, 444/2 125) subjects were diagnosed as DR. Among which, 438 (20.61%, 438/2 125) subjects were NPDR, 6 (0.28%, 6/2 125) subjects were PDR. A total of 419 (19.72%, 419/2 125) subjects were diagnosed as cataract. The topic awareness rates were all below 45.00%. The overall population awareness rate was 19.45% (4 959/25 500). Awareness rate was correlated with age, visual acuity in daily life, education level, family history of diabetes, diabetic retinopathy grades and the type of treatment for diabetes (P＜0.001). Logistic regression analysis showed that the knowledge rate of prevention and treatment of DR Decreased significantly in patients aged 60-79 compared with those aged under 50 (P＜0.05). Compared with those with visual acuity＜0.1 in daily life, the knowledge rate of DR prevention and treatment in those with visual acuity≥0.1 was significantly decreased (P＜0.05). While primary school to college education, with family history of diabetes, with DR, oral hypoglycemic agents and/or insulin treatment were associated with higher awareness rate (P＜0.05). ConclusionsThe DR knowledge level is low among diabetics in Funing County, Jiangsu Province in 2021. Age, visual acuity in daily life, education level, family history of diabetes, with DR and receiving drug treatments are main influencing factors for diabetic’s awareness.
Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P＜0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=−5.413, P＜0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.
ObjectiveTo investigate the related factors of the retina1 hemorrhage in newborns. Methods9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCamⅢat 0-4 days after born. According to the literature, retinal hemorrhage was classified into degreeⅠ, ⅡandⅢ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intracranial hemorrhage, maternal age, first-time mom, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy-induced hypertension, gestational diabetes, oxytocin, prenatal body mass index (BMI). Multivariate logistic regression analysis was used. ResultsIn 9558 cases of newborns, retinal hemorrhages were found in 2753 infants (28.8%), including 1137 degreeⅠ(41.3%), 895 degreeⅡ(32.5%) and 721 degreeⅢ(26.2%). Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage (r=0.146, 5.841, 1.847, 0.071, 0.246, 0.965;P < 0.05). The degree of fundus hemorrhage was not related to birth weight and BMI (P > 0.05). ConclusionsThe neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.
ObjectiveTo observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).MethodsRetrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.ResultsOf the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ2=5.741, 8.103; P＜0.05). There was no significant difference in age (t=－1.364), duration of diabetes (t=0.538), preoperative vision (t=1.897), preoperative fasting blood glucose level (t=1.938), preoperative postprandial blood glucose level (t=1.508), preoperative systolic blood pressure (t=－0.571), preoperative diastolic blood pressure (t=0.275), whether received laser treatment (χ2=2.678), the number of laser points during operation (t=0.565), whether received lens removal during operation (χ2=0.331), whether found new blood vessels during operation (χ2=2.741) and whether received intraocular filling during operation (χ2=0.060) between the patients with and without PVH (P＞0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (rs=0.208, 0.229, 0.240, 0.285; P＜0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P＜0.05).ConclusionFundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.
ObjectiveTo analyze the clinical features and prognosis factors of aquaporin 4 (AQP4) antibody-positive neuromyelitis optica spectrum disorders related optic neuritis (NMOSD-ON). MethodsAn ambidirectional cohort study. From June 1, 2015 to June 1, 2019, 103 patients with AQP4 antibody-positive NMOSD-ON in Department of Neuro-ophthalmology, The First Medical Center of PLA General Hospital were included. All patients of followed-up period were ≥24 months. According to the best corrected visual acuity (BCVA) at the last follow-up, the affected eyes were divided into the low vision group [log of minimum resolution angle (logMAR) BCVA≥1.0] and the non-low vision group (logMAR BCVA＜1.0), 66 and 37 cases, respectively. The two groups of patients were compared the genernal clinical characteristics, and the logistic regression model and COX proportional hazard model were used to analyze the relevant factors affecting the patient's visual prognosis and recurrence. ResultsAmong the 103 cases, 96 cases (93.2%, 96/103) were female; 94 cases (91.3%, 94/103) had unilateral disease; 48 cases (46.6%, 48/103) were the first onset; 85 cases (82.5%, 85/103) were effected by eye pain or orbital pain; 21 cases (20.4%, 21/103) had optic disc edema; 51 cases (49.5%, 51/103) serologically autoimmune antibody test were positive. Orbital magnetic resonance imaging (MRI) was performed in 101 cases. There was no obvious abnormal signal in visual pathways except for 5 cases (5.0%, 5/101); 96 cases (95.0%, 96/101) had abnormal signal in the visual path, and the optic nerve was found in the orbit; 52 cases had abnormal optic nerve in orbital segment (51.5%, 52/101); 37 cases (35.9%, 37/103) recurred within 24 months. The recovery of logMAR BCVA after the first onset and the logMAR BCVA at the first onset, at 6 months of follow-up in two groups were 1.4±1.0, 0.3±0.4, 1.9±0.7 and 0.4±0.5, 2.1±0.6, 0.3±0.4, respectively; and there were statistically significant differences between the two groups of patients at different times（Z=－4.967,－7.603,－8.027; P＜0.001). Logistic regression multivariate analysis showed that recovery of BCVA≥1.0 logMAR after the first onset [odds ratio (OR)=226.276, P＜0.001] and the number of attacks (OR=8.554, P=0.003) were independent risk factors for low vision. Multivariate analysis of the Cox proportional hazards model showed the higher the MRI score [hazard ratio (HR)=0.588, P=0.007] and plasma exchange (HR=0.124, P=0.049) in the acute phase were protective factors for recurrence. ConclusionsVision loss accompanied by eye pain or orbital pain is the main symptom of onset AQP4 antibody-positive NMOSD-ON, a small number of patients have disc edema, 49.5% patients serologically autoimmune antibody test are positive. Abnormal optic nerve signals can be seen in 95.0% of patients in orbital MRI, and 51.5% patients have abnormalities in the orbital optic nerve. The worse the recovery of BCVA after the first onset and the greater the number of attacks are unfavorable factors affecting the prognosis of vision. High MRI scores and plasma exchange in the acute phase are favorable factors to prevent the recurrence of the disease.
ObjectiveTo observe and preliminary investigate the influencing factors of exudative retinal detachment in patients with severe preeclampsia (S-PE) and its influence on pregnancy outcome.MethodsA total of 89 patients of S-PE patients diagnosed in Department of Obstetrics in The Third Central Hospital of Tianjin from July 2018 to June 2020 were included in this study. According to whether the patients were complicated with exudative retinal detachment, they were divided into retinal detachment group (43 cases) and non retinal detachment group (46 cases). All patients underwent direct ophthalmoscopy, and those with suspected or definite retinal detachment underwent optical coherence tomography or B-mode ultrasonography. The age, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, laboratory serum albumin level, 24 h urinary protein, platelet count, mean platelet volume, platelet distribution width and serum uric acid content were collected. The average age (t=−1.01), body mass index (t=−1.799), course of disease (t=−1.657) and constituent ratio of primipara and multipara in the two groups were compared (χ2=1.411), the difference was not statistically significant (P＞0.05). The end of pregnancy time, systemic complications, fetal outcomes and neonatal Apgar scores were analyzed, retrospectively. Independent sample t test was used to compare the quantitative data between the two groups; Chi square test was used to compare qualitative data. Binary logistic regression analysis to screen the influencing factors of exudative retinal detachment in S-PE.ResultsSystolic blood pressure and diastolic blood pressure were higher in the retinal detachment group than in the non retinal detachment group, and the difference was statistically significant (t=2.087, 2.810; P=0.040, 0.006). Serum albumin (t=−10.404), 24-hour urinary protein quantification (t=6.401), blood uric acid (t=3.910), platelet count (t=−6.124) and platelet distribution width (t=2.992) were compared between the two groups, and the differences were statistically significant (P＜0.05). There were 30 (69.77%, 30/43) cases in retinal detachment group and 14 (30.43%, 14/46) cases in non retinal detachment group with severe systemic complications; The average time of ending pregnancy was 34.66±3.29 and 38.25±1.62 weeks; The average Apgar scores at birth were 7.28±3.40 and 9.46±1.59. The incidence of severe systemic complications in two groups (χ2=13.755), the end of pregnancy time (t=−6.448), Apgar score at birth (t=−3.824), the differences were statistically significant (P=0.000、0.000、0.000). Fetal distress and death were 8 (18.60%, 8/43), 7 (16.28%, 7/43) and 7 (15.22%, 7/46), 1 (2.17%, 1/46) in retinal detachment group and non retinal detachment group respectively. There was no significant difference in the incidence of fetal distress between the two groups (χ2=0.182, P=0.670). The difference of fetal mortality was statistically significant (P= 0.027). Logistic regression analysis showed that serum albumin and uric acid were associated with exudative retinal detachment in patients with S-PE (P＜0.05).ConclusionsSerum albumin and uric acid are the influencing factors of exudative retinal detachment in patients with S-PE. Patients with exudative retinal detachment are prone to adverse pregnancy outcomes.
Objective To investigate the prevalence and related factors of diabetic retinopathy (DR) among residents with type 2 diabetes mellitus (T2DM) in Culai Town of Tai'an City in Shandong Province. Methods According to the DM management file database for community, 785 patients with T2DM were randomly selected by cluster sampling method. The questionnaires, routine general examinations, visual and fundus-free fluoroscopy were performed on all the patients. DR diagnosis and classification was according to the guidelines for clinical diagnosis and treatment of DR in China (2014). Both monocular and binocular DR were selected as DR patients, and the worse eye for binocular DR were treated as the DR classification of the patient. The patients were grouped by presence or absence of DR. GraphPad Prism 6, SigmaPlot 12.5, SPSS 20.0 and Excel were used to achieve data analysis. Also, SPSS 20.0 was used for multi-factor logistic regression analysis. Results A total of 699 patients (89.04%) were actually recorded. There were 122 eyes of 63 patients (9.01%) with DR (DR group), 1272 eyes of 636 patients (90.99%) without DR (NDR group). Among the 122 eyes of DR, there were 19 (15.57%), 17 (13.93%), 70 (57.38%), 10 (8.20%), 6 (4.92%) eyes in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, respectively. The differences of mean age (t=15 290, P=0.002), DM duration (t=9075, P＜0.000) and diastolic blood pressure (t=15 810, P=0.006) between the two groups were statistically significant. There were 23 (36.51%) and 394 (61.95%) patients with hypertension history in the DR group and the NDR group, with the significant difference ( χ2=15.42, OR=0.35, 95%CI 0.21-0.60). There were 57 (90.48%) and 500 (78.62%) patients with fasting blood glucose larger than 6.11 mmol/L in the DR group and the NDR group, with the significant difference (OR=2.51, 95%CI 1.06-5.95, P=0.031). Logistic regression analysis showed that the age, fasting blood glucose and DM duration were influencing factors for DR (OR=1.039, 0.864, 0.898; P=0.021, ＜0.000, ＜0.000). Conclusion The prevalence of DR in patients with T2DM in Culai Town of Tai'an City is 9.01%. Age, DM duration, fasting blood glucose are associated to DR. Those with a history of hypertension may have a lower risk of DR than those without a history of hypertension.
ObjectiveIn order to provide guidance for early interference of diabetic retinopathy (DR) in patients with diabetes mellitus (DM), we surveyed the prevalence and analysis the related factors of DR in Shanghai Songnan community. MethodsBased on an established resident health database, an epidemiology study was performed on the residents with DM in Shanghai Songnan community.1177 patients completed questionnaire survey, and received physical examination and laboratory tests. The diagnosis and grading of DR were established based on the ocular fundus images acquired by digital non-mydriasis fundus camera. Patients with incomplete questionnaires were excluded. ResultsThere were 1120 DM patients with valid questionnaires. DR was found in 264 (23.57%) patients. The prevalence of mild, moderate, severe non-proliferative DR and proliferative DR was 17.05%, 5.09%, 1.16% and 0.27% respectively. There was significant differences in age, disease course, systolic blood pressure, insulin usage between the DR group and NDR group(t=-2.647, 2.688, 2.204, 2.291;χ2=12.527;P=0.008, 0.007, 0.028, 0.022, 0.000). There was significant differences in fasting blood-glucose and insulin usage between the mild, the moderate and the severe DR group(t=21.964, χ2=14.996;P=0.000, 0.001). Stepwise logistic analysis identified that age, DM course, and insulin usage were the related factors of DR (OR=0.769, 1.239, 1.100, 1.071, 1.682;P=0.001, 0.043, 0.176, 0.097, 0.005). ConclusionThe age, DM course, and insulin usage were the related factors of DR. The high prevalence of DR indicated the importance of the management of diabetic patients.