ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 (10.0, 15.0) years and a median weight of 41.9 (30.5, 55.4) kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 (13.0, 29.0) years, and the median weight was 50.5 (47.3, 75.0) kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 (262.0, 395.5) min, the median aortic cross-clamping time was 45.0 (38.3, 51.3) min, the median mechanical ventilation time was 22.5 (16.8, 52.5) h, the median postoperative hospital stay was 29.5 (20.0, 43.0) d, and the median intensive care unit stay was 6.0 (5.0, 8.3) d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.
ObjectiveTo analyze the subfoveal choroidal thickness in retinitis pigmentosa (RP) patients and to evaluate the correlation between the subfoveal choroidal thickness (SCT) and visual function. MethodsTotally 42 RP patients (84 eyes) and 49 age and diopter-matched normal controls (98 eyes) were enrolled in this study. All the patients were taken the enhanced depth imaging technique of optical coherence tomography (EDI-OCT) examination for the measurement of the SCT. The covariate analysis was used to analyze the interaction effect between age and group. Then the SCT was amended. The RP patients were examined by 30°visual field test (T32 or LVC program) and electroretinogram (ERG) test. 32 eyes examined by T32 program, 52 eyes examined by LVC program. The waveform of ERG, mean sensitivity (MS) and mean defect (MD) were recorded. The relationship of SCT, MS and MD were analyzed by Pearson correlation analysis. ResultsThe SCT of RP patients and controls were (223.12±69.59), (288.29±52.36) μm. The covariate analysis of covariance with different age group interaction was not statistically significant (F=1.619, P=0.205), as amended SCT of RP patients and controls were (217.34±6.60), (293.20±6.00) μm, respectively. The SCT was decreased in RP patients (t=7.042, P < 0.001). Among 84 eyes, bright cone response weaken in 35 eyes, scotopic rod response weaken in 31 eyes. The difference of SCT in different ERG waveform was not significant (t=-0.976, -1.584; P=0.332, 0.117). The MS and MD of 32 eyes using T32 program were (9.05±6.42), (18.84±6.30) dB, the SCT was (209.83±71.48) μm; the MS and SCT of 52 eyes using LVC program were (7.14±5.03) dB and (228.32±66.32) μm. The SCT was related to MS (r=0.494, P=0.003) and MD (r=-0.448, P=0.009) in eyes using T32 program. There was no correlation between SCT and MD in eyes using LVC program (r=-0.232, P=0.095). ConclusionsThe SCT of RP patients is thinner than that of normal controls. The SCT of RP patients is related to MS and MD of T32 program, but not correlated to ERG waveform and MS of LVC program.
Objective To evaluate the therapeutic effect of vitreo-retinal surgery on oclular siderosis. Methods The clinical data of 22 patinets (22 eyes) with ocular siderosis due to the magnetic foreign body at intraocular postsegment were retrospectively analyzed. The patients aged from 6 to 54 years (average 40 years), including 21 males and 1 femal. The duration of the magnetic foreign body remained in the eye lasted for 1 month to 20 years. The preoperative best corrected visual acuity (BCVA) was ＜0.01 in 15 eyes, 0.01-0.15 in 5 eyes and 0.1-0.2 in 2 eyes. There was Intra-vitreous foreign body in 18 eyes and ocular wall embedded foreign body in 4 eyes; intraocular foreign body (IOFB) combined with cataract in 18 eyes; combined with retinal detachment in 3 eyes; scleral buckling combined with silicon oil filled in 12 eyes and C3F8 filled in 7 eyes. Cataract extraction was performed in 12 eyes, and 2 eyes underwent filtrating surgery. Results The IOFB was successfully removed by one-off surgery in 22 eyes. BCVA increased in 20 eyes (90.9％) and kept unchanged in 2 eyes (9.1%), including＜0.1 in 7 eyes, 0.1-0.4 in 8 eyes, and 0.5-1.0 in 7 eyes. Operative complications involved retinal holes with retinal detachment in 2 eyes and vitreous haemorrhage secondary to enlarge sclera incision in 2 eyes. Postoperative complications included secondary cataract in 4 eyes, retinal detachment due to silicon oil removal 3 months after submacular removal of foreign body in 1 eye, and retinal detachment 7 days after C3F8 filling in 1 eye; the latter two eyes had reattached retina after another silicon oil filling. At the end of the follow-up period, retina reattached in 22 eyes. Conclusion Advanced modern vireoretinal operation is effective on oclular siderosis, which can avoid the release of Fe+ and improve the patientsprime; visual function.
Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
Myopic macularpathy is the main cause of the decline of visual function in high myopia, which including tigroid fundus, lacquer cracks, diffuse retinal choroid atrophy, plaque retinal choroid atrophy, choroidal neovascularization (CNV), Fuchs spot and posterior staphyloma. The tigroid fundus is the initial myopic retinopathy. The lacquer cracks is a special lesion in the posterior pole of high myopia. When the lacquer cracksen enlarge or lacquer cracks progress to plaque retinal choroid atrophy should be paid to monitoring the occurrence of CNV. Myopic macularpathy progression include two mode. One is from tigroid fundus——lacquer cracks——plaque retinal choroid atrophy——CNV to macular atrophy. And the other is from tigroid fundus——diffuse retinal choroid atrophy——atrophy enlarge to diffuse retinal choroid atrophy with plaque retinal choroid atrophy or plaque retinal choroid atrophy occurence on the border of posterior staphyloma. Understanding the progression patterns and natural course of these lesions will help the clinic to further understand the course of high myoipa.
ObjectiveTo measure and analyze the oxygen saturation and retinal blood vessel diameter in the eyes of patients with convalescence Vogt-Koyanagi-Harada (VKH) syndrome. MethodsIn this cross-sectional study, 28 eyes of 14 patients with convalescence VKH syndrome (VKH group) and 20 eyes of 10 healthy subjects (control group) were enrolled. The oxygen saturation and retinal blood vessel diameter were detected by spectrophotometric oximetry unit. Retinal images were collected using filters with wavelengths of 570 nm and 600 nm in the darkroom by the same technologist and then the fused image was obtained. The oxygen saturation of retinal vessels was marked in different colors. The measurement was repeated 2-3 times for each patient, then take an average. A top-quality image in each eye was selected to detect the oxygen saturation and diameter of retinal vessel which located in 1.5-3.0 disc diameter from the optic disc. Image analysis and data acquisition were completed by another technologist. ResultsRetinal venous oxygen saturation was (54.34±8.05)% in the VKH group and (60.07±7.91)% in the control group. The former was lower than the latter, the difference was significant (t=2.443, P=0.017). The mean diameter of retinal arteries was (102.8±18.1) μm in the VKH group and (112.9±19.8) μm in the control group. The former was smaller than the latter, the difference was significant (t=2.406, P=0.018). There was no significant difference of the mean diameter of retinal veins, oxygen saturation of retinal arteries and the arterial-venous difference between two groups (t=-0.330, 0.804, -0.631; P=0.743, 0.403, 0.536). ConclusionsRetinal venous oxygen saturation and the mean diameter of retinal arteries are significantly decreased in patients with VKH syndrome. There is no significant difference of diameter of retinal veins, oxygen saturation of retinal arteries and the arterial-venous difference between VKH syndrome patients and healthy subjects.
ObjectiveThe aim of this study is to observe the clinical characteristics and surgical effects of macular hole retinal detachment in high myopia patients with pars plana vitrectomy (PPV) and secondary internal limiting membrane (ILM) peeling. MethodsThis was a retrospective study. The clinical data of 15 patients (15 eyes)with macular hole retinal detachment and high myopia, who underwent primary PPV and secondary ILM peeling, were analyzed, including disease history, refraction diopter, ocular axis length, posterior scleral staphyloma, BCVA, macular reattachment and macular hole heeling. There were 3 males (3 eyes) and 12 female (12 eyes), the average age was (60.80±5.85)years. All patients were examined by best corrected visual acuity (BCVA), slit lamp microscopy with 90D pre-lens, indirect ophthalmoscopy, A scan and optical coherence tomography (OCT). After the first PPV and silicone oil tamponade, a shallow retinal detachment around the macular hole, especially around the scleral staphyloma was detected by OCT. During the 2nd surgery to remove the silicone oil, ILM peeling and C3F8 tamponade were performed. ResultsThe average refraction diopter was (-12.6±1.86) D, the average ocular axial length (29.82±0.993) mm and the average disease duration was (5.20±1.24) months. All eyes had total retinal detachment of all four quadrants, choroid detachment and macular choroidal atrophy, and type Ⅱ Curtin posterior scleral staphyloma. After the second surgery, all had retina attached by fundus examination. OCT examination indicated that macular hole closure in 7 eye, macular hole attached and retinal attached in 8 eyes. Their BCVA improved after both the first and second surgery (P=0.000), the BCVA after second surgery was better than that after first surgery (P=0.038). ConclusionsThe clinical characteristic of our series of patients were as follows: long history, with choroidal detachment and type Ⅱ Curtin posterior scleral staphyloma. All 15 eyes showed retinal attached after secondary ILM peeling. The secondary ILM peeling and C3F8 tamponade may improve the visual outcome and retinal reattachment rate.
Objective To investingate the ultrastructural changes of retinal pigment epithelium(RPE) and its permeability in spontaneously hypertensive rats(SHR)and explore the relation between these changes and hypertensive retinopathy.MethodsThe ultrastructure of RPE cells in the SHR aged five,six,seven months wasobserved with transmission electronmicroscope and compared to its normotensive control strain(WKY) with the same age.Then,lanthanum tracer procedures were carried out to investigate pathological changes of the blood-retinal barrier.Results (1)In SHR the main pathological changes involved swelling of mitochondria,enlargement of endoplasmic reticula,decrease of RPE cell infolding,and sparseness of microvilli.These degenerations were more serious in older rats with higher blood pressure.(2)The breakdown of outer blood-retinal barrier with permeation of lanthanum tracers were evident in SHR aged six or seven month,however,in WKY and five-month SHR the traces were prevented from passing by tight junctions.ConclusionThe degeneration of RPE owing to ischemia and anoxia arises in early periosd of hypertensive retinopathy.The pathological changes of ultrastructure and permeability might interact with the damage of visual cells and play a main role in the hypertensive retinopathy.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
Uveitic macular edema (UME) is a major reason of permanent visual loss. Early treatment is essential for achieving a good visual outcome, but some patients are resistant or nonresponsive to the treatment, which is called refractory UME (RUME). Intravitreous injection of glucocorticoids can improve the intraocular drug concentration and avoid systemic side effects. Immunosuppressive agents have a certain role in improving RUME by inhibiting immune cells through a variety of ways. Non-steroidal anti-inflammatory drugs, carbonic anhydrase inhibitors and new biological agents also can improve RUME outcome, but their effectiveness and safety need to be confirmed by large scale randomized clinical trials. Vitrectomy can improve RUME outcome but whether peeling of internal limiting membrane is necessary or not is still controversial. Peeling the inner limiting membrane can eliminate the potential incentive for macular edema and remove the barrier. But the process of stripping may injury the retinal neurepithelium. To eliminate edema and protect the visual function, we should analysis the causes of RUME and treat it individually.