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.
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.
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 risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ObjectiveTo analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. ResultsThe κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). ConclusionThe comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.
Objective To investigate the clinical efficacy and factors influencing treatment of pediatric noninfectious uveitis with Adalimumab (ADA). MethodsA retrospective clinical study. A total of 86 pediatric patients with non-infectious uveitis, diagnosed and treated with ADA at Department of Uveitis Specialist of Xi'an People's Hospital (Xi' an Fourth Hospital) from January 1, 2021 to December 31, 2023, were included in this study. The age of all patients was ≤16 years. Among them, 55 (63.95%, 55/86) patients received ADA combined with one immunosuppressive agent, 28 (32.56%, 28/86) patients received ADA combined with ≥2 immunosuppressive agents, and 3 (3.49%, 3/86) patients received ADA alone without any immunosuppressive agents. All patients underwent best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The thickness of the retinal nerve fiber layer (RNFL) in the macular region was measured using an OCT device. The cumulative treatment effectiveness rate at 12 months post-treatment was evaluated using the Kaplan-Meier survival analysis. Multivariate analysis was performed using the Cox proportional hazards regression model, and the optimal predictive model was selected based on the Bayesian information criterion. The association between different treatment regimens and various clinical outcomes was assessed.ResultsAmong the 86 pediatric patients, 42 were male and 44 were female, with a mean age of (10.47±3.23) years. The distribution of uveitis types was as follows: anterior uveitis in 37 cases, intermediate uveitis in 15 cases, posterior uveitis in 10 cases, and panuveitis in 24 cases. Anterior chamber cells (ACC), keratic precipitates, and synechiae were present in 66, 55, and 38 cases, respectively. The cumulative treatment effectiveness at 12 months was 85.1% [95% confidence interval (CI) 71.9-92.2], with a median time to treatment effectiveness of 3 months. Compared with baseline, after 6 months of treatment, the BCVA, RNFL thickness (Z=−6.323, −8.017), and the grading of ACC and vitreous haze (χ2= −6.917, −5.027) showed significant improvement, with statistically significant differences (P＜0.05). Multivariate analysis revealed that ACC (hazard ratio=22.31, 95%CI 2.43-204.68) and anterior uveitis (hazard ratio=3.88, 95%CI 2.03-7.42) were significantly associated with treatment effectiveness (P＜0.05). Patients with ACC had a median time to treatment effectiveness of 2 months, with a 12-month cumulative treatment effectiveness of 95.5% (95%CI 86.3-98.5). Patients with anterior uveitis had a median time to treatment effectiveness of 2 months, with a 12-month cumulative treatment effectiveness of 97.3% (95%CI 81.3-99.6). Patients without anterior uveitis had a median time to treatment effectiveness of 5 months, with a 12-month cumulative treatment effectiveness of 76.7% (95%CI 54.1-88.2). The cumulative recurrence risk at 12 months was 15.6% (95%CI 6.2-24.1). ConclusionADA is safe and effective in treating pediatric non-infectious uveitis, and ACC and anterior uveitis are associated with response rate.
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.
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 observe the clinical features and visual prognostic factors of ethambutol-induced optic neuropathy (EON).MethodsA cohort study. Twenty-four inpatients (46 eyes) identified as EON in Neuro-Ophthalmology Department of Chinese PLA General Hospital from January 2014 to December 2017 were enrolled, including 14 males (26 eyes) and 10 females (20 eyes) with a ratio of 1.4/1 male/female. The average age was 42.79±15.12 years and the average weight was 62.46±12.31 kg. The average time duration between oral administration of ethambutol and occurrence of EON was 9.94±16.49 months. The average time of ethambutol duration was 7.06±11.68 months, with an average accumulative dose of 156.7±1 779.0 g and the average daily dose of 15.07±8.95 mg/(kg·d). All patients were tested with visual acuity, fundus photos, colour vision, OCT, visual field, VEP, orbital MRI and the gene of OPA1 and mitochondrial deoxyribonucleic acid (mtDNA). All the patients accepted drug withdrawal immediately after diagnosis, and were given the treatment of systemic nerve nutrition and improvement of microcirculation for 2 weeks. The time of follow-up was more than 12 months. According to whether the visual acuity (VA) in any of eyes was over than 0.1 at the last follow-up, all the patients were divided into two groups: the bad VA group (VA less than or equal to 0.1) and the better VA group (VA over than 0.1) group. The χ2 test and Fisher's exact probabilistic method test were used to compare the counting data between groups, and the Wlincox rank sum test was used to compare the measurement data. Multiple factors of VA outcome between the patients with bad or better va were analyzed by logistic regression.ResultsThirty eyes (65.2%) had VA less than or equal to 0.1 and 5 eyes (10.9%) had VA over than 0.5 at EON onset. The VA of the rest 11 eyes (23.9%) was higher than 0.1 and lower than 0.5. At the last follow-up, 20 eyes (43.5%) had VA less than or equal to 0.1 and 9 eyes (19.6%) had VA over than 0.5, the VA of the rest 17 eyes (36.9%) was higher than 0.1 and lower than 0.5. Fundus examination revealed 7 eyes (15.3%) with optic disc edema. OCT revealed significant loss of the retinal nerve fiber layer (RNFL) in the affected eyes, mainly in the temporal RNFL of the optic disc. All patients had dyschromasia, mainly in distinguishing the color of red and green. The types of visual field defect was as following: central dark spot (52.2%), diffuse visual acuity decreased (30.4%), temporal hemianopsia (17.4%). Orbital MRI revealed that 12/24 (50.0%) patients had T2 lesions with T1 enhancement in 6/24 patients (25.0%). Genetic test showed that 4 patients (16.7%) had gene mutation. Among them, there were 2 patients with OPA1 mutation, 1 with mtDNA 14340 point mutation and 1 with the mtDNA 11778 point mutation. Thirteen patients showed better VA outcomes (over than 0.1) while 11 showed bad VA outcomes after discontinuation of ethambutol. Between the better VA group and the bad VA group, there were statistically significant differences in the daily dose of ethambutol and gene mutation (P=0.031, 0.023). The daily dose was related to visual prognosis of EON while only the daily dose of more than 18 mg/(kg·d) may lead to bad VA outcomes according to the logistic analysis (95% CI 0.007-0.736, OR=0.069, P=0.027).ConclusionsEON may have OPA1 and mtDNA mutation with more bilateral eyes involved and less optic edema, which about 43.5% of the patients showed irreversible visual impact. The daily dose of ethambutol is related to the vision recovery.
Objective This study analyzed the medical expenditure and its influential factors, and compared the clinical effectiveness and medical expenditure of three major drugs. Methods We designed the cohort study to compare the difference of medical and pharmaceutical expenditures between patients with and without underlying diseases. Multi-linear regression was applied to analyze the influential factors. Incremental expenditure-effectiveness ratio was applied to study three clinically important drugs. Results The curing rate of non-critical patients was statistically significant than critical patients (73.68%, 99.38%, P=0.000) .The curing rate of non-critical patients without underlying diseases was statistically significant than those with underlying diseases in the cohort (96%, 99.66%, P=0.001 6). No significance was identified in the critical patients cohort. The medical expenditure of non-critical patients with and without underlying diseases were 7 879.22 and 7 172.23 RMB per capita, respectively. Accordingly, the medical expenditure in critical patients was 24 912.89 and 26 433.53 RMB per capita. No significance was identified in the two cohorts. Medical expenditure was positively correlated with age and disease severity, with its equation y=4585.71+79.04X1+17188.87X2 (X1: age, X2: disease severity). Regarding the clinical effectiveness and medical expenditure, no significance was identified in critical patients who administered small and medium dose of Methylprednisolone. The expenditure-effectiveness ratios of Ribavirin that was administered by non-critical patients without underlying dissuades were 6 107 and 4 225 RMB, respectively. Accordingly, the expenditure-effectiveness ratios of Thymosin were 11 651 and 6 107 RMB. Conclusions The curing rate of non-critical patients without underlying diseases was higher than the counterpart in the cohort. No influence of underlying diseases was found in the critical patient cohort. Medical expenditure was positively correlated with age and disease severity. Small-and-medium dose of Methylprednisolone might not influence the curing rate and medical expenditure in critical patients. The effectiveness of Thymosin for non-critical patients with and without underlying diseases was not significantly different. However, additional 5 877 RMB occurred if Thymosin was administrated. Likewise, the effectiveness of Ribavirin for non-critical patients remains the same. However, additional 1 082 RMB was consumed in Ribavirin-administrated patient.