Currently, coronavirus disease 2019 (COVID-19) is still widely prevalent around the world, leading to a major threat to the global public health. COVID-19 mainly involves the respiratory system, but extrapulmonary manifestations including that of the nervous system also exist in the setting of COVID-19. Misdiagnosis and delayed treatment of the disease may easily cause when ocular, especially neuro-ophthalmological symptoms are the first symptoms in early COVID-19, as the neuroophthalmological manifestations are rarely reported. First-line clinicians need to ask about not only respiratory symptoms such as fever, cough and sore throat, but also diplopia, impaired vision, eye motion pain, abnormal gait or other neurological deficits at the first reception, as these extrapulmonary manifestations are often signs of serious infection. The neuroophthalmological manifestations and possible underlying etiology of COVID-19 were summarized in this review, hoping to provide an early identification and effective treatment of COVID-19 for clinicians. More extensive studies are needed in the future to confirm the causal relationship between COVID-19 and neuroophthalmological disease to provide a sufficient basis for a comprehensive understanding of COVID-19.
Objective To evaluate the efficacy and safety of ophthalmic viscosurgical device (OVD)-assisted non-gas dependent pars plana vitrectomy (PPV) combined with an inverted internal limiting membrane (ILM) flap for the treatment of idiopathic macular hole (IMH). MethodsA retrospective cohort study. From June 2023 to February 2024, 33 patients (33 eyes) diagnosed with IMH in Department of Ophthalmology of Changshu Second People’s Hospital were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations were performed on all affected eyes before surgery. BCVA examination was conducted using the international standard visual acuity chart, and the results were converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. The minimum diameter of the hole was measured using OCT. All affected eyes received standard 25G PPV treatment through the three channels of the flat part of the ciliary body. According to the surgical methods, they were divided into two groups: the OVD-assisted non-gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (OVD group, 17 cases and 17 eyes) and the heavy water-assisted gas-dependent PPV combined with internal limiting membrane inversion and coverage treatment group (heavy water group, 16 cases and 16 eyes). Postoperatively, patients in the OVD group were not required to maintain a strict specific position, whereas those in the heavy water group needed to remain in a prone position for one week. The follow-up time points after the operation were 1 week, 1 month and 3 months. The main observation indicators included BCVA, intraocular pressure, hole closure rate and closure morphology of the two groups, as well as the occurrence of complications. The independent sample t test was used for comparison between groups. Pearson correlation analysis was used for the correlation between BCVA at 3 months after surgery and the minimum diameter of the surgical hole and BCVA before surgery. ResultsThree months after the operation, the rate of hole closure in the OVD group and the heavy water group was 17 (100.0%, 17/17) and 15 (93.8%, 15/16) eyes, respectively. There was no statistically significant difference in the hole closure rate (χ2=1.090) and closure type (Z=?0.780) between the two groups (P＞0.05). Compared with before the operation, the logMAR BCVA at each time point after the operation in the OVD group and the heavy water group was significantly improved (F=2.353, 1.375; P＜0.05). One week after the operation, the BCVA in the OVD group was significantly better than that in the heavy water group (t=-3.760, P＜0.01). In terms of intraocular pressure, compared with the baseline value before the surgery, there was a statistically significant difference in the OVD group one week after the surgery (Z=?3.454, P＜0.05). There were statistically significant differences in the heavy water group at 1 week, 1 month and 3 months after the operation (Z=?5.066, ?3.423, ?2.739; P＜0.05). After the operation, one eye in the heavy water group had high intraocular pressure, which returned to normal after combined treatment with intraocular pressure-lowering drugs. No ocular or systemic complications occurred in the OVD group. The results of the correlation analysis showed that postoperative BCVA was correlated with the minimum diameter of the surgical hole and BCVA before the surgery (r=0.543, 0.658; P＜0.05). ConclusionsThe treatment of IMH with OVD-assisted non-gas-dependent PPV combined with internal limiting membrane flip coverage has a good effect. It helps promote the early recovery of macular morphology and visual function after surgery, and at the same time can avoid the maintenance of forced position and reduce perioperative risks.
ObjectiveTo investigate the clinical characteristics of vascular neuro-ophthalmology in patients with central retinal artery occlusion (CRAO). MethodsA single-center, prospective clinical study. From January 2018 to December 2020, 49 eyes of 49 CRAO patients of The Neuro-ophthalmology Department of Xi'an First Hospital were included in the study. Data on patient demographic characteristics, vascular risk factors, disease characteristics, digital subtraction angiography (DSA) imaging characteristics of internal carotid arteries, treatment, treatment-related adverse events, and 1-month follow-up vascular events were collected. All patiens were examined by visual acuity, head CT and or magnetic resonance imaging. At the same time, 35 cases of internal carotid artery vascular DSA were examined; 14 cases of head and neck CT angiography were examined. The anatomical variation of the extracranial segment of the internal carotid artery was divided into tortuous, tortuous, and coiled; the aortic arch was divided into type Ⅰ, type Ⅱ, type Ⅲ, and bovine type. Intravenous thrombolysis, arterial thrombolysis, conservative treatment were performed. The follow-up time was 1 month after treatment. Functional vision was defined as vision ≥20/100. Vascular events were strokes, cardiovascular events, deaths and neovascular glaucoma during follow-up. ResultsAmong 49 eyes of 49 cases, 40 eyes were male (81.6%, 40/49), and 9 eyes were female (18.4%, 9/49); the average age was 60.7±12.9 years. There were 33, 17, and 16 cases with hypertension, type 2 diabetes, and cerebrovascular disease, respectively; 27 and 34 cases had a history of smoking and tooth loss, respectively. Taking antihypertensive, hypoglycemic, antiplatelet aggregation/anticoagulation, and hypolipidemic drugs were 15, 5, 8, and 5 patients, respectively. There were 11 cases of transient amaurosis before the onset, and 17 cases of CRAO after waking up. There were 33 cases (67.3%, 33/49) with infarction of the affected side of the brain tissue. DSA was performed in 35 cases, and the stenosis rate of the internal carotid artery on the affected side was 70%-99% and 100% were 3 (8.6%, 3/35) and 4 (11.4%, 4/35) cases, respectively. The ophthalmic artery on the affected side originated from the external carotid artery in 5 cases (14.3%, 5/35). There were 17 (54.8%, 17/31) and 2 (6.5%, 2/31) cases of tortuousity and kinking in the extracranial segment of the internal carotid artery. There were 15 (42.9%, 15/35), 6 (17.1%, 6/35), and 2 (5.7%, 2/35) cases of aortic arch type Ⅱ, type Ⅲ, and bovine type, respectively. Intravenous thrombolysis and arterial thrombolysis were performed in 13 and 29 cases, respectively. Complications occurred in 2 cases during treatment; 3 cases of symptoms fluctuated after treatment, and 10 cases of asymptomatic new infarcts occurred in imaging studies. Forty-eight cases were treated with antiplatelet aggregation/anticoagulation and hypolipidemic treatment. At discharge and 1 month after treatment, the recovery of functional vision was 7 and 17 cases, respectively. One month after treatment, 1 case died because myocardial infarction; 2 cases of neovascular glaucoma occurred. ConclusionThe proportion of CRAO patients with vascular risk factors and internal carotid artery abnormalities on the affected side is relatively high; the prognosis is relatively good after intravenous thrombolysis and/or arterial thrombolysis and secondary stroke prevention.
With the rapid development of artificial intelligence (AI), especially deep learning, AI research in the field of ophthalmology has presented a trend of diversification in disease types, generalization in scenarios and deepening in researches. The AI algorithm has showed a good performance in the studies of diabetic retinopathy, age-related macular degeneration, glaucoma and other ocular diseases, yielding up the great potential of ophthalmic AI. However, most studies are still in their infancy, and the application of ophthalmic AI still faces many challenges such as lack of interpretability for results, deficiency of data standardization, and insufficiency of clinical applicability. At the same time, it should also be noted that the development of multi-modal imaging, the innovation of digital technologies (such as 5G and the Internet of Things) and telemedicine, and the new discovery that retina status can reflect systemic diseases have brought new opportunities for the development of ophthalmic AI. Learn the current status of AI research in the field of ophthalmology, grasp the new challenges and opportunities in its development process, successfully realizing the transformation of ophthalmic AI from research to practical application.
Objective To find convenient methods for remote consultation of images of ocular fundus diseases. Methods A remote consultation system composed of internet was set up.The con sultation information,including images,words and figures,was published on intern et as web pages,so that the consultants would get the notice and the appointment by email.After reading the information on line,the consultants gave their opinions back to internet. Results The remote consultation system of images of ocular fundus diseases was setted up and managed successfully,and 23 patients had been diagnosed by this system. Conclusion The system which has clinical practicality is a simple,quick,effective and economic method for remote consultation of images of ocular fundus diseases. (Chin J Ocul Fundus Dis, 2001,17:247-248)
Mast cell (MC) play a crucial role in non-allergic fundus diseases, including uveitis, diabetic retinopathy, and age-related macular degeneration. MCs can profoundly influence the pathological processes of these diseases by regulating inflammatory responses, promoting angiogenesis, and facilitating tissue remodeling through the degranulation and release of mediators such as histamine, cytokines, and enzymes. The application of MC-associated inhibitors has been shown to effectively mitigate or inhibit the progression of these pathologies, offering a promising strategy for treating ocular diseases. Understanding the current state of MC research in fundus diseases will enhance our insight into their role in the pathophysiological mechanisms of these conditions and encourage further research aimed at providing more effective treatment options for patients.
ObjectiveTo study the research hot spots of ophthalmology-related coronavirus disease 2019 (COVID-19). MethodsPubMed database as the data source, the literatures of ophthalmology-related COVID-19 published on January 1, 2020 to February 22, 2022 were collected, limited to Medline included, the language type was limited to English and Chinese, and 1 592 literatures were included. By reading the titles and abstracts, the literatures of meeting notice, editor's note, etc. and the literature that was not quite relevant with ophthalmology-related COVID-19 were removed, and finally 1 547 literatures were included. Bibliographic Items Co-occurrence Matrix Builder (BICOMB 2.02 software) was used to collect the frequency of major Mesh terms/subheadings and the frequency of major Mesh terms after removing the subheadings, and the number of included articles published in the top 10 journals by the number of ophthalmology-related COVID-19 articles was recorded. VosViewer 1.6.18 software was used for cluster analysis of collaborator network and major Mesh terms, and the publication status and country or region distribution of active authors of ophthalmology-related COVID-19 were recorded. ResultsOf the 1 547 literatures, the active authors were mainly from India, Italy, Singapore, Spain, and Hong Kong, China, and so on; the top 10 journals published 617 articles in total (39.88%, 617/1 547). The high frequency major Mesh terms/subheadings included COVID-19, viral pneumonia, coronavirus infection, eye diseases/epidemiology, complications, prevention & control, diagnosis, virology, and Severe acute respiratory syndrome coronavirus 2, betacoronavirus/isolation & purification, ophthalmology/education, organization & administration, telemedicine, delivery of health care/organization & administration, and mucormycosis/diagnosis, etc. After taking out the subheadings, the high frequency of major Mesh terms also included conjunctivitis, orbital disease, retinal diseases, neuromyelitis optica, retinal vein occlusion, myopia and other eye diseases, eye diseases-related systemic diseases, such as multiple sclerosis and Miller Fisher syndrome, therapy and prevention-related drugs, such as hydroxyl chloroquine, angiogenesis inhibitors, and vaccination. ConclusionsOphthalmology-related COVID-19 researches have received extensive attention worldwide, COVID-19 is associated with multiple ocular diseases of anterior and posterior segments. COVID-19-related mucormycosis, hydroxychloroquine and possible retinal toxicity, and possible ocular adverse effects associated with vaccination are also noteworthy.