Leukemia is a common, multiple and dangerous blood disease, whose early diagnosis and treatment are very important. At present, the diagnosis of leukemia heavily relies on morphological examination of blood cell images by pathologists, which is tedious and time-consuming. Meanwhile, the diagnostic results are highly subjective, which may lead to misdiagnosis and missed diagnosis. To address the gap above, we proposed an improved Vision Transformer model for blood cell recognition. First, a faster R-CNN network was used to locate and extract individual blood cell slices from original images. Then, we split the single-cell image into multiple image patches and put them into the encoder layer for feature extraction. Based on the self-attention mechanism of the Transformer, we proposed a sparse attention module which could focus on the discriminative parts of blood cell images and improve the fine-grained feature representation ability of the model. Finally, a contrastive loss function was adopted to further increase the inter-class difference and intra-class consistency of the extracted features. Experimental results showed that the proposed module outperformed the other approaches and significantly improved the accuracy to 91.96% on the Munich single-cell morphological dataset of leukocytes, which is expected to provide a reference for physicians’ clinical diagnosis.
ObjectiveTo evaluate the changes of metamorphopsia in patients with rhegmatogenous retinal detachment (RRD) who underwent primary vitrectomy and to analyze the correlation between macular microstructure changes and metamorphopsia.MethodsIt was a retrospective clinical study. From January 2017 to January 2019, 57 patients (57 eyes) with RRD were examined and diagnosed in the Department of Ophthalmology of Baoding First Central Hospital were enrolled in this study. All patients underwent 23G PPV. All patients had retinal anatomical reduction after the first PPV. The best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscope, indirect ophthalmoscope, changes of metamorphopsia, and optical coherence tomography (OCT) were examined before PPV and 1, 6, 12 months after the operation. The BCVA examination was performed using the international standard visual acuity chart, which was converted into a logarithm of the minimum angle of resolution (logMAR) BCVA for the record. The macular fovea retinal thickness (CRT) was measured by Carl Zeiss Cirrus HD-OCT5000 instrument from Carl Zeiss Company, Germany, and the microstructural changes in the macular area were recorded, including the presence of the anterior macular membrane (ERM), cystic macular edema (CME), subretinal fluid (SRF), and the integrity of the ellipsoid zone (EZ) and outer membrane (ELM). The value of metamorphopsia (M value) was measured by the M-Chart table. The changes of BCVA, M value, and the microstructure of the macular area before and after operation were analyzed. The correlation between BCVA and M value was analyzed by Pearson correlation. Spearman correlation analysis was used to analyze the correlation between the changes of macular microstructure and BCVA and M values.ResultsThe mean logMAR BCVA before the operation was 1.15±0.43. At 1, 6, and 12 months after the operation, the mean logMAR BCVA was 0.62±0.17, 0.39±0.18, and 0.34±0.13, respectively. The visual acuity improved significantly after operation compared with before operation, and the difference was statistically significant (F=119.731, P=0.000). The mean CRT before the operation was 476.0±104.1 μm. At 1, 6, and 12 months after the operation, the average CRT were 299.8±29.9, 272.2±17.8, and 261.0±19.3 μm, respectively. The average CRT after the operation was significantly lower than those before the operation (F=185.518, P=0.000). At 1, 6, and 12 months after the operation, the mean M values were 0.62±0.54, 0.43±0.41, and 0.32±0.36, respectively; the difference was statistically significant (F=6.568, P=0.020). After the operation, 48 eyes (84.2%, 48/57) had microstructural abnormalities in the macular area, including EZ and ELM integrity disruption, SRF, CME, and ERM. Correlation analysis showed that M value was significantly positively correlated with BCVA, CRT, and SRF height before operation (r/rs=0.672, 0.385, 0.932; P＜0.05). There was no correlation between M value and BCVA (r/rs=0.503), EZ and ELM integrity (r/rs=0.497, 0.472), SRF (r/rs=0.416), CME (r/rs=0.821) and ERM (r/rs=0.632) after operation (P＞0.05).ConclusionsThe BCVA is significantly increased and the metamorphopsia is improved after anatomically successful RRD surgery. Postoperative M value is highly correlated with preoperative BCVA, CRT, and SRF.
Objective To investigate the degree of retinal developmen t in pret erm infants and compare the electroretinograms between preterm and fullterm in fants. Methods Flash electroretinogram (ERG) were obtained wit h contact lens el ectrodes in one eye from ten preterm infants (10 eyes) and twenty full-term inf a nts (20 eyes) in seven days after birth. The rod cell, cone cell, maximal combi nation, oscillatory potentials, and 30 Hz flicker responses were recorded. Results Compared with the full-term infants, the implicit time of rod cell respon s e (t=3.216，P=0.003) was longer and the amplitudes were lower (t=6.0 50，P=0.000) in the preterm infants; the difference of implicit time of maximal response was not significant (t=0.465，P=0.650; t=1.068，P=0.295), while th e amplitudes dec reased (t=6.584, P=0.000; t=6.649, P=0.000). The a- and b-wav e implicit time of cone response was not differed much between the two groups (t=0.077, P=0.939; t=0.935,P=0.358); the amplitudes was obvious lower in preterm group (t =3 .417，P=0.002；t=6.310，P=0.000); the difference of implicit t ime of 30 Hz flic ker betw een the two groups was not significant (t=3.745，P=0.001). The difference of b/a value of maximal combination response was not obvious between the two groups ( t=0.215, P=0.831). Conclusions The development of retinal function is slower in preterm infants than that in full-term ones．
Objective To investigate the causes of visual loss and failure of treatment after intraocular silicone oil removal. Methods Retrospective clinical analysis of the causes of loss of visual acuity of 15 eyes after silicone oil removal in patients with complicated retinal detachment which were successfully treated with vitreous and retinal microsurgery. Results Among the 15 eyes,retina failed to reattach in 11 eyes,secondary glaucoma occurred in 2 eyes and corneal opacity appeared in another two eyes.All of them were resulted in total loss of vision. Conclusion Retinal redetachment was the leading cause of final visual loss in the failing 15 cases(15 eyes) after intraocular silicone oil removal,and secondary glaucoma and corneal decompensation may also be the causes of visual loss. (Chin J Ocul Fundus Dis, 1999, 15: 230-231)
ObjectiveTo observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.MethodsA retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients (15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index (MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.ResultsAt 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=?0.536, ?0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).ConclusionInternal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).
ObjectiveTo evaluate the characteristics of electroretinagram (EGR) in children with history of pre-threshold or threshold retinopathy of prematurity (ROP). MethodsA total of 24 children (48 eyes) with history of pre-threshold ROP or threshold ROP received F-ERG examination.Ten age and body weight-matched children with a history of premature birth (20 eyes) but without ROP were recruited as control group. The rod response, maximal rod-cone response and cone response of F-ERG were recorded respectively following the International Standard Protocal of ISCEV (2000 version).The latency and amplitude of a-wave and b-wave of various responses were analyzed. The trial was approved by the Ethic Committee of Hunan Children's Hospital and informed consent was obtained from the parents of patients prior to any medical procedure. ResultsThere was significant difference between ROP and control group in rod response,the latency was longer (t=5.643,P<0.05) and the amplitude was lower in ROP group(t=7.068,P<0.05).In maximal rod-cone response both in a and b wave, the latency wave was longer(t=3.099, 2.886;P<0.05) and the amplitude was lower(t=5.614, 2.850;P<0.05) in ROP group. But there is no difference between ROP and control group in cone response latency(t=0.819, 0.948)and amplitude(t=0.904, 0.850). ConclusionERG in ROP children with history of pre-threshold or threshold ROP is abnormal, which mainly in rod response,but the cone response remains normal.
Objective To observe the effects of local macular foveal photoreceptor defects on visual acuity.Methods Thirty-one patients (31 eyes) with photoreceptor defect in macular fovea (case group) diagnosed by spectral domain optical coherence tomography (SD-OCT) and 30 patients (30 eyes) age- and diopter- matched normal subjects (control group) were enrolled in this study. There were 22 eyes with full photoreceptor defects and 9 eyes with outer segment defects in case group. All subjects were examined for best corrected visual acuity (BCVA), slit-lamp microscopy, direct ophthalmoscope and SD-OCT. Independent sample t-test was used to compare central foveal thickness (CFT) between case group and control group. Difference of logMAR BCVA, CFT, maximum width and height of photoreceptor defects, defected area and residual retinal thickness in macular between patients with full photoreceptor defects and outer segment defects were also compared.Results The CFT of case group and control group were (225.32plusmn;19.70),(240.02plusmn;10.70) mu;m, the difference was not statistically significant (t=-1.96, P＞0.05). In full photoreceptor defects and outer segment defects patients, the mean logMAR BCVA were 0.22plusmn;0.31, 0.32plusmn;0.43; the mean CFT were (224.09plusmn;20.57), (228.33plusmn;18.17) mu;m; the maximum width of photoreceptor defects were (131.32plusmn;108.18), (143.22plusmn;66.93) mu;m; the mean defected area were (0.022plusmn;0.054), (0.019plusmn;0.019) mm2; the mean maximum height of photoreceptor defects were (77.41plusmn;6.62), (44.89plusmn;4.26) mu;m; the mean residual retinal thickness were (87.00plusmn;20.31), (128.33plusmn;23.54) mu;m respectively. There was no statistical significance between full photoreceptor defects and outer segment defects patients in the mean logMAR BCVA, CFT, maximum width of photoreceptor defects and defected area (t=-0.76, -0.538, -0.305, 0.166; P＞0.05), but there were significant difference in mean maximum width of photoreceptor defects and residual retinal thickness (t=12.72, -4.91;P＜0.05). Conclusions The local photoreceptor defects in macular fovea can lead to decrease of visual acuity. The wider the photoreceptor defects, the worse the visual acuity.
Objective To investigate the causes of blindness and low vision of the people over 50 years old in Binhu Area of Wuxi City. Methods Cluster sampling was used in randomly selected individuals over 50 years old in 28 villages. The oculopathy related to blindness and low vision of the people over 50 years old were analyzed. The vision acuity lt;0.05 was defined as blindness, while 0.05-0.3 was defined as low vision. SPSS 17.0 software was used to analyze the data. Results Totally 6150 individuals were examined. The bilateral blindness and low vision was found in 47 and 84 individuals, unilateral blindness and low vision was found in 201 and 214 individuals. Among 201 unilateral blindness individuals, there were 55 individuals have low vision in the other eye. In the 295 blind eyes, there are 116 eyes (39.32%) with cataract, 31 eyes (10.51%) with high myopia macular degeneration, and 28 (9.49%) eyes with atrophy eyeballs. In the 437 low vision eyes, there are 223 eyes (51.03%) with cataract, 41 (9.38%) eyes with high myopia macular degeneration, and 41 (9.38%) eyes with age-related macular degeneration. Conclusion Cataract is the first cause leading to blindness and low vision, followed by age-related macular degeneration, high myopia macular degeneration and atrophy eyeballs.
Objective To evaluate the therapeutic effects of vitrectomy on chronic and refractory Behcet′s diseases. Methods The clinical data of 8 patients (10 eyes) with Behcet′s diseases from 0.5 to 3 years after vitrectomy were retrospectively analyzed. Pre-and post-operative visual acuity, control of inflammation after the surgery, and the recurrence were observed and analyzed. Both of the eyes were involved in all of the patients, including complete Behcet′s diseases in 5 and incomplete in 3. Results Vitreous opacity and liquefaction were found in all of the involved eyes, dark retina and thin retinal vessels were seen in most of the eyes, and vascular obstruction or sheath-like changes in different degrees were detected in some eyes. Improvement of visual acuity was observed in all of the eyes which had undergone the treatment after the operation. There was significant difference between the visual acuity before the surgery and at the 1st and 2nd week and the 1st and 6th month after the surgery. During the follow-up period, recurrence of the inflammation was found in 3 eyes within 1 month and in 6 eyes within 6 months; no recurrence was found in 4 eyes after the operation. No acute recurrence of inflammation was found after operation in the involved eyes. Conclusion Vitrectomy for chronic and refractory Behcet′s diseases may improve the visual acuity of the involved eyes, and the surgery is safe and effective. (Chin J Ocul Fundus Dis, 2005, 21: 357-359)
Objective To evaluate the causes of the metamorphopsia in patients with reattached retina after scleral buckling surgery. Methods Amsler grid test, ophthalmoscopic examination, fundus fluores cein angiography (FFA) and optical coherence tomography (OCT) were performed on 79 patients (79 eyes) with reattached retina at the 2nd week, 2nd, 6th month and 1st year after scleral buckling operation. Results Two weeks after the operation, 51 patients (51 eyes, 64.56%) complained of metamorphopsia,and 44 patients (44 eyes, including 35 with and 9 without metamorphopsia) were examined by OCT and FFA. In patients with metamorphopsia, the results of OCT in 31 (88.57%) revealed abnormal macula with seven kinds consisting mostly of stratum neuroepithelium detachment (74.29%), while of FFA in 6 patients showed abnormal macular (17.14%) including 4 with neuroepithelium detachment (66.67%). In patients without metamorphopsia, abnormal macula could be found in 2 by OCT while nothing special was seen in FFA. Most abnormal macula in patients followed-up 2 months, 6 months and 1 year postoperatively meliorated as time went by, with alleviative or disappeared metamorphopsia; while the patients with persistently existing macular membrane had aggravating metamorphopsia. Conclusions Abnormal macula is the main reason for metamorphopsia after scleral buckling surgery. Neuroepithelium detachment and macular membrane are the main causes of metamorphopsia at the early and terminal stage after operation.(Chin J Ocul Fundus Dis，2004，20：94-97)