Chinese Journal of Ophthalmology
Volume 56 · Issue 08 · 2020
Chin J Ophthalmol
Prevention of blindness is of paramount importance for eye care and health care in China. In the past 70 years, we have embraced a lot of advancements in practice, manpower and landmark studies for the prevention of blindness and development of ophthalmic epidemiology. This summary is dedicated to our predecessors and successors for their contributions to the progress of ophthalmology in China, particularly workers in the field of prevention of blindness and ophthalmic epidemiology. Congratulations on the 70th anniversary of Chinese Journal of Ophthalmology.(Chin J Ophthalmol, 2020, 56: 561-566)
Carrying out research on infectious epidemics is an important work contents stipulated in the Law on the Prevention and Control of Infectious Diseases in China. Nowadays, Based on the recent Chinese prevention and treatment system of infectious eye diseases, it is difficult to meet the needs of data collection, etiology determination, and spatiotemporal analysis. The present article explores how to use modern social epidemiology methods to clarify the role of individual factors, social factors, and structural factors in the three links of eye disease epidemic, how to use spatial epidemiology methods to describe, quantify, and explain the spatial distribution characteristics of eye diseases in the population, and how to use infodemiology and digital epidemiology methods to promptly and efficiently mine and process massive amounts of electronic data of eye diseases. These may be used to improve the scientific nature of Chinese eye disease epidemiology research, and strengthen the China′s infectious eye disease prevention and control system.(Chin J Ophthalmol, 2020, 56:567-570)
This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on April 14, 2020. Currently, it is commonly reported that coronavirus disease 2019 (COVID-19) patients are associated with conjunctival congestion and other symptoms, and the transmission route and high-risk eye diseases and high-risk working status are speculated. Are conjunctival congestion and conjunctiva-related symptoms in patients with 2019 novel coronavirus definitely related to the novel coronavirus? Conjunctival congestion is one of the common clinical signs of various types of conjunctivitis. The symptoms and signs of conjunctivitis in COVID-19 patients may be attributed to a variety of factors. Therefore, conjunctival symptoms should not be linked to 2019 novel coronavirus without evidence. ( Chin J Ophthalmol, 2020, 56: 571-572)
In recent years, the diagnosis and treatment technology of glaucoma has developed rapidly. In order to further standardize the clinical diagnosis and treatment of glaucoma in China, the Glaucoma Group of Ophthalmology Branch of Chinese Medical Association and the Glaucoma Group of Ophthalmologists Branch of Chinese Medical Physicians Association have formulated clinical work guidelines for glaucoma from seven parts: glaucoma screening, clinical history inquiry and physical examination, primary open-angle glaucoma and ocular hypertension, primary angle-closure glaucoma and primary angle closure, childhood glaucoma, secondary glaucoma, follow-up and management, which can be used by ophthalmologists for reference in clinical work.(Chinese Journal of Ophthalmology, 2020, 56:573-586)
Visual evoked potentials (VEP) can provide important diagnostic information about the functional integrity of the visual system. This standard was revised by the International Society for Clinical Visual Electrophysiology (ISCEV). The main content of this revision is to recognize the graphic pattern stimuli generated by multiple technologies; Further emphasizes that no change in brightness should be ensured during graphic flipping or graphic feed-withdrawal; Moreover, the text has been adjusted to make the clinical VEP standard more consistent with other ISCEV standards. This clinical VEP standard is based on a series of stimulation parameters and recording conditions, which can provide core clinical information and can be used in most clinical electrophysiological examination rooms worldwide.(Chinese Journal of Ophthalmology, 2020, 56:587-592)
To investigate the prevalence, causes and risk factors of moderate or severe visual impairment and blindness in people with type 2 diabetes over 50 years old in Funing County, Yancheng.
This is a cross-sectional study. Using cluster random sampling, 84 survey sites were selected, and eye examination was performed on people with type 2 diabetes over 50 years old who were registered with the chronic disease information center of Funing County Center for Disease Control and Prevention in Yancheng, Jiangsu. The prevalence of moderate or severe visual impairment and blindness were calculated by different ages and genders. The causes of blindness and visual impairment were determined, and their influencing factors were analyzed by univariate and multivarite logistic regression.
A total of 2 067 people were investigated in this study, and 1 909 people were included. The response rate was 92.4%. Based on PVA, the prevalence of blindness and moderate to severe visual impairment was 5.29% (95%CI: 4.29%-6.30%) and 18.54% (95%CI: 16.80%-20.29%). The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, systolic blood pressure and nuclear opacity. The prevalence of moderate or severe visual impairment was related to age, gender, educational level, diabetes treatment, exercise, and glycated hemoglobin. The prevalence of blindness and moderate to severe visual impairment was 3.67% (95%CI: 2.82%-4.51%) and 9.80% (95%CI: 8.46%-11.13%) based on BCVA. The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, exercise and systolic blood pressure, while the prevalence of moderate or severe visual impairment was related to age, educational level, diabetes treatment and nuclear opacity. The primary cause of blindness and visual impairment is cataract, followed by diabetic retinopathy.
The prevalence of moderate or severe visual impairment and blindness in people with type 2 diabetes in Funing County is relatively high. Attention should be paid to the prevention of blindness in this population.(Chin J Ophthalmol, 2020, 56: 593-599)
To investigate the prevalence and risk factors of pterygium in Han and Yugur populations aged 40-79 years in Gansu Province, China.
This was a cross-sectional study. A multistage cluster sampling method with urbanization level-based stratification was employed. Multiple logistic regression analysis was performed to evaluate the risk factors of pterygium.
A total of 4 193 people (1 840 males, 2 353 females; 3 035 Hans, 1 158 Yugurs) aged over 40 in Gansu Province were included in the study. Among them, 391 patients (9.3%) were found to have pterygium. The prevalence of pterygium adjusted for age and sex was 9.3%. The prevalence rates of Han and Yugur participants were 8.8% (267 patients) and 10.7% (124 patients), respectively, and there was no significant difference between them (χ²=3.629, P=0.057). Multivariate regression analysis showed that the risk factors of pterygium included age (OR=3.66, 95%CI: 2.26-5.92), length of residence in the countryside (OR=2.18, 95%CI: 1.41-3.38), and education level (OR=0.49, 95%CI: 0.29-0.83). In the Han group, the risk factors of pterygium were age (OR=3.84, 95%CI: 2.18-6.78) and length of rural residence (OR=2.02, 95%CI: 1.23-3.33), and a higher level of education (OR=0.36, 95%CI: 0.20-0.66) was a protective factor. Older age (OR=3.11, 95%CI: 1.13-8.59) and rural residential length ratio (OR=3.28, 95%CI: 1.09-9.88) were risk factors for pterygium in Yugur population.
The overall prevalence of pterygium in Han and Yugur populations aged over 40 in Gansu Province, China was 9.3%, with no significant difference between the two nationalities. Older age and rural residency increased the incidence of pterygium, and a higher education level was a protective factor for pterygium.(Chin J Ophthalmol, 2020, 56:600-607)
To explore the short-term effects of ambient PM2.5 on the outpatient visits of allergic conjunctivitis among children in Shenzhen.
It was a ecological study. Data on daily visits including date of visit, sex and age from children with allergic conjunctivitis were collected from Shenzhen Eye Hospital and Shenzhen Children′s Hospital in 2018. Related data on air pollution (PM2.5, PM10, SO2, NO2, CO and O3) and meteorology (atmospheric pressure, temperature and relative humidity) were also collected. Pearson correlation analysis was used for normal distribution data and Spearman rank correlation analysis was used for non-normal distribution data. Generalized additive model was used to estimate the impact of PM2.5 pollution on allergic conjunctivitis outpatients and the lagging effects.
In 2018, there were 16 133 allergic conjunctivitis outpatients in the two hospitals. The maximum age was 18 years and the minimum age was 2 months. Males accounted for 49.3%. The daily average concentration of PM2.5 was 22 (15, 31) μg/m3. Changes of the concentration of PM2.5 had a positive correlation with the amount of allergic conjunctivitis visits, and the Spearman correlation coefficient was 0.150 (P=0.004). The single pollutant model showed that the strongest effect appeared at 3 days (RR=1.111， 95%CI:1.071-1.152). A 10 μg/m3 increase of PM2.5 would result in an excessive number of allergic conjunctivitis outpatients as much as 11.112% (95%CI：7.011%-15.212%). In the multiple air pollutants models, after the introduction of NO2, O3 and CO, the concentration of PM2.5 showed an enhanced effect on the number of hospital visits due to allergic conjunctivitis on the same day, and the difference was statistically significant (P<0.05).
Changes of the concentration of PM2.5 had a positive correlation with daily outpatient visits of allergic conjunctivitis among children in Shenzhen. (Chin J Ophthalmol, 2020, 56: 608-614)
To analyze the reasons that restrict the growth of cataract surgery service capacity in public hospitals in Shanghai in recent years.
The status of surgeries performed in public hospitals are analyzed based on the data related to cataract surgery collected from the database of Shanghai Eye Disease Treatment. Meanwhile, the surgeries performed by ophthalmologists working in the public hospitals are studied based on the National ophthalmology service capacity questionnaire.
The cataract surgery volume performed in public hospitals of Shanghai increased from 45 480 in 2013 to 51 941 in 2015. In 2014, the year on year growth rate of cataract surgery volume in tertiary hospitals was 8.54%, while in 2015, it was -0.21% on an annual basis. More than 70% cataract surgeries were performed in tertiary public hospitals. For those performed in tertiary public hospitals, 80% were performed in urban area. The actual surgeons in tertiary account for 70% of the actual surgeons in all public hospitals. Among all cataract surgeries performed in secondary hospitals, half were performed in urban areas. The volume of cataract surgery by cataract surgeon and the number of the ophthalmologist were higher than those in secondary hospitals. The average cataract surgery volume of tertiary hospitals in urban areas and the average annual cataract surgery volume of the actual surgeons are much higher than those of the secondary hospitals in the urban areas, but it is contrary in exurban areas.
The excessive density of tertiary hospitals in urban area and poor ophthalmology service capacity in secondary hospitals in suburban and exurban areas have restricted the rapid growth rate of cataract surgery and even a decline in Shanghai public hospitals. (Chin J Ophthalmol, 2020, 56: 615-620)
To investigate the in vitro antibacterial sensitivity of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid to 67 strains of Staphylococci in ocular surface infection. The purpose of this study is to provide reference for clinical selection of drugs.
Experimental study. Sixth-seven strains of drug-resistant Staphylococci isolated from the Department of Microbiology, Henan Provincial Ophthalmic Hospital during January 2018 and May 2019 were collected. There were 67 strains of Staphylococci including 28 strains of drug-resistant Staphylococcus epidermidi, 17 strains of drug-resistant Staphylococcus aureus, 15 strains of drug-resistant Staphylococcusintermedius and a few other kinds of drug-resistant Staphylococci. The minimum inhibitory concentrations (minimum inhibitory concentration, MIC) of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid in 67 strains of drug-resistant Staphylococci were determined by microliquid-based method. The sensitivity was determined according to the American CLSI-M100 standard. The statistical analysis of the data was carried out by using two-dimensional test and Fisher accurate test.
Fourteen strains of fusidic acid were sensitive to 17 strains of MRS-Meca-resistant Staphylococcus epidermidis, the difference between fusidic and levofloxacin is statistically significant; 14 strains of cefazolin sodium and 11 strains of fusidic acid were sensitive to 14 strains of β-Lac enzyme-producing Staphylococcus aureus, and there were significant differences between the two drugs and levofloxacin; 6 strains of cefazolin sodium and 5 strains of fusidic acid were sensitive to 10 strains of MRS-Meca-resistant Staphylococcus intermedius, as compared to levofloxacin, there were significant differences between cefazolin sodium and levofloxacin (P=0.011,0.033). Cefazolin sodium was sensitive to 5 strains of MRS-Meca-positive other drug-resistant Staphylococci, which was significantly different from levofloxacin (P=0.048); 54 and 48 strains of cefazolin sodium and fusidic acid were sensitive to 67 strains of drug-resistant Staphylococci, and the sensitive rates were 80.1% and 71.6%, respectively, which were significantly higher than those of levofloxacin, tobramycin and clindamycin. There were significant statistical differences between drug sensitivity (χ²=18.377,9.940；P=0.000,0.003).
The sensitivity of cefazolin sodium and fusidic acid to 67 strains of drug-resistant Staphylococci is better than that of levofloxacin, tobramycin and clindamycin, these findings may provide guidance for the clinical treatment of drug-resistant Staphylococci in ocular infection. (Chin J Ophthalmol, 2020, 56: 621-625)
One patient who complained of oblique eye for 27 years and required surgery to improve the appearance of the eye went to the ophthalmology department. After admission, the eye examination found that the patient's right eye was obviously superior strabismus combined with esotropia, accompanied by insufficient function of right eye turning down. At the same time, orbital CT and MRI examination revealed that the inferior rectus muscle of the right eye was absent, and binocular strabismus correction operation was performed. Intraoperative exploration found that the right eye had thin inferior rectus muscle, and it was diagnosed as congenital inferior rectus paralysis and esotropia of the right eye. In stage I surgery, the superior rectus muscle of the right eye was retrogressed by 5 mm combined with the inferior rectus muscle shortened by 6 mm, and the medial rectus muscle of the left eye was retrogressed by 5 mm combined with the lateral rectus muscle shortened by 4 mm. Small degree esotropia remained after surgery. In stage II surgery, the medial rectus muscle of the right eye was transposed to the nasal lateral edge of the attachment point of the inferior rectus muscle 2 mm. The postoperative eye position was basically orthogonal, and the surgical effect was satisfactory.(Chinese Journal of Ophthalmology, 2020, 56:626-628)
The patient was a male, 81 years old. Because of the slow decline of visual acuity in both eyes for 10 months, he went to the Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Denying history of ocular trauma and surgery; Previous history of prostatic hyperplasia for 2 years, long-term oral tamsulosin; Deny history of other systemic diseases such as hypertension and diabetes. General physical examination: No abnormalities were found in blood and body fluid examination. Eye examination: the visual acuity of both eyes was 0.5, and neither could be corrected; IOP was 14.3 mmHg (1 mmHg =0.133 kPa) in the right eye and 13.7 mmHg in the left eye. Under the slit lamp microscope, the conjunctiva of both eyes was not congested, the cornea was transparent, the anterior chamber was medium-deep, the pupil diameter was 3 mm, and it was sensitive to light. The opacity of the lens of both eyes was assessed by the lens opacity classification system Ⅲ to be approximately C2N2P1In the lens of the left eye, a large amount of fine needle-shaped and highly refractive colored crystalline substances irregularly gather in the central superficial cortex of the front part of the lens. Adjusting the incident angle of the slit lamp light line, the crystalline substances appear in different colors. Using the slit lamp back-illumination method, it can be seen that the crystalline substances appear in thin layers of featherlike shadows (
Fungal keratitis is an important cause of corneal blindness in China. Delayed diagnosis and treatment contribute to its poor prognosis. In recent years, with the advancement of laboratory test techniques, imaging diagnostic techniques and treatment methods, the diagnosis and treatment of fungal keratitis has constantly improved. This article reviews the recent progress of the laboratory and imaging diagnosis, medicine and surgical treatment in fungal keratitis. It may be helpful to promote the application of the new technologies in China and to improve the prognosis of fungal keratitis.(Chin J Ophthalmol, 2020, 56: 631-636)
In order to give full play to the continuing education function of magazines and meet the needs of medical workers to obtain Class II continuing education credits free of charge while reading magazines to improve their knowledge and skills, Chinese Journal of Ophthalmology and Ophthalmology Branch of Chinese Medical Association jointly set up a continuing medical education platform "Expert Forum" for ophthalmologists. The content of each lecture is written by relevant experts appointed by various professional groups of ophthalmology branch according to clinical hotspots, hoping to provide more cutting-edge and systematic ophthalmology knowledge for the majority of ophthalmologists. For many diseases that seriously affect people's eye health, such as myopia in children and adolescents, diabetic retinopathy, etc., large-scale screening can quickly and easily select patients from seemingly healthy people, which plays an important role in public health services. This paper introduces 10 principles of research design for population eye disease screening, the classification of research, and data analysis methods such as how to select screening indicators through Logistic regression analysis, evaluate the discrimination ability of screening technology by subject operating characteristic curve, determine the net benefit of screening technology by decision curve analysis, and predictive analysis by survival analysis, so as to provide reference for population eye disease screening.(Chinese Journal of Ophthalmology, 2020, 56:637-640)
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