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.
Ophthalmic imaging examination is the main basis for early screening, evaluation and diagnosis of eye diseases. In recent years, with the improvement of computer data analysis ability, the deepening of new algorithm research and the popularization of big data platform, artificial intelligence (AI) technology has developed rapidly and become a hot topic in the field of medical assistant diagnosis. The advantage of AI is accurate and efficient, which has great application value in processing image-related data. The application of AI not only helps to promote the development of AI research in ophthalmology, but also helps to establish a new medical service model for ophthalmic diagnosis and promote the process of prevention and treatment of blindness. Future research of ophthalmic AI should use multi-modal imaging data comprehensively to diagnose complex eye diseases, integrate standardized and high-quality data resources, and improve the performance of algorithms.
Objective To investigate the characteristics of ultrasonogram of eyes with silicon oil tamponade. Methods Forty-seven patients (47 eyes) who had undergone the operation of silicon-oil removing were examined by A-(to determine the length of ocular axis) and B-scan before and after the operation respectively. The length of ocular axis and cubage of vitreous chamber were detected and the characteristics of the ultrasonograms were observed according to the default parameters of ultrasonograph. Results The results of A-scan showed that the preoperative axial length was 1.465 times of the postoperative one in the eyes without lens, and 1.284 times in eyes with lens; after modified the parameter according to the acoustic velocity, the preoperative axial length was (0.78±0.34) mm longer than the postoperative one in the eyes without lens, and (0.56±0.32) mm in eyes with lens. The results of A-scan showed that the cubage of vitreous chamber enlarged obviously in eyes with silicon oil tamponade, and the acoustic features included complete filling and partial filling according to the amount of silicon oil. Several arc echoes at the posterior segment of eye were detected in the silicon-oil-filling eyes with retinal detachment. Conclusion In the silicon-oil-filling eyes with lengthened ocular axis, the characteristics of B-scan images are affected by acoustic velocity through silicon oil, the amount of silicon oil capacity and the emulsification of silicon oil. (Chin J Ocul Fundus Dis，2004，20：349-351)
ObjectiveTo observe the demographic data, disease composition and convenience of remote consultation in ophthalmology. MethodsA retrospective study. From 2015 to 2021, the demographic data, changing trends, disease classification of teleconsultation patients, and hospitals participating in teleconsultation, and the waiting time of patients for teleconsultation was analyzed retrospectively; remote consultation physician level composition and other data was analyzed. ResultsDuring the 7-year period, 1 216 patients with remote consultation were obtained through the platform of the telemedicine center. Among them, there were 680 males and 536 females; the average age was 50.8 years. In 2016 and 2017, the number of patients participating in telemedicine consultations reached a peak of 260 and 221 cases, respectively. Among the ophthalmic diseases, there were 490 cases (40.30%, 490/1 216) of retinal and optic nerve-related diseases, 212 cases (17.43%, 212/1 216) of ocular trauma. 678 cases (56.27%, 678/1 205) of remote consultation waiting time were less than 24 hours, 991 cases (82.24%, 991/1 205) were less than 48 hours. Among the physicians who participated in the remote consultation, there were 733 chief physicians (60.3%, 733/1 216) and 466 deputy chief physicians (38.3%, 466/1 216). ConclusionsDuring the seven-year period from 2015 to 2021, there are relatively few patients with ophthalmology teleconsultation; retinal and optic nerve-related diseases accounted for a high proportion. Remote consultation has high convenience.
Inherited retinal diseases (IRD) are a group of genetic disorders with high genetic and clinical heterogeneity. Patients with IRD may have their clinical diagnosis confirmed by genetic testing. Over the past 30 years, rapid advances in molecular genetics have raised the disease-causing gene variant detection rate and the accuracy of genetic testing, which provide hope to patients. The genetic diagnosis of patients with IRD is complicated due to the overlapping clinical phenotypes, and the fact that different variants lead to different phenotypes and severity even of the same gene. It is very important to overall evaluate the clinical phenotype of patients, precisely select genetic testing methods, and reasonably define disease-causing genes and variants during genetic diagnosis, which can guide the patient's subsequent treatment and provide genetic counseling.
【摘要】目的探讨实时超声弹性成像在淋巴结疾病诊断中的应用价值。 方法分析2008年2月4月27例淋巴结疾病患者的65个淋巴结病灶超声弹性图表现,弹性图分级为0~Ⅳ级,弹性图分型为Ⅰ~Ⅲ型。所有淋巴结均经术后病理学或细针抽吸细胞学检查证实,或经随访证实。结果转移性淋巴结弹性分级较高,≥Ⅲ级11/13,占84.62％;淋巴瘤性淋巴结弹性分级较低,≤Ⅱ级16/21,占76.19％。转移性淋巴结中Ⅱ型7/13,占53.85％,转移性淋巴结占全部Ⅱb型的54.55%(6/11);淋巴瘤性淋巴结中Ⅱ型13/21,占61.90％,淋巴瘤性淋巴结占全部Ⅱa型的73.33％(11/15);反应性淋巴结占全部Ⅰa型的68.18％(15/22)。结论实时超声弹性成像能为淋巴结疾病的诊断提供一定信息,弹性图分级对鉴别良恶性淋巴结有统计学意义,分型对于鉴别特定类型淋巴结疾病有一定提示作用。
The improvement of diagnostic levels for fundus diseases depend on the advancements of fundus imaging technology. Different fundus imaging technologies allow doctors to inspect ocular fundus from different aspects such as morphological or functional changes of retina. As a basic fundus examination method, optical coherence tomography provides highresolution and crosssectional retinal images coupled with noninvasive advantages. Fully understanding of the advantages and disadvantages of each fundus imaging technique, appropriate choosing one or combining several imaging techniques, and optimizing diagnostic procedures for each fundus disease are crucial steps to improve our diagnostic levels of ocular fundus diseases.
Ultra-wide-field fluorescein angiography (UWFA) is a novel breakthrough in ocular fundus imaging technology, which can capture a single, high-resolution, 200° wide image of the ocular fundus that traditional fluorescein angiography cannot reach. This technology has important impacts on the screening, diagnosis, staging, treatment and follow-up of vascular diseases involving peripheral retina (such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, uveitis and so on).
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.