ObjectiveTo compare the clinical features of patients with acute Vogt-Koyanagi-Harada syndrome (VKH syndrome) of optic disc swelling (ODS) and serous retinal detachment (RD).MethodsA retrospective clinical study. From January 2013 to November 2019, 212 patients with acute VKH syndrome diagnosed in the Department of Ophthalmology of Shanghai Xuhui District Central Hospital were included in the study. Among them, there were 105 males (210 eyes) and 107 females (214 eyes). The average age was 40.84±13.90 years. All affected eyes were examined by BCVA, FFA, and OCT. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. According to the changes in the fundus, the patients were divided into the ODS group and the RD group, 36 patients with 72 eyes (16.98%) and 176 patients with 352 eyes (83.02%), respectively. The independent sample t test was performed to compare the age of onset, visit time and BCVA of the two groups of patients, the χ2 test was performed to compare the count data.ResultsAmong the 72 eyes of 36 patients in the ODS group, there were 16 males with 32 eyes (44.44%), 20 females with 40 eyes (55.56%). The average age was 40.56±16.57 years, the average visit time was 22.47±19.98 days, the average logMAR BCVA was 0.68±0.53. Among the 352 eyes of 176 patients in the RD group, there were 89 male patients with 178 eyes (50.56%), and 87 female patients with 174 eyes (49.43%). The average age was 40.90±13.34 years, the average visit time was 17.25±24.40 days, the average logMAR BCVA was 0.80±0.56. The average age (t=－0.116), gender composition ratio (χ2=0.448), average visit time (t=1.204), average logMAR BCVA (t=－1.661) comparisons between the two groups showed no statistically significant differences (P＞0.05). There was no statistically significant difference in the average logMAR BCVA between the RD group and the ODS group of different eyes (t=0.227, 0.810; P＞0.05). There were 50 (69.44%, 50/72) and 272 (77.27%, 272/352) eyes in the ODS group and RD group with inflammation of the anterior segment. There were anterior segment reactions between the two groups. There was no statistically significant difference in the number of eyes (χ2=1.003, P＞0.05). There were 34 (19.32%, 34/176) and 2 (5.56%, 2/36) patients with headache and hearing loss, respectively. The comparison of the number of patients with headache and hearing loss between the two groups showed statistically significant differences (χ2=4.015, P＜0.05).ConclusionCompared the patients with ODS acute VKH syndrome, the patients with serous RD acute VKH syndrome are more likely to have extraocular symptoms such as headache and hearing loss.
ObjectiveTo compare the clinical efficacy and complications of intra-arterial chemotherapy (IAC) and intravenous chemotherapy (IVC) for unilateral advanced retinoblastoma (RB). MethodsA retrospective clinical study. From January 2020 to January 2021, 40 patients (40 eyes) unilateral group cT2 RB patients diagnosed at Baoding Children’s Hospital and Beijing Children’s Hospital were recruited in this study. There were 22 males (22 eyes) and 18 females (18 eyes). All were monocular. All the patients were assigned to two groups according to different treatment modalities they received: IVC group and IAC group. There were 26 eyes and 14 eyes, respectively. When the tumor invades the optic nerve, choroid, sclera, anterior chamber and iris, enucleation was performed. The globe salvage rate, tumor extraocular metastasis rate, solid tumor control rate, treatment-related complications and pathological high-risk factors after enucleation were observed. The globe salvage rate and solid tumor control rate were compared between the groups by chi square test. ResultsThe globe salvage rate of IAC group and IVC group were 88.5% (23/26) and 50.0% (7/14), respectively. Solid tumor control of IAC group and IVC group were 84.6% (22/26) and 42.9% (6/14), respectively. There were statistically significant differences in globe salvage rate and solid tumor control between the two groups (χ2=7.18, 7.56; P＜0.05). Compared with IVC group, IAC group had less systemic complications, mild ocular and periocular side effects. Among 26 cases in IAC group and 14 cases in IVC group, 3 and 7 cases underwent enucleation respectively. The results of pathological examination showed that there were 2 cases and 3 cases with pathological high-risk factors in the two groups, respectively. During the follow-up period, 2 cases in IAC group had extraocular metastasis, there was no extraocular metastasis in IVC group. ConclusionCompared with IVC, IAC has the advantages of high tumor control rate, high globe salvage rate, less and mild complications, however, there is still tumor recurrence.
ObjectiveTo evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy (PPV). MethodsA retrospective clinical study. 17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study. Among them, 5 346 eyes in 5 346 cases were male; 5 549 eyes in 5 549 cases were female. The age ranged from 0 to 95 years, with the mean age of (57.74±13.15) years. 6 381 surgeries in 3 615 eyes from August 2015 to December 2018 (the initial period of day surgery) were used as the control group; 11 147 surgeries in 7 280 eyes from January 2019 to June 2023 (the expanded period of day surgery) were used as the observation group. According to the management mode of ambulatory surgery, the observation group was subdivided into the decentralized management group (January 2019 to December 2020) and the centralized management group (January 2021 to June 2023), with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries, respectively. Changes in the percentage of day surgery, average hospitalization days, and average unplanned reoperation rate were compared. The Mann-Whitney U test was used to compare numerical variables between groups; the chi-square test or Fisher's exact test was used to compare categorical variables. ResultsThe number of cases of daytime PPV performed in the observation group and control group was 7 852 (70.44%, 7 852/11 147) and 24 (0.38%, 24/6 381) cases, respectively, and the average hospitalization days were 1 (1) and 5 (3) d. Compared with the control group, the observation group had a significantly higher percentage of day surgery (χ2=8 051.01) and a considerably lower mean hospitalization day (Z=4 536 844.50), and the differences were statistically significant (P＜0.000 1). The mean hospitalization days in the decentralized and centralized management groups were 2 (3) and 1 (0) d, respectively, and unplanned reoperations were 34 (0.73%, 34/4 646) and 171 (2.63%, 171/6 501) eyes, respectively. Compared with the decentralized management group, average hospitalization days was significantly lower (Z=1 436.94) and unplanned reoperation rate was significantly higher (χ2=54.10) were significantly lower in the centralized management group, both of which were statistically significant (P＜0.000 1). ConclusionPPV ambulatory management model can significantly reduce the average hospitalization day, but also results in higher rates of unplanned reoperations.