Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible t...Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible to assess the patient’s state of health, the severity of the CRS and the treatment. The aim of this study was to assess the QoL of patients with CRS in a hospital setting in Kinshasa. Methods: This was a cross-sectional analytical study conducted from June 2020 to May 2021 in the ENT service of the Kinshasa University Hospital and the Monkole Hospital Center. The study involved 113 patients aged at least 18 years, whose QOL was compared with that of a control group consisting of 100 non-patients. QOL was assessed using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire. Results: The mean age of the patients was 41.0 years (18 - 74 years) and that of the controls was 39.1 years (19 - 77 years). More than half of the participants were university graduates. The median SNOT-22 score was 44 (14 - 78) in patients and 7 (1 - 40) in controls. Compared with subjects without CRS, patients with CRS had significantly higher scores in all four domains of the SNOT-22. Around 9 out of 10 patients had a severely impaired QoL compared with 2 out of 10 controls. Considering mildly impaired QoL, we found that in the otological and sleep domains, scores were not significantly different between patients and controls. In the case of severely impaired QoL, however, only the otological domain showed a non-significant difference in scores between the two groups. Conclusion: CRS is a real public health problem in our environment and significantly alters the QoL of patients suffering from it, with repercussions on their professional productivity;hence the need for better management.展开更多
Background:Living well is as important as living longer.The objective of this study is to assess quality of life(QoL)in congenital heart disease(CHD)according to current AHA/ACC anatomical and physiological classifica...Background:Living well is as important as living longer.The objective of this study is to assess quality of life(QoL)in congenital heart disease(CHD)according to current AHA/ACC anatomical and physiological classification.Methods:Cross-sectional study examining the World Health Organization QoL Bref questionnaire(WHOQoL-Bref)in consecutive outpatient CHD patients from a single unit.Results:191 CHD patients were studied.Median age was 28±13 years and 59%were male.44(23%),115(60%)and 33(17%)CHD patients showed mild,moderate and great anatomical defects respectively while 69(36%)patients were in physiological Stage A,27(14%)in Stage B,84(44%)in Stage C and 11(6%)in Stage D.No significant differences were seen in relation the anatomical classification and the different sections of the WHOQoL-Bref questionnaire.CHD patients in Stages C and D had significant lower physical domain scores than patients in the Stage A(p<0.05).However,no significant differences were seen in the psychological,social relationships and environmental domains.The binary logistic regression analysis showed that having a higher educational level was a protective factor[OR 0.32(95%CI,0.12-0.87),p=0.026]while being married or cohabit was a risk factor[OR 3.46(95%CI,1.13-10.63),p=0.030]for having a worse rated QoL.Meanwhile,having a worse functional class(NYHA≥2)[OR 3.44(95%CI,1.20-9.81),p=0.021]was associated with dissatisfaction with health.Conclusion:Patients with advanced physiological stages scored lower on the physiological domain.No statistical significance was seen,according to the anatomical and physiological classification,in the psychological,social relationship and environmental domains.展开更多
Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is t...Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.展开更多
Diabetic macular edema (DME) is the leading cause of blindness in young adults in developed countries, affecting 12% of type 1 and 28% of type 2 diabetic patients. The gold standard DME treatment should be based on a ...Diabetic macular edema (DME) is the leading cause of blindness in young adults in developed countries, affecting 12% of type 1 and 28% of type 2 diabetic patients. The gold standard DME treatment should be based on a good control of glycemia along with control of lipids and renal function. However, despite the systemic metabolic control values being essential for patients with diabetic retinopathy (DR), it has proven to be insufficient for DME if it appears. With these patients, additional measures are needed in order to avoid the subsequent loss of vision. While laser treatment of DME has been the only valid treatment so far, it has been inadequate in chronic cases. The introduction of new treatments, such as intravitreal corticosteroids or anti-VEGF drugs, have recently shown their safety and efficacy and together with laser photocoagulation are becoming the treatments of choice in the management of DME.展开更多
Helicobacter pylori(H. pylori), a Gram-negative bacterium, is one of the most frequent causes of gastrointestinal infections worldwide. It has been associated as a pathogen for the human body with many systemic diseas...Helicobacter pylori(H. pylori), a Gram-negative bacterium, is one of the most frequent causes of gastrointestinal infections worldwide. It has been associated as a pathogen for the human body with many systemic diseases, including different eye diseases. We will focus on a specific eye disease called idiopathic central serous chorioretinopathy(ICSCR). This disease is characterized by a serous detachment of the neurosensory retina in the macular region, which affects the vision to different degrees. Currently, the pathophysiology of ICSCR is not clear and there is no effective treatment. However, several potential risk factors have been elucidated. One of the factors that has more frequently been associated with ICSCR is stress. As H. pylori was identified as a possible etiological factor for occlusive arterial diseases in young people who were particularly stressed, it was thought that H. pylori might also be present in ICSCR. Therefore, some physicians started to test its presence in patents with ICSCR. If H. pylori happened to be associated with ICSCR, the treatment of gastrointestinal infection could also improve visual symptoms and help to remediate this eye disease. Although H. pylori is highly prevalent in the general population, a true cor-relation seems to exist. We present a review on the relationship between ICSCR and H. pylori.展开更多
AIM:To study eyes with extraocular dissemination(EORB),with the following aims:first to establish the mean lag period and to understand various reasons for delayed presentation,second to study their imaging profiles a...AIM:To study eyes with extraocular dissemination(EORB),with the following aims:first to establish the mean lag period and to understand various reasons for delayed presentation,second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.·METHODS:Prospective study of clinical and imaging features of EORBs(stage Ⅲ and Ⅳ International Retinoblastoma Staging System) presenting to a tertiary eye care centre.Histopathological features of eyes enucleated after receiving neoadjuvant chemotherapy were analyzed.A pictorial illustration of the varied imaging profile of EORB was also presented.·RESULTS:Over a period of one year,97 eyes were diagnosed with retinoblastoma;32 children(36 eyes)(37.1%) had EORB.Mean age 3.6±1.9 years,71.9% males,71.9% unilateral,3.1% with positive family history and40.6% with metastasis.On imaging,there was extrascleral involvement in 22.2%,involvement of orbital part of optic nerve in 33.3%,involvement of central nervous system in 27.8% and orbital wall involvement in2.9% eyes.On histopathological analysis of eyesenucleated after neoadjuvant chemotherapy,25.0% had no residual viable tumour tissue and rest all tumours were poorly differentiated.·CONCLUSION:There are very few human malignancies where definitive treatment is started without any confirmed histopathological diagnosis and imaging plays an important role in diagnosis and appropriate staging of the disease.Chemotherapy has a variable effect on EORB,75.0% of eyes with EORB had residual viable tumour tissue when enucleated after receiving neoadjuvant chemotherapy.展开更多
·AIM: To obtain baseline knowledge about the current use of intra-arterial chemotherapy(SSOAIC) in centers worldwide.·METHODS: A survey including questions about the use of SSOAIC was emailed to retinoblasto...·AIM: To obtain baseline knowledge about the current use of intra-arterial chemotherapy(SSOAIC) in centers worldwide.·METHODS: A survey including questions about the use of SSOAIC was emailed to retinoblastoma experts.·RESULTS:Seventy-nine(response rate 69.9%) doctors from 63 centers in 35 countries responded. Thirty-one centers from 19 countries use SSOAIC. Twelve performed more than 50 procedures. Melphalan is the most commonly used drug but 15 centers use more than one drug. First line therapy for advanced unilateral disease is the most common use of SSOAIC(74.2%). Centers with larger experience(>50 applications) were less likely using melphalan alone(P =0.06) and significantly more likely using SSOAIC in more situations such as second line in preference to radiotherapy P =0.05. Nineteen(61.2%)stated that SSOAIC improved their results and 21(77.8%)reported less toxicity compared to other treatments.Three centers reported that SSOAIC did not improve their results. There were regional variations in the use of SSOAIC which is used more frequently as secondary treatment in Europe compared to the USA and Japan.Ten centers identified cost is the major limiting factor for SSOAIC.· CONCLUSION: SSOAIC is used in an increasing number of centers worldwide with regional variations.Centers with more experience in SSOAIC use it in more situations including other drugs than melphalan. The majority of the centers using this technique reportedimproved results and few complications.展开更多
● AIM: To compare the efficacy, tolerability and safety of bromfenac 0.09%, nepafenac 0.1% or diclofenac 0.1% for the prophylaxis of the cystoid macular edema(CME) after phacoemulsification.● METHODS: Group sequenti...● AIM: To compare the efficacy, tolerability and safety of bromfenac 0.09%, nepafenac 0.1% or diclofenac 0.1% for the prophylaxis of the cystoid macular edema(CME) after phacoemulsification.● METHODS: Group sequential observational comparative study. After phacoemulsification, patients received two months for topical treatment of either diclofenac sodium, bromfenac or nepafenac. All patients received concomitant topical tobramycin 0.3% and topical prednisolone 1%. We measured CME using optical coherence tomography(OCT) central foveal thickness, macular thickness and total macular volume.● RESULTS: We enrolled 243 patients from January to June 2015, and 35% received diclofenac, 32.9% bromfenac and 32.1% nepafenac. When we compared pre-operative to three weeks to two months, bromfenac was more effective in reducing foveal volume(21.3 and 35.4 mm3, respectively), compared with the diclofenac(1.3 and 11.5 mm3, respectively), and the nepafenac group, became more edematous 6.4 and 5.3, respectively. Totally 133 patients completed the post-surgical satisfaction questionnaire. Patients complained of eye stickiness in 13.8% whom we gave nepafenac, versus 10.3% whom we gave diclofenac sodium, and in 0 whom we gave bromfenac.● CONCLUSION: Bromfenac is the best tolerated and is more effective than diclofenac and nepafenac in reducing CME after phacoemulsification.展开更多
Diabetic retinopathy (DR) is a complication of diabetesmellitus thatappears in the retina. Clinitians use retina images to detect DR pathologicalsigns related to the occlusion of tiny blood vessels. Such occlusion bri...Diabetic retinopathy (DR) is a complication of diabetesmellitus thatappears in the retina. Clinitians use retina images to detect DR pathologicalsigns related to the occlusion of tiny blood vessels. Such occlusion brings adegenerative cycle between the breaking off and the new generation of thinnerand weaker blood vessels. This research aims to develop a suitable retinalvasculature segmentation method for improving retinal screening proceduresby means of computer-aided diagnosis systems. The blood vessel segmentationmethodology relies on an effective feature selection based on SequentialForward Selection, using the error rate of a decision tree classifier in theevaluation function. Subsequently, the classification process is performed bythree alternative approaches: artificial neural networks, decision trees andsupport vector machines. The proposed methodology is validated on threepublicly accessible datasets and a private one provided by Hospital Sant Joanof Reus. In all cases we obtain an average accuracy above 96% with a sensitivityof 72% in the blood vessel segmentation process. Compared with the state-ofthe-art, our approach achieves the same performance as other methods thatneed more computational power.Our method significantly reduces the numberof features used in the segmentation process from 20 to 5 dimensions. Theimplementation of the three classifiers confirmed that the five selected featureshave a good effectiveness, independently of the classification algorithm.展开更多
INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration...INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration cytology(FNAC)as a diagnostic modality for RB has been controversial,mainly due to concerns of tumor dissemination and extra-ocular spread[1-2].Although the majority of RB cases can be diagnosed without the need for any invasive procedure。展开更多
Dear editor,Globe luxation is defined as complete prolapse of the eyeball outside the orbital cavity with eyelids closed behind the eyeball.Broadly,globe luxation can be categorized as traumatic,spontaneous or volunta...Dear editor,Globe luxation is defined as complete prolapse of the eyeball outside the orbital cavity with eyelids closed behind the eyeball.Broadly,globe luxation can be categorized as traumatic,spontaneous or voluntary;males are affected more than females with an average age of 30 years.[1]Traumatic globe luxation is quite rare in children,with most cases reported in the adult age group.Orbital fracture comprises 5%to 25%of all facial fractures in the paediatric age group.[2]In cases with luxation of globe,immediate reposition is crucial for globe and vision salvage.We describe the clinical features,evaluation,and management of globe luxation present at birth following normal vaginal delivery conducted elsewhere.展开更多
Transcorneal Electrical Stimulation (TES) was applied to a group of volunteer patients suffering from Retinitis Pigmentosa (RP), in order to investigate the effect of TES in Visual Acuity (VA). 28 partial blind patien...Transcorneal Electrical Stimulation (TES) was applied to a group of volunteer patients suffering from Retinitis Pigmentosa (RP), in order to investigate the effect of TES in Visual Acuity (VA). 28 partial blind patients with diagnosis of classic RP, Usher syndrome I and/or II were stimulated transcornealy, during a period of 52 weeks using a non conventional waveform, only in the lowest visually capable eye. The proposed waveform has been modeled from the natural response of human retina and delivered by means of an adaptive generator designed and built for tissue stimulation. Statistical results show the improvement of average VA or at least the contention of the disease natural progress. Categorized analysis of results indicates the same effect that if the age of patients, time since diagnosis and genetic disorder variation (classic RP, Usher syndrome I and/or II) are considered, in this case clinical and electrophysiological follow-up parameters were statistically analyzed in order to know the effect of TES. General results yield an improvement of 48.15% in the average of VA for stimulated eyes against an average degreasing of -8.06% in the same scale, with respect to their basal condition before the start of the experiment.展开更多
In patients with lagophthalmos due to eyelid trauma,it is imperative to ensure adequate closure of the eye to protect the ocular surface.Sometimes it is difficult to surgically close eyelids by conventional methods of...In patients with lagophthalmos due to eyelid trauma,it is imperative to ensure adequate closure of the eye to protect the ocular surface.Sometimes it is difficult to surgically close eyelids by conventional methods of tarsorrhaphy,such as intermarginal suture tarsorrhaphy,Week’s tarsorrhaphy,and tongue-in-groove tarsorrhaphy.We need intact eyelid tissues to perform these procedures and might not be possible in patients with severe lagophthalmos due to lost/damaged eyelid tissues either due to deficient length of tissues or increased tension at the wound site,which can result in surgical failure.[1]展开更多
Dear Editor,Continuous curvilinear capsulorhexis is an essential part of modern cataract surgery,as it safely enables phacoemulsification procedures and permits a stable intraocular lens(IOL)bag implantation.Intumesce...Dear Editor,Continuous curvilinear capsulorhexis is an essential part of modern cataract surgery,as it safely enables phacoemulsification procedures and permits a stable intraocular lens(IOL)bag implantation.Intumescent white cataracts with a hard nucleus and a liquefied cortex have been categorized as type I.展开更多
Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans...Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.展开更多
Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe...Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.展开更多
AIM:To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection.· METHODS:Eightee...AIM:To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection.· METHODS:Eighteen New Zealand white rabbits were divided into three treatment groups(groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group.The right eye was injected with the drug and the left eye received intravitreal injection of 5%dextrose water and served as control eye.The doses delivered to each group were 0.1 mg/0.1 mL,1 mg/0.1 mL and 10 mg/0.1 mL.Simultaneous,bilateral,dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection(baseline) and after 7,14,21 and 28 d,followed by enucleation for histological examination.· RESULTS:Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3(Kruskall-Wallis test,P=0.000).By day 7,no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3,consistent with severe damage due to retinal toxicity.Light microscopy revealed no significant histopathological changes in the group 1,while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases.· CONCLUSION:Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.展开更多
Background: We report the use of intravitreal bevacizumab as an option for the treatment of chronic or recurrent central serous chorioretinopathy (CSC). Methods: Eight eyes with chronic or recurrent CSC received intra...Background: We report the use of intravitreal bevacizumab as an option for the treatment of chronic or recurrent central serous chorioretinopathy (CSC). Methods: Eight eyes with chronic or recurrent CSC received intravitreal bevacizumab (1.25 mg/0.05 cc) and underwent best corrected visual acuity (VA), optical coherent tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG) before, and one, three and six months after treatment. Results: All patients showed improvement in visual acuity, fluorescein angiographic leakage, choroidal hyperpermeability and reduced or resolved neurosensory detachment following treatment. Two patients require a second dose of intravitreal bevacizumab. Conclusions: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with chronic or recurrent CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.展开更多
AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series...AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series of patients diagnosed with vitreoretinal lymphoma between 2009 and 2011 at a single center.RESULTS: Fifteen eyes in 9 patients were included. Common presenting ocular symptoms included blurred vision(78%) and worsening floaters(44%) with an average symptom duration prior to presentation of 88.4 d(range 7-365 d). Common ophthalmic exam findings were vitreous haze(89%) and subretinal lesions(56%). The average time from presentation to diagnosis was 56.3 d(range 16-180 d). All patients were diagnosedwith large B-cell lymphoma according to pathology results. Lymphoma was restricted to the eye in 33%, while 67% of patients had CNS involvement. Of the patients with secondary vitreoretinal lymphoma, 67% initially presented with CNS lymphoma while 33% initially presented with vitreoretinal lymphoma. Of the patients with CNS involvement, memory loss(67%) was the most common presenting symptom.CONCLUSION: Vitreoretinal lymphoma most commonly presents with symptoms of blurred vision and/or worsening floaters and vitreous haze on exam. The average time from presentation to diagnosis may be decreasing with increased awareness among clinicians.展开更多
<strong>Introduction:</strong> Welders are an occupational group at high risk for eye injuries. The aim of this study was to investigate the state of eye protection of metal welders in the workshops of Con...<strong>Introduction:</strong> Welders are an occupational group at high risk for eye injuries. The aim of this study was to investigate the state of eye protection of metal welders in the workshops of Conakry. <strong>Material and Methods: </strong>The study was cross-sectional, descriptive, and included 180 welders from 45 welding workshops in the city of Conakry for a period of three months. It involved all welding professionals working in an informal unit selected by the study and who had agreed to participate in the study. <strong>Results:</strong> The average age of the participants was 33.9 ± 13.4 years, with extremes of 15 and 68 years. The study found that 99% of the welders owned glasses, 27% owned face shields, and 49% owned welding masks. Goggles were used regularly by 86% of the welders but were not suitable for welding (98%). All welders had reported having had an eye injury at least once. Foreign bodies were cited in 81%, arc strike in 65%;eye burns in 61%. However, approximately 81% of welders did not have first aid kits at their work sites. <strong>Conclusion: </strong>The use of protective equipment during welding remains very low in the workshops of Conakry, which is the cause of great ocular morbidity among welders.展开更多
文摘Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible to assess the patient’s state of health, the severity of the CRS and the treatment. The aim of this study was to assess the QoL of patients with CRS in a hospital setting in Kinshasa. Methods: This was a cross-sectional analytical study conducted from June 2020 to May 2021 in the ENT service of the Kinshasa University Hospital and the Monkole Hospital Center. The study involved 113 patients aged at least 18 years, whose QOL was compared with that of a control group consisting of 100 non-patients. QOL was assessed using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire. Results: The mean age of the patients was 41.0 years (18 - 74 years) and that of the controls was 39.1 years (19 - 77 years). More than half of the participants were university graduates. The median SNOT-22 score was 44 (14 - 78) in patients and 7 (1 - 40) in controls. Compared with subjects without CRS, patients with CRS had significantly higher scores in all four domains of the SNOT-22. Around 9 out of 10 patients had a severely impaired QoL compared with 2 out of 10 controls. Considering mildly impaired QoL, we found that in the otological and sleep domains, scores were not significantly different between patients and controls. In the case of severely impaired QoL, however, only the otological domain showed a non-significant difference in scores between the two groups. Conclusion: CRS is a real public health problem in our environment and significantly alters the QoL of patients suffering from it, with repercussions on their professional productivity;hence the need for better management.
文摘Background:Living well is as important as living longer.The objective of this study is to assess quality of life(QoL)in congenital heart disease(CHD)according to current AHA/ACC anatomical and physiological classification.Methods:Cross-sectional study examining the World Health Organization QoL Bref questionnaire(WHOQoL-Bref)in consecutive outpatient CHD patients from a single unit.Results:191 CHD patients were studied.Median age was 28±13 years and 59%were male.44(23%),115(60%)and 33(17%)CHD patients showed mild,moderate and great anatomical defects respectively while 69(36%)patients were in physiological Stage A,27(14%)in Stage B,84(44%)in Stage C and 11(6%)in Stage D.No significant differences were seen in relation the anatomical classification and the different sections of the WHOQoL-Bref questionnaire.CHD patients in Stages C and D had significant lower physical domain scores than patients in the Stage A(p<0.05).However,no significant differences were seen in the psychological,social relationships and environmental domains.The binary logistic regression analysis showed that having a higher educational level was a protective factor[OR 0.32(95%CI,0.12-0.87),p=0.026]while being married or cohabit was a risk factor[OR 3.46(95%CI,1.13-10.63),p=0.030]for having a worse rated QoL.Meanwhile,having a worse functional class(NYHA≥2)[OR 3.44(95%CI,1.20-9.81),p=0.021]was associated with dissatisfaction with health.Conclusion:Patients with advanced physiological stages scored lower on the physiological domain.No statistical significance was seen,according to the anatomical and physiological classification,in the psychological,social relationship and environmental domains.
文摘Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.
文摘Diabetic macular edema (DME) is the leading cause of blindness in young adults in developed countries, affecting 12% of type 1 and 28% of type 2 diabetic patients. The gold standard DME treatment should be based on a good control of glycemia along with control of lipids and renal function. However, despite the systemic metabolic control values being essential for patients with diabetic retinopathy (DR), it has proven to be insufficient for DME if it appears. With these patients, additional measures are needed in order to avoid the subsequent loss of vision. While laser treatment of DME has been the only valid treatment so far, it has been inadequate in chronic cases. The introduction of new treatments, such as intravitreal corticosteroids or anti-VEGF drugs, have recently shown their safety and efficacy and together with laser photocoagulation are becoming the treatments of choice in the management of DME.
文摘Helicobacter pylori(H. pylori), a Gram-negative bacterium, is one of the most frequent causes of gastrointestinal infections worldwide. It has been associated as a pathogen for the human body with many systemic diseases, including different eye diseases. We will focus on a specific eye disease called idiopathic central serous chorioretinopathy(ICSCR). This disease is characterized by a serous detachment of the neurosensory retina in the macular region, which affects the vision to different degrees. Currently, the pathophysiology of ICSCR is not clear and there is no effective treatment. However, several potential risk factors have been elucidated. One of the factors that has more frequently been associated with ICSCR is stress. As H. pylori was identified as a possible etiological factor for occlusive arterial diseases in young people who were particularly stressed, it was thought that H. pylori might also be present in ICSCR. Therefore, some physicians started to test its presence in patents with ICSCR. If H. pylori happened to be associated with ICSCR, the treatment of gastrointestinal infection could also improve visual symptoms and help to remediate this eye disease. Although H. pylori is highly prevalent in the general population, a true cor-relation seems to exist. We present a review on the relationship between ICSCR and H. pylori.
文摘AIM:To study eyes with extraocular dissemination(EORB),with the following aims:first to establish the mean lag period and to understand various reasons for delayed presentation,second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.·METHODS:Prospective study of clinical and imaging features of EORBs(stage Ⅲ and Ⅳ International Retinoblastoma Staging System) presenting to a tertiary eye care centre.Histopathological features of eyes enucleated after receiving neoadjuvant chemotherapy were analyzed.A pictorial illustration of the varied imaging profile of EORB was also presented.·RESULTS:Over a period of one year,97 eyes were diagnosed with retinoblastoma;32 children(36 eyes)(37.1%) had EORB.Mean age 3.6±1.9 years,71.9% males,71.9% unilateral,3.1% with positive family history and40.6% with metastasis.On imaging,there was extrascleral involvement in 22.2%,involvement of orbital part of optic nerve in 33.3%,involvement of central nervous system in 27.8% and orbital wall involvement in2.9% eyes.On histopathological analysis of eyesenucleated after neoadjuvant chemotherapy,25.0% had no residual viable tumour tissue and rest all tumours were poorly differentiated.·CONCLUSION:There are very few human malignancies where definitive treatment is started without any confirmed histopathological diagnosis and imaging plays an important role in diagnosis and appropriate staging of the disease.Chemotherapy has a variable effect on EORB,75.0% of eyes with EORB had residual viable tumour tissue when enucleated after receiving neoadjuvant chemotherapy.
基金Supported in part by the Fund for Ophthalmic Knowledge (New York, USA)the Natali Dafne Flexer (Buenos Aires, Argentina)
文摘·AIM: To obtain baseline knowledge about the current use of intra-arterial chemotherapy(SSOAIC) in centers worldwide.·METHODS: A survey including questions about the use of SSOAIC was emailed to retinoblastoma experts.·RESULTS:Seventy-nine(response rate 69.9%) doctors from 63 centers in 35 countries responded. Thirty-one centers from 19 countries use SSOAIC. Twelve performed more than 50 procedures. Melphalan is the most commonly used drug but 15 centers use more than one drug. First line therapy for advanced unilateral disease is the most common use of SSOAIC(74.2%). Centers with larger experience(>50 applications) were less likely using melphalan alone(P =0.06) and significantly more likely using SSOAIC in more situations such as second line in preference to radiotherapy P =0.05. Nineteen(61.2%)stated that SSOAIC improved their results and 21(77.8%)reported less toxicity compared to other treatments.Three centers reported that SSOAIC did not improve their results. There were regional variations in the use of SSOAIC which is used more frequently as secondary treatment in Europe compared to the USA and Japan.Ten centers identified cost is the major limiting factor for SSOAIC.· CONCLUSION: SSOAIC is used in an increasing number of centers worldwide with regional variations.Centers with more experience in SSOAIC use it in more situations including other drugs than melphalan. The majority of the centers using this technique reportedimproved results and few complications.
文摘● AIM: To compare the efficacy, tolerability and safety of bromfenac 0.09%, nepafenac 0.1% or diclofenac 0.1% for the prophylaxis of the cystoid macular edema(CME) after phacoemulsification.● METHODS: Group sequential observational comparative study. After phacoemulsification, patients received two months for topical treatment of either diclofenac sodium, bromfenac or nepafenac. All patients received concomitant topical tobramycin 0.3% and topical prednisolone 1%. We measured CME using optical coherence tomography(OCT) central foveal thickness, macular thickness and total macular volume.● RESULTS: We enrolled 243 patients from January to June 2015, and 35% received diclofenac, 32.9% bromfenac and 32.1% nepafenac. When we compared pre-operative to three weeks to two months, bromfenac was more effective in reducing foveal volume(21.3 and 35.4 mm3, respectively), compared with the diclofenac(1.3 and 11.5 mm3, respectively), and the nepafenac group, became more edematous 6.4 and 5.3, respectively. Totally 133 patients completed the post-surgical satisfaction questionnaire. Patients complained of eye stickiness in 13.8% whom we gave nepafenac, versus 10.3% whom we gave diclofenac sodium, and in 0 whom we gave bromfenac.● CONCLUSION: Bromfenac is the best tolerated and is more effective than diclofenac and nepafenac in reducing CME after phacoemulsification.
基金This work has been funded by the research project PI18/00169 from Instituto de Salud Carlos III&FEDER funds.University Rovira i.Virgili also provided funds with Project 2019PFR-B2-61.
文摘Diabetic retinopathy (DR) is a complication of diabetesmellitus thatappears in the retina. Clinitians use retina images to detect DR pathologicalsigns related to the occlusion of tiny blood vessels. Such occlusion brings adegenerative cycle between the breaking off and the new generation of thinnerand weaker blood vessels. This research aims to develop a suitable retinalvasculature segmentation method for improving retinal screening proceduresby means of computer-aided diagnosis systems. The blood vessel segmentationmethodology relies on an effective feature selection based on SequentialForward Selection, using the error rate of a decision tree classifier in theevaluation function. Subsequently, the classification process is performed bythree alternative approaches: artificial neural networks, decision trees andsupport vector machines. The proposed methodology is validated on threepublicly accessible datasets and a private one provided by Hospital Sant Joanof Reus. In all cases we obtain an average accuracy above 96% with a sensitivityof 72% in the blood vessel segmentation process. Compared with the state-ofthe-art, our approach achieves the same performance as other methods thatneed more computational power.Our method significantly reduces the numberof features used in the segmentation process from 20 to 5 dimensions. Theimplementation of the three classifiers confirmed that the five selected featureshave a good effectiveness, independently of the classification algorithm.
文摘INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration cytology(FNAC)as a diagnostic modality for RB has been controversial,mainly due to concerns of tumor dissemination and extra-ocular spread[1-2].Although the majority of RB cases can be diagnosed without the need for any invasive procedure。
文摘Dear editor,Globe luxation is defined as complete prolapse of the eyeball outside the orbital cavity with eyelids closed behind the eyeball.Broadly,globe luxation can be categorized as traumatic,spontaneous or voluntary;males are affected more than females with an average age of 30 years.[1]Traumatic globe luxation is quite rare in children,with most cases reported in the adult age group.Orbital fracture comprises 5%to 25%of all facial fractures in the paediatric age group.[2]In cases with luxation of globe,immediate reposition is crucial for globe and vision salvage.We describe the clinical features,evaluation,and management of globe luxation present at birth following normal vaginal delivery conducted elsewhere.
文摘Transcorneal Electrical Stimulation (TES) was applied to a group of volunteer patients suffering from Retinitis Pigmentosa (RP), in order to investigate the effect of TES in Visual Acuity (VA). 28 partial blind patients with diagnosis of classic RP, Usher syndrome I and/or II were stimulated transcornealy, during a period of 52 weeks using a non conventional waveform, only in the lowest visually capable eye. The proposed waveform has been modeled from the natural response of human retina and delivered by means of an adaptive generator designed and built for tissue stimulation. Statistical results show the improvement of average VA or at least the contention of the disease natural progress. Categorized analysis of results indicates the same effect that if the age of patients, time since diagnosis and genetic disorder variation (classic RP, Usher syndrome I and/or II) are considered, in this case clinical and electrophysiological follow-up parameters were statistically analyzed in order to know the effect of TES. General results yield an improvement of 48.15% in the average of VA for stimulated eyes against an average degreasing of -8.06% in the same scale, with respect to their basal condition before the start of the experiment.
文摘In patients with lagophthalmos due to eyelid trauma,it is imperative to ensure adequate closure of the eye to protect the ocular surface.Sometimes it is difficult to surgically close eyelids by conventional methods of tarsorrhaphy,such as intermarginal suture tarsorrhaphy,Week’s tarsorrhaphy,and tongue-in-groove tarsorrhaphy.We need intact eyelid tissues to perform these procedures and might not be possible in patients with severe lagophthalmos due to lost/damaged eyelid tissues either due to deficient length of tissues or increased tension at the wound site,which can result in surgical failure.[1]
文摘Dear Editor,Continuous curvilinear capsulorhexis is an essential part of modern cataract surgery,as it safely enables phacoemulsification procedures and permits a stable intraocular lens(IOL)bag implantation.Intumescent white cataracts with a hard nucleus and a liquefied cortex have been categorized as type I.
基金Geisinger Auxiliary Fundthe Kline&Ditty Health Fund+2 种基金the National Institute of Mental Health (Grant No. R21-MH-086317)the Wounded Warrior OrganizationDepartment of Defense (W81XWH-15-1-0506) to Dr. Joseph A. Boscarino。
文摘Background: The majority of Veterans Affair(VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including posttraumatic stress disorder(PTSD), major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results: A total of 1730 subjects(55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information(n=38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors(e.g., age, gender, marital status and education).Conclusions: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
文摘Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.
文摘AIM:To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection.· METHODS:Eighteen New Zealand white rabbits were divided into three treatment groups(groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group.The right eye was injected with the drug and the left eye received intravitreal injection of 5%dextrose water and served as control eye.The doses delivered to each group were 0.1 mg/0.1 mL,1 mg/0.1 mL and 10 mg/0.1 mL.Simultaneous,bilateral,dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection(baseline) and after 7,14,21 and 28 d,followed by enucleation for histological examination.· RESULTS:Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3(Kruskall-Wallis test,P=0.000).By day 7,no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3,consistent with severe damage due to retinal toxicity.Light microscopy revealed no significant histopathological changes in the group 1,while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases.· CONCLUSION:Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.
文摘Background: We report the use of intravitreal bevacizumab as an option for the treatment of chronic or recurrent central serous chorioretinopathy (CSC). Methods: Eight eyes with chronic or recurrent CSC received intravitreal bevacizumab (1.25 mg/0.05 cc) and underwent best corrected visual acuity (VA), optical coherent tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG) before, and one, three and six months after treatment. Results: All patients showed improvement in visual acuity, fluorescein angiographic leakage, choroidal hyperpermeability and reduced or resolved neurosensory detachment following treatment. Two patients require a second dose of intravitreal bevacizumab. Conclusions: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with chronic or recurrent CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.
基金Supported by Unrestricted departmental funding from Research to Prevent Blindness(New York,NY)
文摘AIM: To assess the presenting clinical features, time from presentation to diagnosis and association with central nervous system(CNS) lymphoma in patients with vitreoretinal lymphoma.METHODS: Retrospective case series of patients diagnosed with vitreoretinal lymphoma between 2009 and 2011 at a single center.RESULTS: Fifteen eyes in 9 patients were included. Common presenting ocular symptoms included blurred vision(78%) and worsening floaters(44%) with an average symptom duration prior to presentation of 88.4 d(range 7-365 d). Common ophthalmic exam findings were vitreous haze(89%) and subretinal lesions(56%). The average time from presentation to diagnosis was 56.3 d(range 16-180 d). All patients were diagnosedwith large B-cell lymphoma according to pathology results. Lymphoma was restricted to the eye in 33%, while 67% of patients had CNS involvement. Of the patients with secondary vitreoretinal lymphoma, 67% initially presented with CNS lymphoma while 33% initially presented with vitreoretinal lymphoma. Of the patients with CNS involvement, memory loss(67%) was the most common presenting symptom.CONCLUSION: Vitreoretinal lymphoma most commonly presents with symptoms of blurred vision and/or worsening floaters and vitreous haze on exam. The average time from presentation to diagnosis may be decreasing with increased awareness among clinicians.
文摘<strong>Introduction:</strong> Welders are an occupational group at high risk for eye injuries. The aim of this study was to investigate the state of eye protection of metal welders in the workshops of Conakry. <strong>Material and Methods: </strong>The study was cross-sectional, descriptive, and included 180 welders from 45 welding workshops in the city of Conakry for a period of three months. It involved all welding professionals working in an informal unit selected by the study and who had agreed to participate in the study. <strong>Results:</strong> The average age of the participants was 33.9 ± 13.4 years, with extremes of 15 and 68 years. The study found that 99% of the welders owned glasses, 27% owned face shields, and 49% owned welding masks. Goggles were used regularly by 86% of the welders but were not suitable for welding (98%). All welders had reported having had an eye injury at least once. Foreign bodies were cited in 81%, arc strike in 65%;eye burns in 61%. However, approximately 81% of welders did not have first aid kits at their work sites. <strong>Conclusion: </strong>The use of protective equipment during welding remains very low in the workshops of Conakry, which is the cause of great ocular morbidity among welders.
