Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR). Methods Retrospective study. One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited. There were 85 males and 52 females. The average age was (60.1±8.8) years old. The duration of diabetes was (10.2±3.6) years. There were 49 patients with ipsilateral carotid artery stenosis. Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV. All eyes were treated with 23G standard three-port PPV. The average follow-up time after PPV was 11.5 months. Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas. Risk factors, such as ipsilateral carotid artery stenosis, the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV, were identified by logistic regression. Results Twenty of 137 patients (14.6%) developed postoperative NVG after PPV. Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048, 95% confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274, 95%CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG, while the application of anti-VEGF drugs was not (OR=1.426, 95%CI 0.463-4.395,P=0.536). But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=−4.370,P=0.000). Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV. The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
ObjectiveTo investigate the awareness of diabetic retinopathy (DR) prevention and treatment knowledge of diabetic patients in the community of Shenzhen, and analyze its influencing factors.MethodsA cluster random sampling method was used to select 904 patients with diabetes diagnosed in 6 community health service centers in 2 administrative districts of Shenzhen and included in this study. Questionnaire survey of patients were performed to understand their knowledge of DR prevention and treatment. The multi-factor logistic regression analysis method was used to analyze the related influencing factors of DR prevention knowledge awareness.ResultsAmong 904 patients, 144 patients (15.93%, 144/904) knew about DR prevention and treatment knowledge. The highest awareness rate were about "Diabetes can affect vision and even cause blindness" (88.60%, 801/904). The lowest awareness rate (6.20%, 56/904) were about "DR treatment methods". About "diabetes requires regular fundus examinations" and "diabetics", the awareness rate of fundus examination interval were less than 50.00%. The results of multivariate logistic regression analysis showed that gender [odds ratio (OR)=1.595], education level (OR=2.963, 3.937), monthly income level (OR=3.871, 4.675), diabetes course ≥15 years (OR=1.829), treatment measures (OR=3.318, 4.512). Whether people had DR (OR=1.605) were important factors that affected the awareness of DR prevention and treatment knowledge (P＜0.05).ConclusionsThe overall awareness of DR prevention and treatment knowledge among diabetic patients in the community of Shenzhen is relatively low. Males, low education and income levels are the main influencing factors.
ObjectiveTo observe the clinical features and visual prognostic factors of ethambutol-induced optic neuropathy (EON).MethodsA cohort study. Twenty-four inpatients (46 eyes) identified as EON in Neuro-Ophthalmology Department of Chinese PLA General Hospital from January 2014 to December 2017 were enrolled, including 14 males (26 eyes) and 10 females (20 eyes) with a ratio of 1.4/1 male/female. The average age was 42.79±15.12 years and the average weight was 62.46±12.31 kg. The average time duration between oral administration of ethambutol and occurrence of EON was 9.94±16.49 months. The average time of ethambutol duration was 7.06±11.68 months, with an average accumulative dose of 156.7±1 779.0 g and the average daily dose of 15.07±8.95 mg/(kg·d). All patients were tested with visual acuity, fundus photos, colour vision, OCT, visual field, VEP, orbital MRI and the gene of OPA1 and mitochondrial deoxyribonucleic acid (mtDNA). All the patients accepted drug withdrawal immediately after diagnosis, and were given the treatment of systemic nerve nutrition and improvement of microcirculation for 2 weeks. The time of follow-up was more than 12 months. According to whether the visual acuity (VA) in any of eyes was over than 0.1 at the last follow-up, all the patients were divided into two groups: the bad VA group (VA less than or equal to 0.1) and the better VA group (VA over than 0.1) group. The χ2 test and Fisher's exact probabilistic method test were used to compare the counting data between groups, and the Wlincox rank sum test was used to compare the measurement data. Multiple factors of VA outcome between the patients with bad or better va were analyzed by logistic regression.ResultsThirty eyes (65.2%) had VA less than or equal to 0.1 and 5 eyes (10.9%) had VA over than 0.5 at EON onset. The VA of the rest 11 eyes (23.9%) was higher than 0.1 and lower than 0.5. At the last follow-up, 20 eyes (43.5%) had VA less than or equal to 0.1 and 9 eyes (19.6%) had VA over than 0.5, the VA of the rest 17 eyes (36.9%) was higher than 0.1 and lower than 0.5. Fundus examination revealed 7 eyes (15.3%) with optic disc edema. OCT revealed significant loss of the retinal nerve fiber layer (RNFL) in the affected eyes, mainly in the temporal RNFL of the optic disc. All patients had dyschromasia, mainly in distinguishing the color of red and green. The types of visual field defect was as following: central dark spot (52.2%), diffuse visual acuity decreased (30.4%), temporal hemianopsia (17.4%). Orbital MRI revealed that 12/24 (50.0%) patients had T2 lesions with T1 enhancement in 6/24 patients (25.0%). Genetic test showed that 4 patients (16.7%) had gene mutation. Among them, there were 2 patients with OPA1 mutation, 1 with mtDNA 14340 point mutation and 1 with the mtDNA 11778 point mutation. Thirteen patients showed better VA outcomes (over than 0.1) while 11 showed bad VA outcomes after discontinuation of ethambutol. Between the better VA group and the bad VA group, there were statistically significant differences in the daily dose of ethambutol and gene mutation (P=0.031, 0.023). The daily dose was related to visual prognosis of EON while only the daily dose of more than 18 mg/(kg·d) may lead to bad VA outcomes according to the logistic analysis (95% CI 0.007-0.736, OR=0.069, P=0.027).ConclusionsEON may have OPA1 and mtDNA mutation with more bilateral eyes involved and less optic edema, which about 43.5% of the patients showed irreversible visual impact. The daily dose of ethambutol is related to the vision recovery.
Objective To investigate the factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection. Methods 292 eyes of 292 patients who were diagnosed retinopathy and suitable to receive ranibizumab intravitreal injection were enrolled in this prospective clinical study. There were 157 males and 135 females. 193 patients diagnosed with age-related macular degeneration and 99 other retinopathy patients. Mean age of patients was 62.75±13.74 years. All subjects underwent systemic and comprehensive ophthalmology examinations. The mean BCVA was 0.68±0.47 logMAR. Mean basal intraocular pressure was 18.1 mmHg (1 mmHg=0.133 kPa). All patients received intravitreal injection with 0.05 ml of ranibizumab (0.5 mg). The intraocular pressure were measured by non-contact tonometer at 10, 30, 120 minutes and 1 day after injection in a sitting position. The patients were grouped by the changes of intraocular pressure 10 minutes after injection. The elevation was more than 10 mmHg as elevation group and less than 10 mmHg as stable group. Analyze the possible related factors with elevation of intraocular pressure after ranibizumab intravitreal injection by comparing the different datum of two groups. Results The mean intraocular pressure were 23.8, 20.5, 19.9 and 17.4 mmHg at 10, 30, 120 minutes and 1 day after injection. The significant elevation level were 5.8, 2.4, 1.8, −0.7 mmHg compared with basal intraocular pressure. Among 292 eyes, intraocular pressure elevation in 68 eyes and stabled in 224 eyes. The age (Z=−0.732), gender (χ2=1.929), right or left eye (χ2=2.910), BCVA (Z=−0.039), diseases (χ2=2.088) were no significant difference between two groups (P＞0.05). The injection number (Z=−2.413, P=0.001), basal intraocular pressure (Z=−3.405, P=0.016) and elevations after injection (Z=−11.501, −8.366, −5.135, −3.568; P＜0.01) were significantly different comparing two groups (P＜0.05). By logistic regression analysis, basal intraocular pressure was positively correlated with the elevation of intraocular pressure 10 minutes after injection (B=−0.844, OR=0.43, 95%CI 0.24−0.76, P=0.004). Patients with higher basal intraocular pressure may occur intraocular pressure elevation after ranibizumab intravitreal injection much probably. Conclusions The factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection were basal intraocular pressure. The higher basal intraocular pressure, the higher risk to gain elevation of intraocular pressure after injection.
Objective To analyze the death cause of residents in Zigong from 1985 to 2009, so as to provide the government with scientific information of health strategies, and disease prevention and control. Methods The death surveillance data in Zigong residents from 1985 to 2009 were collected, and the indexes such as all death mortality rate, infant mortality rate, maternal mortality rate, disease-specific mortality rate, age-specific mortality rate, and life expectancy were analyzed. Results The all death mortality rate had fluctuation of plus or minus 6‰, and the male mortality rate was higher than the female (χ2=8 059.769, P=0.000). The six main influencing factors of the death of Zigong residents were as follows: respiratory system diseases, circulatory system diseases, tumour, injury and poisoning regarded as external cause diseases, digestive system diseases, and infectious diseases and parasitic diseases. The mortality rates of different districts were statistically different (χ2=1 643.926, P=0.000), and Fushun County was the highest among them after standardization. The curve of mortality rate in different sex and age groups was changed alike letter “U”. The mortality rate was ascending with the age in the group of over 15 years old, the ascending trend was more evident especially after 50 years old. The infant mortality declined steadily and was well controlled. The maternal mortality declined obviously. The average life expectancy for the whole city was 74.72, which showed an ascending trend. Conclusion The chronic diseases are the main death cause of residents in Zigong. The prevention and controlling of acute infectious diseases and parasitic diseases should be persistently performed for declining both incidence rate and mortality rate. The Zigong city is gradually stepping into aging society, which requires the great development of senior work.
ObjectiveTo observe the dynamic characteristics of visual acuity after vitrectomy in different sizes of idiopathic macular hole, and analyze the influencing factors.MethodsA retrospective study. From August 2016 to June 2018, 302 patients (302 eyes) with monocular idiopathic macular hole who underwent 25G vitrectomy combined with the internal limiting membrane peeling in Tianjin Eye Hospital were included in the study. There were 130 males and 172 females, with the mean age of 63.36±6.91 years. There were 158 left eyes and 144 right eyes. The logMAR BCVA was 1.13±0.45. The minimum diameter (422.92±211.73 μm) and basal diameter (835.47±366.42 μm) of macular hole and choroid thickness under fovea (244.84±60.68 μm) were measured by OCT. According to the minimum diameter, the holes were divided into small hole group (≤250 μm), middle hole group (＞250 μm and ≤400 μm) and large hole group (＞400 μm). The logMAR BCVA at 1, 3 and 6 months after surgery in 3 groups were observed. Two-factor repeated measure ANOVA was used to compare the visual acuity of the 3 groups. The generalized estimation equation (GEE) was used to analyze the influencing factors of postoperative visual recovery.ResultsOne month after surgery, all the holes were closed. One, 3 and 6 months after surgery, the logMAR BCVA were 0.33±0.25, 0.23±0.18, 0.16±0.17 in the small hole group; the logMAR BCVA were 0.46±0.25, 0.35±0.26, 0.27±0.28 in the middle hole group; the logMAR BCVA were 0.81±0.51, 0.61±0.48, 0.53±0.37 in the large hole group. Through repeated measurement variance analysis of two factors, it was found that there was an interaction between different groups and different time nodes (F=23.133, P＜0.01). All data were segmented and one-way repeated measure ANOVA was performed. The results showed that there was a statistically significant difference in visual acuity between the small hole group and the middle hole group among preoperative and 1 month after surgery (P＜0.05), while there was no statistically significant difference in visual acuity between 1, 3 and 6 months after surgery (P＞0.05). In the large hole group, among preoperative, 1 months after surgery, 3 months after surgery, the visual acuity difference was statistically significant (P＜0.05), while the visual acuity difference between 3 months after surgery and 6 months after surgery was not statistically significant (P＞0.05). The results of GEE analysis showed that hole size (χ2=4.17, P=0.04), basal diameter (χ2=7.25, P=0.01), disease course (χ2=19.26, P=0.00), and choroid thickness (χ2=4.19, P=0.04) were the influencing factors of postoperative visual acuity.ConclusionsAfter vitrectomy of macular holes of different sizes, the visual recovery trend is different. The visual recovery of small holes and middle holes is faster and basically restored at 1 month. The large holes requires a slow recovery process and stabilizes vision at 3 months. Hole size, basal diameter, course of disease and choroid thickness are the influencing factors of visual acuity recovery.
ObjectiveTo explore the application and effect of root cause analysis (RCA) in the management of adverse nursing events. MethodsNursing staff members were trained to establish the team of root cause analysis. They collected related materials of adverse nursing events in the infusion room of the Department of Pediatrics, found out the proximal causes and root causes, developed and implemented the corrective measures. RCA was carried out between January 2013 and December 2014. The efficacy was evaluated and the adverse events rate was compared before and after the practice. ResultsAfter the performance of RCA, the reporting rate of adverse events increased, the rate of adverse events decreased, and the reporting rate of potential safety problems also increased. All those changes were significant (P<0.01). ConclusionRoot cause analysis can decrease the rate of adverse nursing events, raise the reporting rate of adverse events. It is an effective guarantee to improve the nursing safety management.
ObjectiveTo investigate the factors correlated with the visual outcome of idiopathic macular holes (IMH) after vitreoretinal surgery. MethodsA total of 57 eyes of 57 patients with IMH were included. There were 43 females (43 eyes) and 14 male (14 eyes), mean age was (60.46±4.79) years. All the eyes underwent best corrected visual acuity (BCVA), slit-lamp microscope, three-mirror contact-lens and optical coherence tomography (OCT) examinations. BCVA were examined with interactional visual chart and recorded with logarithm of the minimum angle of resolution (logMAR) acuity. The minimum diameter and base diameter of macular holes and central retinal thickness (CRT) were detected by OCT. The average logMAR BCVA of 57 eyes was 0.98±0.41. The minimum diameter and base diameter of macular holes were (479.53±164.16) μm and (909.14±278.65) μm. All the patients underwent pars plana vitrectomy combined with phacoemulsification cataract extraction and intraocular lens implantation. The mean follow-up period was (173.44±147.46) months. The relationships between final BCVA and these parameters were examined by single and multiple regression analysis. The valuable influence factors were filtrated and formulated using multiple linear regression models. ResultsAt the final follow-up, the logMAR BCVA of 57 eyes was 0.44±0.31, the CRT was (158.79±86.96) μm. The final BCVA was positive related to minimum diameter of macular holes and preoperative BCVA (r=0.420, 0.448; P=0.001, 0.000), negative related to postoperative CRT (r=-0.371, P=0.004). There was no relationship between the final BCVA and base diameter of macular holes, age and follow-up (r=0.203, -0.015, 0.000; P=0.130, 0.913, 0.999). The incidence of preoperative BCVA for postoperative BCVA was bigger than preoperative minimum diameter of macular holes (P=0.008, 0.020). ConclusionThe preoperative minimum diameter of macular holes and BCVA are related to postoperative BCVA in IMH eyes.
Objective To observe the short-term intraocular pressure after 25G+ pars plana vitrectomy (PPV) and analyze the possible influencing factors in rhegmatogenous retinal detachment (RRD) and proliferative diabetic retinopathy (PDR) eyes. Methods This is a retrospective case-control study. A total of 160 patients (163 eyes) of RRD and PDR who underwent 25G+ PPV were enrolled in this study. There were 88 males (89 eyes) and 72 females (74 eyes), with the mean age of (50.37±13.24) years. There were 90 patients (92 eyes) with RRD (the RRD group) and 70 patients (74 eyes) with PDR (the PDR group). Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were performed on all the patients. The BCVA was ranged from hand motion to 0.6. The average IOP was (12.61±4.91) mmHg (1 mmHg=0.133 kPa). There were significant differences in crystalline state (χ2=9.285, P=0.009), IOP (χ2=58.45, P=0.000), history of PPV (χ2=4.915, P=0.027) and hypertension (χ2=24.018, P=0.000), but no significant difference in sex (χ2=0.314, P=0.635) and age (χ2=5.682, P=0.056) between the two groups. A non-contact tonometer has been used to measure IOP on postoperative day 1 and 3. The postoperative IOP distribution has been divided into five groups: severe ocular hypotension (≤5 mmHg), mild ocular hypotension (6 - 9 mmHg), normal (10 - 21 mmHg), mild ocular hypertension (22 - 29 mmHg), severe ocular hypertension (≥30 mmHg). Logistic regression analysis has been used to analyze the risk and protective factors. Results On the first day after surgery, there were 21 eyes (12.9%) in mild ocular hypotension, 96 eyes (58.9%) in normal, 22 eyes (13.4%) in mild ocular hypertension and 24 eyes (14.7%) in severe ocular hypertension. On the first day after surgery, there were 18 eyes (11.0%) in mild ocular hypotension, 117 eyes (71.7%) in normal, 23 eyes (14.1%) in mild ocular hypertension and 5 eyes (3.1%) in severe ocular hypertension. There was no significant difference of IOP distribution between the two groups (Z=−1.235, −1.642; P=0.217, 0.101). The results of logistic regression analysis showed that silicone tamponade was a risk factor for ocular hypertension in PDR eyes on the first day after surgery [odds ratio (OR)=15.400, 95% confidence interval (CI) 3.670 - 64.590; P＜0.001], while intraocular lens was the risk factor for ocular hypotension in PDR eyes on third day after surgery (OR=19.000, 95%CI 1.450 - 248.2; P=0.025). As for RRD eyes, the ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=3.755, 95%CI 1.088 - 12.955; P=0.036). For all eyes, silicone tamponade (OR=0.236, 95%CI 0.070 - 0.797), air tamponade (OR=0.214, 95%CI 0.050 - 0.911) and inert gas tamponade (OR=0.092, 95%CI 0.010 - 0.877) were protective factors for ocular hypotension on the first day after surgery (P=0.020, 0.037, 0.038); silicone tamponade was protective factor for ocular hypotension on the third day after surgery (OR=0.249, 95% CI 0.066 - 0.94, P=0.040); while aphakic eyes was the risk factor for ocular hypotension on third day after surgery (OR=7.765, 95% CI 1.377 - 43.794, P=0.020). The ocular hypotension before surgery was a risk factor for ocular hypertension on the third day after surgery (OR=4.034, 95% CI 1.475 - 11.033, P=0.007). Conclusions The abnormal IOP is common after 25G+ PPV with a rate from 28.3% to 31.1%. Silicone tamponade, air tamponade and inert gases tamponade are protective factors for postoperative ocular hypotension, aphakic eye is risk factor for postoperative ocular hypotension. Ocular hypotension before surgery and silicone oil tamponade are risk factors for postoperative ocular hypertension.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.