论著

人工智能在糖尿病视神经病变诊断中的应用价值

Application of artificial intelligence in the diagnosis of diabetic optic neuropathy

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目的:通过分析基于眼底彩照的人工智能(artificial intelligence,AI)在糖尿病视神经病变(diabetic optic neuropathy,DON)中的参数特征,探索AI在DON诊断中的应用价值。
方法:收集2020年1月1日至2022年4月30日就诊于东莞东华医院、横沥医院及东莞市寮步镇社区卫生服务中心并诊断为糖尿病的患者,采集其一般信息并拍摄以黄斑为中心、图片边缘距离视盘中心超过1PD的50°眼底彩照。眼底彩照由人工智能诊断系统分析获得视盘及血管检测参数,由3-4名眼底专家阅片后分为DON(+)、DON(-)两组并作糖尿病视网膜病变(diabetic retinopathy,DR)分期诊断。比较两组间视盘、血管检测参数的差异性,并分析各项参数以及DR分期与DON发病的相关性。
结果:研究共纳入糖尿病患者526人(945眼),其中男性335人,女性191人;平均年龄为51.58±12.21岁,平均病程为5.51±5.20年。所有入组病例中,DON(+)组205眼,DON(-)740眼;根据专科医师判读结果,无DR 723眼,轻度非增殖期糖尿病视网膜病变(non-proliferrative diabetic retinopathy,NPDR)7眼,中度NPDR 184眼,重度NPDR 24眼,增殖期糖尿病视网膜病变(proliferrative diabetic retinopathy,PDR)7眼。AI检测的视盘及血管参数中,水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜静脉血管当量、B区视网膜动静脉比值在有或无DON组间存在显著差异;水平视盘直径、垂直视盘直径、弧形斑和视盘面积比、B区视网膜动脉当量在两组之间无显著差异。相关性分析发现,水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜动静脉比值与DON患病呈负相关;B区视网膜静脉血管当量、DR分期则与其呈正相关。
结论:DON患者的视杯直径、杯盘比、B区视网膜静脉血管当量等基于眼底彩照的人工智能检测参数有显著改变;DON的发病与DR病变严重程度有关。
Objective: To explore the application value of artificial intelligence (AI) in the diagnosis of diabetic optic neuropathy (DON) by analyzing the parameter characteristics of artificial intelligence (AI) based on fundus color photos.
Methods: From January 1, 2020 to April 30, 2022, patients diagnosed with diabetes were collected in Dongguan Donghua Hospital, Hengli Hospital of Dongguan and Community Healthcare Center of Dongguan Liaobu. General information was collected and 50°field vision fundus images(centered on macula and the edge of the images were more than 1PD away from the center of the optic disc) were taken. All the images were divided into DON(+) and DON(-) groups by 3-4 ophthalmologists. All the parameters were detected and analyzed by AI system, and their differences between the two groups were compared. The correlation between each parameter and DR stage with the incidence of DON was analyzed as well.
Results: A total of 526 diabetic patients (945 eyes) were included in this study, including 335 males and 191 females. The mean age was 51.58±12.21 years, and the mean disease duration was 5.51±5.20 years. All the enrolled cases were divided into DON (+) group (205 eyes) and DON (-) group (740 eyes) . According to ophthalmologists’ interpretation, 723 eyes had no DR, 7 eyes had mild nonproliferrative diabetic retinopathy (NPDR), 184 eyes had moderate NPDR, 24 eyes had severe NPDR, 7 eyes had Proliferrative diabetic retinopathy (PDR). Among the parameters detected by AI, there were significant differences in horizontal and vertical optic cup diameter, horizontal and vertical C/D, retinal vein equivalent(RVE) in zone B, and retinal arteriole-to venule ratio(AVR) in zone B between DON(+) and DON(-) groups. There were no significant differences between the two groups in horizontal and vertical optic disc diameter, arc-shaped spot-to-disc area ratio, and retinal artery equivalent(RAE) in zone B. In the analysis of risk factors, horizontal and vertical optic cup diameter, horizontal and vertical C/D, and AVR in zone B were negatively correlated with the diagnosis of DON. RVE in zone B and the severity of DR were positively correlated with the diagnosis of DON.
Conclusions: The AI detection parameters based on fundus color photography have significant changes in the diameter of optic cup, C/D and RVE in zone B in DON patients. The incidence of DON is related to the severity of DR.
论著

白内障手术患者的临床分布特点

Clinical distribution characteristics of patients admitted to hospital for surgical cataract treatment

:133-138
 
目的:了解白内障手术患者的临床分布特点,为基层医院白内障防治工作提供信息参考。方法:选取2019年1月至2019年1 2月在锦州医科大学附属第三医院眼科手术医治的白内障患者892例1 008眼。查阅相关病历资料,收集姓名、性别、年龄、手术眼别、入院时间、有无糖尿病史;术前视力、角膜内皮细胞密度、眼轴、晶状体混浊类型及白内障病因;手术方式、人工晶状体(intraocular lens,IOL)、术中并发症;术后第1天眼压、视力、眼部情况,进行统计学描述及分析。结果:入 选892例1 008眼,其中男357例401眼,女535例607眼,年龄(71.17±10.28)岁,90.7%的患者病因为年龄相关性白内障。入院时间集中在3~6月和9~12月。不同年龄段白内障患者具有各自的眼部特征。白内障类型与年龄差异有统计学意义(P<0.05),相比皮质性、后囊膜下性,核性白内障患者入院年龄偏大。白内障类型与性别、有无糖尿病史差异无统计学意义(P >0.05)。白内障患者选择最多的手术方式是超声乳化吸除术联合IOL植入术,术中并发症少,术后恢复快。结论:白内障的防治工作任重道远。手术多为年龄相关性白内障患者,入院时多年龄偏大,视力偏低,错失了手术最佳时机。不同年龄段、不同类型白内障患者具有不同的特征。超声乳化吸除术因其优势成为患者首选手术方式。
Objective: To understand the clinical distribution characteristics of cataract surgery patients and provide reference for cataract prevention and treatment in primary hospitals. Methods: From January 2019 to December 2019, 892 cataract patients (1 008 eyes) were selected from the Department of Ophthalmology, Third Affiliated Hospital of Jinzhou Medical University. Medical records were collected, including patient’s name, gender, age, surgical eye, admission time and history of diabetes, preoperative vision, corneal endothelial cell density, eye axis, phacoscotasmus type and cataract etiology, surgery method, intraocular lens, intraoperative complications, intraocular pressure, visual acuity and eye recovery on the first day after operation. These data were statistically described and analyzed. Results: A total of 892 cataract patients (1 008 eyes) were included, including 357 males (401 eyes) and 535 females (607 eyes), with the average age of (71.17±10.28) years old. The 90.7% patients cause of disease was age-related cataract. Admission time of all patients was mainly in March–June and September– December. Cataract patients of different ages had their own ocular characteristics. There was a statistically significant difference between the type of cataract and age (P<0.05). Compared with the cortical patients and posterior subcapsular patients, nuclear cataract patients were older at admission. There was no significant difference in the type of cataract between the gender and the patients with diabetes or not (P>0.05). The most frequently selected surgical method for cataract patients was phacoemulsification and intraocular lens implantation, which has the advantages of less intraoperative complications and rapid postoperative recovery. Conclusion: We still have a long way to go in the prevention and treatment of cataract. Most of the operations were performed on age-related cataract patients, and most of them were older and had low vision when they were admitted to hospital, so the optimal timing of the operation was missed. Patients of different age groups and different types of cataract have different characteristics. Phacoemulsification is the first choice because of its own advantages.
论著

眼科专科护理门诊的建立与实践

Establishment and practice of ophthalmology specialist nursing clinic

:934-941
 
目的:建立眼科专科护理门诊及探讨其实施效果。方法:调查2020年7月开展眼科护理门诊以来至2022年3月就诊的206例患者满意度和健康知识知晓率,并由医生、护士对眼科专科护理门诊的实践效果进行评价。结果:206例患者满意度较好,总分在90以上;眼科专科护理门诊针对患者问题提供个体化护理服务,进行眼部检查206人次,健康教育206人次,滴眼药水、涂眼药膏操作示范184人次,术后特殊体位指导38人次,滤过泡按摩26人次,为患者提供了多元化护理服务;同行评价显示眼科护理门诊体现了护士的专业价值;患者就诊后的健康知识知晓率明显高于就诊前,差异有统计学意义(P<0.001)。结论:眼科专科护理门诊的开设满足了患者多元化护理服务需求,提高了患者满意度和健康知识知晓率,提升了护士的自我价值感,为专科护士提供了职业发展平台,促进了眼科专科护理的发展。
Objective: To explore the establishment and effect of ophthalmology specialist nursing clinic. Methods: To Investigate the satisfaction and the awareness rate of health knowledge of 206 patients who visited ophthalmology specialist nursing clinic from July 2020 to March 2022. Doctors and nurses were investigated for evaluation of the clinic. Results: A total of 206 patients were satisfied with a total score of 90 points or more; the ophthalmology specialist nursing clinic provided individualized nursing services for patients’ problems, conducted 206 eye examinations and 206 health education, and demonstrated the operation of eye drops and eye ointment 184 times. 38 patients received post-operative special posture guidance and 26 patients received filter bubble massages. The clinic provided patients with diversified nursing services. Peer reviews showed that the ophthalmological care clinic reflects the professional value of nurses; the awareness rate of health knowledge after the patient’s visit was significantly higher than that before the visit, and the difference was statistically significant (P<0.001). Conclusion: The establishment of ophthalmology specialist nursing clinic meets patients for diversified nursing services, improves patients’ satisfaction and health knowledge awareness rate, and improves nurses’ sense of self-worth. Furthermore, it provides a career development platform for specialist nurses and promotes the development of ophthalmic specialist nursing.
论著

白内障手术患者的临床分布特点

Clinical distribution characteristics of patients admitted to hospital for surgical cataract treatment

:133-138
 
目的:了解白内障手术患者的临床分布特点,为基层医院白内障防治工作提供信息参考。方法:选取2019年1月至2019年12月在锦州医科大学附属第三医院眼科手术医治的白内障患者892例1 008眼。查阅相关病历资料,收集姓名、性别、年龄、手术眼别、入院时间、有无糖尿病史;术前视力、角膜内皮细胞密度、眼轴、晶状体混浊类型及白内障病因;手术方式、人工晶状体(intraocular lens,IOL)、术中并发症;术后第1天眼压、视力、眼部情况,进行统计学描述及分析。结果:入选892例1 008眼,其中男357例401眼,女535例607眼,年龄(71.17±10.28)岁,90.7%的患者病因为年龄相关性白内障。入院时间集中在3~6月和9~12月。不同年龄段白内障患者具有各自的眼部特征。白内障类型与年龄差异有统计学意义(P<0.05),相比皮质性、后囊膜下性,核性白内障患者入院年龄偏大。白内障类型与性别、有无糖尿病史差异无统计学意义(P>0.05)。白内障患者选择最多的手术方式是超声乳化吸除术联合IOL植入术,术中并发症少,术后恢复快。结论:白内障的防治工作任重道远。手术多为年龄相关性白内障患者,入院时多年龄偏大,视力偏低,错失了手术最佳时机。不同年龄段、不同类型白内障患者具有不同的特征。超声乳化吸除术因其优势成为患者首选手术方式。
Objective: To understand the clinical distribution characteristics of cataract surgery patients and provide reference for cataract prevention and treatment in primary hospitals. Methods: From January 2019 to December 2019, 892 cataract patients (1 008 eyes) were selected from the Department of Ophthalmology, Third Affiliated Hospital of Jinzhou Medical University. Medical records were collected, including patient’s name, gender, age, surgical eye, admission time and history of diabetes, preoperative vision, corneal endothelial cell density, eye axis, phacoscotasmus type and cataract etiology, surgery method, intraocular lens, intraoperative complications, intraocular pressure, visual acuity and eye recovery on the first day after operation. These data were statistically described and analyzed. Results: A total of 892 cataract patients (1 008 eyes) were included, including 357 males (401 eyes) and 535 females (607 eyes), with the average age of (71.17±10.28) years old. The 90.7% patients cause of disease was age-related cataract. Admission time of all patients was mainly in March–June and September–December. Cataract patients of different ages had their own ocular characteristics. There was a statistically significant difference between the type of cataract and age (P<0.05). Compared with the cortical patients and posterior subcapsular patients, nuclear cataract patients were older at admission. There was no significant difference in the type of cataract between the gender and the patients with diabetes or not (P>0.05). The most frequently selected surgical method for cataract patients was phacoemulsification and intraocular lens implantation, which has the advantages of less intraoperative complications and rapid postoperative recovery. Conclusion: We still have a long way to go in the prevention and treatment of cataract. Most of the operations were performed on age-related cataract patients, and most of them were older and had low vision when they were admitted to hospital, so the optimal timing of the operation was missed. Patients of different age groups and different types of cataract have different characteristics. Phacoemulsification is the first choice because of its own advantages.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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中山眼科



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