Journal of Otolaryngology and Ophthalmology of Shandong University

Effect of dry eye on refractive cataract surgery

DUAN Lian, MENG FanlanReview,DANG GuangfuGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 1-6. doi:10.6040/j.issn.1673-3770.0.2022.381

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Dry eye is an ocular surface disease characterized by tear film homeostasis imbalance due to various factors. Dry eye is often accompanied by tear film instability, elevated tear osmolality, ocular surface inflammatory damage, and ocular surface nerve sensory abnormalities. With the environmental pollution, the popularity of video terminals, and the change in lifestyle, dry eye has become one of the most common ophthalmic diseases in clinical practice significantly affecting the visual health and quality of life. The incidence of dry eye has increased annually, and more commonly affects the younger population. With the continuous development in cataract surgery technology and intraocular lenses, refractive cataract surgery has been accepted by more doctors and patients and has achieved satisfactory results. However, in clinical practice, there are still some disgruntled patients. Dry eye is an important and common reason for the reduction in satisfaction. Different interventions for dry eye in the perioperative period of patients undergoing refractive cataract surgery directly affect the accuracy of intraocular lens measurement and the stability of the postoperative refractive state. This paper reviews the incidence of dry eye in cataract patients, the risk factors for dry eye, the impact of dry eye on refractive cataract surgery, the impact of preoperative dry eye intervention on refractive cataract surgery, and therapy for postoperative patients with dry eye. This study highlights the importance of dry eye in refractive cataract surgery and the scientific and reasonable way of dealing with this condition. It is an efficient measure to improve the safety, accuracy, and patient satisfaction of refractive cataract surgery.

Prediction and stability of axial intraocular lens position after cataract surgery

SUN JiOverview,LI CanGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 7-12. doi:10.6040/j.issn.1673-3770.0.2022.237

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As the eyeball biometric technology makes progress, a key factor affecting the refractive error after cataract surgery is reflected in the position prediction of intraocular lens after cataract surgery. Some eyeball anatomical parameters reportedly influenced the postoperative prediction of the intraocular lens. Several prediction methods have been developed. However, most intraocular lenses move linearly and stabilize after surgery instead of remaining fixed in the initial position. The change in the lens position is influenced by the eye anatomy, surgical procedure, intraocular lens characteristics, capsular bag, and other related factors. The refractive changes are caused by the changes in the axial position of the intraocular lens, and its stability is crucial to the quality of the patient's vision. This study aimed to review the methods of predicting the axial position of the intraocular lens after cataract surgery and the factors related to its stability.

Effect of higher-order aberrations on visual quality after cataract intraocular lens implantation

HUANG ZiyanOverview,DUAN GuopingGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 13-18. doi:10.6040/j.issn.1673-3770.0.2021.551

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With the development of cataract surgery technology and continuous improvement in people's requirements for a better quality of life, traditional cataract surgery has been changed to refractive surgery. High-order aberrations, including spherical aberrations, comas, and trefoil aberrations, are important factors affecting visual quality—they represent different optical characteristics that could be affected by various aspects. The use of an aspheric intraocular lens improves visual quality by compensating for the spherical aberration and reducing total higher-order aberrations. To that end, the choice regarding the use of multifocal or monofocal intraocular lenses should consider the patients' demands and the preoperative evaluation. Moreover, treatments for complications regarding multifocal intraocular lenses should also be explored. We reviewed the mechanisms of higher-order aberrations, the relationship between higher-order aberrations and visual quality, and the effects of different types of intraocular lenses on high-order aberrations. This paper aimed to provide a new reference for individualized intraocular lens selection in patients with cataract in order to provide better visual quality to the patients.

Research progress on the effects of tear film stability on visual quality after phacoemulsification

LI YansongOverview,ZHU YuguangGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 19-25. doi:10.6040/j.issn.1673-3770.0.2022.157

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The incidence of dry eye disease(DED)is increasing year by year and has become one of the most common eye diseases. DED causes irregularity of the ocular surface and reduces the tear film stability with effects on the visual function and quality of life. With the aging of society, the incidence of cataracts has increased, phacoemulsification(PHACO)is one of the most successful interventions currently being undertaken in the field of medicine in the worldwide, PHACO affects the tear film stability and reduces the visual quality. Tear film instability has been associated closely with DED. During the perioperative period of cataract surgery, ocular surface diseases plays an important role in the treatment of DED, improvement of visual quality, and increase of patients's atisfaction. In the article, we review advances in the tear film effects on visual quality after PHACO.

Effects of tilt and decentration on visual quality after various intraocular lens implantations

HUANG ZiyanOverview,DUAN GuopingGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 26-31. doi:10.6040/j.issn.1673-3770.0.2021.544

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Cataract phacoemulsification and intraocular lens(IOL)implantation are currently recognized as effective treatments for cataracts. The goal of cataract surgery has changed to refractive surgery to achieve good visual quality. Postsurgical IOL decentration and tilt can increase high-order aberrations and reduce visual quality. Different IOL have diverse effects on visual quality caused by postoperative decentration and tilt due to their design and other factors. Compared to the visual quality of other types of IOL, those of aspheric and multifocal IOLs are more susceptible to decentration and tilt. This paper reviews the relevant recent literature on tilt and decentration after IOL implantation, analyzes the cause and effect of the visual quality differences between various IOLs, and highlights additional treatment options and research directions to improve the prognosis of cataract patients.

Short-term clinical outcomes of regional refractive intraocular lens implantation in patients with an angle alpha of 0.5-0.8 mm

SUN Lu, ZHANG Shunhua, WU Yuzhou, CHEN Lulu, CAO Di, GAN Linyang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 32-37. doi:10.6040/j.issn.1673-3770.0.2021.251

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Objective To evaluate and compare the effect of regional refractive intraocular lens implantation through a personalized surgical design in eyes with an angle alpha of less than or equal to 0.5 mm and 0.5-0.8 mm. Methods The patients were divided into two groups based on OPD examination before the surgery. The observation and control groups included patients with an angle alpha of 0.5-0.8 mm and less than or equal to 0.5 mm, respectively. Phacoemul-sification cataract extraction and regional refractive intraocular lens SBL-3 implantation were performed. The observation group used an individualized surgical design to determine the direction of intraocular lens placement. We compared the uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), total eye aberration, corneal aberration, and intraocular aberration within a 4 mm pupil diameter between the two groups at one month after surgery. In addition, we compared the changes in angle alpha before and after surgery between the two groups. The Mann-Whitney U test was used to analyze the data. Results The observation and control groups comprised 16 cases(16 eyes)and 17 cases(17 eyes), respectively. There was no statistical difference between the two groups of patients in terms of UDVA(P=0.286), UIVA(P=0.318), UNVA(P=0.449). High-order aberrations(P_{whole eye}=0.368,P_{cornea changes}=0.705), all intraocular aberration(P_{whole eye}=0.407,P_{cornea changes}=0.387), coma aberration(P_{whole eye}=0.957,P_{cornea changes}=0.599), intraocular clover aberration(P_{whole eye}=0.101, P_{cornea changes}=0.576), and spherical aberration(P_{whole eye}=0.785, P_{comea changes}=0.443)of the whole eye and cornea changes were not statistically significant; intraocular high-aberrations(P=0.387), intraocular clover aberration(P=0.139), all intraocular aberration(P=0.249), and coma aberration(P=0.33)were not statistically significant; intraocular spherical aberration(P=0.007)was statistically significant. There was no significant difference in angle alpha between the observation and control groups(P=0.985, P=0.890)before and after surgery. Conclusion Patients with an angle alpha of 0.5-0.8 mm can achieve the same surgical effect as that of patients with angle alpha less than or equal to 0.5 mm, by rotating the lens SBL-3 to make the visual axis land in the distal region.

Current status of comprehensive pathway management atrial fibrillation before cataract surgery: a cross-sectional survey

LI Aijun, CUI Xiaomei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 38-44. doi:10.6040/j.issn.1673-3770.0.2022.186

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Objective To investigate the status of comprehensive pathway management of atrial fibrillation and stroke cognition in a pre-cataract atrial fibrillation population, analyze the associated risk factors, optimize and promote comprehensive pathway management, and prevent and reduce the risk of stroke. Methods From June 2021 to March 2022, a self-made questionnaire on the comprehensive pathway management of atrial fibrillation and stroke cognition was provided to patients with atrial fibrillation before cataract surgery. The CHA2DS2-VASc score was used for statistical analysis using the SPSS 22.0 statistical software. Results We distributed 133 self-made questionnaires on comprehensive pathway management of atrial fibrillation and stroke cognition, and recovered 133 valid responses; the effective rate was 100%. The age of the investigated preoperative atrial fibrillation population was 60-95 years old,(average age: 76.83±7.452 years), and the prevalence rate of atrial fibrillation was 1.44%. The number of patients with atrial fibrillation increased with age, with more men than women. The awareness rate of comprehensive pathway management and the stroke awareness rate in the pre-cataract atrial fibrillation population was 36.09%, and patients who followed the comprehensive pathway management accounted for 12.03%. The anticoagulation/antiplatelet treatment, rhythm control treatment, and stroke rates were 36.09%, 64.66%, and 11.28%, respectively, while 61.65% of the patients with atrial fibrillation before cataract surgery had concomitant diseases, and 24.06% had two or more concomitant diseases simultaneously. Among 133 patients with atrial fibrillation, 66.17% had unsatisfactory disease control, 59.40% had unhealthy lifestyles, and 54.88% had bad habits. High-risk patients accounted for 73.68% in the CHA2DS2-VASc score. Conclusion Among elderly individuals who experience atrial fibrillation before cataract surgery, along with poor awareness of comprehensive management of atrial fibrillation, lack of knowledge about stroke, low rate of early anticoagulation treatment after the identification of atrial fibrillation, many concomitant diseases and unsatisfactory control, unhealthy lifestyle and bad habits are major and potential risk factors for stroke. Cataract and atrial fibrillation patients with a history of stroke who do not follow the comprehensive pathway management are at high risk of re-stroke. Health education on atrial fibrillation cognition in pre-cataract patients with atrial fibrillation should be reinforced to guide optimization and promote comprehensive pathway management strategies.

Effect of brimonidine tartrate 0.2% on visual quality after phaco and extended depth of focus intraocular lens implantation with dysphotopsia under mesopic condition

YU Tengfei, LI Yansong, LIU Zhen, ZHOU Weiwei, ZHU Yan, ZHU Yuguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 45-50. doi:10.6040/j.issn.1673-3770.0.2022.220

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Objective To investigate the effect of brimonidine tartrate 0.2% ophthalmic solution on visual quality after phaco and extended depth of focus intraocular lens(EDOF IOL)implantation with dysphotopsia under mesopic conditions. Methods This prospective non-randomized study enrolled 21 eyes with dysphotopsia from 21 age-related cataract patients who underwent phacoemulsification and EDOF IOL implantatiosn. The pseudophakic eye was topically administered bromonidine tartrate 0.2% at 1 month follow-up after EDOF IOL implantation. Before and 2 hours, 4 hours after brimonidine tartrate drops was administered topically. Under mesopic conditions, OPD-Scan III was used to measure the objective visual quality, including the strehl ratio(SR), higher-order aberrations(HOA), spherical aberration(SA), coma and trefoil aberration. Intraocular pressure(IOP)was further measured with a non-contact tonometer. The pupil size was evaluated under mesopic conditions. Uncorrected distance visual acuity(UDVA)and the best corrected distance visual acuity(CDVA)were measured using a high-contrast projected logMAR chart. The Visual Functioning-14(VF-14)scale was used to assess visual functioning and vision-related functional impairment. Results Significant differences were observed in ocular HOA, SA and Trefoil, as well as in optical quality parameters(all P<0.05)after brimonidine tartrate 0.2% administration compared to baseline,. The visual quality improved and reached its optimum value 2 h after 0.2% brimonidine 0.2% administration, which lasted beyond 4 h after administration. The ocular Coma after administration did not significantly differ(P=0.570). Significant differences were observed in the mesopic pupil size at 2 and 4 hours after brimonidine administration compared with baseline(P<0.001). The mesopic pupil size reached its minimum value 2 h after brimonidine administration. IOP reduction was observed at 2 and 4 hours after brimonidine administration, showing significant differences compared with the baseline IOP(P<0.001). UDVA and CDVA did not significantly differ after brimonidine administration(P=0.051,P=0.063). The VF-14 scale demonstrated that symptoms of glare or halos could be eliminated after brimonidine administration in 67% of pseudophakic eyes, and was alleviated in 24% and did not improve in 5%. Conclusion Brimonidine tartrate 0.2% ophthalmic solution exerts an antimydriatic effect under mesopic conditions in patients with EDOF IOL implantation. Brimonidine tartrate 0.2% may be applied to improve night visual quality in pseudophakic eyes through reducing ocular HOA, SA and Trefoil, increasing SR, and alleviating symptoms of glare or halos in pseudophakic eyes.

Retinal detachment with concurrent annular fibrous hyperplasia around the ciliary body after congenital cataract surgery: a case report and literature review

YANG Xuepeng, SHI Long, CUI Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 51-55. doi:10.6040/j.issn.1673-3770.0.2022.370

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Objective To report the clinical features and treatment of retinal detachment, combined with annular fiber hyperplasia around the ciliary body, in a patient who underwent congenital cataract surgery. We also reviewed the pathological mechanism of its formation. Methods The diagnosis and treatment of this case were reviewed, and the clinical file and related literature were reviewed. Results The intraocular lens was removed intraoperatively, and a vitrectomy was performed. Silicone oil was injected after stripping and removing the annular proliferator to reset the retina. After three months, the silicone oil was removed, and the intraocular lens was suspended. Then the patient's retina was flattened, and the intraocular pressure normalized. Conclusion Retinal detachment is a severe complication of congenital cataract surgery. Patients with annular fibrous hyperplasia around the ciliary body may present with chronic hypotony and corneal zonal degeneration. Surgical management should aim to maintain intraocular pressure and improve visual acuity.

Enterococcus faecalis endophthalmitis after cataract surgery: a case report and literature review

LI Man, WANG Yanling, ZHAO Lu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 56-59. doi:10.6040/j.issn.1673-3770.0.2021.187

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Objective To analyze the risk factors and clinical characteristics of Enterococcus faecalis endophthalmitis after cataract surgery and provide information for inproring diagnosis and therapy. MethodsThe medical records of a 76yearold patient diagnosed with Enterococcus faecalis endophthalmitis after cataract surgery in our hospital were reviewed.ResultsThe patient underwent a vitrectomy, and the bestcorrected visual acuity of the affected eye recovered to 0.6 (standard logarithmic visual acuity chart) one week later. ConclusionEntercococcal faecalis endophthalmitis is characterized by rapid onset and deterioration. Careful attention should be paid to the clinical condition of the patient during diagnosis and treatment. Accurately estimating the clinical course of the disease and adopting appropriate treatment as soon as possible can improve the prognosis.

Surgical treatment of a cataract complicated by anti-glaucoma surgery in an adult patient with Blau syndrome

SHI Boying, LIANG Hao, LI Yihong, TANG Dongyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 60-65. doi:10.6040/j.issn.1673-3770.0.2021.396

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Objective To observe the effect of surgical treatment of an adult patient with BLAU syndrome diagnosed in the past 11 years who developed a variety of ocular lesions successively, providing guidance and reference for standardized diagnosis and treatment, and perioperative management. Methods This is a case report of 1 adult BLAU syndrome patient who, in the course of the disease, developed binocular uveitis, binocular secondary angle-closure glaucoma, and binocular concurrent cataract. In 2016 his left eye received a glaucoma valve tube implantation, allograft sclera transplantation, anterior chamber remodeling, and pupil reconstruction. In 2020, phacoemulsification of the left eye combined with intraocular lens implantation and peri-iridectomy were performed. In this paper an analysis and summary of the clinical diagnosis, treatment conception and perioperative management of concurrent cataracts in a patient with Blau syndrome is presented. Results Three and six months after the operation, the patient's visual acuity improved significantly, her intraocular pressure returned to normal, the anterior chamber was deep, the peri-iris incision was smooth, and the intraocular lens was in the right position. Conclusion Ocular lesions of patients with Blau syndrome require early and continuous observation and monitoring. After timely, standardized, and well-considered diagnosis and treatment, patients can maintain enough vision to sustain their quality of life.

A case of oculocutaneous albinism combined with bilateral complicated cataract and literature review

REN Qing, ZHANG Feng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 66-69. doi:10.6040/j.issn.1673-3770.0.2022.185

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Objective This study aimed to report a case of phacoemulsification and one-stage intraocular lens(IOL)implantation in a patient with oculocutaneous albinism(OCA), complicated with bilateral cataracts. Methods A 66-year-old male patient with OCA presented with a half-year history of progressive decline of binocular vision. After a general physical examination, visual acuity testing, intraocular pressure testing, slit lamp examination, ophthalmic B-ultrasound, other ophthalmic auxiliary examinations, and a chest computed tomography scan, the patient was diagnosed with bilateral complicated cataracts. He underwent bilateral cataract phacoemulsification and IOL implantation. His left eye was stained with an indocyanine green-assisted capsule. Results The patient's visual acuity improved after postoperative. The position of the IOL was correct, and no postoperative complication was observed in his 1-month follow-up. The patient was satisfied with the postoperative results. Conclusion The application of cataract phacoemulsification, combined with a one-stage IOL implantation, is effective in treating OCA-complicated cataracts, improving the patients' vision and quality of life. The psychological burden of OCA patients should also be considered in their diagnosis and treatment.

Effects and influencing factors of family-oriented customized sound therapy on patients with tinnitus and hearing loss

WANG Xinyi, YANG Wenjie, YU Wenxing, XU Yanhong, HU Chunhong, MU Xiaosong, PU Xiaobing, REN Jianjun, ZHAO Yu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 70-76. doi:10.6040/j.issn.1673-3770.0.2022.327

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Objective To evaluate the efficacy of family-oriented customized sound therapy in patients with tinnitus in the absence or presence of hearing loss, and analyze the effects of related factors by sound therapy. Methods We retrieved electronic medical records from March 2019 to March 2022 from four hospitals in Sichuan province, and conducted a retrospective cohort study to analyze data on 212 patients with tinnitus who received family-oriented customized sound therapy. The demographic, hearing loss characteristics, and the tinnitus handicap inventory scores before and after treatments were extracted. Binary logistic regression was used to analyze the factors associated with efficacy. Results The effectiveness of family-oriented customized sound therapy for all patients with tinnitus and hearing loss was 43.87%. Patients treated for more than 12 months(57.4%)had a significantly higher percentage of improvement than those treated for less than 12 months(31.5%)with the odds ratio(OR)of 2.93(95%CI: 1.67-5.14). The multivariable regression analysis showed that there was significant difference in treatment cycles with an OR of 2.23(95%CI: 1.09-5.00)and the association of age with an OR of 1.03(95%CI: 1.01-1.09). Conclusion Family-oriented customized sound therapy can effectively improve the clinical symptoms and annoyance in patients with tinnitus. Treatment period is the main factor associated with the efficacy of family-oriented customized sound therapy. Clinicians are thus advised to adopt family-oriented customized sound therapy for patients diagnosed with different types of hearing loss and tinnitus.

Clinical efficacy of intratympanic administration of budesonide combined with ambroxol hydrochloride in the treatment of secretory otitis media in adults

SUN Yan, YAO Hao, GU Li'an

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 77-82. doi:10.6040/j.issn.1673-3770.0.2022.312

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Objective The aim of this study was to investigate the clinical efficacy of intratympanic injection comprising budesonide combined with ambroxol hydrochloride in treating secretory otitis media in adults. Methods Sixty patients with secretory otitis media who were selected and divided randomly into three groups; the observation, control, and experimental groups, each with 20 patients. The observation group received tympanocentesis and drainage; the control group was administered intratympanic ambroxol hydrochloride, and the experimental group was administered intratympanic budesonide combined with ambroxol hydrochloride. The three groups were compared prior and after the treatment with regard to the total effective rate of disease control, level of inflammatory response-related indexes, ear function-related indexes, time taken for symptom disappearance, time taken to recover based on the examination results of the internal ear, and incurrence of any adverse reactions. Results The total effective rate of disease control in patients in the experimental group was higher than those in the observation and control groups(all P<0.001). The level of inflammatory response- and ear function-related indexes in the experimental group before and after treatment improved more significantly than those in the observation and control groups(all P<0.001); the time taken for symptom disappearance and normal recovery in the experimental group was shorter than those in the observation and control groups(all P<0.001); no significantly different adverse reactions were observed between the three groups(P=0.804). Conclusions Treatment of patients with secretory otitis media by intratympanic injection of budesonide combined with ambroxol hydrochloride can effectively control the inflammatory response, improve the inflammatory indexes and ear function, shorten the treatment time, and improve the total treatment efficiency.

Application of combining fiberoptic endoscopic evaluation of swallowing technology and swallowing quality of life scale in patients with dysphagia after chemoradiotherapy for nasopharyngeal carcinoma

REN Jia, LÜ Dan, ZHANG Yin, SUN Jiali, MA Lan, ZHENG Yitao, YANG Jimin, YU Lingyu, LI Bo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 83-88. doi:10.6040/j.issn.1673-3770.0.2021.249

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Objective to evaluate the post-chemoradiotherapy quality of life of nasopharyngeal carcinoma patients with dysphagia using the swallowing quality of life(SWAL-QOL)scale and fiberoptic endoscopic evaluation of swallowing(FEES)in order to expand the clinical applications. Methods A total of 162 nasopharyngeal carcinoma patients meeting the inclusion criteria were enrolled as the patient group in the West China Hospital from September 2019 to April 2020, who had received chemoradiotherapy and were with dysphagia problem. Additionally, 144 individuals without relevant problems were recruited as the control group. All the participants were asked to fill the SWAL-QOL scale, and 96 individuals from the patient group received further FEES examination and were graded by the Penetration-Aspiration Scale(PAS). Results Participants in patient group had significantly lower total scores(124.69±25.57)and swallowing symptoms subscale scores(58.56±9.46)than those in control group(P<0.05). In the quality of life subscale, except for the two dimensions of “fatigue” and “sleep”, the differences in other dimensions were statistically significant(P<0.05). Significant differences were presented in all other dimensions,except for “fatigue” and “sleep”. The PAS results revealed 22 patients with no penetration(22.92%), 60 patients with penetration(62.50%)and 14 patients with silent aspiration(14.58%). Significant difference was observed in the three goups, include the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire. No significant difference was presented between groups of no penetration and penetration in the total scores of SWAL-QOL and the scores of all the dimensions in the questionnaire(P>0.05). However, significant difference was observed between groups of no penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 4 dimensions in the questionnaire(P<0.05). Significant difference was observed between groups of penetration and silent aspiration in the total scores of SWAL-QOL and the scores of 2 dimensions in the questionnaire(P<0.05). Conclusion Dysphagia could affect the post- chemoradiotherapy quality of life of nasopharyngeal carcinoma patients in many aspects. Additionally, the SWAL-QOL can be used to evaluate the swallowing-related quality of life of nasopharyngeal carcinoma patients after chemoradiotherapy.

Effects of Helicobacter pylori infection on salivary pepsin concentration in patients with symptomatic laryngopharyngeal reflux

SHAO Na, ZHANG Qingqing, LIU Xiaohong, XIE Meng, GUO Ruixin, MA Sijing, LIU Haiqin, REN Xiaoyong, LUO Huanan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 89-95. doi:10.6040/j.issn.1673-3770.0.2022.350

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Objective To examine the effect of Helicobacter pylori(HP)infection on the salivary pepsin concentration in patients with symptomatic laryngopharyngeal reflux(LPR). Methods We enrolled 229 newly diagnosed outpatients with LPR who complained of non-specific symptoms, including pharyngeal foreign body sensation and repeated throat clearing. HP infection was confirmed by performing a ¹⁴C breath test, and patients in the HP-positive and HP-negative groups were prescribed HP eradication treatment(triple therapy)and proton pump inhibitors, respectively. Saliva samples were collected from all patients at initial diagnosis and post-treatment follow-ups(the HP-positive group underwent the ¹⁴C breath test at follow-up visits), and differences in the reflux symptom index(RSI)score, the reflux finding score(RFS)score, and salivary pepsin concentration were compared before and after treatment. Results There were no significant differences in total RSI and RFS scores between HP-positive and HP-negative patients with LPR(11.00 vs 9.00, P=0.077; 8.50 vs 9.00, P=0.415). However, scores for symptoms and signs such as hoarseness(P=0.005), annoying cough(P=0.016), vocal cord edema(P=0.002), and salivary pepsin concentration(94.90 μg/mL vs 45.28 μg/mL, P<0.001)were significantly higher in HP-positive patients than those in HP-negative patients with LPR. Furthermore, compared with HP-negative patients with LPR, HP-positive patients exhibited a more significant reduction in RSI and RFS scores and salivary pepsin concentrations after treatment(P=0.012,P=0.019,P=0.013,P=0.027). Conclusion HP eradication therapy could significantly reduce scores of specific symptoms and signs, as well as the salivary pepsin concentration in HP-infected patients with LPR, suggesting that HP infection plays an important role in the pathogenesis of LPR.

A case report of rhino-orbitocerebral mucormycosis

SONG Huarong, TANG Guanghua, ZHU Renliang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 96-100. doi:10.6040/j.issn.1673-3770.0.2021.582

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Objective This study aimed summarize the diagnosis and treatment experience in the case of rhino-orbitocerebral mucormycosis(ROCM)and improve the understanding of the disease. Methods The clinical case data of a patient with ROCM were retrospectively reviewed and summarized in combination with relevant literature. Results This patient's first manifestation was oral dental soreness, with poor glycemic control previous diabetes. The relevant examinations were improved, and the diagnosis of ROCM due to Rhizopus infection was confirmed by the laboratory. After controlling the underlying disease, antifungal and surgical operations, the patient final clinical outcome was death. Conclusion ROCM mostly is seen in patients with uncontrolled diabetes. Its clinical presentation is diverse, and typically involves localized cutaneous or mucosal eschar necrosis. There was no specific manifestation in the imaging examination. Pathology and fungal culture were the gold standard for diagnosis. Early diagnosis and effective treatment, such as antifungal therapy, basic disease treatment, and surgical treatment are the key to diagnosis and treatment.

Effects of subretinal hyperreflective material on the visual prognosis of anti-VEGF therapy in patients with neovascular macular degeneration

WANG Luping, KOU Fangning, WANG Hao, ZHANG Canwei, WANG Yanling, YOU Ran, WU Weizhen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 101-105. doi:10.6040/j.issn.1673-3770.0.2022.345

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Objective This study aimed to investigate the effect of subretinal hyperreflective material(SHRM)on the visual prognosis of neovascular macular degeneration(nAMD)patients with anti-vascular endothelial growth factor. Methods A total of 50 patients(50 eyes)diagnosed with nAMD were retrospectively analyzed. To determine whether SHRM affects the visual prognosis of these patients, they were divided into two groups. A total of 27 and 23 patients were grouped into the improved vision and non-improved vision groups, respectively. The effects of SHRM on the visual acuity of patients before and after treatment were evaluated by comparing the baseline and end points with or without SHRM. Results Before the treatment, no significant differences in sex, age, baseline best-corrected visual acuity(BCVA), baseline central macular thickness(CMT), baseline width and height of the SHRM, or injection times were observed between the two groups. After 12 months of treatment, CMT(P=0.027), width(P=0.036), and height(P=0.027)of SHRM were significantly lower in the improved vision group than those in the non-improved vision group. Furthermore, patients with nAMD who had baseline SHRM had a lower baseline BCVA than those without baseline SHRM(P=0.022). Patients without baseline or endpoint SHRM had significantly better endpoint BCVA than those with baseline or endpoint SHRM(P=0.015, P=0.008). Conclusion Patients that endpoint visual acuity better than baseline had lower SHRM width and height. On the other hand, patients with baseline or endpoint SHRM had poorer visual prognoses. SHRM may be used as an optical coherence tomography biomarker to assist ophthalmologists in predicting the visual prognosis of patients with nAMD.

A case report of Leber's idiopathic stellate neuroretinitis and literature review

WANG Qian, LIU Na, WANG Shaopeng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 106-110. doi:10.6040/j.issn.1673-3770.0.2021.426

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Objective To discuss the diagnosis and treatment of Leber's idiopathic stellate neuroretinitis. Methods We reviewed the medical records of a 47-year-old male patient whose main complaint was that visual acuity of the right eye had beendecreased for 1 week and had worsened over the lastday. After systemic examination, fundus fluorescein angiography, and indocyanine green angiography, the patient was diagnosed with Leber's idiopathic stellate neuroretinitis in the right eye. The patient considered the side effects of the glucocorticoids and refused treatment. Results After 3 months of follow-up, the patient's vision improved to 0.8. Conclusion The etiology of Leber's idiopathic stellate neuroretinitis is unknown. It is necessary to exclude diseases with similar clinical manifestations but clear etiology. The first line of treatment for this disease is glucocorticoid anti-inflammatory therapy, which can be combined with antibiotics, antiviral, vasodilators and traditional Chinese medicine. The disease is self-limiting and generally has a good prognosis.

The advances in application of mastoid obliteration materials in mastoidectomy canal wall down with tympanoplasty

ZHU Jun, NIE RuyaOverview,LI GuoyiGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 111-116. doi:10.6040/j.issn.1673-3770.0.2021.301

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Mastoidectomy canal wall down with tympanoplasty is an effectively surgical technique for the treatment of diseases such as middle ear cholesteatoma and chronic suppurative otitis media. It aims to completely remove the lesions, so as to achieve dry ears, promote drainage of the lesions and avoid intracranial and external complications. However, the large mastoid cavity left by the operation may cause repeated purulence of the surgical ear, regular scab removal after the operation, vestibular dysfunction related to temperature changes, infection of the surgical cavity and inconvenient wearing of invisible hearing aids, which all seriously affect the patients' quality of life. Therefore, mastoid reduction surgery is very important to improve the treatment effect of mastoidectomy canal wall down with tympanoplasty. With the advancement of medical technology and the continuous development of materials science, more and more materials are used in the clinical practice of mastoid reduction surgery by clinicians, but the way of taking various obliteration materials, the amount of tissue, whether it is easy to survive and absorb and other characteristics are different, each has advantages and disadvantages. Therefore, this article will review the application of mastoid reduction surgery in mastoidectomy canal wall down with tympanoplasty and the selection of mastoid obliteration materials.

Research progress in internet medical services of CPAP use in patients with obstructive sleep apnea hypopnea syndrome

PAN Jianyun, MO KunlanOverview,HU Yuli, LI ChaoyuGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 117-122. doi:10.6040/j.issn.1673-3770.0.2021.458

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Continuous positive airway pressure(CPAP)is the first-line treatment for obstructive sleep apnea hypopnea syndrome. However, CPAP adherence is often sub-optimal. Using Internet medical services, patients can complete related disease consultations without leaving their homes, saving them time and money and reducing outpatient flow. Different intervention devices and measures based on internet services can improve OSAHS patients' compliance with CPAP, improve patients' quality of life and improve patient satisfaction. This article sorts and summarizes relevant domestic and foreign studies of internet telemedicine equipment and intervention measures and provides a theoretical reference for the development of Internet telemedicine services.

Progress of cyclodestructive surgeries for treating glaucoma

LIU Lele, KONG XiangyunOverview,SHEN JiaquanGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(6): 123-128. doi:10.6040/j.issn.1673-3770.0.2021.323

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Cyclodestruction is a kind of anti-glaucoma surgery that reduces intraocular pressure by damaging ciliary body to supress aqueous humor production in various ways, including cyclodiathermy, cyclocryotherapy, cyclophotocoagulation, photodynamic therapy of the ciliary body, and high-intensity focused ultrasound cycloplasty. In the past, it was considered as the last means to treat glaucoma and reduce intraocular pressure because of it's severe and serious complications and an unpredictable dose-effect relationship. With the development of medical technology, cyclodestructive surgeries have been greatly improved, intraocular pressure reduction become more effective, and the complications are significantly reduced and mild. It is a great progress in the history of anti-glaucoma surgery. This article introduces the characteristics, application, and progress of each type of cyclodestructive surgries.

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