Risk factors associated with postoperative pain and discomfort in oculoplastic surgery with general anesthesia: a prospective study Huijing Ye,1* Rongxin Chen,1* Xiufen Lian,1* Jingxia Huang,2 Yuxiang Mao,1 Rong Lu,1 Siming Ai,1 Wenfang Ma,1 Jingyi Lin,2 Huasheng Yang,1 Wenjun Guo2 1Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China; 2Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China *These authors contributed equally to this work Purpose: To evaluate patient pain and discomfort following oculoplastic surgery performed under general anesthesia and to assess key factors associated with postoperative pain and discomfort. Methods: A prospective observational cohort study was conducted among 212 consecutive patients who underwent oculoplastic surgery performed under general anesthesia. The patients were assessed according to quantified levels of pain and discomfort postoperatively. Analgesic requests were recorded, and responses were statistically analyzed. Results: Pain and discomfort after oculoplastic surgery under general anesthesia were reported by 32.1% and 28.3% of the patients, respectively; 2.8% of the patients requested analgesic medication within 18 hours after surgery. The patients who underwent orbital decompression, secondary orbital implantation, and orbital fracture repair were more likely to develop significant postoperative pain and discomfort (P<0.001), and the patients who underwent enucleation/evisceration during orbital implantation were more likely to develop postoperative discomfort (P<0.001). The predictors of pain were smoking history, prior surgery on the operative eye, and anxiety (P<0.05), and the predictor of discomfort was anxiety (P<0.05). Conclusion: Patients undergoing oculoplastic surgery tend to experience postoperative pain and discomfort. Anxiety is a risk factor for both postoperative pain and discomfort, while smoking history and prior surgery on the operative eye may be associated with postoperative pain. Keywords: pain level, discomfort level, ophthalmic surgery, related factors, prevalence, Chinese

Background: To investigate the application effect of artificial intelligence (AI)-based fundus screening system in real-world clinical environment. Methods: A total of 637 color fundus images were included in the analysis of the application of the AI-based fundus screening system in the clinical environment and 20,355 images were analyzed in the population screening. Results: The AI-based fundus screening system demonstrated superior diagnostic effectiveness for diabetic retinopathy (DR), retinal vein occlusion (RVO) and pathological myopia (PM) according to gold standard referral. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of three fundus abnormalities were greater (all > 80%) than those for age-related macular degeneration (ARMD), referable glaucoma and other abnormalities. The percentages of different diagnostic conditions were similar in both the clinical environment and the population screening. Conclusions: In a real-world setting, our AI-based fundus screening system could detect 7 conditions, with better performance for DR, RVO and PM. Testing in the clinical environment and through population screening demonstrated the clinical utility of our AI-based fundus screening system in the early detection of ocular fundus abnormalities and the prevention of blindness.

Objective. This study is aimed at exploring the impact of eye model based on multichannel convolutional neural network (CNN) on eye plastic surgery and aesthetic effect, thus formulating methods to improve the effect of eye plastic surgery. Methods. A total of 64 patients who underwent pouch plastic surgery from January 2020 to March 2021 were selected as the research objects and were divided into observation group and control group by random number table method. The subjects in the observation group were evaluated by multichannel CNN-based eye model and doctors’ experience, while those in the control group were evaluated by doctors’ experience only, with 32 cases in both groups. Blepharoplasty, lower eyelid skin wrinkles, skin luster, and aesthetic scores were compared between the two groups. Results. The similarity between the multichannel CNN model detected shape and the actual eye shape (98.78%) was considerably higher than that of the CNN model detected shape (78.65%) ( ). After treatment, the indexes of pouch degree, lower eyelid skin wrinkle, eyelid lacrimal sulcus, skin gloss, and aesthetic score in the observation group were better than those in the control group ( ). The incidence of complications in the observation group (13%) was considerably lower than that in the control group (28%) ( ). Conclusion. The eye model based on the multichannel CNN model was helpful to improve the surgical repair and aesthetic effect of patients and can improve the occurrence of postoperative complications.

Purpose: Solitary eyelid juvenile xanthogranuloma (JXG) is extremely rare, and there is limited literature on its clinical features and treatment outcomes. Here, we present a case series and comprehensive review of the literature on patients with isolated eyelid JXG. Methods: We systematically extracted data from our institution’s records of isolated eyelid JXG cases and conducted a search for additional cases from the literature utilising the PubMed, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. Patients with JXG were analysed with respect to age, sex, clinical presentation, therapy, and outcome. Group comparisons were performed. Results: Thirty-two patients (including 13 at our institution and 19 from prior publications) were identified. The median age at first presentation was higher in current patients than in the patients from the published cases (median 9 years, range 1.2 to 47.0 years; median 2 years, range 0.5 months to 46.0 years, respectively, P = 0.014). Of the patients who had known characteristics, no significant differences were observed between the two groups in terms of sex, affected eye, eyelid site, type of cutaneous involvement, or duration of symptoms (each P > 0.05). Seventeen (54.8%) patients were male. The most common lesion location was the upper eyelid (n = 10, 62.5%). Twenty-four (75.0%) cutaneous lesions had full-thickness skin involvement; 8 (25.0%) subcutaneous masses had a chalazion-like appearance. Histologically, the JXG masses were characterised by Touton giant cells with inflammatory cells. Additionally, there was no significant difference in treatment modalities between the two groups (P = 0.072), and 24 (75.0%) patients underwent surgical excision. The overall recurrence-free survival was 3.6 to 52.8 (median 27.0) months in the current patients. For published cases with available follow-up information, there was no recurrence in 10 cases and improvement in 1 case, with a median follow-up of 9.5 months. Conclusion: Solitary eyelid JXG is a rare clinical entity and should be included in the differential diagnosis of eyelid mass lesions in patients of all age groups. Surgical excision is often selected for efficient treatment and to obtain an excisional biopsy.

Purpose: This study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C. Methods: A prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA). Results: A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period. Conclusion: Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.

Purpose: To assess the quality of vision (QOV) of patients with chronic dacryocystitis and explore the impact of endoscopic dacryocystorhinostomy (En-DCR) on patients’ QOV, with the aim of increasing clinicians’ attention to the potential QOV changes in patients with chronic dacryocystitis. Patients and Methods: Chronic dacryocystitis patients who attended the Department of Oculoplastics, Zhongshan Ophthalmic Center, Sun Yat-sen University from January 2022 to June 2022 and had En-DCR were included. The QOV was evaluated preoperatively and postoperatively using the Quick-contrast sensitivity function test (qCSF) and the OPD ScanIII comprehensive visual quality analyser, and the contrast sensitivity function (CSF), higher-order aberrations (HOAs), and modulation transfer function (MTF) data were recorded. Results: Thirty-eight patients with chronic dacryocystitis were included. QOV analysis of those with monocular chronic dacryocystitis revealed that HOAs were significantly higher in affected eyes than in contralateral eyes (P < 0.05), and CSF and MTF were significantly lower in affected eyes than in contralateral eyes (P < 0.05). One month after En-DCR, patients’ HOAs, CSF, and MTF were significantly improved (P < 0.05), and there was no statistically significant difference in the effect of intraoperative combined silicone intubation versus no intubation on QOV (P > 0.05). Conclusion: Chronic dacryocystitis can significantly affect the QOV of patients. Successful En-DCR significantly improves the CSF, HOAs and MTF, which can effectively improve the QOV.