Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty. Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed. Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P < 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P < 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit. Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature, short and stubby hands and feet, language disorders and mental retardation. He developed bilateral angle closure glaucoma, ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome. The child was successfully treated by combined CO2 laser-assisted sclerectomy surgery and trabeculectomy.

Objective To investigate the efficacy of video-assisted teaching ward rounds for typical cases of oph-thalmology in clinical practice for medical undergraduates.Methods A total of 45 students from clinical medicine in Peking Union Medical College were enrolled.They were randomly divided into the experimental group(23 students)and control group(22 students).Primary angle closure glaucoma(PACG)was selected as the learning content,the experimental group was trained by video-assisted teaching ward rounds,while the control group was trained by internship in outpatient clinic.All students joined the test of typical case PACG and a ques-tionnaire survey was implemented for the experimental group.Results The average score of experimental group was higher than control group[(84.30±4.53)vs.(78.05±5.76),t＝4.05,P＜0.001].For video-assisted teaching ward rounds,in experimental group,86.9%(20/23)students believed it was more practical,95.6%(22/23)students thought it was very helpful and 91.3%(21/23)students considered it was conductive to im-prove interest of learning and clinical thinking ability.Conclusions Video-assisted teaching ward rounds improves students'understanding memory of ophthalmic typical cases,which is a potential supplement teaching method in clinical practice training of ophthalmology for medical undergraduates.

Objective To explore pediatric nurses' perceptions about patients' safety culture and identify the factors that affect patients' safety culture so as to provide evidences for improving patients' safety. Methods A cross-sectional study with convenience sampling was performed on 886 pediatric nurses working in a children's hospital from July 2016 to September 2016. Patients' safety culture was assessed using the Chinese version of the Hospital Survey on Patient Safety Culture.Results 74.1% of nurses evaluated patients' safety grade as either 'very good' or 'good'. The advantage areas with positive responsive rates higher than 75% were described as follows "feedback and communication about error", "teamwork within units" and "organizational learning and continuous improvement". Areas need to be improved with positive responsive rates lower than 50% included "staffing" and "frequency of events reported". Multiple linear regression analysis indicated that ages and overtime work of nurses were main factors that affected nurses' knowledge of patients' safety culture. The two factors explained 10.8% of total variation.Conclusions Nurses in the children's hospital has an overall high level of knowledge to patients' safety culture. However, several aspects need to be improved. It is necessary to provide positive interventions to factors that affect knowledge of safety culture.