目的：测量医联体糖尿病患者眼科随访依从性及相关的健康信念，分析其影响因素。方法：采用便利抽样的方法，使用中文版糖尿病眼科随访依从性问卷对在广州医科大学附属第二医院所辖医联体内的334例糖尿病患者进行调查。结果：仅24.3%的受访者在过去的1年中接受过眼科散瞳检查，受访者眼科随访健康信念的总体评分为3.09±0.64，其中感知的益处和威胁维度评分最高，行为线索维度评分最低。糖尿病类型、就医倾向、合并其他糖尿病并发症、医联体相关知识和家庭类型是糖尿病患者眼科随访健康信念的主要影响因素。结论：医联体糖尿病患者眼科随访健康信念处于一般水平，缺乏行为线索支持，提示在糖尿病眼部并发症筛查和防治过程中，医联体应发挥下筛上转的功能，通过对障碍因素的干预，提高辖区糖尿病患者接受眼科随访的依从性。
Objective: To measure the adherence to ophthalmology follow-up and the related health belief of patients with diabetes in medical alliance, and analyze the influencing factors. Methods: Totally 334 community-dwelling patients with diabetes mellitus were recruited in a medical alliance in Guangzhou by convenient sampling method. They were investigated by the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C). Results: Dilated fundus examination within the last year were only reported by 24.3% of respondents. The mean score of the CADEES-C was 3.09±0.64, with the highest score in perceived benefit and threat dimensions and the lowest score in behavioral cue dimension. The factors that mainly influence the adherence to ophthalmology follow-up and their related health beliefs of patients with diabetes are types of diabetes, propensity to seek treatment, other complications of diabetes, knowledge of medical alliance and family pattern. Conclusion: The adherence to ophthalmology follow-up and the related health belief of patients with diabetes are at low level with the deficiency of behavioral cues. It is suggested that medical alliance should play a critical role to improve the status quo by developing more screening and referrals.
目的：探讨2型糖尿病(type 2 diabetes mellitus，T2DM)患者二甲双胍治疗与糖尿病性视网膜病变(diabetic retinopathy，DR)的相关性。方法：回顾2015年9月至2020年8月在中日友好医院眼科就诊的1 891例T2DM患者的临床资料，对病程≥10年的324例T2DM患者的一般资料、内科疾病史、糖尿病治疗史、眼科检查和实验室血生化指标进行回顾性病例研究。根据是否接受二甲双胍治疗分为二甲双胍治疗组与非二甲双胍治疗组，根据眼底检查结果同时结合DR临床诊断标准，将DR分为无明显DR、非增生性DR及增生性DR。采用logistic多因素回归分析判断年龄、性别、糖尿病发病年龄、糖尿病病程、高血压病程、高血脂病程、吸烟年数、体重指数、胰岛素治疗及空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、尿酸和血肌酐水平对结局变量的影响。结果：在DR的发病风险方面，二甲双胍治疗组与非二甲双胍治疗组的差异无统计学意义(P>0.05)。对T2DM患者DR发生及不同分期的相关变量行单因素及多因素分析，结果显示吸烟年数、空腹血糖及肌酐均与DR发病呈正相关(均P<0.05)，而年龄与DR发病呈负相关(P<0.01)，糖尿病发病年龄与DR发生呈显著负相关(OR=0.95，95%CI：0.92~0.98，P=0.0003)。在二甲双胍治疗的T2DM患者中，二甲双胍的疗程(OR=1.02，95%CI：0.96~1.08，P>0.05)及平均剂量(OR=1.50，95%CI：0.79~2.84，P>0.05)与DR的发生与进展均无显著相关性；女性DR发生与进展的风险较男性低(P<0.05)；合并胰岛素治疗与DR发生呈明显正相关(OR=3.11，95%CI：1.59~6.07，P<0.01)；吸烟年数长、糖化血红蛋白及尿酸水平高于正常范围均与DR的发生与进展呈正相关(P<0.05)。在口服二甲双胍患者中，未使用胰岛素治疗组和联合使用胰岛素组的DR发病风险有显著差异(P<0.01)；而未口服二甲双胍患者中，胰岛素治疗与DR发生呈正相关(OR=12.43，95%CI：3.75~41.19，P<0.0001)。结论：病程10年以上T2DM患者中，二甲双胍治疗与DR发生与进展均无显著相关性。
Objective: To investigate the correlation between metformin therapy and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: The clinical data of 1 891 patients with type 2 diabetes mellitus attending the ophthalmology department of China-Japan Friendship Hospital from September 2015 to August 2020 were reviewed. A retrospective study was performed on 324 cases of these T2DM patients with disease duration ≥10 years. Medical records of all patients including general information, history of medical disease, diabetes treatment, ophthalmologic examination and blood biochemical indices were collected. According to whether metformin treatment was received or not, the patients were divided into a metformin-treated and a non-metformin-treated groups. DR is classified into non-obvious DR, non-proliferative DR and proliferative DR according to the fundus examination and the clinical diagnostic criteria of DR. Logistic multiple regression analysis was used to determine the effects of age, sex, age of DM onset, duration of DM, duration of hypertension,duration of hyperlipidemia, years of smoking, body mass index, insulin treatment and fasting glucose, glycated hemoglobin, total cholesterol, triglycerides, uric acid and blood creatinine levels on DR. Results: There was no statistically significant difference in the risk of developing DR between the metformin-treated and non-metformin-treated groups (P>0.05). Univariate and multifactorial analyses of variables related to the occurrence and different stages of DR in patients with T2DM showed that years of smoking, fasting glucose and creatinine were positively associated with DR (P<0.05), while age was negatively associated with DR (P<0.01), and age of DM onset was significantly negatively associated with DR (OR=0.95, 95%CI: 0.92 to 0.98, P=0.0003). In T2DM patients treated with metformin, neither the duration of metformin (OR=1.02, 95%CI: 0.96 to 1.08, P>0.05) nor the mean dose(OR=1.50, 95%CI: 0.79 to 2.84, P>0.05) was significantly associated with developing DR. The risk of developing DR was lower in women than in men (P<0.05); combined insulin therapy was significantly positively correlated with the risk of DR (OR=3.11, 95%CI: 1.59 to 6.07, P<0.01); long-term smoking, glycosylated hemoglobin and uric acid levels higher than normal were positively associated with DR (P<0.05). In metformin users, there was a significant difference in the risk of developing DR between the no-insulin treatment group and the combined insulin group (P<0.01); and among patients not using metformin, insulin therapy was positively associated with the occurrence of DR (OR=12.43, 95%CI: 3.75 to 41.19, P<0.0001). Conclusion: There was no significant association between metformin treatment and DR among patients with T2DM for >10 years.
在晶状体纤维细胞分化的终末阶段，细胞核、线粒体、内质网及高尔基体等膜性细胞器会发生程序性的降解，这对晶状体透明性的维持至关重要。然而，晶状体细胞器降解过程的机制尚不明确。研究晶状体细胞器的降解过程可为阐明白内障的发病机制提供理论依据，也有望为晶状体再生提供新的干预靶点。本文就晶状体细胞器降解过程及其机制进行综述。
During terminal differentiation of lens fiber cells, nuclei and other organelles experience programmed elimination.This process is essential for the maintenance of lens transparency. However, the mechanisms underlying lens organelle degradation remain unclear. Identification of the mechanisms can provide a theoretical basis for elucidating the pathogenesis of cataract and is expected to reveal new intervention targets for lens regeneration. In this review, we discuss potential mechanisms and the process of lens organelle degradation.
真菌性角膜炎是我国导致角膜盲的重要原因之一。由于部分患者在感染早期缺乏合理治疗，导致病情迁延难治，最终行角膜移植是主要的治疗手段。然而真菌感染十分顽固，术后仍有一定概率复发。因此，了解真菌性角膜炎的最新研究进展以及不同类型抗真菌药物和角膜移植手术的优劣，根据适应证选择合理的治疗方案，才能最大程度控制感染，降低真菌复发率，挽救患者视力。与此同时，对角膜移植后真菌复发的相关文献进行研究，总结其复发规律、影响因素和临床特征以及治疗手段和预后。为制订合理的、符合国情的治疗策略提供参考依据。
Fungal keratitis is one of the important causes of corneal blindness in China. Due to the lack of reasonable treatment for some patients in the early stage of infection, the disease is protracted and refractory, and eventually, corneal transplantation is the main treatment. However, Fungal keratitis infection is very stubborn, and there is still a certain probability of recurrence after surgery. Therefore, understanding the latest research advances in fungal keratitis as well as the advantages and disadvantages of different types of antifungal drugs and corneal transplantation, and choosing a reasonable treatment plan according to the indications can maximize the control of the infection, reduce the recurrence rate of the fungus and save the vision of patients. In addition, the relevant literature on fungal recurrence after corneal transplantation was studied to summarize its recurrence pattern, influencing factors and clinical features, as well as treatment means and prognosis. The purpose of this study is to provide a reference basis for formulating a reasonable treatment strategy in line with China’s national conditions.
白内障作为一种常见的眼科疾病，是全球第一位致盲眼病，目前尚无药物能够治疗，手术是唯一有效的办法。随着现代眼科手术技术的发展以及人工晶状体(intraocular lens，IOL)设计和功能的更新升级，人们对视觉质量的要求越来越高，白内障超声乳化联合IOL植入术已经从单纯的复明手术转变为个性化的屈光手术。为满足不同需求的患者术后获得较好的视觉质量，IOL经历了从单焦点到多焦点、球面到非球面的发展，还有散光型IOL和各类功能性IOL的临床应用，也为患者提供了更多的选择。充分了解不同类型IOL的优势和特点，根据患者自身眼部情况、日常用眼习惯以及需求，个性化地选择IOL植入对视觉质量的恢复和满意度起着至关重要的作用。因此本文将针对不同类型的IOL，从设计与分类、术后临床效果及适应人群进行综述，为IOL的选择提供指导建议。
As a common eye disease, cataract is the first-leading cause of blindness in the world. Currently, there is no drug to treat it, and surgery is the only effective way. With the development of modern ophthalmic surgical technology and the updating and upgrading of the design and function of intraocular lens (IOL), people have higher and higher requirements for visual quality. Cataract phacoemulsification combined with IOL implantation has transformed from a simple vision restoration to personalized refractive surgery. In order to meet the needs of patients with different needs to obtain better visual quality after surgery, IOL has experienced the development from monofocal to multifocal, spherical to aspherical, as well as the clinical application of astigmatic IOL and various functional IOLs, which also provides more choices for patients. Fully understanding the advantages and characteristics of different types of IOLs, according to the patient’s own eye conditions, daily eye habits and needs, individualized selection of IOL implantation plays a crucial role in the recovery and satisfaction of visual quality. Therefore, this article will review different types of IOLs from the aspects of design and classification, postoperative clinical effects and adaptation to the population, and provide guidance for the selection of IOLs.
猫抓病(cat scratch disease，CSD)是由巴尔通体引起的一种人畜共患病。该病不仅有多种全身表现，还可能出现各种危害视力的眼部并发症。随着家庭饲养宠物不断增多，CSD发病率逐年上升，眼科医生应重视此病。CSD的临床表现多种多样，容易误诊，与猫等宠物接触的病史、高滴度的血清免疫球蛋白G抗体是诊断的关键，聚合酶链反应也有助于诊断。由于CSD通常是免疫能力强的个体的自限性感染，因此通常不需要抗生素治疗。然而，当免疫力低或感染重时，多西环素是最常用的抗生素。
Cat scratch disease (CSD) is a zoonotic disease caused by Bartonella, which not only has a variety of systemic manifestations, but also may have various ocular complications that endanger vision. With the increasing number of pets kept at home, its incidence shows an increasing trend year by year. Therefore, ophthalmologists should pay attention to this disease. The clinical manifestations of CSD are various, which easily lead to misdiagnosis. The medical history of contact with cats and other pets and serum immunoglobulin G antibody with high titer are the key to diagnosis, and polymerase chain reaction is also helpful to diagnosis. Because CSD is usually a self-limiting infection of individuals with strong immune ability, antibiotic treatment is usually not required. However, when immunity is low or infection is severe, doxycycline is the most commonly used antibiotic.
