青光眼是全世界范围内不容忽视的致盲性眼病,其起病隐匿,视功能损害进展迅速,晚期预后不理想。长期发展且未行治疗的青光眼患者视神经呈进行性损害,引起视力急剧下降、视野不可逆性缺损,严重降低患者的生活质量。为了适应逐渐恶化的视功能,患者注视行为发生明显变化,由此在日常活动中引起步态行为随之改变,意外事故频繁发生。故目前对于青光眼的研究引起国内外广泛重视,虚拟现实技术(virtual reality,VR)作为青光眼早期诊断及康复治疗的新手段已被现代医学所尝试。本文具体阐述了青光眼的视觉损害与注视行为及运动行为间的联系,并总结了目前国内外关于VR诊断青光眼及作为康复治疗的相关研究。
Glaucoma is a blinding eye disease that cannot be ignored worldwide. Its onset is insidious, visual impairment is progressing rapidly, and the late prognosis is not ideal. Long-term untreated glaucoma patients show progressive damage to the optic nerve, causing a sharp decline in vision, irreversible visual field defects, and severely reducing the quality of life of the patients. In order to adapt to the gradual deterioration of visual function, the patient’s gaze behavior changes significantly, which causes the gait behavior to change in daily activities, and accidents occur frequently. Therefore, the current research on glaucoma has attracted wide attention in the nation and abroad,and virtual reality (VR) technology has been tried in modern medicine as a new method for early diagnosis and rehabilitation of glaucoma. This article specifically elaborates the relationship between the visual impairment of glaucoma and the gaze behavior and movement behavior, and summarizes the current domestic and foreign research on the diagnosis of glaucoma and the rehabilitation of VR technology.
目的:中重度甲状腺相关眼病内下壁骨性减压联合脂肪减压术的临床疗效观察。方法:回顾性分析25例(31眼)在浙江大学医学院附属第二医院眼科行内下壁骨性减压联合脂肪减压术治疗的甲状腺相关眼病患者,观察时间为2020年1月至2022年1月。术前所有患者均进行了眼眶CT检查,并对双眼视力、眼球突出、复视及双眼外观形态进行了测量。手术效果评价指标为:术后眼球突出度、视力和复视程度,并对相关数据进行统计和分析。结果:术后眼球突出度回退2~6 mm,平均回退(3.45±0.93)mm,切除眶内脂肪1.4~3.6 mL,平均切除(2.33±0.66)mL,外观恢复满意。4例患者术前存在复视,2例患者术后新发复视,术前已存在复视的患者,术后复视程度并未加重,新发的2例复视患者均为轻度复视。术后CT检查显示眼眶减压效果良好。结论:内下壁骨性减压与脂肪减压术联合,可以有效扩大眼眶容积,对眼球进行回纳,减少眼球突出程度,改善容貌外观,且手术切口隐蔽美观,具有较好的临床疗效果。
Objective: To observe the clinical efficacy of medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe thyroid associated ophthalmopathy (TAO). Methods: A retrospective analysis was performed on 25 patients (31 eyes) with moderate-to-severe TAO from January 2020 to January 2022 in Eye Hospital of Zhejiang University, who were treated with medial-inferior wall orbital decompression combined with fat decompression. All of patients were given orbital computed tomography to measure visual acuity, exophthalmos, diplopia and ocular appearance before operation. The preoperative and postoperative exophthalmos, visual acuity and diplopia before and after operation were taken as efficacy evaluating indicators. The related data was counted and analyzed statistically. Results: After operation, the reduction of exophthalmos was 2-6 mm, with an average of (3.45±0.93) mm, the volume of intrazonal fat-removal was 1.4-3.6 mL, with an average of (2.33±0.66) mL, with a satisfactory appearance. There were 4 cases of preoperative diplopia and 2 cases of new diplopia after operation, all of which were mild diplopia. Diplopia did not exacerbate after operation in the patients who had diplopia before operation. Conclusion: Medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe TAO can effectively expand orbital volume, reduce exophthalmos, improve appearance with a concealed beautiful surgical incision, showing its good clinical efficacy.
角膜病是眼科常见疾病,治疗主要以病因治疗为主。角膜疾病治疗不及时会发展为角膜云翳、角膜斑翳、角膜白斑甚至丧失视力。本例患者主要是一例因外伤形成角膜白斑致使视力低下,于三峡大学附属仁和医院行自体穿透性角膜移植(autologous penetrating keratoplasty,APK)的特殊病例。
Keratoconus is a common disease in ophthalmology and treatment is mainly based on etiology. Untreated corneal diseases can develop into corneal clouding, corneal macula, corneal leukoplakia or even loss of vision. This is a special case of a patient who underwent autologous penetrating keratoplasty (APK) in our hospital for low vision due to traumatic formation of corneal leukoplakia.
抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗视网膜静脉阻塞(retinal vein occlusion,RVO)继发黄斑水肿(macular edema,ME)的有效性及安全性已得到广泛证实。但抗VEGF治疗方案尚无统一标准。现行的治疗方案主要包括固定治疗方案、按需(pro re nata,PRN)治疗方案、稳定性标准驱使的按需(stabilization criteria-driven PRN)治疗方案、治疗与延长(treat and extend,T&E)方案。近年来不少研究综合比较了各个治疗方案在改善视功能、量化评估疾病活动性、调整随访频率等多个维度的表现,为临床医生提供选择抗VEGF治疗方案的参考依据。本文旨在回顾并总结近年来对抗VEGF药物治疗RVO继发ME的研究,阐述抗VEGF治疗方案的研究进展。
The efficacy and safety of anti-vascular endothelial growth factor (VEGF) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) have been widely confirmed. However, there is no unified standard for anti-VEGF treatment regimens. Current treatment regimens mainly include fixed treatment regimen, pro re nata (PRN) treatment regimen, stabilization criteria-driven PRN treatment regimen, and treat and extend (T&E) regimen. In recent years, many studies have compared different treatment regimens in composite dimensions,including improving visual function, assessing disease activity quantitatively and adjusting the follow-up frequency,to provide clinicians with a reference of choosing anti-VEGF treatment regimens. The purpose of this article is to review and summarize recent researches on anti-VEGF drugs in the treatment of ME secondary to RVO, and to clarify the research progress in the anti-VEGF treatment regimens.
暴露性角膜炎是角膜失去眼睑保护而暴露在空气中,引起角膜干燥、上皮细胞脱落进而继发感染的角膜炎症,多见于眼睑缺损、眼球突出、睑外翻、面神经麻痹、手术麻醉等。泪液的缺失、眼睑闭合不全、眼表暴露等因素皆会影响角膜健康,使其处于炎症、溃疡及穿孔的危险中。暴露性角膜炎治疗目的是去除暴露因素、保护角膜上皮和维持眼表湿润,目前常用的治疗手段有手术治疗与药物治疗,有些是暂时性的,有些是永久性的。
Exposure keratitis is an inflammation of the cornea that occurs when the cornea loses the protection of the eyelid and is exposed to air, resulting in dryness, epithelial exfoliation, and secondary infection. Most of them are found in eyelid defect, protopsis, eyelid ectropion, facial palsy, and anesthesia. Loss of tears, lagophthalmos and exposed ocular surface all affect the health of the cornea, putting it at risk of inflammation, ulceration, and perforation. The purpose of treatment is to remove exposure factors, protect the corneal epithelium and keep ocular surface moist.Currently, the commonly used treatments are surgical treatment and medical treatment, and some of them are temporary while others are permanent.
在大力发展精准医疗的时代背景下,北京大学第三医院眼科中心率先建立干眼精准医疗平台。通过规范和优化干眼诊疗流程,为患者提供个性化的治疗方案和预防指导意见,有效提高了干眼诊断的精确性与治疗的有效性,同时提升了干眼门诊接诊效能,改善了患者就诊体验。本文将从干眼精准医疗平台体系的建设内容、标准化的检查流程、个性化的诊疗方案等方面进行阐述,并结合实际临床案例,综合分析北京大学第三医院在干眼精准医疗方面进行的探索,展望干眼精准医疗平台的前景与未来。
In the era of developing precision medicine, the Ophthalmic Center of Peking University Third Hospital has taken the lead in establishing a dry eye precision medical platform. By standardizing and optimizing the diagnosis and treatment process of dry eye, this center provides personalized treatment plan and prevention guidance for patients, effectively improves the accuracy of dry eye diagnosis and the effectiveness of treatment, at the same time,improves the reception efficiency of dry eye clinic, and improves the patient’s clinic experience. In this paper, the construction content, standardized inspection process and personalized diagnosis and treatment scheme of dry eye precision medicine platform system will be described. Combined with the actual clinical cases, the exploration of the Peking University Third Hospital in dry eye precision medicine will be comprehensively analyzed, and the future of dry eye precision medical platform will be prospected.
间充质干细胞由于其独特的自我更新和多向分化能力,成为了一种替代无效的常规治疗的新兴治疗方法。间充质干细胞通过免疫调节、促修复、抗新生血管机制和细胞替代作用在眼表疾病中发挥作用,而不同来源的间充质干细胞其作用机制也不完全相同。迄今为止,已有8项注册的间充质干细胞治疗的临床试验应用于干眼、角膜烧伤、圆锥角膜等眼表疾病。
Due to its unique self-renewal and multi-directional differentiation capabilities, mesenchymal stem cells (MSCs) have become an emerging therapy that replaces of ineffective conventional options in treating multiple diseases. It plays an important role in ocular surface illnesses through a variety of functions, including immunoregulation, promoting repairing, anti-angiogenesis mechanisms, and cell replacement. MSCs from different sources have different mechanisms.So far, 8 registered clinical trials of MSCs therapy have been applied to treat dry eye, ocular burn, keratoconus and other ocular surface diseases.
血源性滴眼液是治疗干眼的一种有效的治疗方法。来源可分为自体、供体,其中供体来源又可分为成人外周血及脐带血,并以血清、富血小板血浆、血小板来源生长因子以及血小板裂解产物的形式制成。由于各种血液制品的原理及适应症不同,本文将对不同血源性滴眼液制品的制备及面临的挑战的共识问题进行解读。
Blood-based eye drops can be used effectively in the treatment of dry eyes. The sources of blood-based eye drops can be divided into autologous and donor, and donor sources can be divided into adult peripheral blood and umbilical cord blood, which are prepared in the form of serum, platelet-rich plasma, platelet-derived growth facters and platelet lysate. Due to the different principles and indications of various blood products, the consensus issues on the preparation and challenges of different blood-based eye drop products are reviewed.
干眼是以泪膜稳态丢失及伴随眼部不适症状为特征的最常见眼表疾病,泪膜不稳定、泪液高渗透性、眼表炎症及感觉神经异常为其主要病因。地夸磷索钠是一种P2Y2受体激动剂,能刺激黏蛋白及泪液分泌,其独特的作用机制为干眼的治疗开辟了新的方向,本文就地夸磷索钠近年的临床及基础研究进展作一综述。
Dry eye is one of the most common ocular surface diseases. It is characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play major etiological roles. Diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that promotes mucin and aqueous tear secretion. The unique pharmacological mechanism of diquafosol tetrasodium opens up a new direction for the medical therapies of dry eye. This article reviews the clinical therapeutic effect and research progress of diquafosol tetrasodium for the past few years.
在热带和亚热带国家,真菌性角膜炎是角膜盲的一个重要原因。随着现代医学的进展,早期真菌性角膜炎通过药物或者手术治疗后治愈率有了显著改善,但是很多真菌性角膜炎患者由于缺乏及时合理的治疗,病情变得迁延难治,预后较差。随着无数学者的努力,近年来在难治性真菌性角膜炎领域在抗真菌药物、给药方式及其他治疗方式上有了一些新的进展,目前可选的难治性真菌性角膜炎治疗方式各有特点及优劣之处。了解目前可用的抗真菌治疗方式、其适应证及不良反应等,是处理难治性真菌性角膜炎病例的必要条件。
Fungal keratitis is a significant cause of corneal blindness in tropical and subtropical countries. With the development of modern medicine, the cure rate of early fungal keratitis has been significantly improved after medical or surgical treatment. However, due to the lack of timely and reasonable treatment for many patients with fungal keratitis, the disease has become difficult to treat and the prognosis is poor. With the efforts of numerous scholars, some new advances have been made in the treatment of recalcitrant fungal keratitis in recent years, such as antifungal drugs and administration methods. At present, the treatment methods of recalcitrant fungal keratitis have their own characteristics, advantages and disadvantages. It is necessary to understand the available antifungal therapies, their indications and side effects for the treatment of recalcitrant fungal keratitis.