眼睛由屈光系统和视觉神经系统两大部分构成，是人体最重要的感觉器官之一。眼部各组织的发育或功能异常都可能造成不同程度的视力损害。目前主要通过动物实验或体外细胞培养的方法探究眼病的病理生理机制和治疗手段，但上述两种方法都存在一定的局限性。体外细胞培养不能完全反映器官的形态、结构和生化特征，而动物模型的物种和遗传背景具有异质性。近年来，随着原代组织、胚胎干细胞、诱导多能干细胞衍生的体外三维结构类器官和器官微流控芯片技术的不断发展，构建出了与在体器官的结构、功能更为相似的器官克隆模型，能够提供更敏感、定量、规模化的表型分析，更好地应用于眼的发育、生理结构、疾病机制、个性化医学诊断和治疗方法等方面的研究。目前，眼科的微流控器官芯片与类器官技术在角膜、晶状体、泪腺、视网膜结构发育和疾病模型均展现出巨大的应用潜力。
The eye is composed of refractive system and visual nervous system. It is one of the most important sensory organs of the human body. The abnormal development or function of eye tissues may cause various degrees of visual impairment. At present, the pathophysiological mechanism and treatment of eye diseases are mainly explored through animal experiments and in-vitro cell culture. However, they are of certain limitations. The in-vitro cell culture cannot fully reflect the morphological, structural and biochemical characteristics of organs, whereas the animal models are heterogeneous of species and genetic background. In recent years, with the continuous development of in-vitro three-dimensional structure organoids and organ microfluidic organ-on-a-chip technology derived from primary tissues, embryonic stem cells and induced pluripotent stem cells, organ cloning models more similar to in vivo organs in terms of the structure and function have been constructed. These models can provide more sensitive, quantitative and large-scale phenotypic analysis, and can be better applied to the research of eye development, physiological structure, disease mechanism, personalized medical diagnosis and treatment. At present, microfluidic organ-on-a-chip and organoids technologies have shown great application potential in the structural development and disease models’ construction of cornea, lens, lacrimal gland and retina.
因不同的眼部和神经性疾病，导致视觉功能严重受损，为低视力患者日常活动(如阅读及驾驶)及生活质量、心理健康带来严重的影响。人们对外界信息的感知主要来源于视觉，除威胁生命的重大疾病外，对人感官影响最大的损害当属视觉损伤。且随着人口日益老龄化，该问题日趋加重，低视力已成为目前全球范围内一个严重的公共卫生问题。目前，低视力康复发展面临着临床和科研的巨大挑战，要研发出一种能有效改善视觉功能，同时能兼顾多种功能的视障辅助技术，这需要医学、生物学、工程学、微电子学、计算机学等多学科的共同发展和相互合作。低视力康复通过为患者提供适宜的视障辅助技术，最大化利用患者的残余视力及视觉功能，改善与低视力相关的功能限制，有效改善其独立性和整体生活质量，使其独立生活、工作并融入社会成为可能。该文对经典的助视器、人工视觉(视觉假体/视觉感官替代设备)、经颅刺激及视觉生物反馈训练等视障辅助技术在低视力康复中的应用进展进行综述。
Patients with low vision are severely impaired in visual function due to different ocular and neurological disorders,which have a serious impact on their daily activities (such as reading and driving), quality of life and mental health.People's perception of external information mainly comes from vision. Expect for the life-threatening major diseases,visual damage has the greatest impact on people's senses. With the ageing of the population, the problem is getting worse, and low vision has become a serious public health problem in the world. Currently the development of low vision rehabilitation is facing a huge challenge in clinical and scientific research, to develop a visual impairment assistance technology that can effectively improve visual function while balancing multiple functions. It requires the joint development and cooperation of multiple disciplines such as medicine, biology, engineering, microelectronics, and computer science. Low vision rehabilitation provides patients with appropriate visual impairment assistance technology,maximizing the use of residual vision and visual function of patients, improving the functional limitations associated with low vision, effectively improving their independence and overall quality of life, and makes it possible for them to live, work and integrate into the society independently. This article reviews the progress in the application on visual impaired assistive technologies such as classic visual aids, artificial vision (visual prostheses/visual sensory replacement devices), transcranial stimulation and visual biofeedback training in low vision rehabilitation.
目的：探究T盒转录因子2(T-box transcription factor 2,TBX2)在葡萄膜黑色素瘤(uveal melanoma,UVM)中的表达水平、生存预后、免疫浸润相关性。方法：首先通过TIMER2.0数据库分析正常组织和肿瘤组织中TBX2表达和临床特征，从UCSC Xena数据库下载泛癌的生存数据，使用Cox比例风险模型和Kaplan-Meier曲线分析评估TBX2对预后的预测价值。然后使用cBioPortal数据库分析人源TBX2突变前后生存改变，通过BloodSpot和TIMER2.0数据库探究TBX2与癌症免疫浸润之间的相关性。癌症单细胞状态图谱和基因集变异分析(gene set variation analysis,GSVA)探究其表达与分子机制的相关性。结果： 15种肿瘤类型的TBX2 mRNA表达水平显著改变，TBX2是肾上腺皮质癌(adrenocortical carcinoma,ACC)、肾乳头状细胞癌(kidney renal papillary cell carcinoma,KIRP)、UVM典型的生存预后标志物。其突变与生存状态无明显相关性，在UVM中T淋巴细胞浸润水平提高导致不良预后风险升高。此外，在UVM中TBX2通路富集至ATP结合盒(ATP-binding cassette transporter,ABC)转运蛋白、DNA修复和损伤。结论：TBX2在UVM的生存和免疫浸润中起着关键作用，将来可能作为一种UVM预后及免疫治疗效果的预测因子。
Objective: To investigate the expression level of T-box transcription factor 2(TBX2) in uveal melanoma (UVM), the correlation between survival prognosis and immune infiltration. Methods: The expression and clinical features of TBX2in normal and tumorwere analyzed by TIMER2.0 database. The survival data of pancarcinoma were downloaded from UCSC Xena database, and the prognotic value of TBX2 was evaluated using Cox proportional risk model and Kaplan-Meier curve analysis. Then cBioPortal database was used to analyze the changes before and after TBX2 mutation survivalin human, and BloodSpot and TIMER2.0 databases were used to explore the correlation between TBX2 and cancer immune infiltration. Cancer single cell status mapping and gene set variation analysis (GSVA) were used to explore the correlation between its expression and molecular mechanisms. Results: The mRNA expression levels of TBX2 were significantly changed in 15 tumor types. TBX2 is adrenocortical carcinoma (ACC) and kidney renal papillary cell carcinoma (Kidney renal papillary cell carcinoma). KIRP and UVM are typical prognostic markers of survival. The mutation had no significant correlation with survival status, and increased T cell infiltration level in UVM led to increased risk of poor prognosis. In addition, the TBX2 pathway is enriched to the ATP-binding cassette transporter (ABC) transporters, DNA repair, and damage in UVM. Conclusion: TBX2 plays a key role in survival and immune invasion of uveal melanoma.and may be used as a predictor of UVM prognosis and immunotherapy effect in thefuture.
患者女，60岁，因“右眼前黑影飘动1月，视力下降8天”就诊。视力：右眼0.1，不能矫正；左眼0.6矫正0.9。右眼眼底见视盘周围边界清晰不规则灰白色区，并波及中心凹。视野检查：右眼对应眼底病灶的视野缺损；左眼正常。光学相干断层成像术(optical coherence tomography，OCT)显示灰白色区域椭圆体带不规则、缺失，视网膜色素上皮(retinal pigment epithelium，RPE)层见数个指状隆起。眼底自发荧光(autofluorescence，AF)示：受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影(fundus fluorescein angiography，FFA)示：早期见荧光渗漏，晚期荧光着染、蓄积。吲哚菁绿血管造影(indocyanine green angiography，ICGA)示：见以视乳头为中心，边界清晰的低荧光区。诊断：右眼急性轮状外层视网膜病变。治疗：给予抗炎和改善血循环4周，眼底灰白色环状带消失，视力明显好转。随访6个月，患者病情控制良好。
A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography (OCT) showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium (RPE) layer. Fundus autofluorescence (AF): High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography (FFA): Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography (ICGA): A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously
本文报道2例诊断为后极部肉芽肿型弓蛔虫病的患者，病例1接受糖皮质激素及玻璃体切割联合剥膜手术，术后视力明显提高；病例2因错过治疗时机，致视力丧失。提示后极部肉芽肿型眼弓蛔虫病致视网膜前膜时，眼科医生应积极给予手术治疗，改善患者视功能。
We reported two cases of posterior pole granuloma toxocariasis with different prognosis to remind ophthalmologists to attach importance to the active treatment. Two patients were diagnosed with posterior pole granuloma toxocariasis. One patient received prednisolone and pars plana vitrectomy combined with peeling of retinal membrane, and his vision was improved significantly. The other patient missed opportunity to perform surgery and lost his vision. It is important to make accurate diagnosis and active treatment for posterior pole granuloma toxocariasis. Eyes with posterior pole granuloma toxocariasis should be treated with surgery without delay to avoid visual loss when epiretinal membrane causes the absence of normal macular structure.
原发性干燥综合征(primary Sj?gren’s syndrome，SS)是一种主要累及外分泌腺体的自身免疫性疾病，患者通常因为严重的干眼症状首先就诊于眼科，大多数临床医师对原发性干燥综合征相关性干眼(Sj?gren’s syndrome dry eye disease，SS-DED)认识不足，可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展，将有助于发现SS-DED的真面目，并可能从新的角度阐释其发病机制，为其诊断、分类及治疗提供新的思路。SS-DED的治疗没有特效的药物，大多数患者需接受多种方法的治疗，以了解哪些方法最有效。
Primary Sj?gren’s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sj?gren’s syndrome probably leading to misdiagnosis or missing the diagnosis.The diagnosis of Sj?gren’s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment.
孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)是一种严重威胁视力的眼部疾病，目前治疗手段以手术为主，手术方式主要有视网膜气体填充术(pneumatic retinopexy,PR)、巩膜扣带术(scleral buckling,SB)以及经睫状体扁平部玻璃体切割术(pars plana vitrectomy,PPV)。目前对于RRD手术术式的选择仍然存在争议，因此研究及制定RRD手术方式抉择的临床策略具有重要的临床意义。而临床上制定RRD患者手术方案往往与患者的年龄、视网膜脱离时间、裂孔的类型、位置、数量、大小等等临床因素有关，该文就影响孔源性视网膜脱离手术抉择的相关临床因素进行综述。
Rhegmatogenous retinal detachment (RRD) is a serious eye disease threatening vision. Surgery is main treatment currently, and surgery approaches include pneumatic retinopexy (PR), scleral buckling (SB), and pars plana vitrectomy(PPV). There is still controversy over the selection of RRD surgery approaches, so it is great significant to study and develop clinical strategies for RRD surgery approaches. The surgical plans for RRD patients are often related to clinical factors, such as the patient’s age, retinal detachment time, type, location, quantity, size, etc. This article reviews the related clinical factors affecting the surgical decision for rhegmatogenous retinal detachment.
目的：评价欧堡Daytona 200度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法：本研究为前瞻性病例研究，收集爱尔眼科医院要求行屈光手术的近视患者1 000例(2 000只眼)，分别进行小瞳下欧堡Daytona 200度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查，记录检查结果并进行比较分析。结果：通过欧堡Daytona 200度超广角激光扫描检眼镜检查发现有周边视网膜病变共230例(310只眼)，检出阳性率为15.50%；三面镜检查发现周边部视网膜病变共242例(322只眼)，检出阳性率为16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性(Kappa值0.8~1.0)。结论：欧堡Daytona 200度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法，在屈光手术前筛查视网膜周边部病变，具有广阔的临床应用前景。
Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by three- mirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery.
目的：研究调节抑制对不同单色光中豚鼠眼屈光发育的作用。方法：根据光照不同将豚鼠分成蓝光组(430 nm)、绿光组(530 nm)和白光组(色温5 000 K)，每组各8只。各组豚鼠右眼均点1%阿托品滴眼液，每天1次，持续6周。实验前后各测一次屈光度、角膜曲率半径以及眼轴各参数。结果：实验前各组豚鼠双侧眼间及组间同侧眼屈光度差异无统计学意义(约4.25 D，P >0.05)。但实验结束时蓝光组和绿光组双侧眼间屈光度差异显著(P=0.0003和P=0.028)，而白光组双侧眼间无显著差异(P=0.7486)。实验结束时各组左眼(P<0.05)、绿光组和白光组右眼(P=0.001)以及蓝光组和绿光组右眼(P <0.001)屈光差异有统计学意义。蓝光组和白光组右眼屈光差异无统计学意义( P =0.072)。实验开始时各组双侧眼间及各组间同侧眼玻璃体腔长度差异无统计学意义(约3.2 mm，P>0.05)。实验结束时，蓝光组和绿光组双侧眼间玻璃体腔长度差异有统计学意义(P=0.0017和P=0.0113)，但白光组双侧眼间差异无统计学意义(P=0.9371)。同时，各组间同侧眼玻璃体腔长度差异有统计学意义(P<0.01)。此外，实验前后各组双侧眼间及组间同侧眼角膜曲率半径、前节长度、晶状体厚度差异无统计学意义(P>0.05)。结论：1%阿托品加强530 nm单色光促进豚鼠眼玻璃体腔延长和近视形成的作用，但减弱430 nm单色光抑制豚鼠眼玻璃体腔延长和远视形成的作用。眼调节反应可能参与了单色光中豚鼠眼的屈光发育机制。阿托品影响单色光中豚鼠眼屈光发育的作用可能是通过抑制眼调节反应实现的。
Objective: To investigate the effect of inhibiting accommodation on ocular refractive development of guinea pigs in different monochromatic lights. Methods: Twenty-four pigmented guinea pigs were randomly divided into three groups with 8 animals per group: short-wavelength light (SL, 430 nm) group, middle-wavelength light (ML,530 nm) group and broad-band light (BL, 5 000 K color temperature) group. The right eyes of all animals were treated by 1% Atropine solution once a day for 6 weeks. Measurements of ocular refraction, corneal curvature, and axial length were performed at the start and the end of the study. Results: There was no significant difference in bilateral ocular refraction for all groups at the beginning of the experiment (about 4.25 D, P>0.05) and in ipsilateral ocular refraction among groups at the start of the experiment (P>0.05). But at the end of the experiment,significant differences were detected between binocular refraction of the ML group (P=0.028) and the SL group (P=0.0003), however, there was no significant difference between bilateral refraction in the BL group (P=0.7486).There were significant differences in refraction between the left eyes of any two groups (P<0.05), between the right eyes of the ML and BL group (P=0.001), and between the right eyes of the ML and SL (P<0.001) at 6 weeks.No significant refractive difference was detected between the right eyes of the SL and BL groups (P=0.072). The vitreous length was about 3.2 mm in bilateral eyes of all groups at the onset of the experiment (all inner- or inter-group P>0.05). After the experiment, the bilateral difference in vitreous length was significant in the ML group(P=0.0113) and the SL group (P=0.0017), but not significant in the BL group (P=0.9371). There were significant vitreous differences in right or left eyes among the groups at the end of the experiment (P<0.01). There were no significant inter-group (ipsilateral) or inner-group (bilateral) differences at any time in any of corneal radius of curvature, anterior segment length and lens thickness (P>0.05 for all comparisons). Conclusion: 1% atropine can strengthen the effect of vitreous elongation and myopic formation on guinea pig eyes in 530 nm monochromatic light. Moreover, atropine can weaken the effect of vitreous shortening and hyperopic formation on guinea pig eyes in 430 nm monochromatic light. Ocular accommodation response should involve in the mechanism of refractive development of guinea pig in monochromatic light. Atropine can influence the refractive development of guinea pig in monochromatic light possibly by inhibiting accommodation response.
一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
