慢性移植物抗宿主病(chronic graft-versus-host disease，cGVHD)是骨髓移植后最具有破坏性并发症之一。移植物抗宿主病(graft-versus-host disease，GVHD)发生在10%~80%的造血干细胞移植(hematopoietic stem cell transplantation)受者中，而眼睛是人身体最脆弱的器官之一，有40%~60%接受HSCT的患者发生眼部GVHD，它主要影响泪腺、睑板腺、角膜和结膜等。cGVHD相关性干眼(dry eye associated with chronic graft-versus-host disease，cGVHD-DE)是眼部GVHD最多见的表现形式。cGVHD-DE的长期治疗因涉及多学科、多重结合治疗，至今仍然具有挑战性，其除了全身免疫抑制和眼部润滑剂外，通常还使用局部类固醇、环孢霉素和他克莫司滴眼液。针对中度和重度cGVHD-DE的治疗干预包括使用自体血清滴眼液和佩戴巩膜镜等，新兴起的治疗方案包括重链透明质酸 (heavy chain-hvaluronan/穿透素(pentraxin 3)结膜下注射、间充质基质细胞静脉注射、抑制纤维化药物等。
Chronic graft-versus-host disease (cGVHD) is one of the most devastating complications following bone marrow transplantation. GVHD develops in 10–80% of patients after hematopoietic stem cell transplantation (HSCT). The eye is one of the most vulnerable organs of the human body. Ocular GVHD occurs in 40–60% of patients with GVHD undergoing HSCT, and it mostly affects the lacrimal glands, meibomian glands, cornea, and conjunctiva. The most common form of ocular GVHD is dry eye disease (DED). The long-term treatment of cGVHD-related dry eye syndrome remains challenging and involves a multidisciplinary approach. Besides systemic immunosuppression and ocular lubricants, topical steroids, topical cyclosporine, and topical tacrolimus are commonly prescribed. Newer therapeutic interventions for moderate and severe cGVHD-related DED include using serum eye drops and scleral contact lenses. Emerging treatment options include subconjunctival injection of heavy chain-hyaluronan (HC-HA)/ pentraxin 3 (PTX3), intravenous injection of mesenchymal stromal cells, antifibrotic drugs, etc. This article reviews the mechanisms, clinical findings, and treatment of cGVHD-related dry eye syndrome.
目的：了解干眼患者自我护理能力水平并分析其影响因素。方法：选取2022年2月—6月在中山大学中山眼科中心就诊的干眼患者为研究对象，采用一般资料调查表、自我护理能力量表、一般自我效能感量表对患者进行调查分析。结果：共调查293例干眼患者，其自我护理能力评分为(113.34±9.98)分，处于中等水平。相关性分析中干眼患者的自我护理能力总分与自我效能感得分呈正相关(r=0.421，P<0.001)，多重线性回归分析显示，累计屏幕使用时间>10 h/d、合并全身疾病、低自我效能感评分是干眼患者自我护理能力的危险因素(P<0.05)。结论：干眼患者自我护理能力水平处于中水平，仍需加强。医护工作者在工作中应重点关注屏幕使用时间长、合并全身疾病及自我效能感低的患者，并制定相应的护理对策，以改善患者的自我护理能力水平。
Objective: To understand the self-care ability of patients with dry eye and analyze its infuencing factors. Methods: A total of 293 patients with dry eye were selected from Zhongshan Opthalmic Center, Sun Yat-sen University from February 2022 to June 2022, the general data Questionnaire the general self-efcacy Scale and the self-care ability Scale survey were collected. Results: A total of 293 patients with dry eye were surveyed, and the self-care ability score was 113.34±9.98, which was at the medium level. The total score of self-care ability, the scores of self-concept, self-care responsibility, health knowledge level and self-care skills of patients with dry eye were positively correlated with the scores of self-efcacy (r=0.421, allP<0.001).Multiple linear regression analysis showed that cumulative screen usage time>10 hours/day, comorbid systemic diseases, and low self-efficacy scores were risk factors for self-care ability in patients with dry eye (P<0.05). Conclusions: Te self-care ability of patients with dry eye disease is at a medium level, and still needs to be strengthened. Medical workers should focus on patients with prolonged screen usage, comorbid systemic diseases, and low self-efficacy in their work, and tailor relevant nursing strategies to improve their self-care abilities.
目的：了解干眼患者自我护理能力水平并分析其影响因素。方法：选取2022年2月—6月在中山大学中山眼科中心就诊的干眼患者为研究对象，采用一般资料调查表、自我护理能力量表、一般自我效能感量表对患者进行调查分析。结果：共调查293例干眼患者，其自我护理能力评分为(113.34±9.98)分，处于中等水平。相关性分析中干眼患者的自我护理能力总分与自我效能感得分呈正相关(r=0.421，P<0.001)，多重线性回归分析显示，累计屏幕使用时间>10 h/d、合并全身疾病、低自我效能感评分是干眼患者自我护理能力的危险因素(P<0.05)。结论：干眼患者自我护理能力水平处于中水平，仍需加强。医护工作者在工作中应重点关注屏幕使用时间长、合并全身疾病及自我效能感低的患者，并制定相应的护理对策，以改善患者的自我护理能力水平。
Objective: To understand the self-care ability of patients with dry eye and analyze its infuencing factors. Methods: A total of 293 patients with dry eye were selected from Zhongshan University Zhongshan Ophthalmology Center from February 2022 to June 2022, the general data Questionnaire the general self-efcacy Scale and the self-care ability Scale survey were collected. Results: A total of 293 patients with dry eye were surveyed, and the self-care ability score was 113.34±9.98, which was at the medium level. The total score of self-care ability, the scores of self-concept, self-care responsibility, health knowledge level and self-care skills of patients with dry eye were positively correlated with the scores of self-efcacy (r=0.421, allP<0.001). Multiple linear regression analysis showed that cumulative screen usage time>10 hours/day, comorbid systemic diseases, and low self-efficacy scores were risk factors for self-care ability in patients with dry eye (P<0.05). Conclusions: Te self-care ability of patients with dry eye disease is at a medium level, and still needs to be strengthened. Medical workers should focus on patients with prolonged screen usage, comorbid systemic diseases, and low self-efficacy in their work, and tailor relevant nursing strategies to improve their self-care abilities.
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.
目的：评价海藻糖滴眼液对摘除眶内眶外泪腺的实验性大鼠干眼的疗效。方法：SD大鼠30只，随机分成正常组、对照组、实验组，每组10只(20只眼)。正常组不给予处置，实验组和对照组通过摘除大鼠主泪腺制作干眼动物模型。对照组和实验组于造模完成术后1周后分别给予生理盐水、海藻糖滴眼液点双眼，每天4次，治疗共4周。分别于造模术前和造模术后1，2，3，5周进行基础泪液分泌试验(Shirmer I test)，角膜上皮荧光染色评分检测；造模5周后将大鼠处死，采用免疫组织化学方法对结膜上皮细胞中Bcl-2和Bax凋亡基因蛋白表达进行检测，观察干眼动物模型结膜上皮细胞凋亡与眼表干眼病变及组织损伤的关系。结果：基础泪液分泌试验结果显示，对照组和实验组除术后第5周比较差异有统计学意义外(P<0.05)，其余时间点差异无统计学意义(P>0.05)，术后各时间点与正常组比较差异均有统计学意义(P<0.05)。造模术后第1周，对照组和实验组角膜荧光色染色评分明显高于正常组；术后第2周后，对照组和实验组评分差异无统计学意义(P>0.05)，随着时间的延长，术后第3周和第5周，两组评分差异均有统计学意义(P<0.05)，且实验组评分小于对照组。结膜上皮细胞免疫组织化学检测结果显示：正常组结膜上皮细胞Bax蛋白阳性表达的细胞数较对照组和实验组少，与对照组比较，差异有统计学意义(P<0.05)，与实验组比较差异无统计学意义(P>0.05)；正常组可见大量Bcl-2蛋白阳性表达，且多于实验组，差异无统计学意义(P>0.05)，多于对照组，差异有统计学意义(P<0.05)；对照组结膜上皮细胞中可见大量Bax蛋白阳性表达于细胞质，呈棕黄色颗粒，实验组中Bax蛋白阳性表达相对于对照组明显较少，两者差异有统计学意义(P<0.05)；实验组结膜上皮细胞中可见大量Bcl-2蛋白阳性表达，对照组Bcl-2蛋白表达相对于实验组明显减少，差异有统计学意义(P<0.05)。结论：海藻糖滴眼液可以减少角膜表层上皮脱落，对结膜上皮细胞有一定的保护作用，可以拮抗结膜上皮细胞的凋亡，从而增强角结膜上皮屏障功能，改善由干燥引起的眼表上皮的损伤。海藻糖溶液可用于眼表上皮疾病的潜在临床应用，为治疗眼表疾病如干眼症提供治疗选择。
Objective: To observe the efficacy of trehalose eye drops on experimental dry eye rat with removal of inside and outside lacrimal glands. Methods: A total of 30 SD rats were randomly divided into a normal group, a control group, and an experimental group, with 10 rats for each group (20 eyes). The normal group was not treated, and the experimental group and the control group were made into a dry eye animal model by removing the main lacrimal gland of the rat. The control group and the experimental group were given with normal saline and trehalose eye drops once a week after the completion of modeling, 4 times a day for 4 weeks. Shirmer I test and fluorescence staining test were carded before and 1, 2, 3, and 5 weeks after modeling. After 5 weeks of modeling, the rats were sacrificed and the expression of Bcl-2 and Bax apoptosis protein in conjunctival epithelial cells was detected by immunohistochemistry in order to observe the relationship between apoptosis of conjunctival epithelial cells and dry eye lesions and tissue damage in dry eye animal models. Results: Schirme I test results showed that there was no significant difference between the control group and the experimental group (P>0.05) except for the 5th week after operation (P<0.05). There was a statistical difference between the two groups and the normal group at each time point after surgery (P<0.05). At the first week after modeling, the corneal fluorescence staining scores of the control group and the experimental group were significantly higher than those of the normal group. After the second week after surgery, there was no significant difference between the control group and the experimental group (P>0.05). The prolongation of time, the 3 week and the 5th week after surgery, the difference between the two groups was statistically significant (P<0.05), and the score of the experimental group was smaller than the control group. The immunohistochemical results of conjunctival epithelial cells showed that the number of Bax protein positive cells in the normal conjunctival epithelial cells was less than that in the control group and the experimental group. The difference between the normal group and the control group was statistically significant(P<0.05). There was no significant difference between the two groups (P>0.05). There was a large amount of Bcl- 2 protein in the normal group, which was more than the experimental group. The difference was not statistically significant (P>0.05), which was more than the control group. The difference was statistically significant (P<0.05); a large amount of Bax protein was positively expressed in the cytoplasm and brownish-yellow particles in the conjunctival epithelial cells of the control group. The positive expression of Bax protein in the experimental group was significantly less than that in the control group, and the difference was statistically significant (P<0.05). A large amount of Bcl-2 protein was positively expressed in the conjunctival epithelial cells of the experimental group, and the expression of Bcl-2 protein in the control group was significantly decreased compared with the experimental group (P<0.05).Conclusion: Trehalose eye drops can reduce epithelial detachment of the cornea and have a protective effect on conjunctival epithelial cells, which can antagonize the apoptosis of conjunctival epithelial cells,thereby enhancing the keratoconjunctival barrier function and improving the ocular surface epithelium caused by dryness. The potential clinical application of trehalose solution for ocular surface epithelial diseases and provide treatment options for ocular surface diseases, such as dry eye.
干眼是指以泪膜稳态失衡为主要特征并伴有眼部不适症状的多因素眼表疾病。目前干眼的主要治疗手段包括药物治疗(人工泪液替代疗法、抗炎治疗、免疫抑制治疗)和必要时的手术干预治疗。地夸磷索四钠属于P2Y2受体激动剂，是一种治疗干眼的新型药物。它通过刺激位于眼表组织的P2Y2受体，促进泪液、黏液、脂质分泌，增强泪膜稳定性，从而改善干眼的症状和体征。
Dry eye refers to a series of chronic and progressive ocular surface diseases characterized by imbalanced tear film accompanied with ocular discomfort symptoms. The available methods mainly include pharmacotherapy (artificial tears replacement, anti-inflammatory, immunosuppressive therapy) and ophthalmic surgery. P2Y2 receptor agonist is a novel pharmaceutical agent for dry eye treatment, which could stimulate tear fluid secretion and mucin secretion through binding with P2Y2 receptors on the ocular surface, so that improve tear film stability and alleviate symptoms of dry eye. 3% diquafosol ophthalmic solution is the only P2Y2 receptor agonist available for dry eye.
目的：探讨赋能教育模式在干眼患者健康教育中的应用价值。方法：选取2017年6月至12月期间首诊于南方医科大学珠江医院眼科的干眼患者，按照完全随机分配法分为试验组(n=73)及对照组(n=73)，试验组采用赋能教育模式，对照组采用传统健康教育方式。经治疗1周、1个月、2个月及6个月后，分别随访并记录每组患者的眼表疾病指数(ocular surface disease index，OSDI)、泪膜破裂时间值(tear film break up time，BUT)，同时记录患者家庭护理(清洁睑缘、热敷、睑板腺按摩)频率以及复诊频率。结果：赋能教育组家庭护理频率及复诊频率均优于传统教育组(P<0.05)。治疗前两组OSDI和BUT差异均无统计学意义(P>0.05)，但试验组OSDI随时间的推移呈下降趋势，BUT值呈上升趋势；而对照组OSDI以及BUT值的变化均不明显。结论：运用赋能教育模式有助于提高干眼患者治疗的依从性，提高患者的家庭护理频率和复诊频率，显著改善患者的眼表情况，进而提高长期治疗效果。
Objective: To evaluate the application value of empowerment education mode in health education for patients with dry eye syndrome. Methods: Patients with dry eye syndrome were recruited from Department of Ophthalmology, Zhujiang Hospital, Southern Medical University from June 2017 to December 2017. All patients were randomly divided into the experimental group (n=73), educated with empowerment education mode, and control group (n=73), treated with traditional health education. Patients were followed up after 1 week, 1 month,2 months and 6 months, respectively. Data were collected in each follow-up visit including ocular surface disease index (OSDI), tear film break up time (BUT), the frequency of home care (cleaning eyelid margin, hot compress,palpebral gland massage) and re-visit frequency. Results: The OSDI and BUT were similar between two groups before corresponding treatment (P>0.05). After the treatment, patients in the experimental group showed a downtrend in the OSDI and uptrend in the BUT. No significant changes were found in the control group during the follow-up. The frequency of family nursing and re-visit in the experimental group was statistically higher than that in the control group. Conclusion: The application of empowering education mode can improve the compliance of dry eye patients, improve the frequency of home care and follow-up visit, and mitigate the ocular surface of patients, thereby enhancing the long-term efficacy.
干眼为最常见的眼表疾病之一，以泪膜稳态丢失及伴随眼部症状为特征。干眼的治疗以消除病因、缓解症状和保护视功能为目标，而其中的心理护理、眼睑物理治疗、健康宣教和院外管理尤为重要。优质的整体护理方案有助于干眼患者的治疗。本团队在参考干眼诊疗共识的基础上，结合自身护理经验，为干眼患者制定了个性化、涵盖全面的整体护理方案并运用。
Dry eye is one of the most common ocular surface diseases, characterized by a loss homeostasis of tear film,and accompanied by ocular symptoms. The treatment of dry eye aims to eliminate the cause of disease, relieve symptoms, and protect the visual function, among which psychological care, physical treatment of eyelid, health education and management outside the hospital are particularly important. High quality holistic nursing plan is helpful to the treatment of dry eye patients. Based on the consensus of the diagnosis and treatmen of dry eye,combined with our nursing experience, our team has developed and applied a personalized and comprehensive holistic nursing plan for dry eye patients.
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.
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.
