综述

药物治疗单纯疱疹病毒基质型角膜炎的研究进展

Research progress in drug treatment of herpes simplex virus stromal keratitis

:651-657
 
单纯疱疹病毒基质型角膜炎是引起角膜盲的主要原因之一,目前以局部使用糖皮质激素联合口服抗病毒药物治疗为主。传统治疗存在生物利用度低、药物不良反应等缺点,因此亟需寻找替代药物、开发新剂型。环孢素A和他克莫司等免疫抑制剂疗效明显、不良反应少,可能是糖皮质激素的潜在替代品。α干扰素联合阿昔洛韦可缩短病程,而单独使用效果有限。基质再生剂具有新的抗病毒机制,值得进一步研究。此外,纳米载体递送系统,如脂质体、纳米胶束、立方液晶纳米粒,由于能够增强药物角膜穿透性和延长药物释放,在治疗基质型单纯疱疹性角膜炎方面具有巨大潜力。
Herpes simplex virus stromal keratitis is one of the leading causes of corneal blindness. A topical corticosteroid
agent in conjunction with an oral antiviral agent is the preferred treatment, which has the disadvantages of low bioavailability and drug side effects. Therefore, there is an urgent need to find alternative drugs and develop new dosage forms. Immunosuppressants such as cyclosporine A and tacrolimus have obvious curative effects and few side effects, and may be potential substitutes for glucocorticoids. Interferon-α combined with acyclovir can shorten the course of disease, but the effect is not obvious when used alone. Matrix regenerating agents have new antiviral mechanisms and deserve further study. In addition, nanocarriers delivery systems, such as liposomes, nanomicelles and cubosomes, have great potential in the treatment of herpes simplex virus stromal keratitis due to their ability to enhance drug corneal penetration and prolong drug release.
小儿眼病专题

先天性鼻泪管阻塞的临床治疗

:795-798
 
目的:探讨先天性鼻泪管阻塞的临床治疗效果。方法:选取在咸阳彩虹医院接受治疗并有随诊记录的先天性鼻泪管阻塞患儿共630例(827眼)。根据年龄大小,采用4种方式统计治疗效果。结果:年龄0~2个月患儿230例(286眼),选取泪囊按摩和局部点抗炎眼水治疗,182眼(63.63%)治愈;2~6个月患儿240例(340眼),选取加压冲洗或泪道探通术治疗,338眼(96.74%)治愈;6~12个月患儿150例(188眼),选取泪道冲洗+泪道探通术治疗,188眼(89.74%)治愈;1岁以上患儿10例(13眼),选取泪道探通术加局部抗炎治疗,10眼(76.92%)治愈。结论:2~6个月是先天性鼻泪管阻塞治疗的最佳时间,泪道冲洗加探通技术在治疗婴幼儿先天性鼻泪管阻塞创伤小,疗效肯定,远期复发率低。
Objective: To discuss the therapeutic effects of congenital nasolacrimal duct obstruction. Methods: A total of 630 children (827 eyes) with congenital nasolacrimal duct obstruction who were treated in Xianyang Rainbow Hospital and had follow-up records were selected. According to the age, the therapeutic effects were carried out in four ways. Results: A total of 230 cases (286 eyes) aged 0–2 months were treated by massaging lacrimal sac withantiinflammatory eye water, 182 eyes (63.63%) were healed; 240 cases (340 eyes) aged 2–6 months were treated by pressor clysis and lacrimal passages probing, and among them 338 eyes (96.74%) were healed. 150 cases (188 eyes) aged 6–12 months were treated with lacrimal passage irrigation and lacrimal passage probing. 188 eyes (89.74%) were cured; 10 cases (13 eyes) aged over 1 year old were tread by probing of the lacrimal passages with anti-inflammatory eye water, 10 eyes (76.92%) were healed. Conclusion: 2 to 6 months is the best time for the treatment of congenital nasolacrimal duct obstruction, the therapy of pressor clysis with lacrimal passages probing chosen according to the age can treat the congenital nasolacrimal duct obstruction efficiently and decrease the long-term recurrence
小儿眼病专题

不同剂量康柏西普治疗早产儿视网膜病变的疗效对比

Comparison of the efficacy of different doses of conbercept in the treatment of retinopathy of prematurity

:786-794
 
目的:观察玻璃体腔内注射不同剂量康柏西普治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效以及术后的眼压变化。方法:前瞻性随机对照研究。将2018年1月1日至2021年6月30日在厦门市妇幼保健院确诊为Ι型阈值前期ROP、阈值期ROP、急进性ROP(aggressive ROP,A-ROP)的患儿纳入研究。随机分为减量组和常量组,分别玻璃体腔注射10 mg/mL康柏西普注射液0.015 mL(含康柏西普0.15 mg)和0.025 mL(含康柏西普0.25 mg)。测量并记录注射前5min、注射后5min、30min、1h、12h及24 h的眼压情况。术后1周开始随访眼底情况。疗效评价分为一次治愈、复发和加重。结果:共49例98眼纳入研究,常量组27例54眼,一次治愈成功率79.6%(43/54),复发率16.7%(9/54),加重率3.7%(2/54);减量组2 2例44眼,一次治愈成功率68.2%(30/44),复发率27.3%(12/44),加重率4.5%(2/44);两组间差异无统计学意义(χ 2=1.672,P=0.196)。治疗前5min两组眼压差异无统计学意义(P=0.494);注药后5 min、1 h、12h两组眼压差异有统计学意义(均P<0.05);注药后24 h两组间的眼压差异无统计学意义(P=0.101)。常量组注药前5 min和注药后24 h眼压差异有统计学意义(P=0.03),减量组注药前5 min和注药后24h眼压差异无统计学意义(P=0.84)。结论:减量剂量康柏西普(0.15mg)治疗ROP有效,疗效与常规剂量(0.25 mg)相近,且术后眼压升高幅度较低,更快恢复至术前水平,更安全。
Objective: To evaluate the effectiveness of intravitreal injection of various doses of conbercept in the treatment of retinopathy of prematurity (ROP) and change of intraocular pressure (IOP) after operation. Methods: It was a prospective randomized controlled study. Children who were diagnosed with pre-threshold ROP, threshold phrase ROP, and aggressive ROP (A-ROP) in Xiamen Maternity and Child Healthcare Hospital from January 1, 2018 to June 30, 2021 were included in the study. The children were randomly divided into a reduction group and a constant group, and received intravitreal injection of10 mg/mL conbercept at 0.015 mL (containing 0.15 mg of conbercept) and 0.025 mL (containing 0.25 mg of conbercept) respectively. IOP was measured and recorded 5 min before injection, 5 min, 30 min, 1 h, 12 h and 24 h after injection. The fundus condition was followed up 1 week after the operation. The efficacy evaluation is divided into one cure, recurrence and exacerbation. Results: A total of 98 eyes of 49 cases were included in thestudy. For 27 cases of 54 eyes in the constant group, the one-time cure success rate was 79.6% (43/54), the recurrence rate was 16.7% (9/54), and the exacerbation rate was 3.7% (2/54). In the reduction group, there were 22 cases (44 eyes). The one-time cure success rate was 68.2% (30/44), the recurrence rate was 27.3% (12/44), and the exacerbation rate was 4.5% (2/44). There was no significant difference between the two groups (χ2=1.672,P=0.196). There was no significant difference in IOP between the 2 groups 5 min before treatment (P=0.494). There were statistically significantdifferences in IOP between the 2 groups at 5 min after injection, 1 h after injection, and 12 h after injection (all P<0.05). There was no difference in IOP between the two groups 24 h after injection (P=0.101). There was a statistically significant difference in IOP between 5 min before and 24 h after injection in the constant group (P=0.03), and there was no significant difference in IOP between 5 min before and 24 h after injection in the reduction group (P=0.84). Conclusion: Reduced dose of conbercept (0.15 mg) is effective in the treatment of ROP, and the efficacy is similar to that of conventional dose (0.25 mg). The reduction can help lower the increase of postoperative IOP, returning to the preoperative level more rapidly and safely.
小儿眼病专题

镜下改良眼轮匝肌手术治疗先天性下睑内翻的临床疗效

Clinical efficacy of modified orbicularis oculi surgery under microscope in the treatment of congenital lower eyelid entropion of children

:780-785
 
目的:分析临床应用镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻的效果。方法:回顾性分析安康市中医医院2年期间,应用镜下改良眼轮匝肌手术治疗61例(112眼)儿童先天性下睑内翻,根据睑内翻程度决定缝线跨度、松紧度及去除肌皮瓣量,0/6缝线将睑缘下眼轮匝肌与下睑缩肌缝合,0/8缝线连续缝合皮肤伤口,并做好术后护理。结果:所有患儿随访6~24个月,刺激症状缓解,106眼治愈,2眼好转,4眼复发,总有效率达96.43%。结论:镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻美观、易操作、复发率低。
Objective: To analyze the clinical efficacy of modified orbicularis oculi surgery under microscope in the treatment of congenital lower eyelid entropion of children. Methods: Sixty-one cases (112 eyes) of children with congenital lower eyelid entropion treated by modified orbicularis oculi surgery in Ankang Hospital of Traditional Chinese Medicine from Aug 2020 to Sep 2022 were retrospectively analyzed. The suture span, tightness and the amount of myocutaneous flap removed were determined according to the degree of entropion. The orbicularis oculi muscle of lower eyelid margin was suturedwith 0/6 suture, and the skin wound was sutured continuously with 0/8 suture, and postoperative nursing was done well. Results: All children were followed up for 6–24 months, and the irritation symptoms were relieved, 106 eyes were cured, 2 eyes turned well, and 4 eyes relapsed. The total effective ratereached 96.43%. Conclusion: The modified orbicularis oculi surgery for treatment of children with congenital lower eyelid entropion conforms to visual aesthetics. In addition, it is easy to operate and have a low recurrence rate.
小儿眼病专题

早产儿视网膜病变患儿治疗后屈光状态的改变

Changes of refractive statues in infants with retinopathy ofprematurity after different treatments

:774-779
 
目的:研究早产儿视网膜病变患儿经不同治疗措施后屈光状态的改变。方法:将72例(127眼)早产儿视网膜病变患儿按治疗方式分为3组:激光光凝组、注药(抗血管内皮生长因子药物)组和自然消退组。并于治疗前,治疗后1、4、7、12个月对其进行睫状肌麻痹检影验光,对比分析3组的球镜和等效球镜的差异。结果:在治疗后1、4、7及12个月,三组患儿的球镜度和等效球镜度的差异有统计学意义(P<0.05):注药组的球镜和等效球镜小于自然退化组及激光组(均P0.05)。治疗后12个月时激光光凝组、注药组和自然消退组近视发生率分别是2.4%、7.8%和2.0%,差异无统计学意义(P=0.356)。结论:经不同治疗措施的ROP患儿近视发生率无明显差异,但经玻璃体腔注射抗VEGF药物的ROP患儿正视化进程更快。
Objective: To observe the changes of refractive statues in infants with retinopathy of prematurity retinopathyof prematurity (ROP) after different treatments. Methods: According to different treatment methods, 72 cases(127 eyes) of infants with ROP were divided into 3 groups: laser photocoagulation group, intravitreal injectionof anti-vascular endothelial growth factor (VEGF) drugs group and natural regression group. Their sphere andspherical equivalent were measured by retinoscopy optometrist after the ciliary muscles paralyzed. The data beforetreatments and 1, 4, 7 and 12 months after treatments were recorded and analyzed. Results: The differences ofsphere and spherical equivalent among three groups were statistically significant: intravitreal injection of VEGFdrugs group was lower than natural regression group and the laser photocoagulation group, but there was no significant difference between natural regression group and laser photocoagulation group. Incidence of myopiaof laser photocoagulation, intravitreal injection of VEGF drugs, natural regression group were 2.4%, 7.8%, 2.0%,which was not statistically significant. Conclusion: There was no significant difference about the incidence rate ofmyopia among the three groups, but the emmetropization in infants with ROP after intravitreal injection of anti-VEGF drugs might be faster in the future.
小儿眼病专题

儿童癔症性视力障碍的临床分析与治疗

Clinical analysis and treatment of hysterical visual impairment in children

:769-773
 
目的:对儿童癔症性视力障碍的病因进行分析,比较试镜与人工泪液给药治疗的疗效。方法:纳入2013年10月至2020年10月以“癔症性突发视力下降”于深圳市儿童医院门诊就诊的36例患儿,其中男16例,女20例。按随机原则分为试镜组与人工泪液给药组。两组在治疗过程中都辅以语言暗示。两组治疗的首次有效率采用SPSS17.0软件Fisher精确概率检验。分析儿童癔症性视力障碍的发病原因,提出诊断要点和防治对策。结果:在辅以语言暗示的前提下,试镜组人工泪液给药组治疗方案的首次有效率分别为94.4%、83.3%,差异有统计学意义(P<0.05)。在相关病因分析中,学习压力相关的有20例,占55.6%,包括成绩下降、逃避考试、因成绩受到家长或老师的训斥,甚至体罚。家庭变故13例,占36.1%,父母离异为主要原因。留守儿童不愿返乡、同学纠纷、校园霸凌以及外伤等为其他原因。结论:试镜加语言暗示比人工泪液加语言暗示更能有效提高癔症性视力障碍的首次治疗有效率。学习压力、家庭变故相关因素为癔症性视力障碍的最常见原因
Objective: To analyze the causes of hysterical visual impairment in children, and to compare the efficacy of two treatments of trial frame and artificial tears administration. Methods: A total of 36 children with sudden hysterical visual impairment admitted to Shenzhen Children’s Hospital from October 2013 to October 2020 were enrolled in our study, including 16 males and 20 females. They were randomly divided into trial frame group and artificial tears group. Both groups were supplemented with verbal suggestion during the treatment. The primary effective rates of the two groups were compared by SPSS 17.0 Fisher’s exact test. The causes of hysterical visual impairment in children were analyzed, and the main points of specific diagnostic tests and treatments were summarized. Results: The primary effective rate of the trial frame group and the artificial tears group were 94.4% and 83.3% respectively.Thedifference was statistically significant (P<0.05). In this study, therewere 20 cases (55.6%) related to study pressure, including decline in academic performance, evasion of exams, reprimand by parents or teachers, and even corporal punishment. There were 13 cases (36.1%) caused by family accidents, and parents’ divorce was the main reason. Leftover children unwilling to return hometown, classmate disputes, campus bullying and trauma were other reasons. Conclusion: Trialframe is more effective than artificial tears therapy in improving primary effective rate of hysterical visual impairment. Study pressure, family accident are the most common causes of hysterical visual impairment
综述

糖尿病肾病血液透析治疗与糖尿病视网膜病变的关系

Relationship between the hemodialysis of diabetic nephropathy and the development of diabetic retinopathy

:43-47
 
糖尿病视网膜病变(diabetic retinopathy,DR)在糖尿病肾病(diabetic nephropathy,DN)人群,特别是终末期糖尿病肾病(end stage diabetic nephropathy,ESRD)患者中的发病率和严重程度明显高于糖尿病人群。其中ESRD的一项重要治疗手段——血液透析(Hemodialysis,HD)可能会增加机体氧化应激反应、出血风险以及视神经的缺血缺氧,加重DR的发生发展;但另一方面也可通过清除尿毒症毒素、控制血压以及清除多余体液等途径改善糖尿病和DN对眼部的损伤。
The incidence and severity of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN), especially those with end-stage renal disease (ESRD), were higher than those with diabetes. Hemodialysis (HD), an important treatment of ESRD, may aggravate DR by increasing the oxidative stress, fundus hemorrhage and hypoxia of the optic nerve. On the other hand, HD can improve the ocular damage caused by diabetes mellitus and DN by removing uremia toxin, controlling blood pressure and removing excess body fluid.
论著

光学相干断层扫描血管成像观察玻璃体腔注射抗VEGF治疗视网膜分支静脉阻塞合并黄斑水肿的疗效

Optical coherence tomography angiography used to observe intravitreal injection of anti-VEGF on branch retina vein occlusion combined with macular edema

:28-32
 
目的:以光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗前后的变化。方法:回顾性收集从2017年1月至2018年1 2月在汕头国际眼科中心的确诊为BRVO合并黄斑水肿的患者共3 1例3 2眼。患眼行玻璃体腔注射抗VEGF药物治疗,记录治疗前和治疗后1个月的最佳矫正视力(best corrected visual acuity,BCVA),OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness,FMT)、黄斑区血流密度。比较治疗前后各指标的变化。结果:治疗后BCVA较治疗前显著提高,差异有统计学意义(P<0.001);FMT[(242.13±86.02) μm]较治疗前[(521.44±190.27) μm]明显下降,差异有统计学 意义(P<0.001);中心凹浅层血流密度[(18.44±4.98)%]及中心凹旁浅层血流密度[(44.83±3.19)%]均较治疗前[(25.46±9.21)%,(46.06±5.25)%]相比明显下降,差异有统计学意义(P <0.001)。结论:玻璃体腔注射抗VEGF治疗BRVO合并黄斑水肿效果显著;OCTA能有效评价抗VEGF治疗BRVO合并黄斑水肿的临床疗效。
Objective: To evaluate the efficacy in patients with macular edema due to branch retinal vein occlusion (BRVO) treated with intravitreal anti-VEGF drug. Methods: In this retrospective study, 32 eyes of 31 patients with BRVO combined with macular edema at Joint Shantou international eye center of Shantou University and TheChinese University of Hong Kong during January 2017 to December 2018 were enrolled in this study. All the affected eyes received intravitreal anti-VEGF drug injections. BCVA (best corrective visual acuity) and optical coherence tomography angiography (OCTA) were performed before and one month after intravitreal anti-VEGF drug injections. Foveal macular thickness (FMT), macular blood flow density was measured in all eyes and compared. Results: The BCVA before therapy was (0.77±0.46) LogMAR and increased to (0.46±0.30) LogMAR in one month after therapy, which showed a statistical difference (P<0.001). The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density before therapy were (521.44±190.27) μm, (21.85±6.17)% and (46.29±2.70)%, respectively. The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density decreased to (242.13±86.02) μm, (18.40±5.18)% and (44.75±3.40)%, respectively. There was significant statistical difference for them (P<0.001). Conclusion: Intravitreal injection of anti-VEGF is effective in the treatment of BRVO combined with macular edema. OCTA can effectively evaluate the clinical efficacy of anti-VEGF in the treatment of BRVO combined with macular edema.
论著

两种不同部位强脉冲激光治疗方法对睑板腺功能障碍所致干眼的疗效

Efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction

:15-21
 
目的:对比两种不同部位M22优化脉冲激光治疗方法治疗睑板腺功能障碍(meibomian gland dysfunction,MGD)所致干眼的疗效。方法:回顾性分析汕头博德眼科医院干眼门诊患者105例,包括常规治疗组和改良治疗组两个组别,常规治疗组激光部位为下睑,改良治疗组激光部位为联合上下睑,所有患者行M22优化脉冲光治疗一个疗程(每月1次,共3次),治疗前后均采用keratograph 5M干眼分析仪分析评估患者的泪河高度情况、泪膜破裂时间(break-up time,BUT)、角膜荧光染色(corneal fluorescence staining,CFS)和睑板腺排出能力等参数。采用t检验分析对比治疗前后变化情况。结果:患者治疗后泪河高度较强脉冲光治疗前明显增高,BUT时间延长,角膜荧光染色和睑板腺排出能力评分均有好转,每组治疗后与治疗前差异有统计学意义(P<0.01),两组间治疗前后各参数差异比较均没有统计学意义。结论:两种不同部位M22优化脉冲激光治疗方法在治疗MGD导致的干眼方面有较好的效果,是较安全有效地治疗方法,两种不同方法治疗效果无明显差异。
Objective: To study the efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction (MGD). Methods: A total of 105 patients collected from Shantou Balder Eye Hospital were divided into two groups. The treatment position of the conventional group was lower eyelid, the other group was combined with upper and lower eyelid. All patients accepted M22 Optimal Pulsed Technology treatment for three times, once a month. Keratograph 5M dry eye analyzer was used to assess the height of tears river, break-up time (BUT), corneal fluorescence Staining(CFS)and meibomian gland expressibility. The results before and after laser treatment were compared using t-test in this study. Results: After treatment, the height of tear river, BUT, CFS and meibomian gland expressibility were improved. There was a statistically significant difference between each group after and before treatment (P<0.01). There was no significant difference before and after treatment between the two groups. Conclusion: The two methods of M22 Optimal Pulsed Technology are effective in treating dry eyes caused by MGD. There is no significant difference in the therapeutic effect between two methods.
论著

氦氖激光治疗喀什地区儿童弱视的随机对照研究

氦氖激光治疗喀什地区儿童弱视的随机对照研究

:2-7
 
目的:通过随机对照试验,观察氦氖激光在喀什地区弱视儿童中的治疗效果。方法:选取2016年2月至2018年11月期间就诊喀什地区第一人民医院符合纳排标准的弱视儿童,按随机数字表法,分为试验组(氦氖激光+弱视常规治疗组)与对照组(弱视常规治疗组),比较两组的弱视治疗效果。结果:本试验成功纳入弱视儿童111例(177眼),其中试验组61例(97眼),对照组50例(80眼)。与对照组相比,汉族试验组弱视儿童效果明显(P=0.023),维吾尔族试验组弱视儿童未见明显疗效(P=0.481);试验组与对照组在喀什地区不同年龄、不同弱视程度、不同弱视类型及不同弱视眼数儿童中未见明显差异(P>0.05)。结论:氦氖激光治疗喀什地区弱视儿童作用有限,为避免过度医疗,不建议在南疆地区开展。
Objective: To observe the therapeutic effect of helium-neon laser in amblyopia children in Kashgar by a randomized controlled trial. Methods: Amblyopia children who met eligibility criteria during February 2016 to November 2018 were selected and divided into two groups according to random number table: test group(helium-neon laser + conventional treatment for amblyopia) and control group (conventional treatment for amblyopia). The effects of amblyopia treatment were compared between two groups. Results: One hundred and eleven amblyopic children (177 eyes), including 61 children (97 eyes) of the test group and 50 children (80 eyes) of the control group were included in this study. The effect of helium-neon laser was significant in Han children (P=0.023), but not in Uygur children (P=0.481) in the test group compared with the control group.Conclusion: Helium-neon laser has limited effect in treating children with amblyopia in Kashgar region. To avoid over-treatment, it is not recommended to perform it in southern Xinjiang.

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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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