喉罩在男性肥胖患者眼科日间手术中的应用:一项回顾性研究

Application of laryngeal mask airway in obese male patients undergoing ophthalmic day surgery: a retrospective study

 

目的:分析喉罩在肥胖患者眼科日间手术中的应用特点。方法:选择 2021 年 1 月— 2024 年 3 月在中山大学中山眼科中心行日间眼科手术 且体质量指数(body mass index,BMI)≥25 kg/m2的男性患者进行分析,将患者分为2组:超重组(BMI 25~<30 kg/m2)及肥胖组(BMI≥30 kg/m2)。比较两组患者入室时(T1)、诱导后(T2)、喉罩置入后(T3)、手术开始时(T4)、手术开始10 min(T5)、手术结束时(T6)、入麻醉恢复室(post-anesthesia care unit,PACU)(T7)、喉罩拔除时(T8)的血流动力学和血氧饱和度变化情况;并分析喉罩置入后(T3)、手术开始时(T4)、手术开始10 min(T5)、手术结束时(T6)和喉罩拔除时(T8)患者的呼吸参数变化情况,记录两组患者的喉罩通气成功率及复苏室的停留时间。结果:纳入 118 例患者,其中超重组 57 例、肥胖组 61 例。两组均未出现喉罩通气失败病例,肥胖组在T3、T4、T5、T6以及T8等时点气道峰压均高于超重组(< 0.05);肥胖组的呼吸道不良事件发生率高于超重组(< 0.05)。两组患者围术期生命体征平稳(> 0.05),复苏室停留时间在组间比较差异无统计学意义> 0.05)且均顺利日间手术离院。结论:喉罩通气下全身麻醉能安全应用在肥胖患者眼科日间手术中,高BMI与高气道峰压相关。


Objective: General anesthesia using laryngeal mask airway (LMA) ventilation can facilitate ambulatory ophthalmic surgery, however, there remains debates about the use of LMA for obese patients. This study retrospectively analyzed the application of LMA in obese patients for ambulatory ophthalmic surgery. Methods: In this retrospective study, we analyzed all patients with a BMI≥25 kg/m2 who underwent ambulatory ophthalmic surgery under general anesthesia at the Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2021 to March 2024.  The patients were divided into two groups: overweight group (BMI 25~<30 kg/m2) and obese group (BMI ≥30 kg/m2) . We compared the changes in hemodynamics and oxygen saturation at the several time points, baseline after entering operating room (T1), anesthesia induction (T2), LMA insertion (T3), start of surgery (T4), 10 minutes after surgery (T5), surgery completion (T6), transfer to PACU (T7), and LMA removal (T8);and analyzed the changes in respiratory parameters of the patient at T3, T4, T5, T6, and T8 time points between both groups. We also observed the differences in success rate of LMA insertion and ventilation and PACU stay time as well as time to discharge home between two groups. Results: 118 cases were found suitable for the final analysis and divided into overweight group (n=57) and obese group (n=61). All patients in the two groups uneventfully completed the ophthalmic ambulatory surgery and discharged home under the laryngeal mask airway ventilation, none of patients in both group displayed LMA ventilation failure. The hemodynamics and oxygen saturation in both groups were stable during perioperative period(> 0.05). The peak airway pressures in obese group were dramatically increased than in overweight group at T3, T4, T5, T6 and T8 time points (< 0.05), and the incidences of adverse respiratory events in obese group were significant higher than in overweight group (< 0.05). The PACU stay time was comparable in both groups (P > 0.05). Conclusion: LMA can be safely used for obese patients undergoing ophthalmic surgery, high BMI is related to high peak airway pressures.

视盘内出血伴视盘旁视网膜下出血:一例病例报告并文献复习

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage: a case report and literature review

 
视盘内出血伴视盘旁视网膜下出血(intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage, IHAPSH)的病例报道较为少见。此病好发于患有轻、中度近视的中青年,且伴有视盘向倾斜或小视盘的患者,具有自限性,视力预后良好,无后遗症,而且很少复发。IHAPSH的眼底表现为视盘内出血、视盘旁视网膜下出血,严重者可出现玻璃体积血。文章报道一例IHAPSH,患者为26岁中度近视女性,主要症状为左眼无痛性视力下降伴眼前黑影飘动6 d。双眼最佳矫正视力均为1.0。眼底检查发现双眼视盘偏小,呈倾斜位,右眼视盘鼻侧见红色视网膜下出血灶;左眼视盘内及视盘鼻侧、上方、颞上方视网膜浅层出血,视盘鼻侧见边界清晰的新月形红色视网膜下出血。未进行特殊治疗,2个月后出血完全吸收。此病病因复杂多样,需与多种眼底疾病相鉴别,及时行眼科相关检查以排除其他原因导致的视盘水肿、视盘出血。文章通过文献回顾,总结其临床特征、发病机制、诊断、鉴别诊断、治疗及预后。
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is rarely reported. IHAPSH commonly affects young myopic eyes with tilted optic discs and spontaneously resolves without treatment, with an excellent prognosis for vision recovery and very rarely recur. The fundus manifestations of IHAPSH are intrapapillary hemorrhage, peripapillary subretinal hemorrhage, or even with vitreous bleeding. An 26-year-old female with mild myopia presented with symptoms of blurry vision and black filamentous floaters for 6 days. Her BCVA was 1.0 in both eyes. Fundus examination showed that both discs appear small, and elevated in the nasal regions. Intrapapillary hemorrhage, peripapillary subretinal hemorrhage and vitreous hemorrhage were observed in the left eye, while only peripapillary subretinal hemorrhage was seen in the right eye. The hemorrhage was resolved spontaneously without any complication after 2 months. The etiology of IHAPSH is complex, and it should be differentiated from other causes of papilledema and disc hemorrhage. The clinical characteristics, pathogenesis, diagnosis, differential diagnosis, treatment and prognosis were summarized through the literature review.

细胞衰老与年龄相关性黄斑变性

Cellular senescence in the pathogenesis of age-related macular degeneration

 
年龄相关性黄斑变性(age-related macular degeneration, AMD)是导致老年人失明的主要原因之一,其特征为光感受器的死亡和视网膜色素上皮细胞的变性。该病的发病机制复杂,涉及遗传、环境和代谢等多种因素。细胞衰老是AMD的重要危险因素,表现为细胞在经历有限次数的分裂后进入永久性细胞周期停滞状态。随着年龄增长,衰老细胞的数量增加,并与多种年龄相关的慢性疾病密切相关。细胞衰老的潜在机制包括氧化应激、DNA损伤、线粒体功能障碍、自噬/线粒体自噬缺陷以及表观遗传改变等。在AMD中,色素上皮细胞、血管内皮细胞、Bruch膜、感光细胞和小胶质细胞等不同类型的细胞均表现出衰老及其相关变化。细胞衰老在AMD的发病机制中起着关键作用,涉及多种视网膜细胞类型和血管系统的退化。通过深入研究这些机制,期望能开发出更有效的治疗方法,以帮助患者恢复和保护视力。本文回顾了细胞衰老的生物学机制及其在AMD中的作用,深入探讨了不同细胞衰老引发AMD发病的具体机制,旨在为AMD的发病机制和治疗研究提供新思路。
Age-related macular degeneration (AMD) is a leading cause of blindness among the elderly, characterized by the degeneration of retinal pigment epithelial cells and the death of photoreceptors. The pathogenesis of AMD is complex, involving a multitude of factors, including genetic, environmental, and metabolic influences. Cellular senescence serves as a significant risk factor for AMD, where cells enter a permanent state of cell cycle arrest after a limited number of divisions. As age increases, the accumulation of senescent cells is closely associated with various age-related chronic diseases. Key mechanisms underlying cellular senescence include oxidative stress, DNA damage, mitochondrial dysfunction, defects in autophagy and mitophagy, and epigenetic alterations. In the context of AMD, various cell types-including pigment epithelial cells, vascular endothelial cells, cells of Bruch's membrane, photoreceptors, and microglia-exhibit signs of senescence and related changes. Cellular senescence plays a pivotal role in the pathogenesis of AMD, contributing to the degeneration of different retinal cell types and supporting vascular systems. By thoroughly investigating these mechanisms, there is hope for the development of more effective therapies aimed at restoring and protecting vision in affected patients. This article reviews the biological mechanisms of cellular senescence and its role in AMD, exploring how different cell types contribute to the disease's onset, with the goal of providing new insights into the pathogenesis and treatment of AMD.

Schlemm's canal结构和功能调控的研究进展及其在青光眼治疗中的应用

Research progress on the structure and functional regulation of Schlemm's canal and its application in glaucoma treatment

 
Schlemm管(Schlemm's canal,SC)作为房水流出的主要通道,通过调节房水外排来维持眼内压的平衡,其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索新的途径以增加房水排出,从而为降低眼压和青光眼治疗的新药物开发提供基础。目前,对SC发育和功能的调节机制的认识仍然有限,缺乏针对SC的特异性治疗策略。近年来,关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示,功能调控的关键分子靶标也相继被发现,这促进了对SC结构和功能调控的深入理解。此外,作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究,总结关键的分子和细胞学调控机制,归纳SC靶向药物和手术疗法的最新进展,为青光眼的临床诊治提供了新的思路。
Schlemm's canal (SC), as the primary pathway for aqueous humor drainage, maintains intraocular pressure balance by regulating aqueous outflow. Abnormalities in its structure and function are closely associated with elevated intraocular pressure and the development of glaucoma. Research on SC aids in elucidating the mechanisms behind outflow resistance and exploring new avenues to enhance aqueous drainage, thereby providing a foundation for the development of new drugs aimed at lowering intraocular pressure and treating glaucoma. Currently, our understanding of the mechanisms regulating SC development and functionality remains limited, with a lack of specific therapeutic strategies targeting SC. In recent years, advancements in measurement and imaging technologies have revealed the molecular and cellular mechanisms underlying SC development, leading to the identification of key regulatory targets. This has enhanced our understanding of SC structural and functional regulation. Furthermore, innovative applications of SC as a target for intraocular pressure-lowering medications and surgical interventions are continually expanding. This article systematically reviews the research on the structure and function of SC, summarizes the key molecular and cellular regulatory mechanisms, and discusses the latest advancements in SC-targeted pharmacological and surgical therapies, providing new insights for the clinical diagnosis and management of glaucoma.

青光眼中神经退行性病变的机制研究和治疗进展

Pathogenesis and therapeutic advances of neurodegenerationin glaucoma

 
青光眼是全球第一大不可逆性致盲性眼病,影响全球7 000多万人,其特征是视网膜神经节细胞的退行性病变。到2040年,预计全球青光眼患者人数将增加至1.12亿,其中约10%的人至少一只眼睛失明。由高眼压诱发、多种致病因素导致的视网膜神经节细胞死亡是青光眼进展过程中视功能损伤的主要病理过程,也是青光眼病程中视功能损害不可逆的重要原因。目前降眼压治疗是唯一的干预疗法,然而其仍然不能完全遏止视网膜神经节细胞进行性损伤,并且既往病程造成的视神经损伤不可逆转。探索青光眼进程中视网膜神经节细胞退行性改变的直接致病因素,寻找关键的治疗靶点,以及开发新的具有神经保护作用的治疗药物,具有重要意义。文章回顾了近年来青光眼中视网膜神经节细胞退行性病变的机制和治疗的新进展,强调了神经血管单元的改变在青光眼发病机制中的重要作用和干预价值。同时,靶向代谢的药物应用、抑制早期炎症反应和减少氧化应激,辅以营养和运动支持等可能延缓和抑制神经退行性病变的发生,起到神经保护作用。未来青光眼发病机制的研究重点仍然在眼压之外的致病因素上,从血流、代谢和免疫串扰的病理环境中发掘对神经退行性改变重要的致病因素并进行干预治疗具有广阔的前景。在多种动物模型中验证干预手段的神经保护作用,也有望提高青光眼神经保护的临床转化成功率,以拓展青光眼的治疗理念与药物选择。
Glaucoma stands as the leading cause of irreversible blindness globally, affecting over 70 million individuals. It is characterized by progressive degeneration of retinal ganglion cells (RGCs). By 2040, the global prevalence of glaucoma is expected to rise to 112 million, with approximately 10% experiencing blindness in at least one eye. The primary pathological basis for visual function impairment in glaucoma progression is the loss of RGCs induced by elevated intraocular pressure (IOP) and various pathogenic factors. Currently, IOP-lowering treatment is the only intervention available, but it cannot completely halt the progressive injury to RGCs, nor can it reverse the optic nerve damage caused by prior disease progression. Exploring the direct pathogenic factors of RGC degeneration in glaucoma, identifying key therapeutic targets, and developing new neuroprotective treatments are of great importance. This review discusses recent advancements in the mechanisms and treatments of retinal ganglion cell degeneration in glaucoma, highlighting the significant role of neurovascular unit changes in the pathogenesis of glaucoma and the potential value of interventions. Additionally, targeting metabolites, inhibiting early inflammatory responses, and reducing oxidative stress, supplemented by nutritional and exercise support, may help delay and inhibit neurodegenerative processes, offering neuroprotective effects.Future research on glaucoma pathogenesis should focus on factors beyond IOP, exploring pathogenic factors in the pathological environment of blood flow, metabolism, and immune crosstalk for targeted therapeutic interventions. Also, verifying the neuroprotective effects of these interventions in various animal models holds promise for improving the clinical translation success rate of neuroprotection in glaucoma, thus expanding therapeutic concepts and drug options.

慢性肝病患者眼底表现及眼底检查的临床应用进展

Ocular fundus manifestations and the clinical application of fundal examinations in patients with chronic liver disease: a systematic review

 
慢性肝病(chronic liver disease, CLD)是一种或多种损伤因素长期作用于肝脏导致的疾病总称,其影响范围广、患者人群基数大。病毒性肝炎、非酒精性脂肪性肝病和终末期肝病等慢性肝病会累及眼底,造成视网膜渗出、出血等病变;同时眼底结构改变,如脉络膜和视网膜不同层次厚度,也与慢性肝病严重程度相关。对慢性肝病患者进行眼底检查不仅用于防治相关的眼底并发症,也对肝病临床评估及监测具有潜在应用价值。文章综述不同病因、严重程度和药物治疗下的慢性肝病患者可能出现的眼底病变,以及眼底结构功能检查在慢性肝病患者中的临床应用进展,以比较不同眼底检查方法在慢性肝病患者临床实施过程中的特点及适用场景,并提示未来在慢性肝病患者中应用眼底检查的潜在新方向。
Chronic Liver Disease (CLD) is a collective term for diseases resulting from the long-term effects of one or more damaging factors on the liver. It has a broad impact and affects a large patient population. Viral hepatitis, non-alcoholic fatty liver disease, and end-stage liver disease can involve the ocular fundus, leading to retinal exudates and hemorrhages. Additionally, structural changes in the fundus, such as the thickness of the choroid and different retinal layers, are associated with the severity of chronic liver disease. Through fundus examinations in patients with chronic liver disease, not only can ocular complications related to liver disease be prevented and treated, but these examinations may also offer potential value in the clinical assessment and monitoring of liver disease. This article reviews the potential ocular fundus abnormalities in patients with chronic liver disease under different etiologies, severities, and drug treatments. It discusses the progress in the clinical application of fundus structure and function examinations in patients with chronic liver disease. It compares the characteristics and appropriate clinical scenarios of various fundus examination methods in these patients and suggests potential new directions for the future use of fundus examinations in chronic liver disease management.

正常眼的脉络膜血管系统研究进展

Research progress on choroidal vascular system in healthy eyes

 
脉络膜是视网膜的主要血供来源,脉络膜血管系统为眼内最大、最重要的血管系统,在给外层视网膜供血方面起着至关重要的作用。脉络膜是一个动态、多功能性结构,其生理性特性受多种因素影响。这些因素包括年龄、性别、解剖位置、眼轴长度、昼夜节律与饮酒等。脉络膜涡静脉根据解剖学位置可分为眼内、巩膜内和眼外三大部分,又进一步分为脉络膜静脉、壶腹前部、壶腹、壶腹后部、巩膜入口、巩膜内通道、巩膜出口和巩膜外涡静脉八个区域。在正常眼中,涡静脉的类型不仅限于传统认知中出口位于赤道部近睫状体平坦部的涡静脉,研究发现还存在出口位于后极部的后极部涡静脉。根据涡静脉的形态及解剖特点,涡静脉又分为四类:缺失型涡静脉、不完整型涡静脉、完整型涡静脉、完整型涡静脉伴壶腹。文章旨在阐述正常人眼的脉络膜血流及涡静脉解剖基础,以深入了解正常状态下的脉络膜特征,这不仅有助于辨别脉络膜的病理性变化,且对脉络膜相关眼部疾病的诊断与鉴别诊断有重要价值。
The choroid is the primary source of blood supply for the retina. As the largest and most important vascular system within the eye, the choroidal vasculature plays a crucial role in providing blood to the outer retina. The choroid is a dynamic, multifunctional structure whose physiological characteristics are influenced by a variety of factors. These factors include age, gender, anatomical location, axial length of the eye, circadian rhythm, and alcohol consumption, among others. Choroidal vortex veins can be anatomically divided into three main parts: intraocular, scleral, and extraocular. Furthermore, they can be subdivided into eight distinct regions: choroidal veins, pre-ampulla, ampulla, post-ampulla, scleral entrance, intrascleral canal, scleral exit, and extrascleral vortex vein. In the healthy eye, the types of vortex veins are not limited to the traditionally recognized veins with exits near the ciliary body pars plana in the equatorial region. Recent research has revealed the existence of posterior vortex veins with exits in the posterior pole of the eye. Based on the morphology and anatomical characteristics of vortex veins, they can be further classified into four types:absent vortex veins, incomplete vortex veins, complete vortex veins, complete vortex veins with ampulla. This paper aims to elucidate the blood flow and vortex veins anatomical foundation of the choroid in normal human eyes. Understanding these characteristics in a healthy state will aid in identifying pathological changes in the choroid, which is of significant value for the diagnosis and differential diagnosis of ocular diseases.

Faricimab玻璃体腔内注射治疗视网膜静脉阻塞的研究进展

Advances in the treatment of retinal vein occlusion with Faricimab intravitreal injection

 
视网膜静脉阻塞(retinal vein occlusion, RVO)是导致视力损害的主要眼底疾病之一,常引发视网膜缺血、出血、液体渗漏和黄斑水肿,从而导致视力下降甚至永久丧失。目前,RVO继发黄斑水肿的主要治疗方法是玻璃体腔内注射抗血管内皮生长因子(vascular endothelial growth factor, VEGF)药物。然而,RVO的病理机制不仅限于VEGF,还涉及血管生成素-2(angiopoietin-2, Ang-2)的作用。在病理状态下,Ang-2通过破坏血管稳定性,诱导新生血管形成,并加剧炎症反应,进一步促进RVO的病程进展。法瑞西单抗(Faricimab)作为一种双特异性抗体药物,能够同时抑制VEGF-A和Ang-2这两条关键的病理通路,显示出在改善患者视力方面的潜在优势。文章对Faricimab在RVO治疗中的作用机制、临床应用、相关治疗药物对比及未来发展前景进行了详细论述,为其在眼科领域的进一步应用提供了理论依据和参考。
Retinal vein occlusion (RVO) is one of the leading retinal diseases causing vision impairment and is often associated with retinal ischemia, hemorrhage, fluid leakage, and macular edema, ultimately resulting in decreased vision or even permanent vision loss. Currently, the primary treatment for RVO-associated macular edema is intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. However, the pathological mechanisms of RVO are not limited to VEGF alone, but also involve angiopoietin-2 (Ang-2). Under pathological conditions, Ang-2 disrupts vascular stability, induces neovascularization, and exacerbates inflammatory responses, thereby accelerating the progression of RVO. Faricimab, as a bispecific antibody, can simultaneously inhibit both VEGF-A and Ang-2 pathways, which are critical in RVO pathogenesis, and has shown potential advantages in improving visual outcomes. The article provides a detailed discussion on the mechanism of action, clinical applications, comparison with related therapeutic agents, and future development prospects of Faricimab in the treatment of RVO, offering a theoretical basis and reference for its further application in ophthalmology.

重视先天性白内障术后高眼压和青光眼的防治

Prioritizing Prevention and Treatment of High Intraocular Pressure and Glaucoma Following Congenital Cataract Surgery

 
先天性白内障是严重影响婴幼儿视功能的疾病。随着白内障手术和人工晶体植入手术技术的发展,先天性白内障患者术后多可获得高质量的视觉康复。然而,如何更好防治手术相关的不良事件和并发症、先天性白内障伴随的其他眼部发育不良疾病的治疗以及形觉剥夺性弱视的治疗,仍然是先天性白内障手术后需要重视的临床问题。文章对先天性白内障摘除及人工晶体植入术后高眼压和继发性青光眼的发生、相关危险因素、治疗和预防的手段进行总结,以期进一步提高对先天性白内障术后高眼压和青光眼防治的认识,减少术后并发症对视功能造成的进一步损害。
Congenital cataract is a significant condition that profoundly impacts the visual function of infants and young children. Advancements in cataract surgery and intraocular lens implantation have enabled the achievement of high-quality visual rehabilitation after congenital cataract surgery. Nevertheless, effective prevention and treatment of surgery-related adverse events and complications, as well as managing other ocular dysplasia and form deprivation amblyopia that may arise in conjunction with the surgery, continue to pose important clinical challenges following congenital cataract surgery. This article provides a comprehensive overview of the occurrence, risk factors, treatment and prevention of high intraocular pressure and secondary glaucoma after congenital cataract and intraocular lens implantation. Its aim is to enhance the comprehension of preventive and therapeutic measures for high intraocular pressure and glaucoma after congenital cataract surgery, thereby minimizing potential postoperative complications and preserving visual function.

角膜屈光手术对角膜生物力学影响的研究进展

Research progress on the effect of corneal refractive surgery on corneal biomechanics

 
角膜屈光手术是目前屈光手术的主流术式,随着全飞秒、全激光手术方式的发展,手术变得更加安全精准,不仅角膜创伤小,术后恢复时间也进一步缩短。角膜具有屈光特性和典型的生物软组织力学特性,角膜力学特性不仅参与维持角膜形态,影响角膜手术尤其屈光手术的效果及预后,而且还与部分角膜疾病的发生和发展密切相关。近年来生物力学研究发展迅速,其在眼部疾病的诊疗中发挥着越来越重要的作用。角膜生物力学的变化与术前角膜的形态、不同手术方式的选择、术后角膜厚度的改变等多种因素相关,但手术导致的角膜自身形态改变是不可逆的,若术后角膜生物力学的变化较大,可能会引起医源性角膜扩张、继发性圆锥角膜等并发症的发生。为了规避术后角膜扩张风险和指导个性化的术式选择,了解角膜生物力学特性的影响至关重要。文章对角膜的基础结构、角膜生物力学特性、生物力学测量方法和不同术式及不同角膜瓣厚度术后生物力学变化的研究进展进行综述,为近视患者的个性化精准治疗提供理论指导。
Corneal refractive surgery is currently main stream of refractive surgery. With the development of femtosecond and laser surgery, the surgery has become safer and more accurate, resulting in less corneal trauma and a shorter postoperative recovery time. In recent years, biomechanics research has rapidly progressed, and its clinical application has gradually increased. The cornea not only possesses refractive properties but also exhibits typical biological soft tissue mechanical properties. Corneal mechanical properties not only play a role in maintaining corneal morphology but also influence the outcome and prognosis of corneal surgery, especially refractive surgery, and are closely related to the occurrence and development of some corneal diseases. Corneal refractive surgery involves cutting the cornea according to the patient's diopter, which disrupts the integrity of the cornea and inevitably affects its biomechanical stability. Changes in corneal biomechanics are associated with various factors, such as preoperative corneal morphology, the selection of different surgical methods, and postoperative changes in corneal thickness. However, the self-morphology changes caused by surgery are irreversible. If the postoperative changes in corneal biomechanics are significant, it may lead to complications such as postoperative corneal dilation and secondary keratoconus. To avoid postoperative iatrogenic corneal dilation and guide personalized surgical choice, it is crucial to understand the limits of influence of corneal biomechanical properties. This article reviews the research progress regarding corneal biomechanical properties and changes associated with corneal refractive surgery.

眼移植物抗宿主病的临床诊疗新进展

Research progress on clinical diagnosis and treatment of ocular graft-versus-host disease

 
随着移植技术逐年发展,异基因造血干细胞移植患者的生存期延长,长期并发症成为影响患者预后及生活质量的主要原因。眼移植物抗宿主病是异基因造血干细胞移植术后最常见的眼部并发症,发生率可高达50%以上。根据发病时间可分为急性及慢性眼移植物抗宿主病,临床上最常以慢性炎症及眼表组织纤维化为特点,主要表现为干眼和不同程度的角结膜炎,治疗较为棘手,可不同程度影响患者视觉质量及生活质量,严重可致盲。近年来眼移植物抗宿主病越来越受到国内外学者重视,其发病机制、临床特点、诊断及治疗相关研究逐渐深入,文章针对眼移植物抗宿主病的临床诊疗新进展进行综述。总体而言,眼移植物抗宿主病早期识别仍较为困难,早期诊断策略有待进一步探索。目前治疗对眼移植物抗宿主病的效果较为有限,或缺乏充足的循证医学证据,临床上缺乏针对不同严重程度及疾病活动度的分级诊疗策略,未来有待进一步探索新的治疗靶点及疾病活动监测指标,将有助于改善患者长期预后及生活质量。
Despite advancements in allogeneic hematopoietic stem cell transplantation techniques leading to improved overall survival rates, long-term complications have emerged as the primary contributors to poor prognosis and diminished quality of life. Ocular graft-versus-host disease (oGVHD), a prevalent complication affecting over 50% of patients post-transplantation, frequently manifests as refractory dry eye, often accompanied by keratoconjunctivitis. Patients with oGVHD routinely suffer from visual impairment and a decline in their quality of life.Currently, research into the mechanisms, clinical features, diagnosis, and treatment of oGVHD has progressively deepened. This article reviews the latest advancements in the clinical diagnosis and management of oGVHD. Notably, there is a pressing need for strategies focused on early diagnosis and treatment, as early recognition of oGVHD remains challenging. Existing treatments for oGVHD either exhibit limited efficacy or lack robust clinical evidence to support their use as the best available options.Further research is imperative to develop tiered diagnostic and treatment approaches, including the exploration of novel therapeutic targets and biomarkers for disease detection. Such endeavors hold the promise of enhancing patients' long-term prognosis and quality of life.

眼中洞见:人工智能解码全身健康

Insights from the eye: artificial intelligence decodes systemic health

 
人工智能(artificial intelligence, AI)在医学领域的广泛应用为探索眼部与全身健康的关系提供了新的机遇。文章回顾了眼科AI在心血管健康、神经系统健康、肾脏健康和衰老过程中的应用。在心血管健康方面,AI能够通过分析眼底图像预测心血管疾病风险因素和未来心血管事件,并提供了简便、有效的风险分层方法。在神经系统健康方面,眼科AI在阿尔茨海默病早期诊断和帕金森病识别方面显示出潜力,尽管对未来事件预测仍具挑战性。针对多发性硬化,眼科AI在诊断和预测残疾进程上展现了良好效果。在肾脏健康中,眼科AI技术通过分析视网膜图像可预测肾功能相关指标、直接检测肾病事件,展示了其在改善肾病筛查方式和减轻医疗负担方面的潜力。在衰老过程中,AI能够利用眼部图像预测生物年龄、视网膜年龄差和晶状体年龄等参数提供了生物衰老指标,为理解衰老与眼部健康的关联提供了新视角。
The widespread application of artificial intelligence (AI) in the medical field has provided new opportunities to explore the relationship between eye and whole body health. This article reviews the application of ophthalmic AI in cardiovascular health, neurological health and aging. In terms of cardiovascular health, AI can predict cardiovascular disease risk factors and future cardiovascular events by analyzing fundus images, and provides a simple and effective risk stratification method. In terms of neurological health, ophthalmic AI shows potential in early diagnosis of Alzheimer's disease and identification of Parkinson's disease, although the prediction of future events remains challenging. For multiple sclerosis, ophthalmic AI has shown good results in diagnosing and predicting the progression of disability. In kidney health, ophthalmic AI technology can predict kidney function-related parameters and detect kidney disease events by analyzing retinal images, demonstrating its potential in improving kidney disease screening methods and reducing medical burdens. In the aging process, AI can use eye images to predict biological age. Parameters such as retinal age gap and LensAge provide biological aging indicators, providing a new perspective for understanding the relationship between aging and eye health.
其他期刊
  • 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
    浏览
  • 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
    浏览
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