论著

光学眼科生物测量仪StarEyes 900与IOLMaster 500对眼球生物学测量的一致性评价

Consistency evaluation of eyeball biological measurements using StarEyes 900 and IOLMaster 500

:125-130
 
目的:评价StarEyes 900(万灵帮桥,中国)与IOLMaster 500(蔡司,德国)2种眼科光学生物测量仪测量健康受试者眼部参数的差异性、相关性及一致性。方法:前瞻性观察2021年6月至7月于中山大学中山眼科中心进行眼部检查的62例健康受试者共124只眼,分别通过StarEyes 900与IOLMaster 500完成眼轴长度(axial length,AL)、最小角膜屈光力径线上角膜曲率(keratometry for the flattest meridian,Kf)、最大角膜屈光力径线上角膜曲率(keratometry for the steepest meridian,Ks)、平均角膜曲率(mean keratometry,Km)、角膜白到白直径(white-to-white corneal diameter,WTW)等参数的测量,采用配对t检验、Pearson相关分析和Bland-Altman法对其测量结果的差异进行评价。结果:StarEyes 900与IOLMaster 500测量的AL分别为(24.18±1.08) mm和(24.16±1.08) mm;Kf分别为(42.84±1.65) D和(43.04±1.57) D;Ks分别为(44.34±1.90) D和(44.17±1.80) D;Km分别为(43.59±1.73) D和(43.61±1.64) D;WTW分别为(11.64±0.29) mm和(11.64±0.30) mm。StarEyes 900与IOLMaster 500在测量Km、WTW时,其差异无统计学意义(P>0.05),而在AL、Kf、Ks的测量上差异有统计学意义(P<0.01)。其中StarEyes 900所测的AL和Ks值大于IOLMaster 500,而Kf、Km和WTW值则小于IOLMaster 500。经Pearson相关分析,2种仪器的测量结果均表现出较高的相关性;经Bland-Altman法评价,2种仪器的测量结果均表现出较高的一致性。结论:StarEyes 900与IOLMaster 500测量的Km、WTW均表现出较高的一致性,2种方法可互为参考;测量的AL、Kf、Ks存在的差异具有统计学意义;各项参数的测量均具有较好的相关性和一致性。
Objective: To evaluate the difference, correlation and agreement of eye parameters measured by StarEyes 900 visual function analyzer (Wan Ling Bang Qiao, China) and IOLMaster 500 (Carl Zeiss, Germany) swept-source optical coherence tomography biometer. Methods: A prospective study was designed involving 62 healthy subjects (124 eyes) undergoing ophthalmic examinations in Zhongshan Ophthalmic Center from June 2021 to July 2021. Data from their both eyes were selected for analysis in all patients. Axial length (AL), keratometry for the steepest meridian (Ks), keratometry for the flattest meridian (Kf), mean keratometry (Km) and corneal diameter (WTW) were measured by the StarEyes 900 visual function analyzer and IOLMaster 500 swept-source optical coherence tomography biometer. A paired t-test was used to analyze the differences in measurement results. The Pearson correlation coefficient was used to analyze the correlation. Bland-Airman method was used to assess the agreement of the instruments. Results: The AL, Kf, Ks, Km and WTW obtained by StarEyes 900 and IOLMaster 500 were (24.18±1.08) mm and (24.16±1.08) mm, (42.84±1.65) D and (43.04±1.57) D, (44.34±1.90) D and (44.17±1.80) D, (43.59±1.73) D and (43.61±1.64) D, and (11.64±0.29) mm and (11.64±0.30) mm, respectively. The Km and WTW of the two devices showed no significant difference (P>0.05), while the AL, Ks and Kf showed significant differences (all P<0.01). The AL and Ks obtained by StarEyes 900 were higher than by IOLMaster 500, while the Kf, Km and WTW were lower. The measurements of five aforementioned biometric parameters by both devices showed good correlation by Pearson correlation coefficient and good agreement by Bland-Airman. Conclusion: The Km and WTW measured by the two devices showed no significant difference, and provided references to one another. The difference in AL, Kf and Ks between the two devices showed significant differences. All of the measurements showed good correlation by Pearson correlation coefficient and good agreement by Bland-Airman.
论著

Corvis ST角膜生物力学分析仪测量近视眼角膜厚度

Measurement of corneal thickness in myopia with Corvis ST corneal biomechanical analyzer

:117-124
 
目的:比较角膜生物力学分析仪(Corvis ST)、A型超声测厚仪(A超)、Lenstar LS 900(Lenstar)在测量近视眼角膜厚度的差异,为屈光术前筛查提供参考。方法:纳入2020年3至12月佛山市第二人民医院收治的屈光术前近视患者244例(244只右眼),并按中央角膜厚度(central corneal thickness,CCT)将患者分为3组:薄角膜组(CCT≤520 μm)、正常角膜组(520 μm570 μm),分别采用Corvis ST、A超、Lenstar三种仪器测量3组患者的中央角膜厚度,并纳入对比指标。结果:Corvis ST与A超、Lenstar在薄角膜组、正常角膜组、厚角膜组的测量值对比差异均有统计学意义(均P<0.05);在相关性方面,Corvis ST与A超、Lenstar在薄角膜组、正常角膜组、厚角膜组呈正相关(r=0.841,P<0.001 vs r=0.832,P<0.001;r=0.866,P<0.001 vs r=0.918,P<0.001;r=0.497,P<0.001 vs r=0.801,P<0.001);在一致性方面,Corvis ST与A超、Lenstar在薄角膜组、正常角膜组、厚角膜组上一致性系数ICC及95%置信区间分别为0.602(0.091,0.857),0.758(0.221,0.901)、0.741(0.207,0.890),0.845(0.396,0.938)、0.417(0.005,0.679),0.667(0.172,0.851),95%一致性区间范围分别是(-2.2~24.2 μm,-6.7~19.5 μm;-8.4~24.6 μm,-6.8~19.4 μm;-8.7~23.8 μm,-7.0~18.3 μm)。结论:通过对3组数据统计分析得出,Corvis ST与A超、Lenstar的测量值相比,差异均有统计学意义,且Corvis ST的测量值均高于后两种仪器;Corvis ST与后两者均有着较高的相关性,且在正常角膜厚度测量上相关性最高;在一致性方面,从ICC点估计及95%置信区间数值分析,一致性较差;从Bland-Altman角度分析,Corvis ST与后两者的绝对值最大差值超过10 μm,一致性较差,但在与Lenstar的绝对值最大差值均在20 μm内。因此,在测量精度要求较高的屈光手术筛查方面,Corvis ST与A超、Lenstar之间不能相互替代,而对于大规模临床筛查,其角膜厚度测量值对眼压的影响有一定的临床参考意义。
Objective: To compare the differences of corneal thickness measured by corneal biomechanical analyzer (Corvis ST), A-mode ultrasonic thickness meter (A-ultrasound) and Lenstar LS 900 (Lenstar) in myopia, so as to provide reference for preoperative screening of refractive surgery. Methods: A total of 244 patients (244 right eyes) with myopia before refractive surgery in Foshan Second People’s Hospital from March to December 2020 were included in the study, and the patients were divided into three groups according to the central corneal thickness (CCT): the thin cornea group (CCT≤520 μm), the normal cornea group (520 μm570 μm). The central corneal thickness (CCT) of the three groups was measured by Corvis ST, A-type ultrasonic thickness gauge and Lenstar LS 900, respectively, and included in the comparison index. Results: The measured values of Corvis ST, A-ultrasound and Lenstar in the thin cornea group, the normal cornea group and the thick cornea group were statistically significant (all P<0.05). Corvis ST was positively correlated with A-ultrasound and Lenstar in the thin cornea group, the normal cornea group and the thick cornea group (r=0.841, P<0.001 vs r=0.832, P<0.001; r=0.866, P<0.001 vs r=0.918, P<0.001; r=0.497, P<0.001 vs r=0.801, P<0.001). In terms of consistency, the consistency coefficients ICC of Corvis ST, A-ultrasound and Lenstar in the thin cornea group, the normal cornea group and the thick cornea group were 0.602 (0.091, 0.857), 0.758 (0.221, 0.901); 0.741 (0.207, 0.890), 0.845 (0.396, 0.938); 0.417 (0.005, 0.679), 0.667 (0.172, 0.851), and the range of 95% consistency interval were -2.2–24.2 μm, -6.7–19.5 μm; -8.4–24.6 μm, -6.8–19.4 μm; -8.7–23.8 μm, -7.0–18.3 μm. Conclusion: Through the statistical analysis of the data from the three groups, it is concluded that the measured values of Corvis ST are statistically significant compared with those of A-ultrasound and Lenstar, and the measured values of Corvis ST are higher than those of the latter two instruments. Corvis ST has a high correlation with the latter two, and the correlation is the highest in the measurement of normal corneal thickness. In terms of consistency, from the ICC point estimation and 95% confidence interval numerical analysis, the consistency was poor. From the perspective of Bland Altman, the maximum absolute value difference between Corvis ST and Lenstar was more than 10 μm, indicating poor consistency, but the maximum absolute value difference between Corvis ST and Lenstar was within 20 μm. Therefore, in refractive surgery screening with high measurement accuracy, Corvis ST, A-ultrasound and Lenstar cannot replace each other. However, in large-scale clinical screening, the measured value of corneal thickness has a certain clinical reference significance on the impact of intraocular pressure.
论著

高度近视有晶状体眼后房型人工晶状体术后孔源性视网膜脱离的临床特征及预后分析

Clinical presentation and outcomes of rhegmatogenous retinal detachment in phakic eyes after posterior chamber phakic intraocular lens implantation for high-myopia

:111-116
 
目的:分析高度近视有晶状体眼后房型人工晶状体植入术后孔源性视网膜脱离的临床特征及预后。方法:回顾分析2012年4月至2021年6月中山眼科中心收治的9例(9只眼)行后房型人工晶状体植入术后孔源性视网膜脱离患者的临床特征、手术方式及疗效,随访(4.96±4.78)个月。结果:患者年龄(30.44±20.11)岁,屈光手术至发病时间(32.10±17.80)个月。4例(44.4%)马蹄形裂孔,1例(11.1%)萎缩性裂孔,4例(44.4%)巨大裂孔;9眼裂孔均位于赤道部前,除2眼(22.2%)为单个巨大裂孔,1眼(11.1%)单个马蹄孔,余6眼(66.7%)均有视网膜周边变性区存在;视网膜脱离范围(3.0±1.12)个象限,8例累及黄斑;增殖性玻璃体视网膜病变C级以上4眼。视网膜初始复位率为77.8%,最终视网膜复位率100%。末次随访最佳矫正视力优于术前(P<0.05)。随访期间,2例硅油填充眼发生并发性白内障,4眼发生术后早期高眼压。结论:有晶状体眼后房型人工晶状体植入术前存在的视网膜变性或术后玻璃体牵引的存在可能是孔源性视网膜脱离发生的危险因素。
Objective: To analyze the clinical presentation, surgical management, and outcomes of rhegmatogenous retinal detachment (RRD) in patients with high-myopia corrected by posterior chamber phakic (PCP) intraocular lens (IOL) implantation. Methods: Nine eyes of 9 patients in whom RRD developed after PCPIOL implantation from April 2012 to June 2021 in Zhongshan Ophthalmic Center were retrospectively studied. Mean follow-up after retinal detachment surgery was (4.96±4.78)months. Results: Mean patient age was (30.44±20.11) years old. RRD occurred (32.10±17.80) months after PCPIOL implantation. Four (44.4%) breaks were horseshoe tear, 1 (11.1%) was atrophic hole and 4 participants (44.4%) had a giant retinal tear. Nine cases had causative breaks located anterior to the equator while peripheral retina lattice degeneration was found in 6 eyes. RRD extended from 1 to 4 quadrants (3.0±1.12 quadrants) and 8 cases were macula-off retinal detachments. Four eyes’ proliferative vitreoretinopathy were more severe than level C. Initial reattachment rate was 77.80%. Final retinal reattachment was 100%. Final follow-up BCVA was significantly better than baseline (P<0.05). Furthermore, concurrent cataract occurred in 2 eyes in which silicone oil was used as tamponade. Ocular hypertension was detected in 4 eyes after surgery. Conclusion: The existed lattice degeneration and postoperative vitreous traction may be risk factors for RRD after PCPIOL implantation.
发明与创新

一种洗眼车的研制

Development of an eyewash cart

:162.html-
 
本洗眼车功能齐全,也可通过调整位置,满足对同一治疗室内不同治疗椅上的患者进行眼部清洗;同时,避免医护人员操作过程中的频繁转身和走动,节省时间和体力。
We have developed an eyewash cart which is fully functional and meets the needs of eye cleaning for patients on different treatment chairs by adjusting the position of the eyewash cart in the same treatment room. At the same time, this eyewash cart can avoid frequent turning and walk of medical staffs during operation, so as to save their time and energy.
病例报告

白内障术后早期囊袋阻滞综合征1例

Early capsular block syndrome after cataract surgery: A case report

:157-161
 
囊袋阻滞综合征(capsular block syndrome,CBS)是白内障手术较为罕见的并发症,可发生在白内障术中、术后早期及晚期。本文报道1例23岁的女性患者,为发生在白内障术后早期的CBS,因左眼激素性白内障而实施左眼白内障超声乳化联合后房型人工晶状体(intraocular lens,IOL)植入术,术后患者因屈光不正、后囊膜及IOL之间较宽间隙而诊断为CBS,行Nd:YAG激光后囊膜切开治疗后,患者视力恢复至正常,后囊膜及IOL贴合紧密,随访期间未出现黄斑水肿及视网膜脱离等并发症。
Capsular block syndrome (CBS), a fairly rare complication of phacoemulsification, can develop into one of the three following possible clinical scenarios: intraoperative, early postoperative, and late postoperative, depending primarily on the timing of its occurrence following surgery. This paper reported a patient who developed early capsular block syndrome. A 23-year-old patient complained of poor distant vision after undergoing phacoemulsification combined with intraocular lens (IOL) implantation because of steroid-induced cataract. Anterior segment examination confirmed the diagnosis of capsular block syndrome. Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy resulted in complete resolution of her symptoms. No complication happened during follow-up.
“筑梦·铸人”专题

糖尿病性视网膜病变脂质代谢的研究进展

Emerging insights into lipid metabolism in diabetic retinopathy

:93-99
 
脂质代谢异常是糖尿病性视网膜病变可能的危险因素。糖尿病性视网膜病变被认为是致盲的主要原因。近年来研究认为总胆固醇、三酰甘油等血脂与糖尿病性视网膜病变及糖尿病黄斑水肿的进展有关,降脂药物的应用能够延缓糖尿病性视网膜病变进展。随着色谱分离和质谱分析等脂质组学分析方法的发展,除了常规的血清脂质标志物以外的各种脂质成分也被发现可能与糖尿病性视网膜病变进展有关。现总结脂质及其衍生物在糖尿病性视网膜病变发病机制中的作用,阐述糖尿病性视网膜病变脂质代谢治疗的潜在靶点和前景。
Abstract Abnormal lipid metabolism is a possible risk factor for diabetic retinopathy. Diabetic retinopathy is considered to be the main cause of blindness. In recent years, studies have shown that serum lipids, such as total cholesterol, triglycerides, are related to the progress of diabetic retinopathy and diabetic macular edema, and lipid-lowering drugs can delay the progress of diabetic retinopathy. With the development of lipidomics analysis methods such as chromatographic separation and mass spectrometry, lipid components other than conventional serum lipid markers have also been found to be related to the progression of diabetic retinopathy. The review summarizes the role of lipids and their derivatives in the pathogenesis of diabetic retinopathy, and highlights the potential targets and prospects of lipid metabolism treatment for diabetic retinopathy.
“筑梦·铸人”专题

中国温州学龄儿童近视进展的危险因素

Risk factors for myopia progression in school-age children in Wenzhou, China

:85-92
 
目的:观察学龄儿童的近视进展情况,分析近视进展的危险因素。方法:于2014年纳入温州2所小学二、三年级近视儿童,每年随访1次,直至小学毕业。检查内容包括非睫状肌麻痹主觉验光、双眼视功能检查(隐斜、调节性集合/调节、正负相对调节、正负融像性聚散)和问卷调查。采用无序多分类logistic回归分析近视进展速度的危险因素。结果:共纳入152名近视儿童[年龄7~9岁,95名(62.5%)男性],初始屈光度为-1.30±0.95屈光度(diopter,D),年近视进展量为-0.68±0.35 D。回归分析表明:与慢速组相比(年近视进展量>-0.50 D),中速组(-1.00 D<年近视进展量≤-0.50 D)与快速组(年近视进展量≤-1.00 D)中初始屈光度≤-1.00 D的儿童占比更大(中速组:OR=3.51,P=0.003;快速组:OR=3.29,P=0.044),快速组中女性占比更大(OR=4.52,P=0.012),基线双眼视功能参数在不同组间差异均无统计学意义(均P>0.05)。结论:学龄儿童近视进展速度与性别、初始屈光度相关,与基线双眼视功能无关。女孩、初始近视程度大(7~9岁时,屈光度≤-1.00 D)的儿童近视进展快。
Objective: To investigate myopia progression and analyze the risk factors associated with myopia progression in a cohort of primary schoolchildren. Methods: The study was conducted in two primary schools in Wenzhou. Schoolchildren from grades 2 and 3 were examined in 2014 and were followed up annually until primary school graduation at grade 6. Children who were myopic at baseline were included in this study. The examination included non-cycloplegic subjective refraction, questionnaire survey, and binocular visual function parameters such as phoria, accommodative convergence/accommodation, positive relative accommodation, negative relative accommodation, and fusional convergence range. Multinomial logistic regression analysis was conducted to investigate the risk factors associated with various myopia progression speeds. Results: A total of 152 myopic schoolchildren [baseline age range 7–9 years; 95 male (62.5%)] were included in this study. The average refractive error (spherical equivalent refraction, SER) at baseline was -1.30±0.95 D, and the average annual myopia progression was -0.68±0.35 D. Multinomial logistic regression analysis showed that compared to the slow myopia progression group (annual myopia progression >-0.50 D), the moderate myopia progression group (-1.00 D < annual myopia progression ≤-0.50 D) and the fast myopia progression group (annual myopia progression ≤-1.00 D) were associated with having SER values ≤-1.00 D at baseline (moderate: OR=3.51, P=0.003; fast: OR=3.29, P=0.044); the fast myopia progression group was also associated with female sex (OR=4.52, P=0.012); baseline binocular visual function parameters were not related to various myopia progression speeds (P>0.05 for all). Conclusion: Sex and baseline refractive error were associated with various myopia progression among primary schoolchildren. No correlation between baseline binocular visual functions and myopia progression was found in this study. Myopia progressed faster in girls and children who had greater myopia (SER values ≤?1.00 D at age 7–9 years) at baseline.
“眼科再生医学”专题

培养皿中的眼睛:眼组织类器官技术发展与应用

An eye in a culture dish: ocular organoids and their application

:100-110
 
眼睛是人体最重要的感觉器官之一,主要由角膜和晶状体构成的屈光系统和视网膜构成的视觉神经系统2个部分构成。眼睛各组织的发育和功能异常都可影响视功能,甚至致盲。现有的致盲眼病的治疗方式均存在各自瓶颈问题,新的诊治方法亟待开发。近年来,得益于干细胞和组织工程学的发展,结合现有眼各组织的发育理论知识,研究者们利用多种来源的干细胞在体外成功诱导出具有组织特异结构和功能的眼类器官。眼类器官研究为利用干细胞研究眼组织发育和眼病发病机制、药物筛选以及替代治疗创造了新机遇,将干细胞治疗眼病的转化研究推向了一个更高平台。本文将对现有眼类器官的技术发展及应用进行综述。
Being one of the most important sensory organs, the eye is composed of the cornea, the lens, which are responsible for refraction, and the retina, which is the neural sensory part of the eye. Various kinds of developmental abnormalities and functional defects could lead to visual dysfunctions, and even blindness. Current treatments for blindness-causing eye diseases all have their own limitations, awaiting new efficient diagnostic and treating methods. Thanks to the development in stem cell biology and bioengineering, taking advantage of the rich knowledge accumulated on the mechanisms governing eye development, researchers have successfully generated various ocular organoids using multiple sources of stem cells in vitro, which resemble their counterparts in vivo on both the structural level and functional level. Ocular organoids provide valuable material and models for studying eye development, pathology, drug screening, and cell replacement therapy, pushing translational studies of ocular stem cell to a new era. Here, the paper reviews the development and application of ocular organoid technologies.
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.
综述

糖尿病性角膜病变的研究进展

Research progress of diabetic keratopathy

:65-71
 
晚期糖尿病(diabetes mellitus,DM)患者常出现的糖尿病性视网膜病变能够被发现,而糖尿病性角膜病变(diabetic keratopathy,DK)却时常被人们忽略。近年来的许多研究表明,DK对角膜的结构、代谢、生理功能等多个方面均有重要影响。目前临床上尚无根治DK的有效疗法,现主流疗法多集中于对症治疗以维持光滑湿润的眼表,最大限度地减少视觉损失以及提高舒适度,如局部滴用人工泪液、使用角膜绷带镜及局部使用抗炎药物等,但这些现有的治疗方法对于角膜组织损伤的修复能力有限。近年来出现神经生长因子、胰岛素疗法等新兴的治疗方法,有望未来应用于临床。
The diabetic retinopathy which often occurs in patients with advanced diabetes mellitus (DM) can usually be realized, but diabetic keratopathy (DK) could sometimes be ignored. In recent years, many studies have found out that DK can cause significant abnormal changes in many ways, including structure, metabolism and physiological functions of the cornea. At present, there is no effective therapy to cure DK. The current mainstream therapy mostly focuses on symptomatic treatment to maintain a smooth and moist ocular surface, minimize visual loss and improve comfort, such as local drip of artificial tears, use of corneal bandage lens and local use of anti-inflammatory drugs. However, these existing treatment methods have limited repair ability for corneal tissue damage. In recent years, a number of new treatment methods have emerged, which are expected to be clinically used in the future, such as nerve growth factors and insulin therapy.
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  • 眼科学报

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    主办:中山大学
    承办:中山大学中山眼科中心
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    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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