Original Article

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm, hemifacial spasm and synkinesis treated with botulinum toxin injection

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm, hemifacial spasm and synkinesis treated with botulinum toxin injection

:22-42
 
Background: Benign essential blepharospasm (BEB), aberrant facial nerve degeneration and hemifacial spasm (HFS) are all examples dystonia which, though not life-threatening, can have a significant impact on patient quality of life. The need for reliable self-rating surveys to monitor functional disability is fundamental. The Blepharospasm Disability Index (BSDI) is already a widely utilised and validated self-rating score for blepharospasm whilst the functional disability score (FDS) requires further validation. The principle aim of this study is to repeat validation of the FDS against the BSDI, which has been validated by several groups since its original description but only in patients with BEB.
Methods: A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB, aberrant facial nerve degeneration and HFS. Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.
Results: Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability. Both scales were also found to be moderately correlated with the Jankovic disease severity score.
Conclusions: This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration. It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.
Background: Benign essential blepharospasm (BEB), aberrant facial nerve degeneration and hemifacial spasm (HFS) are all examples dystonia which, though not life-threatening, can have a significant impact on patient quality of life. The need for reliable self-rating surveys to monitor functional disability is fundamental. The Blepharospasm Disability Index (BSDI) is already a widely utilised and validated self-rating score for blepharospasm whilst the functional disability score (FDS) requires further validation. The principle aim of this study is to repeat validation of the FDS against the BSDI, which has been validated by several groups since its original description but only in patients with BEB.
Methods: A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB, aberrant facial nerve degeneration and HFS. Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.
Results: Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability. Both scales were also found to be moderately correlated with the Jankovic disease severity score.
Conclusions: This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration. It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.
Review Article

A narrative review of ocular surface disease considerations in the management of glaucoma

A narrative review of ocular surface disease considerations in the management of glaucoma

:22-59
 
Background and Objective: Ocular surface disease (OSD) is a common yet often overlooked consideration in the management of patients with glaucoma. Although there have been several review articles summarizing the relationship between glaucoma medications and OSD, there is a relative absence of such articles on the effects of glaucoma surgical treatments. Here, we present a comprehensive review of the literature regarding the relationship of glaucoma management and OSD, with an emphasis on surgical considerations.
Methods: PubMed, Google Scholar, and Cochrane Review searches were performed using the following search terms: ocular surface, dry eye, minimally invasive glaucoma surgeries (MIGS), trabeculectomy,glaucoma medications. The titles and abstracts from those searches were screened for relevance to our review topics. Publications were included if the subjects included glaucoma patients, and if ocular surface outcomes were described. Non-English papers were excluded.
Key Content and Findings: Topical glaucoma medications frequently cause adverse effects on the ocular surface, both through direct action of the medications themselves as well as through toxicity from their associated preservatives. Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma, such as trabeculectomy, can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications. Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates, while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability. The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden. It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity. However, more research is needed to directly assess the extent of improvement seen after MIGS.
Conclusions: A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.
Background and Objective: Ocular surface disease (OSD) is a common yet often overlooked consideration in the management of patients with glaucoma. Although there have been several review articles summarizing the relationship between glaucoma medications and OSD, there is a relative absence of such articles on the effects of glaucoma surgical treatments. Here, we present a comprehensive review of the literature regarding the relationship of glaucoma management and OSD, with an emphasis on surgical considerations.
Methods: PubMed, Google Scholar, and Cochrane Review searches were performed using the following search terms: ocular surface, dry eye, minimally invasive glaucoma surgeries (MIGS), trabeculectomy,glaucoma medications. The titles and abstracts from those searches were screened for relevance to our review topics. Publications were included if the subjects included glaucoma patients, and if ocular surface outcomes were described. Non-English papers were excluded.
Key Content and Findings: Topical glaucoma medications frequently cause adverse effects on the ocular surface, both through direct action of the medications themselves as well as through toxicity from their associated preservatives. Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma, such as trabeculectomy, can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications. Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates, while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability. The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden. It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity. However, more research is needed to directly assess the extent of improvement seen after MIGS.
Conclusions: A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.
Review Article

A narrative review of limbal stem cell deficiency & severe ocular surface disease

A narrative review of limbal stem cell deficiency & severe ocular surface disease

:22-35
 
Background and Objective: Limbal stem cell deficiency (LSCD) describes the clinical condition when there is dysfunction of the corneal epithelial stem/progenitor cells and the inability to sustain the normal homeostasis of the corneal epithelium. The limbal stem cells are located in a specialized area of the eye called the palisades of Vogt (POV). There have been significant advances in the diagnosis and management of LSCD over the past decade and this review focuses on the pathophysiology of LSCD, its clinical manifestations, diagnosis, and causes.
Methods: Papers regarding LSCD were searched using PubMed to identify the current state of diagnosis and causes of LSCD published through to June 2022. 
Key Content and Findings: LSCD is clinically demonstrated by a whorl-epitheliopathy, loss of the POV, and conjunctivalization of the cornea. The diagnosis of this condition is based on clinical examination and aided by the use of impression cytology, in vivo confocal microscopy, and anterior segment optical coherence tomography (asOCT). There are many causes of LSCD, but those which are most common include chemical injuries, aniridia, contact lens wear, and Stevens-Johnson syndrome (SJS).
Conclusions: While this condition is most commonly encountered by corneal specialists, it is important that other ophthalmologists recognize the possibility of LSCD as it may arise in other co-morbid eye conditions.
Background and Objective: Limbal stem cell deficiency (LSCD) describes the clinical condition when there is dysfunction of the corneal epithelial stem/progenitor cells and the inability to sustain the normal homeostasis of the corneal epithelium. The limbal stem cells are located in a specialized area of the eye called the palisades of Vogt (POV). There have been significant advances in the diagnosis and management of LSCD over the past decade and this review focuses on the pathophysiology of LSCD, its clinical manifestations, diagnosis, and causes.
Methods: Papers regarding LSCD were searched using PubMed to identify the current state of diagnosis and causes of LSCD published through to June 2022. 
Key Content and Findings: LSCD is clinically demonstrated by a whorl-epitheliopathy, loss of the POV, and conjunctivalization of the cornea. The diagnosis of this condition is based on clinical examination and aided by the use of impression cytology, in vivo confocal microscopy, and anterior segment optical coherence tomography (asOCT). There are many causes of LSCD, but those which are most common include chemical injuries, aniridia, contact lens wear, and Stevens-Johnson syndrome (SJS).
Conclusions: While this condition is most commonly encountered by corneal specialists, it is important that other ophthalmologists recognize the possibility of LSCD as it may arise in other co-morbid eye conditions.
Review Article

Pregnancy and diabetic retinopathy—considerations for evaluation and treatment: a review

Pregnancy and diabetic retinopathy—considerations for evaluation and treatment: a review

:22-82
 
The prevalence of diabetic retinopathy (DR) continues to increase in pregnant females; these individuals are also at a higher risk of disease progression. The lack of evidence regarding the safety and efficacy of current treatment options in pregnancy makes disease management particularly challenging.All pregnant women with diabetes should have a prenatal DR screening, as well as receive counseling regarding the progression and management of DR during pregnancy. Optimal blood glucose and blood pressure control should be encouraged. For patients with proliferative diabetic retinopathy (PDR) in the absence of visually significant diabetic macular edema (DME), panretinal photocoagulation (PRP) remains a safe and effective treatment option. Visually significant DME can be treated with focal laser if areas of focal leakage are identified in the macula on fluorescein angiogram, intravitreal steroids or anti-vascular endothelial growth factor (VEGF) agents, The theoretical risk of anti-VEGF agents to the fetus should be considered and the patients should be extensively counselled regarding the risks and benefits of initiating anti-VEGF therapy before initiating treatment. When the decision is made to treat with anti-VEGF agents, Ranibizumab should be the agent of choice. In conclusion, ophthalmologists should make treatment decisions in pregnant patients with DR on a case-by-case basis taking into consideration disease severity, risk of permanent threat to vision, gestational age, and patient preferences.
The prevalence of diabetic retinopathy (DR) continues to increase in pregnant females; these individuals are also at a higher risk of disease progression. The lack of evidence regarding the safety and efficacy of current treatment options in pregnancy makes disease management particularly challenging.All pregnant women with diabetes should have a prenatal DR screening, as well as receive counseling regarding the progression and management of DR during pregnancy. Optimal blood glucose and blood pressure control should be encouraged. For patients with proliferative diabetic retinopathy (PDR) in the absence of visually significant diabetic macular edema (DME), panretinal photocoagulation (PRP) remains a safe and effective treatment option. Visually significant DME can be treated with focal laser if areas of focal leakage are identified in the macula on fluorescein angiogram, intravitreal steroids or anti-vascular endothelial growth factor (VEGF) agents, The theoretical risk of anti-VEGF agents to the fetus should be considered and the patients should be extensively counselled regarding the risks and benefits of initiating anti-VEGF therapy before initiating treatment. When the decision is made to treat with anti-VEGF agents, Ranibizumab should be the agent of choice. In conclusion, ophthalmologists should make treatment decisions in pregnant patients with DR on a case-by-case basis taking into consideration disease severity, risk of permanent threat to vision, gestational age, and patient preferences.
Review Article

An updated narrative review of treatment for limbal epithelial stem cell deficiency

An updated narrative review of treatment for limbal epithelial stem cell deficiency

:22-51
 
Background and Objective: Nearly 30 years have passed since limbal stem cell deficiency (LSCD) was first identified by pioneers and given clinical attention. LSCD remains a difficult disease to treat. It can potentially lead to blinding. At present, understanding of limbal stem cells (LSCs) has deepened and various treatment options for LSCD have been devised. The objective of this review is to summarize basic knowledge of LSCD and current treatment strategies.
Methods: PubMed search was performed to find studies published in English on LSCs and LSCD including original reports and reviews. Literatures published from 1989 to 2022 were reviewed.
Key Content and Findings: LSCs are enigmatic stem cells for which no specific marker has been discovered yet. Although LSCD is not difficult to diagnose, it is still challenging to treat. An important advancement in the treatment of LSCD is the provision of guidelines for selecting systematic surgical treatment according to the patient’s condition. It is also encouraging that stem cell technologies are being actively investigated for their potential usefulness in the treatment of LSCD.
Conclusions: Although various treatment options for LSCD have been developed, it should be kept in mind that the best chance of treatment for LSCD is in the early stage of the disease. Every effort should be made to preserve as many LSCs as possible in the early treatment of LSCD.
Background and Objective: Nearly 30 years have passed since limbal stem cell deficiency (LSCD) was first identified by pioneers and given clinical attention. LSCD remains a difficult disease to treat. It can potentially lead to blinding. At present, understanding of limbal stem cells (LSCs) has deepened and various treatment options for LSCD have been devised. The objective of this review is to summarize basic knowledge of LSCD and current treatment strategies.
Methods: PubMed search was performed to find studies published in English on LSCs and LSCD including original reports and reviews. Literatures published from 1989 to 2022 were reviewed.
Key Content and Findings: LSCs are enigmatic stem cells for which no specific marker has been discovered yet. Although LSCD is not difficult to diagnose, it is still challenging to treat. An important advancement in the treatment of LSCD is the provision of guidelines for selecting systematic surgical treatment according to the patient’s condition. It is also encouraging that stem cell technologies are being actively investigated for their potential usefulness in the treatment of LSCD.
Conclusions: Although various treatment options for LSCD have been developed, it should be kept in mind that the best chance of treatment for LSCD is in the early stage of the disease. Every effort should be made to preserve as many LSCs as possible in the early treatment of LSCD.
综述

miR-26b 在眼科疾病中的研究进展

Research progress of miR-26b in ophthalmic diseases

:535-540
 
微RNA-26b(microRNA-26b,miR-26b)是miR-26家族中的一员,作为基因表达调控因子,在细胞代谢、增殖、分化、凋亡、自噬、侵袭、转移等生物学过程中均发挥着重要的调控作用。近年来,随着对miR-26b研究的深入,研究者认识到miR-26b稳定存在于角膜、结膜上皮、晶状体、睫状体、小梁网、房水、玻璃体和视网膜等眼部组织中,且有越来越多的研究证实miR-26b在眼科疾病,例如翼状胬肉、白内障、增生性玻璃体视网膜病变、增生型糖尿病视网膜病变、年龄相关性黄斑变性等疾病的发生和发展中有着重要的调控作用。该文对近年miR-26b在眼科疾病方面的研究进行了综述,为探讨miR-26b在眼科疾病中发挥作用过程中的分子机制提供理论基础。
MicroRNA-26b (miR-26b) is a member of the miRNA-26 family. As a gene expression regulator, it plays an important regulatory role in biological processes such as cell metabolism, proliferation, differentiation, apoptosis, autophagy,invasion and metastasis. In recent years, with the in-depth study on miR-26b, researchers found that miR-26b stably exists in the cornea, conjunctival epithelium, lens, ciliary body, trabecular meshwork, aqueous humor, vitreous, retina and other ocular tissues. More study results confirmed that miR-26b acted on eye diseases, and played an important regulatory role in diseases occurrence and development, such as pterygium, cataract, proliferative vitreo retinopathy,proliferative diabetic retinopathy, age-related macular degeneration, etc. This article reviews the research progress of miR-26b in eye diseases recently, to provide a theoretical basis on molecular mechanisms involving in the role of miR-26b in eye diseases.
综述

Bruch 膜开口 - 最小盘沿宽度在开角型青光眼中的应用

Application of Bruch's membrane opening minimum rim width in open-angle glaucoma

:526-534
 
青光眼是全球首位不可逆性致盲眼病,该疾病与进行性视网膜神经节细胞凋亡相关,大多数患者在视功能改变之前视盘结构已经发生改变,检测视盘R结构改变对于早期青光眼的诊断至关重要。近几年新视盘参数Bruch膜开口-最小盘沿宽度(Bruch's membrane opening minimum rim width,BMO-MRW)在临床上应用越来越广泛,成为目前临床研究的一个热点参数。众所周知视网膜神经纤维层(retinal nerve fiber layer,RNFL)具有很好的青光眼诊断能力,很多研究表明BMO-MRW与RNFL具有相似的诊断性能,并在近视性、异常视盘等一些视盘结构不清晰的青光眼中,BMO-MRW的诊断能力优于RNFL,该参数在监测青光眼病情变化方面也起到一定作用。也有研究表明该参数对青光眼术后随访的应用可能受到一定限制。该文对BMO-MRW在开角型青光眼的诊断及随访中的临床应用加以综述,供临床同道参考。
Glaucoma is the leading cause for irreversible blindness in the world, which is associated with progressive retinal ganglion cell apoptosis. The changes in optic disc structure have been found before visual function variation in many patients. Detecting changes in the structure of the optic disc R is crucial for the diagnosis of early glaucoma. Recently, a new optic disc parameter, Bruce's membrane opening minimum rim width (BMO-MRW) , has been increasingly widely used in clinical practice and become a popular parameter in current clinical research. Retinal nerve fiber layer (RNFL)is an important diagnostic indicator for glaucoma. Many studies indicated that BMO-MRW and RNFL have similar diagnostic performance. In some glaucoma cases with unclear optic disc structure, such as myopia and abnormal optic disc, BMO-MRW provides better diagnostic parameter than RNFL does. It also plays a role in monitoring the changes of glaucoma. Some studies also stated the limitation of the application of this parameter in glaucoma postoperative follow-up. This artice reviews the clinical application of BMO-MRW in diagnosis and follow-up of open-angle glaucoma,providing reference for clinical practicers.
综述

超声睫状体成形术治疗不同类型青光眼的研究进展

Research progress in different types of glaucoma treatment with ultrasound cyclo-plasty

:518-525
 
超声睫状体成形术(ultrasound cyclo-plasty,UCP),是一种新型的睫状体治疗手术,目前已应用于治疗不同类型的青光眼。UCP通过微型高强度聚焦超声(high-intensity focused ultrasounds,HIFU)设备,高度选择性作用于睫状体,实现温和可控、稳定的降眼压(intraocular pressure,IOP)效果。相较于传统的睫状体破坏手术,UCP具有操作简单、耗时短、可重复性高及安全性高的特点。该文从UCP的由来、结构特点、作用机制、疗效、特点及安全性对UCP治疗不同类型青光眼的研究进展进行综述。
Ultrasound cyclo-plasty (UCP) is a novel technique for ciliary body surgery, which has been applied to treat different types of glaucoma. UCP works on the cilary body highly and selectively with the micro high-intensity focused ultrasounds (HIFU) to achieve a mild, controllable, and stable intraocular pressure(IOP) effect. Compared with the traditional ciliary body destruction surgery, UCP is simple operation, efficiency, high repeatability, and high safety.This article reviews the research progress in the UCP treating various types of glaucoma, from its origin, structural characteristics, mechanism, efficacy, characteristics, and safety.
综述

局限性脉络膜凹陷的临床研究进展

The clinical progress of focal choroidal excavation

:512-517
 
局限性脉络膜凹陷(focal choroidal excavation,FCE)是表现为光感受器细胞层、视网膜色素上皮层向脉络膜层凹陷的眼底病变。发病机制多认为是先天脉络膜发育异常、炎症或感染。基于光学相干断层扫描(optical coherence tomography,OCT),可将FCE从光感受器尖端与视网膜色素上皮层是否分离、形态特征或中央脉络膜厚度三种方式对其进行分类。FCE常合并脉络膜新生血管等疾病。该文对FCE的临床研究现状做一综述。
Focal choroidal excavation (FCE) is a retinopathy, expressing with a depression in photoreceptor cell layer and retinal pigment layer towards the choroidal layer. The pathogenesis is recongized as congenital choroidal developmental abnormalities, inflammation, or infection. Based on optical coherence tomography (OCT), FCE can be classified by three methods: the situation of photoreceptor separating from the retinal pigment upper cortex, morphological features, or central choroidal thickness. FCE is usually associated with other diseases such as choroidal neovascularization. This article reviews the current clinical research on FCE.
综述

影响孔源性视网膜脱离手术抉择相关临床因素的研究进展

Research progress in clinical factors affecting surgical decisions for rhegmatogenous retinal detachment

:504-511
 
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.
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
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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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