糖尿病性黄斑水肿(diabetic macular edema, DME)是糖尿病最常见和最严重的并发症之一,也是中青年劳动人群常见的致盲原因。DME病理生理机制复杂,是多种因素相互作用的结果,控制这些危险因素是降低发病率的关键。DME是全身病相关性眼病,其发生与发展受众多危险因素的影响,但此前文献对其总结不足,本文从全身因素及眼部因素两个方面就DME的危险因素进行综述。全身危险因素主要包括血糖控制欠佳、糖尿病病程长、高血压、血脂代谢紊乱、肥胖、肾功能异常、妊娠状态、降糖药物使用、贫血、阻塞性睡眠呼吸暂停低通气综合征、遗传因素、吸烟、饮酒、高血钙、低血镁等;而其眼部危险因素主要包括白内障、青光眼及玻璃体切割术、全视网膜激光光凝术、合并视网膜静脉阻塞和相关细胞因子等。深入认识和理解这些危险因素,有助于更好地预防和早期治疗DME,同时为治疗糖尿病视网膜病变过程中控制DME进展提供指引和参考。但是,其中一部分因素还存在一定争议,更多的DME危险因素仍有待进一步探索,期望在不久的将来,更多基础和前瞻性临床研究为DME危险因素及治疗提供高质量的证据。
目的:了解湿性老年性黄斑变性(age-related macular degeneration,AMD)患者自我感受负担(self-perceived burden,SPB)现状及其影响因素。方法:采用方便抽样法选取2021年1月至11月在中山大学中山眼科中心就诊的204例湿性AMD患者为研究对象,采用一般资料调查表、SPB量表、家庭支持自评量表、医学应对问卷对其进行测评。结果:患者SPB得分是(21.98±6.68)分,总体属于轻度SPB。湿性AMD患者的SPB水平与家庭支出(r=?0.326, P<0.001)和面对应对(r=?0.365, P<0.001)呈负相关,与回避(r=0.456, P<0.001)及屈服(r=0.310, P<0.001)应对方式呈正相关性。多重线性回归显示,独居、高龄、自费、双眼患病及采用回避应对的患者的SPB更高,而高文化水平、高家庭支持的患者SPB较轻。结论:湿性AMD患者有轻度SPB,但仍存在改善空间,医护工作者在工作中应重点关注高龄、文化程度低、家庭收入低、自费、独居、双眼患病及低视力的患者,及时进行心理疏导,减轻患者的SPB水平。
年龄相关性黄斑变性(age-related macular degeneration, AMD)是老年人视力丧失的主要原因之一,其中新生血管性AMD (neovascular AMD, nAMD)以其进展迅速、严重损伤视力的特点,成为全球眼科研究的焦点。随着人口老龄化加剧,nAMD的疾病负担日益沉重,对其发病机制的深入研究和有效治疗策略的探 索迫在眉睫。近年来,高通量组学技术的蓬勃发展为解析nAMD复杂的分子病理机制提供了前所未有的机遇。基因组学、转录组学、蛋白质组学、代谢组学以及多组学整合分析,不仅有助于深入挖掘疾病相关的关键分子、通路和网络,也为发现新的生物标志物和潜在治疗靶点提供了新的视角。文章系统综述了近年来分子组学技术在nAMD研究中的最新进展,重点关注不同组学方法在各类生物样本研究中 的发现,分析多组学整合在揭示疾病机制和筛选生物标志物方面的优势,以期为该领域的未来研究提供参考。
Background: The purpose is to investigate the relationship between full-thickness macular hole (MH) and retinal break (RB) and/or lattice degeneration.Methods: Patients diagnosed as full-thickness MH and referred to Dr. Lin Lu from January 2009 to December 2013 were evaluated. All patients underwent general ophthalmologic examinations, fundus examination and optical coherence tomography (OCT). The RB and/or lattice degeneration were recorded.Results: Totally 183 eyes of 167 patients were included. The sex ratio of men to women was 1:2.88. A total of 17 eyes were pseudophakic and 166 eyes were phakic. RB and/or lattice degeneration were found in 62 eyes (33.88%). The prevalence of RB and/or lattice degeneration was similar between men and women (P=0.344>0.05). There was no statistical diff erence between the pseudophakic eyes and phakic eyes (P=0.138>0.05). All of the RB and/or lattice degeneration were located near or anterior to the equator. The inferior quadrants and the vertical meridian were aff ected more often than the superior quadrants and the horizontal meridian.Conclusions: We identified a high incidence of RB/lattice degeneration in cases of full-thickness MH. Carefully examination of the peripheral retina and prophylactic treatment of RB and/or lattice degeneration are critical.
Diabetic macular edema (DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids (dexamethasone implants and fl uocinolone acetonide inserts) and anti-vascular endothelial growth factor (VEGF) (ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.
目的:观察睡眠呼吸暂停综合征(Sleep apnea syndrome, SAS)患者睡眠前后黄斑厚度的改变。
方法:选择 2003 年 8 月至 2007 年 1 月经确诊的在我院门诊和住院部治疗的 SAS 患者共 32 例(63 只眼),分别在上午 11:00 ~ 12:00(睡眠前)及患者晨起 20 ~ 30 分钟内(睡眠后)采用相干光断层扫描仪(Optical Coherence Tomography, OCT)进行黄斑中心凹厚度的测量。
结果:睡眠前黄斑中心小凹平均视网膜厚度为(123.00 ± 19.98)μm,睡眠后黄斑中心小凹平均视网膜厚度为(134.25 ± 19.92)μm。睡眠后黄斑中心凹厚度比睡眠前厚度增加(11.25 ± 9.04)μm,95% 可信区间为(8.98,13.53)μm,差异有统计学意义(t = 9.878,P < 0.05)。
结论:睡眠呼吸暂停综合征患者睡眠时的缺血缺氧可以导致黄斑视网膜的水肿增厚。
Background: To find the changes of macular perimetry (MP) and the correlations between MP and best correct visual acuity (BCVA) in different phases of the acute central serous chorioretinopathy (CSC).Methods: Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively. MP at 2°, 4° and BCVA in the active and resolved phase were collected and analyzed. The differences of these parameters in CSC eyes and fellow eyes were analyzed. Spearman correlation was used for analysis of correlation between MP and BCVA.Results: From 29 eyes with CSC analysed 27eyes (93.10%) recovered to the previous VA. Compared with the active phase, MP at 2°, 4° and BCVA were significantly improved in the resolved phase(P=0.000, 0.000, 0.000, respectively). MP at 2°, 4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase (P=0.000, 0.000, 0.000, respectively). In the resolved phase there was no significant difference between the CSC eyes and fellow eyes (P=0.339, 0.141, 0.161, respectively). BCVA was shown to significantly correlate with MP at 2° in the active phase (ρ=–0.630, P<0.001).Conclusions: The acute CSC often had a good prognosis both in BCVA and MP. MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC.