综述

外泌体在眼科疾病中的研究进展

Research progress of exosomes in eye diseases

:472-477
 
外泌体(exosome)是直径30 nm~150 nm的纳米级囊泡,由脂质双分子层、蛋白质和遗传物质组成。人体内几乎所有类型的细胞都能分泌外泌体。它们在细胞通信、免疫调节、炎症反应和新生血管形成中起着关键作用。目前,外泌体已在肿瘤、心血管及泌尿系统中得到广泛研究。近年来,外泌体在眼科疾病中的作用受到越来越多的关注。外泌体在角膜病变、年龄相关性黄斑病变、糖尿病视网膜病变、青光眼等常见眼科疾病的发生、发展中发挥重要作用。不同间充质干细胞来源的外泌体在眼科疾病中的治疗潜力是当下的热点。间充质干细胞来源的外泌体具有与间充质干细胞相似的抗炎、抗凋亡、神经保护和组织修复的作用,因此外泌体可能是多种眼科疾病无细胞疗法治疗研究的新方向。进一步了解外泌体的生物学特性以及外泌体在眼科疾病的最新研究进展,将为相关眼病的发生机制和防治策略提供参考依据。
Exosomes are nanoscale vesicles with a diameter of 30 nm to 150 nm, which are composed of lipid bilayers, proteins, and genetic material. Almost all types of cells in the human body can secrete exosomes. Tey play key roles in cellular communication, immune regulation, infammatory responses and neovascularization. At present, exosomes have been widely studied in tumors, cardiovascular and urinary systems. In recent years, the role of exosomes in eye diseases has attracted more and more attention. The exosomes play an important role in the occurrence and development of common eye diseases such as keratopathy, age-related macular disease, diabetic retinopathy, glaucoma, etc. Currently it is a hot topic that the therapeutic potential of extracellular vesicles derived from diferent mesenchymal stem cells in eye  diseases. Te exosomes derived from mesenchymal stem cells have anti-infammatory, anti apoptotic, neuroprotective and tissue repairing effects, which are similar to those of mesenchymal stem cells. Thus, exosomes may be a novel direction of research in the treatment of many eye diseases without cell therapy. Further understanding of the biological characteristics of exosomes and the latest research progress of exosomes in common eye diseases will provide reference for the pathogenesis and prevention strategies of related eye diseases.
综述

基于深度学习和智能手机的眼病预防与远程诊疗

Prevention and telemedicine of eye diseases based on deep learning and smart phones

:230-237
 
随着智能手机覆盖率的增加与可用性的提升,实现智能健康管理的应用程序成为新兴研究热点。新一代智能手机可通过追踪步数,监测心率、睡眠,拍摄照片等方式进行健康分析,成为新的医学辅助工具。随着深度学习技术在图像处理领域的不断进展,基于医学影像的智能诊断已在多个学科全面开花,有望彻底改变医院传统的眼科疾病诊疗模式。眼科疾病的常规诊断往往依赖于各种形式的图像,如裂隙灯生物显微镜、眼底成像、光学相干断层扫描等。因此,眼科成为医学人工智能发展最快的领域之一。将眼科人工智能诊疗系统部署在智能手机上,有望提高疾病诊断效率和筛查覆盖率,改善医疗资源紧张的现状,具有极大的发展前景。综述的重点是基于深度学习和智能手机的眼病预防与远程诊疗的进展,以糖尿病性视网膜病变、青光眼、白内障3种疾病为例,讲述深度学习和智能手机在眼病管理方面的具体研究、应用和展望。
With the increasing coverage and availability of smart phones, the application of realizing intelligent health management has become an emerging research hotspot. The new generation of smart phones can perform health analysis by tracking the step numbers, monitoring heart rate and sleep quality, taking photos and other approaches, thereby becoming a new medical aid tool. With the continuous development of deep learning technology in the field of image processing, intelligent diagnosis based on medical imaging has blossomed in many disciplines, which is expected to completely change the traditional eye diseases diagnosis and treatment mode of hospitals. The conventional diagnosis of ophthalmic diseases often relies on various forms of images, such as slit lamp biological microscope, fundus imaging, optical coherence tomography, etc. As a result, ophthalmology has become one of the fastest growing areas of medical artificial intelligence (AI). The deployment of ophthalmological AI diagnosis and treatment system on smart phones is expected to improve the diagnostic efficiency and screening coverage to relieve the strain of medical resources, which has a great development prospect. This review focuses on the prevention and telemedicine progress of eye diseases based on deep learning and smart phones, taking diabetic retinopathy, glaucoma and cataract as examples to describe the specific research, application and prospect of deep learning and smart phones in the management of eye diseases.
综述

OCT测量黄斑区神经节细胞复合体厚度在高度近视眼中的应用进展

Application progress of OCT measurement for ganglion cell complex thickness in high myopic eyes

:274-286
 
近视防控已经上升到我国国家战略层面,高度近视引起的视神经病变会损害视功能,但在临床上常常被忽视。OCT可以非侵入、高分辨率、快速以及可重复地定量视网膜各层厚度,是评估高度近视相关视神经病变的有力工具。由于高度近视常合并视盘和盘周的改变,视神经纤维层厚度的定量常出现误差。近年来,学者开始聚焦于黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的研究,但其在高度近视眼中的变化规律尚不统一。该文针对近年来高度近视眼黄斑区GCC的测量规范、诊断价值、变化规律等进行综述,以期提高眼科医师对高度近视视神经病变的重视和研究水平。
Myopia prevention and control has risen to the national strategic level in China. Optic neuropathy caused by high myopia can damage visual function, but it is often ignored in clinical practice Optical coherence tomography (OCT) characterized by non-invasiveness, high resolution, rapid, and repeatable quantifying the thickness of each layer in the retina has emerged as a powerful tool for evaluating high myopia related optic neuropathy. Due to the changes in and near the optic disc in high myopia, errors often occur in the quantification of the thickness of the optic nerve fiber layer. In recent years, researchers have gradually focused on the study of the thickness of ganglion cell complex (GCC), but the regularity of its changes in high myopia is not yet unified. This article reviews the measurement specifications, diagnostic values, and change rules of GCC in the macular region of high myopia in recent years, in order to improve the attention and research level of ophthalmologists on high myopia optic neuropathy.
论著

高效液相色谱法测定曲伏噻吗滴眼液中曲伏前列素有关物质

Determination of related substances of travoprost in travoprost and timolol maleate eye drops by HPLC

:471-482
 
目的:建立高效液相色谱法(high-performance liquid chromatography,HPLC)测定曲伏噻吗滴眼液中曲伏前列素有关物质。方法:采用Agilent SB-C18色谱柱(50 mm×2.1 mm,2.7 μm);以磷酸溶液(取磷酸2.0 mL,加水稀释并定容至1 000 mL,用氢氧化钠溶液调节pH至3.0)为流动相A,乙腈为流动相B,洗脱梯度;流速为每分钟3.0 mL;柱温为30 ℃;检测波长为220 nm;进样体积100 μL。结果:在该色谱条件下,曲伏前列素与各杂质均可良好分离;在酸、碱、氧化、高温和强光破坏条件下,曲伏前列素峰纯度合格,物料守恒。曲伏前列素、5,6-反式曲伏前列素和15-酮曲伏前列素分别在0.041~3.245 μg/mL(r=1.000 0)、0.040~3.229 μg/mL(r=1.000 0)、0.039~3.088 μg/mL(r=0.999 9)范围内线性关系良好,其最低检测限分别为0.020、0.020和0.020 μg/mL;6份样品中5,6-反式曲伏前列素的含量相对标准偏差(relative standard deviatio,RSD)为0.2% (n=6),15-酮曲伏前列素的含量RSD为0.3% (n=6),重复性良好;对照品溶液和供试品溶液在室温条件下放置100h稳定,5,6-反式曲伏前列素的平均回收率为95.2%,相对标准偏差RSD为0.5% (n=9),15-酮曲伏前列素的平均回收率为92.7%,RSD为1.2% (n=9)该方法重现性好。结论:本方法简便、快速、准确。适用于检测曲伏噻吗滴眼液中的曲伏前列素有关物质。
Objective: To develop a high-performance liquid chromatography (HPLC) method for the determination of related substances in Travoprost and Timolol Maleate Eye Drops, sepcifically focusing on Travoprost and its impurities. Methods: The analytic column used was an Agilent SB-C18 (50 mm × 2.1 mm,2.7 μm) . A phosphoric acid solution (prepared by diluting 2.0 mL of phosphoric acid with water tto final volume of 1,000 mL and adjust the pH to 3.0 with sodium hydroxide solution) was used as mobile phase A, while acetonitrile served as mobile phase B. The elution was performed using a gradient program at a flow rate of 3.0 mL/min. The detection wavelength was set at 220 nm, and the column temperature was maintained at 30 ℃. The injection volume is 100 μL. Results: Under the described chromatographic condition, Travoprost and its various impurities were well separated. The purity of the Travoprost peak was qualified, and the material remained stable under conditions of acid, alkali, oxidation, high temperature, and strong light exposure. The linear ranges for Travoprost, 5,6-trans-Travoprost, and 15-keto-Travoprost were determined to be 0.041~3.245 μg/mL(r=1.0000), 0.040~3.229 μg/mL(r=1.0000), 0.039~3.088 μg/mL(r=0.9999), respectively. The lowest detection limits for these compounds were all 0.020 μg/mL, The relative standard deviation (RSD) for the content of 5,6-trans-travoprost and 15 keto trovopros in six samples were 0.2% (n=6) and 0.3% (n=6), respectively, indicating good reproducibility. Both the reference solution and the test solution remained stable at room temperature for 100 hours,The average recovery rates for 5,6-trans-Travoprost and 15-keto-Travoprost were 95.2% (RSD 0.5%,n=9) and 92.7% (RSD 1.2%, n=9) respectively, further confirming the high reproducibility of the method. Conclusions: The developed HPLC method is simple, rapid, and accurate, making it suitable for the determination of related substances in Travoprost and Timolol Maleate Eye Drops.
团体标准解读

《基于眼睑清洁仪的睑缘清洁操作流程》团体标准解读

Operation procedure of eyelid margin cleaning based on eyelid cleaning device

:382-386
 
睑缘炎是一种普遍存在的慢性眼部炎症,主要影响睑缘的皮肤和黏膜。患者常表现为眼部干痒、异物感等刺激症状,以及睑缘充血、肥厚和睫毛反复脱落等。睑缘清洁可以抑制部分眼表细菌生长,也可以去除睑缘油脂、分泌物、角化上皮细胞,清洁眼表环境,对治疗睑缘炎具有较好效果。为确保患者的治疗安全,并指导和规范临床眼科医护人员的操作,由中山大学中山眼科中心牵头,联合全国17所医疗机构进行反复修订,于2023年12月17日在全国团体标准信息平台发布《基于眼睑清洁仪的睑缘清洁操作流程》的团体标准。文章对该团体标准进行深度解读,详细解读睑缘清洁操作的适应证与禁忌证、具体操作的重点、难点与细节等内容,以更好地指导临床医护人员实施规范有效的治疗操作,保证患者治疗效果与确保患者治疗安全。旨在规范和推进基于眼睑清洁仪的睑缘清洁操作流程的精准化发展,更为促进我国眼前段疾病医学和护理精准应用的水平提供重要的标准依据。
Blepharitis is a common chronic eye inflammation that mainly affects the skin and mucosa of the eyelid margin. It is characterized by eye irritation symptoms such as dryness, itching, and foreign body sensation, accompanied by clinical manifestations such as eyelid congestion, thickening, and repeated eyelash loss. It can damage the conjunctival tissue even. Eyelid cleaning can inhibit the growth of some bacteria on the ocular surface, remove eyelid oil, secretions, and keratinized epithelial cells, clean the ocular environment, and have a good effect on treating blepharitis. In order to ensure the safety of patient treatment and guide and standardize the operation of clinical ophthalmic medical staff, led by the Zhongshan Ophthalmic Center, Sun Yat-sen University, and jointly revised by 17 medical institutions across the country, the group standard " Operation procedure of eyelid margin cleaning based on eyelid cleaning device" was released on the National Group Standard Information Platform on December 17, 2023. This article provides an in-depth interpretation of the group's standards, detailing the indications and contraindications, key points, difficulties, and details of eyelid cleaning procedures, in order to better guide clinical medical staff in implementing standardized and effective treatment procedures, ensuring patient treatment effectiveness and safety. Aiming to standardize and promote the precise development of eyelid margin cleaning procedures based on eyelid cleaning devices, and provide important standard basis for promoting the level of medical and nursing precision application of anterior segment diseases in China.
论著

基于 OpenFDA 数据库的盐酸环喷托酯滴眼液不良反应信号检索与分析

Retrieval and analysis of cyclopentolate hydrochloride eye drops related adverse drug reaction signals based on OpenFDA

:331-339
 

目的:利用美国食品药品监督管理局公共数据开放项目(OpenFDA)检索并分析盐酸环喷托酯滴眼液药品不良反应adverse drug reactionsADRs的报告情况,为临床安全用药提供参考 方法: 盐酸环喷托酯滴眼液作为检索词,在OpenFDA数据库中检索200411日至202481日期间盐酸环喷托酯滴眼液相关ADRs的所有信息,对检索到的数据进行分析。 结果:共检索到盐酸环喷托酯滴眼液相关ADRs 11851185患者中,剔除性别不详,女性男性分别为516和48343.54% vs 40.76%;剔除年龄不详后,ADRs发生率较高的是65~<80患者221例,18.65%50~<65患者176例,14.85%3~<13患者140例,11.81%)。盐酸环喷托酯滴眼液发生率较高ADRs眼器官疾病(767例,64.73%神经系统疾病(254例,21.43%及胃肠系统疾病(228例,19.24% 结论:盐酸环喷托酯滴眼液可发生眼局部和全身ADRs临床在使用时应详细询问患者疾病史和用药史,加强用药监护,提高患者用药的安全性。

Objective: To retrieve and analyze adverse drug reactions (ADRs) of cyclopentolate hydrochloride eye drops on the US Food and drug Administration Public Data Open Project (OpenFDA), so as to provide reference for clinical rational drug use. Methods: Using "Cyclopentolate hydrochloride eye drops" as the search term, retrieve all information related to ADRs of cyclopentolate hydrochloride eye drops from the OpenFDA database from January 1, 2004 to August 1, 2024, and analyze the retrieved data  Results: A total of 1 185 cases of ADRs associated with cyclopentolate hydrochloride eye drops were found. Among the 1185 patients, 516 were female and 483 were male ( 43.54 % vs 40.76 % ) after excluding the unknown gender. After excluding patients with unknown age, the incidence of ADRs was higher in patients aged 65~ < 80 years old ( 221 cases, 18.65 % ), 50~< 65 years old ( 176 cases, 14.85 % ), and 3~ < 13 years old ( 140 cases, 11.81 % ). The ADRs with high incidence of cyclopentolate hydrochloride eye drops were ocular organ diseases ( 767 cases, 64.73 % ), nervous system diseases ( 254 cases, 21.43 % ) and gastrointestinal system diseases ( 228 cases, 19.24 % ). Conclusions: Cyclopentolate hydrochloride eye drops can cause local and systemic adverse reactions. In clinical use, the patient 's disease history and medication history should be asked in detail, and medication monitoring should be strengthened to improve the safety of patient medication.

论著

Outcomes of Coaxial Micro-incision Phacoemulsification in Nanophthalmic Eyes: Report of Retrospective Case Series

Outcomes of Coaxial Micro-incision Phacoemulsification in Nanophthalmic Eyes: Report of Retrospective Case Series

:94-100
 
Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications.
Methods: Fifty nine patients (89 eyes) with axial length (AL)<21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate.
Results: The median AL was 19.63 mm. Sixty-six eyes (74.16%) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P<0.001), whereas postoperative IOP was decreased significantly. (P< 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P<0.01), and both preoperative and postoperative IOP (P<0.001). Postoperative BCVA was improved in 94.38% of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74%). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84%), anterior inflammatory response (AIR) (19 eyes, 21.35%), cystoid macular edema (CME) (14 eyes, 15.73%), and uveal effusion (4 eyes, 4.49%). Late postoperative complications included CME (8 eyes, 8.99%),  uveal effusion (8 eyes, 8.99%), malignant glaucoma (2 eyes, 2.25%) and posterior capsular opacification (PCO)(10 eyes, 11.24%). The majority of complications (80%) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).
Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.
Purpose: The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsification and evaluate postoperative complications.
Methods: Fifty nine patients (89 eyes) with axial length (AL)<21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-incision phacoemulsification and IOL implantation. The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), intraocular pressure (IOP) and best corrected visual acuity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were performed for statistical tests as appropriate.
Results: The median AL was 19.63 mm. Sixty-six eyes (74.16%) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P<0.001), whereas postoperative IOP was decreased significantly. (P< 0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P<0.01), and both preoperative and postoperative IOP (P<0.001). Postoperative BCVA was improved in 94.38% of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74%). Early postoperative complications included temporary corneal edema (TCE) (23 eyes, 25.84%), anterior inflammatory response (AIR) (19 eyes, 21.35%), cystoid macular edema (CME) (14 eyes, 15.73%), and uveal effusion (4 eyes, 4.49%). Late postoperative complications included CME (8 eyes, 8.99%),  uveal effusion (8 eyes, 8.99%), malignant glaucoma (2 eyes, 2.25%) and posterior capsular opacification (PCO)(10 eyes, 11.24%). The majority of complications (80%) were successfully resolved by pharmacotherapy or operation. The risk of surgical complications was greater in patients with lower AL, ACD, ACV or ACA and higher nuclear hardness or mean keratometry (Km).
Conclusion: With reasonable preoperative management, prudent selection of the lens, rigorous surgical technique and unerring cognition of potential complications, coaxial microincision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.
News
病例报告

眼睑无色素性黑色素瘤伪装成霰粒肿1例

A case of amelanotic melanoma of the eyelid masquerade as chalazion

:51-55
 
报道一例发生在41岁中年女性左眼上睑的无色素性黑色素瘤,曾在当地医院误诊为霰粒肿。体检见左眼上睑结膜面一大小约2 cm × 2 cm红色肿物,手术切除肿物送病理检查,标本经10%福尔马林固定,常规石蜡包埋切片,HE染色及免疫组织化学染色。光镜下见肿瘤细胞呈片状及巢状排列,瘤细胞圆形及梭形,部分瘤细胞胞浆空泡状呈气球样形,部分细胞核仁明显。免疫组化显示肿瘤细胞S-100、HMB-45阳性,CK及EMA阴性,最终病理诊断为左眼上睑无色素性黑色素瘤。对于临床上患者年龄较大无典型霰粒肿特征的眼睑肿物,术后标本均应送病理检查以除外其它肿瘤的可能。
To report a case of amelanotic melanoma located in the leff upper eyelid misdiagnosed as chalazion in a 41-yearold woman. Examination showed a red 2 cm × 2 cm mass in the left upper palpebral conjunctiva. The tumor was excised and regular fixed in 10% formalin, embedded, sectioned, HE stained and immunohistochemistry stained. Histopathological examination revealed nests of round atypical tumor cells with vacuolated cytoplasm and sheets of spindle atypical tumor cells. Some tumor cells had conspicuous nucleoli. Immunohistochemistry some tumor cells were positive for melanocytic markers S-100, HMB-45 and negative for CK, EMA. So the pathological diagnosis was palpebral conjunctiva amelanotic melanoma in the leff upper eyelid. For the mass in palpebral conjunctiva of senile patients without typical characteristics of chalazion, the surgical specimen should be performed for pathologic examination to rule out other tumors.
论著

3种滴眼液对麻醉小鼠可逆性白内障的保护作用

Effect of eye drops on the development of cataract in anesthetized mice

:60-63
 
目的:探讨3种不同的滴眼液在麻醉小鼠晶状体浑浊中的保护作用。方法:将20只6周龄C57BL/6j小鼠分为4组,A组为自然暴露组(对照组),B组为滴用透明质酸钠组,C组为滴用甲基纤维素滴眼液组,D组为滴用生理盐水组。分别于麻醉后10,20,30,45和60 min观察小鼠晶状体浑浊情况。结果:与A组相比,3种滴眼液均不同程度地延长小鼠晶状体浑浊的时间;30 min时,4组小鼠浑浊 发生率分别为90%,50%,50%和10%,并延缓晶状体浑浊的进展;60 min时,4组小鼠3级浑浊的发生率为30%,10%,10%和0,其中生理盐水的作用效果最优,可以明显延迟晶状体变浑浊的时间。结论:麻醉小鼠的晶状体浑浊程度可以被相关滴眼液延缓,适用于短时间的眼科检查和处理,又因其经济易得,可广泛应用于小鼠活体的眼科检查中。
Objective: To study the effect of saline, carboxymethylcellulose sodium eye drops and sodium hyaluronate gel to stop the development of cataract in anesthetized mice. Methods: Twenty C57BL/6j mice, aged 6 weeks, were divided into four groups, group A was naturally exposed to air, group B was treated with sodium hyaluronate gel, group C was treated with carboxymethylcellulose sodium eye drops and group D was treated with saline. The lens opacity was observed at 10, 20, 30, 45 and 60 min after the start of the experiment. Results: Compared with group A, the eye drops delayed the development of lens opacity in varying degrees. At 30 min, the incidence rate of cataract in group A, B, C and D was 90%, 50%, 50% and 10%, respectively. At 60 min, the incidence rate of grade 3 cataract in group A, B, C and D was 30%, 10%, 10% and 0 respectively, saline did the best, which can significantly slow the process. Conclusion: Cataract development can be slowed by the protective eye drops. This finding is relevant for those experimental settings in which clear ocular media are required. 
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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