综述

眼科成像设备在接触镜适配中的应用

Application of ophthalmic imaging modalities in contact lens fitting

:74-84
 
接触镜在全球的应用日益广泛,配适方法的不断进步是目前接触镜安全性、舒适性不断提高的原因之一。在接触镜适配过程中,越来越多的先进影像技术被运用于指导接触镜的配适,这些技术的出现简化了接触镜适配的过程,为临床医生进行简便、准确、个性化的接触镜适配提供了帮助,也为接触镜的个性化设计提供了参考数据。
Contact lens has been widely applied worldwide, and the advancement of fitting strategy is one of the reasons which improve the safety and comfort of contact lens fitting. During the contact lens fitting procedure, more and more ophthalmic imaging modalities have been applied to guide the contact lens fitting. These techniques simplify the contact lens fitting procedure, help optometrists accurately perform the customize contact lens fitting, and assist the personalized contact lens design technique.
综述

眼部相关全身疾病的人工智能诊断

Artificial intelligence diagnosis of eye-related systemic diseases

:222-229
 
全身疾病通过一定途径累及眼球,产生眼部病变,这些眼部病变的严重程度与全身疾病的进展密切相关。人工智能(artificial intelligence,AI)通过识别眼部病变,可以实现对全身疾病的评估,从而实现全身疾病早期诊断。检测巩膜黄染程度可评估黄疸;检测眼球后动脉血流动力学可评估肝硬化;检测视盘水肿,黄斑变性可评估慢性肾病(chronic kidney disease,CKD)进展;检测眼底血管损伤可评估糖尿病、高血压、动脉粥样硬化。临床医生可以通过眼部影像评估全身疾病的风险,其准确度依赖于临床医生的经验水平,而AI识别眼部病变评估全身疾病的准确度可与临床医生相媲美,在联合多种检测指标后,AI模型的特异性与敏感度均可得到显著提升,因此,充分利用AI可实现全身疾病的早诊早治。
Systemic diseases affect eyeballs through certain ways, resulting in eye diseases; The severity of eye diseases is closely related to the progress of systemic diseases. By identifying eye diseases, artificial intelligence (AI) can assess systemic diseases, so as to make early diagnosis of systemic diseases. For example, detection of the degree of icteric sclera can be used to assess jaundice. Detection of the hemodynamics of posterior eyeball can be used to evaluate cirrhosis. Detection of optic disc edema and macular degeneration can be used to evaluate the progress of chronic kidney disease (CKD). Detection of ocular fundus vascular injury can be used to assess diabetes, hypertension and atherosclerosis. Clinicians can estimate the risk of systemic diseases through eye images, and its accuracy depends on the experience level of clinicians, while the accuracy of AI in identifying eye diseases and evaluating systemic diseases can be comparable to clinicians. After combining various detection indexes, the specificity and sensitivity of AI model can be significantly improved, so early diagnosis and early treatment of systemic diseases can be realized by making full use of AI.
综述

脉络膜在近视发展中的调控作用及其机制

The regulatory role and mechanism of choroid in the development of myopia

:657-665
 
近年来,随着现代社会生活节奏的加快以及电子产品的普及,近视逐渐呈现低龄化、高发病率的趋势,成为不容忽视的公共卫生问题。动物和人类研究均发现,在近视的发展过程中,脉络膜表现出变薄的现象,并伴有血流量减少,这些变化与近视度数增加和眼轴增长呈正相关。研究表明,脉络膜厚度的变化不仅发生在近视初期,而是在近视进展阶段持续发生。此外,脉络膜血流量的调节也与近视的发生和发展密切相关,可能通过神经机制及生长因子的作用影响眼球的生长。光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)技术在探索近视进程中的脉络膜变化和血管功能方面展现了巨大的潜力。它能够提供无创性的脉络膜结构和血流信息,对于理解脉络膜在近视调控中的作用至关重要。未来的研究应当结合先进的OCTA技术,进一步探讨脉络膜在不同阶段近视中的具体变化及其背后的机制,特别是脉络膜血流调节与眼球生长之间的关系。深化对脉络膜在近视调控中作用的理解,将有助于开发有效的预防和控制措施,为近视防控策略提供理论依据。
In recent years, with the acceleration of the pace of life in modern society and the popularization of electronic products, myopia has gradually affected younger individuals and has a higher incidence rate, becoming a public health problem that cannot be ignored. Both animal and human studies have found that during the development of myopia, the choroid exhibits thinning and is accompanied by reduced blood perfusion. These changes are positively correlated with increased myopia and axial growth. Studies have shown that changes in choroidal thickness not only occur in the early stages of myopia, but also continue to occur in the progression stage of myopia. In addition, the regulation of choroidal blood flow is also closely related to the occurrence and development of myopia, which may affect the growth of the eyeball through the action of neural mechanisms and growth factors. Optical coherence tomography angiography (OCTA) technology has shown great potential in exploring choroidal changes and vascular function in the progression of myopia. It can provide non-invasive information on choroidal structure and blood flow, which is crucial for understanding the role of the choroid in the regulation of myopia. Future research should combine advanced OCTA technology to further explore the specific changes in the choroid in different stages of myopia and the underlying mechanisms, especially the relationship between choroidal blood flow regulation and eyeball growth. A better understanding of the role of choroid in myopia regulation will aid in developing effective prevention and control measures, providing a solid theoretical foundation for myopia prevention strategies.

Macular hemorrhage in high myopia

Macular hemorrhage in high myopia

:401-417
 
Macular hemorrhage (MH) is one of the most severe complications of high myopia, posing a significant threat to vision. MH can occur with or without choroidal neovascularization (CNV), with the CNV-associated form being the most prevalent. CNV-related MH may develop secondary to conditions such as pathological myopia, and punctate inner choroidopathy. Conversely, MH without CNV is often linked to factors like lacquer cracks, trauma, ocular surgery. While the exact mechanisms of CNV in high myopia are still not fully understood, anti-VEGF injections have been shown to be effective in improving visual function in patients with CNV. This review summarizes the clinical characteristics of various causes of MH and their respective treatments, providing valuable insights to help clinicians make informed diagnostic and therapeutic decisions.
Macular hemorrhage (MH) is one of the most severe complications of high myopia, posing a significant threat to vision. MH can occur with or without choroidal neovascularization (CNV), with the CNV-associated form being the most prevalent. CNV-related MH may develop secondary to conditions such as pathological myopia, and punctate inner choroidopathy. Conversely, MH without CNV is often linked to factors like lacquer cracks, trauma, ocular surgery. While the exact mechanisms of CNV in high myopia are still not fully understood, anti-VEGF injections have been shown to be effective in improving visual function in patients with CNV. This review summarizes the clinical characteristics of various causes of MH and their respective treatments, providing valuable insights to help clinicians make informed diagnostic and therapeutic decisions.
综述

眼组学在神经退行性疾病中的研究进展

Research progress of oculomics in neurodegenerative diseases

:578-585
 

神经退行性疾病会损害大脑和神经系统的结构和功能,导致认知和行为能力逐渐下降,因此,早期诊断神经系统疾病可以促进预防、监测和治疗,从而改善患者的预后。眼与脑在结构和胚胎学上的相似之处为评估中枢神经系统的神经和微血管变化提供了潜在可能。眼组学是眼科学、遗传学和生物信息学的交叉学科,目标是开发快速、无创、具有成本效益的生物标志物,用于全身性疾病的筛查、诊断和风险分层。随着诊断和眼科成像技术的进步,用于检测眼的结构、功能和视觉变化的各项技术得到了快速发展。眼部生物标志物成为评估神经退行性疾病进展有前景的工具。文章采用眼部影像学例如光学相干断层扫描(optical coherence tomography, OCT)和OCT 血管成像 (OCT angiography, OCTA)和电生理学例如视觉诱发电位(visual evoked cortical potentials, VEP)、视网膜电图(electroretinogram, ERG)等筛查方法检测眼部异常神经退行性疾病,总结了眼组学在神经退行性疾病的应用,包括阿尔茨海默病、帕金森病、额颞叶痴呆、肌萎缩侧索硬化症和亨廷顿病,旨在为神经退行性疾病的诊断和治疗提供新的思路。尽管并非所有生物标志物都是疾病特异性的,但未来大数据、人工智能和眼组学的融合,有可能进一步深入了解这些神经退行性疾病。

Neurodegenerative diseases can damage the structure and function of the brain and nervous system, leading to a gradual decline in cognitive and behavioral abilities. Therefore, early diagnosis of neurological diseases can promote prevention, monitoring, and treatment, thereby improving the prognosis of patients. The structural and embryological similarities between the eyes and the brain provide potential for evaluating neurological and microvascular changes in the central nervous system. oculomics is an interdisciplinary field that combines ophthalmology, genetics, and bioinformatics, with the goal of developing rapid, non-invasive, and cost-effective biomarkers for screening, diagnosis, and risk stratification of systemic diseases. With the advancement of diagnostic and ophthalmic imaging technologies, various techniques for detecting the structure, function, and visual changes of the eye have been rapidly developed. Eye biomarkers have become promising tools for assessing the progression of neurodegenerative diseases. The article uses screening methods such as eye imaging (such as OCT, OCTA) and electrophysiology (such as VEP, ERG) to detect abnormal neurodegenerative diseases in the eyes. It summarizes the application of oculomics in neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, frontotemporal dementia, amyotrophic lateral sclerosis, and Huntington's disease, aiming to provide new ideas for the diagnosis and treatment of neurodegenerative diseases. Although not all biomarkers are disease-specific, the integration of big data, artificial intelligence, and oculomics in the future may further deepen our understanding of these neurodegenerative diseases.
Review Article

Trends and hotspots concerning lupus retinopathy from 2003 to 2022: a bibliometric analysis and knowledge graph study

Trends and hotspots concerning lupus retinopathy from 2003 to 2022: a bibliometric analysis and knowledge graph study

:224-236
 
Purpose: To explore the status of current global research, trends and hotspots in the field of lupus retinopathy (LR). Methods: Publications related to LR from 2003 to 2022 were extracted from the Web of Science Core Collection (WOSCC). Citespace 6.2.R4 software was used to analyze the raw data. Bibliometric parameters such as publication quality, countries, authors, international cooperation, and keywords were taken into account. Results: A total of 315 publications were retrieved. The annual research output has increased significantly since 2010, especially since 2017. Marmor MF, Lee BR, and Melles RB contributed the highest number of articles published on LR. The top three publishing countries were the USA, China, and UK. Stanford University, Hanyang University, and Harvard Medical School were the top three producing institutions in the world for LR research. The top ten commonly used keywords include the following: systemic lupus erythematosus, retinopathy, retinal toxicity, antimalarial, hydroxychloroquine, optical coherence tomography, antiphospholipid syndrome, microvascular, optic neuritis, optical coherence tomography angiography. The keywords "optical coherence tomography angiography" and "vessel density" have exploded in recent years. Conclusion: By analyzing the current body of LR literature, specific global trends and hotspots for LR research were identified, presenting valuable information to track cutting- edge progress and for future cooperation between various authors and institutions.
Purpose: To explore the status of current global research, trends and hotspots in the field of lupus retinopathy (LR). Methods: Publications related to LR from 2003 to 2022 were extracted from the Web of Science Core Collection (WOSCC). Citespace 6.2.R4 software was used to analyze the raw data. Bibliometric parameters such as publication quality, countries, authors, international cooperation, and keywords were taken into account. Results: A total of 315 publications were retrieved. The annual research output has increased significantly since 2010, especially since 2017. Marmor MF, Lee BR, and Melles RB contributed the highest number of articles published on LR. The top three publishing countries were the USA, China, and UK. Stanford University, Hanyang University, and Harvard Medical School were the top three producing institutions in the world for LR research. The top ten commonly used keywords include the following: systemic lupus erythematosus, retinopathy, retinal toxicity, antimalarial, hydroxychloroquine, optical coherence tomography, antiphospholipid syndrome, microvascular, optic neuritis, optical coherence tomography angiography. The keywords "optical coherence tomography angiography" and "vessel density" have exploded in recent years. Conclusion: By analyzing the current body of LR literature, specific global trends and hotspots for LR research were identified, presenting valuable information to track cutting- edge progress and for future cooperation between various authors and institutions.
论著

基于钉钉平台的全面质量管理模式在眼科教学中的应用

Application of a total quality management model based on the DingTalk platform in ophthalmology education

:527-532
 
目的:结合眼科住院医师规范化培训(住培)的特点,建立基于钉钉平台的全面质量管理模式(total quality management, TQM),探索一种高效的顺应时代特征的眼科教学管理模式。方法:研究团队依托中山大学中山眼科中心,选取82名眼科四证合一的住培一年级的学生作为研究对象,并将其随机分为两组,试验组41人采用基于钉钉平台的TQM模式进行全过程教学管理,采用全员参与、全程跟踪、全面评价的管理模式以保障教学质量。对照组41人接受传统的教学管理模式。观察指标为两组间教学前后测试分数、教学后满意度调查的问卷得分等。结果:通过对两组学生进行课前课后的测试,TQM模式组相较于传统模式组在学习成绩有所提升,课前课后分数的差值分别为40(30,40)分和30(20,50)分,比较差异有统计学意义(=0.031)。问卷调查结果显示,两组满意度总分比较差异无统计学意义[10(10,10) 分 vs. 10(9,10)分,=0.207],但在满意度分项内容掌握性上,TQM模式组分值高于传统模式组[5(5,5)分 vs5(4,5)分,=0.046]。结论:基于钉钉平台的TQM模式在眼科教学中能够有效提高住培的教学质量与学生满意度,相比传统教学管理模式具有更大的教学优势,可为眼科住培提供了一种创新且实用的教学管理模式,对于培养适应时代需求的高水平眼科医师具有重要意义。

Objective: To combine the characteristics of standardized training for ophthalmic resident physicians, establishes a Total Quality Management (TQM) model based on the DingTalk platform, and explored an efficient ophthalmic teaching management model that adapts to the characteristics of the times. Methods: The research team, based at Zhongshan Ophthalmic Center, selected 82 first-year postgraduate students undergoing the national standardized training for resident doctors (STRD) as participants, randomly allocating them into two groups. The experimental group consisting of 41 trainees received TQM-modeled online learning via the DingTalk platform, adopting a management model of full participation, full process tracking, and comprehensive evaluation to ensure teaching quality. While the control group, also comprising 41 trainees, underwent traditional offline instruction. The TQM group engaged in live streaming lectures on the DingTalk platform, whereas the conventional group continued with face-to-face teaching in classroom. Data including pre- and post-teaching scores, as well as scores from satisfaction surveys are analyzed. Results: Comparing pre- and post-teaching scores, significant statistical differences were found between the TQM and traditional groups, with mean score improvements of 40(30,40) points and 30(20,50) points, respectively, indicating statistical significance (=0.013). Furthermore, the questionnaire survey revealed that the TQM group scored higher than the traditional group in aspects such as course design, clinical relevance, content mastery, and instructor satisfaction. In addition, the questionnaire survey showed that there was no statistically significant difference in the total satisfaction score between the two groups (10(10,10) points vs. 10(9,10)points =0.207), but in terms of mastery of satisfaction sub items, the TQM model group scored higher than the traditional model group (5(5,5) points vs. 5(4,5) points, =0.046). Conclusions: The application of a TQM-based model on the DingTalk platform significantly enhances the teaching quality and student satisfaction in the residency training of ophthalmologists, demonstrating greater pedagogical advantages over traditional methods. This efficient ophthalmic teaching management model thus provides a promising solution for standardized residency training in ophthalmology, and holds considerable importance for nurturing highly competent ophthalmologists who can meet the demands of the current era.
综述

红光疗法在眼科疾病中的应用研究进展

Research progress of red-light therapy in the treatment of ocular diseases

:471-480
 
红光是波长范围在620~760 nm的可见光,兼有良好的光化学和热作用,其穿透力较强,能够达到皮肤深层及组织内部,从而产生一系列的生物效应。在眼科领域,红光疗法最初主要应用于弱视和眼睑皮肤相关疾病的治疗,随着研究的进一步深入,红光逐渐被应用于控制近视进展和视网膜相关疾病。目前,重复低强度红光(repeat low-level red-light, RLRL)在近视进展的控制效果得到充分肯定,成为红光疗法在眼科应用最受关注的热点之一,其主要可能机制包括红光照射能激活线粒体中的细胞色素C氧化酶的活性,促进三磷酸腺苷(adenosine triphosphate, ATP) 生成,改善网膜缺氧状况;促进一氧化氮 (nitric oxide, NO)的合成和释放,引起脉络膜血管的扩张及血流量的增加;诱导巩膜细胞外基质的重塑,增加巩膜的强度。此外,红光疗法可抑制视网膜感光细胞调节通路中的氧化应激、炎症和细胞凋亡,减轻眼表炎症反应和疼痛,有助于周围神经损伤后修复等。文章针对红光疗法在近视、视网膜相关疾病、弱视及眼睑皮肤相关疾病的治疗机制、有效性及安全性进行综述,为红光疗法在眼科领域的应用提供重要的参考价值和依据。
Red light is visible light with a wavelength range of 620-760 nm, which has excellent photochemical and thermal effects. It can penetrate deeply into the skin and tissues with strong power, resulting in a series of biological effects. In the field of ophthalmology, red-light therapy was initially mainly used in the treatment of amblyopia and eyelid skin-related diseases, and with the further development of research, red light has been gradually used in the myopia control and the study of retina-related diseases. At present, the effect of repeated low-intensity red light (RLRL) on myopia progression has been fully recognized, and it has become one of the most concerned hotspots in the application of red-light therapy in ophthalmology. The main possible mechanisms include that red light therapy can activate the activity of cytochrome C oxidase in mitochondria, promote ATP production, and improve retinal hypoxia. It can also induce the synthesis and release of NO, cause the expansion of choroidal vessels with improvement of blood flow, and increase scleral strength by remodeling of scleral extracellular matrix. In addition, red- light therapy can reduce oxidative stress, inflammation and apoptosis in the regulatory pathways of photoreceptor cells, reduce eye inflammation and pain, and help repair peripheral nerves after injury. This article will review the mechanism, effectiveness and safety of red-light therapy in myopia, retinal diseases, amblyopia, and eyelid skin-related diseases, in order to provide important reference value and basis for the application of red-light therapy in ophthalmology.
综述

儿童Ⅱ期人工晶状体植入术后青光眼相关不良事件影响因素与预测的研究进展

Research progress on associated factors and prediction of glaucoma-related adverse events following secondary intraocular lens implantation in pediatric eyes

:416-423
 
儿童白内障是全球范围内可治疗儿童盲症的主要原因之一。对于这些患儿而言,手术是恢复或保护视力的主要方法。然而,手术后的并发症,特别是青光眼相关不良事件(glaucoma-related adverse events, GRAEs),常常成为导致儿童二次致盲的主要原因,这引起了眼科医疗领域的广泛关注。文章综述了儿童Ⅱ期人工晶状体植入术后GRAEs的影响因素,包括手术设计、眼部解剖特征、其他眼部发育异常和全身疾病等。手术设计中是否植入人工晶状体(intraocular lens,IOL)以及植入的时机和位置都对GRAEs的发生有显著影响。此外,眼部解剖特征如角膜直径、眼轴长度、前房深度、中央角膜厚度和术前晶状体厚度等,也是影响GRAEs发生的重要因素。同时,其他眼部发育异常和全身疾病,如先天性无虹膜、先天性风疹综合征等,也会增加儿童白内障术后青光眼的发生率。文章还总结了预测GRAEs的方法,并推荐使用Cox回归模型建立预测模型。这种模型可以有效地预测儿童Ⅱ期IOL植入术后在特定时间段内发展为GRAEs的概率,从而为早期识别GRAEs高危儿童提供了重要的借鉴。通过对GRAEs影响因素的深入分析和预测模型的建立,文章旨在帮助眼科医生更好地理解GRAEs的发生机制,并在手术前对患儿进行风险评估,从而选择最佳的手术方案和预防措施。这对于改善患儿的术后恢复、减少并发症、保护视功能具有重要的临床意义。
Pediatric cataract is one of the leading causes of treatable childhood blindness worldwide. For these children, surgery is the primary method to restore or preserve vision. However, postoperative complications, particularly glaucoma-related adverse events (GRAEs), often become the main reason for secondary blindness in children, attracting widespread concern in the field of ophthalmology. This study reviews the impact factors of glaucoma-related adverse events after secondary intraocular lens (IOL) implantation in children, including surgical design, ocular anatomical characteristics, other ocular developmental abnormalities, and systemic diseases. Whether to implant an IOL in the surgical design and the timing and positioning of the implantation have a significant impact on the occurrence of GRAEs. In addition, ocular anatomical characteristics, such as corneal diameter, axial length, anterior chamber depth, central corneal thickness, and preoperative lens thickness, are also important factors affecting the occurrence of GRAEs. At the same time, other ocular developmental abnormalities and systemic diseases, such as congenital aniridia and congenital rubella syndrome, also increase the incidence of glaucoma after pediatric cataract surgery. The article also summarizes methods for predicting GRAEs and recommends using the Cox regression model to establish a predictive model. This model can effectively predict the probability of children developing GRAEs after secondary IOL implantation within a specific time period, providing an important reference for the early identification of high-risk children for GRAEs. Through in-depth analysis of the impact factors of GRAEs and the establishment of predictive models, the article aims to help ophthalmologists better understand the mechanisms of GRAEs and assess the risks of children before surgery, thereby selecting the best surgical plan and preventive measures. This is of great clinical significance for improving postoperative recovery in children, reducing complications, and protecting visual function.

Review Article

Extrinsic regulation of optic nerve regeneration

Extrinsic regulation of optic nerve regeneration

:145-159
 
Retinal ganglion cells (RGCs) extend through the optic nerve, connecting with neurons in visually related nuclei. Similar to most mature neurons in the central nervous system, once damaged, RGCs are unable to regenerate their axons and swiftly progress to cell death. In addition to cell-intrinsic mechanisms, extrinsic factors within the extracellular environment, notably glial and inflammatory cells, exert a pivotal role in modulating RGC neurodegeneration and regeneration. Moreover, burgeoning evidence suggests that retinal interneurons, specifically amacrine cells, exert a substantial influence on RGC survival and axon regeneration. In this review, we consolidate the present understanding of extrinsic factors implicated in RGC survival and axon regeneration, and deliberate on potential therapeutic strategies aimed at fostering optic nerve regeneration and restoring vision.
Retinal ganglion cells (RGCs) extend through the optic nerve, connecting with neurons in visually related nuclei. Similar to most mature neurons in the central nervous system, once damaged, RGCs are unable to regenerate their axons and swiftly progress to cell death. In addition to cell-intrinsic mechanisms, extrinsic factors within the extracellular environment, notably glial and inflammatory cells, exert a pivotal role in modulating RGC neurodegeneration and regeneration. Moreover, burgeoning evidence suggests that retinal interneurons, specifically amacrine cells, exert a substantial influence on RGC survival and axon regeneration. In this review, we consolidate the present understanding of extrinsic factors implicated in RGC survival and axon regeneration, and deliberate on potential therapeutic strategies aimed at fostering optic nerve regeneration and restoring vision
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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