眼底影像专栏

一站式玻璃体腔注药中心成立前后效果评价

The evaluation of the effects before and after the establishment of a one-stop intravitreal injection center

:252-260
 
目的:探讨一站式玻璃体腔注药中心成立前后不同管理模式下的成效,分析其对患者就医时间和就医体验的影响。方法:采用回顾性临床研究。选择2023年1月—2024年3月在汕头大学·香港中文大学联 合汕头国际眼科中心接受玻璃体腔注药的2955例患者纳入研究。将2023年1月—2023年8月玻璃体腔注 药中心成立前接受玻璃体腔注药的1399例患者作为对照组;2023年9月—2024年3月玻璃体腔注药中心成立后接受玻璃体腔注药的1556例患者作为观察组。对照组采用常规日间手术流程,观察组成立一 站式玻璃体腔注药中心,优化诊疗和护理服务流程。通过使用问卷调查比较两组患者就医期间从预约手术、手术当天到术后复查各节点的等待时间、健康教育知晓率、患者满意度及不良事件发生率的差异。结果:问卷调查结果显示,对照组、观察组患者间预约等待手术时间分别为(3.93±2.98) d、 (1.34±2.38) d,手术时间分别为(2.53±2.11) min、(1.93±1.82) min,在院时间分别为(313.62±184.96) min、(85.43±34.14) min,术后复查耗时分别为(45.92±48.44) min、(25.82±16.21) min,差异均有统计学意义(P<0.001);患者的总体健康教育知晓率成立前后分别为(95.50%、98.70%),差异有统计学意义 (χ2 =16.09,P<0.001);患者满意度调查结果显示,各项就医体验选项“非常满意”的占比成立后比 成立前明显提高。结论:一站式玻璃体腔注药中心护理模式简化了就医流程,极大地减少了患者就医期 间从预约手术、手术当天到术后复查各节点的等待时间、可显著提升工作效率,明显改善患者整体就 医体验。

To explore the application effects of different nursing models before and after the establishment of a one-stop intravitreal injection center, and to analyze their impact on patient's medical time and experience. Methods: A retrospective clinical study was conducted. From January 2023 to March 2024, 2955 patients who received anti-VEGF drug treatment at the Shantou International Eye Center, a joint initiative of Shantou University and the Chinese University of Hong Kong, were included in the study. The 1399 patients who received anti-VEGF drug treatment before the establishment of the intravitreal injection center from January 2023 to August 2023 were set as the control group; the 1556 patients who received anti-VEGF drug treatment after the establishment of the intravitreal injection center from September 2023 to March 2024 were set as the observation group. The control group followed the routine day surgery process, while the observation group established a one-stop intravitreal injection center to optimize the diagnosis, treatment, and nursing service process. A questionnaire survey was used to compare the differences in waiting time at various points from appointment to surgery, on the day of surgery, and postoperative review, health education awareness rate, patient satisfaction, and adverse event rate between the two groups. Results: The questionnaire survey showed that the waiting time for surgery between the control group and the observation group was (3.93±2.98) d, (1.34±2.38) d, respectively, the surgery time was (2.53±2.11) min, (1.93±1.82) mi, the in-hospital time was (313.62±184.96 min, 85.43±34.14) min, and the postoperative review time was (45.92±48.44) min, (25.82±16.21) min, with all differences being statistically significant (P <0.001); the overall health education awareness rate before and after the establishment was (95.50%, 98.70%), with a significant difference (P <0.001, χ2=16.09); the patient satisfaction survey showed that the proportion of "very satisfied" in various medical experience options was significantly higher after the establishment than before. Conclusions: The one-stop intravitreal injection center nursing model has simplified the medical process, greatly reducing the waiting time at various points from appointment to surgery, on the day of surgery, and postoperative review, significantly improving work efficiency, and significantly improving the overall medical experience of patients.

眼底影像专栏

非感染性葡萄膜炎继发脉络膜新生血管的多模式影像特征

Multimodal imaging features of choroidal neovascularization secondary to non-infectious uveitis

:241-251
 
目的:评估炎非感染性葡萄膜炎继发炎性脉络膜新生血管(inflammatory choroidal neovascularization, iCNV)的临床特征及眼底多模式影像表现。方法:采用回顾性观察性研究,采用眼底荧光素血管造影(fundus fluorescein angiography, FFA)、吲哚菁绿血管造影(Indocyanine green angiography, ICGA)、谱域相干光断层扫描(spectral domain optical coherence tomography, SD-OCT)联合光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)等多种眼底影像学方法,对纳入患者的眼底进行检查,分析非感染性iCNV的面积、分型、位置及形态等影像学特征与临床特征的关系。结果:研究共纳入39例患者,对48只患眼中的51处iCNV病灶进行了评估。纳入患者年龄为(35.28±13.62)岁。其中3例患眼出现多灶性CNV。SD-OCT显示92.16%(47/51)的iCNV为2型CNV,17.65%(9/51)的iCNV出现海绵征,13.72%(7/51)的iCNV伴有局灶脉络膜凹陷。ICGA造影期间,74.50%的iCNV病灶(38/51)伴有弱荧光病灶,25.49%的病例(13/51)显示脉络膜高通透性表现。OCTA enface图像显示iCNV形态多样,包括焦点状(15例,29.41%)、盘状/海扇状(16例,31.37%)、枯树状(9例,17.65%)、星状(9例,17.65%)及弥漫网状(2例,3.92%)。其中,枯树状及星状iCNV提示iCNV为非活动性(P<0.01)。结论:非感染性iCNV与炎性病灶关系密切,在SD-OCT,ICGA上皆具特征性的影像表现。OCTA能直观地观察到iCNV的形态。这些多模式影像特征为临床医生提供了对于非感染性iCNV重要的鉴别诊断依据,有助于制定有效的诊疗方案。
Objective: To evaluate the clinical characteristics and multimodal imaging features of non-infectious inflammatory choroidal neovascularization (iCNV). Methods: In this study retrospective, observational study, multimodal imaging examinations, including fluorescein angiography (FFA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA), were used to observe the morphology of non-infectious iCNV in patients diagnosed with uveitis. The area of iCNV, CNV types, CNV morphology and other imaging characteristics were further analyzed. Results: A total of 39 patients were included, with 48 affected eyes and 51 iCNV were identified. The average age of the included patients was 35.28±13.62 years. Among the affected eyes, 3 presented with multifocal CNV, and 92.16% of iCNV were classified as type 2 CNV. iCNV exhibited diverse morphologies, including focal-like pattern (15 cases, 29.41%),sea-fan pattern(16 cases, 31.37%), dead-tree pattern CNV(9 cases, 17.65%), stellar pattern (9 cases, 17.65%), and diffuse reticular (2 cases, 3.92%). Notably, tree-like and stellar pattern iCNV showed a significant correlation with non-active CNV (P < 0.01). Conclusions: Non-infectious iCNV is closely related to inflammatory lesions, exhibiting characteristic imaging features on SD-OCT and ICGA. OCTA allows for direct observation of the morphology of iCNV. These multimodal imaging characteristics provide important diagnostic criteria for clinicians, aiding in the formulation of effective treatment plans.
团体标准解读

《睑板腺按摩操作流程》团体标准解读

Interpretation of the group standard for operation procedure of meibomian gland massage

:236-240
 
睑板腺功能障碍可导致眼表微环境失衡,眼部不适及视功能障碍,深刻影响着患者的视觉生活质量。睑板腺按摩作为一种通过机械挤压睑板腺疏通睑板腺开口,排出异常睑酯的治疗手段,目前已被广泛应用于临床干眼患者,成为睑板腺功能障碍最常见的物理治疗方法。但由于睑板腺按摩的操作手法多样,不同医疗机构所积累的操作经验也不尽相同,导致在治疗过程中存在较多潜在风险,若操作不当,可造成眼部感染、眼睑红肿、结膜水肿出血,甚至角膜损伤。因此,制定标准化的操作流程,规范睑板腺按摩治疗非常重要。然而,目前尚缺乏全面、系统化且规范化的睑板腺按摩操作的临床实践指导。鉴于此,中山大学中山眼科中心联合全国19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《睑板腺按摩操作流程》的团体标准。文章对该团体标准进行深度解读,以更好指导临床工作。
Meibomian gland dysfunction (MGD) can lead to an imbalance in the ocular surface microenvironment, eye discomfortable, and visual impairment, thereby profoundly affecting the visual quality of life of patients. Meibomian gland massage is now widely used in clinical patients, serving as the most prevalent physical therapy for MGD. The mechanism of meibomian gland massage is to open the meibomian gland opening by squeezing the meibomian gland and expel abnormal eyelid esters. However, due to the diverse techniques used in meibomian gland massage and the varying levels of operational experience accumulated by different medical institutions, there are many potential risks in treatment process. If medical staff operate improperly, it can cause eye infections, eyelid redness and swelling, conjunctival edema and bleeding, and even corneal damage. Therefore, it is crucial to establish the standardized procedure of meibomian gland massage therapy. Yet, there is currently lack of comprehensive, systematic, and standardized clinical practice guidance. Thus, the Zhongshan Ophthalmic Center, Sun Yat-sen University, in collaboration with 19 medical institutions across the country, has released the group standard for Operation Procedure of Meibomian Gland Massage on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group standard to guide clinical work better.
团体标准解读

《强脉冲光治疗睑板腺功能障碍操作流程》团体标准解读

Operation procedure of intense pulsed light for meibomian gland dysfunction

:231-235
 
睑板腺功能障碍(meibomian gland dysfunction, MGD)是一种慢性弥漫性睑板腺疾病,可引起眼红、眼干、异物感等眼部不适,影响患者的眼健康及生活质量。强脉冲光(intense pulsed light, IPL)作为一种新兴有效的物理治疗方法,目前已广泛应用于治疗MGD及其他常见的眼表疾病,如蠕形螨性睑缘炎、睑缘炎相关角结膜病变、复发性睑板腺囊肿等。在IPL临床应用中,规范的操作是保障治疗有效性与安全性的关键。为更好指导和规范临床眼科医护人员的IPL治疗操作,由中山大学中山眼科中心牵头,联合全国19所医疗机构,经过多次修订,于2023年12月17日在全国团体标准信息平台发布了《强脉冲光治疗睑板腺功能障碍操作流程》的团体标准。文章旨在对该团体标准进行深度解读,详细阐述操作中的重点、难点与操作细节,以更好地指导临床工作。
Meibomian gland dysfunction is a chronic diffuse meibomian gland disease that can cause eye discomfort such as redness, dryness, and foreign body sensation in patients, and influence their eye health and quality of life. Intense pulsed light (IPL), as an effective physical therapy for meibomian gland dysfunction, is being used to treat meibomian gland dysfunction and related diseases widely, such as demodex blepharitis, keratoconjunctivitis, recurrent meibomian gland cysts and so on.. In the clinical application of IPL, standardized procedures are key to ensuring the effectiveness and safety of treatment. In order to better guide and standardize the IPL treatment operation of clinical ophthalmic medical workers, led by the Zhongshan Ophthalmic Center, Sun Yat-sen University, and joined with 19 medical institutions across the country, after multiple revisions, the group standard " Operation Procedure of Intense Pulsed Light for Meibomian Gland Dysfunction" was released on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group's standards, detailing the key points, difficulties, and operational details of specific operations, in order to better guide clinical work.
团体标准

广东省玻璃体腔注药操作及质量控制规范

Standard operating procedure and quality control Standards for Intravitreal Injection in Guangdong Province

:223-230
 
玻璃体腔注药是年龄相关性黄斑变性、糖尿病视网膜病变、视网膜静脉阻塞等常见慢性眼底病的主要治疗方式,凭借其治疗量大、操作流程化、实施简便,已成为眼科临床常规诊疗项目。基于《“十四五”全国眼健康规划(2021-2025年)》要求,秉承以患者为中心的服务理念,在确保医疗安全的基础上,优化治疗流程,提升患者接受玻璃体腔注药治疗的就诊体验和治疗效果。同时,广东省将有望承接越来越多港澳的眼病患者,需要建立融合粤港澳大湾区的广东省注药标准。因此,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构共同起草,通过函审、专家论证会等形式,共邀广东省内35名权威专家进行多轮会审,在参考国内外玻璃体腔注药标准的基础上,结合粤港澳大湾区眼科现状,共同讨论最终确定了本标准。本团体标准系统地描述了玻璃体腔注药的基本要求、适应证与禁忌证,制定了全新的玻璃体腔注药标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构所开展的玻璃体腔注药的临床应用以及质量评估提供指导。
Intravitreal injection represents the primary method of drug administration for a range of common chronic endophthalmic diseases, including age-related macular degeneration, diabetic retinopathy and retinal vein occlusion. Recognized for its high clinical efficacy, procedural standardization, and operational accessibility, this has become a routine clinical practice in ophthalmology. In alignment with the "National Eye Health Plan during the 14th Five-Year Plan period (2021–2025)" and the patient-centered service philosophy, this approach optimizes treatment processes and enhances patient experience and therapeutic outcomes while ensuring medical safety. Furthermore, Guangdong Province is poised to become a pivotal hub for ophthalmic care within the Guangdong-Hong Kong-Macao Greater Bay Area, anticipating a growing influx of patients from Hong Kong and Macao. This necessitates the development of a unified intravitreal injection standard tailored to regional healthcare integration. Under the auspices of the Guangdong Medical Association, a consortium led by Zhongshan Ophthalmic Center, Sun Yat-sen University, and 21 collaborating medical institutions across Guangdong, formulated this standard. Through iterative reviews involving correspondencebased evaluations and multidisciplinary expert consultations, 35 distinguished specialists refined the standard, synthesizing global best practices with insights into the Greater Bay Area’s unique ophthalmological landscape. This group standard systematically outlines the basic requirements, indications and contraindications of intravitreal injection, establishes a new standard operating procedure for intravitreal injection and quality control standards for this procedure. In addition, we have introduced guidance for the clinical application of this technique and quality assessment, as well as for the prevention and management of complications or adverse reactions.
综述

新生血管性年龄相关性黄斑变性的分子组学研究进展

Research progress in molecular omics of neovascular age-related macular degeneration

:215-222
 
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。

Age-related macular degeneration (AMD) is one of the leading causes of vision loss in elderly population. Among its subtypes, neovascular AMD (nAMD) has become a global focus in ophthalmological research due to its rapid progression and severe vision impairment. With the acceleration of population aging, the disease burden of nAMD is increasingly heavy, making it urgent to conduct in-depth research on its pathogenesis and explore effective therapeutic strategies. In recent years, the rapid development of high-throughput omics technologies has provided unprecedented opportunities to decipher the complex molecular pathological mechanisms of nAMD. Genomics, transcriptomics, proteomics, metabolomics, and multi-omics integration analyses have not only helped to deeply explore disease-related key molecules, pathways, and networks but also provided new perspectives for discovering novel biomarkers and potential therapeutic targets. This review systematically summarizes the recent advances in molecular omics technologies in nAMD research, focusing on findings from different omics approaches across various biological samples, and analyzes the advantages of multi-omics integration in revealing disease mechanisms and screening biomarkers, aiming to provide references for future research in this field.

综述

探索表皮玻璃疣:从多模式影像特点到临床诊疗的全方位解析

Exploration of cuticular drusen: comprehensive analysis from multi-modal imaging characteristics to clinical diagnosis and treatment

:208-214
 
随着多模式影像技术的应用,年龄相关性黄斑变性(age related macular degeneration, AMD)的一种特殊亚型:表皮玻璃疣(cuticular drusen)被发现,其与AMD尤其是非渗出性AMD又称干性(dry)AMD进展密切相关。但目前聚焦于AMD合并表皮玻璃疣的多模式影像特点等的相关文献较少,因此研究和阐明表皮玻璃疣的多模式影像特点、与其他AMD亚型玻璃疣的鉴别诊断、病理生理机制、治疗方法等具有重要的临床意义。运用多模式影像可以看到表皮玻璃疣呈双眼对称的无数散在的大小均匀的黄色视网膜下结节,典型的“星空状”荧光素钠眼底血管造影(fundus fluorescein angiography, FFA)表现, 以及光学相干断 层成像(optical coherence tomography, OCT)中视网膜色素上皮(retinal pigment epithelium, RPE)和Bruch膜之 间的锯齿状隆起。AMD合并表皮玻璃疣患者的分布特点个体差异很大,容易与AMD其他亚型的玻璃疣混淆,需要与硬性玻璃疣、软性玻璃疣、大胶质玻璃疣、Sorsby眼底营养不良(Sorsby's fundus dystrophy , SFD) 等相鉴别。研究表明表皮玻璃疣具有遗传性的类似动脉粥样硬化的发病机制,与RPE分泌的大型脂蛋白颗粒的堆积密切相关。未来可能会有针对补体系统的药物用于延缓表皮玻璃疣相关病变的进展。文章就表皮玻璃疣的临床表现、多模式影像的典型特点、鉴别诊断、遗传学基础、病理生理学发病机制、 并发症以及临床诊疗策略进行综述。

With the application of multimodal imaging techniques, a specific subtype of age-related macular degeneration (AMD),
known as cuticular drusen, has been identified. This subtype is closely associated with the progression of AMD, particularly non-exudative AMD, also referred to as dry AMD. However, there is a scarcity of literature focusing on the multimodal imaging characteristics of AMD combined with cuticular drusen. Therefore, studying and elucidating the multimodal imaging features of cuticular drusen, its differential diagnosis from other AMD subtypes of drusen, pathophysiological mechanisms, and treatment methods holds significant clinical importance. Multimodal imaging reveals cuticular drusenas numerous, symmetrical, evenly sized, yellow subretinal nodules in both eyes, exhibiting a typical "stars-in-the-sky" appearance on fluorescein angiography (FFA) and zigzag elevations between the retinal pigment epithelium (RPE) and Bruch's membrane on optical coherence tomography (OCT). The distribution characteristics of AMD patients with cuticular drusen vary greatly among individuals and can easily be confused with drusen from other AMD subtypes, so the differentiation from hard drusen, soft drusen, large colloidal drusen, and Sorsby's fundus dystrophy (SFD) is necessary. Studies suggest that cuticular drusen have a genetic, atherosclerosis- like pathogenesis which closely related to the accumulation of large lipoprotein particles secreted by the RPE. Future therapies targeting the complement system maybe employed to delay the progression of cuticulardrusen-related lesions. This article reviews the clinical manifestations, typical multimodal imaging features, differential diagnosis, genetic basis, pathophysiological mechanisms, complications, and clinical management strategies of cuticulardrusen.

综述

基于 en face OCT 的视网膜前巨噬细胞样细胞在眼底病中的研究进展

Research progress in epiretinal macrophage-like cells characterized by en face OCT in ocular fundus diseases

:202-207
 
巨噬细胞样细胞(macrophage-like cells, MLC)指起源、功能与巨噬细胞类似的免疫细胞,包括小胶质细胞、玻璃体细胞及巨噬细胞。将en face OCT显示层面设置在视网膜表明即可观测到视网膜表明的 MLC(epiretinal MLC, eMLC),随后利用ImageJ软件即可对细胞进行提取和量化。研究表明,eMLC在炎症情况下均可出现细胞募集及活化现象,但在不同眼底病中各具特点。在糖尿病视网膜病变、视网膜静脉阻塞等视网膜缺血缺氧性疾病中,eMLC密度越高,黄斑水肿可能越严重。此外,eMLC密度更高的视网膜静脉阻塞患者抗VEGF疗效更差,视力预后不佳,提示基于en face OCT的eMLC不仅可用于评估视网膜炎情况,而且还能充当提示疾病疗效及预后的标志物。在葡萄膜炎等免疫炎症性疾病中,en face OCT亦可观测到eMLC密度、形态等改变。白塞病葡萄膜炎患者视网膜血管渗漏程度与eMLC密度相关性强,故eMLC密度可充当无创评估视网膜血管渗漏程度的新指标。然而,目前提取和量化eMLC的方法及标准不统一,降低了各研究间的可比性。因此,亟需制定统一的操作规范和评估标准。此外eMLC 所代表的具体细胞类型及功能仍需进一步探究。未来,研究者可以利用en face OCT对眼底炎症地进行无创评估。基于en face OCT的eMLC还能作为基础研究与临床研究之间的桥梁,为揭示疾病的致病机制提供重要参考。

Macrophage-like cells (MLC) refer to immune cells that originate from and function similarly to macrophages, including microglia, hyalocytes, and macrophages themselves. By setting the display level of en face OCT to the retinal surface, epiretinal MLC (eMLC) can be observed and subsequently extracted and quantified using ImageJ software. Studies indicate that eMLC can exhibit cell recruitment and activation in inflammatory conditions, each displaying distinct characteristics in different retinal diseases. In ischemic and hypoxic retinal conditions such as diabetic retinopathy and retinal vein occlusion, higher densities of eMLC are associated with more severe macularedema. Moreover, patients with retinal vein occlusion showing higher eMLC densities tend to have poorer responses to anti-VEGF treatments and worse visual prognoses, suggesting that eMLC identified via en face OCT can be used not only to assess retinal inflammation but also as biomarkers for disease efficacy and prognosis. In immune-inflammatory diseases like uveitis, changes in eMLC density and morphology can also be observed through en face OCT. Inpatients with Beh?et's disease, a strong correlation exists between the degree of retinal vascular leakage and eMLC density, making eMLC density a potential non-invasive marker for assessing retinal vascular leakage. However, the current methods and standards for extracting and quantifying eMLC are not unified, significantly reducing comparability between studies. Therefore, there is an urgent need to establish uniform operational protocols and assessment standards. Furthermore, the specific cell types and functions represented by eMLC observed via en face OCT require further investigation. In the future, en face OCT could be utilized for non-invasive assessment of retinal inflammation. eMLC based onen face OCT could also serve as a bridge between basic research and clinical studies, providing valuable insights into the pathogenic mechanisms of diseases.

综述

息肉状脉络膜血管病变的临床病理研究现状

Research status of clinicopathologic studies of polypoidal choroidal vasculopathy

:196-201
 
息肉状脉络膜血管病变(polypoidal  choroidal vasculopathy, PCV)是中国人新生血管性年龄相关性黄斑变性的(age-related macular degeneration, AMD)主要亚型。PCV与典型的新生血管性AMD在流行病学、临床表现、影像学特征和自然病程方面存在一定差异。近年来的研究表明,除了传统的玻璃膜疣驱动机制外,PCV可能与肥厚脉络膜机制相关,后者在亚洲人群中更为常见。深入的病理学探索将有助于揭示PCV的发病机制,并探索PCV与其他脉络膜疾病之间的内在联系。由于PCV患者眼球标本的稀缺,现有的病理学研究较少,且结果之间存在一定差异。文章通过介绍笔者最新的临床病理研究结果,并结合历年来国内外的研究,总结了关于PCV病灶所在的层次、起源及血管内皮生长因子(vascular endothelial growth factor, VEGF)表达水平的争议问题,阐明了PCV的临床病理研究现状。第一,PCV病灶的层次。临床上,OCT成像显示PCV病灶位于视网膜色素上皮(retinal pigment epithelium, RPE)与Bruch膜的高反射线之间,属于I型脉络膜新生血管的特殊亚型。部分病理学研究认为PCV病灶位于Bruch膜内,但实际上PCV病灶更准确地位于RPE基底膜下。第二,异常分支血管网(branching vascular networks, BVN)的起源。尸体眼标本的病理分析表明,BVN起源于脉络膜动脉,且动脉穿过Bruch膜后,转变为薄壁毛细血管形成I型脉络膜新生血管。少数研究指出PCV可能由静脉扩张形成,并存在脉络膜静脉的淤滞。第三,VEGF在PCV病灶中的表达。VEGF是新生血管性AMD的关键致病因子,一些研究表明PCV病灶中VEGF表达升高,提示PCV可能与新生血管性AMD具有相似的发病机制,但也有研究发现PCV病灶中的VEGF表达为阴性,提示PCV的机制可能不完全依赖于VEGF。综上,PCV的病理特征具有复杂性,既有与新生血管性AMD相似的表现,也有肥厚脉络膜的特征。随着眼球捐献意识的提高,未来有望获得更多宝贵的眼球标本,为进一步探索PCV的发病机制提供支持,并为其临床诊断和治疗提供更有效的策略。
Polypoidal choroidal vasculopathy (PCV) is the main subtype of neovascular age-related macular degeneration (AMD) in China.  PCV differs from typical neovascular AMD in terms of epidemiology, clinical presentation, imaging features, and natural disease course. Recent studies suggest that, in addition to the traditional drusen-driven mechanism, PCV may also be associated with pachychoroid mechanism, which is particularly more common in Asian populations. In-depth pathological research will help uncover the pathogenesis of PCV and explore the intrinsic connections between PCV and other choroidal diseases. Due to the rarity of eye specimens from PCV patients, there is limited pathological research, and results can vary. Herein, this article summarize the controversial issues regarding the location level, origin, and the vascular endothelial growth factor (VEGF) expression of PCV lesions by introducing our latest clinicopathologic study on PCV and combining with previous studies in China and worldwide. First, the layer of PCV lesions. Clinically, OCT imaging shows that PCV lesions are located between the retinal pigment epithelium (RPE) and the hyperreflective line of Bruch membrane, making them a special subtype of type I choroidal neovascularization. Some pathological studies suggest that PCV lesions are located within Bruch membrane, but in fact, PCV lesions are more accurately located beneath the RPE basement membrane. Second, the origin of the branching vascular networks (BVN). Pathological analysis of postmortem eye specimens indicates that BVN originates from choroidal arteries, and after passing through Bruch membrane, they transform into thin-walled capillaries, forming type I choroidal neovascularization. A few studies suggest that PCV may result from dilation of choroidal vein, accompanied with vein stasis. Third, VEGF expression in PCV lesions. VEGF is a key pathogenic factor in neovascular AMD. Some studies show increased VEGF expression in PCV lesions, suggesting that PCV may share a similar pathogenic mechanism with neovascular AMD. However, other studies have found negative VEGF expression in PCV lesions, indicating that the mechanism of PCV may not be entirely dependent on VEGF. In conclusion, the pathological features of PCV are complex, showing both similarities to neovascular AMD and characteristics of pachychoroid. With the increasing awareness of eye donation, more valuable eye specimens are expected to be obtained in the future, providing support for further ex;ploration of the pathogenesis of PCV and offering more effective strategies for its clinical diagnosis and treatment.
综述

血糖变异性对糖尿病视网膜病变的影响及研究进展

The impact of blood glucose variability on diabetic retinopathy

:189-195
 
糖尿病视网膜病变(diabetic retinopathy, DR)作为糖尿病的一种常见并发症是导致工作年龄人群失明的主要原因。血糖变异性(glycemic variability, GV)指血糖波动的程度。最新研究表明,GV与糖尿病患者的代谢状况和微血管病变密切相关。该文综述了GV对DR的影响及其研究进展。GV是指血糖水平在高点和低点之间波动的不稳定状态,分为长期GV和短期GV。长期GV主要通过空腹血糖(fasting plasma glucose, FPG)、餐后血糖(postprandial plasma glucose, PPG)和糖化血红蛋白(glycated hemoglobin, HbA1c)评估,短期GV则通过血糖标准差(standard deviation, SD)、变异系数(coefficient of variation, CV)、低血糖指数(low blood glucose index, LBGI)等指标量化。研究表明,GV是糖尿病大管和微血管并发症的重要风险预测因子,与冠状动脉综合征、心肌梗死、脑卒中、糖尿病肾病、周围神经病变等密切相关。在DR方面,GV可能是其进展的风险因素,高GV会加剧氧化应激、炎症反应、内皮功能障碍和新生血管生成,从而促进DR的发展。治疗策略包括动态血糖监测系统、药物干预(如基础胰岛素、阿格列汀等)、合理饮食和运动等,这些方法可改善GV,降低并发症风险,提高患者预后和生活质量。

Diabetic retinopathy (DR) is a common complication of diabetes and is a leading cause of blindness in the working-age population. Glycemic variability (GV) refers to the degree of fluctuation in blood glucose levels. Recent studies have shown that GV is closely related to the metabolic status and microvascular complications in patients with diabetes. This article reviews the impact of glycemic variability (GV) on diabetic retinopathy (DR) and the latest research progress.GV is defined as the unstable state of blood glucose levels fluctuating between highs and lows, which is categorized into long-term GV and short-term GV. Long-term GV is mainly assessed through fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c). Short-term GV is quantified by indicators such as the standard deviation of blood glucose (SD), coefficient of variation (CV), and low blood glucose index (LBGI).Studies have shown that GV is an important risk predictor for both macrovascular and microvascular complications in diabetic patients, being closely associated with conditions such as coronary artery syndrome, myocardial infarction, stroke, diabetic nephropathy, and peripheral neuropathy. Regarding DR, GV is likely a risk factor for its progression. High GV can exacerbate oxidative stress, inflammatory responses, endothelial dysfunction, and neovascularization, thereby promoting the development of DR.Treatment strategies include continuous glucose monitoring systems, pharmacological interventions (such as basal insulin, alogliptin, etc.), as well as proper diet and exercise. These approaches can improve GV, reduce the risk of complications, and enhance patients' prognosis and quality of life.
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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