目的：探讨人工晶状体(IOL)预先巩膜悬吊在严重晶状体半脱位中的应用效果。方法：选取 2018年12月至2022年7月四川省人民医院收治的>180°的严重晶状体半脱位患者8例(8 眼)。术中避开脱位的晶状体，预先将IOL悬吊于玻璃体腔，再将晶状体托起置于IOL上方，必要时辅助以虹膜拉钩，稳定晶状体，确保超声乳化手术安全完成。结果：严重的晶状体半脱位患者8例，其中晶状体核N1-N3硬度的患者各1例，单独使用IOL预先巩膜悬吊于术中稳定脱位的晶状体，3例超声乳化手术均顺利完成；达N4患者3例、N5患者2例，其中4例在虹膜拉钩的辅助下安全完成超声乳化；有1例N5的患者，由于悬韧带损伤超过270°，在将晶状体托起放置于IOL之上时，坠入玻璃体腔，给予玻璃体腔超声粉碎处理。8例患者术后IOL均居中，视力有不同程度的提高，眼压正常，未见严重并发症。结论：在严重晶状体半脱位的超声乳化手术中，对于N2~N3的软核，IOL预先巩膜悬吊可以良好地稳定晶状体，确保超声乳化手术的顺利进行；对于N4~N5的硬核，IOL预先巩膜悬吊可以作为一种辅助方法，联合虹膜拉钩共同稳定晶状体，确保超声乳化手术的安全进行。
Objective: To investigate the effect of intraocular lens (IOL) pre-suspension in thetreatment of severe lens subluxation. Methods: Retrospective case study. From December 2018 to July 2022, 8 eyes of 8 patients with severe lens subluxation greater than 180 degrees admitted to our hospital were selected. During surgery, the IOL should avoid the subluxated lens and be pre-suspended in the vitreous cavity, and then the lens is lifted and placed above the IOL. If necessary, the iris hook can be used to stabilize the lens to ensure the safe completion of phacoemulsification. Results: There were 8 patients with severe subluxation of lens. Among them, the hardness of 3 patients' lens nucleus ranged from N1 to N3. In these 3 patients, we used the IOL pre-suspension alone to stabilize the subluxated lens, and phacoemulsification in these 3 patients was successfully completed. Three patients had N4 and 2 patients had N5, of which 4 patients underwent phacoemulsification safely with the assistance of iris hook. In another patient with N5, the lens fell into the vitreous cavity during surgery (the suspension ligament rapture greater than 270 degrees) when it was lifted and placed on the IOL which was crushed by the vitreous cavity ultrasound. After surgery, the IOL was centered in all 8 patients, visual acuity was improved to varying degrees, intraocular pressure was normal, and no serious complications were observed. Conclusions: In severe lens subluxation surgery, IOL presuspension in soft nuclei of N2 to N3 can stabilize the lens well and ensure the safety of phacoemulsification. For hard nuclei N4 to N5, IOL presuspension can be used as an auxiliary method in combination with iris hook to stabilize the lens and ensure the safety of phacoemulsification.
近年来随着人口老龄化的发展、人群用眼方式的改变，现有的眼科医疗资源正越来越难以满足日渐增长的医疗需求，亟需新型的诊疗模式予以补足。眼科人工智能作为眼科领域的新兴元素，在眼病的筛查诊断中发展迅速，主要表现为“眼部图像数据+人工智能”的模式。近年来，随着该模式在白内障、青光眼、糖尿病性视网膜病变(diabetic retinopathy，DR)等常见病中研究的深入，相关技术日渐成熟，表现出了较大的应用优势与应用前景，部分技术甚至成功转化并被逐渐应用于临床。眼科诊疗向智慧医学模式的过渡，有望缓解日益增长的医疗需求与紧缺的医疗资源之间的矛盾，从而提高整体的医疗服务水平。
The development of population aging and changes in the way people use their eyes over the recent years have increasingly challenged the existing ophthalmic medical resources to meet the growing medical needs, thus urgently calling for a novel diagnostic and treatment mode. Despite its status as an emerging sector in ophthalmology, ophthalmic artificial intelligence has developed rapidly in the screening and diagnosis of eye diseases, as can be seen in practices adopting the “eye imaging data + AI” mode. In recent years, with the intensified research on this mode with respect to common diseases such as cataract, glaucoma and diabetic retinopathy, relevant technologies have grown increasingly mature, presenting undeniable application superiority and prospects. Some of the relevant technical achievements have also been successfully transformed for practical usage, and are gradually being applied to clinical practices. Ophthalmic diagnosis and treatment are transitioning toward the era of intelligent medical services, which are expected to reduce the contradictions between the growing medical needs and the shortage of medical resources, as well as ultimately improve the overall experience of medical services.
糖尿病视网膜病变(diabetes retinopathy, DR)是糖尿病常见的眼部并发症，其病理过程复杂，涉及多种细胞及炎症因子。Müller细胞作为视网膜主要支持细胞，在DR中不仅产生白介素-17(interleukin-17, IL-17)，还作为其主要靶点发挥作用，通过谷氨酸代谢异常、血管内皮生长因子(vascular endothelial growth factor, VEGF)分泌增加及调控参与DR的病理过程，加重炎症反应。IL-17主要由辅助性T细胞17(T helper cell 17, Th17)分泌，通过促进多种炎症介质(如细胞因子、趋化因子和金属蛋白酶)的分泌，增强炎症反应，导致视网膜微血管损害和神经元凋亡，促进DR的发展。高糖环境下，Müller细胞功能受损，IL-17进一步加剧其功能障碍形成恶性循环。研究表明，阻断IL-17及核因子-κB激活剂1(Nuclear factor-kappa B activator 1, Act1)/肿瘤坏死因子受体关联因子6(tumor necrosis factor receptor associated factor 6, TRAF6)/核因子-κB(Nuclear factor-kappa B, NF-κB)信号通路可减轻DR的病理改变，为DR的治疗提供了新的思路。因此，深入研究IL-17与Müller细胞在DR中的相互作用机制，对于研究该疾病的发病机制及开发精准有效的治疗策略具有重要意义。
Diabetes retinopathy (DR) is a common ocular complication of diabetes, characterized by a complex pathological process involving multiple cells and inflammatory factors. Müller cells, as the primary supporting cells of the retina, not only produce interleukin-17 (IL-17) but also serve as a primary target in DR. They participate in the pathological process of DR by contributing to abnormal glutamate metabolism, increased secretion of vascular endothelial growth factor (VEGF), and regulatory functions, thereby exacerbating the inflammatory response. IL-17 is primarily secreted by T helper cell 17 (Th17) cells and enhances the inflammatory response by promoting the secretion of various inflammatory mediators (such as cytokines, chemokines, and metalloproteinases), leading to retinal microvascular damage and neuronal apoptosis, which accelerates the progression of DR. In a high-glucose environment, Müller cell function is impaired, and IL-17 further exacerbates this dysfunction, creating a vicious cycle. Studies have shown that blocking the IL-17 and Act1/TRAF6/NF-κB signaling pathways can mitigate the pathological changes associated with DR, providing new insights for the treatment of this disease. Therefore, conducting in-depth research on the interaction mechanism between IL-17 and Müller cells in DR is of great significance for exploring the pathogenesis of this disease and developing precise and effective treatment strategies.
前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段增大疾病，表现为大角膜(直径≥ 12.5 mm)、前房极深、角膜厚度正常或轻中度变薄和睫状环扩大等。并发性白内障以及晶状体脱位是导致AM视力下降的主要原因。然而，解剖结构的异常使AM白内障手术具有很大的挑战性。文章报道了一例AM合并白内障的48岁男性患者，成功为其行手法小切口白内障摘除联合人工晶状体(intraocular lens, IOL)一期植入术，患者术后视力恢复良好，IOL位置居中，未出现较大的屈光误差。对该典型AM病例的临床特点以及手术难点的回顾总结，有助于加深广大眼科临床工作者对该疾病的认识。
Anterior megalophthalmos is a rare congenital enlargement of the anterior segment, characterized by bilateral nonprogressive megalocornea (diameter ≥12.5 mm), extremely deep anterior chamber, normal or moderate thinning of the cornea, and elongation of the ciliary ring. Cataract and lens dislocation are the main causes of decreased vision in patients with AM. However, cataract surgery on patients with AM are challenging due to the anatomical abnormalities. This case reports a 48-year-old male patient diagnosed with AM and cataract, who successfully underwent a manual small incision cataract extraction combined with intraocular lens implantation. Finally, our patient showed a good visual outcome with a well centered IOL and without obvious refractive error. In this typical AM case, we reviewed and summarized the clinical characteristics and the challenges of surgical treatment so that other ophthalmologists can learn about this disease.
青光眼是全球第一大不可逆性致盲性眼病，影响全球7 000多万人，其特征是视网膜神经节细胞的退行性病变。到2040年，预计全球青光眼患者人数将增加至1.12亿，其中约10%的人至少一只眼睛失明。由高眼压诱发、多种致病因素导致的视网膜神经节细胞死亡是青光眼进展过程中视功能损伤的主要病理过程，也是青光眼病程中视功能损害不可逆的重要原因。目前降眼压治疗是唯一的干预疗法，然而其仍然不能完全遏止视网膜神经节细胞进行性损伤，并且既往病程造成的视神经损伤不可逆转。探索青光眼进程中视网膜神经节细胞退行性改变的直接致病因素，寻找关键的治疗靶点，以及开发新的具有神经保护作用的治疗药物，具有重要意义。文章回顾了近年来青光眼中视网膜神经节细胞退行性病变的机制和治疗的新进展，强调了神经血管单元的改变在青光眼发病机制中的重要作用和干预价值。同时，靶向代谢的药物应用、抑制早期炎症反应和减少氧化应激，辅以营养和运动支持等可能延缓和抑制神经退行性病变的发生，起到神经保护作用。未来青光眼发病机制的研究重点仍然在眼压之外的致病因素上，从血流、代谢和免疫串扰的病理环境中发掘对神经退行性改变重要的致病因素并进行干预治疗具有广阔的前景。在多种动物模型中验证干预手段的神经保护作用，也有望提高青光眼神经保护的临床转化成功率，以拓展青光眼的治疗理念与药物选择。
Glaucoma stands as the leading cause of irreversible blindness globally, affecting over 70 million individuals. It is characterized by progressive degeneration of retinal ganglion cells (RGCs). By 2040, the global prevalence of glaucoma is expected to rise to 112 million, with approximately 10% experiencing blindness in at least one eye. The primary pathological basis for visual function impairment in glaucoma progression is the loss of RGCs induced by elevated intraocular pressure (IOP) and various pathogenic factors. Currently, IOP-lowering treatment is the only intervention available, but it cannot completely halt the progressive injury to RGCs, nor can it reverse the optic nerve damage caused by prior disease progression. Exploring the direct pathogenic factors of RGC degeneration in glaucoma, identifying key therapeutic targets, and developing new neuroprotective treatments are of great importance. This review discusses recent advancements in the mechanisms and treatments of retinal ganglion cell degeneration in glaucoma, highlighting the significant role of neurovascular unit changes in the pathogenesis of glaucoma and the potential value of interventions. Additionally, targeting metabolites, inhibiting early inflammatory responses, and reducing oxidative stress, supplemented by nutritional and exercise support, may help delay and inhibit neurodegenerative processes, offering neuroprotective effects.Future research on glaucoma pathogenesis should focus on factors beyond IOP, exploring pathogenic factors in the pathological environment of blood flow, metabolism, and immune crosstalk for targeted therapeutic interventions. Also, verifying the neuroprotective effects of these interventions in various animal models holds promise for improving the clinical translation success rate of neuroprotection in glaucoma, thus expanding therapeutic concepts and drug options.
Stargardt病(STGD1, OMIM#248200)是最常见的遗传性黄斑营养不良，是由ABCA4基因突变引起的常染色体隐性遗传病。该病通常在儿童晚期或成年早期发病，导致视力进行性、不可逆地损害。近年研究者在STGD1临床和分子特征以及潜在的病理生理学方面取得的重大进展，促成了许多已完成的、正在进行的和计划中的新疗法的人体临床试验。文章聚焦于STGD1的基因治疗研究进展。STGD1基因治疗的主要障碍是ABCA4基因序列过长以及ABCA4基因在光感受器细胞中的特异性转导效率不高。解决这一问题的关键是研究出具有大运载量和能高效将ABCA4基因转导进光感受器细胞的载体。目前STGD1的基因治疗策略主要包括腺相关病毒(adeno-associated viral, AAV)载体、慢病毒载体、纳米颗粒、光遗传学和反义寡核苷酸等。随着研究的深入，未来有望开发出针对STGD1的有效基因治疗方法，为患者带来新的治疗希望。该综述为临床应用和科学研究提供了宝贵的参考和思路。
Stargardt disease (STGD1, OMIM#248200) is the most common hereditary macular dystrophy, caused by mutations in the ABCA4 gene, and is an autosomal recessive inherited disorder. The disease typically manifests in late childhood or early adulthood, leading to progressive and irreversible visual impairment. Significant advances in understanding the clinical and molecular characteristics, as well as the underlying pathophysiology, have ultimately facilitated numerous human clinical trials of new therapies that have been completed, are ongoing, and are planned. This review focuses on the progress in gene therapy research for STGD1. The primary obstacle in STGD1 gene therapy is the lengthy sequence of the ABCA4 gene and the low efficiency of specific transduction of the ABCA4 gene into photoreceptor cells. The key to addressing this issue is to develop a vector with a large carrying capacity that can efficiently transduce the ABCA4 gene into photoreceptor cells. Current gene therapy strategies for STGD1 mainly include adeno-associated viral (AAV) vectors, lentiviral vectors, nanoparticles, optogenetics, and antisense oligonucleotides(AONs). With the deepening of research, it is hoped that effective gene therapy methods for STGD1 will be developed in the future, bringing new therapeutic hope to patients. This review provides valuable references and ideas for clinical applications and scientific research.
Aims: Divided nevus of the eyelid is a congenital pigmented nevus that impacts eyelid function and aesthetics. While surgical excision and laser ablation are current treatment options, they have limitations when dealing with large lesions. This study aims to investigate the efficacy and safety of carbon dioxide (CO2) laser excision treatment for divided nevus of the eyelid. Methods: This retrospective study included 10 patients (5 males, 5 females) with a mean age of 23.7 years (9-54 years). All underwent CO2 laser excision and were followed up for 12 months. Treatment outcomes were assessed through clearance and recurrence rates, evaluated using digital photography. Postoperative complications were closely monitored throughout the 12-month follow-up period. Patient satisfaction was assessed using a comprehensive questionnaire. Results:All patients presented with unilateral divided nevus of the eyelid, with lesion diameters ranging from 25 to 50 mm and heights ranging from 0.3 to 6 mm (mean: 3.93 mm). Patients received between 1 and 5 laser treatment sessions. At the 12-month follow-up, a 100% clearance rate was achieved, with no recurrence observed in any patient. All patients maintained a continuous eyelid margin with acceptable irregularity. Complications were minimal, with partial eyelash loss in 8 patients, hyperpigmentation in 2 patients, and mild upper eyelid trichiasis in 1 patient. No severe complications, such as ectropion, eyelid margin notching, corneal erosion, or significant scar hypertrophy, were reported. All patients expressed being "very satisfied" with the functional and cosmetic outcomes in a questionnaire. Conclusions: CO2 laser excision offers a simple, precise, and effective treatment approach for divided nevus of the eyelid. This innovative technique simplifies the treatment process, achieves excellent cosmetic outcomes, and eliminates the need for skin grafting, making it a promising option for the management of large divided nevus.
Aims: Divided nevus of the eyelid is a congenital pigmented nevus that impacts eyelid function and aesthetics. While surgical excision and laser ablation are current treatment options, they have limitations when dealing with large lesions. This study aims to investigate the efficacy and safety of carbon dioxide (CO2) laser excision treatment for divided nevus of the eyelid. Methods: This retrospective study included 10 patients (5 males, 5 females) with a mean age of 23.7 years (9-54 years). All underwent CO2 laser excision and were followed up for 12 months. Treatment outcomes were assessed through clearance and recurrence rates, evaluated using digital photography. Postoperative complications were closely monitored throughout the 12-month follow-up period. Patient satisfaction was assessed using a comprehensive questionnaire. Results: All patients presented with unilateral divided nevus of the eyelid, with lesion diameters ranging from 25 to 50 mm and heights ranging from 0.3 to 6 mm (mean: 3.93 mm). Patients received between 1 and 5 laser treatment sessions. At the 12-month follow-up, a 100% clearance rate was achieved, with no recurrence observed in any patient. All patients maintained a continuous eyelid margin with acceptable irregularity. Complications were minimal, with partial eyelash loss in 8 patients, hyperpigmentation in 2 patients, and mild upper eyelid trichiasis in 1 patient. No severe complications, such as ectropion, eyelid margin notching, corneal erosion, or significant scar hypertrophy, were reported. All patients expressed being "very satisfied" with the functional and cosmetic outcomes in a questionnaire. Conclusions: CO2 laser excision offers a simple, precise, and effective treatment approach for divided nevus of the eyelid. This innovative technique simplifies the treatment process, achieves excellent cosmetic outcomes, and eliminates the need for skin grafting, making it a promising option for the management of large divided nevus.
目的：分析Hallermann-Streiff综合征(Hallermann-Streiff syndrome,HSS)继发性青光眼的临床表现，探讨其治疗方法。方法：采用病例系列研究与文献回顾方法，记录3例确诊为HSS继发性青光眼患者的视力、眼压、裂隙灯、超声生物显微镜、相干光断层扫描、角膜地形图、A超、B超、X线眼眶大小测量等检查结果。随访患者药物治疗、周边虹膜切除术、小梁切除术或青光眼阀植入术的疗效。结果：3例患者年龄分别为9、29和47岁，其中女性2例、男性1例。最佳矫正视力为0.04-0.5，平均屈光度为+12.1D，平均眼压为37.7 mmHg，平均角膜直径为9.1 mm，平均中央前房深度为2.43 mm，平均眼轴长度为18.13 mm，角膜地形图示平均K1值为56.97 D，平均K2值为60.65 D。眼眶水平径为28.86~31.40 mm，垂直径为30.16~32.90 mm。2例年轻患者为无晶状体眼，伴葡萄膜炎、瞳孔区纤维膜、视盘旁脉络膜萎缩弧。年长患者表现为蓝色巩膜、白内障、房角关闭，眼底表现为青光眼性视杯凹陷。3例患者平均身高143 cm，伴头发及眉毛稀疏、额头前凸、鼻子呈喙状、牙齿发育不全、下颌发育不全。术后平均随访47.7个月(范围：11~84个月)，眼压控制，视力与术前一致，无治疗相关并发症出现。结论：HSS继发性青光眼的眼部病变可表现为小眼眶、小眼球、小角膜、蓝色巩膜、无晶状体、瞳孔区纤维膜、葡萄膜炎、继发性青光眼及视盘旁脉络膜萎缩。对HSS继发性青光眼的患者，个性化地选择治疗方案，可以获得较好的治疗效果。
Objective: To demonstrate the clinical characteristics and surgical effects of glaucoma in Hallermann-Streiff syndrome(HSS). Methods: Observational case series and literature review. The results of ophthalmic examinations of three patients diagnosed as glaucoma with HSS were recorded, including visual acuity, intraocular pressure (IOP), slit-lamp microscopy, ultrasound biomicroscopy, optical coherence tomography, corneal topography, A-scan and B-scan ultrasonography, and orbital size measurement by X-ray. Peripheral iridectomy, glaucoma drainage device implantation or trabeculectomy, were performed in these patients. Results: Three HSS patients were 9, 29 and 47 years old, respectively, including 2 females and 1 male. The best corrected visual acuity was 0.04-0.5. The mean spherical equivalent refraction was +12.1 D. The average IOP was 37.7 mm Hg, and the average corneal diameter was 9.1 mm. The average central anterior chamber depth was 2.43mm. The average axial length was 18.13mm. Keratometry showed average K1 of 56.97 degrees, and K2 of 60.65 degrees. Two younger patients were aphakic bilaterally with uveitis, pupillary fibrous membrane and peripapillary choroidal atrophy. The older patient showed blue sclera, cataract, and anterior chamber angle closure. The horizontal orbital diameter was 28.76-31.40 mm, and vertical orbital diameter was 30.16-32.90 mm. All patients were proportionate nanism, with an average height of 143 cm. Craniofacial manifestations included dyscephalia and “bird-like” face, hypotrichosis, dental anomalies, and mandibular hypoplasia. They were followed up for an average of 47.7 months(range:11-84 months) after surgery. The IOPs were all controlled, and the visual acuities remained unchanged. No treatment-related complications occurred. Conclusions: HSS patients with glaucoma may present as small orbit, microphthalmia, microcornea, blue sclera, aphakia, pupillary fibrous membrane, uveitis, with atrophic chorioretinal changes. For these patients, personalized treatment may help to achieve better therapeutic effects.
培养合格的眼科医师对于防盲治盲工作、为人民提供优质眼健康服务是十分重要的，不同地区的住院医师规范化培训各有特点。文章从各个方面比较了内地与香港眼科住院医师规范化培训体系的异同，包括培训对象、培训师资、轮转阶段和要求、考核机制。香港的培训体系时间为6年，大致上相当于住院医师规范化培训和专科医师规范化培训结合在一起。通过比较两者的差异，有助于我们结合自己的实际情况，改进内地的眼科学住院医师教育培养体系，也为下一步开展眼科专科医师规范化培训提供参考。
The training of qualified ophthalmologists holds paramount significance in preventing blindness, treating eye diseases, and delivering optimal eye health services to the people. Given the unique nature of standardized residency training across geographical regions, this study delves into the comparative analysis of ophthalmology residency standardized training systems in the Mainland and Hong Kong. Specifically, we examine the the similarities and disparities in multiple facets, encompassing trainees' profiles, faculty expertise, rotation phases and prerequisites, as well as assessment methodologies. Notably, the training system in Hong Kong has a duration of 6 years, approximating the combined length of standardized residency training and standardized specialist training. By comparing the differences, we aim to facilitate the refinement of ophthalmology residency education and training in Mainland China, tailored to our specific context, while also serving as a reference for advancing standardized ophthalmology specialist training initiatives.
目的：基于我国国情构建科学、简便且高效的眼科急诊预检分诊标准，为眼科医护人员提供高效的眼科急诊预检分诊工具。方法：基于文献查询法、半结构访谈法、德尔菲法及层次分析法确定眼科急诊预检分诊标准内容。通过提取2023年8月1日-2023年8月10日急诊分诊系统及HIMSS电子病历系统数据，分析初次分诊的级别与接诊医生最终诊断的所属级别符合率，对眼科急诊预检分诊标准体系的应用效果进行初步验证。结果：对18名专家进行２轮专家咨询，有效问卷回收率均为100%，专家权威系数均为0.95，肯德尔和谐系数分别为0.5640.117(均P＜0.05)。最终构建的眼科急诊预检分诊标准体系包括3个一级指标、11个二级指标。初步验证显示，该预检分诊标准体系具有92.7%的分诊准确率。结论：本研究构建的眼科急诊预检分诊标准体系结构合理、内容全面，具有科学性及实用性，可为眼科临床急诊预检分诊工作提供准确、有效的分诊工具，有助于提高临床工作效率及预检分诊质量。
Objective: To establish a scientific, simple, and efficient ophthalmic emergency pre-examination triage standard, and provide efficient ophthalmic emergency pre-examination triage tools for ophthalmic staffs, based on national conditions. Methods: With literature search, semi-structured interview, Delphi Method, and Analytic Hierarchy Process, the content of ophthalmic emergency pre-examination and triage standard are confirmed. By extracting data from the emergency triage system and HIMSS electronic medical record system from August 1st, 2023 to August 10th, 2023, the consistency rate between the initial triage level and the final diagnosis level of the attending doctor was analyzed, and the application effect of the ophthalmic emergency pre-examination and triage standard system was preliminarily verified. Results: Two rounds of expert consultation were conducted among 18 experts, all with a 100% effective questionnaire response rate. The expert authority coefficients were 0.95, and the Kendall harmony coefficients were 0.564 and 0.117, respectively (all P<0.05). The final constructed ophthalmic emergency pre-examination triage standard system includes 3 primary indicators and 11 secondary indicators. Through verification, the pre screening triage standard system has a good triage accuracy rate of up to 92.7%. Conclusions: The structure of the ophthalmic emergency pre-examination triage standard system constructed in this study is reasonable, comprehensive, scientific, and practical. It can provide accurate and effective triage tools for ophthalmic clinical emergency pre-examination triage work efficiency, and preexamination triage quality.
