音乐作为一种非侵入性的感官刺激，凭借其独特的治疗价值在医疗领域的应用日益广泛。文章综述了音乐在眼底诊疗领域的应用现状及研究进展。大量临床研究表明，音乐干预可以显著降低患者在眼科诊疗过程中的焦虑水平，改善医疗体验。在玻璃体腔注射、早产儿视网膜病变筛查、视野检查等不同临床场景中，音乐的应用均显示出积极效果。此外，在眼科模拟手术操作研究中，背景音乐的存在不仅没有对医生的手术操作造成干扰，反而可能通过调节术者的心理状态，优化手术环境。虽然音乐干预效果存在个体差异，不同患者对音乐类型、节奏和音量的偏好各异，但总体而言，作为一种安全、经济且易于实施的辅助手段，音乐疗法在眼底临床实践中展现出良好的应用前景。目前已有初步研究表明，音乐在糖尿病视网膜病变合并抑郁症的大鼠实验模型中可减少细胞凋亡并改善抑郁。未来需要开展更多严谨的随机对照试验，建立标准化的音乐干预方案，以充分发挥音乐在眼科诊疗中的积极作用。同时，也应该重视个体化治疗原则，根据患者的个人喜好和具体临床情况，制定合适的音乐干预策略。
Music, as a non-invasive sensory stimulus, has been increasingly applied in medical fields due to its unique therapeutic value. This article reviews the current applications and research progress of music in fundus examination and treatment. Extensive clinical studies have demonstrated that music intervention can significantly reduce patients' anxiety levels during ophthalmic procedures and improve their medical experience. Positive effects have been observed across various clinical scenarios, including intravitreal injections, retinopathy of prematurity screening, and visual field examinations. Furthermore, studies on simulated ophthalmic surgical procedures have shown that background music not only does not interfere with surgeons' operational performance but may actually optimize the surgical environment by regulating the operator's psychological state. Although the effectiveness of music intervention varies among individuals, with patients showing different preferences for music types, rhythms, and volumes, music therapy generally demonstrates promising potential in fundus clinical practice as a safe, economical, and easily implemented auxiliary measure. Preliminary studies have demonstrated that music can reduce cell apoptosis and improve depression in rat models of diabetic retinopathy complicated with depression. Looking forward, more rigorous randomized controlled trials are needed to establish standardized music intervention protocols to maximize the positive effects of music in ophthalmic treatment. Meanwhile, emphasis should be placed on the principle of individualized treatment, developing appropriate music intervention strategies based on patients' personal preferences and specific clinical conditions.
目的：利用超高效液相色谱串联四极杆-静电场轨道阱高分辨质谱(ultra-high per formance liquid chromatography tandem quadrupole-electrostatic field orbitrap high resolution mass spectrometer, UHPLC- HRMS)代谢组学技术结合机器学习识别与糖尿病视网膜病变(diabetic retinopathy, DR)进展过程中的房水代谢差异，以寻找DR进展相关生物标志物。方法：本研究共纳入78例2型糖尿病(type 2 diabetes mellitus, T2DM)患者以及30名年龄性别匹配健康对照人群。使用UHPLC- HRMS检测所有患者及对照人群房水中的代谢物丰度，结合机器学习筛选T2DM和DR进展相关代谢物标志物并建立预测模型。结果：在校正混杂因素后，与健康人群对比1, 5-脱水山梨醇、硫酸十四烷基酯和N,N,N-三甲基-5-氨基戊酸在T2DM患者中表现出显著差异(均P < 0.05)；而N-乙酰色氨酸、亚油酰胺、油酰胺、棕榈酰胺、戊酸(游离脂肪酸(5:0)和琥珀酸与DR进展显著相关(均P < 0.001)。代谢通路分析表明，“缬氨酸、亮氨酸和异亮氨酸的生物合成”“精氨酸的生物合成”和“半胱氨酸及蛋氨酸代谢”是T2DM差异代谢途径。基于生物标志物的随机森林预测模型显示，差异代谢产物对T2DM和DR进展的预测准确率分别为81.3%和74%。结论：代谢组学结合机器学习方法有效揭示了T2DM及与DR进展相关的代谢特征，亚油酰胺和油酰胺有望成为DR进展的生物标志物，为DR的诊断和个体化治疗提供了新的可能性。
Objective: To identify aqueous humor metabolic profiles associated with the progression of type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR), aiming to discover potential biomarkers for DR progression. Ultra-high performance liquid chromatography tandem quadrupole-electrostatic field orbitrap high-resolution mass spectrometry (UHPLC-HRMS) will be utilized in conjunction with machine learning (ML) for comprehensive analysis. Methods: A total of 78 patients with T2DM and 30 age- and gender-matched healthy controls were included. UHPLC-HRMS was used to identify metabolites in the aqueous humor of all participants. ML was employed to screen for metabolites associated with T2DM and DR progression, and predictive models were established. Results: After adjusting for covariates, 1,5-anhydroglucitol, tetradecyl sulfate, and n,n,n-trimethyl-5-aminovaleric acid identified as significant indicators for T2DM compared to controls (all P < 0.05). N-acetyltryptophan, linoleamide, oleamide, palmitic amide, valeric acid(FFA(5:0), and succinic acid emerged as predictors for DR progression (all P < 0.001). Metabolic pathway analysis revealed that "valine, leucine and isoleucine biosynthesis", "arginine biosynthesis," and "cysteine and methionine metabolism" were the most enriched pathways for T2DM. Predictive models achieved R² values of 81.3%, and 74% for T2DM and DR progression, respectively. Conclusions: Metabolomic combined with ML effectively uncovered metabolic characteristics associated with T2DM and DR progression. Linoleamide and oleamide represent promising potential biomarkers for DR progression, offering new opportunities for diagnosis and personalized treatment of DR.
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.
眼结核的表现形式多样，有时会被误诊漏诊。本病例为一年轻男性，以右眼视力突发下降为主诉就诊，眼部表现可见黄斑区脉络膜占位病灶及视网膜内小病灶，经γ-干扰素释放试验、胸部CT等检查，确诊为血型播散性肺结核，眼部诊断为结核性脉络膜结节联合视网膜结节，全身接受抗结核治疗后，眼部病灶消退。
Ocular tuberculosis encompasses a variety of clinical manifestations, which is easily misdiagnosed sometimes. In this article, a young male was admitted to our hospital with a chief complaint of sudden blurred vision in his right eye. His ocular examination detected a tiny mass in the choroid and a small lesion in the retina. After interferon-gamma release assay (IGRA) and chest CT scan, the patient was diagnosed with military tuberculosis. The ocular examination confirmed the diagnosis of choroidal tubercle complicated with intrarentinal tubercle, which were healed after systemic anti-tuberculosis therapy.
目的：观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的自然病程中渗漏点的形态及变化。方法：本研究为前瞻性研究，使用光学相干断层扫描(optical coherence tomography，OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态，测量并计算Hall层、脉络膜全层各自厚度及比值，并进行比较。结果：共20例患者[男14例，女6例，年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment，PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium， RPE)小凸起。在随访期间，仅1例患者的PED完全恢复，其他19例患者在视网膜下液被完全吸收时，RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06，P=0.003；最后1次随访时为0.801±0.07 vs 0.851±0.06，P=0.004)。结论：本研究观察到在急性CSC患者自然病程中，即使视网膜下液吸收，OCT显示渗漏点处仍存在持续的PED，更厚的Haller层及更薄的内层脉络膜，这些发现为CSC的发病机制提供了更多线索。
Objective: To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy (CSC). Methods: This study was a prospective study, using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset, measuring the thickness and ratio of Hall layer and the whole choroid, and then compare them. Results: A total of 20 patients were included in the study, including 14 males and 6 females, aged from 33 to 59, with the median being 41 years old. The follow-up time ranged from 5 months to 13 months. Minute retinal pigment epithelial detachments (PED) were observed in 19 patients. A small bulge of retinal pigment epithelium (RPE) was observed in 1 patient. During the follow-up, only one patient totally recovered. Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients. The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea (0.806±0.08 vs 0.863±0.06, P=0.003, at the first visit; 0.801±0.07 vs 0.851±0.06, P=0.004, at the last follow-up). Conclusion: This study observed that in the natural course of acute CSC patients, even if the subretinal fluid was absorbed, OCT still showed that there was persistent PED at the leakage point, thicker Haller layer and thinner inner choroid layer. These findings provided more clues to the pathogenesis of CSC.
目的：观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的自然病程中渗漏点的形态及变化。方法：本研究为前瞻性研究，使用光学相干断层扫描(optical coherence tomography，OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态，测量并计算Hall层、脉络膜全层各自厚度及比值，并进行比较。结果：共20例患者[男14例，女6例，年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment，PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium，RPE)小凸起。在随访期间，仅1例患者的PED完全恢复，其他19例患者在视网膜下液被完全吸收时，RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06，P=0.003；最后1次随访时为0.801±0.07 vs 0.851±0.06，P=0.004)。结论：本研究观察到在急性CSC患者自然病程中，即使视网膜下液吸收，OCT显示渗漏点处仍存在持续的PED，更厚的Haller层及更薄的内层脉络膜，这些发现为CSC的发病机制提供了更多线索。
Objective: To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy (CSC). Methods: This study was a prospective study, using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset, measuring the thickness and ratio of Hall layer and the whole choroid, and then compare them. Results: A total of 20 patients were included in the study, including 14 males and 6 females, aged from 33 to 59, with the median being 41 years old. The follow-up time ranged from 5 months to 13 months. Minute retinal pigment epithelial detachments (PED) were observed in 19 patients. A small bulge of retinal pigment epithelium (RPE) was observed in 1 patient. During the follow-up, only one patient totally recovered. Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients. The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea (0.806±0.08 vs 0.863±0.06, P=0.003, at the first visit; 0.801±0.07 vs 0.851±0.06, P=0.004, at the last follow-up). Conclusion: This study observed that in the natural course of acute CSC patients, even if the subretinal fluid was absorbed, OCT still showed that there was persistent PED at the leakage point, thicker Haller layer and thinner inner choroid layer. These findings provided more clues to the pathogenesis of CSC.
