Meibomian gland dysfunction (MGD) manifests through two main clinical presentations, characterized by the meibomian gland (MG) ductal obstruction or acinar dropout. While previous research has predominantly associated MGD pathogenesis with hyperkeratinization-related MG ductal obstruction and subsequent acinar atrophy, recent cases have shown significant functional acinar loss in the absence of apparent ductal keratinization or blockage. The deterioration of either MG obstruction or dropout exacerbates the condition of the other, suggesting an independent yet interconnected relationship that perpetuates the vicious cycle of MGD. Understanding the distinct pathological features of MG obstruction and dropout is crucial for delineating their etiology and identifying targeted therapeutic strategies. This review explores the nuanced interrelations of MG obstruction and dropout, elucidating potential pathological mechanisms to establish a foundation for early MGD diagnosis and intervention.
Meibomian gland dysfunction (MGD) manifests through two main clinical presentations, characterized by the meibomian gland (MG) ductal obstruction or acinar dropout. While previous research has predominantly associated MGD pathogenesis with hyperkeratinization-related MG ductal obstruction and subsequent acinar atrophy, recent cases have shown significant functional acinar loss in the absence of apparent ductal keratinization or blockage. The deterioration of either MG obstruction or dropout exacerbates the condition of the other, suggesting an independent yet interconnected relationship that perpetuates the vicious cycle of MGD. Understanding the distinct pathological features of MG obstruction and dropout is crucial for delineating their etiology and identifying targeted therapeutic strategies. This review explores the nuanced interrelations of MG obstruction and dropout, elucidating potential pathological mechanisms to establish a foundation for early MGD diagnosis and intervention.
越来越多的证据表明，空气污染可严重损害人体健康，成为全球疾病负担的主要原因。并且污染空气中的主要成分空气颗粒物可渗透到肺部和心血管系统，引起缺血性心脏病、肺炎、慢性阻塞性肺疾病甚至肺癌，导致空气污染相关的发病率和死亡率升高。城市颗粒物作为城市居住人群面临的主要空气污染问题，被证实与多种炎症性眼表疾病密切相关，如过敏性结膜炎、角膜炎、干眼等。高浓度城市颗粒物暴露还会引起睑板腺病理性结构改变和功能异常，诱发炎性睑板腺功能障碍。文章综述了城市颗粒物相关的眼表疾病类型及其致病机制的最新研究，旨在阐明空气污染对于眼表组织的损害和相应的潜在治疗靶点，指导临床上环境相关眼病的诊断与治疗。
More and more evidence indicate that air pollution can seriously damage human health and become a major cause of the global disease burden. The main component of air pollution, particulate matter, can penetrate the lungs and cardiovascular system, causing ischemic heart disease, pneumonia, chronic obstructive pulmonary disease, and even lung cancer, leading to an increase in the incidence and mortality rates related to air pollution. Urban particulate matter, as the main air pollution problem faced by urban residents, has been shown to be closely related to various inflammatory eye diseases, such as allergic conjunctivitis, keratitis, and dry eye. Our research further confirms that exposure to high concentration of urban particulate matter can also cause pathological structural changes and functional abnormalities in the meibomian gland, leading to inflammatory meibomian gland dysfunction. This review comprehensively summarizes the latest research on the eye surface diseases related to urban particulate matter and their pathogenic mechanisms, aims to elucidate the damage of air pollution to eye surface tissues, identify potential therapeutic targets, and guide the diagnosis and treatment of environmentally related eye diseases in clinical practice.
铁离子在维持角膜细胞正常代谢、DNA合成和修复等生理活动中发挥关键作用，但过量的铁离子可能引发铁稳态失衡继而导致细胞毒性损伤和死亡。圆锥角膜是最常见的扩张性角膜疾病，其典型的Fleischer环是铁稳态失衡的直接证据。圆锥角膜与铁代谢相关的前期研究显示，铁稳态失衡有可能是诱发圆锥角膜发生和发展的潜在致病机制。文章总结了人体及角膜中正常的铁代谢循环以及圆锥角膜铁稳态失衡的证据，并从维持铁稳态角度出发探索可能的治疗策略，为扩张性眼病治疗提供新的思路。
Iron ions are essential for normal metabolism, DNA synthesis, and cellular repair in corneal cells. Nevertheless, an excess of these ions can disrupt iron homeostasis, leading to cellular toxicity, damage, and death. Keratoconus, the most prevalent ectatic corneal disorder, is often marked by the Fleischer ring, which indicates an imbalance in iron homeostasis. A review of early studies on keratoconus and iron metabolism suggests that this imbalance may be a potential pathogenic mechanism contributing to the onset and progression of the disease. This article aims to provide a comprehensive overview of normal iron metabolism in the human body and cornea, highlighting the evidence of iron homeostasis imbalance in keratoconus. It also explores potential therapeutic strategies focused on maintaining iron homeostasis, thereby offering novel insights into the treatment of ectatic eye diseases.
Purpose: To report a case of interface fluid syndrome following small incision lenticule extraction (SMILE) and subsequent CIRCLE enhancement. Case Presentation: A 30-year-old female experienced progressively worsening vision following refractive enhancement surgery. The patient had experienced a transient increase in intraocular pressure (IOP) after SMILE, normalized poststeroid cessation. Three months after the enhancement, her best-corrected visual acuity deteriorated from 20/20 in both eyes before the surgery to 20/300. IOP measured by non-contact tonometry was 25.3 mmHg in the right eye and 26.7 mmHg in the left eye, while the measurements off the flap using iCare were 55.3 mmHg and 47.8 mmHg, respectively. Examination revealed moderate corneal edema, interface fluid pockets, and haze, which were confirmed by anterior segment optical coherence tomography. Treatment involved the discontinuation of steroids and the introduction of hypotensive medication, leading to significant symptom relief. Conclusion: This case highlights the importance of cautious and conservative steroid use, particularly in steroid-responsive patients. When steroids are administered in cases potentially involving diffuse lamellar keratitis and haze, monitoring peripheral IOP is essential.
Purpose: To report a case of interface fluid syndrome following small incision lenticule extraction (SMILE) and subsequent CIRCLE enhancement. Case Presentation: A 30-year-old female experienced progressively worsening vision following refractive enhancement surgery. The patient had experienced a transient increase in intraocular pressure (IOP) after SMILE, normalized poststeroid cessation. Three months after the enhancement, her best-corrected visual acuity deteriorated from 20/20 in both eyes before the surgery to 20/300. IOP measured by non-contact tonometry was 25.3 mmHg in the right eye and 26.7 mmHg in the left eye, while the measurements off the flap using iCare were 55.3 mmHg and 47.8 mmHg, respectively. Examination revealed moderate corneal edema, interface fluid pockets, and haze, which were confirmed by anterior segment optical coherence tomography. Treatment involved the discontinuation of steroids and the introduction of hypotensive medication, leading to significant symptom relief. Conclusion: This case highlights the importance of cautious and conservative steroid use, particularly in steroid-responsive patients. When steroids are administered in cases potentially involving diffuse lamellar keratitis and haze, monitoring peripheral IOP is essential.
随着移植技术逐年发展，异基因造血干细胞移植患者的生存期延长，长期并发症成为影响患者预后及生活质量的主要原因。眼移植物抗宿主病是异基因造血干细胞移植术后最常见的眼部并发症，发生率可高达50%以上。根据发病时间可分为急性及慢性眼移植物抗宿主病，临床上最常以慢性炎症及眼表组织纤维化为特点，主要表现为干眼和不同程度的角结膜炎，治疗较为棘手，可不同程度影响患者视觉质量及生活质量，严重可致盲。近年来眼移植物抗宿主病越来越受到国内外学者重视，其发病机制、临床特点、诊断及治疗相关研究逐渐深入，文章针对眼移植物抗宿主病的临床诊疗新进展进行综述。总体而言，眼移植物抗宿主病早期识别仍较为困难，早期诊断策略有待进一步探索。目前治疗对眼移植物抗宿主病的效果较为有限，或缺乏充足的循证医学证据，临床上缺乏针对不同严重程度及疾病活动度的分级诊疗策略，未来有待进一步探索新的治疗靶点及疾病活动监测指标，将有助于改善患者长期预后及生活质量。
Despite advancements in allogeneic hematopoietic stem cell transplantation techniques leading to improved overall survival rates, long-term complications have emerged as the primary contributors to poor prognosis and diminished quality of life. Ocular graft-versus-host disease (oGVHD), a prevalent complication affecting over 50% of patients post-transplantation, frequently manifests as refractory dry eye, often accompanied by keratoconjunctivitis. Patients with oGVHD routinely suffer from visual impairment and a decline in their quality of life.Currently, research into the mechanisms, clinical features, diagnosis, and treatment of oGVHD has progressively deepened. This article reviews the latest advancements in the clinical diagnosis and management of oGVHD. Notably, there is a pressing need for strategies focused on early diagnosis and treatment, as early recognition of oGVHD remains challenging. Existing treatments for oGVHD either exhibit limited efficacy or lack robust clinical evidence to support their use as the best available options.Further research is imperative to develop tiered diagnostic and treatment approaches, including the exploration of novel therapeutic targets and biomarkers for disease detection. Such endeavors hold the promise of enhancing patients' long-term prognosis and quality of life.
圆锥角膜（KC）是一种典型的扩张性眼病，以角膜扩张变薄并向前锥形突起为特征，严重时可致盲。KC三联征之一铁锈色Fleischer环，主要由上皮细胞基底膜周围的铁离子沉积组成。近年来，越来越多研究表明，铁稳态失衡可能与KC的发生和发展密切相关。KC患者泪液中铁相关蛋白的异常表达，提示铁稳态失衡可能是诱发KC的潜在致病机制。此外，角膜上皮细胞内铁稳态失衡导致细胞内铁离子异常积聚，进而引发活性氧和脂质过氧化物的大量生成，最终可能触发细胞铁死亡。从恢复铁稳态角度出发，螯合过量的铁离子和调控铁死亡过程关键靶点可能是未来KC潜在的治疗方法。目前关于铁稳态失衡导致KC发病的具体机制仍存在诸多谜团。随着相关研究的不断深入，有望通过改善角膜铁稳态失衡，为KC临床治疗带来新的思路和突破，也为KC患者提供更精准和个体化的治疗策略。
圆锥角膜（KC）是一种典型的扩张性眼病，以角膜扩张变薄并向前锥形突起为特征，严重时可致盲。KC三联征之一铁锈色Fleischer环，主要由上皮细胞基底膜周围的铁离子沉积组成。近年来，越来越多研究表明，铁稳态失衡可能与KC的发生和发展密切相关。KC患者泪液中铁相关蛋白的异常表达，提示铁稳态失衡可能是诱发KC的潜在致病机制。此外，角膜上皮细胞内铁稳态失衡导致细胞内铁离子异常积聚，进而引发活性氧和脂质过氧化物的大量生成，最终可能触发细胞铁死亡。从恢复铁稳态角度出发，螯合过量的铁离子和调控铁死亡过程关键靶点可能是未来KC潜在的治疗方法。目前关于铁稳态失衡导致KC发病的具体机制仍存在诸多谜团。随着相关研究的不断深入，有望通过改善角膜铁稳态失衡，为KC临床治疗带来新的思路和突破，也为KC患者提供更精准和个体化的治疗策略。
间充质干细胞由于其独特的自我更新和多向分化能力，成为了一种替代无效的常规治疗的新兴治疗方法。间充质干细胞通过免疫调节、促修复、抗新生血管机制和细胞替代作用在眼表疾病中发挥作用，而不同来源的间充质干细胞其作用机制也不完全相同。迄今为止，已有8项注册的间充质干细胞治疗的临床试验应用于干眼、角膜烧伤、圆锥角膜等眼表疾病。
Due to its unique self-renewal and multi-directional differentiation capabilities, mesenchymal stem cells (MSCs) have become an emerging therapy that replaces of ineffective conventional options in treating multiple diseases. It plays an important role in ocular surface illnesses through a variety of functions, including immunoregulation, promoting repairing, anti-angiogenesis mechanisms, and cell replacement. MSCs from different sources have different mechanisms.So far, 8 registered clinical trials of MSCs therapy have been applied to treat dry eye, ocular burn, keratoconus and other ocular surface diseases.
干眼是以泪膜稳态丢失及伴随眼部不适症状为特征的最常见眼表疾病，泪膜不稳定、泪液高渗透性、眼表炎症及感觉神经异常为其主要病因。地夸磷索钠是一种P2Y2受体激动剂，能刺激黏蛋白及泪液分泌，其独特的作用机制为干眼的治疗开辟了新的方向，本文就地夸磷索钠近年的临床及基础研究进展作一综述。
Dry eye is one of the most common ocular surface diseases. It is characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play major etiological roles. Diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that promotes mucin and aqueous tear secretion. The unique pharmacological mechanism of diquafosol tetrasodium opens up a new direction for the medical therapies of dry eye. This article reviews the clinical therapeutic effect and research progress of diquafosol tetrasodium for the past few years.
医学生在不久的将来需担起保障人民健康的重任，必须坚持正确政治方向，思想政治教育(思政教育)融入医学课程显得格外重要。眼科疾病与全身疾病息息相关，眼科学是临床医学生的一门必修课程。思政教育与眼科学专业课相融合可激励学生自觉把个人的理想追求融入国家和民族的事业中，勇做走在时代前列的奋进者、开拓者。中山大学中山眼科中心因材施教，针对临床医学专业本科生，通过生动的例子将“防盲治盲责任”“近视防控国家需求”等思政内容融入眼科学本科教学的各个章节中，旨在培养学生树立为服务人民、服务国家健康战略而努力学习的理想和价值观。课程结束后，采用问卷调查了解学生对思政教育与眼科学专业课融合的接受度、课程建议及效果评估，发现学生对眼科学课程中融入思政教育接受度较高，效果较好。
Medical students must adhere to the correct political direction because they need to protect people's health in the near future. It is particularly important to integrate ideological education into medical curriculum. Ophthalmic diseases are closely related to systemic diseases. Ophthalmology is a compulsory course of clinical medicine for medical college students. The integration of ideological education into ophthalmology professional courses can encourage students to integrate their personal ideals into national undertaking, motivate students to become strivers and pioneers in the new era. Zhongshan Ophthalmic Center, Sun Yat-sen University taught students according to their aptitude and integrated the ideological contents such as “prevention of blindness” and “myopia prevention” into each chapter of ophthalmology teaching through vivid examples for clinical medical undergraduates. It would be helpful for the students to establish the ideal and values of “serve the people”. At the end of the course, the medical students were investigated by questionnaires to evaluate the effect of ideological education integration, as well as the acceptance and suggestion from the students. The results showed that studentswere satisfied with the teaching quality of ideological contents and the curriculum integration has achieved the desired effect.
