甲状腺相关眼病是一种器官特异性自身免疫性疾病，其发病机制复杂，是成人最常见的眼眶疾病，且发病率逐年升高。该病不仅会导致眼球突出、眼睑退缩、睑裂扩大、眼球运动障碍等外观上的变化，且患者往往伴发眼红、眼痛、干涩、异物感、复视、视力下降等不适症状，其中眼表疾病的发病率较正常人明显增高，但其具体发病机制尚待进一步挖掘。目前研究表明甲状腺相关眼病患者的眼表损伤主要与眼表暴露增加、炎症侵犯、激素改变有关。角膜、结膜、泪膜、睑板腺等组织受累发生病理改变是患者表现出不同临床症状的直接原因。文章通过分析近年来国内外关于甲状腺相关眼病与眼表疾病等方面的相关研究，针对甲状腺相关眼病眼表损伤的病理改变及机制研究进展做一综述。
Tyroid-associated ophthalmopathy is an organ-specifc autoimmune disease with complex pathogenesis. It is the most common orbital disease in adults, and its incidence increases year by year. Tis disease can not only lead to appearance changes such as eyeball protrusion, eyelid retraction, eyelid cleat enlargement, eye movement disorders, and patients are ofen accompanied by red eyes, eye pain, dryness, foreign body sensation, diplopia, vision loss and other uncomfortable symptoms, among which the incidence of ocular surface diseases is signifcantly higher than that of normal people, but its specifc pathogenesis needs to be further explored. Current studies have shown that ocular surface injury in patients with thyroid-associated ophthalmopathy is mainly related to increased ocular surface exposure, infammatory invasion, and hormonal changes. Te pathological changes of cornea, conjunctiva, tear flm, meibomian gland and other tissues involved are the direct causes of different clinical symptoms of patients. In this paper, through the analysis of recent domestic and foreign studies on thyroid-associated ophthalmopathy and ocular surface diseases, the pathological changes and mechanism of ocular surface injury in thyroid-associated ophthalmopathy were reviewed.
外伤性视神经病变是因外力损伤视神经，进而严重损害视力的致盲性眼病。自噬是一种细胞内降解途径，有助于维持细胞正常组分合成与受损细胞器及有毒细胞成分的分解之间的平衡。视神经受创后，视神经和视网膜中自噬标志物增加。自噬在外伤性视神经病变的不同阶段对视网膜神经节细胞可能起不同作用。多数研究表明，上调自噬可以减轻外伤性视神经病变中视网膜神经节细胞的死亡；也有研究提示在视神经损伤后极早的时期抑制自噬可以抑制视网膜神经节细胞轴突变性。该文对自噬的定义及功能、自噬的发生机制、视神经创伤后自噬水平改变、自噬在视神经创伤后对视网膜神经节细胞的作用的研究结果进行综述。
Traumatic optic neuropathy is a blinding eye disease that causes severe damage to vision due to external force damage to the optic nerve.. Autophagy is an intracellular degradation pathway that helps maintain the balance between the synthesisof normal cell components and the breakdown of damaged organelles and toxic cellular components. Autophagy markers are increased in optic nerve and retina after optic nerve trauma. Autophagy may play different roles on retinal ganglion cells (RGCs) at different stages of traumatic optic neuropathy. Most studies have shown that upregulating autophagy can attenuate RGCs death in traumatic optic neuropathy; however, it has also been suggested that inhibition of autophagy at ultra-early stage after injury can inhibit RGCs axonal degeneration. In this review, we reviewed the definition and function of autophagy, the mechanism of autophagy, and summarized the change of autophagy level after optic nerve trauma, as well as the effects of autophagy in RGCs after optic nerve trauma.
目的：回顾性分析以双眼复视为主要症状患者的病因及临床特点。方法：总结2021年1月至2022年3月就诊于潍坊医学院附属医院神经眼科的双眼复视患者的临床资料，分析其病因及临床特点。结果：共29例患者，男16例，女13例，年龄17岁～81岁，平均(59±14)岁；其中血管性因素8例，包括脑血管病5例，后交通动脉瘤2例，核间性眼肌麻痹1例；炎症、免疫性因素8例，包括重症肌无力4例，Tolosa-Hunt综合征2例，肥厚性硬脑膜炎1例，炎性假瘤1例；内分泌因素9例，包括糖尿病外周神经病变5例，甲状腺相关眼病4例；肿瘤2例，包括动眼神经鞘瘤1例，眼眶MALT淋巴瘤1例，外伤2例。结论：双眼复视的病因复杂，临床医生应重视筛查全身疾病，参照先定位，后定性原则，提高诊断正确率、减少误诊率。
Objective: The etiology and clinical characteristics of patients with binocular diplopia as main symptom were investigated using retrospective analysis method. Methods: The clinical data of patients with binocular diplopia treated in department of ophthalmolog y, affiliated hospital of Weifang Medical University from January 2021 to March 2022 was summarized and the etiology and clinical characteristics retrospectively. Results: There were totally 29 patients, 16 males and 13 females, aged from 17 to 81 years, with an average of (59 ± 14) years; among them, there were 8 cases derived from vascular factors, including 5 cases with cerebrovascular disease, 2 cases with posterior communicating artery aneurysm and 1 case with internuclear ophthalmoplegia. There were 8 cases derived from inflammatory and immune factors, including 4 cases with myasthenia gravis, 2 cases with Tolosa-Hunt syndrome, 1 case with hypertrophic meningitis and 1 case with inflammatory pseudotumor. There were 9 cases derived from endocrine factors, including 5 cases with peripheral neuropathy in diabetes and 4 cases with thyroid related ophthalmopathy. There were 2 cases derived from tumors, including 1 case with oculomotor schwannoma, 1 case with orbital MALT lymphoma and there were 2 other cases of trauma. Conclusions: The etiology of binocular diplopia is complicated and the clinicians should pay attention to the screening of systemic diseases of patients refer to the principle of localization diagnosis first and qualitative analysis next so as to improve the diagnostic accuracy and reduce the misdiagnosis rate.
渐进性视功能障碍多见于屈光不正、原发性开角型青光眼、白内障、视神经视网膜遗传代谢性疾病等，少见于眶内和颅内占位性疾病。颅内蛛网膜囊肿通常是无症状的先天性良性病变，少数出现视功能障碍。 视神经管骨壁缺如见于后组筛窦和蝶窦气化良好的正常人。该文报告 1例59岁男性患者，因左眼视野缺损伴视物模糊1年余就诊，确诊左侧颞极蛛网膜囊肿合并视神经管骨壁缺如。笔者通过收集该患者的病史、影像学资料和视功能检查结果，分析其出现视功能障碍的机制。
Progressive visual impairment is more common in ametropia, primary open-angle glaucoma, cataract, hereditary and metabolic diseases of optic nerve and retina, and less common in orbital and intracranial masses. Intracranial arachnoid cysts are usually asymptomatic benign congenital lesions with a small number of visual impairments. The absence of the bone wall of the optic canal was seen in normal subjects with good gasification of the posterior ethmoid sinus and sphenoid sinus. In this case report we describe a 59-year-old man with a left temporal arachnoid cyst and a defect of the bone wall of the optic canal complained of left visual field defect and blurred vision for more than one year. The mechanism of visual dysfunction was analyzed by collecting the patient’s medical history, imaging data and the results of visual function examination.
目的：通过对改良“Z”形无线结经巩膜缝线固定人工晶状体手术和传统有线结巩膜缝线固定人工晶状体手术治疗先天性晶状体脱位的比较来评价改良术式的临床疗效。方法：回顾性病例研究。纳入2018年1月—2021年3月期间于中山大学中山眼科中心行手术治疗的先天性晶状体脱位患者73例73眼，按手术方式不同将患者分为无线结组36例36眼和有线结组37例37眼。比较两组患者术前和术后1年的球镜度(DS)、柱镜度(DC)、等效球镜(SE)、最佳矫正视力(BCVA)、眼压(IOP)、眼轴长度(AL)、角膜内皮细胞计数和术后并发症的发生率。结果：两组患者术前各项观察指标组间比较差异无统计学意义(均P>0.05)。两组患者术后1年 BCVA 均较术前提高(均P<0.05)，SE均较术前降低(均P<0.05)。两组患者术后1年 BCVA 、DS、DC、SE、IOP、AL、角膜内皮细胞丢失率组间比较差异均无统计学意义(均P>0.05)。术后1年，有线结组有5例(13.5%)出现缝线暴露，无线结组未出现缝线暴露，组间比较差异有统计学意义(P<0.05)。结论：改良无线结 IOL 巩膜缝线固定手术可改善CEL患者的最佳矫正视力和屈光不正，有效减少缝线暴露及相关并发症。
Objective: To evaluate the clinical efficacy of modified “Z”-shaped knotless transscleral suture fixation intraocular lens (IOL) and traditional knotted transscleral suture fixation IOL in congenital ectopia lentis. Methods: A retrospective case study. A total of 73 eyes of 73 patients with congenital ectopia lentis who underwent surgical treatment in our hospital from January 2018 to March 2021 were included. According to different surgical methods, the patients were divided into the knotless group (36 eyes) and knotted group (37 eyes). Preoperative and postoperative of 1-year diopter sphere (DS), diopter cylinder (DC), spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL), corneal endothelial cell counts and the occurrence of postoperative complications rate were analyzed among two groups. Results: There was no significant difference in preoperative outcome measures between the two groups (P>0.05). BCVA at 1-year postoperative was significantly better (P<0.05), and SE at 1-year postoperative was significantly lower (P<0.05). There was no significant difference in BCVA, DS, DC, SE, IOP, AL, and corneal endothelial cell loss rate between the two groups at 1-year after operation (P>0.05). One year after the operation, there were 5 cases of suture exposure (13.5%) in the knotted group and no suture exposure in the knotless group, and the difference was statistically significant (P<0.05). Conclusions: The modified knotless IOL transscleral suture fixation can improve the best corrected visual acuity and alleviate ametropia of CEL patients, and reduce suture exposure and related complications effectively.
晶状体脱位是指由于各种病因引起的悬韧带发育异常及断裂，从而导致晶状体的位置异常。晶状体脱位的类型复杂，临床处理也各不相同。本文报道了一名老年男性，因外伤分别致右眼晶状体全脱位，左眼人工晶状体不全脱位，伴高同型半胱氨酸血症，在入院后行双眼手术，术式不一，但都获得了预期效果。
Ectopai lentis refers to the abnormal development and rupture of the suspensory ligament caused by various causes, which leads to the abnormal position of the lens. The types of lens dislocation are complex and the clinical treatment methods are different. This article reports an elderly man who suffered from complete dislocation of the right eye lens and incomplete dislocation of the left eye intraocular lens in the left eye, respectively, accompanied by hyperhomocysteinemia due to trauma. After admission, he underwent binocular surgery after admission, and the surgical methods were different, but the expected results were obtained.
目的：探讨一种改良的简便的儿童晶状体不全脱位摘除技术的手术方法及临床效果。方法：对23例(40眼)晶状体不全脱位儿童采用改良手术方法进行脱位晶状体摘除，术中先做巩膜隧道切口，3个角膜缘穿刺口，经穿刺口放置前房维持器，在维持前房灌注下，截囊针撕囊，水分离后抽吸针头吸净晶状体内容物。撤去前房维持器，用撕囊镊和线镊将囊袋从主切口拖出。若有玻璃体脱出则行前部玻璃体切除术，然后行人工晶状体巩膜缝线固定术。术后中位随访39.0个月，观察其手术效果。结果：术后患儿平均裸眼视力为(0.44±0.22)LogMAR，平均最佳矫正视力为(0.20±0.16)LogMAR，较术前均显著提高(P<0.001)。所有患儿术中眼内压稳定，术中术后没有继发视网膜脱离、脉络膜上腔出血等眼底并发症的发生。结论：改良的儿童晶状体不全脱位摘除技术具有对玻璃体扰动少、手术时间较短、简便易学、对手术设备要求低的优点，值得临床推广。
Objective: To investigate the operation method and clinical effects of a modified-simple technique in children with subluxated lens extraction. Methods: Lens extraction was performed in 40 eyes of 23 children. During operation, the scleral tunnel and 3 lateral corneal incision were made, and anterior chamber maintainer was inserted through one corneal incision. Under stable anterior chamber perfusion, anterior capsulorrhexis was made by needle capsulotome. After hydro-dissection, the content of lens was withdrawn by suction needle completely. Then anterior chamber maintainer was removed, and the capsular bag was dragged out by capsulorhexis forceps and fixation forceps. Anterior vitrectomy was performed if there was prolapse of vitreous. Then scleral intraocular lens fixation was performed. The surgical effects were observed at median 39.0 months postoperative. Results: After surgery, the average uncorrected visual acuity was (0.44±0.22) LogMAR, the average best corrected distant visual acuity was (0.20±0.16) LogMAR. The uncorrected visual acuity and best corrected distant visual acuity were improved postoperative(P<0.001). The intraocular pressure of all patients was stable during operation. During and after operation, there were no fundus complications, such as secondary retinal detachment and suprachoroidal hemorrhage. Conclusion: Modified-simple technique of subluxated lens extraction of children has little disturbance on vitreous and takes shorter time of operation. It is simple, easy to learn and requires simple surgical equipment. This modified technique deserves to be generalized.
随着近视人口的逐年增长，近视已经成为全球关注的热点问题。如何预防近视、控制近视进展、减少病理性近视的发生、减少近视的成本投入是临床工作及科学研究的主要目的。阿托品是目前防控近视的主要药物方法，实验室研究及临床试验均已证实其显著的近视防控效果。美国眼科学会推荐使用0.01%低浓度阿托品，目前报道其近视防控效果为50%~53%。本文汇总了近年来近视防控相关的临床与实验室研究，对阿托品近视防控效果、其相关影响因素(如浓度、个体差异、生物利用度等)以及作用机制等方面的研究进展进行归纳综述，并分析了阿托品用于临床儿童近视防控工作存在的困难与挑战。
As the population of myopia grows rapidly, myopia has become a hot issue of global concern. Preventing myopia and slowing the progression of myopia to reduce the occurrence of pathological myopia and reduce the cost of myopia is the main purpose of related clinical work and scientific researches. Currently, atropine is the main drug for the prevention and control of myopia, and both laboratory studies and clinical trials have confirmed its effect. The American Academy of Ophthalmology recommends the use of 0.01% atropine, which is reported to be 50% to 53% effective in preventing and controlling myopia. This review collects the clinical and laboratory researches in decades to summarize the study progress in atropine for preventing and controlling myopia, including the clinical application effects, the influencing factors such as concentration, individual differences, bioavailability, and the related mechanisms. We also highlight the existing difficulties and challenges in the use of atropine in clinic.
目的：对兰州市中小学生的屈光状态进行调查分析，了解兰州市中小学生筛查性屈光不正的流行病学特征。方法：采用横断面研究方法，用随机分层抽样法抽取2021年4至12月在甘肃省兰州市47所学校的中小学生作为调查对象。以学校为单位，采用国际标准视力表检查视力，采用非睫状肌麻痹的电脑自动验光仪进行屈光检查。裸眼视力<0.8为视力低下，具体分为：近视为等效球镜度≥–0.75 DS；远视为等效球镜度≥+2.00 DS；散光为柱镜度≥1.00 DC；屈光参差为双眼屈光度数差值(等效球镜度)≥1.00 DS。比较不同年级不同屈光状态人数所占的百分比。结果：共纳入40 302人，其中男21 328人，女18 974人；汉族37 938人，少数民族2364人。小学、初中、高中各26 122、9346和4834人。视力低下的总检出率为59.1%(23 832/40 302)，小学、初中和高中年级视力低下的检出率分别为48.8%(12 748/26 122)，76.9%(7 189/9 346)和87.9%(4 250/4 834)。近视的总检出率为63.3%(25 521/40 302)，其中，小学、初中和高中筛查性近视的检出率分别为51.4%(13 438/26 122)，84.4%(7 888/9 346)和86.8%(4 195/4 834)。筛查性视力低下、远视、近视、散光及屈光参差的检出率在低中高年级间比较差异均有统计学意义(均P<0.001)。结论：兰州市中小学生视力低下和近视人群的检出率高于国家平均水平，且随着年级的增加检出率逐渐升高。
Objective: To investigate and analyze the refractive status of primary and secondary school students in Lanzhou City, and to understand the epidemiological characteristics of screening refractive errors among primary and secondary school students in Lanzhou City. Methods: Using the cross-sectional research method, primary and secondary school students from 47 schools in Lanzhou City, Gansu Province from April to December 2021 were selected as survey subjects by random stratified sampling method. Taking school as a unit, international standard visual acuity chart was used to check the eyesight and non-cycloplegia computerized autorefractor was used for refractive examination. Visual acuity ≥5.0 is considered normal; whereas visual acuity <4.8 is considered as poor vision. Poor vision is further divided into: short-sightedness with myopic spherical equivalent ≥0.75 DS; long-sightedness with telephoto spherical equivalent ≥+2.00 DS; astigmatism with cylinder mirror equivalent ≥1.00 DC; anisometropia with the difference of diopters between the two eyes (spherical equivalent) ≥1.00 DS. The percentage of the survey subjects with different refractive status in different grades were compared. Results: A total of 40 302 subjects were enrolled, including 21 328 males and 18 974 females. There were 37 938 Han and 2 364 ethnic minorities; 26 122 elementary, 9 346 middle and 4 834 high schools. The total detection rate of low visual acuity was 59.1% (23 832/40 302), and 48.8% (12 748/26 122) in primary school, junior middle school and senior high school, 76.9% (7 189/9 346) and 87.9% (4 250/4 834), respectively. The total detection rate of myopia was 63.3% (25 521/40 302), among which, the detection rate of screening myopia in primary school, middle school and high school was 51.4% (13 438/26 122), 84.4% (7 888/9 346) and 86.8% (4 195/4 834), respectively. The detection rates of screening low visual acuity, hyperopia, myopia, astigmatism and anisometropia were statistically significant in low, middle and high grades (all P<0.001). Conclusion: The detection rate of low vision and myopia among primary and secondary school students in Lanzhou is higher than the national average, and the detection rate increases gradually with the increase of grades.
高度近视(high myopia，HM)作为一种特殊类型的屈光型眼病，不仅会导致进行性、退行性眼底改变，其视神经损伤的患病率也很高。青光眼是全球范围内最常见的一种不可逆致盲性眼病，原发性开角型青光眼(primary open-angle glaucoma，POAG)是最常见的青光眼类型。近年来的研究发现HM与POAG的病理改变存在相似之处。由于HM眼底改变与早期POAG眼底改变容易混淆，HM患者早期发现POAG对延缓或阻止疾病进展很重要。HM患者长期随访不仅要观察黄斑病变，视神经形态与结构改变的观察也不容忽视。
As a special type of refractive eye disease, high myopia (HM) not only causes progressive and degenerative fundus changes, but also has a high prevalence of optic nerve damage. Glaucoma is the most common form of irreversible blinding eye diseases worldwide, among which, primary open-angle glaucoma (POAG) is the most common type. In recent studies, HM is found to have similarities on pathological changes as that of POAG. And HM fundus changes are easily confused with early stage POAG fundus changes; thus, the early detection of POAG on HM patients is highly important on disease deferment or prevention of disease progression. Macular degeneration as well as optic nerve morphology and structural changes are to be observed in the long-term follow-up for HM patients.
