近年来随着医疗领域数字化、信息化建设的加速推进，人工智能的应用越来越广泛，在眼科医学方面尤为突出。婴幼儿处于视觉系统发育的关键时期，此时发生的眼病往往会造成不可逆的视功能损伤，带来沉重的家庭和社会负担。然而，由于婴幼儿群体的特殊性以及小儿眼科医生的短缺，开展大规模小儿眼病筛查工作十分困难。最新研究表明：人工智能在先天性白内障、先天性青光眼、斜视、早产儿视网膜病变以及视功能评估等领域已经得到相关应用，在多种婴幼儿眼病的早期筛查、诊断分期、治疗建议等方面都有令人瞩目的表现，有效解决了许多临床难点与痛点。但目前婴幼儿眼科人工智能仍然不如成年人眼科发展充分，亟须进一步的探索和研发。
In recent years, with the acceleration of digitalization and informatization in medical field, artificial intelligence (AI) is more and more widely applied, especially in ophthalmology. Infants are in the critical period of visual development, during which eye diseases can lead to irreversible visual impairment and bring heavy burden to family and society. Due to the particularity of infants and the shortage of pediatric ophthalmologists, it is challenging to carry out large-scale screening for eye diseases of infants. According to the latest studies, AI has been studied and applied in the fields of congenital cataract, congenital glaucoma, strabismus, amblyopia, retinopathy of prematurity, and evaluation of visual function, and it has achieved remarkable performance in the early screening, diagnosis stage and treatment suggestions, solving many clinical difficulties and pain points effectively. However, AI for infantile ophthalmology is not as developed as for adult ophthalmology, so it needs further exploration and development.
目的：调查新疆英吉沙县7~16岁儿童和青少年近视前期 ( 屈光度≤+0.75 D且>-0.50 D)患病率及其相关因素,为该地区近视防控提供依据。方法：在2024年5—6月采用简单抽样法选取新疆喀什地区英吉沙县一所中学和芒辛镇一所小学的学生进行问卷调查、视力、散瞳验光、眼轴、眼前段、眼底检查等横断面评估，分析纳入等效球镜(spherical equivalent，SE)度数较高眼的数据，采用单因素和多因素逻辑回归分析人口学特征、家族史、用眼行为、生活习惯等潜在相关因素与近视前期的关系。结果：共纳入3 247名参与者，男性占50.14%，女性占49.86%。近视前期1 652人(50.88%)，近视621人(19.12%)，非近视974人(30.00%)。近视前期患病率为50.88%(95%CI:49.16%~52.60%)，近视患病率为19.12%(95%CI:17.81%~20.51%)。多因素回归分析显示，女性(OR=2.56, 95%CI:2.09~3.13, P<0.001)、较大年龄(OR=1.19, 95%CI:1.13~1.24 , P<0.001)和较长眼轴(OR=2.68, 95%CI: 2.31~3.11 , P<0.001)是近视前期的相关因素。结论：在新疆喀什地区英吉沙县7~16岁儿童和青少年中，半数处于近视前期，其相关因素包括年龄偏大、女性及眼轴偏长。
Objective: To investigate the prevalence of pre-myopia (defined as spherical equivalent ≤+0.75 D and >−0.50 D) and its related factors among children and adolescents aged 6–16 years in Yengisar County, Xinjiang, China, providing evidence for regional myopia prevention. Methods: In May and June 2024, a comprehensive assessment was carried out on students selected through simple sampling from a middle school in Yingjisha County, Kashgar Prefecture, Xinjiang, and a primary school in Mangxin Town, Yingjisha County. ,The assessment included a questionnaire survey, visual acuity test, dilated eye refraction measurement, axial length measurement, anterior segment examination, and fundus examination. The data included eyes with high spherical equivalent (SE) power. Single-factor and multiple-factor logistic regression analyses were used to investigate the relationship between demographic characteristics, family history, eye-use behavior, lifestyle habits, and other potential related factors with pre myopia. Results: A total of 3,247 participants were included in the study, with 50.14% being male and 49.86% female. Among them, 1,652 (50.88%) individuals had preclinical myopia, 621 (19.12%) had myopia, and 974 (30.00%) had non myopia. The preclinical prevalence of myopia was 50.88% (95% CI: 49.16-52.60), and the prevalence of myopia was 19.12% (95% CI: 17.81-20.51). Multivariate regression analysis showed that female (OR=2.56, 95% CI: 2.09-3.13, P<0.001), older age (OR=1.19, 95% CI: 1.13-1.24, P<0.001), and longer axial length (OR=2.68, 95% CI: 2.31-3.11, P<0.001) were related factors in the preclinical stage of myopia. Conclusions: Among children and adolescents aged 7-16 in Yingjisha County, Kashgar Prefecture, Xinjiang, Half were in the preclinical stage of myopia. The related factors include older age, female gender, and axial length.
先天性白内障是晶状体发育异常引起的以晶状体混浊为特征的疾病，导致婴幼儿中重度视力损害，严重影响患儿长期生存质量，给全球带来较大的社会经济负担。目前先天性白内障的发病机制尚未得到很好的阐明，遗传因素虽在其中扮演重要角色，但已知基因突变仅能解释约30%的病例，大多数患儿发病原因仍不明确。晶状体的透明性依赖于晶状体上皮细胞和纤维细胞精密有序的排列，这与受到严格调控的晶状体发育过程密切相关，任何环节异常均可能导致晶状体早期混浊。故阐明调控晶状体发育的分子与细胞机制，是深入探究先天性白内障病因的前提。表观遗传学是在DNA序列不改变的情况下，对控制基因的活性和表达的因素进行研究的学科，包括DNA甲基化、组蛋白修饰、染色质重塑、非编码RNA调控等多种修饰，近年受到生命科学领域研究者较多的关注。在眼发育及眼部各类疾病机制探索中，表观遗传调控已被证实参与多种生理与病理过程。本综述通过总结已发表的与晶状体发育和先天性白内障发病机制相关的表观遗传学研究，尝试汇总与先天性白内障发生发展相关的表观遗传分子及通路，为进一步揭示疾病机制提供理论依据，并为未来的临床诊疗提供新的思路和方法。
Congenital cataract is a disease characterized by lens opacity due to abnormal lens development.This opacity results in moderate to severe visual impairment in infants and young children, significantly impacting their long-term quality of life and imposing a substantial socioeconomic burden globally. The pathogenesis of congenital cataract remains not fully understood. Although genetic factors play a significant role, known gene mutations account for only about 30% of cases, leaving the underlying cause unclear for the majority of affected children. Lens transparency depends on the precise, ordered arrangement of lens epithelial cells and fiber cells, a process that is closely tied to the strictly regulated lens development. Abnormalities at any stage of development may lead to early lens opacity. Therefore, clarifying the molecular and cellular mechanisms that regulate lens development is a prerequisite for investigating the etiology of congenital cataract. Epigenetics is the field of study that focuses on factors controlling gene activity and expression without altering DNA sequences. It encompasses a wide range of modifications including DNA methylation, histone modifications, chromatin remodeling, and non-coding RNA regulation, and has garnered significant attention from researchers in recent years. In the context of ocular development and the mechanisms underlying various eye diseases, epigenetic regulation has been shown to participate in multiple physiological and pathological processes. This review synthesizes published research on epigenetics related to lens development and the pathogenesis of congenital cataract. It aims to summarize the epigenetic molecules and pathways associated with the onset and progression of congenital cataracts, providing a theoretical foundation for further elucidating disease mechanisms and offering new insights and approaches for future clinical diagnosis and treatment.
白内障是全球第一大致盲眼病，表现为由多种原因导致的晶状体病变，进而出现视物模糊的现象，严重者会进一步丧失视力。白内障的类型较多，发病机制尚未完全阐释清楚，氧化应激是目前公认的主要影响因素。药物治疗一直是白内障患者临床治疗的一大难题，目前市面上还没有能够真正逆转白内障的药物，现有的药物仅能在一定程度上缓解白内障的进展。手术治疗仍是现阶段唯一有效的治疗方式，但经济因素和术后并发症的风险限制了部分患者通过手术恢复视力。白内障的治疗一直是眼科领域研究的重点，目前研究主要集中在两个战略方向上：优化手术技术并结合更优的围术期药物治疗方案以减少并发症，以及对疾病机制进行基础研究以促进新靶点药物的发现。有效的药物治疗一直是目前临床治疗的一大缺口，近年来研究者在白内障机制探索和新药研发上取得了显著进展，多个新的治疗靶点以及相关治疗药物不断被发现，但相关药物真正进入临床还面临着诸多挑战。文章主要从机制研究进展、药物治疗现状和前景较好的白内障药物临床研究进展等进行综述，旨在为新的白内障药物研发提供最新的参考。
Cataracts remain the leading cause of blindness globally. They manifest as lens opacification triggered by various factors, leading to blurred vision. In severe cases, patients may eventually lose their vision entirely. There are many types of cataracts, and their pathogenesis has not been fully clarified. Currently, oxidative stress is widely acknowledged as the primary influencing factor. Pharmacological intervention remains a significant clinical challenge in cataract management. At present, there are no drugs on the market capable of truly reversing cataracts; existing medications can only alleviate the progression of the condition to a certain extent. Surgical treatment remains the only effective approach at this stage. However, economic limitations and the risks of postoperative complications hinder its accessibility for certain patient groups. The treatment of cataracts has consistently been a research hotspot in the field of ophthalmology. Current research mainly centers on two strategic approaches: optimizing surgical techniques alongside improved perioperative pharmaceutical regimens to minimize complications, and conducting basic researches on disease mechanisms to facilitate drug discovery. Effective drug treatment has long been a major gap in current clinical treatment. In recent years, significant progress has been achieved in the exploration of cataract mechanisms and the development of new drugs. Despite the remarkable advancements in uncovering cataract pathogenesis and identifying novel therapeutic targets in recent years, substantial challenges remain in translating these discoveries into clinically applicable medications. This article reviews the progress in mechanism research, the current state of pharmacological interventions, and the clinical research developments of several promising cataract drugs, aiming to provide the latest reference for the research and development of new cataract drugs.
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.
目的： 探讨EZ Prep清洗液替代二甲苯进行手工脱蜡制作特殊染色片的效果。 方法: 应用EZ Prep清洗液替代二甲苯脱蜡，选取中山大学中山眼科中心临床病理科石蜡标本100例进行回顾性研究，常规切片后切片一式两份，分别采用传统二甲苯和EZ Prep清洗液手工脱蜡后按实验室标准化操作流程进行特殊染色，并比较脱蜡时间和染色效果。 结果： EZ Prep清洗液手工脱蜡处理的切片在革兰染色(Gram's)、六胺银染色(GMS)、过碘酸—雪夫染色(PAS)、马松(Masson)三色染色、刚果红等多种特殊染色中的染色质量和二甲苯脱蜡处理的效果一致，两组间染色片优良率比较差异无统计学意义(Z=0. 32，P＞0. 05)，且平均脱蜡时间由(33.0±2.7) min缩短至(7.2±1.1) min，加快了染色出片时间。结论：EZ Prep清洗液可以替代二甲苯在眼组织特殊染色中脱蜡，并具有脱蜡时间短、环保的优点，值得推广应用。
Objective: To investigate the effect of EZ Prep cleaning solution as an alternative to xylene for manual deparaffinization in the preparation of special staining slides. Methods: EZ Prep cleaning solution was utilized to replace xylene for deparaffinization in a retrospective study involving 100 paraffin-embedded specimens from the Clinical Pathology Department of Zhongshan Ophthalmic Center, Sun Yat-sen University. Routine sections were prepared and duplicated, with one set deparaffinized using traditional xylene and the other using EZ Prep cleaning solution. Subsequent special staining was performed following standardized laboratory protocols. Deparaffinization time and staining outcomes were compared. Results: Slides treated with EZ Prep cleaning solution for manual deparaffinization demonstrated staining quality comparable to xylene treatment across various special stains, including Gram's, GMS, PAS, Masson's trichrome, and Congo red. The difference in the excellent rate between the two methods is not statistically significant (χ 2 = 0.33, P > 0.05). Moreover, the average deparaffinization time is significantly reduced from 33.0±2.7 minutes to 7.2±1.1 minutes, thereby speeding up the staining process. Conclusion: EZ Prep could replace xylene deparaffinized sections in special staining of ocular tissues with the advantages of shorter deparaffinized time and environmental protection, which is worthy of promotion and application.
神经营养性角膜病变是一种与角膜神经退行性改变有关的疾病，表现为角膜神经的知觉和营养功能受损，导致角膜上皮缺损、角膜溃疡和角膜穿孔。目前对神经营养性角膜病变的主要治疗方式有药物治疗、非手术干预治疗和手术治疗，但是对于重度病变患者行药物治疗、非手术干预治疗通常效果不佳。对未恢复角膜神经营养功能的患者行角膜移植术，可能导致角膜移植术后上皮持续不愈合，因此恢复角膜神经营养功能是该类患者复明的重要前提。角膜神经移植术是重度神经营养性角膜病变患者恢复角膜神经营养功能，提高角膜知觉，改善角膜透明度的重要和有效的治疗方法。角膜神经移植术通过将具有正常功能的供体神经移植到麻痹眼角膜缘周围，使神经末梢重新长入角膜基质，恢复角膜知觉功能。随着角膜神经移植术的术式的不断改进，其良好的术后效果和优点已经渐渐凸显。文章基于作者结合团队在角膜神经移植术方面经验结合近年研究进展阐述了神经营养性角膜病变的治疗手段和不同术式在角膜神经移植术中的应用，并进行展望。
Neurotrophic keratopathy is a disease related to degenerative changes in corneal nerves, resulting in impaired sensory and nutritive functions of corneal nerves. This leads to corneal epithelial defects, corneal ulcers, and corneal perforation. Currently, the main treatment modalities include pharmacotherapy, non-surgical interventions, and surgical treatment. However, drug therapy and non-surgical interventions often yield unsatisfactory results for severe neurotrophic keratopathy patients. Performing corneal transplantation in patients with unrecovered corneal sensation may result in persistent epithelial defect. Therefore, the restoration of corneal sensation is a crucial prerequisite for visual rehabilitation. Corneal neurotization emerges as an important and effective therapeutic approach for severe cases of neurotrophic keratopathy, aiming to restore corneal sensation and enhance corneal transparency. The procedure involves transplanting nerves from a donor with normal sensory function to the paralyzed sub-Tenon perilimbal space, allowing nerve endings to regenerate into the corneal stroma and restoring corneal sensory function. With continuous improvements in the technique of corneal neurotization, its favorable postoperative outcomes and advantages are becoming increasingly evident. This article, based on the team's experience in corneal neurotization, elaborates on the treatment modalities for neurotrophic keratopathy and the application and prospects of various surgical techniques in corneal neurotization.
目的：系统分析脑卒中后视野缺损患者干预方案的相关研究，识别、归纳及总结干预的具体内容、结局指标和干预效果，为临床实践及未来该领域研究提供参考。方法：采用范围综述研究框架，系统检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Web of Science、Embase、CINAHL、Cochrane Library共9个数据库。检索时限为建库至2024年4月10日。对纳入文献进行筛选、汇总和分析。结果：最终纳入12篇文献，总结脑卒中后视野缺损患者干预方法及结局指标，干预方法包括替代性干预、补偿性干预、恢复性干预等，结局指标包括日常生活活动能力、日常生活扩展活动能力、阅读表现、视野检查等。结论：目前针对脑卒中后视野缺损患者的干预方案内容多样化、证据质量较低、结局指标不统一，有待进一步开展高质量研究探索最佳训练计划和规范结局指标。未来应不断改进、优化康复策略，建立最佳的多学科结构，制定科学、系统、个性化方案。
Objective: To systematically analyze the related studies on intervention schemes for patients with visual field defects after stroke, and to identify, summarize, and summarize the specific content, outcome indicators, and intervention effects, thereby providing a reference for clinical practice and future research in this field. Methods: Utilizing the scoping review method, a systematic search was conducted in 9 databases: CNKI, CQVIP, Wanfang Database, China Biomedical Literature Database, PubMed, Web of Science, Embase, CINAHL and the Cochrane Library. The search encompassed the period from the inception of each database to April 10, 2024. The selected literature was subsequrently screened, summarized, and analyzed. Results: A total of 12 articles were finally included, summarizing the intervention methods and outcome indicators for patients with visual field defects after stroke. The intervention methods comprised alternative intervention, compensatory intervention, and rehabilitative interventions. Outcome indicators include daily living activities, daily living extended activities, reading performance and visual field examination. Conclusion: Current intervention schemes for patients with visual field defects after stroke exhibit diverse content, charaterized by low evidence quality and inconsistent outcome indicators. Further high-quality research is needed to explore optimal training plans and standardize the outcome indicators. In the future, continuous improvement and optimization of rehabilitation strategies should be carried out to establish the best multidisciplinary framework and formulate scientific, systematic and individualized plans.
青光眼是全球首位不可逆性致盲性眼病，其特征是视网膜神经节细胞(retina ganglion cells, RGCs)的退行性改变，对全球经济和健康造成了重大影响。其病理变化的分子及生物机制尚不明确，目前青光眼手术和药物治疗仍然局限于将眼压控制在正常范围。小梁网作为房水排出的重要途径，是眼压控制的关键一环。眼压改变引起的视网膜退行性改变是青光眼重要病理过程之一。小梁网及视网膜的体外模型构建是研究青光眼发生发展的主要研究方法。三维培养技术可以使细胞在体外形成一定的空间结构，有利于细胞-细胞及细胞-环境的相互作用，相比传统二维培养，三维培养更加接近体内细胞的生理环境，对于研究疾病的病理生理变化及高通量药物筛选具有重要意义，同时，三维培养更有利于对细胞空间构象变化及其力学性质改变进行研究。三维打印等新技术也在三维细胞培养中有所应用，为三维定制化培养提供技术基础。文章综述了小梁网及视网膜细胞三维培养在青光眼基础研究中的应用研究进展，旨在为进一步探究青光眼病理生理机制提供新的思路。
Glaucoma is the world's first irreversible blinding eye disease, characterized by degenerative changes in retinal ganglion cells (RGCs), which have a significant impact on the global economy and health. The molecular and biological mechanisms of its pathological changes are still unclear. At present, glaucoma surgery and drug therapy are still limited to controlling the intraocular pressure in the normal range. Three-dimensional culture technology can enable cells to form a certain spatial structure in vitro, which is conducive to cell-cell and cell-environment interactions. Compared with traditional two-dimensional culture, three-dimensional culture technology is closer to the physiological environment of cells in vivo, which is of great significance for the study of pathophysiological changes of diseases and high-throughput drug screening. This review discusses the application of trabecular mesh and three-dimensional culture of retinal cells in the basic research of glaucoma, aiming to provide new ideas for further exploring the pathophysiological mechanism of glaucoma.
糖尿病性黄斑水肿(diabetic macular edema, DME)是糖尿病最常见和最严重的并发症之一，也是中青年劳动人群常见的致盲原因。DME病理生理机制复杂，是多种因素相互作用的结果，控制这些危险因素是降低发病率的关键。DME是全身病相关性眼病，其发生与发展受众多危险因素的影响，但此前文献对其总结不足，本文从全身因素及眼部因素两个方面就DME的危险因素进行综述。全身危险因素主要包括血糖控制欠佳、糖尿病病程长、高血压、血脂代谢紊乱、肥胖、肾功能异常、妊娠状态、降糖药物使用、贫血、阻塞性睡眠呼吸暂停低通气综合征、遗传因素、吸烟、饮酒、高血钙、低血镁等；而其眼部危险因素主要包括白内障、青光眼及玻璃体切割术、全视网膜激光光凝术、合并视网膜静脉阻塞和相关细胞因子等。深入认识和理解这些危险因素，有助于更好地预防和早期治疗DME，同时为治疗糖尿病视网膜病变过程中控制DME进展提供指引和参考。但是，其中一部分因素还存在一定争议，更多的DME危险因素仍有待进一步探索，期望在不久的将来，更多基础和前瞻性临床研究为DME危险因素及治疗提供高质量的证据。
Diabetic macular edema (DME) is one of the most common and severe complications of diabetes, and it is a leading cause of blindness in the working-age population. The pathophysiology of DME is complex, resulting from the interplay of various factors. Controlling these risk factors is crucial in reducing the incidence of DME. As a systemic diseaserelated ocular condition, the onset and progression of DME are influenced by numerous risk factors. However, previous literature has provided insufficient summaries of these factors. This review aims to summarize the risk factors for DME from both systemic and ocular perspectives. The systemic risk factors primarily include poor glycemic control, prolonged duration of diabetes, hypertension, dyslipidemia, obesity, renal dysfunction, pregnancy, the use of hypoglycemic medications, anemia, obstructive sleep apnea-hypopnea syndrome, genetic factors, smoking, alcohol consumption, hypercalcemia, and hypomagnesemia. On the other hand, ocular risk factors include cataracts, glaucoma and vitrectomy, panretinal photocoagulation, coexisting retinal vein occlusion, and related cytokines. A deeper understanding of these risk factors will aid in the better prevention and early treatment of DME, while also providing guidance and reference for controlling the progression of DME during the treatment of diabetic retinopathy. However, some of these factors remain controversial, and additional DME risk factors still need to be explored. It is hoped that, in the near future, morefoundational and prospective clinical studies will provide high-quality evidence on DME risk factors and treatments.
