论著

IgG4相关性眼病影像学特征与疾病严重程度相关性分析

Analysis of the correlation between imaging features and disease severity in IgG4-related ophthalmic disease

:35-44
 
目的:研究IgG4相关性眼病(IgG4-related ophthalmic disease, IgG4-ROD)患者的影像学特征与外周血免疫球蛋白G4(IgG4)水平之间的相关性,为评估IgG4相关性疾病全身性严重程度提供新思路。方法:收集2023年8月—2024年9月在吉林大学第二医院眼科医院经术后组织标本病理确诊的29例IgG4-ROD阳性患者。回顾性分析患者眼眶影像学特点与血清IgG4水平相关性,探讨影像学中特征性表现包括泪腺肿大、三叉神经分支增粗、眼外肌增粗、鼻黏膜类炎症改变、眼睑软组织肥厚,以及其他眶内软组织增生等特征性影像学改变出现比例,并按照累及组织结构情况分级评分,评估特征性影像学改变与血清IgG4水平之间的相关性。结果:29例病理确诊IgG4-ROD患者中,泪腺均受累,占比100%;眼外肌受累17例,占比58.62%;三叉神经分支受累5例(4例眶下神经受累,3例额神经病受累,2例眶下神经与额神经同时受累),占比17.24%眼睑软组织肥厚24例,占比82.76%鼻黏膜出现类炎症反应15例,占比51.72%;合并眶内其他软组织增生性病变2例,占比6.90%。影像学中特征性受累组织结构分级评分与血清IgG4水平呈正相关(< 0.05)。结论:IgG4-ROD影像学中特征性组织结构受累及范围与血清IgG4水平明显相关,可以辅助评估IgG4相关性疾病全身性严重程度。
Objective: To investigate the correlation between the imaging characteristics of patients with IgG4-related ophthalmic disease (IgG4-ROD) and the serum immunoglobulin G4 (IgG4) levels, providing new insights for assessing the systemic severity of IgG4-related diseases. Methods: This study collected postoperative tissue samples from 29 patients with histopathologically conffrmed IgG4-ROD at the Ophthalmology Department of Jilin University Second Hospital from August 2023 to September 2024. TTis study retrospectively analyzed the correlation between patients' orbital imaging features and serum IgG4 levels, and explored the proportion of characteristic imaging changes including enlargement of the lacrimal gland, thickening of the trigeminal nerve branches, thickening of the extraocular muscles, inffammatory like changes of the nasal mucous membranes, hypertrophy of the eyelid soft tissues, as well as hyperplasia of other intraorbital soft tissues in the imaging. A grading score for affected tissue structures was established to evaluate the correlation between characteristic imaging changes and serum IgG4 levels. Results: Among the 29 patients diagnosed with IgG4-ROD, lacrimal gland involvement was observed in all patients (100%). Extraocular muscle involvement was present in 17 patients (58.62%). Five patients had involvement of the trigeminal nerve branches (including 4 with infraorbital nerve involvement and 3 with frontal nerve involvement, with 2 patients having simultaneous involvement of both nerves), accounting for 17.24% of the cases. Eyelid soff tissue hypertrophy was observed in 24 patients (82.76%), and nasal mucosal inflammatory responses were noted in 15 patients (51.72%). Additionally, two patients (6.90%) presented with other proliferative lesions within the orbit. The correlation analysis between the grading scores for imaging features and serum IgG4 levels demonstrated a significant positive correlation. Conclusions: The extent of characteristic structural involvement observed in the imaging features of IgG4-ROD is significantly correlated with serum IgG4 levels. TTis correlation can assist in evaluating the systemic severity of IgG4-related diseases and provides clinical evidence supporting the need for comprehensive systemic evaluations, such as PET-CT, in patients whose initial presentation is IgG4-related ophthalmic disease.
论著

门诊重症疑难眼病的会诊现状

Present situation of the consultation for severe eye disease in outpatients

:161-166
 
目的:了解中山大学中山眼科医院门诊重症疑难眼病会诊的现状,探讨门诊重症疑难眼病会诊亚专科的分布情况及会诊效果,为建立科学的门诊重症疑难眼病会诊体系提供支持和依据,同时也为合理安排会诊流程提供依据。方法:对中山大学中山眼科医院2016年3月至2017年4月收集的265例门诊重症疑难病例,通过时间、地区、性别、年龄、会诊原因、会诊亚专科、会诊后的转归及效果等方面进行统计分析,所有数据均通过Excel软件进行录入,根据分析目的和资料的类型,采用相应的统计指标进行描述,并进行统计推断,检验水准为α=0.05。结果:2016年3月至2017年4月期间中山大学中山眼科医院门诊重症疑难眼病会诊人数265例。在地区分布中,广东省地区最多,为145例,外国最少,为3例。人群分布中,男167例,女98例,男女比例为1.70:1。年龄分布中,30~44岁及45~59岁的病例数最多,均为53例(20%),70岁以上老年病例最少,为13例(4.9%)。中山大学中山眼科医院门诊重症疑难眼病会诊中,2016年3月至2017年4月期间,各眼科亚专科共参加会诊714次,眼底外科参加会诊次数最多,为147次(20.5%),结膜科参加会诊的次数最少,为1次(0.1%)。在分析会诊原因方面,因诊治涉及多个专科而会诊的病例数最多,为161例,因病因不明会会诊的病例最少,为20例;会诊后比会诊前明确治疗方案的病例数增加190例。结论:中山大学中山眼科医院门诊组织实施重症疑难眼病会诊使明确治疗方案率大幅提高,在提高疑难眼病治疗效果方面起到一定的促进作用。
Objective: To understand the current situation of the consultation for outpatients with severe eye disease in Zhongshan Ophthalmic Center, and to explore the distribution and effects of sub-specialty consultation for outpatients with severe eye disease. To set up a scientific system of the consultation for outpatients with severe eye disease, and also provide a basis for reasonable arrangement of consultation process. Methods: We analyzed 265 severe cases from March 2016 to April 2017 in Zhongshan Ophthalmic Center by time, region, gender, age, cause of consultation, sub-specialty, and outcomes after consultation. And all data was analyzed by Excel software, according to the purpose and the type of data, and the corresponding statistical index and statistical inference, inspection level for α=0.05. Results: There were 265 cases with severe eye disease from March 2016 to April 2017. As for the regional distribution, Guangdong province was the largest, with 145 cases, while the lowest number was from foreign countries, which was 3 cases. In the population distribution, 167 cases were males, 98 were females and the ratio was 1.70. In age distribution, patients aged from 30 to 44 years and 45 to 59 years predominated and the number of cases were both 53, accounting for 20% of the total number. Patients over 70 were the least which were 13 cases, accounting for 4.9% of the total number. From March 2016 to April 2017, all sub-specialties attended consultation for 714 times, as Ocular Fundus Department attended the most, accounting for 20.5% of the total number while Conjunctive Department attended the least, for only one, accounting for 0.1% of the total number. As for the reason of the consultation, the number of cases involving multiple specialties was the largest, with 161 cases, while the lowest number of cases due to unexplained causes, which were 20 cases. The number of cases of explicit treatment was increased by 190 after consultation. Conclusion: Consultations organized by Zhongshan Ophthalmic Center improves the treatment for outpatients with severe eye disease.
综述

原发性干燥综合征相关性干眼在眼科诊疗中的现状及研究进展

Current status and research advances in diagnosis and treatment of primary Sjogren’s syndrome associated dry eye disease in ophthalmology

:163-169
 

原发性干燥综合征 (primary Sjogren' s syndromeSS) 是一种主要累及外分泌腺体的自身免疫性疾病,患者通常因为严重的干眼症状首先就诊于眼科,大多数临床医师对原发性干燥综合征相关性干眼 (Sjogren' s syndrome dry eye diseaseSS-DED) 认识不足,可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展,将有助于发现 SS-DED 的真面目,并可能从新的角度阐释其发病机制,为其诊断、分类及治疗提供新的思路。SS-DED 的治疗没有特效的药物,大多数患者需接受多种方法的治疗,以了解哪些方法最有效。

Primary Sjogren' s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sjogren' s syndrome probably leading to misdiagnosis or missing the diagnosis. The diagnosis of Sjogren' s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment. 

医学教育

以上睑下垂为例阐明教学查房在外眼疾病教学中的重要性

Importance of teaching rounds in the teaching of external eye diseases illustrated by taking blepharoptosis as an example

:126-128
 

教学查房是手把手教学的重要手段和具体表现,是让同学们把书本知识应用到医疗诊疗中的重要桥梁。眼科学具有形象生动、结构复杂、直观性和操作性强等特点。外眼疾病的特征更是显而易见,针对外眼疾病诊疗中的一些不规范的操作也更易暴露出来。本文以上睑下垂为例,旨在阐明教学查房在外眼疾病教学中的重要性。

Teaching rounds are an important means and concrete manifestation of hands-on teaching, and an important bridge for students to apply book knowledge to medical diagnosis and treatment. Ophthalmology has the characteristics of vivid image, complex structure, intuition and strong operability. The characteristics of external eye diseases are more obvious, and some non-standard operations in the diagnosis and treatment of external eye diseases are easier to expose. This article takes blepharoptosis as an example to illustrate the importance of teaching rounds in the teaching of external eye diseases.

Editorial

推广新生儿眼病筛查的必要性

Necessity of screening for neonatal eye disease

:72-77
 

目的:探讨推广新生儿眼病筛查以及婴儿期定期眼保健的必要性。方法:回顾分析 2014 年 1 月至 2016 年 12 月 20800 例惠州市妇幼保健计划生育服务中心门诊收集的婴儿眼保健资料。结果:共检出致盲性眼病 7 种 158 例,其中满 42 d 内检出 147 例,3 个月内检出 8 例,6 个月内检出 2 例,12 个月内检出 1 例。检出时已合并眼位、眼前节异常、影响视功能者 8 例。不同出生胎龄致盲性眼病检出率:≤ 34 周为 11.64%,34~37 周为 1.24%,≥ 37 周为 1.29%。相对于纸质宣传材料,开展家长学校讲课,利用 PPT 结合实际病例讲解,更有助于普及眼保健。相对于眼底检查,眼前节的方式更容易被接受、被推广。结论:致盲性眼病婴儿期发病在临床中并不少见,并且部分是可以早期筛查、早期治疗以避免视功能损害的。临床中需要大力普及眼保健知识,并可以在具备条件的医院,适当利用新生儿广域成像系统推广新生儿眼病普筛。


Objective: To discuss the necessity of screening for neonatal eye disease and regular eye care in infancy. Methods: A retrospective analysis of 20 800 infants in our hospital from January 2014 to December 2016 was conducted. From January 2014 to December 2016. Results: Seven types of blindness eye diseases were detected in 158 cases, including 147 cases at 42 days, 8 cases at 3 months, 2 cases at 6 months and 1 case at 12 months after birth. Eight cases were supervened with abnormal eye position, anterior segment abnormality and poor visual function. The detection rate of blindness-inducing diseases was 11.64% for infants aged  34 weeks, 1.24% for 3437 weeks and 1.29% for 37 weeks. Compared with the paper propaganda materials, the introduction of parental school lectures and PPT combined with explanation of actual cases was more conducive to popularize eye care. Compared with fundus examination, anterior segment examination was more likely to be accepted and popularized. Conclusion: Eye disease inducing blindness in infancy are commonly encountered in clinical practice, which can be screened and treated early to avoid visual impairment. It is necessary to popularize the knowledge of eye care, and promote the screening of newborn eye disease in qualified hospitals.

常见角膜病变基因治疗的进展

Development of Gene Therapy on Common Corneal Diseases

:1-3
 

角膜是基因治疗的理想靶器官。角膜碱烧伤、角膜新生血管、角膜移植术后排斥反应因其病理机制复杂所牵涉的致病因素众多而治疗困难,疗效不佳。本文就基因治疗在上述疾病中的应用加以综述,以了解基因治疗应用于角膜病变的新进展 。

Cornea is an ideal target organ for gene therapy. Corneal alkali burn, cornealneovascularization and corneal graft rejection tend to be with poor treatment elicacydue to its complex pathogenesis. This article aims to update the recent progress of genetherapy on corneal diseases.
综述

眼移植物抗宿主病的临床诊疗新进展

Research progress on clinical diagnosis and treatment of ocular graft-versus-host disease

:299-305
 
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.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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