微RNA-26b(microRNA-26b,miR-26b)是miR-26家族中的一员,作为基因表达调控因子,在细胞代谢、增殖、分化、凋亡、自噬、侵袭、转移等生物学过程中均发挥着重要的调控作用。近年来,随着对miR-26b研究的深入,研究者认识到miR-26b稳定存在于角膜、结膜上皮、晶状体、睫状体、小梁网、房水、玻璃体和视网膜等眼部组织中,且有越来越多的研究证实miR-26b在眼科疾病,例如翼状胬肉、白内障、增生性玻璃体视网膜病变、增生型糖尿病视网膜病变、年龄相关性黄斑变性等疾病的发生和发展中有着重要的调控作用。该文对近年miR-26b在眼科疾病方面的研究进行了综述,为探讨miR-26b在眼科疾病中发挥作用过程中的分子机制提供理论基础。
MicroRNA-26b (miR-26b) is a member of the miRNA-26 family. As a gene expression regulator, it plays an important regulatory role in biological processes such as cell metabolism, proliferation, differentiation, apoptosis, autophagy,invasion and metastasis. In recent years, with the in-depth study on miR-26b, researchers found that miR-26b stably exists in the cornea, conjunctival epithelium, lens, ciliary body, trabecular meshwork, aqueous humor, vitreous, retina and other ocular tissues. More study results confirmed that miR-26b acted on eye diseases, and played an important regulatory role in diseases occurrence and development, such as pterygium, cataract, proliferative vitreo retinopathy,proliferative diabetic retinopathy, age-related macular degeneration, etc. This article reviews the research progress of miR-26b in eye diseases recently, to provide a theoretical basis on molecular mechanisms involving in the role of miR-26b in eye diseases.
大麻二酚(Cannabidiol,CBD)为大麻提取物中的一种非成瘾性活性成分,是目前研究最热门的植物源性大麻素之一。内源性大麻素系统(endocannabinoid system,ECS)在眼表和视网膜中的研究也已经取得显著进展。CBD可以广泛存在于整个眼球,且其分布和功能具有组织特异性。近年来研究发现CBD具有良好的抗炎、抗损伤、降低眼压及神经保护作用。该文详细介绍了CBD在眼部疾病中的研究进展,以及其对各种眼部疾病的治疗潜力。此外,还讨论了CBD在临床眼科治疗中的应用面临的挑战和未来的发展方向。
Cannabidiol(CBD), a non-addictive active ingredient in cannabis extract, is one of the most popular plant-derived cannabinoids. The study on the endoenuous cannabionoid system (ESC) has made significant progress in the ocular surface and retina. CBD exists extensively in the eyeball, and its distrution and functions of anti-inflammatory,antiinjury, reducing intraocular pressure, and neuroprotective effects have been found. This article introduces the research progress in CBD in eye diseases and the therapeutic potential of cannabidiol for various eye diseases in detailed.Furthermore, the challenges and prospect for the application of CBD in clinical ophthalmology were discussed.
目的:调查眼病患儿家长在患儿手术前的健康教育需求,为责任护士开展个性化、高质量的健康教育提供依据。方法:采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查,并对调查结果进行统计分析。结果:家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05);家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论:眼病患儿家长对患儿术前健康教育需求较高,医务工作者应丰富知识层面,加强专科学习及相关知识培训,把专科知识与健康教育有机地结合,并探索有效的线上健康教育方式,更好地为患者服务。
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
患者女,因左眼睑反复红肿3个月余就诊。眼眶CT检查:左眶前部可见边界清楚的低密度软组织影,病变向眶外上方延伸,通过位于蝶骨大翼与蝶骨嵴交汇处侵蚀性骨孔与颅内病变沟通。颅内可见额叶、颞叶散在分布的团块状高密度病灶。眼眶MRI检查:边界清楚的异常信号病灶从左上睑延伸至眶上方和眶外上方,呈囊性改变。颅内病变呈混杂信号,散在分布于颞叶和额叶。临床诊断为左眼眶、颅沟通性病变。于全身麻醉下行左眼眶病变切除术,术后病理诊断为眼眶棘球蚴囊肿(包虫病)。发生于眶、颅的沟通性包虫病少有报道,本病例提示对于眶、颅沟通性包虫病需要根据病变的性质、位置采取个性化治疗原则,术前影像学检查的判断分析是辅助治疗的重要手段。
A young female patient complained of recurrent redness and swelling of the right eyelid for more than 3 months.Orbital CT examination showed that low density soft tissue density shadow with clear boundary can be seen in the anterior part of the left orbit. The lesion extended to the upper part of the orbit and communicated with the intracranial lesion through the erosive foramen at the intersection of the great wing of the sphenoid bone and the sphenoid ridge. There were massive high-density lesions in the frontal and temporal lobes. MRI examination of orbit showed that the left upper eyelid extended to the upper orbit and the upper extraorbital region. There were cystic signal of the orbit lesion and mixed signals of intracranial scattering in temporal and frontal lobes. The clinical diagnosis was left orbital cranial communicating lesion. The patient underwent orbital tumor resection under general anesthesia and was diagnosed as echinococcosis by postoperative pathology. This case suggests that for orbital cranial communicating echinococcosis, individualized treatment should be adopted according to the nature and location of the lesions, in which imaging examination are important.
眼附属器淋巴组织增生性疾病作为一类疾病的总称,包括了良性淋巴组织增生、非典型性淋巴组织增生、IgG4相关眼病以及多种恶性淋巴瘤在内的数十种疾病类型。临床诊断此类疾病应将患者眼部体征、影像学检查与病理学检查紧密结合。随着免疫表型及分子病理等检测技术的进步,此类疾病之间的鉴别诊断正逐渐清晰。本文就眼附属器淋巴组织增生性疾病进行系统性描述,并重点探讨该类疾病的病理鉴别诊断。
Ocular adnexal lymphoproliferative disease, as a general term, contains reactive lymphoid hyperplasia, atypical lymphoid hyperplasia, IgG4 related ocular disease and malignant lymphoma. The clinical diagnosis of this kind of disease should integrate patient’s symptoms, imaging features and pathology characteristics. Development of immunophenotyping, molecular pathology and other detection technology will help with the differential diagnosis of ocular adnexal lymphoproliferative disease. This article is going to discuss the etiology, epidemiology,diagnosis and treatment of ocular adnexal lymphoproliferative disease, with a focus on the clinicopathological differential diagnosis of such disease.
光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)是一种非接触、无创的、快速的血管造影技术,它通过检测红细胞在血管内的光学相干断层扫描(optical coherence tomography,OCT)信号的变化来提供血管影像。由于这项技术不需要注射血管造影剂,使得它比传统的眼科血管造影技术更安全。在前节疾病的检查中,OCTA不仅能够量化前节血管的范围和密度,还显示出良好的成像质量,为临床监测疾病的病程和对治疗的反应提供客观的评价。
Optical coherence tomography angiography (OCTA) is a noncontact, noninvasive, and rapid angiography technique. It provides vascular images by detecting changes in the optical coherence tomography (OCT) signal of red blood cells in the blood vessel. Since this technique does not require injection of angiography, it is safer than traditional ophthalmic angiography. In the examination of anterior segment diseases, OCTA can not only quantify the range and density of anterior segment blood vessels, but also shows good imaging quality, providing an objective evaluation for clinical monitoring of the disease course and response to treatment.
CRISPR(clustered regularly interspaced short palindromic repeats)基因编辑技术通过精准改变细胞DNA序列,控制细胞命运及表型,是有望从根本上改变疾病治疗的新技术。由于眼球独特的生理构造,基因编辑疗法在治疗眼科疾病方面的应用具有明显的优势。目前,CRISPR基因编辑疗法治疗10型Leber先天性黑矇(Leber congenital amaurosis 10,LCA10)的临床试验已经展开,治疗其他多种眼科疾病的临床试验也即将开始。随着新一代CRISPR基因编辑技术的发展,基因编辑疗法有望为眼科疾病的治疗提供新的手段。
Clustered regularly interspaced short palindromic repeats (CRISPR) genome editing is a newly developed technology to precisely modify cellular DNA sequence, which could control cell fate and phenotype and fundamentally reform disease treatment. The structure of the eye offers unique advantages as a genome editing target. Recently, a CRISPR genome editing therapy has begun to be tested in Leber congenital amaurosis 10 (LCA10) patients, and the clinical trials for more ocular diseases are about to start. The development of CRISPR/Cas genome editing tools will drive major advances in the application of gene therapies in the treatment of ophthalmic disease.
目的:了解儿童罹患青光眼的疾病类型、特点,更好地做到早期发现早期治疗。方法:收集北京同仁医院2014—2019年度834例0~18周岁住院接受抗青光眼手术的患者,回顾性分析患者的人群特点与疾病构成特点。结果:834例患者中,原发青光眼397例(47.6%),继发青光眼429例(51.4%)。另有8例无法明确诊断青光眼类型。原发青光眼中以原发先天性青光眼最常见,继发青光眼中以白内障术后继发青光眼为主,两种类型的青光眼占总患者数的50%。结论:儿童罹患青光眼的疾病种类繁多,其中原发先天青光眼与白内障术后继发青光眼最常见,重视婴幼儿先天青光眼的筛查,监测儿童白内障术后眼压有助于早期发现青光眼,并给予治疗,延缓儿童青光眼患者视功能的损害。
Objective: To understand the types and characteristics of glaucoma in pediatric inpatients to achieve early detection and treatment. Methods: A total of 834 patients aged 0–18 years who underwent anti-glaucoma surgery in Beijing Tongren Hospital from 2014 to 2019 were collected and their population characteristics and disease composition characteristics were retrospectively analyzed. Results: In all of the 834 cases, there were 397 patients (47.6%) with primary glaucoma and 429 (51.4%) with secondary glaucoma. The type of glaucoma could not be definitively diagnosed in 8 cases. Primary infant glaucoma and secondary glaucoma following cataract surgery accounted for above 50%. Conclusion: The causes of pediatric inpatients with glaucoma are various. Screening of primary infant glaucoma should be taken seriously and monitoring intraocular pressure after cataract surgery is also important. Early detection and treatment can prevent further visual loss of pediatric patients with glaucoma.
遗传在儿童和青少年的眼耳功能障碍发病机制中起着重要作用。由于眼耳有共同的神经内、外胚层起源,具有相似的基因网络,所以当共同的基因发生致病性变异时会导致眼耳双重感觉丧失。有超过70多种病因与聋盲有关,常见的伴有听力异常并累及视神经和视网膜的综合征型眼遗传病,包括CHARGE综合征、Usher综合征、Stickler综合征、Alport综合征、Wolfram综合征、Waardenburg综合征等。其他如染色体和胚胎的异常也会出现导致眼耳发育障碍,如Down综合征、Dandy-Walker综合征等。一些已知的眼遗传病致病基因变异也可导致听力异常,如OPA1基因。由于遗传异质性,眼耳综合征的临床诊断往往很困难,尤其是对婴幼儿。了解遗传综合征中眼耳相关临床特征,有利于早期发现和正确诊断;而当综合征中眼部表型不典型,可以通过耳部等其他系统表型协助诊断。同时,明确诊断对终生视觉和听觉功能的监测,以及与优生遗传咨询均有重要意义。
Heredity plays an important role in the pathogenesis of eye and ear dysfunction in children and adolescents. Because of common neural endodermal and ectodermal origins, the eyes and ears have the similar networks of genes Therefore, when pathogenic mutations occur in common genes, it can lead to loss of double sensation in the eyes and ears. There are more than 70 etiologies associated with the deafblindness, including CHARGE, Usher, Down, Stickler, Alport, Wolfram and Waardenbur syndromes, which are the most common syndromic ophthalmic genetic diseases with hearing and optic nerve/retinal abnormalities. Other abnormalities such as chromosomal and embryonic abnormalities can also lead to hearing and vision impairment, like Down and Dandy Walker syndromes. Some known genetic variants in ocular genetic diseases can also lead to hearing loss, such as OPA1 gene. Due to genetic heterogeneity, the clinical diagnosis of ocular and ear syndrome is often difficult, especially for infants and young children. With understanding the clinical features of eyes and ears in genetic syndrome,is conducive to early detection and accurate diagnosis, and when the ocular phenotype in the syndrome is atypical, it can be assisted by other systematic phenotypes such as the ear. At the same time, clear diagnosis is important for lifelong monitoring of visual and auditory function, as well as for eugenic genetic counseling.
目的:借助于人工智能(artificial intelligence,AI)眼底筛查远程接转诊系统,探索“患者-社区-医院”远程筛查模式,推进眼科分级诊疗和双向转诊实施,为地市级医疗机构开展眼底疾病人工智能筛查工作提供一定的经验借鉴。方法:通过AI辅助远程筛查基层医疗机构的4886例患者,完成眼科检查并经AI初判、人工复核形成眼底诊断结论。通过医联体和专科联盟模式,对基层医疗机构的4886例患者的AI诊断系统结果和上级医师审核结果进行对照分析,分析AI诊断系统在眼科常见病种筛查中的推广应用的可信度和可行性。结果:AI检出DR的灵敏度为94.70%,特异度96.06%;DME的灵敏度96.43%,特异度96.55%;AMD的灵敏度77.55%,特异度95.74%;同时,其在病理性近视、白内障、青光眼等常见病种眼底筛查中也有一定作用。结论:AI辅助远程筛查系统对于绝大多数眼底疾病有较高的敏感性和特异性,适用于眼底疾病的筛查工作,利于基层医院或社区医院对于眼底疾病的初步诊断,落实眼科分级诊疗,有借鉴推广意义。
Objective: With the help of artificial intelligence (AI) based fundus screening remote referral telemedicine system,it enables us to explore the remote screening mode of patient-community-hospital, and promote the two-way referral and ophthalmic graded diagnosis. This investigation provides certain practice experiences for prefecture-level medical institutions to carry out AI screening for fundus diseases. Methods: Ophthalmologic examination was performed on 4,886 patients in primary medical institutions through AI-aided remote screening, and the final fundus diagnosis conclusion was formed after AI preliminary judgment and manual review. Through the Medical Consortium and specialty alliance model, the results of the AI diagnosis system and the audit results of superior physicians for 4 886 patients in primary care institutions were compared and analyzed, and the credibility and feasibility of the AI diagnosis system application in the screening of common ophthalmic diseases were discussed. Results: The sensitivity and specificity of AI detection of diabetic retinopathy were 94.70% and 96.06%, respectively. In the diabetic macular edema classification, the sensitivity and specificity were 96.43% and 96.55%, respectively. In the age-related macular degeneration classification, the sensitivity and specificity were 77.55% and 95.74%, respectively. Meanwhile, it also plays a role in screening common fundus diseases such as pathological myopia, cataract and glaucoma. Conclusion: The AI-aided remote screening system has high sensitivity and specificity for most of fundus diseases, indicating it is promising for fundus diseases screening in primary medical institutions. It is conducive for primary hospitals or community hospitals to carry out the initial diagnosis of fundus diseases, as well as the implementation of graded diagnosis and treatment of ophthalmology, which has reference and promotion significance.