青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。
青光眼是一组以病理性眼压升高为主要危险因素的,以青光眼性神经萎缩和视野缺损为主要特征的全球首位不可逆性致盲眼病。超声睫状体成形术(UCP)是一种新型非侵入性青光眼治疗技术,其降眼压主要原理为利用高强度聚焦超声破坏睫状突上皮细胞以减少房水生成,并增加葡萄膜巩膜通道的房水流出。UCP适应证广泛,早期主要用于各类难治性青光眼患者,特别是晚期及绝对期患者,研究者发现其除降眼压外,还能够显著缓解该类患者的局部疼痛。近年来,UCP在未经手术治疗的青光眼患者和早、中期青光眼病例中,也表现出了良好的降眼压效果,同时显示出较少的并发症和较轻的术后反应,并可重复治疗。然而不同类型青光眼UCP疗效存在一定差异,且为达最佳治疗效果,其治疗需匹配恰当的探头型号以及适当的治疗扇区。现有较广泛应用于国外的基于眼轴和白到白参数的公式计算方法,测算精度并不适用于国人,然而精准度更高的模型法,其便捷性仍有待进一步提高。UCP虽可减少降眼压药物用量,但术后用药策略的调整仍可能导致眼压波动。综上,针对UCP手术的适应证选择、手术参数设计、疗效预判以及术后管理策略等,仍有待开展相关临床研究,以期为其临床应用提供更加可靠的依据。
目的:探讨大泡性角膜病变(bullous keratopathy,BK)患者行飞秒激光辅助的角膜内皮移植术(endothelium keratoplasty,EK)的围手术期护理。方法:回顾性分析在南京总医院眼科行飞秒激光辅助角膜内皮移植的BK20例患者,分析并总结患者术前的心理疏导、术前准备、眼科检查、术中如何配合医生、术后特殊体位、高眼压的护理及如何正确用药和出院健康教育等。结果:患者得到及时、有效的护理,术后视力均有所提高,内皮贴伏好,无排斥反应及其他并发症的发生。结论:通过对患者围手术期的护理,可提高护理质量,缩短患者住院时间。
Objective: To observe the perioperative nursing of femtosecond laser-assisted corneal endothelial transplantation in the treatment of patients with bullous keratopathy. Methods: A retrospective analysis of 20 patients with bullous keratopathy with femtosecond laser-assisted corneal endothelial transplantation in our department. The preoperative psychological counseling, preoperative preparation, ocular examination, how to cooperate with the doctors in operation, nursing of special position, high intraocular pressure after surgery, how to use eye drops correctly and health education after discharge were summarized. Results: Nursing were performed to the patients timely and effectively. Postoperative visual acuity of all the patients were improved, the endothelial and corneal stroma bed are well combined and no graft rejection and other complications occurred in the patients postoperatively. Conclusion: We concluded that the quality of nursing was improved and the time of hospitalization was shortened after perioperative nursing.
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.
青光眼是一种以视网膜神经节细胞(retinal ganglion cell, RGC)及其轴突的进行性变性和丢失为主要特征的眼病,是导致视力丧失的最常见原因。尽管其具体的发病机制尚未完全明确,但众所周知,眼内压升高是青光眼进展的主要危险因素。目前,通过药物和手术治疗降低眼内压是控制疾病进展的主要手段。他氟前列素因其能有效长期稳定地降低眼内压,且不良反应轻微、患者依从性高、无明显全身不良反应,已成为治疗原发性开角型青光眼及眼高压症的一线治疗药物。近年来的研究表明,他氟前列素除了具有降低眼内压的效果外,还可能具有神经保护作用。文章对他氟前列素的药理作用及其在神经保护方面的潜在效益进行综述,为开发更有效的治疗青光眼药物提供理论依据和科研基础。然而,目前缺乏充分的临床研究证据支持其神经保护效应,未来研究应进一步探索这一领域,以促进针对视神经保护的药物开发和基于视神经再生的视觉功能重建。
Glaucoma is characterized by the progressive degeneration and loss of retinal ganglion cells (RGC) and their axons,making it one of the most common causes of vision loss. Although the exact underlying mechanisms remain unclear, it is well known that elevated intraocular pressure (IOP) is a major risk factor for the progression of glaucoma. Currently, the primary means of controlling glaucoma involves reducing IOP through medication and surgery. Tafluprost, due to its effective and long-term ability to lower IOP, minimal side effects, high patient compliance, and absence of significant systemic side effects, has become the first-line treatment for primary open-angle glaucoma and ocular hypertension. Recent studies suggest that tafluprost may also have neuroprotective effects beyond its IOP-lowering effects. This article aims to review the pharmacological and potential neuroprotective effects of tafluprost, providing a theoretical basis and research foundation for developing more effective drugs for glaucoma treatment. However, there is still a lack of sufficient clinical evidence to support the neuroprotective effects of tafluprost, and further investigations are required to explore in this field to furnish critical theoretical backing for the development of drugs that target optic nerve protection and facilitate vision restoration through optic nerve regeneration.
先天性白内障是严重影响婴幼儿视功能的疾病。随着白内障手术和人工晶体植入手术技术的发展,先天性白内障患者术后多可获得高质量的视觉康复。然而,如何更好防治手术相关的不良事件和并发症、先天性白内障伴随的其他眼部发育不良疾病的治疗以及形觉剥夺性弱视的治疗,仍然是先天性白内障手术后需要重视的临床问题。文章对先天性白内障摘除及人工晶体植入术后高眼压和继发性青光眼的发生、相关危险因素、治疗和预防的手段进行总结,以期进一步提高对先天性白内障术后高眼压和青光眼防治的认识,减少术后并发症对视功能造成的进一步损害。
Congenital cataract is a significant condition that profoundly impacts the visual function of infants and young children. Advancements in cataract surgery and intraocular lens implantation have enabled the achievement of high-quality visual rehabilitation after congenital cataract surgery. Nevertheless, effective prevention and treatment of surgery-related adverse events and complications, as well as managing other ocular dysplasia and form deprivation amblyopia that may arise in conjunction with the surgery, continue to pose important clinical challenges following congenital cataract surgery. This article provides a comprehensive overview of the occurrence, risk factors, treatment and prevention of high intraocular pressure and secondary glaucoma after congenital cataract and intraocular lens implantation. Its aim is to enhance the comprehension of preventive and therapeutic measures for high intraocular pressure and glaucoma after congenital cataract surgery, thereby minimizing potential postoperative complications and preserving visual function.
息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是亚洲人群中常见的致盲性眼病,发生大出血并发症后严重危害视力且预后差。PCV大出血包括视网膜下出血(subretinal hemorrhage,SRH)和玻璃体积血(vitreous hemorrhage,VH)。SRH的危险因素包括较长病程、簇型PCV、息肉状病灶不消退、合并视网膜色素上皮脱离;其治疗方式包括抗血管内皮生长因子药物、光动力疗法、激光、玻璃体腔注气、眼内注射组织纤溶酶原激活剂、玻璃体切割术或联合治疗等方式,其中,黄斑中心凹是否受累和出血时间是影响治疗方式选择的主要因素。发病年龄较大、白细胞计数较高、天门氨酸转移酶和丙氨酸转氨酶的比值较高、活化部分凝血活酶时间较长、曾行光动力疗法、有玻璃体腔注药治疗史、SRH面积大、出现视网膜色素上皮脱离的PCV患者发生VH的风险高。浓厚的VH通常需行玻璃体切割术,其手术时机和手术方式的选择是临床关注的焦点。鉴于目前PCV大出血的危险因素尚不完全明确、治疗方面也尚未达成共识,需要开展相关临床研究,提供更多依据。
息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是亚洲人群中常见的致盲性眼病,发生大出血并发症后严重危害视力且预后差。PCV大出血包括视网膜下出血(subretinal hemorrhage,SRH)和玻璃体积血(vitreous hemorrhage,VH)。SRH的危险因素包括较长病程、簇型PCV、息肉状病灶不消退、合并视网膜色素上皮脱离;其治疗方式包括抗血管内皮生长因子药物、光动力疗法、激光、玻璃体腔注气、眼内注射组织纤溶酶原激活剂、玻璃体切割术或联合治疗等方式,其中,黄斑中心凹是否受累和出血时间是影响治疗方式选择的主要因素。发病年龄较大、白细胞计数较高、天门氨酸转移酶和丙氨酸转氨酶的比值较高、活化部分凝血活酶时间较长、曾行光动力疗法、有玻璃体腔注药治疗史、SRH面积大、出现视网膜色素上皮脱离的PCV患者发生VH的风险高。浓厚的VH通常需行玻璃体切割术,其手术时机和手术方式的选择是临床关注的焦点。鉴于目前PCV大出血的危险因素尚不完全明确、治疗方面也尚未达成共识,需要开展相关临床研究,提供更多依据。
该文报道一例30岁的男性患者因“双眼自幼视力不佳,强光下视物模糊加重4年余”就诊,经过眼部检查评估,诊断为双眼瞳孔残膜、双眼屈光不正。患者接受一期双眼瞳孔残膜切除、二期双眼行有晶状体眼后房型环曲面人工晶状体(toric implantable collamer lens,TICL)植入手术,术后视力恢复良好。文章回顾了该例患者的诊治过程,为临床屈光不正同时伴有瞳孔残膜患者的诊治提供参考。
A 30-year-old male patient presented at our institution with a history of poor vision in both eyes since childhood, exacerbated by blurriness under bright light for over four years. Following a comprehensive ophthalmic examination, the patient was diagnosed with bilateral pupillary membrane remnants and refractive errors. The patient underwent a two-stage surgical intervention, starting with the removal of the pupillary membrane remnants, followed by the implantation of toric implantable collamer lenses (TICL) in the posterior chamber of the lensless eyes. Postoperative outcomes were favorable, with significant improvement in visual acuity. This article reviews the therapeutic journey of the patient, offering insights into the diagnosis and management of individuals with concurrent refractive anomalies and pupillary membrane remnants, thereby contributing to the clinical discourse on the subject.
随着角膜疾病治疗技术的不断进步,前弹力层移植技术(包括Inlay和Onlay技术)已成为晚期圆锥角膜治疗的重要手段,能有效改善患者的角膜地形图和视力结果,稳定角膜扩张,提高患者的生活质量。该文综述了前弹力层移植技术的理论基础、移植物的来源与制备技术、手术技术、临床疗效以及相关并发症,为晚期圆锥角膜的治疗提供了新的视角。研究表明,这种先进的移植技术相较于传统方法,在减少手术风险、简化手术流程以及加快术后恢复方面具有明显优势,特别是在降低异体移植物排斥反应及手术并发症的风险上,前弹力层移植表现出色。Onlay技术作为一种近期开发的新方法,其独特优势是无需剖离角膜,更好地保护角膜结构。此外这种技术的高度适应性和可逆性,为患者提供了更多的治疗选择和更好的视觉恢复。尽管如此,技术细节如移植物的尺寸和形状定制、手术深度的最优化等方面仍需进一步研究和优化,以提高整体治疗效果。
With the continuous advancement of corneal disease treatment technology, Bowman layer transplantation (including Inlay and Onlay technology) has become an important means for the treatment of advanced progressive keratoconus, which can effectively improve the corneal topography and visual acuity of patients, stabilize corneal dilation, and improve the quality of life of patients. Tis article reviews the theoretical basis of Bowman layer transplantation, the source and preparation of grafs, surgical techniques, clinical efcacy, and related complications, which provides a new perspective for the treatment of advanced keratoconus. It is stated in the research that this advanced transplantation technique has significant advantages over traditional methods in reducing surgical risks, simplifying the surgical procedures, and improving postoperative recovery. Especially in reducing the risk of allograft rejection and surgical complications, the bowman layer transplantation performs excellently. As a novel developed method, Onlay technology has the unique advantage of eliminating the need to dissect the cornea, which beter protects the corneal structure. In addition, due to the highly adaptable and reversible nature of this technique, it provides patients with more treatment options and beter visual recovery. However, in terms of technical details such as customizing the size and shape of the transplant, optimizing the surgical depth, etc., it is needed to conduct further research and optimization to improve the overall treatment efect.
青光眼是全球第二大致盲眼病,第一大不可逆性致盲眼病,其中原发性闭角型青光眼(primary angle closure glaucoma,PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy,LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔,解除PACG的瞳孔阻滞,加深前房,扩大房角,恢复生理性房水排出途径,从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压,是相对安全的治疗方法。
Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.
原发性干燥综合征(primary Sj?gren’s syndrome,SS)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(Sj?gren’s syndrome dry eye disease,SS-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 Sj?gren’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 Sj?gren’s syndrome probably leading to misdiagnosis or missing the diagnosis.The diagnosis of Sj?gren’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.