论著

干眼患者知信行现状调查及影响因素分析

An Investigation into the current status of knowledge, attitudes and practices among patients with dry eye disease and an analysis of influencing factors

:1-10
 
目的:了解干眼患者相关知识、管理态度及防治行为的现状及影响因素,为临床制定针对性的干预措施提供依据。方法:采用便利抽样法,选取2025年1—3月在中山大学中山眼科中心干眼与眼表疾病门诊就诊的患者为研究对象。调查工具为一般资料调查表、中国干眼问卷及干眼患者知信行问卷。知信行问卷包括知识(16个条目)、态度(7个条目)、行为(9个条目) 3个维度,共32个条目。使用单因素分析及多元线性回归分析确定影响因素。 结果:有效回收调查问卷325份,325例干眼患者的知信行问卷平均得分为(62.89±9.00)分;标准分为(78.61±11.25)分,处于中等水平。其中知识维度平均得分为(9.89±4.88)分,134例(41.2%)处于较差水平;态度维度得分较高,总均分为(26.92±2.24)分,标准分(96.16±8.03)分,处于较高水平;行为维度总均分为(26.06±5.43)分,标准分(72.41±15.09)分,处于中等水平。单因素分析结果显示,不同年龄、文化程度、家庭人均月收入、是否经常使用电子设备、是否主动查询疾病知识的干眼患者,其知信行得分比较差异有统计学意义(P<0.05)。年龄、文化程度、是否主动查询疾病知识是干眼患者知信行得分的影响因素(P<0.05)。 结论:干眼患者知信行水平处于中等,表现为疾病知识掌握片面、防治态度较积极但行为水平有待提高,且受多因素影响,应制订精准、个性化健康教育内容,以提高干眼患者的知信行水平。
Objective: To investigate the current status and identify the influencing factors regarding the knowledge, attitudes, and practices related to dry eye disease (DED) among patients. This study aims to provide a solid foundation for the development of targeted clinical interventions. Methods: With convenience sampling, patients diagnosed with DED were selected at the Dry Eye and Ocular Surface Disease Clinic of Zhongshan Ophthalmic Center from January to March 2025 as study subjects. The survey tools consisted of a general information questionnaire, the Chinese Dry Eye Questionnaire, and the Knowledge, Attitudes, and Practices (KAP) Questionnaire for DED patients. The KAP questionnaire was structured into three dimensions: knowledge (16 items), attitudes (7 items), and practices (9 items), making a total of 32 items. Univariate analysis and multiple linear regression were employed to identify influencing factors. Results: A total of 325 valid questionnaires were collected. Among the 325 DED patients, the average KAP score was 62.89±9.00, and the standardized score was 78.61±11.25, indicating a moderate level. In the knowledge dimension, the average score was 9.89±4.88 and 134 patients (41.2%) had poor scores. The attitudes dimension showed a relatively high level, with a total mean score of 26.92±2.24 and a standardized score of 96.16±8.03, reflecting that the patients generally held positive attitudes towards the prevention and treatment of DED. For the practices dimension, the total mean score was 26.06±5.43, and the standardized score was 72.41±15.09, indicating a moderate level of behaviorial practices. Univariate analysis revealed significant differences in KAP scores among patients with different ages, education levels, monthly household income per capita, frequencies of electronic device use, and whether they actively sought disease-related knowledge (P<0.05). Further, age, education level, and proactive information-seeking behavior were identified as significant influencing factors for KAP scores (P<0.05). Conclusions: The KAP level of DED patients is moderate. Their disease knowlege is fragmented, while they exhibit positive attitudes toward prevention and treatment. However, their behavioral practices are subptimal and are influenced by multiple factors. Therefore, it is essential to develop tailored and personalized health education programs to enhance the KAP level of DED patients.
论著

视网膜母细胞瘤钙化容积 CT 影像特征和临床应用价值

CT imaging features and clinical application significance of calcification volume in retinoblastoma

:-
 
目的:通过计算机体层扫描(computed tomography,CT)平扫和三维重建等利用图像后处理系统软件,评估视网膜母细胞瘤(Retinoblastoma,RB)病灶的钙化水平,并探究其与患者性别、眼别、年龄及影像学分期之间的相关性。方法:选取2022年5月—2024年12月经我院眼眶病与眼肿瘤科手术病理证实及临床确诊的108例RB患者127眼进行分析。应用CT重建和工作站分割技术对眼球、肿瘤、钙化进行分割和采用容积定量分析方法,运用R语言进行统计学处理,比较不同性别(男/女)、眼别(左/右)、年龄分层及影像学分期间的钙化最高CT值、肿瘤钙化容积(calcified regional volume,CRV)、肿瘤容积(tumor volume,TV)、患侧容积(eyeball volume,EV)、CRV/EV、TV/EV、CRV/TV比值的差异。结果:不同性别组其EV比较差异有统计学意义(P<0.05);不同年龄组RB其CRV、EV、CRV/EV比较差异有统计学意义(P<0.05);影像分期(眼内期、青光眼期、眼外期组)和晶状体位置变化(位置改变、形态位置密度改变、无变化组)的CRV 、TV、CRV/EV、TV/EV差异均有统计学意义(P< 0.05)。结论:RB患者的钙化沉积水平随着病程推进,在眼球内期、青光眼期至眼外期的不同阶段呈现逐级升高的态势。晶状体位置变化随病情进展、RB患者钙化程度逐渐增加。
Objective: To evaluate the calcification level of retinoblastoma (RB) lesions using image post-processing system software, such as that for computed tomography (CT) noncontrast scanning and three-dimensional reconstruction. Additionally, this study aimed to explore the relationship between retinoblastoma (RB) and patient gender (male/female) , as well as the correlation among ocular (left/right), age, and radiographic stage (e.g., international intraocular RB stage).  Methods: The study enrolled 108 patients (127 eyes) with tumors confirmed by both surgical pathology and clinical diagnosis. These patients received treatment at the Orbital Disease and Ocular Oncology Department of Zhongshan Ophthalmic Center, Sun Yat-sen University (ZOC, SYSU) from May 2022 to December 2024. CT reconstruction and workstation segmentation techniques were used to delineate the eyeball, tumour, and calcification. A quantitative volumetric analysis method was applied, and statistical processing was conducted using R language (version 4.2.1). Comparisions were made across different genders (male/female), eye segmentation (left/right), age stratifications, and imaging stages. The t-test was applied to analyze the highest CT value, calcified regional volume (CRV), tumor volume (TV), eyeball volume (EV), CRV/EV ratio, TV/EV ratio, and CRV/TV ratio in these tumor patients. Results: There was no significant differences in CT value, CRV, TV,  CRV/EV ratio, TV/EV ratio, and CRV/TV ratio among patients with different eye sides, genders and age groups (P>0.05). Only EV showed statistical significant across different age groups. Statistically significant changes were observed in CRV, TV, CRV/EV ratio, TV/EV ratio , and CRV/TV ratio with respect to both intraocular stage (including intraocular stage, glaucoma stage, extraocular stage) and lens position changes (inculding position changes, morphological position density changes, no change groups) (P< 0.05), No other statistically significant differences were found (P>0.05). Conclusions: In this group of tumor patients, the level of calcification deposition gradually increased as the disease progressed through the intraocular stage, glaucoma stage, and extraocular stage. Lens positional changes were associated with a gradual increase in the degree of calcification in patients with retinoblastoma (RB) as the disease advanced.

Plateau Iris in Whites versus Asians

Plateau Iris in Whites versus Asians

:13-18
 
Purpose: To evaluate the prevalence of plateau iris diagnosed by ultrasound biomicroscopy after laser peripheral iridotomy in Whites as compared to Asians in a U. S. clinic setting.
Methods: This was a prospective, observational study of narrow angle patients(n=55)who underwent laser peripheral iridotomy. Ultrasound biomicroscopy was performed in 4 quadrants of only one eye of each patient 4~6 weeks before and after surgery. The images were randomized and interpreted qualitatively by a single observer. Plateau iris was diagnosed in eyes with persistent appositional angles after laser peripheral iridotomy when at least 2 quadrants fulfilled the following criteria:1. The ciliary process was directed anteriorly. 2. The ciliary sulcus was absent. 3. The central iris plane was flat.
Results: Twenty eight subjects (50.1%)were Whites, and 27 subjects (49.0%)were Asians. Plateau iris was assessed in 18 subjects (32.7%):9 of 28 Whites (32.1%)and 9 of 27 Asians (33.3%). The proportion of plateau iris did not differ between Whites and Asians (P>0.99).
Conclusion: The prevalence of plateau iris did not differ between Whites and Asians.  Both groups had a substantial proportion of narrow angle patients with this clinical entity. (Eye Science  2012:27:13-18)
Purpose: To evaluate the prevalence of plateau iris diagnosed by ultrasound biomicroscopy after laser peripheral iridotomy in Whites as compared to Asians in a U. S. clinic setting.
Methods: This was a prospective, observational study of narrow angle patients(n=55)who underwent laser peripheral iridotomy. Ultrasound biomicroscopy was performed in 4 quadrants of only one eye of each patient 4~6 weeks before and after surgery. The images were randomized and interpreted qualitatively by a single observer.  Plateau iris was diagnosed in eyes with persistent appositional angles after laser peripheral iridotomy when at least 2 quadrants fulfilled the following criteria:1. The ciliary process was directed anteriorly. 2. The ciliary sulcus was absent. 3. The central iris plane was flat.
Results: Twenty eight subjects(50. 1%)were Whites, and 27 subjects(49. 0%)were Asians. Plateau iris was assessed in 18 subjects(32. 7%):9 of 28 Whites(32. 1%)and 9 of 27 Asians (33. 3%). The proportion of plateau iris did not differ between Whites and Asians(P>0. 99).
Conclusion: The prevalence of plateau iris did not differ between Whites and Asians.  Both groups had a substantial proportion of narrow angle patients with this clinical entity. (Eye Science  2012:27:13-18)
眼底影像专栏

急性黄斑神经视网膜病变中视网膜前巨噬细胞样细胞和视网膜脉络膜血流变化

Characterization of epiretinalmacrophage-like cells and retinochoroidal blood flow in acute macular neuroretinopathy

:454-463
 

目的:分析视网膜前巨噬细胞样细胞(epiretinal macrophage-like cellseMLC和视网膜脉络膜血流在急性黄斑神经视网膜病变(acute macular neuroretinopathyAMN)患眼的临床特征。方法回顾性分析202212—20235月在中山大学中山眼科中心就诊的病程2周内的AMN患者2137眼)及年龄匹配的健康对照组3338眼)的临床资料通过黄斑区内界膜上μmeface 光学相干断层扫描(optical coherence tomographyOCT)分层信息eMLC进行半自动分析提取和定量,同时测量OCT血管成像(optical coherence tomography angiographyOCTA6 mm x 6 mm 的黄斑区域内视网膜脉络膜血流参数进行分析对比。结果 AMN黄斑区eMLC数量329.78±77.38)个,密度为(9.16±2.15/mm2,均较对照组(202.63±41.72、(5.63±1.16/mm2增加P0.001)。AMN组浅层和深层视网膜血流密度分别为33.00±6.49)%和(32.59±7.41%,均较对照组(36.18±5.63)%和(37.08±5.65%减少(P0.05。视网膜全层中心凹无血管区(foveal avascular zoneFAZ面积、视网膜全层血流密度、脉络膜毛细血管和脉络膜大中血管血流密度在两组间比较差异无统计学意义(P0.05)。浅层及深层视网膜血流密度和FAZ面积对eMLC密度无影响(P0.05)。13AMN患者(231个月时的随访资料显示:AMN组末次随访时eMLC数量248.70±59.88)个、密度为6.91±1.66)个/mm2初次就诊时(307.87±82.98和(8.55±2.30)个/mm2减少(P0.001,但仍高于同期对照组(176.58±27.89和(4.91±0.77/mm2P0.001)。视网膜和脉络膜血流参数较初次就诊时比较差异无统计学意义(P0.05)。结论AMN患眼中eMLC异常增多和聚集,同时存在轻度的视网膜血流密度下降,但无脉络膜血流参数变化,且eMLC变化与AMN病程相关但与视网膜血流变化无关,提示eMLC所代表的炎症可能独立参与了AMN的发生

Objective: To investigate the clinical characteristics of epiretinal macrophage-like cells (eMLC) and retinochoroidal blood flow in eyes affected by acute macular neuroretinopathy (AMN). Methods: This retrospective case series study included 21 (37 eyes) patients diagnosed with AMN and 28 (33 eyes) healthy age-matched subjects. A 3 mm En-face optical coherence tomography (OCT) slab on the inner limiting membrane of the macular region was used to visualize and binarize the MLCs. The MLCs were binarized and quantified using a semiautomated method. Optical coherence tomography angiography (OCTA) was used to evaluate the perfusion status and obtain the structural data of macular within a 6 x 6 mm² macular region. Results: The number and density of macular eMLC in AMN eyes were significantly increased in comparison to control eyes: 329.78±77.38 vs. 202.63±41.72, (P0.001) and 9.16±2.15 cells/mm2 vs. (5.63±1.16) cells/mm2 (P0.001). In the macular region, both superficial and deep retinal vessel densities were significantly lower in the AMN eyes than in the control eyes: (33.00±6.49)% vs. (36.18±5.63)% (P=0.040); (32.59±7.41)% vs. (37.08±5.65)% (P=0.008). There were no significant differences in the vessel densities and foveal avascular zone (FAZ) area of full retina and choroidal vessel density between the two groups (P0.05). The eMLC density was not associated with the superficial and deep retinal FAZ area and vessel densities (all P0.05). At the one-month follow-up data of 13 patients (23 eyes), the number and density of macular eMLC were significantly lower in comparison to the initial visit: 248.70±59.88 vs. 307.87±82.98, P0.001 and (6.91±1.66) cells/mm2 vs. (8.55±2.30) cells/mm2 (P0.001). However, the number and density of macular eMLC are still noticeably higher than those of the control group during the same timeframe: 248.70±59.88 vs. 176.58±27.89 (P0.001) and (6.91±1.66) cells/mm2 vs. (4.91±0.77) cells/mm2 (P0.001). There was no significant difference in the vessel density of retina and choroidal during the follow-up (P0.05 ). Conclusions: The aggregation and activation of eMLC and a mild decrease in retinal blood flow density are observed in AMN, yet there is no corresponding shift in choroidal vessel densityThe changes of eMLC are linked to the course of AMN, but they are not related to retinal vessel density. The inflammatory response represented by eMLC might independently contribute to the pathogenesis and progression of AMN.

泪器病专栏

曲安奈德在治疗慢性泪囊炎鼻内镜术后造瘘口肉芽增生中的应用

Application of intralesional triamcinolone acetonide injections in the treatment of ostium granulomas following endoscopic dacryocystorhinostomy

:446-453
 

目的:分析慢性泪囊炎患者鼻内镜下泪囊鼻腔造瘘口术后的远期肉芽增生情况,评价物理清除联合曲安奈德(triamcinolone acetonide,TA)局部注射治疗慢性泪囊炎鼻内镜术后造瘘口肉芽组织增生的效果。方法:回顾性分析接受鼻内镜手术的慢性泪囊炎患者98例115眼。随访收集术后造瘘口肉芽组织增生发生情况,分析肉芽增生与无肉芽增生患者的临床特征。对有肉芽增生的患者26例31眼,根据治疗方式分为物理清除联合TA局部注射组13例16眼和单纯物理清除组13例15眼,比较2组间治疗有效率。结果:鼻内镜术后造瘘口肉芽增生病例共31眼(26.96%)。物理清除联合TA组的治愈率、好转率分别为93.75%、6.25%,物理清除组相应为60%、33.33%,组间比较差异有统计学意义(< 0.05)。结论:物理清除联合TA局部注射治疗泪囊炎鼻内镜术后造瘘口肉芽组织增生安全、有效。

Objective: This study aimed to analyze the formation of ostium granulomas following endonasal endoscopic dacryocytostomy (DCR) in patients with chronic dacryocystitis and to evaluate the efficacy of excision combined with triamcinolone (TA) injection for treating ostium granulosis after endoscopic dacryocystorhinostomy. Methods: A retrospective analysis was conducted on 98 patients (115 eyes) with chronic dacryocystitis who underwent endoscopic dacryocystorhinostomy.  Postoperative growth of the ostium granulomas was monitored, and clinical characteristics were compared between patients with and without ostium granulomas. Among these, 26 cases (31 eyes) of ostium granuloma were identified and randomly assigned to either an excision combined with triamcinolone injection group (13 cases with 16 eyes) or excision-only group (13 cases with 15eyes) based on the treatment method. The effective ratebetween two groups was compared. Results: Ostium granulomas occurred in 31 eyes (26.96%). The cure rate and improvement rate in the excision combined with TA group were 93.75% and 6.25%, respectively, whereas in the excision-only group, they were 60% and 33.33%. These differences were statistically significant (< 0.05).  Conclusion: Excision combined with intralesional triamcinolone acetonide injections proved effective in promoting the regression of ostium granuloma after DCR.

泪器病专栏

日间病房模式下行En-DCR的PANDO患者术后自我护理单中心回顾性分析

A single-center retrospective analysis of postoperative self-care in PANDO patients undergoing endoscopic nasal dacryocystorhinostomy (En-DCR) under the day-ward model

:437-445
 

目的分析日间病房模式下原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction, PANDO)患者行经鼻内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)的术后自我护理现状并进行早期效果评价。方法纳入2021年112022年8月在中山大学中山眼科中心眼整形与泪道科日间病房En-DCR手术治疗的90PANDO患者,术后常规给予术后自我护理指导。术后1个月复查采用调查问卷的方式记录患者术后自我护理情况及不适症状评估患者手术效果并进一步探究术后自我护理因素与手术效果及术后不适症状的相关性。结果90例行En-DCR手术治疗的PANDO患者共计90术后1个月手术总成功率为92.22%其中治愈率65.56%好转26.67%)。术后自我护理与手术效果的特征分析显示,术后遵医嘱鼻腔冲洗每日至少1次(= 0.002)、遵医嘱喷鼻每日至少1次(= 0.008)、术后无上呼吸道感染= 0.047)的患者手术效果更好术后自我护理与术后不适症状的特征分析显示每日至少1鼻腔冲洗(= 0.006)和义管在位(= 0.003)的患者术后不适症状较少同时对置管患者进行心理负担相关性分析结果显示置管不适与心理负担呈正相关(= 0.4210.001结论在日间病房模式下,医护人员En-DCR术后患者进行详细的自我护理指导,有助于患者的术后恢复及保证良好的手术疗效。指导重点包括术后1月内每日至少1鼻腔冲洗,规律使用抗炎喷鼻剂并防止上呼吸道感染;另外应重点关注泪道置管患者术后局部不适症状,针对术后不适症状优化用药使用互联网护理门诊或电话随访做好护理指导和心理疏导,促进患者术后康复

Objective: To investigate  postoperative self-care practices and evaluate the early outcomes of patients with Primary Acquired Nasolacrimal Duct Obstruction (PANDO) undergoing Endoscopic Dacryocystorhinostomy (En-DCR) in a day ward setting. Methods: 90 PANDO patients who underwent En-DCR surgery at the Oculoplastic and Lacrimal Surgery day ward at Zhongshan Ophthalmic Center, Sun Yat-sen University, between November 2021 and August 2022, were enrolled in this study. All patients received standardized postoperative self-care instructions. At the one-month follow-up, a questionnaire survey was used to record patients' self-care adherence to self-care practices, postoperative discomfort symptoms, and assess surgical outcomes. Furthermore, the correlation between self-care factors and surgical outcomes/discomfort symptoms was explored. Results: A total of 90 eyes from 90 PANDO patients undergoing En-DCR were included. The overall surgical success rate at one month was 92.22% , comprising a cure rate of 65.56% and an improvement rate of 26.67%. Analysis of self-care practices related to surgical outcomes showed significantly better results in patients who adhered to nasal irrigation at least once daily (= 0.002), used prescribed nasal spray at least once daily (= 0.008), and avoided upper respiratory tract infections (= 0.047). Regarding postoperative discomfort, patients who performed nasal irrigation at least once daily (= 0.006) and had the lacrimal stent (tube) in situ (= 0.003) experienced significantly fewer symptoms. Furthermore, correlation analysis in stented patients indicated a positive correlation between stent discomfort and psychological burden (= 0.421, < 0.001). Conclusion: In the day ward model, detailed self-care guidance provided by healthcare professionals for En-DCR patients contributes to postoperative recovery and ensures favorable surgical outcomes. Key instructions include performing nasal irrigation at least once daily, using anti-inflammatory nasal spray regularly, and preventing upper respiratory infections during the first postoperative month. Additionally, particular attention should be paid to localized discomfort in patients with lacrimal stents. Optimizing medication regimens for discomfort, utilizing internet-based nursing clinics or telephone follow-ups for guidance and psychological support are crucial to promote postoperative rehabilitation.

论著

首诊眼科的 4 例 2 型神经纤维瘤病眼部病变特征

Characteristics of ocular alterations in four cases of neurofibromatosis Type 2 first diagnosed in ophthalmology

:1-6
 
目的:回顾2型神经纤维瘤病(neurofibromatosis type 2, NF2)患者的眼部表现,分析NF2眼部病变的临床和影像学特征,以助该病的早期诊断。方法:收集来自深圳市眼科医院的1例和来自中山眼科中心的3例NF2患者完整的临床资料并进行总结分析。结果:这4例患者均因眼部异常首诊于眼科且符合曼彻斯特诊断标准。4例患者中,3例为NF2早发型(<20岁),1例为晚发型(>20岁),男女比例1∶1。3例患者因视力下降、1例患者因复视首诊于眼科。3例行眼底光学相干断层成像(optical coherence tomography, OCT)检查显示,视网膜错构瘤2例,视网膜前膜2例,视盘隆起2例,视网膜神经纤维层和节细胞层变薄1例。其他表现包括麻痹性斜视2例,复视1例,白内障1例,球后段视神经增粗1例,眼眶肿瘤1例。结论:NF2的眼部表现多种多样,可出现在神经症状和听力损失之前。详细的眼科检查及影像学检查对年轻患者的早期诊断非常有价值,有助于选择更好的治疗计划。
Objective: Review the ocular manifestations of patients with neurofibromatosis type 2 (NF2), and analyze the clinical and imaging features of the ocular lesions in NF2, so as to facilitate the early diagnosis of this disease. Methods: The complete medical records of 1 case from Shenzhen Eye Hospital and 3 cases of NF2 from Zhongshan Ophthalmic Center were collected. Results: All four patients were first diagnosed in ophthalmology due to eye symptoms and met the Manchester diagnostic criteria. Of the four patients, three were NF2 early hairstyles (<20 years old), one was late hairstyle (>20 years old), and the male-to-female ratio was 1:1. Three patients were first diagnosed in the ophthalmology department due to decreased visual acuity, and one patient was first diagnosed due to diplopia. Optical coherence tomography (OCT) examinations were performed on three patients, which showed that there were two cases of retinal hamartoma, two cases of epiretinal membrane, two cases of optic disc elevation, and one case of thinning of the retinal nerve fiber layer and ganglion cell layer. Other manifestations included two cases of paralytic strabismus, one case of diplopia, one case of cataract, one case of thickening of the retrobulbar optic nerve, and one case of orbital tumor. Conclusions: The ocular manifestations of NF2 are diverse and can precede neurological symptoms and hearing loss. Detailed ophthalmic examinations and imaging studies are highly valuable for early diagnosis in young patients, aiding in the selection of a better treatment plan.
封面简介

内镜下泪囊鼻腔吻合联合人工泪管植入术治疗小泪囊型泪囊炎的疗效分析

Efficacy of endoscopic dacryocystorhinostomy combined with bicanalicular silicone tube intubation for the management of chronic dacryocystitis with small lacrimal sac

:0-0
 
       小泪囊型慢性泪囊炎是泪道阻塞性疾病中的特殊亚型,目前尚无针对小泪囊的确切定义,传统内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗小泪囊型慢性泪囊炎因泪囊体积小手术操作难度大、术后吻合口易闭锁和成功率低而被视为相对禁忌。本研究通过CT泪囊造影(CT dacryocystography, CT-DCG)三维精准测量、定义小泪囊(水平径≤3 mm、前后径≤3 mm、垂直径≤6 mm),提出开放泪总管平面技术以扩大泪囊鼻腔吻合口,同时联合双管人工泪管植入术的En-DCR治疗方案,术后予以肾上腺皮质激素(激素)喷鼻剂辅助,显著提升手术疗效。
      研究纳入61例小泪囊型泪囊炎患者,术后9个月随访显示,解剖成功率达80. 33%(49/61),功能成功率为75.41%(46/61)。术中开放泪总管平面技术有效扩大手术窗口;短期双管人工泪管植入(术后3个月取出)联合激素喷鼻剂使用可降低吻合口闭锁风险同时未增加肉芽增生和感染风险。与传统治疗相比,该方案突破小泪囊手术禁忌,为患者提供更优选择。
       小泪囊型慢性泪囊炎是泪道阻塞性疾病中的特殊亚型,目前尚无针对小泪囊的确切定义,传统内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗小泪囊型慢性泪囊炎因泪囊体积小手术操作难度大、术后吻合口易闭锁和成功率低而被视为相对禁忌。本研究通过CT泪囊造影(CT dacryocystography, CT-DCG)三维精准测量、定义小泪囊(水平径≤3 mm、前后径≤3 mm、垂直径≤6 mm),提出开放泪总管平面技术以扩大泪囊鼻腔吻合口,同时联合双管人工泪管植入术的En-DCR治疗方案,术后予以肾上腺皮质激素(激素)喷鼻剂辅助,显著提升手术疗效。
      研究纳入61例小泪囊型泪囊炎患者,术后9个月随访显示,解剖成功率达80. 33%(49/61),功能成功率为75.41%(46/61)。术中开放泪总管平面技术有效扩大手术窗口;短期双管人工泪管植入(术后3个月取出)联合激素喷鼻剂使用可降低吻合口闭锁风险同时未增加肉芽增生和感染风险。与传统治疗相比,该方案突破小泪囊手术禁忌,为患者提供更优选择。
综述

双眼视与执行能力的交互关系:基于神经机制与临床影响的研究

The interactive relationship between binocular vision and executive ability: a study based on neural mechanisms and clinical impact

:355-362
 

双眼视,即双眼同时工作、协调和整合视觉信息的能力,能够产生单一、立体和深度感的视觉体验,近年来在认知心理学和神经科学研究中逐渐受到越来越多的重视,尤其是在探讨其与执行能力之间复杂关联的方面。执行能力作为一项至关重要的认知功能,涉及多个方面,包括注意力、工作记忆、决策和问题解决等,这些因素共同影响着个体在日常生活和工作中的表现和效率。当前的研究表明,双眼视不仅在视觉信息的处理上发挥着关键作用,还对个体的执行能力产生了显著的影响。双眼视异常群体(如斜视、弱视患者)在执行功能测试中普遍表现出反应抑制延迟、工作记忆容量降低等特征然而,现有文献中关于双眼视与执行能力之间关系的研究,特别是基于神经机制及其临床影响的系统性分析仍显得相对不足。为此,本文通过对现有研究的综述,深入探讨双眼视在执行能力中的作用,详细分析其背后的神经机制,并讨论这些发现对临床实践可能产生的影响。此外,文章还提出了未来研究的方向,以期更全面地理解双眼视与执行能力之间复杂的交互关系,从而为相关领域的研究提供新的视角和思路,推动这一领域的进一步发展。

Binocular vision, the ability of both eyes to work simultaneously, coordinate, and integrate visual information, can produce a unified, three-dimensional, and depth-perceptive visual experience. In recent years, it has garnered increasing attention in cognitive psychology and neuroscience research, particularly in exploring its complex relationship with executive functions. Executive functions, as a crucial cognitive capability, encompass various aspects, including attention, working memory, decision-making, and problem-solving, all of which collectively influence an individual's performance and efficiency in daily life and work. Current research indicates that binocular vision plays a key role not only in processing visual information but also has a significant impact on an individual's executive functions. Groups with binocular vision abnormalities (such as strabismus and amblyopia patients) generally exhibit characteristics like delayed response inhibition and reduced working memory capacity in executive function tests. However, existing literature on the relationship between binocular vision and executive functions, especially systematic analyses based on neural mechanisms and their clinical implications, remains relatively insufficient. Therefore, this article reviews existing research to delve into the role of binocular vision in executive functions, analyzes the underlying neural mechanisms in detail, and discusses the potential clinical implications of these findings. Additionally, the article proposes future research directions to comprehensively understand the complex interplay between binocular vision and executive functions, aiming to provide new perspectives and ideas for research in related fields and promote further development in this area.

综述

新型纳米材料介导治疗念珠菌角膜炎研究进展

Research progress on novel nanomaterials mediated treatment of candidal keratitis

:348-354
 

真菌性角膜炎是我国常见的致盲性眼病,其中排前3位的致病病原菌分别为曲霉菌、镰刀菌以及念珠菌。念珠菌作为一种条件致病真菌,在宿主免疫功能低下或眼表微环境失衡时易引发机会性感染,其发病率因免疫抑制药物的滥用以及隐形眼镜佩戴的增加等因素逐年上升。在机会感染后,由于念珠菌本身以及生物膜形成的特殊作用,常导致其对现用系统性抗真菌药物,如伏立康唑、两性霉素B、伊曲康唑及氟康唑等耐药性增加。近年来,关于纳米材料介导的药物传递系统作用于治疗念珠菌角膜炎的研究日益增多,新型纳米材料通过作为抗真菌药物的载体,增加药物溶解度,延长眼表停留时间,加强生物膜、角膜穿透性,提高了抗真菌药物对念珠菌的抗菌作用,为解决念珠菌感染耐药性难题提供了新思路。文章综述了纳米聚合物、纳米颗粒、纳米凝胶、脂质体载体、纳米立方体、纳米微针和纳米胶束等新型纳米材料作为治疗念珠菌角膜炎的新型给药载体的研究现状与进展,突破传统疗法的局限,为改善目前临床存在抗真菌治疗药物有限的问题提供新的可行思路。

Fungal keratitis is a prevalent blinding ocular disease in China, with Aspergillus, Fusarium, and Candida ranking as the top three pathogenic fungi. As an opportunistic pathogenic fungus, Candida readily causes opportunistic infections when host immunity is compromised or the ocular surface microenvironment is imbalanced. The incidence of Candida keratitis has been rising annually due to factors such as the misuse of immunosuppressive drugs and increased contact lens wear. Following infection, Candida itself and the formation of biofilms contribute to enhanced resistance against currently used systemic antifungal agents, including voriconazole, amphotericin B, itraconazole, and fluconazole, posing significant challenges to clinical treatment.Recently, research on nanomaterials-mediated drug delivery systems for treating Candida keratitis has burgeoned. Novel nanomaterials, serving as carriers for antifungal drugs, enhance therapeutic efficacy by improving drug solubility, prolonging ocular surface retention time, penetrating biofilms, and enhancing corneal permeability. These advancements offer new strategies to address drug resistance in Candida infections. This article reviews the research status and progress of emerging nanomaterialssuch as nanopolymers, nanoparticles, nanogels, liposomal carriers, nanocubes, nanoneedles, and nanomicellesas innovative drug delivery vectors for Candida keratitis. By overcoming the limitations of conventional therapies, these nanomaterials provide feasible solutions to the clinical challenges of limited antifungal options and drug resistance. The integration of nanotechnology holds promise for revolutionizing the treatment of Candida keratitis and advancing precision medicine for ocular surface fungal infections.

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
    浏览