目的：探讨基于微信的图像存储和传输系统(picture archiving and communication system，PACS)教学在眼眶科规培医生中的教学效果及质量评价。方法：将中山眼科中心眼眶科轮训的66名规培医生分为A组(PACS组)与B组(微信+PACS组)。通过出科考核和问卷分析比较两组学生的教学效果及满意度。结果：B组学生的基础知识测试和阅片技能测试得分均显著高于A组(P<0.001，P=0.037)。教学效果自我评估量表显示B组学生对解剖结构位置的熟悉程度、影像学诊断、鉴别诊断能力、工作中解读CT或MRI图像的能力预判，以及对CT或MRI影像学的兴趣，明显优于A组(均P<0.001)。所有学生(100.00%)对这种教学模式感到非常满意。结论：在眼眶科住院医师规划化培训中应用基于微信的PACS教学模式能显著提高教学效果和满意度，提高教学质量。
Objective: To evaluate the application quality of picture archiving and communication system (PACS) based on WeChat in standardized resident training in orbital department. Methods: A total of 66 doctors trained in the Orbital Department of Zhongshan Ophthalmic Center were divided into group A (PACS group) and Group B (WeChat +PACS group). The quality and feedback of teaching of the two groups of students were compared through examination and questionnaire. Results: The scores of basic knowledges and reading skills of group B were significantly higher than those of group A (P<0.001, P=0.037). The self-assessment scale for teaching quality showed that the students in group B were superior to group A in understanding the position of anatomical structure, imaging diagnosis and differential diagnosis according to CT or MRI, interpreting CT or MRI images in the future, and interest in CT or MRI imaging (all P<0.001). All the students (100.00%) were very satisfied with this mode of teaching. Conclusion: The application of PACS based on WeChat in standardized resident training in orbital department can significantly improve the quality and satisfaction of ophthalmology teaching.
内源性干细胞在组织的损伤修复过程中组织相容性好、致瘤风险低，相较于外源性干细胞具有不需要体外扩增和培养、疾病传播风险低的优点，在细胞治疗领域具有显著优势。现在已经有多种使用内源性干细胞进行疾病治疗的成熟方式，应用领域包括了全身各种器质性和功能性疾病。在眼组织中，晶状体具有终生生长的能力且便于观察，是实现再生修复的突破点。哺乳动物中晶状体再生的实现有赖于晶状体内源性干细胞的定位和改良手术方式，以保留晶状体干细胞，并创造适合晶状体再生的微环境。对再生后的晶状体蛋白质组成分析，发现其类似成熟晶状体，而非胚胎期的晶状体，提示晶状体再生的调控与胚胎期的诱导发生并不相同；而调控晶状体再生的策略不仅着眼于干细胞的激活和正确分化的诱导，对其上皮间质转化过程也需要进行调控。在未来，为将晶状体再生的经验应用于其他眼组织中，动员内源性干细胞并促进其生长，可以添加细胞有效成分，比如外泌体、线粒体、小分子化合物等，模拟细胞应激；此外，还可以通过手术或生物材料辅助，恢复晶状体结构和环境。
Endogenous stem cells have significant advantages in cell therapy for excellent histocompatibility, low tumorigenicity risk, unnecessity for in vitro expansion and culture, and low disease transmission risk. There have been some applications for endogenous stem cells in treating diseases, targeting some organic and functional diseases throughout the body. In ocular tissue, the lens is a breakthrough for regenerative therapy due to its potential to grow throughout life and observation accessibility. Achieving lens regeneration in adult mammals attributes to some prerequisites. Firstly, the location of endogenous stem cells in the lens has been identified. Then, surgical approaches have been advanced to preserve lens stem cells and create a microenvironment suitable for lens regeneration. Protein compositional analysis of the regenerated lens reveals that it is similar to a mature lens rather than an embryonic lens, suggesting that the regulation of lens regeneration is not the same as the induction of embryonic onset. The strategy for regulating lens regeneration needs to focus not only on the activation and proper differentiation of stem cells but also on regulating the process of epithelial mesenchymal transition (EMT). In the future, in order to apply the experiences of lens regeneration to other ocular tissues, to mobilize endogenous cells and promote their growth, some strategies could be used. These strategies include mimicking cellular stress via the addition of cellular active ingredients, such as exosome, mitochondria, and small molecular compounds. Additionally, we can also try to restore lens tissue structure and microenvironment through surgical or biomaterial assistance.
目的：探讨基因多态性与2型糖尿病(type 2 diabetes mellitus，T2DM)患者发生增生性糖尿病性视网膜病变(proliferative diabetic retinopathy，PDR)的相关性。方法：2019年1月至2020年9月桂林医学院附属医院收治的700名T2DM患者，分为无糖尿病性视网膜病变(non-diabetic retinopathy，NDR)组(n=386)与PDR组(n=314)。收集临床基本资料，抽取患者外周血，使用竞争性等位基因特异性聚合酶链反应(kompetitive allele specific polymerase chain reaction，KASP)基因分型检测法检测两组患者血清中的内皮素-1(endothelin 1，EDN1)基因的rs5370位点和补体因子H(complement factor H，CFH)基因的rs800292位点基因型。用logistic回归分析这2个基因位点的多态性与广西汉族T2DM患PDR的关系。结果：收缩压、使用胰岛素治疗以及肾小球滤过率(glomerular filtration rate，GFR)的分析结果显示两组间差异有统计学意义(P收缩压=0.025，P胰岛素=0.001，PGFR=0.013)。排除以上混杂因素后，EDN1基因的rs5370位点上TT基因型与PDR易感性呈正相关(P=0.03，OR=2.973；adj.P=0.011，OR=2.718)；CFH基因的rs800292位点上AA基因型与PDR易感性呈正相关(P=0.037，OR=1.949；adj.P=0.044，OR=2.058)。结论：收缩压增高、GFR降低可能与T2DM患者发生PDR相关。EDN1基因的rs5370位点与CFH基因的rs800292位点的多态性与广西汉族人群的PDR易感性显著相关。
Objective: To investigate the relationship between gene-polymorphisms and proliferative diabetic retinopathy in patients who have type 2 diabetes mellitus (T2DM). Method: A total of 700 hospitalized T2DM patients were included in this study from January 2019 to September 2020. They were divided into two groups: the no-diabetic retinopathy (NDR) group (n=386) and the proliferative diabetic retinopathy (PDR) group (n=314). Basic clinical data were collected, and clinical indexes affecting diabetic retinopathy were analyzed. Two tag SNPs rs5370 in endothelin 1 (EDN1) and rs800292 in complement factor H (CFH) were examined using kompetitive allele-specific polymerase chain reaction (KASP) genotyping assays. Logistic regression was used to analyse the relationship between the polymorphisms of these two SNPs and PDR in a Guangxi Han population with T2DM. Results: Significant differences were found through the analysis of the systolic blood pressure—whether using insulin or not—and the glomerular filtration rate (GFR) between the two groups (Psystolic blood pressure=0.025, Pinsulin=0.001, PGFR=0.013) The TT genotype of rs5370 was determined to be associated with an increased risk of PDR (P=0.03, OR=2.973; adj.P=0.011, OR=2.718). The AA genotype of rs800292 was also determined to be associated with an increased risk of PDR (P=0.037, OR=1.949; adj.P=0.044, OR=2.058). Conclusion: Increased systolic blood pressure and decreased GFR may be associated with PDR in patients with T2DM. The rs5370 polymorphism of the EDN1 gene and the rs800292 polymorphism of the CFH gene are significantly associated with the risk of PDR in Guangxi’s Han population.
目的：评价不同操作者使用视网膜自动图像分析(automated retinal image analyzer，ARIA)软件测量糖尿病患者视网膜血管管径和迂曲度的重复性和再现性。方法：采用前瞻性诊断性试验研究设计，由2名熟练操作者应用ARIA软件对49名糖尿病患者以视盘为中心的45°数码眼底彩照进行视网膜血管半自动分析。通过测量距离视盘0.5~1.0个视盘直径内的视网膜动静脉血管参数，各选取6条最粗的动静脉综合计算得到中央动脉管径当量(central retinal artery equivalent，CRAE)、视网膜中央静脉管径当量(central retinal vein equivalent，CRVE)、视网膜动静脉比值(arteriole-to-venule ratio，AVR)、平均视网膜动脉迂曲度(mean retinal arteriolar tortuosity，MRAT)、平均视网膜静脉迂曲度(mean retinal venular tortuosity，MRVT)。在此基础上，评价同一操作者与不同操作者间测量结果的重复性和再现性，并绘制Bland-Altman图进行一致性分析。结果：操作者A两次测量的CRAE、CRVE、AVR差异无统计学意义(t= -0.089、-1.425、1.214，均P>0.05)，重复性良好(ICC≥0.725)且高度正相关(r≥0.721)。操作者A与操作者B对同一受试者2次测量的CRAE、CRVE、AVR差异无统计学意义(t= -1.169、-0.050、0.941，均P>0.05)，再现性良好(ICC≥0.750)且高度正相关( r≥0.697)。同一操作者和不同操作者间的MR AT、MRVT差异无统计学意义(P≥0.05)，Spearman非参数相关性分析重复性和再现性较好(r≥0.571，r≥0.588，均P<0.01)。结论：利用ARIA软件测量糖尿病患者视网膜血管管径及迂曲度具有良好的重复性和再现性。
Objective: To assess the repeatability and reproducibility in measurements of retinal vessel diameter and tortuosity in diabetic patients using the Automated Retinal Image Analyzer (ARIA). Methods: A prospective diagnostic trial was performed; 2 skilled researchers performed a semi-automatic analysis of retinal vessels in digital color fundus photography (45° field of view centered on the optic disc) from 49 diabetic patients using ARIA software. Six largest arterioles and venules coursing through an area of 0.5–1.0 disc diameter surrounding the optic disc were selected. Then the retinal vessel parameters were calculated into the central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), arteriole-to-venule ratio (AVR), mean retinal arteriolar tortuosity (MRAT) and mean retinal venular tortuosity (MRVT). To evaluate the repeatability of those values in 2 measurements by the same researcher and the reproducibility between different researchers. Bland-Altman analysis was employed to assess the agreement of the outcomes. Results: There was no significant difference in the CRAE, CRVE, and AVR values in the two-time measurements of researcher A (t= -0.089, -1.425 and 1.214, all P>0.05). It also showed a good repeatability and a highly positive correlation (ICC≥0.725, r≥0.721). There was no significant difference in those measurements between researcher A and B (t= -1.169, -0.050, 0.941, all P>0.05). It also showed a good reproducibility and a highly positive correlation (ICC≥0.750, r≥0.697). Results showed that there was no significant difference in the MRAT and MRVT values both in intraobserver and interobserver measurements (P≥0.05). Besides, Spearman’s nonparametric correlation analysis showed good repeatability and reproducibility (r≥0.571, r≥0.588, all P<0.01). Conclusion: ARIA software yields good repeatability and reproducibility in the measurements of retinal vessel diameter and tortuosity in diabetic patients.
目的：探究角膜移植日间手术患者的延续护理需求现状及其影响因素。方法：采用便利抽样法抽取行角膜移植日间手术的173例患者，采用课题组自行设计的一般资料调查表、角膜移植日间手术患者延续护理需求调查问卷进行调查。采用独立样本t检验、单因素方差分析、多元线性回归进行统计分析。结果：角膜移植日间术后患者延续护理需求得分为88.13±15.55，其中，对疾病相关知识的需求得分最高，为4.39±0.66，对心理护理的需求得分最低，为2.72±1.18；在延续护理实施方式方面，74.6%患者倾向于电话随访，只有5.8%倾向于上门服务；在影响因素方面，婚姻状况、视力、家庭月收入、文化程度是延续护理需求的影响因素。结论：角膜移植日间术后患者的延续护理需求较高，应根据患者延续护理需求及影响因素进行个性化指导，以提高角膜移植手术的成功率和减少并发症的发生。
Objective: To explore transition care needs among patients with keratoplasty in day ward and analyze the influencing factors. Methods: Using convenience sampling method, 173 patients undergoing keratoplasty in day ward were selected, and they were investigated by using a self-designed general information questionnaire and a questionnaire of transitional care needs of patients with keratoplasty in day ward. T-test, one-way analysis of variance (ANOVA), multiple linear regression were used to analyze the data. Results: The total score of transitional care needs among patients with keratoplasty in day ward was 88.13±15.55. The demand for disease related knowledge was the highest (4.39±0.66), the demand for mental nursing was the lowest (2.72±1.18). In terms of the way of implementation, 74.6% patients preferred telephone follow-up and only 5.8% preferred door-to-door service. Single-factor analysis showed that marital status, vision, monthly income, educational level were the factors influencing the demand for transitional care (P<0.05). Conclusion: Patients with keratoplasty in day ward have a high demand for transitional care. In order to improve the success rate of keratoplasty and reduce the incidence of complications, personalized guidance should be given according to patients’ transitional care needs and influencing factors.
目的：宏观了解2015—2020年中国眼科药物临床试验情况，为我国眼科药物的研发和临床研究提供最新数据参考，为相关决策提供依据。方法：自国家药品监督管理总局药物临床试验登记与信息公示平台登记数据库提取2015—2020年登记的眼科药物临床试验和相关试验药物信息，汇总分析眼科药物临床试验数量、试验分期、试验范围、适应证、药物类型等。结果：2015年1月1日至2020年12月31日共登记98项眼科临床试验。统计每年眼科药物临床试验登记数量，2020年登记的数量最多(28项，占28.57%)；申办方类型中，国内制药企业(75项，占76.53%)发起的眼科药物临床试验数量远高于外资制药企业(23项，占23.47%)；试验分期中，I期临床试验最多(35项，占35.71%)，III期次之(30项，占30.61%)；药物类型中，生物制品数量最多(55项，占56.12%)，化学药物次之(36项，占36.73%)。结论：近6年来，我国眼科药物临床试验进入蓬勃发展时期，尤其是眼底科领域，近2年发展迅速。在创新药领域，国内制药企业已成为眼科新药研发的中坚力量。但创新药大部分集中在眼底科领域，在青光眼、干眼等领域仍需要继续创新。
Objective: To get a macro understanding of the clinical trials of ophthalmic drugs in China from 2015 to 2020, provide the latest data reference for development of ophthalmic drugs and clinical research in China, and provide the basis for relevant decision-making. Methods: The number of clinical trials and related investigational products from 2015 to 2020 were acquired in the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies. Characteristics on number, stage, scope, indications, type were summarized and depicted. Results: There were 98 ophthalmic clinical trials registered in China from January 1, 2015 and December 31, 2020. The year of 2020 hit the highest record of registered ophthalmic clinical trials for 28, accounting for 28.57%. Among sponsor, 75 (accounting for 76.53%) were initiated by domestic pharmaceutical enterprises, much higher than initiated by foreign pharmaceutical enterprises (23, accounting for 23.47%). Among stage, the quantity of phase I (35, accounting for 35.71%) was the largest, followed by phase III (30, accounting for 30.61%). Among type, the quantity of biological product was the largest (55, accounting for 56.12%), followed by chemical product (36, accounting for 36.73%). Conclusion: The past 6 years have seen vigorous growth of ophthalmic clinical trials, particularly in the last 2 years in the field of fundus. Domestic pharmaceutical enterprises have become the central pillar of ophthalmic drugs renovation. However, their focus is limited to fundus, innovation is still needed in areas such as glaucoma xerophthalmia.
眼表菌群是定植于眼表的各种微生物群落，以细菌为主。在正常情况下，眼表菌群与人体眼表组织的细胞和平共生，维持眼表的稳态，共同保证眼表的健康。但在环境改变或免疫力低下的情况下，眼表菌群会发生变化，与眼部疾病的产生与发展关系密切，对人类的健康造成巨大的危害。随着组学研究的不断发展，我们对眼表菌群有了新的认识，为眼表疾病的发病机制、治疗开辟了新的思路，同时也提出了新的挑战。本文对国内外眼表菌群与疾病关系进行综述，为眼表疾病的发生、发展以及治疗提供参考。
The microbiome of the ocular surface consists of various microbial communities that colonize on the eye surface, mainly bacteria. The stabilization of the microbiome and the other ocular surface components plays an important role in maintaining the homeostasis of the ocular surface. However, unpredictable changes of ocular surface microbiome are strongly associated with ocular surface diseases in the situation of environmental changes or destruction of immune system. With the innovation of inspection technology, the current gene sequencing technology is applied to detect the ocular surface microbiome and confirm that the eye microbiome is closely related to ocular surface diseases. This paper investigates the corelation of ocular surface microbiomes and diseases. Moreover, we provide areference for the occurrence and development of ocular surface diseases and their treatment.
眼部移植物抗宿主病发生在超过一半的慢性移植物抗宿主病患者中，涉及眼表持续的炎症以及纤维化改变，最常见的表现为干燥性角膜结膜炎。严重的眼部移植物抗宿主病不但影响患者的工作和生活质量，同时也增加了其他眼部并发症的风险。慢性眼部移植物抗宿主病的治疗主要包括局部应用人工泪液、血清类制剂、抗炎药物等药物治疗，佩戴隐形眼镜、睑板腺按摩等物理治疗、封闭泪点、重建眼表等手术治疗。随着对眼部移植物抗宿主病发病机制的深入研究，许多新的治疗药物和治疗手段涌现临床。总结目前慢性眼部移植物抗宿主病在药物治疗、物理治疗、手术治疗方面的最新研究进展，将有助于为慢性眼部移植物抗宿主病的治疗带来更多选择和更新的研究思路。
More than half of the patients developed chronic graft-versus-host disease after accepting allogeneic hematopoietic stem cell transplantation suffer from ocular graft-versus-host disease. Ocular graft-versus-host disease involves persistent inflammation and fibrosis of the ocular surface and keratoconjunctivitis sicca is the most common symptom. Severe ocular graft-versus-host disease not only affects patients’ life quality, but also increases the risk of other ocular complications. The treatment of chronic ocular graft-versus-host disease mainly includes drug treatment, such as local application of artificial tears, serum eye drops and anti-inflammatory drugs; physical treatment, such as wearing contact lenses and meibomian gland massage; surgical treatment, such as punctal occlusion and reconstructing ocular surface. With the in-depth study of the pathogenesis of ocular graft-versus-host disease, many new therapeutic drugs and methods have emerged. Summarizing the latest research progress in drug, physical and surgical therapy of chronic ocular graft-versus-host disease will give us insights into treatment options and hot spot of research.
随着近视人口的逐年增长，近视已经成为全球关注的热点问题。如何预防近视、控制近视进展、减少病理性近视的发生、减少近视的成本投入是临床工作及科学研究的主要目的。阿托品是目前防控近视的主要药物方法，实验室研究及临床试验均已证实其显著的近视防控效果。美国眼科学会推荐使用0.01%低浓度阿托品，目前报道其近视防控效果为50%~53%。本文汇总了近年来近视防控相关的临床与实验室研究，对阿托品近视防控效果、其相关影响因素(如浓度、个体差异、生物利用度等)以及作用机制等方面的研究进展进行归纳综述，并分析了阿托品用于临床儿童近视防控工作存在的困难与挑战。
As the population of myopia grows rapidly, myopia has become a hot issue of global concern. Preventing myopia and slowing the progression of myopia to reduce the occurrence of pathological myopia and reduce the cost of myopia is the main purpose of related clinical work and scientific researches. Currently, atropine is the main drug for the prevention and control of myopia, and both laboratory studies and clinical trials have confirmed its effect. The American Academy of Ophthalmology recommends the use of 0.01% atropine, which is reported to be 50% to 53% effective in preventing and controlling myopia. This review collects the clinical and laboratory researches in decades to summarize the study progress in atropine for preventing and controlling myopia, including the clinical application effects, the influencing factors such as concentration, individual differences, bioavailability, and the related mechanisms. We also highlight the existing difficulties and challenges in the use of atropine in clinic.
眼睛由屈光系统和视觉神经系统两大部分构成，是人体最重要的感觉器官之一。眼部各组织的发育或功能异常都可能造成不同程度的视力损害。目前主要通过动物实验或体外细胞培养的方法探究眼病的病理生理机制和治疗手段，但上述两种方法都存在一定的局限性。体外细胞培养不能完全反映器官的形态、结构和生化特征，而动物模型的物种和遗传背景具有异质性。近年来，随着原代组织、胚胎干细胞、诱导多能干细胞衍生的体外三维结构类器官和器官微流控芯片技术的不断发展，构建出了与在体器官的结构、功能更为相似的器官克隆模型，能够提供更敏感、定量、规模化的表型分析，更好地应用于眼的发育、生理结构、疾病机制、个性化医学诊断和治疗方法等方面的研究。目前，眼科的微流控器官芯片与类器官技术在角膜、晶状体、泪腺、视网膜结构发育和疾病模型均展现出巨大的应用潜力。
The eye is composed of refractive system and visual nervous system. It is one of the most important sensory organs of the human body. The abnormal development or function of eye tissues may cause various degrees of visual impairment. At present, the pathophysiological mechanism and treatment of eye diseases are mainly explored through animal experiments and in-vitro cell culture. However, they are of certain limitations. The in-vitro cell culture cannot fully reflect the morphological, structural and biochemical characteristics of organs, whereas the animal models are heterogeneous of species and genetic background. In recent years, with the continuous development of in-vitro three-dimensional structure organoids and organ microfluidic organ-on-a-chip technology derived from primary tissues, embryonic stem cells and induced pluripotent stem cells, organ cloning models more similar to in vivo organs in terms of the structure and function have been constructed. These models can provide more sensitive, quantitative and large-scale phenotypic analysis, and can be better applied to the research of eye development, physiological structure, disease mechanism, personalized medical diagnosis and treatment. At present, microfluidic organ-on-a-chip and organoids technologies have shown great application potential in the structural development and disease models’ construction of cornea, lens, lacrimal gland and retina.
脉络膜破裂大部分是由撞击引起的对冲伤，冲击力通过玻璃体传导眼底引起，因此一般脉络膜破裂会有比较明确的外伤或者钝挫伤病史。本文将报告1例16岁体校男生在无明显外伤史出现多发性脉络膜破裂伤，通过查阅文献发现有文献报道在隐匿性假性黄色瘤(pseudoxanthoma elasticum，PXE)疾病中可在无明显外伤或轻微外伤出现脉络膜破裂，并根据文献复习考虑本病例为隐匿性PXE可能。
Most of the choroidal rupture is mostly caused by impact injury, and the impact force is caused by the vitreous conduction through the fundus. Therefore, the choroidal rupture generally has a clear history of trauma or blunt trauma. This article will report a case of a 16-year-old boy in a sports school who developed multiple choroidal ruptures without obvious trauma history. Through literature review, it was found that choroidal rupture can occur without obvious or minor trauma in subtle pseudoxanthoma elasticum (PXE) disease, and based on literature review, this case was considered as a possibility of subtle PXE.
