近视眼视网膜的血氧代谢研究

目前近视眼视网膜血氧代谢研究主要聚焦于视网膜血氧饱和度和视网膜血流量。视网膜血氧饱和度研究现只局限于视网膜大血管的测量。近视眼患者视网膜血管直径减小,视网膜血流量下降,黄斑中心凹及视乳头周围毛细血管密度减少,中心凹无血管区范围增大。儿童青少年近视者视网膜动脉、静脉血氧饱和度与眼轴呈正相关。成年人高度近视眼动脉与静脉的血氧饱和度差值明显低于正视眼。     

正常人群视网膜血氧饱和度的测量

目的 测量正常人群中的视网膜血氧饱和度。设计 观察性横断面研究。研究对象 纳入的正常受试者91例,其中男性37例,女性54例,平均年龄（37.5±14.0）岁。方法 对所有受试者进行全身及眼科检查,并采用视网膜血氧仪（Oxymap）测量视网膜血氧饱和度。选取鼻上、鼻下、颞上及颞下象限来分别进行视网膜血氧含量的测量,测量范围为距视盘边缘0.5个直径至3个视盘直径之间,选取象限内最粗的动脉和静脉。将视网膜动、静脉血氧饱和度作为因变量,眼部参数及全身系统性参数作为自变量进行多因素线性回归,分析视网膜动、静脉血氧饱和度与全身因素及眼部指标之间的相关性。主要指标 视网膜平均动脉血氧饱和度（SaO2-A）,视网膜平均静脉血氧饱和度（SaO2-V）,视网膜平均动静脉血氧饱和度差值（SaO2-AV）。结果 中国正常人群的视网膜平均SaO2-A为（92.1±7.2）%;视网膜平均SaO2-V为（52.5±6.6）%;视网膜平均SaO2-AV为（39.6±7.5）%。鼻上象限的SaO2-A、SaO2-V和SaO2-AV较高,分别为（98.5±10.1）%、（57.3±8.7）%和（41.3±11.9）%。在多因素分析中,与SaO2-A相关的系统性因素包括高龄（B=0.24,P=0.049）,高脂血症（B=0.26,P=0.018）。吸烟与SaO2-V的降低有一定的相关性（B=-0.25,P=0.033）;SaO2-V与年龄（P=0.665）、眼压（P=0.073）、舒张压（P=0.616）无显著相关性。SaO2-AV与年龄呈正相关（B=0.219,P=0.046）,与性别成负相关（B=-0.253,P=0.019）。结论 高龄人群的视网膜动脉血氧含量相对较高;吸烟可能会导致视网膜静脉血氧含量降低;视网膜动静脉血氧饱和度差值与年龄呈正相关;男性的视网膜动静脉血氧饱和度差值较大。（眼科,2016, 25： 339－342）     

糖尿病患者视网膜血管血氧饱和度变化研究

目的 观察糖尿病患者与健康人群视网膜血管血氧饱和度的差异.方法 临床确诊为糖尿病的71例(71眼)患者和91名(91眼)健康者分别纳入糖尿病组和正常组.采用视网膜血管血氧饱和度测量仪检测两组受检者,并应用仪器配套软件分析距离视盘中心1.5-3.0个视盘直径的视网膜动脉、静脉血氧饱和度值.结果 71例糖尿病患者中,男性与女性、各个年龄段、不同糖尿病病程间比较,视网膜动脉、静脉及其各象限分支动脉、静脉的血氧饱和度差异均无统计学意义(均为P ＞0.05).糖尿病组视网膜动脉血氧饱和度较正常组显著升高(P=0.00);糖尿病组视网膜动脉各象限的血氧饱和度均较正常组高,其中颞上分支、颞下分支与正常组相比差异均有统计学意义(均为P ＜0.05).糖尿病组视网膜静脉血氧饱和度较正常组有升高的趋势,但差异无统计学意义(P＞0.05);糖尿病组视网膜静脉血氧饱和度颞上分支、颞下分支较正常组高,鼻下分支较正常组低,差异均有统计学意义(均为P ＜0.05).糖尿病组视网膜动静脉血氧饱和度差值较正常组显著升高(P=0.00).结论 糖尿病患者视网膜血管血氧饱和度与健康人群存在显著差异;糖尿病患者不同象限的血管血氧饱和度存在不同程度的改变,提示视网膜氧代谢异常程度在各象限的分布并不均匀.     

青光眼视网膜血氧饱和度与结构功能损害程度的相关分析

目的比较青光眼与正常人视网膜血氧饱和度的差异,分析青光眼患者中视网膜血氧饱和度与结构功能损害程度的相关性。方法病例对照研究。选取原发性开角型青光眼患者28例（35眼）为青光眼组,记录患者年龄、性别、眼压、血压、杯盘比,并进行中心30°阈值视野检测和光学相干断层扫描（OCT）检测视乳头旁视网膜神经纤维层（RNFL）厚度,并纳入27例（41眼）正常人作为对照组,采用视网膜血氧饱和度分析仪测量青光眼患者和正常人视网膜血管血氧饱和度。2组动静脉血氧饱和度差异比较采用独立样本t检验。采用Pearson或Spearman秩相关分析对青光眼组视网膜血氧饱和度与年龄、眼压、血压、杯盘比、视野平均缺损（MD）、视野指数（VFI）、视乳头旁RNFL厚度进行相关分析。结果青光眼组与正常对照组的视网膜动脉血氧饱和度差异无统计学意义,青光眼组静脉血氧饱和度较对照组高（t=4.017,P＜0.001）,动静脉血氧饱和度差值较小（t=-4.431,P＜0.001）。青光眼组视网膜动脉血氧饱和度、静脉血氧饱和度、动静脉血氧饱和度差值与年龄、眼压、血压均无线性相关性。视网膜动脉血氧饱和度与杯盘比、视野MD、VFI、视乳头旁RNFL厚度等均无线性相关。视网膜静脉血氧饱和度与杯盘比、视野MD值呈正相关（杯盘比：r=0.418,P=0.012;视野MD：r=0.504,P=0.002）,与RNFL厚度、VFI呈负相关（RNFL：r=-0.514,P=0.002;VFI：r=-0.470,P=0.004）。视网膜动静脉血氧饱和度差值与杯盘比、视野MD均呈负相关（杯盘比：r=-0.390,P=0.021;视野MD：r=-0.478,P=0.004）,与VFI、视乳头旁RNFL厚度呈正相关（VFI：r=0.449,P=0.007;RNFL：r=0.385,P=0.022）。结论随着青光眼加重,静脉血氧饱和度增加,动静脉血氧饱和度差值降低。青光眼患者视网膜耗氧量降低可能与视网膜神经组织萎缩有关。     

芪明颗粒对非增生期糖尿病视网膜病变患者视网膜微循环状态影响的临床研究

目的探讨芪明颗粒对非增生期糖尿病视网膜病变患者视网膜微循环状态的影响。 方法纳入2016年10月至2017年5月于成都中医药大学附属医院眼科确诊为非增生期糖尿病视网膜病变(DR)的16例(31只眼)患者。其中,男性12例(23只眼),女性4例(8只眼);年龄49~75岁,平均年龄(62.5±8.3)岁。观察并记录芪明颗粒治疗前、治疗后4周、治疗后8周及治疗后12周患者的视力、眼底出血面积、糖化血红蛋白(HbA1c)、视网膜血氧饱和度、视网膜血管管径、眼平均灌注压的变化情况。治疗前后患者的视力、眼底出血面积、HbAlc、视网膜血氧饱和度、视网膜血管管径及眼平均灌注压等定量数据,以均数±标准差表示。采用单因素重复测量方差分析比较患者治疗前后视力的变化情况;采用配对样本t检验比较组内治疗前后HbAlc、视网膜血氧饱和度、视网膜血管管径及眼平均灌注压的变化。 结果受试者糖尿病病程1~30年,平均(13.75±9.31)年。在治疗前、治疗后4周、治疗后8周及治疗后12周患者的视力分别为(73.81±7.90)、(73.97±8.53)、(74.74±7.29)及(76.26±6.80)。经单因素重复测量方差分析,治疗前后患者视力的比较,差异无统计学意义(F＝2.162,P>0.05)。治疗前患者的收缩压、舒张压、眼压及眼平均灌注压分别为(129.13±8.36)mmHg(1 mmHg＝0.133 kPa)、(74.44±6.92)mmHg、(15.58±2.90)mmHg及(46.06±4.90)mmHg。治疗后12周分别为(126.94±10.11)mmHg、(70.81±8.83)mmHg、(14.54±1.84)mmHg及(45.43±4.80)mmHg。经t检验,治疗前后患者收缩压、舒张压、眼压及眼平均灌注压的比较,差异无统计学意义(t＝0.797,1.383,1.853,0.538;P>0.05)。治疗前患者的HbAlc、视网膜静脉血氧饱和度平均值及视网膜动静脉血氧饱和度差值的平均值分别为(7.68±1.17)%、(63.18±7.07)%及(37.93±6.50)%。治疗后12周分别为(6.73±1.49)%、(60.16±5.21)%及(39.93±4.04)%。经t检验,治疗前后患者HbAlc、视网膜静脉血氧饱和度平均值及视网膜动静脉血氧饱和度差值平均值的比较,差异有统计学意义(t＝2.611,2.482,-2.259;P<0.05)。治疗前患者的眼底出血面积和视网膜动脉血氧饱和度平均值分别为(4713.70±8082.42)像素和(101.12±6.54)%。治疗后12周分别为(3776.66±6553.91)像素和(100.09±5.95)%。经t检验,治疗前后患者眼底出血面积和视网膜动脉血氧饱和度平均值的比较,差异无统计学意义(t＝1.571,1.047;P>0.05)。 结论芪明颗粒可以降低非增生期糖尿病视网膜病变患者视网膜静脉血氧饱和度,增大视网膜动静脉血氧饱和度差值。     

可疑青光眼患者视野指数与眼底血管变化的关系

目的探讨可疑青光眼者眼底血氧饱和度的基本特征及其与视野指数的关系。方法采用横断面研究设计,对可疑青光眼者及正常对照者应用视网膜血氧饱和度测量仪测量眼底血氧饱和度,同时进行中心30°阈值视野检测;统计分析平均视网膜光敏感度（ MS）、平均视野缺损度（MD）及丢失方差（LV）三个视野指数,以及视网膜血氧饱和度,并进行相关分析。结果可疑青光眼者与正常者MD存在统计学差异（P ＜0．05）;可疑青光眼者平均视网膜动脉血氧饱和度及视网膜鼻下支动脉血氧饱和度与正常者比较存在统计学差异（P ＜0．05）;可疑青光眼者视野检测的MD与NIA存在相关性,（r ＝0．368,P ＝0．045）。结论可疑青光眼者眼底血管可能发生了相应的变化,视网膜血氧饱和度状况与视野指数间存在一定联系。     

阴血虚和阳气虚患者视网膜血氧饱和度差异

目的：研究糖尿病、慢性肾病患者相同中医证型视网膜血氧饱和度的特征。方法：病例对照研究。基于证素辨证研究，纳入2014 年11 月至2016 年1 月四川省中医院2 型糖尿病患者64 例、慢性肾病患者83 例及门诊体检正常人103 例，采集视网膜动脉、静脉血氧饱和度，计算动静脉血氧饱和度差值，探索同证异病视网膜血氧饱和度及管径的差异。数据比较采用方差分析、Kruskal-Wallis秩和检验。结果：阴血虚与阳气虚患者视网膜动脉血氧饱和度分别为（101.4±10.2）%和（98.3±6.0）%，差异无统计学意义，与正常人比较3组差异有统计学意义（H=15.74，P < 0.001）；阴血虚、阳气虚患者视网膜静脉血氧饱和度分别为（62.2±8.4）%和（63.2±5.7）%，与正常人比较3组差异无统计学意义（F=0.56，P=0.569）；阴血虚患者视网膜平均动静脉血氧差值[（39.2±7.8）%]较阳气虚平均动静脉血氧差值[（35.0±5.8）%]高，差异有统计学意义（P < 0.001）。结论：阴血虚患者视网膜动静脉血氧饱和度差值较阳气虚患者大，提示阴血虚患者机体耗氧量较高。     

视网膜血氧饱和度测量技术的研究进展

视网膜血氧饱和度的测量方法分为有创和无创技术.有创的方法是利用氧敏感的微电极直接测量,该方法测量结果准确,但只用于动物实验.无创的方法有多波长眼底照相术和相干光断层扫描,前者操作快速、便捷,目前广泛应用于临床研究;后者能够扫描深层的视网膜、脉络膜,但目前临床研究不多.视网膜是全身唯一可活体观察血管及其分布形态的组织,利用这些测量视网膜血氧饱和度的技术,将有助于提高对许多眼部疾病的认识.     

晶状体混浊程度对糖尿病性白内障患者视网膜血氧饱和度的影响

目的：探讨晶状体混浊程度对糖尿病性白内障患者视网膜血氧饱和度的影响。

方法：横断面研究。选择2017-06/12于我院入院就诊的糖尿病性白内障患者68例68眼作为研究对象,采用视网膜血氧饱和度测量仪测定视网膜动、静脉及其颞上、鼻上、鼻下、颞下分支血氧饱和度,通过视觉质量分析系统Ⅱ测量眼部客观散射指数(OSI),并根据OSI对晶状体混浊程度进行分级。

结果：本组患者视网膜动脉及其分支血氧饱和度分别为101.39%±10.84%、106.19%±11.40%、103.22%±10.91%、102.36%±20.31%、101.29%±13.88%,视网膜静脉及其分支血氧饱和度分别为62.51%±8.95%、66.37%±10.74%、64.81%±8.97%、58.37%±13.85%、58.66%±19.94%,动静脉血氧饱和度差值为40.72%±12.08%。本组患者68例68眼OSI值为4.21±3.14,其中晶状体1级混浊15眼,2级混浊14眼,3级混浊23眼,4级混浊16眼。Pearson相关分析显示,视网膜动、静脉及其分支与OSI呈负相关(均P<0.01),而视网膜动、静脉血氧饱和度差值与OSI呈正相关(P<0.01)。不同晶状体混浊程度患者视网膜动、静脉及其分支血氧饱和度比较,差异均有统计学意义(P<0.05),其中晶状体4级混浊的患者视网膜动、静脉及其分支血氧饱和度均显著低于晶状体1、2、3级混浊的患者,差异均有统计学意义(P<0.05),而晶状体1、2、3级混浊的患者动、静脉及其分支血氧饱和度比较,差异均无统计学意义(P>0.05)。不同晶状体混浊程度患者视网膜动静脉血氧饱和度差值比较,差异无统计学意义(P>0.05)。

结论：糖尿病性白内障患者晶状体混浊程度为1～3级时,视网膜血氧代谢异常程度不明显,晶状体混浊程度达到4级则会导致患眼视网膜动、静脉及其分支血氧饱和度下降。     

视网膜血管手术操作技术的研究及临床应用

视网膜血管手术操作技术主要包括视网膜动脉和静脉的穿刺、插管、血管内注射药物和动脉内栓子的驱除等干预手段，目前不仅获得了较多的实验研究结果，而且视网膜静脉注射组织型纤溶酶原激活剂治疗视网膜静脉阻塞也获得了初步效果，这项技术的发展可为视网膜血管疾病，特别是视网膜中央静脉阻塞和视网膜中央动脉阻塞，提供一种新的治疗方法。     

Imaging in retinal vascular disease: A review

Retinal vascular diseases represent a broad field of ocular pathologies. Retinal imaging is an important tool for diagnosis, prognosis and follow up of retinal vascular diseases. It includes a wide variety of imaging techniques ranging from colour fundus photography and optical coherence tomography to dynamic diagnostic options such as fluorescein angiography, and optical coherence tomography angiography. The newest developments in respective imaging techniques include widefield imaging to assess the retinal periphery, which is of especial interest in retinal vascular diseases. Automatic image analysis and artificial intelligence may support the image analysis and may prove valuable for prognostic purposes. This review provides a broad overview of the imaging techniques that have been used in the past, today and maybe in the future to stage and monitor retinal vascular disease with focus on the main disease entities including diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion.     

Diffusion-Weighted Magnetic Resonance Imaging in Acute Retinal Pathology

The authors describe diffusion-weighted magnetic resonance imaging (DWI) as an accessible way to screen for acute retinal pathology in emergency setting. They describe three proof-of-principle patients who had abrupt onset of vision loss from acute retinal pathology where DWI was diagnostic. The deficits included central retinal artery occlusion and acute retinitis with retinal necrosis. DWI can be non-specific for aetiology, but it can rapidly localise the retinal pathology and initiate early therapeutic interventions in the emergency room.     

Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence

AIM: To describe retinal findings of various imaging modalities in acute retinal ischemia. METHODS: Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A) and fundus autofluorescence (FAF) images of 13 patients (mean age 64y, range 28-86y) with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome. RESULTS: All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. CONCLUSION: Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.     

光学相干断层扫描血流成像技术(OCTA)在视网膜静脉阻塞中的应用

光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)是一种近年来新兴的无创、快速、高分辨率的眼底血管成像技术.OCTA拥有分层观察不同层面的视网膜血管形态,量化血流灌注的独特优势,现广泛应用于各类眼底血管疾病的诊断及随访.视网膜静脉阻塞是一种常见的眼底血管病变,本文对OCTA在视网膜静脉阻塞的应用进行综述.     

Review of the association between retinal microvascular characteristics and eye disease

Computerized retinal imaging technologies enable the static and dynamic measurement of a range of retinal microvascular parameters. Large population‐based studies have reported associations between these microvascular indices and various ophthalmic diseases including diabetes, age‐related macular degeneration, retinal artery embolism, retinal vein occlusion, glaucoma and non‐glaucomatous optic neuropathies. Increasingly, sophisticated imaging and analysis techniques have the potential to provide relevant clinical information regarding disease risk and progression; however, further studies are required to verify associations and strengthen the predictive power of these techniques. We summarize the current state of knowledge regarding retinal microvascular characteristics and eye disease.     

视网膜静脉阻塞动物模型的制作方法

视网膜静脉阻塞(RVO)分为视网膜分支静脉阻塞和视网膜中央静脉阻塞,是以视网膜静脉扩张迂曲、血流瘀滞、出血和水肿为特征的病变,常并发黄斑水肿和新生血管,新生血管型青光眼是其最严重的并发症。视网膜静脉阻塞对视力危害较大,是仅次于糖尿病性视网膜病变的第二大致盲性眼病。目前为止,视网膜静脉阻塞的患病人数增多,但其发病机制尚未完全明了,而且也无长久有效的治疗方法。实验室中动物模型对视网膜静脉阻塞发病机制和治疗方法的研究至关重要,因此本文对视网膜静脉阻塞实验中使用的动物及模型的制作方法做了简要综述,并对各种视网膜静脉阻塞动物模型的优缺点进行讨论。     

Management of macular oedema due to retinal vein occlusion: An evidence-based systematic review and meta-analysis

Background

Central retinal vein occlusion and branch retinal vein occlusion are common causes of visual loss due to associated macular oedema. The aim of this review was to assess the effectiveness of interventions improving vision and treating macular oedema in central retinal vein occlusion and branch retinal vein occlusion.

Methods

Medical search engines and clinical trial registries were systematically searched. Randomised clinical trials with ≥90 eyes and real-world outcome studies with ≥100 eyes each with ≥6 months follow-up were included.

Results

There were 11 randomised controlled trials evaluating treatments for central retinal vein occlusion which met the inclusion criteria and 10 for branch retinal vein occlusion. There were 10 real world outcome studies of central retinal vein occlusion and 5 real world outcome studies of branch retinal vein occlusion. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were change in visual acuity at 6-, 12-, 24- and 36 months by treatment.

Conclusions

Intravitreal anti-vascular endothelial derived growth factor is recommended as first line treatment over intravitreal corticosteroid due to its effectiveness and lower rate of ocular adverse events. Best outcomes are achieved when intravitreal treatment is started early. Macular laser may have an adjunctive role in branch retina vein occlusion but not central retinal vein occlusion.     

Methods for making animal models of retinal vein occlusion

Retinal vein occlusion (RVO) is divided into branch retinal vein occlusion and central retinal vein occlusion. It is characterized by retinal vein dilatation and tortuosity, blood flow stasis, bleeding and edema. It is often accompanied by macular edema (ME) and neovascularization. Neovascular glaucoma is the most serious complications. RVO is the second most common cause of visual loss classified under retinal vascular disorders after diabetic retinopathy. So far, the number of patients suffering from retinal vein occlusion has increased, but the pathogenesis of retinal vein occlusion has not been fully understood and there are no treatments that are very long-lasting. The research of animal models on the pathogenesis and treatment of the RVO is very important. Therefore, this article gives a briefly review to the animals and model making methods used in retinal vein occlusion experiments, and discusses the advantages and disadvantages of various RVO animal models.     

眼底自发荧光技术在眼科中的应用

眼底自发荧光是一种新近发展的眼底成像技术,它能显示RPE的分布情况。观察自发荧光的分布及其强度,有助于确定某些视网膜疾病的诊断及其预后评价。本文就自发荧光的基本原理及其在各种视网膜疾病中的表现作一综述。     

Combined central retinal artery and vein occlusion from orbital inflammatory pseudotumour

Progressive, painful blurred vision and proptosis developed in the left eye of a 32-year-old man over an 8-day period. On initial neuro-ophthalmic evaluation the visual acuity in the left eye was no light perception. Erythema of the periorbital skin, 5 mm of proptosis, and ophthalmoplegia were noted on the left side. Funduscopy revealed occlusion of the central retinal artery and central retinal vein. Computed tomography and magnetic resonance imaging revealed marked distension of the left optic nerve and enhancement of the contents within the left orbit, with clear paranasal sinuses. The diagnosis of orbital inflammatory pseudotumour was made and the orbital signs improved rapidly with 80 mg of prednisone per day. Combined occlusion of the central retinal artery and vein is a rare complication of orbital inflammatory pseudotumour. It is postulated that marked distension of the optic nerve caused mechanical compression of the central retinal vessels leading to the vascular occlusions.