增生型糖尿病视网膜病变微创玻璃体切割手术后新生血管性青光眼的危险因素分析

目的分析增生型糖尿病视网膜病变(PDR)25G玻璃体切割手术(PPV)后发生新生血管性青光眼(NVG)的危险因素。方法回顾性病例研究。2017年1月至2018年12月在天津医科大学眼科医院首次行PPV治疗的PDR合并玻璃体积血(VH)患者340例340只眼纳入研究。其中,男性185例,女性155例;平均年龄(55.79±10.82)岁。患者平均糖尿病病程(13.01±7.70)年;平均空腹血糖(7.55±2.15)mmol/L。合并冠心病19例,合并脑梗死20例。所有患眼均行最佳矫正视力(BCVA)、眼压、间接检眼镜、彩色眼底照相等检查。BCVA检查采用国际标准Snellen视力表进行,并将结果换算为最小分辨角对数(logMAR)视力记录。患眼平均logMARBCVA2.04±0.73,平均眼压(15.45±2.93)mmHg(1 mmHg=0.133kPa)。VH持续时间3周?6个月,平均时间(2.98±1.46)个月。340只眼中,Ⅳ期93只眼(27.35%),Ⅴ期107只眼(31.47%),Ⅵ期116只眼(34.12%);伴牵引性视网膜脱离(TRD)83只眼。所有患眼均行25G标准经睫状体平坦部三通道PPV。57只眼手术前3d行玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗,234只眼手术中剥除内界膜,262只眼同时行白内障超声乳化手术,141只眼手术完毕时行玻璃体腔注射抗VEGF药物治疗。手术后随访至少12个月,平均随访时间(10.80±5.79)个月。以裂隙灯显微镜或房角镜检查发现虹膜和(或)房角存在新生血管且眼压〉21mmHg者诊断为NVG。采用Kaplan-Meier法和Cox单因素、多因素回归分析手术前基线因素、眼部因素、手术因素与手术后NVG发生的关系。结果340只眼中,PPV后发生NVG者66只眼(19.41%);发生NVG的时间为手术后6?335 d,平均时间为(98.00±5.79)d。PPV后第3、6、12个月,NVG发生风险比分别为11.50%、15.29%、20.75%。单因素Cox分析结果表明,年龄、合并冠心病或脑梗死疾病等手术前基线因素对手术后发生NVG有影响(P<0.05);PDR分期、合并TRD、手术前logMAR BCVA、手术前眼压等眼部因素对手术后发生NVG无影响(P>0.05);联合白内障超声乳化手术、手术中剥除内界膜、手术前3d玻璃体腔注射抗VEGF药物等手术因素对手术后发生NVG有影响(P<0.05)。将Cox单因素分析有意义的变量纳入多因素Cox比例风险模型进行分析,逐步回归探索手术后NVG的影响因素。结果显示,年龄、合并冠心病或脑梗死、联合白内障超声乳化和手术中内界膜剥除是手术后发生NVG的独立风险预测因素(P<0.05)。结论低龄、合并冠心病或脑梗死、联合白内障超声乳化手术是PDR患者PPV后发生NVG的危险因素,手术中剥除内界膜可减少NVG的发生。     

Commentary review on peripapillary morphological characteristics in high myopia eyes with glaucoma: diagnostic challenges and strategies

The incidences of open angle glaucoma(OAG)and high myopia are increasing concomitantly.Considering the aging population and concurrent rapid increase in the number of individuals with myopia,the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few decades.However,precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc,as well as extensiveβ-zone parapapillary atrophy in highly myopic eyes.Recent advances in optical coherence tomography(OCT)and OCT angiography(OCTA)technologies imply that both modalities are promising tools for the detection of highly myopic OAG.Notably,the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages(e.g.visual field defect,visual electrophysiological changes).We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.     

Human bone marrow mesenchymal stem cells-derived exosomes protect against nerve injury via regulating immune microenvironment in neonatal hypoxic-ischemic brain damage model

Neonatal hypoxic-ischemic (HI) brain injury is a serious injury caused by various perinatal factors, which has become a heavy mental burden to the family. The molecular mechanism underlying neonatal hypoxic-ischemic brain injury remains largely unknown. Human bone marrow mesenchymal stem cells (hBMSCs) have caused wide public concern due to the immunomodulatory properties. Exosomes can polarize human microglia and thus changed it into an anti-inflammatory phenotype to reduce the release of pro-inflammatory factors. However, it is unclear whether hBMSCs-exosomes have effect on neonatal hypoxic-ischemic brain injury. In this study, we aimed at investigating the role of hBMSCs-exosomes in regulating immune response and nerve injury in neonatal hypoxic-ischemic brain damage model. In the research, we identified the exosome secretion of hBMSCs could transferred into human microglia (HMC). Moreover, we determined the importance of hBMSCs-exosomes in regulating HMC polarization and inflammatory response. Our research findings might provide a new insight into slowing the disease progression of neonatal hypoxic-ischemic brain injury.     

Opportunistic pneumonia caused by E. cuniculi in mice immunosuppressed with cyclophosphamide

Opportunistic fungal pneumonia is a cause of concern in immunocompromised patients due to its high morbidity and mortality rates. One such opportunistic agent affecting immunocompromised patients is the microsporidia called Encephalitozoon cuniculi. This study aimed to evaluate pneumonia caused by E. cuniculi in mice treated with the immunosuppressive agent cyclophosphamide (Cy). This study also aimed to describe the immune cells associated with the microsporidial pneumonia. C57BL/6 mice were infected intravenously with E. cuniculi spores and treated with Cy (75 mg/kg/week, intraperitoneally). Thirty days post-infection, the fungal burden (qPCR), histopathological lesions, cytokine production, and the phenotype of the immune cells in the lung parenchyma were evaluated. Histologically, interstitial pneumonia with lymphocytic infiltrate was observed in the infected animals. The infiltrate mainly consisted of CD8⁺ and CD4⁺ T lymphocytes, with reduced populations of B lymphocytes and macrophages. The production of tumor necrosis factor-alpha (TNF-α) was significant in the animals of the infected groups. Also, the fungal burden was higher in the Cy-treated animals, which was confirmed by the immunohistochemical observation of spores. These results demonstrated that E. cuniculi infection of C57BL/6 mice caused lymphocytic interstitial pneumonia (characterized by a predominant lymphocytic infiltrate), which was aggravated by Cy-induced immunosuppression. Thus, these results can be used to understand the different pathological, immunological, and therapeutic aspects of lymphocytic interstitial pneumonia.     

视网膜母细胞瘤诊断和治疗的研究进展

视网膜母细胞瘤(RB)是儿童最常见的眼内恶性肿瘤,常严重影响患儿的视功能、生活质量甚至生命安全。随着医学技术的不断发展,RB的诊断与治疗取得许多新的突破,有效地提高了RB患儿的保眼率及生存率。除了传统的影像学、眼科特检等检查外,基因诊断近些年来在临床上广泛开展。本文将重点对RB的诊断及治疗的新进展进行综述。     

miRNA-451 regulates rhesus choroid-retinal endothelial cell function and proteome profile

AIM: To evaluate the effect of miRNA-451 on rhesus macaque choroid-retinal endothelial (RF/6A) cell function and proteome profile. METHODS: The RF/6A cells were transfected with miRNA-451 mimic and inhibitor. The role of miRNA-451 on proliferation ability was evaluated by CCK-8 assay. Furthermore, iTRAQ quantitative proteomic analysis was applied to comprehensively illuminate the change of cellular proteins and biological function between different groups. RESULTS: In miRNA-451 overexpression group, cell proliferation of RF/6A decreased both at 24h and 48h; while in miRNA-451 inhibition group, on the contrary, RF/6A cell proliferation was increased at 48h. Based on iTRAQ quantitative proteomic analysis, 23 differentially expressed proteins (DEPs) were detected in the comparison of miRNA-451 mimic and mimic control-transfected RF/6A cells, and 30 DEPs were identified in the comparison of RF/6A cells transfected with miRNA-451 inhibitor and inhibitor control. DEPs such as GORASP2, KRT1, SLC7A2, RIC8A, DDX42, CAP1, PCBP2 might be closely related to the inhibitory effect of miRNA-451 on RF/6A cell proliferation, while PCYT1A, MGAT1, TUBB, MCU, SIL1, BID, MSH6 might account for the positive effect of miRNA-451 inhibitor on RF/6A cell growth. PTPN1, as the only protein exhibiting an opposite trend between miRNA-451 mimic and inhibitor-transfected cells, was most likely accountable for the inhibition of miRNA-451 mimic on RF/6A cell growth, and the promotion of miRNA-451 inhibitor on RF/6A cell proliferation. CONCLUSION: miRNA-451 overexpression can suppress the growth of RF/6A cells while knockdown of miRNA-451 can promote RF/6A cell viability. Among all DEPs, increased PTPN1 is most likely to account for the negative regulation of miRNA-451 on RF/6A proliferation. miRNA-451 can be a protective factor for neovascular disease of fundus via regulating choroid retinal endothelial cell function.     

新型眼前节相干光层析成像仪与Scheimpflug眼前节分析仪测量年龄相关性白内障患者角膜屈光力及散光的比较

目的比较新型扫频源眼前节相干光层析成像仪CASIA2与Scheimpflug眼前节分析仪Pentacam测量年龄相关性白内障患者角膜屈光力、角膜散光的差异性和一致性。方法横断面研究。收集2020年4至5月在天津医科大学眼科医院白内障科拟行超声乳化白内障吸除联合人工晶状体植入术的年龄相关性白内障患者共112例(112只眼),分别采用Pentacam和CASIA2测量角膜前后表面及全角膜的陡峭轴、平坦轴及平均角膜屈光力、散光度数及散光轴向,采用算术法和矢量法分析散光的差异。采用配对样本t检验或Wilcoxon符号秩检验进行两组测量结果间差异性分析,一致性评价采用Bland-Ahman分析。结果112例(112只眼)患者中,男性44例,女性68例,年龄(67±10)岁。Pentacam与CASIA2测量的角膜前表面陡峭轴及平均角膜屈光力差异均无统计学意义(均P>0.05);测量的平坦轴角膜屈光力分别为(44.24±1.73)、(44.14±1.64)D,差异有统计学意义(t=2.278;P<0.05)。Pentacam测量的角膜后表面陡峭轴、平坦轴及平均角膜屈光力分别为(-6.60±0.29)、(-6.34±0.27)、(-6.47±0.26)D,CASIA2测量的角膜后表面陡峭轴、平坦轴及平均角膜屈光力分别为(-6.45±0.28)、(-6.17±0.25)、(-6.31±0.25)D,二者差异均有统计学意义(t=-14.440,-13.522,-17.186,均P<0.01)。Pentacam测量的全角膜陡峭轴、平坦轴及平均角膜屈光力分别为(45.08±1.84)、(44.18±1.85)、(44.63±1.82)D,CASIA2测量的全角膜陡峭轴、平坦轴及平均角膜屈光力分别为(43.94±1.64)、(43.02±1.64)、(43.48±1.60)D,二者差异均有统计学意义(t=21.016,21.819,22.981;均P<0.01)。两设备散光度数及散光轴向的测量结果差异均无统计学意义(均P>0.05)。矢量运算结果显示,Pentacam与CASIA2测量角膜前表面散光差异矢量质心为0.06 D@57°±0.64 D,其中47只眼(41.96%)>0.50 D;角膜后表面散光差异矢量质心为0.07 D@174°±0.21 D,其中2只眼(1.79%)>0.50 D;全角膜散光差异矢量质心为0.13 D@3°±0.69 D,其中59只眼(52.68%)>0.50 D。相关性分析显示,两设备测量结果均呈正相关,角膜前表面陡峭轴、平坦轴、平均角膜屈光力及散光度数的r值分别为0.970,0.968,0.976,0.697;角膜后表面陡峭轴、平坦轴、平均角膜屈光力及散光度数的r值分别为0.918,0.875,0.925,0.517;全角膜陡峭轴、平坦轴、平均角膜屈光力及散光度数的r值分别为0.951,0.955,0.959,0.622(均P<0.01)。Bland-Altman分析显示,两设备测量角膜前、后表面陡峭轴、平坦轴、平均角膜屈光力及散光度数均有较好的一致性,2.68%~8.04%的测量差值在95%一致性界限(95%LoA)外;两设备测量全角膜陡峭轴、平坦轴及平均角膜屈光力的95%LoA范围分别为0.01~2.28、0.06~2.27、0.10~2.20 D,95%LoA范围较宽,一致性较差。结论CASIA2与Pentacam测量年龄相关性白内障患者角膜屈光力及散光,在角膜前表面差异性较小,一致性较好,但角膜后表面及全角膜屈光力测量结果差异性较大,临床上不建议互换。     

视觉健康管理背景下眼视光教育的探索与实践

世界卫生组织及我国“健康中国”战略都将视觉健康管理提升到前所未有的高度,多方位、全周期保障民众视觉健康,增强人们视觉保健的意识是我国实现健康中国的战略重点。而人才培养是行业发展的命脉与基石,因此眼视光人才教育的探索与建设又是重中之重。本文以天津医科大学眼视光专业为例,就当今社会视觉健康管理的背景下,如何切实有效地开展眼视光教育、培养与时俱进的眼视光专业人才进行探讨。     

Consistency of autorefraction by two autorefractors in 1138 Chinese children and adolescents

AIM: To assess the consistency of refractive errors measured by two autorefractors in myopia screening of school-age Chinese children. METHODS: Topcon RM-8900 and Tianle RM-9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16y who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed. RESULTS: A total of 2276 eyes of 1138 subjects with a mean age of 10.49±2.66y were finally enrolled. Spearman correlation analysis showed that sphere (r=0.958, P<0.0001), cylinder (r=0.769, P<0.0001), and spherical equivalent (r=0.962, P<0.0001) measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic (P<0.0001) with a mean difference of 0.44 D (SD: 0.37; 95%CI: -0.27, 1.16) while the maximum absolute value (1.13 D) of the difference within the 95%CI was above the clinically acceptable range; however, no significant difference (P=0.83) was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D (SD: 0.31; 95%CI= -0.62, 0.61) while the maximum absolute value (0.62 D) of the difference within the 95%CI was clinically acceptable. The proportion of the axial deviation within ±20° was 84.6% (1503/1777) in eyes with cylinder ≤ -0.25 D while that rose to 96.4% (853/885) in eyes with cylinder ≤ -0.75 D. CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.