Effects of immunosuppressants after penetrating keratoplasty:meta-analysis of randomized controlled trials

AIM:To assess the effectiveness of immunosuppressants in the prophylaxis of corneal allograft rejection after high-risk keratoplasty and normal-risk keratoplasty.METHODS:We searched the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,EMBASE,CNKI,VIP and reference lists of articles.Date of most recent search:18 June,2011.All randomised controlled trials(RCTs) assessing the use of immunosupressants in the prevention of graft rejection,irrespective of publication language.Two authors assessed trial quality and extracted data independently.Only dichotomous outcomes(clear graft survival,ratio of immune reactions and side effects) were available and were expressed as relative risk(RR) and 95% confidence intervals(CI).RESULTS:Seven studies were included in this review.In the comparing of mycophenolate mofetil(MMF) with placebo,the results showed MMF could significantly reduce immune reactions compared with placebo(RR 1.08 95% Cl 0.95 to 1.21),but no effect on clear graft survival(RR 1.11 95% Cl 0.90 to 1.35).In clear graft survival and immune reactions,MMF and cyclosporine A(CsA) showed similar effect(RR 1.11 95% Cl 0.90 to 1.35,and RR 1.48,95% Cl 0.56 to 3.93,respectively).Tacrolimus(FK506) and steroid showed similar effects on clear graft survival and immune reactions(RR 0.32,95% CI 0.02 to 6.21,and RR 1.00,95%CI 0.88 to 1.14,respectively).No drug relative side effect has been found.CONCLUSION:MMF may reduce immune reactions in both normal-risk and high-risk rejection of penetrating keratoplasty.CsA and FK506 showed similar effects as MMF.However,due to the lack of large clinical trials,the evidence remain weak,the quality of evidences were rated as very low to moderate.Large,properly randomised,placebo-controlled,double masked trials are needed to evaluate the effect of immunosuppressants.     

糖尿病导致视路神经元病变的研究进展

糖尿病是一组能引起严重眼部并发症的慢性代谢性疾病。近年来研究发现:糖尿病早期在视网膜微血管病变之前,就出现视路神经元结构与功能的异常改变。因此,导致糖尿病患者视功能障碍的原因,不仅在于视网膜微血管病变,还与视路多部位神经系统的功能障碍有关。我们将从临床观察、视功能检查以及组织形态学研究等方面对糖尿病视路神经元病变的研究进展进行综述。     

A novel NF1 frame-shift mutation c.703_704delTA in a Chinese pedigree with neurofibromatosis type 1

We analyzed the clinical features and NF1 gene mutation in a Chinese pedigree of neurofibromatosis type 1 (NF1). Three members of this family were NF1 patients presenting with different clinical phenotypes and the others were asymptomatic. Exons of NF1 were amplified by polymerase chain reaction, sequenced, compared with a reference database. One novel NF1 frame-shift mutation c.703_704delTA, which resulted in a premature stop signal at codon 720 and the synthesis of truncated, was revealed. This mutation segregated with the NF1 members is likely responsible for the pathogenesis of NF1 in the family.     

鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识(2022，北京)

鼻用减充血剂可以快速缓解鼻塞，但长期过量使用可导致药物性鼻炎。目前临床上对鼻用减充血剂的使用和药物性鼻炎的治疗还存在很多误区。鉴于此，中国鼻病研究协作组召集国内中青年鼻科专家，基于临床经验和循证医学证据制订了鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识。本共识系统总结了临床应用鼻用减充血剂治疗鼻塞的注意事项及药物性鼻炎的治疗原则，旨在指导并规范临床应用鼻用减充血剂，并正确有效地治疗药物性鼻炎。     

原发性开角型青光眼患者黄斑色素密度与神经节细胞-内丛状层厚度的相关性

目的　研究原发性开角型青光眼（POAG）患者黄斑色素密度（macular pigment optical density,MPOD）与神经节细胞-内丛状层（ganglion cell and inner plexiform layer,GCIPL）厚度的相关性。方法　前瞻性病例对照研究。选取2017年6月至2019年10月在我院眼科就诊的62例62眼POAG患者为POAG组，103例103眼健康志愿者为对照组。采用单波长眼底光谱反射测量法测量黄斑区MPOD，对MPOD容积、面积、最大值和平均值四个参数进行分析。采用频域光学相干断层扫描技术测量视网膜黄斑区GCIPL厚度。分别比较两组间MPOD的容积、面积、最大值、平均值以及黄斑区GCIPL厚度之间的差异，使用Spearman 秩相关分析MPOD各参数与视网膜GCIPL的关系。结果　POAG组MPOD最大值、平均值及GCIPL厚度均较对照组显著降低（均为P<0.05），MPOD容积、面积与对照组比较差异均无统计学意义（均为P>0.05）。POAG组GCIPL厚度与MPOD的容积、最大值、平均值及年龄均呈负相关（r=-0.374、-0.538、-0.587、-0.470，均为P<0.05）；对照组GCIPL厚度与MPOD的容积、最大值、平均值及年龄均呈负相关（r=-0.375、-0.434、-0.510、-0.478，均为P<0.05）。POAG组和对照组GCIPL厚度与MPOD面积均无相关性（均为P>0.05）。结论　POAG患者MPOD的容积、平均值、最大值和GCIPL厚度均明显低于正常人群；MPOD测量对青光眼诊断及治疗有较好的临床应用价值。     

他克莫司治疗春季卡他性角结膜炎的疗效分析

目的：评价免疫抑制剂——他克莫司滴眼液治疗春季卡他性角结膜炎(vernal keratoconjunctivitis,VKC)的治疗效果。

方法：随机双盲试验,安慰剂对照。收集四川大学华西医院眼科16例门诊患者,将16例患者按就诊顺序随机分为治疗组与对照组。治疗组使用他克莫司滴眼液,对照组使用他克莫司滴眼液基础液,观察期为28d。对研究眼眼部体征和自觉症状分别进行单项评分,以治疗前后眼部体征总分变化量为主要疗效指标,主观症状为次要疗效指标。

结果：(1)组内比较：两组症状和体征在用药前后的差异具有统计学意义,治疗组用药后各个时期的自觉症状评分均低于用药前,且随着时间推移,症状评分逐渐降低,差异有统计学意义,对照组用药后不同时期之间的差异无统计学意义。(2)组间比较：两组患者的主观症状和体征在用药前和用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。评分变化量(用药前评分-用药后评分)在用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。

结论：他克莫司滴眼液能改善VKC患者的体征与症状,对于使用抗过敏滴眼液无明显改善的VKC,具有迅速、优良的改善效果,可应用于临床。     

Statistical virtual eye model based on wavefront aberration

Wavefront aberration affects the quality of retinal image directly. This paper reviews the representation and reconstruction of wavefront aberration, as well as the construction of virtual eye model based on Zernike polynomial coefficients. In addition, the promising prospect of virtual eye model is emphasized.     

成都市767例干部体检眼科疾病构成分析

目的:了解四川省成都市干部的眼部患病情况。方法:对2012年在四川大学华西医院体检的成都市高干人群,总计767例进行眼科初步体检,包括常规视力、裂隙灯、眼压及直接眼底镜检查。结果:有565例(73.7%)体检者患有眼病。其中检出白内障379例(49.4%),屈光不正209例(27.2%),黄斑病变28例(3.7%),青光眼10例(1.3%),视网膜病变7例(0.9%),翼状胬肉5例(0.7%)。本次体检新发现患眼病的有白内障52例,青光眼1例,翼状胬肉5例。结论:四川省成都市干部眼病检出率73.7%,主要是白内障、屈光不正、黄斑病变。通过体检新发现眼病58例,常规体检有助于早发现疾病,及时转诊到专科就诊。