阈下微脉冲激光在糖尿病黄斑水肿中作用机制的研究进展

阈下微脉冲激光是近年来应用于眼科的一种以长间歇为特征的激光模式,可以在达到有效治疗效应的同时将其对组织的损伤降到最小,目前已应用于糖尿病黄斑水肿(DME)的治疗。早期研究认为,阈下微脉冲激光选择性地作用于视网膜色素上皮细胞,通过调节炎性生物标志物、生长因子、热休克蛋白等物质的表达达到减轻黄斑水肿的目的。近年来随着研究进展,越来越强调视网膜胶质细胞在DME中的作用,Müller细胞也被认为可能是微脉冲激光作用的靶细胞之一,但目前尚没有微脉冲激光直接或间接作用于Müller细胞的证据。期待不远的将来发现更多阈下微脉冲激光的靶细胞,并通过Müller细胞或Müller细胞与视网膜色素上皮细胞共培养进行体外实验以进一步证实,从而更为详细地探讨阈下微脉冲激光在DME中的作用机制。     

Embryonic stem cells-derived exosomes enhance retrodifferentiation of retinal Müller cells by delivering BDNF protein to activate Wnt pathway

ObjectiveThe present study was intended to investigate the role of embryonic stem cell-derived exosomes (ESC-Exos) in Müller cell retrodifferentiation and their specific mechanism.MethodsFollowing co-incubation of the extracted ESC-Exos and Müller cells, their effects on the retrodifferentiation and proliferation of Müller cells were measured by EdU staining, immunofluorescence, and western blot. ESCs transfected with small interfering RNA of BDNF were co-incubated with Müller cells to determine Müller cell proliferation and retrodifferentiation. β-catenin expression in the nucleus and GSK-3β phosphorylation were measured to determine the role of the Wnt pathway in Müller cells. The function of the retina in RCS rats was observed using flash electroretinogram.ResultsCo-incubation of ESCs with Müller cells or overexpression of BDNF contributed to Müller cell retrodifferentiation and proliferation, as evidenced by increased cell proliferation, fluorescence intensities of proliferation markers and retinal stem cell markers, and expression of BDNF and β-catenin, and suppressed GSK-3β phosphorylation. However, co-incubation with ESCs silencing BDNF or treatment with GW4869 inhibited the proliferation and retrodifferentiation of retinal Müller cells. In addition, exosome injection increased BDNF, BrdU, PH3, SOX2, and Pax6 expression, enhanced β-catenin expression in the nucleus, diminished GSK-3β, and improved retinal degeneration in RCS rats.ConclusionESC-Exos accelerated Müller cell retrodifferentiation and proliferation through Wnt pathway activation by delivering BDNF protein to Müller cells.     

学龄前高度远视和低度远视儿童屈光发育比较

目的：比较学龄前高度远视和低度远视儿童的屈光发育特点。方法：回顾性系列病例研究。收集 2020年7月至2021年12月在天津医科大学眼科医院就诊的学龄前远视性屈光不正儿童43例（86眼）。 根据睫状肌麻痹后球镜度结果将儿童分为高度远视组27例（54眼）,低度远视组16例（32眼）,分别于 基线和随访1年记录2组儿童的屈光度和眼球生物学参数,包括眼轴长度（AL）、角膜曲率半径、轴 率比。采用自身配对t检验进行组内屈光度和眼球生物学参数分析;采用Wilcoxon符号秩检验进行 组内最佳矫正视力比较;采用独立样本t检验进行组间眼生物学参数年变化量的差异分析。结果： 与基线值[（8.37±1.84）D]相比,高度远视组等效球镜度（SE）年降低量为（0.72±0.41）D（t=-9.26, P<0.001）。高度远视组AL年增长量[（0.31±0.18）mm]与低度远视组年增长量[（0.21±0.09）mm]的 差异有统计学意义（t=3.53,P=0.001）,2组间角膜曲率半径年变化差异无统计学意义;高度远视组 轴率比的年增长量（0.04±0.02）与低度远视组年增长量（0.02±0.03）的差异有统计学意义（t=3.23, P=0.002）。结论：与学龄前低度远视儿童相比,学龄前高度远视儿童的AL和轴率比的年增长幅度更 大,这提示有必要对高度远视儿童进行密切随访。     

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM:To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation(phaco-vitrectomy)in idiopathic macular holes(IMH).METHODS:A total of 56 eyes with IMH(IMH group)that underwent phaco-vitrectomy and 44 eyes with age-related cataract(ARC group)that underwent cataract surgery were retrospectively reviewed.The best corrective visual acuity(BCVA),predicted refractive error(PRE),actual refractive error(ARE),axial length(AL),were measured in both groups before and 6 mo after operation.The power calculation of IOL and the predicted refractive error(PRE)were calculated according to the SRK/T formula.The difference of PRE and ARE between the two groups were compared and analyzed.RESULTS:In the IMH group,the diameters of macular holes were 271.73±75.85μm,the closure rate was 100%.The pre-and post-operative BCVA were 0.80±0.35 and 0.40±0.35 log MAR.The PRE of A-ultrasound and IOL Master in the IMH group was-0.27±0.25 and 0.10±0.66 D.The postoperative mean absolute prediction error(MAE)was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound(P=0.758).The PRE and ARE of the IMH group were 0.10±0.66 D and-0.19±0.64 D(P=0.102).The PRE and ARE of the ARC group was-0.43±0.95 and-0.31±0.93 D(P=0.383).The difference between PRE and ARE was-0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups(P=0.021).The proportion of myopic shift was 67.9%in the IMH group and 27.3%in the ARC group(P=0.004).CONCLUSION:The myopic shift can be observed in patients with IMH after phaco-vitrectomy.     

Induced antigen-binding polyreactivity in human serum IgA

Previous studies have shown that polyreactive antibodies play an important role in the frontline defense against the dissemination of pathogens in the pre-immune host. Interestingly, antigen-binding polyreactivity can not only be inherent, but also acquired post-translationally. The ability of individual monoclonal IgG and IgE antibodies to acquire polyreactivity following contact with various agents that destabilize protein structure (urea, low pH) or have a pro-oxidative potential (heme, ferrous ions) has been studied in detail. However, to the best of our knowledge this property of human IgA has previously been described only cursorily. In the present study pooled human serum IgA and two human monoclonal IgA antibodies were exposed to buffers with acidic pH, to free heme or to ferrous ions, and the antigen-binding behavior of the native and modified IgA to viral and bacterial antigens were compared using immunoblot and ELISA. We observed a dose-dependent increase in reactivity to several bacterial extracts and to pure viral antigens. This newly described property of IgA may have therapeutic potential as has already been shown for pooled IgG with induced polyreactivity.     

两种电脑验光仪对1 138例中国儿童青少年屈光度测量的一致性

目的：比较两种电脑验光仪在近视筛查中对中国学龄期儿童屈光度测量的一致性。

方法：应用拓普康RM-8900和天乐RM-9000电脑验光仪对从天津东丽区四所中小学分层抽样得到的6～16岁学生测定非睫状肌麻痹下的屈光度。运用Sperman相关分析和Bland-Altman法评价两种方法测量球镜度、柱镜度和等效球镜度的一致性,同时分析两种方法测量的散光轴向差异分布情况。

结果：研究最终纳入1 138例患者2 276眼,平均年龄10.49±2.66岁。Spearman相关分析显示,天乐RM-9000测量的球镜度(r=0.958, P<0.0001)、柱镜度(r=0.769, P<0.0001)和等效球镜度(r=0.962, P<0.0001)均与拓普康RM-8900测量结果高度相关。Bland-Altman分析表明,天乐RM-9000测定的球镜度比拓普康RM-8900显著偏向远视(P<0.0001),平均差异为0.44 D(标准差：0.37; 95%置信区间：-0.27,1.16),其中95%置信区间内最大球镜度差值的绝对值(1.13 D)超出临床误差可接受范围(-0.50～+0.75D); 然而,两种方法测定的柱镜度差异无统计学意义(P=0.83),平均差异为-0.01 D(标准差：0.31; 95%置信区间：-0.62,0.61),其中95%置信区间内最大柱镜度差值的绝对值(0.62 D)在临床误差可接受范围(-0.50～+0.75D)内。两种仪器测定的柱镜轴向差异在20°以内的比例在柱镜度 ≤-0.25 D的散光眼中达到84.6%(1 503/1 777),而这一比例在柱镜度≤-0.75 D的散光眼(n=885)中升高至96.4%(853/885)。

结论：天乐RM-9000电脑验光仪测量的球镜度相比于Topcon RM-8900结果显著偏向远视,两种仪器对于柱镜度及柱镜轴向的测量一致性在临床可接受范围内。     

泪腺腺样囊性癌的分期及临床治疗进展

泪腺腺样囊性癌是泪腺最常见的恶性上皮性肿瘤,手术治疗效果不理想。近年来,随着多种放射治疗和化学治疗的应用,泪腺腺样囊性癌的治疗模式发生较大转变。一方面,临床分期逐步完善,以新的分期为基础的综合治疗得到规范化应用; 另一方面,在质子放疗、中子放疗、经动脉细胞减容化疗等新辅助治疗的支持下,保眼手术逐渐增多,局部复发率和转移率逐渐降低,无病生存期获得延长,但还需要长期观察。本文就近年来国际上泪腺腺样囊性癌相关方面的治疗进展进行综述,以提供新的参考依据。     

A pilot study of the precision of digital intraocular pressure measurement during vitrectomy

AIM: To evaluate the precision of digital intraocular pressure (IOP) measurement in silicone oil (SO) filled eyes during vitrectomy. METHODS: This is a retrospective, single-blind study. Patients who were diagnosed with retinal detachment and scheduled for vitrectomy with SO injection were consecutively enrolled. During the vitrectomy, IOP was digitally measured and then by a rebound tonometer (IcarePRO). The rebound tonometer readings were masked to the surgeons. The digitally measured IOP and that of rebound tonometer were compared, and the inter-methods agreement was assessed. The absolute deviation in IOP values between these two methods (?IOP) was also calculated, and correlations between ?IOP and refractive status, lens status and levels of surgeons’ experience were analyzed. RESULTS: A total of 131 patients (131 eyes) were recruited, with a mean age of 51.0±16.1y. There was no significant difference in IOPs between digital measurement and the rebound tonometer (15.6±4.3 vs 15.7±5.1 mm Hg; t=0.406, P=0.686). Intraclass correlation coefficients (ICC) analysis indicated a strong correlation between these two measurements (ICC=0.830, P<0.001). The mean ?IOP was 2.0±1.9 mm Hg (range: 0-12.8 mm Hg), with 98 eyes (74.8%) had the ?IOP within 3 mm Hg. ?IOP was found to be negatively correlated with levels of surgeons’ experience (r=-0.183; P=0.037), but not with the refractive status or lens status of the patients (both P>0.05). CONCLUSION: For experienced surgeons, the digital IOP measurement may be an acceptable technique for IOP measurement in SO filled eyes during vitrectomy. However, its use by inexperienced surgeons should be taken with caution.     

Predictive value of pupillography on intraoperative floppy iris syndrome in preoperative period

AIM: To evaluate related factors with the change of spherical equivalents (ΔSE) and determine the suitable predictor of clinically significant ΔSE with cyclopentolate hydrochloride on Chinese children. METHODS: A total of 145 right eyes of 145 children aged 4 to 15y were enrolled. Intraocular pressure, axial length and lag of accommodation were assessed before cycloplegia induced by 3 drops of 1% cyclopentolate at 5-minute intervals. SE was measured before and 1h after the first drop of cyclopentolate. ΔSE was compared between different gender groups and among refractive groups. Multivariate linear regression analysis was performed to find related factors with ΔSE. ROC analysis was used to figure out the suitable predictor of clinically significant ΔSE (≧0.50D). RESULTS: For the total 145 eyes, the mean SE reached up to -0.70±1.86 D from -1.30±1.62 D, with the mean ΔSE of 0.60±0.55 D. The mean ΔSE were 0.63±0.55 D and 0.57±0.56 D respectively in the male and female group (P=0.40). The mean ΔSE was significantly different among different refractive groups (P<0.0001), with the ΔSE of hyperopia group (1.12±0.64 D) larger than that of the emmetropia (0.56±0.43 D, P=0.001) and myopia group (0.32±0.28 D, P<0.0001). The ΔSE was correlated with lag of accommodation (B=-0.54, P<0.0001), cycloplegic spherical equivalent (B=0.10, P<0.0001) and age (B=-0.04, P<0.0001). ROC curve indicated that lag of accommodation predicted clinically significant ΔSE by 82% (area under the curve, AUC=0.82) alone, while the value was slightly improved to 85% (AUC=0.85) in combination with axial length and 86% (AUC=0.86) in association with axial length as well as age. CONCLUSION: After cycloplegia with cyclopentolate, the ΔSE decreases with larger lag of accommodation, longer axial length and older age. Specifically, lag of accommodation plays a more vital role in predicting clinically significant ΔSE.