澳大利亚土著居民的沙眼和糖尿病性视网膜病变

作者于1992年在澳大利亚的部分土著居民社区进行了沙眼和糖尿病性视网膜病变的流行病学调查。土著居民的沙眼患病率为19．1%，在进行眼底照相检查的Ⅱ型糖尿病患者中，视网膜病变的患病率为19．3%。作者并给合文献进行了讨论。     

蒙古族白内障防盲治盲三级网站建立与实施

我国属多民族国家,目前对各民族自内障的流行病学调查资料尚不完整。蒙古族属我国人口较多的少数民族,就白内障发病率调查资料甚少,尤其对蒙古族白内障流行病学     

氧化应激机制在眼科疾病研究中的新进展

氧化还原反应是人体最基本的生化反应,对细胞生命活动产生着重要的影响。当机体遭受有害刺激导致氧化应激时,机体、组织、细胞受到一系列损伤。眼睛是位于体表的器官,易于受到各种理化因素影响导致氧化应激。本文介绍氧化应激机制在眼科眼表疾病、青光眼、白内障、糖尿病视网膜病变研究中的一些最新进展以及关于抗氧化的最新研究,为眼科疾病的研究以及防治提供方法及思路。     

白内障手术对糖尿病视网膜病变进展的影响

白内障手术对糖尿病视网膜病变进展的影响尹虹姜燕荣黎晓新徐秀兰随着现代糖尿病治疗水平的提高，糖尿病合并白内障的患者逐渐增多，白内障手术是否导致糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｍｏｐａｔｈｙ，ＤＲ）进展？我们对１９８８年至１９９４年在我院行白内障...     

重视糖尿病眼部并发症的诊断和治疗

糖尿病是糖代谢紊乱导致的全身性慢性疾病,高血糖、高血脂和高血压是糖尿病患者的主要特征,长期的高血糖环境引起人体组织和器官的微血管和大血管相关并发症,是目前全球劳动力人口致残率和致死率较高的疾病之一.糖尿病已经成为发展中国家严重的公共卫生问题,而糖尿病患者眼部并发症发病风险增加,发病率也逐年升高,成为不容忽视的致盲眼病.常见的糖尿病眼部并发症包括糖尿病视网膜病变(DR)、糖尿病性视神经病变(DN)、青光眼、白内障、糖尿病眼表疾病等,治疗棘手,因此糖尿病眼部并发症的预防、早期诊断和及时治疗是眼科医师面临的主要挑战.眼科医师在临床工作中应对糖尿病患者及其眼部并发症给予足够的重视,实时跟踪国内外关于糖尿病眼部并发症诊疗指南的更新和研究现状,对相关疾病做到早期发现、合理管理和及时治疗,降低糖尿病眼部并发症的致盲率和经济负担.     

我国防盲治盲工作的进展

进入新世纪以来,我国继续将白内障盲的手术治疗作为防盲治盲的重点。全球最大的防盲项目“视觉第一中国行动”取得了重大成效。1997年至2001年的5年内施行了206万例白内障复明手术,实现了我国每年白内障手术数超过了白内障盲新发人数40万例的历史性转变。地方各级政府积极组织开展防盲治盲工作。白内障手术率明显提高。眼病流行病学研究取得了新的进展。目前防盲治盲中存在的最主要问题是根治白内障盲的进展缓慢,这是我国防盲治盲工作发展过程中的问题,是可以解决的。     

亚洲防盲基金会和香港盲人辅导会在中国防盲治盲计划中取得的进展

1.流动眼科治疗中心计划。2.培训中国眼科医生并在县医院配备白内障手术设备。2.1.为陕西、广东、江苏及山东省的6个县医院培训了眼科医生并配置了手术设备。2.2.在新疆自治区的和田地区培训眼科医生并为6个县医院提供了白内障手术设备。3.亚太地区低视力工厂和视觉2020地区性低视力资源中心。4.为了最大限度地扩大共同努力的成果，香港盲人辅导会和亚洲防盲基金会将与中国卫生部、中国残疾人联合会、各省卫生厅、省残联和各医院及其它国际非政府机构等紧密合作为中国的防盲治盲及低视力康复而努力奋斗。     

玻璃体的新功能：氧调节代谢及其在眼病中的作用

本文综述了近年来国内外有关眼内玻璃体氧分压分布及变化机制的研究进展,明确玻璃体氧分压的维持主要是与眼内抗坏血酸盐耗氧有关,探讨了玻璃体切除术后提高的玻璃体氧分压有助于改善糖尿病视网膜病变的缺血、缺氧状态,并能够减轻糖尿病患者视网膜黄斑水肿。维持玻璃体内氧分压梯度有助于保护晶状体及小梁网免受氧化应激的损伤,玻璃体切除术后晶状体、小梁网周围的氧分压升高可能导致术后核性白内障、开角型青光眼的发病率升高。此外,还介绍了玻璃体氧分压及视网膜氧分压的检测方法,玻璃体维持氧分压梯度对药物性玻璃体切除临床应用的意义。（国际眼科纵览,2012,36：352-357）     

老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

Past, present, and future in Leber's hereditary optic neuropathy]

Leber's disease is a disease of optic atrophy first reported by Theodor Leber in 1871. Since then, 130 years have passed. Recently, several new findings about the pathology, causes, and heredity of this disease have been made. In 1988 Wallace and others reported a new mutation of 11778 base pairs of mtDNA of patients with Leber's disease. Since then, the study of this disease has progressed remarkably. In this review clinical studies on Leber's disease which were carried out in our department from 1990 are summarized. 1. Genetic diagnosis and clinics Two hundred and twenty-four cases were examined, including patients at our hospital, for the 8 years between 1990 and 1998. Among them, 72 cases were diagnosed as Leber's disease. There were 3 cases (4%) of 3460 mutations, 63 cases(83%) of 11778 mutations, and 6 cases(8%) of 14484 mutations as primary mutations. The reasons for performing the genetic diagnosis were mostly the need for a definite diagnosis of Leber's disease and research on the genesis of optic nerve atrophy of unknown origin. Concerning the secondary mutations, it was confirmed that these mutations were polymorphic as seen in European and American patients. There is a problem of heteroplasmy about the mtDNA mutation. We developed a simple and exact method to evaluate heteroplasmy by using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). In a study of peripheral blood samples in one family, Leber's disease does not appear under conditions of less than 60% mtDNA mutation. As for the three kinds of mutation in Leber's disease, cases of recovery of a visual acuity of 0.3 and above were only 7% in 11778 mutations, but 38% in 3460 mutations and 50% in 14484 mutations. It is assumed that visual prognosis depends on the kind of mutation. 2. Characteristics of visual evoked potential(VEP) In pattern VEP in the acute stage, latency was not delayed very much, but the amplitude was low. On the other hand, in the acute stage of optic neuritis, the latency was very much delayed and the amplitude was diminished. Therefore, I deduced that not only demyelination of the optic nerve fibers but also papilla-macula bundle defects may play an important role. In flash VEP, only the amplitude was low, but latency was normal. 3. Image analysis of the optic nerve In high resolution T2-weighted fast spin-echo magnetic resonance imaging(MRI), the image of the optic nerve can be clearly demonstrated within a short operation time. In MRI in the acute stage of Leber's disease, the image of the optic nerve appeared almost normal. But in the course of time, patients with Leber's disease showed markedly high signals in the optic nerve on the T2-weighted fast spin-echo MRI, and in the atrophic stage the image of the optic nerve showed thinning. The results in this study support the hypothesis that a primary lesion in Leber's disease may be intraocular. 4. Possibility of therapy at the present time The effectiveness of using idebenone combined with vitamin B2, vitamin C, and isopropyl unoprostone(Rescula) for recovery of the circulation of the optic nerve head for patients in the acute stage was compared with untreated patients. In patients with visual acuity of 0.3 and more, there was no statistical difference between the two groups. The recovery interval up to 0.3 was significantly shorter in the treated group than in the untreated group. I suggest that this kind of treatment may aid spontaneous recovery. Among 15 cases of Leber's disease which occurred in the patients teens, at least one eye in 8 cases(53%) recovered to 0.3 or more. Among the 8 recovered cases, 5 cases were from the treated group. On the other hand, 6 cases were treated and 5 cases recovered visual acuity. It is said that the patients developing the disease at younger ages have a tendency toward visual recovery. Pharmacological treatment can aid recovery. 5. Visual function after the recovery of visual acuity The recovery of visual acuity in Leber's disease has the characteristics of fenestrated central scotoma. The visual acuity can be recovered by the appearance of a small part of sensitive area inside the absolute central scotoma. This phenomenon coincides with the results of VEP which does not recover in spite of recovery of vision. Good visual acuity or bad visual acuity depends not only on the recovery of the total area of the central part but on the existence of an area with good sensitivity. In the results of a Humphrey visual field analyzer(10-2) obtained from 8 recovering patients, the part nasal to the fovea was more sensitive than the temporal area. In the early stage of visual recovery, scanning laser ophthalmoscope(SLO) microperimetry can detect this sensitive area, and with the enlargement of this sensitive area, the Humphrey visual field analyzer(10-2) can also detect this recovery area. 6. Strategy for gene therapy We have succeeded in cloning a human retina-specific amine oxidase gene which was found specifically in retinal ganglion cells. By using this promoter, we are now developing a vector specific to the ganglion cells. The fact that there is spontaneous recovery shows the possibility that some papillamacular bundle may exist. In Leber's disease, retinal ganglion cells may die from the mechanism of apoptosis. Therefore it may be possible to treat this disease by transferring the apoptosis block gene to ganglion cells for protection, and to protect the cells from death by apoptosis.     

The blood-ocular barriers: past, present, and future

The blood-ocular barriers system is formed by two main barriers: the blood-aqueous barrier and the blood-retinal barrier. They combine to maintain the eye as a privileged site and are essential for normal visual function. After reviewing where the blood-aqueous barrier and blood-retinal barrier are located and the main transport mechanisms involved in the regulation of the microenvironment of ocular tissues, special attention is given to the clinical significance of breakdown of the blood-retinal barrier. New perspectives on the clinical significance of breakdown of the blood-retinal barrier are offered by the demonstration of a specific alteration of the glucose transport in diabetes, by the development of new diagnostic instrumentation, and by the utilization of the blood-retinal barrier for new strategies for drug delivery to the retina. New diagnostic instrumentation includes the topographic imaging vitreous fluorometer, which simultaneously measures the localized blood-retinal barrier and images the retinal region, and the retinal thickness analyzer for mapping retinal edema. Drug delivery to the retina may be improved by modification of blood-retinal barrier permeability, chemical modification of the drug for better blood-retinal barrier penetration, and liposome encapsulation or coupling of the drug to specific vectors. Read at the October 27, 1966 meeting of the Academia Ophthalmogica Internationalis, in Chicago, Illinois.     

Spectacles: past, present, and future

The history of spectacles is reviewed with particular attention to recent developments in lens materials. The author advocates the use of polycarbonate, a high resin plastic, because of its strength, high refractive index, light weight, and resistance to fogging.