焦亡与视网膜相关疾病

焦亡是一种炎症相关的程序性细胞死亡,其特征为细胞膜上形成孔洞,细胞迅速肿胀及膜破裂,以致大量胞质内容物漏出。近年来研究者对细胞死亡方式的理解进一步深入,为焦亡在糖尿病视网膜病变、年龄相关性黄斑变性、视网膜脱离、青光眼视神经损伤等视网膜相关疾病中的应用提供了新思路。本文就细胞焦亡及其在视网膜相关疾病中的应用进展进行综述,以期为该类眼病的治疗提供新的思路与方法。     

细胞焦亡在眼部疾病中的研究进展

细胞焦亡与细胞凋亡、细胞坏死及自噬不同,是一种程序性促炎性细胞死亡方式。其主要信号通路包括依赖caspase-1的经典焦亡途径和依赖caspase-4/5、caspase-11的非经典焦亡途径。已有大量研究表明,细胞焦亡与感染性疾病、动脉粥样硬化性疾病、代谢性疾病及重要脏器非细菌性炎性疾病相关。近几年细胞焦亡在眼部疾病中也有部分研究,包括老年性黄斑变性、角膜炎、白内障等疾病。本文主要综述细胞焦亡的主要机制及其在眼部疾病中的研究进展。     

NLRP3参与的细胞焦亡在眼科疾病的研究进展

核苷酸结合寡聚化结构域(NOD)样受体家族含 Pryrin 结构域蛋白 3(NLRP3)炎性体是位于细胞内的一种蛋白质复合体,大量的活性氧(ROS)释放后可激活细胞内NLRP3炎性小体的产生,这个炎性小体由NLRP3、 半胱氨酸蛋白酶募集结构域(ASC)及半胱氨酸蛋白酶-1前体(pro-caspase-1 )组成,NLRP3炎性小体在组装成型的同时活化 caspase-1。 随后caspase-1 对细胞因子白介素1和白介素 18(pro-IL-1/18)进行切割,使其成为成熟形式行使其促炎功能。细胞焦亡是炎症小体介导的依赖于caspase-1 的细胞程序性死亡。本文就 NLRP3炎性小体的结构、功能及其与细胞焦亡之间的关系以及在眼科疾病中的研究进展做以综述。     

白藜芦醇在年龄相关性眼病中的研究进展

年龄相关性眼病是指随着年龄增长,由眼退行性改变引起的一系列眼科疾病,青光眼、白内障和年龄相关性黄斑变性(age-related macular degeneration,AMD)是常见的几种年龄相关性眼病,炎症反应和氧化应激在其发病过程中扮演着重要角色。白藜芦醇是一种天然植物抗毒素,通过调节多个细胞转导通路发挥抗氧化应激、抗炎作用,已成为抗衰老领域的研究热点,并取得了较大进展。目前,白藜芦醇与年龄相关性眼病的研究仍处于初始阶段,本文重点介绍白藜芦醇在年龄相关性眼病中的最新研究进展。     

肥胖与眼病

肥胖是全球范围内的重大公共卫生问题,在许多国家患病率以惊人的速度增长。肥胖被认为是许多眼病重要的危险因素,尤其是年龄相关的眼病如白内障、青光眼、年龄相关性黄斑病变、糖尿病性视网膜病变等。随着全球老龄化加剧,肥胖引起的眼病增加,对社会及家庭的各种负担也会加剧,因此强调防止肥胖至关重要。目前尚缺少肥胖与眼病相关性的病理生理学机制明确的解释,因此是亟需研究的重要课题。（国际眼科纵览,2016,40：201-205）     

细胞焦亡在青光眼发病机制和治疗中的研究进展

细胞焦亡是一种继细胞凋亡、细胞坏死及自噬之后新发现的炎性体介导的程序性促炎性反应造成细胞死亡方式,其主要信号通路包括依赖半胱天冬酶1（caspase-1）的经典焦亡途径和依赖caspase-4、caspase-5、caspase-11的非经典焦亡途径,参与机体正常生理功能,在许多疾病的发病过程起重要作用,尤其在神经退行...     

细胞焦亡在视网膜疾病发病机制中的研究进展

细胞焦亡是一种炎性形式的程序性细胞死亡, 包括经典焦亡途径和非经典焦亡途径。关于细胞焦亡的研究在多种视网膜疾病中均有报道, 但目前更集中于糖尿病视网膜病变、老年性黄斑变性等常见疾病。许多视网膜疾病因其病因和发病机制的复杂性而增加了治疗的难度, 细胞焦亡的发现为这些疾病的发病机制带来了新的内容, 也为治疗这些疾病指引了新的方向。细胞焦亡并不是独立发生的, 它与凋亡、自噬等存在关联, 但具体机制尚不明确;尽管如此, 焦亡过程中最主要的生物分子现已基本确定, 且已有方法可以对细胞焦亡进行干预, 并取得了初步的成效。这提示抑制细胞焦亡可能是视网膜疾病治疗的一个新方向, 具有广阔的研究前景。     

糖尿病性白内障晶状体上皮细胞焦亡研究

目的:探究晶状体上皮细胞焦亡在糖尿病性白内障发生中的可能作用。方法:实验研究。选择2020年3至11月就诊于天津医科大学眼科医院行白内障摘除手术的70例（70只眼）患者,收集手术中房水及晶状体前囊膜。根据是否伴有2型糖尿病,分为糖尿病组和非糖尿病组,每组35例（35只眼）。采用Western印迹分析、实时定量PCR和免...     

卫生经济学评价常见致盲眼病筛查的进展

糖尿病视网膜病变(DR)、青光眼、年龄相关性黄斑变性(AMD)和白内障是全球范围内常见的眼病,也是导致视力障碍和失明的主要原因.目前,已有多个国家或地区从卫生经济学角度评价上述眼病常规筛查的成本效益.但对其单独或联合筛查是否有成本效益尚无明确定论.本文中笔者就近年来国内外眼病筛查的卫生经济学研究进行综述,以期为我国常见...     

The importance of epidemiology in understanding eye disease

Most leading causes of visual impairment are age related, so the health care implications of an increasing prevalence of eye disease in the elderly are significant. Epidemiological research provides the foundation to address immediate and long-term needs associated with visual impairment and eye disease. It contributes to a community's knowledge of the presence, diagnosis, characteristics, and distribution of eye conditions affecting the elderly. Obtaining accurate epidemiological information on the extent of visual impairment and eye disease in the community is essential to determine and estimate the cost of primary and secondary eye health care needs.     

Eye Care Disparities and Health-Related Consequences in Elderly Patients with Age-Related Eye Disease

ABSTRACT

The elderly population in the United States (age 65 and older) is growing rapidly, estimated by the U.S. Census Department to reach 83.7 million by 2050.¹ Visual impairment increases with age among all racial and ethnic groups.² In the elderly, the most common culprits for vision loss are cataract, glaucoma, and age-related macular degeneration (AMD).² In the developed world, vision loss from cataract has been dramatically reduced by increased access to cataract surgery. However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD are expected to double by 2050, reaching 17.8 million among patients age 50 or older.³ Similarly, cases of glaucoma are expected to reach 5.5 million by 2050, an increase of over 90% from 2014.³ The visually impaired elderly face disparities in access to eye care, and subsequent general medical and psychosocial complications.     

白内障手术前后干眼的临床分析

目的探讨白内障患者手术前后干眼的发病情况。方法对189例（216只眼）白内障手术前3天、术后1周、1个月、3个月进行干眼检查,包括：裂隙灯显微镜观察眼表情况、泪膜破裂时间（BUT）、Schirmer I试验,手术方式采用超声乳化吸出联合人工晶状体植入术。结果手术后部分病人出现不同程度的干眼症状和体征或原有干眼症状和体征的加重。该情况在术后1周出现,术后1个月最明显,术后3个月部分患者有一定程度的改善。结论白内障手术后患者会出现明显的干眼症状和体征,应及时给予处理和治疗     

老年黄斑变性合并白内障患者行超声乳化术疗效分析

目的 探讨老年黄斑变性合并白内障患者行超声乳化手术联合人工晶状体植入的临床效果及安全性、可行性.方法 对40例52只眼老年黄斑变性合并白内障患者,行超声乳化联合人丁晶状体植入术,其中干性老年黄斑变性者45只眼,湿性老年黄斑变性者7只眼.收集其资料进行回顾性分析,观察患者术后视力改善情况及有无并发症发生.结果 术后3月时,90.38%患者视力不同程度提高,视力无明显提高甚至下降者5只眼,均为湿性黄斑变性患者.最佳矫正视力0.3-0.6者12只眼(其中达0.6者8只眼),0.1-0.3者35只眼,<0.1者5只眼.4例术中后囊破裂,3例术后角膜雾状水肿.术后1年,7只眼湿性黄斑变性均有不同程度的加重,干性黄斑变性患者未发现眼底新生血管之类改变.结论 超声乳化联合人工晶状体植入术可明显提高老年黄斑变性合并白内障患者术后视力,但对于湿性黄斑变性患者手术应慎重.     

干眼症患者白内障手术后的观察

目的：探讨干眼症患者白内障手术后应进行的观察及治疗。方法：22例干眼症患者中4例伴口腔干燥及类风湿因子阳性的患者为A组，18例单纯角结膜干燥的患者为B组。所有术眼均进行白内障囊外摘除联合人工晶状体植入。术后给予典必殊目水（Tobredex,0.3%妥布霉素＋0.1%地塞米松）及泪然目水（Tears Naturale Ⅱ,0.3%羟丙基甲基纤维素，Alcon公司）。结果：两组术眼术后都出现了角膜上皮缺损，A组较B组上皮缺损严重且持续时间长，恢复慢。结论：干眼症患者白内障手术后易出现角膜上皮缺损，尤其是伴类风湿因子阳性的患者。因此术后应密切观察角膜情况及伤口恢复情况，并及时给予积极治疗。     

超声乳化白内障术后干眼症的临床分析

目的 观察白内障超声乳化术后干眼症的发生情况.方法 回顾性分析在我院施行老年性白内障手术患者178例,均为单眼患者,男性93例,女性85例,年龄70 ～95岁,平均78岁.根据手术切口方式不同,分成A、B两组,各组为89例.A组施行透明角膜切口白内障超声乳化术,B组施行巩膜隧道切口白内障超声乳化术.术后1个月、3个月分别行BUT、SIt、角膜荧光素染色(FL)等相关于眼症的检查,观察术后干眼症的发生率.结果 白内障患者术后均获得了良好的视功能,但术后部分患者出现了明显的干眼症状.术后1个月,A组发生干眼症为27例,B组发生干眼症为15例.x2=4.49,P＜0.05,差异有显著性.术后3个月,A组干眼症为15例,B组干眼症为12例,x2检验,x2=0.39,P＞0.05,差异无显著性.结论 白内障超声乳化术后可出现明显的干眼症,应及时干预和治疗.     

Dry eye disease in children and adolescents in India

PurposeTo describe the etiological causes and clinical profile of dry eye disease (DED) among children and adolescents seeking eye care in India.MethodsThis was a cross-sectional study of 1023 new patients (≤21 years of age) diagnosed with DED presenting between 2010 and 2018 to a multi-tier ophthalmology hospital network. Children and adolescents with both symptoms and signs of dry eyes were considered as subjects. The data entry and retrieval were done using an electronic medical record system and analyzed using appropriate statistical tests.ResultsThe mean age of the patients was 15.2 ± 5.6 years and 76% were in their early and late adolescence. Overall, the main etiologies responsible for DED in children and adolescents were Meibomian gland dysfunction (MGD) in 49% of cases, Stevens-Johnson Syndrome (SJS) in 33% and Vitamin A deficiency (VAD) in 9%. Aqueous deficiency dry eye (ADDE) because of SJS and VAD accounted for most of the cases in infancy (92%), toddlerhood (96%), early childhood (76%) and middle childhood (68%). While Meibomian gland dysfunction (MGD) related evaporative dry eye (EDE) was the leading cause of DED in early (51%) and late adolescence (66%). Severe visual impairment and blindness was significantly greater in eyes with ADDE as compared to those with EDE (p < 0.0001), 81% of which were affected by SJS.ConclusionThe causes of and visual morbidity due to DED varied significantly in different age-groups. Most of the visual morbidity in children and adolescents was limited to eyes with ADDE due to SJS.     

Amniotic membrane transplantation for Mooren's ulcer

Background: To describe the outcome of surgery using amniotic membrane transplantation for Mooren's ulcer. Design: A prospective interventional case series from the Vietnam National Institute of Ophthalmology. Participants: Eighteen eyes of 14 patients with Mooren's ulcer. Seven eyes had recurrent episodes of ulceration, and 11 were not responsive to medical therapy or conjunctival resection. Methods: All eyes were treated with amniotic membrane grafts for Mooren's ulcer (10 eyes with multilayer grafts; 8 with a single layer graft). Five eyes with a 360° peripheral ulcer were treated with an overlay amniotic membrane graft, and 13 eyes were treated with a freehand graft tailored to fit the localized defect. Main Outcome Measures: Time to epithelial healing. Visual acuity outcome. Result: Sixteen of 18 eyes were treated by a single surgery with amniotic membrane with rapid healing of the epithelial defect (mean time to complete epithelialization 12.4 days). Two eyes required a second amniotic membrane graft: one eye required regrafting following a subgraft haemorrhage and another eye required regrafting for a persistent epithelial defect. Vision was stabilized in all eyes with 10 of 18 eyes obtaining vision of 6/12 or better. Conclusion: Amniotic membrane transplantation may be a useful treatment for selected patients with Mooren's ulcer especially where systemic immunosuppressive drugs are unavailable.     

白内障超声乳化联合人工晶状体植入手术后干眼发生的相关因素分析

目的评估不同危险因素在白内障超声乳化联合人工晶状体植入术后干眼发生中的作用,为术后干眼发生的预测及防治提供依据。方法记录93例(98只眼)术前无干眼白内障患者手术前及术后3个月常见的全身疾病,并进行干眼问卷调查及相关眼部检查,包括睑板腺功能检查、BUT、SchirmerⅠ试验、角膜荧光素染色等,对检查结果进行多因素回归分析及多元线性回归分析,分析其危险因素。结果 44例47只眼(48%)白内障术后确诊为干眼,Logistic回归分析显示:睑脂粘度(OR=2.670,P=0.025)和结膜松弛(OR=4.537,P=0.004)是白内障术后干眼发生的独立危险因素。糖尿病(OR=3.778,P=0.037)、高血脂(OR=11.645,P=0.023)、睑板腺分泌物(OR=5.660,P=0.025)及睑脂粘度(OR=2.881,P=0.018)是BUT值缩短的独立危险因素。多元线性回归分析显示:睑脂粘度与角膜染色呈正相关(F=79.282,P<0.001)。结论白内障术后干眼的发生与全身及局部多种因素相关,术前针对相关危险因素进行评估,可有助于术后干眼发生的预测并提前进行综合干预治疗。