年龄相关性白内障遗传流行病学研究进展

【摘要】年龄相关性白内障（age related cataract, ARC）为多因素疾病,目前确切病因不明。近年来流行病学研究表明ARC发病有一定的家族聚集性,遗传和分子流行病学研究进一步揭示了一些特定基因如谷胱甘肽S转移酶基因、DNA修复基因、EPHA2基因等特定基因多态性在人类ARC发病过程中的相关性和作用。而另一些基因,如晶状体膜蛋白基因、半乳糖激酶基因、α-晶状体蛋白基因等与ARC的相关性则需进一步研究证明,这些研究为ARC的发病机制提供了遗传学理论依据。（国际眼科纵览, 2013, 37： 117-122）     

Etiopathogenesis of cataract: An appraisal

Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc.), traumatic, complicated (inflammatory and degenerative diseases of eye), metabolic (diabetes, galactosemia etc.), toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc.) are implicated as significant risk factors in the development of cataract.     

白内障形成的相关危险因素研究

目的:探讨与白内障形成有密切关联的各种危险因素,寻求预防干预白内障形成的积极措施,减少其发病率。方法:收集2006-12/2009-10我院门诊及住院的白内障患者206例,调查其身体健康状况与白内障形成的关系。结果:酗酒、过量吸烟、糖尿病、高血压病、心血管疾病、青光眼等与白内障的发生成正相关,血液中血糖浓度、尿素氮、肌酐、血胆固碳、甘油三酤等浓度的升高与白内障形成亦成正相关;而血二氧化碳结合力、钙、磷、血清总空白,白蛋白的合量与白内障的发生成负相关。结论:积极治疗原发疾病,形成良好的生活习惯。是减少和延缓白内障发生的重要因素。     

Casteldaccia eye study: prevalence of cataract in the adult and elderly population of a Mediterranean town

Prevalence of cataract was studied in a population based survey performed in adults aged 40 years or more living in Casteldaccia, a small Sicilian town. Lens opacities of moderate or severe grade (type II or worse, according to the Lens Opacity Classification System II) were found at the following rates: nuclear opalescence in 18.5%, cortical cataract in 12.9%, posterior subcapsular cataract in 10.8%. All these types of cataract were much more frequent in the elderly population and were about 1.5 times more common in women than in men. Late cataract was found in about 1/3 of subjects aged 60 to 69 years, in 2/3 of subjects aged 70 or more, but rarely under 60 years of age. However, early cataract was rather common among younger subjects. Cataracts causing a reduction of visual acuity under 0.7 in the worst eye were found in 4%, 8.7% and 21.5% respectively in the three age groups ranging from 40 to 49, 50 to 59 and 60 to 69 years and in 54.4% of subjects 70 years old or over.     

Lower nasal distribution of cortical cataract: the Blue Mountains Eye Study

Previous reports have indicated that cortical cataract commences in the lower nasal lens, possibly due to sunlight exposure because of the shallow brow temporally. The present study aimed to assess the lens sector distribution of cortical cataract in a population. The Blue Mountains Eye Study assessed 3654 residents aged 49–97years; 3270 phakic subjects had retroillumination lens photographs graded using the Wisconsin method, which divides the lens into eight radial sectors with a grid overlay. Graders estimated percentage of cortical opacity in each sector. The lower nasal area consistently had the greatest opacity, a pattern present at each age and similar in both sexes, despite the 20% greater cortical cataract in women. The mean area of lens cortex involved by opacities in the lower nasal hemisphere was four fold greater than in the upper temporal hemisphere at each age. The lower nasal distribution was highly symmetrical when both eyes were affected. When > 20% of the lower nasal lens quadrant had cortical opacity, 88% of bilaterally affected subjects had cortical cataract in the same quadrant of the fellow eye. The lower nasal distribution may indicate a role for sunlight in the aetiology of cortical cataract, which could be considered when examining other cortical cataract risk factors, such as diabetes, vascular disease and hormonal factors in women.     

玻璃体手术后白内障发生率的中远期回顾调查

为探讨玻璃体手术后白内障发生率及其影响因素，回顾性地调查近５年的玻璃体手术病人。观察指标有性别、眼别、年龄、病程、病因、视力、术式、手术次数、并发症及玻璃体状态等。晶体混浊判定采用ＬＯＣＳⅡ系统；采用Ｂａｙｅｓ逐步判别法进行统计学处理。追踪观察２９～６５个月（平均４３．４±９．４个月），玻璃体手术后白内障发生率为９．９２％，其中核硬化占６９．２３％，后囊下混浊占３０．７７％。影响因素有年龄、病因、病程及术后高眼压（Ｆ＝２时，判对率９３．４８％，Ｐ＝０．００００）。结论：在较高年龄组（平均４８．５６岁），晶体混浊与病因及年龄相关，主要表现为核硬化；在较低年龄组（平均２６．２５岁），多与病程较长（１１．２５个月）、病变广泛有关，表现为囊下混浊。术后高眼压对两者均有影响     

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.     

年龄相关性白内障患者超声乳化术后并发眼内感染的风险因素分析

目的：探讨影响年龄相关性白内障患者超声乳化手术治疗后的眼内感染风险因素,为降低术后眼内感染发生率提供合理干预对策,提高治疗效果。

方法：选取我院2012-06/2017-03收治的4 500例6 180眼进行超声乳化手术治疗的年龄相关性白内障患者病历资料进行分析,对于出现手术后眼内感染的患者进行玻璃体穿刺,收集标本进行采集培养和检查,分析感染性病原菌分布情况、患者年龄、术前慢性病史、手术切口等各种因素对发生眼内感染的影响,数据采用SPSS 18.0统计软件进行分析处理。

结果：本研究中,所有患者超声乳化术后眼内感染发生率为0.19%(12/6180),年龄≥75岁、伴有糖尿病、采取透明角膜切口手术的患者,术后眼内感染发生率明显更高,差异具有统计学意义(P<0.05); 手术过程中玻璃体溢出和晶状体后囊破裂的术后眼内感染发生率分别为60.00%(9/15)和66.67%(8/12),明显高于未发生患者,差异有统计学意义(P<0.01)。

结论：对于年龄≥75岁、伴有糖尿病的白内障患者术前应提前做好干预措施,手术过程中应合理选择手术切口并尽量避免玻璃体溢出和晶状体后囊破裂等并发症,以降低眼内感染发生率,提高患者术后恢复和手术成功率。     

Independent risk factors of type III acute acquired concomitant esotropia: A matched case–control study

Purpose:To investigate the risk factors and surgical design for type III acute acquired concomitant esotropia (AACE).Methods:In this retrospective, matched, case–control study, 51 patients developed type III AACE between March 2018 and September 2020, and the control group consisted of 60 patients matched by age and refractive power during the same period. A history of the duration of near work per day and the use of glasses were reviewed, and the refractive power of both eyes, deviation angles at both near and far vision, visual function, and treatment options were analyzed. Additionally, the distance from medial rectus insertion to the limbus was measured in surgical patients. The data were analyzed by logistic regression analysis.Results:We found that 99.96% of the patients and 91.67% of the controls had myopia. Of these, 60.8% and 20.0%, respectively, did not wear glasses for near work. Twelve patients were treated with a prism and 39 were treated surgically. The average time devoted to near work per day was 7.24 and 3.7 h by the patients and controls, respectively. Univariate logistic regression analysis showed that increased hours of near work per day and near work without the use of spectacles were associated with the incidence of type III AACE. Multiple logistic regression analysis revealed that increased hours of near work per day and near work without the use of glasses were independent risk factors for AACE.Conclusion:Increased hours of near work per day and uncorrected myopia in near work are independent risk factors for type III AACE.     

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review

Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.     

生命早期及儿童期影响因素对年龄相关性白内障的影响

目的：评价生命早期及儿童期影响因素与成人年龄相关性白内障( age-related cataract,ARC)发病的关系,为早期预防、早期发现、早期治疗ARC提供理论依据。
　　方法：我院2011-04/2012-10开展以医院为基础的病例对照研究,病例由41~60岁的360例360眼施行白内障摘除术的患者所组成。对照组由与病例的年龄和性别进行匹配、因罹患各种与ARC无关的疾病、同期入住相同医院的360例非白内障的患者所组成。采用自制的调查问卷对所有研究对象进行调查,包括研究对象的一般状况、生命早期影响因素,以及儿童期暴露因素。采用非条件Logistic回归模型对结果进行分析。
　　结果：出生时胎龄越早,出生时体质量越低,均与发生ARC的危险性具有显著性关联(分别为 OR =1.152,95%CI：1.029~2.235, P=0.024;OR=1.374,95%CI：1.156~2.581,P=0.037);母亲孕前糖尿病( OR=1.587,95%CI：1.177~2.915,P =0.019)、孕期糖尿病(OR =1.763,95%CI：1.375~2.367,P =0.004)、先兆子痫( OR=1.581,95%CI：1.139~1.996,P=0.021),以及妊娠期高血压(OR=1.517,95%CI：1.032~1.963, P=0.024)均可使发生ARC的危险性升高;而儿童期的影响因素只有10岁时的身高低于同龄儿童和体质量高于同龄儿童才与发生ARC危险性具有十分显著性关联(分别为 OR=1.329,95%CI：1.072~2.351,P=0.038;OR=2.302,95%CI：1.323~3.196,P=0.011)。
　　结论：出生时胎龄越早、低体质量出生、母亲孕前糖尿病、孕期糖尿病、先兆子痫、妊娠期高血压、10岁时身高较矮,以及体质量升高均是ARC发病的危险因素。但需要进一步开展历时长、大规模的前瞻性研究,以证实我国人群ARC的早期危险因素。     

近视的危险因素及流行病学研究进展

近视是发病率最高的眼部疾病之一。高度近视可引起一系列严重影响患者视力及各种视觉功能的并发症,如视网膜脱离、视网膜下新生血管形成、白内障和青光眼等。近年来,大量的流行病学研究对近视在全球各个地区的分布进行了科学、细致的调查,这些研究中大多数为横断面研究,纵向队列研究相对缺乏。近半个世纪的流行病学调查显示,近视的患病率明显增加,不同种族和地区的患病率各不相同,其中经济水平较发达、工业化速度较快的东亚地区人们近视患病率增长最快。近视的发生与环境危险因素、社会经济发展和生活方式改变密切相关。许多学者对近视的分子生物学机制也进行了深入的研究,这些研究结果进一步支持了以下结论,即近视的发生是遗传易感性和环境暴露之间复杂相互作用的结果。本文对近视的危险因素及流行病学研究结果做一综述。