Age‐related macular degeneration and recent developments: new hope for old eyes?

Age-related macular degeneration (AMD) is the commonest cause of blindness in the population over 60 years of age and accounts for over 50% of those registered blind in the UK. The incidence is increasing and as older generations live longer a growing number of patients will be affected in the future. Affected patients lose central vision, important in all aspects of everyday life. This review outlines risk factors for AMD, clinical features, treatment and management strategies for patients, families and physicians caring for those with AMD. Recent trials are included along with practical clinical advice. While there is no curative treatment at present, intervention can reduce the risk of developing AMD and limit disease progression if it occurs. These modalities are discussed here. As new discoveries in the field of genetics and novel therapies emerge, a brighter future seems certain for the ageing population.     

Current concepts and recent advances in the management of age-related macular degeneration

Background Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the Western World in those aged 65 and older.¹ At present, several treatment modalities are utilised and several more are undergoing investigation in an attempt to retard the occurrence and progression of this devastating condition. Aims To provide the non-ophthalmologist with an understanding of the current treatment options available to patients suffering from all variants of AMD. Methods Medline and Embase search. Results Several treatment modalities have been investigated and utilised in the treatment of all variants of this condition. While promising results have been reported, no treatment is ideal. Conclusion While no curative treatment for this condition currently exists, early recognition and treatment, if indicated, have been shown to reduce the risk of severe vision loss in patients with this condition.     

舒肝明目丸治疗肝郁肾虚型年龄相关性黄斑变性(干性)的临床研究

目的观察舒肝明目丸对肝郁肾虚型年龄相关性黄斑变性(干性)的临床疗效。方法将43例患者随机分为治疗组(n=22)和对照组(n=21)。治疗组给予舒肝明目丸口服;对照组口服维生素E胶丸、维生素C,均连续用药30 d为1个疗程。分别观察两组治疗前后远视力、Amsler表、PVEP潜时及中医症状积分的变化。结果两组药物均有治疗肝郁肾虚型年龄相关性黄斑变性(干性)的作用,治疗组在远视力、Amsler表表现、PVEP潜时及中医症状积分的变化方面优于对照组,差异有统计学意义(P<0.05)。结论舒肝明目丸对肝郁肾虚型年龄相关性黄斑变性(干性)有一定的治疗作用。可能与调节视网膜色素上皮功能,改善黄斑区视网膜微循环,增强细胞的免疫调节作用有关。     

黄斑地图状萎缩的治疗进展

尽管在过去十年中玻璃体视网膜疾病取得了历史性的进步,但地图状萎缩是引起永久性视力丧失的重要原因,它是一种常见但无法治愈的晚期年龄相关性黄斑变性.本文主要综述地图状萎缩的最新治疗方法.     

人工智能诊断系统在视网膜疾病的研究进展

视网膜疾病是人类严重视力丧失的主要原因,糖尿病视网膜病变(DR)、青光眼视网膜病变、视神经病变及年龄相关性黄斑变性(AMD)等疾病的早期筛查及按时随访是疾病防治的重点。但由于眼科医生数量有限、难以开展大规模人工筛查。人工智能(AI)技术在眼科领域的应用为解决上述难题带来曙光。本文对AI在DR、青光眼视网膜病变及视神经病变、AMD等疾病诊断中的临床应用进行综述,探讨AI诊断系统在视网膜疾病教学中的应用,并指出目前AI诊断系统面临的问题,展望其在视网膜疾病领域的应用前景。     

年龄相关性黄斑变性的治疗进展

年龄相关性黄斑变性(AMD)引起脉络膜新生血管的形成,可伴随有视网膜下积液、视网膜下出血及纤维瘢痕组织,导致中心视力进行性、不可逆的下降。以往的治疗方法包括激光光凝术、经瞳孔温热疗法、黄斑转位术等,随着科学技术的发展,新生血管性AMD的治疗也有了很大的进步,光动力疗法可减少黄斑病变患者视力损失的风险。曲安奈德、抗血管内皮生长因子等药物被证明可以有效抑制或延缓患者视力的损失,甚至可以提高患者的视敏度。尤其是抗血管内皮生长因子的研究越来越受关注。另外,基因治疗的不断发展为治疗新生血管性AMD开辟了一条新路,受到了眼科医师的重视。     

Health maintenance issues of the elderly. Vision: age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States among persons over 50 years old. The majority of patients who develop severe visual loss from AMD have exudative disease. Treatment for AMD has been shown to be effective for only a small portion of patients who have well-defined choroidal neovascular membranes (CNVM) outside the foveal center. Even when successfully treated, severe visual loss is postponed for only about 18 months because of the high rate of recurrent CNVMs extending through the fovea. Presently, low-vision aids are the only treatment available for the majority of patients with exudative disease.     

Single-site Baseline and Short-term Outcomes of Clinical Characteristics and Life Quality Evaluation of Chinese Wet Age-related Macular Degeneration Patients in Routine Clinical Practice

Background:

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the older population. In China, treatment of age-related ocular diseases is becoming a priority in eye care services. This study was to investigate the clinical characteristics and quality of life of Chinese patients with wet AMD and current treatment types, to evaluate short-term gains in different treatments, and to investigate associations between visual function and vision-related quality of life (VRQoL).

Methods:

A prospective, observational, noninterventional study was conducted. Basic data were collected from patients with clinical diagnoses of wet AMD before clinical assessments at baseline. VRQoL was measured with the Chinese version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Correlations of the NEI VFQ-25 subscale scores with best-corrected visual acuity (BCVA) and between-group differences were analyzed.

Results:

A total of 80 wet AMD patients were enrolled, with the mean age of 68.40 years. About one-quarter of wet AMD patients received intravitreal (IVT) ranibizumab treatment, and 67% of them were treated on a pro re nata basis. The visual acuity of patients treated with IVT ranibizumab at month 3 after treatment was significantly increased, whereas patients treated with traditional Chinese medicine achieved no significant improvement. Cronbach''s α for the NEI VFQ-25 subscales ranged from 0.697 to 0.843. Eight subscale and overall composite scores were moderately correlated with the BCVA of the better-seeing eye. Significant differences in the overall NEI VFQ-25 scores and other subscales were observed between patients with BCVA in the better-seeing eye of less than 50 letters and the others.

Conclusions:

Patients treated with IVT ranibizumab experienced better vision improvement at short-term follow-up. The Chinese version of the NEI VFQ-25 is a valid and reliable tool for assessing the VRQoL of Chinese wet AMD patients.     

上海市北新泾街道老年人年龄相关性黄斑变性的患病率调查

目的 调查上海市北新泾街道≥60岁人群中年龄相关性黄斑变性(AMD) 的患病情况。方法 于2007年11月—2008年4月,采用整群抽样的方法对上海市北新泾街道≥60岁的居民进行AMD患病率和相关因素的调查。调查内容包括一般资料、既往眼病诊断和治疗史、日常生活视力和针孔矫正视力;进行眼科基本检查,并采用眼底照相机拍摄后极部45°范围内2个不同区域内的照片。由2名以上医师独立读片确立AMD的诊断;AMD的分类采用全国眼底病学组指定的标准。结果 本调查共纳入4 153人,实际受检3 571人,受检率85.99%。确诊AMD患者477例(778眼),占受检人群的13.36%。确诊湿性AMD患者64例(85眼),占受检人群的1.79%。在60～69、70～79、80岁以上各年龄段人群中,AMD的检出率分别为6.23%、14.98%和29.91%,差异有统计学意义(χ2=169.40,P<0.01);在文盲、小学、中学及中学以上不同受教育程度人群中,AMD的检出率分别为15.2%、18.75%、9.36%和8.22%,差异有统计学意义(χ2=59.56,P<0.01);AMD在男性与女性人群中的患病率比较差异无统计学意义（χ2=0.03,P>0.05）。AMD眼中,盲和低视力的比例分别为3.08%和18.51%。湿性AMD眼中,盲和低视力的比例为15.29%和32.95%,分别高于干性AMD眼的1.59%和16.73%。结论 AMD的患病率随着年龄增长而显著升高,随着受教育程度的提高而显著下降,严重影响患者视力。     

老年黄斑变性研究

通过对老年黄斑变性(AMD)的流行病学、发病因素和视功能等综合研究,显示此病已成为对老年人值得注意的致盲眼病。虽然多数患者为AMD干性和尚有较好视力,但各种视功能测定显示可有不同程度损害。控制光损害和改善微量元素代谢有助于AMD的早期预防和治疗,此病也成为亚洲国家防盲的一项重要任务。     

杞黄颗粒对肝肾阴虚型年龄相关性黄斑变性临床证候的影响

[目的]观察杞黄颗粒治疗肝肾阴虚型年龄相关性黄斑变性的临床疗效。[方法]肝肾阴虚型年龄相关性黄斑变性干性、湿性患者共120例,随机分为杞黄颗粒治疗组62例、维生素C对照组58例,观察治疗前后视力及中医证候评分变化。[结果]视力方面:对年龄相关性黄斑变性(AMD)患者治疗组与对照组治疗前后的总体视力进行组间比较,差异无统计学意义(P0.05);对AMD患者治疗组与对照组治疗前后的总体视力进行组内比较,差异有统计学意义(P0.05);杞黄颗粒治疗组显效24例,有效36例,无效2例,总有效率为96.77%。维生素C对照组显效4例,有效31例,无效23例,总有效率为60.35%。治疗组中医证候的改善明显优于对照组,经秩和检验,两组治疗前后对比差异有统计学意义(P0.05)。杞黄颗粒治疗组内干性共45例,显效19例,有效24例,无效2例,总有效率为95.56%;湿性共17例,显效5例,有效12例,无效0例,总有效率为100%。经秩和检验,干性与湿性对比结果差异无统计学意义(P0.05)。[结论]杞黄颗粒和维生素C对肝肾阴虚型AMD患者的视力均有一定的改善作用;杞黄颗粒对AMD患者的中医证候改善作用明显,具有良好的临床疗效。     

年龄相关性黄斑病变新兴药物的治疗进展

年龄相关性黄斑病变(AMD)是发达国家老年人首位的致盲眼病。在我国,由于人口的老龄化,AMD发病率也呈上升趋势,因此需正确深入认识此病并且采取有效的治疗措施。AMD在临床上分为萎缩性和渗出性,虽然渗出性发病率低,但对患者的视力危害极大,主要表现为脉络膜新生血管(CNV)及黄斑部出血、渗出。相关学者开始在这些复杂的病理生理过程中寻找定位于多靶点的、不同作用机制的新的因子。目前,很多药物治疗研究已被证实能够成功减少因AMD造成的视力下降,并有可能取得进一步发展的潜力。     

视网膜色素上皮细胞来源外泌体与老年性黄斑病变

老年性黄斑病变（age-related macular degeneration,AMD）也被称为年龄相关黄斑变性、增龄性黄斑变性。多双眼发病,病发时一般双眼先后或同时发病,出现中心暗点、视物变形等视觉障碍,多发生在50 岁以上的中老年中,且感染几率会随着年龄的增长而增加,成为导致当今中老年失明的重要原因。眼科领域普遍认为视网膜色素上皮（retinal pigment epithelium,RPE）细胞分泌的外泌体很可能参与AMD 的发生与发展。RPE 细胞通过分泌携带内容物的外泌体,将其转移到邻近或远处细胞,完成细胞间的信息交流,并对细胞造成一定程度的影响,参与细胞生长与转移、血管生成,在免疫调节、炎症反应等诸多病理生理过程中发挥重要作用。在对RPE 细胞外泌体进行深入研究的同时,也发现了外泌体对AMD 早期诊断和治疗的新潜力,为AMD 的研究带来了新的方向。     

Principles of diagnosing and managing postmenopausal osteoporosis for the podiatric physician

Osteoporosis is an asymptomatic disease until a fracture occurs. The prevalence of osteoporosis will rise with the aging of the population. Recent advances have led to more efficacious treatment options. Targeted screening, educating patients about preventive strategies, and providing appropriate treatment for those at high risk will allow physicians to reduce the enormous morbidity and mortality associated with osteoporosis.     

HIV-associated facial lipoatrophy--review of current therapy options

Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy for HIV-infected patients. Long-term complications of both HIV-infection and antiretroviral agents are therefore of increasing concern. Facial lipoatrophy (FLA) is a stigmatizing complication associated with sever social impact and a reduced quality of life for the patient. - We aimed to review the treatment options of HIV-associated FLA. The current treatments available for treating FLA are limited and can be classified in three main categories: I. Medial therapy, II. Injectables with different duration of effect, and III. Surgical treatment options. Medical therapy can provide a small benefit but improvement is, at best, slow and partial. Injectables can yield marked results but are costly, time consuming and may be associated with complications such as granuloma formation. Surgical options such as augmentation with specially designed silicone implants may be of benefit for severe cases of FLA, however, they are associated with higher surgical complications and do not account for the dynamic process of FLA. - To summarize, until today no ideal strategies for treatment of HIV-associated FLA are available, and new therapies are strongly required. heart disease.     

Retinal pigment epithelial tear after intravitreous triamcinolone acetonide injection for fibrovascular pigment epithelial detachment

A 78-year-old woman was diagnosed with fibrovascular pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD) affecting both eyes. Due to decreased vision in her left eye (20/2000) and disease progression, the patient received 4 mg of triamcinolone acetonide (TA) by intravitreal injection into her left eye. There were no immediate post-injection complications in the left eye. However, one week later, a retinal pigment epithelial (RPE) tear, temporal-inferior to the fovea in the left eye, was noted and confirmed by fundus photography, fluorescein angiography and optical coherence tomography. In contrast, there no similar RPE tear occurred in her right eye after treated several times by intravitreous bevacizumab injection. Not only anti-vascular endothelium growth factor agents, but also intravitreal TA when used to treat AMD with PED, would seem to induce a RPE tear in the absence of previous or concurrent adjuvant therapy. Further investigations are required to confirm the mechanism by which the RPE tear occurs.     

老年性黄斑变性患病年龄、视力与中医证型的关系

作者将122名老年性黄斑变性(AMD)患者行中医辨证分型,结果在符合中医证型诊断的53例患者中,气虚型最为多见,占45.28％,均明显高于其他证型。然而气虚证型患者患病年龄是否会提前和视力损害程度是否会较其他证型患者为重这一假设,在我们的资料中未能得到证实。对其影响因素,作者作了初步的分析。     

中医辨证治疗老年性黄斑变性的视觉生理变化意义

目的 观察中医辨证治疗老年性黄斑变性(AMD)变化的生理意义. 方法 采用闪光视网膜电流图(F-ERG)和视觉诱发电位(P-VEP). 结果 脾虚湿困型AMD的F-EKG改变较肝肾亏损型AMD显著,渗出型AMD的F-ERG改变较萎缩型AMD显著:脾虚湿因型及肝肾亏损型患者p-VEP均有不同程度的异常,但异常率与中医证型无关;经过中医辨证治疗.患者F-EKG的明适应振幅有所提高,P-VEP的振幅有所提高,潜伏时有所缩短. 结论 中医辨证治疗老年性黄斑变性,在阻止病情发展,防止痛变反复,提高视力上有一定的效果.     

挤压综合征相关急性肾损伤的诊疗进展

挤压综合征广泛存在于自然灾害、创伤及交通事故中，主要表现为低血容量休克、急性肾损伤、高钾血症、酸中毒等，其中急性肾损伤是挤压综合征患者病死率居高不下的重要因素之一。目前挤压综合征相关急性肾损伤的治疗包括早期补液、对症治疗及肾脏替代疗法等，然而效果并不理想。国内外针对挤压综合征相关急性肾损伤的治疗尚无标准方案，因此明确发病机制及制定有效治疗方案可能是未来亟待解决的问题。本文就挤压综合征相关急性肾损伤的发病机制及治疗策略进行综述。     

Wilms'' tumour: adjuvant treatment with actinomycin D and vincristine.

In an unselected series of 49 children with Wilms' tumour treated in 1969-74 the 5-year relapse-free survival and survival rates were 78% and 81%, respectively, whereas in the series of children treated in 1963-68 the corresponding rates were 49% and 70%. The significant improvement in the relapse-free survival rate was a result of adjuvant treatment with actinomycin D and vincristine (AMD + VCR), which, in some patients, eradicated occult metastatic disease. In the treatment of lung metastases the combination of whole-lung irradiation and maintained chemotherapy with AMD + VCR proved excessively toxic: in 5 of 11 patients acute diffuse pneumonitis developed, and it was fatal in 3. Adjuvant AMD + VCR therapy is advocated in all patients with Wilms' tumour except children less than 12 months old with a tumour of moderate size, limited to the kidney and completely resectable.