自噬调控眼部疾病进程的研究进展

细胞自噬是一种在生理和病理条件下发生的高度保守的自我降解过程.近年来研究表明,细胞自噬在眼部疾病的发生、发展中起着至关重要的作用.本文就细胞自噬在眼病发病机制中的作用进行了综述,为今后眼病的临床治疗提供新的思路.     

Alport综合征眼部表现及其病理机制研究进展

Alport综合征(Alport syndrome，AS)是一种累及肾脏、耳、眼的基底膜结构异常的遗传性疾病，发病率约为1：5000。其眼部异常的报道较少见，但对疾病的诊断却有重要的价值，眼部异常相关病理机制分析将为我们揭开眼部异常发生的真正原因，对于疾病的认识和治疗具有重要意义。     

弱视患者发病机制及眼部结构的研究进展

弱视是一种儿童视觉发育关键期常见的眼科疾病,其发病机制复杂。传统观念认为弱视不会出现明显眼球器质性改变,但近年随着研究的深入,研究者们发现弱视患者不仅脑部解剖存在差异,在眼部结构也与正常人不尽相同,这为探索弱视发病机制提供了新的思路。本文就弱视患者的发病机制及眼部结构改变进行了总结,从发病机制、脉络膜厚度(CT)、眼部血管面积及密度、视网膜神经纤维层(RNFL)厚度以及弱视患者遮盖治疗后的眼部结构改变等方面进行综述。     

小分子热休克蛋白在眼部表达及其影响因素的研究进展

小分子热休克蛋白(small heat shock proteins,sHSPs)是热休克蛋白的亚单位,在各种应激状态下,它在组织中迅速表达增强,参与对组织的保护和损伤作用。sHSPs的研究已经受到国内外学者的广泛关注,认为其在作为分子伴侣、协同免疫、抑制凋亡、抗原提呈以及甾体激素受体功能等方面具有重要作用。充分认识sHSPs在眼部疾病中的功能及其作用机制,能进一步了解眼部疾病的发病机制,为疾病的治疗研究提供新的分子生物学依据。     

模拟长期微重力环境下大鼠眼底血流动力学、眼轴长度及血清中IFN-γ、IL-10含量的变化

目的　探讨模拟微重力环境下大鼠视网膜中央动脉血流动力学、眼轴长度及血清中γ-干扰素（interferon-γ,IFN-γ）、白细胞介素10（interlunkin-10,IL-10）含量的变化。方法　40只SD大鼠随机均分为8组:正常对照组、尾吊1 d组、尾吊4 d组、尾吊1周组、尾吊2周组、尾吊1个月组、尾吊2个月组及尾吊3个月组。采用尾悬吊法建立模拟微重力环境动物模型,利用彩色多普勒超声诊断仪测量大鼠视网膜中央动脉血流动力学及眼轴长度变化,血流动力学参数包括收缩期最大血流速度（peak systolic velocity,PSV）、舒张末期血流速度（end diastolic velocity,EDV）;应用酶联免疫吸附试验检测大鼠尾吊后不同时间血清中IFN-γ、IL-10含量。结果　正常对照组PSV与尾吊各组比较,差异均有统计学意义（均为P＜0.05）,PSV均较正常对照组下降;尾吊3个月组同其余各组差异均有统计学意义（均为P＜0.05）,PSV降至最低。正常对照组EDV除与尾吊1 d组、尾吊1周组及尾吊2个月组差异无统计学意义外,与其余各组差异均有统计学意义（均为P＜0.05）,EDV均较正常对照组下降;尾吊3个月组与其余各组差异均有统计学意义（均为P＜0.05）,EDV降至最低。尾吊1 d组眼轴长度除与正常对照组差异无统计学意义外,与其余各组差异均有统计学意义（均为P＜0.05）,其余各组均较尾吊1 d组眼轴变短;尾吊1个月组同尾吊各组差异均有统计学意义（均为P＜0.05）,眼轴最短。正常对照组血清中IFN-γ含量与尾吊各组差异均有统计学意义（均为P＜0.05）,尾吊各组IFN-γ含量均较正常对照组增加;尾吊2周组与其余各组差异均有统计学意义（均为P＜0.05）,IFN-γ含量降至最低,但仍高于正常对照组;尾吊3个月组同其余各组差异均有统计学意义（均为P＜0.05）,IFN-γ含量基本稳定。正常对照组IL-10含量与尾吊各组差异均有统计学意义（均为P＜0.05）,尾吊各组IL-10含量均较正常对照组降低,尾吊1 d组下降明显;尾吊2个月组同尾吊1个月组、尾吊3个月组差异均有统计学意义（均为P＜0.05）,尾吊2个月、3个月IL-10含量逐渐增加。结论　长期模拟微重力环境下大鼠眼底血流及眼轴长度均有变化;随尾吊时间延长,眼底血流流速降低,眼轴变短;大鼠血清IFN-γ变化呈“M”形正向曲线分布,IL-10变化呈“W”形负向曲线分布。     

人类白细胞抗原分型检测及其与眼部疾病相关性的研究进展

人类白细胞抗原(HLA),又称人类主要组织相容性复合体。其分型检测方法历经了血清学分型、细胞学分型及脱氧核糖核酸(DNA)分型的发展过程。目前,DNA分型检测方法为主要的HLA分型检测方法,且有逐渐取代其他两种分型检测方法的趋势。此外,经国内外的诸多学者研究发现,HLA与多种疾病具有相关性。其中,关于眼部疾病与HLA相关性的报道更是层出不穷,尤其是在葡萄膜炎的相关研究中。故本文拟对HLA分型检测及其与眼部疾病的相关性进行综述。     

特殊自然环境对眼压的影响及其机制的研究进展

随着人类探索和活动范围不断扩大, 越来越多人群在特殊自然环境中工作和生活。特殊自然环境有其相对独特的环境特点, 不仅可导致人机体发生病理生理变化和新陈代谢紊乱, 而且可对眼部造成影响, 需要关注维持正常视功能。本文总结了高原缺氧、太空微重力、深水、黑暗、寒冷及空气污染等特殊自然环境对眼压的影响, 并探讨眼压在这些特殊自然环境下改变的机制, 以期为临床诊疗和研究工作提供参考。     

Waardenburg综合征的眼部特征及其分子遗传学研究进展

Waardenburg综合征以感音神经性听力损失和全身性(皮肤、毛发和眼球)色素沉着异常为主要表现, 其具有高度的临床表型和遗传学异质性。患者通常伴有连眉、内眦距增宽、鼻根高而宽、白色额发等特殊颅面部改变。虹膜异色是其最常见且最具辨识度的眼部色素异常表现, 还可出现脉络膜和视网膜的色素异常。若伴随上睑下垂、斜视和青光眼等眼部异常, 则可能导致视功能障碍。根据临床表现可分四个亚型, 每个亚型均可出现眼部色素异常, 其中I型和III型可伴有内眦距增宽, IV型累及神经系统时可表现为眼球震颤。目前已知的致病基因有PAX3、MITF、EDN3、EDNRB、SOX10和SNAI2等6个。(国际眼科纵览, 2023,47:238-243)     

白化病的眼表现及其发生机制

白化病是一组由黑色素合成相关基因突变导致的眼或眼、皮肤、毛发黑色素缺乏性遗传病，根据色素缺乏受累的部位和有无其他异常分为三种类型，分别是眼、皮肤和毛发均呈色素缺乏的眼皮肤型白化病，仅有眼色素缺乏的眼白化病，以及既有眼一皮肤白化病表现又有其他系统症状的白化病相关综合征。三种类型患者的共同特征是眼均存在色素的缺乏，眼发育过程中黑色素的缺乏引起眼一系列严重的功能改变和临床表现。     

法舒地尔对大鼠急性高眼压视网膜神经节细胞的保护作用及其机制

目的 观察法舒地尔对大鼠急性高眼压视网膜神经节细胞(RGCs)的保护作用并探讨其机制.方法 实验研究.24只SD大鼠被随机分入正常组(N组)、模型组(M组)、模型+磷酸缓冲液组(MP组)、模型+法舒地尔组(F组),正常组不做任何处理,后三组制作急性高眼压模型(生理盐水灌注法).其中MP组和F组于造模前1周、当天及其后每天分别腹腔注射磷酸缓冲液(PBS) 25 mg/kg和法舒地尔25 mg/kg,各组于造模后7 d取眼球和心脏血,采用TUNEL法测定RGCs凋亡指数(AI)反映RGCs凋亡情况,免疫组化法观察各组视网膜中Rho激酶-2(ROCK-2)和内皮素(ET-1)的分布,并用吸光度值(OD)反映各自表达量;采用Western blotting法测定各组视网膜中磷酸化的肌球蛋白磷酸酶靶单位(p-MYPT-1)的表达,放射免疫法测定血浆中ET-1含量,血液流变仪测量不同剪变率下的全血黏度、红细胞聚集指数(BCAI)和红细胞压积(HCT).各指标组间比较采用单因素方差分析,两两比较采用LSD-t检验.结果 各组RGCs AI差异具有统计学意义(F=402.041,P=0.000),其中F组RGCs AI为33.3%±2.0%,少于M组(64.3%±2.2%)或MP组(62.5%±2.2%)(P<0.05).N组视网膜的节细胞层(GCL)中仅散在几个ROCK-2和ET-1阳性细胞,M、MP和F组ROCK-2阳性细胞分布于GCL、内丛状层(IPL)、内核层(INL)、外丛状层(OPL)和外核层(ONL)中,而ET-1阳性细胞分布于前4层,ONL中无表达,且两者在M和MP组中的OD值高于N组(N、M及MP组ROCK-2:0.21±0.03、0.52±0.06、0.54±0.03;ET-1:0.22±0.05、0.51±0.03、0.51±0.04)(P均<0.01),F组OD值(ROCK-2:0.37±0.04;ET-1:0.35±0.06)低于M或MP组(P均<0.05),但仍高于N组(P均<0.05).ROCK-2和ET-1在各组表达差异具有统计学意义(F=82.862、56.491,P=0.000).Western blotting检测发现各组视网膜中P-MYPT-1表达差异具有统计学意义(F=606.236,P=0.000),M和MP组表达量分别为0.522±0.013和0.520±0.013,高于N组(0.263±0.014)(P<0.01),F组表达量(0.302±0.015)低于M或MP组(P<0.05),但仍高于N组(P<0.05).放射免疫法检测发现各组血浆ET-1含量差异有统计学意义(F=8.750,P=0.000),M和MP组含量均为(96±10)pg/ml,高于N组[(72±10)pg/ml](P<0.05),F组含量为(78+10)pg/ml,低于M或MP组(P<0.05),但仍高于N组(P<0.05).血液流变仪检测发现各组低切、中切、高切状态下全血黏度,BCAI和HCT差异有统计学意义(F=7.086、4.279、14.780、37.351、143.264,P均<0.05),且各指标中M或MP组较N组高(P<0.05),F组较M或MP组低(P<0.05),但仍高于N组(P<0.05).结论 法舒地尔可以抑制大鼠急性高眼压模型中RGCs的凋亡,对RGCs有保护作用,推测其机制可能与抑制ROCK-2、减少p-MYPT-1、减少肌动蛋白-肌球蛋白交联、抑制平滑肌收缩、减少缩血管因子ET-1表达、降低血黏度有关.     

Charles Bonnet综合征研究进展

Charles Bonnet综合征（CBS）的主要特征为发生于非精神异常患者的复杂性幻视,患病率约为0.4%~40％。其病因学尚不明确,临床特征亦复杂多样,目前尚无有效药物治疗。及时诊断、合理解释将有助于缓解患者情绪。治疗方案仍有待进一步研究。本文将近年来有关CBS的研究进行综述。     

泪膜与眼表微环境的研究进展

泪膜覆盖眼表,是眼表微环境的重要组成部分,其稳态失衡可以造成眼表其他细胞和组织结构与功能异常,从而加重眼表疾病的发生和发展。笔者旨在对泪膜与眼表微环境中其他的成分包括眼表上皮、角膜基质、角膜神经和眼表微生物群的作用方面进行综述,以期为眼表疾病的发病机制研究及诊疗提供新的思路。     

妊娠期健康孕妇眼部改变的研究进展

妊娠期内,孕妇体内激素水平通常会发生显著的变化,其体内各器官、组织也随之出现生理性或病理性改变。视觉器官同样会受其影响。因此,笔者就近年来健康孕妇眼部在妊娠期发生变化的相关研究进行综述。     

阿尔茨海默病视功能损伤及机制研究进展

阿尔茨海默病(Alzheimer''s disease,AD)是神经退行性疾病,是痴呆最常见的类型。患者的个人生活质量受到了严重的影响,给其家庭和整个社会带来了较大的经济和社会负担。认知障碍的患者会出现一些与认知能力下降相关的眼科改变。但目前视功能与AD之间的关系仍未得到充分研究。当认知能力下降时,患者会用其视觉等感官感知周围的世界,然而大脑却无法将感知的信息整合到一起来理解周围的环境。由于视功能损伤为AD患者感官功能损伤中较为明显的一种,对其损伤的认识能够帮助我们对AD患者进行早期诊断。为了进一步探究其视功能变化,现通过各种文献复习,对AD患者视功能损伤及其机制进行综述。     

Correctable and non-correctable visual impairment among young males: a 12-year prevalence study of the Military Service in Poland

Purpose:  To evaluate the prevalence of correctable and non-correctable visual impairment in a representative sample of young males commissioned for Military Service in Poland.
Material and methods:  Data concerning vision status was retrospectively reviewed in 969 subjects of European Caucasian origin, most of whom live and have lived in Poland. They were selected from the original database comprising 105017 subjects examined in the period 1993–2004. Based on the age of subjects they were divided into two groups; group I aged 18–24 and group II aged 25–34 years. Visual impairment was defined as distance visual acuity of <20/40 in one or both eyes. Non-correctable impairment was defined as that which was not eliminated by refractive correction.
Results:  A total of 1938 eyes of 969 white males were examined. There was statistically significant association between rates of visual impairment and increasing age ( p  < 0.001). Visual impairment was found in 128 (13.2%) subjects in at least one eye. Non-correctable visual impairment was found in 12 (1.2%) subjects. Amblyopia was the main cause, accounting for eight cases (66.67%). Correctable visual impairment was found in the remaining 116 (12.0%) patients. Among them myopia was the most common refractive error and accounted for 75.8%. Differences between age-specific rates of refractive errors were statistically significant ( p  = 0.003).
Conclusions:  Appropriate refractive correction improves visual acuity in most subjects presenting with visual impairment. There was a relatively low prevalence of non-correctable visual impairment in a population of young adults in Poland, and this was mainly due to amblyopia.     

天津市视障学校学生视觉损害的病因及康复现状

目的：调查天津市视障学校学生视觉损害的分级及病因,分析不同类型助视器的康复效果,为儿童视觉损害的康复工作提供指导依据。

方法：于2019-08/09纳入天津市视力障碍学校学生86例。通过视力、屈光及眼部检查等方法,评估学生视觉损害的分级及主要病因。对盲和低视力学生分别验配3种远用及近用助视器,分析其康复效果。

结果：学生86例中盲49例,低视力37例,主要病因为先天性眼球发育不良26例(30%)。盲和低视力学生应用助视器后康复远视力均有所提升(F=110.59,P<0.01),低视力组远视力优于盲目组(F=184.06,P<0.01)。盲目组应用3种远用助视器脱残率及低视力组脱残率均无差异,3种近用助视器阅读成功率在盲目组无差异,低视力组电子助视器优于手持放大镜及眼镜式助视器(χ²=7.974、10.571,均P<0.01)。

结论：儿童视觉损害以先天性眼病为主,验配合适的助视器可提高其康复效果,低视力患者电子助视器康复效果优于手持放大镜及眼镜式助视器。     

视觉障碍与认知障碍的相关性研究进展

随着全世界范围进入老龄化社会，老年人口逐年增加，视觉障碍和认知障碍也因此成为全球性的重要问题，给全球带来了极大的社会经济负担。近年来，大量的研究表明视觉障碍与认知障碍之间存在密切的联系，视觉障碍患者更容易发生认知能力下降，尤其是痴呆症。此外，也有证据表明，改善视力对认知功能的改善有显著的效果，通过提高视功能可以延缓认知功能下降和痴呆的发展，这为公共卫生工作通过改善视功能延缓和减轻认知功能下降和痴呆提供了新的思路。视觉障碍与认知障碍之间关联的可能机制尚不明确，有待深入研究。     

Correctable visual impairment and its impact on quality of life in a marginalized Canadian neighbourhood

Objective: To study the impact of visual impairment due to either underlying ocular pathology or easily correctable refractive error on vision-related functioning and quality of life (QOL) in Vancouver's downtown eastside (VDES).Design: Cross-sectional study.Participants: Two hundred consecutive patients seeking general medical care at the Vancouver Native Health Society (VNHS) medical clinic were included.Methods: An ocular examination was performed and a standardized history and QOL information were obtained for each participant. Effective visual impairment was classified based on patients' current refractive means. Pathological visual impairment was classified based on patients' best-corrected visual acuity (VA).Vision-related functioning was quantified using the Daily Tasks Dependent on Vision (DTDV) questionnaire. Health-related QOL was assessed using the 12-Item Short Form Health Survey (SF-12).Results: Two hundred patients participated; they suffered, on average, 6.2 comorbid conditions. Sixty-two patients (31%) were effectively visually impaired and, of these, 14 patients (7%) were effectively blind. Ten patients (5%) had pathological eye disease to explain their visual impairment. The remaining 52 visually impaired patients (26%) had VA that normalized with correction. Difficulty with the tasks described in the DTDV questions was significantly correlated with effective visual impairment. Patients with effective visual impairment had lower Physical Composite Scores on the SF-12 in multivariate analyses.Conclusions: We have demonstrated a very high rate of visual impairment in a low socioeconomic population that is associated with decreased vision-dependent functioning and decreased overall physical health status. Public health efforts need to be directed toward improving easily correctable refractive error.     

Changes in causes of low vision between 1988 and 2009 in a Dutch population of children

Purpose: Causes of low vision in the Netherlands may have changed over time. The purpose of this study is to assess trends over the last two decades. Methods: Socio‐demographic and medical data, including ophthalmic diagnosis and inheritance patterns for 2843 children with low vision (0–21 years; 50% representation) referred to a Dutch institute for low vision (Bartiméus) over a 21‐year period between 1988 and 2009, were included in the analysis. For the 19 most common diagnoses, inheritance and presence of mental impairment, trend analyses were performed with logistic regression models; odds ratios (OR) for a 10‐year time span were reported. Results: Cerebral visual impairment (CVI) was found in 27.2% (97% mental impairment), albinism in 8.0%. Over time, nystagmus (6.6%; OR = 1.42), retinitis pigmentosa (2.9%; OR = 1.61), cone‐rod dystrophy (2.6%; OR = 1.98) and hyperopia (2.0%; OR = 3.66) increased significantly. Cataract (4.9%; OR = 0.64), aniridia (1.6%; OR = 0.42) and retinopathy of prematurity (ROP; 2.0%; OR = 0.45) decreased significantly. There was a significant increase in genetic disorders (41.0%; OR = 1.49) and in co‐occurrence of mental impairment (52.2% OR = 1.16). Conclusion: In the last two decades, treatable or preventable disorders (such as cataract and ROP) have become a less common cause of low vision in children. However, the prevalence of complex (genetic) and untreatable disorders (CVI) has taken its place, as a result of increased survival of preterm and low birth weight children and improved diagnostic possibilities. Knowledge of the prevalence of low vision, its causes and trends over time may help policy makers to define effective intervention strategies and to monitor its impact.