春季角结膜炎患者眼表及角膜形态的改变

目的 对比春季角结膜炎(VKC)患者与健康人群的主观症状及眼表改变。利用非侵入性眼表综合分析仪和活体共聚焦显微镜(IVCM)评估春季角结膜炎(VKC)患者的泪膜和角膜形态学变化。方法 前瞻性病例对照研究,病例组共纳入VKC患者21例(42眼),对照组共纳入健康志愿者16例(32眼)。用OSDI评分量表评估两组受试者主观症状改变,利用非侵入性眼表综合分析仪对比两组的泪河高度、无创泪膜破裂时间、睑板腺缺失程度、角膜荧光素染色、眼红程度,利用活体共聚焦显微镜(IVCM)对比两组的朗格汉斯细胞密度、角膜神经、睑板腺腺泡密度、睑板腺腺泡长径、睑板腺腺泡短径。结果 病例组OSDI评分显著高于对照组(P<0.05),非侵入性眼表综合分析仪结果显示病例组的泪河高度、NIKBUT、睑板腺缺失评分、角膜荧光素染色、眼红分析均较对照组严重,且差异有统计学意义(P<0.05)。IVCM检查显示VKC患者睑板腺腺泡萎缩,角膜上皮下可见大量朗格汉斯细胞浸润、神经纤维变细(P<0.05)。结论 春季角结膜炎患者的主观症状、眼表体征均明显较健康志愿者严重;非侵入性眼表分析仪和IVCM对VKC的评估有...     

眼球表面的蒸发与干眼

通过对眼球表面蒸发量的测定与研究发现,过强的眼表蒸发会导致干眼。眼表蒸发受多种因素影响,如眼表温度、睑板腺功能、环境湿度与空气质量、暴露性眼病和角膜接触镜的配戴等。从这一角度来说,有效减少眼表蒸发对治疗干眼有重要的意义。     

眼球表面的蒸发与干眼

通过对眼球表面蒸发量的测定与研究发现,过强的眼表蒸发会导致干眼.眼表蒸发受多种因素影响,如眼表温度、睑板腺功能、环境湿度与空气质量、暴露性眼病和角膜接触镜的配戴等.从这一角度来说,有效减少眼表蒸发对治疗干眼有重要的意义.     

纹眼线美容术对眼表损伤的临床观察

目的通过观察纹眼线美容术后患者的眼表损伤程度,探讨其对角膜上皮、泪液分泌、睑板腺功能等的影响。方法选择2016年12月至2018年12月于中国航天科工集团七三一医院就诊的女性纹眼线患者45例(90眼)为病例组,同时选取年龄相匹配的未纹眼线健康女性45例(90眼)为对照组。所有研究对象进行基础泪液分泌试验(Schirmer I test, SIT),泪膜破裂时间(tear break up time, BUT)、泪河宽度(tear meniscus height, TMH)、角膜荧光素染色、睑缘形态、睑板腺分泌功能检查,对两组检测结果进行比较。结果病例组的角膜荧光素染色、睑缘形态及睑板腺分泌功能评分均明显高于对照组,差异有统计学意义(P <0.01),BUT、SIT、TMH均较对照组降低,差异有统计学意义(P<0.01)。病例组的泪液分泌量和泪膜稳定性、睑板腺功能均较对照组下降。结论纹眼线美容术术后可导致急性角膜上皮损伤,破坏睑缘的睑板腺开口,造成睑板腺功能障碍,从而引起不同程度的眼表损害和眼部不适。     

糖尿病角膜和泪膜改变的研究进展

糖尿病(diabetes mellimus,DM)是一组由遗传和环境因素相互作用而引起的临床综合征.近年来,糖尿病患者日渐增多,预计到2010年我国糖尿病患者总数可能超过3 000万[1];欧美各国糖尿病是四大致盲眼病中占第1位或第2位的眼病.糖尿病可引起的多种眼部并发症,其中糖尿病性视网膜病变(diabetic retinopathy,DR)和白内障早已为人熟知.由于糖尿病患者常出现眼部烧灼感、异物感、干涩感等症状,尤其是玻璃体切割手术治疗在严重糖尿病性视网膜病变中应用,患者出现角膜上皮水肿,角膜上皮再生延迟,反复角膜上皮糜烂等眼表并发症,引起了眼科工作者的重视,对糖尿病患者角膜及泪膜的改变做了较多的研究.本文着重对糖尿病引起的角膜和泪膜改变及其发生机制作一综述.     

2型糖尿病患者睑板腺形态与功能的改变及其对眼表的影响

目的:探讨2型糖尿病患者睑板腺形态与功能的改变及其对眼表的影响。方法:收集自2016年9月-2017年9月就诊于我院门诊已确诊的2型糖尿病患者128例作为试验组,于同一时间段在我院就诊的白内障患者130例作为对照组,分别比较试验组与对照组间的眼表症状评分、非侵入式泪膜破裂时间、睑板腺缺失面积评分分级、睑板腺开口堵塞程度评分及睑板腺分泌物性状评分。结果:试验组患者OSDI评分为（25.12±12.24）,明显高于对照组（11.12±8.48）,差异有统计学意义（Z=-6.018,P<0.001）;试验组NI-BUT（3.86±2.60 s）明显短于对照组（8.96±4.74 s）,差异具有统计学意义（Z=-7.632,P<0.001）;试验组中59.37%的患者存在睑板腺缺失,明显多于对照组38.46%;试验组患者睑板腺缺失面积评分明显高于对照组,差异具有统计学意义（Z=-3.865,P<0.001）;睑板腺开口堵塞评分试验组（1.89±0.87）明显高于对照组（0.84±0.72）,差异均具有统计学意义（Z=-8.413,P<0.001)。试验组睑板腺分泌物评分为（1.46±0.68）,明显高于对照组（0.82±0.63）,差异具有统计学意义（Z=-8.761,P<0.001）。结论:2型糖尿病患者出现眼表功能改变及眼部不适症状的概率远远高于非糖尿病人群,且与非糖尿病患者相比,糖尿病患者中干眼的症状程度较重,睑板腺形态及功能出现异常的比例以及异常的程度也较非糖尿病患者明显升高。     

角膜激光共聚焦显微镜联合眼表综合分析仪在蠕形螨感染所致眼表疾病诊治中的应用

目的:探讨角膜激光共聚焦显微镜联合眼表综合分析仪辅助诊断蠕形螨感染所致相关眼表疾病的临床应用价值。方法:收集眼科门诊眼表疾病患者194例,采用角膜激光共焦显微镜进行眼部蠕形螨感染的检查,对蠕形螨感染阳性患者(121例)以Oculus Keratograph 5M眼表综合分析仪检测非侵入性首次泪膜破裂时间(NITBUTf)、非侵入性平均泪膜破裂时间(NITBUTav)、下泪河高度(LTHM),并对睑板腺缺失进行评分。结果:睑缘炎患者(126例)中蠕形螨感染阳性率(85. 7%)明显高于非睑缘炎患者(68例)中蠕形螨感染阳性率(19. 1%);经眼表综合分析仪检查确诊蠕形螨感染的睑缘炎患者中同时伴有干眼患者89例(82. 4%),睑板腺功能障碍患者86例(79. 6%),蠕形螨感染的非睑缘炎患者中经眼表综合分析仪检查确诊同时伴有干眼患者3例(23. 1%),睑板腺功能障碍患者2例(15. 4%),蠕形螨感染的睑缘炎组干眼及睑板腺功能障碍发生率均高于非睑缘炎组(P<0. 05)。结论:角膜激光共焦显微镜联合眼表综合分析仪能显著提高蠕形螨性睑缘炎诊断准确率,并可对蠕形螨感染所致的眼表损害进行综合评价,指导临床精准治疗,减少相关并发症的发生。     

糖尿病致眼部表面器官的病理变化研究现状

随着社会和经济的发展，生活及饮食习惯的变化，糖尿病发病率有明显增高趋势，预计到2010年中国糖尿病患总人数可超过3000万．糖尿病可引起糖尿病性视网膜病理变化及糖尿病性自内障等严重并发症，很多糖尿病患以眼异物感、干燥感及畏光等症状为主诉而就医．且糖尿病患在接受白内障、玻璃体及视网膜等手术后常出现角膜上皮水肿、角膜上皮再生延迟及反复性角膜上皮糜烂等眼部表面并发症，眼部表面包括上下睑缘间的整个黏膜上皮层，包括角膜、结膜及覆盖于其表面的泪膜，这三间相互影响，关系紧密，任何一方的改变均可导致眼部表面病理变化．本对糖尿病引起的角膜、结膜及覆盖于其表面的泪膜改变的研究现状进行了概述．     

泪腺相关疾病对泪液分泌与眼表的影响

<正>泪腺疾病是常见的眼眶疾病,其类型多样,主要分为两大类,包括肿瘤性疾病和非肿瘤性疾病。泪腺肿瘤常见包括泪腺多形性腺瘤,泪腺腺样囊性癌等。泪腺非肿瘤性疾病包括泪腺的炎性病变,还有其他的泪腺相关疾病,包括特发性泪腺萎缩、泪腺的良性上皮病变、泪腺淋巴瘤等。眼表的构成部分分为:角膜、结膜、副泪腺和睑板腺、主泪腺以及神经。这些组成部分     

睑板腺压榨治疗睑板腺开口阻塞的疗效观察

目的观察睑板腺压榨治疗睑板腺开口阻塞伴眼表面不适的疗效和睑板腺分泌物的细胞组成。方法选择2006年1—8月就诊于我科门诊的28例睑板腺开口阻塞伴眼表面不适患者（睑板腺积分均≥3分）,对所有患者行睑板腺压榨治疗,以国际眼表面疾病指数（OSDI）积分法等评价其疗效。结果治疗后大部分患者睑板腺开口变为通畅,眼部不适明显缓解;睑板腺积分治疗前为（3．9&#177;1．0）分,治疗后为（1．2&#177;0．8）分,差异有统计学意义（P〈0．05）;OSDI积分治疗前为（47．9&#177;12．9）分,治疗后为（12．1&#177;4．1）分,差异有统计学意义（P〈0．05）;治疗后2例于次日出现结膜下出血,8例出现眼分泌物增多;26例睑板腺分泌物涂片见少量上皮细胞,2例涂片见多量中性粒细胞和少量上皮细胞。结论睑板腺开口阻塞是引起眼表面不适的重要原因之一,睑板腺压榨是有效的治疗措施,这种治疗措施对于缓解症状、提高睑板腺分泌作用明显;小部分睑板腺开口阻塞可能与感染和炎症有关。     

Retinopathy in a diabetic population

Aims and Objectives: The study was conducted with the aim to find out the prevalence of diabetic retinopathy among diabetics on treatment, to find out the presence of associated risk factors and to determine the knowledge of diabetic retinopathy among patients with diabetic mellitus. Methodology: Cross sectional screening of 316 diabetic patients on treatment presenting to Kalimati Diabetic Clinic and Kathmandu Medical College was done over a period of 8 months for the presence of diabetic retinopathy, associated risk factors and the knowledge of diabetic retinopathy. Results: 21% of the known diabetics had evidence of various grades of diabetic retinopathy although 75.3% of the enrolled patients had history of diabetes mellitus of less than 10 years. Associated risk factors were present in 66.46%. However, only 50% diabetics had the knowledge of diabetic retinopathy. Conclusion: As 21% of the diabetic patients on treatment had various grades of diabetic retinopathy and 50% of the diabetic patients were not aware of diabetic retinopathy, emphasis has to be given for the awareness of ocular involvement in diabetes mellitus such that blindness from retinopathy can be prevented. The responsibility lies on treating physicians or Diabetic Centres for referral of diabetic patients for ophthalmic evaluation. Similarly, control of associated risk factors like hypertension, hyperlipidemia is equally important. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Laser Photocoagulation.     

Diabetic retinopathy: management update

The objective of the study is to review the current knowledge and management of diabetic retinopathy. Current information from multi-centre controlled clinical trials and epidemiological studies in different parts of the world were used to review the epidemiology, pathophysiology, classification, clinical features and management of diabetic retinopathy. Diabetes mellitus affects all ocular tissues. Retinopathy, its most devastating ocular complication, presents with similar clinical picture in both types 1 and 2 diabetes. In Nigeria, diabetic retinopathy has an incidence of 33%; accounts for 16.7% of retinal diseases and leads to bilateral blindness in 22.2% of diabetics. Its incidence depends on both the duration of diabetes and the level of glycaemic control. Hypertension, dyslipaemia, hyperglycaemia and cigarette smoking aggravate retinopathy and adversely affect its response to treatment. Strict blood sugar control delays the onset of retinopathy and retards the progression of established disease. Timely laser and vitrectomy surgeries obviate severe visual loss in diabetic retinopathy. The role of medical therapy for diabetic retinopathy is still experimental. Diabetes occurs worldwide; diabetic retinopathy is increasing in incidence. Developed countries have clear guidelines on the care of diabetes and its complications. The need for similar guidelines in Nigeria is urgent.     

2型糖尿病患者血浆内皮生长因子水平与胰岛素和空腹血糖的相关性探讨

目的探讨了2型糖尿病患者血浆内皮生长因子水平的变化及其与胰岛素和血糖的相关性。方法分别应用放免法ELISA法和生化法对72例2型糖尿病患者进行了血浆VEGF和INS、FBG水平的检测,并与35名正常健康人作比较。结果2型糖尿病无视网膜病变组和伴视网膜病变组血浆VEGF水平非常显著地高于正常人组(P0.05-0.01),患者血浆VEGF水平与空腹血糖呈正相关(r=0.3912 P0.01),与胰岛素水平无直接相关性。结论2型糖尿病的视网膜病变的发生与发展与血管内皮生长因子水平密切相关。     

Knowledge of diabetes and its associated ocular manifestations by diabetic patients: A study at Korle-Bu Teaching Hospital,Ghana

Background:

Diabetes mellitus is a significant cause of visual impairment, hence adequate knowledge on this condition and its ocular manifestations is of immense importance to diabetic patients.

Aim:

To assess the knowledge of diabetic patients on the disorder and its ocular manifestations, and their attitude towards ocular examinations.

Materials and Methods:

A cross-sectional survey involving the use of a structured interview was conducted among diabetic patients attending the Diabetic Clinic of the Korle-Bu Teaching Hospital. Using Fishers Exact Chi-square (χ²) and Odds Ratios (ORs), data obtained was analyzed.

Results:

Only 103 (26.4%) patients knew the type of diabetes mellitus they were suffering from. Knowledge on ocular effects of diabetes mellitus was low and only 15 (3.8%) knew that it could affect the ocular refraction with no patient mentioning that diabetes mellitus could cause cataract or diabetic retinopathy. Attitude to routine eye examination was poor. As much as 135 (34.6%) had never had an eye examination since being diagnosed of diabetes. Knowledge of the type of diabetes mellitus the individual had or any ocular complication of this disorder was significantly related (OR: 4.22; P < 0.001 and OR: 2.55; P < 0.001) respectively to their attitude to seeking eye care.

Conclusion:

Diabetic patients’ knowledge on diabetes mellitus and its ocular manifestations, and the attitude of diabetic patients towards eye examination were poor. Intensive health education by diabetes care givers and leaders of the Ghana Diabetic Association for diabetic patient is therefore required to improve attitude towards eye care to prevent visual impairment.     

Diabetic retinopathy

Retinal involvement from diabetes mellitus is the leading cause of new blindness in the United States. Many diabetic patients, though they have perfect vision and no ocular complaints or symptoms, harbor retinal pathology capable of leading to severe loss of vision. Therefore, all medical personnel caring for the diabetic patient must recognize the importance of dilated pupil retinal examinations by an ophthalmologist or vitreoretinal surgeon. Lack of timely diagnosis and treatment is a major factor leading to blindness from diabetic retinopathy. On a more positive note, prompt laser treatment of diabetic retinopathy can reduce severe visual loss by more than 50%.     

Ophthalmic screening for diabetics: the importance of physician-ophthalmologist collaboration in the prevention of blindness

Diabetes mellitus as a disease is a dragon with many heads. To cope with it, each manifestation must be deftly handled by family physician and specialists in unison. Similarly, the spectre of diabetic retinopathy is best exorcised before it manifests - by effective prophylactic screening. This programme can only be successful through a co-ordinated effort of both physicians and ophthalmologists. In this paper, we present one such agenda which we have adopted, The result indicate that a fifth of diabetics have retinopathy, and that sight threatening disease affects 7% of those screened. More critically, it also establishes that a cost-effective method of screening can be achieved through a synergetic endeavour of primary care physician and specialist.     

Early detection of diabetes retinopathy by new algorithms for automatic recognition of vascular changes

Diabetes mellitus often results in diabetic retinopathy caused by pathological changes of the retinal vessel tree. Early detection of these changes can delay the disease. Image processing can reduce the workload of screeners and can play a central role in quality assurance tasks. Therefore we aimed at the refinement and development of image processing algorithms to improve the quality and cost effectiveness of screening and diagnosis of diabetic retinopathy. In order to support ophthalmologists in their routine and to enable the quantitative assessment of vascular changes in colour fundus photographs a multi-resolution approach was developed which segments the vessel tree efficiently and precisely into digital images of the retina. The vessel tracker aims at determining as correctly as possible the retinal vascular network captured on a digital image irrespective of its origin. In addition to the tracker, algorithms were developed to detect the optic disk, bright lesions such as cotton wools spots, and dark lesions such as haemorrhages. The following classification of veins and arteries identifies arteries in 78.4 % and veins in 66.5% correctly. This helps selecting conspicuous images from a great number of patients.     

Diabetic retinopathy in a rural diabetic population. Prevalence and risk

As part of the West Virginia Diabetes Eye Care Project of 1986, 178 patients in a rural diabetic population were screened for diabetic retinopathy using psychophysical testing and stereo fundus photography. The effects of sex, age, mode of therapy, and duration of diabetes mellitus on the prevalence of retinopathy were investigated. The prevalence of retinopathy was 34 per cent among insulin-treated patients, 18 per cent for those receiving oral hypoglycemics, and seven per cent for the diet-controlled group. Diabetic retinopathy was most prevalent among insulin-dependent patients with prolonged duration of disease. Age did not affect the prevalence of retinopathy after adjustment for sex and duration of diabetes.     

STUDY OF DIABETIC EYE COMPLICATIONS OTHER THAN DIABETIC RETINOPATHY

In a series of 735 diabetics, a search for ocular signs other than diabetic retinopathy to help diabetes diagnosis suggests that reduced corneal s.ensitivity, somewhat high intraocular pressure and heightened dark adaptation threshold without significant cause all may in- dicate diabetes mellitus.     

糖尿病与骨质疏松症

在糖尿病并发症中,心、脑、肾、眼、皮肤及神经等系统的并发症已被普遍认识,但糖尿病并发骨质疏松症是近几年才开始被医学界认识。糖尿病与骨质疏松症的关系复杂,高血糖、胰岛素分泌缺乏、胰岛素抵抗、雌激素分泌减少、脂肪细胞因子以及糖尿病并发症如糖尿病肾病、糖尿病视网膜病变、糖尿病神经病变等均可引起骨代谢改变。