天津蓟县桑梓村≥40岁人群白内障相关危险因素分析

目的探讨白内障的危险因素。方法2003年1～3月,在天津蓟县桑梓村进行白内障的调查,并通过问卷调查获取资料,对≥40岁人群进行了白内障的相关因素分析。结果≥40岁人群共1987人,1776人接受了检查及问卷调查,应答率为8938%。单因素分析显示年龄、性别、文化程度、高血压、高血压病程、服用利尿剂、糖尿病、糖尿病病程≥5年及青光眼与白内障呈正相关;多因素分析显示年龄、性别、文化程度、高血压、高血压病程及糖尿病病程≥5年均为白内障的独立危险因素。结论多种危险因素与白内障相关,在白内障的防治工作中,通过控制这些因素降低白内障的患病率。     

西藏拉萨白内障病例对照研究

1986年在西藏拉萨地区门诊工作中收集到的白内障病例对照162例,进行统计学上的比较。发现白内障的发生与户外工作、职业及日照时数有关。每日平均日照时数超过六小时可视为危险因素,其加权平均比数比几乎为4。日照时间、户外工作以及职业是紧密相关联的。除此之外,性别、高血压、嗜酒、嗜烟等的平均比数比分别是1.03,1.46,1.09,1.14,虽然未有统计学上的意义,但亦不能以此否定它们与白内障形成的关系。     

常规体检人群中特发性黄斑前膜的相关因素分析

背景特发性黄斑前膜常导致患者视力的进行性下降。研究该病的危险因素有助于对其发病机制的研究,并指导临床上对高危人群的筛查和制定预防、治疗策略。目的分析健康体检人群中特发性黄斑前膜发生的相关因素。方法对2009年11月至2010年10月在北京协和医院体检中心进行健康体检的人群进行眼科检查,并对体检中发现的特发性黄斑前膜患者与无该病人群的临床特点进行分析比较,通过多因素logistic回归模型分析特发性黄斑前膜与年龄、体重指数、高血压、糖尿病、高脂血症、血清白蛋白、肾功能及白内障的相关性。结果研究期间共27400人进行了眼科检查,发现特发性黄斑前膜76例。特发性黄斑前膜患者均无明显的眼科主诉,40岁以下患病者12例（12／11659）,51—60岁患病者21例（21／4595）,60岁以上患病者32例（32／2544）。发生特发性黄斑前膜的人群中42％合并高血压,5％合并糖尿病,66％合并血脂水平异常,6％合并肾功能不全,18％合并白内障。在单因素logistic回归分析中,51岁以上患高血压、高脂血症和白内障者发生特发性黄斑前膜病变的风险增加,与50岁以下无高血压、无高脂血症和无白内障者比较差异均有统计学意义（P〈0．01）。多因素logistic回归模型中,与年龄40岁以下的患者比较,51～60岁的人群患病风险增加（OR=2．50,95％CI：1．20～5．40,P=0．02）,〉60岁的人群患病风险增加（OR=7．30,95％CI：3．40～15．60,P〈0．01）,高脂血症仍与特发性黄斑前膜的发生有明显相关性（OR=2．10,95％CI：1．30～3．50,P〈0．01）。结论50岁以上人群及高脂血症患者发生特发性黄斑前膜的风险显著增加。     

黑龙江省明水县农村人口白内障及其手术的调查分析

目的 明确明水县农村人口白内障的患病率以及治盲状况,白内障手术治疗的现状,并估计白内障手术覆盖率(CSC)、白内障手术负荷量,为制定今后的治盲策略提供可靠的数据支持.方法 以人群为基础,整群随机抽样.由两个调查组同时进行面谈,并进行眼科检查.统计白内障的患病率、双眼白内障盲的患病率,逻辑回归(Logistic回归)分析白内障和双眼白内障盲与年龄、性别的关系;并计算白内障手术覆盖率(CSC)、白内障手术负荷量.结果 白内障的患病率4.42％ (95％CI:4.0％～4.8％),危险因素包括年龄(≥40岁)、女性.双眼白内障盲的患病率是0.35％ (95％CI:0.24％～0.46％),性别并非其危险因素,年龄(≥50岁)是其危险因素.白内障手术覆盖率(CSC)为12.42％(95％CI:11.28％～13.56％),在50～59岁年龄中CSC最高.不同性别没有差别.白内障手术的负荷量是3.26％.结论 白内障是本地区≥50岁人群中致盲的首位原因,白内障手术覆盖率低,白内障盲人所造成的社会负担较重.提高白内障手术覆盖率是消灭白内障盲的根本手段.     

青海省平安县年龄相关性白内障的流行病学调查

目的调查青海省平安县50岁及以上人群的年龄相关性白内障患病率,了解当地年龄相关性白内障的患病情况。方法采用整群抽样方法抽取青海省平安县10个自然村1486例50岁及以上人群进行问卷、视力和眼部检查。诊断采用LOCSⅡ分级标准。结果调查应答率为86.20%。在1281例受检者中,年龄相关性白内障患病率为41.84%。随着年龄的增加患病率明显升高,50～59岁患病率为18.79%,60～69岁为51.17%,70岁以上为86.51%。女性和文盲者患病率较高,分别为43.69%及48.70%。按照WHO的盲与低视力的诊断标准,年龄相关性白内障导致的双眼盲占2.58%,导致的双眼低视力占6.56%。结论青海省平安县≥50岁老年人群的年龄相关性白内障患病率为41.84%,老龄、女性及文盲者患病率较高。     

常规体检人群中早期年龄相关性黄斑变性的相关因素

目的 分析参加健康体检人群中早期年龄相关性黄斑变性的相关因素.方法 比较2010年1月至10月在我院健康体检人群中发现的早期年龄相关性黄斑变性患者和无该病人群的临床特点,通过多因素Logistic回归模型分析早期年龄相关性黄斑变性与年龄、体质量指数、高血压、糖尿病、高脂血症及肾功能损害的相关性.结果 研究期间共有12 926人进行了眼科检查,发现早期年龄相关性黄斑变性患者共65人,其中36.9％为超重或肥胖,30.8％合并高血压,7.7％合并糖尿病,50.8％合并血脂异常,11.5％合并肾功能损害.在单因素Logistic回归分析中,年龄增大、患有高血压、肾功能损害的人群发生早期年龄相关性黄斑变性的风险增加,而超重与较低的患病率相关.多因素Logistic回归模型中,年龄增加和超重仍然维持显著的相关性.结论 50岁以上体检人群发生早期年龄相关性黄斑变性风险显著增加.超重可能是该病的保护因素,值得今后进一步研究.     

高脂血症对年龄相关性核性白内障患者晶状体密度影响分析

目的 探讨高脂血症对年龄相关性核性白内障患者晶状体密度影响.方法 收集2007年1月至2008年12月在沈阳市第四人民医院眼科就诊的年龄相关性核性白内障患者136例(189只眼)作为研究组.其中,男59例,女77例.年龄51～91岁,平均年龄(71.3±8.6)岁.同时,随机选取同期年龄匹配的90例(180只眼)健康体检者作为对照,年龄54～83岁,平均年龄(68.9±7.4)岁.受检者抽取静脉血后检测进行血清总胆固醇(TC)、甘油三酯(TG),低密度脂蛋白胆固醇(LDLC)的测定.同时对受检者进行眼科检查,检测其晶状体密度LOCSⅢ分级和LogMAR视力.结果 年龄相关性核性白内障患者的血清TC、TG和LDLC值分别为(6.958+1.87)mmo1/L、(1.97+0.71)mmol/L和(4.17+1.83)mmol/L,均显著高于对照组的(4.26+0.78)mmol/L、(1.29+0.48)mmol/L和(2.85+0.67)mmol/L,组间差异具有统计学意义,P＜0.05.年龄相关性核性白内障患者的晶状体密度、LOCSⅢ分级分值和LogMAR视力均显著高于对照组,两组差异具有统计学意义(P＜0.01).血清TC、TG和LDLC与年龄相关性核性白内障患者晶状体密度呈正相关,其相关系数r分别为0.671、0.835和0.569.经检验,P＜0.05或0.01.结论 高脂血症能使年龄相关性核性白内障患者晶状体密度增加,是年龄相关性白内障发病的危险因素之一.     

西藏那曲地区年龄相关性白内障的流行病学调查

目的调查西藏那曲地区50岁及以上人群年龄相关性白内障的患病率及白内障手术覆盖率。方法调查研究。采用随机整群抽样的方法,选取西藏那曲地区11个县50岁及以上人群进行问卷调查,并进行视力和眼部检查,以了解该人群接受白内障手术的情况。采用卡方趋势检验分析白内障患病率与年龄、性别的关系。结果应检人群1 760例,受检1 603例,应答率为91.08%。50岁及以上人群年龄相关性白内障患病率为46.48%,随着年龄的增大患病率显著提高（χ²=298.195,P＜0.01）,女性白内障患病率略高于男性,但差异无统计学意义（χ²=3.598,P＞0.05）,白内障手术覆盖率为23.00%。结论西藏那曲地区50岁及以上人群年龄相关性白内障患病率较高,而白内障手术覆盖率偏低,防盲治盲任务任重而道远。     

白内障术后眼内炎的危险因素分析及预后

目的：探讨白内障术后眼内炎的危险因素及玻璃体切割术治疗术后眼内炎的预后。
　　方法：研究在我院进行白内障手术患者1900例1900眼,根据术后有无发生眼内炎分为感染组与对照组。分析患者各临床指标对白内障术后眼内炎发生的影响,采用单因素检验及多因素Logistic回归分析相关危险因素。另外,对所有眼内炎患者进行玻璃体切割术治疗,观察手术对患者预后的影响。
　　结果：单因素分析显示,年龄、高血压、糖尿病、玻璃体溢出、手术时间、普通手术室内进行手术以及麻醉剂开启后未在规定时间内使用等均是导致白内障术后眼内炎发生的危险因素( P<0.05);多因素Logistic回归分析显示,年龄≥70岁、高血压、糖尿病、玻璃体溢出、手术时间≥10 min、普通手术室进行手术以及麻醉剂开启后未在规定时间内使用均是导致白内障术后眼内炎发生的独立危险因素(P<0.05)。经玻璃体切割术治疗后,患者视力得到明显的提高(P<0.05)。
　　结论：年龄、高血压、糖尿病、玻璃体溢出、手术时间、普通手术室进行手术以及麻醉剂开启后未在规定时间内使用等因素均是导致白内障术后眼内炎发生的危险因素。而通过玻璃体切割术治疗,能够有效改善患者的视力。     

重庆市主城区年龄相关性黄斑变性患病率调查

目的 探讨重庆市主城区50岁以上人群中年龄相关性黄斑变性(ARMD)的患病情况及相关危险因素.方法 对重庆主城区老年大学及敬老院50岁以上人员进行ARMD的流行病学调查.采用问卷调查和眼部裂隙灯、检眼镜等检查方法,进行视力、角膜、瞳孔、晶状体和眼底等检查.ARMD的诊断采用全国高等学校教材眼科学(第7版)的标准,部分可疑ARMD患者行眼底照相后再(或)做眼底荧光造影检查.结果 本研究受检人群1513人,确诊ARMD患者122例(178只眼),ARMD的患病率8.06%.确诊患者中干性(萎缩性)ARMD 117例(171只眼),占95.90%;湿性(渗出性)ARMD 5例(7只眼),占4.10%.与ARMD患病有关的危险因素有:性别、高血压病史、吸烟嗜酒史、白内障手术史等;与ARMD患病无明显相关的因素有:雌激素、体重指数、VitC、E、Zn等抗氧化剂的补充及食用油种类等.本受检人群中ARMD患者Amsler表检查敏感性19.66%,特异性95.37%.结论 该病治疗重在早期预防,注意相关危险因素的规避和完善营养素的补充,尽量控制ARMD病变发展.     

Changes in Bruch's membrane in experimental hypercholesteremia in rats

PURPOSE: We investigated the effect of high cholesterol diet for the aging changes in Bruch's membrane of rats. METHODS: After feeding a 4% cholesterol diet for 15 weeks to three young rats 3 months old and four aged rats 23 months old, we observed the morphological changes of Bruch's membrane by electron microscopy, and made a comparison with rats fed an ordinary diet. RESULTS: In one young rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris formed multiple folds separated from the plasma membrane of the endothelium and showed lamellar thickening and crack in some areas. The elastic fiber layer in Bruch's membrane disappeared partly and some new microfibrils appeared. In one aged rat fed a high-cholesterol diet, the endothelial basement membrane of the choriocapillaris showed more lamellar thickening with lumps in some parts. Compared with rats fed an ordinary diet, rats fed a high-cholesterol diet showed thickening of the basement membrane and the changes were more severe. CONCLUSIONS: Our data indicated that high-cholesterol diet might promote age-related changes of Bruch's membrane.     

Advances in imaging in oculoplastics

Color Doppler imaging, computed tomography (CT) and magnetic resonance (MR) imaging are the most precious imaging tools for the clinician in the field of oculoplastics. Orbital and facial vasculature, with its dynamic changes and flow velocities seen in orbital varices, carotid-cavernous fistulas, and dural cavernous arteriovenous malformations, is best detected by Color Doppler imaging. Computed tomography remains the dominant imaging modality in the evaluation of orbital trauma. Helical CT axial scanning with multiplanar reconstruction and three-dimensional CT imaging are most helpful in assessing iatrogenic, traumatogenic, and teratogenic orbital abnormalities. Despite its poor histologic specificity, MR imaging provides superior soft tissue contrast, and contrast-enhanced MR imaging has an established role regarding soft tissue tumor infiltration. The greatest value of MR studies in the evaluation of orbital and palpebral tumors is that it has the capacity to show the precise relation between lesions and adjacent structures before the clinician contemplates a surgical approach. Finally, contrast-enhanced MR imaging proved to be a valuable vascularization indicator based upon the extent of relative enhancement within porous orbital implant in anophthalmic socket.     

Follow-up studies in pattern VECP in demyelinating diseases in children

Spectral sensitivity functions and the transient decrease of sensitivity to short wavelengths after the offset of yellow light (transient tritanopia) were measured by increment threshold techniques in patients suffering from hereditary macular degenerations. Color vision defects were determined by arrangement tests and the anomaloscope. Central areolar choroidal dystrophy was found to produce a mild protan defect and to reduce foveal spectral sensitivity throughout the visible spectrum by a factor of 100; it also abolishes transient tritanopia. Electroretinogram (ERG) was normal, electrooculogram (EOG) subnormal. Stargardt's disease, despite numerous fluorescent macular spots, does not abolish transient tritanopia nor does it reduce spectral sensitivity, although scotopic matches were performed on the Nagel anomaloscope. Only in severe, advanced cases was transient tritanopia reduced and spectral sensitivity found to follow the absorption spectrum of rods. Routine ERGs and EOGs were normal. Vitelliform macular degeneration, despite the ophthalmoscopically pronounced dystrophic macula, produced only very small changes in spectral sensitivity and transient tritanopia, although a widened matching range on the Nagel anomaloscope and electrophysiological abnormalities were found. Apparently damage of the retinal circuit which connects long and short wavelength-sensitive cones, caused by hereditary conditions, is different from that caused by retinotoxic drugs.     

Refractive error in children in a rural population in India

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. METHODS: Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in seven clusters. RESULTS: A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. CONCLUSIONS: Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.     

Vitrectomy in traumatic cataracts and in the complications of surgery in congenital cataract in children

Vitrectomies were carried out in 35 children with traumatic cataracts and complications of surgery for cataracts, caused by injury to the posterior lenticular capsule and incorporation of its fragments to the vitreous. Complete removal of lenticular rudiments rapidly eliminated phacogenic iridocyclitis and improved visual acuity. Improvement of visual functions was attained in 66.6% cases; in 33.4% cases visual acuity did not change. Hemorrhages to the vitreous cavity occurred in 4 cases with pronounced iridocyclitis; therefore, a corneal approach is preferable for cases with pronounced iridocyclitis.     

Refractive error in children in an urban population in New Delhi

PURPOSE: To assess the prevalence of refractive error and related visual impairment in school-aged children in an urban population in New Delhi, India. METHODS: Random selection of geographically defined clusters was used to identify a sample of children 5 to 15 years of age. From December 2000 through March 2001, children in 22 selected clusters were enumerated through a door-to-door survey and examined at a local facility. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in four of the clusters. RESULTS: A total of 7008 children from 3426 households were enumerated, and 6447 (92.0%) examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 6.4%, 4.9%, and 0.81%, respectively. Refractive error was the cause in 81.7% of eyes with vision impairment, amblyopia in 4.4%, retinal disorders in 4.7%, other causes in 3.3%, and unexplained causes in the remaining 5.9%. There was an age-related shift in refractive error from hyperopia in young children (15.6% in 5-year-olds) toward myopia in older children (10.8% in 15-year-olds). Overall, hyperopia was present in 7.7% of children and myopia in 7.4%. Hyperopia was associated with female gender. Myopia was more common in children of fathers with higher levels of education. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a major public health problem in urban school-aged children in India. Cost-effective strategies are needed to eliminate this easily treated cause of vision impairment.