西双版纳傣族自治州青少年儿童斜弱视的流行病学调查

目的：调查云南省西双版纳傣族自治州傣族、哈尼族、拉祜族和当地汉族小学生斜视弱视的患病情况,分析其差异性和危险因素。

方法：选取云南省西双版纳傣族自治州少数民族最集中的勐腊县7 214名6～15岁在校小学生,检查包括裸眼视力和最佳矫正视力、屈光度、眼位、眼前节和眼底情况等,并进行Logistic回归分析影响因素。

结果：(1)所有研究对象中,斜视患病率为2.12%(外斜视占85.62%),弱视患病率为0.60%(屈光性占74.42%);(2)斜视患病率在性别、年龄和民族方面比较,差异无统计学意义(P>0.05),而外斜视患病率在民族方面差异有统计学意义(P<0.05)。拉祜族比汉族发生外斜视风险高(OR=1.86,95% CI：1.12～3.09)。直系亲属斜视或外斜视者、近视、远视均是斜视的危险因素(P<0.05,OR>1),其中近视是外斜视的危险因素(OR=2.13,95% CI：1.32～3.44); 随近视度数增加,外斜视的OR值增大(P<0.05);(3)弱视的患病率在性别、年龄、民族方面无差异性(P>0.05)。Logistic回归分析显示,近视和远视均是弱视的危险因素(P<0.05,OR>1)。

结论：西双版纳傣族自治州少数民族青少年儿童直系亲属有斜视者发生斜视的危险性高,外斜视有一定民族差异性; 近视和远视均是斜视、弱视的主要危险因素,斜视、外斜视的患病风险随近视屈光度的增加而加大。当地的低弱视率和屈光不正患病率较低有关。     

新疆叶城县维吾尔族6～12岁儿童的近视及远视储备现况

目的：了解新疆叶城县维吾尔族6～12岁儿童近视及远视储备现状。

方法：采用横断面研究，共有来自新疆叶城县维吾尔族6～12岁的50 151名学生均接受了全面的视力筛查检查，其中包括全自动电脑验光仪进行验光、室内远用灯箱式E字标准对数视力表(GB 11533)测裸眼远视力及戴镜矫正视力。

结果：2021-10/2022-01新疆叶城县维吾尔族6～12岁近视儿童等效球镜度(SE)为-0.875(-1.625，-0.625)D，近视检出率为6.75%(3384/50151)，其中6～12岁近视儿童SE分别为6岁-0.75(-1.125，-0.625)D、7岁-0.75(-1.125，-0.625)D、8岁-0.875(-1.125，-0.625)D、9岁-0.875(-1.375，-0.625)D、10岁-0.875(-1.6，-0.625)D、11岁-0.875(-1.625，-0.625)D、12岁-1.25(-2.125，-0.75)D。6～12岁非近视儿童SE为+0.25(-0.125，+0.5)D，远视储备不足检出率为75.51%，其6～12岁非近视儿童SE分别为6岁+0.25(-0.125，+0.5)D、7岁+0.25(0，+0.5)D、8岁+0.125(-0.125，+0.5)D、9岁+0.25(-0.125，+0.5)D、10岁+0.125(-0.125，+0.5)D、11岁+0.125(-0.125，+0.5)D、12岁+0.25(-0.125，+0.625)D。近视检出率分别为6岁6.78%、7岁5.64%、8岁5.72%、9岁5.36%、10岁5.01%、11岁6.82%、12岁12.14%； 非近视远视储备不足检出率分别为6岁91.67%、7岁92.04%、8岁92.91%、9岁83.85%、10岁68.89%、11岁54.01%、12岁26.71%。9～12岁非近视儿童女生远视储备不足检出率高于男生(χ²=8.94、19.99、19.91、39.11，均P<0.05)； 10～12岁儿童女生近视检出率高于男生(χ²=5.402、8.493、36.9711，均P<0.05)。

结论：新疆叶城县维吾尔族6～12岁儿童近视患病率6.75%，而非近视远视储备不足检出率高达75.51%，预测近视高危儿童人数较多，故儿童的远视储备早期监测对于近视防控策略至关重要。     

山东省龙口市7～18岁中小学生近视患病率调查分析

目的：调查研究山东省龙口市7～18岁中小学生近视患病率情况,为近视防控提供科学依据。

方法：采用横断面随机整群抽样的方法于2015-01/12对山东省龙口市7～18岁在校学生以学校为抽样单位进行近视情况的调查,共抽取学校58所,有效抽样61 036人。按地域分为城市、城乡结合部及农村3类地区。由相关工作人员在全程质量控制下采用标准对数视力表检查受检者双眼裸眼视力,采用自动验光仪(TOPCON-RM8900)在非散瞳情况下行电脑验光检查。采用Microsoft Excel工作表建立数据库,SPSS 21.0软件进行统计学分析。

结果：2015年龙口市7～18岁中小学生的总体近视患病率为49.81%,11～12岁时总体近视患病率增幅最快,13岁时轻度近视患病率最高。男性和女性总体近视患病率分别为46.41%、53.39%,女性总体近视患病率高于男性。城市、城乡结合部及农村地区学生总体近视患病率分别为55.18%、49.75%、44.47%,城市学生总体近视患病率明显高于城乡结合部及农村地区。总体近视患病率与年龄呈正相关(r_s=0.943,P<0.05),即总体近视患病率随年龄的增长而逐渐升高。

结论：山东省龙口市2015年中小学生近视患病率较高,且随年龄的增长而逐渐升高,女性高于男性,城市高于城乡结合部及农村地区。     

青海省西宁市学龄前儿童视力及屈光状态调查

目的：对西宁市的4家幼儿园共1 084名学龄前儿童的视力及其屈光状态进行调查,以发现超出正常范围的视力异常及屈光异常。

方法：横断面调查研究。采用整体抽样的方法,于2019-10在西宁市城东、城西、城南和城北分别抽取4家幼儿园总计1 084名3～6岁学龄前儿童,检查其裸眼远视力,并使用屈光筛查仪检查屈光状态。

结果：西宁市幼儿园学龄前儿童视力异常检出率为12.21%,随着年龄的增长视力异常检出率有增加的趋势(χ²_lineartrend=94.40,P<0.05),且不同年龄组间比较具有差异性(χ²=293.55,P<0.05)。屈光异常占检查总人数的6.09%,随着年龄增长,复性远视散光比例降低(χ²_lineartrend=1.79,P>0.05)。

结论：西宁市学龄前儿童视力异常随年龄增长而逐渐增加; 屈光状态以散光为主,其中混合散光和单纯近视散光比例最高,其次为单纯远视散光和复性远视散光; 随着年龄增长,复性远视散光屈光度逐渐降低,符合儿童眼屈光发育的规律。     

渐进衍射型多焦点IOL植入术后视功能和视觉质量的研究

目的：评价渐进衍射型多焦点人工晶状体(multifocal intraocular lens,MIOL)植入术后的临床效果。

方法：采取随机对照临床试验研究方法,将年龄相关性白内障患者72例分为两组,32例32眼植入渐进衍射型MIOL,40例40眼植入单焦点人工晶状体(monofocal intraocular lens, MoIOL)。术后3mo进行裸眼远视力、中间视力、近视力及矫正远、近、中视力及对比敏感度检查,并进行视功能和生存质量问卷调查。

结果：术后3mo,多焦点组裸眼近视力高于单焦点组(P<0.05),中间距离视力(40,60,80cm)均高于单焦点组(P<0.05),两组裸眼远视力、矫正远视力、矫正近视力及最佳矫正远视力下近视力差异无统计学意义(P>0.05)。术后3mo两组对比敏感度相比差异无统计学意义(P>0.05)。术后多焦点组脱镜率高于单焦点组(P<0.05),视近满意度多焦点组好于单焦点组(P<0.05),术后不良视觉症状及视远满意度两组相比差异无统计学意义(P>0.05)。

结论：渐进衍射型MIOL能提供良好的全程视力和视觉质量,有效降低术后脱镜率,提高患者术后的生活质量。     

长沙市天心区应届高中毕业生视力与近视情况调查

目的：调查分析高中毕业生视力和近视情况,对近视防治工作提供参考依据。

方法：对2011/2013年长沙天心区8所高中的应届毕业学生10 593人进行视力和屈光状态检查,记录结果并进行统计学处理及分析。

结果：天心区应届高中毕业生近视眼患病率高达88.76%。2011年、2012年和2013年近视患病率分别为88.40%,88.91%和88.95%,无明显差异(P>0.05)。重点中学毕业生近视患病率较普通中学高, 女生近视患病率较男生高,差异均有统计学意义(P<0.01)。

结论：高中毕业生近视患病率高,应引起相关部门重视,制定有效措施防治近视的发生和进展。     

北海市海城区小学生屈光状态调查分析

目的：了解北海市海城区小学生屈光状态的流行现状。

方法：采用横断面研究,整群抽样调查的方法。选取2019-10/2020-01参加体检的北海市海城区共15所小学30 716名6～14岁学生,检测视力、小瞳下屈光度。采用SPSS17.0统计学软件进行数据分析。

结果：本次监测的15所小学30 716名61 432眼中,屈光状态以轻度近视(29.62%)、0.50D<散光<2.00D(25.43%)、正视(21.05%)及轻度远视(15.85%)为主。随着年龄的增长,正视及远视所占比例呈整体下降趋势; 而近视所占比例呈整体上升趋势。配戴框架眼镜者共1 894例3 788眼,视力不良眼戴镜率为23.30%,框架眼镜矫正合格率为64.57%。左眼和右眼等效球镜比较有差异,且右眼等效球镜P₅₀较左眼更趋于负值。男生和女生等效球镜比较有差异,且女生等效球镜P₅₀较男生更趋于负值。

结论：随着年龄的增长,轻度远视及正视眼的比例逐年下降; 近视眼的比例逐年上升。在视力不良的学生中,常规配戴眼镜的人数较少; 而戴镜后,仍有部分学生的框架眼镜矫正视力不达标。右眼较左眼的屈光状态更趋于负值; 女生较男生屈光状态更趋于负值。     

SMILE和FS-LASIK联合monovision治疗近视合并老视的疗效比较

目的：观察用monovision原理设计治疗近视合并老视在飞秒激光小切口基质透镜取出术(SMILE)和飞秒激光辅助原位角膜磨镶术(FS-LASIK)应用后的远视力、近视力。

方法：在我院行monovision设计进行近视激光治疗的近视合并老视患者,SMILE组10例20眼,年龄45±2.83岁,屈光度-5.42±1.74D; FS-LASIK组9例18眼,年龄45±1.97岁,屈光度-5.60±1.84D。组间及组内对比手术前后单眼及双眼远、近视力。

结果：术前SMILE组：主视眼：远视力0.05±0.04,近视力0.36±0.15; 客观眼：远视力0.35±0.11,近视力0.16±0.11; 双眼：远视力0.05±0.05,近视力0.18±0.09。术前FS-LASIK组：主视眼：远视力0.09±0.09,近视力0.42±0.17; 客观眼：远视力0.44±0.11,近视力0.19±0.10; 双眼：远视力0.03±0.04,近视力0.19±0.11。两组间术前各参数均无差异(P>0.05)。术后SMILE组：主视眼：远视力为-0.01±0.06,近视力为0.32±0.14; 客观眼：远视力0.16±0.18,近视力0.12±0.12; 双眼：远视力-0.04±0.07,近视力0.10±0.11。术后FS-LASIK组：主视眼：远视力0.03±0.03,近视力0.45±0.13; 客观眼：远视力0.20±0.15,近视力0.24±0.12; 双眼：远视力0.01±0.03,近视力0.22±0.09。术后两组双眼远视力、近视力均有差异(t=-2.383,P=0.034; t=-2.424,P=0.027)。SMILE组术后主视眼远视力(t=3.914,P=0.004),客观眼远视力(t=4.894,P=0.001),双眼远视力(t=4.870,P=0.001),双眼近视力(t=2.388,P=0.041)均优于术前预计视力。FS-LASIK组术后客观眼远视力优于术前(t=4.068,P=0.004)。

结论：对近视角膜屈光手术的患者,用monovision设计治疗老视,SMILE和FS-LASIK均能达到预计效果,但SMILE术后的双眼远、近视力更优。     

新疆叶城县6～18岁中小学生屈光状态筛查及近视戴镜率分析

目的：调查研究新疆叶城县6～18岁中小学生的屈光状态及近视戴镜率情况。

方法：横断面调查。于2021-10/2022-06采用以学校为单位的分层随机抽样法选取新疆喀什地区叶城县51所小学和30所中学学生81 863人纳入研究，收集学生的基本资料，并进行非睫状肌麻痹验光，检测裸眼远视力和戴镜矫正视力，观察不同年龄、性别及民族学生的屈光状态、近视戴镜率和足矫率情况。

结果：纳入学生近视检出率为13.39%(10958/81863)，戴镜率为23.96%(2626/10958)，足矫率为50.57%(1328/2626)。随着年龄的增长近视检出率呈一定的上升趋势，且女生近视检出率大于男生(15.75% vs 10.96%)，汉族、维吾尔族、其他民族学生近视检出率分别为68.12%、12.63%、22.42%。

结论：新疆叶城县6～18岁中心学生筛查性近视检出率及戴镜率均较低，而汉族学生近视检出率及戴镜率明显较维吾尔族及其他民族学生高。     

双眼单焦点与多焦点人工晶状体混搭植入术后视觉质量评估

目的：比较主视眼植入单焦点人工晶状体(SIOL)、对侧非主视眼植入多焦点人工晶状体(MIOL)和双眼均植入SIOL的临床疗效。

方法：选取2019-01/2021-01于成都爱尔眼科医院行白内障超声乳化联合IOL植入术的年龄相关性白内障患者60例120眼,主视眼均已植入SIOL,根据对侧非主视眼植入IOL的类型分为三组,其中A组患者18例36眼非主视眼植入MIOL(SBL-3); B组患者19例38眼非主视眼植入MIOL(SN6AD1); 对照组23例46眼双眼均植入SIOL。术后3mo,评估并比较三组患者双眼视力及视觉质量。

结果：术后3mo,三组患者双眼裸眼和矫正远视力、裸眼中视力及矫正近视力均无差异(P>0.05),A组和B组患者双眼裸眼近视力和矫正中视力均显著优于对照组(P<0.05)。Catquest 9SF-CN量表评分显示,A组和B组患者(11.11±1.323、11.89±1.883分)视觉质量均优于对照组(14.65±1.722分,均P<0.05)。A组、B组和对照组患者脱镜率分别为88.9%、84.2%、39.1%,A组患者脱镜率显著高于对照组(P<0.0167)。

结论：白内障患者主视眼植入SIOL、对侧非主视眼植入MIOL(SBL-3/SN6AD1)可获得较双眼均植入SIOL更优的全程视力,术后不良视觉症状少,脱镜率及满意度高。     

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.     

p53 expression in pterygium in two climatic regions in Turkey

Purpose:

To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey.

Materials and Methods:

Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson''s chi-square test was used to compare the p53 immunoreactivity.

Results:

The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group (P<0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 (P= 0.060).

Conclusion:

The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.     

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.     

Trends in Patterns of Anterior Uveitis in a Tertiary Institution in Singapore

Purpose: To report the trends in etiology of patients with anterior uveitis (AU) in Singapore over 6 years.

Methods: A retrospective review of the clinical records of all new patients who presented with anterior uveitis to the uveitis subspecialty clinic from 2005 to 2010 at Tan Tock Seng Hospital, Singapore.

Results: There were 552 new cases of AU. This comprised 59.5% of a total of 928 new patients diagnosed with uveitis from 2005 to 2010. The mean age was 48.0?±?17.2 years. There was a male predominance (62.5%), with a male:female ratio of 1.7:1. The majority were of Chinese ethnicity (69%), followed by Malays (13.2%). Most cases were unilateral (79.5%) and idiopathic (50.4%). Common etiological causes included Fuchs heterochromic iridocyclitis (FHI) (5.6%), ankylosing spondylitis (AS)-related AU (5.1%), herpes simplex virus (HSV) (4.7%), and herpes zoster virus (HZV) (4.5%). There were increasing trends in AS-related AU from 3.2% in 2008 to 6.5% in 2010, and psoriasis-associated AU from 1.7% in 2005 to 4.0% in 2008. There were decreasing trends in the incidence of FHI from 10.6% in 2006 to 4.7% in 2009. No change in incidence of viral etiologies was noted, but cytomegalovirus-related immune-recovery uveitis (IRU) comprised 7.4%. IRU showed an increasing trend from 1.7% in 2005 to 11.9% in 2007, then decreased to 3.3% in 2010. Using the Pearson chi-square test, there was no statistically significant association between ethnicities (Chinese, Malay, Indian) comparing infectious and noninfectious cases (p?=?0.788), idiopathic and nonidiopathic cases (p?=?0.170), or between the various etiologies of uveitis (p?=?0.168).

Conclusions: AU was the predominant form of uveitis seen at our centers. Infectious etiologies (18.5%) are the most common among nonidiopathic cases, with herpes viruses (9.2%) being most prevalent. Despite increased use of polymerase chain reaction (PCR) in the detection of microbial and viral DNA, there was no overall increase in detection of infectious causes for uveitis. The changes in CMV-related immune recovery uveitis from 2005 to 2010 could reflect a change in HIV management in Singapore.     

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews. Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49 D and the median refractive cylinder was ‐0.50 D (range zero to ‐4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.     

内毒素诱导的大鼠葡萄膜炎的巨噬细胞中Toll样受体4的表达

目的 探讨在内毒素诱导的Wistar大鼠葡萄膜炎中Toll样受体4(TLR4)阳性细胞与虹膜组织中巨噬细胞的动态变化和分布.方法 实验研究.Wistar大鼠50只,用随机数字法随机分为5组,每组10只,分别为正常对照(0 h)组、6 h组、12 h组、24 h组及48 h组.除0 h组外其余各组均足垫部注射霍乱弧菌内毒素200μg,注射后于裂隙灯显微镜下观察双眼前节炎症反应变化.按实验分组于0、6、12、24、48 h处死大鼠.取虹膜一睫状体及脉络膜组织.通过葡萄膜铺片免疫组织化学方法检测TLR4和巨噬细胞的标记CD163的表达.人工计数虹膜中TLR4~+与CD163~+的细胞并计算细胞密度,计算圆形和多形性的CD163~+细胞占所有CD163~+细胞的百分比.进一步采用免疫荧光双标记检测TLR4和CD163共表达的情况.通过单因素方差分析分别对大鼠虹膜内阳性细胞密度以及圆形、多形性CD163~+细胞的百分比进行统计学检验.结果 正常大鼠虹膜睫状体组织不表达TLR4.6 h组有2只大鼠虹膜内可见少量TLR4~+细胞,12～48 h组所有大鼠虹膜内TLR4~+细胞明显增多(F=167.2,P＜0.001),虹膜内TLR4~+细胞密度分别为(506.1±39.5)个/mm~2(12 h组)、(492.3±54.5)个/mm~2(24 h组)及(663.8±150.2)个/mm~2 (48 h组).在注射LPS后12～48 h期间TLR4~+细胞形态无明显变化.0～48 h组大鼠虹膜内均有CD163~+细胞,0 h组圆形和多形性CD163~+细胞百分比为13%,12～48 h组其百分比约为80%,且圆形细胞主要位于虹膜基质层.免疫荧光双标记可见TLR4和CD163的共表达,TLR4位于细胞膜,CD163位于细胞质.5组大鼠脉络膜内均未见TLR4表达.结论 内毒素诱导的大鼠葡萄膜炎中虹膜内TLR4表达增高,部分虹膜固有巨噬细胞表达TLR4.TLR4可能在葡萄膜炎的发生发展中起一定作用.     

弱视眼底光学相干断层扫描的研究进展

弱视是由于视觉发育关键期内各种异常的视觉经验导致单眼或双眼最佳矫正远视力低于正常同龄儿童,而眼部无明显器质性病变。目前普遍观点认为,弱视的发病机理主要源于视皮层。近年来,光学相干断层扫描（OCT）作为一种先进的活体成像技术,促进了对视网膜形态结构的大量研究,同时也被应用到弱视的研究领域。陆续有不同的研究人员利用OCT发现弱视患者眼底视网膜、脉络膜等眼部结构存在改变。笔者将对弱视眼底OCT的研究进展做一综述。