Omega-3治疗干眼的研究进展

干眼是眼科常见病、多发病,可以引起一系列严重影响患者视功能的并发症.近年来流行病学调查显示干眼患病率逐年增加.由于干眼病因繁多,发病机制复杂,目前临床上对干眼缺乏有效的治疗.近期学者们发现,口服omega-3甚至局部使用omega-3滴眼可以起到治疗干眼的作用.本文就omega-3治疗干眼的研究进展及其治疗干眼的机制作一综述,为干眼的治疗提供新的思路.     

氧化应激因素在干眼中的临床研究

干眼是由于泪液的量或质的异常引起的泪膜不稳定和眼表面的损害，从而导致眼不适症状的一类疾病。干眼与多种因素相关。本文主要探讨氧化应激因素对干眼的影响及临床治疗。针对氧化应激因素，干眼周期概念、干眼的眼表炎症和蛋白质组学相关研究证明了两者的相关性，有利于进行针对性临床治疗。针对氧化应激因素的治疗是干眼的潜在治疗方式，无防腐剂眼药水的使用、碘离子电渗疗法及其他蛋白质组学方法的临床试验证明了其合理性与有效性。随着近年来对抗老化药物、预防性整体健康以及环境科学作用的重视，对眼表氧化应激的研究可能会在未来几年产生越来越大的影响。     

基因组学在干眼研究中的应用进展

干眼是伴有眼部不适症状,严重影响患者工作和生活的一种常见眼表疾病。干眼的病因众多且易复发,难以有效地治愈。随着聚合酶链式反应(PCR)和免疫印迹实验(Western blot)等技术在干眼研究领域的运用,宏基因组学、基因工程动物及基因转染等基因组学事件在干眼研究中得到了进一步的探索。本文旨在总结基因组学在干眼研究中的应用进展,为进一步揭示干眼发生的危险因素和发病机制,探索有效治疗干眼的新型药物和疗法提供重要依据。     

针灸治疗干眼的代谢组学分析

目的:探讨干眼(DED)发病及其有效治疗的分子机制。方法:采用超高效液相色谱-四极杆飞行时间质谱(UHPLC-Q-TOF-MS)非靶向技术对18例经药物或针灸治疗的DED患者的泪液样本进行代谢组学研究。结果:在待测样品中共鉴定出190种代谢物,是迄今为止最广泛的泪液代谢组学研究。结果表明,所有患者的代谢组学特征明显不同,但药物或针灸治疗后的代谢组学差异非常细微。药物治疗后只有6种代谢物发生显著变化,其中肌苷、单胺四乙酸、尿酸盐、丙酰胆碱、烟酰胺等5种代谢物的含量均增加并参与炎症反应。针刺治疗后只有4种代谢物,其中丙氨酸、丝氨酸和高丝氨酸的含量有显著差异。对上述显著变化的代谢物的代谢途径进一步分析表明,针灸治疗的患者只有1种代谢途径,即氨酰tRNA生物合成受到显著影响,这与疾病的病因高度相关,表明针灸疗法可以解决干眼的病因,而不是症状,与药物治疗相比,在一定程度上显示出更好的疗效。结论:代谢组学分析有助于明确有效治疗干眼的潜在机制中涉及到的关键调控因素或途径,并将有助于为DED治疗提供新的潜在靶点和策略。     

关注干眼患者的心理问题

干眼是最常见的眼表疾病，长期慢性眼表疼痛、刺激感、视疲劳等症状严重影响患者的生活质量。部分患者对治疗失去信心、对工作和生活缺乏热情，流行病学研究显示干眼与焦虑、抑郁具有明显的相关性。干眼的积极治疗有利于患者抑郁状态的缓解，而有效的抑郁治疗又有助于干眼症状的缓解，因此眼科医生应关注干眼相关抑郁、焦虑等心理障碍的类型、机制及预防治疗措施。     

中山大学中山眼科中心干眼整体护理方案

干眼为最常见的眼表疾病之一,以泪膜稳态丢失及伴随眼部症状为特征.干眼的治疗以消除病因、缓解症状和保护视功能为目标,而其中的心理护理、眼睑物理治疗、健康宣教和院外管理尤为重要.优质的整体护理方案有助于干眼患者的治疗.本团队在参考干眼诊疗共识的基础上,结合自身护理经验,为干眼患者制定了个性化、涵盖全面的整体护理方案并运用.     

黏蛋白和干眼的研究进展

干眼是由于泪液的质和量的异常引起泪膜的不稳定和眼表损害，从而导致眼部不适。黏蛋白是泪膜的重要成分，对维持眼表稳定及预防眼表病变起着重要作用。对眼表黏蛋白的功能和调节机制的研究将为干眼的治疗提供新的有效途径。[眼科新进展2007；27（3）：239-2,40]     

间充质干细胞源性外泌体治疗干眼的研究进展

外泌体是一种细胞外囊泡,通过生物分子传递改变受体细胞的生化特性,并在细胞通讯中发挥作用。其中,间充质干细胞源性外泌体(MSC-Exos)是由间充质干细胞分泌的双层脂质囊泡,具有与间充质干细胞(MSCs)相似的功能,并携带蛋白质、脂质和核酸等生物活性物质,可作为细胞间通讯的媒介参与免疫调节、组织损伤修复和促进血管生成等多种重要生理过程,近年来在治疗免疫炎性疾病、缺血性疾病等相关领域成为研究的热点。本文从MSC-Exos的生物学功能出发,针对干眼不同发病机制如炎症反应、神经及组织修复等,阐述其治疗干眼的可能机制,以期为MSC-Exos在干眼治疗中的应用奠定基础,并为未来的临床应用提供参考依据。     

氟米龙滴眼液治疗干眼的国内外研究进展

干眼是全球普遍存在的眼科疾患,患病率与日俱增。干眼的治疗措施虽多,但临床效果并不尽如人意。炎症与干眼的关系密切,抗炎治疗逐渐受到越来越多的重视,以氟米龙的研究和应用最为成熟。本文通过回顾性研究国内外氟米龙作用干眼的临床和实验研究现状,探讨以氟米龙为代表的抗炎药物治疗干眼的疗效,同时提出其发展的问题及不足之处,为氟米龙治疗干眼的进一步研究奠定基础,为临床使用抗炎药物治疗干眼提供强有力的理论依据。     

蛋白组学在干眼研究中的应用进展

干眼的病理机制复杂,涉及免疫、炎症等多种通路,需要整体研究方案从全局进行把控。各类组学技术可以从整体和全局的高度阐明生物体复杂的生理病理状态,提供更加全面的生物信息。质谱技术可以灵敏检测出泪液样本中的蛋白含量变化,为干眼的蛋白组学研究提供了便捷条件。目前蛋白组学在干眼类型鉴别、严重程度分级、疗效评价等方面都显示出应用价值,并且与代谢组学、微生物组学联用可以更加全面地阐释干眼发病机制。未来蛋白组学有望为干眼的精准诊疗提供更加有力的支持,并在靶向治疗中发挥优势。     

Dry Eye Disease

Dry eye (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation. DED is a common clinical problem and is among the most frequent diagnoses in ophthalmology. It substantially affects quality of life because of the constant ocular discomfort and decrease in visual function. This review discusses the etiology, classification, diagnosis procedures, clinical, and surgical treatments of dry eye.     

New approaches for diagnosis of dry eye disease

We reviewed the literature for different diagnostic approaches for dry eye disease (DED) including the most recent advances, contradictions and promising diagnostic tools and technique. We performed a broad literature search for articles discussing different methods for diagnosis of DED including assessment of tear osmolarity, tear film stability, ocular biomarkers and others. Articles indexed in PubMed and google scholar were included. With the growing cosmetic industry, environmental pollution, and booming of digital screens, DED is becoming more prevalent. Its multifactorial etiology renders the diagnosis challenging and invites the emergence of new diagnostic tools and tests. Diagnostic tools can be classified, based on the parameter they measure, into tear film osmolarity, functional visual acuity, tear volume, tear turnover, tear film stability, tear film composition, ocular biomarkers and others. Although numerous methods exist, the most accurate diagnosis can be reached through combining the results of more than one test. Many reported tests have shown potential as diagnostic/screening tools, however, require more research to prove their diagnostic power, alone or in combination. Future research should focus on identifying and measuring parameters that are the most specific to DED diagnosis.     

Transgenic dry eye mouse models: powerful tools to study dry eye disease

Dry eye disease (DED) is one of the most common chronic multifactorial ocular surface diseases with high prevalence and complex pathogenesis. DED results in several ocular discomforts, vision fluctuation, and even potential damage of the ocular surface, bringing heavy burdens both on individuals and the society. The pathology of DED consists of tear film hyperosmolarity and immune responses on the ocular surface. Mice are widely used for developing models that simulate human DED features for investigating its pathogenesis and treatment. DED can be classified into aqueous-deficiency dry eye (ADDE) and evaporative dry eye (EDE). ADDE can be further divided into Sjögren syndrome dry eye (SSDE) and non-Sjögren syndrome dry eye (NSSDE). SSDE mouse models include natural strains, typified by non-obese diabetic (NOD) mice, and genetically engineered ones, like Aire-/- and Id3 knockout mice. Intrinsic EDE mainly refers to meibomian gland dysfunction (MGD). Eda-/- Tabby, Sod1-/-, Elovl1-/- are the most common transgenic MGD mouse models. Transgenic mouse models provide useful tools for studying the pathogenesis of DED and evaluating its novel therapies. This review compares the major transgenic dry eye mouse models and discusses their applications in DED research.     

Ocular surface immunity: homeostatic mechanisms and their disruption in dry eye disease

The tear film, lacrimal glands, corneal and conjunctival epithelia and Meibomian glands work together as a lacrimal functional unit (LFU) to preserve the integrity and function of the ocular surface. The integrity of this unit is necessary for the health and normal function of the eye and visual system. Nervous connections and systemic hormones are well known factors that maintain the homeostasis of the ocular surface. They control the response to internal and external stimuli. Our and others' studies show that immunological mechanisms also play a pivotal role in regulating the ocular surface environment. Our studies demonstrate how anti-inflammatory factors such as the expression of vascular endothelial growth factor receptor-3 (VEGFR-3) in corneal cells, immature corneal resident antigen-presenting cells, and regulatory T cells play an active role in protecting the ocular surface. Dry eye disease (DED) affects millions of people worldwide and negatively influences the quality of life for patients. In its most severe forms, DED may lead to blindness. The etiology and pathogenesis of DED remain largely unclear. Nonetheless, in this review we summarize the role of the disruption of afferent and efferent immunoregulatory mechanisms that are responsible for the chronicity of the disease, its symptoms, and its clinical signs. We illustrate current anti-inflammatory treatments for DED and propose that prevention of the disruption of immunoregulatory mechanisms may represent a promising therapeutic strategy towards controlling ocular surface inflammation.     

Role of lymphotoxin alpha as a new molecular biomarker in revolutionizing tear diagnostic testing for dry eye disease

Dry eye disease (DED), primarily classified as multifactorial ocular surface disorder, afflicts tens of millions of individuals worldwide, adversely impacting their quality of life. Extensive research has been conducted on tear film analysis over the past decades, offering a range of tests to evaluate its volume, health, and integrity. Yet, early diagnosis and effective treatment for DED continue to pose significant challenges in clinical settings. Nevertheless, by recognizing key phenomena in DED such as ocular surface inflammation, hyperosmolarity, and tear film instability, this article provides a comprehensive overview of both traditional and recently developed methods for diagnosing and monitoring DED. The information serves as a valuable resource not only for clinical diagnosis but also for further research into DED.     

Dry eye disease and proteomics

Dry eye disease (DED) is a highly prevalent disease worldwide mostly associated with age, though other factors such as screen use and contact lens wear explain why it is increasingly diagnosed in younger people. DED also disproportionately affects women. Symptoms include eye dryness, burning, pain and sensitivity to light that can significantly affect quality of life. This condition may progress to cause lasting damage to the ocular surface if left untreated. Currently, diagnosis is through assessment of signs and symptoms determined by clinical tests and questionnaires. However, there is considerable overlap between normal and DED result distributions of currently available metrics as signs and symptoms fluctuate over time and with disease severity.Importantly, the non-targeted approach of proteomics means that significant changes in novel proteins may be discovered. Proteomics is a powerful tool that has been applied to the field of DED to understand changes at a biochemical level, uncover new disease biomarkers and determine the success of clinical interventions. While individual proteins may not be sensitive enough when used as single biomarkers, proteomics opens the possibility to uncover several relevant proteins that may be combined in a panel to provide more accurate diagnostic value i.e. parallel testing. In this review we discuss the use of proteomics in DED research and the potential for application of proteomic results in the clinic. We also identify shortcomings and future avenues for research.     

Metabolomics analysis revealed acupuncture treatment target the upstream for dry eye disease

AIM: To find out the pathogenesis of dry eye disease (DED) and the possible mechanisms of available effective treatments. METHODS: A non-targeted technology, ultra-high performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF-MS), to investigate metabolic characterizations for tear samples from 18 patients with DED upon drug or acupuncture treatment. RESULTS: A total of 190 named metabolites were identified, which presented so far the broadest tear metabolome. Further analysis indicated a significantly distinct metabolomics profile among all patients, but very subtle metabolic differences upon drug or acupuncture treatment. On one hand, only six significantly changed metabolites were determined after drug treatment, five of which including inosine, monopalmitin, urate, propionylcarnitine, and nicotinamide were all increased and involved in inflammatory responses. On the other hand, merely four metabolites including alanine, serine, and homoserine were found to be significantly different. Further pathway analysis of those six and four significantly changed metabolites revealed that only one pathway, aminoacyl-tRNA biosynthesis was significantly influenced in acupuncture-treated patients, which were highly associated with the cause of the disease. The results here indicated acupuncture treatment may address the cause rather than the symptoms for dry eye disease, displaying partially better compared with drug treatment. CONCLUSION: Collectively, this work extended our understanding on the key regulatory elements or pathways involved in the potential mechanisms of available effective treatments, and would be useful for providing novel potential targets and therapeutic strategies for DED.     

诊断干眼的非侵入性新检测技术及应用价值

本文对诊断干眼的非侵入性新检测技术及其在干眼诊断中的作用进行综述,其中包括泪液量、泪膜稳定性、睑板腺形态及功能、角膜形态、生物标志物、眼表温度的成像技术,以及泪液渗透压、光学质量、眨眼测试等。新的检测技术可提供客观参数以评价眼表、泪液情况及视觉质量等。泪液量、睑板腺成像和泪液渗透压等检测技术已被广泛认可并应用于临床,与传统测试相比表现出了更高的特异性和敏感性。其它检测技术,如SM技术,干涉术、光散射技术、双通道系统,眨眼测试等目前处于临床研究阶段,未来或将转化为临床常规检测技术。新的检测技术,可无创评估眼表及泪液情况,并测量与病情相关的成分变化,在干眼的诊断、分类、临床管理和疗效评估中发挥重要作用。     

Keratitis in Dry Eye Disease and Topical Ciclosporin A

Tear film alterations in dry eye disease (DED) include reduced tear volume and an increase in inflammatory cytokines. Instability and reduced tear production initiate a vicious cycle where hyperosmolarity, ocular inflammation, and apoptosis may induce damage of the ocular surface including keratitis. Topical cyclosporine (CsA) has been used for the treatment of moderate-to-severe DED; however, previous studies failed to demonstrate its benefits by the European Agency standards. A new formulation of CsA 0.1% has been recently approved in the EU to treat severe keratitis in DED patients. Patients with severe keratitis showed a better improvement after 6 months of treatment with CsA compared with vehicle. HLA-DR expression was significantly reduced by CsA treatment. The clinically significant improvement in keratitis associated with the inflammatory biomarker HLA-DR confirms the efficacy of CsA to improve inflammation and its damaging effect on the ocular surface in DED patients.     

An overview on dry eye disease diagnosis: options for new non-invasive testing technologies

This literature review intends to provide an overview of the new non-invasive testing technologies and their role in the diagnosis of dry eye disease (DED). Including imaging technologies of tear volume, tear film stability, meibomian glands morphology and function, corneal morphology, biomarkers and ocular surface temperature, as well as tear osmolarity, optical quality, blinking test and so on. New testing technologies can provide an indirect and objective assessment of the ocular surface, tear condition and visual quality. Testing technologies, such as tear volume, meibography and tear osmolarity have been widely recognized and applied in clinical practice, showing higher specificity and sensitivity than traditional tests. Others, such as strip meniscometry, interferometer, light scattering technology, double-pass system, blinking test and so on, are currently in the stage of clinical research and improvement, and may translate to routine clinical detection techniques in the future. The new non-invasive testing technologies can non-invasively evaluate the ocular surface and tears, and measure the changes of components related to the disease, which play an important role in the diagnosis, classification, clinical management and curative effect evaluation of DED.