北京市城乡40岁以上限定人群视网膜血管异常的患病率

目的描述北京市城乡限定人群视网膜血管异常（RMA）患病率及其分布特征。设计横断面研究。研究对象“北京眼病研究”城乡40岁以上居民4439人。方法对每位受检者进行问卷调查和全面眼科检查,其中包括散瞳后彩色眼底照相检查。随机选每位受检者一眼进行眼底照片中视网膜血管异常的评价。局限性视网膜血管异常（局限性视网膜动脉缩窄、动静脉交叉压迫征和视网膜病变）采用定性方法评价;弥漫性视网膜动脉缩窄采用计算机辅助的定量方法评价。计算以上各种视网膜血管异常的患病率,并分析其分布特征。主要指标视网膜血管异常的患病率。结果局限性视网膜动脉缩窄、动静脉交叉压迫征和视网膜病变的患病率分别为7．5％、7．2％和7．5％,三者均随年龄的增加而逐渐增加（P〈0．001）;男性的视网膜血管异常患病率（24．4％）明显比女性（17．6％）高（P〈0．001）。各种局限性视网膜血管异常和弥漫性视网膜动脉缩窄的患病率在农村人群均明显高于城市人群（P均〈0．001）。结论北京市限定地区城乡40岁以上人群中视网膜血管异常并不少见,其患病率随年龄增加逐渐增加;农村居民比城市居民患病率高。     

视网膜微血管异常与心脑血管疾病关系的流行病学研究

近年来人群为基础的流行病学调查,对眼底照片中视网膜微血管异常进行定性和定量评价,观察其与高血压病、脑卒中及冠心病等心脑血管疾病之间的关系。结果表明,视网膜微血管异常与心脑血管疾病的发生、发展以及预后密切相关;弥漫性视网膜动脉缩窄和动静脉交叉征是慢性高血压引起的血管损伤的标志;局限性动脉缩窄、视网膜出血、微动脉瘤和棉絮斑等则反映近期高血压病的严重程度;视网膜微血管异常可成为高血压病、脑卒中以及冠心病等发病及病程进展的预测因素。     

视网膜分支静脉阻塞视网膜微血管改变的定量研究

【摘要】 目的 研究视网膜分支静脉阻塞（BRVO）患者视网膜微血管改变的特点。设计 病例对照研究。研究对象 河北省邯郸市眼科医院连续的BRVO患者58例,对照组为“邯郸眼病研究”中按匹配原则抽取的非BRVO者200例。方法 对被研究者的眼底彩色照片定性判读视网膜微血管局部改变;利用计算机辅助软件（IVAN software, Australia）定量测量视网膜微血管管径,比较两组间的差异。主要指标 视网膜微血管局部改变包括局部视网膜动脉缩窄（FAN）、视网膜动静脉交叉压迫征（AVN）和动脉反光增强（OPAC）。定量测量指标为视网膜中央动脉直径（CRAE）、视网膜中央静脉直径（CRVE）和视网膜动静脉比值（AVR）。结果 CRAE、CRVE、AVR在BRVO组和非BRVO组分别为（136.0±20.7） μm Vs. （152.0±19.3） μm（P=0.000）;（207.2±23.1） μm Vs. （235.3±29.7） μm（P=0.000）;（0.66±0.13） Vs. （0.65±0.06）（P=0.019）。经多因素校正后视网膜血管局部改变FAN、AVN和OPAC在两组间比较的相对危险度分别为5.65（95%CI=1.77~18.03）、3.42（95%CI=1.48~7.89）和3.44（95%CI=1.44~8.24）（P均<0.05）。结论 视网膜动、静脉直径在BRVO者比非BRVO者均变窄,视网膜血管的局部改变在BRVO者比非BRVO者显著,因此视网膜血管的定量、定性分析可作为BRVO的观察指标。（眼科,2012,21：239-243）     

视网膜微血管异常与心脑血管疾病关系的流行病学研究

近年来人群为基础的流行病学调查，对眼底照片中视网膜微血管异常进行定性和定量评价，观察其与高血压病、脑卒中及冠心病等心脑血管疾病之间的关系。结果表明，视网膜微血管异常与心脑血管疾病的发生、发展以及预后密切相关；弥漫性视网膜动脉缩窄和动静脉交叉征是慢性高血压引起的血管损伤的标志；局限性动脉缩窄、视网膜出血、微动脉瘤和棉絮斑等则反映近期高血压病的严重程度；视网膜微血管异常可成为高血压病、脑卒中以及冠心病等发病及病程进展的预测因素。     

眼底指标改变与脑卒中患病的相关性

【摘要】 目的  探讨眼底指标改变与脑卒中患病风险的相关性。设计  病例对照研究。研究对象  北京同仁医院、北京天坛医院年龄（63.6±10.2）岁的脑卒中患者450例,对照组为年龄（62.5±8.7）岁“北京眼病研究”非脑卒中受检者566例。方法  所有受试者单张45度眼底数码照相。两位眼科医师盲法评价眼底指标改变。应用Logistic 回归分析眼底指标与脑卒中患病的相关性及脑卒中发病风险性,应用Orange 2 软件统计图对分析结果进行可视化。主要指标  视网膜神经纤维层缺损（RNFLD）、视网膜动脉缩窄、动静脉交叉压迫征、视网膜静脉迂曲扩张、视盘改变、黄斑病变的构成比及与脑卒中患病的OR值。结果 非脑卒中组、脑卒中组视网膜动脉管径缩窄出现率分别为46.3%、65.1%（P<0.05）,视网膜静脉扩张出现率分别为12.5%、38.0%（P<0.05）,RNFLD出现率分别为12.7%、38.0%（P<0.05）,视网膜棉絮斑出现率分别为1.6%、4.4%（P<0.05）,视网膜出血出现率分别为4.6%、11.3%（P<0.05）,视盘病变出现率分别为7.1%、16.9%（P<0.05）,黄斑病变出现率分别为6.4%、13.1%（P<0.05）。Logistic 回归分析显示,RNFLD（OR=4.163, 95%CI 2.792-6.208）和视网膜静脉扩张（OR=3.443, 95%CI 2.333-5.082）与脑卒中患病高度相关。除性别对于脑卒中患病有负向影响（男性更易罹患脑卒中）外,RNLFD、视网膜静脉扩张、黄斑病变对脑卒中患病有正向影响。在眼底组合指标中,视网膜动脉缩窄、静脉扩张、RNFLD同时存在与脑卒中患病相关性最大。结论  眼底RNLFD、视网膜动脉缩窄、静脉扩张三项指标联合对脑卒中发病预警有重要提示作用,眼底血管变化与RNFLD改变可为脑血管病变的筛查提供简易方法。（眼科, 2015, 24： 13-18）     

动态血压,偶测血压与高血压性视网膜病变相关性的研究

目的研究２４ｈ动态血压与高血压性视网膜病变的关系。方法应用２４ｈ动态血压监测，并与偶测血压比较，以３１例正常血压者作对照，观察了９５例高血压病人的视网膜病变。结果２４ｈ、白昼、夜间平均血压及血压负荷与视网膜病变呈正相关（Ｐ＜０．０５），以舒张压与视网膜病变的相关性最为显著（Ｐ＜０．０１）。偶测舒张压与视网膜病变呈正相关（Ｐ＜０．０５），偶测收缩压与视网膜病变无相关性（Ｐ＞０．０５）。血压昼夜节律紊乱则视网膜病变较严重。组间两两比较正常血压组与高－正常血压组的视网膜病变无显著性差异（Ｐ＞０．０５），而正常血压组与１、２、３级高血压组间视网膜病变差异呈显著性（Ｐ＜０．０５）。结论动态血压与高血压性视网膜病变相关性要较偶测血压为好，舒张压增高对视网膜病变的作用更显著。     

视网膜微血管异常与心脑血管健康评估

要点 ·视网膜微血管异常包括视网膜微动脉瘤、出血、棉絮斑、硬性渗出、水肿等视网膜病变和视网膜动脉缩窄、动静脉交叉压迫征、动脉白鞘等视网膜血管改变 ·视网膜微血管异常的评价方法有定性、定量两种 ·视网膜微血管异常可出现于心脑血管疾病之前,并可能预测心脑血管疾病的发生、病程及预后 ·视网膜血管地形特征的描述将成为个体独立的心脑血管疾病危险性的评价标志     

本期导读

本期以眼底疾病诊治及眼病流行病学研究为报道重点。
 近年来特发性黄斑裂孔手术后裂孔闭合率逐步提高,患者围手术期的生活质量受到更多关注。术后俯卧位影响患者生活质量,对一些患有基础疾病的患者,保持长时间的俯卧位比较困难,且可能会诱发或加重心脏病、深静脉血栓,李筱荣等就特发性黄斑裂孔患者玻璃体切除术后俯卧位的必要性撰写了述评,指出术后采用更短效气体填充且术后不用俯卧位可能是将来研究和发展的趋势。白内障超声乳化吸除术对于糖尿病合并白内障患者具有特殊意义,手术不仅为改善视力而且为及时筛检和治疗糖尿病视网膜病变（DR）提供便利,有研究表明,白内障摘除术后DR进展加速,也有研究报道认为白内障摘除术后DR进展与白内障摘除术无关,与患者糖尿病控制差、病程长及胰岛素治疗等因素相关,刘巨平等用Meta分析的方法,纳入以对侧眼作为对照的前瞻性研究对白内障超声乳化术是否会加速DR进展和增加DME发生率进行了评价,结果表明,白内障超声乳化术会加速糖尿病合并白内障患者糖尿病视网膜病变进程且增加糖尿病性黄斑水肿的发生率,但仍需大样本、长期随访的研究进一步证实。张鹏等的病例对照研究探讨视网膜中央静脉阻塞（CRVO）与静脉血栓危险因素之间的相关性,结果发现颈动脉粥样硬化、血中高水平的Hcys以及低叶酸与CRVO的发生密切相关,控制这些与血栓有关的危险因素可能有助于CRVO的防治。王爽等以“北京眼病研究”人群为基础的队列研究描述该人群从2001年随访至2006年5年间非糖尿病的中老年人中视网膜微血管异常的累积发病率,并分析其与高血压的相关性,研究显示在非糖尿病患者中高血压与视网膜微血管异常的发病率和进展变化具有强相关性;血压控制理想者的视网膜微血管异常发病率较低,局限性动脉缩窄好转率较高,表明如果高血压控制良好,作为视网膜微血管异常的早期表现,局限性视网膜动脉缩窄是可逆的。郭燕等对湖南省儿童医院近两年的早产儿进行眼底检查,了解早产儿视网膜病变（ROP）的发病情况及危险因素,认为对于出生体重＞2000 g的早产儿,在各方面条件允许的情况下,尽量进行ROP筛查,以避免漏诊后造成严重后果。对于出生体重＞3000 g的早产儿,则需根据临床情况进行选择性检查。曾惠阳等的实验研究发现在视网膜变性模型rd小鼠视网膜中β趋化因子受体1（CCR1）表达于感光细胞并随其变性程度加重表达升高,CCR1的活化可能在rd小鼠感光细胞凋亡中发挥作用。贾红艳等通过对一个X连锁隐性遗传家族性渗出性玻璃体视网膜病变（FEVR）家系进行致病基因的突变筛查研究,发现一个新的错义突变G113D。沈志军等通过研究当归提取液对培养的成年人视网膜神经细胞活性的影响,发现当归提取液对成年人视网膜神经细胞有一定的保护作用,有望成为一种新的防治视网膜疾病的辅助药物。
 苏炳南等应用长波长前节OCT对睑板腺进行扫描,观察睑板腺开口阻塞情况及脂栓形成的睑板腺开口数量,并测量睑板腺腺体宽度及距睑结膜位置等,发现使用长波长前节OCT可较好地显示睑板腺开口和睑板腺的分布形态,对睑板腺功能障碍（MGD）的诊断具有一定的应用价值。霍艳娇等的研究发现Cirrus-HD OCT测得的黄斑神经节细胞-内丛状层厚度参数与视盘周围RNFL厚度参数类似,具有较好地区别正常个体和早期青光眼患者的能力,可作为早期青光眼诊断的有用工具。
 本期还刊登了与羟基磷灰石义眼台暴露的手术修复及眼外伤有关的短篇论著;与全身应用抗心律失常、抗精神病药物相关的眼部并发表现、角膜溃疡穿孔的应急处理、多发性大动脉炎的眼底表现等相关病例报告等,希望能引起读者关注。     

无需使用造影剂的宽域毛细血管造影

目的评估毛细血管异常形态在常见视网膜病变的早期诊断、治疗和随访中的作用。方法系列病例研究。收集糖尿病视网膜病变、视网膜静脉阻塞、中心性浆液性视网膜病变、年龄相关性黄斑变性和代谢综合征的患者130例,以及37例健康志愿者。对这些研究对象采用视网膜功能成像仪（RFI）拍摄无创伤性毛细血管的灌注（nCPM）图像。图像经过处理,使用像素值的变化来分析血管中红细胞的运动。结果由RFI产生的nCPMs图像可显示微血管的详细形态,该功能与目前的金标准眼底荧光素血管造影（FFA）显示的微血管的细节相同。成像结果可以清楚地显示视网膜的新生血管和毛细血管无灌注区;同时清晰地显示黄斑中心凹无血管区（FAZ）的范围,并发现糖尿病视网膜病变患者的FAZ直径较正常对照组大[（641.5±82.3）µm vs. （463.7±105.0）µm,P<0.01];并且可以发现FFA无法显示的血管异常形态,如分流和血管环路。结论基于追踪红细胞的运动来作为血管造影剂的活体视网膜毛细血管造影是一种非侵入性、舒适、安全和可重复应用的血管造影手段,可用于视网膜疾病的早期诊断、治疗指导以及随访。     

糖尿病性视网膜病变治疗进展

糖尿病视网膜病变（DR）是糖尿病最常见最严重的微血管并发症之一。糖尿病视网膜病变病理特征是视网膜新生血管形成和BRB破坏，它是糖尿病患者视力丧失主要原因。DR的高发病率、高致盲率的特点，严重威胁着人类的生存质量，是当今医学领域急需解决的重大攻关课题，受到国内外医学界的高度重视，严格的血糖、血压控制和激光光凝术是治疗和预防糖尿病视网膜病变，减少失明的主要措施。本文通过文献回顾，对糖尿病性视网膜病变的治疗进行综述。     

The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study

PURPOSE: To describe the prevalence of retinal microvascular characteristics and their associations with atherosclerosis in elderly, nondiabetic persons. DESIGN AND PARTICIPANTS: Population-based, cross-sectional study comprising 2050 men and women aged 69 to 97 years without diabetes, living in four communities. METHODS: Participants underwent retinal photography and standardized grading of retinal microvascular characteristics, including retinopathy (e.g., microaneurysms, retinal hemorrhages), focal arteriolar narrowing, and arteriovenous nicking. In addition, calibers of retinal arterioles and venules were measured on digitized photographs to obtain an estimate of generalized arteriolar narrowing. Atherosclerosis and its risk factors were obtained from clinical examination and laboratory investigations. MAIN OUTCOME MEASURES: Prevalence of retinal microvascular abnormalities and their associations with measures of atherosclerosis. RESULTS: The prevalence of retinal microvascular abnormalities was 8.3% for retinopathy, 9.6% for focal arteriolar narrowing, and 7.7% for arteriovenous nicking. All retinal lesions were associated with hypertension (odds ratios [OR] were 1.8 for retinopathy, 2.1 for focal arteriolar narrowing, 1.5 for arteriovenous nicking, and 1.7 for generalized arteriolar narrowing). After controlling for age, gender, race, mean arterial blood pressure, and antihypertensive medication use, retinopathy was associated with prevalent coronary heart disease (OR, 1.7), prevalent myocardial infarction (OR, 1.7), prevalent stroke (OR, 2.0), presence of carotid artery plaque (OR, 1.9), and increased intima-media thickness of the common carotid (OR, 2.3; fourth vs. first quartile) and internal carotid (OR, 1.8; fourth vs. first quartile) arteries. In contrast, focal arteriolar narrowing, arteriovenous nicking, and generalized arteriolar narrowing were not associated with any measures of atherosclerosis. CONCLUSIONS: Retinal microvascular abnormalities are common in older persons without diabetes and are related to hypertension. Retinopathy is associated with prevalent coronary heart disease, stroke, and carotid artery thickening, but focal and generalized arteriolar narrowing and arteriovenous nicking are not related to most measures of atherosclerosis. These data suggest that retinal microvascular abnormalities reflect processes associated with hypertension but distinct from atherosclerosis.     

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

PURPOSE: To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population. METHODS: The Blue Mountains Eye Study examined 3654 residents aged 49+ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines. RESULTS: Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n=261), retinal vein occlusion (n=52) or missing/un-gradable photographs (n=102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (Pfor trend=0.012). Neither fasting blood glucose (age-sex-adjusted P=0.147) nor hypertension (adjusted Pfor trend=0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0). CONCLUSIONS: Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.     

Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality

Retinal microvascular abnormalities, such as generalized and focal arteriolar narrowing, arteriovenous nicking and retinopathy, reflect cumulative vascular damage from hypertension, aging, and other processes. Epidemiological studies indicate that these abnormalities can be observed in 2-15% of the nondiabetic general population and are strongly and consistently associated with elevated blood pressure. Generalized arteriolar narrowing and arteriovenous nicking also appear to be irreversible long-term markers of hypertension, related not only to current but past blood pressure levels as well. There are data supporting an association between retinal microvascular abnormalities and stroke, but there is no convincing evidence of an independent or direct association with atherosclerosis, ischemic heart disease, or cardiovascular mortality. New computer-related imaging methods are currently being developed to detect the presence and severity of retinal arteriolar narrowing and other microvascular characteristics. When reliably quantified, retinal microvascular abnormalities may be useful as risk indicators for cerebrovascular diseases.     

The relation of retinal microvascular characteristics to age-related eye disease: the Beaver Dam eye study

PURPOSE: To examine the relationship between microvascular characteristics (central retinal artery equivalent [CRAE], central retinal vein equivalent [CRVE], arteriole-to-venule ratio [AVR], focal retinal arteriolar narrowing, arteriovenous [A/V] nicking, and retinopathy) associated with systemic hypertension and ocular disease (age-related maculopathy [ARM], three types of cataract, and open-angle glaucoma). DESIGN: Population-based cohort study. METHODS: Standardized grading of microvascular characteristics was performed at baseline on fundus photographs taken on 4,926 persons aged 43 to 86 years who participated in the Beaver Dam Eye study at the baseline examination. Age-related maculopathy, cataract, and glaucoma status were determined at baseline; ARM and cataract were again determined at 5-year and 10-year follow-up examinations using standard protocols. RESULTS: While controlling for age and sex, generalized retinal arteriolar narrowing (lowest quintile of CRAE) was associated with the 10-year cumulative incidence of retinal pigment epithelial (RPE) depigmentation (risk ratio [RR] 1st vs 5th quintile, 1.93; 95% confidence interval [CI], 1.11, 3.34) and, inversely, with incident nuclear cataract (RR, 0.71; 95% CI, 0.50, 0.99). Arteriovenous nicking was associated with the incidence of early ARM (RR, 2.39; 95% CI, 1.02, 5.57). Otherwise, there were no statistically significant associations of focal arteriolar narrowing or retinopathy with incident ARM or any type of age-related cataract and no relation of CRAE, focal arteriolar narrowing, A/V nicking, or retinopathy with the prevalence of glaucoma. CONCLUSION: These data show that retinal vascular characteristics associated with hypertension are related to the incidence of ARM and nuclear cataract but not to prevalent glaucoma. Relationships, however, were weak and inconsistent.     

Retinal arteriolar changes in malignant arterial hypertension

Experimental renovascular malignant arterial hypertension was produced by modified Goldblatt's procedures, in 60 rhesus monkeys, and various retinal arteriolar changes in hypertensive retinopathy were studied in detail (by serial ophthalmoscopy, and stereoscopic color fundus photography and fluorescein fundus angiography on long-term follow-up). The retinal arteriolar changes, in ophthalmoscopically visible arterioles, consisted of arteriolar sclerosis and associated changes, e.g., increased arteriolar tortuosity, arteriolar narrowing and in some animals occlusion and sheathing of the fine arterioles; we could find no evidence of localized or generalized 'spasm' in these retinal arterioles. Eyes in animals with accelerated arterial hypertension revealed focal dilatation and leakage of the retinal precapillary terminal arterioles (resulting in development of focal intraretinal periarteriolar transudates), and also occlusion of the terminal retinal arterioles (producing cotton-wool spots and associated intraretinal microvascular abnormalities). We discuss the controversial subjects of narrowing (particularly 'spasm') of ophthalmoscopically visible retinal arterioles and of fibrinoid necrosis in malignant hypertension.     

Retinal microvascular abnormalities and 10-year cardiovascular mortality: a population-based case-control study

PURPOSE: Retinal microvascular abnormalities reflect persistent arteriolar damage from hypertension and independently predict stroke. We examined their associations with long-term cardiovascular mortality. DESIGN: Population-based, nested, case-control study. POPULATION: Cases were Beaver Dam Eye Study participants (age range, 43-84 years) who died of coronary heart disease or stroke between the baseline examination in 1988 to 1990 and 1999 (n = 413). Nearly 3 controls per case were selected from the baseline cohort, frequency-matched on 5-year age intervals and gender (n = 1198). METHODS: Retinal photographs of cases and controls at baseline were evaluated for retinopathy, focal arteriolar narrowing, and arteriovenous nicking by graders masked to case-control status using standardized protocols. To obtain an estimate of generalized arteriolar narrowing, photographs were digitized and diameters of individual retinal vessels were measured and summarized by a computer program. MAIN OUTCOME MEASURE: Ten-year cardiovascular mortality. RESULTS: After controlling for systolic blood pressure, diabetes, glycosylated hemoglobin levels, and other risk factors, retinopathy was associated with increased cardiovascular mortality, with odds ratios of 1.8 (95% confidence interval [CI], 1.2, 2.7). For other retinal abnormalities, associations with cardiovascular mortality were present only in younger people, with odds ratios of 2.7 (95% CI, 1.0, 7.4) for focal arteriolar narrowing, 1.8 (95% CI, 0.8, 4.5) for arteriovenous nicking, and 1.9 (95% CI, 1.2, 2.9) for generalized arteriolar narrowing in persons 43 to 74 years of age but odds ratios of 1.1, 0.4, and 1.0 for the corresponding retinal abnormalities in persons 75 years and older. CONCLUSIONS: Retinopathy is independently associated with cardiovascular mortality. Associations for other retinal abnormalities were only observed in middle-aged persons. These data support recent studies that suggest retinal microvascular abnormalities provide independent information regarding cardiovascular risk.