中心性浆液性视网膜病变病因的探讨

中心性浆液性视网膜病变病因的探讨河南郑州市中原区须水卫生院董文泉，肖丽萍河南省鹤壁市淇县卫生学校孙秀兰，董爱梅中心性浆液性视网膜病变是常见的眼底病，多发生于青壮年，单眼发病较多．亦有双眼受累者。本病愈后较好，但易于复发，如反复次数较多，可有不同程度的...     

环状RNA与视网膜发育和视网膜疾病的相关性

Circular RNA (circRNA) is a special type of non-coding RNA molecule ubiquitous in eukaryotes. It has a closed loop structure, and is highly conservative and stable, and has a regulatory role in a variety of diseases. CircRNA can participate in the regulation of retinal inflammation, cell apoptosis, angiogenesis, and oxidative stress response, etc., and plays an important regulatory role in eye development and disease progression. The change of circRNA may be earlier than the change of the fundus morphology, so the circRNA detected in tissues, saliva, blood and exosomes is expected to be used for biomarkers for diagnosis and prognosis of retinal diseases (such as glaucoma, diabetic retinopathy, proliferative vitreoretinopathy, age-related macular degeneration, etc.). Intervention of circRNA expression can significantly affect the biological functions of vascular endothelial cells and regulate vascular permeability. It is expected to be used as a gene therapy method to provide a new direction for the treatment of retinal diseases.(Int Rev Ophthalmol, 2020, 45: 455-458)     

视网膜母细胞瘤的超声影像分析

目的 分析视网膜母细胞瘤(RB)超声影像表现,探讨超声在RB诊断中的影像学价值。方法 选取2013年9月至2020年7月在河北省眼科医院就诊的RB患者83例(83只眼)术后经病理确诊为RB患儿的眼部超声影像特征进行回顾性分析。其中男性43例(43只眼),女性40例(40只眼),年龄(2.08±1.65)岁(2个月至9岁)。结果 本组病例RB的眼部超声均表现为起自后方球壁的球内实性肿物声像,其中表现为半球形12只眼,球形14只眼,不规则形17只眼,充满玻璃体腔形32只眼,延视网膜弥漫生长8只眼。方差分析结果显示肿物基底部宽度与高度：不规则形>球形>半球形,差异均具有统计学意义(F=17.189、12.460,P﹤0.001),LSD-t检验：半球形与球形、半球形与不规则形两两比较差异均有统计学意义(基底部高度比较t=-4.927,-3.784,P﹤0.05,宽度比较t=-4.436,-5.028,P﹤0.05),球形与不规则形两两比较高度没有统计学意义,宽度有统计学意义(基底部高度比较t=0.615,P﹥0.05,宽度比较t=-2.464,P﹤0.05)。其中77只眼出现钙斑...     

糖尿病视网膜病变

一、发病率和分期糖尿病是以相代谢紊乱为主的常见全身性疾病。我国人群发病率约1％（池芝盛，1981）．糖尿病视网膜病变（dabeticretinopathy，DR）是糖尿病眼部并发症之一，也是常见的致盲原因。病程和血糖控制不良是引起DR的主要因素。二者之间，病程更具相关性．病程越长，眼底病变越多见，情况越严重。根据国内外统计资料，糖尿病病人中DR的阳性率在50％左右，其中病程5年以上者为25％，10年以上者60％，15年以上者可高达80～90％。在相同病程了非胰岛素依赖型略低于胰岛素依赖型。文献中曾有不少学者提出多种临床分期方法，如Scott…     

周边视网膜变性广角多模影像研究进展

周边视网膜变性是眼科临床常见的病变,不同类型的变性影响不同的视网膜层次,可能对视力造成威胁。尽管现代眼底成像技术被应用于研究其病理生理机制,由于其所处的特殊部位,影像学检查困难,因此发病机制仍不清楚。本文总结了有关周边视网膜变性的多种广角成像技术的影像特征,包括超广角眼底成像、广角频域光学相干断层扫描、光学相干断层扫描血管成像、荧光素眼底血管造影等,及其发病机制或病理特点的新观点,为临床诊疗提供新的思路。由于样本量非常少,且缺乏前瞻性、长期的多模态影像的观察研究,因而目前仍无法全面评价不同类型病变的进展性及危险性。期望在更广的范围内应用多模态广角成像技术对此类疾病进行研究,指导临床干预决策。     

外伤性视网膜脱离100例临床分析及病因探讨

眼外伤是引起裂孔源性视网膜脱离的原因之一,我院于1977年7月至1990年12月(13年6个月),共收治有明显眼部外伤史的视网膜脱离100例,占同期视网膜脱离359例的27.9%。现分析报告如下: 临床资料     

视网膜与视网膜色素上皮联合错构瘤的多模式影像分析

目的:观察视网膜与视网膜色素上皮联合错构瘤(CHRRPE)的多模式影像特征。方法:采用横断面研究,纳入2013年3月至2019年7月在云南省第二人民医院诊断为CHRRPE的患者16例16眼,收集患者彩色眼底照相、光相干断层扫描(OCT)、血流成像OCT(OCTA)、眼底炫彩成像、眼底自发荧光(FAF)、荧光素眼底血管造...     

视网膜病变中的生长因子

此综述的目的是提供生长因子与眼后部疾病的明确关系。生长因子能够结合到特定的细胞表面受体上，单独或协同地做为多功能信号来调节细胞的生长和增殖。它们对细胞的生物作用包括：细胞粘连、移行、生存、分化、细胞外基质分泌、蛋白酶和蛋白酶抑制剂释放、其它生长活动的产生和血管生成。生长因子使细胞和微环境联系起来。因为一些生长因子是损伤修复和血管生成的可溶性介质。因此，增殖性玻璃体视网膜病变（PVR）和增殖性糖尿病性视网膜病变（PDR）可能都由这些因子引起和加重，其它因子作为生存因子，能够防止视网膜变性。生长因子的多功能特性使它有可能在未来投入实际应用。     

副肿瘤性视网膜病变的发病机制及临床特点

副肿瘤性视网膜病变(PR)是一种少见的副肿瘤综合征,因肿瘤表达异常抗原,产生自身抗体与视网膜自身抗原发生交叉免疫反应,导致病变.PR包括癌症相关性视网膜病变(CAR)、黑色素瘤相关性视网膜病变(MAR)及双侧弥漫性葡萄膜黑色素细胞增生症(BDUMP).目前发现多种导致CAR的自身抗体,如抗恢复蛋白(recoverin)抗体、抗α烯醇化酶抗体及抗转导蛋白-α(transducin-α)抗体等,可以与视网膜相应的自身抗原结合;导致MAR的自身抗体最主要为抗TRPM1抗体,可以与视网膜双极细胞离子通道的TRPM1结合;导致BDUMP的抗体目前只发现抗recoverin抗体和抗热休克蛋白70(HSP70)抗体.PR的临床表现主要为短期内双眼视力下降及夜盲等,眼底表现可正常或轻度异常,视网膜电图(electroretinogram,ERG)表现为不同类型的异常,其中BDUMP有双眼多发橘红色斑块等特殊表现.临床表现往往因自身抗体类型的不同而存在差异,主要原因在于针对自身抗原的不同生理作用,表现为发病时间、进展速度、严重程度及ERG表现等.目前对于PR的治疗主要为治疗原发肿瘤,及针对自身抗体进行糖皮质激素、血浆置换及免疫球蛋白等单独及联合的治疗.     

远达性外伤性视网膜病变

目的 探讨远达性外伤性视网膜病变的眼底、荧光素眼底血管造影(FFA)表现特点,发病机制、治疗及预后.方法 回顾分析8例(10眼)由外伤所引起的本病视网膜病变的临床资料,观察视力预后与眼底、FFA表现的关系.结果 治疗后7眼的视力有不同程度的提高.3眼永久性视力损伤,其原因是视网膜病变位于黄斑中心凹或视神经萎缩.结论 远达性外伤性视网膜病变的视力预后与视网膜脉络膜损伤的部位和程度相关,黄斑损害和视神经萎缩者预后不良.     

Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap)

Purpose To compare the diagnostic properties of a nonmydriatic 200° ultra-widefield scanning laser ophthalmoscope (SLO) versus onsite mydriatic ophthalmologic examination for diabetic retinopathy. Methods A consecutive series of 51 eyes of 51 patients with different levels of diabetic retinopathy (DR) was examined. Grading of diabetic retinopathy and macular edema obtained on stereoscopic dilated funduscopy by a retina specialist was compared against grading obtained from Optomap Panoramic200 SLO images. All SLOs were performed with an undilated pupil, and no additional clinical information was used for evaluation of the Optomap images by three independent, masked expert graders. Results A total of five images (9.8%) were not gradable due to insufficient quality. Clinically 4 eyes had proliferative diabetic retinopathy (PDR), while 9 had none, 5 mild, 19 moderate and 14 severe nonproliferative diseases (NPDR). Of the gradable 46 images, a clinically significant macular edema (CSME) was present in 28 eyes clinically. On Optomap, all eyes with PDR were detected as being proliferative, and a sensitivity of 94% at a specificity of 100% was obtained for all graders to detect more than mild DR. Agreement between Optomap retinopathy grading and clinical assessment was good with unweighted kappas of 0.68, 0.68 and 0.51. Assessment of CSME yielded sensitivities of 93, 93 and 89% at specificities of 89, 72 and 83%. Conclusions The Optomap Panoramic200 nonmydriatic images are of sufficient quality to assess DR and CSME validly and therefore fulfill the basic requirements for telescreening programs. Aljoscha S. Neubauer and Marcus J. Kernt contributed equally. The authors do not have any commercial interest in any of the materials and methods used in this study.     

Comparison of spectral-domain and time-domain optical coherence tomography in solar retinopathy

The purpose of this article is to compare spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) findings in patients with solar retinopathy. Complete ocular examinations and OCT were performed in two patients presenting with acute solar retinopathy soon after observation of an eclipse. Both patients were evaluated with SD-OCT and TD-OCT at the same time. SD-OCT demonstrated characteristic defects at the level of the inner and outer segment junction of the photoreceptors in all the affected eyes and decreased reflectiveness of the retinal pigment epithelium layer. TD-OCT images showed unremarkable findings in two eyes with deteriorated visual acuity. SD-OCT improves diagnosis and assessment of the degree and nature of foveal damage in patients with solar retinopathy and may be an important tool for use in identifying foveal damage not detected by TD-OCT. SD-OCT may be preferable to TD-OCT for confirmation or assessment of the degree of foveal damage in patients with solar retinopathy.     

Studies of the retinal microcirculation using human donor eyes and high-resolution clinical imaging: Insights gained to guide future research in diabetic retinopathy

The microcirculation plays a key role in delivering oxygen to and removing metabolic wastes from energy-intensive retinal neurons. Microvascular changes are a hallmark feature of diabetic retinopathy (DR), a major cause of irreversible vision loss globally. Early investigators have performed landmark studies characterising the pathologic manifestations of DR. Previous works have collectively informed us of the clinical stages of DR and the retinal manifestations associated with devastating vision loss. Since these reports, major advancements in histologic techniques coupled with three-dimensional image processing has facilitated a deeper understanding of the structural characteristics in the healthy and diseased retinal circulation. Furthermore, breakthroughs in high-resolution retinal imaging have facilitated clinical translation of histologic knowledge to detect and monitor progression of microcirculatory disturbances with greater precision. Isolated perfusion techniques have been applied to human donor eyes to further our understanding of the cytoarchitectural characteristics of the normal human retinal circulation as well as provide novel insights into the pathophysiology of DR. Histology has been used to validate emerging in vivo retinal imaging techniques such as optical coherence tomography angiography. This report provides an overview of our research on the human retinal microcirculation in the context of the current ophthalmic literature. We commence by proposing a standardised histologic lexicon for characterising the human retinal microcirculation and subsequently discuss the pathophysiologic mechanisms underlying key manifestations of DR, with a focus on microaneurysms and retinal ischaemia. The advantages and limitations of current retinal imaging modalities as determined using histologic validation are also presented. We conclude with an overview of the implications of our research and provide a perspective on future directions in DR research.     

血浆内皮素、一氧化氮与妊娠高血压综合征眼底视网膜血管病变关系的临床研究

目的 探讨血浆内皮素(ET)、一氧化氮(N0)在妊娠高血压综合征(PIH)眼底视网膜血管病变发病中的作用。 方法 采用放射免疫分析法检测75例住院PIH患者和20例正常足月妊娠待产产妇产前和产后血浆ET、NO水平，同时专人检查PIH患者产前、产后眼底视网膜病变情况；对比分析PIH患者与正常足月妊娠待产妇血浆ET、N0水平的差异以及PIH患者产前、产后血浆ET、N0水平变化与眼底改变之间的关系。 结果 重度PIH组患者血浆ET为(145.OO±54.41)ng／L，明显高于正常妊娠组和轻、中度PIH组[ET分别为(81.50±43.80)、(85.30±33．33)、(90．20±39.25)ng／L]；PIH患者产后血浆 ET为(118．70±33．44)ng／L，较其产前无显著性变化，但仍明显高于正常妊娠组。重度、中度PIH组血浆 N0分别为(87．56±35．58)、(78．11±28．96)ng／L，均明显高于正常妊娠组[(46.70±32.64)ng／L]；轻度 PIH组血浆NO为(52．56±28．35)ng／L，轻度、中度PIH组血浆NO水平明显低于重度PIH组；PIH患者产后血浆N0水平较其产前明显降低，但仍明显高于正常妊娠组。PIH患者血浆ET、NO水平随眼底视网膜病变的加重而升高。 结论 PIH患者血浆ET、NO水平与PIH病情严重程度有关，血浆ET水平与 PIH眼底病变高度相关；ET、NO可能在PIH眼底视网膜病变发生发展过程中发挥重要作用。尤其是ET可能是反映PIH视网膜病变程度的良好指标。 （中华眼底病杂志，2004，20：12-15）     

低灌注视网膜病变荧光素眼底血管造影-27例临床分析

目的 观察头颈部周围血管狭窄、闭锁所致低灌注视网膜病变的荧光素眼底血管造影（FFA）特征. 方法 回顾分析我院血管外科经动脉数字减影血管造影仪行数字减影动脉造影（DSA）、头颈部周围血管多普勒及血管搏动检查确诊的头颈部周围血管狭窄、闭锁患者27例常规FFA检查资料. 结果 全部患者臂-网膜循环时间延长，最短20．0s，最长81.08 s，平均32.1 s。视网膜动静脉充盈时间差延长，最短6.0 s最长64.0 s,平均24.2 s。其中单纯臂-视网膜循环时间延长，动静脉充盈时间差延长10例,占37.0％；伴有微血管瘤、血管壁着染、毛细血管无灌注区11例，占40.7％；合并眼前部缺血综合征者6例，占22.2%。合并眼前部缺血综合征的6例患者中4例出现视网膜动脉变细，血流呈节段样改变及小血管闭锁或动静脉血管异常吻合；2例同时可见粗大血管袢。 结论 低灌注视网膜病变患者的FFA改变以视网膜灌注不良及视网膜缺血改变为主，其改变程度与颈动脉狭窄、闭锁程度及病程有关。严重供血不足可伴有眼前部缺血综合征. （中华眼底病杂志，2004，20：84-86）     

急性区域性隐匿性外层视网膜病变的临床表现及频域光相干断层扫描图像特征

目的 观察急性区域性外层视网膜病变(AZOOR)的临床特点以及频域光相干断层扫描(SD-OCT)的图像特征,探讨OCT在评估AZOOR发生、发展中的临床价值.方法 临床检查确诊的AZOOR患者52例66只眼纳入研究.其中,男性8例10只眼,女性44例56只眼;年龄15～65岁.均以视力下降、闪光感、暗点及眼前遮挡感为主述就诊.根据眼底有无改变将患者分为Ⅰ、Ⅱ型AZOOR,分别为28、38只眼.Ⅱ型AZOOR 38只眼中,多发性一过性白点综合征(MEWDS)9只眼、点状内层脉络膜病变(PIC)25只眼、多灶性脉络膜炎(MC)4只眼.所有患者均行视力、裂隙灯显微镜、眼底彩色照相、SD-OCT检查.行视野检查37只眼;视网膜电图(ERG)检查32只眼,其中Ⅰ型AZOOR 28只眼,Ⅱ型AZOOR MEWDS 4只眼;荧光素眼底血管造影(FFA)检查48只眼,其中联合吲哚青绿血管造影(ICGA)检查22只眼.随访15 d～2年.回顾分析患者的临床资料和OCT图像特征.结果 Ⅱ型AZOOR 38只眼中,MEWDS 9只眼就诊时眼底均可见后极部或中周部白点.PIC 25只眼眼底均可见后极部散在黄白色、边界清楚,周围有色素的点状萎缩病灶,其中并发脉络膜新生血管(CNV) 13只眼.MC 4只眼玻璃体腔均可见少量炎性细胞,眼底后极部可见散在分布的多处圆形或椭圆形黄白色病灶.视野检查结果显示,Ⅰ型AZOOR 28只眼中,中心和旁中心暗点15只眼;生理盲点扩大或与生理盲点相连的局部视野损害9只眼;非特异性视野改变,散在暗点4只眼.Ⅱ型AZOOR MEWDS 9只眼主要表现为暗点和局部多处视野缺损.ERG检查结果显示,Ⅰ型AZOOR 28只眼中,眼暗视及明视ERG振幅均较对侧眼降低,暗视ERG振幅下降更明显12只眼;仅表现为暗视ERG振幅下降9只眼;无明显改变7只眼.Ⅱ型AZOOR MEWDS4只眼均可见暗视及明视ERG振幅下降,潜伏期轻度延长.FFA和(或)ICGA检查结果显示,Ⅱ型AZOOR 26只眼中,MEWDS9只眼FFA检查可见后极部或中周部视网膜外层或视网膜色素上皮(RPE)层强荧光灶,晚期荧光略增强但无渗漏,其中ICGA检查可见后极部或中周部圆点状弱荧光灶3只眼.PIC13只眼可见血管弓附近点状病灶呈透见荧光改变及黄斑区活动性CNV病灶.MC 4只眼FFA可见早期中周部点状病灶呈弱荧光,晚期荧光增强,轻度渗漏.OCT检查结果显示,Ⅰ型AZOOR 28只眼主要表现为后极部光感受器内外节连接(IS/OS)层紊乱,局部缺失;COST(cone outer segment tip)带反射减弱.Ⅱ型AZOOR MEWDS 9只眼表现为与眼底点状病灶相对应的视网膜外层IS/OS带局部反射减弱,COST带不可见;PIC患者中并发CNV者黄斑区神经视网膜下可见强反射团块突破RPE层.末次随访时,Ⅰ型AZOOR 28只眼中,IS/OS层连续性恢复22只眼;未恢复6只眼.Ⅱ型AZOOR 38只眼中,MEWDS 9只眼均在患病后1～2个月IS/OS层随病情好转而逐渐恢复;PIC 25只眼IS/OS层连续性无改变;MC 4只眼IS/OS层连续性恢复.结论 AZOOR急性期发病隐匿;SD-OCT可动态监测IS/OS层的改变,反映AZOOR的发生、发展的不同程度.     

Kinetics of retinal vaso-obliteration and neovascularisation in the oxygen-induced retinopathy (OIR) mouse model

Purpose  To evaluate the kinetics of peripheral vascularisation, central vessel regression and neovascularisation in the OIR mouse model in order to: i) generate standard kinetics for further studies in this model, and ii) define optimal time points to investigate cellular mechanisms of retinal vascular plasticity. Methods  From postnatal day 7 (P7) until P12, newborn mice were kept at 75% oxygen. The animals were sacrificed on different time points, during and after O₂ exposure. After intracardial perfusion with FITC–dextran, retinal flatmounts were prepared, and the size of the retinal vascular network, the size of the central avascular area, and the number of blood vessel tufts and clusters were determined. In addition to the fluorescein stain for perfused capillaries, endothelial cells were stained with isolectin. Results  Upon O₂ exposure, there is a rapid depletion of capillaries starting adjacent to the large central arteries. These avascular stripes fuse to form an avascular central area which amounts to 37% of the whole retinal surface after 2 days of hyperoxia. The peripheral capillary network remains intact throughout the incubation period, even though the pace of its centrifugal spreading is decelerated compared to room air controls. Already during O₂ exposure, revascularisation of the central avascular area is initiated by peripheral vessels sprouting in a centripetal direction. Revascularisation is accelerated after the return to room air, and is completed at P25. Maximal pathological neovascularisation can be found at P17, at the border between the avascular and vascular retina. Conclusion  Hyperoxia leads to a rapid development of a central avascular area of the retina, with its maximum during not at the end of the hyperoxic phase. Central capillary loss and peripheral vascularisation take place simultaneously, indicating different cellular control mechanisms for different areas of the retina. These standard kinetics for peripheral vascularisation and central vessel regression will: 1) help to compare the effects of angio-modulation, and 2) serve as normal baseline for the characterization of knock-out mice strains with regard to gene-specific vascular changes in the OIR-model. None of the authors has financial relationships with companies or organisations mentioned in the study     

Ⅱ型糖尿病患者血红蛋白晚期糖基化终末产物与视网膜病变的关系

目的 研究糖尿病(diabetes mellitus, DM)患者血红蛋白晚期糖基化终末产物(hemoglobin-advanced glycosylation end products, Hb-AGE)与糖尿病视网膜病变(diabetic retinopathy, DR)的关系。 方法 采用竞争性ELISA法检测125例并发或未并发DR的Ⅱ型 DM患者的Hb-AGE含量,并与50例正常对照者比较。 结果 DM患者Hb-AGE比正常对照者平均增加65%;并发DR者Hb-AGE显著高于无DR患者;空腹血糖(fasting plasma glucose FPG)水平与Hb-AGE含量及DR发生率无直接相关性,血压(BP)、HbA1c及血脂水平与Hb-AGE含量和DR发生率有关(P<0.05,或P<0.01)。多因素分析显示DR严重度与Hb-AGE关系更为密切(偏相关系数=0.604, P<0.001)。 结论 DM控制与体内血红蛋白晚期糖基化终末产物(hemoglobin-hemoglobin-advanced glycosylation end producs,Hb-AGE）含量改变有关, AGE大量形成与DR发生和发展有关。(中华眼底病杂志,2000,16:147-149)