早产儿血清IGF-1浓度变化及与早产儿视网膜病的关系

目的测定不同胎龄新生儿和早产儿视网膜病(retinopathy of prematurity,ROP)患儿血清胰岛素样生长因子-1(insulin like growth factor 1,IGF-1)的浓度变化,并探讨其与ROP发生发展的关系。方法新入院的新生儿184例,分为<32周组、～36周组及足月儿组;各组根据是否吸氧再分为未吸氧和吸氧两个亚组。ROP组为出生体重<2kg,经眼科筛查确诊为ROP的早产儿。各组新生儿分别在出生后第1、3、5、7周用ELISA法检测血清IGF-1浓度。结果在未吸氧的新生儿中,足月儿组血清IGF-1浓度随着日龄的增加呈上升趋势,<32周组和～36周组血清IGF-1浓度则随着日龄的增加先下降,然后再缓慢回升,约在第5周时恢复至出生时的水平。<32周早产儿组和～36周早产儿组在第1周和第3周时的血清IGF-1浓度显著低于足月儿组(P<0.01)。在<32周组及～36周组,吸氧组与未吸氧组之间血清IGF-1浓度差异均无统计学意义(P均>0.05);在足月儿组,吸氧组血清IGF-1浓度在第1周显著低于未吸氧组(P<0.01)。ROP组患儿的胎龄均<32周,均吸氧≥3d。ROP组血清IGF-1浓度较<32周早产儿的吸氧组和未吸氧组低,在第1周时差异有统计学意义(P<0.05)。在纠正胎龄31周时,ROP组血清IGF-1浓度显著低于非ROP早产儿组(P均<0.01)。ROP组血清IGF-1低于30ng/ml的持续天数较<32周早产儿组显著延长(P<0.01)。结论在早产儿出生后第1周或在纠正胎龄31周时,血清IGF-1浓度明显较低或低血清IGF-1的持续时间较长,这可能预示ROP的发生。     

早产儿视网膜病经间接检眼镜激光治疗后视网膜脱离分析

目的分析严重早产儿视网膜病(ROP)经间接检眼镜激光治疗后出现视网膜脱离的特点。方法回顾性收集2006年1月至2008年2月经间接检眼镜激光治疗后出现视网膜脱离的ROP患儿,统计其性别、孕周、出生体重、ROP诊断、激光治疗参数、眼底随访情况、RetCam图片等临床资料,分析激光治疗后视网膜脱离的发生时间、部位和范围等特点。结果7例患儿(共12只眼)经间接检眼镜激光治疗后出现视网膜脱离,其平均孕周为29.9周(28～35周),平均出生体重1366g(1140～1810g)。激光治疗前诊断为阈值病变8只眼(占66.7%),阈值前病变1型4只眼(33.3%)。所有患眼激光治疗后平均5.8周出现视网膜脱离,其中11只眼(91.7%)在治疗后2～7周出现视网膜脱离,仅1只眼(8.3%)于激光治疗后24周出现4B期。所有患眼中,9只眼(75.0%)表现为颞侧、局限性的牵引性视网膜脱离,脱离范围<4个钟点,1只眼(8.3%)表现为鼻侧、局限性视网膜脱离,脱离范围4个钟点,另2只眼(16.7%)为累及各象限的完全性视网膜脱离。所有患儿激光治疗后平均随访27.2周。结论严重早产儿视网膜病经间接检眼镜激光治疗后7周内出现视网膜脱离的可能性比较大,主要表现为颞侧玻璃体增殖、牵引而导致的局限性视网膜脱离。     

早产儿视网膜病的手术治疗

早产儿视网膜病(retinopathy of prematurity,ROP)是儿童重要的可预防的致盲性疾病,需早期发现、及时治疗,对于阈值期及阈值前1型病变首选激光光凝治疗,如果进展为视网膜脱离需进行巩膜扣带术或玻璃体手术,文章对ROP手术治疗的现状及进展进行评述。     

Visual Field Abnormalities in Early-Stage Diabetic Retinopathy Assessed by Chromatic Perimetry

PurposeThe purpose of this study was to define the nature and extent of sensitivity loss using chromatic perimetry in diabetics who have mild or no retinopathy.MethodsThirty-four individuals with type II diabetes mellitus who have mild nonproliferative diabetic retinopathy (MDR; N = 17) or no diabetic retinopathy (NDR; N = 17) and 15 visually normal, non-diabetic controls participated. Sensitivity was assessed along the horizontal visual field meridian using an Octopus 900 perimeter. Measurements were performed under light- and dark-adapted conditions using long-wavelength (red) and short-wavelength (blue) Goldmann III targets. Cumulative defect curves (CDCs) were constructed to determine whether field sensitivity loss was diffuse or localized.ResultsSensitivity was reduced significantly under light-adapted conditions for both stimulus colors for the NDR (mean defect ± SEM = −2.1 dB ± 0.6) and MDR (mean defect ± SEM = −4.0 dB ± 0.7) groups. Sensitivity was also reduced under dark-adapted conditions for both stimulus colors for the NDR (mean defect ± SEM = −1.9 dB ± 0.7) and MDR (mean defect ± SEM = −4.5 ± 1.0 dB) groups. For both diabetic groups, field loss tended to be diffuse under light-adapted conditions (up to 6.9 dB loss) and localized under dark-adapted conditions (up to 15.4 dB loss).ConclusionsVisual field sensitivity losses suggest neural abnormalities in early stage diabetic eye disease and the pattern of the sensitivity losses differed depending on the adaptation conditions. Chromatic perimetry may be useful for subtyping individuals who have mild or no diabetic retinopathy and for better understanding their neural dysfunction.     

m6A modifications of circular RNAs in ischemia-induced retinal neovascularization

Ischemia-induced pathological neovascularization in the retina is a leading cause of blindness in various age groups. The purpose of the current study was to identify the involvement of circular RNAs (circRNAs) methylated by N⁶-methyladenosine (m⁶A), and predict their potential roles in oxygen-induced retinopathy (OIR) in mice. Methylation assessment via microarray analysis indicated that 88 circRNAs were differentially modified by m⁶A methylation, including 56 hyper-methylated circRNAs and 32 hypo-methylated circRNAs. Gene ontology enrichment analysis predicted that the enriched host genes of the hyper-methylated circRNAs were involved in cellular process, cellular anatomical entity, and protein binding. Host genes of the hypo-methylated circRNAs were enriched in the regulation of cellular biosynthetic process, the nucleus, and binding. According to the Kyoto Encyclopedia of Genes and Genomes analysis, those host genes were involved in the pathways of selenocompound metabolism, salivary secretion, and lysine degradation. MeRIP-qPCR verified significant alterations in m⁶A methylation levels of mmu_circRNA_33363, mmu_circRNA_002816, and mmu_circRNA_009692. In conclusion, the study revealed the m⁶A modification alterations in OIR retinas, and the findings above shed light on the potential roles of m⁶A methylation in circRNA regulatory functions in the pathogenesis of ischemia-induced pathological retinal neovascularization.     

A Comparison of Artificial Intelligence and Human Diabetic Retinal Image Interpretation in an Urban Health System

Introduction:Artificial intelligence (AI) diabetic retinopathy (DR) software has the potential to decrease time spent by clinicians on image interpretation and expand the scope of DR screening. We performed a retrospective review to compare Eyenuk’s EyeArt software (Woodland Hills, CA) to Temple Ophthalmology optometry grading using the International Classification of Diabetic Retinopathy scale.Methods:Two hundred and sixty consecutive diabetic patients from the Temple Faculty Practice Internal Medicine clinic underwent 2-field retinal imaging. Classifications of the images by the software and optometrist were analyzed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and McNemar’s test. Ungradable images were analyzed to identify relationships with HbA1c, age, and ethnicity. Disagreements and a sample of 20% of agreements were adjudicated by a retina specialist.Results:On patient level comparison, sensitivity for the software was 100%, while specificity was 77.78%. PPV was 19.15%, and NPV was 100%. The 38 disagreements between software and optometrist occurred when the optometrist classified a patient’s images as non-referable while the software classified them as referable. Of these disagreements, a retina specialist agreed with the optometrist 57.9% the time (22/38). Of the agreements, the retina specialist agreed with both the program and the optometrist 96.7% of the time (28/29). There was a significant difference in numbers of ungradable photos in older patients (≥60) vs younger patients (<60) (p=0.003).Conclusions:The AI program showed high sensitivity with acceptable specificity for a screening algorithm. The high NPV indicates that the software is unlikely to miss DR but may refer patients unnecessarily.     

2型糖尿病患者血清SUA和CysC水平与糖尿病视网膜病变的关系

目的:探讨血清尿酸(SUA)、胱抑素C(CysC)水平与糖尿病视网膜病变(DR)的关系。方法:前瞻性研究。选取2019-05/2021-05本院收治无DR的2型糖尿病(T2DM)患者53例和DR患者83例,DR患者中包括非增殖型糖尿病视网膜病变(NPDR)47例、增殖型糖尿病视网膜病变(PDR)36例。另选取同期体检中心体检健康者48人作为对照组。比较受试者血清学指标,尿酸氧化酶法检测SUA水平,免疫比浊法检测血清CysC含量,Spearman相关性分析血清SUA、CysC与其他血清学指标的相关性,多因素线性逐步回归法分析血清SUA、CysC的影响因素,使用受试者工作特征曲线(ROC)分析血清SUA、CysC对DR预测效能。结果:T2DM组、NPDR组和PDR组的体质量指数(BMI)、收缩压(SBP)均明显高于对照组(均P<0.05),PDR组的SBP均明显高于T2DM组和NPDR组(均P<0.05),NPDR组和PDR组糖尿病病程均明显高于T2DM组(均P<0.05),PDR组糖尿病病程明显高于NPDR组(P<0.05)。对照组、T2DM组、NPDR组、PDR...     

康柏西普在眼部新生血管性疾病中的应用进展

康柏西普是中国自主研发的一种抗血管内皮生长因子新药。自从2013年被中国国家食品药品管理总局批准用于临床,康柏西普在治疗湿性年龄相关性黄斑变性、脉络膜新生血管、黄斑水肿等眼部新生血管性疾病过程中显示出可靠的安全性和疗效。针对不同的疾病,康柏西普的治疗策略有所不同。本文就近年来康柏西普在湿性年龄相关性黄斑变性、糖尿病性黄斑水肿、病理性近视脉络新生血管、新生血管性青光眼、未成熟儿视网膜病变、角膜新生血管等眼部新生血管性疾病中的应用进展进行综述,总结探讨康柏西普的用药适应证、给药方案和治疗效果。期待康柏西普的用药适应证会更广,给药方案会更多,为眼部新生血管性疾病的治疗带来新的思路。     

雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿

目的:观察雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿(DME)的临床疗效。方法:选取2016-06/2019-09就诊于广西壮族自治区人民医院确诊为重度DME的患者52例52眼,随机分为观察组(26例26眼,予雷珠单抗联合577nm微脉冲激光治疗)和对照组(26例26眼,仅予雷珠单抗治疗)。两组患者均予“3+PRN”方案行玻璃体腔注射雷珠单抗治疗。治疗(首次玻璃体腔注射)后随访9mo,观察黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)情况及玻璃体腔注射雷珠单抗次数。结果:与治疗前相比,两组患者治疗后各时间点CMT、BCVA均明显改善(均P<0.001),但两组间均无差异(P>0.05)。随访期间,观察组玻璃体腔雷珠单抗注射次数明显少于对照组(5.88±1.24次vs 7.12±1.24次,P=0.001)。结论:雷珠单抗联合577nm微脉冲激光和单用雷珠单抗均能有效降低重度DME患者黄斑水肿程度,改善视力,但联合治疗可减少雷珠单抗的注射次数。     

Multitarget microangiopathy in a young healthy man with COVID-19 disease: A case report

A 41-year-old man presented to the emergency department complaining of decrease of vision in his left eye. Initial examination was consistent with retrobulbar optic neuritis, and an intravenous drip of methylprednisolone was started. On the third day, the fundus examination revealed the appearance of multiple Purtscher-like cotton-wool spots in the posterior pole and nasally to the optic disc, slight retinal whitening around the fovea, and cherry-red spot. The patient reported flu-like symptoms, and he tested positive at PCR (polymerase chain reaction) test for 2019-nCoV (2019 novel coronavirus) infection. Assuming possible 2019-nCoV-related vascular damage, we prescribed low-molecular-weight heparin. The lesions were regressing at follow-up, and we registered a complete visual recovery.