非诺贝特治疗糖尿病视网膜病变的临床研究进展

非诺贝特是过氧化物酶增殖物激活受体α（PPAR-α）激动剂,在临床上作为调脂药物被广泛使用。它能够降低甘油三酯水平,升高高密度脂蛋白胆固醇（HDL-C）水平,降低冠脉血管事件的风险。最近的临床试验表示,非诺贝特能够延缓增殖期糖尿病视网膜病变的进展,且发现非诺贝特的这种作用与其抗炎作用等有关。现主要就非诺贝特在糖尿病视网膜病变发病中的作用及其机制进行综述。     

儿童白内障手术人工晶状体度数计算准确性分析

目的 分析儿童眼人工晶状体度数计算的准确性.方法 回顾性研究37例(62只眼)行先天性白内障摘除加人工晶状体(IOL,intraocular lens)植入术患儿生物测量及屈光状态数据,应用SRKⅡ计算IOL度数.术后2个月行视网膜检影验光检测屈光状态.分析手术年龄,眼轴长度,IOL植入时机与IOL度数计算准确性关系.结果 全部平均绝对预测误差为(1.56±1.43)D.绝对预测误差低于1.0 D共32只眼,占总眼数52%.眼轴≤20 mm组绝对预测误差为(2.75±1.66)D,＞20 mm组为(1.06±0.93)D,2组间差异具有统计学意义(P＜0.01).年龄≤2岁组绝对预测误差为(2.38±1.65)D,＞2岁为(1.04±0.99)D,2组间差别具有统计学意义(P＜0.01).Ⅰ期IOL植入组绝对预测误差为(1.37±1.35)D,Ⅱ期IOL植入为(2.03±1.56)D,2组间差异无统计学意义(P=0.22).结论 全组植入的IOL度数安全有效.眼轴≤20 mm及年龄≤2岁患儿绝对预测误差明显增加.该研究证明,专门为儿童眼设计IOL计算公式是有必要的.

Abstract：

Objective To determine the accuracy of intraocular lens (IOL) power calculation in a group of pseudophakic children. Methods A relrospective analysis of biometric and refractive data was performed on 62 eyes of 37 infants and children, who successfully underwent cataract extraction and IOL implantation. SRKII were used to calculate the IOL power. The postoperative refractive outcome was taken as the spherical equivalent of the refraction at 2 months afier surgery by retinoscopy. The data were analyzed to assess the effects of age at the time of surgery, axial length, and primary or secondary intraocular lens implantation on the accuracy of calculation of IOL power. Results For the overall group the mean and median prediction errors were 1.56D (SD 1.43). There were 32 eyes'absolute predictions errors lower than 1D (52%). The mean absolute prediction errors in eyes with axial lengths≤20 mm were 2.75 D (SD 1.66), and in eyes ＞20 mm were 1.06 D (SD 0.93). The mean absolute prediction errors in eyes in children aged≤2 years were 2.38 D (SD 1.65), and in children aged ＞2 years were 1.04D (SD 0.99). The differences between the absolute prediction errors for both axial length and age were statistically significant (P ＜0.01). The mean-absolute prediction errors in eyes with primary IOL implantation were 1.37D (SD 1.35), and secondary intraocular lens implantation were 2.03D (SD 1.56). The differences between the absolute prediction errors primary or secondary intraocular lens implantation, were not statistically significant (P =.22). Conclusions For the overall group IOL power calculation is generally acceptable. In eyes with axial lengths less than 20 mm and in children younger than 2 years of age larger errors can arise, and the variations increase. This study demonstrates the need for an IOL formula specifically designed for pediatric use.     

糖尿病视网膜病变相关“代谢记忆”的研究进展

糖尿病患者若高血糖不能及时有效控制，即使后期血糖长期控制良好，仍可能发生糖尿病慢性并发症即为高血糖的“代谢记忆”效应。糖尿病视网膜病变（DR）是糖尿病最常见的微血管并发症之一，糖尿病早期高血糖如不能得到及时控制，后期及时严格控制血糖，DR仍会发生、发展。多项糖尿病临床试验研究发现早期严格控制血糖可以延缓DR的病程，但糖尿病血管性应激物仍然处于高水平。炎症因子瀑布、氧化应激增强以及表观遗传修饰的变化等在高血糖“代谢记忆”现象发生发展中发挥重要作用。