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中华眼视光学与视觉科学杂志
中华眼视光学与视觉科学杂志

瞿佳

月刊

1674-845X

zhysgx@vip.126.com

0577-86699366

325035

浙江省温州市茶山高教园区温州医学院

中华眼视光学与视觉科学杂志/Journal Chinese Journal of Optometry Ophthalmology and Visual ScienceCSCDCSTPCD北大核心
查看更多>>中华医学会主办，温州医学院承办。本刊是眼科学与视光学领域的高级学术性期刊。以广大眼科医生、视光配镜师、眼视光学科研人员为主要读者对象。报道眼视光学与视觉科学领域的最新研究成果、临床诊疗经验，以及与本学科相关的基础理论研究的最新进展。本刊主要栏目有：专家述评，专题论著，论著，临床研究，病例报告，文献综述。本刊原刊名为《眼视光学杂志》，目前已被国内外数十种权威数据库收录。
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    亚洲近视管理共识

    Jong MonicaResnikoff SergeTan Kah Ooi吕帆...
    161-169页
    查看更多>>摘要：本指南是从国际近视研究所（IMI）白皮书中提取出来的有关近视管理方面的建议 [1,2]。本指南所提供的内容都是根据现有最新数据（截至2022年3月）而来，其治疗可行性和执业范围因地区而异，应根据实际情况做调整。
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    近视防控博鳌宣言3.0版（中国眼谷）

    季魏红
    170-176页
    查看更多>>摘要：2017年12月1日，中华医学会眼科学分会眼视光学组会同中国疾病预防控制中心及相关专家联合发布2017"近视科学防控"博鳌宣言（以下简称"博鳌宣言2017"），首次明确提出将近视防控纳入慢病管理，并从建立视觉健康档案、增加户外活动、近距离用眼减负减量、规范矫正近视、科学控制近视、重视高度近视危害等方面提出建议性倡议。博鳌宣言2017发布以来，得到了积极的回应和广泛的好评，为国家综合防控儿童青少年近视实施方案等措施的出台起到了重要的推动作用。2018年，习近平总书记就儿童青少年近视问题连续作出批示，提出要"共同呵护好孩子的眼睛，让他们拥有一个光明的未来"。同年8月，教育部等国家八部委联合印发《综合防控儿童青少年近视实施方案》，近视防控上升为国家战略。
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    多模式影像技术在Stargardt病不同病变阶段的临床运用

    张丽珠黎铧马银燕李娟娟...
    177-185页
    查看更多>>摘要：目的： 观察多模式影像技术在Stargardt病不同病变阶段的影像特征。 方法： 回顾性系列病例研究。对云南大学附属医院2016年5月至2019年8月确诊的28例（56眼）Stargardt患者进行眼底彩色照相、自发荧光、眼底荧光血管造影、光学相干断层扫描（OCT）、炫彩眼底成像、血流成像OCT（OCTA）等多模式检查，总结各类影像检查在疾病不同阶段的特征。 结果： 眼底彩色照相可显示，随病变进展黄斑区的萎缩病变逐渐扩大，伴后极部眼底色泽改变。炫彩成像通过多波长的组合，可用更好的对比度和层次感显示出萎缩的细胞和范围。眼底自发荧光通过自发荧光的高低变化提示视网膜色素上皮（RPE）的受损情况，同时能清楚直观地显示黄斑区萎缩病灶的大小。眼底荧光血管造影在Stargardt病中的观察可直接反映视网膜色素上皮层、脉络膜血管的损伤程度。随着Stargardt病的发展，黄斑区RPE层萎缩范围扩大，视网膜及脉络膜毛细血管继发进行性萎缩。OCT提供了断层眼底的影像信息，随病变进展，中心凹周围神经上皮层变薄，光感受器不同程度萎缩、消失，RPE层不同程度萎缩，反光减弱，脉络膜层毛细血管萎缩，从层次深度和范围的广度都体现了病变的发展。OCTA中本研究观察到随着病变的进展，各层次血管密度呈减少趋势。扫描视网膜深层血管时，透见了下方的脉络膜血管，随着萎缩加重，透见的脉络膜血管的范围扩大。 结论： 不同的眼科影像技术在Stargardt病的不同阶段表现有各自特点和优势，为临床医师提供了更多角度的追踪随访、病情评估的手段。 Objective: To explore the imaging characteristics of a multi-mode imaging techniques at different stages of Stargardt's disease. Methods: This was a retrospective analysis of 28 cases (56 eyes) of patients with Stargardt's disease diagnosed in Affiliated Hospital of Yunnan University from May 2016 to August 2019. Fundus color photography, autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), multicolor fundus imaging, OCT angiography (OCTA), and characteristics of various imaging examinations at different stages of the disease were summarized. Results: Color photography of the fundus showed that the atrophic lesions in the macular area gradually expand with the progression of the lesion, with color change at the posterior pole. Multicolor imaging combines multiple wavelengths to show the atrophy of cells and range with better contrast. The fundus autofluorescence showed the damage in the retinal pigment epithelium (RPE), and can clearly and visually show the size of the atrophy lesion in the macular area. Fundus fluorescein angiography can directly reflect the degree of damage in the retinal pigment epithelial layer and choroidal blood vessels in Stargardt's disease. With the development of Stargardt's disease, the atrophy of the RPE layer in the macular area was enlarged, and the retina and choroidal capillaries progressively atrophied. OCT provided image information of the fundus in different layers. As the lesion progressed, the peripheral nerve epithelial layer became thinner, the photoreceptors and RPE shrank and disappeared to varying degrees, and the choroidal capillary shrank from the depth and range of the layer. In the OCTA, we observed that as the lesion progressed, the vascular density at each level decreased. When the deep blood vessels of the retina were scanned, the choroidal blood vessels below were observed, and as the atrophy increased, the range of the exposed choroidal vessels increased. Conclusions: Different ophthalmologic imaging techniques have their own characteristics and advantages in Stargardt's disease, providing more perspectives for follow-up and disease assessment.

    Stargardt病多模式眼底成像黄斑变性自然病程

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    糖尿病视网膜病变患者行全视网膜光凝术中的疼痛反应

    王超军陈金桃吕晓贝吴飞盈...
    186-190页
    查看更多>>摘要：目的： 观察并评估糖尿病视网膜病变（DR）患者行全视网膜激光光凝术（PRP）治疗时的疼痛反应。 方法： 回顾性系列病例研究。选择台州市立医院眼科门诊于2019年7─12月进行PRP治疗的DR患者55例，年龄45~72（60.7±7.9）岁，每次PRP治疗后应用数字分级法（NRS）对疼痛反应进行评估。采用Spearman相关分析年龄、性别及各激光部位与疼痛反应程度的相关性。疼痛评分数据采用Fisher精确概率法进行统计分析。 结果： 在纳入的患者中，年龄和性别对患者的疼痛反应均没有影响（r=-0.58，P=0.338；r=0.06，P=0.305）。患者周边部（上、下、鼻、颞）4个象限之间的疼痛反应评分差异无统计学意义（P=0.763）；但后极部光凝疼痛评分低于周边部光凝疼痛评分（P<0.001）。 结论： 在DR患者行PRP术中，后极部的疼痛感轻于周边部，临床医师可优先选择无疼痛或疼痛相对较轻的部位行激光光凝术。 Objective: To observe and evaluate the pain response in patients with diabetic retinopathy (DR) treated with panretinal laser photocoagulation (PRP). Methods: This was a retrospective case series study. Fifty-five patients aged 45-72 years (average age: 60.7¡À7.9 years old) with DR who were treated with PRP from July 2019 to December 2019 were recruited at Taizhou Municipal Hospital. After PRP, the numerical rating scale was used to evaluate the pain response, and the pain responses from peripheral retinal photocoagulation and posterior polar retinal photocoagulation were compared by Spearman correlation analysis. The pain score was statistically analyzed by the Fisher exact test. Results: In this study, age and gender had no effect on the patient's pain response (correlation coefficientr=-0.58, P=0.338 r=0.06, P=0.305). There was no significant difference in pain response between the four quadrants (upper, lower, nasal, temporal) for PRP (P=0.763), but the pain score of the posterior pole was lower than that of peripheral retina (P<0.001). Conclusions: The induced pain response of the posterior pole was milder than that of the peripheral retina in patients with diabetic retinopathy during PRP. The areas with no pain or relatively mild pain from laser photocoagulation should be preferentially considered by doctors.

    糖尿病视网膜病变数字分级法视网膜激光光凝

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    糖尿病黄斑水肿患者视觉相关生活质量的调查

    臧博温良李冬臧冬晓...
    191-197页
    查看更多>>摘要：目的： 评估伴有糖尿病黄斑水肿（DME）的2型糖尿病患者的视觉相关生活质量（VRQoL）。 方法： 横断面调查研究。将2017年6月至2019年5月从抚顺市眼病医院门诊招募的伴有DME的2型糖尿病患者（187例）纳入研究。采用美国国立眼科研究院视功能问卷（NEI-VFQ-25）中文版量表来评估患者的VRQoL。不同人口学特征、临床特征的DME患者间NEI-VFQ-25分数比较采用Wilcoxon秩和检验。根据眼底照相将DME分为轻度、中度和重度。采用广义估计方程探讨DME严重程度与VRQoL的相关性。 结果： 最终纳入DME患者159例。伴视力损害患者的一般视力、近距离活动、远距离活动、社交功能、依赖性、心理健康、角色困难、色觉、周边视觉和NEI-VFQ-25总分分数较无视力损害（小数视力>0.3）患者低（均P<0.001）。双眼受累患者的一般健康、一般视力、近距离活动、远距离活动、依赖性、心理健康、角色困难、驾驶、色觉、周边视野和NEI-VFQ-25总分分数较单眼受累患者低（均P<0.05）。随着DME严重程度的增加，一般健康（P趋势=0.013）、总体视力（P趋势<0.001）、近距离活动（P趋势=0.001）、远距离活动（P趋势=0.002）、依赖性（P趋势=0.023）、心理健康（P趋势=0.001）、社会角色（P趋势=0.022）、周边视野（P趋势=0.041）、NEI-VFQ-25总分（P趋势=0.001）的得分逐渐降低。NEI-VFQ-25问卷中得分下降最多的是心理健康（β=-15.01，95%CI：-26.73~-3.30，P=0.012）和总体视力（β=-13.66，95%CI：-19.86~-7.47，P<0.001）。 结论： DME对VRQoL有明显的影响。随着DME严重程度增加，VRQoL逐渐降低，尤其在总体视力和心理健康方面最为明显。 Objective: To investigate the effect of diabetic macular edema (DME) on vision-related quality of life (VRQoL) in patients with type 2 diabetes. Methods: In this cross-sectional study, 187 patients with type 2 diabetes diagnosed with DME were included from June 2017 to May 2019. Questionnaires were completed to collect information about their sociodemographic and healthcare characteristics. VRQoL was assessed using the 25-Item National Eye Institute Visual Questionnaire (NEI-VFQ-25). NEI-VFQ-25 scores that were compared between groups using the Wilcoxon rank-sum test. The severity of DME in each eye was graded as mild, moderate, or severe. A generalized estimating equation model was used to assess the relationship between NEI-VFQ-25 scores and DME severity. Results: A total of 159 patients were recruited for the study eventually. Compared with patients without visual impairment (decimal visual acuity >0.3), those with visual impairment showed statistically significant compromises in terms of general vision, near activities, distance activities, social functioning, dependency, mental health, role difficulties, color vision, peripheral vision, and NEI-VFQ-25 composite scores ( P<0.001). Compared with unilateral DME, bilateral DME was associated with greater dependency and role difficulties, compromised near and distance activities, and poorer general health, general vision, color vision, peripheral vision, mental health, and NEI-VFQ-25 composite scores (P<0.05). Scores for NEI-VFQ-25 on general health (Ptrend=0.013), general vision (Ptrend<0.001), near activities (Ptrend=0.001), distance activities (Ptrend=0.002), mental health (Ptrend=0.001), role difficulties (Ptrend=0.022), dependency (Ptrend=0.023), peripheral vision (Ptrend=0.041) and NEI-VFQ-25 composite (Ptrend=0.001) decreased gradually as DME severity increased. β coefficients were the largest for mental health (β=-15.01, 95%CI: -26.73- -3.30, P=0.012) and general vision (β=-13.66, 95%CI: -19.86- -7.47, P<0.001). Conclusions: DME severity significantly affects patients' VRQoL, particularly their general vision and mental health. NEI-VFQ-25 should be widely used to assess overall health in patients.

    糖尿病黄斑水肿视觉相关生活质量问卷调查

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    RASGRF1基因遗传多态性与甘肃地区近视易感性的相关性

    汪向利杨丽媛金庸李培强...
    198-207页
    查看更多>>摘要：目的： 分析RASGRF1基因顺式调控元件中单核苷酸多态性与甘肃地区近视人群的相关性。 方法： 系列病例对照研究。选取2018年1月至2019年1月就诊于甘肃省人民医院眼视光学中心的高度近视患者166例（332眼）和中低度近视患者92例（184眼）分别作为高度近视组和中低度近视组，并将77例（154眼）无近视的志愿者作为正常对照组。首先利用"DNA元件百科全书"计划（ENCODE）和基因型组织表达数据库（GTEx）确定眼组织细胞相关功能性调控元件中的5个单核苷酸多态性（SNP），并利用多重连接酶检测反应技术进行候选SNP的基因分型。在不同遗传模式下，采用卡方检验、非条件Logistic回归分析近视患者和正常对照人群的基因型频率分布差异。 结果： rs8033417 T/C在显性模式下含等位基因C的个体近视的发病风险明显降低（P=0.035）；rs8033417与甘肃地区中低度近视发病风险无相关性，但在显性模式和加性模式下能明显降低高度近视患者的患病风险（P=0.043、0.032）。进一步的生物信息学分析发现，rs8033417 T/C与RASGRF1基因的反义长非编码RNA基因RP11-16K12.1的表达相关。 结论： rs8033417可能是甘肃地区近视发生相关的遗传变异位点，推测其可能通过影响反义长非编码RNA基因RP11-16K12.1的表达，继而调控RASGRF1基因表达从而影响近视尤其是高度近视的患病风险。 Objective: To analyze the association between the SNPs in the cis-regulatory elements of the RASGRF1 gene and myopia patients in Gansu province. Methods: In a prospective case-control study, 166 patients with high myopia (332 eyes), 92 patients with moderate and low myopia (184 eyes) and 77 people from a normal control population (154 eyes) were enrolled in the Optometry Center, Gansu Provincial Hospital from January 2018 to January 2019. Five SNPs were identified using ENCODE and GTEx, and candidate SNPs were genotyped using a multiple ligase detection reaction technique. A Chi-square test and unconditional logistic regression were used to analyze the differences in genotype frequency distribution between the myopia patients and the normal control population under different genetic patterns. Results: Rs8033417 T/C allele C significantly reduced the risk of myopia in the dominant mode (P=0.035). Rs8033417 had no significant correlation with the risk of moderate and low myopia in Gansu, but it significantly reduced the risk of high myopia (P=0.043, 0.032). Further bioinformatics analysis showed that rs8033417 T/C was correlated with the expression of RP11-16K12.1, the antisense long non-coding RNA of the RASGRF1 gene. Conclusion: Rs8033417 may be a genetic variation locus associated with myopia in Gansu province. It is speculated that rs8033417 may affect the risk of myopia, especially high myopia, by affecting the expression of the antisense long non-coding RNA gene RP11-16K12.1 and then regulating the expression of the RASGRF1 gene.

    近视RASGRF1RP11-16K12.1单核苷酸多态性长链非编码RNA

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    葡萄膜黑色素瘤生存预后相关lncRNA的初步筛选及相关性分析

    尚会平林祥祥吴飞盈
    208-215页
    查看更多>>摘要：目的： 通过构建lncRNA-miRNA-mRNA的内源竞争RNA（ceRNA）网络，筛选与葡萄膜黑色素瘤（UM）生存预后相关的长链非编码RNA（lncRNA），并进行相关性分析。 方法： 以生物信息学为手段，通过疾病预后相关分析，LncRNA亚细胞定位检索，从肿瘤基因组图谱数据库中筛选lncRNA表达数据集。通过mircode数据库和targetscan数据库找到lncRNAs对应的靶microRNA（miRNA），Venn分析筛选出共同的与UM预后相关的miRNA。在多个数据库中同时检索，筛选出共同的miRNA-mRNA。通过KEGG富集与lncRNA-miRNA-mRNA网络可视化，最终确定出与UM生存预后相关的候选lncRNA。 结果： 在对lncRNA的下游靶miRNA及功能基因的预测中，鉴定出了630对候选miRNA-mRNA。通过ceRNA调控基因表达的机制，筛选出了9个可能发挥ceRNA功能的lncRNA。KEGG分析得到lncRNA的下游调控基因主要富集在参与肿瘤病理进程的信号通路中。SHNG6可能通过调控has-miR-214-5p、has-miR-214-3p、has-miR-let-7b-5p、has-miR-let-7c-3p等miRNAs，调节下游的功能基因BAX、IGF1R、KRAS、PIK3R1、PDGFD等。 结论： lncRNAs通过ceRNAs机制，调控一系列参与肿瘤发生发展的致癌基因的表达，影响UM的预后及治疗，SHNG6、LINC01278等lncRNAs可能在其发生发展、迁移及侵袭等方面扮演着重要角色。 Objective: To construct a competing endogenous RNA (ceRNA) network of lncRNA-miRNA-mRNA, and to screen the long non-coding RNA (lncRNA) associated with the survival prognosis of uveal melanoma (UM). Methods: In this study, the expression data set of lncRNA was screened from the Tumor Genome Atlas Database through disease prognosis correlation analysis and a subcellular localization search of lncRNA using bioinformatics methods. Target microRNAs (miRNAs) corresponding to lncRNAs were found by the mircode database, targetscan database, and common miRNAs associated with UM prognosis were screened out by Venn analysis. The common miRNA-mRNA was screened from multiple databases simultaneously. Through KEGG enrichment and lncRNA-miRNA-mRNA network visualization, candidate lncRNAs related to the survival prognosis of UM were finally identified. Results: In the prediction of downstream target miRNAs and the functional genes of lncRNAs, 630 pairs of candidate miRNA-mRNA were identified. Based on the mechanism of gene expression regulation by ceRNAs, 9 lncRNAs that might play the role of ceRNAs were screened out. KEGG analysis showed that the downstream regulatory genes of lncRNAs were mainly enriched in the signaling pathways involved in the pathological process of tumors. SHNG6 may regulate miRNAs such as has-miR-214-5p, has-miR-214-3p, has-miR-let-7b-5p, and has-miR-let-7c-3p, the regulators of downstream functional genes BAX, IGF1R, KRAS, PIK3R1, PDGFD and so on. Conclusions: Through the mechanism of ceRNAs, lncRNAs regulate the expression of a series of oncogenes involved in tumor genesis and development, and affect the prognosis and treatment of UM. lncRNAs such as SHNG6 and LINC01278 may play an important role in its occurrence, development, migration and invasion.

    葡萄膜黑色素瘤长链非编码RNA内源竞争RNA

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    B/F Ratio、中央角膜厚度对SimK和TCRP一致性的影响

    吴万民柴飞燕刘杰为吴昔昔...
    216-220页
    查看更多>>摘要：目的： 分析正常角膜白内障患者角膜后前表面曲率半径之比（B/F Ratio）、中央角膜厚度（CCT）对模拟角膜屈光力（SimK）和全角膜屈光力（TCRP）一致性的影响。 方法： 回顾性系列病例研究。收集2019年9月至2020年1月在山西省眼科医院行超声乳化白内障联合人工晶状体（IOL）植入术的正常角膜白内障患者202例的临床资料及术前Pentacam HR眼前段分析仪测量结果，包括瞳孔中央4 mm区域内的角膜SimK、TCRP、B/F Ratio、CCT及SimK和TCRP差异△Km（△Km=SimK-TCRP）。若患者为单眼手术，则取手术眼的检查结果用于统计；若患者为双眼手术，则通过抛投硬币的方法，随机选择1眼的检查结果用于统计。对Pentacam HR眼前段分析仪测量结果中SimK和TCRP数据进行配对样本t检验，并采用Pearson相关性分析CCT、B/F Ratio与△Km相关性，建立多重线性回归方程。 结果： 202例患者角膜SimK、TCRP、△Km、B/F Ratio、CCT分别为（44.45±1.51）D、（44.34±1.59）D、（0.11±0.30）D、（82.04±1.52）%、（537±30）μm。△Km为0 D占比12.4%，SimK与TCRP差异有统计学意义（t=5.22，P<0.001）。B/F Ratio、CCT与△Km呈负相关（r=-0.22，P<0.001；r=-0.17，P=0.014）；B/F Ratio、CCT与△Km多重线性回归方程为：△Km=6.882-6.549×B/F Ratio-0.003×CCT（R2=0.13；F=14.90，P<0.001）。 结论： SimK和TCRP之间存在差异，该差异与B/F Ratio、CCT呈负相关。过小的B/F Ratio、CCT会使SimK高于TCRP，从而引起△Km远视漂移。 Objective: To evaluate the effects of the back-front corneal radius ratio (B/F Ratio) and central corneal thickness (CCT) on the consistency of the simulated keratometry (SimK) and total corneal refractive power (TCRP) in normal corneal patients with cataract. Methods: This retrospective analysis focused on the clinical data of 202 patients with cataracts and a normal cornea who underwent phacoemulsification with intraocular lens implantation in Shanxi Eye Hospital from September 2019 to January 2020. Corresponding measurement results of preoperative Pentacam HR anterior segment analyzer were analyzed, including the corneal SimK, TCRP, B/F Ratio, CCT and △Km (△Km=SimK-TCRP), which is the difference between SimK and TCRP, in the central 4 mm area of the pupil. Only 1 eye from each patient was selected, and if the patient had binocular surgery, a random eye was chosen by tossing a coin. Then, a paired samples t-test on SimK and TCRP data was conducted on the measurement results of the Pentacam HR anterior segment analyzer. Pearson correlation analysis was applied to evaluate the correlation of CCT and B/F Ratio with △Km, followed by the establishment of the multiple linear regression equation. Results: The mean values of corneal SimK, TCRP, △Km, B/F Ratio and CCT in 202 patients were 44.45¡À1.51 D, 44.34¡À1.59 D, 0.11¡À0.30 D, 82.04%¡À1.52%, and 537¡À30 μm, respectively. △Km=0 D accounted for 12.4% of the difference between SimK and TCRP, which was significant ( t=5.2, P<0.001). The B/F Ratio and CCT were negatively correlated with △Km (r=-0.22, P<0.001 r=-0.172, P=0.014). The linear regression equation of the B/F Ratio, CCT and △Km was △Km=6.882-6.549×B/F Ratio-0.003×CCT (R2=0.13 F=14.90, P<0.001). Conclusions: There is a divergence between SimK and TCRP, which is negatively correlated with the B/F Ratio and CCT. The SimK will exceed the TCRP which can cause the hyperopia shift based on △Km, if the B/F Ratio and CCT are too small.

    角膜全角膜屈光力中央角膜厚度角膜后前表面曲率半径比值

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    微导管辅助小梁切开术治疗儿童青光眼的疗效

    刘伟伟杨潇远马聪慧卢跃兵...
    221-226页
    查看更多>>摘要：目的： 观察微导管辅助的小梁切开术治疗儿童青光眼的临床效果及术后1年切开小梁的开放情况。 方法： 前瞻性临床研究。纳入2018年1月至2019年12月于河南省立眼科医院青光眼中心接受微导管辅助的小梁切开术治疗的4~16岁儿童青光眼患者21例（28眼）。观察记录患者手术前后最佳矫正视力（BCVA）、眼压、抗青光眼药物使用数量、房角情况、术中及术后并发症。术后随访1年。采用配对t检验、Wilcoxon符号秩和检验、Kruskal-Wallis H检验、Spearman秩相关分析等对数据进行分析。 结果： 所有患者均完成了微导管辅助的小梁切开术，其中完全切开16例（22眼），次全切开5例（6眼）。术前及术后末次随访的BCVA（LogMAR视力）分别为0.80（0.00~2.00）和0.75（0.00~1.60），差异无统计学意义（Z=-1.41，P=0.157）。术前及术后末次随访的眼压分别为（30.4±4.8）mmHg（1 mmHg=0.133 kPa）和（14.1±4.5）mmHg，末次随访眼压较术前明显降低（t=14.11，P<0.001）。术前使用降眼压药物数量中位数为3（1~4），末次随访时下降至0（0~3） （Z=-4.35，P<0.001）。末次随访时切开小梁开放范围中位数为302.5°（70°~360°）。所有患者中15例（21眼）手术完全成功，4例（5眼）条件成功，2例（2眼）手术失败，这3类患者切开小梁开放范围中位数分别为330°（210°~360°）、205°（180°~225°）、85°（70°~100°），差异有统计学意义（¦Ö2=15.20，P=0.001）。切开小梁开放范围与眼压呈负相关（r=-0.82，P<0.001）。 结论： 微导管辅助的小梁切开术治疗儿童青光眼具有良好的临床效果，且术后切开小梁开放范围是影响患者预后的重要因素。 Objective: To investigate the clinical efficacy of ab externo microcatheter-assisted trabeculotomy (MAT) in childhood glaucoma and the open range of the incised trabecular meshwork one year after surgery. Methods: This was a prospective clinical study. 21 patients (28 eyes) with childhood glaucoma, aged 4-16 years, were enrolled in the glaucoma center of Henan Eye Hospital from January 2018 to December 2019. All patients underwent ab externo MAT. Patients were followed up for one year after surgery. The best corrected visual acuity (BCVA), intraocular pressure (IOP), usage of anti-glaucoma medication, the condition of the anterior chamber angle and complications were observed and analyzed. A paired t test, Wilcoxon signed-rank test, Kruskal-Wallis H test, and Spearman rank correlation were used to analyze the data. Results: All patients underwent ab externo MAT successfully. Surgery on 16 patients (22 eyes) was performed with full incisions and surgery on 5 patients (6 eyes) was performed with a subtotal incision. Preoperative BCVA (median: 0.8, range: 0.00-2.00) was not significantly different from postoperative BCVA (median: 0.75, range: 0.00-1.60) (Z=-1.41, P=0.157). Preoperative and postoperative IOPs were 30.4¡À4.8 mmHg (1 mmHg=0.133 kPa) and 14.1¡À4.5 mmHg, respectively. The difference was statistically significant (t=14.11, P<0.001). The amount of the postoperative anti-glaucoma medication (median: 0, range: 0-3) was significantly lower than preoperative levels (median: 3, range: 1-4) (Z=-4.35, P<0.001). At the last follow-up, the open range of the incised trabecular meshwork median was 302.5° (range: 70°-360°). Fifteen cases (21 eyes) and 4 cases (5 eyes) achieved complete and qualified success 2 cases (2 eyes) failed. The open range medians of the incised trabecular meshwork of the 3 groups were 330°(210°-360°), 205°(180°-225°), and 85°(70°-100°) at the last visit. The open ranges of the different groups were statistically significant (¦Ö2=15.20, P=0.001). The open range of incised trabecular meshwork was negatively correlated with intraocular pressure (r=-0.82, P<0.001). Conclusions: Ab externo MAT is effective for treating childhood glaucoma,and the postoperative open range of the incised trabecular meshwork is an important factor affecting the prognosis for children.

    微导管辅助的小梁切开术青光眼眼压房角儿童

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    眼科专科医院伦理委员会现状分析及对策探讨

    王晨晓苗丹谷佩秋俞阿勇...
    227-230页
    查看更多>>摘要：目的： 调研中国眼科专科医院伦理委员会建设现状，了解其建设及运转情况，以发现存在的主要问题并提出相关解决对策。 方法： 横断面研究。采取便利抽样并结合网络发放的方式，于2018年10月至2019年10月对全国33家眼科专科医院的伦理委员会展开调查，内容包括伦理委员会概况、建设、运行等。选取有效问卷数据，采用描述性统计分析进行数据分析。 结果： 33家眼科专科医院中，21家（64%）设立了伦理委员会，另外12家（36%）没有设立伦理委员会。21家设有伦理委会的医院中有12家设置独立伦理委员会，9家设有专职秘书/工作人员，4家伦理委员会无院外委员，7家伦理委员会未制定主审制，4家未开展年度/定期跟踪审查，3家伦理委员会没有对本单位的研究者开展伦理相关内容培训。 结论： 眼科专科医院伦理委员会存在隶属关系混乱、成员组成不合理、委员培训不到位、缺乏伦理审查的全程性等问题；眼科专科医院仍需在伦理委员会设置、人员构成、有效的保障条件、委员的有效培训机制、规范的伦理审查程序等方面加强建设。建议以成立眼科专科医院伦理协作审查联盟的方式，积极推进联盟内成员单位伦理委员会的规范化建设，修订和完善标准操作规程，在提高伦理审查效率的同时，促进眼科专科医院伦理委员会规范、高质量地发展。 Objective: To detect the main problems in the formation of ethics committees in eye hospitals in China and to provide relevant solutions for them by investigating the current status and understanding the establishment and operation at these hospitals. Methods: This was a cross-sectional study. Convenience sampling combined with online distribution was adopted to investigate 33 ethics committees in eye hospitals all over the country from October 2018 to October 2019. The contents included the profile, formation, and operation of these ethics committees. Valid questionnaire data were selected and analyzed using descriptive statistical analysis. Results: A total of 21(64%) eye hospitals had established ethics committees, and the other 12(36%) had not. Of the 21 hospitals with ethics committees, 12 hospitals had independent ethics committees, 9 hospitals had full-time secretaries or staff, 4 hospitals did not have outside committee members, 7 hospitals had not established the presiding censorship, 4 hospitals had not conducted annual or regular follow-up reviews, and 3 hospitals had not organized ethics-related training for their researchers. Conclusions: There are problems in ethics committees in eye hospitals, such as chaotic subordinate relationships, inappropriate membership, inadequate training of committee members, and a lack of the whole course of ethics censorship. Specialized eye hospitals still need to strengthen the establishment of ethics committee setup, personnel composition, effective guaranteed conditions, effective training mechanisms, and normalized ethical review procedures. Mean while, it is recommended to establish a collaborative ethics censor alliance in eye hospitals, to actively promote a more normalized formation of ethics committees in the alliance, and to revise and improve standard operating procedures. While increasing the efficiency of ethical reviews, there are benefits in promoting the development, normalization and high quality of these ethics committees in eye hospitals.

    眼科专科医院伦理委员会伦理审查协作审查

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