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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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    彩色角膜接触镜规范验配白皮书

    吕帆季魏红
    481-484页
    查看更多>>摘要：软性接触镜自问世以来，以其良好的视觉质量与舒适度，于20世纪70年代开始在临床上大规模应用，至2011年全球有超过1.4亿人口配戴接触镜 [1,2]，且呈逐年递增趋势。《2018—2023年中国隐形眼镜市场分析与投资前景研究报告》 [3]显示，2010—2017年期间，中国接触镜消费额平均增长率为17.6%，而彩色角膜接触镜的复合年均增长率远高于这一数值，在整个接触镜行业中占据的份额逐年增高。《天猫隐形眼镜行业人群洞察白皮书》 [4]显示，彩色隐形眼镜于2019年、2020年、2021上半年的商品交易总额市场增速分别达到20%、45%、83%。

    彩色角膜接触镜规范验配白皮书

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    Vipr2敲除对小鼠视网膜功能的影响

    赵福新汪琪王莉阳凡...
    485-493页
    查看更多>>摘要：目的： 检测血管活性肠肽受体2（Vipr2）敲除小鼠多巴胺（DA）等神经递质含量和视网膜电生理，明确Vipr2敲除对视网膜功能的影响。 方法： 实验研究。利用RT-PCR检测血管活性肠肽（Vip）、Vipr2在4周龄雄性C57BL/6J小鼠眼球组织中的表达水平。通过CRISPR-Cas9基因编辑技术构建Vipr2敲除（Vipr2-KO）小鼠，然后在4周龄时检测Vipr2-KO和Vipr2野生型（Vipr2-WT）小鼠视网膜中DA等神经递质含量及视网膜电生理功能。Vipr2-KO小鼠与Vipr2-WT小鼠DA等神经递质含量比较采用独立样本t检验，而2种小鼠视网膜电生理数据比较采用双因素重复测量方差分析。 结果： Vip和Vipr2 mRNA在小鼠视网膜、脉络膜+视网膜色素细胞、角膜和巩膜中均有表达；在虹膜和晶状体中Vipr2呈低表达，未检测到Vip表达。与Vipr2-WT小鼠相比，Vipr2-KO小鼠表现为近视（t=2.51，P=0.017），视网膜DA、3, 4-二羟基苯乙酸（DOPAC）、高香草酸（HVA）含量均明显升高（t=3.42，P=0.001；t=2.15，P=0.037；t=3.27，P=0.002），DOPAC/DA比值无变化；而玻璃体液中DA、DOPAC、DOPAC/DA、HVA、去甲肾上腺素含量差异均无统计学意义。视网膜和玻璃体液中天冬氨酸、谷氨酸、丝氨酸、谷氨酰胺、甘氨酸、牛磺酸和γ氨基丁酸含量在Vipr2-KO小鼠与Vipr2-WT小鼠之间差异均无统计学意义。在暗适应不同光刺激强度下（-3.699、-2.201、-0.699、0.301、0.799 log cd·s/m2），Vipr2-KO小鼠相比Vipr2-WT小鼠，b波振幅明显增加（F=8.65，P=0.015）。 结论： Vipr2敲除可引起4周龄小鼠屈光向近视发展，影响视网膜中DA、DOPAC、HVA合成代谢，并引起视网膜电生理功能异常。提示Vipr2敲除可能通过影响视网膜功能参与近视形成，但具体作用机制有待进一步研究。 Objective: To determine if the loss of function of retinal vasoactive intestinal peptide receptor 2 (Vipr2) affects dopamine (DA) turnover and retinal electrophysiology behavior. Methods: This is an experimental study. RT-PCR analyzed vasoactive intestinal peptide (Vip) and Vipr2 mRNA expression levels in different ocular tissues of 4- week-old male wildtype C57BL/6J mice. CRISPR-Cas9 gene-editing technology constructed the Vipr2-KO mice. Their refraction, turnover of retinal dopamine, and electroretinograms were measured and compared in these two different groups of 4-week-old Vipr2-KO and Vipr2-WT mice. Statistical analysis of the refraction and DA turnover used the independent sample t-test, and the data of retinal electrophysiology were evaluated with the two-way repeated measures ANOVA between these two different groups of mice. Results: Vip and Vipr2 mRNA levels were highly expressed in the retina, choroid/retinal pigment cells, cornea, and sclera. In the iris and lens, Vipr2 mRNA was expressed at very low levels whereas the Vip mRNA expression level was undetectable. The refraction of 4-week-old Vipr2-KO mice was significantly shifted more towards myopia than that in the Vipr2-WT mice (t=2.51, P=0.017). The contents of DA, 3, 4-dihydroxyphenylacetate (DOPAC), and homovanillic acid (HVA) were significantly increased more in the 4-week-old Vipr2-KO mice than in the Vipr2-WT mice (t=3.42, P=0.001 t=2.15, P=0.037 t=3.27, P=0.002, respectively). However, the levels of DA, DOPAC, DOPAC/DA, HVA, and norepinephrine in the vitreous humor were not altered between these two different groups. The amino acid contents of aspartic acid, glutamic acid, serine, glutamine, glycine, taurine, and γ-aminobutyric acid were invariant in the retina and vitreous humor of these groups. The b-wave amplitudes under scotopic conditions (-3.699, -2.201, -0.699, 0.301, 0.799 log cd·s/m 2) were higher in the 4-week-old Vipr2-KO mice than in its Vipr2-WT counterpart (F=8.65, P=0.015). Conclusions: Loss of Vipr2 function induces a refractive shift towards myopia at age 4 weeks, and alters both the retinal DA turnover and electroretinogram pattern. These changes suggest that loss of Vipr2 function alters retinal function and is thereby involved in myopia progression, but its mode of action requires further study.

    Vipr2Vipr2敲除多巴胺高效液相色谱法视网膜电生理

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    基于RNA-seq技术的雏鸡晚期离焦识别转录组学研究

    孙丽媛朱莉陈思童王凯...
    494-505页
    查看更多>>摘要：目的： 探讨晚期离焦识别的分子机制。 方法： 实验研究。将30只7 d龄白来航鸡随机分为负镜组、正镜组和对照组，分别给予雏鸡右眼-10 D/+10 D/0 D透镜诱导，干预时间为6 d。所有动物均在光学干预前后测量屈光度、眼轴和后极部各组织厚度等生物学参数。采用单因素方差分析对数据进行分析。眼球生物学参数测量完毕后分离眼后极部组织，提取RNA，应用RNA-seq技术筛选差异表达基因，并对其进行GO功能注释、KEGG通路分析及PPI网络分析，观察离焦干预对雏鸡后极部各组织转录组的影响。 结果： 负镜组、正镜组雏鸡的屈光度、眼轴长度以及脉络膜厚度，与对照组相比，差异具有统计学意义（P<0.05）；以P<0.05和|log2FC|>1为筛选标准，负镜组与对照组相比，视网膜有203个差异表达基因，脉络膜有757个差异表达基因，巩膜有1 509个差异表达基因；正镜组与对照组相比，视网膜有191个差异表达基因，脉络膜有378个差异表达基因，巩膜有1 918个差异表达基因。与对照组比，负镜组与正镜组的重叠基因除LOC121112941外均表现出相同的差异表达趋势，GO分析通路存在50%以上重合，KEGG分析视网膜水平的重叠通路是花生四烯酸代谢、酪氨酸代谢和视黄醇代谢；脉络膜水平的重叠通路是内质网中的蛋白质加工，精氨酸和脯氨酸代谢和视黄醇代谢；巩膜水平的重叠通路则为细胞粘附分子、ECM-受体相互作用、粘着斑、细胞因子-细胞因子受体相互作用、硫代谢、糖胺聚糖生物合成-硫酸软骨素/硫酸皮肤素、Toll样受体信号通路、TGF-β信号通路和MAPK信号通路。通过PPI蛋白互作网络分析鉴定出离焦识别过程中各组织的关键基因。 结论： 本研究在转录组水平上筛选出晚期离焦识别过程的绝大多数重叠基因保持着相同的上调或下调表达趋势，不同方向的离焦信号可能诱导部分通路的相似变化。 Objective: To investigate the molecular mechanism of late defocus recognition. Methods: In this experimental study, 30 7-day-old White Leghorn chicks were randomly divided into a minus-lens group, a plus lens group and a control group, and the chicks were induced with -10 D/+10 D/0 D lens in the right eye of the chicks respectively, with 6 days' intervention time. Biological parameters such as diopter, axial length, and thickness of each tissue in the posterior pole were measured in all animals before and after the optical intervention, and the data were analyzed by one-way ANOVA. After the measurement of the biological parameters of the eyeball, the posterior pole tissues of the eyes were isolated, RNA was extracted respectively, and differentially expressed genes (DEGs) were screened by RNA-seq technology. GO analysis, KEGG pathway analysis, and PPI network analysis was performed to observe the effect of defocus intervention on the transcriptome of each tissue in the posterior pole of chicks. Results: The diopter, axial length, and choroidal thickness of the chicks in the minus-lens group and the plus lens group were significantly different from those in the control group (P<0.05) withP<0.05 and |log2FC|>1 as the screening criteria, compared with the control group and the minus-lens group, there were 203 DEGs in the retina, 757 DEGs in the choroid, and 1 509 DEGs in the sclera compared with the control group and plus-lens group, the retina had 191 DEGs, the choroid had 378 DEGs, and the sclera had 1 918 DEGs. Compared with the control group, the overlapping genes of minus-lens group and plus-lens group all showed the same differential expression trend except forLOC121112941. There was more than 50% overlap in the GO analysis pathways. The common pathways in the KEGG analysis at the retinal level were arachidonic acid metabolism, tyrosine metabolism, and retinol metabolism overlapping pathways at the choroidal level were protein processing in the endoplasmic reticulum, arginine and proline metabolism, and retinol metabolism at the scleral level were cell adhesion molecules, ECM-receptor interactions, focal adhesions, cytokines - cytokine receptor interaction, sulfur metabolism, glycosaminoglycan biosynthesis - chondroitin sulfate/dermatan sulfate, Toll-like receptor signaling, TGF-β signaling, and MAPK signaling. Key genes in each tissue during out-of-focus recognition were identified by protein-protein interaction network analysis. Conclusion: This study screened out most of the overlapping genes in the late defocus recognition process at the transcriptome level, maintaining the same up- or down-regulation trend, and defocus signals in different directions may induce similar changes in some pathways.

    正视化屈光不正视网膜脉络膜巩膜RNA-seq

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    基于功能性裂隙灯生物显微镜对巩膜镜初戴者球结膜微循环改变的研究

    范歆黄惠敏田丽施策...
    506-513页
    查看更多>>摘要：目的： 比较巩膜镜初戴者戴镜前、后的球结膜微循环的改变，观察配戴巩膜镜对球结膜微循环的影响。 方法： 前瞻性临床研究。共纳入温州医科大学从未配戴过巩膜镜的在校健康学生22名，所有被检者根据随机数字表法随机选择一眼进行数据采集，配戴巩膜镜。使用功能性裂隙灯生物显微镜（FSLB）分别于戴镜前，戴镜0、1、2、3 h拍摄颞侧巩膜镜镜下和镜外区域的球结膜获得球结膜微循环和微血管影像，并使用自行编写的软件测量获得微循环及微血管参数。采用单因素方差分析法分析戴镜前/后、镜下/镜外的球结膜微循环及微血管参数之间的差异，并采用Pearson相关分析方法进行相关性分析。 结果： 纳入22名被检者的22只眼（13只右眼，9只左眼），在眼表微血管形态方面，镜外区域戴镜0 h时血管密度（1.482±0.100）较戴镜前血管密度（1.408±0.124）明显升高（P=0.019）。在眼表微循环方面，镜外区域戴镜前血流量[（104.5±28.4）pl/s]高于戴镜1 h时血流量[（86.1±20.9）pl/s] （P=0.027）；镜下区域血管直径在戴镜3 h时[（18.39±1.90）μm]与戴镜前[（17.71±1.49）μm]、戴镜0 h[（17.63±2.11）μm]、戴镜1 h[（17.85±1.86）μm]时差异均有统计学意义（均P<0.05），戴镜0 h较戴镜前降低，戴镜1~3 h血管直径逐渐升高；血流量在戴镜1 h[（61.6±22.8）pl/s]时与戴镜前[(77.4±27.0）pl/s)、戴镜3 h[（76.9±22.3）pl/s]差异均有统计学意义（均P<0.05），戴镜1 h较戴镜前明显降低，戴镜3 h较戴镜1 h时明显升高。 结论： 配戴巩膜镜初期，结膜受巩膜镜压力出现一过性循环障碍，之后因眼表逐渐适应巩膜镜以及巩膜镜对眼表的炎性刺激使球结膜的微循环升高。这提示使用FSLB量化获得的球结膜的微循环参数或许可以作为巩膜镜适配的客观准确的可视化工具，并可用于监测巩膜镜长期配戴者的球结膜血管系统，为巩膜镜配戴的安全性及配戴者的眼表健康提供线索。 Objective: To explore the changes of microcirculation of the bulbar conjunctiva after wearing the scleral lenses. Method: Prospective clinical study. The healthy students from Wenzhou Medical University were included in this study. The subjects randomly selected one eye as the experimental subject according to the random number table, the experimental subject wore scleral lenses. Functional slit lamp biomicroscopy (FSLB) was used to capture temporal bulbar conjunctival microcirculation and microvascular images under the lenses and outside of the lenses before and during the wear at 0 h, 1 h, 2 h and 3 h. Custom-built software has been utilized for the quantification of microvascular morphology and hemodynamics. The changes of the indicators before and during wearing the scleral lenses were observed. The microcirculation and microvascular parameters were analysed using ANOVA and Pearson correlation. Result: 22 subjects were enrolled in the study, including 13 right eyes and 9 left eyes. Outside of the scleral lenses, the vessel density before wearing lenses (1.408±0.124) was less than that at 0 h(1.482±0.100) (P=0.019).Outside of the scleral lenses, the blood flow volume was (104.5±28.4)pl/s before wearing lenses and (86.1±20.9)pl/s after wearing 1 h. The comparison before and after wearing the scleral lenses was statistically significant (P=0.027). Under the scleral lenses, the vessel diameter at 3 h (18.39±1.90) μm was statistically significant ( P<0.05) from before wearing the lenses (17.71±1.49) μm and after wearing the lenses at 0 h (17.63±2.11) μm, 1 h (17.85±1.86) μm. The vessel diameter at 0 h after lens insertion was decreased than before lens wearing, however, the vessel diameter was increased after 1, 3 h wearing. The blood flow volume at 1 h [(61.6±22.8)pl/s ]was less than that before wearing lenses (77.4±27.0)pl/s and at 3 h [ (76.9±22.3)pl/s] (P<0.05). The comparison of 1 h after wearing the scleral lenses and before wearing lenses, 3 h after wearing the scleral lenses was statistically significant. Conclusion: At the beginning of wearing the scleral lenses, the bulbar conjunctival vessels suffered transient circulatory disturbance due to the pressure of the scleral lens. Then the microcirculation of the bulbar conjunctiva increased due to the gradual adaptation of the scleral lenses and the inflammatory stimulation. The study of the conjunctival microcirculation and microvascular may contribute to explore the safety of wearing the ScCL and monitoring conjunctiva vascular system in long-term scleral lenses wearers.

    巩膜镜球结膜血流速度微血管微循环显微镜检查

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    基于图像拼接方法对不同程度干眼症患者角膜上皮基底神经丛的定量分析

    高欢于花郑晓汾赵炬伟...
    514-521页
    查看更多>>摘要：目的： 利用图像拼接方法对不同程度干眼症患者角膜上皮基底神经丛进行定量分析，探讨其变化规律。 方法： 横断面研究。选取2021年4—10月于山西省眼科医院门诊就诊的干眼症患者共91例（91眼），其中轻度干眼34例、中度干眼33例、重度干眼24例，同时征集正常健康志愿者作为对照组共27例（27眼），所有受检者均选择右眼数据分析，对所有受检者分别行常规眼科检查、眼表综合分析仪检查、角膜共焦显微镜检查后，运用Photoshop CC 2018图像处理软件合成大范围角膜上皮基底细胞层下神经丛（SNP）结构拼图，截取以涡状结构为中心的、大小为700 μm×700 μm的图像进行分析，结合Image J图像分析系统计算得出图像中神经纤维总长度（NFL），将所得数据通过图像大小与像素之间的换算关系计算出单位面积（1 mm2）的神经纤维总长度值即神经纤维密度值（mm/mm2）。采用单因素方差分析对各组数据进行比较，同时对两两之间进行LSD多重比较；采用Pearson线性相关分析各组角膜SNP密度与眼表综合分析检查中各项指标间的相关性。 结果： 4组间性别、年龄比较差异无统计学意义。对照组SNP密度为（22.71±6.19）mm/mm2，轻度干眼组为（28.58±5.19）mm/mm2，中度干眼组为（28.17±4.71）mm/mm2，重度干眼组为（5.98±7.32）mm/mm2，4组SNP密度总体差异有统计学意义（F=88.10，P<0.001）；轻、中、重度干眼SNP密度与对照组差异均有统计学意义（均P<0.001），轻度干眼组与中度干眼组间差异无统计学意义，重度干眼组与轻、中度干眼组间差异均有统计学意义（均P<0.001）。干眼症患者角膜SNP密度与泪河高度、睑板腺缺失面积评分（上+下）及眼表充血评分之间无明显相关性，与非侵入性泪膜破裂时间呈正相关（r=0.51，P<0.001），与脂质层分级、角膜荧光素钠染色分级呈负相关（r=-0.30，P=0.004；r=-0.68，P<0.001）。 结论： 角膜SNP密度及形态改变与干眼症的严重程度分级有关，可作为临床评估干眼程度的有效指标。 Objective: To quantitatively analyze the corneal epithelial basal plexus in patients with different degrees of dry eye by image mosaic method and to explore its changes. Methods: Cross sectional study. A total of 91 eyes of dry eye patients (n=91) with mild dry eye (n=34), moderate dry eye (n=33), and severe dry eye (n=24) were recruited from the outpatient clinic of Shanxi Eye Hospital between April 2021 and October 2021. A total of 27 eyes (n=27) were recruited from normal healthy volunteers as the control group, and all subjects were selected for right eye data analysis. After routine ophthalmic examination, comprehensive ocular surface analyzer examination, and confocal microscopy of the cornea were performed for all subjects, the structural puzzle of the large corneal epithelial basal nerve plexus (SNP) was synthesized using Photoshop CC 2018 and captured as a vortex structure centered at 700 μm×700 μm of the images were analyzed, combined with the calculation of the total length of nerve fibers (NFL) in the images by the image J. The resulting data were converted from the image size to pixels to calculate the total length of nerve fibers per unit area (1 mm 2), which was the value of nerve fiber density (mm/mm2). One way ANOVA was used to statistically compare the data in each group,while pairwise comparisons were made between the means of each group (LSD multiple comparisons), and Pearson's linear correlation was used to analyze the correlation between corneal nerve fiber density in each group and each index in the comprehensive analysis examination of the ocular surface. Result: Comparison of gender and age among the 4 groups showed no significant difference. In the control group, nerve fiber density was (22.71±6.19) mm/mm2, Mild dry eye group was (28.58±5.19) mm/mm2, Moderate dry eye group was (28.17±4.71) mm/mm2, and Severe dry eye group was (5.98±7.32) mm/mm2,corneal SNP density was significantly different between groups (F=88.10, P<0.001). The density of SNP in the control group was significantly different from that in the mild,moderate,and severe dry eye groups (P<0.001), that in the mild dry eye group was not significantly different from that in the moderate dry eye group, and that in the mild,moderate dry eye group was significantly different from that in the severe dry eye group (P<0.001). There were no significant correlations between corneal SNP density and tear meniscus height, meibomian gland missing area score (superior+inferior) or ocular surface hyperemia score, a positive correlation with noninvasive breakup time (r=0.51, P<0.001), lipid layer grade (r=-0.30, P=0.004) and corneal fluorescein sodium staining grade (r=-0.68, P<0.001). Conclusion: The density and morphological changes of the basal nerve plexus in the corneal epithelium are associated with the severity grading of dry eye and can be used as a useful indicator for clinical assessment.

    干眼症共焦显微镜角膜上皮基底神经丛图像拼接方法定量分析

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    SMILE术后眼前节变化对眼压测量值的影响

    宋爽梁涛冷林刘胜男...
    522-529页
    查看更多>>摘要：目的： 探讨飞秒激光小切口角膜基质透镜取出术（SMILE）后眼压（IOP）检测的影响因素，分析眼前节参数变化与IOP的关系。 方法： 前瞻性临床研究。收集2020年6—11月在青岛大学附属医院眼科接受SMILE手术患者141例（258眼)的资料。根据剩余基质床厚度（RST）分为3组，分别为A组（280 μm<RST≤320 μm）、B组（320 μm<RST≤360 μm）、C组（RST>360 μm）。采用Pentacam测量眼前节形态参数，非接触眼压计（NCT）测量IOP，Corvis ST测量角膜生物力学参数。观察患者术前，术后1、3、6个月不同时间点参数的变化。数据采用方差分析、Pearson线性相关、配对t检验进行分析。 结果： 除前房角（ACA）外，各组术后CCT、中央前房深度（ACD）、前房容积（ACV）等眼前节形态学参数均较术前降低，差异均有统计学意义（P<0.05）；3组术后6个月与术前相比，第一压平时间（A1T）、角膜硬度参数（SP-A1）降低，变形幅度（DA）、峰距（PD）、水平方向Ambrosio相关厚度（ARTh）增加；组间比较A组中△A1T、第一压平速率的变化量（△A1V）、△DA及△PD高于B、C组，差异均有统计学意义（P<0.05）；各组△IOP与|SE|、术前IOP、△CCT、△ACD、△ACV呈正相关关系（P<0.05），与△ACA无相关性（P>0.05）；A组中△ACD、△ACV与△A1T、△SP-A1、△ARTh呈正相关，与△DA呈负相关（P<0.05）；3组分别建立△IOP的线性回归方程，进而得出术后IOP的校正方程：A组IOP术后校正值=IOP术后测量值+0.572×IOP术前+15.759×△ACD-2.401（调整后R2=0.55，P<0.001）；B组IOP术后校正值=IOP术后测量值+0.471×IOP术前+0.54×SE-1.099×△CV-3.551（调整后R2=0.50，P<0.001）；C组IOP术后校正值=IOP术后测量值+0.553×IOP术前+0.304×SE-4.013（调整后R2=0.38，P<0.001）。 结论： SMILE术后ACD、ACV变化与△IOP呈正相关关系，RST在280~320 μm范围时，IOP的测量需要考虑前房参数变化的影响。 Objective: To discuss the factors that influence intraocular pressure (IOP) after small incision lenticule extraction (SMILE), and to analyze the anterior segment parameters that influence changes in IOP. Methods: In this prospective clinical study, 141 patients (258 eyes) with myopic astigmatism who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from June to November 2020 were enrolled. They were divided into three groups according to the residual stromal thickness (RST): 280 μm -320 μm in group A, 320 μm -360 μm in group B, >360 μm in group C. Tomography and biomechanical parameters of all eyes were obtained with Pentacam and Corvis ST, respectively. The changes in parameters were observed preoperatively and at 1, 3 and 6 months postoperatively. The data were analyzed by a measurement analysis of variance, Pearson linear correlation and paired t-test. Results: Except for the anterior chamber angle (ACA), the postoperative CCT, anterior chamber depth (ACD), anterior chamber volume (ACV) and other anterior segment morphological parameters in each group were generally lower than those before surgery, with statistically significant differences (all P<0.05). The first applanation time (A1T) and stiff parameter (SP-A1) decreased, the deformation amplitude (DA) and the peak distance (PD) at 6 months after the operation in the three groups were compared with those before the operation and Ambrosio relational thickness horizonal (ARTh) increase. For pairwise comparison between the groups, the ranges in the changes in ∆ A1T, ∆ A1V, ∆ DA, and ∆ PD in group A were greater than those for the other two groups, with statistically significant differences (allP<0.05). ∆ IOP and spherical equivalent (SE), preoperative IOP (IOPpre), ∆ CCT, changes in corneal volume (∆ CV), changes in central anterior chamber depth (∆ ACD) and changes in anterior chamber volume (∆ ACV) were positively correlated (all P<0.05). However, there was no correlation with the change in the anterior chamber angle (∆ ACA) (all P>0.05). In group A, ∆ ACD and ∆ ACV had a medium and low positive correlation with ∆ A1T, ∆ SP-A1, and ∆ ARTh, and a low negative correlation with ∆ DA (allP<0.05). A multiple linear regression equation of ∆ IOP was established for each group, and the corrected equation for the postoperative IOP was obtained: Group A, IOPpost corrected=IOPpost measured+0.572×IOPpre+15.759× ∆ ACD-2.401 (after adjustment R2=0.55, P<0.001) Group B, IOPpost corrected=IOPpost measured+0.471×IOPpre+0.54×SE-1.099× ∆ CV-3.551 (after adjustment R2=0.50, P<0.001) Group C, IOPpost corrected=IOPpost measured+0.447×IOPpre+0.304×SE-4.013 (after adjustment R2=0.38, P<0.001). Conclusions: The changes in ACD and ACV have a positive correlation with ∆ IOP after SMILE. When the RST is in the range of 280-320 μm, the change in anterior chamber parameters should be considered in the measurement of IOP.

    角膜屈光手术眼压测量剩余基质床厚度眼前节参数角膜生物力学

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    高度散光儿童眼前节生物学参数的特征分析

    楚莹莹刘伟伟刘婷李萍...
    530-535页
    查看更多>>摘要：目的： 分析高度散光儿童眼前节生物学参数的特征。 方法： 系列病例研究。收集2020年10月至2021年10月就诊于河南省儿童医院的散光患儿82例（82眼），其中高度散光患儿64例（散光≥2.00 DC），中低度散光患儿18例（散光<2.00 DC）。采用SIRIUS天狼星三维角膜地形图及眼前节分析系统测定患儿眼前节生物学参数，包括角膜参数和前房参数。角膜参数包括角膜最薄点厚度、角膜最薄点位置、中央角膜厚度、角膜体积、角膜前后表面K1、角膜前后表面K2、角膜前后表面球镜度、角膜前后表面柱镜度、光学区4 mm球镜度、光学区4 mm柱镜度；前房参数包括前房深度、水平虹膜直径、虹膜角膜夹角、前房直径。采用独立样本t检验、单因素方差分析等方法对眼前节各生物学参数进行统计学分析。 结果： 高度散光组儿童与中低度散光组相比，前房参数、角膜厚度和角膜体积差异均无统计学意义，2组角膜最薄点位置分别有97%和89%位于颞下方，高度散光组角膜前、后表面K1值较低（t=-2.61, P=0.011 t=2.40, P=0.019），角膜前、后表面散光及光学区4 mm散光度数较大（t=-11.00, P<0.001 t=5.58, P<0.001 t=-10.25, P<0.001）。散光程度较高组，前房直径较大，2组差异具有统计学意义（F=3.03, P=0.036）。高度散光组屈光状态转化为等效球镜度，等效球镜度越小，前房深度和房角越大，组间差异具有统计学意义（F=11.12, P<0.001 F=5.07, P=0.009）。 结论： 高度散光组儿童的角膜前后表面散光及光学区4 mm散光较大，角膜最薄点位置大多位于颞下方，角膜前后表面K1值较低，散光程度较高组儿童，前房直径较大，高度散光组等效球镜度越小，前房深度和房角越大。 Objective: To analyze the characteristics of biological parameters of anterior segment in children with high astigmatism. Methods: In this case-series study. A total of 82 cases with 82 eyes of children with astigmatism in Henan Children's Hospital from October 2020 to October 2021 were collected, including 64 children with high astigmatism (astigmatism ≥2.00 DC), and 18 children with moderate to low astigmatism (astigmatism<2.00 DC). Use SIRIUS three-dimensional corneal topography and anterior segment analysis system to determine the biological parameters of cornea and anterior chamber. Corneal parameters include corneal thinnest point thickness, corneal thinnest point position, central corneal thickness, corneal volume, corneal anterior and posterior surface K1, corneal anterior and posterior surface K2, corneal anterior and posterior surface spherical lens, corneal anterior and posterior surface cylindrical lens, optical zone 4 mm spherical lens, optical zone 4 mm cylinder anterior chamber parameters include anterior chamber depth, horizontal iris diameter, iris corneal angle, and anterior chamber diameter. The biological parameters of the anterior segment were statistically analyzed by independent samplest test and one-way ANOVA. Results: There were no significant differences in anterior chamber parameters, corneal thickness and corneal volume between the high astigmatism group and the moderate-low astigmatism group. In the two groups, 97% and 89% of the corneal thinnest points were located in the inferior temporal area, respectively, the K1 value of the anterior and posterior corneal surfaces of the high astigmatism group was lower (t=-2.61, P=0.011 t=2.40, P=0.019), and the astigmatism of the anterior and posterior corneal surfaces and the 4 mm astigmatism of the optical zone were larger (t=-11.00, P<0.001 t=5.58, P<0.001 t=-10.25, P<0.001). Children in the higher astigmatism group had larger anterior chamber diameter, and the difference between the groups was statistically significant (F=3.03, P=0.036). The refractive state of the high astigmatism group was transformed into spherical equivalent. The smaller the spherical equivalent value, the greater the anterior chamber depth and angle, and the difference between the groups was statistically significant (F=11.12, P<0.001 F=5.07, P=0.009). Conclusions: The astigmatism of the anterior and posterior corneal surfaces of the children in the high astigmatism group and the 4 mm astigmatism of the optical zone are larger, the corneal thinnest point is mostly located in the inferior temporal area, the K1 value of the anterior and posterior corneal surfaces is lower, and the children in the higher degree of astigmatism group have a larger anterior chamber diameter, the smaller the spherical equivalent value of the high astigmatism group, the larger the anterior chamber depth and angle.

    高度散光儿童眼前节生物学参数

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    学龄前高度远视和低度远视儿童屈光发育比较

    王丽俊魏楠宁玉贤李静...
    536-540页
    查看更多>>摘要：目的： 比较学龄前高度远视和低度远视儿童的屈光发育特点。 方法： 回顾性系列病例研究。收集2020年7月至2021年12月在天津医科大学眼科医院就诊的学龄前远视性屈光不正儿童43例（86眼）。根据睫状肌麻痹后球镜度结果将儿童分为高度远视组27例（54眼），低度远视组16例（32眼），分别于基线和随访1年记录2组儿童的屈光度和眼球生物学参数，包括眼轴长度（AL）、角膜曲率半径、轴率比。采用自身配对t检验进行组内屈光度和眼球生物学参数分析；采用Wilcoxon符号秩检验进行组内最佳矫正视力比较；采用独立样本t检验进行组间眼生物学参数年变化量的差异分析。 结果： 与基线值[（8.37±1.84）D]相比，高度远视组等效球镜度（SE）年降低量为（0.72±0.41）D（t=-9.26，P<0.001）。高度远视组AL年增长量[（0.31±0.18）mm]与低度远视组年增长量[（0.21±0.09）mm]的差异有统计学意义（t=3.53，P=0.001），2组间角膜曲率半径年变化差异无统计学意义；高度远视组轴率比的年增长量（0.04±0.02）与低度远视组年增长量（0.02±0.03）的差异有统计学意义（t=3.23，P=0.002）。 结论： 与学龄前低度远视儿童相比，学龄前高度远视儿童的AL和轴率比的年增长幅度更大，这提示有必要对高度远视儿童进行密切随访。 Objective: To compare the characteristics of refractive development in preschoolers with high hyperopia and low hyperopia. Method: In this retrospective case-series study, a total of 43 preschool children (86 eyes) with hypermetropia who were admitted to Tianjin Medical University Eye Hospital from July 2020 to December 2021 were enrolled. According to the results of spherical diopter after ciliary paralysis, the children were divided into two groups: high hyperopia group 27 cases with 54 eyes and low hyperopia group 16 cases with 32 eyes.Recording the diopter and eye biologic parameters including axial length (AL), corneal curvature radius, axial length/corneal radius of curvature at baseline and follow-up of one year.Intra-group diopter and eye biological parameters were analyzed by self paired t test. Intra-group best corrected visual acuity was compared by Wilcoxon signed rank test. Independent sample t test was used to analyze the difference of changes in eye biological parameters between groups. Results: The annual decrease of equivalent spherical equivalent (SE) in high hyperopia group was (0.72±0.41)D (t=-9.26, P<0.001), compared to baseline (8.37±1.84)D. The difference of annual growths of AL in high hyperopia group [(0.31±0.18)mm] and low hyperopia group [(0.21±0.09)mm] was statistically significant (t=3.53, P=0.001).There was no significant difference between the annual changes of corneal curvature radius in the two groups. The annual increases of AL/corneal radius of curvature in high hyperopia group (0.04±0.02) was significantly different from that in low hyperopia group (0.02±0.03) (t=3.23, P=0.002). Conclusion: Compared with preschool children with low hyperopia, the annual increase of AL and AL/corneal radius of curvature was larger in preschool children with high hyperopia, suggesting that it is necessary to follow up children with high hyperopia closely.

    高度远视低度远视眼轴长度学龄前儿童屈光发育

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    3D平视技术在玻璃体切割联合白内障手术中的应用

    樊芳芳杨潇许腾予李婕...
    541-546页
    查看更多>>摘要：目的： 比较3D平视技术与显微镜目镜下行玻璃体切割联合白内障手术的疗效和安全性。 方法： 回顾性系列病例研究。收集2018年9月至2021年6月于徐州市第一人民医院眼科行玻璃体切割联合白内障手术的患者48例（48眼）的临床资料。根据手术时观察系统不同分为3D平视技术组和显微镜目镜组，每组24例（24眼）。比较2组患者术眼手术持续时间及术中并发症等情况。术后随访3个月，评估术眼手术前后最佳矫正视力（BCVA）、术后解剖复位率和术后并发症发生率情况。数据采用t检验、卡方检验及Fisher确切概率法进行分析。 结果： 显微镜目镜组、3D平视技术组的手术时间依次为（64.4±19.8）min和（63.1±18.5）min，差异无统计学意义（t=-0.27，P=0.089）。术后1、3个月，显微镜目镜组和3D平视技术组术眼BCVA均较术前明显提高，且术后3个月BCVA均优于术后1个月，差异均有统计学意义（P<0.05）。术后1、3个月复查时，同一时间点2组BCVA比较差异均无统计学意义。2组术中出血率、后囊膜破裂率、气体注入率和硅油注入率及术后出现角膜水肿、前房反应、高眼压及低眼压率差异均无统计学意义。随访3个月时显微镜目镜组和3D平视技术组均未出现术后并发症。 结论： 3D平视技术下的玻璃体切割联合白内障手术可以达到与显微镜目镜下同样的治疗效果，且安全性好，可在临床上进行推广。 Objective: To compare the efficacy and safety of 3D heads-up technique and microscope eyepiece in vitrectomy combined with cataract surgery. Methods: This was a retrospective case series study. The clinical data of 48 cases (48 eyes) who underwent vitrectomy combined with cataract surgery in the Department of Ophthalmology in Xuzhou First People's Hospital from September 2018 to June 2021 were selected. According to the surgical observation system, they were divided into 3D heads-up technology group and microscope eyepiece group, with 24 cases (24 eyes) in each group. The duration of intraoperative eye surgery and intraoperative complications were compared between the two groups. After 3 months of follow-up, BCVA, postoperative anatomical reset rate and surgical complications occurred before and after surgery were evaluated. Data were analyzed byt-test, Chi-square test and Fisher exact method. Results: The surgery time of the microscope eyepiece group and 3D heads-up technology group was (64.4±19.8) min and (63.1±18.5) min, and the difference was not statistically significant (t=-0.27, P=0.089). In the microscope group and the 3D heads-up technology group, postoperative BCVA was significantly improved 1 month and 3 months after surgery compared with that before surgery, and improvement of BCVA 3 months after surgery was better than that 1 month after surgery, the difference was statistically significant (P<0.05). At 1 and 3 months after surgery, there was no statistically significant difference in postoperative BCVA at the same time point between the two groups. There was no significant difference in the bleeding rate, posterior capsule rupture rate, gas injection rate and silicone oil injection rate, the rates of corneal edema, anterior chamber reaction, high intraocular pressure and low intraocular pressure between the two groups. There were no postoperative complications in the microscope eyepiece group and the 3D heads-up technique group during the 3-month follow-up. Conclusion: Vitrectomy combined with cataract surgery under 3D heads-up technology can achieve the same therapeutic effect as under microscope eyepieces, with good safety, and can be promoted clinically.

    3D平视技术玻璃体切割手术白内障手术

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    AQP4-IgG阳性复发型视神经脊髓炎谱系疾病视野随访1例

    李盼盼朱妍宋愈吴昔昔...
    547-550页
    查看更多>>摘要：患者，女，56岁，因"左眼疼痛伴视力下降5 d"于2021年1月19日至南通市第一人民医院眼科就诊。患者自诉2012年因双下肢无力至复旦大学附属华山医院就诊，诊断为脊髓炎，病程中予以地塞米松磷酸钠抗炎治疗（具体剂量不详），双下肢无力好转。现患者双上肢肌力5级，双下肢肌力2级（肌力的六级记录法 [1]）。眼科专科检查示：右眼裸眼视力0.2，左眼光感（双眼矫正无提高）；眼压：右眼眼压为20 mmHg（1 mmHg=0.133 kPa），左眼为21 mmHg；右眼光反射正常，左眼光反射迟钝，相对性传入性瞳孔功能障碍(Relative afferent papillary，RAPD)（+），散瞳后眼底未见异常。查视觉诱发电位（Visual evoked potential，VEP）示：右眼P100的潜伏期及振幅正常，左眼P100波形未引出。光学相干断层扫描（OCT）未见异常。头颅核磁共振成像（MRI）未见异常。颈椎MRI示：胸椎术后改变，局部脊髓变细移位，颈椎胸椎退行性改变。患者免疫球蛋白、甲状腺激素及甲状腺功能自身抗体检查未见异常。初步拟诊为：左眼视神经脊髓炎谱系疾病（Neuromyelitis optica spectrum disorders, NMOSD）。治疗方案：2021年1月19日起予以银杏达莫（贵州益佰制药）25 ml，静脉滴注，1次/d，连续12 d，以改善微循环；甲钴胺（瑞阳制药）2 mg，静脉滴注，1次/d，连续12 d，以营养神经；甲泼尼龙（比利时辉瑞制药）500 mg，静脉滴注，1次/d，连续5 d冲击治疗。2021年1月21日，患者眼底荧光素血管造影（FFA）示双眼后极部散在点状荧光；吲哚青绿血管造影（ICGA）示双眼脉络膜血管高通透，晚期斑片状弱荧光。治疗方案：给予螺内酯片（江苏正大丰海制药）每次20 mg，口服，2次/d，以改善脉络膜血供。2021年1月24日起甲泼尼龙减量至每次250 mg，静脉滴注，1次/d，连续3 d，且每连续治疗3 d后甲泼尼龙予以依次减半治疗。2021年1月25日，患者行脑脊液常规、脑脊液免疫球蛋白检查未见异常，脑脊液生化测定结果示：葡萄糖4.96 mmol/L（2.5~4.5 mmol/L）；乳酸3.30 mmol/L（参考值：1.19~2.09 mmol/L）。2021年1月26日，血清液抗水通道蛋白4（Aquaporin 4，AQP4）抗体IgG示1：1000（强阳），抗少突胶质细胞糖蛋白（Myelin oligodendroeyte glycoprotein，MOG）抗体IgG阴性，抗髓鞘碱性蛋白（Myelin basic protein，MBP）抗体IgG阴性；脑脊液抗AQP4抗体IgG示1：32（弱阳），抗MOG抗体IgG阴性，抗MBP抗体IgG阴性。复查视野示右眼视野缺损较前好转。重新诊断：双眼NMOSD。治疗方案：给予吗替麦酚酯胶囊（上海罗氏制药）每次0.5 g，2次/d，长期口服。患者2021年1月30日出院，予以甲泼尼龙（天津天药公司）每次56 mg，1次/d口服，每2周依次减8 mg至维持剂量16 mg，吗替麦酚酯胶囊每次0.5 g，2次/d口服。复查血常规、肝肾功能均未见明显异常。患者视力、视野均较前明显改善（见表1和图1），VEP示右眼正常，左眼P100波形峰时延迟、振幅降低。
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