Two-year longitudinal change in choroidal and retinal thickness in school-aged myopic children:exploratory analysis of clinical trials for myopia progression

Background:With increasing axial length(AL)and myopia progression,the micro-structure of the retina and choroid gradually changes.Our study describes the longitudinal changes in retinal and choroidal thickness in school-aged children with myopia and explores the relationship between changes in choroidal thickness and myopia progression.Methods:An exploratory analysis of a randomized trial was performed.Children(n=168,aged 7 to 12 years)with myopia from-0.75 diopter(D)to-4.00 D were enrolled in this prospective longitudinal study.Cycloplegic refraction,AL,retinal and choroidal thicknesses were measured at baseline and at 1-and 2-year follow-ups."Rapid progression myopia"was defined as increasing in myopia>1.00 D and'"stable progression myopia"was≤1.00 D during the 2-year follow-up.Factors affecting the changes in choroidal thickness were analysed using linear mixed models.Results:AL significantly increased by 0.67±0.24 mm with a myopic shift of-1.50±0.64 D over the 2 years.The overall retinal thickness increased from 251.12±15.91μm at baseline to 253.47±15.74μm at the 2-year followup(F=23.785,P<0.001).The subfoveal choroidal thickness decreased from 231.03±54.04μm at baseline to 206.53±59.71μm at the 2-year follow-up(F=73.358,P<0.001).Choroidal thinning was significantly associated with AL elongation(β=-43.579μm/mm,P=0.002)and sex(β=-17.258,P=0.001).Choroidal thickness continued to decrease in subjects with rapid progression(F=92.06,P<0.001)but not in those with steady progression(F=2.23,P=0.119).Conclusion:Significant choroidal thinning was observed and was associated with rapid progression and sex.These findings indicate a need to understand the role of the choroid in eye growth and myopia development.Synopsis/Precis:The macular choroidal thickness of myopic children is relevant to different degrees of myopic progression in this 2-year longitudinal study.These findings suggest that control of choroidal thickness might work to regulate human ocular growth.

间歇性外斜视儿童矫正术后远期疗效

目的：探讨间歇性外斜视儿童斜视矫正术后的远期临床效果及其术后动态变化.方法：回顾性系列病例研究.收集2013年2月至2014年8月于温州医科大学附属眼视光医院斜弱视专科接受手术治疗且随诊时间超过12个月的间歇性外斜视儿童,分析患儿术前、术后1周、术后1个月和末次随访时的远、近斜视角及双眼视功能参数.采用独立样本t检验比较术前和术后各时期的远、近斜视角.采用卡方检验比较手术前后远、近知觉性融合及立体视功能.结果：共纳入患儿139例,手术年龄为7.4±2.6（4～14）岁.随访时间为21.0±10.5（12～51）个月.术前视远和视近的斜视度分别为-33.9△±10.9△（-20△～-75△）和-38.2△±10.2△（-20△～-85△）.末次随访时视远和视近的斜视度分别为-6.4△±8.0△（＋16△～-35△）和-7.7△±9.6△（＋20△～-40△）,103例（74.1%）保持成功,35例（25.2%）欠矫复发,1例（0.7%）保持过矫.末次随访时双眼视功能显著改善,远、近知觉性融合功能较术前均有显著改善（χ2=26.88、26.24,均P〈0.001）,远、近立体视较术前均显著改善（χ2=64.38,P〈0.001;χ2=14.63,P=0.002）.末次随访时复发的35例患儿其远知觉性融合功能较术前显著改善（χ2=14.58,P=0.002）,远、近立体视水平均有所改善,但差异无统计学意义.结论：约3/4的间歇性外斜视儿童术后远期能维持正位,患者术后双眼视功能有显著改善.即便是术后复发患儿,其双眼视功能仍较术前有所改善.

成人斜视患者术后生存质量分析

目的:探讨成功接受斜视矫正手术的成人患者术后生存质量水平,分析其生存质量水平的影响因素。方法:回顾性病例对照研究。92例于2011年1-12月在温州医科大学附属眼视光医院接受斜视手术并获得成功效果,随诊1年以上的患者,通过中文版成人斜视生存质量评估量表(CAS-20)调查其术前、术后生存质量,同时收集患者的临床特点、年龄、性别和受教育程度等。并与其年龄和性别匹配的89例无斜视病史的普通人群进行比较。采用Wilcoxon秩和分析、单因素方差分析、配对t检验和独立样本t检验分析术后CAS-20得分的差异,多因素方差分析术后CAS-20得分的相关因素。结果:92例患者术后CAS-20得分显著提高,包括社会心理维度(Z=3.25,P=0.001)、视功能维度(Z=3.19,P=0.001)和总量表(Z=3.60,P=0.001)。术后立体视功能水平更好者,其CAS-20得分更高(F=4.33,P=0.016),40例获得感觉性融像功能者,其CAS-20得分比无融合功能者更高(Z=2.60,P=0.009)。68例术后自我感觉无斜视者,其CAS-20得分高于其余24例仍自我感觉有斜视者(Z=3.69,P<0.001)。与对照的普通人群相比,斜视患者术后生存质量水平仍较差(Z=11.23,P<0.001),32%的患者术后生存质量得分达到正常人群的最低阈值。患者自我感觉有无斜视是影响其术后生存质量状况的主要因素。结论:斜视成功矫正的成人患者,其生存质量显著改善,但仍显著低于普通无斜视病史的人群。术后恢复一定双眼视功能者,其生存质量评分更高。术后自我感觉有无斜视是影响患者生存质量的主要因素。

近距离视觉行为与儿童近视进展的关系

目的:探讨学龄近视儿童近距离用眼行为对近视进展的影响。方法:前瞻性研究。招募2014—2015年就诊于温州医科大学附属眼视光医院的7~12岁近视儿童121例,分为单光镜组56例、近附加为+2.00 D渐变镜组65例,随访观察其2年的近视度数进展情况,并使用Polhemus系统随访采集受检儿童近距离用眼行为参数,分析其阅读和书写距离以及注视角度。均取右眼数据进行分析。采用广义估计方程分析近距离用眼行为的变化规律,采用Pearson相关性及线性回归分析近距离用眼行为与近视进展的关联。结果:单光镜组与渐变镜组儿童在近视度数、近距离用眼行为参数的差异均无统计学意义。儿童基线阅读与书写距离分别为(31.8±5.8)cm和(25.2±5.8)cm。儿童基线书写距离与近视进展(-1.54±0.60)D存在相关性(r=-0.25,P=0.014)。书写距离低于20 cm与近视进展量存在相关性(r=-0.52,P=0.011)。书写距离低于20 cm与书写距离高于30 cm的近视进展量之间差异有统计学意义(F=3.86,P=0.020)。结论:较近的工作距离与近视进展快相关。培养儿童合适的用眼行为是儿童近视防控的重要策略之一。

新型冠状病毒核酸检测在眼科医院疫情防控中的实践与有效性研究

目的:探索以系统化、标准化的新型冠状病毒核酸检测为核心和重要组成部分,建立适合于眼科医院新冠疫情精准防控切实可行的防控体系。方法:系列病例研究。自2020年2月24日至3月2日期间,以标准化病毒核酸检测联合血常规、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)等检测作为所有眼科手术患者术前筛查常规检测项目,同时也为返岗员工提供病毒核酸检测。设计调查问卷了解受检者对鼻咽拭子采样的接受度以及核酸检测结果对其心理状态的影响。结果:99例患者血液学检测结果有一定的异常比例,其中SAA检测结果增高13例,淋巴细胞计数减低12例、增高5例,白细胞计数增高11例、减低1例,CRP增高2例,新型冠状病毒核酸检测均阴性。33例本院职工新型冠状病毒核酸检测均阴性。12%的受访者对鼻咽拭子采样接受度评分较低。受检者在核酸检测前后思想压力评分较高的比例分别为46.7%和6.7%。结论:该项举措一方面为术前新冠病毒肺炎筛查及鉴别诊断提供了客观依据,很大程度上排除了隐性无症状感染者传播的可能,有利于减少二次传播的风险,降低院内交叉感染的概率;另一方面,核酸检测阴性结果有利于调整患者术前的心理状态并缓解医护人员在疫情防控期间的心理压力。

Comparative transcriptome analysis of global effect of ddh and lysE deletion on 4-hydroxyisoleucine production in Corynebacterium glutamicum

4-hydroxyisoleucine(4-HIL)is a potential drug for diabetes and weight control.4-HIL was produced by expressing ido gene in L-isoleucine(Ile)-producing Corynebacterium glutamicum.But L-lysine(Lys)was also accumulated as the main by-product in this recombinant strain SN02.To attenuate Lys synthesis,two genes in Lys synthetic pathway,i.e.,ddh encoding the diaminopimelic acid dehydrogenase and lysE encoding the specific Lys exporter were deleted in SN02.However,the deletion of ddh increased 4-HIL titer by 28.1%,but did not decrease Lys content;while the deletion of lysE significantly reduced Lys content by 66.7%,but 4-HIL titer also decreased by 19.3%.Therefore,we carried out transcriptome analysis to reveal the global variation in these mutants.Deletion of ddh and lysE(especially lysE)enhanced the transcription of key enzymes in succinylase branch of Lys synthesis pathway(DapD and DapC)and several enzymes involved in succinyl-CoA accessibility(SucC,SucD and OdhI),suggesting the compensatory synthesis of Lys via succinylase branch.In addition,the transcription of ilvBN in Ile synthesis pathway was improved,while the transcription of some genes in the 2-methylcitrate cycle and inositol metabolism pathway was weakened in these mutants.Mere deletion of ddh enhanced the transcription of aceA,ppc and pck,thus promoting oxaloacetate supply and 4-HIL synthesis.Deletion of lysE affected the transcription of some stress-related genes and transporter genes,suggesting that this mutant would be under stress,thus attenuating its 4-HIL synthesis.These findings will be helpful for systematic microbiology and bio-manufacturing of C.glutamicum.