Application of immersion B-scan ultrasonography in diagnosis of complex retinal detachment,persistent hyperplastic primary vitreous and intraocular tumors

AIM:To evaluate the diagnostic value of panoramic immersion B-scan ultrasonography(Pano-immersion B-scan,PIB)in complex retinal detachment(RD),persistent hyperplastic primary vitreous(PHPV)and intraocular tumors.METHODS:The clinical data of 44 patients collected from May 2012 to December 2019 in Chinese PLA General Hospital was retrospectively studied.All of these patients underwent PIB of the eye,because it was difficult to diagnose by routine ocular fundus examination,conventional ultrasound or/and ultrasonic biomicroscope(UBM)due to opacity of refractive media,pupillary occlusion,large involvement or special location of the lesion.The imaging features of difficult cases in PIB were analyzed.The diagnosis accuracy rating of PIB were evaluated and contrasted with conventional ultrasound or UBM by the standard of intraoperative diagnosis or/and pathological results.RESULTS:According to intraoperative diagnosis or pathological results as gold standard,among the 44 cases,there were 19 cases missed diagnosis,misdiagnosed or difficult-to-diagnose by conventional ultrasound or UBM,including 4 cases of long-standing RD difficult to diagnose,4 cases misdiagnosed,and 11 cases incompletely observed or miss diagnosed.The diagnostic accuracy rate of PIB and conventional ultrasound or UBM were 100%(44/44)and 56.82%(25/44),and the sensitivity of them were 100%and 56.82%.All the patients underwent PIB and were diagnosed as RD(15 cases),retinal and choroidal detachment(4 cases),subchoroidal hematocele(1 case),vitreous opacity and/or organic membrane formation(4 cases),PHPV(12 cases),iris and/or ciliary body tumors(3 cases),and choroidal tumors(6 cases).According to the intraoperative diagnosis or pathological results,the diagnostic coincidence rate of PIB was 100%,which was significantly higher than conventional ultrasound and UBM.CONCLUSION:PIB can help to accurately diagnose complex RD,PHPV,and intraocular masses with special location or/and excessive size.It has important diagnostic value for patients with equivocal findings at conventional ultrasound examination.

Structural measurements and vessel density of spectraldomain optic coherence tomography in early,moderate,and severe primary angle-closure glaucoma

AIM:To compare the macular ganglion cell-inner plexiform layer(GCIPL)thickness,retinal nerve fiber layer(RNFL)thickness,optic nerve head(ONH)parameters,and retinal vessel density(VD)measured by spectral-domain optical coherence tomography(SD-OCT)and analyze the correlations between them in the early,moderate,severe primary angle-closure glaucoma(PACG)and normal eyes.METHODS:Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis.PACG eyes were further separated into early,moderate,or severe PACG eyes using the Enhanced Glaucoma Staging System(GSS2).The GCIPL thickness,RNFL thickness,ONH parameters,and retinal VD were measured by SD-OCT,differences among the groups and correlations within the same group were calculated.RESULTS:The inferior and superotemporal sectors of the GCIPL thickness,rim area of ONH,average and inferior sector of the retinal VD were significantly reduced(all P<0.05)in the early PACG eyes compared to the normal and the optic disc area,cup to disc ratio(C/D),and cup volume were significantly higher(all P<0.05);but the RNFL was not significant changes in early and moderate PACG.In severe group,the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups(all P<0.01).In the early PACG subgroup,there were significant positive correlations between retinal VD and GCIPL thickness(except superonasal and inferonasal sectors,r=0.573 to 0.641,all P<0.05),superior sectors of RNFL thickness(r=0.055,P=0.049).More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness(r=0.650,P=0.022),and temporal sectors of RNFL thickness(r=0.740,P=0.006).In the severe PACG eyes,neither GCIPL nor RNFL thickness was associated with retinal VD.CONCLUSION:The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes.As the PACG disease progressed from the early to the moderate stage,the correlations between the retinal VD and RNFL thickness increases.

Intraocular retinal thickness asymmetry in early stage of primary open angle glaucoma and normal tension glaucoma

AIM： To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer（pR NFL） and macular layers measured by spectral-domain optical coherence tomography（SD-OCT） in patients with early stage of primary open angle glaucoma（POAG） and normal tension glaucoma（NTG）.METHODS： A total of 117 patients with early stage of glaucoma（54 patients with POAG and 63 patients with NTG） and 32 normal subjects were recruited for the study. The pR NFL thickness, total macular layer（TML） thickness, and isolated inner macular layer（IML） thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pR NFL and IML between superior and inferior quadrants were calculated. Asymmetry indices（AIs） of the p RNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves（AROCs） were generated to determine the diagnostic capabilities of different parameters. RESULTS： Intraocular p RNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups（P=0.009 and P〈0.001, respectively）. Intraocular p RNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups（P=0.035 and P〈0.001, respectively）. The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups（P=0.001 and P=0.001, respectively） and between normal and POAG groups（P=0.032 and P=0.020, respectively）. The thickness differences and AIs of macular ganglion cell layer（mG CL） between superior and inferior quadrants were significantly different between normal and NTG groups（P=0.013 and P=0.004, respectively）, and between NTG and POAG groups（P=0.015 and P=0.012, respectively）. The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes（AROC=0.832）.CONCLUSION： Intraocular retinal thickness asymmetry in pR NFL, TML and mG CL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.

Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude

AIM:To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients.METHODS:Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed.Validated questionnaires:the Pittsburg Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS)were administered prospectively.Subjects with nonglaucomatous optic neuropathy or concomitant retinal pathology were excluded.Glaucoma severity was based on HVF 24-2 perimetry.Binocular single vision was represented based on the better eye.Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared.RESULTS:A total of 79 primary open angle glaucoma(POAG),27 primary angle-closure glaucoma(PACG)patients,and 89 controls were recruited.PACG patients had higher median PSQI scores(P=0.004)and poorer sleep quality(P<0.001).Compared to controls,PACG patients were 3.34 times more likely to have poor sleep quality(P=0.008),which remained significant after adjustment for demographics(P=0.016)and predictive variables(P=0.013).PACG patients have poorer sleep quality when visual acuity(VA)was 6/15 or worse(P=0.009).Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance.CONCLUSION:PACG patients have poorer sleep quality but not daytime sleepiness.This is important in South-East Asian population with heavy disease burden.Evaluations on sleep disturbances can be considered to provide more ho istic care.

高度近视与原发性开角型青光眼临床特征的研究进展

随着人们生活方式的显著改变,全球近视患病率日益上升,引发了临床医生的密切关注。近视易合并其他严重的眼科疾病,尤其是高度近视(HM)患者,常合并原发性开角型青光眼(POAG),其发病率远远高于屈光状态正常的人群。当高度近视与原发性开角型青光眼并存时,病情变得尤其复杂。近年我们在临床工作中集中关注患者的眼底改变特征。从高度近视人群中早期发现原发性开角型青光眼患者,这是对两种疾病深入了解并进行有效防治的关键。文章通过回顾分析近年文献,从流行病学、发病机制及临床特征方面对高度近视与原发性开角型青光眼的关系及研究进展进行综述,以期为疾病早期发现、早期诊断、早期治疗提供帮助。

基于“五轮学说”探讨脏腑辨证在RP的应用

原发性视网膜色素变性(RP)是以进行性夜盲、视野渐窄伴视力持续性下降为主要表现的眼病,因其不可逆的特性,被认为是常见的致盲眼病之一。中医学认为,本病病机以肝肾亏损为本,病理性质多以虚为主,瘀为标。“五轮学说”为中医眼科特有的重要理论之一,为后世中医眼科辨证施治提供核心理论依据。本文旨在基于“五轮学说”,运用脏腑辨证理论,深入探讨其在治疗RP中的临床应用,分辨病性,加深认识,并以此为诊疗此病提供新的临床思路和方法。

Diagnostic capability of Fourier-Domain optical coherence tomography in early primary open angle glaucoma

Background Optical coherence tomography （OCT） is a high resolution noncontact imaging modality which can quantitatively detect the optic disc and retinal structure.This study was designed to evaluate the diagnostic capability of parameters of the optic disc, retinal nerve fiber layer thickness, and ganglion cell complex （GCC） using a new technology called Fourier-domain OCT （FD-OCT） for early primary open angle glaucoma （POAG） patients.Methods Two groups of patients, early perimetric damage POAG and normal subjects were included in this observational cross-sectional study.All patients underwent FD-OCT and visual field examination in addition to full ophthalmic examinations.Receiver operating characteristic curves （ROC） were studied for all parameters.The sensitivity and specificity for distinguishing between normal and early glaucomatous eyes, the areas under the receiver operating characteristic curves （AROC） and positive, negative likelihood ratios were evaluated for all the single parameters and selected combined parameters using arbitrary cutoffs.Results Thirty-four eyes of 34 early POAG patients and 42 eyes of 42 normal subjects were analyzed.Cup/disc （C/D）vertical ratio presented the best sensitivity and positive likelihood ratio for selected specificities （95% and 85%） which were 79.4% and 88.2%, 33.4 and 7.4, respectively.Among all single parameters, the C/D vertical ratio demonstrated the highest AROC which was at 0.930.The average thickness of circumpapillary RNFL on 3.45 mm showed the highest AROC among all of the peripapillary RNFL parameters.The sensitivity at selected specificity and AROC of GCC were not as high as C/D vertical ratio and RNFL AT on 3.45 mm.When the C/D vertical ratio, RNFL AT on 3.45 mm, and rim area were combined using a logistical diagnostic model, the AROC was raised to 0.949 but not significantly different from the top single parameter, C/D vertical ratio.Conclusions The key parameters obtained by FD-OCT were able to show the significant differences of optic discs,thickness of RNFL and GCC between POAG patients and normal subjects.According to sensitivity, specificity, likelihood ratio and AROC, the top three parameters from FD-OCT for early diagnosis of POAG were C/D vertical ratio, RNFL AT on 3.45 mm, and the rim area.

A Case of Primary Vitreous Retinal Lymphoma

To the Editor： Primary central nervous system lymphoma （PCNSL） is defined as lymphoma confined to the brain, spinal cord, eye, or leptomeninges. Ocular involvement can be detected in about 20% of PCNSL patients with primary vitreous retinal lymphoma （PVRL）, which is generally a high-grade diffuse large B-cell lymphoma, being the most common subtype.

Activation of Parvalbumin-Positive Neurons in Both Retina and Primary Visual Cortex Improves the Feature-Selectivity of Primary Visual Cortex Neurons

Several recent studies using either viral or transgenic mouse models have shown different results on whether the activation of parvalbumin-positive（PV~＋）neurons expressing channelrhodopsin-2（ChR2） in the primary visual cortex（V1） improves the orientation-and direction-selectivity of V1 neurons. Although this discrepancy was thoroughly discussed in a follow-up communication, the issue of using different models to express ChR2 in V1 was not mentioned. We found that ChR2 was expressed in retinal ganglion cells（RGCs） and V1 neurons in ChR2fl/~＋; PV-Cre mice. Our results showed that the activation of PV~＋RGCs using white drifting gratings alone significantly decreased the firing rates of V1 neurons and improved their direction-and orientation-selectivity. Longduration activation of PV~＋interneurons in V1 further enhanced the feature-selectivity of V1 neurons in anesthetized mice, confirming the conclusions from previous findings. These results suggest that the activation of both PV~＋RGCs and V1 neurons improves feature-selectivity in mice.

亢泽峰教授“瞳神络病”理论辨治原发性视网膜色素变性经验

基于亢泽峰教授“瞳神络病”理论,结合临床实践,探讨原发性视网膜色素变性的辨治思路,认为目窍失养、目络瘀滞是核心病机,提出益精养血、通络明目为主要治法,通补兼施,自拟经验方分期论治,构建标准化中医特色综合疗法周期性治疗方案,为临床诊疗提供思路。

喻京生教授基于肝肾同源理论辨治原发性视网膜色素变性经验

原发性视网膜色素变性是以进行性感光细胞及色素上皮功能丧失为共同表现的遗传性视网膜变性疾病,属于中医“高风内障”范畴。湖南中医药大学第一附属医院眼科喻京生教授,在近40年的临床工作中,积累了中医药防治各种眼底疾病的经验。此文主要从理论基础、病因病机、辨治思路、典型案例、总结分析等方面,初步探讨喻京生教授基于“肝肾同源”理论辨治原发性视网膜色素变性的经验,总结如下以供临床参考。

原发性视网膜色素变性并发白内障超声乳化手术临床探讨

目的对于原发性视网膜色素变性并发性白内障,利用超声乳化手术,探讨其临床疗效。方法回顾性病例研究。收录我院2019年1月至2022年6月在本院手术的原发性视网膜色素变性并发白内障的患者,共26例(45只眼),其中男性20例(37只眼),性6例(8只眼),年龄(57.58±7.72)岁(43~71岁),术前明确诊断为原发性视网膜色素变性并发白内障,其中术前发现有浅前房4只眼,晶状体轻度震颤1只眼,黄斑水肿2只眼,无法窥清眼底黄斑区有4只眼。使用超声乳化白内障吸除联合人工晶状体植入术,观察术后的指标有视力,眼压,裂隙灯,眼底等。结果术后最佳矫正视力≥0.5者21只眼(46.67%),0.5>矫正视力≥0.3者18只眼(40.00%),矫正视力<0.3者6只眼(13.33%),视力无提高者3只眼(6.67%)。术中均一期植入人工晶状体,其中1只眼植入张力环后再植入人工晶状体。术前有4只眼为浅前房,术后仍为浅前房,给予行Nd:YAG激光上方虹膜根切后,前房未加深,其中2只眼眼压观察未升高,2只眼药物控制眼压稳定,术后2只眼出现角膜水肿,观察1周后角膜恢复透明;术后1只眼出现眼压一过性升高,最高为26 mmHg,经过处理后恢复正常,术后1周所有患者眼压与术前比较差异无统计学意义(P>0.05);所有患者均手术顺利,未出现明显手术并发症。结论对于原发性视网膜色素变性并发性白内障,使用超声乳化手术是安全、有效的。

Primary Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

Purpose: To evaluate the role and the anatomic and visual results of primary pars plana vitrectomy(PPV) in treating cases with rhegmatogenous retinal detachment associated with choroidal detachment. Methods:All patients were divided into 2 groups. Each group included 23 consecutive eyes with rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C. In the study group, controlled removal of vitreous traction was achieved by primary vitrectomy and augmented by scleral buckling if needed. The breaks were treated by focused endolaser coagulation. Postoperative tamponade was done by SF6 or C3F8 gas. In the control group, all patients underwent regular scleral buckling procedure. The cases were followed up for 6 to 12 months. Results: In the study group, retinal reattachment could be achieved in 21 cases (91.30%) after the first operation and in all cases after the second procedure. No occurrence of choroidal detachment occurred after the first procedure. Retinal reattachment rate and visual results tended to be better compared with conventional surgical techniques in the control group. Conclusion: Primary vitrectomy represents a safe, effective method in the management of rhegmatogenous retinal detachment associated with choroidal detachment.

Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective:The objective is to estimate the prevalence and grading of hypertensive retinopa-thy in the primary care setting;examine the patient characteristics associated with hypertensive retinopathy;and examine the association of hypertensive retinopathy and other hypertension complications.Methods:This is a retrospective cross-sectional study.Subjects included adult hypertensive patients with available and gradable retinal photographs.Results:Two hundred fifty-six male hypertensive patients(34.3%)and 491 female hyper-tensive patients(65.7%)were included.The average duration of hypertension was 7.2 years,and 49.8%and 41.2%of patients were taking one or two antihypertensive medications respectively.Among 1491 qualified retinal photographs(744 right eye and 747 left eye),24.9%,62.6%,and 12.5%were classified as showing normal,mild,and moderate hypertensive retinopathy respec-tively.The three commonest retinal signs were generalized or focal arteriolar narrowing(650 cases,43.6%),hard exudates(168 cases,11.3%),and opacity(copper or silver wiring)of the arteriolar wall(166 cases,11.1%).Patients older than 61 years,having hypertension for more than 15 years,or taking three or more antihypertensive medications were significantly associated with hyperten-sive retinopathy(P<0.05).Conclusion:In a primary care clinic in Hong Kong,77.1%of hypertensive patients had hypertensive retinopathy.Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.

SD-OCT检测Nd∶YAG激光周边虹膜切除术后黄斑区视网膜厚度变化

目的:探讨Nd∶YAG激光周边虹膜切除术(LPI)对原发性闭角型青光眼(PACG)患者黄斑区视网膜厚度的影响。方法:前瞻性研究。选取2019-10/2021-10我院PACG患者30例30眼为PACG组,同期健康体检者20名20眼为正常对照组(随机选取一眼)。PACG组患者接受LPI治疗,术后随访1mo。两组受试者均行最佳矫正视力(BCVA)、眼压、角膜内皮细胞、IOL Master 500光学测量仪测量前房深度(ACD)及眼轴长度(AL)、频域光学相干断层扫描(SD-OCT)检查黄斑区视网膜厚度。比较两组受试者及PACG组患者LPI前后ACD、眼压、AL和黄斑区视网膜厚度,并行相关性分析。结果:PACG组患者术后1wk, 1mo ACD较术前变深(均P<0.05)。PACG组患者手术前后眼压和AL均无差异(均P>0.05)。PACG组患者术前黄斑中心区,内外环上方、颞侧、下方、鼻侧,共9个区域视网膜厚度分别为243.50±13.24、324.50±13.46、308.83±15.94、310.00±14.24、314.50±16.29、300.67±19.95、290.17±12.58、302.40±16.37、307.33±14.84μm,正常对照组相应部位分别为266.14±16.16、342.67±15.86、327.95±16.41、337.85±13.03、341.24±15.58、313.76±17.59、290.24±16.29、303.81±13.91、323.01±14.80μm,两组间中心区、内环上方、颞侧、下方、鼻侧比较均有差异(均P<0.05)。PACG组术后1wk黄斑区9个区域视网膜厚度分别与术前相比均增加,术后1mo接近术前水平,但手术前后各分区比较均无差异(均P>0.05)。结论:与正常受试者比较,PACG患者黄斑区视网膜厚度较薄。PACG患者LPI术后早期黄斑区视网膜可变厚。

人参皂苷Rg1注射液联合肌苷片和维生素B_(1)治疗原发性视网膜色素变性

目的:探讨人参皂苷Rg1注射剂联合肌苷片和维生素B_(1)对原发性视网膜色素变性的血清脑源性神经营养因子(BDNF)、垂体腺苷酸环化酶激活多肽(PACAP)影响及临床疗效。方法:纳入2019-08/2022-03河北北方学院附属第二医院眼科收治的50例100眼原发性视网膜色素变性患者作为研究对象,按随机数字表分为研究组和对照组,各50眼。对照组患者给予肌苷片和维生素B_(1)治疗,研究组患者给予人参皂苷Rg1注射剂联合肌苷片和维生素B_(1)治疗。比较治疗前后两组血清BDNF和PACAP表达、视网膜电图、光谱域光学相干断层扫描(SD-OCT)检查黄斑中心凹为圆点直径1mm范围视网膜厚度(RT)、视野平均缺失(MD)及临床疗效及安全性指标。结果:治疗前,两组MD比较无差异(t=1.670,P=0.098)。治疗后,研究组MD显著低于对照组(t=3.628,P<0.01);治疗前,两组黄斑中心凹为圆点直径1mm范围RT比较无差异(t=0.108,P=0.914)。治疗后,研究组黄斑中心凹为圆点直径1mm范围RT显著高于对照组(t=6.125,P<0.01);治疗前,两组各项视网膜电图暗适应的结果比较无差异(均P>0.05)。治疗后,研究组各项暗视网膜电图暗适应的结果改善均显著优于对照组(均P<0.01)。治疗前,两组各项视网膜电图明适应的结果比较无差异(均P>0.05)。治疗后,研究组各项视网膜电图明适应的结果改善显著优于对照组(均P<0.01)。治疗前,两组BDNF、PACAP比较无差异(均P>0.05);治疗后,研究组BDNF、PACAP高于对照组(均P<0.01)。治疗后,两组均未见任何的不良反应。结论:原发性视网膜色素变性患者采用人参皂苷治疗可通过调节BDNF和PACAP的表达,改善患者视网膜功能,促进病情转归,且安全性高。

急性视网膜动脉缺血的防治研究进展

急性短暂性或永久性视网膜动脉缺血是需要及时诊断和治疗的眼部和全身急症。单眼一过性黑矇属于短暂性视网膜动脉缺血,并不会遗留永久性视功能损害。视网膜中央动脉阻塞和视网膜分支动脉阻塞在大部分患者均会遗留永久性视功能损害。目前的治疗方式包括降眼压、扩血管、高压氧、经静脉或动脉溶栓治疗等,但仍缺乏标准治疗方案。对高危人群应早期一级预防。急性视网膜动脉缺血患者发生继发卒中和不良心血管事件的风险高,应及时发现相关危险因素,积极治疗原发病,采取适当的二级预防措施改善预后。本文对急性视网膜动脉缺血事件的治疗和预防研究进展进行综述,以便为该类疾病的防治和研究提供参考。

高度近视合并原发性开角型青光眼眼底结构改变的研究进展

高度近视是原发性开角型青光眼(POAG)发生发展的重要危险因素,如何在高度近视人群中发现POAG患者一直是国内外学者研究的热点和难点。高度近视患者并发POAG的概率明显高于非高度近视患者。高度近视本身就可能发生眼部一系列结构和功能的改变,当高度近视合并POAG时,复杂的眼底改变造成近视与早期开角型青光眼相互混淆,使早期青光眼的诊断具有一定的难度。本文将回顾高度近视合并POAG的相关文献,从流行病学、视盘、视神经节细胞层、视网膜神经纤维层、血管密度等眼底结构特点做一综述。

基于数据挖掘研究针刺治疗视网膜色素变性的经穴规律

目的 通过数据挖掘技术,研究现代文献中针刺治疗原发性视网膜色素变性的选经取穴规律。方法 纳入1990年1月—2021年12月收录于中国知网、万方数据库、维普中文期刊服务平台、PubMed数据库中关于针刺治疗视网膜色素变性的临床文献。将各数据库符合纳入标准的文献导入EndNote软件,提取文献作者、见刊时间、题目、各组病例数、各组平均病程、针刺处方(腧穴名称)、留针时间、频次、归经、疗程及疗效评价指标并汇总。将以上信息录入Microsoft office 2019软件中建立Excel数据库并进行分析。结果 (1)一般情况:共纳入中文文献19篇,英文文献1篇。涉及病例数1,143例,11条经脉,40个腧穴,使用总频次达217次。其中特定穴26个,经外奇穴7个。(2)所属经脉:针刺治疗视网膜色素变性使用腧穴频次≥10次的经脉有6条,其中最高的是足太阳膀胱经(56次,25.81%);所用腧穴≥3个的经脉有5条,其中最多的是足太阳膀胱经(8个,20.00%)。(3)腧穴频次:针刺治疗视网膜色素变性的腧穴使用频次≥5次的共16个,排名前5位的分别为球后(17次,7.83%)、太阳(16次,7.37%)、睛明(14次,6.45%)、足三里(13次,5.99%)、三阴交(12次,5.53%)。(4)特定穴和经外奇穴使用频次:特定穴共26个,累计频次为178次,占比82.03%,使用频次最高的是交会穴(65次,29.95%),其中使用频次最高的穴位是睛明(14次,6.45%)。经外奇穴共7个,累计频次46次,占比21.20%,其中使用频次最高的是球后(17次,7.83%)。(5)分布部位:腧穴在全身各部位的分布按降序排列依次为头面颈项(112次,51.61%)、下肢(49次,22.58%)、腰背(35次,16.13%)、上肢(14次,6.45%)和胸腹(7次,3.23%)。(6)腧穴聚类分析:对频次≥5次的腧穴进行聚类分析,得到3组小聚类群。第1组为肾俞、肝俞、脾俞、太溪、太冲、睛明、光明、足三里;第2组为合谷;第3组为太阳、三阴交、百会、丝竹空。(7)腧穴关联规则:常用的腧穴配伍组合相关性最高的前5位为太阳-三阴交;三阴交-足三里-太阳;太阳-三阴交-足三里-睛明;球后-攒竹;睛明-足三里-球后。结论 针刺治疗视网膜色素变性多以补虚通脉,调整阴阳为纲,以局部取穴及上下配穴为主,注重选取特定穴,多取足三阳经、经外奇穴及足太阴脾经等腧穴,常选球后、太阳、睛明为主穴,可酌情借鉴高频次腧穴配伍选经取穴组方。

原发性开角型青光眼房水中EPO、Sema3A、TGF-β1与视网膜纤维层厚度、视野缺损的相关性研

目的探讨原发性开角型青光眼(POAG)患者房水中促红细胞生成素(EPO)、信号素3A(Sema3A)、转化生长因子β1(TGF-β1)与视网膜纤维层厚度、视野缺损的相关性。方法前瞻性病例对照研究。选取2019年6月至2020年6月期间来我院就诊的POAG患者156例(156只眼)作为观察组,并选取同期进行白内障手术的78例(78只眼)作为对照组。根据POAG患者视野平均缺损程度将患者分为A组55只眼、B组66只眼和C组35只眼。采用相干光层析成像术(OCT)术测量患者视网膜纤维层厚度,使用一次性无菌注射器取房水标本,采用酶联免疫吸附试验检测房水中EPO,采用Western blot法检测房水中信号素3A(semaphorin 3A,Sema3A)水平,采用酶联免疫双抗体夹心法检测房水中TGF-β1水平。分析房水中EPO、Sema3A、TGF-β1水平变化与POAG患者视网膜纤维层厚度、视野缺损的关系。结果观察组患者眼压、视野平均缺损、杯盘比显著高于对照组(P<0.05)。观察组患者房水中EPO、Sema3A、TGF-β1水平高于对照组,且观察组中B组和C组房水中EPO、GF-β1水平高于A组,组间比较差异具有统计学意义(P<0.05)。观察组患者视网膜纤维层厚度显著低于对照组,且观察组中B组和C组视网膜纤维层厚度低于A组,组间比较差异具有统计学意义(P<0.05);观察组患者视野平均缺损程度显著高于对照组,且观察组中B组和C组视野平均缺损程度显著高于A组,组间比较差异具有统计学意义(P<0.05)。Pearson相关性分析结果显示,房水中EPO水平与视网膜纤维层厚度呈负相关关系(r=-0.348,P<0.05),与视野缺损程度呈正相关关系(r=0.518,P<0.05);房水中Sema3A水平与视网膜纤维层厚度呈负相关关系(r=-0.426,P<0.05),与视野缺损程度呈正相关关系(r=0.629,P<0.05);房水中TGF-β1水平与视网膜纤维层厚度呈负相关关系(r-0.457,P<0.05),与视野缺损程度呈正相关关系(r=0.532,P<0.05)。结论POAG患者房水中EPO、Sema3A、TGF-β1水平与视野缺损加重、视网膜纤维层厚度变薄密切相关,可为POAG预防病情进展提供参考依据。