Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from dam...Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.展开更多
AIM:To investigate the effects of estrogen replacement therapy (ERT) on apoptosis and vascular endothelial growth factor (VEGF) expression in ocular surface in an experimental rat model.· METHODS:Forty female,Wis...AIM:To investigate the effects of estrogen replacement therapy (ERT) on apoptosis and vascular endothelial growth factor (VEGF) expression in ocular surface in an experimental rat model.· METHODS:Forty female,Wistar rats were randomized in 4 groups in the study.Subcutaneous ERT (17β-estradiol,10g/kg/day) was administered to the first group without ovariectomy and to the second group with ovariectomy for three months.Third group had only ovariectomy and fourth group had sham operation.All rats were sacrificed in estrous cycles determined by vaginal smear test and their right eyes were enucleated at the end of the third month.Enucleated eyes were analyzed by immunohistochemical method for expressions of caspase-3,bcl-2,VEGF and TUNEL assay.· RESULTS:Caspase-3 expression of conjunctival epithelium was significantly higher in group 3 than group 1 (P =0.005),and group 2 (P =0.007).TUNEL score of conjunctival epithelium was significantly higher in group 3 than group 1 (P =0.006).TUNEL score of corneal epithelium was significantly higher in group 3 than group 2 (P =0.012),and group 4 (P =0.002).There was no significant difference between groups in that bcl-2 and VEGF expressions.· CONCLUSION:We determined increased apoptosis in ocular surface epithelial cells in ovariectomized rats.ERT and endogen estrogen decreased the apoptosis,and did not result in difference in VEGF expression between the groups.Estrogen may be beneficial for the treatment of apoptosis-mediated ocular surface disorders such as dry eye.Further studies are needed on this subject for a better understanding of the role of estrogen and to provide a new insight for treatment and prevention of apoptosis-mediated ocular surface disorders.展开更多
AIM: To investigate the ocular hemodynamic effects of applying a hot compress to the eye.METHODS: The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18 min. An independentl...AIM: To investigate the ocular hemodynamic effects of applying a hot compress to the eye.METHODS: The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18 min. An independently designed novel ocular contacttype temperature measuring device was used to measure the ocular surface temperature before and after the heating. Relevant retrobulbar hemodynamic parameters such as peak systolic velocity(PSV), end diastolic velocity(EDV), and resistance index(RI) of each of the central retinal artery(CRA), long posterior ciliary artery(LPCA), and ophthalmic artery(OA), as well as the mean velocity(V) of the central retinal vein(CRV), were measured using a color Doppler flow imaging(CDFI) technique and expressed as mean values with standard deviation(mean±SD). A statistical analysis was conducted based on a paired t-test and the Wilcoxon signed-rank test. RESULTS: The employed real-time temperature measuring device was able to accurately measure ocular surface temperature during the hot-compress process. The temperature increased after the hot compress was applied. Analysis showed that the PSV and EDV values of the CRA and LPCA significantly increased after the application of the hot compress, as did the Vof the CRV. There were no significant changes in the EDV of the OA nor the RI of each artery. CONCLUSION: This experiment, which is the first of its kind, confirms that the retrobulbar blood flow velocities can increase upon heating the ocular surface. This simple method may be useful in the future.展开更多
The amniotic membrane(AM) is the inner layer of the fetal membranes and consist of 3 different layers: the epithelium, basement membrane and stroma which further consists of three contiguous but distinct layers: the i...The amniotic membrane(AM) is the inner layer of the fetal membranes and consist of 3 different layers: the epithelium, basement membrane and stroma which further consists of three contiguous but distinct layers: the inner compact layer, middle fibroblast layer and the outermost spongy layer. The AM has been shown to have anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Also because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it is being used increasingly for ocular surface reconstruction in a variety of ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and sceral melts and perforations. However indiscriminate use of human AM needs to be discouraged as complications though infrequent can occur. These include risk of transmission of bacterial, viral or fungal infections to the recipient if the donors are not adequately screened for communicable diseases, if the membrane is not processed under sterile condi-tions or if storage is improper. Optimal outcomes can be achieved only with meticulous case selection. This review explores the ever expanding ophthalmological indications for the use of human AM.展开更多
Will Goldmann Applanation Tonometry, the age old “gold standard” of intraocular pressure (IOP) measurement, be replaced with newer methods? One of the newer methods of IOP measurement is Pascal, dynamic contour tono...Will Goldmann Applanation Tonometry, the age old “gold standard” of intraocular pressure (IOP) measurement, be replaced with newer methods? One of the newer methods of IOP measurement is Pascal, dynamic contour tonometry (DCT). A review of the history, scientific principles, clinical validation and clinical utility of DCT is presented.展开更多
Confocal microscopy is a method which has been increasingly used over the last decade in the study of the anterior ocular surface. The method allows testing and <em>in vivo</em> high resolution imaging of ...Confocal microscopy is a method which has been increasingly used over the last decade in the study of the anterior ocular surface. The method allows testing and <em>in vivo</em> high resolution imaging of the structures of the anterior eye segment, at a cellular level, which is close to the histological examination of tissues. The data provided by this method allow for a better understanding of both the functional and pathological processes occurring in the anterior ocular surface not only for scientific purposes but also in clinical practice. The aim of the present work is to summarize the current knowledge and applications of confocal microscopy of the anterior ocular surface.展开更多
Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surfa...Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surface disorders,ranging from inflammatory to infectious,traumatic to neoplastic,the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist.The purpose of this paper is to provide ophthalmologists with an updated,evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction,reviewing its common and even experimental applications known to date.The methods of amniotic membrane preservation,the available commercial amniotic membrane products to date,and future directions for amniotic membrane use,including amniotic membrane extract eye drops(AMEED),are also discussed.It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic.By familiarizing the general ophthalmologist with its diverse applications,we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice,or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.展开更多
Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropath...Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.展开更多
In his beautiful book,Consilience:The Unity of Knowledge,the eminent biologist Edward O Wilson,advocates the need for integration and reconciliation across the sciences.He defines consilience as“literally a‘jumping ...In his beautiful book,Consilience:The Unity of Knowledge,the eminent biologist Edward O Wilson,advocates the need for integration and reconciliation across the sciences.He defines consilience as“literally a‘jumping together’of knowledge with a linking of facts…to create a common groundwork of explanation”.It is the premise of this paper that as much as basic biomedical research is in need of data generation using the latest available techniques–unifying available knowledge is just as critical.This involves the necessity to resolve contradictory findings,reduce silos,and acknowledge complexity.We take the cornea and the lens as case studies of our premise.Specifically,in this perspective,we discuss the conflicting and fragmented information on protein aggregation,oxidative damage,and fibrosis.These are fields of study that are integrally tied to anterior segment research.Our goal is to highlight the vital need for Wilson’s consilience and unity of knowledge which in turn should lead to enhanced rigor and reproducibility,and most importantly,to greater understanding and not simply knowing.展开更多
Purpose: To evaluate the influence of commonly used eye drops on contrast sensitivity (CS). Design: Prospective study. Participants: One hundred twenty volunteers (120) were enrolled. Methods: The CS of ophthalmologic...Purpose: To evaluate the influence of commonly used eye drops on contrast sensitivity (CS). Design: Prospective study. Participants: One hundred twenty volunteers (120) were enrolled. Methods: The CS of ophthalmologically healthy individuals was evaluated at baseline examination before the instillation, 20 and 40 minutes after the instillation of diclofenac sodium and commonly used antiglaucoma eye drops (latanoprost, brimonidine tartrate, combination of dorzolamide hydrochloride and timolol maleate). CS was assessed at 7 spatial frequencies varying from 1.5 c/d to 20 c/d by the use of Mentor B-VAT II-SG video acuity tester. Results: Diclofenac sodium induced a mild, however statistically significant decrease on the CS in 4 out of 30 subjects 20 minutes after instillation at the spatial frequency of 1.5 c/d and 3 c/d (p p > 0.05). Brimonidine tartrate decreased CS in 4 out of 30 subjects 20 minutes after the instillation at a high spatial frequency (20 c/d) yet this decrease was marginally statistically significant (p = 0.057). CS returned to baseline scores 40 minutes after the instillation for all drugs. Conclusions: Diclofenac sodium eye drops had a mild temporal effect on the low spatial frequencies of 1.5 c/d and 3 c/d in some individuals. Latanoprost and dorzolamide/timolol had a non-statistically significant effect on the same spatial frequencies. Brimonidine eye drops had a temporal effect on the high spatial frequency of 20 c/d with marginal statistical significance. The CS scores returned to normal, in all cases, within the next 40 minutes after the instillation. Ophthalmologists should be aware of the fact that some eye drops may have an influence on CS.展开更多
Background:To evaluate the conjunctival flap cover surgery for the treatment of ocular surface disorders.Methods:Retrospective uncontrolled study was performed.A total of 253 eyes of 253 patients who had received conj...Background:To evaluate the conjunctival flap cover surgery for the treatment of ocular surface disorders.Methods:Retrospective uncontrolled study was performed.A total of 253 eyes of 253 patients who had received conjunctival flap cover surgery during a 10-year period were included.The indications,symptoms and complications experienced by patients undergoing partial or total conjunctival flap cover surgery were reviewed.Results:In all of these cases,satisfactory anatomic and functional outcomes were achieved.The BCVA of 224 eyes out of 253 patients(88.5%)were no worse than that of preoperative and the BCVA of 29 eyes out of 253 patients(11.5%)decreased postoperatively.No eye pain,foreign body sensation and other discomforts presented in the last visit.The surgical indications was therapeutic for 138 out of 253 patients(54.5%),aesthetic for 63 eyes out of 253 patients(24.9%),tectonic for 45 eyes out of 253 patients(17.8%),and analgesic for 7 eyes out of 253 patients(2.8%).The primary diagnose of therapeutic indications is refractory corneal ulcer for 135 eyes out of 253 patients(53.4%).The main diagnose of aesthetic indications is atrophy of eyeball for 45 eyes out of 253 patients(17.8%)and corneal leukoma for 18 eyes out of 253 patients(7.1%).The principal diagnose of tectonic indications is corneal perforation for 43 eyes out of 253 patients(17%).The main intraoperative complications is buttonhole formation for 8 eyes out of 253 patients(3.2%),which can be handled by simple suture.The most severe complications postoperatively was conjunctival flaps dissolving and corneal perforation for 3 eyes out of 253 patients(1.2%),and corneal transplantation had to be performed to avoid enucleation.In addition,4 eyes out of 253 patients(1.6%)presented cystic flap and two of them received surgical excision.Conclusions:Conjunctival flap cover surgery is an underused technique.Its primary indication is refractory corneal ulcer and corneal perforation,and its second indication is aesthetic with poor visual potential coexisting ocular surface diseases.It represents an interesting alternative to more mutilating surgeries.展开更多
目的探讨2型糖尿病患者角膜知觉减退及其与眼表异常的相关性。方法采用前瞻性病例对照研究。采用Cochet-Bonnet角膜知觉测量仪分别测定并比较38例(68眼)2型糖尿病患者(糖尿病组)和33例(57眼)无糖尿病患者(对照组)中央角膜知觉,同时对糖...目的探讨2型糖尿病患者角膜知觉减退及其与眼表异常的相关性。方法采用前瞻性病例对照研究。采用Cochet-Bonnet角膜知觉测量仪分别测定并比较38例(68眼)2型糖尿病患者(糖尿病组)和33例(57眼)无糖尿病患者(对照组)中央角膜知觉,同时对糖尿病患者行泪膜破裂时间测定(break up time,BUT)、基础泪液分泌试验(SchirmerⅠ)及角膜荧光素染色。对角膜知觉与后三者进行相关性研究。结果糖尿病组角膜知觉为(36.07±14.26)mm,对照组为(52.98±3.89)mm,两者差异有显著性(P<0.01)。糖尿病患者SchirmerⅠ试验平均值为(12.41±3.22)mm,BUT值平均为(8.82±2.70)s,角膜荧光素染色累积分平均值为(3.94±1.66)分。糖尿病患者角膜知觉与泪膜破裂时间(r=0.330,P=0.006)、角膜荧光素染色(r=-0.342,P=0.004)有相关关系,与泪液分泌量无相关关系(P=0.538)。结论糖尿病患者角膜知觉明显减退,而角膜知觉减退是影响角膜上皮病变、干眼症等眼表疾病的因素之一。展开更多
文摘Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.
基金Supported by the Research Fund of Adnan Menderes University,Aydin,Turkey
文摘AIM:To investigate the effects of estrogen replacement therapy (ERT) on apoptosis and vascular endothelial growth factor (VEGF) expression in ocular surface in an experimental rat model.· METHODS:Forty female,Wistar rats were randomized in 4 groups in the study.Subcutaneous ERT (17β-estradiol,10g/kg/day) was administered to the first group without ovariectomy and to the second group with ovariectomy for three months.Third group had only ovariectomy and fourth group had sham operation.All rats were sacrificed in estrous cycles determined by vaginal smear test and their right eyes were enucleated at the end of the third month.Enucleated eyes were analyzed by immunohistochemical method for expressions of caspase-3,bcl-2,VEGF and TUNEL assay.· RESULTS:Caspase-3 expression of conjunctival epithelium was significantly higher in group 3 than group 1 (P =0.005),and group 2 (P =0.007).TUNEL score of conjunctival epithelium was significantly higher in group 3 than group 1 (P =0.006).TUNEL score of corneal epithelium was significantly higher in group 3 than group 2 (P =0.012),and group 4 (P =0.002).There was no significant difference between groups in that bcl-2 and VEGF expressions.· CONCLUSION:We determined increased apoptosis in ocular surface epithelial cells in ovariectomized rats.ERT and endogen estrogen decreased the apoptosis,and did not result in difference in VEGF expression between the groups.Estrogen may be beneficial for the treatment of apoptosis-mediated ocular surface disorders such as dry eye.Further studies are needed on this subject for a better understanding of the role of estrogen and to provide a new insight for treatment and prevention of apoptosis-mediated ocular surface disorders.
基金Supported by the National Natural Science Funds for Young Scholar(No.81400394)Heilongjiang Province Science Foundation for Youths(No.QC08C97)Research Fund for the Doctoral Program of the Second Affiliated Hospital of Harbin Medical University(No.BS2008-23)
文摘AIM: To investigate the ocular hemodynamic effects of applying a hot compress to the eye.METHODS: The right eyes of five New Zealand white rabbits, both male and female, were hot-compressed for 18 min. An independently designed novel ocular contacttype temperature measuring device was used to measure the ocular surface temperature before and after the heating. Relevant retrobulbar hemodynamic parameters such as peak systolic velocity(PSV), end diastolic velocity(EDV), and resistance index(RI) of each of the central retinal artery(CRA), long posterior ciliary artery(LPCA), and ophthalmic artery(OA), as well as the mean velocity(V) of the central retinal vein(CRV), were measured using a color Doppler flow imaging(CDFI) technique and expressed as mean values with standard deviation(mean±SD). A statistical analysis was conducted based on a paired t-test and the Wilcoxon signed-rank test. RESULTS: The employed real-time temperature measuring device was able to accurately measure ocular surface temperature during the hot-compress process. The temperature increased after the hot compress was applied. Analysis showed that the PSV and EDV values of the CRA and LPCA significantly increased after the application of the hot compress, as did the Vof the CRV. There were no significant changes in the EDV of the OA nor the RI of each artery. CONCLUSION: This experiment, which is the first of its kind, confirms that the retrobulbar blood flow velocities can increase upon heating the ocular surface. This simple method may be useful in the future.
文摘The amniotic membrane(AM) is the inner layer of the fetal membranes and consist of 3 different layers: the epithelium, basement membrane and stroma which further consists of three contiguous but distinct layers: the inner compact layer, middle fibroblast layer and the outermost spongy layer. The AM has been shown to have anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Also because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it is being used increasingly for ocular surface reconstruction in a variety of ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and sceral melts and perforations. However indiscriminate use of human AM needs to be discouraged as complications though infrequent can occur. These include risk of transmission of bacterial, viral or fungal infections to the recipient if the donors are not adequately screened for communicable diseases, if the membrane is not processed under sterile condi-tions or if storage is improper. Optimal outcomes can be achieved only with meticulous case selection. This review explores the ever expanding ophthalmological indications for the use of human AM.
文摘Will Goldmann Applanation Tonometry, the age old “gold standard” of intraocular pressure (IOP) measurement, be replaced with newer methods? One of the newer methods of IOP measurement is Pascal, dynamic contour tonometry (DCT). A review of the history, scientific principles, clinical validation and clinical utility of DCT is presented.
文摘Confocal microscopy is a method which has been increasingly used over the last decade in the study of the anterior ocular surface. The method allows testing and <em>in vivo</em> high resolution imaging of the structures of the anterior eye segment, at a cellular level, which is close to the histological examination of tissues. The data provided by this method allow for a better understanding of both the functional and pathological processes occurring in the anterior ocular surface not only for scientific purposes but also in clinical practice. The aim of the present work is to summarize the current knowledge and applications of confocal microscopy of the anterior ocular surface.
文摘Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surface disorders,ranging from inflammatory to infectious,traumatic to neoplastic,the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist.The purpose of this paper is to provide ophthalmologists with an updated,evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction,reviewing its common and even experimental applications known to date.The methods of amniotic membrane preservation,the available commercial amniotic membrane products to date,and future directions for amniotic membrane use,including amniotic membrane extract eye drops(AMEED),are also discussed.It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic.By familiarizing the general ophthalmologist with its diverse applications,we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice,or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.
文摘Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
文摘In his beautiful book,Consilience:The Unity of Knowledge,the eminent biologist Edward O Wilson,advocates the need for integration and reconciliation across the sciences.He defines consilience as“literally a‘jumping together’of knowledge with a linking of facts…to create a common groundwork of explanation”.It is the premise of this paper that as much as basic biomedical research is in need of data generation using the latest available techniques–unifying available knowledge is just as critical.This involves the necessity to resolve contradictory findings,reduce silos,and acknowledge complexity.We take the cornea and the lens as case studies of our premise.Specifically,in this perspective,we discuss the conflicting and fragmented information on protein aggregation,oxidative damage,and fibrosis.These are fields of study that are integrally tied to anterior segment research.Our goal is to highlight the vital need for Wilson’s consilience and unity of knowledge which in turn should lead to enhanced rigor and reproducibility,and most importantly,to greater understanding and not simply knowing.
文摘Purpose: To evaluate the influence of commonly used eye drops on contrast sensitivity (CS). Design: Prospective study. Participants: One hundred twenty volunteers (120) were enrolled. Methods: The CS of ophthalmologically healthy individuals was evaluated at baseline examination before the instillation, 20 and 40 minutes after the instillation of diclofenac sodium and commonly used antiglaucoma eye drops (latanoprost, brimonidine tartrate, combination of dorzolamide hydrochloride and timolol maleate). CS was assessed at 7 spatial frequencies varying from 1.5 c/d to 20 c/d by the use of Mentor B-VAT II-SG video acuity tester. Results: Diclofenac sodium induced a mild, however statistically significant decrease on the CS in 4 out of 30 subjects 20 minutes after instillation at the spatial frequency of 1.5 c/d and 3 c/d (p p > 0.05). Brimonidine tartrate decreased CS in 4 out of 30 subjects 20 minutes after the instillation at a high spatial frequency (20 c/d) yet this decrease was marginally statistically significant (p = 0.057). CS returned to baseline scores 40 minutes after the instillation for all drugs. Conclusions: Diclofenac sodium eye drops had a mild temporal effect on the low spatial frequencies of 1.5 c/d and 3 c/d in some individuals. Latanoprost and dorzolamide/timolol had a non-statistically significant effect on the same spatial frequencies. Brimonidine eye drops had a temporal effect on the high spatial frequency of 20 c/d with marginal statistical significance. The CS scores returned to normal, in all cases, within the next 40 minutes after the instillation. Ophthalmologists should be aware of the fact that some eye drops may have an influence on CS.
文摘Background:To evaluate the conjunctival flap cover surgery for the treatment of ocular surface disorders.Methods:Retrospective uncontrolled study was performed.A total of 253 eyes of 253 patients who had received conjunctival flap cover surgery during a 10-year period were included.The indications,symptoms and complications experienced by patients undergoing partial or total conjunctival flap cover surgery were reviewed.Results:In all of these cases,satisfactory anatomic and functional outcomes were achieved.The BCVA of 224 eyes out of 253 patients(88.5%)were no worse than that of preoperative and the BCVA of 29 eyes out of 253 patients(11.5%)decreased postoperatively.No eye pain,foreign body sensation and other discomforts presented in the last visit.The surgical indications was therapeutic for 138 out of 253 patients(54.5%),aesthetic for 63 eyes out of 253 patients(24.9%),tectonic for 45 eyes out of 253 patients(17.8%),and analgesic for 7 eyes out of 253 patients(2.8%).The primary diagnose of therapeutic indications is refractory corneal ulcer for 135 eyes out of 253 patients(53.4%).The main diagnose of aesthetic indications is atrophy of eyeball for 45 eyes out of 253 patients(17.8%)and corneal leukoma for 18 eyes out of 253 patients(7.1%).The principal diagnose of tectonic indications is corneal perforation for 43 eyes out of 253 patients(17%).The main intraoperative complications is buttonhole formation for 8 eyes out of 253 patients(3.2%),which can be handled by simple suture.The most severe complications postoperatively was conjunctival flaps dissolving and corneal perforation for 3 eyes out of 253 patients(1.2%),and corneal transplantation had to be performed to avoid enucleation.In addition,4 eyes out of 253 patients(1.6%)presented cystic flap and two of them received surgical excision.Conclusions:Conjunctival flap cover surgery is an underused technique.Its primary indication is refractory corneal ulcer and corneal perforation,and its second indication is aesthetic with poor visual potential coexisting ocular surface diseases.It represents an interesting alternative to more mutilating surgeries.
文摘目的探讨2型糖尿病患者角膜知觉减退及其与眼表异常的相关性。方法采用前瞻性病例对照研究。采用Cochet-Bonnet角膜知觉测量仪分别测定并比较38例(68眼)2型糖尿病患者(糖尿病组)和33例(57眼)无糖尿病患者(对照组)中央角膜知觉,同时对糖尿病患者行泪膜破裂时间测定(break up time,BUT)、基础泪液分泌试验(SchirmerⅠ)及角膜荧光素染色。对角膜知觉与后三者进行相关性研究。结果糖尿病组角膜知觉为(36.07±14.26)mm,对照组为(52.98±3.89)mm,两者差异有显著性(P<0.01)。糖尿病患者SchirmerⅠ试验平均值为(12.41±3.22)mm,BUT值平均为(8.82±2.70)s,角膜荧光素染色累积分平均值为(3.94±1.66)分。糖尿病患者角膜知觉与泪膜破裂时间(r=0.330,P=0.006)、角膜荧光素染色(r=-0.342,P=0.004)有相关关系,与泪液分泌量无相关关系(P=0.538)。结论糖尿病患者角膜知觉明显减退,而角膜知觉减退是影响角膜上皮病变、干眼症等眼表疾病的因素之一。