目的 本研究探讨类风湿关节炎患者干眼的发病特点,并对干眼的严重程度与类风湿关节炎疾病活动度的相关性进行研究,以期对类风湿关节炎干眼的发病机制能有进一步的了解,进而对类风湿关节炎干眼提供诊疗帮助.方法 收集笔者医院风湿免疫科经临床确诊的2014年3月～2016年12月住院类风湿关节炎合并干眼患者48例,同期就诊于眼科门诊的非类风湿关节炎干眼患者(单纯干眼组)50例和正常志愿者50例.对所有研究对象行眼表疾病指数(ocular surface disease index,OS-DI)问卷评分、泪液分泌试验Ⅰ(schirmerⅠtest,SⅠt)、泪膜破裂时间(tear break-up time,BUT)、角膜荧光染色(corneal fluoresce-in staining,FL)干眼相关指标进行统计,并同时采集红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)等类风湿活动度相关的指标.依据干眼BUT、SⅠt、FL客观检测指标,对干眼严重程度分级,对类风湿关节炎疾病活动强度分级采用DAS28积分方法.对研究对象间类风湿性关节炎疾病活动度指标、干眼指标、类风湿性关节炎疾病活动度强度与干眼严重程度的相关性进行统计学分析.结果 3组间OSDI、SⅠt、BUT、FL的检查结果比较,类风湿关节炎干眼组、单纯干眼组SⅠt、BUT低于正常对照组,OSDI、FL高于正常对照组,总体比较差异有统计学意义(P<0.05).类风湿关节炎干眼组与单纯干眼组比较,BUT低于单纯干眼组,差异有统计学意义(P<0.05);FL高于单纯干眼,差异有统计学意义(P<0.05);OSDI、SⅠt类风湿关节炎干眼组与单纯干眼组比较,差异无统计学意义(P>0.05);3组间风湿活动性指标ESR、CRP、RF检查结果比较,单纯干眼组、正常对照组ESR、CRP、RF低于类风湿关节炎干眼组,总体差异有统计学意义(P<0.05);单纯干眼组与正常对照组间差异无统计学意义(P>0.05);类风湿关节炎干眼组中BUT与ESR、CRP、RF均呈负相关(P<0.05),FL与ESR、CRP、RF均呈正相关(P<0.05),SⅠt、OSDI与ESR、CRP、RF无相关性(P>0.05);类风湿关节炎组疾病活动度强度与干眼指标BUT呈负相关(P<0.05),与FL呈正相关(P<0.05),与SⅠt、OSDI无相关性(P>0.05);类风湿关节炎组干眼的严重程度与类风湿活动指标ESR、CRP、RF呈正相关(P<0.05).结论 类风湿关节炎干眼患者较单纯干眼患者干眼症状重,推断类风湿关节炎干眼与单纯干眼可能存在不同的致病机制;类风湿关节炎疾病活动度越高,干眼的症状越重,推测类风湿关节炎疾病活动度可能影响干眼的严重程度.类风湿关节炎的疾病活动度与干眼症状的严重程度之间存在相关性,推测通过对类风湿关节炎患者干眼症状检查,可以评价类风湿关节炎疾病活动度与病情.

Recently,although the phacoemulsification of cataract is improving,various complications of surgery still exist.As that most elderly patients are suffering from both cataract and diabetes,complications of cataract surgery in these people become an important issue.In this review,we summarized the recent research on the physiological characteristics of diabetic patients` retinal conditions and the impact from surgery itself,aiming at providing a useful clinical reference.

? AIM: To identify the effective and safety of ranibizumab intravitreal injection in patients with macular edema ( ME ) caused by diabetic macular ( DM ) and retinal vein obstruction ( RVO) .?METHODS: Thirty-eight eyes of thirty-five patients was retrospectively evaluated, twenty- three with ME caused by DM and fifteen with RVO, who received intravitreal ranibizumab ( 0. 5mg/0. 05ml ) and were followed up for at least a month. , The best corrected visual acuity ( BCVA ) , central retinal thickness ( CRT ) and intraocular pressure(IOP) were followed up at 1, 3d, 1wk and 1mo respectively. The effect of the DME and RVO-ME were compared.?RESULTS:DME and RVO- ME group after treatment in 1, 3d, 1wk, the BCVA were obviously improved, and the differences were statistically significant (P<0. 05). But compared the BCVA in 1mo with before showed no statistically significant difference (P>0. 05). DME and RVO-ME group after treatment in 1, 3d, 1wk and 1mo, CRT was obviously improved, and the differences were statistically significant (P<0. 05). The BCVA and CRT of treatment showed no statistically significant difference between DME with RVO-ME (P>0. 05). <br> ?CONCLUSION: Bevacizumab intravitreal injection for ME caused by DM and RVO was safe and effective.

Diabetic retinopathy(DR),which can cause blindness, is a serious eye diseases. Diabetic macular edema ( DME) , often causes irreversible vision loss, can occur in any period of DR. The treatment of DME, including laser photocoagulation, anti-inflammatory therapy, anti-VEGF therapy and surgical treatment have made great progress in recent years as the researches on the pathogenesis deepening. The innovation of minimally invasive technique also proved the surgical treatment more convenience. The joint application of a variety of treatments, also become the main trend of treatment. A review of the present status and progress of the treatment was made in this paper.

目的 探讨难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者角膜和结膜钙化与血管钙化之间的关系.方法 用裂隙灯检查角膜和结膜钙化(conjunctival and corneal calcification,CCC)的情况并量化评分,采用腹部侧位X线平片评判患者腹主动脉钙化(abdominal aortic calcification,AAC)情况,心脏彩超评估心脏瓣膜钙化(cardiac valve calcification,CVC).Spearman相关性分析CCC与CVC、AAC之间的相关性,用单因素方差分析方法分析难治性SHPT患者不同CCC评分分组的可能影响因素. 结果 ①共入选43例难治性SHPT患者,平均年龄(49.51±9.66)岁,中位透析龄96(12,204)月.CVC和CCC评分之间的Spearman等级相关系数为(r=0.321,P=0.036),AAC和CCC评分之间的Spearman等级相关系数为(r=0.337,P=0.027).②AAC＜5分组与AAC≥5分组患者在年龄(t=-2.258,P=0.029)、吸烟史(t=-2.332,P=0.025)、CVC评分(t=-2.835,P=0.007)之间的差异也具有统计学意义;CVC≤1分组与CVC＞1分组患者在年龄(t=-2.283,P=0.028)、透析龄(t=-2.235,P=0.023)、血磷(t=2.927,P=0.006)、尿素(t=2.330,P=0.025)、尿酸(t=2.541,P=0.015)、血高密度脂蛋白(t=-2.634,P=0.012)、AAC评分(t=-2.595,P=0.013)之间的差异存在统计学意义.③CCC不同评分分组间单因素方差分析结果提示透析龄(F=4.772,P=0.014),吸烟史(F=3.334,P=0.046),AAC评分(F=6.803,P=0.003),CVC评分(F=6.227,P=0.004)存在显著差异.结论 难治性SHPT患者普遍存在角膜和结膜钙化,CCC与AAC、CVC间呈正相关关系,腹主动脉钙化、心脏瓣膜钙化越重,透析时间越长,发生角膜和结膜钙化的风险也越高.

?Dry eye is a multi-factorial disease of tear film and ocular surface, and it can result in discomfort, visual disturbance and tear film instability and potential damage of ocular surface, accompanied by hyper osmolarity of tears and ocular surface inflammation. lnflammation is the key factor to dry eye. Many kinds of immune cells and inflammatory factors are involved in the occurrence and development of dry eye syndrome. Cell apoptosis, nerve dysregulation, disorders of sex hormones also play an important role in pathologic process of dry eye. Recently, while illustrating the pathophysiology and pathogenesis of dry eye has been made some progress, there is still no single standard. The possible mechanisms of ocular surface inflammation and tear dysfunction of dry eye were reviewed in this article.

Objective To study the time and effect of laser treatment of patients with diabetic retinopathy after cataract surgery .Methods 75 cases(114 eyes) with cataract extraction combined with intraocular lens implantation were included: non-proliferative diabetic retinopathy(NPDR)21 eyes, pre-proliferative diabetic retinopathy (PPDR) 25 eyes, proliferative diabetic retinopathy (PDR) 68 eyes. They were treated with the retinal photocoagulation and followed-up 6-12 months.Results The effective rate in the improvement of vision and retinopathy was 74.6%、78.0% respectively, but that in the high-risk PDR group was statistically worse than the other groups(P< 0.05).Conclusion Timely and reasonable laser therapy is a key to keep the vision of DR patients stable and reduce the rate of blind.

To observe the effect of autologous stem cell transplantation in diabetic retinopathy. <br> ●METHODS:Totally 58 cases (116 eyes) who underwent autologous stem cell transplantation were confirmed as no diabetic retinopathy (18 eyes), mild non-proliferative diabetic retinopathy (NPDR) (41 eyes), mid-level NPDR (51 eyes); severe NPDR (6 eyes) by ophthalmoscope directly or indirectly and fluorescence fundus angiography (FFA ). Follow - up was 6 - 12mo, the changes of retinopathy were observed. <br> ●RESULTS: The total effective rate of vision and retinopathy was 84. 4%, 76. 7%. The results of severe NPDR was statistically worse than the other groups ( P <0. 05). <br> ●CONCLUSlON: The stable blood glucose level and improved pancreatic function after autologous stem cell transplantation might be helpful in diabetic retinopathy, the long effects need to be researched further.

Objective To detect the change of macular retinal thickness (RT)and retinal nerve fi bre layer (RNFL) thickness in normal subjects and type 2 diabetes patients with no diabetic retinopathy using OCT.Methods Forty eyes of patients with NDR were enrolled. While eyes of normal population (n=40) were also examined. The retinal and RNFL thickness were both measured in two groups by OCT. The RT in A1-A9 areas, the thickness in central fovea and RNFL in the peripheral area (temporal, superior, nasal and inferior) of the macula were all calculated and compared with healthy controls.Results Comparing with the normal eyes, retinal thickness signifi cantly decreased in A3 and A5 and RNFL thickness signifi cantly decreased in the superior and temporal in NDR group.Conclusion This study indicates that there may be a neurodegenerative disease in retinal fundus of diabetic patients. OCT checking could provide help for the early diagnosis, pathogenesis research and treatment of this disease.

AlM:To compare the effect of different incision in corneal astigmatism after phacoemulsification. METHODS: Totally 88 cases ( 122 eyes ) with pure cataract were randomly divided into two groups. Forty cases (60 eyes) were clarity corneal incision in group A, and 48 cases ( 62 eyes ) were sclera tunnel incision in group B. Mean corneal astigmatism, surgically induced astigmatism ( SlA ) , uncorrected visual acuity ( UCVA ) and best correct vision acuity ( BCVA ) were observed in pre- and post-operation at 1d;1wk;1mo. RESULTS: The mean astigmatism had statistically significant difference between two groups at 1d; 1wk;1mo after operation(P<0. 05). The SlA had statistically significant difference at 1d ( P<0. 05 ); The SlA had no statistically significant difference between two groups at 1mo after operation (P>0. 05). UCVA≥0. 5 and BCVA≥0. 8 had statistically significant difference at 1d; 1wk ( P<0. 05) . There had no statistically significant difference at 1mo after operation (P>0. 05). CONCLUSlON: Phacoemulsification with scleral tunnel incision remove combined intraocular lens ( lOL ) implantation has small changes to corneal astigmatism. By selecting personalized corneal incision according to the corneal topography might be more beneficial.

AlM: To investigate and evaluate the prevalence of xerophthalmia among aerospace science and technology staff and its influencing factors for the eye health guidance. <br> METHODS: The staff underwent physical examination in our examination center from September 2013 to June 2014 were preliminary screened, and those patients with symptoms of dry eye were investigated with questionnaires and diagnosed by basic lacrimal secretion test ( Schirmer l ) , breakup time of tear film ( BUT ) test and fluorescein ( FL) staining test . <br> RESULTS: There were 606 complaints of dry eye symptoms of the 1 000 premiers, distributed in random (60. 6%), and 432 employees were diagnosed (43. 2%). The positive rate of dry eye was 71. 3%. The causes of xerophthalmia, besides of gender, age, also include a variety of factors such as air-conditioner, heating, video terminals, sleep time, etc. <br> CONCLUSlON: Dry eye, an epidemic disease, has a variety of symptoms and complex etiology, the main causes of aerospace science and technology staff with&nbsp;dry eye is working environment and some local factors. We can give appropriate health guidance according to the different factors. Meanwhile the relevant series of dry eye screening should also be taken as a routine examination in ophthalmic examination.

Age-related macular degeneration(AMD), the most common cause of irreversible blindness over 50 years in developed countries, is a degenerative disease occurs with age. The prevalence rate in our country is also increasing by year and the pathogenesis is still undiscovered. In this review, we focus on the associated risk factors reported in recent years, aim to further understand the pathogenesis of AMD.

AIM: To observe the influence of cataract phacoemulsification on corneal endothelial cell of cataract patients combined with diabetes or hypertension. METHODS: Clinical case-control study was used. Totally 104 cases(174 eyes)of patients who underwent phacoemulsification were divided into three groups: senile cataract patients, diabetes mellitus cataract patients and hypertension cataract patients. The changes of endothelial cell density(CD), percentage of regular hexagonal cells(6A), coefficient of variation(CV)between pre-operation and post-operation at 1wk, 1mo were compared. The data were analyzed statistically by means of SPSS 13.0 software.RESULTS: Pre-operative results: the percentage of CD and 6A cell were decreased and CV was increased in diabetes and hypertension group compared with control group. There were statistical differences in 6A and CV in diabetes group(P<0.05). There were statistical differences in 6A in hypertension group(P<0.05). Post-operative results: the percentage of CD and 6A were decreased, and CV was increased after operation of 1wk and 1mo. There were significant differences in three groups(P<0.01). CD had statistical differences(P<0.05), CV and 6A had significant differences(P<0.01)between diabetes group and control group. 6A and CV had significant differences(P<0.01)between hypertension group and control group. CONCLUSION: Cataract phacoemulsification has certain injury on corneal endothelial cell. Cataract patients combined with diabetes or hypertension are easier to be damaged than that of senile cataract in the phacoemulsification. They are more sensitive after surgery.

目的通过光学相干断层扫描仪观察糖尿病患者白内障术后黄斑区视网膜厚度的变化。方法对比分析行超声乳化白内障吸出术的糖尿病患者59眼以及无糖尿病行超声乳化白内障吸出术患者54眼手术前及术后1d、1周、1个月时黄斑中心凹厚度的光学相干断层扫描测量资料。结果糖尿病患者白内障超声乳化手术前黄斑中心凹视网膜平均厚度为(228.05±20.131)μm,术后1d黄斑视网膜平均厚度为(229.56±20.279)μm,较术前相比差异无统计学意义,术后1周、1个月黄斑视网膜平均厚度分别为(235.78±19.836)μm、(242.83±20.966)μm,较术前相比差异有统计学意义(P<0.05),神经上皮层视网膜术前平均厚度为(174.61±17.887)μm,术后1d、1周、1个月神经上皮层视网膜平均厚度分别为(178.92±18.596)μm,(182.75±19.559)μm,(189.71±19.211)μm,较术前相比差异有统计学意义(P<0.05),色素上皮层视网膜术前平均厚度为(53.47±8.014)μm,术后1d色素上皮层视网膜平均厚度为(54.39±7.134)μm,较术前相比差异无统计学意义,术后1周色素上皮层视网膜平均厚度为(55.76±7.260)μm,较术前相比差异有统计学意义(P<0.05),术后1个月时色素上皮层视网膜平均厚度为(55.05±7.558)μm,较术前相比差异无统计学意义。结论糖尿病患者白内障超声乳化吸出术后1周开始黄斑区视网膜厚度增加,神经上皮层视网膜厚度在术后1d时已经开始增加,色素上皮层视网膜厚度在术后1周时增厚,1个月时恢复至术前水平。这说明对于糖尿病患者,与视网膜色素上皮层相比,视网膜神经上皮层更容易受到白内障手术的损害,且恢复较慢。

Phacoemulsification with small incision, reduced number of inflammation cells, and better postoperative recovery has been recognized as the world's most popular option for cataract surgery. Modern cataract surgery is developing gradually from sight rehabilitating to refractive surgery with better vision acuity. Being the most important part of the eye refractive system, maintenance of the cornea's transparency relies heavily upon the healthy endothelial cells. It is well known that there will be endothelial cell loss after phacoemulsification and the damage of the endothelial cells may lead to corneal swellings and opacity, or even the corneal descompensation, which often severely influenced the postoperative vision recovery. This is a review of phacoemulsification and the risk factors of corneal endothelial damage pre-and postoperation.

Objective To observe the clinical efficacy of cataract surgery after glaucoma filtration.Methods Phacoemulsification and intraocular lens implantation through clear corneal incision were performed on 43 eyes of 32 cases after glaucoma filtering surgery.Results The postoperative visual acuity was improved in all cases compared with preoperative varying degrees.The visual acuity of 0.3 ～ 0.5 was 10 eyes (23.26％),0.6 to 0.8 was 15 eyes (34.88％),≥ 1.0 was 8 eyes (18.60％).The postoperative complications were intraoperative posterior capsular rupture in 1 eye (2.32％),the cornea with above moderate edema 8 eyes (18.60％),postoperative hyphema 2eyes (4.65％),postoperative high intraocular pressure 6 eyes (13.95％),postoperative iritis 3 eyes (6.98％) and optic atrophy 6 eyes(13.95％).No serious complications occurred.Conclusion The advantages of the surgery were simple,small damage,faster visual recovery and the good effect reducing the intraocular pressure.

<正>干眼是临床上最常见的慢性眼表疾病之一,近几年,随着社会的发展和科技的进步,电子产品广泛普及,生活环境相对封闭,人们在工作生活包括出行等方面用眼的时间、强度明显多于从前,因此眼部不适及干眼症的发生频率愈发变高,于是干眼症等一些眼表疾病便逐步成为人们关注的焦点,越来越引起重视。目前国内外关于干眼发生的相关因素的研究仍然有限,并且内容尚无统一,故以下主要针对干眼患病相关因素及防治措施的研究进展予以综述。

With the increasing progress of cataract surgery, the postoperative residual astigmatism has become one of the factors that influence the desirable refractive outcome for patients. At present, the most commonly used cataract extraction is also traditional phacoemulsification cataract surgery with incision size of 3.2 mm. With the progress of Micro-incision cataract surgery(MICS), the postoperative residual astigmatism decreased. The different surgery induce different postoperative residual astigmatism. Through literature review, to analyze the causes of postoperative residual astigmatism by different incision cataract.

Objective To investigate the relationship between nonarteritic anterior ischemic neuropathy and ischemic stroke.Methods Thirty-two NAION and forty IS patients from July 2010 to July 2013 in department of Ophthalmology, Beijing Aerospace Center Hospital were recorded on demographic features and past history.Except of fundus fluorescein angiography ( FFA ) , both groups underwent the examination of fundus photography,visual field,carotid artery ultrasound and brain MRI.Chi-square test was used to evaluate the difference incidence of systemic diseases between two groups.Results Diabetes, hypertension,carotid artery stenosis and other risk factors existed in both groups.The incidence of diabetes, hypertension,carotid artery stenosis and ischemic change of cerebra was 21.87%,40.62%,31.25% in NAION group,lower than that in IS group,which was 52.50%,72.50%,100.00%,and difference was statistically significant(χ2 =7.02,7.43,39.60;P <0.05).The incidence of carotid artery stenosis and carotid arterial plaque was 15.62%,46.87% in NAION group,lower than that in IS group,which was 32.50%,60.00%,and the difference was not statistically significant(χ2=2.70,1.23;P>0.05).There was no hypotension patiens in IS group.Conclusions The relationship between NAION and IS are unclear. Except for carotid artery stenosis,the risk factors of two diseases are common incompletely.

Phacoemulsification has become the most popular surgical procedure for cataract patients nowadays.To analyze the main causes and strategies of low vision after phacoemulsification and intraocular lens (IOL) implantation.To explore the main factors of low vision after phacoemulsification in cataract patients.