OBJECTIVE:To observe the clinical efficacy and safety of Chinese herbal medicine Jiawei Simiao Yongan granules (, JWSMYAG) in the treatment of non-infectious anterior uveitis (NIAU). METHODS:We conducted a single-center, randomized, open-labeled clinical trial in adults with NIAU. Patients received standard treatment or a combination of JWSMYAG (twice daily) for three months, with a 3-month withdrawal period for observation. The primary endpoint was the recurrence rate within six months. RESULTS:A total of 98 patients were included in the intention-to-treat analysis, including 49 patients in the Traditional Chinese Medicine (TCM) group and 49 patients in the control group. Compared with the control group, the number of relapses was significantly lower in the TCM group [24.5% vs6.1%, P = 0.0224; Hazard Ratio = 0.208, 95% Confidence Interval (0.059, 0.737)]; in addition, patients in the TCM group had lower symptom scores of eye pain, insomnia, and bitter taste within two weeks (all P < 0.05). There was no significant difference between the two groups in terms of the difference in best corrected visual acuity change over six months, the number of intraocular pressure elevations > 10 mm Hg, the scoring of anterior chamber cells, the number of patients with keratic precipitates (+) after 1/2 weeks of treatment, and the scores of conjunctival hyperemia, headache, photophobia, and lacrimation. The difference in the number of adverse events between the two groups over six months was not statistically significant. CONCLUSION:JWSMYAG can reduce the recurrence rate of NIAU, alleviate ocular pain, insomnia, and bitter taste symptoms in patients with NIAU, and have a favorable safety profile.

Objective:To observe the effect of the direct stimulation of acupuncture at extraocular muscle attachment point on acquired extraocular muscle palsy. Methods:Thirteen patients with acquired extraocular muscle palsy were treated with acupuncture directly at extraocular muscle (paralytic muscle) attachment point. Firstly, the intraocular conjunctival sac drops of topical anesthetic (procaine hydrochloride eye drops) were administered, 0.2 mL each time, once every 10 minutes, for a total of 3 times. Acupuncture was delivered immediately after the third drop. The sterile acupuncture needle for single use, 0.25 mm×25 mm, was inserted at the anatomical location of the corneal limbal attachment of paralytic extraocular muscle, with an angle of 10° to 15° formed between the needle tip and extraocular muscle, and a depth of 0.3 mm to 0.5 mm. Pivoted by the needle tip, the eyeball was moved passively towards the direction of normal action of orbital muscle, 30 to 50 times until the patient felt soreness of the eyeball; afterwards, the needle was removed. After acupuncture, levofloxacin eye drops were administered once (0.2 mL) at the affected eye. The treatment was given twice a week, and completed when diplopia disappeared. Before and after treatment, the diplopia and the synoptophore circumference were observed respectively. Results:After 7 to 24 (15.46±5.56) times of direct stimulation with acupuncture at extraocular muscle attachment point, the symptoms of diplopia disappeared in 13 patients, the eye position restored to orthophoria, and the circumference of synoptophore was reduced to be (4.04±0.82)° from (19.38±3.98)° detected before treatment (P<0.05). Conclusion:Acupuncture directly at extraocular muscle attachment can attenuate diplopia and improve ocular muscle function in patients with acquired extraocular muscle palsy.

Several studies have reported the efficacy of traditional Chinese medicine (TCM) for central serous chorioretinopathy (CSC), while some ophthalmologists are concerned that TCM may be a risk factor for CSC as some chinese herbs contain hormonal ingredients. This study aimed to evaluate the efficacy and safety of TCM in treating patients with CSC. Randomized controlled trials (RCTs) and observational studies of TCM for CSC were searched up to July 10, 2023 on the following biological databases without language and publication time restrictions: PubMed, Ovid Medline, Embase, Cochrane Library, The Chinese National Knowledge Infrastructure Database (CNKI), Technology Periodical Database (VIP), Wanfang, and Chinese Biomedical Literature Service System (SinoMed). Review Manager V.5.4.1 and Stata 14 software were used for data analysis. Finally, thirty-eight studies were finally included including 23 RCTs and 15 cohort studies. The meta-analysis showed that compared with the routine treatment alone, the combination of TCM can not only reduce the recurrence rate (OR = 0.29, 95% CI: 0.21,0.40; I2 = 0%) and central retinal thickness (CRT) (MD = - 35.63, 95% CI: - 45.96,-25.30; I2 = 89%) of CSC, but improve patients’ best corrected visual acuity (BCVA) (SMD = 0.86, 95% CI: 0.62,1.11; I2 = 77%); additionally, it has no obvious side effects compared with routine treatment (OR = 0.72, 95% CI: 0.39,1.34; I2 = 10%). Overall, this study shows that the use of TCM does not increase the risk of CSC recurrence; on the contrary, the combination of TCM may reduce the recurrence of CSC and improve BCVA and CRT in patients with CSC compared with conventional treatment.

Eye disease patients often suffer from liver disease, liver Qi stagnation, poor circulation of Qi and blood, and blockage of eye orifices, which leads to the onset of the disease.The depression and anxiety caused by eye disease have a great impact on the patients. Some patients with macular edema are worried about blindness and often accompanied by depression,tension, and anxiety, which worsens the condition and creates a vicious cycle. In clinical practice,the patients with decreased vision may experience emotional discomfort, stagnation of Qi, and a series of organ dysfunction, which belong to the category of "Yu syndrome" in Traditional Chinese Medicine. Depending on the patient’s condition, the treatment strategy of Traditional Chinese Medicine based on the differentiation of symptoms and signs of internal organs can be adopted,and the advantages of treating different diseases with the same method can be fully utilized. This approach can effectively alleviate depression and treat macular edema, thus relieving the bidirectional vicious cycle caused by depression due to decreased vision, and achieving good therapeutic effects.

目的 对比活体激光扫描共聚焦显微镜(IVCM)与传统的光学显微镜对睑缘蠕形螨的检出阳性率,评价其临床应用价值.方法 收集2020年10月—2021年2月期间就诊于中国中医科学院西苑医院眼科门诊的患者93例(186只眼).对同一患者分别使用IVCM法与光学显微镜法检测蠕形螨感染情况,记录不同方法检测出的蠕形螨的阳性率、漏诊率和检出蠕形螨数量的分布情况,比较光学显微镜检查法检测上、下睑缘的检出率.结果 (1)阳性率:2种方法检测蠕形螨均为阴性的患者8例(8.60%).IVCM检测阳性83例(89.25%),高于光学显微镜检测阳性的56例(60.22%),差异有统计学意义(χ2=20.755,P=0.000).(2)上、下睑缘检出蠕形螨阳性率:光学显微镜法检出上、下睑蠕形螨均为阳性或均为阴性的患者84例(90.32%),不一致的患者9例(9.68%).(3)漏诊率:IVCM法漏诊3例(3.23%),低于光学显微镜法漏诊24例(25.81%),差异有统计学意义(χ2=19.107,P=0.000).(4)蠕形螨数量的分布情况:2种检查方法检xu出不同数量蠕形螨的分布情况比较,差异有统计学意义(χ2= 42.809,P=0.000);对于同一患者IVCM法计数结果高于光学显微镜法2倍以上的患者达73例(86.90%).结论 与传统光学显微镜法比较,IVCM对睑缘蠕形螨的检出的阳性率更高,漏诊率更低,定量更为准确,具有一定的临床应用价值.

目的 基于五运六气理论分析先天运气禀赋差异对干眼罹患的影响.方法 收集2020年6月—2021年4月中国中医科学院西苑医院干眼患者541例,根据患者的出生日期推算出五运六气,包括干支纪年、岁运、地支、司天、在泉、岁运-司天综合运气和节气,并进行统计分析.结果 (1)干支纪年分布:出生于己巳年的人数最多(4.25％),甲申年出生者最少(0.18％).干支纪年分布差异具有统计学意义(x2=156.486,P=0.000).(2)天干化五运:天干化五运分布、岁运之太过与不及比较均无统计学意义(P＞0.05).(3)六气分布:十二地支的分布以卯为最多(11.65％),未最少(5.91％).十二地支的分布情况具有统计学意义(x2=22.468,P=0.021).司天-在泉的分布以阳明燥金司天、少阴君火在泉最多(21.26％),太阴湿土司天、太阳寒水在泉最少(12.57％).司天-在泉分布具有统计学意义(x2=14.316,P=0.014).地支五行属性的五方正位分布最多者为卯木(17.85％),最少者为未土(9.07％).地支五行之五方正位分布具有统计学意义(x2=20.235,P=0.005).(4)岁运-司天分布:岁运少火,阳明燥金司天出现频率最高(5.91％);岁运太水,太阳寒水司天最少(1.66％).岁运-司天分布具有统计学意义(x2=44.083,P=0.036).(5)节气分布:干眼患者出生于节气属霜降最多(6.47％),秋分最少(2.03％).节气分布具有统计学意义(x2=35.577,P=0.046).结论 干眼的罹患与出生时的运气禀赋有一定的相关性.出生在己巳年,地支为卯,岁运少火,阳明燥金司天,少阴君火在泉,节气为霜降的人群更容易罹患干眼.尚不能认为岁运对干眼的罹患有影响.

中心性浆液性脉络膜视网膜病变(简称"中浆")常因精神紧张和过度疲劳,情志不舒,气机失畅,郁而发病.中浆的发生与肝失疏泄,情绪郁结,脾失运化,痰湿阻滞,郁而化火等密切相关,患者多有抑郁和焦虑的表现,属于中医"郁证".朱丹溪首次提出"气、血、痰、火、湿、食"六郁致病之说,诸多目病,多生于郁,情志变化会导致脏腑气血平衡失调,引发多种病变."六郁"又可相继而生,气不行则血行不畅病血瘀,同样气郁可致水液代谢失常、产生湿郁、痰郁、食郁,其他郁证就会相继而生,并且"六郁"相互影响.本文从"六郁"探讨中浆病因病机及治疗,指出从"六郁"论治中浆,临床之中,往往病情复杂,又可诸郁并见,治疗需从本出发,兼顾诸症,可以起到较好疗效.

视网膜色素上皮(RPE)撕裂是湿性年龄相关性黄斑变性(wAMD)的一种常见并发症,也属于中医眼科学的"视瞻昏渺""暴盲"等范畴,从病因病机方面认为其可能与脏腑气机的升降失调、肝失疏泄、脾失健运以至气血运行不畅,不能濡养清窍,目失所养等有关.临床表现为视力骤降、视物遮挡等,黄斑区出现水肿、渗出、出血等病变.周婉瑜教授根据此中医诊疗思路运用半夏泻心汤加减治疗RPE撕裂肝郁脾虚证临床疗效显著,体现了治病求本,病证结合,标本兼治的思想,兹将其经验总结于此,供大家临床参考.

突如其来的新冠疫情打乱了我们的工作生活节奏,受影响最大的应该就是青少年了,长时间封闭在家里,户外活动明显减少,但是"停课不停学",居家上网课,由于长时间近距离用电子设备,凭空又多出了不少"小四眼儿"——也算是新冠的一个特殊"并发症"吧. 当然也不能把"小四眼儿"完全归咎于疫情影响.2018年底,国家卫生健康委会同教育部、财政部组织开展了全国儿童青少年近视调查工作,结果显示2018年全国儿童青少年总体近视率为53.6％,其中6岁儿童为14.5％,小学生为36％,初中生为71.6％,而高中生的近视率高达81％.看着满课堂亮晶晶的眼镜,不能不有所触动.

目的 旨在分析老年复杂性视网膜脱落患者乐商、平静心境、幸福感和心理弹性之间相关性.方法 选取北京地区6所医院眼科于2018年1月至2019年1月间收治老年复杂性视网膜脱落患者298例作为研究对象,调查其乐商、平静心境、幸福感和心理弹性.结果 老年复杂性视网膜脱离患者乐商对平静心境的直接效应为0.42,总效应为0.94(P<0.05);幸福感、心理弹性均在老年复杂性视网膜脱离患者乐商与平静心境中起间接中介效应(P<0.05),中介效应为0.20和0.22,占总效应的21.28％和23.40％;两者连续路径起链式中介效应(P<0.05),中介效应为0.10,占总效应的10.64％.结论 老年复杂性视网膜脱落患者幸福感、心理弹性能够有效提高其乐商水平,增加其平静心境,在乐商和平静心境间起中介效应和链式中介效应.

总结房定亚教授运用络病理论分期治疗白塞综合征葡萄膜炎的经验.认为热毒入络、毒瘀深伏于络是白塞综合征葡萄膜炎反复发作的根本原因.基于"络以通为用"的基本治则,根据病变特点,将白塞综合征葡萄膜炎分为活动期、迁延期及晚期进行辨治.活动期宜清热解毒、利湿通络,方用甘草解毒汤加减;迁延期宜祛除余邪、清热通络,方用四妙勇安汤加减;晚期宜温经养血、护脉通络,方用当归饮子加减.

Objective: to observe the clinical efficacy of Shenling Baizhu Powder (SLBZP) combined with a subconjunctival injection of triamcinolone acetonide (TA) in treating macular edema (ME) induced by retinal vein occlusion (RVO). Methods: there were 62 patients (62 eyes) with ME induced by RVO that were selected and divided into two groups in accordance with the random number table. Each group had 31 eyes. Group one, the control group, was treated with a single subconjunctival injection of TA; group two, the observation group, was treated with a single subconjunctival injection of TA (20mg/0.5mL) per eye and one month of SLBZP. To evaluate the clinical efficacy, both groups were checked (3×) with the best corrected-visual acuity (BCVA), center macular thickness (CMT), and intraocular pressure (IOP). The checks were before treatment, one month after injection, and three months after injection. Results: there were 26 eyes (83.87％) in the observation group, and 17 eyes (54.84%) in the control group in which the BCVA was significantly improved. The ME obviously decreased in 27 eyes (87.10%) the observation group and in 19 eyes (61.29%) the control group. The clinical efficacy of the observation group was significantly better than that of the control group (P<0.05). Conclusion: as one method to treat ME induced by RVO, SLBZP combined with subconjunctival injection of TA is significantly more effective than a single subconjunctival injection of TA.Besides, the SLBZP had less side-effects. Based on the above, this method deserves in-depth research.

玄府理论的建立主要基于玄府学说与临床实践的结合,本文主要目的是探析玄府理论在糖尿病性黄斑水肿(DME)治疗上的应用.气、血、水代谢失常是DME的基本病理因素,其主要病理过程可概括为糖尿病(DM)从阴虚燥热向阴阳两虚的证候转化中引起的五脏功能失调、玄府郁闭,进一步可导致气滞、血瘀、水液内停,病变的根本在于眼之玄府,目中玄府郁闭为核心病机.在治疗上,以开通玄府为根本,以开府益气、活血利水法并重为法则,提倡辨证与辨病论治相结合,以逍遥散合五苓散为基础方,根据黄斑水肿气滞、血瘀、水停的偏重加减.在用药上,宜用辛散、开府之药,如柴胡、薄荷等,且善用虫类开府,如地龙等.玄府理论进一步丰富和完善了中医治法在DME的应用.

目的 评价单纯应用中药治疗干眼的有效性及主要治法.方法 按Cochrane系统评价方法 检索数据库查找有关中药治疗干眼的随机对照试验,检索时间从建库至2019年2月.对纳入研究进行质量评价,使用RevMan5.3统计软件进行资料提取与Meta分析.结果 纳入15篇文献,共包括2182眼,全部为中文文献.Meta分析结果 显示,与对照组相比,单纯中药治疗干眼在延长泪膜破裂时间(BUT)[MD=2.29,95％CI(1.43,3.16),P=0.000]、增加泪液分泌量(SⅠT)[SMD=0.92,95％CI(0.45,1.39),P=0.000]及提高总体疗效方面[OR=3.29,95％CI(2.49,4.34),P=0.000]均有统计学意义(P<0.05),在改善角膜荧光染色(FL)[SMD=0.52,95％CI(-0.36,1.40),P=0.24]和干眼症状方面[SMD=0.10,95％CI(-0.68,0.89),P=0.80]无统计学意义.另外,13个研究主要治法为滋养阴液之法,其余以疏肝、清热润燥、温肾助阳为主.有2个研究干预组采用中药内服加外熏;仅有1个研究进行了泪河高度测定.结论 中药治疗干眼能显著延长患者泪膜破裂时间和增加泪液分泌量,在治疗干眼总体疗效上更有优势.单纯应用中药治疗干眼时,多为滋养阴液之法.

本文通过对治疗热毒炽盛之脱疽专方四妙勇安汤溯源、方解、现代药理及抗炎机制研究,充分论证了四妙勇安汤具有解毒活血通络的功效;葡萄膜炎是一种血管炎,相当于中医的络病,其病因是先天阳性体质与后天热邪相搏,形成热毒,腐络伤血,在病理上谓络病瘀滞,气血失运,形成血瘀、出血、水肿、渗出.周婉瑜主任以四妙勇安汤加味诊治葡萄膜炎的临床验案,在临床疗效、缩短病程、减少复发等方面效果显著,论证了从络病治疗葡萄膜炎的经验,体现中医学异病同治的治疗法则,可以将其作为治疗葡萄膜炎基本方的思路加以推广.

Valsalva 视网膜病变(valsalva retinopathy)是Duane在1972年首次提出的[1].该病多因Valsalva动作导致眼内的静脉压突然增高,引起黄斑区表层毛细血管破裂[2],黄斑区内界膜下出血,可单眼或双眼发病.

病证结合是当前中医眼科的主要临证模式,气、血、水三者在病理和生理上密切相关,其病理状态是眼睛局部证候的反应,是辨证治疗眼底病不可或缺的证候要素.非动脉炎性前部缺血性视神经病变(NAION)好发于老年人群中,是临床常见的急性致盲性视神经病变.基于病证结合的气血水理论,其主要病机可概括为气、血、水运行和代谢障碍、络脉阻塞,病变的根本在目系络脉.在治疗上,采用中药联合针刺进行治疗,中药治疗以益气活血、利水通络法为基本法则,以补阳还五汤为基本方,根据气滞、血瘀、水停的偏重加减用药;针刺选穴以局部穴位为主、远端穴位为辅的原则,以达益气化瘀、通络明目之功.

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)自2019年12月爆发以来,由于具有高传染性,迅速在世界各地蔓延,国内外疫情防治形势空前严峻.COVID-19不仅造成肺部、肠道、肾脏等多脏器损害,且部分患者以眼表损害为首发或伴发症状出现,临床上很容易被忽视.COVID-19的眼表损害归属于祖国医学"天行赤眼"范畴,本文结合国内外最新的文献报道,探讨新型冠状病毒(2019 novel corona virus,2019-nCoV)对眼表的损害,阐明其可能机制,并从中西医角度提出可行的治疗措施.

非动脉炎性前部缺血性视神经病变(NA-AION)是一种严重损害视力、视野的眼病,中医、西医治疗本病均有一定的优势,但各有不足之处.大量临床研究证明针刺联合常规药物在改善AION视野、视力方面有可喜的疗效,本文现对近几年针刺联合常规药物治疗本病进行综述说明.

Paracentral acute middle maculopathy (PAMM) was first named by Sarraf, et al(1) in 2013, and was categorized as one of the acute macular neuroretinopathies (AMNs).To date, there is still no effective approach to this disease.We report a patient diagnosed with PAMM who was treated with Chinese medicine (CM)-based acupuncture.