Background: The increasing prevalence of myopia among Chinese children and adolescents, especially at younger ages, has emerged as a significant concern in recent years. Pre-myopia is a key period for myopia prevention and control in children and adolescents. Previous studies suggested auricular acupressure (AA) therapy might offer a viable approach to prevent and slow down myopia progression. Nonetheless, these studies lack robust, high-quality, large-scale, multi-center evidence to conclusively support such assertions. The purpose of this research is to evaluate the efficacy, safety, and economic benefits of AA therapy in preventing myopia in Chinese children aged 6–12 years with pre-myopia. Methods: The single-blind, multi-center, parallel-group, randomized controlled trial will involve 318 pre-myopic children from 20 different centers across China. After recruitment, these participants will be randomly assigned to two groups (the AA group and the control group) at a 1:1 ratio. The AA group will receive auricular point sticking therapy along with health education for a period of 24 weeks, while the control group will be provided the sham AA treatment and routine health education. The assessments of outcomes will be conducted at the start of this study, and then after 4, 8, 12, and 24 weeks. The primary outcome is the change in spherical equivalent refraction at various follow-up times. The secondary outcomes include the number of myopia cases, uncorrected visual acuity, axial length, corneal curvature radius, accommodation amplitude, retinal and choroidal thickness, and eye behavior management. In addition, the cost-effectiveness analysis will be used as the evaluation index for economic assessment. Discussion: The results of this research will provide evidence on the efficacy, safety, and economic benefits of AA therapy in preventing myopia among children aged 6–12 years with pre-myopia in China.

Dry age-related macular degeneration (AMD) is a prevalent clinical condition that leads to permanent damage to central vision and poses a significant threat to patients' visual health. Although the pathogenesis of dry AMD remains unclear, there is consensus on the role of retinal pigment epithelium (RPE) damage. Oxidative stress and chronic inflammation are major contributors to RPE cell damage, and the NOD-like receptor thermoprotein structural domain-associated protein 3 (NLRP3) inflammasome mediates the inflammatory response leading to apoptosis in RPE cells. Furthermore, lipofuscin accumulation results in oxidative stress, NLRP3 activation, and the development of vitelliform lesions, a hallmark of dry AMD, all of which may contribute to RPE dysfunction. The process of autophagy, involving the encapsulation, recognition, and transport of accumulated proteins and dead cells to the lysosome for degradation, is recognized as a significant pathway for cellular self-protection and homeostasis maintenance. Recently, RPE cell autophagy has been discovered to be closely linked to the development of macular degeneration, positioning autophagy as a cutting-edge research area in the realm of dry AMD. In this review, we present an overview of how lipofuscin, oxidative stress, and the NLRP3 inflammasome damage the RPE through their respective causal mechanisms. We summarized the connection between autophagy, oxidative stress, and NLRP3 inflammatory cytokines. Our findings suggest that targeting autophagy improves RPE function and sustains visual health, offering new perspectives for understanding the pathogenesis and clinical management of dry AMD.

Visible light serves as a crucial medium for vision formation.;however, prolonged or excessive exposure to light is recognized as a significant etiological factor contributing to retinal degenerative diseases. The retina, with its unique structure and adaptability, relies on the homeostasis of cellular functions to maintain visual health. Under normal conditions, the retina can mount adaptive responses to various insults, including light-induced damage. Unfortunately, exposure to intense and excessive light triggers a cascade of pathological alterations in retinal photoreceptor cells, pigment epithelial cells, ganglion cells, and glial cells. These alterations encompass disruption of intracellular REDOX and Ca²⁺ homeostasis, pyroptosis, endoplasmic reticulum stress, autophagy, and the release of inflammatory cytokines, culminating in irreversible retinal damage. We first delineate the mechanisms of retinal light damage through 4 main avenues: mitochondria function, endoplasmic reticulum stress, cell autophagy, and inflammation. Subsequently, we discuss protective strategies against retinal light damage, aiming to guide research toward the prevention and treatment of light-induced retinal conditions.

青少年近视患病率逐渐上升,且低龄化现象日益明显,严重影响了青少年身心健康.青少年近视防控已提升为国家战略.中医对近视的治疗及调理有很大的优势,而且强调近视防控的重点在于预防,这与《黄帝内经》提出的"治未病"思想相吻合,与健康中国战略中"预防为主、防治结合、中西医并重"的原则高度一致.多数疾病在功能性阶段给予干预,能取得良好的效果.而假性近视正是发展为真性近视的功能性损害阶段,这一时期发挥中医治未病的传统优势,给予积极干预治疗,是确保青少年视力正常发育的关键.因此,假性近视的防治对近视的预防尤为重要.中医在青少年假性近视的防治上方法较多,疗效明显.本文整理了近年来青少年假性近视防治的中医非药物疗法的研究进展,主要包括针刺、推拿、耳穴及联合治疗等,以期为青少年假性近视的防治提供帮助.

Traditional Chinese Medicine（TCM） constitution theory contained in Huangdineijing has guiding significance for clinical diagnosis and treatment of ophthalmology.Dry eye is one of the common ophthalmic diseases, which is classified as "white astringent disease" "holy water will wither" "dry, astringent and faint" in TCM. By analyzing the physical characteristics of perimenopausal women, this paper discovers that the main cause of dry eye in perimenopausal women is the imbalance of Yin and Yang, and the main pathogenesis is the decline of kidney Qi, the exhaustion of menstruation, the deficiency of Chong and Ren, and the imbalance of kidney Yin and Yang. In terms of treatment, the method of balancing Yin and Yang is adopted, and the reinforcing methods as well as the reducing methods are applied according to the difference of deficiency and obstruction. In terms of point selection, it is advisable to combine meridian syndrome differentiation and viscera syndrome differentiation on the basis of point selection around the eyes. This paper discusses the application of TCM constitution theory in the treatment of perimenopausal dry eye in Huangdineijing, in order to improve the relevant acupuncture treatment scheme for this disease and provide new ideas for clinical treatment.

本文立足"阳气者,精则养神,柔则养筋"经典理论,认为上睑下垂病机核心为阳气不振,失于养神柔筋,胞睑失用;提出阳气与经筋、元神关系为:阳气外为柔软养于筋,而筋构胞丝,阳气内化精微养于神,而神驭胞睑;其五体病位在筋,五脏病位在肝,与脾密切相关;并立通督调阳疗法,可为上睑下垂临床治疗提供新思路.

后天获得性上睑下垂是上睑提肌功能不全或丧失,导致上睑部分或全部不能提起的状态,主要特征是影响视瞻,中医属于"睢目""侵风""睑废"范畴.传统多从虚实辨证论治该病,梁凤鸣认为阳气不足,眼睑升提无力,阳明、太阳筋经失养而致上睑下垂.重视督脉为"阳脉之海"的理论,且眼为七窍之一,居头面之高,受控于脑神,非阳气而不能提升,非清气而不能濡养,强调从通督升阳,濡筋托睑论治上睑下垂,为针刺治疗后天获得性上睑下垂提供新思路.

近视是儿童青少年常见的眼病之一,也是视力受损的主要原因之一.目前全球近视发病率为28.3％,其中我国是近视人数占比最高的国家之一,近视发病逐渐呈现出低龄化、发展快的特征,近期研究结果显示儿童青少年近视率随年龄增长呈上升趋势[1-4].经教育部会同"卫生健康委员会"核定,2018年我国儿童青少年总体近视率为53.6％[5].儿童近视已成为全球公共卫生难题,世界卫生组织将儿童近视列入"Visual 2020"行动中[6].目前国内外学者从多方面开展有关近视影响因素的分析研究,不断明确可能引起近视的发病因素,通过科学有效的干预措施降低近视发病率和延缓近视的发展.本文就儿童青少年近视影响因素及中西医防治措施的研究进展综述如下.

?Myopia is an extremely common state of refractive error, and the incidence of myopia is increasing year by year and the age of onset is usually earlier. It has grown up to be a major public health problem that endangers people' s visual health. Studies have demonstrated that myopia is a multi-factor complex disease which affected by genetic factors, environmental factors and gene -environment interaction. Genetics includes classical genetics and epigenetics. The emergence of epigenetic research has opened a new perspective of basic research on myopia. In recent years, the researchers have proposed that the occurrence of myopia may be related to epigenetics, and more and more experimental studies have also proved this view. The genetic study of myopia has identified several myopia genes and candidate genes for high myopia and myopia by using linkage and genome-wide association methods, which greatly deepened the understanding of the genetic basis of myopia. This article reviews the research on classical genetics and epigenetics of myopia in recent years.

青光眼是一种不可逆性视力损害的视神经疾患.针刺作为西医治疗的补充,能有助于保护或维持患者残存的视功能.针刺是中医学的重要分支,几千年来一直用于治疗多种疾病.研究发现,针刺可能增强传统降眼压药物的降压效果,但由于针灸医师针刺手法、刺激强度、刺激方式、选穴不同、测量时间差异等,对眼压调节作用备受争议.针刺还可以改善眼部和视神经乳头的血液流动,影响电生理,改善视觉功能.此外,针刺具有抗细胞凋亡作用,通过调节神经生长因子和神经营养因子及其受体发挥神经保护作用.目前针刺治疗青光眼的确切作用机制还未阐明.本文从以上几个方面进行综述,为针刺治疗眼部疾病,尤其是青光眼视神经疾病提供理论依据.

年龄相关性黄斑变性(age-related macular degeneratin.AMD),是威胁中老年人视功能的主要致盲眼病之一,病变在发展过程中可出现黄斑区色素脱失、增殖,玻璃膜疣,黄斑区脉络膜新生血管(CNV),视网膜色素上皮层脱离(PED),黄斑区反复出血等眼底改变从而导致视力下降或丧失,其发病率随着年龄的增长逐年增高,症状主要表现为单眼或双眼中心视力减退,视物变形,中心视野暗点或视物遮挡[1].

Objective To popularize acupuncture in the treatment of acquired paralytic strabismus.Methods Two cases of acquired paralytic strabismus treated by acupuncture were studied to analyze the etiology and pathogenesis, the choice of acupoints and the effective mechanism of acupuncture.Results Two cases of acquired paralytic strabismus were cured quickly by local acupuncture.Conclusion It was further confirmed that the treatment of acquired paralytic strabismus by acupuncture has a short course and quick effect, and the method is simple and easy to implement, which is worth promoting.

AIM:To evaluate the long-term efficacy and safety of retinal photocoagulation combined with intravitreal injection of Ranibizumab(IVR)and simple Ranibizumab in the treatment of branch retinal vein occlusion secondary macular edema(BRVO-ME).METHODS: The literatures related to randomized controlled clinical studies on the treatment of BRVO-ME with laser and Ranibizumab in Embase, The Cochrane Library, PubMed, China National Knowledge Infrastructure(CNKI), Wanfang Database and China Science and Technology Journal Database(VIP)were systematically retrieved, and the risk assessment was carried out and data indicators were extracted for the included studies. RevMan 5.3 software was used for data analysis and funnel plot was used to evaluate publication bias.RESULTS: Totally 7 studies were included, with 641 eyes. There was no significant difference in the best corrected visual acuity(BCVA)between the laser combined with Ranibizumab group and the simple Ranibizumab group at 12mo \ and 24mo \ after treatment. There was no significant difference in central foveal thickness between the two groups at 12mo \ and 24mo \. There were no statistically significant differences in the injection times of Ranibizumab and the incidence of final adverse events between the two groups at 12mo and 24mo after treatment.CONCLUSION: Compared with the treatment of BRVO-ME with simple Ranibizumab, there was no significant difference in the long-term efficacy of vision and central foveal thickness for the laser combined with Ranibizumab, and there was no significant difference in the injection times and safety of Ranibizumab.

动眼神经的神经纤维包括躯体运动神经纤维及内脏运动神经纤维,躯体运动神经纤维主要支配上直肌、下直肌、内直肌、下斜肌及提上睑肌,内脏运动神经纤维支配瞳孔括约肌和睫状肌,故动眼神经麻痹的临床表现为患眼内转、下转及上转受限,上睑下垂,瞳孔散大,对光反射迟钝或消失,可伴有复视.动眼神经麻痹的发病原因复杂多样,其中以炎症因素、脑干病变、肿瘤、脱髓鞘疾病、外伤、血管病变为主.中医据其症状将动眼神经麻痹称之为“上胞下垂、目偏视病、视歧”等,主要病因是气血不足,风邪侵入;或脾不化湿,聚湿生痰,复感风邪;或头面部外伤或肿瘤压迫脉络.笔者临床跟随梁凤鸣教授临床学习过程中,运用针药联合治疗后天性不完全性动眼神经麻痹1例疗效较好,报道如下.

玻璃体积血是眼科常见病、多发病,也是难治病之一,能引起视力下降甚至失明.本病主要因内眼血管性疾患和损伤引起,也可由玻璃体后脱离、视网膜裂孔以及全身性疾患引起[1].西医目前尚无特效治疗药物,主要以玻璃体切除手术治疗为主,但存在一定风险,且可能引起严重的并发症.中医学认为,玻璃体积血是血不循经,血溢络外,滞于神膏所致,离经之血属于瘀血,治疗当以活血化瘀为主.笔者(第一作者)跟师(通讯作者)采用血府逐瘀汤加减治疗糖尿病视网膜病变引起的玻璃体积血1例,取得显效,现介绍如下.

动眼神经麻痹是眼科的常见疾病之一,常以患眼上睑下垂、除外展位外其余眼球各运动方位均受限等为主要症状,病因多且复杂.西医治疗动眼神经麻痹采用营养神经、扩张血管药物、糖皮质激素治疗为主,或采用佩戴三棱镜、手术治疗等方法[1],但治疗效果欠佳.在此基础上,中医通过辨病辨证进行个体化治疗,采用中药与针刺相结合的治疗方法,可取得较好的疗效.梁凤鸣教授临床治疗动眼神经麻痹,采用针刺眼周及远端穴位疏经通络、调和气血,加之中药祛风除湿、化痰通络,并配合西药对症支持疗法,疗效显著,现介绍其验案1则如下.

Age-related macular degeneration (AMD) is a major clinical blind-inducing eye disease, and its pathogenesis is closely related to the autophagy of RPE cells and the signaling pathway of nuclear factor erythroid-2 related factor 2 (Nrf2). Autophagy is one of the common and important physiological phenomena in human body, which is of vital significance for maintaining the stability and metabolism of cells. Nrf2 is a key transcription factor regulating cells to fight against foreign bodies and oxidative damage, and Nrf2 signaling pathway plays a wide range of cell protective functions in anti-tumor, anti-stress and other aspects. With the development of research, it is found that there are extensive interaction mechanisms between autophagy and Nrf2 signaling pathway. Inhibition of autophagy leads to accumulation of p62, which activates the Nrf2 signaling pathway by binding with Keap1 (kelch-like ech-associated protein1). At the same time, studies have also found that reactive oxygen species (ROS) and other factors also participate in the mutual regulation between autophagy and Nrf2.This paper will review the recent research progress on the interaction between Nrf2 signaling pathway and autophagy in the development of AMD. Hope to provide a new perspective for the treatment of AMD.

缺血性视神经病变是供给视神经的血管发生阻塞、缺血导致筛板前后的视神经供血不足而产生的病变.临床表现为突发无痛性的视力下降、视盘弥散性或节段性水肿、相对性传入瞳孔阻滞以及与生理盲点相连的象限性视野缺损.本病好发于中老年人,可双眼先后发病,间隔时间不等[1].西医治疗主要是急性期给予糖皮质激素促进视盘水肿消退,同时配合扩张血管、营养神经、降低眼压等药物治疗,可控制视盘水肿,促进视力、视野的恢复,但远期疗效欠佳[2].笔者(第一作者)跟师采用中西医结合治疗缺血性视神经病变2例,现报告如下.

梁凤鸣现任天津中医药大学第一附属医院眼科主任,擅长针刺治疗麻痹性斜视、视神经萎缩、干眼症等.现将梁凤鸣运用针刺及中药治疗麻痹性斜视经验总结如下. 1病因病机 目为宗脉之所聚,脏腑精气通于经络上滋于目,视而精明.《素问·阴阳应象大论》曰:“诸脉者,皆属于目,目得血而能视,五脏六腑精气,皆上注于目,而为之精.”“眼通五脏,气贯五轮”,眼与脏腑、经络的关系密切,五脏六腑的精气依靠经络为之贯通,并通过经络的运行上注于目.

分析近年来相关文献,就中医药调控缺氧诱导因子1(hypoxia inducible factor-1,HIF-1)防治湿性年龄相关性黄斑变性(wet age-related macular degeneration,WAMD)的机理进行探讨.