Macular oedema

黄斑水肿
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:目的是研究一组埃及糖尿病性黄斑水肿(DMO)患者的房水炎症介质水平。
    方法:这是一项病例对照前瞻性研究,对2组进行:22例(11例女性)寻求DMO治疗的患者的25只眼作为患者组,以10例(4例女性)白内障患者10只眼为对照组。在玻璃体内注射(患者组)或白内障手术(对照组)之前抽吸房水。使用27种预混合细胞因子的多重珠免疫测定试剂盒测量房水中的炎症介质。
    结果:Eotaxin,干扰素γ诱导蛋白10(IP-10),与对照组相比,患者组的单核细胞趋化蛋白-1(MCP-1/CCL2)和白细胞介素-8(IL-8/CXCL8)显着升高(p=0.043,0.037,0.001,0.015)。相反,发现对照组的干扰素-γ(IFN-γ)和粒细胞集落刺激因子(G-CSF)明显高于患者组(p分别为0.003,0.019)。在对照组中发现碱性成纤维细胞生长因子(碱性FGF/FGF-2)和白介素-1受体拮抗剂(IL-1ra)较高(但无统计学意义)(分别为p=0.100和0.070)。此外,房水中的Eotaxin水平与中央黄斑厚度之间呈负相关。
    结论:某些介质可能与DMO的发病机制有关,无论是增强还是抑制作用。eotaxin,IP-10,MCP-1和IL-8可能在对标准抗血管内皮生长因子(VEGF)疗法无反应的情况下发挥作用。IL-1ra可能具有保护作用;因此,玻璃体内注射IL-1ra同源物的有效性需要在未来的临床试验中进行研究.
    BACKGROUND: The aim was to study aqueous humour inflammatory mediators\' levels in a cohort of Egyptian patients with diabetic macular oedema (DMO).
    METHODS: This was a case-control prospective study conducted on 2 groups: 25 eyes of 22 (11 females) patients seeking treatment for DMO as patients group, and 10 eyes of 10 (4 females) cataract patients as a control group. Aqueous humour was aspirated before intravitreal injection (patients\' group) or cataract surgery (control group). Inflammatory mediators in aqueous humour were measured using a multiplex bead immunoassay kit of 27 pre-mixed cytokines.
    RESULTS: Eotaxin, interferon gamma-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1/CCL2) and interleukin-8 (IL-8/CXCL8) were found significantly higher in patients\' group compared to control group (p = 0.043, 0.037, 0.001, 0.015 respectively). On the contrary, interferon-gamma (IFN-gamma) and granulocyte colony-stimulating factor (G-CSF) were found significantly higher in control group than patients\' group (p = 0.003, 0.019 respectively). Basic fibroblast growth factor (Basic-FGF/FGF-2) and interleukin-1 receptor antagonist (IL-1ra) were found higher (but not statistically significant) in controls (p = 0.100 and 0.070 respectively). Additionally, a negative and significant correlation was found between Eotaxin level in aqueous humour and central macular thickness.
    CONCLUSIONS: Some mediators might be implicated in the pathogenesis of DMO either augmenting or suppressing role. Eotaxin, IP-10, MCP-1 and IL-8 might have a role in cases not responding to standard anti-vascular endothelial growth factor (VEGF) therapy. IL-1ra might have a protective role; therefore, the effectiveness of intravitreal injection of IL-1ra homologue needs to be studied in future clinical trials.
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  • 文章类型: Journal Article
    遗传性视网膜营养不良(IRD)是劳动人口中合法失明的主要原因。囊性黄斑水肿(CME)是视力丧失的可治疗原因之一,影响高达50%的患者。结合“遗传性视网膜营养不良”进行了书目审查,“色素性视网膜炎”,“黄斑水肿”和根据“美国医疗保健研究和质量机构”的证据和建议水平的诊断治疗方案。该协议已在XAREADHR小组的每月会议上进行了讨论,超过25位眼科医生参加了会议,达成共识文件。CME的病因是多因素的:血-视网膜屏障的功能障碍,视网膜色素上皮,还有穆勒细胞,炎症,和玻璃体牵引.OCT是与IRD相关的CME的诊断和随访的首选测试。具有最高科学证据的药物是碳酸酐酶抑制剂(IAC)。玻璃体内皮质类固醇,抗VEGF,和玻璃体切割剥离内界膜没有足够的证据。针对成人IRD中的CME提出了一种治疗方案,另一个用于儿科患者,另一个用于IRD和白内障手术。口服和局部IAC可有效治疗IRD继发的CME。用皮质类固醇治疗,抗VEGF,玻璃体切除术是二线选择。需要进行随机临床试验以建立这些患者的治疗量表。
    Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining \"inherited retinal dystrophy\", \"retinitis pigmentosa\", \"macular oedema\" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the \"US Agency for Healthcare Research and Quality\". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.
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  • 文章类型: Journal Article
    回顾了有关年度糖尿病视网膜病变(DR)筛查间隔是否可以延长的当前证据。遵循系统审查方案(PROSPEROID:CRD420223559590)。专门评估DR筛查间隔的原始纵向文章为英文,并包括2000年后收集的数据。两名审稿人独立进行了搜索,并审查了文章的质量和相关信息。数据的异质性意味着荟萃分析是不合适的。包括12种出版物。研究质量很好,许多使用的数据来自DR筛查计划。研究分为三类;那些评估特定DR筛查间隔的研究,那些确定最佳DR筛查间隔的人和那些建立/评估DR筛查风险方程的人.对于那些患有2型糖尿病的人来说,在没有基线DR的患者中,将筛查间隔延长至3~4年的时间似乎是安全的.DR风险方程考虑了临床因素,并分配了那些风险较低的DR进展筛查间隔长达五年。那些基线DR或1型糖尿病患者似乎有更高的STDR进展风险,需要更频繁的筛查。在某些情况下,DR筛查间隔可以延长至每年3-5次。这些包括2型糖尿病患者和目前没有DR,以及那些对血糖和血压等其他危险因素有最佳管理的人。
    The current evidence on whether annual diabetic retinopathy (DR) screening intervals can be extended was reviewed. A systematic review protocol was followed (PROSPERO ID: CRD42022359590). Original longitudinal articles that specifically assessed DR screening intervals were in English and collected data after 2000 were included. Two reviewers independently conducted the search and reviewed the articles for quality and relevant information. The heterogeneity of the data meant that a meta-analysis was not appropriate. Twelve publications were included. Studies were of good quality and many used data from DR screening programs. Studies fit into three categories; those that assessed specific DR screening intervals, those that determined optimal DR screening intervals and those that developed/assessed DR screening risk equations. For those with type 2 diabetes, extending screening intervals to 3- to 4-yearly in those with no baseline DR appeared safe. DR risk equations considered clinical factors and allocated those at lower risk of DR progression screening intervals of up to five years. Those with baseline DR or type 1 diabetes appeared to have a higher risk of progression to STDR and needed more frequent screening. DR screening intervals can be extended to 3-5 yearly in certain circumstances. These include patients with type 2 diabetes and no current DR, and those who have optimal management of other risk factors such as glucose and blood pressure.
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  • 文章类型: Journal Article
    目的:为非传染性疾病的管理制定基于证据的专家共识建议,非肿瘤性,非脱髓鞘疾病相关葡萄膜炎。
    方法:确定了与文件目的相关的临床研究问题,并重新配制成PICO格式(患者,干预,比较,结果)由一个专家小组根据他们在该领域的经验选出。对现有证据进行了系统审查,证据根据等级(建议评估等级,发展,和评估)标准。随后,提出了建议。
    结果:构建了三个PICO问题,涉及前葡萄膜炎,非前并并发黄斑水肿。共提出19项建议,根据发现的证据和/或专家共识。
    结论:这里我们提出了西班牙风湿病学会关于治疗非感染性和非脱髓鞘疾病相关葡萄膜炎的第一个官方建议。它们可以直接应用于西班牙医疗保健系统,作为援助和治疗均质化的工具。
    OBJECTIVE: To develop evidence-based expert-consensus recommendations for the management of non-infectious, non-neoplastic, non-demyelinating disease associated uveitis.
    METHODS: Clinical research questions relevant to the objective of the document were identified, and reformulated into PICO format (patient, intervention, comparison, outcome) by a panel of experts selected based on their experience in the field. A systematic review of the available evidence was conducted, and evidence was graded according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Subsequently, recommendations were developed.
    RESULTS: Three PICO questions were constructed referring to uveitis anterior, non-anterior and complicated with macular edema. A total of 19 recommendations were formulated, based on the evidence found and/or expert consensus.
    CONCLUSIONS: Here we present the first official recommendations of the Spanish Society of Rheumatology for the treatment of non-infectious and non-demyelinating disease associated uveitis. They can be directly applied to the Spanish healthcare system as a tool for assistance and therapeutic homogenisation.
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  • 文章类型: Journal Article
    目的:本研究通过多模式测量评估了0.19mg氟轻松(FAc)植入物在西班牙非感染性葡萄膜炎(NIU)患者中的有效性。
    方法:对患有NIU包括葡萄膜性黄斑水肿(UME)的患者进行了前瞻性研究,随访时间≥12个月。排除标准包括感染性葡萄膜炎和不受控制的青光眼或需要超过2种药物的高眼压。使用包括9个结果的多成分结果测量来评估有效性。有效性定义为在每个时间点满足所有组件。次要结果指标是青光眼的发作或进展以及研究者报告的不良事件。
    结果:纳入22例患者的26只眼,96.2%有包括UME在内的适应症。在为期12个月的研究中,FAc植入物对15只(57.7%)眼有效,植入后2周即可达到疗效。平均最佳矫正视力和平均中央黄斑厚度(CMT)显着改善与所有时间点的基线(所有比较p<0.01)。在为期12个月的研究中,炎症标志物(前房细胞和玻璃体雾霾)也显着下降。预测12个月时疗效的因素是FAc前的全身皮质类固醇剂量,基线时免疫调节治疗(IMT)负荷较高,基线时视网膜神经纤维层(RNFL)较厚(均p<0.05)。预测失败的因素是男性,基线时RNFL较薄,1个月时治疗无效(均p<0.05)。并行,皮质类固醇和IMT的使用也显著下降.未检测到IOP的显著增加。
    结论:在西班牙的现实环境中,FAc植入物在治疗NIU超过12个月时是安全有效的。
    OBJECTIVE: This study assessed the effectiveness of the 0.19-mg fluocinolone acetonide (FAc) implant by multimodal measurements in patients with non-infectious uveitis (NIU) in a real-world setting in Spain.
    METHODS: A prospective study of patients who had NIU including uveitic macular oedema (UME) with ≥ 12 months follow-up was done. Exclusion criteria include infectious uveitis and uncontrolled glaucoma or ocular hypertension requiring more than 2 medications. Effectiveness was assessed using a multicomponent outcome measure that included nine outcomes. Effectiveness was defined as all components being met at every timepoint. Secondary outcome measures were onset or progression of glaucoma and investigator-reported adverse events.
    RESULTS: Twenty-six eyes from 22 patients were included, with 96.2% having an indication including UME. During the 12-month study, the FAc implant was effective in 15 (57.7%) eyes, reaching effectiveness as soon as 2 weeks post-implantation. Mean best-corrected visual acuity and mean central macular thickness (CMT) were significantly improved vs. baseline at all timepoints (all comparisons p < 0.01). During the 12-month study, inflammation markers (anterior chamber cells and vitreous haze) had also significantly declined. Factors predicting effectiveness at month 12 were systemic corticosteroid dose pre-FAc, higher immunomodulatory therapy (IMT) load at baseline and thicker retinal nerve fibre layer (RNFL) at baseline (all p < 0.05). Factors predicting failure were male gender, thinner RNFL at baseline and treatment ineffectiveness at 1 month (all p < 0.05). In parallel, corticosteroid and IMT use also declined significantly. No significant increase in IOP was detected.
    CONCLUSIONS: The FAc implant is safe and effective at treating NIU over 12 months in a real-world setting in Spain.
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  • 文章类型: Meta-Analysis
    背景:视网膜中央静脉阻塞和视网膜分支静脉阻塞是相关黄斑水肿导致视力丧失的常见原因。这篇综述的目的是评估在视网膜中央静脉阻塞和视网膜分支静脉阻塞中改善视力和治疗黄斑水肿的干预措施的有效性。
    方法:系统搜索医学搜索引擎和临床试验注册中心。包括≥90只眼的随机临床试验和≥100只眼的真实世界结局研究,每次随访≥6个月。
    结果:有11项随机对照试验评估了符合纳入标准的视网膜中央静脉阻塞的治疗方法和10项视网膜分支静脉阻塞的治疗方法。有10个视网膜中央静脉阻塞的真实世界结果研究和5个视网膜分支静脉阻塞的真实世界结果研究。对符合定义的纳入标准的研究进行Meta分析。主要结果是6-,12-,24个月和36个月的治疗。
    结论:由于其有效性和较低的眼部不良事件发生率,建议玻璃体内注射抗血管内皮衍生生长因子作为一线治疗优于玻璃体内皮质类固醇。当早期开始玻璃体内治疗时获得最佳结果。黄斑激光可能在视网膜分支静脉阻塞而不是视网膜中央静脉阻塞中起辅助作用。
    Central retinal vein occlusion and branch retinal vein occlusion are common causes of visual loss due to associated macular oedema. The aim of this review was to assess the effectiveness of interventions improving vision and treating macular oedema in central retinal vein occlusion and branch retinal vein occlusion.
    Medical search engines and clinical trial registries were systematically searched. Randomised clinical trials with ≥90 eyes and real-world outcome studies with ≥100 eyes each with ≥6 months follow-up were included.
    There were 11 randomised controlled trials evaluating treatments for central retinal vein occlusion which met the inclusion criteria and 10 for branch retinal vein occlusion. There were 10 real world outcome studies of central retinal vein occlusion and 5 real world outcome studies of branch retinal vein occlusion. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were change in visual acuity at 6-, 12-, 24- and 36 months by treatment.
    Intravitreal anti-vascular endothelial derived growth factor is recommended as first line treatment over intravitreal corticosteroid due to its effectiveness and lower rate of ocular adverse events. Best outcomes are achieved when intravitreal treatment is started early. Macular laser may have an adjunctive role in branch retina vein occlusion but not central retinal vein occlusion.
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  • 文章类型: Journal Article
    To suggest a unique missense variant candidate based on long-term ophthalmological changes and associated systemic signs described in five patients from two unrelated families affected by an autosomal dominant multi-systemic disorder including Retinal dystrophy, Optic nerve oedema, Splenomegaly, Anhidrosis and migraine Headaches, called ROSAH syndrome, related to a unique missense variant in ALPK1 gene. Observational longitudinal follow-up study of unrelated families. Clinical analysis of ophthalmological and systemic examinations was performed, followed by genetic analysis, including targeted Next Generation Sequencing (NGS) and Whole-Genome Sequencing (WGS). The ophthalmological phenotype showed extensive optic nerve swelling associated with early macular oedema and vascular leakage. The main associated systemic manifestations were recurrent fever, splenomegaly, anhidrosis, mild cytopenia, anicocytosis and hypersegmented polynuclear cells. WGS, shortened in the second family by the gene candidate suggestion, revealed in all patients the heterozygous missense variant c.710C>T; p.(Thr237Met) in ALPK1. The primary morbidity in ROSAH syndrome in this cohort appeared ophthalmological. Comprehensive, detailed phenotype changes aided by the advancement in genetic testing could allow an early genetic diagnosis of ROSAH syndrome and targeted treatment. The unique missense variant may be suggested as a target of gene correction therapy.
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  • 文章类型: Journal Article
    过氧化物酶体生物发生障碍(PBD)是一组异质性的遗传疾病。多个过氧化物酶体途径受损,超长链脂肪酸(VLCFA)是诊断的一线生物标志物。PBD的临床表现可能从严重,致命的多系统疾病,迟发性疾病。绝大多数PBD属于Zellweger频谱失调(ZSD),代表了一系列重叠的临床症状,Zellweger综合征是最严重的,Heimler综合征是较不严重的疾病。轻度临床症状常表现为正常或轻微的生化改变,使这些患者的诊断具有挑战性。在本研究中,我们使用WES和RNA-seq组合策略来诊断以视网膜营养不良为主要临床症状的患者。结果显示该患者为PEX1突变的复合杂合。VLCFA正常,但包含C22:0-C26:0物种的溶血磷脂酰胆碱(LPC)的回顾性分析发生了变化。这种简单的测试可以避免轻度表型患者的诊断冒险,比如这里描述的个人,在成年后很晚才被诊断出来.我们在细胞系模型中提供了功能数据,这些数据可以通过证明深层内含子变体改变PEX1mRNA加工的低态性质来解释患者的轻度表型。
    Peroxisomal biogenesis disorders (PBDs) are a heterogeneous group of genetic diseases. Multiple peroxisomal pathways are impaired, and very long chain fatty acids (VLCFA) are the first line biomarkers for the diagnosis. The clinical presentation of PBDs may range from severe, lethal multisystemic disorders to milder, late-onset disease. The vast majority of PBDs belong to Zellweger Spectrum Disordes (ZSDs) and represents a continuum of overlapping clinical symptoms, with Zellweger syndrome being the most severe and Heimler syndrome the less severe disease. Mild clinical conditions frequently present normal or slight biochemical alterations, making the diagnosis of these patients challenging. In the present study we used a combined WES and RNA-seq strategy to diagnose a patient presenting with retinal dystrophy as the main clinical symptom. Results showed the patient was compound heterozygous for mutations in PEX1. VLCFA were normal, but retrospective analysis of lysosphosphatidylcholines (LPC) containing C22:0-C26:0 species was altered. This simple test could avoid the diagnostic odyssey of patients with mild phenotype, such as the individual described here, who was diagnosed very late in adult life. We provide functional data in cell line models that may explain the mild phenotype of the patient by demonstrating the hypomorphic nature of a deep intronic variant altering PEX1 mRNA processing.
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  • 文章类型: Journal Article
    糖尿病是一种慢性代谢性疾病,每小时患病率不断增加。白内障是最常见的眼部并发症之一,它们会影响眼睛的所有结构。糖尿病患者白内障的发病率通过几种机制增加。随着技术的进步,白内障手术现在是糖尿病患者的必要手术。高危并发症,比如糖尿病性黄斑水肿,糖尿病视网膜病变(DR),Phakic,术后囊肿,术后黄斑水肿,假性囊肿手术后黄斑水肿和眼内炎,可能会导致失明。术前的重要性,术中,和术后因素在控制并发症和改善视觉结果方面不能过高估计。如果DR恶化并导致非增生性或增生性DR,或者如果眼中的液体积聚被诊断为黄斑水肿,则DR可能是一个严重的问题。在育龄期发展到威胁视力的DR的妇女经历痛苦并且经常需要眼部治疗。糖尿病已经存在了更长时间,以及更严重的高血糖症,高血压,心血管疾病,血压升高,大幅预测DR的发展。氧化应激可由高血糖引起,不规则的代谢过程,和患有DR的人正在发展神经变性。因此,控制餐后高血糖对预防DR至关重要。飞秒激光技术,多焦点人工晶状体,和其他手术创新被普遍称为手术管理;它将从事在未来的时代,以确定是否会继续减少白内障手术的并发症。本文旨在回顾DR与卒中的相关性及其筛查,并概述关键管理策略。
    Diabetes mellitus is a chronic metabolic disorder with increasing prevalence per hour. Cataracts are one of the most common eye complications, and they affect all structures of the eye. The incidence of cataracts is increasing in patients with diabetes by several mechanisms. With the advancement of technology, cataract surgery is now a necessary procedure for diabetic patients. High-risk complications, like diabetic macular oedema, diabetic retinopathy (DR), phakic, postoperative cyst, and postoperative macular oedema, and macular oedema and endophthalmitis following surgery for a pseudocyst, could result in blindness. The importance of preoperative, intraoperative, and postoperative factors cannot be overestimated in managing complications and improving visual outcomes. DR can be a severe problem if it worsens and causes non-proliferative or proliferative DR or if fluid accumulation in the eye is diagnosed as macular oedema. A woman progressing to sight-threatening DR during childbearing age experiences distress and often requires ocular treatment. Diabetes that has been present for a more extended period, as well as more significant hyperglycaemia, hypertension, cardiovascular diseases, and elevated blood pressure, substantially predict the development of DR. Oxidative stress can be caused by hyperglycaemia, irregular metabolic processes, and people with DR developing neurodegeneration. Therefore, controlling postprandial hyperglycaemia is crucial for preventing DR. Femtosecond laser technology, multifocal intraocular lenses, and other surgical innovations are popularly referred to as surgical management; it will be engaged in the coming era to determine whether there will be a continued reduction in the complication of cataract surgery. This article aims to review the correlation of DR with stroke and its screening and to outline the critical management strategies.
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