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中山大学中山眼科中心:倾尽全力攻克难治性眼底病,让患者重获光明

2018-03-06 李涛 健康报医生频道

难治性眼底病是指衰老、炎症、糖尿病等因素引起的眼底血管及神经组织病变,可导致感光及神经传导功能丧失。该类疾病由于病因复杂,诊断分期不完善,治疗预后不佳,已逐渐成为全球不可逆性盲的主要原因。


解读中华医学科技奖

难治性眼底病是指衰老、炎症、糖尿病等因素引起的眼底血管及神经组织病变,可导致感光及神经传导功能丧失。该类疾病由于病因复杂,诊断分期不完善,治疗预后不佳,已逐渐成为全球不可逆性盲的主要原因。

中山大学中心眼科中心刘奕志教授及其研究团队,在6项国家自然科学基金项目资助下,历时10年,围绕难治性眼底病进行了系列基础和临床研究,取得一系列核心研究成果。

研究发现了视网膜新生血管发病新机理。发现修复眼底血管损伤的关键因子——血小板源性生长因子-CC,发现糖尿病视网膜病变发生发展的相关标志——神经生长因子(NGF),为治疗提供了新的药物靶点。

研究阐明了视网膜病变神经损害和保护机制。发现糖尿病视网膜病变视神经损害早于视网膜血管损害,证实外源性SHH信号通路激动剂,对糖尿病引起的视网膜神经节细胞和胶质细胞损伤具有保护作用,有助于制定早期保护策略。

该团队首次报道中国正常人脉络膜厚度正常值,提出脉络膜变薄是特发性黄斑裂孔(IMH)发病的危险因素。对脉络膜脱离型视网膜脱离患者,首次提出脉络膜脱离严重程度定量标准,用于指导治疗方案的制定。还提出进展性先天性视网膜劈裂的临床分级,用于指导手术时机的选择。

该研究创新了疑难眼底病的手术技术。创立可松解环扎的视网膜复位新术式,系统性开展360°视网膜切开技术治疗重症息肉样脉络膜血管病变(PCV)研究,并且建立23G微创硅油取出新技术。创新应用玻璃体腔注气术治疗视盘小凹黄斑病变,减少了并发症,提高了手术效率。

此外,还制定了全球应用的眼底镜检查规范和指南,在《新英格兰医学杂志》发表了眼底镜检查的规范,有利于全科医生和专科医生掌握标准的眼底检查方法,作为评价糖尿病、高血压等全身疾病的重要常规手段。

科研不仅革新技术 

更助力解决“看病难” 

舍我其谁,敢为天下先

眼底病诊断困难、治疗效果差,是眼科界公认的“硬骨头”。

中山大学中山眼科中心作为中国最大的眼科医疗机构,大批面临失明的眼底病患者慕名而来,渴望重获光明。在本项目开展之前,许多息肉样脉络膜血管病变视网膜下大出血患者辗转全国各地求诊,得到的结论却是病情严重、难治疗,最终只得放弃治疗。

科研之路从不平坦,成功并不是一蹴而就。敢为天下先,不是盲目,而是一份源自心底的自信,一代代中山眼科人的深耕细作,为今天的突破奠定了深厚的基础。敢为天下先,不是冲动,是源自医者父母心的责任,新一代的中山眼科人在历史的传承中锐意进取,敢啃“硬骨头”,才能不断进步、守护光明。

举重若轻,攻克难题

巩膜扣带术是治疗孔源性视网膜脱离的经典术式,但可引起眼球变形和前后段缺血,而且术后并发症多,视力预后差。研究表明,巩膜外植体的顶压作用,在术后2~3个月内足以实现视网膜复位。而晚期对眼球的持续外加压,是造成术后并发症的主要原因,通过二次手术取出植入物,则会增加损伤及并发症的可能。

研究团队创新性提出可松解环扎带“早期加压、晚期松解”的理念,并通过临床研究证明可松解环扎带可以减少巩膜扣带术后并发症,改善患者术后视功能。美国Klufas MA教授评价这项技术革新为“近20年来视网膜材料和手术技术的最显著进步”。该技术最大的亮点在于巧妙利用可吸收缝线的代谢特点,在不增加手术难度和费用的情况下,成功解决了困扰业界几十年的问题。更换一根缝线,看似举重若轻,但背后却是研究者日常临床工作中不断积累、思考的成果。

责无旁贷,履行社会责任

中国医疗发展不平衡,能开展眼底病手术的医疗机构多集中在北上广等城市的大型三甲医院。眼底病患者大量集中,造成就诊过程中专家门诊“一号难求”,需要手术时则是“一床难求”。

面对患者和社会需求,刘奕志院长带领专家团队进行技术攻关,提出眼底病临床分级新标准,对手术技术进行创新,提高了诊断率,优化了治疗方案,提升了手术效率。率先开展眼底病日间手术模式,将住院时间由1周减至1天,将患者等候手术时间从4~8个月减至2周,节约医疗成本,解决了患者就医难、手术难的问题。眼底病日间手术模式还在全国推广,极大提高了我国眼科的临床服务能力。(文/中山大学中山眼科中心副教授 李涛)

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    2018-03-08 freve
  4. [GetPortalCommentsPageByObjectIdResponse(id=1814760, encodeId=c6741814e60a2, content=<a href='/topic/show?id=bc4c96052ae' target=_blank style='color:#2F92EE;'>#重获光明#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96052, encryptionId=bc4c96052ae, topicName=重获光明)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=295c372, createdName=chaojitidian, createdTime=Sun Apr 15 08:54:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458387, encodeId=2f41145838ef3, content=<a href='/topic/show?id=12e5e27551d' target=_blank style='color:#2F92EE;'>#眼底病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72755, encryptionId=12e5e27551d, topicName=眼底病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3296055952, createdName=huiwelcome, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528453, encodeId=d7971528453d9, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555761, encodeId=325e1555e61e2, content=<a href='/topic/show?id=5900221140f' target=_blank style='color:#2F92EE;'>#中山大学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22114, encryptionId=5900221140f, topicName=中山大学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d5414663053, createdName=kalseyzl, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293619, encodeId=7e832936198f, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Tue Mar 06 19:06:04 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293608, encodeId=7f392936087d, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:28:02 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293607, encodeId=125629360edc, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:27:54 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1814760, encodeId=c6741814e60a2, content=<a href='/topic/show?id=bc4c96052ae' target=_blank style='color:#2F92EE;'>#重获光明#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96052, encryptionId=bc4c96052ae, topicName=重获光明)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=295c372, createdName=chaojitidian, createdTime=Sun Apr 15 08:54:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458387, encodeId=2f41145838ef3, content=<a href='/topic/show?id=12e5e27551d' target=_blank style='color:#2F92EE;'>#眼底病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72755, encryptionId=12e5e27551d, topicName=眼底病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3296055952, createdName=huiwelcome, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528453, encodeId=d7971528453d9, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555761, encodeId=325e1555e61e2, content=<a href='/topic/show?id=5900221140f' target=_blank style='color:#2F92EE;'>#中山大学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22114, encryptionId=5900221140f, topicName=中山大学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d5414663053, createdName=kalseyzl, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293619, encodeId=7e832936198f, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Tue Mar 06 19:06:04 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293608, encodeId=7f392936087d, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:28:02 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293607, encodeId=125629360edc, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:27:54 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 131****1460

    学习了受益匪浅

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1814760, encodeId=c6741814e60a2, content=<a href='/topic/show?id=bc4c96052ae' target=_blank style='color:#2F92EE;'>#重获光明#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96052, encryptionId=bc4c96052ae, topicName=重获光明)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=295c372, createdName=chaojitidian, createdTime=Sun Apr 15 08:54:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458387, encodeId=2f41145838ef3, content=<a href='/topic/show?id=12e5e27551d' target=_blank style='color:#2F92EE;'>#眼底病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72755, encryptionId=12e5e27551d, topicName=眼底病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3296055952, createdName=huiwelcome, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528453, encodeId=d7971528453d9, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555761, encodeId=325e1555e61e2, content=<a href='/topic/show?id=5900221140f' target=_blank style='color:#2F92EE;'>#中山大学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22114, encryptionId=5900221140f, topicName=中山大学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d5414663053, createdName=kalseyzl, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293619, encodeId=7e832936198f, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Tue Mar 06 19:06:04 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293608, encodeId=7f392936087d, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:28:02 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293607, encodeId=125629360edc, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:27:54 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 惠映实验室

    学习.谢谢分享.

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1814760, encodeId=c6741814e60a2, content=<a href='/topic/show?id=bc4c96052ae' target=_blank style='color:#2F92EE;'>#重获光明#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96052, encryptionId=bc4c96052ae, topicName=重获光明)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=295c372, createdName=chaojitidian, createdTime=Sun Apr 15 08:54:00 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458387, encodeId=2f41145838ef3, content=<a href='/topic/show?id=12e5e27551d' target=_blank style='color:#2F92EE;'>#眼底病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72755, encryptionId=12e5e27551d, topicName=眼底病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3296055952, createdName=huiwelcome, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528453, encodeId=d7971528453d9, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555761, encodeId=325e1555e61e2, content=<a href='/topic/show?id=5900221140f' target=_blank style='color:#2F92EE;'>#中山大学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22114, encryptionId=5900221140f, topicName=中山大学)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d5414663053, createdName=kalseyzl, createdTime=Thu Mar 08 08:54:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293619, encodeId=7e832936198f, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Tue Mar 06 19:06:04 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293608, encodeId=7f392936087d, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:28:02 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293607, encodeId=125629360edc, content=学习.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Mar 06 18:27:54 CST 2018, time=2018-03-06, status=1, ipAttribution=)]
    2018-03-06 惠映实验室

    学习.谢谢分享.

    0

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