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Retinal light damage: From mechanisms to protective strategies 视网膜光损伤:从机制到保护策略
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-23 DOI: 10.1016/j.survophthal.2024.07.004
Zhao Zhang , Xiaoqian Shan , Shujiao Li , Jun Chang , Zhenhua Zhang , Yang Dong , Li Wang , Fengming Liang

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.

可见光是视力形成的重要媒介,然而,长期或过度暴露在光线下被认为是导致视网膜退行性疾病的重要病因。视网膜具有独特的结构和适应能力,依靠细胞功能的平衡来维持视觉健康。在正常情况下,视网膜能对各种损伤(包括光引起的损伤)做出适应性反应。不幸的是,暴露在强烈和过度的光线下会引发视网膜感光细胞、色素上皮细胞、神经节细胞和神经胶质细胞的一系列病理改变。这些改变包括细胞内 REDOX 和 Ca²⁺ 稳态的破坏、裂解、内质网应激、自噬和炎症细胞因子的释放,最终导致视网膜不可逆转的损伤。我们首先通过线粒体功能、内质网应激、细胞自噬和炎症这四个主要途径来阐述视网膜光损伤的机制。随后,我们讨论了针对视网膜光损伤的保护策略,旨在指导研究如何预防和治疗光引起的视网膜病变。
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引用次数: 0
Advances in artificial intelligence for meibomian gland evaluation: A comprehensive review 用于睑板腺评估的人工智能的进步:全面回顾。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-23 DOI: 10.1016/j.survophthal.2024.07.005
Li Li , Kunhong Xiao , Xianwen Shang , Wenyi Hu , Mayinuer Yusufu , Ruiye Chen , Yujie Wang , Jiahao Liu , Taichen Lai , Linling Guo , Jing Zou , Peter van Wijngaarden , Zongyuan Ge , Mingguang He , Zhuoting Zhu

Meibomian gland dysfunction (MGD) is increasingly recognized as a critical contributor to evaporative dry eye, significantly impacting visual quality. With a global prevalence estimated at 35.8 %, it presents substantial challenges for clinicians. Conventional manual evaluation techniques for MGD face limitations characterized by inefficiencies, high subjectivity, limited big data processing capabilities, and a dearth of quantitative analytical tools. With rapidly advancing artificial intelligence (AI) techniques revolutionizing ophthalmology, studies are now leveraging sophisticated AI methodologies--including computer vision, unsupervised learning, and supervised learning--to facilitate comprehensive analyses of meibomian gland (MG) evaluations. These evaluations employ various techniques, including slit lamp examination, infrared imaging, confocal microscopy, and optical coherence tomography. This paradigm shift promises enhanced accuracy and consistency in disease evaluation and severity classification. While AI has achieved preliminary strides in meibomian gland evaluation, ongoing advancements in system development and clinical validation are imperative. We review the evolution of MG evaluation, juxtapose AI-driven methods with traditional approaches, elucidate the specific roles of diverse AI technologies, and explore their practical applications using various evaluation techniques. Moreover, we delve into critical considerations for the clinical deployment of AI technologies and envisages future prospects, providing novel insights into MG evaluation and fostering technological and clinical progress in this arena.

人们日益认识到,睑板腺功能障碍(MGD)是导致干眼症蒸发的重要因素,严重影响视觉质量。据估计,全球发病率为 35.8%,这给临床医生带来了巨大挑战。传统的干眼症人工评估技术面临着效率低、主观性强、大数据处理能力有限以及缺乏定量分析工具等局限性。随着人工智能(AI)技术的飞速发展,眼科领域正在发生革命性的变化,目前的研究正在利用先进的人工智能方法,包括计算机视觉、无监督学习和有监督学习,来促进对睑板腺(MG)评估的全面分析。这些评估采用了各种技术,包括裂隙灯检查、红外成像、共聚焦显微镜、光学相干断层扫描等。这种模式的转变有望提高疾病评估和严重程度分类的准确性和一致性。虽然人工智能在睑板腺评估方面取得了初步进展,但系统开发和临床验证方面的不断进步势在必行。我们回顾了睑板腺评估的发展历程,将人工智能驱动的方法与传统方法并列,阐明了各种人工智能技术的具体作用,并利用各种评估技术探讨了它们的实际应用。此外,我们还深入探讨了人工智能技术临床应用的关键考量因素,并展望了未来前景,从而为MG评估提供了新的见解,并促进了这一领域的技术和临床进步。
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引用次数: 0
Role of inflammation in diabetic macular edema and neovascular age-related macular degeneration 炎症在糖尿病黄斑水肿和新生血管性老年黄斑变性中的作用。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-18 DOI: 10.1016/j.survophthal.2024.07.006
Stela Vujosevic , Marco Lupidi , Simone Donati , Carlo Astarita , Valentina Gallinaro , Elisabetta Pilotto

Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial disorders that affect the macula and cause significant vision loss. Although inflammation and neoangiogenesis are hallmarks of DME and nAMD, respectively, they share some biochemical mediators. While inflammation is a trigger for the processes that lead to the development of DME, in nAMD inflammation seems to be the consequence of retinal pigment epithelium and Bruch membrane alterations. These pathophysiologic differences may be the key issue that justifies the difference in treatment strategies. Vascular endothelial growth factor inhibitors have changed the treatment of both diseases, however, many patients with DME fail to achieve the established therapeutic goals. From a clinical perspective, targeting inflammatory pathways with intravitreal corticosteroids has been proven to be effective in patients with DME. On the contrary, the clinical relevance of addressing inflammation in patients with nAMD has not been proven yet. We explore the role and implication of inflammation in the development of nAMD and DME and its therapeutical relevance.

糖尿病性黄斑水肿(DME)和新生血管性老年性黄斑变性(nAMD)是影响黄斑并导致视力严重下降的多因素疾病。虽然炎症和新生血管生成分别是 DME 和 nAMD 的特征,但它们有一些共同的生化介质。炎症是导致 DME 发生的诱因,而在 nAMD 中,炎症似乎是视网膜色素上皮和布鲁氏膜改变的结果。这些病理生理学上的差异可能是导致治疗策略不同的关键因素。血管内皮生长因子抑制剂改变了这两种疾病的治疗方法,但许多 DME 患者未能达到既定的治疗目标。从临床角度来看,使用玻璃体内皮质类固醇针对炎症通路治疗 DME 已被证实有效。相反,解决 nAMD 患者炎症问题的临床意义尚未得到证实。我们将探讨炎症在 nAMD 和 DME 发展过程中的作用和影响及其治疗意义。
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引用次数: 0
Revisiting acute retinal pigment epitheliitis (Krill disease) 重温急性视网膜色素上皮炎(克里尔氏病)
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-16 DOI: 10.1016/j.survophthal.2024.07.003
Yousef A. Fouad , Maria Vittoria Cicinelli , Alessandro Marchese , Giuseppe Casalino , Lee M. Jampol

We reevaluate acute retinal pigment epitheliitis (ARPE) first described by Krill and Deutman in 1972, integrating a meticulous literature review with advanced multimodal imaging analyses. Our review included 98 eyes from 86 published cases diagnosed with ARPE. We scrutinized ARPE's clinical presentations, variability, and imaging characteristics, revealing that a large majority (90 %) of cases previously diagnosed as ARPE align more closely with other retinal disorders based on modern diagnostic criteria and imaging techniques. Only a small fraction (5 eyes) did not fit into any known categories, casting doubt on ARPE's distinct existence. This underscores the critical role of multimodal imaging in redefining our understanding of macular diseases and challenges the historical classification of ARPE as a unique clinical entity.

我们对 Krill 和 Deutman 于 1972 年首次描述的急性视网膜色素上皮炎(ARPE)进行了重新评估,将细致的文献综述与先进的多模态成像分析相结合。我们的研究包括 86 个已发表的确诊为 ARPE 的病例中的 98 只眼睛。我们仔细研究了 ARPE 的临床表现、变异性和成像特征,发现绝大多数(90%)以前诊断为 ARPE 的病例根据现代诊断标准和成像技术更接近于其他视网膜疾病。只有一小部分病例(5 眼)不符合任何已知的类别,这让人对 ARPE 的独特存在产生了怀疑。这凸显了多模态成像在重新定义我们对黄斑疾病的认识方面所起的关键作用,并对历史上将 ARPE 划分为一个独特的临床实体提出了挑战。
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引用次数: 0
Advances in ophthalmic therapeutic delivery: A comprehensive overview of present and future directions 眼科治疗给药的进展:当前和未来发展方向的全面概述。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-08 DOI: 10.1016/j.survophthal.2024.07.002

Ophthalmic treatment demands precision and consistency in delivering therapeutic agents over extended periods to address many conditions, from common eye disorders to complex diseases. This diversity necessitates a range of delivery strategies, each tailored to specific needs. We delve into various delivery cargos that are pivotal in ophthalmic care. These cargos encompass biodegradable implants that gradually release medication, nonbiodegradable implants for sustained drug delivery, refillable tools allowing flexibility in treatment, hydrogels capable of retaining substances while maintaining ocular comfort, and advanced nanotechnology devices that precisely target eye tissues. Within each cargo category, we explore cutting-edge research-level approaches and FDA-approved methods, providing a thorough overview of the current state of ophthalmic drug delivery. In particular, our focus on nanotechnology reveals the promising potential for gene delivery, cell therapy administration, and the implantation of active devices directly into the retina. These advancements hold the key to more effective, personalized, and minimally- invasive ophthalmic treatments, revolutionizing the field of eye care.

眼科治疗要求在长时间内精确一致地输送治疗药物,以应对从常见眼疾到复杂疾病等多种病症。由于病症多种多样,因此需要根据具体需求量身定制一系列给药策略。这篇综合论文深入探讨了在眼科治疗中举足轻重的各种给药载体。这些载体包括可逐渐释放药物的生物降解植入物、可持续给药的非生物降解植入物、允许灵活治疗的可填充工具、能够在保持眼部舒适度的同时保留物质的水凝胶,以及可精确靶向眼部组织的先进纳米技术设备。在每种药物类别中,我们都会探讨最前沿的研究方法和美国食品及药物管理局批准的方法,全面介绍眼科给药的现状。特别是,我们对纳米技术工具的关注揭示了基因递送、细胞疗法给药以及将活性设备直接植入视网膜的巨大潜力。这些进步是实现更有效、个性化和微创眼科治疗的关键,将彻底改变眼科护理领域。
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引用次数: 0
Risk of stroke development following retinal vein occlusion: A systematic review and meta-analysis 视网膜静脉闭塞后发生中风的风险:系统回顾和荟萃分析。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-03 DOI: 10.1016/j.survophthal.2024.06.007

Retinal vein occlusion (RVO) and cerebrovascular disease share common risk factors and may be independently associated; however, the strength and nature of this association remain unclear. We conducted a systematic review and meta-analysis, informed by studies from PubMed, Scopus, EMBASE, Web of Science, and Google Scholar until January 6, 2024, aimed to clarify this relationship. Eligible studies included cohorts observing stroke incidence in RVO patients for over a year. Pooled effect estimates were calculated using random-effects models, with subgroup analyses evaluating associations between RVO types (central and branch) and stroke subtypes (ischemic and hemorrhagic). Ten cohort studies with a total of 428,650 participants (86,299 RVO patients) were included. Compared to controls, RVO patients exhibited a significantly increased risk of stroke (pooled risk ratio [RR]=1.38, 95 % confidence interval (95 %CI)=1.34–1.41). Subgroup analyses indicated elevated risk for both ischemic (RR=1.37, 95 %CI=1.32–1.42) and hemorrhagic (RR=1.55, 95 %CI=1.08–2.22) strokes in RVO patients. Additionally, both central (RR=1.50, 95 %CI=1.27–1.78) and branch (RR=1.41, 95 %CI=1.32–1.50) RVO were associated with stroke risk. Sensitivity analyses confirmed consistent results across various criteria, and funnel plots indicated no publication bias. RVO significantly increases the risk of both ischemic and hemorrhagic stroke, regardless of RVO type, suggesting a strong independent association between these conditions.

视网膜静脉闭塞(RVO)和脑血管疾病(CVD)有共同的风险因素,而且可能是独立相关的;然而,这种关联的强度和性质仍不清楚。我们进行了一项系统性综述和荟萃分析,参考了截至 2024 年 1 月 6 日来自 PubMed、Scopus、EMBASE、Web of Science 和 Google Scholar 的研究,旨在澄清这种关系。符合条件的研究包括观察 RVO 患者中风发生率一年以上的队列。采用随机效应模型计算汇总效应估计值,并通过亚组分析评估 RVO 类型(中央型和分支型)与中风亚型(缺血性和出血性)之间的关系。十项队列研究共纳入 428650 名参与者(86299 名 RVO 患者)。与对照组相比,RVO 患者发生中风的风险明显增加(汇总风险比 [RR]=1.38, 95% 置信区间 (95%CI)=1.34-1.41 )。亚组分析表明,RVO 患者缺血性中风(RR=1.37,95%CI=1.32-1.42)和出血性中风(RR=1.55,95%CI=1.08-2.22)的风险均升高。此外,中心型(RR=1.50,95%CI=1.27-1.78)和分支型(RR=1.41,95%CI=1.32-1.50)RVO 均与中风风险相关。敏感性分析证实各种标准的结果一致,漏斗图显示无发表偏倚。无论 RVO 类型如何,RVO 都会明显增加缺血性和出血性中风的风险,这表明这些疾病之间存在很强的独立关联。
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引用次数: 0
Diabetic retinopathy: New concepts of screening, monitoring, and interventions 糖尿病视网膜病变:筛查、监测和干预的新概念。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-07-02 DOI: 10.1016/j.survophthal.2024.07.001

The science of diabetes care has progressed to provide a better understanding of the oxidative and inflammatory lesions and pathophysiology of the neurovascular unit within the retina (and brain) that occur early in diabetes, even prediabetes. Screening for retinal structural abnormalities, has traditionally been performed by fundus examination or color fundus photography; however, these imaging techniques detect the disease only when there are sufficient lesions, predominantly hemorrhagic, that are recognized to occur late in the disease process after significant neuronal apoptosis and atrophy, as well as microvascular occlusion with alterations in vision. Thus, interventions have been primarily oriented toward the later-detected stages, and clinical trials, while demonstrating a slowing of the disease progression, demonstrate minimal visual improvement and modest reduction in the continued loss over prolonged periods. Similarly, vision measurement utilizing charts detects only problems of visual function late, as the process begins most often parafoveally with increasing number and progressive expansion, including into the fovea. While visual acuity has long been used to define endpoints of visual function for such trials, current methods reviewed herein are found to be imprecise. We review improved methods of testing visual function and newer imaging techniques with the recommendation that these must be utilized to discover and evaluate the injury earlier in the disease process, even in the prediabetic state. This would allow earlier therapy with ocular as well as systemic pharmacologic treatments that lower the and neuro-inflammatory processes within eye and brain. This also may include newer, micropulsed laser therapy that, if applied during the earlier cascade, should result in improved and often normalized retinal function without the adverse treatment effects of standard photocoagulation therapy.

随着糖尿病护理科学的进步,人们对糖尿病早期甚至糖尿病前期视网膜(和大脑)内神经血管单元的氧化和炎症病变及病理生理学有了更深入的了解。传统上,视网膜结构异常的筛查是通过眼底检查或彩色眼底照相来进行的;然而,目前的这些成像技术只有在出现足够的病变(主要是出血性病变)时才能检测到疾病,而这些病变被认为是在疾病进程的晚期,即神经元显著凋亡和萎缩以及微血管闭塞并导致视力改变之后发生的。因此,干预措施主要是针对后期发现的阶段,临床试验虽然显示疾病的发展速度有所减缓,但视力改善甚微,长期持续丧失的情况也略有减少。同样,利用视力表测量视力也只能在晚期发现视功能问题,因为这一过程通常从眼窝旁开始,数量越来越多,并逐渐扩大,包括扩大到眼窝。长期以来,视敏度一直被用来定义此类试验的视觉功能终点,但本文评述的现有方法并不精确。我们回顾了经改进的视功能测试方法和较新的成像技术,并建议必须利用这些方法在疾病进程的早期发现和评估损伤,即使是在糖尿病前期。这样就能更早地使用眼部和全身药物治疗来降低眼部和脑部的神经炎症过程。这也可能包括较新的微脉冲激光疗法,如果在早期级联过程中使用这种疗法,应能改善视网膜功能并使其恢复正常,而不会产生标准光凝疗法的不良治疗效果。
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引用次数: 0
Applications of artificial intelligence in diagnosis of uncommon cystoid macular edema using optical coherence tomography imaging: A systematic review 人工智能在利用光学相干断层成像诊断不常见囊样黄斑水肿中的应用:系统综述。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-27 DOI: 10.1016/j.survophthal.2024.06.005

Cystoid macular edema (CME) is a sight-threatening condition often associated with inflammatory and diabetic diseases. Early detection is crucial to prevent irreversible vision loss. Artificial intelligence (AI) has shown promise in automating CME diagnosis through optical coherence tomography (OCT) imaging, but its utility needs critical evaluation. This systematic review assesses the application of AI to diagnosis CME, specifically focusing on disorders like postoperative CME (Irvine Gass syndrome) and retinitis pigmentosa without obvious vasculopathy, using OCT imaging. A comprehensive search was conducted across 6 databases (PubMed, Scopus, Web of Science, Wiley, ScienceDirect, and IEEE) from 2018 to November, 2023. Twenty-three articles met the inclusion criteria and were selected for in-depth analysis. We evaluate AI's role in CME diagnosis and its performance in “detection”, “classification”, and “segmentation” of OCT retinal images. We found that convolutional neural network (CNN)-based methods consistently outperformed other machine learning techniques, achieving an average accuracy of over 96 % in detecting and identifying CME from OCT images. Despite certain limitations such as dataset size and ethical concerns, the synergy between AI and OCT, particularly through CNNs, holds promise for significantly advancing CME diagnostics.

囊样黄斑水肿(CME)是一种威胁视力的疾病,通常与炎症和糖尿病相关。早期发现对于防止不可逆转的视力丧失至关重要。人工智能(AI)在通过光学相干断层扫描(OCT)成像自动诊断 CME 方面已显示出前景,但其实用性还需要严格评估。本系统性综述评估了人工智能在CME诊断中的应用,特别关注术后CME(欧文-加斯综合征)和无明显血管病变的视网膜色素变性等疾病的OCT成像。从 2018 年到 2023 年 11 月,我们在 6 个数据库(PubMed、Scopus、Web of Science、Wiley、ScienceDirect 和 IEEE)中进行了全面检索。有 23 篇文章符合纳入标准,并被选中进行深入分析。我们评估了人工智能在 CME 诊断中的作用及其在 OCT 视网膜图像的 "检测"、"分类 "和 "分割 "中的性能。我们发现,基于卷积神经网络(CNN)的方法始终优于其他机器学习技术,在从 OCT 图像检测和识别 CME 方面的平均准确率超过 96%。尽管存在数据集规模和伦理问题等某些限制,但人工智能与 OCT 之间的协同作用,特别是通过 CNN,有望显著推进 CME 诊断。
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引用次数: 0
Multimodal imaging in diabetic retinopathy and macular edema: An update about biomarkers 糖尿病视网膜病变和黄斑水肿的多模态成像:生物标志物的最新进展。
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-26 DOI: 10.1016/j.survophthal.2024.06.006

Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and blindness in patients with diabetes. Current knowledge of retina anatomy and function and DME pathophysiology has taken great advantage of the availability of several techniques for visualizing the retina. Combining these techniques in a multimodal imaging approach to DME is recommended to improve diagnosis and to guide treatment decisions. We review the recent literature about the following retinal imaging technologies: optical coherence tomography (OCT), OCT angiography (OCTA), wide-field and ultrawide-field techniques applied to fundus photography, fluorescein angiography, and OCTA. The emphasis will be on characteristic DME features identified by these imaging technologies and their potential or established role as diagnostic, prognostic, or predictive biomarkers. The role of artificial intelligence in the assessment and interpretation of retina images is also discussed.

糖尿病黄斑水肿(DME)是指由于视网膜内液体积聚引起的眼窝附近或涉及眼窝的视网膜增厚,可导致糖尿病患者视力受损和失明。目前,人们对视网膜解剖和功能以及 DME 病理生理学的了解,已极大地利用了多种视网膜可视化技术。我们建议将这些技术结合起来,对DME进行多模式成像,以改善诊断并指导治疗决策。我们回顾了有关以下视网膜成像技术的最新文献:光学相干断层扫描(OCT)、OCT 血管造影(OCTA)、应用于眼底摄影的宽视场和超宽视场技术、荧光素血管造影和 OCTA。重点将放在这些成像技术所发现的 DME 特征及其作为诊断、预后或预测性生物标志物的潜在或既定作用。此外,还将讨论人工智能在视网膜图像评估和解读中的作用。
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引用次数: 0
A journey through the world of vitreous 玻璃体世界之旅
IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Pub Date : 2024-06-15 DOI: 10.1016/j.survophthal.2024.06.004

Vitreous, one of the largest components of the human eye, mostly contains water. Despite decades of studying the vitreous structure, numerous unanswered questions still remain, fueling ongoing active research. We attempt to provide a comprehensive overview of the current understanding of the development, morphology, biochemical composition, and function of the vitreous. We emphasize the impact of the vitreous structure and composition on the distribution of drugs. Fast-developing imaging technologies, such as modern optical coherence tomography, unlocked multiple new approaches, offering the potential for in vivo study of the vitreous structure. They allowed to analyze in vivo a range of vitreous structures, such as posterior precortical vitreous pockets, Cloquet canal, channels that interconnect them, perivascular vitreous fissures, and cisterns. We provide an overview of such imaging techniques and their principles and of some challenges in visualizing vitreous structures. Finally, we explores the potential of combining the latest technologies and machine learning to enhance our understanding of vitreous structures.

玻璃体是人眼最大的组成部分之一,主要含水。尽管对玻璃体结构进行了数十年的研究,但仍有许多未解之谜,这也推动了当前的积极研究。我们试图全面概述目前对玻璃体的发育、形态、生化成分和功能的理解。我们强调玻璃体结构和组成对药物分布的影响。快速发展的成像技术,如现代光学相干断层扫描,开启了多种新方法,为玻璃体结构的活体研究提供了可能。这些技术可以在体内分析一系列玻璃体结构,如后皮质前玻璃体袋、Cloquet 管、相互连接的通道、血管周围玻璃体裂隙和贮水池。我们概述了此类成像技术及其原理,以及玻璃体结构可视化所面临的一些挑战。最后,我们探讨了将最新技术与机器学习相结合以增强我们对玻璃体结构的理解的潜力。
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Survey of ophthalmology
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