视盘重塑与生物力学在青光眼中的研究进展

Research Progress of Optic Disc Remodeling and Biomechanics in Glaucoma

摘要: 青光眼是出现特征性的视神经萎缩和进行性视野缺损的一系列疾病，是目前全球首位不可逆性致盲性眼病。据统计到2040年青光眼患者可达1.114亿。青光眼的进展主要是由于视网膜神经节细胞轴突的丢失，主要的危险因素是眼压(intraocular pressure, IOP)升高，而IOP正是青光眼视神经病变的主要生物力学驱动因素，通过直接作用于筛板和间接通过巩膜传递应力，导致视盘结构的重塑，即使IOP在正常范围内，筛板和巩膜的生物力学特性差异也可能使某些个体更容易发生青光眼特征性的视杯扩大和RGC轴突损伤，因此生物力学仍然是青光眼研究的一个积极方面，有助于其从基础科学向临床方向转化。视盘重塑与青光眼进展的反馈机制设计生物力学应力、细胞外基质(extracellular matrix, ECM)细胞功能异常、免疫反应以及血供等多方面因素，本文将进一步阐明这些机制的具体作用，为青光眼早期诊断提供标志物以及临床生物力学治疗提供新靶点。

Abstract: Glaucoma is a series of diseases characterized by characteristic optic nerve atrophy and progressive visual field defects. It is currently the leading irreversible blinding eye disease worldwide. According to statistics, the number of glaucoma patients could reach 111.4 million by 2040. The progression of glaucoma is mainly due to the loss of axons in retinal ganglion cells. The main risk factor is the increase of intraocular pressure (IOP), which is the main biomechanical driving factor of optic neuropathy in glaucoma. It transmits stress by directly acting on the lamina cribrosa and indirectly through the sclera. This leads to the remodeling of the optic disc structure. Even within the normal range of IOP, the differences in biomechanical properties between the lamina sieve and the sclera may make some individuals more prone to glaucomatous characteristic cup enlargement and RGC axonal injury. Therefore, biomechanics remains a positive aspect of glaucoma research, facilitating its transformation from basic science to clinical practice. The feedback mechanism design of optic disc remodeling and glaucoma progression involves multiple factors such as biomechanical stress, abnormal extracellular matrix (ECM) cell function, immune response, and blood supply. This article will further clarify the specific roles of these mechanisms. It provides markers for the early diagnosis of glaucoma and new targets for clinical biomechanical treatment.