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padding: 12px; border-radius: 8px; margin: 12px 0px; text-decoration: none !important; } .embed-title { font-size: 16px; font-weight: 700; color: #535150; margin-bottom: 8px; text-align: left; line-height: 1.5; text-decoration: none !important; } .embed-description { width: 100%; font-size: 14px; color: #7A7574; line-height: 1.5; max-height: 150px; text-align: left; overflow: hidden; padding: 12px 0px; } .embed-url > a { width: 100%; font-size: 14px; color: #141413 !important; text-decoration: none !important; line-height: 1.5; text-align: left; } .embed-thumbnail-wrapper { padding-left: 12px; } .embed-thumbnail { width:100px; border-radius: 8px; } pre { background: #F6F6F6; border-radius: 8px; padding: 16px; font-size: 16px; color: #535150; line-height: 180%; text-align: left; } .lexical__textBold { font-weight: bold; } .lexical__textItalic { font-style: italic; } .lexical__textUnderline { text-decoration: underline; } .lexical__textStrikethrough { text-decoration: line-through; } .lexical__textUnderlineStrikethrough { text-decoration: underline line-through; } .lexical__textSubscript { font-size: 0.8em; vertical-align: sub; } .lexical__textSuperscript { font-size: 0.8em; vertical-align: super; } .lexical__textCode { background-color: rgb(240, 242, 245); padding: 1px 0.25rem; font-family: Menlo, Consolas, Monaco, monospace; font-size: 94%; } Opt_story本篇你將學到視網膜代謝(Retinal Metabolism)視網膜血液供應(Retinal blood supply)脈絡膜微血管(睫狀視網膜動脈—Cilioretinal artery)、視網膜中央動脈(視乳突)血液視網膜屏障(Blood-retinal barrier)視網膜老化(Aging changes in retinal)視網膜代謝(Retinal Metabolism)「葡萄糖代謝」來獲取能量。穆勒氏細胞會儲存肝醣,提供葡萄糖穩定來源。藉由促進擴散(facilitated diffusion)的方式,血液▶視網膜組織。網膜可由「無氧醣解作用」▶「有氧代謝作用」(無氧醣解作用效率好)己糖磷酸路徑(hexose monophosphate pathway)在感光細胞內活躍,已滿足「視紫質循環再生」與「核苷酸合成」需求。耗氧量感光細胞比中樞快3-4倍,因此脈絡膜流速也很快(2000ml/min/100g)。視網膜血液供應(Retina blood supply)視網膜外叢層的外層是無血管的。視網膜血管不會與其他的血管系統吻合,因此又稱「末端血管(end vessels)」。周圍細胞的「收縮功能」可以幫助血液流動。脈絡膜微血管(睫狀視網膜動脈—Cilioretinal artery)由「自主神經」支配;呈現扁平緞帶狀。代謝藉由「擴散方式」▶通過Bruch氏膜▶RPE 、感光細胞。老年黃斑病變AMD、中央漿性視網膜病變CSR。孔洞型,可以讓大分子進出脈絡膜組織。視網膜中央動脈(視乳突)提供營養給內側視網膜;不受自主神經系統調節。根據血液中代謝物和營養物質的濃度自主調控。外圍有星狀細胞包覆;黃斑無此血管。雙極、水平、無軸突、Muller 、神經節。糖尿病、心臟病、高血壓、視網膜靜脈阻塞。Opt_storyOpt_story血液視網膜屏障(Blood-retinal barrier)可以預防血漿的成分阻礙光線進到視網膜。脈絡膜微血管是「孔洞型」,可以讓大分子進出脈絡膜組織。連結色素上皮的「閉鎖小帶」可以預防這些分子進入視網膜內。視網膜微血管是「無孔洞型」,內皮組織內含有閉鎖小帶,防止大分子從視網膜的血管滲出。外泌體(exosomes)是視網膜色素上皮細胞內的小膜囊泡,有助於避開血液視網膜屏障。沿著細胞骨架路徑(cystoskeletal tracts)運輸。幫助玻璃體內誘導的藥物(如:VEGF)到達脈絡膜,抑制新生血管生成。視網膜老化(Aging changes in retinal)黃斑的厚度會隨著年齡增長而減少。桿狀細胞的密度會隨著老化而降低,不過對「暗視覺」敏感度的影響似乎不明顯。星狀膠細胞(astroglial cells)的數量會隨著老化而減少。神經纖維數量減少,當纖維退化時,會被「締結組織」取代。視網膜神經纖維層每10年減少約0.1~5um。視網膜上皮細胞數量從4000/mm²降到2000/mm²。視網膜色素上皮層:衰減、多形性(pleomorphism)、萎縮、黑色素減少、脂褐質增加。視乳突周圍脈絡膜視網膜萎縮(peripapillary chorioretinal atrophy):明顯蒼白無血色的顳側新月形(temporal crescent)視網膜鋪路石狀退化(paving stone degeneration)周邊網狀退化(peripheral reticular degeneration)周邊囊狀退化(peripheral cystoid degeneration)結語Opt_story驗光師的「落日條款」即將結束,這意味著,我們「眼鏡產業」將會有巨大改革。