My name is Carlos Pavesio. I’ve been a consultant of ophthalmology at Moorfields for 25 years now.
我是卡洛斯·帕维西奥。在（全球历史最悠久的眼科医院）英国伦敦摩菲眼科医院担任主任医师25年。
Part of my activities as a consultant at Moorfields involve research. And I have been the lead clinician for the clinical trials unit for inflammatory diseases.
科学研究也是我作为英国伦敦摩菲眼科医院主任医师的一部分工作，我同时担任炎症性疾病研究方向的学科带头人。
I have been working very much on inflammatory diseases of the inside of the eye.
我的临床工作重点集中于治疗眼内的炎症性疾病。
Infectious diseases that affect the part of the back of the eye can cause damage to the retina.
波及到眼球后部的感染性疾病可以对视网膜造成损害。
And also inflammatory disease in general.
而普遍而言，炎性疾病都可能导致这种情况。
Vascular diseases or inflammatory disease of the coats of the eye. These are the main areas I have been working on in recent times.
近年来我专攻的主要是眼球球壁血管性疾病或炎症性疾病。
Well let’s start from the outside and go inside of the eye.
咱们就先说眼球外部（的炎症性疾病），然后再来谈谈眼球里面的那些事儿。
So if you get inflammation of the white coat of the eye. You have a condition called scleritis.
如果眼球的白色外壁发生了炎症，患者便得了一种称为巩膜炎的疾病。
It’s very painful and cause a lot of problems for the patients.
这种疾病会给患者带来包括剧烈疼痛在内的很多问题。
And it can be connected to bad systemic diseases.
这类疾病也可能与很严重的全身疾病相关。
So it’s a disease that needs treatment for. So these are areas where you need aggressive treatment early on.
也正因此，这类疾病需要得到治疗，而且是尽早的积极治疗。
Identify an underlying cause.To try to preserve vision.
需要找出病因源头，需要试图挽救视力。
In the same time, protect the patient from another serious complication of another disease to the rest of their body.
而与此同时，还需要保护患者不会因为其他并发疾病的严重并发症，而遭受身体其他部位的损害。
Going inside the eye the inflammation can affect the blood vessels, can affect the retina, can affect the choroid which is a different layer of the inside of the eye.
谈到眼内的疾病，炎症性疾病可以损害血管，可以损害视网膜，也可以损害眼球壁内部的另一层称为葡萄膜的结构。
And all this can be very serious, can produce serious consequences to the eye and loss of vision.
这些损害都可能程度很重，可能产生严重后果而导致视力丧失。
And it’s especially important because it can affect the young people.
尤其重要的一点是，年龄较小的人群也可能遭受这类疾病。
So children and young people can have these diseases.
孩子、青年都可能患病。
So losing vision in early stage in life can be very serious.
在人生的早期阶段丧失视力是很重大的问题。
Of course it means the rest their lives and for society as well.
无疑这意味着对患者的人生和整个社会将产生不良影响。
So it’s very important that these conditions are recognized early, treated aggressively and tried to prevent loss of sight.
所以早期发现、采取很积极的治疗、尽可能防止视力丧失，是非常重要的。
Treating those is not easy.
然而，炎症性疾病在治疗上并不简单。
You have to many times use steroids, either injections or oral.
需要多次注射或口服甾体类激素。
And many times you use (immune)suppressive.
很多时候还需要使用免疫抑制剂。
So these patients have potentially complications related to the treatment as well.
患者还可能因为治疗而遭受并发症。
So they are patients that need expertise care.
因而对于这类疾病需要很专业的治疗。
Expert care. And we provide that as much as we can.
需要经验丰富的专家给予专业性的治疗，这也是我们正在尽最大努力为患者提供的服务。
In recent times there has been a huge emphasis on local therapy for inflammatory disease of the eye.
近年来，业界存在很大呼声，主张对眼部炎症性疾病实施局部治疗。
So the delivery of drugs right into the eye.
也就是把药物直接输送到眼内。
With device that allow the release of the drug over three years for instance.
通过缓释工具，使药物在一段时间内逐渐释放，例如三年。
So there are many things under development now which are allowing patients to receive local therapy, protecting the eye for a long time.
目前正在开发的很多技术，都是为了使患者能够接受到局部治疗，使患眼长期得到保护。
And consequently, avoiding the side effects of taking the tablets that they may have to take for many years.
这些技术也能相应的避免患者因为需要长年服用口服药而遭受并发症。
There are new drugs coming now that will eliminate the side effects of steroids that we are using inside the eye.
还有一些新的药物可以消除眼内局部使用甾体类激素所造成的副作用。
So they can protect the eye and still achieve the same benefits of protection.
新技术、新药物的目的是在使患者受益的同时对眼球加以保护。
Other things that are happening. Other new drugs are coming on the market.
此外还有一些其他的进展，一些新药正在走进市场。
Injectable drugs. Not in your eye but in your subcutaneous tissue or intra-venous drugs that also provide better control of inflammation by affecting the immune system in a different way from the current drugs used.
例如一些注射类药物，不是注射到眼内而是注射到皮下或静脉内。这些药物可以通过与现有药物不同的方式对免疫系统施加影响，从而更好地控制炎症。
So they are called biologics, man-made antibodies that are targeting immune-response.
这类药物称为生物制剂，本质上是为了干预免疫反应而人工制备的抗体。
Patient presenting with an inflammatory problem in the eye, they will come because they’re symptomatic.
眼部有炎症性问题的患者，通常会因为出现症状而去就诊。
Their vision is blurred or they see floaters or they have some disturbance in their vision.
例如视物模糊、眼前有黑影漂浮或感到有些视觉干扰。
What we do is we first identify where the problem really is.
医生们采取的措施通常是先弄清导致症状的问题究竟是什么。
Which part of the eye is affected.
眼球的哪一部分遭到了损害。
And once you know that, and you put the features of that problem together, you start making your list of what potentially can be the cause of this problem.
一旦搞清了这些情况，就可以把问题的特征放在一起，列举分析可能的病因。
And that will lead you to how you investigate this patient.
通过这样的分析，就能制订出对患者的检查方案。
How you are going to progress in your treatment.
以及明确需要采取什么样的治疗措施。
Many types of investigations are necessary：Blood tests, imaging of the chest, or imaging of the brain depending on the nature of the problem.
这个过程需要涉及很多项检查，例如根据病情特征选择血液检查、胸部影像学检查或脑部影像学检查。
And of course once you have all the results together you’ll be able to elaborate a bit better on the cause of the eye problem.
显然，一旦把得到的所有检查结果放在一起，对眼部问题的病因分析也就会更详尽明确。
And that’s when it’s important to link up the eye to the rest of the body.
而与此同时，很重要的一点是将眼部和全身其他部位的问题结合起来分析。
Because the eyes are not isolated organ. It’s connected to everything.
因为眼睛并不是身体内的孤立器官，而是与全身各部分相联系
And many systemic diseases will have repercussions in the eye.
很多全身系统性疾病都会对眼部产生映射反应。
And inflammatory diseases especially, many of them will lead to this problem.
尤其是炎症性疾病，很多都会导致眼部问题。
So if we can identify specifically what’s causing the eye disease, we can then target the treatment more specifically and hopefully protect the eye from damage.
所以如果我们可以明确产生眼病的原因，就能实施针对性的治疗，以期可以防止对眼部造成损害。
And not only that, you protect the body from suffering damage as a consequence of the same disease.
不仅如此，还需要通过治疗防止基础疾病带来的其他全身损害。
When we order tests. For instance X-rays or scans of the chest, we are looking specifically for signs that will help us identify pathology that is located outside the eye but connected to the eye problem.
在送患者接受辅助检查时，例如X光或胸部扫描，我们寻找的是帮助我们确定眼部以外、与眼部问题有关的病变。
So for instance, two good examples are sarcoidosis and tuberculosis. These are inflammatory diseases.
例如，两个很好的例子就是结节病和结核病，都属于炎症性疾病。
Many times starting on the chest, in the lungs, but can manifest anywhere in the body.
这类疾病通常最先波及胸部、肺部，但也可以出现在身体其他部位。
The eye being a site where we see a lot of problems.
眼睛就是经常遭受病变的部位。
And many of them leading to blindness if not well controlled.
如果控制不良，很多患者会因此失明。
So when we look at the X-rays or scans we are looking specifically for sites of abnormalities which are going to be allowing us a more specific diagnosis of these two conditions.
因此在阅读X光片或其他影像扫描结果时，我们会特别留意寻找能够帮助诊断这两类疾病的征象。
There are other things that we can do if we suspect some of these conditions. There are tests, specific blood tests we can request.
在怀疑基础病变是这两类疾病时，还可以采取一些其他措施。有些特定的血液检查可以协助确诊。
Which are going to try to identify changes in your blood which are markers, more specific markers of what’s happening in the eye. Both in terms of infections or pure inflammation.
这些检查可以帮助寻找血液中是否存在与特定病变反应相关的标记物，无论是感染或是单纯的炎症反应。
There is a condition called Birdshot Retinal Choroiditis which is not a very common disease.
例如有一种不是很常见的、称为鸟枪弹样视网膜脉络膜病变。
MedEther Notes:
Birdshot retinochoroidopathy (BSRC) is an uncommon chronic inflammation in the posterior part of the eye, characterized by vitritis and multiple ovoid spots, which are orange to cream in color and mainly distributed in the posterior pole and in the mid periphery of the retina. The classic presentation is described to "resemble the pattern seen with birdshot in the scatter from a shotgun."
MedEther小编啰嗦：鸟枪弹样视网膜脉络膜病变（Birdshot retinochoroidopathy (BSRC)），是一种眼球后部的慢性炎症，通常会表现为玻璃体腔内的炎症，以及眼底视网膜中央和靠近中央的区域出现多处卵形橙色或乳白色的病灶。比较经典的表现就是病灶的分布很像是一枪多弹的鸟枪在发射时留下的多处射击痕迹。
But it is something we see in large number in specialized clinics.
这种发病率不是很高的疾病在我们的专科门诊中却很多见。
And patients really benefit from the expertise of people who have seen these patients for a long time. Because we can identify very early on.
长期专注于这个领域的医生可以在很早期确诊，使患者从治疗中充分受益。
We make the diagnosis because we suspect on the base of the clinical findings. We use angiographies, fluorescein and ICG (indocyanine green) angiography to identify the abnormalities in the eye and quantify the amount of damage already happening in the eye.
我们的诊断通常是从临床表现中的可疑征象开始，通过荧光和吲哚青绿血管造影来发现眼内异常，对眼内已经发生的损害进行量化。
And then we specially request tests, such as blood tests of actually markers which will give us more precise identification of the problem.
然后针对性的安排辅助检查，例如针对特定标记物的血液检查，以便可以准确的找出问题。
There are many other investigations that can be carried out. We have scans of the retina that can help identify where in the retina the problem is happening. And how severe it is. The angiograms I mentioned before are extremely helpful in measuring the amount of leakage or amount of damage in the back of the eye. Both the retina and the choroid which is a vascular layer right below the retina.
此外，还可以开展很多其他检查。例如可以对眼底视网膜进行扫描，找出视网膜的哪部分发生了病变，以及病变严重程度如何。我提到的血管造影，对于评估血管渗漏程度和眼底组织损伤程度是特别有帮助的一种检查。这里提到的眼底组织包括视网膜和脉络膜，而脉络膜是紧贴视网膜下方的一层血管组织。
But these are, putting the things together, none of these tests in isolation will give a diagnosis, but it is the putting together of all the pieces of the jigsaw that will reach a diagnosis that is sensible for guiding treatment and will hopefully change the prognosis of these patients.
上述检查中，无法单独凭借哪一项做出诊断，但就像做拼图游戏，把所有证据放在一起，才能做出对治疗方案有指导意义、有可能改善患者预后结局的诊断。
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