球后阻滞是将局部麻醉药注入眼球后方的肌锥内，通过阻断鼻睫神经、动眼神经和睫状神经节，达到镇痛，限制眼球运动和降低眼内压的作用。现代球后阻滞技术是内眼手术眼球制动与麻醉的“金标准”，也是最常用的眼部区域阻滞方式。虽然与该技术相关的并发症少见，但可危害视力甚至危及生命。本专家共识介绍了球后阻滞的应用范围，系统描述了支配眼球运动与感觉的神经解剖、球后阻滞的安全性、操作方法、常用药物、禁忌证和并发症的处理等，为此技术的临床应用提供指导。
Retrobulbar block refers to the injection of local anesthetics into the muscle cone behind the eyeball, blocking the ciliary, oculomotor, and ciliary ganglion nerves, to provide pain relief, restrict eye movement, and reduce intraocular pressure. Modern retrobulbar block is the "gold standard" for eyeball immobilization and anesthesia in intraocular surgeries, and it is the one of the most commonly used methods for ocular regional block. Although the complications related to this method are rare, the complications will threaten the vision and even life. Th is expert consensus introduces the application scope of retrobulbar block, and systematically describes functional neuroanatomy of eye sensation and movements, safety and procedures of retrobulbar block, local anesthetics, contraindications and complications of the block, which can provide the reference for clinical application of this method.
目的：调查临床医学5年制本科生对见习教学的满意度，并分析其影响因素。方法：采用匿名线上问卷调查，向中山大学2019级临床医学5年制4年级的结束所有临床科室见习的本科生发放见习满意度问卷。结果：共有75人完成了问卷调查。在最满意的见习课程中，眼科学见习满意度最高(39人，52%)，其次是外科学(18人，24%)和内科学(7人，9.33%)。教学满意度的影响因素综合得分排名前5位的选项分别是“A课程设置合理，临床见习重点突出”“B见习小课授课水平高”“C师资配备好，小组教学”“D临床资源丰富，利于见习教学”以及“E教学方法先进，方式灵活多样，新型教学形式丰富”。在选择排序第一(B 33.33%，A 25.86%，E 21.15%)和第二(E 26.92%，B 24.56%，A 24.14%)的影响因素时，前三位的选项均为A、B、E，学生对见习课程设置、见习小课水平和见习教学方式、方法非常重视。在学生从事眼科专业的意愿方面，5人(6.67%)表示非常愿意、32人(42.67%)表示有可能今后从事眼科专业，二者比例合计与眼科学获得最满意见习课程的比例非常接近。结论：见习课程设置、小课授课水平以及见习教学的方式、方法是见习教学满意度的重要影响因素。临床见习的满意度对学生的职业导向具有一定的影响。
Objective: To investigate the satisfaction of 5-year undergraduate students in clinical medicine with clerkship teaching and analyze its influencing factors. Methods: Anonymous online questionnaire survey was conducted. Satisfaction questionnaires were distributed to undergraduate students in the 4th year of the 5-year clinical medicine at Sun Yat- sen University who had completed clerkship in all clinical departments. Results: A total of 75 students completed the questionnaire survey. Among the most satisfactory clerkship courses, ophthalmology had the highest satisfaction rate (39 votes, 52%), followed by surgery (18 votes, 24%) and internal medicine (7 votes, 9.33%). Te top 5 options in terms of comprehensive scores for infuencing factors of teaching satisfaction are "A. Reasonable curriculum with prominent focuses", "B. High clerkship class teaching level", "C. Strong teaching staf", "D. Abundant clinical resources ", and "E. Advanced teaching methods ". When selecting the infuencing factors that rank frst (B 33.33%, A 25.86%, E 21.15%) and second (E 26.92%, B 24.56%, A 24.14%), the top three options are A, B, and E. Students atach great importance to the seting of clerkship courses, the level of clerkship courses, and the teaching methods. In terms of students' willingness to engage in ophthalmology, 5 students (6.67%) expressed great willingness, and 32 students (42.67%) expressed the possibility. Conclusions: Te seting of clerkship courses, the level of small class teaching, and the clerkship teaching method are important infuencing factors of clerkship satisfaction. Te satisfaction of clerkship has a certain impact on students' career selection.
目的：探讨眼底外科医护一体组团合作模式在管理眼底病日间手术患者实践效果。方法：选取2022年1—6月进行日间手术的582例眼底病患者为对照组，2023年1—6月进行日间手术的633例眼底病患者为研究组，对照组实施责任制整体护理，研究组采取实施医护一体组团合作管理模式进行全流程患者管理。使用χ2检验和t检验比较两组患者围术期护理知识健康教育知晓度、满意度、出院24 h内眼科急症就诊率、出院24 h内随访率、护士职业获益感的差异。结果：研究组患者健康教育知晓度高于对照组，组间比较差异具有统计学意义(t=–18.47，P＜0.05)；研究组患者满意度高于对照组，组间比较差异具有统计学意义(t=–4.005，P＜0.05)；研究组患者出院24 h内随访率为100%，对照组为98.1%，两组比较差异有统计学意义(χ2=12.073，P＜0.05)；研究组患者出院24 h内眼科急症就诊率0.94%，对照组为1.89%，组间比较差异无统计学意义(χ2=1.951，P=0.222)；实施后护士职业获益感分值高于实施前，组间比较差异具有统计学意义(t=–6.637，P＜0.001)。结论：医护一体组团合作管理模式进行眼底外科日间手术患者围术期的全流程管理，改善患者就医感受，提升患者就医体验，提高眼底外专科日间手术患者的依从性，保障患者的安全，提高护士职业获益感。
Objective: To investigate the practical effect of the integrated group cooperation model in managing patients with fundus diseases in day surgery. Methods: 582 patients with fundus disease who underwent day surgery from January to June in 2022 were included as the control group, and 633 patients with fundus disease who underwent day surgery from January to June in 2023 were selected as the study group. The control group implemented the overall responsibility nursing system, while the study group carried out the collaborative management model, integrating medical and nursing for the entire process of patient management. Chi-square test and T-test were used to compare the differences of perioperative nursing knowledge, health education awareness, satisfaction, emergency ophthalmological consultation rate within 24 hours of discharge, follow-up rate within 24 hours of discharge, and nurses' sense of professional benefit between the two groups. Results: The awareness of health education in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–18.47, P<0.05). The satisfaction of patients in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–4.005, P ＜ 0.05). The follow-up rate within 24 hours after discharge was 100% in the study group and 98.1% in the control group, and the difference was statistically significant (χ2=12.073, P<0.05). The incidence of ophthalmic emergencies within 24 hours of discharge in the study group was 0.94%, while in the control group it was 1.89%. There was no statistically significant difference between the two groups (χ2= 1.951, P=0.222). The perceived benefit score of nurses after implementation was higher than that before implementation, and there was statistically significant between two groups (t=–6.637, P<0.05). Conclusions: The medical and nursing integrated group cooperation management model is used to manage the entire perioperative process of patients undergoing day surgery in fundus surgery. This model can improve patients' medical experience, enhance their compliance with ophthalmic surgery, ensure their safety. At the same time, it can enhance the senses of professional benefits for nurses.
糖尿病视网膜病变是最为常见的糖尿病微血管并发症，主要由糖尿病引起的机体代谢紊乱导致。而然在临床工作中发现，部分患者通过单纯控制血糖以延缓糖尿病视网膜病变进展，所取得效果不甚理想，一些其他因素对于糖尿病视网膜病变的发生、发展，也起到不可忽视的作用。研究表明，在并发高脂血症的糖尿病视网膜病变患者中，胆固醇代谢异常是诱发视网膜病变的主要原因之一。胆固醇代谢异常通过减弱肝脏X受体，导致胆固醇在视网膜上不断积累，降低视网膜血管内皮功能，从而造成视网膜缺血、缺氧环境的形成，又可通过增加炎症因子和细胞黏附分子-1的表达，使原本病态的糖尿病视网膜血管变得更加脆弱，该文总结了糖尿病视网膜病变的病理因素，对比分析当前糖尿病视网膜病变的主要治疗手段，通过分析胆固醇逆向转运(cholesterol reverse transport,RCT)途径转运对糖尿病视网膜病变发生、发展的影响，发现降低高血脂可提高糖尿病视网膜病变的治愈率，这将为糖尿病视网膜病变的临床防治工作提供新思路。
Diabetic retinopathy is the most common diabetic microvascular complication, which is mainly caused by metabolic disorders caused by diabetes. However, in clinical work, it is found that some patients do not achieve satisfactory results in delaying the progress of diabetic retinopathy by simply controlling blood sugar, and some other factors contribute to the occurrence and development of diabetic retinopathy. Also played a role that can not be ignored. Studies have shown that abnormal cholesterol metabolism is one of the main causes of retinopathy in diabetic retinopathy patients with hyperlipidemia. Abnormal cholesterol metabolism leads to the accumulation of cholesterol in the retina and the decrease of retinal vascular endothelial function by weakening the X receptor in the liver, resulting in the formation of retinal ischemia and hypoxia environment. it can also increase the expression of inflammatory cytokines and cell adhesion molecule-1 to make the originally morbid retinal vessels more fragile. This paper summarizes the pathological factors of diabetic retinopathy. By comparing and analyzing the main treatment methods of diabetic retinopathy at present, and by analyzing the influence of cholesterol reverse transport (cholesterolreversetransport,RCT) pathway on the occurrence and development of diabetic retinopathy, it is found that reducing hyperlipidemia can improve the cure rate of diabetic retinopathy, which will provide new ideas for the clinical prevention and treatment of diabetic retinopathy.
甲状腺相关眼病(thyroid-associated ophthalmopathy,TAO)，又称Graves眼病，是与甲状腺疾病密切相关的一种器官特异性自身免疫性疾病。眼球突出是TAO的主要临床表现之一，也是临床上多数患者就诊的原因。眼球突出一方面会影响美观，另一方面可因眼睑闭合不全导致暴露性角膜炎或因眼眶压力增大导致压迫性视神经病变。眼眶减压术用于重度TAO已有过百年历史，从最早经外眦皮肤切开的传统外部切口入路进行骨性眼眶减压及脂肪减压到内镜下经鼻入路眼眶减压术，其安全性和有效性均已得到肯定。术后复视是眼眶减压术常见的并发症。近年来，随着眼眶减压术的发展，其越来越多地用于美容目的以矫正眼球突出。然而术后的新发复视仍然是困扰众多相关眼科医疗工作者的难题。近年来，多项研究对术后新发复视的相关因素进行了探讨，并由此对眼眶减压术进行改良，在对术后新发复视的减少方面取得不同程度的进展。该文对眼眶减压术后新发复视的研究进展进行综述，旨在促进专科医生更精准地开展TAO的手术，进而提高手术患者术后的生活质量及手术满意度。
Thyroid-associated ophthalmopathy (TAO), known as Graves’orbitopathy, is an organ specific autoimmune disease closely related to thyroid diseases. Exophthalmos is one of the main clinical manifestations of thyroid related ophthalmopathy and is also the reason for most patients seeking medical atention in clinical practice.Eyeball protrusion can afect aesthetics on the one hand, and on the other hand, it can lead to exposed keratitis due to incomplete closure of the eyelids or compressive optic neuropathy due to increased orbital pressure.Orbital decompression has been used to treat severe TAO that threatens vision for over 100 years, and its safety and efectiveness have been confrmed.However, postoperative new diplopia remains a challenge for many ophthalmic medical workers.In recent years, many studies have explored the relevant factors of postoperative new diplopia, and improved the surgery, achieving varying degrees of progress in reducing postoperative new diplopia.Tis article reviews the research progress of new diplopia afer orbital decompression, aiming to promote more accurate surgery for thyroid related eye diseases by specialized doctors.
年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种发生在黄斑区的退行性变，其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)以黄斑区新生血管为主要病理特征，是导致老年人视力受损甚至失明的重要原因，视网膜下纤维化是wAMD最常见的自然后遗症，可导致光感受器、视网膜色素上皮(retinal pigment epithelial,RPE)和脉络膜毛细血管受损，导致不可逆转的中心视力丧失。多种基线特征被发现是视网膜下纤维化的危险因素，可用于预测早期视网膜下纤维化的发生。迄今为止，还没有有效的抗纤维化治疗方法，抗血管内皮生长因子(anti-vascular endothelia growth factor, anti-VEGF)治疗是wAMD的一线治疗方案，该治疗方法不能改善视网膜下纤维化，但及时启动治疗可能有助于预防或延缓纤维化的进展，目前多种靶向分子药物正被研发用于抗纤维化的治疗。该文综述了wAMD视网膜下纤维化的临床表现及意义、预测纤维化形成的基线特征、基本发病机制及潜在的抗纤维化治疗方法，旨在为临床诊治工作提供参考。
Age-related macular degeneration (AMD) is a degenerative disease of the macular, and wet age-related macular degeneration(wAMD) is mainly characterized by macular neovascularization, which is an important reason of visual impairment or even blindness in the elderly. Subretinal fibrosis is the most common natural sequelae of wAMD, which can lead to irreversible central vision loss by damaging photoreceptors, RPE, and choroidal capillaries. Multiple baseline features have been identified as the risk factors for subretinal fibrosis, which can be used to predict the early subretinal fibrosis. Heretofore, no anti fibrotic treatment method is effective. Anti vascular endothelial growth factor (anti VEGF) treatment is the first-line treatment for wAMD. This therapy cannot improve subretinal fibrosis, but timely initiation of treatment may help prevent or delay the progression of fibrosis. Currently, multiple targeted molecular drugs are being developed for anti fibrotic treatment. This article reviews the clinical manifestations and significance of subretinal fibrosis in wet age-related macular degeneration, baseline features for predicting the formation of fibrosis, basic pathogenesis, and potential anti-fibrosis treatment methods,aiming to provide reference for clinical diagnosis and treatment.
朗格汉斯细胞组织细胞增生症 (Langerhans cell histiocytosis,LCH) 是一种由骨髓细胞肿瘤性增殖引起的罕见疾病，多见于儿童。LCH临床表现多样，以骨骼受累最常见。该文报道了一例儿童颅眶沟通LCH，影像学检查结果提示患儿右侧眉弓处类圆形穿凿样骨质破坏，通过手术切除病灶，送组织病理学检查明确诊断，同时选择通过3D打印聚醚醚酮(polyetheretherketone,PEEK)材料修补颅眶缺损部位，PEEK材料匹配度高、安全性好，改善患儿预后，提升患儿生存质量。
Langerhans cell histiocyte (LCH) is a rare disease caused by the tumor-like proliferation of bone marrow cells, which is mostly seen in children. Its clinical manifestations can be diverse, in which the skeletal system is most involved. This paper reports a case of LCH in cranio-orbital communication of a child. The imaging results suggest that there is a round chisel damage at the patient’s right brow ridge. In terms of definitive diagnosis and treatment, this patient underwent surgical resection and histopathological examination. 3D-printed polyether-ether-ketone (PEEK) material was selected to repair the cranio-orbital defect. The material can achieve better biocompatibility, while 3D-printing technique allows higher matching degree, both help to improve the prognosis and quality of life of the patient.
Terson综合征又称蛛网膜下腔出血合并玻璃体积血综合征，是一种较为罕见的眼科疾病。患者多因颅内出血而存在意识障碍、沟通困难，极易漏诊，错过最佳治疗时机。该文报道了一例30岁男性患者，因弥漫蛛网膜下腔出血，突发昏迷，于发病1个月后出现双眼视物模糊，最终确诊为双眼Terson综合征，并行双眼玻璃体切割术及右眼视网膜前膜剥膜术治疗。术后54 d，患者左眼视力由指数/5 cm恢复至矫正视力0.3。术后19 d，患者右眼视力由手动/20 cm恢复至矫正视力0.12。
Terson syndrome, also known as subarachnoid hemorrhage combined with vitreous hemorrhage syndrome, is a relatively rare ophthalmic condition. Patients mostly have impaired consciousness and communication difficulties due to intracranial hemorrhage, which makes it very easy to miss the diagnosis and the best time for treatment. This article reports the basic case of a 30-year-old male patient with sudden coma due to diffuse subarachnoid hemorrhage. And he had blurred vision in both eyes 1 month later, which was finally diagnosed as binocular terson syndrome. He was treated with vitrectomy in the left eye and vitrectomy + anterior retinal detachment surgery in the right eye. The visual acuity of patient was restored from finger count/5cm to corrected visual acuity of 0.3 in the left eye when 54 days after surgery and from manual/20 cm to corrected visual acuity of 0.12 in the right eye when 19 days postoperative.
患者，男性，1岁9个月。以“发现右眼上、下眼睑肿物25 d”首诊于眼科，要求切除，但经影像学及病理学检查，诊断为多发性朗格汉斯细胞组织细胞增生症，且全身骨骼多处出现溶骨性改变，不符合切除指征。给予多次全身化学治疗后眼部肿物明显变小。该例诊治提醒眼科医生，眼部肿物可由全身系统性疾病引起，不可盲目切除，必要时做进一步检查。术中切除物均建议行病理活组织检查，以免延误治疗。
patient, male, 1year and 9months old, was first diagnosed as “eye tumor” in the ophthalmology department and requested for excision. But it was diagnosed as multiple Langerhans cell histiocytosis (LCH) through imaging and pathological examination ultimately.Bone lytic changes appeared in many parts of the whole body, which did not meet the indication of excision.The tumor was smaller after systemic chemotherapy. The diagnosis and treatment of this case suggests ophthalmologists that eye tumors can be caused by caused by systemic diseases, systemic diseases. During operation, it is recommended to perform pathological biopsy to avoid treatment delay.
