血泪是指因各种原因导致眼部流出血性泪液的症状,其病因和临床表现复杂多样,往往涉及多学科多专业。不同病因引起的血泪,无论是临床表现,还是诊治方法均差异很大。为了向临床医生提供可参考的血泪临床诊疗流程,中国医师协会眼科医师分会泪器病专业委员会及中国中西医结合学会眼科专业委员会泪器病学组组织有关专家以临床实践经验为基础,经过认真讨论建立本共识,对血泪的病因、临床特征及诊疗流程提出指导性意见。
Bloody tears refers to the symptoms of blooding tears flowing from the eye due to various reasons. Its etiology and clinical manifestations are complex and diverse, often involving multiple disciplines and specialties. In order to provide clinicians with a reference for the clinical diagnosis and treatment process of bloody tears, Lacrimal Diseases Professional Committee of Ophthalmologist Branch of Chinese Medical Doctor Association and Lacrimal Diseases Group of Ophthalmic Professional Committee of Chinese Association of Integrated Medicine organized relevant experts to establish this consensus based on clinical practice after serious discussion, and put forward guiding opinions on the etiology, clinical characteristics, and diagnosis and treatment process of bloody tears.
“六要素,三个一”是眼底影像基础阅片工作中进行眼底疾病临床创新性研究的模式要点,即在眼底阅片过程中捕捉到1个异常的病例后,通过积累病例、提炼特征、文献检索、寻同查异,进而扩展到1组病例,最后通过思辨创新,提出或完善1种新的疾病或疾病表征。近二十年来,在此模式的指导下,团队在眼底疾病研究工作中取得了一些原创性的成果:比如息肉状脉络膜血管病变的认识及其在国人新生血管性年龄相关性黄斑变性中发病比例第一,提出点状内层脉络膜病变病灶国际分期和命名新亚型,年龄相关的吲哚菁绿血管造影晚期散在弱荧光点揭示潴留性视网膜色素上皮脱离的发病机制,发现急性黄斑神经视网膜病变是登革热患者视力下降的主要原因,在全球最大的持续性鳞状黄斑病变的病例系列中明确病灶层次等创新性成果。“六要素”框架规范眼底影像研究流程,强调研究过程的严谨性与渐进性,且多次循环后衍生发散出更多研究线索和思路,极大拓展研究深度和广度。“三个一”路径体现了研究的层次性,从个体现象(点)到群体规律(线),最终构建疾病认知的立体网络(面);指导眼底异常影像征象、罕见病、新病种研究,加速疾病谱系完善。以“六要素”为纲,以“三个一”为略,将继续推动眼底疾病临床研究的创新与突破。
The "6 Elements, 3 Ones" constitutes a methodological framework for conducting innovative clinical research of ocular fundus diseases in foundational fundus imaging interpretation. This model emphasizes: 1) identifying a single abnormal case during routine fundus evaluation; 2) systematically expanding this observation into a case series through case accumulation, feature extraction, literature review, and comparative analysis; and 3) ultimately proposing or refining novel disease entities or manifestations through critical thinking and innovation. Over the past two decades, guided by this paradigm, our research team has achieved several original breakthroughs in fundus imaging studies, including: establishing polypoidal choroidal vasculopathy as the predominant subtype of neovascular age-related macular degeneration in Chinese populations; proposing an international staging system and novel subtypes for punctate inner choroidopathy; elucidating the pathogenesis of retentional retinal pigment epithelial detachment through the sign of age-related scattered hypofluorescent spots on late-phase indocyanine green angiography; identifying acute macular neuroretinopathy as the primary cause of vision loss in dengue fever patients; and precisely localizing lesion in the world's largest case series of persistent placoid maculopathy. The "6 Elements" framework standardizes fundus disease research protocols, emphasizing methodological rigor and progressive investigation while generating multiple research trajectories through iterative cycles, thereby expanding both the depth and breadth of scientific inquiry. The "3 Ones" pathway embodies hierarchical research progression - transitioning from individual phenomena (point observations) to population-level patterns (linear correlations), ultimately constructing a multidimensional disease cognition network (planar integration). This approach guides investigations ranging from signs of common disease to rare disorders and novel disease entities, accelerating the refinement of disease taxonomies. By adhering to the "6 Elements" as the structural framework and implementing the "3 Ones" as the strategic pathway, we will continue to advance innovation and achieve breakthroughs in clinical fundus disease researches.
玻璃体腔注药是年龄相关性黄斑变性、糖尿病视网膜病变、视网膜静脉阻塞等常见慢性眼底病的主要治疗方式,凭借其治疗量大、操作流程化、实施简便,已成为眼科临床常规诊疗项目。基于《“十四五”全国眼健康规划(2021-2025年)》要求,秉承以患者为中心的服务理念,在确保医疗安全的基础上,优化治疗流程,提升患者接受玻璃体腔注药治疗的就诊体验和治疗效果。同时,广东省将有望承接越来越多港澳的眼病患者,需要建立融合粤港澳大湾区的广东省注药标准。因此,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构共同起草,通过函审、专家论证会等形式,共邀广东省内35名权威专家进行多轮会审,在参考国内外玻璃体腔注药标准的基础上,结合粤港澳大湾区眼科现状,共同讨论最终确定了本标准。本团体标准系统地描述了玻璃体腔注药的基本要求、适应证与禁忌证,制定了全新的玻璃体腔注药标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构所开展的玻璃体腔注药的临床应用以及质量评估提供指导。
Intravitreal injection represents the primary method of drug administration for a range of common chronic endophthalmic diseases, including age-related macular degeneration, diabetic retinopathy and retinal vein occlusion. Recognized for its high clinical efficacy, procedural standardization, and operational accessibility, this has become a routine clinical practice in ophthalmology. In alignment with the "National Eye Health Plan during the 14th Five-Year Plan period (2021–2025)" and the patient-centered service philosophy, this approach optimizes treatment processes and enhances patient experience and therapeutic outcomes while ensuring medical safety. Furthermore, Guangdong Province is poised to become a pivotal hub for ophthalmic care within the Guangdong-Hong Kong-Macao Greater Bay Area, anticipating a growing influx of patients from Hong Kong and Macao. This necessitates the development of a unified intravitreal injection standard tailored to regional healthcare integration. Under the auspices of the Guangdong Medical Association, a consortium led by Zhongshan Ophthalmic Center, Sun Yat-sen University, and 21 collaborating medical institutions across Guangdong, formulated this standard. Through iterative reviews involving correspondencebased evaluations and multidisciplinary expert consultations, 35 distinguished specialists refined the standard, synthesizing global best practices with insights into the Greater Bay Area’s unique ophthalmological landscape. This group standard systematically outlines the basic requirements, indications and contraindications of intravitreal injection, establishes a new standard operating procedure for intravitreal injection and quality control standards for this procedure. In addition, we have introduced guidance for the clinical application of this technique and quality assessment, as well as for the prevention and management of complications or adverse reactions.
睑板腺功能障碍(meibomian gland dysfunction, MGD)是一种慢性弥漫性睑板腺疾病,可引起眼红、眼干、异物感等眼部不适,影响患者的眼健康及生活质量。强脉冲光(intense pulsed light, IPL)作为一种新兴有效的物理治疗方法,目前已广泛应用于治疗MGD及其他常见的眼表疾病,如蠕形螨性睑缘炎、睑缘炎相关角结膜病变、复发性睑板腺囊肿等。在IPL临床应用中,规范的操作是保障治疗有效性与安全性的关键。为更好指导和规范临床眼科医护人员的IPL治疗操作,由中山大学中山眼科中心牵头,联合全国19所医疗机构,经过多次修订,于2023年12月17日在全国团体标准信息平台发布了《强脉冲光治疗睑板腺功能障碍操作流程》的团体标准。文章旨在对该团体标准进行深度解读,详细阐述操作中的重点、难点与操作细节,以更好地指导临床工作。
Meibomian gland dysfunction is a chronic diffuse meibomian gland disease that can cause eye discomfort such as redness, dryness, and foreign body sensation in patients, and influence their eye health and quality of life. Intense pulsed light (IPL), as an effective physical therapy for meibomian gland dysfunction, is being used to treat meibomian gland dysfunction and related diseases widely, such as demodex blepharitis, keratoconjunctivitis, recurrent meibomian gland cysts and so on.. In the clinical application of IPL, standardized procedures are key to ensuring the effectiveness and safety of treatment. In order to better guide and standardize the IPL treatment operation of clinical ophthalmic medical workers, led by the Zhongshan Ophthalmic Center, Sun Yat-sen University, and joined with 19 medical institutions across the country, after multiple revisions, the group standard " Operation Procedure of Intense Pulsed Light for Meibomian Gland Dysfunction" was released on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group's standards, detailing the key points, difficulties, and operational details of specific operations, in order to better guide clinical work.
睑板腺功能障碍可导致眼表微环境失衡,眼部不适及视功能障碍,深刻影响着患者的视觉生活质量。睑板腺按摩作为一种通过机械挤压睑板腺疏通睑板腺开口,排出异常睑酯的治疗手段,目前已被广泛应用于临床干眼患者,成为睑板腺功能障碍最常见的物理治疗方法。但由于睑板腺按摩的操作手法多样,不同医疗机构所积累的操作经验也不尽相同,导致在治疗过程中存在较多潜在风险,若操作不当,可造成眼部感染、眼睑红肿、结膜水肿出血,甚至角膜损伤。因此,制定标准化的操作流程,规范睑板腺按摩治疗非常重要。然而,目前尚缺乏全面、系统化且规范化的睑板腺按摩操作的临床实践指导。鉴于此,中山大学中山眼科中心联合全国19所医疗机构进行反复修订,于2023年12月17日在全国团体标准信息平台发布《睑板腺按摩操作流程》的团体标准。文章对该团体标准进行深度解读,以更好指导临床工作。
Meibomian gland dysfunction (MGD) can lead to an imbalance in the ocular surface microenvironment, eye discomfortable, and visual impairment, thereby profoundly affecting the visual quality of life of patients. Meibomian gland massage is now widely used in clinical patients, serving as the most prevalent physical therapy for MGD. The mechanism of meibomian gland massage is to open the meibomian gland opening by squeezing the meibomian gland and expel abnormal eyelid esters. However, due to the diverse techniques used in meibomian gland massage and the varying levels of operational experience accumulated by different medical institutions, there are many potential risks in treatment process. If medical staff operate improperly, it can cause eye infections, eyelid redness and swelling, conjunctival edema and bleeding, and even corneal damage. Therefore, it is crucial to establish the standardized procedure of meibomian gland massage therapy. Yet, there is currently lack of comprehensive, systematic, and standardized clinical practice guidance. Thus, the Zhongshan Ophthalmic Center, Sun Yat-sen University, in collaboration with 19 medical institutions across the country, has released the group standard for Operation Procedure of Meibomian Gland Massage on the National Group Standard Information Platform on December 17, 2023. This article aims to provide an in-depth interpretation of the group standard to guide clinical work better.