目的：建立能驱动GFP在视网膜神经节细胞(retinal ganglion cell，RGC)中特异性表达的小鼠胚胎干细胞系。方法：通过同源重组的方式建立Brn3b-GFP敲入的小鼠胚胎干细胞系(Brn3b-GFP ESC)，利用3D培养将其诱导成视网膜类器官检测GFP表达的细胞特异性，再用流式细胞分选富集GFP阳性RGC，采用玻璃体腔注射的方式将GFP阳性RGC移植到健康小鼠和NMDA损伤模型小鼠眼中探索该细胞的应用价值。结果：Brn3b-GFP ESC经3D视网膜诱导培养后在RGC中特异性表达GFP，将这些GFP阳性RGC移植到两种小鼠中2周后能在所有视网膜内观察到GFP阳性细胞存活，且均能观察到有供体RGC整合到宿主视网膜RGC层。结论：本研究建立了RGC特异的报告基因干细胞系Brn3b-GFP ESC，通过将该细胞系诱导成视网膜类器官进而获得的GFP阳性RGC移植后能够整合进宿主视网膜。该细胞系的建立将为青光眼及相关疾病提供重要的研究手段和工具。

Objective: This study was designed to establish a mouse embryonic stem cell line that can drive GFP expression specifically in retinal ganglion cells (RGCs). Methods: In this study, we established a Brn3b-GFP knock-in embryonic stem cell line (Brn3b-GFP ESC) by homologous recombination. By 3D culture, we induced these cells into retinal organoids to investigate the cell-specificity of GFP expression. GFP-positive RGCs were then enriched by flow cytometry and transplanted by intravitreal injection into the eyes of healthy mice and NMDA injury model mice to explore the feasibility of a potential clinical application. Results: GFP was specifically expressed in RGCs following induction of Brn3b-GFP ESCs into 3D retinal organoids. Two weeks after these GFP-positive RGCs were transplanted into the control and injured mice, GFP-positive cells were observed in all transplanted retinas, and donor RGCs were seen to integrate into the RGC layer of the host retina. Conclusion: This study has established a retinal ganglion cell-specific reporter stem cell line Brn3b-GFP ESC. The GFP-positive RGCs obtained by inducing the cell line into retinal organoids can be integrated into the host retina after transplantation. The establishment of such a cell line will provide an important research tool for glaucoma and related diseases.

视网膜疾病大多以周边视网膜病变为首要表现，后者的早期诊断、监测对于视网膜疾病的治疗及预防起着至关重要的作用。以往传统眼底成像技术仅能提供20°视网膜的可视范围，即便使用蒙太奇拍摄技术，也只能采集部分眼底范围。目前眼底成像技术已步入最新的超广角时代，其所提供的眼底视野至少可达200°，并且基于该技术的超广角眼底彩色照相、荧光素血管造影、光学相干断层扫描及其血管造影等已广泛应用于临床实践中，对于诊断及评估视网膜疾病发挥重要作用，如糖尿病性视网膜病变、视网膜静脉阻塞、早产儿视网膜病变、视网膜色素变性及视网膜脱离等。本文将从超广角成像技术的产生、发展及其国内外的临床应用现状作一综述，旨在为临床工作及研究提供指导意义。

Retinal diseases primarily feature with peripheral retinopathy, and its early diagnosis as well as the later following up both play a vital role in the treatment and prevention of retinal diseases. In the past, traditional fundus imaging technology can only provide the visual range of 20 degrees. Even if montage photography technology is used, it can only partially reveal the fundus field. At present, fundus imaging technology has entered the latest era of ultra-wide-field, which provides at least 200-degree fundus field of vision. Ultra-wide-field fundus photochromy, fluorescein angiography, optical coherence tomography and angiography based on this technology have been widely used in clinical practice, and play an important role in the diagnosis and evaluation of retinal diseases, such as diabetes retinopathy, retinal vein occlusion, retinopathy of prematurity, retinitis pigmentosa and retinal detachment. This article aims to review the occurrence and development of ultra-wide-field fundus imaging technology and its clinical applications up to now to provide a relative guideline for clinic and research.

    白内障作为一种常见的眼科疾病，是全球第一位致盲眼病，目前尚无药物能够治疗，手术是唯一有效的办法。随着现代眼科手术技术的发展以及人工晶状体(intraocular lens，IOL)设计和功能的更新升级，人们对视觉质量的要求越来越高，白内障超声乳化联合IOL植入术已经从单纯的复明手术转变为个性化的屈光手术。为满足不同需求的患者术后获得较好的视觉质量，IOL经历了从单焦点到多焦点、球面到非球面的发展，还有散光型IOL和各类功能性IOL的临床应用，也为患者提供了更多的选择。充分了解不同类型IOL的优势和特点，根据患者自身眼部情况、日常用眼习惯以及需求，个性化地选择IOL植入对视觉质量的恢复和满意度起着至关重要的作用。因此本文将针对不同类型的IOL，从设计与分类、术后临床效果及适应人群进行综述，为IOL的选择提供指导建议。

As a common eye disease, cataract is the first-leading cause of blindness in the world. Currently, there is no drug to treat it, and surgery is the only effective way. With the development of modern ophthalmic surgical technology and the updating and upgrading of the design and function of intraocular lens (IOL), people have higher and higher requirements for visual quality. Cataract phacoemulsification combined with IOL implantation has transformed from a simple vision restoration to personalized refractive surgery. In order to meet the needs of patients with different needs to obtain better visual quality after surgery, IOL has experienced the development from monofocal to multifocal, spherical to aspherical, as well as the clinical application of astigmatic IOL and various functional IOLs, which also provides more choices for patients. Fully understanding the advantages and characteristics of different types of IOLs, according to the patient’s own eye conditions, daily eye habits and needs, individualized selection of IOL implantation plays a crucial role in the recovery and satisfaction of visual quality. Therefore, this article will review different types of IOLs from the aspects of design and classification, postoperative clinical effects and adaptation to the population, and provide guidance for the selection of IOLs.

眼眶骨折是外伤性疾病常见的眼眶并发症，部分需要行眼眶骨折修复手术治疗。不同材料的植入物，是影响手术效果和预后的重要因素之一。植入物的选择国内外至今尚未有统一的标准。目前临床上使用的植入材料多为异质材料，有不可吸收材料和可吸收材料两类。不可吸收材料使用最多的是钛网和高密度多聚乙烯(Medpor)。可吸收材料主要是各类高分子聚合物。这两类材料在临 床的使用过程中都表现出了不同的优缺点，通过查阅近5年的相关报道，对比这两类材料的优缺点，可以为临床医生的选择提供一些参考。

Orbital fracture is a common orbital complication of traumatic diseases, and some of them need to be treated by orbital fracture repair surgery. Implants of different materials are one of the important factors affecting the surgical outcome and prognosis. There is no uniform standard for the selection of implants at home and abroad. At present, most of the implant materials used in clinical practice are heterogeneous materials, including non-absorbable materials and absorbable materials. The most commonly used non-absorbable materials are titanium mesh and high-density polyethylene (Medpor). Absorbable materials are mainly all kinds of macromolecular polymers. These two types of materials have shown different advantages and disadvantages in clinical. By reviewing the relevant reports recent 5 years, and comparing the advantages and disadvantages of these two types of materials, we can provide some references for clinicians to choose from.

目的：通过在血管灌注尸头标本上模拟经鼻内镜下鼻泪管-泪囊切除术探讨该术式的基本操作以及在经鼻内镜下鼻泪管-泪囊和其周围结构的解剖关系，以期为临床开展该术式提供解剖学依据。方法：采用5个动、静脉双灌注成人尸头标本(共10侧)进行解剖学研究。在标本上进行经鼻内镜下暴露全程鼻泪管及泪囊，观察鼻泪管-泪囊切除过程的解剖标志和毗邻关系。结果：10侧泪囊-鼻泪管的解剖显示全部泪囊均位于鼻丘的前方稍外侧，泪囊顶基本和鼻丘顶平齐，泪囊体大部分位于中鼻甲腋窝水平线上方。泪囊窝后内壁由泪骨构成，泪骨后内方与鼻丘气房相邻。泪囊底向下移行为膜性鼻泪管进入骨性鼻泪管，鼻泪管在鼻腔外侧壁的投影位于钩突垂直部前缘前方约3~7mm。鼻泪管下鼻道开口距离下鼻甲前端的距离为(16±3)mm。泪囊长度为(13.8±1.8)mm，鼻泪管长度为(23.2±3.6)mm。结论：经鼻内镜入路可充分暴露和切除全程鼻泪管和泪囊。本解剖研究展示的基本操作过程和解剖标志可为临床开展经鼻内镜鼻泪管-泪囊切除术提供解剖学参考。

Objective: By simulating transnasal endoscopic resection of nasolacrimal duct and lacrimal sac on cadaveric specimens with vascular perfusion, the basic process of this procedure and the anatomical relationship between nasolacrimal duct and lacrimal sac were explored, providing anatomical basis for clinical application. Methods: Five adult cadaver head specimens (10 sides in total) were used for anatomical study. The nasolacrimal duct and lacrimal sac were exposed under transnasal endoscopy, and the anatomical landmarks and their relationship with adjacent areas during the resection of nasolacrimal duct and lacrimal sac were observed. Results: Ten sides of nasolacrimal duct and lacrimal sac showed that all lacrimal sacs were located anterior and slightly lateral to the nasal mound. The roof of lacrimal sac was almost the same height as the roof of nasal mound. The body of lacrimal sac was almost located above the horizontal line of the middle turbinate axilla. The posterior inner wall of the lacrimal fossa was composed of lacrimal bone. The posterior inner side of the lacrimal bone was adjacent to the agger nasi cell. The bottom of the lacrimal sac moved downward as the membranous part of the nasolacrimal duct located in the bony part of the nasolacrimal duct. The projection of the nasolacrimal duct on the lateral nasal wall was located about 3–7 mm in front of the anterior edge of the vertical part of the uncinate process. The distance between the inferior meatus opening of the nasolacrimal duct and the anterior end of the inferior turbinate was (16±3) mm. The length of the lacrimal sac was (13.8±1.8) mm, and the length of the nasolacrimal duct was (23.2±3.6) mm. Conclusion: The transnasal endoscopic approach can fully expose and resect the nasolacrimal duct and lacrimal sac. The basic operation process and anatomical landmarks demonstrated in this anatomical study provide an anatomical reference for the clinical development of transnasal endoscopic resection of nasolacrimal duct and lacrimal sac.

目的：探讨医用自交联透明质酸钠凝胶对鼻内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryocystorhinostomy，En-DCR)后的影响。方法：将219例单侧慢性泪囊炎(chronic dacryocystitis CD)患者随机分为医用自交联透明质酸钠凝胶组(A组)和对照组(B组)。所有患者行En-DCR。A组将医用自交联透明质酸钠凝胶填充吻合口，B组不做任何处理。随访12个月。比较创面黏膜上皮化、肉芽形成情况、渗血情况及吻合口通畅成功率。结果：A组98例，B组102例。随访2周，A组86例患者鼻腔吻合口黏膜上皮完整，B组77例患者鼻腔吻合口黏膜上皮完整。随访12个月，A组有7例患者存在瘢痕(7.1%)，8例患者出现肉芽肿(8.2%)，而B组有17例患者存在瘢痕(16.7%)，18例患者出现肉芽肿(17.6%)。两组瘢痕形成及出现肉芽肿差异均有统计学意义(P<0.05)。A组的吻合口通畅成功率达到90.8%(89/98)，而B组的成功率为78.4%(80/102)(P<0.05)。B组患者术后渗血情况A组相当(P>0.05)。结论：医用自交联透明质酸钠凝胶填充吻合口可通过促进En-DCR术后吻合口黏膜上皮愈合和降低伤口瘢痕及肉芽肿生成率，提高En-DCR治疗CD的成功率。

Objective: To investigate the effect of medical self-crosslinking sodium hyaluronate gel on endonasal endoscopic dacryocystorhinostomy (En-DCR). Methods: A total of 219 patients with unilateral chronic dacryocystitis (CD) were selected and randomly divided into two groups: medical self-crosslinking sodium hyaluronate gel group (group A) and control group (group B). All patients underwent En-DCR. Group A received medical self-crosslinking sodium hyaluronate gel filling the ostium at the end of En-DCR, whereas group B received no treatment. Patients were followed-up for 12 months. The mucosal epithelialization of the wound, the granulation formation, bleeding, and the success rate of ostial patency were compared in the two groups. Results: Our study included 98 patients in group A and 102 patients in group B. After 2 weeks, the number of absorbable hemostatic patients who had intact mucosal epithelium lining the ostia was 86 in group A and 77 in group B. At 12 months follow up, there were 7 patients with scar (7.1%) and 8 patients with granuloma (8.2%) in group A, compared with 17 patients with scar (16.7%) and 18 patients with granuloma (17.6%) in group B. There were significant differences in scar formation and granuloma between the two groups (P<0.05). The success rate of anastomotic patency reached 90.8% (89/98) in group A whereas the success rate was 78.4% (80/102) in group B (P<0.05). The situation of postoperative bleeding in group B was similar to that in group A (P>0.05). Conclusion: The medical self-crosslinking sodium hyaluronate gel can improve the success rate of En-DCR treatment of CD through promoting the healing of anastomotic mucosa and reducing the rate of wound scar and granuloma formation.

目的：探讨连续锁边缝合联合角膜绷带镜在翼状胬肉手术中应用的效果。方法：采用前瞻性随机对照临床研究。选取2018年1月到2021年6月期间在我院行翼状胬肉切除联合自体角膜缘结膜瓣移植术的患者132例180眼，按结膜瓣固定方式随机分为A、B两组，其中A组患者(64例90眼)行间断缝合固定法，B组患者(68例90眼)行连续锁边缝合法，术毕两组患者均给与配戴角膜绷带镜。比较两组患者的术后眼部疼痛程度评分、术后效果及并发症。结果：术后1、3 d，B组疼痛评分明显低于A组，差异有统计学意义(P<0.01)；术后1、3、7 d两组间角膜染色评分差异无统计学意义(P>0.05)；术前、术后3个月两组间泪膜破裂时间(breakup time of tear film，BUT)差异无统计学意义(P>0.05)，但术后3个月组内的BUT较手术前有明显改善(P<0.05)。术前、术后2周两组间视力差异均无统计学意义(P>0.05)，术后2周两组组内视力较手术前均有明显改善(P<0.05)。随访3个月，两组患者主要术后并发症包括胬肉撕除后浅层基质损伤延迟愈合、线结处结膜增生、结膜植片松脱等，并发症发生率两组相当。结论：采用连续锁边缝合联合配戴角膜绷带镜治疗翼状胬肉可以促进角膜创面的修复，减轻患者的术后刺激症状，提高患者术后舒适度；连续锁边缝合时需要适当增加缝线跨度，可减少术后结膜植片的松脱。

Objective: To investigate the effect of continuous locking suture combined with corneal bandage lens in the operation of pterygium. Methods: A prospective randomized controlled clinical trial was conducted. From January 2018 to June 2021, 132 patients (180 eyes) who underwent pterygium excision combined with autologous limbal conjunctival flap transplantation were randomly divided into group A and group B according to the fixation of conjunctival fla. The patients in group A (64 cases, 90 eyes) were treated with intermittent suture and fixation, and the patients in group B (68 cases, 90 eyes) were treated with continuous locking suture. Both groups were given corneal bandage lenses at the end of the operation. The postoperative ocular pain score, postoperative effect and complications were compared between the two groups. Results: The pain score in group B was significantly lower than that in group A at 1 and 3 d after operation (P<0.01), and there was no significant difference in corneal staining score between the two groups at 1, 3 and 7 d after operation (P>0.05). There was no significant difference in breakup time of tear film (BUT) between the two groups before and 3 months after operation (P>0.05), but the BUT at 3 months after operation in the group was significantly better than that before operation (P<0.05). There was no significant difference in visual acuity between the two groups before and 2 weeks after operation (P>0.05). The visual acuity of the two groups was significantly improved 2 weeks after operation (P<0.05). During the follow-up of 3 months, the main postoperative complications of the two groups included delayed healing of superficial matrix injury after pterygium avulsion, conjunctival hyperplasia, conjunctival graft loosening and so on. Conclusion: Continuous locking suture combined with corneal bandage lens in the treatment of pterygium can promote the repair of corneal wound, reduce the postoperative irritation symptoms and improve the postoperative comfort of patients. It is necessary to increase the suture span during continuous locking suture, which can reduce the loosening of conjunctival graft after operation.

眼睛是人体最重要的感觉器官之一，主要由角膜和晶状体构成的屈光系统和视网膜构成的视觉神经系统2个部分构成。眼睛各组织的发育和功能异常都可影响视功能，甚至致盲。现有的致盲眼病的治疗方式均存在各自瓶颈问题，新的诊治方法亟待开发。近年来，得益于干细胞和组织工程学的发展，结合现有眼各组织的发育理论知识，研究者们利用多种来源的干细胞在体外成功诱导出具有组织特异结构和功能的眼类器官。眼类器官研究为利用干细胞研究眼组织发育和眼病发病机制、药物筛选以及替代治疗创造了新机遇，将干细胞治疗眼病的转化研究推向了一个更高平台。本文将对现有眼类器官的技术发展及应用进行综述。

Being one of the most important sensory organs, the eye is composed of the cornea, the lens, which are responsible for refraction, and the retina, which is the neural sensory part of the eye. Various kinds of developmental abnormalities and functional defects could lead to visual dysfunctions, and even blindness. Current treatments for blindness-causing eye diseases all have their own limitations, awaiting new efficient diagnostic and treating methods. Thanks to the development in stem cell biology and bioengineering, taking advantage of the rich knowledge accumulated on the mechanisms governing eye development, researchers have successfully generated various ocular organoids using multiple sources of stem cells in vitro, which resemble their counterparts in vivo on both the structural level and functional level. Ocular organoids provide valuable material and models for studying eye development, pathology, drug screening, and cell replacement therapy, pushing translational studies of ocular stem cell to a new era. Here, the paper reviews the development and application of ocular organoid technologies.

目的：探讨“破窗理论”在手术室护理安全管理中的应用，为构建手术期间质量安全保障体系提 供新的管理依据。方法：于2019年2月至2020年6月组织佛山市三水区人民医院手术室医护人员对 “破窗理论”进行学习，调查分析护理质量、护理满意度以及手术室护理中出现的安全问题，进 而分析“破窗理论”在手术室护理安全管理中的应用效果。结果：实施前不安全事件发生率高于 实施后(16.00% vs 4.00%，P<0.05)。实施后手术室护理安全管理、药物使用规范性、感染控制程 度、基础护理质量评分高于实施前(P<0.05)。与实施前相比，实施后手术医生、医护人员、患者 满意度明显上升(P<0.05)。结论：“破窗理论”在传统护理的基础上提供了一种更为积极的干预 模式，其在护理安全管理中的应用值得进一步推广应用。

Objective: To provide a new management system to increase the quality and safety during the operation through applicating the broken window theory in the operating room nursing quality management. Methods: From February 2019 to June 2020, we organized medical staff in the operating room to study the broken window theory, investigated the nursing quality, nursing satisfaction and safety problems in operating room nursing, and then analyze the application effect of the theory in the nursing safety management. Results: The incidence of unsafe events before implementation of the broken window theory were significantly higher than that after the implementation (16.0% vs 4.0%, P<0.05). After the implementation, the scores of nursing safety management, standardized drug use, infection control and basic nursing quality in the operating room were higher than those before the implementation (P<0.05). The satisfaction of surgeons, medical staff and patients increased significantly after implementation as compared with before implementation (P<0.05). Conclusion: The broken window theory effectively provides a more active intervention model than traditional care, and it deserves further application in nursing safety management.

目的：探索局部麻醉辅助小剂量丙泊酚联合瑞芬太尼镇静镇痛在成人斜视矫正术中的应用效果。方法：本研究为前瞻性队列研究，选取2020年10月1日至2021年5月31日于北京同仁医院行斜视矫正术的成年患者24例，单纯局部麻醉组、镇静镇痛组各12例。所有患者均应用2%利多卡因10 mL+0.1% 肾上腺素0.1 mL混合液进行眼部局部浸润注射，静脉滴注昂丹司琼8 mg。镇静镇痛组患者静脉滴注咪达唑仑1 mg、舒芬太尼5 μg，继之以丙泊酚0.6~3 mg/(kg·h)、瑞芬太尼0.01~0.05 μg/(kg·min)持续输注，使Ramsay镇静分级维持在II级。记录两组患者术中视觉模拟评分(visual analog scale，VAS)、脑电双频指数(bispectral index，BIS)、术者满意度评分及调节眼位配合度评分，术中恶心呕吐、眼心反射、呼吸抑制、血压心率等情况，以及丙泊酚、瑞芬太尼输注速度。结果：镇静镇痛组患者丙泊酚持续输注速度为0.6~1.8 mg/(kg·h)，瑞芬太尼持续输注速度为0.01~0.03 μg/(kg·min)。镇静镇痛组患者 术中VAS、BIS、心率增快发生率均低于单纯局部麻醉组(P<0.05)，术者满意度评分、血压下降发生率均高于单纯局部麻醉组(P<0.05)；两组患者术中恶心呕吐、眼心反射、呼吸抑制、血压升高发生率及调节眼位配合度评分差异均无统计学意义(P>0.05)。结论：在成人斜视矫正术中，局部麻醉辅 助小剂量丙泊酚联合瑞芬太尼镇静镇痛可有效减轻患者术中疼痛，作用安全可靠。

Objective: To explore the effect of local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil in adult strabismus surgery. Methods: This study was a prospective cohort study. Twenty-four adult patients who underwent strabismus surgery in Beijing Tongren Hospital from October 1, 2020 to May 31, 2021 were selected and divided into local anesthesia group, and sedation and analgesia group, eachwith 12 patients. All patients received local anesthesia with a mixture of 2% lidocaine 10 mL and 0.1% epinephrine 0.1 mL, and intravenous ondansetron 8 mg. Patients in the sedation and analgesia group received intravenous infusion of midazolam 1mg and sufentanil 5 μg, followed by continuous infusion of propofol 0.6–3 mg/(kg·h) and remifentanil 0.01~0.05 μg/(kg·min) to maintain Ramsay sedation score at grade II. Visual Analogue Scale (VAS), bispectral index (BIS), operator’s satisfaction score, patient’s coordination score, nausea and vomiting, oculocardiac reflex, respiratory depression, blood pressure, heart rate and the infusion rate of propofol and remifentanil during operation were recorded in these two groups. Results: In the sedative and analgesic group, the infusion rates of propofol and remifentanil were 0.6–1.8 mg/(kg·h) and 0.01–0.03 μg/(kg·min), respectively. VAS, BIS and the incidence of increased heart rate in the sedation and analgesia group were lower than those in the local anesthesia group (P<0.05); operator’s satisfaction score and the incidence of decreased blood pressure in the sedation and analgesia group were higher than those in the local anesthesia group (P<0.05); there was no significant difference in the incidence of intraoperative nausea and vomiting, oculocardiac reflex, respiratory depression, elevated blood pressure and patient’s coordination score between the two groups (P>0.05). Conclusion: In adult strabismus surgery, local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil can effectively relieve intraoperative pain, which is safe and reliable.