目的:调查眼科学硕士研究生批判性思维能力的现况,并了解其相关因素。方法:采用中文版评判性思维能力测量表(Critical Thinking Disposition Inventory-Chinese Version, CTDI-CV)对81名眼科学硕士研究生进行问卷调查,比较不同性别、年级、学位类别、学制的学生批判性思维能力的差异。结果:81名眼科学硕士研究生的CTDI-CV总分为(294.79±29.18)分,表明普遍具备积极的批判性思维能力,但“寻找真相”和“系统化能力”得分较低;不同年级与学位类型的眼科学硕士研究生的批判性思维能力等级分布存在差异。多因素线性回归显示,学位类型与眼科学硕士研究生的批判性思维能力相关。结论:眼科学硕士研究生普遍展现出正性的批判性思维特质,但在特定领域,其批判性思维能力仍有待提高,研究生教育应当采取针对性措施,培养研究生的批判性思维能力。
Objective: To investigate the current situation of critical thinking abilities of masters’ degree postgraduates in ophthalmology and identify the factors affecting the critical thinking abilities. Methods: Using the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV), a questionnaire survey was conducted among 81 masters’ degree postgraduates in ophthalmology. Results: The average total score of the CTDI-CV for the 81 master’s degree postgraduates in ophthalmology was 294.79±29.18, indicating a general possession of positive critical thinking abilities, yet scores in “Truth Seeking” and “Systematicity” were relatively low. There are differences in critical thinking abilities among master’s degree postgraduates in ophthalmology of various grades and degree categories. Multivariate linear regression indicates that degree categories is correlated with the critical thinking abilities of ophthalmology graduate students. Conclusions: The masters’ degree postgraduates in ophthalmology generally exhibit positive traits of critical thinking, yet there is room for improvement in specific areas. Postgraduate education should adopt targeted measures to cultivate the critical thinking abilities of postgraduates.
培养合格的眼科医师对于防盲治盲工作、为人民提供优质眼健康服务是十分重要的,不同地区的住院医师规范化培训各有特点。文章从各个方面比较了内地与香港眼科住院医师规范化培训体系的异同,包括培训对象、培训师资、轮转阶段和要求、考核机制。香港的培训体系时间为6年,大致上相当于住院医师规范化培训和专科医师规范化培训结合在一起。通过比较两者的差异,有助于我们结合自己的实际情况,改进内地的眼科学住院医师教育培养体系,也为下一步开展眼科专科医师规范化培训提供参考。
The training of qualified ophthalmologists holds paramount significance in preventing blindness, treating eye diseases, and delivering optimal eye health services to the people. Given the unique nature of standardized residency training across geographical regions, this study delves into the comparative analysis of ophthalmology residency standardized training systems in the Mainland and Hong Kong. Specifically, we examine the the similarities and disparities in multiple facets, encompassing trainees' profiles, faculty expertise, rotation phases and prerequisites, as well as assessment methodologies. Notably, the training system in Hong Kong has a duration of 6 years, approximating the combined length of standardized residency training and standardized specialist training. By comparing the differences, we aim to facilitate the refinement of ophthalmology residency education and training in Mainland China, tailored to our specific context, while also serving as a reference for advancing standardized ophthalmology specialist training initiatives.
目的:研究准分子激光原位角膜磨镶术(laser in situkeratomileusis,LASIK)前后角膜滞后量(corneal hysteresis,CH)和角膜阻力因子(corneal resistance factor,CRF)变化量,对其相关因素进行多元线性回归分析。方法:前瞻性研究。纳入行LASIK手术的近视眼及近视散光患者70眼(38例),术前与术后6个月各项参数分别由眼反应分析仪(ocular response analyzer,ORA)、非接触眼压仪、超声角膜测厚仪及Pentacam眼前节分析仪测量。分析LASIK手术前后△CH,△CRF与术前、手术设计等参数的相关性,并对相关参数进行多元线性回归分析。结果:手术前后CH分别为(10.05±1.36),(8.15±0.90) mmHg(1 mmHg=0.133 kPa),CRF分别为(9.91±1.38),(6.92±0.88) mmHg,差异均有统计学意义(P<0.01);△CH与△CRF分别为(1.90±1.15),(2.99±1.23) mmHg。△CH与术前CH,CRF,眼压(intraocular pressure,IOP),预计切削深度(ablative depth,AD)以及AD/CCT呈正相关;△CRF与术前CH,CRF,IOP,AD,AD/CCT,术前等值球镜(spherical equivalent,SE)以及预计基质床厚度(residual stromal bed’s thickness,RSBT)有相关性。采用多元线性回归对LASIK手术前后△CH,△CRF与术前、手术设计等各相关参数进行分析,回归方程为:△CH=?6.182+0.658CH术前+8.421AD/CCT (R2=0.639,P<0.01),△CRF=?0.007+0.725CRF术前?0.014RSBT (R2=0.689,P<0.01)。结论:LASIK术前后CH与预计AD和角膜厚度比值密切相关,CRF变化量与预计角膜RSBT密切相关,在设计手术时应慎重考虑预计AD与预计RSBT。
Objective: To discuss the change of corneal hysteresis and corneal resistance factor before and after laser in situkeratomileusis (LASIK), and to analyze their related factors by multivariate linear regression. Methods: In this prospective study, 70 eyes (38 patients) with myopia and myopic astigmatism undergoing LASIK were included. Related factors were measured preoperatively and at 6 months postoperatively by ocular response analyzer, noncontact tonometer (NCT), ultrasonic pachymeter, and Pentacam system. TTe correlation was analyzed between △CH, △CRF and preoperative and operative design’s parameters, and correlative factors analyze. △CH and △CRF were analyzed by the multiple linear regression. Results: CH before and after LASIK were (10.05±1.36) and (8.15±0.90) mmHg, and CRF before and affer LASIK were (9.91±1.38) and (6.92±0.88) mmHg. TTere was signiffcant difference between preoperative and postoperative CH and CRF (P<0.01). △CH and △CRF were (1.90±1.15) and (2.99±1.23) mmHg. Preoperative CH, CRF, intraocular pressure (IOP), ablative depth (AD) and AD/CCT were positive correlated with △CH. Preoperative CH, CRF, IOP, AD, AD/CCT, preoperative spherical equivalent (SE) and predicted residual stromal bed’s thickness (RSBT) were correlated with △CRF. TTe regression equation of △CH and △CRF and influencing factors were △CH =?6.182 + 0.658CHpreoperative + 8.421AD/CCT (R2 =0.639, P<0.01), △CRF =?0.007 + 0.725CRFpreoperative ? 0.014RSBT (R2 =0.689, P<0.01). Conclusion: The change of CH before and after LASIK is correlative with AD/CCT. The change of CRF before and after LASIK is correlative with predicted residual stromal bed’s thickness. Ablative depth and predicted residual stromal bed’s thickness should be considered carefully during the surgical design.
目的:探讨正常成年 SD 大鼠的明视视网膜电图(Electroretinogram,ERG)特征。
方法:选取正常 9~12 周 SD 大鼠 60 只,使用罗兰视觉电生理仪记录大鼠右眼的明视闪光 ERG。使用 SPSS 统计分析 a 波、b 波和明视负波反应(Photopic negative response,PhNR)的隐含期和振幅。比较雄性和雌性 SD 大鼠明视 ERG 特征。
结果:每只 SD 大鼠均能记录到稳定的 a 波、b 波和 PhNR,其中 a 波的隐含期和 PhNR 的隐含期及振幅均符合正态分布,而其余指标均不符合正态分布。PhNR 的隐含期为 124.6±8.5 ms,其变异系数最小(0.07)。PhNR 的振幅为(11.3±4.2)μV,变异系数为 0.37。雄性和雌性 SD 大鼠明视 ERG 的各反应波之间无显著差异。
结论:在正常成年 SD 大鼠,明视闪光 ERG 是一项客观评价大鼠明视状态下视网膜功能的手段,PhNR 可以作为一项稳定的评价内层视网膜功能的指标。
Purpose: To study the characteristics of photopic flash electroretinogram (ERG) in normal adult SD rats.
Methods: Sixty normal adult SD rats aged 9 to 12 weeks old were enrolled in this study. Photopic flash ERG was recorded from these 60 SD rats. The results were analyzed with SPSS.
Results: Stable a, b and PhNR waves could be recorded in each rat. The implicit time of a wave, implicit time and amplitude of PhNR fit normal distribution. The implicit time of PhNR was (124.6 ± 8.5) ms with the smallest coefficient of variation of 0.07. The amplitude of PhNR was (11.3 ± 4.2) μV and the coefficient of variation was 0.37. There was no difference between the results of female and male rats.
Conclusion: Photopic flash ERG is an objective method in evaluating the retinal function in rats and PhNR can be used as a sensitive index of inner retinal function.
眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟,但眼科规培过程管理中仍存在诸多问题,包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等,很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善,配备更充足的教学资源,有一定的规培经验,是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式,注重规范化、标准化和个性化相结合,并通过借鉴香港及海外住院医师培训经验,丰富理论培训形式,优化操作培训环境,突出外语和科研能力训练,强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考,总结当前眼科专科医院规培现状,并提出对策和建议。
Standardized training for ophthalmology residents is an essential stage during the development of ophthalmologists. The standardized training system has become more and more mature, while problems still exist in the aspects of coordination between specialized hospitals and general hospitals, teacher resources, unevenness of trainees, combination of postgraduate education and residency standardized training, microsurgical skills training, and so on. Therefore, programs and strategies of standardized training are still under exploration. Eye hospitals, with the excellent disciplinary system, adequate resources, and advanced experience, play a key role in standardized training for ophthalmology residents. Joint Shantou International Eye Center has set up a training model in accordance with national requirements, focusing on the combination of standardization, normalization, and individuation. Besides, by learning from the oversea experience of residents training, Joint Shantou International Eye Center has enriched the training forms, optimized the skill training environment, and highlighted the training of foreign language, scientific research, and systematic clinical thinking. This paper, based on the 5-year experience and reflection on standardized training for ophthalmology residents in Joint Shantou International Eye Center, summarizes the current status of standardized training and put forward some measures and suggestions.
目的:探索白内障术眼低视力的原因。方法:对2011年10月至2013年3月在汕头国际眼科中心行白内障手术,术前无法窥清眼底,术后1周最佳矫正视力<0.3的患者进行视力、最佳矫正视力、眼压测量、裂隙灯检查、眼底镜检查、眼底照相及光学相干断层扫描(optical coherence tomography,OCT),若未发现任何视网膜器质性病变,再进行视觉诱发电位检查及视野检查。由2位医生对检查结果进行分析,对不同的眼底病变做出诊断,统计分析白内障术眼低视力的原因。结果:共纳入行白内障手术患者5 608例,术后1周最佳矫正视力<0.3的患者共49例(共49眼),其中男20例,女29例,右眼31只,左眼18只,年龄(69.11±12.05)岁。白内障术后低视力比例为0.87%。其中高度近视性脉络膜视网膜病变12例(24.5%),椭圆体带连续性破坏10例(20.4%),糖尿病性视网膜病变8例(16.3%),黄斑孔5例(10.2%),老年性黄斑变性4例(8.1%),黄斑前膜3例(6.1%),黄斑区视网膜厚度变薄1例(2.0%),视网膜色素变性1例(2.0%),视网膜劈裂症1例(2.0%),视网膜分支动脉阻塞1例(2.0%),白塞氏病1例(2.0%),缺血性视神经病变1例(2.0%),视网膜前膜1例(2.0%)。结论:在本组白内障术眼低视力的患者中,高度近视性脉络膜视网膜病变占主要部分,为24.5%,其次分别为椭圆体带连续性破坏、糖尿病性视网膜病变、黄斑孔、老年性黄斑变性和黄斑前膜。利用OCT可发现影响白内障术后视力的细微视网膜结构变化,对于白内障术前眼底可见的患者常规行OCT有利于判断手术预后,便于医患沟通,提高手术满意度。
Objective: To explore the causes of low vision after cataract surgery. Methods: Patients who underwent cataract surgery at Joint Shantou International Eye Center of Shantou University and the Chinese university of Hong Kong ( JSIEC) from October 2011 to March 2013, whose fundus status could not be seen before surgery, and the best corrected visual acuity <0.3 in the first week after surgery, underwent a series of detailed ocular examinations, including visual acuity, best corrected visual acuity, intraocular pressure, slit-lamp examination, fundus examination, fundus photography and optical coherence tomography. If no organic lesions of the retina were found, then visual evoked potential examination and visual field examination were performed. Two doctors analyzed the examination results of the examination, made the diagnosis of different fundus diseases, and statistically analyzed the causes of low vision after cataract surgery. Results: A total of 5 608 cataract surgeries were performed in our hospital from October 2011 to March 2013. A total of 49 patients (49 eyes) with best corrected visual acuity worse than 0.3 within postoperative 1 week 20 male and 29 female, 31 right eyes and 18 left eyes, aged (69.11±12.05) years on average. The proportion of low vision after cataract surgery was 0.87%. 12 cases (24.5%) of high myopic chorioretinopathy, 10 cases (20.4%) of ellipsoidal band defect, 8 cases (16.3%) of diabetic retinopathy, 5 cases (10.2%) of macular holes, 4 cases (8.1%) of age-related macular degeneration, 3 cases (6.1%) of macular epiretinal membrane, 1 case (2.0%) of thinning macular retinal thickness, 1 case (2.0%) of retinitis pigmentosa, 1 case of retinoschisis (2.0%), 1 case of branch retinal artery occlusion (2.0%), 1 case of Behcet’s disease (2.0%), and 1 case of ischemic optic neuropathy (2.0%), 1 case of epiretinal membrane (2.0%). Conclusion: Among patients with low vision after cataract surgery, high myopic chorioretinopathy accounts for 24.5%, followed by ellipsoidal band defect, diabetic retinopathy, macular hole, age-related macular degeneration, and macular epiretinal membrane. The use of optical coherence tomography can detect subtle microscopic retinal structural changes that affect vision after cataract surgery. For patients with visible fundus before cataract surgery, routine optical coherence tomography contributes to evaluating the prognosis of the operation, facilitating doctorpatient communication, and improving the degree of surgical satisfaction.