马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病，约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者，因患有MFS致双眼晶状体半脱位伴双眼并发性白内障，先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术，术后保留低度近视，随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。

Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.

目的：探讨提高眼科喉罩全身麻醉患儿在麻醉后恢复室(postanesthesia care unit, PACU)复苏质量与效率的整体护理策略。方法：选取2020年1月—2023年12月在中山大学中山眼科中心行眼科全身麻醉并保留喉罩进入PACU复苏的24 180例小儿患者，总结患儿在PACU复苏的护理措施及复苏质量。结果：所有患儿经复苏期综合护理后均顺利拔除喉罩完成麻醉复苏，未发生苏醒期二次插管或非计划转院治疗。采取个性化的整体护理策略后，喉罩全身麻醉患儿PACU平均复苏时间明显缩短。部分术后常见并发症(术后躁动，低氧血症和呼吸道梗阻)和护理不良事件(留置针脱落和眼包脱落)发生率逐年降低，经治疗和护理后均获得改善。结论：针对眼科全身麻醉的患儿特点，在麻醉复苏期采取个性化的整体护理策略，有利于顺利完成麻醉复苏，降低麻醉并发症和护理不良事件的发生率，提高复苏质量效率，满足眼科日间手术快速康复的需求。

Objective: Exploring holistic nursing strategies to improve the quality and efficiency of postanesthesia care unit (PACU) resuscitation in childrenpatients undergoing ophthalmic laryngeal mask anesthesia. methods: Selecting a total of 24,180 children patients who underwent general anesthesia and retained laryngeal mask airway for PACU resuscitation at Sun Yat-sen Ophthalmic Center of Sun Yat sen University from January 2020 to December 2023, this study reviews and summarizes the nursing measures and resuscitation quality of children patients undergoing PACU resuscitation. Results: All patients underwent comprehensive care during the recovery period and successfully removed the laryngeal mask to complete anesthesia recovery. There were no cases of secondary intubation or unplanned transfer for treatment during the recovery period. After adopting personalized holistic nursing strategies, the average recovery time of PACU in children under laryngeal mask anesthesia was significantly shortened.The incidence of common postoperative complications(postoperative agitation, hypoxemia and respiratory obstruction)and adverse nursing events (indwelling needle falls off, eye bandage fall off)have been decreasing year by year. These complications have been improved after treatment and care. Conclusions: Based on the characteristics of children patients undergoing general anesthesia in ophthalmology, adopting personalized holistic nursing strategies during the anesthesia recovery period is beneficial for successfully completing anesthesia recovery, reducing the incidence of anesthesia complications and adverse nursing events, improving the quality and efficiency of recovery, and meeting the needs of rapid recovery in ophthalmic day surgery.

目的：分析全身麻醉在青光眼日间手术中的应用特点。方法：回顾性收集2023年1月—6月于中山大学中山眼科中心在全身麻醉下接受青光眼日间手术患者71例(全麻组)，并选择同时期在局部麻醉下接受青光眼手术患者154例(局麻组)，同时以年龄为配对因素行倾向评分匹配分析。主要观察指标为患者术后离院时间，并对患者的手术时间、手术前后眼压、视力、中央前房深度、周边前房深度、甘露醇使用情况以及术后较术前眼压降低差值进行分析。结果：与局麻组比较，全麻组患者术后离院时间未有延长(P>0.05)；全麻组患者术前眼压较高(P<0.001)、中央前房深度浅(P=0.018)、周边前房深度浅(P<0.001)；且全麻组患者在术后较术前眼压降低差值更大(P=0.002)。组间术后中央前房深度、术后使用甘露醇者比例及术后视力提高者比例比较差异均无统计学意义(P>0.05)。结论：术前眼部条件较差的青光眼患者能在全身麻醉下完成日间手术，且不延长术后离院时间。

Objective: To analyze the application of general anesthesia in the ambulatory glaucoma surgery. Methods: This retrospective study collected 71 patients who underwent ambulatory glaucoma surgery withgeneral anesthesia at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2023 to June 2023, and 154 patients who underwent similar glaucoma surgery with local anesthesia during the same period. Age differences between the two groups were balanced by propensity score-matched analysis. The main outcome measures were the patient's post-operative discharge time, and the secondary end points included the duration of surgery, the patients' preoperative and postoperative intraocular pressure (IOP), visual acuity status, central anterior chamber depth, peripheral anterior chamber depth, mannitol use, the difference in IOP reduction after surgery compared to preoperative. Results: After propensity score-matched analysis, as compared with group L, general anesthesia did not prolong the patient's post-operative discharge time(P>0.05).Patients in the group G displayed significant higher IOP (P<0.001), shallower central anterior chamber depth (P=0.018), and shallower peripheral anterior depth (P<0.001). The dramatic reductions in IOP after surgery were exhibited in group G as compared with group L(P=0.002). There were no statistically significant differences in postoperative central anterior chamber depth, incidences in postoperative mannitol use, as well as incidences in visual acuity improvement on the first day after surgery. Conclusion: Glaucoma patients with poor preoperative ocular conditions were able to complete the complex glaucoma surgery under general anesthesia without prolonging their post-operative discharge time.

前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。

前段巨眼(anterior megalophthalmos, AM)是一种罕见的双侧非进展性先天性眼前段扩大疾病，表现为大角膜、角膜厚度正常或轻中度变薄、前房明显加深、睫状环扩大和悬韧带松弛。早期症状可仅表现为角膜散光和屈光不正等，并发性白内障和晶状体脱位是AM患者视力下降的主要原因。眼前段解剖结构的异常使AM患者的白内障手术具有很大的挑战性。首先，极端前房深度引起的有效晶状体位置(ELP)预测误差及公式选择不当是导致其术后较大屈光误差的主要原因；其次，悬韧带松弛易导致晶状体脱位、后囊膜破裂和玻璃体脱出等术中并发症的发生；由于超大囊袋及悬韧带松弛，人工晶状体(IOL)偏心甚至脱位也是术后常见的并发症。因此，需根据患者悬韧带情况、晶状体混浊程度采取合适的手术方式及谨慎选择IOL的类型。采用手法小切口晶状体囊外摘除术，可避免超声乳化的高灌注压对悬韧带的进一步损伤，增加手术的安全性；植入光学面及襻宽大的IOL术后具有较好的稳定性；新公式如Barrett Universal Ⅱ、Kane和EVO等公式具有较好的屈光预测准确性。然而，目前关于AM患者的白内障手术治疗报道仍属于个案报道，未来还需要更大样本量的临床研究进一步证实。

目的：分析有意愿接受准分子激光角膜屈光手术治疗近视的患者在术前检查后未行手术的原因。方法：选取2015年1月至2017年6月在安徽医科大学附属第一医院眼科激光中心检查的近视患者，分析其中未行激光手术的原因。结果：共2 875例患者准备接受准分子激光角膜屈光手术，其中821例(28.6%)检查后未进行手术，男462例(56.3%)，女359例(43.7%)，年龄18~51(23.69±5.85)岁。821例中社会心理因素影响484例(59.0%)，角膜薄或角膜厚度不足182例(22.2%)，超高度近视(>10.00 D)100例(12.2%)，高眼压19例(2.3%)，弱视13例(1.6%)，角膜曲率异常11例(1.3%)，眼底病变7例(0.9%)，角膜变性3例(0.4%)，其他2例(0.2%)。结论：近视治疗术前检查后未进行准分子激光角膜屈光手术的原因多种多样，其中社会心理因素及角膜厚度不足是最主要的原因。术前详细检查，严格掌握手术适应证和禁忌证以及充分医患沟通是手术安全的保障。

Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054 (71.4%) of them received refractive surgery. Among 821 (28.6%) patients who did not get laser refractive keratomileusis, 462 (56.3%) were male and 359 (43.7%) were female, aged 18–51 years (range, 23.69±5.85 years). The most common reason for not offering refractive surgery were social psychological factors (59.0%), low central corneal thickness (22.2%), high myopia (12.2%), high intraocular pressure (2.3%), poor corrected visual acuity (1.6%), corneal topography anomaly (1.3%), retinal disease (0.9%), corneal (0.4%) and other diseases (0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.

目的：探讨县级基层医院白内障患者术前焦虑情况，以便改善护理流程。方法：本研究为回顾性研究，收集河源光明眼科医院2017年1至9月2 182例行白内障复明手术患者的术前焦虑视觉模拟量表(The Anxiety Visual Analogue Scale，VAS-A)评分及阿姆斯特丹术前焦虑与信息需求表(Amsterdam Preoperative Anxiety and Information Scale，APAIS)评分，采用t检验和Spearman相关性检验进行术前焦虑情况分析。结果：2 182例白内障手术患者VAS-A焦虑评分为4.74±1.93，APAIS焦虑评分为6.46±1.66，男性患者术前焦虑程度低于女性患者，患者术前焦虑程度与年龄呈低度负相关。结论：两种术前焦虑评分均能反映患者术前焦虑程度，可根据其对麻醉或手术信息需求度的不同选择相应的护理对策，以缓解患者术前焦虑，改善护理质量。

Objective: To investigate the preoperative anxiety in patients with cataract in a township hospital. Methods: A retrospective study was conducted on preoperative anxiety of 2 182 patients with cataract according to the Anxiety Visual Analogue Scale (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) from Jan 1, 2017 to Sep 30, 2017 in Heyuan Guangming Eye Hospital. Student’s t-test and Spearman correlation were used to evaluate the preoperative anxiety. Results: The score of preoperative anxiety was 4.74±1.93 with the VAS-A and was 6.46±1.66 with the APAIS. The preoperative anxiety in male was lower than that in female, and the degree of the preoperative anxiety was negatively correlated with age. Conclusion:The preoperative anxiety of patients with cataract can be properly evaluated using either the VAS-A or the APAIS.The nursing care should be adjusted corresponding to patients’ different needs of the information about anesthesia and surgery in order to alleviate the preoperative anxiety and improve the nursing care.

目的：探讨大泡性角膜病变(bullous keratopathy，BK)患者行飞秒激光辅助的角膜内皮移植术(endothelium keratoplasty，EK)的围手术期护理。方法：回顾性分析在南京总医院眼科行飞秒激光辅助角膜内皮移植的BK20例患者，分析并总结患者术前的心理疏导、术前准备、眼科检查、术中如何配合医生、术后特殊体位、高眼压的护理及如何正确用药和出院健康教育等。结果：患者得到及时、有效的护理，术后视力均有所提高，内皮贴伏好，无排斥反应及其他并发症的发生。结论：通过对患者围手术期的护理，可提高护理质量，缩短患者住院时间。

Objective: To observe the perioperative nursing of femtosecond laser-assisted corneal endothelial transplantation in the treatment of patients with bullous keratopathy. Methods: A retrospective analysis of 20 patients with bullous keratopathy with femtosecond laser-assisted corneal endothelial transplantation in our department. The preoperative psychological counseling, preoperative preparation, ocular examination, how to cooperate with the doctors in operation, nursing of special position, high intraocular pressure after surgery, how to use eye drops correctly and health education after discharge were summarized. Results: Nursing were performed to the patients timely and effectively. Postoperative visual acuity of all the patients were improved, the endothelial and corneal stroma bed are well combined and no graft rejection and other complications occurred in the patients postoperatively. Conclusion: We concluded that the quality of nursing was improved and the time of hospitalization was shortened after perioperative nursing.

角膜屈光手术是目前屈光手术的主流术式，随着全飞秒、全激光手术方式的发展，手术变得更加安全精准，不仅角膜创伤小，术后恢复时间也进一步缩短。角膜具有屈光特性和典型的生物软组织力学特性，角膜力学特性不仅参与维持角膜形态，影响角膜手术尤其屈光手术的效果及预后，而且还与部分角膜疾病的发生和发展密切相关。近年来生物力学研究发展迅速，其在眼部疾病的诊疗中发挥着越来越重要的作用。角膜生物力学的变化与术前角膜的形态、不同手术方式的选择、术后角膜厚度的改变等多种因素相关，但手术导致的角膜自身形态改变是不可逆的，若术后角膜生物力学的变化较大，可能会引起医源性角膜扩张、继发性圆锥角膜等并发症的发生。为了规避术后角膜扩张风险和指导个性化的术式选择，了解角膜生物力学特性的影响至关重要。文章对角膜的基础结构、角膜生物力学特性、生物力学测量方法和不同术式及不同角膜瓣厚度术后生物力学变化的研究进展进行综述，为近视患者的个性化精准治疗提供理论指导。

Corneal refractive surgery is currently main stream of refractive surgery. With the development of femtosecond and laser surgery, the surgery has become safer and more accurate, resulting in less corneal trauma and a shorter postoperative recovery time. In recent years, biomechanics research has rapidly progressed, and its clinical application has gradually increased. The cornea not only possesses refractive properties but also exhibits typical biological soft tissue mechanical properties. Corneal mechanical properties not only play a role in maintaining corneal morphology but also influence the outcome and prognosis of corneal surgery, especially refractive surgery, and are closely related to the occurrence and development of some corneal diseases. Corneal refractive surgery involves cutting the cornea according to the patient's diopter, which disrupts the integrity of the cornea and inevitably affects its biomechanical stability. Changes in corneal biomechanics are associated with various factors, such as preoperative corneal morphology, the selection of different surgical methods, and postoperative changes in corneal thickness. However, the self-morphology changes caused by surgery are irreversible. If the postoperative changes in corneal biomechanics are significant, it may lead to complications such as postoperative corneal dilation and secondary keratoconus. To avoid postoperative iatrogenic corneal dilation and guide personalized surgical choice, it is crucial to understand the limits of influence of corneal biomechanical properties. This article reviews the research progress regarding corneal biomechanical properties and changes associated with corneal refractive surgery.

目的：比较单一EYESi虚拟手术模拟器(Dry-lab)、Wet-lab以及两种方式联合教学在超声乳化白内障吸除显微手术培训中的效果及差异，以期探索更科学高效的教学方式。方法：选取中山大学中山眼科中心接受住院医师规范化培训的1年级住院医师18名，随机分为Dry-lab组、Wet-lab组和联合组，每组各6人，分别接受8次有效Dry-lab训练、8次Wet-lab训练、4次有效Dry-lab训练联合4次Wet-lab训练。培训前后问卷调查评估三种教学方式的模拟效果与学员满意度，并在猪眼模型上考核超声乳化白内障吸除手术的三个主要步骤，以评估学员的培训效果。结果：Dry-lab与Wet-lab训练均能有效帮助学员学习使用显微器械，操作手感较好。但在立体感(P=0.007)、与人眼操作相比近似度(P<0.001)以及对掌握技术的帮助度(P=0.003)上，Wet-lab优于Dry-lab训练；而在缩短培训用时(P<0.001)上，Dry-lab培训更具优势。联合培训模式培训效果优于单一Wet-lab训练(P=0.014)和模拟器培训(P=0.012)，整体满意度高于Wet-lab训练(P=0.042)和Dry-lab培训(P=0.042)。结论：Dry-lab与Wet-lab训练在超声乳化白内障吸除显微手术培训中各有优势，而两者相结合的教学模式更为高效，培训效果更佳，整体满意度高。

Objective: To compare the effects and distinctions among three methods of phacoemulsification training: EYESi simulator (Dry-lab), Wet-lab, and a combined approach, in order to find out more scientific and efficient teaching method. Methods: 18 first-year residents undergoing residency training at Zhongshan Ophthalmic Center, Sun Yatsen University were randomly assigned to three groups: Dry-lab, Wet-lab, and Combined. Each group, consisting of 6 individuals, underwent a specific training regimen—8 sessions of effective simulator training for the Dry-lab group, 8 Wet-lab sessions for the Wet-lab group, and a combination of 4 effective simulator sessions with 4 Wet-lab sessions for the Combined group. The questionnaires were administered to assess simulation effects and student satisfaction before and after each training sessions. Additionally, the training effects were recorded in the three main steps of phacoemulsification cataract extraction surgery on a pig eye model. Results: Both the EYESi simulator and Wet-lab were proved to be effective in facilitating the learning of microscopic instrument use with commendable operating experience. However, Wet-lab is superior to the virtual simulator in terms of stereoscopic sensation (P=0.007), similarity to the human eye (P<0.001), and assistance in mastering techniques(P=0.003). Simulator training is found to be more advantageous in shortening the overall training time (P<0.001). The training effect of the joint training mode is better than that of single Wet-lab training (P=0.014) and simulator training (P=0.012), and the overall satisfaction is higher than that of Wet-lab training (P=0.042) and simulator training (P=0.042). Conclusion: The EYESi virtual surgery simulator and Wet-lab training have their advantages respectively in training for phacoemulsification cataract extraction microsurgery, and the combined teaching mode is more efficient, with better training effects and overall satisfaction.

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.