目的：应用活体共聚焦显微镜（in vivo confocal microscopy，IVCM）观察视网膜激光光凝术对角膜上皮下神经的影响。方法：收集行视网膜激光光凝术的患者 36 例 46 眼，分为糖尿病性视网膜病变（diabetic retinopathy，DR）组（14 例 22 眼）与非DR组（22 例 24 眼），在治疗前及治疗后 1 周、1 个月应用IVCM采集两组角膜基底层下神经纤维图像，使用Image J和Neuron J软件计算其长度及密度。结果：DR组术前角膜神经纤维主干密度（corneal nerve fiber density，CNFD）、角膜神经纤维分支密度（corneal nerve branch density，CNBD）和角膜神经纤维长度（corneal nerve fiber length，CNFL）均低于非DR组，角膜神经弯曲度（corneal nerve fiber tortuosity，CNFT）高于非DR组。两组间角膜神经总分支节点密度（corneal total branch node，CTBN）无显著差异。DR组光凝术后CNFD，CNFL测量值持续降低，术前、术后 1 周、术后 1 个月 3 个观察时段两两之间的差异有统计学意义；光凝术后 1 个月CNFT与术前的差异有统计学意义。非DR组光凝术后CNFD，CNFL持续降低，术前、术后 1 周、术后1个月3个观察时段两两之间的差异有统计学意义；CNBD持续升高，术后 1 周、术后 1 个月测量值与术前的差异有统计学意义；CNFT持续升高，术后 1 周、术后 1 个月测量值与术前的差异均有统计学意义。结论：IVCM结合附属软件可量化评估角膜上皮下神经，糖尿病状态和视网膜激光光凝均可对角膜上皮下神经造成损伤。

Objective: To evaluate the effect of retinal photocoagulation on corneal sub-basal nerve using in vivo confocal microscopy （IVCM）. Methods: In this study, 46 eyes of 36 cases were enrolled. All patients were divided intotwo groups, 22 eyes in the diabetic retinopathy （DR） group and 24 eyes in the non-diabetic retinopathy （NDR） group. IVCM images were obtained to observe sub-basal nerve plexus before retinal photocoagulation and 1 week, 1 mouth after the treatment. Image J and Neuron J software were used for analysis. Results: In the DR group, before retinal photocoagulation, the corneal nerve fiber density （CNFD）, corneal nerve branch density （CNBD） and corneal nerve fiber length （CNFL） were lower than those in the NDR group while the corneal nerve fiber tortuosity （CNFT） was higher than that in the NDR group. There were no significant differences in corneal total branch node （CTBN） between two groups. The CNFD, CNFL were decreased constantly in the DR group. No statistical significance was observed in either CNBD or CTBN at any time point. After the treatment, the CNFT was enhanced; however, significant differences were noted between 1 week and 1 month. In the NDR group, CNFD, CNFL were declined continually to 1 month, whereas CNBD was increased. CTBN was slightly elevated at each time point without statistical significance. After treatment, CNFT was significantly increased, whereas no statistical significance was observed between 1 week and 1 month. Conclusion: IVCM combined with assistant software could be used to quantify corneal sub-basal nerve fiber. Retinal photocoagulation as well as diabetes mellitus can injure corneal sub-basal nerve fiber.

目的：调查引导式教育训练对视力障碍学生生活质量的影响。方法：前瞻性随机对照临床研究。选取2020年在泉州特殊教育学校就读视力障碍学生，按照入组条件随机分为引导式教育训练组和对照组，引导式教育训练组进行引导式教育训练，对照组进行常规康复训练。采用中文版低视力者生活质量量表(Chinese-version low vision quality of life questionnaire，CLVQOL)评估视力障碍学生的基线和训练3个月的生活质量，并进行比较分析。结果：72例视力障碍学生全部完成了基线和随访时的生活质量问卷调查。进行基线检查时，各组CLVQOL评分总分差异无统计学意义(P>0.05)。3个月后，各组CLVQOL评分总分均增加，引导式教育训练组从基线59(48.5，80.5)上升到105(97.5，119.5)，差异有统计学意义(Z=?4.781，P<0.001)；对照组从基线69(56，85)上升到106(80，112)，差异有统计学意义(Z=?4.438，P<0.001)；引导式教育训练组在CLVQOL评分总分(P=0.021)及阅读和精细工作维度(P=0.004)、日常生活能力维度(P=0.003)的评分差值均高于对照组。结论：引导式教育训练是一种重要的低视力康复训练方法，可以明显提高患者的生活质量。

Objective: To investigate the effect of conductive education training on the quality of life in visually impaired students. Methods: It was a prospective randomized controlled trial. The visual impairment students who had registered in Quanzhou Special Education School in 2020 were selected and randomly divided into two groups: conductive education training group and control group. The conductive education training group received conductive education training, while the control group received routine rehabilitation training. Chinese version low vision quality of life questionnaire (CLVQOL) was used to assess the quality of life of low vision students at baseline and 3 months after training, and comparative analysis was conducted. Results: All 72 students with visual impairment completed CLVQOL surveys. At baseline, there was no significant difference in total CLVQOL scores between groups. After 3 months, overall CLVQOL scores increased in both groups, from baseline 59 (48.5, 80.5) to 105 (97.5, 119.5) in the conductive education group (Z=-4.781, P<0.001), and 69 (56, 85) to 106 (80, 112) in the control group (Z=-4.438, P<0.001). The total score of CLVQOL (P=0.021), reading and fine work subscale (P=0.004), and daily activities subscale (P<0.003) in the conductive education training group were higher than those in the control group. Conclusion: Conductive education training is an important method of low vision rehabilitation training, which can significantly improve the quality of life of patients.

目的：调查引导式教育训练对视力障碍学生生活质量的影响。方法：前瞻性随机对照临床研究。选取2020年在泉州特殊教育学校就读视力障碍学生，按照入组条件随机分为引导式教育训练组和对照组，引导式教育训练组进行引导式教育训练，对照组进行常规康复训练。采用中文版低视力者生活质量量表(Chinese-version low vision quality of life questionnaire，CLVQOL)评估视力障碍学生的基线和训练3个月的生活质量，并进行比较分析。结果：72例视力障碍学生全部完成了基线和随访时的生活质量问卷调查。进行基线检查时，各组CLVQOL评分总分差异无统计学意义(P>0.05)。3个月后，各组CLVQOL评分总分均增加，引导式教育训练组从基线59(48.5，80.5)上升到105(97.5，119.5)，差异有统计学意义(Z=-4.781，P<0.001)；对照组从基线69(56，85)上升到106(80，112)，差异有统计学意义(Z=-4.438，P<0.001)；引导式教育训练组在CLVQOL评分总分(P=0.021)及阅读和精细工作维度(P=0.004)、日常生活能力维度(P=0.003)的评分差值均高于对照组。结论：引导式教育训练是一种重要的低视力康复训练方法，可以明显提高患者的生活质量。

Objective: To investigate the effect of conductive education training on the quality of life in visually impaired students. Methods: It was a prospective randomized controlled trial. The visual impairment students who had registered in Quanzhou Special Education School in 2020 were selected and randomly divided into two groups: conductive education training group and control group. The conductive education training group received conductive education training, while the control group received routine rehabilitation training. Chinese version low vision quality of life questionnaire (CLVQOL) was used to assess the quality of life of low vision students at baseline and 3 months after training, and comparative analysis was conducted. Results: All 72 students with visual impairment completed CLVQOL surveys. At baseline, there was no significant difference in total CLVQOL scores between groups. After 3 months, overall CLVQOL scores increased in both groups, from baseline 59 (48.5, 80.5) to 105 (97.5, 119.5) in the conductive education group (Z=?4.781, P<0.001), and 69 (56, 85) to 106 (80, 112) in the control group (Z=?4.438, P<0.001). The total score of CLVQOL (P=0.021), reading and fine work subscale (P=0.004), and daily activities subscale (P<0.003) in the conductive education training group were higher than those in the control group. Conclusion: Conductive education training is an important method of low vision rehabilitation training, which can significantly improve the quality of life of patients.