目的：观察黏膜瓣泪小点成形术用于治疗慢性泪小管炎的疗效。方法：回顾性病例系列研究。收集2018年1月至2020年12月中山眼科中心眼整形科就诊的44例慢性泪小管炎患者的临床资料，分析其性别、年龄、患病眼别、临床症状、泪道冲洗结果等临床特点。采用黏膜瓣泪小点成形术进行治疗，术后随访评估其疗效。结果：44例慢性泪小管炎患者以女性为主(男女比例1:3.9)，单侧发病，多累及下泪小管(上下泪小管比例1:3)，主要表现为分泌物增多、溢泪以及内眦部位红肿，结石阳性率为95.7%，病原微生物检查结果显示以放线菌感染为主(78.3%)。大部分患者术后1周内症状得到明显改善，其中1例上下泪小管炎患者于术后2个月出现上泪小管炎复发。总体治愈率为97.8%，随访时间为(20.7±10.9)个月。结论：黏膜瓣泪小点成形术治疗慢性泪小管炎的临床疗效确切，方法可靠。
Objective: To evaluate the efficacy of mucosal flap punctoplasty in patients with chronic canaliculitis. Methods: In this retrospective serial case study, the clinical data of 44 patients with chronic canaliculitis were collected from the Oculoplastic Department of Zhongshan Ophthalmic Center at Sun Yat-sen University between January 2018 and December 2020. Demographic data such as gender, age, affected eye, clinical presentations and lacrimal duct irrigation results were analyzed. The efficacy of the procedure, symptom resolution and complications were assessed. Results: Of the 44 patients, most (male:female 1:3.9) were female, and the disease most often (upper:lower 1:3) involved the lower lacrimal canaliculus of only one eye. Main symptoms included increased secretion, tearing, and swelling of the inner canthus. Stones were present in 95.7% of patients and Actinomyces israelli was found to be the most common pathogen (78.3%). Most patients’ symptoms improved significantly within 1 week after surgery. Only one patient, who had infections in both the upper and lower canaliculi, had recurrence of upper canaliculitis 2 months after the surgery. The overall cure rate was 97.8%, and the follow-up time was (20.7±10.9) months. Conclusion: Mucosal flap punctoplasty is an efficacious and reliable method in the treatment of chronic canaliculitis.
目的：评价上睑下垂矫正术后并发上睑内翻倒睫的手术治疗效果，并分析其发生原因。方法：回顾性分析2015年1月1日至2020年6月30日因上睑下垂矫正术后并发上睑内翻倒睫在中山大学中山眼科中心接受手术治疗，随访时间6个月以上的患者资料。患者的内翻倒睫矫正手术方案根据有无合并上睑下垂过矫或者欠矫，以及原上睑下垂矫正的矫正方式进行设计。评价术前、术后患者的睑裂高度、眼睑闭合不全程度、上睑睑缘弧度、内翻倒睫矫正状态和角膜荧光素染色评分。结果：本研究共收录上睑下垂术后并发上睑内翻倒睫患者19例(20眼)，其中额肌肌瓣悬吊术后17例(18眼：上睑过矫8眼，欠矫6眼，睑裂高度正常4眼)，提上睑肌缩短术后2例(2眼：上睑过矫1例，欠矫1例)。所有患者的上睑内翻倒睫经手术治疗均完全矫正，角膜上皮荧光素染色评分显著降低(P<0.05)。上睑下垂过矫或欠矫术后均矫正满意，术前睑裂高度正常的患者矫正内翻倒睫没有改变睑裂高度。总结术中探查所见，上睑下垂矫正术后发生上睑内翻倒睫可能与多个因素相关：上睑皮肤切口位置过低；睑缘眼轮匝肌去除过多；额肌肌瓣分离不佳；额肌肌瓣在睑板上的固定位置过高；术中对睑裂高度评估不准确引起上睑下垂过矫等。结论：上睑下垂矫正术后并发上睑内翻倒睫再次手术可以达到满意的治疗效果，但手术操作较为棘手。为降低此类并发症的发生和患者多次手术的风险，应规范上睑下垂矫正手术操作，总结教训。
Objective: To evaluate the surgical treatment outcome of upper eyelid entropion after ptosis correction and analyze the complicated causes. Methods: A retrospective analysis was performed on patients who underwent surgical treatment for complicated upper eyelid entropion after ptosis correction and were followed up for more than 6 months at Zhongshan Ophthalmic Center from January 1, 2015 to June 30, 2020. Pre- and postoperative lid height, lagophthalmos, upper lid margin curvature, eyelid entropion and corneal fluorescein staining scoreswere evaluated. Results: A total of 18 cases (19 eyes) were included, among which 17 cases (18 eyes: 8 eyes of ptosis overcorrection, 6 eyes of ptosis undercorrection, and 4 eyes with normal eyelid height) were post-frontalis flap suspension, and 2 cases (2 eyes: 1 eye of ptosis undercorrection, 1 eye of ptosis overcorrection) post-levator resection. All patients had a complete correction of upper eyelid entropion and a significant reduction in corneal epithelial fluorescein staining score (P<0.05). Both the complicated ptosis undercorrection and overcorrection were treated with satisfactory outcome. Correction of entropion did not change the eyelid height in patients with preoperative normal height. The intraoperative findings showed that several factors related to original ptosis surgery may be involved in complicated upper eyelid entropion, including: the skin incision too close to the upper lid margin, excessive resection of the orbicularis oculi muscle along the eyelid margin, poor separation of the frontalis muscle flap, inappropriate eyelid plate fixation site of the frontalis muscle flap, and ptosis overcorrection caused by inaccurate evaluation of the intraoperative eyelid height, etc. Conclusion: Surgical treatment of the upper eyelid entropion secondary to ptosis correction is safe and effective, but is complicated and difficult. Skillful ptosis surgery and appropriate surgical techniques are crucial to reduce its occurrence.
目的：观察视网膜激光光凝术(laser photocoagulation，LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity，ROP)的疗效。方法：收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症，分析不同手术方式的效果。结果：LP组20例(37只眼)行视网膜激光光凝治疗，术后未出现复发，首次治愈率100%；术后(3.42±1.57)周病情控制，术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗，39只眼行单次手术后病情控制，首次治愈率88.6%，5眼术后病情未控制。术后(2.95±2.58)周病情控制，术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论：视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效，IVR复发率较高，手术方式的选择需慎重。
Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.
黏膜相关淋巴组织(mucosa-associated lymphoid tissue lymphomas，MALT)淋巴瘤是原发性眼附属器淋巴瘤(primary ocular adnexal lymphoma，POAL)中最常见的病理类型。目前，原发性眼附属器黏膜相关淋巴组织淋巴瘤(primary ocular adnexal mucosa-associated lymphoid tissue lymphoma，POAML)的临床类型和临床表现尚未被眼科医师熟练掌握，临床治疗亦无共识和指南。本文根据POAML起源位置，重点介绍各临床类型的早中期临床表现，以及针对各临床类型和病变范围的个体化治疗方法。
Mucosa-associated lymphoid tissue lymphomas (MALT) lymphoma is the most common pathologic type in primary ocular adnexal lymphoma (POAL). Currently, the clinical types and manifestations of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML) have not been well understood by ophthalmologists, and there is no consensus or guideline for clinical treatment. According to the original location, this paper focuses on the clinical manifestations of early and intermediate-stage POAML, as well as the individualized treatment for each clinical type and lesion range.
青光眼是全世界范围内不容忽视的致盲性眼病，其起病隐匿，视功能损害进展迅速，晚期预后不理想。长期发展且未行治疗的青光眼患者视神经呈进行性损害，引起视力急剧下降、视野不可逆性缺损，严重降低患者的生活质量。为了适应逐渐恶化的视功能，患者注视行为发生明显变化，由此在日常活动中引起步态行为随之改变，意外事故频繁发生。故目前对于青光眼的研究引起国内外广泛重视，虚拟现实技术(virtual reality，VR)作为青光眼早期诊断及康复治疗的新手段已被现代医学所尝试。本文具体阐述了青光眼的视觉损害与注视行为及运动行为间的联系，并总结了目前国内外关于VR诊断青光眼及作为康复治疗的相关研究。
Glaucoma is a blinding eye disease that cannot be ignored worldwide. Its onset is insidious, visual impairment is progressing rapidly, and the late prognosis is not ideal. Long-term untreated glaucoma patients show progressive damage to the optic nerve, causing a sharp decline in vision, irreversible visual field defects, and severely reducing the quality of life of the patients. In order to adapt to the gradual deterioration of visual function, the patient’s gaze behavior changes significantly, which causes the gait behavior to change in daily activities, and accidents occur frequently. Therefore, the current research on glaucoma has attracted wide attention in the nation and abroad,and virtual reality (VR) technology has been tried in modern medicine as a new method for early diagnosis and rehabilitation of glaucoma. This article specifically elaborates the relationship between the visual impairment of glaucoma and the gaze behavior and movement behavior, and summarizes the current domestic and foreign research on the diagnosis of glaucoma and the rehabilitation of VR technology.
目的：中重度甲状腺相关眼病内下壁骨性减压联合脂肪减压术的临床疗效观察。方法：回顾性分析25例(31眼)在浙江大学医学院附属第二医院眼科行内下壁骨性减压联合脂肪减压术治疗的甲状腺相关眼病患者，观察时间为2020年1月至2022年1月。术前所有患者均进行了眼眶CT检查，并对双眼视力、眼球突出、复视及双眼外观形态进行了测量。手术效果评价指标为：术后眼球突出度、视力和复视程度，并对相关数据进行统计和分析。结果：术后眼球突出度回退2~6 mm，平均回退(3.45±0.93)mm，切除眶内脂肪1.4~3.6 mL，平均切除(2.33±0.66)mL，外观恢复满意。4例患者术前存在复视，2例患者术后新发复视，术前已存在复视的患者，术后复视程度并未加重，新发的2例复视患者均为轻度复视。术后CT检查显示眼眶减压效果良好。结论：内下壁骨性减压与脂肪减压术联合，可以有效扩大眼眶容积，对眼球进行回纳，减少眼球突出程度，改善容貌外观，且手术切口隐蔽美观，具有较好的临床疗效果。
Objective: To observe the clinical efficacy of medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe thyroid associated ophthalmopathy (TAO). Methods: A retrospective analysis was performed on 25 patients (31 eyes) with moderate-to-severe TAO from January 2020 to January 2022 in Eye Hospital of Zhejiang University, who were treated with medial-inferior wall orbital decompression combined with fat decompression. All of patients were given orbital computed tomography to measure visual acuity, exophthalmos, diplopia and ocular appearance before operation. The preoperative and postoperative exophthalmos, visual acuity and diplopia before and after operation were taken as efficacy evaluating indicators. The related data was counted and analyzed statistically. Results: After operation, the reduction of exophthalmos was 2-6 mm, with an average of (3.45±0.93) mm, the volume of intrazonal fat-removal was 1.4-3.6 mL, with an average of (2.33±0.66) mL, with a satisfactory appearance. There were 4 cases of preoperative diplopia and 2 cases of new diplopia after operation, all of which were mild diplopia. Diplopia did not exacerbate after operation in the patients who had diplopia before operation. Conclusion: Medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe TAO can effectively expand orbital volume, reduce exophthalmos, improve appearance with a concealed beautiful surgical incision, showing its good clinical efficacy.
角膜病是眼科常见疾病，治疗主要以病因治疗为主。角膜疾病治疗不及时会发展为角膜云翳、角膜斑翳、角膜白斑甚至丧失视力。本例患者主要是一例因外伤形成角膜白斑致使视力低下，于三峡大学附属仁和医院行自体穿透性角膜移植(autologous penetrating keratoplasty，APK)的特殊病例。
Keratoconus is a common disease in ophthalmology and treatment is mainly based on etiology. Untreated corneal diseases can develop into corneal clouding, corneal macula, corneal leukoplakia or even loss of vision. This is a special case of a patient who underwent autologous penetrating keratoplasty (APK) in our hospital for low vision due to traumatic formation of corneal leukoplakia.
抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗视网膜静脉阻塞(retinal vein occlusion，RVO)继发黄斑水肿(macular edema，ME)的有效性及安全性已得到广泛证实。但抗VEGF治疗方案尚无统一标准。现行的治疗方案主要包括固定治疗方案、按需(pro re nata，PRN)治疗方案、稳定性标准驱使的按需(stabilization criteria-driven PRN)治疗方案、治疗与延长(treat and extend，T&E)方案。近年来不少研究综合比较了各个治疗方案在改善视功能、量化评估疾病活动性、调整随访频率等多个维度的表现，为临床医生提供选择抗VEGF治疗方案的参考依据。本文旨在回顾并总结近年来对抗VEGF药物治疗RVO继发ME的研究，阐述抗VEGF治疗方案的研究进展。
The efficacy and safety of anti-vascular endothelial growth factor (VEGF) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) have been widely confirmed. However, there is no unified standard for anti-VEGF treatment regimens. Current treatment regimens mainly include fixed treatment regimen, pro re nata (PRN) treatment regimen, stabilization criteria-driven PRN treatment regimen, and treat and extend (T&E) regimen. In recent years, many studies have compared different treatment regimens in composite dimensions,including improving visual function, assessing disease activity quantitatively and adjusting the follow-up frequency,to provide clinicians with a reference of choosing anti-VEGF treatment regimens. The purpose of this article is to review and summarize recent researches on anti-VEGF drugs in the treatment of ME secondary to RVO, and to clarify the research progress in the anti-VEGF treatment regimens.
暴露性角膜炎是角膜失去眼睑保护而暴露在空气中，引起角膜干燥、上皮细胞脱落进而继发感染的角膜炎症，多见于眼睑缺损、眼球突出、睑外翻、面神经麻痹、手术麻醉等。泪液的缺失、眼睑闭合不全、眼表暴露等因素皆会影响角膜健康，使其处于炎症、溃疡及穿孔的危险中。暴露性角膜炎治疗目的是去除暴露因素、保护角膜上皮和维持眼表湿润，目前常用的治疗手段有手术治疗与药物治疗，有些是暂时性的，有些是永久性的。
Exposure keratitis is an inflammation of the cornea that occurs when the cornea loses the protection of the eyelid and is exposed to air, resulting in dryness, epithelial exfoliation, and secondary infection. Most of them are found in eyelid defect, protopsis, eyelid ectropion, facial palsy, and anesthesia. Loss of tears, lagophthalmos and exposed ocular surface all affect the health of the cornea, putting it at risk of inflammation, ulceration, and perforation. The purpose of treatment is to remove exposure factors, protect the corneal epithelium and keep ocular surface moist.Currently, the commonly used treatments are surgical treatment and medical treatment, and some of them are temporary while others are permanent.
在大力发展精准医疗的时代背景下，北京大学第三医院眼科中心率先建立干眼精准医疗平台。通过规范和优化干眼诊疗流程，为患者提供个性化的治疗方案和预防指导意见，有效提高了干眼诊断的精确性与治疗的有效性，同时提升了干眼门诊接诊效能，改善了患者就诊体验。本文将从干眼精准医疗平台体系的建设内容、标准化的检查流程、个性化的诊疗方案等方面进行阐述，并结合实际临床案例，综合分析北京大学第三医院在干眼精准医疗方面进行的探索，展望干眼精准医疗平台的前景与未来。
In the era of developing precision medicine, the Ophthalmic Center of Peking University Third Hospital has taken the lead in establishing a dry eye precision medical platform. By standardizing and optimizing the diagnosis and treatment process of dry eye, this center provides personalized treatment plan and prevention guidance for patients, effectively improves the accuracy of dry eye diagnosis and the effectiveness of treatment, at the same time,improves the reception efficiency of dry eye clinic, and improves the patient’s clinic experience. In this paper, the construction content, standardized inspection process and personalized diagnosis and treatment scheme of dry eye precision medicine platform system will be described. Combined with the actual clinical cases, the exploration of the Peking University Third Hospital in dry eye precision medicine will be comprehensively analyzed, and the future of dry eye precision medical platform will be prospected.
