近年来，眼科人工智能(artificial intelligence，AI)迅猛发展，眼底影像因易获取及其丰富的生物信息成为研究热点，眼底影像的AI分析在眼底影像分析中的应用不断深入、拓展。目前，关于糖尿病性视网膜病变(diabetic retinopathy，DR)、年龄相关性黄斑变性(age-related macular degeneration，AMD)、青光眼等常见眼底疾病的临床筛查、诊断和预测已有较多AI研究，相关成果已逐步应用于临床实践。除眼科疾病以外，探究眼底特征与全身各种疾病之间的关系并据此研发AI诊断系统已经成为当下的又一热门研究领域。AI应用于眼底影像分析将改善医疗资源紧缺、诊断效率低下的情况，为多种疾病的筛查和诊断开辟“新赛道”。未来眼底影像AI分析的研究应着眼于多种眼底疾病的智能性、全面性诊断，对复杂性疾病进行综合性的辅助诊断；注重整合标准化、高质量的数据资源，提高算法性能、设计贴合临床的研究方案。
In recent years, artificial intelligence (AI) in ophthalmology has developed rapidly. Fundus image has become a research hotspot due to its easy access and rich biological information. The application of AI analysis in fundus image is under continuous development and exploration. At present, there have been many AI studies on clinical screening, diagnosis and prediction of common fundus diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma, and related achievements have been gradually applied in clinical practice. In addition to ophthalmic diseases, exploring the relationship between fundus features and various diseases and developing AI diagnostic systems based on this has become another popular research field. The application of AI in fundus image analysis will improve the shortage of medical resources and low diagnostic efficiency, and open up a “new track” for screening and diagnosis of various diseases. In the future, research on AI analysis of fundus image should focus on the intelligent and comprehensive diagnosis of multiple fundus diseases, and comprehensive auxiliary diagnosis of complex diseases, and lays emphasis on the integration of standardized and high-quality data resources, improve algorithm performance, and design clinically appropriate research program.
目的：探讨青光眼日间手术患者的自我管理行为现状及影响因素分析。方法：采用便利抽样法选取2021年9月—2022年5月于广州市某三级甲等眼科专科医院就诊的223例青光眼日间手术患者。采用一般资料调查表、青光眼自我管理行为量表、慢性疾病自我效能量表和青光眼知识学习问卷进行问卷调查。结果：青光眼日间手术患者的自我管理行为得分为(54.03±6.95)分，其中生活调整维度得分最低。慢性病自我效能与自我管理行为呈正相关(r=0.368, P<0.001)。疾病知识与自我管理行为无显著相关性(r=0.077, P=0.252)。多因素线性回归分析结果显示，患者的文化程度(P<0.001)和自我效能(P=0.028)是自我管理行为的影响因素，可解释自我管理行为总变异的12.4%。结论：青光眼日间手术患者具有良好的自我管理行为，较低的自我效能和文化程度是自我管理行为的危险因素，因此应优先提高患者的自我效能，并提供个性化教育。
Objective: To determine self-management and its association with self-efficacy and knowledge among glaucoma patients undergoing day surgery. Methods: A total of 223 glaucoma patients were recruited from September 2021 to May 2022and they were investigated with the Glaucoma Self Management Questionnaire (GSMQ), The Self- Efficacy in Chronic Disease Scale (SECD-6), and the glaucoma knowledge questionnaire. Results: Of the 223 study participants, the study population had a total GSMQ score of 54.03±6.95 with the lowest score found in the life adjustment dimension. The total SECD-6 score was showing a significantly positive correlation with the total GSMQ score(r =0.368, P <0.001). The total score of disease knowledge was without significant correlation with the total GSMQ score (r =0.077, P =0.252). Multivariate linear regression analysis showed that self-efficacy (P <0.001) and education level was independently associated with self-management(P =0.028). Conclusions: Glaucoma patients undergoing daytime surgery demonstrated good overall self-management, yet further improvement was required in terms of life adjustment. Low self-efficacy and educational level were identified as risk factors for self-management. Therefore, self-management programs should prioritize enhancing patients' self-efficacy and delivering individualized education.
目的：了解湿性老年性黄斑变性(age-related macular degeneration,AMD)患者自我感受负担(self-perceived burden,SPB)现状及其影响因素。方法：采用方便抽样法选取2021年1月至11月在中山大学中山眼科中心就诊的204例湿性AMD患者为研究对象，采用一般资料调查表、SPB量表、家庭支持自评量表、医学应对问卷对其进行测评。结果：患者SPB得分是(21.98±6.68)分，总体属于轻度SPB。湿性AMD患者的SPB水平与家庭支出(r=?0.326, P<0.001)和面对应对(r=?0.365, P<0.001)呈负相关，与回避(r=0.456, P<0.001)及屈服(r=0.310, P<0.001)应对方式呈正相关性。多重线性回归显示，独居、高龄、自费、双眼患病及采用回避应对的患者的SPB更高，而高文化水平、高家庭支持的患者SPB较轻。结论：湿性AMD患者有轻度SPB，但仍存在改善空间，医护工作者在工作中应重点关注高龄、文化程度低、家庭收入低、自费、独居、双眼患病及低视力的患者，及时进行心理疏导，减轻患者的SPB水平。
Objective: To understand the current status and influencing factors of self-preceived burden (SPB) in patients with wet age-related macular degeneration (AMD). Methods: 204 patiens with wet AMD who were treated in Zhongshan Ophthalmic Center, Sun Yat-sen University from January to November 2021 were enrolled as the study subjects with convenience sampling method. A general information questionnaire, SPB scale, family support self-assessment scale, and medical coping questionnaire were collected from the subjects for assessment. Results: The patient’s SPB score was 21.98±6.68, which is generally mild SPB. The SPB level of patients with wet AMD was negatively correlated with family support (r=-0.326, P<0.001) and coping (r=?0.365, P<0.001), and were positively correlated with avoidance (r= 0.456,P<0.001), and surrender (r=0.310, P<0.001) coping style. Multiple linear regression showed that the patients who lived alone, were elder and self-funded, had binoclur diseases and used avoidance coping, had higher SPB. While the patients with high education and family support had lower SPB. Conclusions: It is still needed to pay attention to the patients with AMD having mild SPB. Medical workers should focus on patients with elder age, low education level, low family income, self-funded, living alone, binocular disease and low vision in their work, and provide timely psychological counseling to reduce the SPB level of patients.
目的：了解医学专业学位硕士(专硕)研究生培养并轨住院医师规范化培训制度下的眼科专硕科研能 力现状，并提出提升科研能力的对策。方法：对哈尔滨医科大学三所附属医院眼科学76名不同年级 专硕研究生的科研能力现状、阻碍科研学习的因素、科研训练意愿等进行问卷调查。结果：在目前 的培养模式下，专硕科研和临床知识基础相对薄弱及临床学习任务繁重是科研学习的主要障碍。 结论：提出教学基地可以因需施教、提供多模式科研训练；强化临床诊疗培训为科研思维培养助 力；导师可以结合新时代发展背景优化科研选题策略、拓宽学生科研视野等措施。
Objective: To understand the current situation of scientific research ability of postgraduates with professional degrees in ophthalmology and put forward improvement measures. Methods: A questionnaire survey was conducted on the current situation of scientific research ability, scientific research obstacles and scientific research training willingness, 76 postgraduate students of different grades majoring in ophthalmology of three affiliated hospitals of Harbin Medical University were involved. Results: Under the merging residency training system, the foundation of scientific research and clinical knowledge of postgraduates is relatively weak, and the heavy clinical learning task were the main obstacles to scientific research of postgraduates. Conclusion: It is proposed that the teaching bases could provide multi-mode scientific research training to cater to students' individual needs. Not only clinical diagnosis and treatment training could be strengthened to cultivate students’ scientific research thinking, but scientific research topic selection strategy could be optimized by to meet the demand for development of times and broaden students’ scientific research vision.
目的：了解干眼患者自我护理能力水平并分析其影响因素。方法：选取2022年2月—6月在中山大学中山眼科中心就诊的干眼患者为研究对象，采用一般资料调查表、自我护理能力量表、一般自我效能感量表对患者进行调查分析。结果：共调查293例干眼患者，其自我护理能力评分为(113.34±9.98)分，处于中等水平。相关性分析中干眼患者的自我护理能力总分与自我效能感得分呈正相关(r=0.421，P<0.001)，多重线性回归分析显示，累计屏幕使用时间>10 h/d、合并全身疾病、低自我效能感评分是干眼患者自我护理能力的危险因素(P<0.05)。结论：干眼患者自我护理能力水平处于中水平，仍需加强。医护工作者在工作中应重点关注屏幕使用时间长、合并全身疾病及自我效能感低的患者，并制定相应的护理对策，以改善患者的自我护理能力水平。
Objective: To understand the self-care ability of patients with dry eye and analyze its infuencing factors. Methods: A total of 293 patients with dry eye were selected from Zhongshan Ophthalmic Center, Sun Yat-sen University from February 2022 to June 2022, the general data Questionnaire the general self-efcacy scale, and the self-care ability scale survey were collected. Results: A total of 293 patients with dry eye were surveyed, and the self-care ability score was 113.34±9.98, which was at the medium level. The total score of self-care ability, the scores of self-concept, self-care responsibility, health knowledge level and self-care skills of patients with dry eye were positively correlated with the scores of self-efcacy (r=0.421, all P<0.001).Multiple linear regression analysis showed that cumulative screen usage time>10 hours/day, comorbid systemic diseases, and low self-efficacy scores were risk factors for self-care ability in patients with dry eye (P<0.05). Conclusions: Te self-care ability of patients with dry eye disease is at a medium level, and still needs to be strengthened. Medical workers should focus on patients with prolonged screen usage, comorbid systemic diseases, and low self-efficacy in their work, and tailor relevant nursing strategies to improve their self-care abilities.
原发性干燥综合征(primary Sj?gren’s syndrome，SS)是一种主要累及外分泌腺体的自身免疫性疾病，患者通常因为严重的干眼症状首先就诊于眼科，大多数临床医师对原发性干燥综合征相关性干眼(Sj?gren’s syndrome dry eye disease，SS-DED)认识不足，可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展，将有助于发现SS-DED的真面目，并可能从新的角度阐释其发病机制，为其诊断、分类及治疗提供新的思路。SS-DED的治疗没有特效的药物，大多数患者需接受多种方法的治疗，以了解哪些方法最有效。
Primary Sj?gren’s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sj?gren’s syndrome probably leading to misdiagnosis or missing the diagnosis.The diagnosis of Sj?gren’s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment.
眼肌型重症肌无力(ocular myasthenia gravis，OMG)是一种累及神经肌肉接头突触后膜的自身免疫性疾病。OMG波动性的临床特征易导致较高的漏诊率和误诊率，严重影响患者的生活质量。因此，检测方法在早期确诊OMG中发挥重要作用。本文围绕临床检查、新斯的明试验、自身抗体检测、电生理检测等方面对OMG检测方法作一综述，以期为OMG的早期确诊提供有益的指导。
Ocular myasthenia gravis (OMG) is an autoimmune disease involving the postsynaptic membrane of the neuromuscular junction. The fluctuation of OMG and the clinical characteristics of fatigue easily lead to a high rate of missed diagnosis and misdiagnosis, which seriously affects the quality of life of patients. Therefore, detection methods play an important role in the early diagnosis of OMG. In this paper, OMG detection methods were reviewed in clinical examination, neostigmine test, autoantibody detection, electrophysiological detection, and other aspects, in order to provide useful guidance for the early diagnosis of OMG.
目的：调查民航飞行员视频终端疲劳综合征(visual display terminal syndrome，VDTS)的现状并分析其原因，为民航飞行员眼部保健工作提供依据。方法：对1 631名民航飞行员进行问卷调查，了解暴露时间，比较不同暴露强度人群的不适症状和发病率。结果：民航飞行员视频终端暴露时间为(4.43±2.24) h，VDTS发病率和不适症状检出率均随暴露时间增加而增加。结论：长时间视频终端暴露不利于眼健康。应加强对民航飞行员的眼保健教育，避免或减少视频终端暴露带来的健康危害。
Objective: To investigate the status of visual display terminal syndrome (VDTS) in civil aviation pilots and analyze the causes, so as to provide evidence for eye health care of pilots. Methods: A questionnaire survey was conducted among 1 631 pilots to understand the exposure time and to compare the incidence rate of discomfort in participants with different exposure intensities. Results: The average exposure time of pilots’video terminals was (4.43±2.24) h. The incidence rate of VDTS and the detection rate of discomfort increased with the increase of exposure time. Conclusion: Prolonged exposure to video terminal is not conducive to eye health. The eye health education for pilots should be strengthened to avoid or reduce the health hazards caused by video terminal exposure.
眼科病理学是系统组织病理学的重要分支，作为基础医学与临床医学之间的桥梁和纽带，对于深入认识和揭示眼部疾病的发病特点发挥着重要作用。眼科病理学在老一辈专家们的努力下奠定了坚实的基础。目前眼科病理学学科的发展随着眼科临床技术以及系统病理学的发展在不断的前进，细胞生物学及分子生物学的全方位结合和纵深应用带动并拓展了眼科病理学的研究领域，临床病理学及实验病理学的研究不断更新，新形势下眼科病理学的发展充满着机遇和挑战。
Ophthalmic pathology is an important branch of histopathology. As a bridge and link between basic medicine and clinical medicine, ophthalmic pathology plays an important role in understanding and revealing the characteristics of ocular diseases. The previous generations have laid a solid foundation for ophthalmic pathology with their hard work. Moreover, the advancement of ophthalmic clinical technology and systematic pathology in recent years have further facilitated the development of ophthalmic pathology. The comprehensive combination and in-depth application of cell biology and molecular biology have promoted and expanded the research field of ophthalmic pathology. In addition, new progress has been witnessed in the field of clinical pathology and experimentalpathology constantly. Under the new situation, the development of ophthalmic pathology is faced with both opportunities and challenges.
青光眼不仅常见，而且严重损伤患者的视功能，被认定为全球首位不可逆致盲性眼病。仔细观察发现诊断不及时、治疗不合理、随诊不规律是导致青光眼患者致盲的常见原因。机会性筛查是临床早期发现青光眼患者的主要手段。为了提高筛查的效率，筛查时应当密切关注青光眼的高危人群，包括原发性青光眼患者的直系亲属、老年人群和高度近视患者。此外，要对发生青光眼全过程加深了解，无论是原发性闭角型青光眼，还是原发性开角型青光眼，其病情的进展都存在一个连续体概念。应当在青光眼患者出现症状或严重视功能损伤之前加以诊断。合理治疗应当包括应用适当的药物、激光或手术治疗，将每只患眼的眼压控制到与该眼的视盘和视野改变相适应的目标眼压范围内，尽量提高患者用药的依从性。对青光眼的持续性防治取决于是否有能力评估治疗效果以及发现病情的不稳定性状态，并加以恰当的处理。青光眼是可防可治的眼病。通过加强青光眼的早期诊断、合理治疗和长期随诊，可降低青光眼的致盲率，从而改变青光眼是首位致盲性眼病的现状。
Glaucoma not only is common, but also seriously damages the visual function of the patients, and is recognized as the first irreversible blinding disease in the world. After careful observation, we recognize that untimely diagnosis,unreasonable treatment and irregular follow-up are leading causes to blindness. Opportunistic screening is a main measure to early find the glaucoma in clinical practice. To improve the screening efficiency, the high-risk mass of glaucoma, such as immediate family members of glaucoma patients, older adults and high myopia should be closely focused. In addition, the ophthalmologists should understand the whole process of glaucoma. The development of the primary angle closure glaucoma or primary open angle glaucoma is a concept of continuum. We should make the diagnosis of glaucoma before the patients have any symptoms or serious damage of the visual function. Reasonable treatment should include controlling intraocular pressure in the scope of the target pressure adopting to the optic damage and visual field defect in that eye by drugs, laser or surgery, and as far as possible to improve the drug compliance. Sustained control of glaucoma management depends on the ability to assess the effect of treatment, and to find the instability of the disease and the appropriate management. Glaucoma is a preventable and treatable eye disease. We can decrease the blinding rate and change the current status of the first blinding eye disease for glaucoma.
