准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)是矫正屈光不正的重要角膜屈光手术方式之一。经过准分子激光切削的角膜，生物测量数据发生改变。对于此类患者，通过常规测量获得的参数数据以及使用常规计算公式确定的IOL屈光度将变得不再准确，由此将会导致术后较大的屈光误差，进而影响患者的视觉质量。本文报道一例46岁的男性白内障患者。该患者既往双眼屈光不正，曾接受过LASIK手术治疗。白内障术前角膜地形图检查发现该患者双眼存在角膜偏心切削，这为IOL屈光度的确定带来困难。手术医生通过角膜地形图判断角膜切削的居中性，在特定区域内选择角膜曲率K值，并采用Barrett True K公式计算出IOL屈光度。白内障术后患眼屈光误差相对较小，视力提高，视觉质量改善。

Laser-assisted in situ keratomileusis (LASIK) is a crucial corneal refractive surgery for correcting refractive errors. The cornea, after undergoing excimer laser ablation, undergoes changes in biometric measurements. For such patients, conventional measurements and IOL power calculations based on standard formulas may no longer be accurate, leading  to significant postoperative refractive errors and subsequently impacting the patient's visual quality. This article presents a case of a 46-year-old male cataract patient who had a history of refractive errors in both eyes and had previously undergone LASIK surgery. Preoperative corneal topography revealed corneal eccentric ablation in both eyes, posing challenges in determining IOL power. The surgeon assessed the centration of corneal ablation using corneal topography, selected the keratometry value (K value) within specific corneal regions, and calculated the IOL power using the Barrett True K formula. Postoperatively, the cataract patient experienced relatively minor refractive errors, leading to improved vision and enhanced visual quality.

近年来，眼部电流刺激(electrical stimulation,ES)在不同方向的研究中逐渐揭示了其在多种视网膜疾病中的潜在治疗价值。其中，经角膜电刺激(transcorneal electrical stimulation,TES)作为一种非侵入性的治疗方法，能对视网膜、视神经、眼底血管及其相关结构产生积极的影响。TES能够改善视力，在保护感光细胞和减缓疾病进展方面显示出积极效果，提高患者的生存质量，还能够在不损伤眼球的情况下调节大脑中的神经元活动，为视网膜疾病的治疗提供一种新的选择。该文对近年来TES在视网膜色素变性(retinitis pigmentosa,RP)、年龄相关性黄斑变性(age-related macular degeneration,AMD)、视网膜血管病、青光眼以及视神经病变等疾病中的应用研究进行了综述。研究发现，TES治疗是一种安全且无需手术的辅助治疗工具，具有广泛的应用前景。该文旨在为临床医师提供一个全面的TES研究概述，并深入探讨其在眼科学领域的潜在应用价值。然而，TES治疗的具体机制仍需进一步探讨，以便更好地应用于临床实践。同时，未来研究还应关注TES与其他治疗方法相结合的效果，以期为患者提供更多有效的治疗选择。

In recent years, electrical stimulation of the eye (ES) has gradually revealed its potential therapeutic value in a variety of retinal diseasesin different directions. Among them, transcorneal electrical stimulation (TES), as a non-invasive treatment, can have a positive effect on the retina, optic nerve, fundus vessels and related structures. TES can improve vision, show positive effects in protecting photoreceptor cells and slowing disease progression, improve the quality of life of patients, and can regulate neuronal activity in the brain without damaging the eyeball, providing a new option for the treatment of retinal diseases. The research on the application on TES on retinitis pigementosa (RP), age-related macular degeneration (AMD), retinal angiopathy, glaucoma and optic neuropathy are reviewed in this article. It is found in the study that TES therapy is a safe and surgery-free adjuvant therapy tool, and has a wide application prospect. The purpose of this article is to provide clinicians with a comprehensive overview of TES research,and to explore its potential application value in the field of ophthalmology. However, the specific mechanism of TES therapy still needs to be further explored in order to better apply in clinical practice. At the same time, future studies should also focus on the effect of combining TES with other treatment methods, in order to provide more effective treatment options for patients.

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.

角膜缘的细胞，特别是角膜缘干细胞，对于维持角膜的透明和健康至关重要。基于影像技术对角膜缘进行高精度可视化评价是相关疾病诊疗的重要手段。眼科临床使用的裂隙灯显微镜、共聚焦显微镜、眼前节光学相干断层扫描仪(optical coherence tomography,OCT)等成像技术，因低分辨、低对比度、侵入性等原因，限制了其在角膜缘细胞结构及功能影像评估中的应用。本团队创新研发新型双模态全视场光学相干断层扫描仪(full-field OCT，FFOCT)，成功实现了无标记的角膜缘细胞级分辨率结构及功能成像。FFOCT基于空间非相干光平面干涉原理提取组织内部散射光，获得微米级分辨率三维结构成像；通过FFOCT原始相干信号的高时空分辨率采集及动态特征解析，实现源于活细胞新陈代谢运动的无标记细胞功能影像可视化。双模态FFOCT创新性地整合了高分辨率、无标记的结构及功能成像模态，不仅清晰获取角膜缘组织的高精结构特征如Vogt栅栏、角膜缘隐窝、血管壁等，同时还能捕捉不同角膜缘细胞内的代谢活性动态变化，无需使用外源荧光染料或标记剂，为角膜缘生物学及疾病机制研究提供全新细胞水平结构及功能成像方法，具有广泛应用前景。

角膜缘的细胞，特别是角膜缘干细胞，对于维持角膜的透明和健康至关重要。基于影像技术对角膜缘进行高精度可视化评价是相关疾病诊疗的重要手段。眼科临床使用的裂隙灯显微镜、共聚焦显微镜、眼前节光学相干断层扫描仪(optical coherence tomography,OCT)等成像技术，因低分辨、低对比度、侵入性等原因，限制了其在角膜缘细胞结构及功能影像评估中的应用。本团队创新研发新型双模态全视场光学相干断层扫描仪(full-field OCT，FFOCT)，成功实现了无标记的角膜缘细胞级分辨率结构及功能成像。FFOCT基于空间非相干光平面干涉原理提取组织内部散射光，获得微米级分辨率三维结构成像；通过FFOCT原始相干信号的高时空分辨率采集及动态特征解析，实现源于活细胞新陈代谢运动的无标记细胞功能影像可视化。双模态FFOCT创新性地整合了高分辨率、无标记的结构及功能成像模态，不仅清晰获取角膜缘组织的高精结构特征如Vogt栅栏、角膜缘隐窝、血管壁等，同时还能捕捉不同角膜缘细胞内的代谢活性动态变化，无需使用外源荧光染料或标记剂，为角膜缘生物学及疾病机制研究提供全新细胞水平结构及功能成像方法，具有广泛应用前景。

圆锥角膜（KC）是一种典型的扩张性眼病，以角膜扩张变薄并向前锥形突起为特征，严重时可致盲。KC三联征之一铁锈色Fleischer环，主要由上皮细胞基底膜周围的铁离子沉积组成。近年来，越来越多研究表明，铁稳态失衡可能与KC的发生和发展密切相关。KC患者泪液中铁相关蛋白的异常表达，提示铁稳态失衡可能是诱发KC的潜在致病机制。此外，角膜上皮细胞内铁稳态失衡导致细胞内铁离子异常积聚，进而引发活性氧和脂质过氧化物的大量生成，最终可能触发细胞铁死亡。从恢复铁稳态角度出发，螯合过量的铁离子和调控铁死亡过程关键靶点可能是未来KC潜在的治疗方法。目前关于铁稳态失衡导致KC发病的具体机制仍存在诸多谜团。随着相关研究的不断深入，有望通过改善角膜铁稳态失衡，为KC临床治疗带来新的思路和突破，也为KC患者提供更精准和个体化的治疗策略。

圆锥角膜（KC）是一种典型的扩张性眼病，以角膜扩张变薄并向前锥形突起为特征，严重时可致盲。KC三联征之一铁锈色Fleischer环，主要由上皮细胞基底膜周围的铁离子沉积组成。近年来，越来越多研究表明，铁稳态失衡可能与KC的发生和发展密切相关。KC患者泪液中铁相关蛋白的异常表达，提示铁稳态失衡可能是诱发KC的潜在致病机制。此外，角膜上皮细胞内铁稳态失衡导致细胞内铁离子异常积聚，进而引发活性氧和脂质过氧化物的大量生成，最终可能触发细胞铁死亡。从恢复铁稳态角度出发，螯合过量的铁离子和调控铁死亡过程关键靶点可能是未来KC潜在的治疗方法。目前关于铁稳态失衡导致KC发病的具体机制仍存在诸多谜团。随着相关研究的不断深入，有望通过改善角膜铁稳态失衡，为KC临床治疗带来新的思路和突破，也为KC患者提供更精准和个体化的治疗策略。

随着角膜疾病治疗技术的不断进步，前弹力层移植技术(包括Inlay和Onlay技术)已成为晚期圆锥角膜治疗的重要手段，能有效改善患者的角膜地形图和视力结果，稳定角膜扩张，提高患者的生活质量。该文综述了前弹力层移植技术的理论基础、移植物的来源与制备技术、手术技术、临床疗效以及相关并发症，为晚期圆锥角膜的治疗提供了新的视角。研究表明，这种先进的移植技术相较于传统方法，在减少手术风险、简化手术流程以及加快术后恢复方面具有明显优势，特别是在降低异体移植物排斥反应及手术并发症的风险上，前弹力层移植表现出色。Onlay技术作为一种近期开发的新方法，其独特优势是无需剖离角膜，更好地保护角膜结构。此外这种技术的高度适应性和可逆性，为患者提供了更多的治疗选择和更好的视觉恢复。尽管如此，技术细节如移植物的尺寸和形状定制、手术深度的最优化等方面仍需进一步研究和优化，以提高整体治疗效果。

With the continuous advancement of corneal disease treatment technology, Bowman layer transplantation (including Inlay and Onlay technology) has become an important means for the treatment of advanced progressive keratoconus, which can effectively improve the corneal topography and visual acuity of patients, stabilize corneal dilation, and improve the quality of life of patients. Tis article reviews the theoretical basis of Bowman layer transplantation, the source and preparation of grafs, surgical techniques, clinical efcacy, and related complications, which provides a new perspective for the treatment of advanced keratoconus. It is stated in the research that this advanced transplantation technique has significant advantages over traditional methods in reducing surgical risks, simplifying the surgical procedures, and improving postoperative recovery. Especially in reducing the risk of allograft rejection and surgical complications, the bowman layer transplantation performs excellently. As a novel developed method, Onlay technology has the unique advantage of eliminating the need to dissect the cornea, which beter protects the corneal structure. In addition, due to the highly adaptable and reversible nature of this technique, it provides patients with more treatment options and beter visual recovery. However, in terms of technical details such as customizing the size and shape of the transplant, optimizing the surgical depth, etc., it is needed to conduct further research and optimization to improve the overall treatment efect.

目的：旨在研究按移植指征分类以及移植前角膜血管形成对手术后5年内排斥反应和移植物失败率的相对风险。方法：分析1999—2017年间，英国移植登记处记录的所有因圆锥角膜(keratoconus,KC)、人工晶状体大泡性角膜病(pseudophakic bullous keratopathy,PBK)或既往感染(病毒/细菌/真菌/原生动物)而首次进行角膜移植的成年人。统计移植前受体角膜血管化象限的数量、血管化类型、移植后排斥反应的间隔时间(如果有的话)以及移植后5年的结果。通过多变量风险调整Cox回归法进行排斥反应和移植失败的危险因素建模。结果：KC、PBK和感染患者的角膜血管形成率分别为10%、25%和67%。只有当存在浅表和(或)深部血管形成时(HR分别为1.3和1.4，P=0.004)，存在两个以上象限的血管形成时，PBK患者移植排斥反应的风险才会增加(HR=1.5，P=0.0004)。因既往感染而接受移植的个体在四个象限的血管形成中发生排斥反应的风险增加(HR=1.6，P=0.003)。在任何一组中，经过风险调整后，与血管形成有关的移植失败率并未上升。对于含有血管的受体角膜，相对于穿透性KC和PBK移植，没有充分的证据显示板层移植在降低排斥反应或失败风险方面存在优势。结论：血管化是5年内角膜移植排斥反应的危险因素。移植的适应证对这种风险的具有临床意义。

Objective: To investigate the relative risk of pretransplant corneal vascularisation on rate of rejection and graft failure within 5 years of surgery when categorised by indication for transplantation. Methods: We analysed all adults recorded in the UK transplant registry who had a first cornea transplant for keratoconus (KC), pseudophakic bullous keratopathy (PBK) or previous infection (viral/bacterial/fungal/protozoan) between 1999 and 2017. We analysed the number of quadrants of the recipient cornea vascularised before transplant and type of vascularisation, the interval posttransplant to rejection, if any, and the outcome at 5 years post-transplant. Risk factors for rejection and transplant failure were modelled by multivariable risk-adjusted Cox regression. Results: Corneal vascularisation was recorded in 10%, 25% and 67% of patients with KC, PBK and infection, respectively. Individuals with PBK had an increased hazard of transplant rejection only when there were more than two quadrants of vascularisation (HR 1.5, p=0.004) when either superficial and/or deep vascularisation was present (HR 1.3 and 1.4, respectively, p=0.004). Individuals who had a transplant for previous infection had an increased hazard of rejection with four quadrants of vascularisation (HR 1.6, p=0.003). There was no risk-adjusted increase in transplant failure associated with vascularisation in any group. There was weak evidence of reduction in risk of rejection and/or failure associated with lamellar compared with penetrating transplantation in KC and PBK in vascularised recipient corneas. Conclusion: Vascularisation is a risk factor for corneal allograft rejection within 5 years. The indication for transplantation has a clinically significant effect on the magnitude of this risk.

目的：采用角膜激光共焦显微镜观察研究颗粒状角膜营养不良家系患者的角膜状况。方法：采用角膜激光共焦显微镜对4例(6只眼)颗粒状角膜营养不良患者的角膜进行扫描检测，对比裂隙灯及普通显微镜观察分析检查情况。结果：颗粒状角膜营养不良患者的病变角膜裂隙灯下呈现面包屑样的灰白色混浊，在苏木精-伊红(hematoxylin-eosin，HE)染色中呈现出伊红染的颗粒，沉积于基质板层之间，在共焦显微镜下则为中高反光的团块，相互融合，并取代了基质细胞。结论：颗粒状角膜营养不良患者角膜病变从裂隙灯到普通HE染色下的显微镜，乃至高倍的共焦显微镜观察到的沉积物，分布情况相吻合，印证角膜病变发展的状况，有利于了解该病变的发展情况。

Objective: To observe and study the corneal in patients of family with granular corneal dystrophy by confocal laser scanning microscopy. Methods: The corneas of 4 patients (6 eyes) with granular corneal dystrophy were scanned by laser confocal microscopy, and the results were compared with those observed by slit lamp and ordinary microscope. Results: The image were gray and white bread-crumb-like opacity under the slit-lamp of cornea in patients of family with granular corneal dystrophy, were eosin-stained granules deposited between stroma layers in hematoxylin-eosin (HE) stain under the microscopy, were high reflective masses under the confocal laser scanning microscopy, which fused with each other. Conclusion: The image of the corneal in patients of family with granular corneal dystrophy were clearer and clearer by from Slit Lamp and microscopy to the confocal laser scanning microscopy. The distribution of sediments was consistent with each other. It can be a good understanding of the development of the disease.

目的：比较活体共聚焦显微镜和病理检查在角膜后部真菌感染的诊断阳性率，探讨两种检查方法在角膜后部真菌感染诊断中的价值。方法：回顾性病例对照研究。收集2009年11月至2020年12月在青岛眼科医院就诊并进行穿透性角膜移植手术治疗角膜后部真菌感染患者，术前均进行角膜刮片KOH涂片检查和活体共聚焦显微镜检查，术后病变角膜进行病理组织切片、过碘酸-Schiff法(PAS)染色和六亚甲基四胺银法(GMS)染色检查，比较不同检查方法诊断的阳性率。结果：18例角膜后部真菌感染患者角膜刮片KOH涂片均未检查到真菌菌丝，其中有16例患者经活体共聚焦显微镜检查到真菌菌丝(88.9%)，而2例患者在术前活体共聚焦显微镜检查中未查到病原体。术后病理检查PAS染色联合GMS染色，18例患者中18例均可检查到真菌菌丝，角膜后部真菌感染患者病理切片中可见角膜深基质层变性坏死，大量炎症细胞浸润，PAS染色和GMS染色可见典型真菌菌丝侵犯角膜基质深层，而角膜基质浅层及上皮层均未查见真菌菌丝。结论：活体共聚焦显微镜诊断角膜后部真菌感染具有一定的局限性，联合术后病理组织切片和特殊染色检查有助于提高角膜后部真菌感染的诊断率。

Objective: To compare the diagnostic rate between in vivo confocal microscopy and pathological examination in retrocorneal fungal infection. Methods: It is a retrospective study. A total of 18 patients with retrocorneal fungal infection and received PKP surgery in the Qingdao Eye Hospital from November 2009 to December 2020 were enrolled. KOH smear and in vivo confocal microscopy examination were performed before surgery, and pathological examination including periodic acid-schiff (PAS) stain and Grocott Methenamine Silver (GMS) stain were performed after surgery. Patients were diagnosed retrocorneal fungal infection based on in vivo confocal microscopy and pathological examination. The diagnostic rates of the two methods were compared. Results: None of the 18 patients with posterior corneal fungal infection were found to have fungal hyphae in the corneal smear.Sixteen patients (88.9%) were found fungal hyphae by in vivo confocal microscopy. Corneal stroma necrosis and a large number of inflammatory cells were shown by postoperative pathologic examination, and all patients were found fungal hyphae in posterior corneal stroma with PAS stain and GMS stain. Conclusion: Confocal microscopy has unique advantages such as non-invasive and rapid examination in the diagnosis of fungal keratitis.However, it needs to combine with pathological examination for diagnosing the retrocorneal fungal infection.

目的：探究球面塑形镜、环曲面塑形镜在矫治近视复合散光的有效性及安全性。方法：回顾分析宜昌市第一人民医院2016年3月至2018年3月角膜塑形镜治疗青少年近视94例(178眼)，按佩戴塑形镜类型分为球面塑形镜组(48例，90眼)与环曲面塑形镜组(46例，88眼)。记录配镜前、佩戴1年后、停戴1周后的视力、角膜散光、眼轴长、球镜屈光度、眼压、泪膜破裂时间及角膜着染率。结果：戴镜1年后，2组组内相比，散光、球镜度数、眼压、泪膜破裂时间均降低，但2组组间相比，仅散光度数差异有统计学意义(P<0.01)。戴镜1年后，两组视力较戴镜前显著提高，停戴后近视度数较佩戴前增加，但组间差异无统计学意义(P>0.05)；2种塑形镜角膜着染发生率差异无统计学意义(P>0.05)。结论：2种塑形镜均能够降低近视复合散光患者度数，有效提高患者视力，但并不能完全阻止近视的进展。虽然环曲面塑形镜在矫正散光方面有优势，但总有效性与安全性并不占优势。

Objective: To observe the effectiveness and safety of orthokeratology lens and toric design othokeratology treatment for compound myopic astigmatism. Methods: From March 2016 to March 2018, 94 teenagers(178 eyes) were selected as the subjects of study. They were divided into two groups according to the type of orthokeratology: the orthokeratology lens group (48 cases, 90 eyes) and the toric design othokeratology group(46 cases, 88 eyes). Visual acuity, corneal astigmatism, axial length, spherical lens refraction, intraocular pressure,tear film rupture time and corneal staining rate were recorded before, after 1 year and after 1 week. Results: After 1 year of wearing the lens, astigmatism, spherical lens degree, intraocular pressure and tear film rupture time were all decreased in the 2 groups compared with each other, but only astigmatism degree was statistically significant between the 2 groups compared with each other (P<0.01). After wearing the glasses for 1 year, the visual acuity of the two groups was significantly improved compared with that before wearing the glasses, and the myopia degree was increased after stopping wearing the glasses compared with that before wearing the glasses, but the difference between the two groups was not statistically significant (P>0.05). There was no statistical significance in the incidence of corneal staining between the two types of shaping lenses (P>0.05). Conclusion: Both of the two shaping lenses can reduce the degree of myopic patients with complex astigmatism and effectively improve the visual acuity of patients, but they can not completely prevent the progress of myopia. Although toroidal shaping mirror has advantages in correcting astigmatism, its overall effectiveness and safety are not.