传统的眼底手术要求眼科医生具备精细的操作技术，但即便拥有再精湛的操作技术，眼底手术还是存在很大的风险性。因此，为了减少手术风险，提高手术质量，对传统眼底手术进行改进是十分必要的。近年来，在我国对于人工智能产业的大力支持之下，应用于各类行业的机器人随之诞生。机器人辅助系统(robot auxiliary system，RAS)在医学领域，特别是眼科学中应用广泛。对近几年RAS应用于眼底手术的案例进行整理总结，并将RAS参与的眼底手术以及传统的眼底手术进行对比，可以发现RAS在眼底手术中的应用可以显著提高手术效率，并降低手术风险。未来RAS的发展趋势可能着重聚焦于与深度学习算法的紧密结合。通过算法对手术中的视野图像进行预测、优化，从而让高精度的眼底手术更加高效、安全。

Traditional fundus surgery requires ophthalmologists to be equipped with sophisticated operating techniques, but even with the most sophisticated operating techniques, fundus surgery still has great risks. Therefore, in order to reduce the risk of surgery and improve the quality of surgery, it is very necessary to improve the traditional fundus surgery. In recent years, with China’s strong support for the artificial intelligence industry, robots used in various industries have been born. Robot auxiliary system (RAS) is widely used in the medical field, especially in ophthalmology. By summarizing the cases of fundus surgery with RAS in recent years and comparing the fundus surgery involving RAS with traditional fundus surgery, it can be found that the application of RAS in fundus surgery can significantly improve the efficiency of surgery and reduce the risk of surgery. The future development trend of RAS may focus on the close integration with deep learning algorithms, which can predict and optimize the field of view images during surgery so that high-precision fundus surgery can be more efficient and safer.

房角镜辅助的内路360°小梁切开术(Gonioscopy-Assisted Transluminal Trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术，是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm's管后，利用微导管张力全周切开小梁网及Schlemm's管内壁，重建生理性房水流出通道，避免小梁网阻力，实现房水从前房直接进入集液管，通过增加房水流出机制降低眼压。GATT适应证广泛，主要应用于开角型青光眼，包括原发型开角型青光眼和继发性开角型青光眼，同时可运用于闭角型青光眼。GATT微创、不依赖滤过泡、能明显减少降眼压药物的使用、中远期疗效稳定、安全性高、较少发生威胁视力的并发症，可作为开角型青光眼的首选手术方式。本文将对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述，以期为其临床运用提供参考。

As a modifed trabeculotomy, Gonioscopy-Assisted Transluminal Trabeculotomy (GAT) is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years. GAT inserts a microcatheter (iTrack) into the Schlemm's canal and advance the catheter through the canal circumferentially 360°, then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal. Tis method can reduce intraocular pressure by increasing the outfow of aqueous humor. Te physiological outfow pathway of aqueous humor is reconstructed, which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber. With a wide range of indications, GAT is mainly used in open-angle glaucoma, including primary open-angle glaucoma and secondary open-angle glaucoma, and is also used in primary closed- angle glaucoma. Additionally, GATT can be the preferred surgical modality for open-angle glaucoma, as it has the following advantages: minimally invasive, independent of fltration bleb, can signifcantly reduce the use of medications, stable medium- and long-term efcacy, high safety, and has fewer sight-threatening complications. In order to provide a reference for clinical application, this article reviews the indications, mechanism of action, surgical procedures, efectiveness, complication and factors afecting therapeutic efect.

目的：探索和实践人工智能辅助诊断的闵行区视觉健康管理模式。方法：介绍闵行区人工智能辅助诊断的视觉健康管理模式；分析对比传统视觉健康管理模式和人工智能辅助诊断视觉健康管理模式下，社区视觉健康筛查情况，眼病发现、需转诊、复诊情况等；工作人员配置、眼科门诊接诊情况、居民眼病知识率和视觉健康服务满意情况等。结果：传统视觉健康管理模式和人工智能辅助诊断模式主要眼病（糖尿病视网膜病变、青光眼、年龄相关性黄斑变性、高度近视）发现率比较差异均有统计学意义（c²=954.03，P ＜0.01），需转诊率差异有统计学意义（c²=431.07，P ＜0.01）。人工智能辅助诊断管理模式与传统视觉健康管理模式的居民在青光眼的知晓率比较差异有统计学意义（c²=4.24，P＜0.05）。传统视觉健康管理模式和人工智能辅助诊断模式居民对视觉健康服务中的服务质量和服务时间的满意度比较差异有统计学意义（Z=-2.75，Z=-2.18，P ＜0.05）。结论：人工智能辅助诊断视觉健康管理模式，糖尿病视网膜病变、青光眼等主要眼病发现率高于传统模式，需转诊率降低，居民对青光眼的知晓率提升，在服务质量和服务时间上的居民满意度较高。基于人工智能辅助诊断的视觉健康筛查与管理模式值得本区其他社区的推广和应用。

Objective To explore and practice the visual health management mode of Minhang District . Methods Introduce the visual health management mode of AI-assisted diagnosis in Minhang District; analyze and compare the traditional visual health management mode and AI-assisted visual health management mode, community visual health screening projects and completion conditions, screening files, eye disease discovery , referral, actual referral and return ; analyze and compare the visual health management mode, staff allocation, ophthalmic outpatient reception, and the satisfaction of visual health service. Results The difference in the discovery rate of major eye diseases (Diabetic Retinopathy,Glaucoma,Age-related Macular Degeneration,High Myopia) between the traditional model and artificial intelligence-assisted diagnosis mode in both communities (c²=954.03, P<0.01), the referral rate (c²=431.07, P<0.01). The awareness of AI-assisted diagnosis management improved in glaucoma in the two modes was statistically significant (c²=4.24, P<0.05). Traditional model and artificial intelligence assisted diagnosis model of visual health service quality and service time is statistically significant (Z=-2.75, Z=-2.18, P<0.05). Conclusion The visual health screening and management mode based on AI-assisted diagnosis is worthy of the promotion and application in other communities in the region.

目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty，EK)患者的护理。方法：对40例 行飞秒激光辅助EK术的患者做好术前心理护理，完善术前检查及术前准备，术后重点做好体位护 理、病情观察及出院指导。结果：4例患者术后发生植片移位，经再次复位后贴合良好，1例术后第1天气泡到后房行前房成形术；13例患者术后出现眼压升高，经治疗眼压得到控制；40例患者全 部治愈出院。结论：对EK术患者应做好术前及术后的护理，及时发现并发症并采取相应的治疗与护理措施，以提高手术的成功率。

Objective: To explore the nursing care of patients with femtosecond laser assisted endothelial transplantation. Methods: Forty patients were involved in this study. Preoperative psychological nursing, ocular examination, and surgical preparation were taken, and the main nursing postoperation focused on patients’ position and the discharge guidance. Results: TTe graffs in 4 cases were displaced, and were all in place affer resetting. The bubble was observed in posterior chamber in 1 case, this case was taken anterior chamber forming operation. Intraocular pressure was high in 13 cases, and those cases were treated with topical medicines. Conclusion: Completing the preoperative nursing of patients with corneal endothelial transplantation, observing the complications and taking corresponding treatment and nursing measures help improve the success rate of the operation.  

目的：评价药物治疗无效的开角型青光眼及部分复杂性青光眼行二氧化碳激光辅助下外层Schlemm管消融术(CO2 laser-assisted sclerectomy surgery，CLASS)的短期临床安全性及有效性。方法：收集2015年5月至2016年1月解放军总医院眼科行CLASS手术和小梁切除手术的青光眼患者各23例，共46例46只眼。观察术后1周、1个月和3个月眼压及并发症发生情况。结果：两组术后1周、1个月及3个月眼压较术前均明显下降(P=0.000)。术后1周、1个月及3个月时CLASS手术组眼压平均值均低于小梁切除术组，但无统计学差异(P>0.05)。CLASS手术组23例均无浅前房、脉络膜脱离等并发症出现。小梁切除手术组有4例在术后早期出现浅前房，其中1例出现脉络膜脱离，经治疗后均治愈。结论：CLASS手术在有效降低眼压的同时，能大幅降低患者术后出现浅前房等并发症的概率，但其远期降眼压效果及并发症发生情况有待进一步深入研究。

Objective: To evaluate the short-term of clinical safety and efficiency of CO2 laser-assisted sclerectomy surgery (CLASS) in patient with open-angle glaucoma and complicated glaucoma. Methods: Our study involved 46 eyes of 46 patients with glaucoma that underwent CLASS and trabeculectomy respectively by the same surgeon (Zhaohui Li) from May 2015 to January 2016 at the PLA General Hospital. Intraocular pressure and complications 1 week, 1 month and 3 months after operation was observed separately. Results: The intraocular pressure (IOP) 1 week, 1 month and 3 months after surgery decreased obviously (P=0.000). Compared to the trabeculectomy group 1 week, 1 month and 3 months after surgery, IOP of CLASS group was lower. But there was no statistically significant difference between these two groups (P>0.05). There was no complication occurred in CLASS group. Early postoperative complications occurred in trabeculectomy group included shallow anterior chamber and choroidal detachment, and they were all successfully resolved by pharmacotherapy. Conclusion: CLASS operation could reduce intraocular pressure effectively and decrease the incidence of complications, such as postoperative shallow anterior chamber in patients with glaucoma. However, its long-term effect and complications need to be further studied.

目的：探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty, EK)手术的护理配合。方法：对19例(19只眼)飞秒激光辅助的EK手术进行术前访视，充分的术前准备，各种仪器调试及器械的准 备，术中熟悉手术过程，指导患者配合手术并密切配合医生，做好患者术中、术后的体位管理，仪器及器械的处理。结果：19例手术均顺利完成，术中无意外发生，患者积极配合，术后视力89.5%(17/19)明显提高，眼部刺激症状消失，植片角膜内皮细胞数丢失不多。结论：飞秒激光辅助EK作为一种全新的手术技术，完善的术前准备，密切的手术配合，特殊体位护理是保证手术成功的关键。

Objective: To investigate nursing and cooperation of femtosecond laser-assisted endothelial keratoplasty (EK). Methods: Preoperative visit and adequate preoperative preparation were proceeded in 19 patients (19 eyes) underwent femtosecond laser-assisted EK, instrument commissioning and equipment preparation were performed before the surgery. We mastered the surgical procedures, guided patients for cooperating the operation, and cooperated closely with surgeon during operation. Management of intraoperative and postoperative body position were accomplished, instruments and equipment were well processed aff er operation. Results: All of the 19 cases were successfully completed without intraoperative accident, all of the patients cooperated actively. Postoperative visual acuities in 89.5% (17/19) of the patients were improved significantly, ocular irritation symptoms were disappeared, and corneal endothelial cells of the grafts were decreased slightly. Conclusion: Femtosecond laserassisted EK is a brand new surgical technology, perfect preoperative preparation, intimate operative cooperation, and management of special body position are essential for a successful operation.

      总结32例飞秒激光辅助角膜移植术患者的护理，认为做好心理护理、术前完善眼部检查和做好充分的准备，术后严密观察敷料、眼压和角膜植片的情况，做好特殊体位和角膜接触镜的护理，并做好出院指导是提高手术的成功率及预防并发症的关键。

This paper summarized the nursing care of 32 patients received femtosecond laser assisted corneal transplantation. The key points to increase the success rate of surgery and prevent complications were psychological nursing, preoperative examinations and fully prepared, postoperative observation of dressing, intraocular pressure and corneal glass, care of special position and corneal contact lens, and discharge guidance.

目的: 建立人晶状体上皮细胞原代培养的简便方法并比较不同来源人晶状体上皮细胞的生物学特性。

方法: 取胎龄 20 周合法引产胚胎眼晶状体囊膜、中山眼科中心眼库眼晶状体囊膜和白内障患者术中撕取的前囊膜, 分别在培养皿中铺平, 加10 μL 10%DMEM 培养液润湿后加盖盖玻

片防止卷曲并促进粘贴, 添加培养液浸没盖玻片, 37℃培养。同时取相同来源的囊膜按照组织块法培养。观察细胞增殖情况并比较原代人晶状体上皮细胞与人晶状体上皮细胞系 SRA01/04 β晶体蛋白的表达差异。

结果: 在盖玻片辅助下, 胚胎眼晶状体囊膜第2天即可见明显的增殖细胞由囊膜缘长出, 眼库眼囊膜和白内障患者术中撕取的囊膜在3～4 d 的潜伏期后亦可见增殖细胞长出; 组织块法培养出现部分组织块漂浮, 且胚胎眼囊膜潜伏期延长至3～4 d, 眼库眼囊膜和白内障患者晶状体囊膜潜伏期延长至4～5 d。

结论: 盖玻片辅助的改良组织块培养法能尽快获得体外培养的原代晶状体上皮细胞, 且操作简便, 值得推广应用于晶状体病的研究。

Purpose: To set up an easy procedure of tissue culture for human lens epithelial cells in vitro and to observe the biological characteristics.

Methods: Capsules from embryo of 20 weeks, eye bank of Zhongshan Ophthalmic Centre and patients with cataract were spread on culture utensil. 10 μ L of 10% DMEM medium was added and a piece of coverslip was lay to prevent crimp. Then the capsules were cultured under 37℃after adding enough medium. Capsules from the same source were cultured by traditional tissue culture method. Expressions of β crystallin between primary tissue culture cells and SRA01/04 cell line were compared by western blotting.

Results: With coverslip assisted, the cells could be observed proliferated and migrated from the edge of embryo capsule 2 days later, and for capsules from eye bank and age-related cataract patients, the interval time was 3 to 4 days. By traditional tissue culture method, the interval time of embryo capsule was 3 to 4 days, and for capsules from eye bank and age-related cataract patients, the interval time was the same. And capsules floated sometimes.

Conclusions: By coverslip assisted primary tissue culture human lens epithelial cells could grow faster and easier, and the method is worthy to be spread in research of lens diseases.

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.

因不同的眼部和神经性疾病，导致视觉功能严重受损，为低视力患者日常活动(如阅读及驾驶)及生活质量、心理健康带来严重的影响。人们对外界信息的感知主要来源于视觉，除威胁生命的重大疾病外，对人感官影响最大的损害当属视觉损伤。且随着人口日益老龄化，该问题日趋加重，低视力已成为目前全球范围内一个严重的公共卫生问题。目前，低视力康复发展面临着临床和科研的巨大挑战，要研发出一种能有效改善视觉功能，同时能兼顾多种功能的视障辅助技术，这需要医学、生物学、工程学、微电子学、计算机学等多学科的共同发展和相互合作。低视力康复通过为患者提供适宜的视障辅助技术，最大化利用患者的残余视力及视觉功能，改善与低视力相关的功能限制，有效改善其独立性和整体生活质量，使其独立生活、工作并融入社会成为可能。该文对经典的助视器、人工视觉(视觉假体/视觉感官替代设备)、经颅刺激及视觉生物反馈训练等视障辅助技术在低视力康复中的应用进展进行综述。

Patients with low vision are severely impaired in visual function due to different ocular and neurological disorders,which have a serious impact on their daily activities (such as reading and driving), quality of life and mental health.People's perception of external information mainly comes from vision. Expect for the life-threatening major diseases,visual damage has the greatest impact on people's senses. With the ageing of the population, the problem is getting worse, and low vision has become a serious public health problem in the world. Currently the development of low vision rehabilitation is facing a huge challenge in clinical and scientific research, to develop a visual impairment assistance technology that can effectively improve visual function while balancing multiple functions. It requires the joint development and cooperation of multiple disciplines such as medicine, biology, engineering, microelectronics, and computer science. Low vision rehabilitation provides patients with appropriate visual impairment assistance technology,maximizing the use of residual vision and visual function of patients, improving the functional limitations associated with low vision, effectively improving their independence and overall quality of life, and makes it possible for them to live, work and integrate into the society independently. This article reviews the progress in the application on visual impaired assistive technologies such as classic visual aids, artificial vision (visual prostheses/visual sensory replacement devices), transcranial stimulation and visual biofeedback training in low vision rehabilitation.