目的：探究囊袋张力环(CTR)植入对五种新一代人工晶状体(IOL)计算公式[Barrett Universal Ⅱ (BUⅡ), Emmetropia Verifying Optical (EVO), Kane, Pearl-DGS和Hill-RBF 2.0]在高度近视患者中预测准确性的影响。方法：前瞻性病例对照研究。观察2020年12月—2021年9月于陕西省眼科医院就诊的眼轴长度(axial length,AL)≥ 27.00 mm行白内障联合IOL(AR40E, 美国强生)植入术的患者。术眼随机分为植入CTR组(A组)和未植入CTR组(B组)。术前根据IOLMaster700测量眼部参数，使用BU Ⅱ公式计算所需IOL度数。记录术后1周、1个月及3个月实际等效球镜度(spherical equivalent,SE)，计算并比较五种公式预测误差(prediction error,PE)和绝对屈光预测误差(absolute Error,AE)。将A组和B组分别分为A1组(27.00 mm ≤ AL ≤ 30.00 mm)和A2组(AL>30.00 mm)；B1组(27.00 mm ≤ AL ≤ 30.00 mm)和B2组(AL >30.00 mm)，分析不同AL范围内CTR植入对公式预测准确性的影响。结果：共纳入患者63例(89眼)，年龄(55.93±10.17)岁，术前AL为(30.30±2.18)mm。A组、A1组及A2组术后不同时间SE值比较差异均无统计学意义(P>0.05)，B组、B1组及B2组术后1周与1个月，术后1周与3月SE值分别比较差异有统计学意义(P<0.05)，术后1个月与3个月比较，差异无统计学意义(P>0.05)。A组、B组、A1组、A2组、B1组和B2组各组中五种公式的AE值比较差异均无统计学意义(均P>0.05)。植入CTR后五种公式的预测误差变化比较差异无统计学意义(P>0.05)。结论：对于AL ≥27.00 mm的白内障患者，植入CTR组术后1周屈光度趋于稳定，未植入组术后1个月屈光度趋于稳定。CTR植入对五种公式预测准确性和选择无影响，五种计算公式均可正常选择。

Objective: To investigate the predictive accuracy and effect of capsular tension ring (CTR) implantation with five new generation intraocular lens (IOL) calculation formulas [Barrett Universal Ⅱ (BU Ⅱ), Emmetropia Verifying Optical(EVO), Kane, Pearl-DGS and Hill-RBF 2.0] in high myopia patients. Methods: This is a prospective case-control study. The patients were enrolled with an axial length (AL)≥27.00 mm, and underwent cataract surgery with AR40E IOL implantation at the Shaanxi Eye Hospital from December 2020 to September 2021. The patients were randomly assigned to the CTR implantation group (group A) and the non-CTR implantation group (group B). With the ocular parameters measured by the IOLMaster700, the IOL power was calculated with the BUⅡformula before surgery. The postoperative actual equivalent spherical diopter (SE) were recorded,and the predicted error (PE) and absolute error (AE) using the five formulas were recorded and compared at 1 week, 1 month, and 3 months, repsectively. Group A was divided to A1 (27.00 mm ≤ AL ≤ 30.00 mm) and A2 (AL>30.00 mm), and group B was divided to B1 (27.00 mm ≤ AL ≤ 30.00 mm) and B2 (AL>30.00 mm). The effects of CTR implantation and the accuracy of the formulas were analyzed with different AL ranges. Results: A total of 63 patients (89 eyes) were included, aged (55.93±10.17) years old, with preoperative AL (30.30± 2.18)mm. There was no statistically significant difference in SE between groups A, A1, and A2 (P>0.05) at different postoperative times. While there was a statistically significant difference in SE between groups B, B1, and B2 (P < 0.05) at 1 week and 1 month after surgery, and between 1 week and 3 months after surgery. There was no statistically significant difference between 1 month and 3 months after suergery (P>0.05). There was no significant difference in the AE using the five formulas among groups A, B, A1, A2, B1, and B2 (P>0.05). There was no statistically significant difference in prediction error changes among the five formulas after CTR implantation (P>0.05). Conclusion: For cataract patients with AL ≥ 27.00 mm, the refractionvalue in the CTR implantation group tended to stabilizeafter one week of surgery. While in the non-CTR implantation group, the refractionvalue tended to stabilize after one month. CTR implantation had no effect on the accuracy and selection of the five formula, and the five IOL calculation formulas can be normally selected.

目的：调查角膜塑形镜对近视儿童脉络膜厚度和脉络膜轮廓的长期影响。方法：受试者来自一项2年的随机对照试验。研究对象为年龄8~12岁、等效球镜在-1.00~-6.00 D的儿童(n=80)，这些研究对象被随机分配到对照组(n=40)和角膜塑形镜组(n=40)。本研究在基线和1、6、12、18、24个月的随访中收集光学相干断层扫描图像(optical coherence tomography,OCT)，然后基于OCT图像计算脉络膜厚度和脉络膜轮廓。在这些随访点也同时测量了眼轴长度(axial length,AL)和其他眼生物学参数。结果：在2年内，对照组的脉络膜厚度随时间变薄，脉络膜轮廓变得更加后凸(均P<0.001)。角膜塑形镜可以改善脉络膜厚度(均P<0.001)，并在所有随访中维持脉络膜轮廓不后凸(均P<0.05)。在角膜塑形镜组中，脉络膜轮廓在颞侧的变化小于鼻侧(P=0.008)，而脉络膜厚度在颞侧以黄斑中心凹为中心、直径3 mm线性扫描区域的增厚更明显(P<0.001)。2年内脉络膜厚度的变化与对照组中2年内AL变化呈负相关(r=-0.52，P<0.001)，然而，这一规律被角膜塑形镜打破(r=-0.05 P=0.342)。在多变量回归模型中校正其他变量后，角膜塑形镜对脉络膜厚度的影响是稳定的。结论：角膜塑形镜可以改善脉络膜厚度并维持脉络膜轮廓，但这种效果在长期内趋于减弱。

Objective: To investigate the long-term effect of orthokeratology on the choroidal thickness and choroidal contour in myopic children. Methods:Subjects were from a conducted 2-year Randomized Clinical Trial. Children (n=80) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were randomly assigned to the control group (n=40) and ortho-k group (n=40). OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits, then the choroidal thickness and choroid contour were calculated. Axial length (AL) and other ocular biometrics were also measured. Results: During two years, in the control group, the choroidal thickness became thinning and the choroidal contour became prolate with time at all visits (all P<0.001). Ortho-k can improve the choroidal thickness (all P<0.001) and maintain the choroidal contour at all visits (all P<0.05). In the ortho-k group, the choroidal contour was less changed in the temporal than nasal (P=0.008), and the choroidal thickness was more thickening in the temporal 3 mm (P<0.001). Two-year change in choroidal thickness was significantly associated with the two-year AL change in the control group (r=-0.52, P<0.001), however, this trend was broken by ortho-k (r=-0.05, P=0.342). After being adjusted by other variables in the multivariable regression model, the effect of ortho-k on choroidal thickness was stable. Conclusions: In a short term, ortho-k can improve the choroidal thickness and maintain the choroidal contour, but this effect diminished in a long term. Further study with larger sample size and longer follow-up is warranted to refine this issue.

目的：探索一种无创的、智能可穿戴设备监测学龄儿童量化的用眼行为，并定量分析近视发生的相关因素。方法：招募佛山市禅城区石湾第二小学三年级及狮城中学小学部五年级的年龄为7~11岁部分学生共171例。所有受试者均按照非睫状肌麻痹主觉验光结果分为近视组108例和非近视组63例，所有受试者均佩戴智能可穿戴设备“云夹”，进行为期10 d(2022年9月21日—2022年10月2日)的用眼行为数据(近距离用眼距离、近距离用眼时间、近距离环境光照、有效户外时间)采集。采用t检验比较近视组与非近视组儿童在用眼行为数据之间的差异，并应用Logistic回归分析用眼行为与近视发生的相关性。绘制受试者操作特征(receiver operating characteristic curve,ROC)曲线，并计算曲线下面积(area undercurve,AUC)分析用眼行为习惯对近视发生的预测价值。结果：学龄期儿童近视患病率为63.2%。近视组与非近视组在每天用眼时间、单次用眼时间、用眼距离、白天用眼光照、晚上用眼光照、每天户外活动时间及每天有效户外活动暴露次数比较差异均有统计学意义(均P＜0.05)。Logistic回归分析显示，单次用眼时间、每天用眼时间是近视发生的危险因素。Spearman相关性分析显示，单次用眼时间及每天用眼时间均与近视发生呈正相关(均P＜0.05)。单次用眼时间预测近视发生的ROC曲线下面积为0.939。结论：可穿戴设备“云夹”可量化学龄期儿童用眼行为；学龄期儿童近视发生可能与近距离用眼时间有一定相关性；预测模型可结合儿童屈光发育档案，量化近视发生风险，对儿童实现分类管理，及时采取个性化干预。

Objective: To investigate a non-invasive,smart device capable of monitoring the quantitative visual behavior of school age children, and to analyze quantitatively the relationship between visual behavior and the occurrence of myopia. Methods: This study recruited 171 subjects aged between 7 and 11 years from the third grade of Shiwan SecondPrimary School and the fifth grade of Shicheng Middle School in Chancheng District, Foshan City. Participants werecategorized into a myopia group (108 subjects) and a non-myopia group (63 subjects) based on results from non-ciliary muscle paralysis optometry. All subjects wore "clips" to track their near-work distance, near-work duration, lighting conditions during near-work, and time spent on outdoor activities between September 21, 2020, and October 10, 2020. Differences in these habits between the myopia and non-myopia groups were compared, and logistic regression analysis was conducted to assess the impact of habitual eye use on myopia. Results: The prevalence of myopia was found to be 63.2%. Statistically significant differences (all P<0.05) were observed between the myopic and non-myopic groups regarding average daily near-work time, average single near-work session duration, average near-work distance, average daytime and nighttime near-work lighting conditions, average daily outdoor activity time, and average daily effective outdoor activity exposure. Logistic regression analysis indicated that longer average single near-work sessions and increased average daily near-work time were risk factors for myopia. Spearman correlation analysis further supported these findings, showing a positive correlation between average single near-work session duration and average daily  near-work time with the occurrence of myopia (all P<0.05). The predictive accuracy of a model combining average single near-work session duration and average daily near-work time for myopia occurrence was high, with an area under the curve of 0.939. Conclusions: The wearable device "Cloud clip" effectively monitors the visual behavior of school-age children. The occurrence of myopia in this age group may be associated with increased near-work activities. A predictive model incorporating refractive development in myopic children can assess the quantitative risk of myopia, enabling the classification and management of school-age children. Personalized interventions may serve as protective factors against myopia.

据统计，目前全球有近14亿近视人口，近视已成为全球主要的健康问题。近视不仅影响个人的视力健康，还可能引发多种严重的并发症，如高度近视相关的黄斑变性和视网膜脱离等，严重时可导致失明。除了对个人健康的影响，近视还带来了巨大的经济负担，包括直接医疗成本(如眼镜、隐形眼镜、矫正手术等费用)和间接成本(如生产力下降、学习能力降低和生活质量的下降)。在中国，近视的问题尤其显著，近视患病率居高不下，这不仅对个人健康构成威胁，也对社会和经济造成重大影响。国际上，近视的经济负担研究涵盖了医疗直接成本、患者时间成本及生产力损失等方面，可以帮助政府和卫生部门了解近视疾病的经济影响，从而制定合理的公共卫生政策和资源分配策略，优化医疗资源使用，减少社会成本。该文从近视疾病经济负担的构成及其测算方式、国内外经济负担现况等方面对近视疾病经济负担进行简要综述，旨在提供一个关于近视疾病经济负担的综合性认识，指出当前研究的方向和成果，以及预防近视和减轻其经济负担的重要性，为未来研究提供方向和基础。

It is estimated that there are nearly 1.4 billion myopic people in the world, and myopia becomes a significant global health problem. Myopia not only affects visual health, but also leads to serious complications such as macular degeneration and retinal detachment, which can cause blindness in severe cases. Apart from its impact on health, myopia also imposes a substantial economic burden. This burden includes direct medical costs (e.g., expenses for eyeglasses, contact lenses, and corrective surgeries) as well as indirect costs (e.g., reduced productivity, learning abilities, and quality of life). The prevalence of myopia is particularly high in China, posing a threat not only to individual health, but also to society and the economy. International studies on the economic burden of myopia have examined the direct medical costs, patient time costs and productivity loss. These studies help governments and health authorities understand the economic impact of myopia to develop effective public health and resource allocation strategies.. By optimizing medical resources and reducing social costs, these measures aim to alleviate the economic burden. This article provides an overview of the economic burden of myopia, including its definition, measurement, current status at home and abroad, and the importance of prevention and alleviation. It also highlights the current research directions and findings, to provide focusing fields and foundations for future research.

随着近视人口的逐年增长，近视已经成为全球关注的热点问题。如何预防近视、控制近视进展、减少病理性近视的发生、减少近视的成本投入是临床工作及科学研究的主要目的。阿托品是目前防控近视的主要药物方法，实验室研究及临床试验均已证实其显著的近视防控效果。美国眼科学会推荐使用0.01%低浓度阿托品，目前报道其近视防控效果为50%~53%。本文汇总了近年来近视防控相关的临床与实验室研究，对阿托品近视防控效果、其相关影响因素(如浓度、个体差异、生物利用度等)以及作用机制等方面的研究进展进行归纳综述，并分析了阿托品用于临床儿童近视防控工作存在的困难与挑战。

As the population of myopia grows rapidly, myopia has become a hot issue of global concern. Preventing myopia and slowing the progression of myopia to reduce the occurrence of pathological myopia and reduce the cost of myopia is the main purpose of related clinical work and scientific researches. Currently, atropine is the main drug for the prevention and control of myopia, and both laboratory studies and clinical trials have confirmed its effect. The American Academy of Ophthalmology recommends the use of 0.01% atropine, which is reported to be 50% to 53% effective in preventing and controlling myopia. This review collects the clinical and laboratory researches in decades to summarize the study progress in atropine for preventing and controlling myopia, including the clinical application effects, the influencing factors such as concentration, individual differences, bioavailability, and the related mechanisms. We also highlight the existing difficulties and challenges in the use of atropine in clinic.

高度近视(high myopia，HM)作为一种特殊类型的屈光型眼病，不仅会导致进行性、退行性眼底改变，其视神经损伤的患病率也很高。青光眼是全球范围内最常见的一种不可逆致盲性眼病，原发性开角型青光眼(primary open-angle glaucoma，POAG)是最常见的青光眼类型。近年来的研究发现HM与POAG的病理改变存在相似之处。由于HM眼底改变与早期POAG眼底改变容易混淆，HM患者早期发现POAG对延缓或阻止疾病进展很重要。HM患者长期随访不仅要观察黄斑病变，视神经形态与结构改变的观察也不容忽视。

As a special type of refractive eye disease, high myopia (HM) not only causes progressive and degenerative fundus changes, but also has a high prevalence of optic nerve damage. Glaucoma is the most common form of irreversible blinding eye diseases worldwide, among which, primary open-angle glaucoma (POAG) is the most common type. In recent studies, HM is found to have similarities on pathological changes as that of POAG. And HM fundus changes are easily confused with early stage POAG fundus changes; thus, the early detection of POAG on HM patients is highly important on disease deferment or prevention of disease progression. Macular degeneration as well as optic nerve morphology and structural changes are to be observed in the long-term follow-up for HM patients.

目的：比较Pentacam三维眼前节分析仪与iTrace视觉分析仪在暗室环境中检测近视眼Kappa角的一致性。方法：采用回顾性研究，对近视门诊的86例志愿者共172眼使用iTrace视觉分析仪和Pentacam三维眼前节分析仪，分别测量其Kappa角，收集所测数据采用SPSS软件进行一致性分析。结果：Pentacam三维眼前节分析仪与iTrace视觉分析仪的Kappa角测量结果中，横坐标X值、纵坐标Y值和方位角度值比较差异有统计学意义(P<0.05)；弦距离值比较差异无统计学意义(P>0.05)。结论：Pentacam三维眼前节分析仪与iTrace视觉分析仪在近视患者Kappa角测量结果一致性存在差异，临床上应谨慎替换使用。

Objective: To compare the consistency of Pentacamand iTrace in detecting anglekappa. Methods: A retrospective study was carried out on a total of 172 eyes of 86 volunteers to measure the anglekappa by iTrace visual analyzer and  Pentacamanterior section analyzer in Zhengzhou Aier Eye Hospital. The measured data were collected and analyzed by SPSS software. Results: In the measurement results between Pentacam and iTrace , there was a statistically significant difference in the X value, Y value, and azimuth angle values of the horizontal axis (P<0.05); There was no statistically significant difference in chord distance values (P>0.05). Conclusions: 3-D anterior section analyzer the significant difference is found in the concordance of the anglekappa measurement results between the Pentacam and iTrace. It should be caution to replace two kinds of equipment in clinical practice.

近视防控已经上升到我国国家战略层面，高度近视引起的视神经病变会损害视功能，但在临床上常常被忽视。OCT可以非侵入、高分辨率、快速以及可重复地定量视网膜各层厚度，是评估高度近视相关视神经病变的有力工具。由于高度近视常合并视盘和盘周的改变，视神经纤维层厚度的定量常出现误差。近年来，学者开始聚焦于黄斑区神经节细胞复合体(ganglion cell complex,GCC)厚度的研究，但其在高度近视眼中的变化规律尚不统一。该文针对近年来高度近视眼黄斑区GCC的测量规范、诊断价值、变化规律等进行综述，以期提高眼科医师对高度近视视神经病变的重视和研究水平。

Myopia prevention and control has risen to the national strategic level in China. Optic neuropathy caused by high myopia can damage visual function, but it is often ignored in clinical practice Optical coherence tomography (OCT) characterized by non-invasiveness, high resolution, rapid, and repeatable quantifying the thickness of each layer in the retina has emerged as a powerful tool for evaluating high myopia related optic neuropathy. Due to the changes in and near the optic disc in high myopia, errors often occur in the quantification of the thickness of the optic nerve fiber layer. In recent years, researchers have gradually focused on the study of the thickness of ganglion cell complex (GCC), but the regularity of its changes in high myopia is not yet unified. This article reviews the measurement specifications, diagnostic values, and change rules of GCC in the macular region of high myopia in recent years, in order to improve the attention and research level of ophthalmologists on high myopia optic neuropathy.

目的: 分析高度近视眼行白内障摘除及后房型人工晶状体植入术后并发裂孔源性视网膜脱离的发生率、相关危险因素及临床特点。

方法 : 回顾性分析高度近视眼行白内障摘除及后房型人工晶状体植入术患者 146 例(232 只眼) 。裂孔源性视网膜脱离在术后随访的3年时间发生。所有眼均进行了详细的眼科检查, 包括: 最佳矫正视力、眼底检查、A 超眼轴长度测量。

结果: 15 只眼发生裂孔源性视网膜脱离(6.4%) , 均需行玻璃体视网膜手术进行视网膜复位。从白内障手术到发生视网膜脱离的平均时间为10 ± 9 个月(0.5～32 个月) 。视网膜脱离经手术治疗后视力为手动 /10 cm～0.06, 12 只眼(80%) 最终视力低于白内障术前。术中后囊膜破裂与术后视网膜脱离的发生显著相关 (P < 0.01) , 60%(9/15) 的视网膜脱离患者术中发生了后囊膜破裂。

结论: 高度近视眼白内障术后并发裂孔源性视网膜脱离的发生率为 6.4%, 其预后差。术中发生后囊膜破裂患者术后发生视网膜脱离的危险性更高, 对术中后囊膜破裂患者需密切随访。

Aim: To analyze the clinical characteristics, incidence and risk of retinal detachment (RD) after cataract surgery and posterior chamber intraocular lens implantation in high myopic patients.

Methods:The medical records of 146 high myopic patients (232 eyes) who underwent cataract surgery and posterior chamber intraocular lens implantation were studied retrospectively. The development of RD was followed up over a 3-year period, and its characteristics were determined. All of the eyes received a comprehensive ophthal-mological examination, including best-corrected visual acuity measurements, a dilated fundus examination and axial length measured by A-scan ultrasonography.

Results: RD developed in 15 eyes of 15 patients. All the 15 eyes needed vitreo-retinal surgery. The mean interval between cataract surgery and the development of RD was 10 ± 9 months (range 0.5～32 months) . The visual results of the eyes after anatomical successful vitreo-retinal surgery ranged from finger count /10 cm to 0.06. 80% (12/15) of the eyes had a worse vision after the surgery than that before cataract surgery. Posterior capsular tear were associated significantly with RD (P < 0.01). Approximately 60%( 9/15) of retinal detachment was attributable to posterior capsule tear during cataract surgery.

Conclusion: Incidence of RD in high myopic patients after cataract surgery was 6.4%. RD was the potentially serious complication and tended to develop more frequently in eyes with posterior capsular rupture during cataract surgery. It is crucial to examine retinal status after cataract surgery and to have a close follow-up to prevent retinal complications, especially for patients with posterior capsular disruption. 

目的：运用孟德尔随机化(Mendelian randomization,MR)方法，探索户外活动与近视之间的双向因果关系。方法：来自英国生物银行(UK Biobank)的大型队列研究数据，选择与欧洲血统人群中户外活动与近视相关的相互独立的遗传位点作为IV。户外活动的全基因组关联研究(genome-wide association study, GWAS)数据包含419 314名欧洲人群，而近视的GWAS数据则包含460 536名欧洲人群，其中37 362名近视者和423 174名对照者。通过运用逆方差加权法(inverse variance weighted,IVW)、加权中位数法(weighted median,WM)以及MR Egger法进行MR分析，将比值比作为效应度量指标，深入探讨两者间的双向因果联系。同时，通过MR多态性残差和异常值检测(MR PRESSO)方法剔除SNP异常值，利用MR Egger法以及IVW法的Cochran Q检验对各个单核苷酸多态性(SNP)之间的异质性进行了评估；并且使用MR Egger截距检验SNP的潜在多效性，通过“留一法”敏感性分析检验MR研究是否受单个SNP的影响。结果：IVW分析显示户外活动能显著降低近视的风险(OR = 0.934, 95% CI: 0.922～0.948, P < 0.01)。反向孟德尔随机化分析发现近视者参与户外活动的意愿较低(OR = 0.925, 95%CI: 0.777～1.103)但P = 0.39，未达到统计学意义。双向孟德尔随机化分析的Cochran Q检验、MR PRESSO检测以及MR Egger截距测试结果均显示所选IV间不存在显著异质性和水平多效性问题，而且，“留一法”敏感性分析证实，单个SNP对整体结果未见影响。结论：户外活动可能明显降低近视的风险。

Objective: To employ Mendelian randomization (MR) methods to explore bidirectional causal relationships between outdoor activities and myopia. Methods: Large-scale cohort study data from the UK Biobank were utilized, selecting independent genetic loci associated with outdoor activities and myopia within the European ancestry population as instrumental variables. The outdoor activities GWAS data included 419,314 individuals of European descent, while the myopia GWAS data comprised 460,536 individuals, including 37,362 myopia cases and 423,174 controls. MR analyses were conducted using inverse variance-weighted (IVW), weighted median, and MR Egger methods, employing the odds ratio as the effect measure to thoroughly investigate bidirectional causal connections. Mendelian randomization pleiotropy residual sum and outlier (MR PRESSO) detection method were employed to eliminate SNP outliers. Cochran's Q test, within MR Egger and IVW methods, was utilized to assess heterogeneity among individual single nucleotide polymorphisms (SNPs). MR Egger intercept testing assessed potential pleiotropy, and sensitivity analysis using the "leave-one-out" method examined the influence of individual SNPs on overall results. Results: IVW analysis demonstrated that outdoor activities significantly reduce the risk of myopia (OR = 0.934, 95% CI: 0.922~0.948, P < 0.01). Reverse Mendelian randomization analysis revealed a non-significant lower propensity for myopic individuals to engage in outdoor activities (OR = 0.925, 95% CI: 0.777~1.103, P = 0.39). Cochran's Q test, MR PRESSO, and MR Egger intercept tests in bidirectional Mendelian randomization analysis all indicated no significant heterogeneity or horizontal pleiotropy issues among the selected instrumental variables. Furthermore, sensitivity analysis using the "leave-one-out" method confirmed that individual SNPs did not significantly impact the overall results. Conclusion: Outdoor activities significantly reduce the risk of myopia.