目的：探索智能语音随访系统在医疗场景中的新型应用服务模式并分析其在新冠肺炎疫情期间的应用效果，以此评估该系统应用于互联网医院开展医疗咨询服务的实际效能。方法：本研究应用智能语音随访系统针对先天性白内障患儿术后的常见问题进行回访。首先，针对随访目的，设计出完善的结构化随访内容与步骤。其次，部署智能外呼系统自动拨打用户电话，并通过语音识别技术对用户的每次应答进行识别，根据用户的应答自动跳转到下一个随访步骤，在完成一系列问答后根据用户的回答给出恰当的建议，实现电话随访的自动化与智能化。收集2020年2月24日至2月28日期间，智能语音随访系统随访的电话内容、呼叫时间、患儿资料等数据，采用描述性统计分析。结果：2020年2月24日至2月28日期间，中山大学中山眼科中心应用智能语音随访系统电话共随访1154例，其中收到有效回访数据561例，平均有效回访率48.6%。有效回访人群中，有204位(36.4%)家属认为疫情期间复诊时间延长，对宝宝眼睛的恢复有影响，309位(55.1%)家属认为对宝宝眼睛的恢复没有影响。360位(64.2%)先天性白内障患儿眼睛恢复情况良好，没有出现不良反应，169位(30.1%)患儿出现不良反应和体征，包括瞳孔区有白点，眼睛发红和有眼屎流眼泪等。统计患儿不同行为显示，有417位(74.3%)患儿佩戴眼镜，135位(24.1%)患儿没有佩戴眼镜，另有9位(1.6%)患儿佩戴眼镜情况不清楚，经常揉眼的患儿更容易出现眼睛发红(20.4%)、眼睛有眼屎或流眼泪(17.0%)和瞳孔区有白点(6.8%)等不良反应。结论：智能语音随访系统在临床随访中显示出巨大的应用潜力，可作为一种新型的智能医疗服务模式。
Objective: This study was designed to explore its potential value for new medical service model based on the intelligent voice follow-up system and analyze its application effect during the outbreak of COVID-19. The actual effectiveness of this intelligent voice follow-up system applied in the Internet hospital to carry out medical consultation service was discussed. Methods: In this study, an intelligent voice follow up system was developed for postoperative follow-up of children with congenital cataract. First, a well-designed and structured questionnaire contents were developed for postoperative follow-up. Secondly, the intelligent voice follow-up system was deployed. The system would automatically jump to the next follow-up step according to the user’s response, and give appropriate suggestions. Finally, the data of telephone recording, call time, children’s attributes were collected and statistically analyzed. Results: From February 24 to March 15, 2020, 561 families of children with congenital cataract from Zhongshan Ophthalmic Center were recruited by using the intelligent voice follow-up system. The system completed a total of 1 154 calls, of which 561 cases received follow-up data, reaching an average effective call rate of 48.6%. Among 561 cases, 204 (36.4%) thought that the extended time of follow-up visit would affect the recovery of children, while 309 (55.1%) thought that it exerted no effect on the recovery. 360 children (64.2%) achieved good ocular recovery without complications, whereas 169 cases (30.1%) developed ocular symptoms. These include white spots in the pupil area, redness and eye secretions. Statistics of different behavior of children showed that there were 417 (74.3%) children wearing glasses, 135 (24.1%) children did not wear glasses, another 9 (1.6%) children wearing glasses were not clear, often rubbing the eyes of children were more likely to appear redness (20.4%), eye secretions (17.0%) and white spots in the pupil area (6.8%) and other adverse reactions. Conclusion: The intelligent voice follow-up system shows great application potential in clinical follow-up, which can be employed as a new service mode of intelligent medical treatment.
目的：针对活体共聚焦显微镜(in vivo confocal microscopy，IVCM)和传统光学相干层析技术(optical coherence tomography，OCT)在人眼角膜成像各自存在成像视野小或无法细胞成像的限制，开发具有高分辨率的非接触全视场光学相干层析系统(full-field optical coherence tomography，FFOCT)，实现活体人眼角膜细胞结构FFOCT成像。方法：FFOCT系统采用高数值孔径干燥显微物镜及高速面阵相机，使用双相位调制图像处理方法，实现系统高速高分辨率非接触成像。利用系统对健康人眼进行角膜各深度层的活体FFOCT成像验证其可行性。结果：本研究团队研发了FFOCT的新型活体人眼角膜高分辨率成像系统，实现理论平面成像分辨率1.7 μm，成像视野1.26 mm×1.26 mm，成像速率达275帧/s。利用该系统对正常活体人眼角膜成像实验，在非接触情况下获取了角膜各主要结构层的高分辨率结构影像。结论：FFOCT高分辨率活体人眼角膜成像系统兼具了传统OCT的非接触、大成像视野及IVCM的细胞级别平面分辨率的优势，将为角膜疾病的研究及临床诊疗提供全新的成像分析技术。
Objective: Due to the limitations of small imaging field of view of in vivo confocal microscopy (IVCM) or the incapability of cellular imaging of traditional optical coherence tomography (OCT) in human corneal imaging, this study was designed to develop a novel high-resolution in vivo human corneal imaging system based on full-field OCT (FFOCT). Methods: The FFOCT system utilized a high numerical aperture air immersion microscope objective and a high-speed area array CMOS camera with two-phase modulation image processing algorithm to achieve high-speed high-resolution non-contact imaging of human cornea. To verify its feasibility, in vivo cornea imaging at different depth was performed on a healthy human subject. Results: The FFOCT system achieved a theoretical lateral imaging resolution of 1.7 μm, an imaging field of view of 1.26 mm×1.26 mm, and an imaging rate of 275 Hz/s. High-resolution FFOCT images of the main structural layers of cornea were achieved by imaging a healthy human cornea in vivo with this system in a non-contact way. Conclusion: The FFOCT human corneal imaging system combines the advantages of the non-contractness and the large imaging field of view of traditional OCT with the cellular lateral resolution of IVCM, potentially providing a new imaging system for the research and clinical diagnosis and treatment of corneal diseases.
目的：对视网膜光学相干断层扫描图像中不同层和积液区域的分割。方法：提出一种基于深度学习的轻量级的神经网络，参考DRUNet体系、膨胀卷积和残差网络的架构，通过连接不同深度网络处得到的上采样输出，进行多尺度特征融合，使网络能够更好地识别出图像中的边界信息。结果：改进型DRUNet显著提升了视网膜分层的效果，准确率较U-Net提高了1.25%，同时能提前1~2次迭代达到传统U-Net的准确度。结论：本文采用的网络结构提高了对视网膜光学相干断层扫描图像的分割性能，同时降低了网络参数，具有强大的应用潜力。
Objective: To achieve the segmentation of different layers and fluid areas on the optical coherence tomography (OCT) image of the retina. Methods: A lightweight neural network based on deep learning was proposed. The network structure adopted in this study was designed based on the architecture of dilated-residual U-Net. By connecting the upsampling output obtained at different depth networks, multi-scale feature fusion was performed to enable the system to accurately identify the boundaries on the OCT image. Results: Compared with U-Net, this algorithm could achieve the same accuracy with 1–2 epochs less, and the accuracy was also improved by 1.25%. Conclusion: The proposed network improves the segmentation performance of retinal OCT images, and reduces the number of parameters, which demonstrates the network has great application potential.
目的：评估白内障人工智能辅助诊断系统在社区筛查中的应用效果。方法：采用前瞻性观察性研究方法对白内障人工辅助诊断系统的应用效果进行分析，结合远程医疗的模式，由社区卫生人员对居民进行病史采集、视力检查和裂隙灯眼前节检查等，将数据上传至云平台，由白内障人工智能辅助诊断系统和人类医生依次进行白内障评估。结果：受检人群中男性所占比例为35.7%，年龄中位数为66岁，裂隙灯眼前节照片有98.7%的图像质量合格。该白内障人工智能辅助诊断系统在外部验证集中检出重度白内障的曲线下面积为0.915。在人类医生建议转诊的病例中，有80.3%也由人工智能系统给出了相同的建议。结论：该白内障人工智能辅助诊断系统在白内障社区筛查的应用中具有较好的可行性和准确性，为开展社区筛查疾病提供了参考依据。
Objective: To evaluate the effectiveness of an artificial intelligence-assisted diagnostic system for cataract screening in community. Methods: A prospective observational study was carried out based on a telemedicine platform. Patient history, medical records and anterior ocular segment images were collected and transmitted from community healthcare centers to Zhongshan Ophthalmic Center for evaluation by both ophthalmologists and artificial intelligence-assisted cataract diagnostic system. Results: Of all enumerated subjects, 35.7% were male and the median age was 66 years old. Of all enumerated slit-lamp images, 98.7% met the requirement of acceptable quality. This artificial intelligence-assisted diagnostic system achieved an AUC of 0.915 for detection of severe cataracts in the external validation dataset. For subjects who were advised to be referred to tertiary hospitals by doctors, 80.3% of them received the same suggestion from this artificial intelligence-assisted diagnostic system.Conclusion: This artificial intelligence-assisted cataract diagnostic system showed high applicability and accuracy in community-based cataract screening and could be a potential model of care in community-based disease screening.
眼科人工智能技术在实践中不断发展，如大数据应用、图像信息分析、机器人时代等，现在又迈上促进生物识别精确化的新台阶，这些实践应用都能更好地保护视器官，使之具备正常视功能，展示出独特的视觉信息特色。眼科人工智能技术不断开辟新领域，取得了诸多新成就。
The application of artificial intelligence technology in ophthalmology has been on the agenda, and has continued to progress in practice, such as the application of big data, image information analysis, the era of robotics, and now it is on a new step to promote the accuracy of biometrics. These are protections for the visual organs and the vision, make they have normal visual function, and display unique characteristic of visual information. The “eye and artificial intelligence” has continuously opened up new fields and achieved new successes.
近年来，晶状体脱位逐渐引起眼科医生的重视，针对晶状体脱位手术的探索与改进一直在持续进行中。随着超声乳化技术的发明和眼内植入材料的改进，晶状体脱位患者人工晶状体(intraocular lens,IOL)的植入和固定成为眼科医生关注的焦点。IOL悬吊术作为治疗严重晶状体脱位以及无晶状体眼且囊袋支撑不足或无囊袋患者的IOL植入的经典术式，主要经历了传统的经巩膜后房型IOL缝线固定术、以Z字形缝合为代表的无线结后房型IOL缝线固定术和无缝线的IOL巩膜层间固定术三个阶段，理解并掌握各种IOL悬吊术的优势和局限性对提高眼科医生的诊疗水平、改善患者的预后具有重要意义。
In recent years, ectopia lentis has gradually attracted the attention of ophthalmologists, and the exploration and improvement of surgery for ectopia lentis has been in progress. With the invention of phacoemulsification technology and the improvement of intraocular implant materials, the implantation and fixation of intraocular lens (IOL) in patients with ectopia lentis has become the focus of ophthalmologists. Suspensory IOL implantation is a classic operation for IOL implantation in patients with severe lens dislocation or aphakia with insufficient capsular bag support. It has mainly gone through three stages: traditional trans-sclera suture-fixed posterior chamber IOL, kontless posterior chamber IOL fixation represented by Z suture, and sutureless intrascleral IOL fixation. Understanding and mastering the advantages and limitations of various IOL fixation methods is of great importance for improving the diagnosis and treatment level of ophthalmologists and as well as the prognosis of patients.
晶状体悬韧带异常（包括松弛和断裂）可引起晶状体虹膜隔前移、前房变浅、房角关闭和眼压升高，即闭角型青光眼（angle closure glaucoma，ACG）的发生。特发性悬韧带异常多发生于原发性闭角型青光眼（primary angle closure glaucoma，PACG），可能是PACG的发病机制之一，但仍需前瞻性队列研究进一步证实。此类患者双眼前房深度不等，虹膜/晶状体震颤等体征及超声生物显微镜（ultrasound biomicroscopy, UBM）检查能够诊断的悬韧带异常比例较低，通常在青光眼白内障联合手术前未能被诊断而在术中被发现，故被称为隐匿性晶状体悬韧带异常。目前根据术中表现如充分散瞳可见晶状体赤道部，连续环形撕囊破囊时可见前囊放射状皱褶，超声乳化时囊袋赤道部移位或卷曲，灌注抽吸时囊袋异常飘动，囊袋口不规则等可明确诊断。根据悬韧带异常的程度、范围，选择超声乳化晶状体吸除联合人工晶体植入，联合或不联合囊袋张力环植入或人工晶体缝合固定术。PACG患者术前和术中应关注是否存在悬韧带异常，制定个体化治疗方案，以保证手术安全和疗效。
Zonulopathy (including zonular laxity and dehiscence) can cause anterior displacement of iris-lens diaphragm, shallow anterior chamber, anterior chamber angle closure and elevated intraocular pressure, resulting in angle closure glaucoma (ACG). Idiopathic zonulopathy is common in primary angle closure glaucoma (PACG), which may be one of the pathogenic mechanisms of PACG. But further prospective cohort studies are needed to verify that. ?e proportion of diagnosis ofzonulopathy in PACG patients before cataract extraction in combination with anti-glaucoma surgery is low by signs of anterior chamber depth differences between both eyes, iridodonesis / phacodonesis and UBM examination. Hence, most cases with zonulopathy in PACG are found during the operation, which is called occult zonulopathy. At present, the diagnosis of zonulopathy in PACG is often made according to the intraoperative manifestations, such as visible capsular equator aěer mydriasis, wrinkling of the anterior capsule during manual capsulorhexis, infolding of peripheral capsule or visualization of the capsular equator during the cortical or nuclear removal; loose or ěoppy capsular bag. According to different ranges and severities ofzonulopathy, phacoemulsi?cation combined with intraocular lens (IOL) implantation, with or without capsule tension ring implantation, or sclera-fixated IOL is selected. PACG patients should be paid more attention to the diagnosis and differentiation ofzonulopathy before and during operation, fully improved the preoperative examination, and formulated individualized treatment plans to ensure the safety and efficacy of operation.
八年制医学教育的目的是培养适合我国国情的高素质医学人才。本文回顾了我国八年制医学教育的产生与发展；介绍了八年制医学教育改革中各个方面积极的探索，包括教师改革、教学理念改革、教学方法改革、教学手段变化和特色课程设置等；总结了我国目前八年制医学教育的现状；并探讨了进一步完善这一教育体系，提高八年制医学生素质的策略与方案。
The purpose of the eight-year medical education is to train students for well-qualified medical talents that are in line with our national conditions. This article introduces the establishment and development of the eight-year medical education in China, and various aspects of exploration in its reform which includes the reform of the tutoring system, teaching philosophy, teaching approach, means of teaching, special courses and so on. It also summarizes the current situation of the eight-year medical education and discusses potential strategies to improve the education system and the quality of eight-year medical students.
医学生在不久的将来需担起保障人民健康的重任，必须坚持正确政治方向，思想政治教育(思政教育)融入医学课程显得格外重要。眼科疾病与全身疾病息息相关，眼科学是临床医学生的一门必修课程。思政教育与眼科学专业课相融合可激励学生自觉把个人的理想追求融入国家和民族的事业中，勇做走在时代前列的奋进者、开拓者。中山大学中山眼科中心因材施教，针对临床医学专业本科生，通过生动的例子将“防盲治盲责任”“近视防控国家需求”等思政内容融入眼科学本科教学的各个章节中，旨在培养学生树立为服务人民、服务国家健康战略而努力学习的理想和价值观。课程结束后，采用问卷调查了解学生对思政教育与眼科学专业课融合的接受度、课程建议及效果评估，发现学生对眼科学课程中融入思政教育接受度较高，效果较好。
Medical students must adhere to the correct political direction because they need to protect people's health in the near future. It is particularly important to integrate ideological education into medical curriculum. Ophthalmic diseases are closely related to systemic diseases. Ophthalmology is a compulsory course of clinical medicine for medical college students. The integration of ideological education into ophthalmology professional courses can encourage students to integrate their personal ideals into national undertaking, motivate students to become strivers and pioneers in the new era. Zhongshan Ophthalmic Center, Sun Yat-sen University taught students according to their aptitude and integrated the ideological contents such as “prevention of blindness” and “myopia prevention” into each chapter of ophthalmology teaching through vivid examples for clinical medical undergraduates. It would be helpful for the students to establish the ideal and values of “serve the people”. At the end of the course, the medical students were investigated by questionnaires to evaluate the effect of ideological education integration, as well as the acceptance and suggestion from the students. The results showed that studentswere satisfied with the teaching quality of ideological contents and the curriculum integration has achieved the desired effect.
北京同仁医院积累了几十年的眼科进修医生的教学经验，近年来在进修医生教学实践中应用“以问题为导向”(Problem-Based Learning，PBL)教学法，逐步总结出独特的“辩误施教”教学法。这种教学方法有利于加深进修医生对基础知识理论的理解，提高进修医生发现问题、解决问题的能力及独立的临床思维能力。每月定期召开进修医生沙龙，进行必要的考核、多种形式的总结和交流有利于促进交流，提高教学效果。
Beijing Tongren Hospital has accumulated decades of ophthalmology teaching experience. In recent years, through the application of Problem-Based Learning (PBL) teaching method, we gradually summed up the unique error-distinguished teaching method, which may enhance the understanding of basic knowledge and theories, improve the ability of doctors to discover and solve problems and enhance their independent clinical thinking. At the same time, monthly salon for physician refresher, necessary assessments, various forms of summaries and communication are conducive to promote further learning and produce a good teaching efficiency.
