目的：分析角膜后前表面曲率半径比值(B/F比值)与年龄相关性白内障患者术后屈光误差的关系，探讨B/F比值对人工晶状体(intraocular lens,IOL)度数计算精确性的影响。方法：选取2019年3—11月在天津医科大学眼科医院白内障中心就诊，并拟行单眼白内障手术的年龄相关性白内障患者共197例(197眼)，术前应用Pentacam眼前节分析仪测量患者眼前节生物参数，并以B/F比值下限25%、上限25%为界将患者分为下25%组、25%～75%组、上25%组。术后3个月应用全自动电脑验光仪评估患者术后屈光状态，并计算患者术后屈光误差(postoperative refractive error,PE)，比较三组平均屈光误差(mean refractive error,ME)、平均绝对误差(mean absolute error,MAE)、中位数绝对误差(median absolute error,MedAE)以及屈光误差在±0.25、±0.50、±0.75、±1.00、>±1.00 D范围内百分比差异。结果：B/F比值与年龄相关性白内障患者术后屈光误差呈中度相关(r=?0.445, P<0.001)。随着B/F比值增大，患者术后屈光状态由远视向近视漂移，术后3个月MAE、MedAE分别为0.55 D、0.46 D。屈光误差在±0.25、±0.50、±0.75、±1.00、>±1.00 D范围的百分比分别为29.4%、52.8%、71.6%、87.6%、12.7%。根据正常年龄相关性白内障人群B/F比值优化得到的矫正角膜折射指数计算角膜曲率后，MAE、MedAE分别为0.51、0.43 D，均低于矫正前(P<0.05)。结论：B/F比值对年龄相关性白内障患者术后屈光状态有影响。随着B/F比值的增加，白内障患者术后屈光状态由远视逐渐向近视漂移，且B/F比值越偏离正常平均值，患者的屈光误差绝对值越大。
Objective: To analyze the relationship between corneal B/F ratio and postoperative refractive error in age-related cataract patients, and to explore the impact of B/F ratio on the accuracy of intraocular lens power calculation. Methods: A total of 197 age-related cataract patients (197 eyes) who were treated in the cataract center of our hospital from March 2019 to November 2019 and were going to undergo monocular cataract surgery were selected. The biological parameters of the anterior segment were measured by Pentacam anterior segment analyzer before surgery, and the patients were divided into three groups (25% below the B/F ratio, 25%~75%, and 25% below the B/F ratio) with the lower limit and the upper limit of 25%. Three months after surgery, the postoperative refractive state of patients was evaluated by automatic computerized refractometer, and the postoperative refractive error (PE) was calculated, and the percentage differences of mean refractive error (ME), mean absolute error (MAE), median absolute error (MedAE) and refractive error in the range of ±0.25, ±0.50, ±0.75, ±1.00 and < ±1.00D were evaluated. Results: The B/F ratio was moderately correlated with postoperative refractive error in age-related cataract patients (r= ?0.445, P < 0.001). With the increase of B/F ratio, the refractive state of patients shifted from hyperopia to myopia after surgery, and the MAE and MedAE were 0.55 D and 0.46 D respectively in 3 months after surgery. The percentages of refractive error in the range of ±0.25, ±0.50, ±0.75, ±1.00 and < ±1.00 D were 29.4%, 52.8%, 71.6%, 87.6% and 12.7%, respectively. After adjusting the corneal curvature according to the B/F ratio of the population based on our previous study, MAE and MedAE were 0.51 D and 0.43 D, respectively, which were lower than those before correction (P< 0.05). Conclusions: There is a correlation between B/F ratio and postoperative refractive error in age-related cataract patients. As the B/F ratio increased, the refractive state of the patient gradually drifted from farsightedness to myopia after cataract surgery, and the more the B/F ratio deviated from the normal average, the greater the absolute value of the patient's refractive error.
目的：评估超脉冲二氧化碳(CO2)激光治疗不同类型眼睑肿物的疗效和安全性。方法：纳入50例眼睑肿物患者，其中男12例、女38例。患者年龄4~84岁。肿物类型包括眼睑色素痣、睑黄瘤、分裂痣、眼睑疣等，其中25例累及眼睑灰线，10例肿物直径>10 mm。所有患者接受超脉冲CO2激光治疗，并进行术后随访。治疗效果通过术后数码照片评估，同时记录术后1个月并发症发生情况。结果：50例眼睑肿物总体治愈率为92%，有效率达到100%。4例眼睑色素痣在治疗后1个月内复发。术后并发症主要包括轻微倒睫(5例)、睫毛稀疏部分缺失(4例)和瘢痕增生及色素沉着(4例)，未出现其他严重并发症。结论：对于眼睑肿物，特别是睑缘肿物及大肿物，超脉冲CO2激光是一种更为精确、微创、安全有效的治疗方法，可作为眼睑肿物治疗的优选方案。
Objective: To evaluate the efficacy and safety of ultrapulse carbon dioxide (CO2) laser in the treatment for various types of eyelid tumors. Methods: A total of 50 patients, including 12 males and 38 females,with eyelid tumors were included in the study The age range is from 4 to 84 years, with an average age of 37.9±20.0 years. The tumors found in our study include eyelid pigmented nevus, xanthelasma, divided nevus, and molluscum. Among them, 25 cases involved the gray line of the eyelid,and 10 cases had a tumor diameter greater than 10 mm. All patients underwent ultrapulse CO2 laser treatment and postoperative follow-up. The treatment outcomes were assessed through digital photos, and complications were recorded one month after surgery. Results: The total cure rate of the 50 cases of eyelid tumors in our study was 92%, with the effective rate reaching 100%. 4 cases of eyelid pigmented nevi recurred within one month after treatment, while all other patients were cured. Postoperative complications mainly included minor trichiasis (5 cases), partial sparse to absent eyelashes (4 cases), and hypertrophic scar with hyperpigmentation (4 cases). No other serious complications were reported in our study. Conclusions: For eyelid tumors, especially eyelid margin and larger tumors, the ultrapulse CO2 laser is a more precise, minimally invasive, safe and effective treatment method. It can be used as a preferred treatment option for eyelid tumors, and should be promoted widely in clinical practice.
糖尿病视网膜病变(diabetic retinopathy,DR)是世界范围内劳动年龄人口视力损伤的主要原因。糖尿病前期和DR临床前期患者作为罹患DR的高危人群，在该阶段可发现视网膜神经元形态功能及视网膜微小血管的改变。视网膜及神经纤维层厚度的变化可部分反映视网膜神经元结构改变；色觉、对比敏感度、视野及视觉电生理等变化可反映视网膜神经元功能改变。随着光学相关断层扫描血管成像技术的发展，临床可以检测出DR之前视网膜微血管的改变。此外，许多生物标志物也可以预测和评估DR。由于目前还没有方法可以阻止DR的发生与进展，临床可以通过观察以上视网膜的改变更为及时地发现DR，以降低其患病率，最大限度地减少DR带来的视力损伤。
Diabetes retinopathy (DR) is the main cause of visual impairment in the working population worldwide. Patients with pre-diabetes and pre-clinic diabetic retinopathy are regarded as in high risk group of DR. The changes in morphology and function of renal neurons and retinal micro-vessels can be found in these patients at this stage. The changes of retinal nerve structure can be partly reflected by changes in the thickness of retina and nerve fiber layer. The changes in function of retinal neurons can be reflected by changes in color vision, contrast sensitivity, visual field and visual electrophysiology.With the development of optical coherence tomography angiography, changes in retinal micro-vessels can be observed prior to clinical detection of DR. In addition, many biomarker can also predict and evaluate DR. Since there is no way to prevent the occurrence and progress of DR at present, more attention should be paid in DR by observing the changes inthe retina mentioned above timely, to reduce its incidence and minimize the visual damage caused by DR.
视神经脊髓炎谱系疾病相关视神经炎是一种累及视神经的脱髓鞘性炎症疾病，视力损伤严重，预后差，复发率高。及时控制急性发作和有效预防复发是治疗的关键。目前治疗主要包括糖皮质激素、血浆置换、免疫吸附、免疫抑制剂、靶向单抗类药物。特别是近年来依库丽单抗、萨特利珠单抗、及依那利珠单抗取得重大进展。该文综述视神经脊髓炎谱系疾病相关视神经炎近年治疗研究进展，期望为临床决策提供有益参考。
Neuromyelitis optica spectrum disorders (NMOSD) is a central nervous system inflammatory demyelinating disease with involvement of the optic nerve and spinal cord, with poor prognosis and high recurrence rate. Timely control of acute attacks and effective prevention of recurrence are the keys to treatment. This article reviews the recent research progress in the treatment of optic neuritis associated with NMOSD , hoping to provide useful references for clinical decision-making.
目的：总结并分析视野为中心暗点的视神经病变的病因和临床特点，为临床诊治提供参考。方法：回顾性病例研究。分析2018年8月至2020年3月期间，在中山大学中山眼科中心神经眼科专科门诊就诊，视野表现为中心暗点且随访1年以上的视神经病变患者的资料。患者双眼均行最佳矫正视力、眼压、裂隙灯显微镜及前置镜、频域光学相干断层扫描、视野、颅脑和眼眶核磁共振检查，静脉采血行血常规、血生化、肝肾功能、感染指标(乙肝、丙肝、梅毒、HIV及结核T-spot)检查及Leber遗传性视神经病变的线粒体DNA和OPA1基因检测。结果：共纳入20例患者，病因诊断构成为：Leber遗传性视神经病变9例(45%)，显性视神经萎缩2例(10%)，乙胺丁醇中毒性视神经病变6例(30%)，营养性视神经病变2例(10%)和特发性脱髓鞘性视神经病变1例(5%)。遗传性视神经病变的视力预后差，特别是Leber遗传性视神经病变，78%的随访视力(≥1年)不高于0.1。伴有mtDNA或OPA1基因突变的乙胺丁醇中毒性视神经病变患者，视力预后差。结论：视野为中心暗点表现的视神经病变，主要为遗传、中毒和营养性视神经病变。遗传性视神经病变具有不完全外显率的特点，视野为中心暗点的视神经病变需行基因检测排除遗传性视神经病变。
Objective: To summarize and analyze the etiology and clinical features of optic neuropathy with visual field defect of central scotoma as a reference for clinical diagnosis and treatment. Methods: In the retrospective case study, the data of patients admitted in Neuro-ophthalmic Department of Zhongshan Ophthalmic Center of Sun Yat-sen University from August 2018 to March 2020, who presented with visual field defect of central scotoma and were followed up for more than 1 year, were analyzed. Both eyes of all the patients underwent best corrected visual acuity, intraocular pressure, slit lamp microscope and front mirror, spectral domain optical coherence tomography, humphry visual field tests and MRI of brain and orbit. We examined the blood routine, biochemical test, renal and liver function, infection indicators (hepatitis B, hepatitis C, syphilis, HIV and tuberculosis T-spot), mitochondrial DNA and OPA1 gene detection of Leber hereditary optic neuropathy. The follow-up time of the patients in neuro-ophthalmic department was more than 1 year. Results: A total of 20 patients were recruited. Among them, the etiological diagnosis consisted of 9 patients of Leber hereditary optic neuropathy (45%), 2 of dominant optic atrophy (10%), 6 of ethambutol-induced optic neuropathy (30%), 2 of nutritional optic neuropathy (10%) and 1 of idiopathic demyelinating optic neuropathy (5%). The patients with hereditary optic neuropathy showed a poorer visual prognosis, especially Leber hereditary optic neuropathy, with 78% of follow-up visual acuity (≥1 year) not higher than 0.1. The visual prognosis of ethambutol-induced optic neuropathy patients with mtDNA or OPA1 gene was poor. Conclusions: The optic neuropathy of visual field defects with central scotoma includes mainly hereditary, toxic and nutritional optic neuropathy. Hereditary optic neuropathy is characterized by incomplete penetrance, and genetic testing is required to exclude hereditary optic neuropathy if the visual field is the central scotoma.
光学相干断层成像(optical coherence tomography，OCT)自1991年发明以来，在生物成像尤其在眼科和心血流成像中起越来越重要的作用。OCT的发展经历了早期的时域系统及最新的频域系统。其中频域系统又分为谱域OCT(spectral domain OCT，SD-OCT)系统和扫频OCT(swept source OCT，SS-OCT)系统。随着眼科临床应用对系统速度、灵敏度及功能化要求的不断提升，眼科扫频OCT已经走向成熟并逐步商用化。本文将简介扫频OCT的原理，并归纳扫频OCT相对于时域和谱域OCT系统的优势，并展示其在眼科临床的应用。
Optical coherence tomography (OCT) has played an important role in biomedical imaging, especially in ocular and cardiovascular imaging. OCT technology has evolved to frequency domain technology from early time-domain technology due to the advantages of high sensitivity and high speed of frequency domain techniques. The swept source OCT is a type of frequency domain OCT. With the increasing requirements for system speed, sensitivity, and functionality in clinical application, swept source OCT is gradually becoming commercially available and widespread in clinical application. In this paper, the principle of swept source OCT was introduced, the advantages of swept source OCT over time domain and spectral domain OCT systems were summarized, and its clinical application in ophthalmology was demonstrated.
目的：探讨人工晶状体(IOL)预先巩膜悬吊在严重晶状体半脱位中的应用效果。方法：选取 2018年12月至2022年7月四川省人民医院收治的>180°的严重晶状体半脱位患者8例(8 眼)。术中避开脱位的晶状体，预先将IOL悬吊于玻璃体腔，再将晶状体托起置于IOL上方，必要时辅助以虹膜拉钩，稳定晶状体，确保超声乳化手术安全完成。结果：严重的晶状体半脱位患者8例，其中晶状体核N1-N3硬度的患者各1例，单独使用IOL预先巩膜悬吊于术中稳定脱位的晶状体，3例超声乳化手术均顺利完成；达N4患者3例、N5患者2例，其中4例在虹膜拉钩的辅助下安全完成超声乳化；有1例N5的患者，由于悬韧带损伤超过270°，在将晶状体托起放置于IOL之上时，坠入玻璃体腔，给予玻璃体腔超声粉碎处理。8例患者术后IOL均居中，视力有不同程度的提高，眼压正常，未见严重并发症。结论：在严重晶状体半脱位的超声乳化手术中，对于N2~N3的软核，IOL预先巩膜悬吊可以良好地稳定晶状体，确保超声乳化手术的顺利进行；对于N4~N5的硬核，IOL预先巩膜悬吊可以作为一种辅助方法，联合虹膜拉钩共同稳定晶状体，确保超声乳化手术的安全进行。
Objective: To investigate the effect of intraocular lens (IOL) pre-suspension in thetreatment of severe lens subluxation. Methods: Retrospective case study. From December 2018 to July 2022, 8 eyes of 8 patients with severe lens subluxation greater than 180 degrees admitted to our hospital were selected. During surgery, the IOL should avoid the subluxated lens and be pre-suspended in the vitreous cavity, and then the lens is lifted and placed above the IOL. If necessary, the iris hook can be used to stabilize the lens to ensure the safe completion of phacoemulsification. Results: There were 8 patients with severe subluxation of lens. Among them, the hardness of 3 patients' lens nucleus ranged from N1 to N3. In these 3 patients, we used the IOL pre-suspension alone to stabilize the subluxated lens, and phacoemulsification in these 3 patients was successfully completed. Three patients had N4 and 2 patients had N5, of which 4 patients underwent phacoemulsification safely with the assistance of iris hook. In another patient with N5, the lens fell into the vitreous cavity during surgery (the suspension ligament rapture greater than 270 degrees) when it was lifted and placed on the IOL which was crushed by the vitreous cavity ultrasound. After surgery, the IOL was centered in all 8 patients, visual acuity was improved to varying degrees, intraocular pressure was normal, and no serious complications were observed. Conclusions: In severe lens subluxation surgery, IOL presuspension in soft nuclei of N2 to N3 can stabilize the lens well and ensure the safety of phacoemulsification. For hard nuclei N4 to N5, IOL presuspension can be used as an auxiliary method in combination with iris hook to stabilize the lens and ensure the safety of phacoemulsification.
近年来随着人口老龄化的发展、人群用眼方式的改变，现有的眼科医疗资源正越来越难以满足日渐增长的医疗需求，亟需新型的诊疗模式予以补足。眼科人工智能作为眼科领域的新兴元素，在眼病的筛查诊断中发展迅速，主要表现为“眼部图像数据+人工智能”的模式。近年来，随着该模式在白内障、青光眼、糖尿病性视网膜病变(diabetic retinopathy，DR)等常见病中研究的深入，相关技术日渐成熟，表现出了较大的应用优势与应用前景，部分技术甚至成功转化并被逐渐应用于临床。眼科诊疗向智慧医学模式的过渡，有望缓解日益增长的医疗需求与紧缺的医疗资源之间的矛盾，从而提高整体的医疗服务水平。
The development of population aging and changes in the way people use their eyes over the recent years have increasingly challenged the existing ophthalmic medical resources to meet the growing medical needs, thus urgently calling for a novel diagnostic and treatment mode. Despite its status as an emerging sector in ophthalmology, ophthalmic artificial intelligence has developed rapidly in the screening and diagnosis of eye diseases, as can be seen in practices adopting the “eye imaging data + AI” mode. In recent years, with the intensified research on this mode with respect to common diseases such as cataract, glaucoma and diabetic retinopathy, relevant technologies have grown increasingly mature, presenting undeniable application superiority and prospects. Some of the relevant technical achievements have also been successfully transformed for practical usage, and are gradually being applied to clinical practices. Ophthalmic diagnosis and treatment are transitioning toward the era of intelligent medical services, which are expected to reduce the contradictions between the growing medical needs and the shortage of medical resources, as well as ultimately improve the overall experience of medical services.
目的：评估分析新疆地区14个地州6~18岁学龄儿童青少年屈光参差的患病率、空间分布特征和影响因素，为制定区域性眼健康干预策略提供科学依据。方法：采用横断面研究设计，纳入新疆地区14个地州的小学、初中及高中学生共64 277名，收集其人口学特征、屈光状态及地域分布数据。通过等效球镜度（spherical equivalent，SE）评估屈光状态，近视为SE ≤ -0.50 D，屈光参差为眼间SE差异≥1.0 D，采用Moran's I分析屈光参差患病率的空间分布，采用单因素及多因素回归分析探讨屈光参差的危险因素。结果：屈光参差的总体患病率为17.9%（95% CI：17.6%～18.2%），女性屈光参差患病率（18.8%）高于男性（16.9%），汉族（23.9%）高于维吾尔族（11.7%）和其他民族（18.4%）（P<0.001）。屈光参差患病率呈空间聚集分布(Moran's I = 0.450，P = 0.043，Z = 2.026)，并且存在地域差异，昌吉最高（24.1%），克孜勒苏柯尔克孜自治州最低（7.9%），城市（19.0%）高于农村（15.6%），北疆（19.9%）高于南疆（13.5%）（P<0.001）。屈光参差的患病率与年龄呈正相关，6岁为9.8%，18岁达22.4%。多因素回归分析显示，女性、北疆地区、近视和较高年龄是屈光参差的独立危险因素（P<0.05）。结论：新疆地区学龄儿童青少年屈光参差患病率较高，在空间上呈聚集分布，且存在显著的人口学及地域差异，女性、北疆地区、近视和较高年龄是屈光参差的独立危险因素，建议加强对高危人群的视力筛查及早期干预。
Objective: To evaluate and analyze the prevalence, spatial distribution characteristics, and influencing factors of anisometropia among school-aged children and adolescents aged 6-18 across 14 prefectures in Xinjiang, thereby providing a scientific foundation for formulation of regional eye health intervention strategies. Methods: A cross-sectional study design was employed, including 64,277 students from primary, middle, and high schools in 14 prefectures of Xinjiang. Data on demographic characteristics, refractive status, and geographical distribution were collected. Refractive status was assessed using spherical equivalent (SE). Myopia was defined as SE ≤ -0.50 D, and anisometropia was defined as an interocular SE difference ≥ 1.0 D. Moran's I analysis was used to evaluate the spatial distribution of anisometropia prevalence. Additionally, univariate and multivariate regression analyses were conducted to identify risk factors for anisometropia. Results: The overall prevalence of anisometropia was 17.9% (95% CI: 17.6%-18.2%). The prevalence was higher among females (18.8%) compared to males (16.9%), and higher among Han Chinese (23.9%) than among Uyghurs (11.7%) and other ethnic groups (18.4%) (P<0.001). The prevalence of anisometropia showed a spatially clustered distribution (Moran's I = 0.450, P= 0.043, Z-score = 2.026) , with notable regional variations. Changji had the highest prevalence (24.1%), while Kizilsu Kirghiz Autonomous Prefecture had the lowest (7.9%). Urban areas (19.0%) had a higher prevalence than rural areas (15.6%), and northern Xinjiang (19.9%) had a higher prevalence than southern Xinjiang (13.5%) (P<0.001). The prevalence of anisometropia was positively correlated with age, increasing from 9.8% at age 6 to 22.4% at age 18. Multivariate regression analysis showed that female gender, residing in northern Xinjiang, myopia, and older age were independent risk factors for anisometropia. Conclusions: The prevalence of anisometropia among school-aged children and adolescents in Xinjiang is relatively high, showing a spatially clustered distribution with significant demographic and regional disparities. Female gender, residing in northern Xinjiang, myopia, and older age are independent risk factors for anisometropia. It is recommended to enhance vision screening and implement early intervention for high-risk populations.
目的：通过前房注射亚硒酸钠溶液建立新西兰兔硒性白内障模型，并评估验证其在药效试验中的应用。方法：采用前房注射10 mmol/L亚硒酸钠溶液(0.1 mL/只)对动物右眼进行造模，于造模第3天根据晶状体混浊度评分选取成模动物分为模型组、吡诺克辛滴眼液(pirenoxine sodium eye drops, PSED)0.05 mg/mL组，以模型组动物左眼作为空白组，每组8只眼；分组后对各组动物眼进行滴眼给药，50 µL/眼/次，3 次/天，连续给药17 d。于给药前、给药第7、17天进行裂隙灯检查拍照在体评估晶状体混浊度，末次给药后完整分离各组动物晶状体，体外评估晶状体透明度，然后将各组动物晶状体匀浆，用于过氧化物酶(peroxidase, POD)及谷胱甘肽过氧化物酶(glutathione peroxidase, GSH-Px)活力测定。结果：与空白组相比，模型组给药前、给药第7、17天晶状体混浊度评分均升高，给药结束后晶状体透明度评分升高，晶状体中GSH-PX和POD活力均降低；与模型组相比，PSED 0.05 mg/mL组给药17d晶状体混浊度和透明度评分均降低，晶状体中GSH-PX活力升高，POD无变化。结论：前房注射亚硒酸钠溶液可诱导新西兰兔发展出稳定的白内障模型症状，适用于药物药效作用的评价。
Objective: To establish a selenium-induced cataract model in New Zealand rabbits by anterior chamber injection of sodium selenite solution and evaluate and verify its application in pharmacodynamic trials. Methods: The right eyes of the animals were modeled by anterior chamber injection of 10 mmol/L sodium selenite solution (0.1 mL per animal). On the third day of modeling, the modeled animals were selected and divided into the model group and the pirenoxine sodium eye drops (PSED) 0.05 mg/mL group based on the lens turbidity score. The left eyes of the animals in the model group were taken as the blank group, with 8 eyes in each group. After grouping, eye drops were administered to the eyes of each group of animals. The dosage was 50 µL per eye each time, three times a day, for 17 consecutive days. Slit lamp examination and photography were conducted on the 7th and 17th days of administration to evaluate the turbidity of the lenses in vivo. After the last administration, the lenses of each group of animals were completely isolated, and the transparency of the lenses was evaluated in vitro. Then, the lenses of each group of animals were homogenized. It is used for the determination of peroxidase (POD) and glutathione peroxidase (GSH-Px) activities. Results: Compared with the blank group, the lens turbidity scores of the model group were significantly increased before administration, on the 7th and 17th days of administration, the lens transparency scores were significantly increased after the end of administration, and the activities of GSH-PX and POD in the lens were significantly decreased. Compared with the model group, the scores of lens turbidity and transparency in the PSED 0.05 mg/mL group and 17 days after administration were significantly decreased, the activity of GSH-PX in the lens was significantly increased, and there was no change in POD. Conclusions: Anterior chamber injection of sodium selenite solution can induce the development of stable cataract model symptoms in New Zealand rabbits and is suitable for the screening and evaluation of drug efficacy.
