目的：分析湖南地区汉族人群中2型糖尿病患者的人口学特征及生化指标，寻找糖尿病视网膜病变的高危因素。方法：釆用病例对照研究，统计湖南地区正常人群、2型糖尿病但无视网膜病变患者、2型糖尿病视网膜病变患者的人口学特征及生化指标的相关数据，进行成组t检验及logistic回归分析，探讨分析糖尿病视网膜病发生的易感因素。所有研究对象均为汉族。结果：对照组[非糖尿病(non-diabetes mellitus，NDM)组]和2型糖尿病未合并视网膜病变[(non-diabetic retinopathy，NDR)]组之间性别分布、年龄分布、BMI、舒张压、HbA1c、总胆固醇、高密度脂蛋白(high-density lipoprotein，HDL)、尿酸及总胆红素差异无统计学意义(均P>0.05)。NDM组中腹围、收缩压、空腹血糖、三酰甘油、肌酐和低密度脂蛋白(low-density lipoprotein，LDL)值均低于NDR组，差异有统计学意义(均P<0.05)。NDM组中BMI、腹围、收缩压、舒张压、空腹血糖、HbA1c、总胆固醇、三酰甘油、肌酐和LDL值均低于2型糖尿病合并视网膜病变组(diabetic retinopathy，DR)组，差异有统计学意义(均P<0.05)。NDR组收缩压、舒张压、HbA1c、总胆固醇、三酰甘油和肌酐值均低于DR组，差异有统计学意义(均P<0.05)。结论：收缩压超过150 mmHg，舒张压超过90 mmHg，糖化血红蛋白超过9%，血清肌酐超过100 μmol/L，三酰甘油超过3 mmol/L均为糖尿病患者发生视网膜病变的高危易感因素。

Objective: To analyze the demographic characteristics and biochemical indexes of type 2 diabetic patients in Han population in Hunan, and to find the high-risk factors of diabetic retinopathy. Methods: The data of demographic characteristics and biochemical indexes of normal population, type 2 diabetic patients but without retinopathy and type 2 diabetic retinopathy in Hunan were analyzed. Group t test and logistic regression analysis were used to analyze the susceptibility factors of diabetic retinopathy. All the subjects were Han population. Results: There were no significant differences in gender distribution, age distribution, BMI, diastolic blood pressure, HbA1c, total cholesterol, high-density lipoprotein, uric acid and total bilirubin between the control group [non-diabetes mellitus (NDM) group] and the type 2 diabetic without retinopathy group [non-diabetic retinopathy (NDR) group] (all P>0.05). The abdominal circumference, systolic blood pressure, fasting blood glucose, triglyceride, creatinine and low-density lipoprotein in NDM group were all lower than those in NDR group, and the differences were statistically significant (all P<0.05). BMI, abdominal circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, total cholesterol, triglyceride, creatinine and LDL in NDM group were all lower than those in type 2 diabetic retinopathy (DR) group, and the differences were statistically significant (all P<0.05). The comparison between the NDR group and the DR group showed that the values of systolic blood pressure, diastolic blood pressure, HbA1c, total cholesterol, triglyceride and creatinine in the NDR group were all lower than those in the DR group, and the differences were statistically significant (all P<0.05). Conclusion: SBP ≥150 mmHg, DBP ≥90 mmHg, HbA1c ≥9%, serum creatinine ≥100 μmol/L, triglyceride ≥3 mmol/L are the high-risk factors of diabetic retinopathy.

目的：比较四种不同原理的仪器在暗室中对年龄相关性白内障患者Kappa角测量的一致性。方法：对年龄相关性白内障术前60例(60只眼)，暗室中适应10 min后，分别应用iTrace视觉分析仪、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径和Kappa角。四种仪器间所测量的数据比较采用单因素方差分析检验和Kruskal-Wallis非参数检验，一致性比较采用Bland-Altman分析。结果：iTrace、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径分别为(4.64±0.71) mm，(2.96±0.47) mm，(4.86±0.76) mm，(4.66±0.92) mm；Kappa角大小分别为(0.227±0.121) mm，(0.161±0.09) mm，(0.2±0.124) mm，(0.203±0.104) mm；大于0.5 mm的Kappa角比例分比为3.33%、3.33%、1.67%、1.67%；Pentacam和iTrace的Kappa角测量结果有统计学意义(P=0.001)，Pentacam和Lenstar900、IOLMaster700的Kappa角测量结果差异无统计学意义(P=0.044，0.036)，其他三种仪器之间Kappa角测量结果差异均无统计学意义(P=0.181，0.245，0.860)； 60例被检测者对iTrace、Pentacam HR、Lenstar900、IOLMaster700四种仪器测量过程中光强度主观评分结果显示60例(100%)被检测者认为Pentacam HR在测量过程中有明显的不适感，40例(66.67%)被检测者认为IOLMaster700检测过程中舒适感最好，结果差异有统计学意义(χ2=191.236，P<0.001)。结论：Pentacam HR与iTrace、Lenstar900和IOLMaster700三种仪器在暗室中Kappa角的测量结果一致性稍差，临床上需谨慎替换使用。

Objective: To compare the consistency of Kappa Angle measurements in patients with age-related cataracts using four instruments of different principles in a dark room. Methods: Sixty cases (60 eyes) of age-related cataract were adapted in the darkroom for 10 minutes. The pupil size and angle Kappa were measured by iTrace, Pentacam HR, Lenstar900 and IOLMaster700. One-way ANOVA test and Kruskal-Wallis nonparametric test were used to compare the measured data among the four instruments, and Bland-Altman analysis was used for consistency comparison. Results: The measured pupil diameters of iTrace, Pentacam HR, Lenstar900 and IOLmaster700 were 4.64±0.71 mm, 2.96±0.47 mm, 4.86±0.76 mm and 4.66±0.92 mm. The Angle Kappa sizes were 0.227±0.121 mm, 0.161± 0.09 mm, 0.2±0.124 mm, 0.203±0.104 mm. The proportion of angle Kappa larger than 0.5 mm was 3.33%, 3.33%, 1.67% and 1.67%. The measurement results of angle Kappa between Pentacam and iTrace were statistically significant (P=0.001). There was no significant difference in the measurement results of angle Kappa between Pentacam and Lenstar900, Pentacam HR and IOL-Master700 (P=0.044, 0.036). There was no significant difference in the results of angle Kappa measurement among the other three instruments. The subjective score of light intensity in the process of measurement of iTrace, Pentacam HR, Lenstar900 and IOLMaster700 showed that during the process of measurement, 60 cases (100%) experienced obvious discomfort caused by the light intensity in Pentacam HR, while 40 cases (66.67%) felt comfort in IOLMaster700. The differences among the subjective score of light intensity of four instruments were statistically significant (P<0.001). Conclusion: The consistency of the measurement results of Kappa angle between Pentacam HR and iTrace, Lenstar900, IOLMaster700 in the darkroom is relatively poor, so it is necessary to be careful to replace them in clinic.

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.

光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)是一种非接触、无创的、快速的血管造影技术，它通过检测红细胞在血管内的光学相干断层扫描(optical coherence tomography，OCT)信号的变化来提供血管影像。由于这项技术不需要注射血管造影剂，使得它比传统的眼科血管造影技术更安全。在前节疾病的检查中，OCTA不仅能够量化前节血管的范围和密度，还显示出良好的成像质量，为临床监测疾病的病程和对治疗的反应提供客观的评价。

Optical coherence tomography angiography (OCTA) is a noncontact, noninvasive, and rapid angiography technique. It provides vascular images by detecting changes in the optical coherence tomography (OCT) signal of red blood cells in the blood vessel. Since this technique does not require injection of angiography, it is safer than traditional ophthalmic angiography. In the examination of anterior segment diseases, OCTA can not only quantify the range and density of anterior segment blood vessels, but also shows good imaging quality, providing an objective evaluation for clinical monitoring of the disease course and response to treatment.

CRISPR(clustered regularly interspaced short palindromic repeats)基因编辑技术通过精准改变细胞DNA序列，控制细胞命运及表型，是有望从根本上改变疾病治疗的新技术。由于眼球独特的生理构造，基因编辑疗法在治疗眼科疾病方面的应用具有明显的优势。目前，CRISPR基因编辑疗法治疗10型Leber先天性黑矇(Leber congenital amaurosis 10，LCA10)的临床试验已经展开，治疗其他多种眼科疾病的临床试验也即将开始。随着新一代CRISPR基因编辑技术的发展，基因编辑疗法有望为眼科疾病的治疗提供新的手段。

Clustered regularly interspaced short palindromic repeats (CRISPR) genome editing is a newly developed technology to precisely modify cellular DNA sequence, which could control cell fate and phenotype and fundamentally reform disease treatment. The structure of the eye offers unique advantages as a genome editing target. Recently, a CRISPR genome editing therapy has begun to be tested in Leber congenital amaurosis 10 (LCA10) patients, and the clinical trials for more ocular diseases are about to start. The development of CRISPR/Cas genome editing tools will drive major advances in the application of gene therapies in the treatment of ophthalmic disease.

目的：探讨折叠式人工玻璃体球囊(foldable capsular vitreous body，FCVB)植入术的护理配合。方法：对2018年6月至12月接受FCVB植入术的33例患者的术中护理配合进行回顾性分析和总结。结果：33例患者的手术均能顺利进行，术后裂隙灯显微镜检查示折叠式人工玻璃体球囊位置均居中；患者均未见球囊排斥、交感性眼炎及其他明显手术并发症。结论：FCVB是全球首创的革命性产品，手术前充分的术前准备，系统规范化的手术巡回配合，是保证手术顺利完成的关键。

Objective: To explore the nursing cooperation of foldable capsular vitreous body implantation. Methods: The intraoperative nursing cooperation of 33 patients who received the operation from June to December 2018 was retrospectively analyzed and summarized. Results: All the 33 patients underwent successfully, and silt lamp microscopy showed that the position of foldable capsular vitreous body was in the center. No foldable capsular vitreous body rejections, sympathetic ophthalmitis or other obvious surgical complications were observed in all cases. Conclusion: Foldable capsular vitreous body is a global innovative product. Adequate preoperative preparation before surgery and systematic and standardized surgical tour coordination are the keys to the successful completion of surgery.

为满足眼部化学伤患者高效急救的需要，发明一种眼部化学伤结膜囊冲洗器，包括进液管道，冲洗管道，手动加压球，流量调节器和结膜囊冲洗头，避免反复更换冲洗液，减少操作时间，同时有利于冲洗液快速大量聚集，为严重眼部化学伤的患者缩短急救等待时间；手动加压球的设置，实现了冲洗液重力基础上的加压冲洗，为患者眼部急救治疗效果提供了可靠保证。

A new conjunctiva sac irrigation device which includs a liquid inlet pipe, flush pipe, and a manual pressure device, a flow regulator and a flush filter was invented to meet needs of efficient first aid for ocular chemical injuries. It is worth noting to avoid changing fushing fliud frequently and shorten time of operation, which is beneficial to gather a lot of flushing fluid in a short time and shorten the first aid waiting time for patients with severe ocular chemical injuries. For this device, the design of manual pressure ball realizes presure flush based on the gravity of flushing fliud, which confirms a reliable effect on the acute treatment to patients' eyes.

目的：构建具有较强科学性和实用性的眼科专科护士培训体系，为眼科专科护士的准入、培养、考核提供理论基础。方法：通过查阅文献、焦点小组和专家会议法，拟定眼科专科护士培训体系的课程、带教、评价体系。结果：构建的眼科专科护士培训体系内容包括课程体系、培训过程、临床实践指标、考核评价方法4个部分。其中，课程体系部分包含一级指标5项，二级指标11项，三级指标55项；培训过程包括一级指标4项、二级指标12项；临床实践指标包括一级指标6项、二级指标23项；考核评价方法包括一级指标5项、二级指标10项。结论：眼科专科护士培训体系构建过程科学，内容设置合理，对开展专科护士培训具有较好的指导意义。

Objective: To develop a scientific and practical training system for ophthalmic specialist nurses and provide theoratical basis for the the admission, training and assessment of ophthalmic specialist nurses. Methods: Through extensive review of domestic and foreign literatures, a focus group interview and an expert meeting, the curriculum, teaching and evaluation system of the ophthalmic specialist nurses training system was developed. Results: The training system for ophthalmic specialist nurses consists of four parts: training content, training process, clinical practice, assessment and evaluation. Among them, the training content includes 5 first-level indicators, 11 second-level indicators and 55 third-level indicators. The training process of ophthalmic specialist nurses includes 4 indicators of the first level and 12 indicators of the second level. The clinical practice indexes of ophthalmic specialist nurses include 6 indexes of the first grade and 23 indexes of the second grade. The methods of assessment and evaluation of ophthalmic specialist nurses include 5 indicators of the first level and 10 indicators of the second level. Conclusion: The scientific process and reasonable content of the training system for ophthalmic specialist nurses have a good guiding significance for the training of ophthalmic specialist nurses.

目的：探讨原发性慢性闭角型青光眼(chronic primary angle-closure glaucoma，CPACG)患者的视网膜血流密度(vessel density，VD)与视野缺损程度的相关性。方法：光学相干断层血管成像技术(optical coherence tomography angiography，OCTA)测量89例(112眼)视野缺损的CPACG患者的黄斑区VD、视盘旁VD，分析VD与视野缺损程度的相关性。结果：视盘旁VD与视野缺损程度成负相关(r>–0.728，P<0.05)。黄斑浅层总VD的受试者工作曲线(receiver operating characteristic，ROC)及曲线下面积(area under the curve，AUC)为0.874。在控制年龄、眼压及视力的情况下，黄斑总浅层VD每降低1%，视野平均缺损(mean deviation，MD)值增加–0.639 dB。结论：CPACG患者VD与视野缺损呈线性负相关，OCTA可以方便无创地观察青光眼患者眼底血流情况，在视野缺损前发现视网膜VD降低，从而可以作为CPACG早期诊断的参考指标。

Objective: To investigate the correlation between the retinal vessel density (VD) and the degree of visual field loss in chronic primary angle-closure glaucoma (CPACG). Methods: Eighty-nine CPACG patients (112 eyes) with different degrees of visual field loss were measured with optical coherence tomography angiography (OCTA) for macular VD and para-optic microcirculation VD, and the correlation between them and the degree of visual field defect were analyzed. Results: There was a negative correlation between the VD of the microcirculation in each zone next to the optic disc and the degree of visual field loss (r>–0.728, P<0.05). The receiver operating characteristic (ROC) and area under the curve (AUC) of the total VD of the superficial macula is 0.874. Under the condition of controlling age, intraocular pressure and vision, for every 1% decrease in the total superficial macular VD, the average visual field defect mean deviation (MD) value increases –0.639 dB. Conclusion: The VD of CPACG patients is linearly negatively correlated with visual field defects. OCTA can conveniently and non-invasively observe the blood flow of the fundus in patients with glaucoma. It is found that the retinal VD is reduced before visual field defects, which can be used as a reference index for early diagnosis of CPACG.

目的：了解原发性开角型青光眼(primary open angle glaucoma，POAG)患者视野缺损的进展情况，探讨其发生进展的相关危险因素。方法：回顾性分析2014年1月至2018年7月就诊于北京大学第三医院眼科并有至少4次视野检查的POAG患者。按照患者首次视野检查的平均偏差或平均缺损进行分期。将历次随访视野检查的平均偏差或平均缺损与时间进行线性回归分析，取其斜率(dB/年)。根据平均偏差或平均缺损的斜率将患者分为进展组与无进展组。分析患者视盘周围视网膜神经纤维层(retinal nerve fiber layer，RNFL)厚度损害位置、平均随诊间隔时间、基线视野分期等因素与青光眼视野缺损进展的关系。结果：共纳入128例患者(252只眼)，其中129眼使用Octopus视野计检查随访，基线视野缺损值为(10.91±5.76) dB；123眼使用Humphrey视野计，基线视野偏差值为(–10.62±6.89) dB。视野缺损早、中、晚期的比例分别为26.19%、36.51%和37.30%。进展组31只眼(12.30%)，无进展组221只眼(87.70%)。上下方RNFL都存在重度损害的患者，其视野缺损更易进展(P<0.001)。平均随诊间隔时间≤4个月的患眼，发生进展的比例高于平均随诊间隔时间>4个月的患眼(P=0.058)。基线视野分期、年龄、性别、总随访时间与视野缺损进展未见显著相关性。结论：青光眼患者的视功能损害出现恶化是普遍存在的。上下方RNFL均存在重度损害、随诊间隔时间短与视野缺损进展相关。视神经结构的改变与功能损害具有相关性，结构改变的方位对功能损害进展有提示功能。规律随诊对病情监测有重要意义，对于可能快速进展的患者，应缩短随诊间隔时间。

Objective: To investigate the progression of visual field defect in primary open angle glaucoma (POAG), and to explore the related risk factors for its progression. Methods: A retrospective analysis was performed on patients with POAG who had at least 4 visual field examinations in the Department of Ophthalmology, Peking University Third Hospital from January 2014 to July 2018. The visual field was staged according to the mean deviation or mean defect of the first visual field examination. Linear regression analyses of mean deviation or mean defect were performed against time, and corresponding regression slopes (in decibels per year) were calculated. Patients were divided into progressive and non-progressive groups according to the mean deviation slope or mean defect slope. The relationship between retinal nerve fiber layer (RNFL) thickness lesion location, mean follow-up interval, baseline visual field staging, and the progression of visual field defect in glaucoma were analyzed. Results: A total of 128 patients (252 eyes) were included. Among them, 129 eyes were followed up with an Octopus perimeter, and the average mean defect value of the baseline visual field was 10.91±5.76 dB; while the other 123 eyes were followed up with a Humphrey perimeter, and the average mean deviation value of the baseline visual field was –10.62±6.89 dB. The proportion of early, middle and late visual field defects was 26.19%, 36.51% and 37.30%. There were 31 eyes (12.30%) in the progressive group and 221 eyes (87.70%) in the non-progressive group. Patients with severe damage to both the upper and lower RNFLs had more visual field defects (P<0.001). Patients with an average follow-up interval ≤4 months had a higher rate of progression than those with an average follow-up interval >4 months (P=0.058). There were no significant differences in baseline visual field stage, age, gender, and total follow-up time between the progression and progression-free groups. Conclusion: Deterioration of visual function impairment is common in glaucoma patients. The progression of visual field defects is associated with severe impairments which are present both in the upper and lower RNFLs, and short follow-up intervals. Optic nerve structure changes are related to functional impairment, and the location of structural changes is suggestive of functional impairment progression. Regular follow-up visits are of great significance for disease monitoring. For patients who may progress rapidly, the follow-up interval should be shortened.