目的：比较单眼发作的原发性急性房角关闭(acute primary angle closure，APAC)患者发作眼与未发作眼眼部生物学参数的差异，分析急性房角关闭发作的可能危险因素。方法：回顾性分析2008年1月至2020年3月中山眼科中心青光眼科222例45岁以上单眼发作的APAC病例。排除双眼发作、另眼有发作史及晶状体源性、外伤性等继发因素。A超测量晶状体厚度、眼轴长度，超生生物显微镜测前房深度。对单眼发作APAC患者的发作眼与未发作眼眼轴长度、前房深度、晶状体厚度、晶状体相对位置等进行统计学分析。结果：患者发作年龄为(62.57±9.14)岁。发作眼与未发作眼前房深度分别为(1.75±0.27) mm和(1.88±0.31) mm，眼轴长度分别为(22.34±0.80) mm和(22.35±0.83) mm，晶状体厚度分别为(5.14±0.38) mm和(5.17±0.42) mm，晶状体相对位置分别为0.195和0.198。发作眼前房深度较浅，晶状体相对位置较靠前，差异有统计学意义(均P<0.001)，发作眼的眼轴长度、晶状体厚度较未发作眼差异无统计学意义(P>0.05)。APAC发作年龄较小(45~59岁)的患者双眼眼轴均短于发作年龄较大(60~69、70岁以上)的患者；发作年龄70岁以上患者双眼前房深度均较浅，双眼晶状体相对位置均较靠前，差异均有统计学意义(P<0.05)。相关性分析表明APAC发作年龄较小的患者双眼眼轴均较短(P<0.001)。结论：APAC发作眼的前房较浅、晶状体相对位置靠前。短眼轴、女性与不同个体的APAC发作相关。浅前房、晶状体厚、晶状体相对位置靠前可能是高龄人群APAC发作的危险因素。

Objective: To compare the ocular biometric parameters between the acute primary angle closure (APAC) eyes and the fellow eyes as well as the risk factors associated with APAC. Methods: From January 2008 to March 2020, 222 monocular APAC patients over 45 years old from the Glaucoma Department of Zhongshan Ophthalmic Center, Sun Yat-sen University were retrospectively studied. Patients with binocular attack, previous attack in the fellow eyes, and secondary factors such as lens-induced and traumatic glaucoma were excluded. Ocular biometric parameters including axial length (AL) and lens thickness (LT) were measured with A-scan ultrasound, while the anterior chamber depth (ACD) was measured by ultrasonic biological microscope. AL, ACD, LT and relative lens position (RLP) were compared between the APAC and the fellows eyes. Results: The average age of onset was (62.57±9.14) years. The ACD was (1.75±0.27) and (1.88±0.31) mm, AL was (22.34±0.80) and (22.35±0.83) mm, LT was (5.14±0.38) and (5.17±0.42) mm, and the RLP was 0.195 and 0.198 for the APAC and the fellow eyes, respectively. Compared with the fellow eyes, the ACD of the APAC eyes was shallower, and the RLP was more anterior (both P<0.001), while the differences of AL and LT were not statistically significant (both P>0.05). Furthermore, AL of patients with a younger age of onset (aged 45 to 59 years) was shorter than that of those with an older age of onset (aged 60 to 69 or over 70 years); patients with an onset age of over 70 years have shallower ACD and more anterior RLP, all statistically significant (P<0.05). In addition, correlation analysis indicated that younger onset age was significantly correlated to shorter axial length of APAC eyes (P<0.001). Conclusion: APAC eyes had shallower ACD and more anterior RLP. Shorter AL and female were associated with APAC attack between individuals. Shallower ACD, thicker lens and more anterior RLP are potential risk factors for APAC among aged population.

光学相干断层扫描血管成像术(optical coherence tomography angiography，OCTA)作为一项新兴的检查手段，现已被广泛应用于眼科临床及科研工作中。鉴于OCTA在血管成像方面的独特优势，近年来关于其在眼前段的临床应用和研究也愈发得到关注。关于OCTA对结膜、巩膜、角膜以及虹膜的血管和相关眼表疾病的研究日益增多，其在眼前段应用潜力巨大。

As a new examination method, optical coherence tomography angiography (OCTA) has been increasingly used in ophthalmology clinical work and scientific research. In view of the unique advantages of OCTA in angiography, the clinical application and research of OCTA in the anterior segment have attracted more and more attention in recent years. Studies of OCTA in vessels of conjunctiva, sclera, cornea, iris, and related ocular surface diseases have shown great potential for its application in the anterior segment.

目的：探讨正常眼压性青光眼(normal tension glaucoma，NTG)患者睡眠体位与其双眼不对称损害的关系。方法：纳入2014年1月至2018年9月在温州青光眼进展研究(Wenzhou Glaucoma Progression Study，WGPS)项目中的NTG患者。眼部主要检查有视野和光学相干断层扫描(optical coherence tomography，OCT)。睡眠体位数据通过基线睡眠体位问卷获得。根据侧卧位睡眠偏好，将NTG患者眼部参数分为卧位高侧眼和卧位低侧眼进行讨论；根据双眼不对称损害，将患者眼部参数分为较好眼和较差眼讨论。双眼不对称损害定义为双眼视野平均偏差(mean deviation，MD)差值>6 dB或杯盘比差值>0.2。结果：共纳入158例NTG患者，最长随访时间为48个月，其中122例(77.22%)患者存在睡眠偏好；存在睡眠偏好的患者中，83例(68.03%)患者存在侧卧位偏好；存在侧卧位偏好的患者中，大多数患者偏好右侧卧位[右vs左：59 (71.1%) vs 24 (28.9%)，P<0.001]。对存在侧卧位偏好的患者进行分析，发现卧位高侧眼与卧位低侧眼眼部参数之间，差异无统计学意义(P>0.05)；卧位低侧眼的视野进展速率[视野指数(visual field index，VFI)、MD]慢于卧位高侧眼(0.48%±1.66%/年 vs ?0.45%±3.07%/年；0.54±0.96 dB/年 vs 0.2±1.15 dB/年)，差异无统计学意义(P=0.086，P=0.308)。对同时存在侧卧位偏好及双眼不对称损害的患者进行分析，发现卧位高侧眼与卧位低侧眼的眼部参数之间，差异无统计学意义(P>0.05)；卧位低侧较好眼的个数及占比高于卧位低侧较坏眼[23 (57.5%) vs 17(42.5%)]，但差异无统计学意义(P=0.132)；卧位低侧眼的视野进展速率(VFI、MD)也慢于卧位高侧眼(1.19%±1.65%/年 vs ?0.86%±3.65%/年；0.71±1.13 dB/年 vs 0.13 dB/年)，但差异无统计学意义(P=0.064，P=0.419)。结论：存在睡眠体位偏好的NTG患者中，约68%存在侧卧位偏好；存在侧卧位偏好的患者中，约70%偏好右侧卧位。但本研究并未发现睡眠体位与青光眼患者双眼不对称损害及其疾病进展存在相关性。

Objective: To investigate the association between lateral decubitus position (LDP) and asymmetric loss in normal tension glaucoma (NTG) patients. Methods: NTG patients were enrolled from Wenzhou Glaucoma Progression Study (WGPS) in Jan. 2014 to Sep. 2018. The main eye examinations included visual field test and optical coherence tomography (OCT). A questionnaire to determine the preferred sleeping position was administered to each patient in the baseline. According to the LDP, the eye parameters were divided into non-dependent eyes (higher lateral eyes) and dependent eyes (lower lateral position eyes) for discussion. According to the asymmetric damage, the ocular parameters of the patients were divided into the better eyes and the worse eyes for analysis. Asymmetric loss was defined as a difference in mean deviation (MD) between the 2 eyes of at least 6 dB or disc/cup >0.2. Results: One hundred and twenty-two patients (77.22%) had sleep preferences among the 158 NTG patients who was finally recruited and the longest follow up time was 48 months. Among the patients with sleep preference, 83 patients (68.03%) preferred the lateral decubitus position. Patients who had the lateral decubitus position mostly preferred the right lateral position [59 (71.1%) vs 24 (28.9%), P<0.001]. For patients who had the lateral decubitus position, the ocular parameters between the dependent eyes and the non-dependent eyes had no statistical difference(P>0.05); the rate of visual field progression in the dependent eyes was slower than that in non-dependent eyes, but there was no statistical difference between the two groups (0.48%±1.66%/year vs ?0.45%±3.07%/year; 0.54±0.96 dB/year vs 0.2±1.15 dB/year; P=0.086, P=0.308, respectively). For patients who had the lateral decubitus position and asymmetric damage, the ocular parameters between the dependent eyes and the non-dependent eyes had also no statistical difference (P>0.05); the number and ratio of the dependent-better eye and the dependent-worse eye were 48 and 41, respectively [23 (57.5%) vs 17 (42.5%), P=0.132]; the rate of visual field progression in the dependent eyes was also lower than that in non-dependent eyes, but there was no statistical difference between the two groups (1.19%±1.65%/year vs ?0.86%±3.65%/year; 0.71±1.13 dB/year vs 0.13 dB/year; P=0.064, P=0.419 respectively). Conclusion: About 68% of NTG patients with sleep preferences preferred the lateral decubitus position; and about 70% of patients with the lateral decubitus position preferred the right side sleeping. However, this study did not find a correlation between lateral decubitus position and asymmetric visual field loss.

目的：应用Cirrus HD-OCT 5000对正常眼黄斑及视盘血流参数进行血管成像测量，评估其可重复性及再现性。方法：纳入40只正常眼进行前瞻性研究。操作者A于一周内3天的同一时段(T1，T2，T3)对正常受试者的同一眼黄斑及视盘进行3次血管成像扫描，扫描过程中均开启FastTracTM图像跟踪功能，操作者B在T2时间点再次对受试者同一眼进行相同程序扫描，使用Angio Plex MetrixTM 量化软件(版本10.0)自动测量黄斑和视盘的血管长度密度(vessel length density，VD)和血管灌注密度(vascular perfusion density，PD)。应用单因素方差分析或非参数检验比较3次扫描的VD、PD是否有差异。采用组内相关系数(intraclass correlation coefficient，ICC)、变异系数(coefficient of variation，CV)评价操作者A的可重复性，采用一致性相关系数(consistent correlation coefficient，CCC)、重复性系数(repeatability coefficient，CR)、CV评价操作者间的再现性。结果：操作者A对黄斑及视盘各区域3次扫描的VD、PD之间差异无统计学意义(P>0.05)。操作者A对黄斑和视盘VD、PD 3次扫描的ICC值分别为0.260~0.517、0.362~0.898，黄斑及视盘各区域VD、PD的CV值均<8.1%。黄斑和视盘VD、PD的操作者间CCC值分别为0.3130~0.5665、0.5149~0.7801；黄斑VD和PD的CR值分别为3.2212~4.6399、0.0574~0.0832；视盘VD和PD的CR值分别为2.0675~4.0630、0.0447~0.0730。黄斑CV值均<9.0%，视盘CV值均<6.9%。结论：非同日的同一时段视盘浅层血流参数具有较好的重复性及再现性，黄斑浅层血流参数的重复性及再现性相对较差。

Objective: To evaluate the repeatability and reproducibility of quantification of macular and peri-papillary superficial capillaries in normal eyes using Cirrus HD-OCT 5000 angiography. Methods: Forty normal eyes were included in this prospective study. Angiography 3 mm × 3 mm scan protocol centered on the disc or macula of the same eye was repeated 3 times by operator A in the same period on 3 days (T1, T2, T3) within 1 week, and the FastTracTM image tracking function was turned on during the scan. Operator B repeated the same scan independently at T2 after operator A. Angio Plex MetrixTM quantification software (version 10.0) was used to automatically measure the vessel length density (VD) and vascular perfusion density (PD) of macular and peri-papillary superficial capillaries. One-way analysis of variance or nonparametric test was used to compare the VD and PD measurements of the 3 scans. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated to evaluate the intra-operator repeatability. Consistent correlation coefficient (CCC), repeatability coefficient (CR), and CV were calculated to evaluate the inter-operator reproducibility. Results: There was no statistically significant difference in the measurements of VD and PD between the 3 scans of the macular and peri-papillary superficial capillaries by operator A (P>0.05). The ICC values for the 3 scans of VD and PD of the macular and peri-papillary superficial capillaries by operator A were 0.260–0.517 and 0.362~0.898, respectively. The CV values of the VD and PD of the macular and peri-papillary superficial capillaries were all <8.1%. The inter-operator CCC values of the macular and peri-papillary superficial capillaries were 0.3130–0.5665 and 0.5149~0.7801, respectively; the CR values of the VD and PD of macula were 3.2212–4.6399 and 0.0574–0.0832, respectively; the CR values of the VD and PD of optic disc were 2.0675–4.0630 and 0.0447–0.0730, respectively. The CV values of macular were all <9.0%, and the CV values of optic disc were all <6.9%. Conclusion: The macular and peri-papillary superficial capillaries parameters in the same period on different days have a good repeatability and reproducibility, while the superficial macular blood flow parameters have relatively poor repeatability and reproducibility.

目的：通过在人小梁网细胞(human trabecular meshwork cell，HTMC)中过表达沉默信息调节因子2相关酶1(silent information regulator 1，SIRT1)，探讨SIRT1对氧化应激下HTMC功能的影响。方法：将SIRT1过表达慢病毒和GFP阴性对照慢病毒按照最佳(multiplicity of infection，MOI)分别转染入HTMC，并用实时定量PCR法对SIRT1是否在细胞中过表达进行验证。实验分为以下4组：正常组、H2O2组、H2O2+Lv-SIRT1-OE(过表达)组、H2O2+Lv-GFP组，分别采用Transwell法和CCK8法检测氧化应激下HTMC的迁移能力和活性。两组间比较采用独立样本t检验。结果：在正常组、H2O2组、H2O2+Lv-SIRT1-OE组、H2O2+Lv-GFP组这4组中，Transwell实验结果分别为436±73、254±25、510±51、327±46，H2O2+Lv-SIRT1-OE组分别与H2O2组和H2O2+Lv-GFP组差异均有统计学意义(P<0.01)。CCK8法结果显示，H2O2+Lv-SIRT1-OE组分别与H2O2组和H2O2+Lv-GFP组相比差异均有统计学意义(P<0.01)。H2O2+Lv-SIRT1-OE组分别与H2O2组和阴性对照组(H2O2+Lv-GFP)相比，Bax表达水平明显下降，Bcl-2表达水平明显提高，差异均有统计学意义(P<0.01)。ROS活性氧测定显示H2O2+Lv-SIRT1-OE组比H2O2组的细胞活性氧水平显著降低(P<0.05)。结论：在HTMC中过表达SIRT1能有效降低氧化应激对HTMC迁移能力和活性的影响，从而对HTMC起到一定的保护作用，为后续研究SIRT1保护氧化应激下HTMC的调控机制打下基础。

Objective: To explore the effect of Silent Information Regulator 1 (SIRT1) on cell function of human trabecular meshwork cell (HTMC) under oxidative stress by overexpressing SIRT1 in HTMC. Methods: This is an experiment research. HTMCs were transfected with SIRT1-ovexpressed lentivirus and GFP-negative control lentivirus (Lv-GFP) at the optimal multiplicity of infection (MOI). Real-time quantitative PCR was used to verify whether SIRT1 was overexpressed in HTMC. The following experiments were divided into four groups: normal control group, H2O2 group, H2O2+Lv-SIRT1-OE group, H2O2+Lv-GFP group. Cell migration was detected by transwell assay. Cell viability was detected by CCK8 assay. Student’s t-test was used for two groups. P<0.05 was set as statistical signi?cance. Results: The number of migration per well of normal control group, H2O2 group, H2O2+Lv-SIRT1-OE group, H2O2+Lv-GFP group were 436±73, 254±25, 510±51, 327±46, respectively. Compared with H2O2 group and H2O2+Lv-GFP group, transwell assay demonstrated that the number of migrations per well of H2O2+Lv-SIRT1-OE group significantly increased (P<0.01). Likewise, CCK8 assay indicated that cell viability of H2O2+Lv-SIRT1-OE group was higher than both of H2O2 group and H2O2+Lv-GFP group (P<0.01). Compared with H2O2+Lv-SIRT1-OE group and negative control group (H2O2+Lv-GFP), the expression level of Bax decreased significantly, and the expression level of Bcl-2 increased significantly (P<0.01). ROS assay showed that the ROS level in H2O2+Lv-SIRT1-OE group was significantly lower than that in H2O2 group (P<0.05). Conclusion: SIRT1 overexpressed in HTMC can effectively reduce the effect of oxidative stress on migration ability and proliferation activity of HTMC, which lays a foundation for further study on the regulatory mechanism of SIRT1 protecting HTMC under oxidative stress.

目的：了解儿童罹患青光眼的疾病类型、特点，更好地做到早期发现早期治疗。方法：收集北京同仁医院2014—2019年度834例0~18周岁住院接受抗青光眼手术的患者，回顾性分析患者的人群特点与疾病构成特点。结果：834例患者中，原发青光眼397例(47.6%)，继发青光眼429例(51.4%)。另有8例无法明确诊断青光眼类型。原发青光眼中以原发先天性青光眼最常见，继发青光眼中以白内障术后继发青光眼为主，两种类型的青光眼占总患者数的50%。结论：儿童罹患青光眼的疾病种类繁多，其中原发先天青光眼与白内障术后继发青光眼最常见，重视婴幼儿先天青光眼的筛查，监测儿童白内障术后眼压有助于早期发现青光眼，并给予治疗，延缓儿童青光眼患者视功能的损害。

Objective: To understand the types and characteristics of glaucoma in pediatric inpatients to achieve early detection and treatment. Methods: A total of 834 patients aged 0–18 years who underwent anti-glaucoma surgery in Beijing Tongren Hospital from 2014 to 2019 were collected and their population characteristics and disease composition characteristics were retrospectively analyzed. Results: In all of the 834 cases, there were 397 patients (47.6%) with primary glaucoma and 429 (51.4%) with secondary glaucoma. The type of glaucoma could not be definitively diagnosed in 8 cases. Primary infant glaucoma and secondary glaucoma following cataract surgery accounted for above 50%. Conclusion: The causes of pediatric inpatients with glaucoma are various. Screening of primary infant glaucoma should be taken seriously and monitoring intraocular pressure after cataract surgery is also important. Early detection and treatment can prevent further visual loss of pediatric patients with glaucoma.

睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤，易因其伪装特性而被漏诊和误诊。本文报道了1例3岁9个月的男性患儿，眼部表现似晶状体破裂，经部分肿物切除活检，病理诊断为睫状体恶性髓上皮瘤。

Medulloepithelioma of the ciliary body is a kind of malignant tumor which arises from neuroepithelium. It is easily misdiagnosed or miss diagnosed due to its masquerade feature in the clinical practice. We report a boy with a tumor in his right eye at age of 3 years and 9 months presented first with lens rupture. Diagnosis of malignant medulloepithelioma of ciliary body was made pathologically by biopsy of the partial tumor.

青光眼不仅常见，而且严重损伤患者的视功能，被认定为全球首位不可逆致盲性眼病。仔细观察发现诊断不及时、治疗不合理、随诊不规律是导致青光眼患者致盲的常见原因。机会性筛查是临床早期发现青光眼患者的主要手段。为了提高筛查的效率，筛查时应当密切关注青光眼的高危人群，包括原发性青光眼患者的直系亲属、老年人群和高度近视患者。此外，要对发生青光眼全过程加深了解，无论是原发性闭角型青光眼，还是原发性开角型青光眼，其病情的进展都存在一个连续体概念。应当在青光眼患者出现症状或严重视功能损伤之前加以诊断。合理治疗应当包括应用适当的药物、激光或手术治疗，将每只患眼的眼压控制到与该眼的视盘和视野改变相适应的目标眼压范围内，尽量提高患者用药的依从性。对青光眼的持续性防治取决于是否有能力评估治疗效果以及发现病情的不稳定性状态，并加以恰当的处理。青光眼是可防可治的眼病。通过加强青光眼的早期诊断、合理治疗和长期随诊，可降低青光眼的致盲率，从而改变青光眼是首位致盲性眼病的现状。

Glaucoma not only is common, but also seriously damages the visual function of the patients, and is recognized as the first irreversible blinding disease in the world. After careful observation, we recognize that untimely diagnosis, unreasonable treatment and irregular follow-up are leading causes to blindness. Opportunistic screening is a main measure to early find the glaucoma in clinical practice. To improve the screening efficiency, the high-risk mass of glaucoma, such as immediate family members of glaucoma patients, older adults and high myopia should be closely focused. In addition, the ophthalmologists should understand the whole process of glaucoma. The development of the primary angle closure glaucoma or primary open angle glaucoma is a concept of continuum. We should make the diagnosis of glaucoma before the patients have any symptoms or serious damage of the visual function. Reasonable treatment should include controlling intraocular pressure in the scope of the target pressure adopting to the optic damage and visual field defect in that eye by drugs, laser or surgery, and as far as possible to improve the drug compliance. Sustained control of glaucoma management depends on the ability to assess the effect of treatment, and to find the instability of the disease and the appropriate management. Glaucoma is a preventable and treatable eye disease. We can decrease the blinding rate and change the current status of the first blinding eye disease for glaucoma.

青光眼作为世界第一位不可逆致盲性眼病，如何早期发现、及时诊断、恰当治疗并坚持随访管理，一直是广大眼科临床工作者所努力的方向。当前，世界处于百年未有之大变局，中国处于近代以来最好的发展时期，两者同步交织、相互激荡。在今后的5~10年中，我国青光眼防治领域将产生很多令人瞩目的成就。笔者仅以个人对本专业粗浅的理解，对未来我国青光眼防治发展作一展望，祝愿我国防盲治盲事业取得更大进步。

Glaucoma is the first irreversible blinding eye disease in the world. How to detect early, diagnose timely, treat appropriately and adhere to follow-up management has always been the direction of Chinese ophthalmic clinical workers. At present, the world is undergoing profound changes, and China is in the best period of development since modern times. In the next 5–10 years, there will be many remarkable achievements in the field of glaucoma prevention and treatment in China. Based on our personal understanding of this specialty, we look forward to the development of glaucoma management in China in the future, and wish to make greater progress in blindness prevention and treatment in China.

青光眼作为首位不可逆性致盲眼病给患者、家庭和社会带来重大损害和沉重的经济负担。在视觉2020计划收官之年，中国青光眼防治工作已获得较好成绩，但仍面临严峻挑战。在未来，中国青光眼防治工作将以《2020中国青光眼指南》为蓝本，有望依托人工智能技术，实现对青光眼患者的高效、便捷、准确的筛查和诊断；以患者个体特征、疾病特点和社会环境为立足点，采取个性化和精准化治疗；结合慢病管理的全生命周期概念，实现对患者的终身监测和指导。提高我国青光眼诊治水平，减少青光眼致残致盲。

Glaucoma is a leading cause of irreversible blindness in the world. It brings great damage and heavy economic burden to patients, their families and society. Under the Vision 2020 initiative, great progress has been achieved in the glaucoma prevention and treatment in China, but there are still severe challenges ahead. In the future, the Guideline for Glaucoma Care in China (2020) will act as the blueprint of the prevention and treatment of glaucoma in China. Efficient, convenient and accurate screening and diagnosis of glaucoma will be achieved relying on the artificial intelligence technology. Personalized and precision therapy will be carried out based on individual and disease characteristics and social environment. Also, lifelong monitoring and guidance of patients will be realized in the context of the whole life cycle of chronic diseases. Glaucoma care will be further improved to continuously reduce vision impairment and blindness caused by glaucoma.