目的：了解行全飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)患者围手术期的体验感受。方法：采用定性调查的方法，选取广东省某医院的15名行SMILE的患者，进行半结构式访谈，将患者围手术期体验归纳为顾虑、紧张、疼痛、担心、放松5个主题概念，用现象学分析法整理、分析资料。结果：把5种体验汇总制成韦恩图，通过韦恩图提炼发现有1人有围手术期5种感受，3位有紧张、疼痛、担心、放松4种心理感受，2位只有紧张的感受，而无其余感受。结论：行SMILE患者的围手术期具有多种体验感受，分析不同感受状态和因素，为眼科医护人员对于寻求SMILE手术的患者做好围手术期的服务提供依据。
Objective: To investigate the perioperative experience after small incision lenticule extraction (SMILE). Methods: A semi-structured interview was conducted in 15 patients who underwent SMILE surgery in Zhuhai People’s Hospital.The data were collected and analyzed by phenomenological analysis. Results: The perioperative feelings of patients were summarized into five categories: concern, tension, pain, worry and relaxation. These feelings were compiled and extracted by Venn diagram. One patient had all five categories of feelings during the perioperative period. Three patients experienced four psychological feelings of tension, pain, worry and relaxation, and 2 patients had only nervous feelings during the full femtosecond operation period. Conclusion: Patients undergoing SMILE have avariety of experience feelings during perioperative period. Analysis of different feeling states and factors will provide evidence for ophthalmic medical staff to provide perioperative services for patients seeking SMILE surgery.
目的：运用Lea Symbols视力表、HOTV视力表对2.5~5.0岁正常儿童视力发育情况进行探究，并评价2种视力表的应用效果。方法：以随机顺序先后应用Lea Symbols视力表与HOTV视力表对广州地区2所早教中心及3所幼儿园共461例儿童(922只眼)进行单眼视力检查，所有儿童提前1 d行小瞳下检影验光、眼前节裂隙灯检查、眼底情况、眼球活动、眼位检查，筛选无器质性眼病、屈光度在正常范围的儿童作为研究对象。视力值采用5分记录方法表示。结果：1 )可测率(视力表使用配合程度)。407名儿童完成Lea Symbols视力检查，总体可测率92.08%；402名儿童完成HOTV视力检查，总体可测率90.95%；前者可测率高于后者，差异无统计学意义(χ2 =0.417，P=0.580)。进一步研究发现2种视力的可测率随年龄增长不断提高，儿童3岁之后基本都能完成2种视力的检查。2)2种视力结果及比较(5分记录法表示)。Lea视力值：右眼为4.89±0.05，左眼为4.90±0.05；HOTV视力值：右眼为4.84±0.05，左眼为4.85±0.04；前者视力好于后者，差异有统计学意义(右眼：t=3.171，P=0.003；左眼：t=3.230，P=0.003)。3)视力发育与年龄的相关性。2种视力发育与年龄存在显著正相关(P<0.001)，即随着年龄的增长，视力水平逐渐提高。4)视力发育与眼别、性别的关系。左右眼之间的视力发育差异无统计学意义(P>0.05)；男性儿童的视力发育好于女性，且差异有统计学意义(P<0.05)。结论：Lea Symbols及HOTV视力表建议用于年龄大于3岁儿童的视力检查，且儿童更容易接受Lea Symbols视力表的检查。伴随年龄的增长，儿童的视力发育呈现提高的趋势；Lea视力优于HOTV视力。视力的发育与眼别无关，男性儿童的视力发育快于女性儿童。
Objective: To conduct a preliminary study of the Lea Symbols and HOTV charts to explore the visual development of children aged 2.5 to 5.0 years, and evaluate the application values of the two charts. Methods: A total of 461 children (922 eyes) in 2 early education centers and 3 kindergartens in Guangzhou were examined by using the Lea Symbols visual acuity chart and HOTV visual acuity chart in random order. All the children underwent low-pupil photometry, anterior section slit-lamp examination, retinal condition, eye movement, and eye position examination 1 day in advance. Children with no organic eye disease and normal diopter were selected as subjects. Visual acuity was recorded with 5 points. Results: 1) Measurable rate (visual acuity chart use degree of cooperation). 407 children completed visual examination of Lea Symbols, with an overall detectable rate of 92.08%; 402 children completed HOTV vision examination, with an overall detectable rate of 90.95%. The detectable rate of the former was higher than that of the latter, but the difference was not statistically significant (χ2 =0.417, P=0.580). Further study found that the detectable rate of both visual acuities increased with age, and children were able to complete both visual acuity tests after the age of 3. 2) Results and comparison of two visual acuity (5-point recording method). The visual acuity of Lea was 4.89±0.05 in the right eye and 4.90±0.05 in the left eye. HOTV visual acuity was 4.84±0.05 in the right eye and 4.85±0.04 in the left eye. The visual acuity of the former was better than that of the latter, the difference was statistically significant (right eye: t=3.171, P=0.003; left eye: t=3.230, P=0.003). 3) Correlation between visual development and age. There was a significant positive correlation between the two types of visual development and age (P<0.001), that is, visual acuity gradually improves with age. 4) The relationship between visual development and eye and sex. There was no difference in visual development between the left and right eyes, but male children had better visual development than female, and the difference was statistically significant (P<0.05). Conclusion: Lea Symbols and HOTV visual acuity charts are recommended for visual acuity examination of children over 3 years old, and children are more likely to receive examination of Lea Symbols visual acuity chart. With the growth of age, the visual development of children shows a trend of improvement. Lea vision is superior to HOTV vision. Vision development has nothing to do with the eye, male children’s vision development is faster than female children.
近视防控已经上升为国家战略，眼轴长度是近视防控的重要建档参数。眼轴长度的测量有多种方法，受到年龄、性别、脉络膜厚度等因素的影响。目前，眼轴长度的定义尚未统一，建议建立标准化的定义和方法学，以指导近视防控的临床和科研工作。
The prevention and control of myopia has become a national strategy, and the axial length is an important parameter in the documentation of myopia prevention and control. This review summarized the measurement technology and factors associated with axial length. Axial length can be measured in various ways and can be influenced by age, gender, choroidal thickness, and other factors. A standardized definition of axial length is warranted to be established for clinical and scientific purposes.
目的：探讨品管圈在缩短眼底外科门诊患者就诊时长中的应用效果。方法：成立品管圈小组，确立缩短眼底外科门诊患者就诊时长活动主题，选择2020年9月份眼底外专科门诊就诊的484例患者为活动前研究对象。2020年12月份眼底外科门诊就诊的976例患者为活动后研究对象，分析干预前眼底外患者就诊时长，患者就医体验差的原因，针对原因拟定对策并组织实施。结果：开展品管圈活动后，眼底外科门诊患者的平均就诊时长显著缩短(P<0.05)。借助信息系统优化就诊流程，提高了患者满意度，圈员的团队凝聚力、积极性、沟通协调能力显著提高。结论：品管圈活动能缩短眼底外科患者就诊时长，提高患者就医体验，提升护理团队综合能力，且改善效果可持续保持。
Objective: To explore the application effect of quality control circle in shortening the length of outpatient visit in fundus surgery. Methods: A quality control circle group was established to set up the activity theme of shortening the duration of treatment for outpatient patients of fundus surgery, and 484 patients who visited outpatient clinics outside fundus in September 2020 were selected as the pre-activity research objects. In December 2020, 976 patients who visited fundus surgery outpatient department were the subjects of the post-activity study. We analyzed the duration of treatment and the reasons for poor medical experience of patients before the intervention, formulated countermeasures for the reasons and organized and implemented them. Results: After the quality control circle activity was carried out, the mean duration of outpatient visits in fundus surgery was significantly shortened (P<0.05). With the help of the information system, the medical treatment process was optimized to improve the satisfaction of patients, and the team cohesion, enthusiasm, communication and coordination ability of the circle members were significantly improved. Conclusion: Quality control circle activities can shorten the duration of treatment for fundus surgery patients, improve patients' medical experience, enhance the comprehensive ability of the nursing team, and the improvement effect can be maintained sustainably.
目的：探讨风筝皮瓣及旋转皮瓣在眼外伤或良性肿物切除术后造成眉眼前层缺损的疗效，评价其预后、修复效果以及美学评分改变。方法：收集2018年5月至2020年5月34例眉/眼外伤或因良性肿物行手术切除患者，其眉眼前层缺损最大直径不超过眼长度1/2，根据创面缺损位置、范围，设计沿皮纹方向的缺损邻接部位局部风筝皮瓣及旋转皮瓣，推进滑行局部转移皮瓣向缺损区移位一期修复缺损。随访6个月观察术后皮瓣愈合情况、缺损的修复效果、并发症、患者满意度，比较手术前后美学评分。结果：所有皮瓣全部成活，切口均为I期甲级愈合，局部皮瓣的皮肤色泽、厚薄、毛发情况、质地以及眉毛走行分布与未手术侧基本一致，皮瓣创周器官组织形态无明显改变，皮瓣上眉毛生长良好，手术切口隐蔽在肌肤纹路处、瘢痕增生不鲜明，所有患者无需再次手术。缺损部无臃肿，双侧连续性以及对称性良好，无眉眼变形、倒睫、睑内外翻、上睑下垂等出现，眉/眼组织形态美观、功能良好。患者对手术效果比较满意。患者术后1d及1、3、6个月的美学评分分别为(73.50±7.79)、(76.97±6.84)、(82.21±6.11)和(87.06±6.07)分，均高于术前的(50.59±9.71)分，比较差异均有统计学意义(均P<0.05)。结论：应用风筝皮瓣及旋转皮瓣I期修复眉/眼皮肤软组织缺损，可较好地恢复眉/眼形态和功能，患者对缺损修复效果满意度高，能取得较高的美学评分，操作简单易行，效果可靠，无明显并发症。
Objective:To investigate the therapeutic efect of kite fap and rotary fap on superfcial tissue defect of eyebrow/eye caused by eyebrow/eye trauma or benign tumor resection, and to evaluate the prognosis, repair effect and aesthetic score changes. Methods: A total of 34 cases of eyebrow/eye trauma or benign tumors who underwent surgical resection were collected between May 2018 and May 2020. Te maximum defect diameter was not more than 1/2 of the length of eyebrow/eye. According to the location and scope of the defect, local kite flaps and rotary flaps were designed at the adjacent along the dermatoglyphic direction, and the sliding local transfer faps were promoted to the defect area to repair the eyebrow and eyelid ocular defects in stage one. Follow up for 6 months to observe the fap healing, defect repair efect, complications, patient satisfaction and aesthetic score. Results:All the skin faps survived, and the wound healing was Grade I A. The skin color, thickness, hair condition, texture and eyebrow shape distribution of the local skin faps were basically similar to the non-surgical side. Tere was no obvious change in the tissue morphology around the faps. Te eyebrows on the skin faps grew well, and the surgical incision was concealed in the skin lines with no distinct scar hyperplasia. All patients did not need operation again. Te defects were not swollen, bilateral continuity and symmetry were good, without eyebrow and eye deformation, without trichiasis, entropion or ptosis, etc. Te eyelid/eyebrow were beautiful and functional. The patients were satisfied with the surgical results. The aesthetic scores of patients at diferent postoperative monitoring times (1 day, 1 month, 3 months and 6 months) afer surgery were (73.50 ± 7.79), (76.97 ± 6.84), (82.21 ± 6.11) and (87.06 ± 6.07) points respectively, which were significantly higher than the preoperative scores (50.59 ± 9.71) points, and the diferences were statistically signifcant (P<0.05). Conclusion: Te kite fap and rotary fap can be used to repair the eyebrow/eye skin and sof tissue defects in Phase I, which can restore the shape and function of the eyebrow/eye well. Te patients are satisfed with the efect of the defect repair, and can obtain a higher aesthetic score. Te operation is simple and easy, the efect is reliable, and there was no obvious complications.
该文报道一例中年男性患者，因“头痛伴左侧听力下降”就诊于我院神经外科，经影像学检查诊断为“左侧三叉神经鞘瘤”， 手术前实验室检查发现血象异常，经血液科会诊后诊断为多发性骨髓瘤IgDλ型，于化疗期间并发神经麻痹性角膜炎(neurotrophic keratitis,NK)，可于角膜中央偏下方的上皮及前基质层见到类圆形的灰白色浑浊，呈胶冻样，经局部药物治疗后好转，但残留角膜基质白色浑浊。由于现阶段临床对NK尚欠缺充分认识，易延误诊治，并且本文报道的此例NK患者，因其有化疗病史且于治疗期间出现相关体征，易被误诊为化疗并发细菌性角膜炎，文章通过分析其角膜病变的特征及简单回顾NK的临床特征、鉴别诊断及治疗，以期临床早期识别及治疗此类患者，恢复角膜的光学特性，维持良好的视觉体验。
Tis article reports a case of a middle-aged male patient who visited the Department of Neurosurgery of our hospital due to headache and lef hearing loss. He was diagnosed with lef trigeminal schwannoma by imaging examination and abnormal blood routine before surgery. During chemotherapy and paralytic keratitis (neurotrophic keratitis, NK), can be seen in the lower part of the corneal center of the epithelium and the prestromal layer of round gray and white turbidities, jelly like, afer local drug treatment improved, but residual corneal stromal white turbidities. Due to the lack of full understanding of NK in clinic at the present stage, diagnosis and treatment is easy to be delayed. In addition, the NK patient reported in this paper was easily misdiagnosed as bacterial keratitis complicated by chemotherapy due to his history of chemotherapy and related signs during treatment. Tis paper analyzed the characteristics of keratopathy and briefy reviewed the clinical characteristics, diferential diagnosis and treatment of NK, in order to identify and treat these patients in early clinical stage, restore the optical characteristics of cornea and maintain good visual experience.
目的：通过球结膜下注射基质金属蛋白酶(metalloproteinase,MMP)-1、3构建结膜松弛症的动物模型。方法：20只新西兰大白兔随机分为4组：对照组无干预措施；伪造模组球结膜下注射生理盐水；MMP-1组球结膜下注射MMP-1；MMP-3组球结膜下注射MMP-3。8周后观察眼前节照相和眼前节光学相干检查、泪液蕨类试验及结膜组织光镜检查结果。结果：对照组和伪造模组未见结膜皱褶形成，泪液羊齿状结晶样结构完整，光镜下未见胶原和弹力纤维破坏；MMP-1组可见结膜皱褶形成，泪液羊齿状结晶样结构破坏，光镜下见胶原和弹力纤维破坏；MMP-3组未见结膜皱褶形成，泪液羊齿状结晶样结构部分破坏，光镜下见胶原和弹力纤维部分破坏。结论：球结膜下注射MMP-1可构建结膜松弛症1~2级的动物模型。
Objective:To establish an animal model of conjunctivochalasis by subconjunctival injection of matrix metalloproteinase 1 and 3. Methods:New Zealand white rabbits were randomly divided into four groups, the control group had no intervention measures; Pseudo model group was injected susbconjunctival with normal saline; MMP-1 group was injected subconjunctival with matrix metalloproteinase 1; MMP-3 group was injected subconjunctival with matrix metalloproteinase 3. Afer 8 weeks, the results of anterior segment photography and optical coherence test, tear fern test and conjunctival tissue light microscopy were observed. Results:No conjunctival folds were observed in the control group and Pseudo model group, the lacrimal fern-shaped crystalline structures were intact, and no destruction of collagen and elastic fbers was found under the light microscope. In MMP-1 group, conjunctival folds were formed, lacrimal ferns crystalline structures were damaged, and collagen and elastic fbers were damaged under light microscope. No conjunctival folds were found in MMP-3 group, and the lacrimal ferns crystalline structure was partially destroyed, while the collagen and elastic fibers were partially destroyed under light microscope. Conclusion:Subconjunctival injection of matrix metalloproteinase-1 can construct the animal model of conjunctivochalasis of 1-2 grades.
局限性脉络膜凹陷(focal choroidal excavation,FCE)是表现为光感受器细胞层、视网膜色素上皮层向脉络膜层凹陷的眼底病变。发病机制多认为是先天脉络膜发育异常、炎症或感染。基于光学相干断层扫描(optical coherence tomography,OCT)，可将FCE从光感受器尖端与视网膜色素上皮层是否分离、形态特征或中央脉络膜厚度三种方式对其进行分类。FCE常合并脉络膜新生血管等疾病。该文对FCE的临床研究现状做一综述。
Focal choroidal excavation (FCE) can be defined as an excavation into the choroid along the retinal pigment epithelium (RPE) based on optical coherence tomography (OCT) without evidence of corresponding staphyloma or other scleral changes. The pathogenesis is usually congenital choroidal dysplasia, inflammation or infection. Based on optical coherence tomography images, FCE can be classified in three ways: whether the photoreceptor cell layer is separated from the retinal pigment epithelium, morphological characteristics or central choroidal thickness. FCE is often associated with choroidal neovascularization and other diseases. This article will review the clinical research status of FCE.
目的：通过分析基于眼底彩照的人工智能（artificial intelligence,AI）在糖尿病视神经病变（diabetic optic neuropathy,DON）中的参数特征，探索AI在DON诊断中的应用价值。
方法：收集2020年1月1日至2022年4月30日就诊于东莞东华医院、横沥医院及东莞市寮步镇社区卫生服务中心并诊断为糖尿病的患者，采集其一般信息并拍摄以黄斑为中心、图片边缘距离视盘中心超过1PD的50°眼底彩照。眼底彩照由人工智能诊断系统分析获得视盘及血管检测参数，由3-4名眼底专家阅片后分为DON(+)、DON(-)两组并作糖尿病视网膜病变（diabetic retinopathy,DR）分期诊断。比较两组间视盘、血管检测参数的差异性，并分析各项参数以及DR分期与DON发病的相关性。
结果：研究共纳入糖尿病患者526人（945眼），其中男性335人，女性191人；平均年龄为51.58±12.21岁，平均病程为5.51±5.20年。所有入组病例中，DON(+)组205眼，DON(-)740眼；根据专科医师判读结果，无DR 723眼，轻度非增殖期糖尿病视网膜病变（non-proliferrative diabetic retinopathy,NPDR）7眼，中度NPDR 184眼，重度NPDR 24眼，增殖期糖尿病视网膜病变（proliferrative diabetic retinopathy,PDR）7眼。AI检测的视盘及血管参数中，水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜静脉血管当量、B区视网膜动静脉比值在有或无DON组间存在显著差异；水平视盘直径、垂直视盘直径、弧形斑和视盘面积比、B区视网膜动脉当量在两组之间无显著差异。相关性分析发现，水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜动静脉比值与DON患病呈负相关；B区视网膜静脉血管当量、DR分期则与其呈正相关。
结论：DON患者的视杯直径、杯盘比、B区视网膜静脉血管当量等基于眼底彩照的人工智能检测参数有显著改变；DON的发病与DR病变严重程度有关。
Objective: To explore the application value of artificial intelligence (AI) in the diagnosis of diabetic optic neuropathy (DON) by analyzing the parameter characteristics of artificial intelligence (AI) based on fundus color photos.
Methods: From January 1, 2020 to April 30, 2022, patients diagnosed with diabetes were collected in Dongguan Donghua Hospital, Hengli Hospital of Dongguan and Community Healthcare Center of Dongguan Liaobu. General information was collected and 50°field vision fundus images(centered on macula and the edge of the images were more than 1PD away from the center of the optic disc) were taken. All the images were divided into DON(+) and DON(-) groups by 3-4 ophthalmologists. All the parameters were detected and analyzed by AI system, and their differences between the two groups were compared. The correlation between each parameter and DR stage with the incidence of DON was analyzed as well.
Results: A total of 526 diabetic patients (945 eyes) were included in this study, including 335 males and 191 females. The mean age was 51.58±12.21 years, and the mean disease duration was 5.51±5.20 years. All the enrolled cases were divided into DON (+) group (205 eyes) and DON (-) group (740 eyes) . According to ophthalmologists’ interpretation, 723 eyes had no DR, 7 eyes had mild nonproliferrative diabetic retinopathy (NPDR), 184 eyes had moderate NPDR, 24 eyes had severe NPDR, 7 eyes had Proliferrative diabetic retinopathy (PDR). Among the parameters detected by AI, there were significant differences in horizontal and vertical optic cup diameter, horizontal and vertical C/D, retinal vein equivalent(RVE) in zone B, and retinal arteriole-to venule ratio(AVR) in zone B between DON(+) and DON(-) groups. There were no significant differences between the two groups in horizontal and vertical optic disc diameter, arc-shaped spot-to-disc area ratio, and retinal artery equivalent(RAE) in zone B. In the analysis of risk factors, horizontal and vertical optic cup diameter, horizontal and vertical C/D, and AVR in zone B were negatively correlated with the diagnosis of DON. RVE in zone B and the severity of DR were positively correlated with the diagnosis of DON.
Conclusions: The AI detection parameters based on fundus color photography have significant changes in the diameter of optic cup, C/D and RVE in zone B in DON patients. The incidence of DON is related to the severity of DR.
视神经炎(optic neuritis,ON)是指视神经的炎性脱髓鞘病变，是引起中青年人视力下降的主要原因。近年来，髓鞘少突胶质细胞糖蛋白抗体阳性视神经炎(myelin oligodendrocyte glycoprotein antibody-positive ON,MOG-ON)成为神经眼科领域的研究热点，国内外报道不断增加。2021年3月，中华医学会眼科学分会神经眼科学组制定了《中国脱髓鞘性视神经炎诊断和治疗循证指南(2021年)》，将MOG-ON作为新的视神经炎亚型纳入脱髓鞘性视神经炎的诊疗体系，给广大眼科医生提供了新的参考依据。因此，临床医生需要充分认识MOG抗体相关疾病和MOG-ON的临床特征和治疗进展，努力提高其诊断和治疗水平，使此类患者能够得到更多的获益，造福于更多的视神经疾病患者。
Optic neuritis(ON)is an inflammatory demyelinating disease of the optic nerve, which is the main cause of vision loss in young and middle-aged people. In recent years, myelin oligodendrocyte glycoprotein antibody-positive ON(MOG-ON)has become a research hotspot in the field of neuro-ophthalmology, and reports at home and abroad are increasing.In March 2021, the Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association formulated the Evidence-Based Guidelines for the Diagnosis and Treatment of Demyelinating Optic Neuritis in China(2021) , and included MOG-ON as a new optic neuritis subtype in the diagnosis and treatment system of myelinating optic neuritis providing a new reference for the majority of ophthalmologists. Therefore, clinicians need to fully understand the clinical features and treatment progress of MOG antibody-related diseases and MOG-ON, and strive to improve the level of diagnosis and treatment, so that such patients can get more benefits and benefit more patients with optic nerve diseases.
