3位国际视网膜专家在中山眼科中心(Zhongshan Ophthalmic Center，ZOC)眼底病中心进行临床查房并讨论了4例具有挑战性且不寻常的视网膜病例：1)VHL病合并视网膜血管母细胞瘤的11年 随访观察；2)半剂量光动力疗法(photodynamic therapy，PDT)或微脉冲激光光凝治疗中心性浆液性视网膜病变(central serous chorioretinopathy，CSC)的观察；3)视神经缺陷儿童的诊断与治疗；4)合并虹膜晶状体脉络膜缺损的视网膜脱离(retinal detachment，RD)的治疗选择。通过讨论有助于我们更好地了解这四例视网膜疾病的发病机制和治疗方法，及其与全身疾病的关系。

目的：研究M22优化脉冲光技术治疗睑板腺功能障碍(meibomian gland dysfunction，MGD)所致干眼的疗效，并用keratograph 5M干眼分析仪分析评估患者治疗前后病情变化。方法：收集汕头博德眼科医院门诊患者46例，年龄31~85(55.39±14.02)岁，行M22优化脉冲光治疗1个疗程(每月1次，共3次)，治疗前后均采用keratograph 5M干眼分析仪分析评估患者泪河高度情况、泪膜破裂时间(break-up time，BUT)、脂质层、睑板腺情况的变化，采用t检验分析对比治疗前后 变化情况。结果：患者治疗后泪河高度较强脉冲光治疗前明显增高，由(0.20±0.11) mm增加到(0.35±0.11) mm，BUT时间延长，由(4.98±2.13) s延长到(10.12±1.86) s，脂质层异常情况好转，有效率达93.48%，睑板腺阻塞情况减轻，有效率达84.78%以上，治疗后与治疗前差异有统计学意义(P<0.01)。结论：M22优化脉冲光技术在治疗MGD导致的干眼有较好的效果，没有出现并发症，是较安全有效地治疗方法，且keratograph 5M干眼分析仪可以较全面的对该病进行评估。

Objective: To study the efficacy of M22 Optimal Pulsed Technology in the treatment of dry eye caused by meibomian gland dysfunction and to evaluate the changes of patients affer treatment with keratograph 5M dry eye analyzer. Methods: Forty-six patients collected from Shantou Balder Eye Hospital receiving M22 Optimal Pulsed Technology treatment for three times, once a month, then using keratograph 5M dry eye analyzer to assess the height of tears river, break-up time (BUT), lipid layer, and meibomian gland. The results before and affer laser treatment were compared using t-test in this study. Results: Affer treatment, there was signiffcant effect than those of before treatment, the BUT time was prolonged from (0.20±0.11) mm to (0.35±0.11) mm, the abnormalities of the lipid layer were alleviated, the cure rate exceeded 93.48%, and the obstruction of the meibomian gland was reduced, the cure rate was higher than 84.78%. TTe difference before and affer corresponding treatment was statistically signiffcant (P<0.01). Conclusion: M22 Optimal Pulsed Technology has a good effect in the treatment of MGD-induced dry eye without complications. So M22 Optimal Pulsed Technology is a safe and effective treatment method. And keratograph 5M dry eye analyzer can deliver comprehensive assessment of dry eye. 

目的：探讨高度近视合并白内障患者白内障术后有效晶状体位置的变化。方法：收集白内障超声乳化摘除联合人工晶状体植入术的高度近视合并白内障患者 21 例共 27 眼，记录术后 1 d、1 周、1 个月视力、屈光度、有效晶状体位置。结果：高度近视合并白内障患者术后 1 d、1 周、1 个月有效晶状体位置分别为（4.17±0.39），（4.09±0.38），（4.31±0.44） mm，且组间比较差异有统计学意义（P < 0.05）。有效晶状体位置的实际轴向运动为（0.19±0.13） mm，与晶状体厚度呈正相关（r = 0.648，P < 0.001），与术前眼轴无相关关系（r = 0.227，P = 0.255）。结论：高度近视合并白内障患者术后 1 d 至 1 周人工晶状体轻度前移而造成近视偏移，而术后 1 个月时则呈远视偏移，且术后有效晶状体位置位移与术前晶状体厚度相关。

Objective: To investigate the change and influencing factors of the effective lens position after cataract surgery in high myopia eyes. Methods: We collected 27 eyes of 21 patients with high myopia who underwent phacoemulsification and intraocular lens implantation. The visual acuity, diopter and effective lens position were recorded 1 day, 1 week, and 1 month after operation. Results: The effective lens position of high myopia combined with cataract patients at 1 day, 1 week, and 1 month was (4.17±0.39), (4.09±0.38), and (4.31±0.44) mm, respectively. The effective lens positions significantly differed between the groups after surgery (P < 0.05). The ELPRMS was (0.19±0.13) mm. The ELPRMS was positively correlated with the lens thickness (r = 0.648, P < 0.001),whereas was not correlated with the preoperative axial length (r = 0.227, P = 0.255). Conclusion: High myopic patients with cataract have a slight forward movement of the effective lens position from 1 day to 1 week after surgery, and a hyperopic shift from 1 week to 1 month. The displacement of effective lens position after surgery is correlated with the preoperative lens thickness.

目的：评价欧堡 Daytona 200 度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法：本研究为前瞻性病例研究，收集爱尔眼科医院要求行屈光手术的近视患者 1 000 例（2 000 只眼），分别进行小瞳下欧堡 Daytona 200 度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查，记录检查结果并进行比较分析。结果：通过欧堡 Daytona 200 度超广角激光扫描检眼镜检查发现有周边视网膜病变共 230 例（310 只眼），检出阳性率为 15.50%；三面镜检查发现周边部视网膜病变共 242 例（322 只眼），检出阳性率为 16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性（Kappa 值 0.8~1.0）。结论：欧堡 Daytona 200 度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法，在屈光手术前筛查视网膜周边部病变，具有广阔的临床应用前景。

Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by threemirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery. 

教学查房是手把手教学的重要手段和具体表现，是让同学们把书本知识应用到医疗诊疗中的重要桥梁。眼科学具有形象生动、结构复杂、直观性和操作性强等特点。外眼疾病的特征更是显而易见，针对外眼疾病诊疗中的一些不规范的操作也更易暴露出来。本文以上睑下垂为例，旨在阐明教学查房在外眼疾病教学中的重要性。

Teaching rounds are an important means and concrete manifestation of hands-on teaching, and an important bridge for students to apply book knowledge to medical diagnosis and treatment. Ophthalmology has the characteristics of vivid image, complex structure, intuition and strong operability. The characteristics of external eye diseases are more obvious, and some non-standard operations in the diagnosis and treatment of external eye diseases are easier to expose. This article takes blepharoptosis as an example to illustrate the importance of teaching rounds in the teaching of external eye diseases.

后极部中心性脉络膜营养不良是一种罕见疾病。本文对 2 例患者进行了荧光素眼底血管造影、眼底自发荧光、相干光层析成像及视觉电生理等检查。眼底检查可见双侧后极部血管弓范围视网膜色素上皮（retinal pigment epithelium，RPE）及脉络膜毛细血管的对称性萎缩。自发荧光可见相应区域的对称性低荧光。光学相干断层成像术（optical coherence tomography，OCT）显示后极部外层视网膜和脉络膜毛细血管的萎缩变薄。

Posterior polar central choroidal dystrophy is a rare disease. Clinical data of two patients with posterior polar central choroidal dystrophy fluorescein angiography, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT), and electrophysiological tests were reported. Fundus examination showed bilateral symmetric atrophy of the retinal pigment epithelium and choriocapillaris in the posterior polar areas between vascular arcades. FAF imaging showed clearly defined hypoautofluorescent areas that corresponded to the aforementioned lesions. Atrophy of the choriocapillaris and outer retinal layer were detected by optical coherence tomography.

强直性瞳孔在临床工作中较为少见，容易被误诊，典型的强直性瞳孔为单侧，随着病程的进展，逐渐转变为双侧。新发双侧强直性瞳孔更是极为罕见，应当引起重视。其典型的临床表现包括瞳孔散大、瞳孔运动迟钝、节段性瞳孔麻痹、无其他眼部器质性病变。依据病因可以分为继发于急性眼内肌麻痹、合并有全身疾病以及特发性三类。目前治疗方面多以病因治疗为主。

Tonic pupil is rare in clinical work and likely to be misdiagnosed. The typical tonic pupil is unilateral, which gradually turns to bilateral with the progress of disease. Newly bilateral tonic pupil is extremely rare, which captivates widespread attention. Typical clinical manifestations include dilated pupils, slow pupil movement, segmental pupillary palsy, and no other ocular diseases. On this basis, the causes can be divided into three categories, including secondary to acute intraocular myoparalysis, complicated with systemic disease and idiopathic type. At present, etiological treatment is the main treatment.

目的：探讨眼外伤门急诊与住院病房一体化管理模式下，眼外伤患者的护理方法。方法：对2018年4月中山大学中山眼科中心 109 例眼外伤急诊手术患者采取有效的护理措施，通过交谈、示范、发放宣传资料等方法，对患者实施心理护理、术前护理、术后护理、出院指导及延续护理。结果：109 例患者均顺利接受手术，其中门急诊患者 43 例当天行手术治疗并于第 2 天眼外伤急诊专科门诊复诊，收入院患者 66 例行手术治疗均治愈出院。结论：在门急诊与住院病房一体化的管理模式下，对患者做好心理护理、术前术后护理及出院指导，使患者安心接受手术，得到相应的健康指导，提高了患者的满意度，值得推广。

Objective: To explore the nursing methods for ocular traumatic patients in the integrated management mode of ocular trauma emergency room and ward. Methods: We took effective nursing measures for the patients who treated with surgeries in our ocular traumatic emergency room, including comprehensive conversation, demonstration, distribution of detailed propaganda, discharge guidance as well as preoperative, postoperative, and discharge psychological nursing, from 1st April, to 30th April, 2018. Results: A total of 109 patients were included in this study. Forty-three of them underwent the emergency surgery on the day of admission and reviewed in the outpatient at postoperative 2 days. The other 66 patients were hospitalized, recovered and discharged. Conclusion: In this integrated management mode, comprehensive psychological nursing, perioperative nursing and discharged guidance would help to comfort patient and improve the degree of satisfaction, which is worthy of widespread application.

目的：探讨以护士为主导的按术式排程手术日模式在眼整形病区的应用与成效。方法：采用便利抽样法，选择实施以护士为主导的按术式排程手术日模式后的 2018年1至6月作为试验组，实施该模式前的 2017年1至6月作为对照组。统计并比较该模式实施前后平均每周手术量、病区关闭时长、水电费用、医务人员对工作的满意度及患者的满意度。结果：该模式实施后平均每周的手术台数由实施前的 26 台升至 31.8 台，关区时长由实施前的 4.5 h 升至 33.2 h，水电费由实施前的 625.3 元降至 518.5 元，差异有统计学意义（t＝2.61，3.94，4.22，P < 0.05）；医护人员对工作的满意度由实施前的 80% 上升至 90%，患者满意度由实施前的 83.3% 上升至 93.3%，差异有统计学意义（χ2＝4.61，5.01，P < 0.05）。结论：以护士为主导的按术式排程手术日模式在眼整形病区切实可行，在保障医疗、护理安全性的同时，可节省医院的运营成本，亦可提高护士、医生、患者的满意度，值得在临床推广。

Objective: To explore the effect of the mode of nurse-led surgery scheduling based on procedure in ocular plastic ward. Methods: Convenience sampling method was adopted, the nurse-led surgery performed from January to June 2018 was assigned in the experimental group, and those conducted from January to June 2017 were assigned into the control group. The average number of operations per week, the length of the ward closure, utilities, medical staff and patients' satisfaction were calculated and compared. Results: After the implementation of this mode, the average number of operations per week increased, the length of the ward closure increased, utilitiesdecreased, and the difference was statistically significant (t=2.61, 3.94, 4.22, P<0.05). The degree of satisfaction of medical staff and patients was significantly improved (χ²=4.61, 5.01, P<0.05). Conclusion: The mode of nurse-led surgery scheduling based on procedure can save hospital operating costs and improve the satisfaction of nurses, doctors and patients, which is worthy of clinical promotion.