近年来，由于经济社会不断发展，社会压力增大，人们精神障碍和干眼的发病率不断增加，这既影响人们身心健康，也给社会经济造成一定负担。大量研究表明精神障碍与干眼显著相关，精神障碍是干眼的独立危险因素之一。然而在临床工作中，精神障碍与干眼间的关系在过去一直未受到重视，本文将从精神障碍与干眼关联性入手，探讨其中介作用，总结了精神障碍因素影响干眼症状和体征分离，并进一步倡导跨学科综合管理来治疗干眼，形成对干眼的正确感知并降低疼痛及健康焦虑水平，以期为干眼临床诊疗提供新的视角。
In recent years, due to the continuous development of economy and society and the increasing social pressure, the incidence rate of mental disorders and dry eyes is increasing, which not only affects people’s physical and mental health, but also creates a certain burden on the social economy. A large number of studies have shown that mental disorder is significantly related to dry eye, and mental disorder is one of the independent risk factors of dry eye. However, in clinical work, the relationship between mental disorder and dry eye has not been paid attention in the past. This paper will start with the correlation between mental disorder and dry eye, explore the mediating effects, summarize the mental disorder factors that affect the separation of symptoms and signs of dry eye, and further advocate interdisciplinary comprehensive management to treat dry eye, form a correct perception of dry eye and reduce the level of pain and health anxiety, In order to provide a new perspective for clinical diagnosis and treatment of dry eye.
鼻内镜外科技术延伸到鼻眼相关疾病的诊断和治疗已经有二十余年的历史。随着鼻眼相关解剖研究、影像诊断技术和手术器械的进步和手术临床经验的积累，大量临床和基础研究不断涌现，逐渐形成了相对成熟的内镜鼻眼相关外科理论与实践体系。本文概述了内镜鼻眼相关外科的发展现状，对几种主要手术提供经验总结并提出展望。
Nasal endoscopic surgery technology has gradually developed and involved into the diagnosis and treatment of nose-eye related disease for more than 20 years. With the improvement of anatomical studies on nose-eye, imaging diagnostic technology and surgical instruments, the accumulation of surgical clinical experience, as well as the increasing emergence of a large number of clinical and basic studies on endoscopic rhino-orbital related surgery, a well-established theoretical and practical system of endoscopic nose-eye surgery has gradually been formed. This article summarized the development of endoscopic rhino-orbital surgery, and the advantages and limitations of several major surgical methods. Also, the further research was prospected.
霍纳综合征是一种由眼交感神经传出通路中任意部分中断所造成的临床综合征，常以上睑下垂、瞳孔缩小等眼部特征为主要临床表现，往往提示头、颈或胸部严重疾病或术后并发症的发生。现报告1例49岁的男性患者，曾在武汉市中心医院耳鼻喉科行右侧咽旁间隙肿物切除术，术后第1天出现右眼上睑下垂，瞳孔缩小，伴同侧面部无汗。术后随访半年，上述症状未见明显改善。右侧咽旁间隙肿物的病理结果证实为交感干神经鞘瘤，该病例临床较为罕见。
Horner syndrome is caused by damage of the oculosympathetic pathway. It is a common disorder characterized by ocular signs such as ptosis and miosis, and these signs usually indicate the occurrence of severe head, neck and chest diseases or surgical complications. We report a case of 49-year-old male patient who underwent parapharyngeal space tumor resection in the Department of otolaryngology. On postoperative day one, the patient presented right eyelid drooping, the right pupil constricted, and the absence of sweating on the right side of the face. After six months of follow-up, the above signs still presented and showed no significant change. T??he pathological assessment of the resected parapharyngeal space tumor demonstrated that it is the sympathetic trunk schwannoma, which is relatively rare in clinical practice.
永存胚胎血管(persistent fetal vasculature，PFV)，也称永存原始玻璃体增生症( persistent hyperplastic primary vitreous，PHPV)，是一种先天性眼病，多发现于婴幼儿时期。因大多数患儿单眼发病、症状隐匿，且易被误诊为单纯的先天性白内障，常常延误手术治疗的最佳时机。因此，正确的诊断和适宜治疗方式的选择对于患儿视功能的预后尤为重要。本文报道了1例6岁6个月的男性患儿，诊断为混合型PFV，眼部特征表现为先天性白内障和黄斑区结构错位。
Persistent fetal vasculature (PFV), also known as persistent hyperplastic primary vitreous (PHPV), is a congenital ocular anomaly, which is common in infants and young children. Due to most children have unilateral occurrence, insidious symptoms and are easily misdiagnosed as simple congenital cataract, the optimum time for treatment is often delayed. Therefore, correct diagnosis and appropriate treatment are particularly significant for the prognosis of PFV children’s visual function. A male child aged 6 years and 6 months with a diagnosis of combined PFV is reported, whose ocular features were congenital cataract and structural dislocation of macula.
目的：探究短期周边遮盖对成年视皮层双眼优势平衡的作用。方法：对12名正常成年人的各眼 (24只眼)分别进行单眼短期周边遮盖。遮盖方式为单眼佩戴90 min的环形、半透明的塑料遮盖板，遮盖板仅能透光，中央留有1 0°~15°视野范围的圆孔，从而实现周边遮盖。受试者在周边遮盖前、遮盖后的0~3、3~6、6~9、9~12、12~15、30、60和90 min均完成双眼竞争任务 (binocular rivalry task)。记录并分析各时间段中各眼的占优时间、双眼竞争在眼别间切换周期数和各眼占优概率随时间改变的特点等。每位受试者左右眼测试间隔1周进行。结果：在遮盖前，12名正常成年受试者被遮盖眼的占优时间与非遮盖眼的差异无统计学意义(92.78±6.33 s vs 87.22±6.23 s，P>0.05)，提示眼优势平衡。遮盖去除后的0~3 min，被遮盖眼占优比例显著增加至 0.721±0.11(P<0.001)，该效应在遮盖去除后的3~30 min均存在(P<0.05)，直至60 min(P=0.445)双眼基本恢复优势平衡。双眼优势转换周期在周边遮盖前后差异无统计学意义(P=0.064)。主导眼在去除周边遮盖后的0~3 min遮盖眼占优时间比例相对基线的改变幅度与遮盖非主导眼的差异无统 计学意义(P=0.835)。结论：短期的周边遮盖可改变成年双眼优势平衡，有望应用于视觉关键期后的弱视治疗中。视觉关键期后双眼视功能仍保留有一定的可塑性。
Objective: To study the effect of short-term peripheral patching on binocular dominance in adult visual cortex. Methods: Monocular short-term peripheral patching was performed on each eye (24 eyes) of 12 normal adults. The patching was achieved by monocularly wearing a ring-shaped, translucent and plastic patch for 90 minutes. The patch could only transmit light, but not pattern, and there was a circular hole with a visual field of 10°–15°, so as to achieve peripheral patching. Participants completed the binocular rivalry task at baseline and 0–3, 3–6, 6–9, 9–12, 12–15, 30, 60 and 90 min after peripheral patching. The dominance duration of each eye and the number of dominance switches between eyes were recorded. The probability of perceiving stimulus of each eye was calculated in each time period. Each participant’s both left and right eyes performed peripheral patching one week apart. Results: Before patching, the dominance duration of the patched eye was not significantly different from the non-patched eye (92.78±6.33 s vs 87.22±6.23 s, P>0.05), which suggests that the eye dominance was balanced. At 0–3 min after the removal of the patch, the dominance duration of the patched eye was increased significantly (P<0.001), and this effect existed until 30 min after the removal of the patch (P<0.05). The dominance duration of the patched eye at post-60 min was not significantly different from the baseline (P=0.445). There was no significant difference in the dominance switches among baseline and each period after patching (P=0.064). After the removal of patch on the dominant eye, the amplitude of change in the dominance duration of the patched eye at 0–3 min was not significantly different from that after the removal of patch on the non-dominant eyes (P=0.835). Conclusion: Short-term peripheral patching can also change the binocular dominance in adults, and it has the potential to be applied in treatment of adult amblyopia. After the critical period for visual development, binocular vision function still retains plasticity.
眼缺血综合征(ocular ischemia syndrome，OIS)是由一系列诱因引发的以慢性眼部低灌注为主要临床表现的眼部疾病。临床相对少见，但对视力的影响较大，其症状主要包括一过性黑朦、缺血性眼痛、永久性视力丧失等。近年来医疗美容行业逐步兴起，自体脂肪填充技术使用逐渐增多，其所引起的OIS不可忽视。本文分析1例自体脂肪填充患者术后致OIS病例，研究该类疾病眼底影像学特征。
Ocular ischemia syndrome (OIS), featuring as chronic ocular hypoperfusion, is an eye disease caused by a series of incentives. It is relatively rare in clinical practice, but has a great impact on vision. The symptoms of OIS mainly include transient amaurosis, ischemic eye pain, permanent vision loss, etc. In recent years, with the rise of the Aesthetic Medicine industry, the technology of autologous fat filling has been increasingly adopted. The OIS caused by the surgery of autologous fat filling is nonnegligible. In this paper, by means of analyzing a case that an autologous fat filling surgery resulted in the OIS, discusses features of fundus angiography of OIS.
猫抓病(cat scratch disease，CSD)是由巴尔通体引起的一种人畜共患病。该病不仅有多种全身表现，还可能出现各种危害视力的眼部并发症。随着家庭饲养宠物不断增多，CSD发病率逐年上升，眼科医生应重视此病。CSD的临床表现多种多样，容易误诊，与猫等宠物接触的病史、高滴度的血清免疫球蛋白G抗体是诊断的关键，聚合酶链反应也有助于诊断。由于CSD通常是免疫能力强的个体的自限性感染，因此通常不需要抗生素治疗。然而，当免疫力低或感染重时，多西环素是最常用的抗生素。
Cat scratch disease (CSD) is a zoonotic disease caused by Bartonella, which not only has a variety of systemic manifestations, but also may have various ocular complications that endanger vision. With the increasing number of pets kept at home, its incidence shows an increasing trend year by year. Therefore, ophthalmologists should pay attention to this disease. The clinical manifestations of CSD are various, which easily lead to misdiagnosis. The medical history of contact with cats and other pets and serum immunoglobulin G antibody with high titer are the key to diagnosis, and polymerase chain reaction is also helpful to diagnosis. Because CSD is usually a self-limiting infection of individuals with strong immune ability, antibiotic treatment is usually not required. However, when immunity is low or infection is severe, doxycycline is the most commonly used antibiotic.
剥脱性青光眼是剥脱综合征继发的一类青光眼，临床上少见。本文报告2例患者，患眼瞳孔缘可见灰白色碎屑样物质沉积，散大瞳孔后可见晶状体前囊周边部混浊带，房角镜下可见Sampaolesi线。认识其临床特征，将有助于提高其诊治率。
Exfoliation glaucoma is a category of glaucoma secondary to exfoliation syndrome, which is rarely encountered in clinical practice. We reported 2 cases with deposits of white material on the pupillary border of the iris. Opacity band could be observed surrounding the anterior lens capsule after pupil dilation, and the Sampaolesi line was seen under gonioscope. Understanding the clinical characteristics contribute to improving the diagnosis and treatment of exfoliation glaucoma.
息肉状脉络膜血管病变(polypoidal choroidal vasculopathy，PCV)是亚洲人中常见的眼底致盲性疾病，当PCV合并视网膜下出血或玻璃体积血(vitreous hemorrhage，VH)时，患者视力骤然下降，视力预后差异大。但目前聚焦于PCV合并VH的相关文献较少，因此研究和阐明PCV继发VH的治疗方法及预后具有重要的临床意义。目前临床上常选择手术干预，玻璃体切除术(pars plana vitrectomy，PPV)是临床上最常选择的一种术式。其他治疗方式包括玻璃体内注射抗血管内皮生长因子(vascular endothelial growth factor，VEGF)、眼内气体或硅油填充、眼内注射组织纤溶酶原激活剂(tissue plasminogen activator，tPA)和光动力疗法(photodynamic therapy，PDT)。PCV合并VH患者的视力预后决定因素是黄斑视功能的保留程度，也与年龄、术前视力、PCV病变部位、视网膜下出血量、视网膜脱离范围、基线黄斑中心厚度(central macular thickness，CMT)、是否出现术后并发症以及是否形成视网膜瘢痕等因素相关，目前也有研究发现视力预后与单核苷酸多态性(single nucleotide polymorphisms，SNP)相关。本文就PCV继发VH的临床特点、治疗及预后进行综述。
Polypoid choroidal vasculopathy (PCV) is a common fundus blinding disease in Asians. When PCV is associated with subretinal hemorrhage or vitreous hemorrhage (VH), patient's visual acuity decreases suddenly and the visual prognosis varies greatly. There are few relevant literatures focusing on VH secondary to PCV, so it is of great clinical significance to study and clarify the treatment methods and prognosis of VH secondary to PCV. At present, surgical intervention is often selected in clinical practice. Vitrectomy is the most commonly selected surgical procedure in clinical practice. The other treatment modalities include intravitreal injection of antivascular endothelial growth factor (VEGF), intraocular gas or silicone oil filling, intraocular injection of tissue plasminogen activator (tPA) and photodynamic therapy. The prognostic determinant of visual acuity in PCVpatients with VH is the degree of preservation of macular visual function. The prognostic is also related to age, preoperative visual acuity, PCV lesion location, amount of subretinal hemorrhage, extent of retinal detachment, baseline central macular thickness (CMT), postoperative complications and retinal scars. Recent studies also find that the prognosis of visual acuity is related to single nucleotide polymorphisms. This article reviews the clinical characteristics, treatment and visual prognosis of PCV associated with VH.
目的：分析医学人工智能通识课程“眼科人工智能的研发与应用”的开展效果，为相关医学人工智能通识课程的开展提供参考和借鉴。方法：纵向观察性研究。观察分析2020年秋季学期眼科人工智能的研发与应用通识课程学生人群，课程考核结果以及学生对课程的整体评价。结果：共有118名本科生同学参与了课程学习。其中大部分为低年级临床医学专业本科生。期中考核得分为77.21±10.07，有56位同学(47.46%)达到80分以上。期末考核得分为82.24±6.77，有91位同学(77.12%)达到80分以上。同学对课程的评分为98.76±3.55，超过90%的同学表示课程备课认真、授课条理清晰、表达准确。结论：本课程的顺利进展证明医学人工智能联合教学模式的可行性，理论和实践穿插的教学设置帮助同学们更好地掌握知识技术，完成教学目标。
Objective: To analyze the effectiveness of medical education curriculum named “Development and Application of Ophthalmic Artificial Intelligence”, and provide reference for the development of other related curriculums. Methods: Longitudinal observational study method was adopted. During the fall semester of 2020, we conducted an education curriculum named “Development and Application of Ophthalmic Artificial Intelligence” and analyzed the results of mid-term and final examinations, and curriculum evaluation of students. Results: There were 118 undergraduate students taking the course and most of them were junior students majoring in clinical medicine. The score of the mid-term examination was in the range of 77.2±10.07, and 56 students (47.46%) got more than 80 points. The score of the final examination was in the range of 82.24±6.77, and 91 students (77.12%) got more than 80 points. The score of course evaluation of students was in the range of 98.76±3.55, and more than 90% of the students thought that teachers have made full preparations before class, together with clear teaching logic and accurate expressions in class. Conclusion: The smooth progress of our course proved the feasibility of medical artificial intelligence teaching. The teaching setting interspersed with theory and practice could help students to master knowledge and technology better, so as to achieve the teaching objectives.
