临床上儿童外眦部肿物合并眼睑畸形及结膜肿物少见,需在切除眼睑、结膜肿物的同时,灵活处置眼睑整复。本文回顾2例就诊于北京儿童医院的先天性外眦肿物合并眼睑缺损的病例。术后病理示皮赘伴结膜皮样脂肪瘤。患儿眼睑肿物切除彻底,眼睑整复后外观满意。
Lateral canthus mass with eyelid deformity and conjunctival mass is rare in children. The eyelid reduction should be handled flexibly while the mass is removed. Two cases of congenital lateral canthus with eyelid coloboma were reviewed in Beijing Children’s Hospital. Postoperative pathology showed fibroepithelial polyp and conjunctival dermolipoma. The eyelid masses of the child were completely excised, and the appearance was satisfactory after eyelid reduction.
干眼是一种临床常见慢性眼表疾病。它不仅能引发患者眼部不适及损害,还易导致患者出现心理障碍。目前最常见的干眼相关心理障碍主要为焦虑、抑郁和睡眠障碍。干眼病情的缓解,不仅需要针对干眼本身的积极治疗,还需要患者保持健康的心理状态。因此,应该关注干眼相关焦虑、抑郁等心理障碍的发病机制及预防、治疗措施。
Dry eye disease (DED) is a common chronic ocular surface disease. It can not only cause discomfort and damage to the eyes but also easily lead to psychological disorders in patients. The most common psychological disorders related to DED are anxiety, depression and sleep disorder. To alleviate the condition of DED, in addition to active treatment for DED itself, it is also necessary for the patients to maintain a healthy psychological state. Therefore, attention should be paid to the pathogenesis, prevention and treatment measures of DED-related anxiety, depression and other psychological disorders.
目的:观察盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术中的临床应用效果,评价盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术麻醉中的有效性和安全性。方法:选择2020年11月至2021年7月在佛山市第二人民医院择期行眼睑肿物刮除术的70例患儿,随机分为A组和B组,每组35例。A组采用七氟烷联合丙泊酚复合麻醉,B组采用盐酸艾司氯胺酮联合丙泊酚复合麻醉。记录两组患儿诱导时间、手术时间、苏醒时间、复苏总时间;监测麻醉前、麻醉后5 min、手术开始前、手术结束后患儿血流动力学及呼吸频率变化;记录两组患儿苏醒后即刻、返回病房即刻的东安大略儿童医院疼痛评分量表(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)疼痛评分、躁动评分、恶心呕吐评分。结果:两组患儿麻醉诱导时间比较差异无统计学意义(P>0.05);两组患儿麻醉过程中血流动力学水平、呼吸频率差异无统计学意义(P>0.05);B组患儿苏醒时间、复苏总时间均明显低于A组(P<0.05);B组患儿苏醒后即刻及返回病房即刻CHEOPS疼痛评分、躁动评分、恶心呕吐评分均明显低于A组(P<0.05)。另外,B组患儿术后出现恶心呕吐概率低于A组(P<0.05)。结论:盐酸艾司氯胺酮联合丙泊酚应用于小儿眼睑肿物刮除术麻醉,能提供良好麻醉镇痛效果,降低躁动反应和恶心呕吐的发生
Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.
近年来人工智能(artificial intelligence,AI)技术在医学领域的应用发展迅猛,尤其在眼科领域,成果显著,极大地提高了相关影像数据的诊断效率,推动了该领域研究的进展。然而,大多数AI的应用都集中于成人眼病,在婴幼儿眼病方向的研究较少。究其原因,可能是婴幼儿眼部影像数据采集配合度低,部分影像设备应用受限,且相关领域专业眼科医生数量匮乏。然而,婴幼儿期是视觉发育最重要的阶段,也是出生缺陷早期筛防诊治的重灾区,对患儿的视觉发展具有长远且重要的影响,亟需AI相关产品提高婴幼儿眼病筛查效率,缓解医疗资源不足的现状。本文将对近年AI在婴幼儿眼病领域的研究应用现状、进展及存在的相关问题进行综述。
In recent years, the application of artificial intelligence (AI) in medicine, especially in ophthalmology, has developed rapidly with remarkable results. This has greatly improved the diagnostic efficiency of relevant imaging data and promoted further research in this field. However, most applications of AI are focused on adult eye diseases, and few studies have addressed infantile eye diseases. This may be because of the non-cooperative nature of infants, the limited availability of imaging equipment in infants, and the lack of pediatric ophthalmologists. Infancy is the most important stage of vision development. Disturbance during this period have a profound and lasting influence on vision development. Hence, early screening, diagnosis, and treatment of birth defects is important. AI-related products, which improves the efficacy of infant eye disease screening, are urgently needed. This paper reviews the current status, progress, and existing problems of recent research related to application of AI in infantile eye diseases.
目的:分析临床应用镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻的效果。方法:回顾性分析安康市中医医院2年期间,应用镜下改良眼轮匝肌手术治疗61例(112眼)儿童先天性下睑内翻,根据睑内翻程度决定缝线跨度、松紧度及去除肌皮瓣量,0/6缝线将睑缘下眼轮匝肌与下睑缩肌缝合,0/8缝线连续缝合皮肤伤口,并做好术后护理。结果:所有患儿随访6~24个月,刺激症状缓解,106眼治愈,2眼好转,4眼复发,总有效率达96.43%。结论:镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻美观、易操作、复发率低。
Objective: To analyze the clinical efficacy of modified orbicularis oculi surgery under microscope in the treatment of congenital lower eyelid entropion of children. Methods: Sixty-one cases (112 eyes) of children with congenital lower eyelid entropion treated by modified orbicularis oculi surgery in Ankang Hospital of Traditional Chinese Medicine from Aug 2020 to Sep 2022 were retrospectively analyzed. The suture span, tightness and the amount of myocutaneous flap removed were determined according to the degree of entropion. The orbicularis oculi muscle of lower eyelid margin was suturedwith 0/6 suture, and the skin wound was sutured continuously with 0/8 suture, and postoperative nursing was done well. Results: All children were followed up for 6–24 months, and the irritation symptoms were relieved, 106 eyes were cured, 2 eyes turned well, and 4 eyes relapsed. The total effective ratereached 96.43%. Conclusion: The modified orbicularis oculi surgery for treatment of children with congenital lower eyelid entropion conforms to visual aesthetics. In addition, it is easy to operate and have a low recurrence rate.
目的:调查干眼在郑州市机关工作者中的患病情况,分析相关危险因素,为有效防治干眼提供科学依据。方法:选取2019年9月到2020年9月在郑州大学第一附属医院体检的郑州市机关工作者873例。采用自行设计的一般资料问卷和OCULUS Jenvis-OSDI干眼问卷进行调查,记录评分结果,同时检查记录裂隙灯、角膜荧光素染色评分(corneal fluorescein staining score,FL)、基础泪液分泌实验(Schimier I test,SIT)、泪膜破裂时间(tear break-up time,BUT)测定结果。统计分析机关工作者干眼患病率与危险因素。结果:体检的873例郑州市机关工作者中360例诊断为干眼,干眼总患病率为41.24%,女性患病率(44.62%)明显高于男性(36.26%),差异有统计学意义(P=0.014)。干眼问卷OSDI评分与FL评分呈正相关,BUT与SIT呈正相关,OSDI(和FL评分)与BUT(和SIT)呈负相关。Logistics多因素分析表明:干眼家族史、绝经、曾行眼部手术、滴眼液使用情况、长时间佩戴角膜接触镜、长时间操作视频终端、睡眠不足、糖尿病史是机关工作者干眼患病的危险因素(均P<0.05),而饮酒是保护因素(P=0.001)。结论:机关工作者干眼患病率较高,危险因素囊括家族患干眼史、绝经、曾行眼部手术、滴眼液使用情况、长时间佩戴角膜接触镜、长时间操作视频终端、睡眠不足、糖尿病病史。加强干眼防治的宣传教育,针对不同危险因素提供眼健康指导并进行防控治疗,保护机关工作者的眼健康。
Objective: To investigate and analyze the prevalence of dry eyes in Zhengzhou office workers, and identify the related risk factors in order to provide evidence for effective prevention and treatment. Methods: We selected 873 cases of Zhengzhou office workers who had checkup in our hospital from September 2019 to September 2020 as the research subjects. They were investigated with self-designed general information questionnaire and OCULUS Jenvis-OSDI dry eye questionnaire and scores of the questionnaires will be assessed. At the same time,they underwent dry-eye-related inspections such as slit lamp examination, corneal fluorescein staining score (FL), Schimier I test (SIT) and tear break-up time (BUT) assessment. The prevalence and risk factors of dry eyes in these office workers were statistically analyzed. Results: Among 873 Zhengzhou office workers, 360 cases were diagnosed as dry eyes, and the total prevalence of dry eye was 41.24%. The female prevalence rate was 44.62%, which was significantly higher than that of male (36.26%, P=0.014). OSDI scores and FL scores were positively correlation as well as BUT and SIT, while OSDI (and FL) and BUT (and SIT) were negatively correlation. Logistic multivariate analysis showed that dry eyes family history, menopause, ocular surgery history, eye drops using, long time corneal contact lenses wearing, long time video terminal operating, lack of sleep and diabetes history were independent risk factors in office workers’ dry eye disease (all P<0.05), while drinking was protective factor (P=0.001). Conclusion: The dry eyes prevalence is high among office workers. The risk factors include dry eye family history, menopause, ocular surgery history, eye drops using, long time corneal contact lenses wearing, long time video terminal operating, lack of sleep and diabetes history. We should strengthen the publicity and education of the dry eye prevention and treatment, provide eye health guidance, prevention and treatment according to different risk factors, and protect the office workers’ eye health.
目的:对比两种不同部位M22优化脉冲激光治疗方法治疗睑板腺功能障碍(meibomian gland dysfunction,MGD)所致干眼的疗效。方法:回顾性分析汕头博德眼科医院干眼门诊患者105例,包括常规治疗组和改良治疗组两个组别,常规治疗组激光部位为下睑,改良治疗组激光部位为联合上下睑,所有患者行M22优化脉冲光治疗一个疗程(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的泪河高度情况、泪膜破裂时间(break-up time,BUT)、角膜荧光染色(corneal fluorescence staining,CFS)和睑板腺排出能力等参数。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,BUT时间延长,角膜荧光染色和睑板腺排出能力评分均有好转,每组治疗后与治疗前差异有统计学意义(P<0.01),两组间治疗前后各参数差异比较均没有统计学意义。结论:两种不同部位M22优化脉冲激光治疗方法在治疗MGD导致的干眼方面有较好的效果,是较安全有效地治疗方法,两种不同方法治疗效果无明显差异。
Objective: To study the efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction (MGD). Methods: A total of 105 patients collected from Shantou Balder Eye Hospital were divided into two groups. The treatment position of the conventional group was lower eyelid, the other group was combined with upper and lower eyelid. All patients accepted M22 Optimal Pulsed Technology treatment for three times, once a month. Keratograph 5M dry eye analyzer was used to assess the height of tears river, break-up time (BUT), corneal fluorescence Staining(CFS)and meibomian gland expressibility. The results before and after laser treatment were compared using t-test in this study. Results: After treatment, the height of tear river, BUT, CFS and meibomian gland expressibility were improved. There was a statistically significant difference between each group after and before treatment (P<0.01). There was no significant difference before and after treatment between the two groups. Conclusion: The two methods of M22 Optimal Pulsed Technology are effective in treating dry eyes caused by MGD. There is no significant difference in the therapeutic effect between two methods.