目的：了解 2014 — 2016 年成都市龙泉驿区高三学生近视现状。方法： 2014 — 2016 年在成都市龙泉驿区随机整群抽样调查 5 所高级中学，对其高三学生进行医学验光及问卷调查。结果：共调查在校高三学生 16796 人，排除不合格 204 人，列入研究者共 16592 人，其中 2014 年 5438 人，2015 年 5213 人，2016 年 5941 人。调查结果表明：重点高中近视率明显高于普通高中（χ² = 322.065，P < 0.01），且重点高中学生的近视程度 (度数) 普遍高于普通高中（χ² = 8.102，P < 0.05）；2016 年近视率较 2014 及 2015 年明显增加（P < 0.01）；学习时间 ≥1 h/次（P < 0.01）、看电视时间 ≥2 h/d（P < 0.05）是近视的危险因素；睡眠时间 ≥8 h/d（P < 0.01）、体育锻炼 ≥1 h/d（P < 0.01）、经常做眼保健操（P < 0.05）为保护因素；学习时间是否大于 1 h（χ² =3.330）、看电视时间是否大于 2 h（χ² = 0.176）、体育锻炼时间是否小于 1 h(χ² = 0.904) 对近视程度的影响并不明显（P > 0.05）；配镜不准确很可能会导致轻度近视向中度近视发展（χ² = 108.218，P < 0.01）；睡眠时间 <8 h/d（χ² = 7.644）、不经常做眼保健操（χ² = 6.396）均会导致近视程度的加深。结论：成都市龙泉驿区重点高中近视率及近视程度均高于普通高中。青少年的近视率的上升与学习压力大、学习时间过长、缺乏休息与户外运动等有密切关系，近视程度的加深与配镜不准确（家长不重视）关系显著。因此，改善学生的学习环境、提高心理素质、减轻学习压力，鼓励劳逸结合，并加强家长与学生本人对近视的认识和建立长期的医患随访关系，对降低成都市龙泉驿区近视率及近视发展具有重要意义。

Objective: To study the current status of myopia among high school students from 2014 to 2016 in Longquanyi District, Chengdu. Methods: Random cluster sampling of five senior high schools in Longquanyi Districtof Chengdu was conducted for three consecutive years. Medical optometry and questionnaire surveys were conducted for high school students. Results: A total of 16 796 high school students were investigated, 204 unqualified individuals were excluded, and a total of 16 592 students were included in the study, including 5 438 in 2014, 5 213 in 2015 and 5 941 in 2016. The survey results showed that the rate of myopia in key high schools was significantly higher than that in ordinary high schools（P<0.01）, and the degree of myopia of students in key high schools was significantly higher than that in ordinary high schools（P<0.05）; the rate of myopia was increased significantly in 2016 compared with those in 2014 and 2015 （both P<0.01）; learning time ≥1 h/time（P<0.01） and watching TV time ≥2 h/d（P<0.05） risk factors for myopia; sleep time ≥8 h/d （P<0.01）, sports exercise ≥1 h/d （P<0.01） and frequent eye exercises（P<0.05） were considered as protective factors. Whether the study time was longer than 1 h, whether the time of watching TV was longer than 2 h, and whether the physical exercise time was shorter than 1 h did not affect the degree of myopia significantly （P>0.05）; inaccurate glasses had a significant impact on the degree of myopia （P<0.01）; sleep time <8 h/d and infrequent eye exercises all resulted in a higher degree of myopia. Conclusion: The rate and degree of myopia in key high schools in Longquanyi District of Chengdu are higher than those in ordinary high schools. The increase in myopia among adolescents is closely correlated with the pressure of study, long learning time, lack of rest and outdoor sports, etc. The aggravation of myopia is significantly correlated with the inaccuracy of glasses. Therefore, there is an urgent need to improve students’ learning environment, improve their psychological quality, reduce learning pressure, encourage the coordination between work and leisure, strengthen parents’ and students’ understanding of myopia andestablish a long-term follow-up relationship between doctors and patients, thereby reducing the risk and progression of myopia.

目的：探讨佩戴 1 年及以上环曲面设计型夜戴型角膜塑形镜的青少年眼轴控制增长情况及眼轴增长因素分析。方法：回顾性病例研究。收集 192 人（372 眼）青少年近视患者，年龄（12.3±3.2）岁，按照佩戴的夜戴型角膜塑形镜的设计类型，分为普通设计组（302 眼）以及环曲面设计组（70 眼），收集佩戴前 1 天患者原始资料及佩戴 1 年后两组眼轴的变化，采用独立样本T检验方式分析两组间眼轴增长差异，采用多因素线性回归分析环曲面设计组眼轴增长因素。结果：普通设计组、环曲面设计组基线球镜分别为（−3.53±1.73）和（−3.96±1.69）D，基线柱镜为（−0.60±0.72）和（−1.41±0.91）D；两组基线眼轴分别为（25.01±1.04）和（25.26±1.17）mm，两组基线眼轴差异无统计学意义（P > 0.05）；戴镜 1 年后两组眼轴增长值分别为（0.09±0.24）和（0.10±0.20）mm，组间眼轴增长差异无统计学意义（P = 0.62）。多因素线性回归分析显示：佩戴初始年龄是影响环曲面设计组眼轴变化的主要因素，与眼轴变化呈负相关（t = −0.43，P < 0.01）。结论：对于合并中高度散光的近视患者，佩戴环曲面设计型夜戴型角膜塑形镜 1 年时间，能有效控制近视眼轴增长，延缓近视进展，佩戴初始年龄是参与影响环曲面夜戴型角膜塑形镜控制眼轴增长的重要因素。

Objective: To investigate the controllable growth of eye axial length and the factors of axial growth in adolescents wearing biaxial orthokeratology lens for 1 year or longer. Methods: Retrospective case studies. A total of 192 patients (372 eyes) with adolescent myopia, aged (12.3±3.2) years, were collected and classified into a general design group (n=302) and a biaxial-design group (n=70) according to the design type of the orthokeratology lens. Changes in the axial data of the patients 1 day before wear and 1 year after wear were collected. Differences in axial length between the two groups were analyzed by independent sample t-test. Multivariate linear regression analysis was used to analyze the factors of the axial growth in the design biaxial-design group. Results: Baseline mean spherical mirrors for the general design group and biaxial design group were (−3.53±1.73) and (−3.96±1.69) D, and the baseline diopter was (−0.60±0.72) and (−1.41±0.91) D; the baseline axial lengths were (25.01±1.04) and (25.26±1.17) mm; there was no significant difference in the baseline axial length between two groups (P>0.05). After wearing glasses for 1 year, the axial length in two groups was increased by (0.09±0.24) and (0.10±0.20) mm,  with no statistical significance (P=0.62). Multivariate linear regression analysis showed that the initial age of wearing glasses was the main factor influencing the change of the ocular axis in biaxial design group, and negatively correlated with the change of the ocular axis. Conclusion: For the myopic patients with high astigmatic myopia, wearing a biaxial-design orthokeratology lens can effectively control the growth of myopic axis and delay the progression of myopia. The initial age of glass wear is associated with the effect of biaxial-design orthokeratology is an influencing factor for the growth of the axial axis.

住院医师规范化培训是培养合格临床医师的重要方式，住院医师临床技能培养是提高临床胜任力的核心，是为基层医疗单位提供能独立、规范地承担本专业常见多发疾病诊疗工作临床医师的必由之路。在眼科专业住院医师规范化培训中，通过立体化培养策略，从多方位多角度强化临床技能的训练，将知识与临床之间形成有效交互的一张网，能够有效提高住院医师临床技能和思维水平。

Standardized training of resident physicians is an important way to train qualified clinicians. The training of clinical skills is the core of improving clinical competency. It is the only way to supply ophthalmological residency who could independently and regularly deal with the common diseases for primary medical units. In the standardized training, we should strengthen the training of clinical skills from multiple angles through stereoscopic culture strategy. It could form an effective network of interaction between knowledge and clinical practice, which can effectively improve the clinical skills and thinking level of residents.

眉的对称和完整对外貌有重要影响，眼外伤常会造成眉毛皮肤缺损，较大缺损会形成皮肤疤痕和畸形，影响患者外貌。烟台市莱阳中心医院门诊急诊收住 1 例眉弓外 1/3 皮肤缺损，采用耳后游离皮片移植缺损处，皮片成活，对患者外貌无明显影响。

Eyebrow symmetry and integrity have important influence on appearance. Eye injury often causes eyebrow skin defect, and large defect can form skin scar and deformity, and affect the appearance of the patient. In the outpatient department of our hospital, one patient was admitted to the emergency department for one third of the skin defect. The graft defect of the free skin graft after ear was used, and the skin graft was not significantly affected by the appearance of the patients.

目的：评估逆行剥离法用于翼状胬肉切除联合球结膜瓣移植术的临床效果并总结手术经验。方法：回顾性收集 2013 年 11 月至 2017 年 10 月于中国人民解放军第 474 医院眼科中心手术的翼状胬肉切除患者 416 例（481 只眼），均接受逆行剥离法翼状胬肉切除联合球结膜瓣移植术，观察胬肉剥离的连续性和评估角膜创面。结果：胬肉剥离一次性完成的有 438 只眼（91.06%），分次完成的有 43 只眼（8.94%）；角膜创面光滑的有 466 只眼（96.88%），胬肉残留的有 15 只眼（3.12%），无一例角膜基质层剥离损伤。结论：逆行剥离法翼状胬肉切除术是安全有效、简便易行的翼状胬肉手术，可替代顺行剥离法在翼状胬肉手术中的应用。

Objective: To evaluate the clinical efficacy of retrograde excision in the pterygium resection combined with conjunctival transplantation and summarize operation techniques. Methods: This study retrospectively analyzed 416 patients (481 eyes) with pterygium admitted to No. 474 Hospital of Chinese People’s Liberation Army from November 2013 to October 2017, who were treated by the retrograde pterygium resection combined with conjunctival transplantation. The degree of corneal injury and the success rate of pterygium disposable stripping were observed. Results: The success rate of pterygium disposable stripping was 91.06% (n=438), the corneal wound was smooth in 466 eyes (96.88%), residual pterygium were observed in 15 eyes (3.12%), and no severe corneal stromal inury was seen. Conclusion: The retrograde excision is better than the anterograde excision in pterygium resection combined with conjunctival transplantation. It is a safe, efficient and simple operation.

目的：探讨 miR-145-5p 调控视网膜 β-catenin 表达对小鼠眼轴的影响。方法：取 18 只雄性 3 周龄 C57BL/6 小鼠按照随机数字表法随机分成对照组，miR-145-5p mimics 组和 miR-145-5p 对照组。分组第 2 ，5 ，8 天双眼玻璃体腔注射 1 次药物，共注射 3 次 ：对照组小鼠玻璃体腔内注射 3 μL 枸橼酸盐缓冲液，miR-145-5p mimics 组小鼠玻璃体腔内注射 3 μL 含有 3 μg miR-145-5p mimics 的枸橼酸盐缓冲液，miR-145-5p 对照组采取同样方法注射 3 μg miR-145-5p 对照载体。最后一次注射完成 3 d 后 A 超测量小鼠眼轴长度，之后取小鼠视网膜组织，采用 RT-PCR 技术检测视网膜中 miR-145-5p 和 β-catenin 的表达，采用 Western 印迹法检测视网膜组织中 β-catenin 的含量。取 6 只成年雄性 C57BL/6 小鼠，构建 β-catenin mRNA 3'UTR 荧光素酶过表达载体，将 β-catenin mRNA 3'UTR 荧光素酶过表达载体与 miR-145-5p mimics 共同转染小鼠视网膜组织，3 d 后取视网膜组织，应用荧光素酶报告基因技术检测和验证 miR-145-5p 与 β-catenin 的相关性。结果：视网膜转染 miR-145-5p mimics 后，小鼠眼轴长度降低，与对照组相比有显著性差异（P < 0.05），视网膜组织中 miR-145-5p 表达上升，β-catenin 在 mRNA 和蛋白水平表达均下降（P < 0.05）。视网膜转染 miR-145-5p 对照后，视网膜组织中 miR-145-5p 表达以及 β-catenin 的蛋白含量未见明显变化（P > 0.05）；荧光素酶报告基因结果显示转染 miR-145-5p 和 β-catenin mRNA 3'UTR 荧光素酶过表达载体后，视网膜组织中荧光活性显著降低（P < 0.001）。结论：miR-145-5p 能够下调视网膜 β-catenin 的表达，进而控制眼轴增长。

Objective: To investigate the effect of miR-145-5p on mouse axial length by regulating the expression of β-catenin.Methods: Eighteen 3-week-old C57BL/6 mice were divided to the control, miR-145-5p mimics and miR-145-5p control groups according to the random number table. Both eyes received intravitreal injection once every 3 days, for 3 injections in total （2nd, 5th and 8th days）. Patients in the control group received intravitreal injection of 3 μL citrate buffer, those in the miR-145-5p mimic group received intravitreal injection of 3 μL citrate buffer with 3 μg miR-145-5p mimics, and patients in the miR-145-5p control group received 3 μg miR-145-5p control. Axial length was measured by A-scan ultrasonography 3 days after the last intravitreal injection, then the expression of miR-145-5p and β-catenin in retinas was analyzed by RT-PCR or Western blot. After the over-expressed luciferase vector of β-catenin mRNA 3'UTR was constructed, the mRNA 3'UTR and miR-145-5p mimics were transfected to the retina of 6 male adult C57BL/6 mice. Luciferase reporter gene assay was used to verify the relationship between miR-145-5p and β-catenin in the retina. Results: After the transfection of miR-145-5p mimics in the retina, the expression of miR-145-5p in the retina was significantly up-regulated （P<0.05）, but the axial length and expression of β-catenin decreased significantly compared to those in the control group （both P<0.05）. There were no significant differences in the axial length, miR-145-5p and β-catenin expression after the transfection of miR-145-5p control. The results of luciferase reporter gene assay showed that the fluorescence activities in the retina were decreased significantly after the transfection of over-expressed luciferase vectors of β-catenin mRNA 3'UTR. Conclusion: miR-145-5p may regulate the axial length growth by inhibiting the Wnt/β-catenin pathway in the mouse retina.

内源性眼内炎发病率较低、早期临床表现缺乏特异性，初次诊断易误诊、漏诊，且起病急，发展快，预后差。本文报道的1例患者为女性，66岁，因无明显原因出现急性左侧腹痛，伴尿频尿急，无肉眼血尿，恶心呕吐胃内容物（量多），稀便起病，就诊于乡卫生院，转诊县级医院肾内科、泌尿外科，先后诊断为：1）休克原因待查（感染中毒性休克、低血容量性休克）；2）左侧输尿管结石、左肾结石并感染；3）急性肾功能不全；4）右眼眶蜂窝组织炎合并内源性眼内炎。后转至眼科，因错失最佳治疗时机，行右眼眼内容物剜除术。提示临床医师应加强对该病的认识，减少误诊、漏诊率，以改善患者预后。

The incidence of endogenous endophthalmitis is relatively low, and early clinical manifestations are not specific. It is easy to misdiagnose and miss the diagnosis, and it requires timely treatment due to rapid progression and poor prognosis. A 66-year-old female patient reported acute left abdominal pain with unknown causes, urinary urgency, no gross hematuria, nausea and vomiting and loose stool. She received ineffective treatment in local public health centre and then transferred to county hospital, successively was diagnosed as: 1） unknown causes of shock （septic shock, hypovolemic shock）; 2） left ureteral calculi left-kidney calculi co-infection; 3） acute renal failure; 4） right orbital cellulitis with endogenous endophthalmitis. Subsequently, she was transferred to the department of ophthalmology and underwent enucleation surgery of the right eye due to treatment delay. It is necessary for clinicians to deepen understanding, reduce the missed diagnosis rate and improve the prognosis of patients.

糖尿病视网膜病变（diabetic retinopathy，DR）是糖尿病中最常见的微血管严重并发症之一，是具有特异性改变的眼底病变。当 DR 发展到增殖性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）阶段，由纤维血管膜的收缩牵拉引起的玻璃体积血及视网膜脱离是导致 PDR 患者视力下降甚至失明的主要因素。纤维血管膜的形成与视网膜的纤维化作用密切相关，而结缔组织生长因子（connective tissue growth factor，CTGF）是与 DR 纤维化密切相关的一种细胞因子，可刺激成纤维细胞和血管内皮细胞的生长、黏附，促进细胞外基质的沉积，造成毛细血管基底层增厚，是视网膜纤维化程度的预测指标。CTGF 还可通过外源性调节和血管生长因子（vascular endothelial growth factor，VEGF）水平之间的平衡，有效延缓视网膜纤维化进程，但其具体机制尚不明确。

Diabetic retinopathy（DR）is one of the most serious complications of diabetic microangiopathy, which has many special fundus lesions. When it is the phase of proliferative diabetic retinopathy（PDR）, vitreous hemorrhage and the retinal detachment caused by the contraction of fibrovascular membrane become the main factors of visual decreasing and even blindness. Fibrovascular membrane formation was closely related with retinal fibrosis, and connective tissue growth factor（CTGF）is a cytokine closely related to the DR fibrosis. It can stimulate the growth and adhesion of fibroblast and vascular endothelial cell, the accumulation of extracellular matrix（ECM）, the proliferation, adhesion and migration of cell, then effectively relieve retinal fibrosis process, but its mechanism has not been yet completely clear.

目的：探讨改良的睑板腺囊肿手术的长期临床效果。方法：选择广东省中西医结合医院确诊睑板腺囊肿的手术 125 例患者（139 眼）实施改良的手术方式，观察术后并发症、术后 1 周治愈率及术后 6 个月内的复发率。结果：125 例（139 眼）患者均实施睑板腺囊肿切开及刮除术；其中 84 眼（60.4%）患者囊壁无增厚，囊腔内 0.5% 聚维酮碘棉片烧灼囊壁；55 眼（39.6%）患者囊壁增厚，联合部分囊壁剪除术。术后 14 例（10.1%）的患者发生皮下淤血，术后 1 周治愈率为 100%，术后 6 个月内复发率为 4.2%。复发的 5 例患者实施二次手术后治愈率为 100%，术后 6 个月再无复发。结论：实施改良的睑板腺囊肿手术，能一期有效治愈，且术后并发症较少，复发患者可行二期手术治疗，亦能达到临床治愈的效果。

Objective: To evaluate the long-term clinical efficacy of modified chalazion surgery. Methods: A total of 139 eyes from 125 patients with chalazion were included in this study. The postoperative complications, the cure rate at 1 week after operation and the recurrence rate within postoperative 6 months were observed. Results: The incision and curettage were performed in 125 cases (139 eyes); 84 eyes (60.4%) had no thickening of the cystic wall, which were cauterized with 0.5% povidone-iodine solution; 55 eyes (39.6%) had thickening of the cystic wall, and combined with partial excision of the cystic wall; 14 patients (10.1%) presented with subcutaneous congestion. At postoperative 1 week, the cure rate was 100%, and the recurrence rate was 4.2% within postoperative 6 months. Five recurrent patients underwent second chalazion surgery. The cure rate was 100% at postoperative 1 week, and no recurrence was observed within postoperative 6 months. Conclusion: The modified chalazion surgery is effective, and yields mild postoperative complications. The recurrent patients can be cure by the second surgery.

目前超过 90%的眼缺血综合征（ocular ischemic syndrome，OIS）由同侧颈动脉狭窄或闭塞引起，颅外段动脉狭窄的发生常代表着更严重的头颅动脉粥样硬化，导致远期缺血性脑卒中的发生。因此合理应用各种影像学方法检查OIS患者颈动脉系统尤为重要，可帮助眼科医师发现眼缺血症结所在，并以此为线索发现个体眼、颅乃至全身血管问题，实施积极对症处理并早期预防心脑血管危险事件的发生。

More than 90% of the ocular ischemic syndrome（OIS）are caused by ipsilateral carotid artery stenosis or occlusion. The occurrence of extracranial artery stenosis often represents more severe intracranial atherosclerosis, resulting in the occurrence of ischemic stroke. The examination of carotid artery system is important to help doctors find the origin of OIS, then to discover individual eyes, cranial and systemic vascular problems, and carry out active symptomatic treatment and early prevention of the cardiovascular risk events.