光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)是一种非接触、无创的、快速的血管造影技术，它通过检测红细胞在血管内的光学相干断层扫描(optical coherence tomography，OCT)信号的变化来提供血管影像。由于这项技术不需要注射血管造影剂，使得它比传统的眼科血管造影技术更安全。在前节疾病的检查中，OCTA不仅能够量化前节血管的范围和密度，还显示出良好的成像质量，为临床监测疾病的病程和对治疗的反应提供客观的评价。
Optical coherence tomography angiography (OCTA) is a noncontact, noninvasive, and rapid angiography technique. It provides vascular images by detecting changes in the optical coherence tomography (OCT) signal of red blood cells in the blood vessel. Since this technique does not require injection of angiography, it is safer than traditional ophthalmic angiography. In the examination of anterior segment diseases, OCTA can not only quantify the range and density of anterior segment blood vessels, but also shows good imaging quality, providing an objective evaluation for clinical monitoring of the disease course and response to treatment.
CRISPR(clustered regularly interspaced short palindromic repeats)基因编辑技术通过精准改变细胞DNA序列，控制细胞命运及表型，是有望从根本上改变疾病治疗的新技术。由于眼球独特的生理构造，基因编辑疗法在治疗眼科疾病方面的应用具有明显的优势。目前，CRISPR基因编辑疗法治疗10型Leber先天性黑矇(Leber congenital amaurosis 10，LCA10)的临床试验已经展开，治疗其他多种眼科疾病的临床试验也即将开始。随着新一代CRISPR基因编辑技术的发展，基因编辑疗法有望为眼科疾病的治疗提供新的手段。
Clustered regularly interspaced short palindromic repeats (CRISPR) genome editing is a newly developed technology to precisely modify cellular DNA sequence, which could control cell fate and phenotype and fundamentally reform disease treatment. The structure of the eye offers unique advantages as a genome editing target. Recently, a CRISPR genome editing therapy has begun to be tested in Leber congenital amaurosis 10 (LCA10) patients, and the clinical trials for more ocular diseases are about to start. The development of CRISPR/Cas genome editing tools will drive major advances in the application of gene therapies in the treatment of ophthalmic disease.
目的：了解玻璃体切除硅油填充术后患者(face-down positioning，FDP)依从性的相关影响因素。方法：采用随机抽样研究的方法，选取2018年1月至2019年12月于无锡市人民医院眼科行玻璃体切除硅油填充术后的患者100例，采用问卷调查对一般资料、FDP可能发生的反应和依从性进行调查。采用SPSS 19.0进行统计分析。结果：患者性别、对疾病的重视程度与FDP的依从性有显著差异(P<0.05)，但家庭支持系统与FDP的依从性差异无统计学意义(P>0.05)。患者术后第1天对FDP依从性的主要影响因素依次为呼吸不畅(84%)、睡眠不佳(78%)、肩颈部不适(10%)；术后第3天的主要影响因素依次为呼吸不畅(66%)、腰酸背痛(50%)、睡眠不佳(39%)；术后第5天的主要影响因素依次为肢体麻木(70%)、腰酸背痛(87%)、睡眠不佳(30%)、肩颈部不适(18%)以及肘关节疼痛(10%)。结论：影响患者依从性的主要因素主要有性别、对疾病的自我重视程度以及FDP引起的不适症状。需加强对高危因素的识别，不同病情时段给予征对性的宣教和指导，以提高患者对FDP的依从性。
Objective: To investigate the influencing factors of compliance of patients with silicone oil tamponade after vitrectomy. Methods: A total of 100 patients with silicone oil tamponade after vitrectomy in Wuxi People’s Hospital of Jiangsu Province from January 2018 to December 2019 were selected by random sampling method.The general information, possible reaction, and compliance of face-down positioning (FDP) were investigated by questionnaire. SPSS 19.0 was used for statistical analysis. Results: There were significant differences in patients’gender, attention to disease and FDP compliance (P<0.05), but there was no significant difference between family support system and FDP (P>0.05). The main influencing factors of FDP compliance were dyspnea (84%), poor sleep (78%), the discomfort of shoulder and neck (10%); on the third day after operation, the main influencing factors were dyspnea (66%), low back pain (50%) and poor sleep (39%); on the fifth day, the main influencing factors were numbness of the limbs (70%), low back pain (87%) and poor sleep (30%), the discomfort of shoulder and neck (18%) and elbow pain (10%). Conclusion: The main factors that affect the compliance of patients are gender, self-awareness of the disease and discomfort caused by FDP. It is necessary to strengthen the identification of high-risk factors, and give symptomatic education and guidance at different stages of illness, to improve the compliance of patients to FDP.
目的：探讨赋能教育模式在干眼患者健康教育中的应用价值。方法：选取2017年6月至12月期间首诊于南方医科大学珠江医院眼科的干眼患者，按照完全随机分配法分为试验组(n=73)及对照组(n=73)，试验组采用赋能教育模式，对照组采用传统健康教育方式。经治疗1周、1个月、2个月及6个月后，分别随访并记录每组患者的眼表疾病指数(ocular surface disease index，OSDI)、泪膜破裂时间值(tear film break up time，BUT)，同时记录患者家庭护理(清洁睑缘、热敷、睑板腺按摩)频率以及复诊频率。结果：赋能教育组家庭护理频率及复诊频率均优于传统教育组(P<0.05)。治疗前两组OSDI和BUT差异均无统计学意义(P>0.05)，但试验组OSDI随时间的推移呈下降趋势，BUT值呈上升趋势；而对照组OSDI以及BUT值的变化均不明显。结论：运用赋能教育模式有助于提高干眼患者治疗的依从性，提高患者的家庭护理频率和复诊频率，显著改善患者的眼表情况，进而提高长期治疗效果。
Objective: To evaluate the application value of empowerment education mode in health education for patients with dry eye syndrome. Methods: Patients with dry eye syndrome were recruited from Department of Ophthalmology, Zhujiang Hospital, Southern Medical University from June 2017 to December 2017. All patients were randomly divided into the experimental group (n=73), educated with empowerment education mode, and control group (n=73), treated with traditional health education. Patients were followed up after 1 week, 1 month,2 months and 6 months, respectively. Data were collected in each follow-up visit including ocular surface disease index (OSDI), tear film break up time (BUT), the frequency of home care (cleaning eyelid margin, hot compress,palpebral gland massage) and re-visit frequency. Results: The OSDI and BUT were similar between two groups before corresponding treatment (P>0.05). After the treatment, patients in the experimental group showed a downtrend in the OSDI and uptrend in the BUT. No significant changes were found in the control group during the follow-up. The frequency of family nursing and re-visit in the experimental group was statistically higher than that in the control group. Conclusion: The application of empowering education mode can improve the compliance of dry eye patients, improve the frequency of home care and follow-up visit, and mitigate the ocular surface of patients, thereby enhancing the long-term efficacy.
目的：比较四种不同原理的仪器在暗室中对年龄相关性白内障患者Kappa角测量的一致性。方法：对年龄相关性白内障术前60例(60只眼)，暗室中适应10 min后，分别应用iTrace视觉分析仪、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径和Kappa角。四种仪器间所测量的数据比较采用单因素方差分析检验和Kruskal-Wallis非参数检验，一致性比较采用Bland-Altman分析。结果：iTrace、Pentacam HR、Lenstar900、IOLMaster700测量瞳孔直径分别为(4.64±0.71) mm，(2.96±0.47) mm，(4.86±0.76) mm，(4.66±0.92) mm；Kappa角大小分别为(0.227±0.121) mm，(0.161±0.09) mm，(0.2±0.124) mm，(0.203±0.104) mm；大于0.5 mm的Kappa角比例分比为3.33%、3.33%、1.67%、1.67%；Pentacam和iTrace的Kappa角测量结果有统计学意义(P=0.001)，Pentacam和Lenstar900、IOLMaster700的Kappa角测量结果差异无统计学意义(P=0.044，0.036)，其他三种仪器之间Kappa角测量结果差异均无统计学意义(P=0.181，0.245，0.860)； 60例被检测者对iTrace、PentacamHR、Lenstar900、IOLMaster700四种仪器测量过程中光强度主观评分结果显示60例(100%)被检测者认为Pentacam HR在测量过程中有明显的不适感，40例(66.67%)被检测者认为IOLMaster700检测过程中舒适感最好，结果差异有统计学意义(χ2=191.236，P<0.001)。结论：Pentacam HR与iTrace、Lenstar900和IOLMaster700三种仪器在暗室中Kappa角的测量结果一致性稍差，临床上需谨慎替换使用。
Objective: To compare the consistency of Kappa Angle measurements in patients with age-related cataracts using four instruments of different principles in a dark room. Methods: Sixty cases (60 eyes) of age-related cataract were adapted in the darkroom for 10 minutes. The pupil size and angle Kappa were measured by iTrace, Pentacam HR, Lenstar900 and IOLMaster700. One-way ANOVA test and Kruskal-Wallis nonparametric test were used to compare the measured data among the four instruments, and Bland-Altman analysis was used for consistency comparison. Results: The measured pupil diameters of iTrace, Pentacam HR, Lenstar900 and IOLmaster700 were 4.64±0.71 mm, 2.96±0.47 mm, 4.86±0.76 mm and 4.66±0.92 mm. The Angle Kappa sizes were 0.227±0.121 mm, 0.161± 0.09 mm, 0.2±0.124 mm, 0.203±0.104 mm. The proportion of angle Kappa larger than 0.5 mm was 3.33%, 3.33%, 1.67% and 1.67%. The measurement results of angle Kappa between Pentacam and iTrace were statistically significant (P=0.001). There was no significant difference in the measurement results of angle Kappa between Pentacam and Lenstar900, Pentacam HR and IOL-Master700 (P=0.044, 0.036). There was no significant difference in the results of angle Kappa measurement among the other three instruments. The subjective score of light intensity in the process of measurement of iTrace, Pentacam HR, Lenstar900 and IOLMaster700 showed that during the process of measurement, 60 cases (100%) experienced obvious discomfort caused by the light intensity in Pentacam HR, while 40 cases (66.67%) felt comfort in IOLMaster700. The differences among the subjective score of light intensity of four instruments were statistically significant (P<0.001). Conclusion: The consistency of the measurement results of Kappa angle between Pentacam HR and iTrace, Lenstar900, IOLMaster700 in the darkroom is relatively poor, so it is necessary to be careful to replace them in clinic.
目的：分析湖南地区汉族人群中2型糖尿病患者的人口学特征及生化指标，寻找糖尿病视网膜病变的高危因素。方法：釆用病例对照研究，统计湖南地区正常人群、2型糖尿病但无视网膜病变患者、2型糖尿病视网膜病变患者的人口学特征及生化指标的相关数据，进行成组t检验及logistic回归分析，探讨分析糖尿病视网膜病发生的易感因素。所有研究对象均为汉族。结果：对照组[非糖尿病(non-diabetes mellitus，NDM)组]和2型糖尿病未合并视网膜病变[(non-diabetic retinopathy，NDR)]组之间性别分布、年龄分布、BMI、舒张压、HbA1c、总胆固醇、高密度脂蛋白(high-density lipoprotein，HDL)、尿酸及总胆红素差异无统计学意义(均P>0.05)。NDM组中腹围、收缩压、空腹血糖、三酰甘油、肌酐和低密度脂蛋白(low-density lipoprotein，LDL)值均低于NDR组，差异有统计学意义(均P<0.05)。NDM组中BMI、腹围、收缩压、舒张压、空腹血糖、HbA1c、总胆固醇、三酰甘油、肌酐和LDL值均低于2型糖尿病合并视网膜病变组(diabetic retinopathy，DR)组，差异有统计学意义(均P<0.05)。NDR组收缩压、舒张压、HbA1c、总胆固醇、三酰甘油和肌酐值均低于DR组，差异有统计学意义(均P<0.05)。结论：收缩压超过150 mmHg，舒张压超过90mmHg，糖化血红蛋白超过9%，血清肌酐超过100 μmol/L，三酰甘油超过3 mmol/L均为糖尿病患者发生视网膜病变的高危易感因素。
Objective: To analyze the demographic characteristics and biochemical indexes of type 2 diabetic patients in Han population in Hunan, and to find the high-risk factors of diabetic retinopathy. Methods: The data of demographic characteristics and biochemical indexes of normal population, type 2 diabetic patients but without retinopathy and type 2 diabetic retinopathy in Hunan were analyzed. Group t test and logistic regression analysis were used to analyze the susceptibility factors of diabetic retinopathy. All the subjects were Han population. Results: There were no significant differences in gender distribution, age distribution, BMI, diastolic blood pressure, HbA1c,total cholesterol, high-density lipoprotein, uric acid and total bilirubin between the control group [non-diabetes mellitus (NDM) group] and the type 2 diabetic without retinopathy group [non-diabetic retinopathy (NDR)group] (all P>0.05). The abdominal circumference, systolic blood pressure, fasting blood glucose, triglyceride,creatinine and low-density lipoprotein in NDM group were all lower than those in NDR group, and the differences were statistically significant (all P<0.05). BMI, abdominal circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, total cholesterol, triglyceride, creatinine and LDL in NDM group were all lower than those in type 2 diabetic retinopathy (DR) group, and the differences were statistically significant (all P<0.05). The comparison between the NDR group and the DR group showed that the values of systolic blood pressure,diastolic blood pressure, HbA1c, total cholesterol, triglyceride and creatinine in the NDR group were all lower than those in the DR group, and the differences were statistically significant (all P<0.05). Conclusion: SBP ≥150 mmHg,DBP ≥90 mmHg, HbA1c ≥9%, serum creatinine ≥100 μmol/L, triglyceride ≥3 mmol/L are the high-risk factors of diabetic retinopathy.
目的：探究球面塑形镜、环曲面塑形镜在矫治近视复合散光的有效性及安全性。方法：回顾分析宜昌市第一人民医院2016年3月至2018年3月角膜塑形镜治疗青少年近视94例(178眼)，按佩戴塑形镜类型分为球面塑形镜组(48例，90眼)与环曲面塑形镜组(46例，88眼)。记录配镜前、佩戴1年后、停戴1周后的视力、角膜散光、眼轴长、球镜屈光度、眼压、泪膜破裂时间及角膜着染率。结果：戴镜1年后，2组组内相比，散光、球镜度数、眼压、泪膜破裂时间均降低，但2组组间相比，仅散光度数差异有统计学意义(P<0.01)。戴镜1年后，两组视力较戴镜前显著提高，停戴后近视度数较佩戴前增加，但组间差异无统计学意义(P>0.05)；2种塑形镜角膜着染发生率差异无统计学意义(P>0.05)。结论：2种塑形镜均能够降低近视复合散光患者度数，有效提高患者视力，但并不能完全阻止近视的进展。虽然环曲面塑形镜在矫正散光方面有优势，但总有效性与安全性并不占优势。
Objective: To observe the effectiveness and safety of orthokeratology lens and toric design othokeratology treatment for compound myopic astigmatism. Methods: From March 2016 to March 2018, 94 teenagers(178 eyes) were selected as the subjects of study. They were divided into two groups according to the type of orthokeratology: the orthokeratology lens group (48 cases, 90 eyes) and the toric design othokeratology group(46 cases, 88 eyes). Visual acuity, corneal astigmatism, axial length, spherical lens refraction, intraocular pressure,tear film rupture time and corneal staining rate were recorded before, after 1 year and after 1 week. Results: After 1 year of wearing the lens, astigmatism, spherical lens degree, intraocular pressure and tear film rupture time were all decreased in the 2 groups compared with each other, but only astigmatism degree was statistically significant between the 2 groups compared with each other (P<0.01). After wearing the glasses for 1 year, the visual acuity of the two groups was significantly improved compared with that before wearing the glasses, and the myopia degree was increased after stopping wearing the glasses compared with that before wearing the glasses, but the difference between the two groups was not statistically significant (P>0.05). There was no statistical significance in the incidence of corneal staining between the two types of shaping lenses (P>0.05). Conclusion: Both of the two shaping lenses can reduce the degree of myopic patients with complex astigmatism and effectively improve the visual acuity of patients, but they can not completely prevent the progress of myopia. Although toroidal shaping mirror has advantages in correcting astigmatism, its overall effectiveness and safety are not.
目的：评估硅油填充术后眼压对角膜内皮细胞的影响及变化特点。方法：选取2019年1月1日至9月30日在佛山市第二人民医院眼科中心行玻璃体切除联合硅油注射的患者共131名，分为高眼压组(n=80)和正常眼压组(n=51)。高眼压组术后任意一次测眼压>21 mmHg，正常眼压组术后眼压均≤21 mmHg。比较填充硅油前与取硅油时的角膜内皮细胞参数测量值。结果：高眼压组的平均眼压为20.79 mmHg，正常眼压组的平均眼压为14.70 mmHg(P<0.001)。取硅油时，两组角膜内皮细胞密度(corneal endothelial cell density，ECD)均明显减少，平均内皮细胞面积均明显增大(P<0.05)，高眼压组内皮细胞大小变异系数(coefficient of variation of endothelial cell size，CV)明显变大(P<0.05)。高眼压组ECD丢失率(6.3%)高于正常眼压组(3.5%)；其中，高眼压组中术后1~6周内的眼压升高(7.1%)、眼压≥40 mmHg(7.3%)对角膜内皮细胞影响最大。ECD丢失与眼压变化有显著相关性(r=0.176，P=0.044)。结论：硅油填充后高眼压是角膜内皮细胞丢失的重要危险因素。
Objective: To evaluate the effect of intraocular pressure (IOP) on corneal endothelial cells after silicone oil tamponade. Methods: Patients (n=131) received vitrectomy with silicone oil injection in Ophthalmology Center in Second People’s Hospital of Foshan City from January 1st to September 30th 2019 were divided into the high IOP group (n=80) and normal IOP group (n=51). IOP was >21 mmHg at any time in the high IOP group and was ≤21mmHg in the normal IOP group after surgery. The values of corneal endothelial cells before filling with silicone oil and before removing silicone oil were compared.Results: The average IOP was 20.79 mmHg in the high IOP group, and 14.70 mmHg in the normal IOP group (P<0.001). The number of endothelial cells (ECD) was reduced, but the average endothelial cell area was increased (P<0.05) in both groups. The coefficient of variation of endothelial cell size in high IOP group was increased (P<0.05). ECD loss rate was 6.3% in the high IOP group and 3.5% in normal IOP group. Increased IOP within 1–6 weeks after surgery (7.1%) and IOP ≥40 mmHg (7.3%) had the greatest impact on ECD. ECD loss was correlated with IOP (r=0.176, P=0.044). Conclusion: High intraocular pressure after silicone oil filling is an important risk factor for the loss of corneal endothelial cells.Keywords intraocular pressure; corneal endothelium; silicone oil; vitrect
睫状体髓上皮瘤是一种源自神经上皮层的恶性肿瘤，易因其伪装特性而被漏诊和误诊。本文报道了1例3岁9个月的男性患儿，眼部表现似晶状体破裂，经部分肿物切除活检，病理诊断为睫状体恶性髓上皮瘤。
Medulloepithelioma of the ciliary body is a kind of malignant tumor which arises from neuroepithelium. It is easily misdiagnosed or miss diagnosed due to its masquerade feature in the clinical practice. We report a boy with a tumor in his right eye at age of 3 years and 9 months presented first with lens rupture. Diagnosis of malignant medulloepithelioma of ciliary body was made pathologically by biopsy of the partial tumor.
光学相干断层扫描血管成像术(optical coherence tomography angiography，OCTA)作为一项新兴的检查手段，现已被广泛应用于眼科临床及科研工作中。鉴于OCTA在血管成像方面的独特优势，近年来关于其在眼前段的临床应用和研究也愈发得到关注。关于OCTA对结膜、巩膜、角膜以及虹膜的血管和相关眼表疾病的研究日益增多，其在眼前段应用潜力巨大。
As a new examination method, optical coherence tomography angiography (OCTA) has been increasingly used in ophthalmology clinical work and scientific research. In view of the unique advantages of OCTA in angiography,the clinical application and research of OCTA in the anterior segment have attracted more and more attention in recent years. Studies of OCTA in vessels of conjunctiva, sclera, cornea, iris, and related ocular surface diseases have shown great potential for its application in the anterior segment.
