目的：探索基于眼外伤急诊救治胜任力的教学模式。方法：通过分析眼外伤急诊救治的教学现状，结合医学生岗位胜任力特征，构建基于眼外伤急诊救治胜任力的教学体系。结果：基于胜任力构建的眼外伤急诊救治教学体系的优势在于一切以临床实际需求为出发点，使学生在临床实践能力、思辨能力、团队合作、自我认知、医学人文素养等几个方面得到提升，从而更好地胜任临床工作。结论：基于胜任力的教学模式可以全面提高培训医师眼外伤急诊救治的实际能力。

Objective: To explore the teaching mode based on competency in emergency treatment of ocular trauma.Methods: By analyzing the teaching status of emergency treatment for ocular trauma and combining with the competency characteristics of medical students, a competency-based teaching system for emergency treatment of ocular trauma was constructed. Results: The advantage of the teaching system for emergency treatment of ocular trauma based on competency was that it took actual clinical needs as the starting point, which could improve students’ clinical practice ability, critical thinking ability, team work, self-cognition, medical humanistic quality and other aspects, so as to be better qualified for clinical work. Conclusion: The teaching mode based on competency can comprehensively improve the practical ability of training doctors in emergency treatment of ocular trauma.

目的：分析眼科护理对人工智能技术应用的内在需求，为眼科医院临床的人工智能技术开发及应用提供导向与依据。方法：采用整群抽样和单纯随机抽样相结合的方法，于2019年7月至2019年8月，对抽取的中山大学中山眼科中心，中山大学附属第一医院、珠海市人民医院、无锡人民医院、新疆维吾尔族自治区人民医院等目标医院其中的眼科护理人员进行问卷调查，内容包括一般资料及人工智能需求等。结果：调查对象绝大部分来自三级甲等医院(89.2%)，以华南地区为主(87.2%)，人工智能在眼科临床护理应用的需求多种多样，其中以健康教育、接诊与分诊、患者回访领域需求最强烈，分别占比95.7%、93.5%、93.2%。结论：人工智能在眼科临床护理应用有较强及多样化的需求，应结合实际需求为导向，重点推进人工智能在眼科患者健康教育等相关应用的研发。

Objective: To analyze the internal demands of the application of artificial intelligence technology to ophthalmic care, and provide guidance and basis for the development and application of artificial intelligence technology in ophthalmic hospitals. Methods: Using the method of combining cluster sampling with simple random sampling, a questionnaire survey was conducted on the ophthalmic nursing staff in the selected target hospitals from July to August 2019, which included general information and artificial intelligence needs. Results: Most of the respondents came from the third-class hospitals (89.2%), and hospitals in South China account for 87.2% of them. There are diverse demands of artificial intelligence in ophthalmology clinical nursing applications, including health education, clinical reception and triage, patients return visits, which have the strongest demand for the artificial intelligence, accounting for 95.7%, 93.5%, and 93.2%, respectively. Conclusion: The application of artificial intelligence in ophthalmic clinical nursing has strong and diversified demands, and the research and development of artificial intelligence in the health education of ophthalmic patients and other related applications should be promoted according to the actual demands.

报告1例因电路短路产生电弧光烧伤患者双眼角膜的病例。专科检查:双眼角膜缘颞侧球结膜缺血区小于1/3，角膜上皮呈白色混浊，上皮部分脱落。入院给予清除角膜表面白色坏死组织、抗炎、扩瞳对症治疗，2周后角膜恢复透明，随访3个月患者晶状体及眼底未见明显异常；探讨电弧光在眼球不同部位的致病机制。

A case of corneal burn caused by arc light due to electrical short is reported. Specialist examination: ischemic areas of the temporal limbus bulbar conjunctiva in both eyes were less than 1/3, the corneal epithelium was white and cloudy, and the epithelium was partially peeled. The corneas became transparent after 2 weeks’ treatment of removing the white necrotic tissue, anti-inflammatory and dilating pupil. During the follow-up within 3 months, the patient’s lens and fundus showed no obvious abnormalities. The injury mechanism of arc light caused by electrical short to the eyeball is discussed.

目的：调查引导式教育训练对视力障碍学生生活质量的影响。方法：前瞻性随机对照临床研究。选取2020年在泉州特殊教育学校就读视力障碍学生，按照入组条件随机分为引导式教育训练组和对照组，引导式教育训练组进行引导式教育训练，对照组进行常规康复训练。采用中文版低视力者生活质量量表(Chinese-version low vision quality of life questionnaire，CLVQOL)评估视力障碍学生的基线和训练3个月的生活质量，并进行比较分析。结果：72例视力障碍学生全部完成了基线和随访时的生活质量问卷调查。进行基线检查时，各组CLVQOL评分总分差异无统计学意义(P>0.05)。3个月后，各组CLVQOL评分总分均增加，引导式教育训练组从基线59(48.5，80.5)上升到105(97.5，119.5)，差异有统计学意义(Z=?4.781，P<0.001)；对照组从基线69(56，85)上升到106(80，112)，差异有统计学意义(Z=?4.438，P<0.001)；引导式教育训练组在CLVQOL评分总分(P=0.021)及阅读和精细工作维度(P=0.004)、日常生活能力维度(P=0.003)的评分差值均高于对照组。结论：引导式教育训练是一种重要的低视力康复训练方法，可以明显提高患者的生活质量。

Objective: To investigate the effect of conductive education training on the quality of life in visually impaired students. Methods: It was a prospective randomized controlled trial. The visual impairment students who had registered in Quanzhou Special Education School in 2020 were selected and randomly divided into two groups: conductive education training group and control group. The conductive education training group received conductive education training, while the control group received routine rehabilitation training. Chinese version low vision quality of life questionnaire (CLVQOL) was used to assess the quality of life of low vision students at baseline and 3 months after training, and comparative analysis was conducted. Results: All 72 students with visual impairment completed CLVQOL surveys. At baseline, there was no significant difference in total CLVQOL scores between groups. After 3 months, overall CLVQOL scores increased in both groups, from baseline 59 (48.5, 80.5) to 105 (97.5, 119.5) in the conductive education group (Z=-4.781, P<0.001), and 69 (56, 85) to 106 (80, 112) in the control group (Z=-4.438, P<0.001). The total score of CLVQOL (P=0.021), reading and fine work subscale (P=0.004), and daily activities subscale (P<0.003) in the conductive education training group were higher than those in the control group. Conclusion: Conductive education training is an important method of low vision rehabilitation training, which can significantly improve the quality of life of patients.

患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。

The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.

局部点药是眼部用药最常见的方式，但一般药物通过角膜困难，药物生物利用度低。纳米载体药物于8 0年代开始用于眼部，脂质体和类脂质囊泡(niosomes)与眼表的黏蛋白相互作用，延长药物在眼表的停留时间。纳米乳剂(nanoemulsion)的表面活性剂可以松解角膜上皮细胞紧密连接，形成转运开口，抑制细胞表面糖蛋白酶P(glycoprotein P，Pgp)降解药物活性蛋白。纳米粒子(nanoparticles)通过角膜上皮和结膜上皮而不会引起毒性。纳米胶囊(nanocapsules)更深地内化到角膜上皮(50 μm处)。聚合物胶束(polymeric micelles)自组装成核-壳纳米载体增强药物渗透角膜的能力。阴离子高代聚酰氨基胺(poly-amidoamine，PAMAM)树枝状大分子增强药物通透性，中性和阳离子低代树枝状大分子通过网格蛋白途径介导药物更高的通透性。纳米晶体(nanocrystal)，除增强药物溶解度和溶解速率之外，它的高黏附能力帮助药物保留和渗透到眼组织中。纳米结构材料与干眼关联密切，为干眼的治疗、诊断提供手段。

Topical administration is the most common method of ocular medication, but it is generally difficult for the drug to pass through the cornea, and the bioavailability of the drug is low. Nanocarrier drugs were used in eyes in the 1980s, and liposomes and lipoids vesicles (Niosomes) interacted with ocular surface mucins to prolong  the residence time of the drug on the ocular surface. Nanoemulsion surfactants can release the tight junctions of corneal epithelial cells, form transport openings, and inhibit the degradation of pharmaceutically active proteins by cell surface glycoprotein P (Pgp). Nanoparticles pass through the corneal and conjunctival epithelium without causing toxicity. Nanocapsules internalize deeper into the corneal epithelium (at 50 μm). Polymeric micelles self-assemble into core-shell nanocarriers to enhance the ability of drugs to penetrate the cornea. Anionic high-generation poly-amidoamine (PAMAM) dendrimers enhance drug permeability. Neutral and cationic low-generation dendrimers mediate higher drug permeability through clathrin pathway. Nanocrystal, in addition to enhancing drug solubility and dissolution rate, its high adhesion ability helps drug retention and penetration into ocular tissues. Nanostructured materials are closely related to dry eye and provide a choice for the treatment and diagnosis of dry eye.

目的：探究特发性黄斑前膜(idiopathic macular epiretinal membrane，IMEM)患者在光学相干断层扫描(optical coherence tomography，OCT)的形态学改变与视力的相关性。方法：回顾性研究。基于OCT图像4级分级方案，纳入3级及以下的特发性黄斑前膜患者35例共37只眼进行OCT扫描，并借助第三方软件分析并获取每只眼在黄斑中心凹直径分别为1、3、6 mm共3个同心圆区域内视网膜各层的平均厚度值，并按照是否存在内核层(inner nuclear layer，INL)囊样改变分为两组。通过建立最小分辨角对数(minimum resolution angle in logarithmic，logMAR)最佳矫正视力(best corrected vision acuity，BCVA)与视网膜各层厚度值的多元线性回归方程，以及比较有INL囊样改变及无INL囊样改变两组的视力，分析视力与视网膜各层厚度值及INL囊样改变的关系。结果：多元线性回归分析显示，在直径1 mm的区域内，logMAR BCVA与神经纤维层(retina nerve fiber layer，RNFL)、INL的厚度值均呈正相关(均P<0.05)，而在直径3 mm和6 mm的区域内，logMAR BCVA仅与INL的厚度值呈正相关(均P<0.05)。与无INL囊样改变组相比，有INL囊样改变组视力及INL厚度差异均有统计学意义(均P<0.05)。结论：特发性黄斑前膜患者当前的视力主要与RNFL和INL厚度值相关。发生在INL层的囊样改变可能很好的提示INL增厚，其与视力具有相关性，具有这种囊样改变的患者往往视力也较差。

Objective: To investigate the morphological changes detected by spectral domain optical coherence tomography (OCT) and their relevance to vision in patients with idiopathic macular epiretinal membranes (IMEM). Methods: This is a retrospective study. OCT recorded 37 eyes with stage 3 and below IMEM according to the 4-level grading system based on OCT images among 35 patients. We managed to obtain thickness of all retina layers in three concentric circular regions with a diameter of 1 mm, 3 mm and 6 mm across macular fovea with the help of a third-party software. Plus we divided all 37 eyes into two groups according to whether there were cystic changes in the inner nuclear layer (INL). Multiple linear regression analyses were performed between thickness of all retina layers and current minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The difference of BCVA between groups with cystic changes and without was also compared. Thus, the relationships between visual acuity and thickness of retina layers, cystic changes in INL were analyzed. Results: Multiple linear regression analyses revealed that thickness of both retina nerve fiber layer (RNFL) and inner nuclear layer have positive correlation with logMAR BCVA in the region with a diameter of 1 mm (P<0.05), while in regions of a diameter of 3 mm and 6 mm, only INL thickness remained positively relevant (all P<0.05). There were significant differences in BCVA and thickness of INL between groups with INL cystic changes and without (all P<0.05). Conclusion: Current visual acuity among preoperative IMEM patients was mostly associated with thickness of RNFL and INL. Cystic change in INL layer may be a good indicator of INL thickening and was visually correlated. Those with this change tend to have worse vision.

本文报告1例2 8岁男性青年患者，行飞秒制瓣准分子激光原位角膜磨镶术(laser-assisted situ keratomileusis，LASIK)术 后1个月视力进行性下降，小瞳下行电脑验光矫正视力，右眼为0.3(-0.25×86°)，左眼为0.2(-0.50×91°)。眼前节及眼底检查未见器质性病变，视觉电生理检查未见异常。视光专科检查示负相对调节/正相对调节(negative correlatione regulation/positive ccorrelation regulation，NRA/PRA)：+2.00 D/?10.00 D(行PRA时稍作停顿后又可看清)，Flipper拍检查：右眼(oculus dexter，OD) 10 cpm(+)，左眼(oculus sinister，OS) 22 cpm(+)，双眼(binocular，OU)12 cpm(+)，正镜片逐渐通过困难。隐斜检查：2△BO@D，13△BI@N。调节性集合与调节的比值(accommodation convergence/accommodation，AC/A)=1。患者PRA显著增高，Flipper检查正片通过困难，看近时外隐斜大于看远，提示可能存在“集合不足，调节超前”。给予托比卡胺滴眼液滴眼3次后验光：OD +1.00/-0.50×80°=1.0，OS +0.75/-0.25×65°=1.0，进一步证实了“调节痉挛”的诊断。给予托比卡胺滴眼液滴双眼，睡前1次，结合调节放松训练。4周后，裸眼视力及屈光度稳定在正常范围。临床上对于视力下降原因不明、排除眼部器质性疾病的患者，经过仔细询问病史、睫状肌麻痹检影和视功能检查“调节痉挛”不难诊断。除传统的睫状肌麻痹剂和近附加镜外，治疗方案建议加用视功能训练可使视力恢复并稳定。

A 28-year-old man was referred to our hospital because of blurred vision in both eyes after LASIK flap made by femtosecond laser surgery for 1 month. The best corrected visual acuity based on computerized optometry was 0.3 (-0.25×86°) in the right eye and 0.2 (-0.50×91°) in the left eye. Routine examinations were conducted to exclude eye diseases. Visual electrophysiological examination showed no abnormalities. Optometry specialty examination: negative relative accommodation (NRA) and positive relative accommodation (PRA) were +2.00 D/?10.00 D (when doing PRA, the patient could see clear slowly after a pause). Flipper examination showed: OD 10 cpm(+), OS 22 cpm(+), OU 12 cpm(+). Phoria-measurement showed 2 prism degree BO@D and 13 prism degree BI@N. AC/A=1. The patient’s high PRA, flipper examination results and convergence insufficiency at near distance indicated the possibility of “convergence insufficiency and accommodative spasm”. Cycloplegic refraction was planned to assess the real diopter. After instillation of cycloplegic drops, the UCVA improved to 1.0 and the refractive error to -0.25×93 in the right eye, in the left eye to 1.0 and the refractive error to -0.25×75. the BCVA was 1.0 (+1.00/-0.50×80°) in the right eye and 1.0 (+0.75/-0.25×65°) in the left eye. A diagnosis of accommodative spasm was made. The patient was counseled and continued cycloplegic drops one time daily before bedtime, participated in vision training for 4 weeks. This patient was a rare occurrence of accommodative spasm after FSLASIK surgery. Young patients with poor gain in UCVA can be subjected to a corrective procedure accidentally. Relaxation exercises and cycloplegic drops may cure accommodative spasm. For patients with unexplained causes of vision loss and excluded organic diseases of the eye, it is not difficult to diagnose “accommodative spasm” by careful medical history inquiry, ciliary muscle paralysis optometry and visual function examination. In addition to traditional ciliary palsy agent and reading glasses, it is suggested that visual function training can restore and stabilize the treatment effect.

近视是危害儿童青少年视力最常见的眼部疾病，高度近视对视功能造成极大的威胁。近年来，我国近视发病率逐年升高，对近视筛查与防控的需求也不断增加，随着人工智能理论与技术的不断发展与成熟，可以辅助眼科医生进行近视筛查、诊断与治疗。本文将简要介绍人工智能在近视的筛查、预测、检测、病理性近视以及角膜屈光手术中的应用，浅谈了目前人工智能在研究中存在的可比度较低、影像要求较高、可解释性较低及隐私保护等问题，并展望人工智能在近视相关领域的应用前景。

Myopia is the most common ocular disease that harms the vision of children and adolescents. High myopia poses a great threat to visual function. The incidence of myopia in China has been increasing in recent years, and the demand for myopia screening, prevention and control has also expanded. With the continuous development of artificial intelligence theory and technology, Artificial intelligence can assist ophthalmologists in myopia screening, diagnosis and treatment. This review will briefly introduce artificial intelligence in the screening, prediction, and detection of myopia; also, the application in pathological myopia and corneal refractive surgery. This review will discuss some problems of current artificial intelligence research, such as low comparability, high image requirements, low interpretability, privacy protection, and the application prospects of artificial intelligence in myopia.