随着白内障手术由复明性向屈光性转变，对角膜的散光矫正显得越来越重要。而角膜散光不仅仅应该关注角膜前表面的散光数据，更应该考虑角膜后表面的散光，否则对散光人工晶状体植入矫正角膜散光可能出现不同程度的术后屈光误差。角膜后表面散光均值约为0.37 D，且多数情况下会产生逆规散光的效果，因此在进行散光型人工晶状体计算时应考虑到这一特点，进一步防止术后欠矫或过矫的发生。
With the cataract surgery evolving from visual restoration surgery to refractive surgery, surgical correction of corneal astigmatism becomes more and more important. For Toric intraocular lens implantation, the surgeon should not only pay attention to the values in surface of anterior corneal astigmatism but also that in posterior corneal astigmatism. Otherwise,unwanted postoperative refractive errors may occur. The mean value of posterior corneal astigmatism was around 0.37 D.In most cases, the posterior corneal astigmatism produces against-the-rule effect. Therefore, the above-mentioned feature of posterior corneal astigmatism should be noticed to prevent the under-correction or over-correction effect of toric lens.
目前对于成人圆锥角膜(keratoconus，KC)的研究已经很广泛，而对于儿童KC的研究则较少，其诊断和治疗常常基于成人KC的研究基础。与成人KC相比，儿童KC的发展更迅速、造成的后果更严重，其导致的儿童视觉障碍会追随其一生，对其生活质量以及教育发展产生严重的负面影响。为了对儿童KC的治疗有较全面的认识和理解，本文针对近几年儿童KC的治疗进展，对不同治疗方法的安全性、有效性和治疗时机等方面进行综述。
At present, the research on adult keratoconus has been extensive, while the research on pediatric keratoconus is few. The diagnosis and treatment of pediatric keratoconus are often based on the study of keratoconus in adults. Pediatric keratoconus is more aggressive than adult keratoconus, resulting in visual impairment that can follow throughout their lives and have a serious negative impact on their quality of life and educational development. In this paper, according to the treatment progress of pediatric keratoconus in recent years, the safety, effectiveness, and treatment timing of different treatment methods were summarized, in order to have a more comprehensive understanding of the treatment of pediatric keratoconus.
青光眼是世界范围内致盲和引起视力损害的主要眼病，也是不可逆性致盲性眼病之一。眼压是青光眼发生发展的重要危险因素，但除眼压外，血压在青光眼进展引起的影响也不可忽视。眼灌注压是血压和眼压的差值，可调节视神经的血液供应。眼压、血压、灌注压在青光眼发生发展中有一定相关性。本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血压监测在青光眼中的应用进行文献索引，分析青光眼24h眼压和血压同步监测的意义。
Glaucoma is a major eye disease causing blindness and visual damage worldwide, and it is also one of the irreversible eye diseases causing blindness. Intraocular pressure (IOP) is an important risk factor for the development of glaucoma, and the influence of blood pressure (BP) on the progression of glaucoma also cannot be ignored. Eye perfusion pressure is the difference between blood pressure and intraocular pressure, regulating the blood supply to the optic nerves. IOP, BP and perfusion pressure are related to the occurrence and the progression of glaucoma. Literature review was performed related to the effects of IOP and BP on glaucoma, and the application of 24-hour IOP and BP monitoring in glaucoma, aiming to analyze the significance of simultaneous monitoring of IOP and BP for 24 hours.
近年来，脂质代谢紊乱与眼科疾病关系密切。体外研究和临床前模型显示，高密度脂蛋白(high density lipoprotein，HDL)及其主要蛋白成分载脂蛋白A1(apolipoprotein A1，apoA1)对内皮细胞具有抗氧化、抗炎和抗凋亡作用，对血管具有强大的保护作用。ApoA1模拟肽能够模拟apoA1功能，且分子质量更小，前景非常乐观。而动物实验及人体试验均证实了模拟肽D-4F口服使用的安全性及有效性，因此目前研究最为广泛。目前来说，对于apoA1及其模拟肽在眼科疾病的研究中属于萌芽阶段。本文总结了apoA1及其模拟肽的结构，及其在眼科疾病如视光学、角膜病、玻璃体视网膜疾病中的研究进展，为apoA1及其模拟肽在眼科的进一步研究及开发利用提供参考。
The recent researches indicate that the disorder of lipid metabolism is closely related to ophthalmic diseases.In vitro studies and preclinical studies have shown that high density lipoprotein (HDL) and its main structural protein apolipoprotein A1 (apoA1) have superior efficacy in blood vessel protection, with antioxidant, anti-inflammatory and antiapoptotic effects on endothelial cells. Prospect of the ApoA1 mimetic peptide is very optimistic as it can mimic the function of apoA1, and its molecular weight is smaller. The safety and efficacy of oral use of mimetic peptide D-4F have been confirmed in both animal experiments and clinic trials. Thus, it had been extensively studied. In this paper, we reviewed the structure of apoA1 and its mimetic peptide, as well as their researches related to ophthalmic diseases, such as optometry, corneal diseases and vitreoretinal diseases, so as to provide reference to further researches in apoA1 and its mimetic peptide in the of ophthalmic diseases.
目的：了解行全飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)患者围手术期的体验感受。方法：采用定性调查的方法，选取广东省某医院的15名行SMILE的患者，进行半结构式访谈，将患者围手术期体验归纳为顾虑、紧张、疼痛、担心、放松5个主题概念，用现象学分析法整理、分析资料。结果：把5种体验汇总制成韦恩图，通过韦恩图提炼发现有1人有围手术期5种感受，3位有紧张、疼痛、担心、放松4种心理感受，2位只有紧张的感受，而无其余感受。结论：行SMILE患者的围手术期具有多种体验感受，分析不同感受状态和因素，为眼科医护人员对于寻求SMILE手术的患者做好围手术期的服务提供依据。
Objective: To investigate the perioperative experience after small incision lenticule extraction (SMILE). Methods: A semi-structured interview was conducted in 15 patients who underwent SMILE surgery in Zhuhai People’s Hospital.The data were collected and analyzed by phenomenological analysis. Results: The perioperative feelings of patients were summarized into five categories: concern, tension, pain, worry and relaxation. These feelings were compiled and extracted by Venn diagram. One patient had all five categories of feelings during the perioperative period. Three patients experienced four psychological feelings of tension, pain, worry and relaxation, and 2 patients had only nervous feelings during the full femtosecond operation period. Conclusion: Patients undergoing SMILE have avariety of experience feelings during perioperative period. Analysis of different feeling states and factors will provide evidence for ophthalmic medical staff to provide perioperative services for patients seeking SMILE surgery.
目的：运用Lea Symbols视力表、HOTV视力表对2.5~5.0岁正常儿童视力发育情况进行探究，并评价2种视力表的应用效果。方法：以随机顺序先后应用Lea Symbols视力表与HOTV视力表对广州地区2所早教中心及3所幼儿园共461例儿童(922只眼)进行单眼视力检查，所有儿童提前1 d行小瞳下检影验光、眼前节裂隙灯检查、眼底情况、眼球活动、眼位检查，筛选无器质性眼病、屈光度在正常范围的儿童作为研究对象。视力值采用5分记录方法表示。结果：1 )可测率(视力表使用配合程度)。407名儿童完成Lea Symbols视力检查，总体可测率92.08%；402名儿童完成HOTV视力检查，总体可测率90.95%；前者可测率高于后者，差异无统计学意义(χ2 =0.417，P=0.580)。进一步研究发现2种视力的可测率随年龄增长不断提高，儿童3岁之后基本都能完成2种视力的检查。2)2种视力结果及比较(5分记录法表示)。Lea视力值：右眼为4.89±0.05，左眼为4.90±0.05；HOTV视力值：右眼为4.84±0.05，左眼为4.85±0.04；前者视力好于后者，差异有统计学意义(右眼：t=3.171，P=0.003；左眼：t=3.230，P=0.003)。3)视力发育与年龄的相关性。2种视力发育与年龄存在显著正相关(P<0.001)，即随着年龄的增长，视力水平逐渐提高。4)视力发育与眼别、性别的关系。左右眼之间的视力发育差异无统计学意义(P>0.05)；男性儿童的视力发育好于女性，且差异有统计学意义(P<0.05)。结论：Lea Symbols及HOTV视力表建议用于年龄大于3岁儿童的视力检查，且儿童更容易接受Lea Symbols视力表的检查。伴随年龄的增长，儿童的视力发育呈现提高的趋势；Lea视力优于HOTV视力。视力的发育与眼别无关，男性儿童的视力发育快于女性儿童。
Objective: To conduct a preliminary study of the Lea Symbols and HOTV charts to explore the visual development of children aged 2.5 to 5.0 years, and evaluate the application values of the two charts. Methods: A total of 461 children (922 eyes) in 2 early education centers and 3 kindergartens in Guangzhou were examined by using the Lea Symbols visual acuity chart and HOTV visual acuity chart in random order. All the children underwent low-pupil photometry, anterior section slit-lamp examination, retinal condition, eye movement, and eye position examination 1 day in advance. Children with no organic eye disease and normal diopter were selected as subjects. Visual acuity was recorded with 5 points. Results: 1) Measurable rate (visual acuity chart use degree of cooperation). 407 children completed visual examination of Lea Symbols, with an overall detectable rate of 92.08%; 402 children completed HOTV vision examination, with an overall detectable rate of 90.95%. The detectable rate of the former was higher than that of the latter, but the difference was not statistically significant (χ2 =0.417, P=0.580). Further study found that the detectable rate of both visual acuities increased with age, and children were able to complete both visual acuity tests after the age of 3. 2) Results and comparison of two visual acuity (5-point recording method). The visual acuity of Lea was 4.89±0.05 in the right eye and 4.90±0.05 in the left eye. HOTV visual acuity was 4.84±0.05 in the right eye and 4.85±0.04 in the left eye. The visual acuity of the former was better than that of the latter, the difference was statistically significant (right eye: t=3.171, P=0.003; left eye: t=3.230, P=0.003). 3) Correlation between visual development and age. There was a significant positive correlation between the two types of visual development and age (P<0.001), that is, visual acuity gradually improves with age. 4) The relationship between visual development and eye and sex. There was no difference in visual development between the left and right eyes, but male children had better visual development than female, and the difference was statistically significant (P<0.05). Conclusion: Lea Symbols and HOTV visual acuity charts are recommended for visual acuity examination of children over 3 years old, and children are more likely to receive examination of Lea Symbols visual acuity chart. With the growth of age, the visual development of children shows a trend of improvement. Lea vision is superior to HOTV vision. Vision development has nothing to do with the eye, male children’s vision development is faster than female children.
近视防控已经上升为国家战略，眼轴长度是近视防控的重要建档参数。眼轴长度的测量有多种方法，受到年龄、性别、脉络膜厚度等因素的影响。目前，眼轴长度的定义尚未统一，建议建立标准化的定义和方法学，以指导近视防控的临床和科研工作。
The prevention and control of myopia has become a national strategy, and the axial length is an important parameter in the documentation of myopia prevention and control. This review summarized the measurement technology and factors associated with axial length. Axial length can be measured in various ways and can be influenced by age, gender, choroidal thickness, and other factors. A standardized definition of axial length is warranted to be established for clinical and scientific purposes.
目的：探讨品管圈在缩短眼底外科门诊患者就诊时长中的应用效果。方法：成立品管圈小组，确立缩短眼底外科门诊患者就诊时长活动主题，选择2020年9月份眼底外专科门诊就诊的484例患者为活动前研究对象。2020年12月份眼底外科门诊就诊的976例患者为活动后研究对象，分析干预前眼底外患者就诊时长，患者就医体验差的原因，针对原因拟定对策并组织实施。结果：开展品管圈活动后，眼底外科门诊患者的平均就诊时长显著缩短(P<0.05)。借助信息系统优化就诊流程，提高了患者满意度，圈员的团队凝聚力、积极性、沟通协调能力显著提高。结论：品管圈活动能缩短眼底外科患者就诊时长，提高患者就医体验，提升护理团队综合能力，且改善效果可持续保持。
Objective: To explore the application effect of quality control circle in shortening the length of outpatient visit in fundus surgery. Methods: A quality control circle group was established to set up the activity theme of shortening the duration of treatment for outpatient patients of fundus surgery, and 484 patients who visited outpatient clinics outside fundus in September 2020 were selected as the pre-activity research objects. In December 2020, 976 patients who visited fundus surgery outpatient department were the subjects of the post-activity study. We analyzed the duration of treatment and the reasons for poor medical experience of patients before the intervention, formulated countermeasures for the reasons and organized and implemented them. Results: After the quality control circle activity was carried out, the mean duration of outpatient visits in fundus surgery was significantly shortened (P<0.05). With the help of the information system, the medical treatment process was optimized to improve the satisfaction of patients, and the team cohesion, enthusiasm, communication and coordination ability of the circle members were significantly improved. Conclusion: Quality control circle activities can shorten the duration of treatment for fundus surgery patients, improve patients' medical experience, enhance the comprehensive ability of the nursing team, and the improvement effect can be maintained sustainably.
目的：探讨风筝皮瓣及旋转皮瓣在眼外伤或良性肿物切除术后造成眉眼前层缺损的疗效，评价其预后、修复效果以及美学评分改变。方法：收集2018年5月至2020年5月34例眉/眼外伤或因良性肿物行手术切除患者，其眉眼前层缺损最大直径不超过眼长度1/2，根据创面缺损位置、范围，设计沿皮纹方向的缺损邻接部位局部风筝皮瓣及旋转皮瓣，推进滑行局部转移皮瓣向缺损区移位一期修复缺损。随访6个月观察术后皮瓣愈合情况、缺损的修复效果、并发症、患者满意度，比较手术前后美学评分。结果：所有皮瓣全部成活，切口均为I期甲级愈合，局部皮瓣的皮肤色泽、厚薄、毛发情况、质地以及眉毛走行分布与未手术侧基本一致，皮瓣创周器官组织形态无明显改变，皮瓣上眉毛生长良好，手术切口隐蔽在肌肤纹路处、瘢痕增生不鲜明，所有患者无需再次手术。缺损部无臃肿，双侧连续性以及对称性良好，无眉眼变形、倒睫、睑内外翻、上睑下垂等出现，眉/眼组织形态美观、功能良好。患者对手术效果比较满意。患者术后1d及1、3、6个月的美学评分分别为(73.50±7.79)、(76.97±6.84)、(82.21±6.11)和(87.06±6.07)分，均高于术前的(50.59±9.71)分，比较差异均有统计学意义(均P<0.05)。结论：应用风筝皮瓣及旋转皮瓣I期修复眉/眼皮肤软组织缺损，可较好地恢复眉/眼形态和功能，患者对缺损修复效果满意度高，能取得较高的美学评分，操作简单易行，效果可靠，无明显并发症。
Objective:To investigate the therapeutic efect of kite fap and rotary fap on superfcial tissue defect of eyebrow/eye caused by eyebrow/eye trauma or benign tumor resection, and to evaluate the prognosis, repair effect and aesthetic score changes. Methods: A total of 34 cases of eyebrow/eye trauma or benign tumors who underwent surgical resection were collected between May 2018 and May 2020. Te maximum defect diameter was not more than 1/2 of the length of eyebrow/eye. According to the location and scope of the defect, local kite flaps and rotary flaps were designed at the adjacent along the dermatoglyphic direction, and the sliding local transfer faps were promoted to the defect area to repair the eyebrow and eyelid ocular defects in stage one. Follow up for 6 months to observe the fap healing, defect repair efect, complications, patient satisfaction and aesthetic score. Results:All the skin faps survived, and the wound healing was Grade I A. The skin color, thickness, hair condition, texture and eyebrow shape distribution of the local skin faps were basically similar to the non-surgical side. Tere was no obvious change in the tissue morphology around the faps. Te eyebrows on the skin faps grew well, and the surgical incision was concealed in the skin lines with no distinct scar hyperplasia. All patients did not need operation again. Te defects were not swollen, bilateral continuity and symmetry were good, without eyebrow and eye deformation, without trichiasis, entropion or ptosis, etc. Te eyelid/eyebrow were beautiful and functional. The patients were satisfied with the surgical results. The aesthetic scores of patients at diferent postoperative monitoring times (1 day, 1 month, 3 months and 6 months) afer surgery were (73.50 ± 7.79), (76.97 ± 6.84), (82.21 ± 6.11) and (87.06 ± 6.07) points respectively, which were significantly higher than the preoperative scores (50.59 ± 9.71) points, and the diferences were statistically signifcant (P<0.05). Conclusion: Te kite fap and rotary fap can be used to repair the eyebrow/eye skin and sof tissue defects in Phase I, which can restore the shape and function of the eyebrow/eye well. Te patients are satisfed with the efect of the defect repair, and can obtain a higher aesthetic score. Te operation is simple and easy, the efect is reliable, and there was no obvious complications.
该文报道一例中年男性患者，因“头痛伴左侧听力下降”就诊于我院神经外科，经影像学检查诊断为“左侧三叉神经鞘瘤”， 手术前实验室检查发现血象异常，经血液科会诊后诊断为多发性骨髓瘤IgDλ型，于化疗期间并发神经麻痹性角膜炎(neurotrophic keratitis,NK)，可于角膜中央偏下方的上皮及前基质层见到类圆形的灰白色浑浊，呈胶冻样，经局部药物治疗后好转，但残留角膜基质白色浑浊。由于现阶段临床对NK尚欠缺充分认识，易延误诊治，并且本文报道的此例NK患者，因其有化疗病史且于治疗期间出现相关体征，易被误诊为化疗并发细菌性角膜炎，文章通过分析其角膜病变的特征及简单回顾NK的临床特征、鉴别诊断及治疗，以期临床早期识别及治疗此类患者，恢复角膜的光学特性，维持良好的视觉体验。
Tis article reports a case of a middle-aged male patient who visited the Department of Neurosurgery of our hospital due to headache and lef hearing loss. He was diagnosed with lef trigeminal schwannoma by imaging examination and abnormal blood routine before surgery. During chemotherapy and paralytic keratitis (neurotrophic keratitis, NK), can be seen in the lower part of the corneal center of the epithelium and the prestromal layer of round gray and white turbidities, jelly like, afer local drug treatment improved, but residual corneal stromal white turbidities. Due to the lack of full understanding of NK in clinic at the present stage, diagnosis and treatment is easy to be delayed. In addition, the NK patient reported in this paper was easily misdiagnosed as bacterial keratitis complicated by chemotherapy due to his history of chemotherapy and related signs during treatment. Tis paper analyzed the characteristics of keratopathy and briefy reviewed the clinical characteristics, diferential diagnosis and treatment of NK, in order to identify and treat these patients in early clinical stage, restore the optical characteristics of cornea and maintain good visual experience.
