目的：测量医联体糖尿病患者眼科随访依从性及相关的健康信念，分析其影响因素。方法：采用便利抽样的方法，使用中文版糖尿病眼科随访依从性问卷对在广州医科大学附属第二医院所辖医联体内的334例糖尿病患者进行调查。结果：仅24.3%的受访者在过去的1年中接受过眼科散瞳检查，受访者眼科随访健康信念的总体评分为3.09±0.64，其中感知的益处和威胁维度评分最高，行为线索维度评分最低。糖尿病类型、就医倾向、合并其他糖尿病并发症、医联体相关知识和家庭类型是糖尿病患者眼科随访健康信念的主要影响因素。结论：医联体糖尿病患者眼科随访健康信念处于一般水平，缺乏行为线索支持，提示在糖尿病眼部并发症筛查和防治过程中，医联体应发挥下筛上转的功能，通过对障碍因素的干预，提高辖区糖尿病患者接受眼科随访的依从性。

Objective: To measure the adherence to ophthalmology follow-up and the related health belief of patients with diabetes in medical alliance, and analyze the influencing factors. Methods: Totally 334 community-dwelling patients with diabetes mellitus were recruited in a medical alliance in Guangzhou by convenient sampling method. They were investigated by the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey (CADEES-C). Results: Dilated fundus examination within the last year were only reported by 24.3% of respondents. The mean score of the CADEES-C was 3.09±0.64, with the highest score in perceived benefit and threat dimensions and the lowest score in behavioral cue dimension. The factors that mainly influence the adherence to ophthalmology follow-up and their related health beliefs of patients with diabetes are types of diabetes, propensity to seek treatment, other complications of diabetes, knowledge of medical alliance and family pattern. Conclusion: The adherence to ophthalmology follow-up and the related health belief of patients with diabetes are at low level with the deficiency of behavioral cues. It is suggested that medical alliance should play a critical role to improve the status quo by developing more screening and referrals.

圆锥角膜在眼科临床工作中是角膜疾病中较为熟知的病种。本文汇报1例角膜病变，女，33岁，无特殊诱因出现视物模糊，初步考虑圆锥角膜，但经过一系列检查后不能确诊该患者此次双眼角膜罹患何种眼疾，且该患者未行规律专科治疗，于家中全休2周后双眼不适症状消失，经甘肃省第三人民医院眼科检查角膜验光恢复正常，矫正视力均达正常。该患者自诉于2014年发作1次，且经过多院就诊，未能确诊，休息2~3周后症状消失。故整理此次就诊经过特汇报出来，供各位专家、同道参阅，以期得到明确诊断或者诊疗方向，为患者后续再次出现该类情况指导诊疗，缩短患者发病时长。

Keratoconus is a well-know disease in ophthalmology. This paper reports a case of keratopathy, female, 33 years old, had blurred vision without special inducement, and keratoconus was initially considered. However, after a series of examinations, diagnosis what kind of ocular disease the patient had in both eyes was not possible, and the patient had no regular specialist treatment, and the discomfort symptoms of both eyes disappeared after taking a full rest at home for 2 weeks, and the cornea was examined by Department of Optometry in Third People’s Hospital of Gansu Province returned to normal and corrected visual acuity was normal. The patient had a seizure in 2014, and after multiple hospital visits, the diagnosis could not be confirmed, after 2–3 weeks of rest, the symptoms disappeared. Therefore, after sorting out the special report of this visit, it is specially reported for the reference of all experts and colleagues to get a clear or direction of diagnosis and treatment, guide the diagnosis and treatment for patients who experience such similar situation in the future, and reduce the length of illness.

目的：分析眼科超说明书用药使用情况，为眼科临床合理用药提供有效、安全的循证参考依据。方法：考察并收集21家爱尔眼科医院集团眼科中心城市及省会级医院备案的超说明书用药情况，同时抽查处方、医嘱用药，对超说明书用药情况进行充分论证评估，参考广东省、山东省等超说明书用药共识、文献，进行统计、分析和归纳，并征求相关眼科临床专家意见。结果：梳理指南、共识及期刊论文等循证医学证据，得出超说明书用药推荐级别1级8项，2级29项，3级24项，并编写了供集团内使用的《眼科医院眼科超药品说明书用药参考目录(2021年版)》，便于临床参考使用。在眼科常用有32种超说明书药品，61项超说明书用药，其中超给药途径32项(52.5%)、超适应证用药13项(21.3%)、超适应症合并超给药途径14项(23.0%)。超说明书品种及超说明用药项目数均以抗菌药物最多，分别为13个(40.6%)品种，26项(42.6%)。结论：眼科因特殊的给药途径，超说明书用药比较普遍，而如抗菌药物注射剂使用眼内注射或滴眼等超说明书用药方式对某些急性眼内感染性疾病起到了很好的治疗效果。规范眼科超说书用药，是降低医疗风险的必要措施。

Objective: To investigate off-label ophthalmic medications, and provide an effective and safe evidence-based reference for the rational use of ophthalmic drugs. Methods: On the basis of collecting the off-label drug use recorded in 21 Aier Eye Hospital Group which including ophthalmic central cities and provincial capital level hospitals, and spot checking the prescription and doctor’s order drug use, this article conducted full demonstration and evaluation of off-label drug use which referred to the off-label drug used consensus of Guangdong and Shandong, and other literature on the off-label drug use in ophthalmology. The paper conducted statistics, analysis and induction, and solicited the opinions of relevant ophthalmology clinical experts. Results: Sorting out the evidence of the guides, consensus, journal papers and other evidence-based medicine in ophthalmic medication, recommending 8 items of level 1, 29 items of level 2, and 24 items of level 3, we compiled the “Reference catalogue for the off-label drug use in ophthalmic hospital (2021 edition)” within the group which can providing reference for clinical use. There were 61 off-label drugs commonly used in ophthalmology, involving 32 drugs. Among them, 32 items (52.5%) were used by over administration route, 13 items (21.3%) were used by over indication, and 14 items (23.0%) were used by over indication and administration route. Antibacterial drugs were the most frequently used in the varieties and items of off-label drug use, accounting for 13 (40.6%) and 26 (42.6%) respectively. Conclusion: Ophthalmic off-label medications are common owing to the special route of administration. Such as intraocular injection or eye drop have played a good role in the treatment of some ocular infectious diseases. Standardizing the off-label drug use of ophthalmology is an effective measure to reducing medical risks.

目的：对兰州市中小学生的屈光状态进行调查分析，了解兰州市中小学生筛查性屈光不正的流行病学特征。方法：采用横断面研究方法，用随机分层抽样法抽取2021年4至12月在甘肃省兰州市47所学校的中小学生作为调查对象。以学校为单位，采用国际标准视力表检查视力，采用非睫状肌麻痹的电脑自动验光仪进行屈光检查。裸眼视力<0.8为视力低下，具体分为：近视为等效球镜度≥–0.75 DS；远视为等效球镜度≥+2.00 DS；散光为柱镜度≥1.00 DC；屈光参差为双眼屈光度数差值(等效球镜度)≥1.00 DS。比较不同年级不同屈光状态人数所占的百分比。结果：共纳入40 302人，其中男21 328人，女18 974人；汉族37 938人，少数民族2364人。小学、初中、高中各26 122、9346和4834人。视力低下的总检出率为59.1%(23 832/40 302)，小学、初中和高中年级视力低下的检出率分别为48.8%(12 748/26 122)，76.9%(7 189/9 346)和87.9%(4 250/4 834)。近视的总检出率为63.3%(25 521/40 302)，其中，小学、初中和高中筛查性近视的检出率分别为51.4%(13 438/26 122)，84.4%(7 888/9 346)和86.8%(4 195/4 834)。筛查性视力低下、远视、近视、散光及屈光参差的检出率在低中高年级间比较差异均有统计学意义(均P<0.001)。结论：兰州市中小学生视力低下和近视人群的检出率高于国家平均水平，且随着年级的增加检出率逐渐升高。

Objective: To investigate and analyze the refractive status of primary and secondary school students in Lanzhou City, and to understand the epidemiological characteristics of screening refractive errors among primary and secondary school students in Lanzhou City. Methods: Using the cross-sectional research method, primary and secondary school students from 47 schools in Lanzhou City, Gansu Province from April to December 2021 were selected as survey subjects by random stratified sampling method. Taking school as a unit, international standard visual acuity chart was used to check the eyesight and non-cycloplegia computerized autorefractor was used for refractive examination. Visual acuity ≥5.0 is considered normal; whereas visual acuity <4.8 is considered as poor vision. Poor vision is further divided into: short-sightedness with myopic spherical equivalent ≥0.75 DS; long-sightedness with telephoto spherical equivalent ≥+2.00 DS; astigmatism with cylinder mirror equivalent ≥1.00 DC; anisometropia with the difference of diopters between the two eyes (spherical equivalent) ≥1.00 DS. The percentage of the survey subjects with different refractive status in different grades were compared. Results: A total of 40 302 subjects were enrolled, including 21 328 males and 18 974 females. There were 37 938 Han and 2 364 ethnic minorities; 26 122 elementary, 9 346 middle and 4 834 high schools. The total detection rate of low visual acuity was 59.1% (23 832/40 302), and 48.8% (12 748/26 122) in primary school, junior middle school and senior high school, 76.9% (7 189/9 346) and 87.9% (4 250/4 834), respectively. The total detection rate of myopia was 63.3% (25 521/40 302), among which, the detection rate of screening myopia in primary school, middle school and high school was 51.4% (13 438/26 122), 84.4% (7 888/9 346) and 86.8% (4 195/4 834), respectively. The detection rates of screening low visual acuity, hyperopia, myopia, astigmatism and anisometropia were statistically significant in low, middle and high grades (all P<0.001). Conclusion: The detection rate of low vision and myopia among primary and secondary school students in Lanzhou is higher than the national average, and the detection rate increases gradually with the increase of grades.

慢性移植物抗宿主病(chronic graft-versus-host disease，cGVHD)是骨髓移植后最具有破坏性并发症之一。移植物抗宿主病(graft-versus-host disease，GVHD)发生在10%~80%的造血干细胞移植(hematopoietic stem cell transplantation，HSCT)受者中，而眼睛是人身体最脆弱的器官之一，有40%~60%接受HSCT的患者发生眼部GVHD，它主要影响泪腺、睑板腺、角膜和结膜等。cGVHD相关性干眼(dry eye associated with chronic graft-versus-host disease，cGVHD-DE)是眼部GVHD最多见的表现形式。cGVHD-DE的长期治疗因涉及多学科、多重结合治疗，至今仍然具有挑战性，其除了全身免疫抑制和眼部润滑剂外，通常还使用局部类固醇、环孢霉素和他克莫司滴眼液。针对中度和重度cGVHD-DE的治疗干预包括使用自体血清滴眼液和佩戴巩膜镜等，新兴起的治疗方案包括重链透明质酸 (heavy chain-hvaluronan，HC-HA)/穿透素(pentraxin 3，PTX3)结膜下注射、间充质基质细胞静脉注射、抑制纤维化药物等。

Chronic graft-versus-host disease (cGVHD) is one of the most devastating complications following bone marrow transplantation. GVHD develops in 10–80% of patients after hematopoietic stem cell transplantation (HSCT). The eye is one of the most vulnerable organs of the human body. Ocular GVHD occurs in 40–60% of patients with GVHD undergoing HSCT, and it mostly affects the lacrimal glands, meibomian glands, cornea, and conjunctiva. The most common form of ocular GVHD is dry eye disease (DED). The long-term treatment of cGVHD-related dry eye syndrome remains challenging and involves a multidisciplinary approach. Besides systemic immunosuppression and ocular lubricants, topical steroids, topical cyclosporine, and topical tacrolimus are commonly prescribed. Newer therapeutic interventions for moderate and severe cGVHD-related DED include using serum eye drops and scleral contact lenses. Emerging treatment options include subconjunctival injection of heavy chain-hyaluronan (HC-HA)/ pentraxin 3 (PTX3), intravenous injection of mesenchymal stromal cells, antifibrotic drugs, etc. This article reviews the mechanisms, clinical findings, and treatment of cGVHD-related dry eye syndrome.

目的：探讨2型糖尿病(type 2 diabetes mellitus，T2DM)患者二甲双胍治疗与糖尿病性视网膜病变(diabetic retinopathy，DR)的相关性。方法：回顾2015年9月至2020年8月在中日友好医院眼科就诊的1 891例T2DM患者的临床资料，对病程≥10年的324例T2DM患者的一般资料、内科疾病史、糖尿病治疗史、眼科检查和实验室血生化指标进行回顾性病例研究。根据是否接受二甲双胍治疗分为二甲双胍治疗组与非二甲双胍治疗组，根据眼底检查结果同时结合DR临床诊断标准，将DR分为无明显DR、非增生性DR及增生性DR。采用logistic多因素回归分析判断年龄、性别、糖尿病发病年龄、糖尿病病程、高血压病程、高血脂病程、吸烟年数、体重指数、胰岛素治疗及空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、尿酸和血肌酐水平对结局变量的影响。结果：在DR的发病风险方面，二甲双胍治疗组与非二甲双胍治疗组的差异无统计学意义(P>0.05)。对T2DM患者DR发生及不同分期的相关变量行单因素及多因素分析，结果显示吸烟年数、空腹血糖及肌酐均与DR发病呈正相关(均P<0.05)，而年龄与DR发病呈负相关(P<0.01)，糖尿病发病年龄与DR发生呈显著负相关(OR=0.95，95%CI：0.92~0.98，P=0.0003)。在二甲双胍治疗的T2DM患者中，二甲双胍的疗程(OR=1.02，95%CI：0.96~1.08，P>0.05)及平均剂量(OR=1.50，95%CI：0.79~2.84，P>0.05)与DR的发生与进展均无显著相关性；女性DR发生与进展的风险较男性低(P<0.05)；合并胰岛素治疗与DR发生呈明显正相关(OR=3.11，95%CI：1.59~6.07，P<0.01)；吸烟年数长、糖化血红蛋白及尿酸水平高于正常范围均与DR的发生与进展呈正相关(P<0.05)。在口服二甲双胍患者中，未使用胰岛素治疗组和联合使用胰岛素组的DR发病风险有显著差异(P<0.01)；而未口服二甲双胍患者中，胰岛素治疗与DR发生呈正相关(OR=12.43，95%CI：3.75~41.19，P<0.0001)。结论：病程10年以上T2DM患者中，二甲双胍治疗与DR发生与进展均无显著相关性。

Objective: To investigate the correlation between metformin therapy and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: The clinical data of 1 891 patients with type 2 diabetes mellitus attending the ophthalmology department of China-Japan Friendship Hospital from September 2015 to August 2020 were reviewed. A retrospective study was performed on 324 cases of these T2DM patients with disease duration ≥10 years. Medical records of all patients including general information, history of medical disease, diabetes treatment, ophthalmologic examination and blood biochemical indices were collected. According to whether metformin treatment was received or not, the patients were divided into a metformin-treated and a non-metformin-treated groups. DR is classified into non-obvious DR, non-proliferative DR and proliferative DR according to the fundus examination and the clinical diagnostic criteria of DR. Logistic multiple regression analysis was used to determine the effects of age, sex, age of DM onset, duration of DM, duration of hypertension,

duration of hyperlipidemia, years of smoking, body mass index, insulin treatment and fasting glucose, glycated hemoglobin, total cholesterol, triglycerides, uric acid and blood creatinine levels on DR. Results: There was no statistically significant difference in the risk of developing DR between the metformin-treated and non-metformin-treated groups (P>0.05). Univariate and multifactorial analyses of variables related to the occurrence and different stages of DR in patients with T2DM showed that years of smoking, fasting glucose and creatinine were positively associated with DR (P<0.05), while age was negatively associated with DR (P<0.01), and age of DM onset was significantly negatively associated with DR (OR=0.95, 95%CI: 0.92 to 0.98, P=0.0003). In T2DM patients treated with metformin, neither the duration of metformin (OR=1.02, 95%CI: 0.96 to 1.08, P>0.05) nor the mean dose(OR=1.50, 95%CI: 0.79 to 2.84, P>0.05) was significantly associated with developing DR. The risk of developing DR was lower in women than in men (P<0.05); combined insulin therapy was significantly positively correlated with the risk of DR (OR=3.11, 95%CI: 1.59 to 6.07, P<0.01); long-term smoking, glycosylated hemoglobin and uric acid levels higher than normal were positively associated with DR (P<0.05). In metformin users, there was a significant difference in the risk of developing DR between the no-insulin treatment group and the combined insulin group (P<0.01); and among patients not using metformin, insulin therapy was positively associated with the occurrence of DR (OR=12.43, 95%CI: 3.75 to 41.19, P<0.0001). Conclusion: There was no significant association between metformin treatment and DR among patients with T2DM for >10 years.

目的：建立高效液相色谱法(high-performance liquid chromatography，HPLC)测定盐酸丁卡因滴眼液中盐酸丁卡因和羟苯乙酯的含量。方法：采用Agilent Eclipse PLUS C18色谱柱(250 mm ×4.6 mm，5 μm)；以1%三乙胺溶液(三乙胺10 mL，加水990 mL，用冰醋酸调节pH值至5.0±0.5)-乙腈(65 : 35)为流动相，流速为1.0 mL/min；柱温为30 ℃；检测波长为256 nm；进样体积20 μL。结果：盐酸丁卡因在0.05~0.36 mg/mL范围内线性关系良好( r =1.000)，平均回收率为99.2%，相对标准偏差(relative standard deviation，RSD)为0.3%(n=9)，羟苯乙酯在3.02~24.14 μg/mL范围内线性关系良好(r=1.000)，平均回收率为98.2%，RSD为0.4%(n=9)，该方法重现性好。对照品溶液和供试品溶液在室温放置24 h基本稳定；结论：本方法简便、快速、准确。适用于检测盐酸丁卡因滴眼液中盐酸丁卡因和羟苯乙酯的含量。

Objective: To establish a high-performance liquid chromatography (HPLC) method for the determination of tetracaine hydrochloride and ethyl hydrobenzoate in tetracaine hydrochloride eye drops. Methods: The analytic column was Agilent Eclipse Plus C18 (4.6 mm ×250 mm, 5 μm) and the mobile phase was 1% triethylamine solution (10 mL triethylamine and 990 mL water, pH adjusted to 5.0±0.5 with glacial acetic acid) - acetonitrile (65:35) at a flow rate of 1.0 mL/min. The detection wavelength was 256 nm and the column temperature was 30 ℃. The injection volume was 20 μL. Results: The linear range of tetracaine hydrochloride was well shown within 0.05–0.36 mg/mL (r=1.000). The average recovery rate of tetracaine hydrochloride was 99.2% with relative standard deviation (RSD) 0.3% (n=9). The linear range of ethyl hydrobenzoate was well shown within 3.02–24.14 μg/mL (r=1.000). The average recovery rate of tetracaine hydrochloride was 98.2% with RSD 0.4%(n=9). The method had high reproducibility. The reference solution and testing solution were stable for 24 h in room. Conclusion: The method is simple, quick and accurate, which is suitable for the determination of tetracaine hydrochloride and ethyl hydrobenzoate in tetracaine hydrochloride eye drops.

内源性干细胞在组织的损伤修复过程中组织相容性好、致瘤风险低，相较于外源性干细胞具有不需要体外扩增和培养、疾病传播风险低的优点，在细胞治疗领域具有显著优势。现在已经有多种使用内源性干细胞进行疾病治疗的成熟方式，应用领域包括了全身各种器质性和功能性疾病。在眼组织中，晶状体具有终生生长的能力且便于观察，是实现再生修复的突破点。哺乳动物中晶状体再生的实现有赖于晶状体内源性干细胞的定位和改良手术方式，以保留晶状体干细胞，并创造适合晶状体再生的微环境。对再生后的晶状体蛋白质组成分析，发现其类似成熟晶状体，而非胚胎期的晶状体，提示晶状体再生的调控与胚胎期的诱导发生并不相同；而调控晶状体再生的策略不仅着眼于干细胞的激活和正确分化的诱导，对其上皮间质转化过程也需要进行调控。在未来，为将晶状体再生的经验应用于其他眼组织中，动员内源性干细胞并促进其生长，可以添加细胞有效成分，比如外泌体、线粒体、小分子化合物等，模拟细胞应激；此外，还可以通过手术或生物材料辅助，恢复晶状体结构和环境。

Endogenous stem cells have significant advantages in cell therapy for excellent histocompatibility, low tumorigenicity risk, unnecessity for in vitro expansion and culture, and low disease transmission risk. There have been some applications for endogenous stem cells in treating diseases, targeting some organic and functional diseases throughout the body. In ocular tissue, the lens is a breakthrough for regenerative therapy due to its potential to grow throughout life and observation accessibility. Achieving lens regeneration in adult mammals attributes to some prerequisites. Firstly, the location of endogenous stem cells in the lens has been identified. Then, surgical approaches have been advanced to preserve lens stem cells and create a microenvironment suitable for lens regeneration. Protein compositional analysis of the regenerated lens reveals that it is similar to a mature lens rather than an embryonic lens, suggesting that the regulation of lens regeneration is not the same as the induction of embryonic onset. The strategy for regulating lens regeneration needs to focus not only on the activation and proper differentiation of stem cells but also on regulating the process of epithelial mesenchymal transition (EMT). In the future, in order to apply the experiences of lens regeneration to other ocular tissues, to mobilize endogenous cells and promote their growth, some strategies could be used. These strategies include mimicking cellular stress via the addition of cellular active ingredients, such as exosome, mitochondria, and small molecular compounds. Additionally, we can also try to restore lens tissue structure and microenvironment through surgical or biomaterial assistance.

目的：探讨基于微信的图像存储和传输系统(picture archiving and communication system，PACS)教学在眼眶科规培医生中的教学效果及质量评价。方法：将中山眼科中心眼眶科轮训的66名规培医生分为A组(PACS组)与B组(微信+PACS组)。通过出科考核和问卷分析比较两组学生的教学效果及满意度。结果：B组学生的基础知识测试和阅片技能测试得分均显著高于A组(P<0.001，P=0.037)。教学效果自我评估量表显示B组学生对解剖结构位置的熟悉程度、影像学诊断、鉴别诊断能力、工作中解读CT或MRI图像的能力预判，以及对CT或MRI影像学的兴趣，明显优于A组(均P<0.001)。所有学生(100.00%)对这种教学模式感到非常满意。结论：在眼眶科住院医师规划化培训中应用基于微信的PACS教学模式能显著提高教学效果和满意度，提高教学质量。

Objective: To evaluate the application quality of picture archiving and communication system (PACS) based on WeChat in standardized resident training in orbital department. Methods: A total of 66 doctors trained in the Orbital Department of Zhongshan Ophthalmic Center were divided into group A (PACS group) and Group B (WeChat +PACS group). The quality and feedback of teaching of the two groups of students were compared through examination and questionnaire. Results: The scores of basic knowledges and reading skills of group B were significantly higher than those of group A (P<0.001, P=0.037). The self-assessment scale for teaching quality showed that the students in group B were superior to group A in understanding the position of anatomical structure, imaging diagnosis and differential diagnosis according to CT or MRI, interpreting CT or MRI images in the future, and interest in CT or MRI imaging (all P<0.001). All the students (100.00%) were very satisfied with this mode of teaching. Conclusion: The application of PACS based on WeChat in standardized resident training in orbital department can significantly improve the quality and satisfaction of ophthalmology teaching.

在晶状体纤维细胞分化的终末阶段，细胞核、线粒体、内质网及高尔基体等膜性细胞器会发生程序性的降解，这对晶状体透明性的维持至关重要。然而，晶状体细胞器降解过程的机制尚不明确。研究晶状体细胞器的降解过程可为阐明白内障的发病机制提供理论依据，也有望为晶状体再生提供新的干预靶点。本文就晶状体细胞器降解过程及其机制进行综述。

During terminal differentiation of lens fiber cells, nuclei and other organelles experience programmed elimination.This process is essential for the maintenance of lens transparency. However, the mechanisms underlying lens organelle degradation remain unclear. Identification of the mechanisms can provide a theoretical basis for elucidating the pathogenesis of cataract and is expected to reveal new intervention targets for lens regeneration. In this review, we discuss potential mechanisms and the process of lens organelle degradation.