视神经脊髓炎相关性视神经炎(neuromyelitis optica spectrum disorder optic neuritis，NMO-ON)是一种常见的视神经炎(optic neuritis，ON)类型。女性非白种人占优势，损伤严重，双侧受累较多，视力预后差。我国有很大部分特发性ON最终诊断为NMO-ON。在相关实验室、光学相干断层扫描(optical coherence tomography，OCT)、磁共振(magnetic resonance imaging，MRI)等技术支持下，目前对NMO-ON的认识有了很大的进步，治疗方式除了皮质类固醇外还有免疫球蛋白、血浆置换及免疫抑制剂等。但提高NMO-ON的诊疗水平还有很长的路，更好地认识NMO-ON有助于更快速的诊断、更规范的治疗、更良好的预后。我们可以联合神经科开展多中心大样本量前瞻性的临床对照研究。

Neuromyelitis optica spectrum disorder- optic neuritis (NMO-ON) is a common type of optic neuritis (ON). This affliction is predominant in female non-Caucasians, with severe injury, more bilateral involvement, and poor visual prognosis. In China, a large proportion of idiopathic ON is ultimately diagnosed as NMO-ON. Our understanding of NMO-ON has made great progress under the technical support, such as the relevant laboratory, optical coherence tomography (OCT), magnetic resonance imaging (MRI). In addition to corticosteroids, immunoglobulin, plasmapheresis and immunosuppressive agents are also available for treatment. However, there is still a long way to improve the diagnosis and treatment level of NMO-ON. A better understanding of NMO-ON contributes to faster diagnosis, more standardized treatment, and better prognosis. We should cooperate with the neurology department to conduct a multi-center, large sample size prospective clinical control study.

近年来，由于经济社会不断发展，社会压力增大，人们精神障碍和干眼的发病率不断增加，这既影响人们身心健康，也给社会经济造成一定负担。大量研究表明精神障碍与干眼显著相关，精神障碍是干眼的独立危险因素之一。然而在临床工作中，精神障碍与干眼间的关系在过去一直未受到重视，本文将从精神障碍与干眼关联性入手，探讨其中介作用，总结了精神障碍因素影响干眼症状和体征分离，并进一步倡导跨学科综合管理来治疗干眼，形成对干眼的正确感知并降低疼痛及健康焦虑水平，以期为干眼临床诊疗提供新的视角。

In recent years, due to the continuous development of economy and society and the increasing social pressure, the incidence rate of mental disorders and dry eyes is increasing, which not only affects people’s physical and mental health, but also creates a certain burden on the social economy. A large number of studies have shown that mental disorder is significantly related to dry eye, and mental disorder is one of the independent risk factors of dry eye. However, in clinical work, the relationship between mental disorder and dry eye has not been paid attention in the past. This paper will start with the correlation between mental disorder and dry eye, explore the mediating effects, summarize the mental disorder factors that affect the separation of symptoms and signs of dry eye, and further advocate interdisciplinary comprehensive management to treat dry eye, form a correct perception of dry eye and reduce the level of pain and health anxiety, In order to provide a new perspective for clinical diagnosis and treatment of dry eye.

目的：建立眼科专科护理门诊及探讨其实施效果。方法：调查2020年7月开展眼科护理门诊以来至2022年3月就诊的206例患者满意度和健康知识知晓率，并由医生、护士对眼科专科护理门诊的实践效果进行评价。结果：206例患者满意度较好，总分在90以上；眼科专科护理门诊针对患者问题提供个体化护理服务，进行眼部检查206人次，健康教育206人次，滴眼药水、涂眼药膏操作示范184人次，术后特殊体位指导38人次，滤过泡按摩26人次，为患者提供了多元化护理服务；同行评价显示眼科护理门诊体现了护士的专业价值；患者就诊后的健康知识知晓率明显高于就诊前，差异有统计学意义(P<0.001)。结论：眼科专科护理门诊的开设满足了患者多元化护理服务需求，提高了患者满意度和健康知识知晓率，提升了护士的自我价值感，为专科护士提供了职业发展平台，促进了眼科专科护理的发展。

Objective: To explore the establishment and effect of ophthalmology specialist nursing clinic. Methods: To Investigate the satisfaction and the awareness rate of health knowledge of 206 patients who visited ophthalmology specialist nursing clinic from July 2020 to March 2022. Doctors and nurses were investigated for evaluation of the clinic. Results: A total of 206 patients were satisfied with a total score of 90 points or more; the ophthalmology specialist nursing clinic provided individualized nursing services for patients’ problems, conducted 206 eye examinations and 206 health education, and demonstrated the operation of eye drops and eye ointment 184 times. 38 patients received post-operative special posture guidance and 26 patients received filter bubble massages. The clinic provided patients with diversified nursing services. Peer reviews showed that the ophthalmological care clinic reflects the professional value of nurses; the awareness rate of health knowledge after the patient’s visit was significantly higher than that before the visit, and the difference was statistically significant (P<0.001). Conclusion: The establishment of ophthalmology specialist nursing clinic meets patients for diversified nursing services, improves patients’ satisfaction and health knowledge awareness rate, and improves nurses’ sense of self-worth. Furthermore, it provides a career development platform for specialist nurses and promotes the development of ophthalmic specialist nursing.

目的：评估白内障手术是否影响高度近视黄斑劈裂的进展，为高度近视黄斑劈裂合并白内障患者先行白内障手术改善视觉质量可行性提供依据。方法：选取2018年4月至2021年1月在上海市第十人民医院眼科确诊为高度近视黄斑劈裂患者共36例36眼纳入研究。根据是否行白内障手术分为实验组：男10例10眼，女8例8眼；对照组：男9例9眼，女9例9眼。比较两组初诊及1个月、3个月、6个月、12个月后黄斑中心区视网膜厚度(central subfield thickness，CST)、黄斑区视网膜容积(macular volume，MV)、视网膜平均厚度(average macular thickness，AMT)、最佳矫正视力(best corrected visual acuity，BCVA)、黄斑劈裂形态学进展率情况。结果：两组CST、MV、AMT时间和组别交互效应差异无统计学意义(F=0.825，P=0.370；F=1.266，P=0.268；F=0.612，P =0.657)，两组间差异无统计学意义(F =2.519，P =0.122；F =3.318，P =0.077；F =1.378，P=0.249)。两组BCVA时间和组别交互效应差异有统计学意义(P<0.001)；做简单效应分析实验组术后1、3、6及12个月BCVA较初诊差异均有统计学意义(均P<0.001)；两组1、3、6、12个月BCVA较初诊BCVA的增量差异均有统计学意义(均P<0.001)。两组黄斑劈裂形态进展率差异无统计学意义(P=1.0)。结论：白内障超声乳化吸除术在短期内不影响高度近视黄斑劈裂的进展，且可以提高高度近视黄斑劈裂合并白内障患者的视力。

Objective: To assess whether cataract surgery can affect the progression of myopic foveoschisis, so as to provide evidence for the feasibility of cataract surgery to improve visual quality in patients with myopia foveoschisis accompanied by cataract. Methods: A total of 36 patients (36 eyes) diagnosed with high myopia foveoschisis at the Department of Ophthalmology, Shanghai Tenth People’s Hospital from April 2018 to January 2021 were enrolled in the study. The patients were divided into an experimental group (10 males with 10 eyes, and 8 females with 8 eyes) and an observation group (9 males with 9 eyes, and 9 females with 9 eyes) according to whether cataract surgery was performed. The central subfield thickness (CST), macular volume (MV), average macular thickness (AMT), best corrected visual acuity (BCVA), and the progression rate of foveoschis morphology were compared between the two groups at the initial diagnosis and 1 month, 3 months, 6 months, and 12 months after the surgery. Results: In terms of CST, MV, and AMT in the central macular area, no significant difference was found between the two groups (F=2.519, P=0.122; F=3.318, P=0.077; F=1.378, P=0.249), and there was no significant difference in time and group interaction effects between the two groups (F=0.825, P=0.370; F=1.266, P=0.268; F=0.612, P=0.657). In terms of BCVA, there was significant difference in time and group interaction effects between the two groups (P<0.001). The simple effect analysis showed that, compared with initial diagnosis, the BCVA in the experimental group was statistically significant at 1, 3, 6 and 12 months after the surgery (all P<0.001). In addition, there was a significant difference in the increments of BCVA between the two groups at 1, 3, 6, and 12 months after the surgery when compared with the initial diagnosis (all P<0.001). However, there was no significant difference in the morphological progression between the two groups (P=1.0). Conclusion: Phacoemulsification will not affect the progression of myopic foveoschisis in a short period, and can improve the vision of patients with myopic foveoschisis accompanied by cataract.

目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)在糖尿病性视网膜病变中的应用。方法：选取2021年中山大学附属第七医院眼科63例糖尿病患者为研究对象，分为无糖尿病性视网膜病变(T0，21眼)、轻度非增殖期(T1，21眼)、中重度非增殖期(T2，14眼)及增殖期(T3，7眼)。收集各组生化指标，包括空腹血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血清尿素氮、肌酐、尿素氮肌酐比值，及OCTA数据，即中心视网膜厚度、Angiography3×3及Angiography6×6血管线性密度及血管灌注密度等。采用单因素方差分析比较各组间差异。结果：T2组、T3组与T0组相比，T3组与T1组相比，糖尿病病程延长；T3组与其他各组相比，尿素氮升高；T1组、T2组、T3组与T0组相比，T3组与T1组相比，6 mm ×6 mm外层血流线性密度减少；与T0组相比，T1组、T2组及T3组6 mm ×6 mm完整血流线性密度减少；与T0相比，T2组、T3组6 mm ×6 mm外层血流灌注密度减少；与T0组相比，T3组6 mm ×6 mm完整血流灌注密度减少；T2组、T3组与T0组相比，T3与T1相比，3 mm ×3 mm内层血流线性密度明显减少；T3组与T0组及T1组相比，3 mm ×3 mm完整血流线性密度减少。结论：随着糖尿病性视网膜病变的进展，患者的尿素氮及肌酐逐渐升高，OCTA的血流线性密度及血流灌注密度逐渐减少。与血流灌注密度相比，血流线性密度对于早期糖尿病性视网膜病变筛查可能更为敏感。而利用Angiography6×6模式可能可以更早地发现糖尿病性视网膜病变的视网膜血流变化。

Objective: To explore the applications of optical coherence tomography angiography (OCTA) in diabetic retinopathy. Methods: A total of 63 diabetic patients in the Department of Ophthalmology, Seventh Affiliated Hospital of Sun Yat-sen University in 2021 were divided into 4 groups: the patients without diabetic retinopathy (T0, n=21), mild non-proliferative diabetic retinopathy (T1, n=21), moderate-to-severe non-proliferative diabetic retinopathy (T2, n=14) and proliferative diabetic retinopathy (T3, n=7). Biochemical Indicators were collected in all patients, such as fasting plasma glucose (FPG), glycated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), the blood urea nitrogen (BUN), creatinine (CRE) and the ratio of blood urea nitrogen and creatinine (BUN/CRE). The Macular Cube 521×128, Angiography3×3, and Angiography6×6 models of OCTA were used to obtain central retinal thickness (CRT), vascular density (VD) and perfusion density (PD) of each group. The data of all subjects was applied to do one-way ANOVA. Results: Prolonged duration of diabetes in T2 and T3 compared to T0 and in T3 compared to T1. Elevated BUN in T3 compared to all other groups. When T1, T2 and T3 were compared to T0, and T3 was compared to T1, the VD of the 6 mm ×6 mm outer layer decreased. Reduced VD of intact 6 mm ×6 mm region in T1, T2 and T3 compared to T0. Declining PD of the 6 mm ×6 mm outer layer in T2 and T3 compared to T0. Diminished PD of whole 6 mm ×6 mm area at T3 compared to T0. The VD of 3 mm ×3 mm inner layer was significantly reduced in T3 compared to T0 and T1. The VD of 3 mm ×3 mm intact area gradually dwindled in T3 compared with T0 and T1 (P<0.05). Conclusion: With the progression of diabetic retinopathy, the levels of BUN and CRE gradually increased, and the OCTA-derived vascular density and perfusion density gradually decrease. Vascular density may be more sensitive for early diabetic retinopathy screening than perfusion density.The use of the Angiography6×6 model may result in an earlier detection of changes in retinal blood flow in diabetic retinopathy.

目的：探讨无糖尿病性视网膜病变(diabetic retinopathy，DR)的糖尿病人群中，糖尿病与近视对黄斑区节细胞-内丛状层(ganglion cell layer and inner plexiform layer，GCIPL)厚度纵向变化的影响。方法：纳入广州糖尿病眼病研究中1165名基线无视网膜病变的糖尿病和正常对照者，纵向随访2年。根据是否存在近视[等效球镜(spherical equivalent，SE)≤-3屈光度(diopter，D)]和糖尿病分为健康组(n=508)、糖尿病组(n=525)及糖尿病合并近视组(n=132)。扫频光学相干断层成像(swept source-optical coherence tomography，SS-OCT)技术测量并比较三组间GCIPL厚度的变化，以确定糖尿病和近视的影响，三组间差异使用协方差分析，采用线性混合模型分析评估GCIPL厚度与相关因素的关系。结果：对照组的SE为(1.07±1.06) D，糖尿病组为(1.02±1.00) D，糖尿病合并近视组为(-5.36±2.30) D，组间差异有统计学意义(P<0.001)。对照组基线GCIPL厚度为(71.1±0.3) μm，糖尿病组为(74.4±0.2)μm，糖尿病合并近视组为(71.7±0.5) μm。在2年随访过程中，对照组GCIPL厚度下降-0.10(95%CI：-2.03~0.05) μm/年，糖尿病组GCIPL厚度下降的速度为对照组的12倍[-1.21(95%CI：-24.04~0.05) μm/年，P<0.001]，糖尿病合并近视组GCIPL厚度下降的速度为对照组的22倍[-2.17(95%CI：-21.63~0.10)μm/年，P<0.001]。结论：近视是无DR的糖尿病患者中GCIPL加速变薄的危险因素，糖尿病和近视在GCIPL损伤中可能存在协同作用。

Objective: To investigate the association between myopia and ganglion cell layer and inner plexiform layer (GCIPL) in diabetic population without diabetic retinopathy (DR). Methods: In this Guangzhou Diabetic Eye study, a total of 1 165 patients aged 30–80 years were recruited followed up longitudinally for 2 years. According to the presence or absence of myopia [spherical equivalence (SE)≤-3 diopter (D)] and diabetics, the patients were divided into a healthy group (n=508), a diabetes mellitus group (n=525), and a diabetes mellitus + myopia group (n=132). GCIPL was measured via swept-source optical coherence tomography. Univariable and multivariable mixed models were used to show the association of GCIPL change and baseline parameters. Results: SE was (1.07±1.06) D in the healthy group, (1.02±1.00) D in the diabetes mellitus group and (-5.36±2.30) D in the diabetes mellitus + myopia group (P<0.001). The baseline GCIPL thickness were (71.1±0.3), (74.4±0.2), and (71.7±0.5) μm, respectively. The slope of GCIPL thickness was -0.10 (95% CI: -2.03 to 0.05) μm/year in the healthy group, which was 12 folds faster than those in the diabetes mellitus group [-1.21(95% CI: -24.04 to 0.05 μm/year, P<0.001] and 22 folds higher among those in diabetes mellitus + myopia group [-2.17 (95% CI: -21.63 to 0.10) μm/year, P=0.009]. Conclusion: Both myopia and diabetes status accelerate macular ganglion cell layer and inner plexiform layer thinning in diabetic patients without diabetic retinopathy.

报道1例人类免疫缺陷病毒(human immunodeficiency virus，HIV)眼部巨细胞病毒性视网膜炎(cytomegalovirus retinitis，CMVR)合并脉络膜结核瘤感染患者，主因双眼视物模糊2周就诊。经眼部检查发现右眼底颞侧视网膜广泛黄白色颗粒样病变，病灶边界可见黄白色奶酪样渗出，左眼下方视网膜大片黄白色渗出伴出血。在随访半年后发现左眼视网膜脉络膜隆起病灶，根据其全身及眼部临床特征，诊断为双眼CMVR伴左眼脉络膜结核瘤，予全身抗病毒及结核治疗后随访1年余，全身情况及眼部病灶稳定。

A case of human immunodeficiency virus (HIV) cytomegalovirus retinitis (CMVR) complicated with choroidal tuberculoma infection was reported. The patient visited hospital due to bilateral blurred vision for 2 weeks. Ocular examination showed extensive yellowish-white granular lesions in the temporal retina of the right fundus, with yellowish-white cheese-like exudation at the border of the lesion, and a large yellowish-white exudation with hemorrhage at the lower part of the left eye’s retina. After six months of follow-up, the patient was found to have a retinal choroid hump in the left eye. Based on her systemic and ocular clinical features, the patient was diagnosed as bilateral CMVR with choroidal tuberculoma of the left eye. The patient had her follow up check-up a year after her systemic antiviral and anti-tuberculosis treatment with her general condition stable and ocular lesions treated.

近年来随着人类生活方式的改变、用眼频率的增加，眼科药物的市场需求持续增长，但是目前眼病治疗仍面临“缺医少药”的困境。由于新药研发面临成本高、周期长、成功率低的风险，眼科药物创新迭代的进程日趋缓慢。人工智能(artificial intelligence，AI)作为一种全新的技术手段，有望赋能眼科药物研发的全过程，包括药物靶点发现、化合物筛选、药物动力学模型创新与临床试验开展等，以期为眼科药物研发“降本增效”。且随着大数据体系的完善、硬件计算力的提升以及生命科学与智能科学的深度融合，AI在眼科药物研发中的作用将进一步得到提升，助力眼科药物研发实现从精准化到智能化的跨越。

With the change of human lifestyle and overuse of eyes in recent years, the market demand for ophthalmic drugs continues to grow. However, the ocular therapy is still facing the shortage of doctors and drugs. Due to the risk of high cost, long lead time and low success rate, the process of novel ophthalmic drug innovation and iteration is getting slower. As an emerging technology, artificial intelligence is expected to enable the whole process of ophthalmic drug discovery and development, including drug target discovery, compound screening, pharmacokinetic model innovation and clinical trials, thus reducing R&D costs and increase efficiency for ophthalmic drug discovery and development. In addition, with the improvement of big data, hardware calculation and the deep integration of life science and intelligent science, the role of artificial intelligence in ophthalmic drug discovery and development will be significant improved , contributing to achieve the leap from precision to intelligence.

本文报告1例28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.

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.