目的：比较硬膜外导管辅助双路置硅胶管术与传统双路置硅胶管术在泪小管断裂吻合术中的疗效。方法：随机将连云港市第二人民医院52例(52眼)行泪小管断裂吻合术的患者分成两组，使用硬膜外导管辅助双路置硅胶管术为A组(30例)；使用传统手术方式(双路置硅胶管术)为B组(22例)。比较两组患者术中置管时间、平均手术时间、鼻腔出血率、术中疼痛评分、一次性吻合成功率的差异。结果：在术中置管时间方面，A组为(11.20±3.80) min，B组为(21.50±12.60) min；在平均手术时间方面，A组为(42.70±5.50) min，B组为(62.20±15.20) min；在术中疼痛评分方面，A组为(3.10±0.80)分，B组为(4.60±1.25)分；在鼻腔出血率方面，A组为3.33%(1/30)，B组为18.2%(4/22)，以上差异均有统计学意义(均P<0.05)；但在一次性吻合成功率方面，A组有效率为93.3%(28/30)，B组有效率为86.4%(19/22)，差异无统计学意义(P>0.05)。结论：在泪小管断裂吻合术中，应用硬膜外导管辅助双路置硅胶管术较传统双路置硅胶管术，在术中置管时间、手术平均时间、鼻腔出血率、患者疼痛程度等方面具有优势，2种置管一次性成功率的差异无统计学意义，硬膜外导管辅助双路置硅胶术方法安全、可靠、优势明显，值得临床手术推广。

Objective: To compare the efficacy of bicanalicular silicone intubation assisted with epidural catheters and traditional bicanalicular silicone intubation in the anastomosis of lacrimal canaliculus rupture. Methods: Fifty-two patients (52 eyes) were randomly divided into two groups. Patients in group A (30 cases) were treated by bicanalicular silicone intubation assisted with epidural catheters, while patients in group B (22 cases) were treated with conventional operation (bicanalicular silicone intubation). The intubation time, average operation time, nasal bleeding rate, intraoperative pain score and one-time success rate were compared between the 2 groups. Results: Intubation time in group A was (11.20±3.80) min and that in group B was (21.50±12.60) min (P<0.05). The mean operation time of group A was (42.70±5.50) min and that of group B was (62.20±15.20) min (P<0.05). Intraoperative pain score was 3.10±0.80 in group A and 4.60±1.25 in group B (P<0.05). The rate of nasal hemorrhage was 3.33% (1/30) in group A and 18.2% (4/22) in group B (P<0.05). With respect to one-time anastomosis success rate assessment, the effective rate was 93.3% (28/30) in group A, and 86.4% (19/22) in group B (P>0.05). Conclusion: During lacrimal canalicular anastomosis, bicanalicular silicone intubation assisted with epidural catheters is superior to bicanalicular silicone intubation in intubation time, average operation time, nasal bleeding rate and pain degree. There is no significant difference between the two methods in one-time success rate. Bicanalicular silicone intubation assisted with epidural catheters is safe, reliable, and worthy of promotion.

目的：探讨睑结膜乳头切除联合自体游离结膜瓣移植术治疗春季角结膜炎的临床效果。方法：在显微镜下对11例(22眼)春季角结膜炎患者行睑结膜乳头切除联合自体游离结膜瓣移植术，观察治疗效果。结果：术后随访36~48个月，11例(22眼)春季角结膜炎患者中，治愈19眼(86.36%)，有效2眼(9.09%)，无效1眼(4.55%)，总有效率95.45%。结论：睑结膜乳头切除联合自体游离结膜瓣移植术是治疗春季角结膜炎安全、有效的方法。

Objective: To evaluate the efficacy and safety of surgical resection of conjunctival papillae combined with autologous conjunctival graft in the treatment of vernal keratoconjunctivitis (VKC). Methods: All 11 cases (22 eyes) with VKC were treated with surgical resection of conjunctival papillae in combination with autologous conjunctival graft. Clinical efficacy and safety were evaluated. Results: After 36 to 48 months of follow-up, 19 eyes were cured (86.36%), 2 eyes were improved (9.09%), and 1 eye was ineffective (4.55%). The total effective rate was 95.45%. Conclusion: Surgical resection of conjunctival papillae combined with autologous conjunctival graft is efficacious and safe in the treatment of VKC.

目的：分析复发与初发睑板腺囊肿患者的睑板腺组织形态学改变在活体共聚焦显微镜(in vivo confocal microscope，IVCM)下的表现及特点。方法：采用横断面研究方法，选取2018年10月至2019年4月在汕头大学·香港中文大学联合汕头国际眼科中心门诊就诊的10例复发性睑板腺囊肿患者、10例初发性睑板腺囊肿以及10例对照组作为观察对象。所有对象行眼科常规检查及IVCM检查。IVCM检测指标包括睑板腺开口面积、开口最短径、开口最长径、睑板腺开口附近腺管形态、睑板腺腺泡样结构形态，分析比较三组的计量指标。结果：复发性睑板腺囊肿组睑板腺开口短径(109.08±49.96) μm，开口长径(144.95±68.10) μm，开口面积为11 621.62 (3 976.49~24 828.82) μm2；初发性睑板腺囊肿组睑板腺开口短径(101.53±29.55) μm，开口长径(130.08±45.21) μm，开口面积10 615.07(5 813.29~18 275.44) μm2；对照组睑板腺开口短径(44.14±14.37) μm，开口长径(55.98±13.46) μm，开口面积2 233.29(1 437.72~2 945.65) μm2。与对照组相比，复发性、初发性睑板腺囊肿组睑板腺开口短径、开口长径及开口面积均明显扩大，差异有统计学意义(P<0.05)；复发与初发睑板腺囊肿组之间差异不具有统计学意义(P>0.05)。复发性睑板腺囊肿组睑板腺腺管扩张，周边腺泡样结构纤维组织增生，伴有炎症细胞浸润。初发性睑板腺囊肿组睑板腺腺管扩张，周边腺泡样结构未见明显纤维组织增生。结论：IVCM可在活体下观察睑板腺囊肿患者睑板腺形态学上的微观改变，复发性睑板腺囊肿睑板腺腺泡样结构形态与初发性睑板腺囊肿表现有差异。

Background: To analyze the morphological changes of meibomian glands in patients with recurrent and primary meibomian gland cyst under in vivo confocal microscope (IVCM). Methods: A cross-sectional study was performed in Shantou International Eye Center from September 2018 to April 2019. Ten patients with recurrent meibomian cyst, 10 patients with primary meibomian cyst and 10 control subjects were selected in this clinical trial. All subjects received routine ophthalmologic examination and IVCM examination. IVCM examination parameters included open area of meibomian gland, and the maximum and minimum diameter of meibomian gland opening. Relevant parameters were analyzed and statistically compared among different groups. Results: The average minimum diameter of meibomian glands opening in the recurrent meibomian gland cyst group was (109.08±49.96) μm, the average maximum diameter of meibomian glands opening was (144.95±68.10) μm, and the median open area of meibomian gland was 11 621.62 (3 976.49–24 828.82) μm2. In the primary meibomian gland cyst group, the average minimum diameter of meibomian glands opening was (101.53±29.55) μm, the average maximum diameter of meibomian glands opening was (130.08±45.21) μm, and the median open area of meibomian gland was 10 615.07 (5 813.29–18 275.44) μm2. The opening of meibomian glands in both the recurrent and primary meibomian gland cyst groups was enlarged, which significantly differed from that in the control group (both P<0.05). No statistical significance was noted between the recurrent and primary meibomian gland cyst groups (P>0.05). The acinus structure around the gland tube was manifested with serious hypertrophic scar complicated with inflammatory cell infiltration. Conclusion: IVCM can detect the morphological changes of meibomian glands in meibomian gland cyst patients. The IVCM findings of recurrent and primary meibomian gland cyst are different.

目的：探讨分析联合应用氦氖激光、重组人干扰素α-2b抑菌软膏与加巴喷丁对急性眼周带状疱疹患者皮损愈合、睡眠、疼痛及病程的改善效果。方法：收集2017年1月至2020年1月在河南大学淮河医院就治的急性眼周带状疱疹患者60例。依据治疗方案不同将其分为实验组与对照组，实验组32例，对照组28例。对照组进行常规基础治疗包括抗病毒、营养神经、重组人干扰素α-2b抑菌软膏与加巴喷丁胶囊治疗，实验组较对照组加用氦氖激光治疗。收集皮疹消肿、止疱、结痂、脱痂与止痛时间，疼痛视觉模拟量表(Visual Analogue Scale，VAS)评分、睡眠时间、不良反应以及有无遗留后神经痛等情况并进行比较分析。结果：两组治疗前各项观察指标均无明显差别，差异无统计学意义(P>0.05)；经治疗后，实验组皮疹观察指标(消肿、止疱、结痂、脱疱)时间及止痛时间均明显少于对照组，治疗后4 d与7 d结痂率均明显高于对照组；治疗后两组患者睡眠时长均延长，VAS评分均降低，差异具有统计学意义(P<0.05)；对于缓解疼痛，延长睡眠时长实验组均优于对照组(P<0.05)。而治疗后2、14、28 d结痂率差异均无统计学意义(均P>0.05)。实验组有效率(93.75%)显著高于对照组(75%)，差异有统计学意义(P=0.047)；两组发生PHN与不良反应差异无统计学意义(P>0.05)。结论：氦氖激光联合重组人干扰素α-2b抑菌软膏与加巴喷丁治疗急性眼周带状疱疹安全有效，可明显缓解患者急性期疼痛，促进皮疹痊愈，改善睡眠质量，缩短病程，可在临床积极推广使用。

Objective: To investigate and analyze the effect of He-Ne laser, recombinant human interferon α-2b ointment and gabapentin on skin lesion healing, sleep, pain and disease course in acute herpes zoster ophthalmicus. Methods: Sixty patients with acute herpes zoster ophthalmicus were collected from January 2017 to January 2020 in our hospital. According to the different treatment, they were divided into an experimental group (32 cases) and a control group (28 cases). The patients in the control group received routine basic treatment including antiviral, neurotrophic therapy, interferon α-2b ointment and gabapentin, and the experimental group was treated with He-Ne laser on the basis of control group treatment. The time of detumescence, blister stopping, scab formation, scab removal and pain relief, Visual Analogue Scale (VAS) score, sleep time, adverse reactions, and postherpetic neuralgia were collected and analyzed. Results: Before treatment, there was no significant difference in the observation indexes between the two groups (P>0.05); after treatment, the observation indexes of skin rash (detumescence, blister stopping, scab formation, scab removal) and pain relief time in the experimental group were significantly less than those in the control group, and the scab removal rate on the 4th and 7th days post-treatment in the experimental group was significantly higher than that in the control group; after treatment, the sleep duration was prolonged, and the VAS score was decreased. For pain relief and prolonging sleep time, the experimental group was better than the control group, and the difference was statistically significant P<0.05). There was no significant difference in scab removal rate on 2, 14 and 28 days post-treatment (P>0.05). The effective rate in the experimental group (93.75%) was significantly higher than that in the control group (75%), and the difference was statistically significant (P=0.047); there was no significant difference in PHN and adverse reactions between the two groups (P>0.05). Conclusion: He-Ne laser combined with interferon α-2b ointment and gabapentin is safe and effective in the treatment of acute herpes zoster ophthalmicus. It can significantly relieve the acute pain, promote the recovery of rash, improve sleep quality, shorten the disease course, and can be actively promoted in clinical usage.

目的：观察和评价改良联合筋膜鞘(combined fascial sheath，CFS)悬吊术治疗复发性上睑下垂的可行性和临床效果。方法：纳入2017年3月至2020年3月于河北省眼科医院眼整形门诊就诊的26例复发性重度上睑下垂患者(32只眼)，均采用改良CFS悬吊术予以矫正。术后随访1年，分别于术后1个月、3个月、6个月及1年时复诊，对患者术后上睑缘中点到角膜反光点的距离(marginal reflex distance-1，MRD1)、眼皮折皱深度、长度、弧度和并发症等情况为主要观察指标给予记录和效果评估。结果：26例患者共32只患眼，临床治愈27只眼(84.4%)，改善4只眼(12.5%)，无效1只眼(3.1%)，对1只无效眼术后6个月进行再次调整，调整后达到临床治愈标准。1例出现结膜脱垂，经过药物与加压包扎治疗后结膜脱垂症状消失，无暴露性角膜炎或其他并发症发生病例。结论：改良CFS悬吊术矫正复发性重度上睑下垂，具有操作简单、创伤小、治疗效果确切、并发症少等优点，值得临床推广与应用。

Objective: To observe and evaluate the feasibility and clinical effect of modified combined fascial sheath (CFS) suspension on the treatment of recurrent severe blepharoptosis. Methods: A total of 26 patients (32 eyes) with recurrent severe ptosis treated in Hebei Eye Hospital from March 2017 to March 2020 were included. All patients were corrected by modified CFS suspension. The patients were followed up for 1 year, and returned to the hospital at 1 month, 3 months, 6 months and 1 year respectively. The marginal reflex distance-1 (MRD1), eyelid crease depth, length, radian, and complications were recorded as the main observation indexes and the effect was evaluated. Results: In the 32 eyes of 26 patients, 27 eyes (84.4%) were completely corrected, 4 eyes (12.5%) were improved, while 1 eye (3.1%) had no improvement, the invalid eye was adjusted again 6 months after operation, and reached the effective standard after adjustment. Conjunctival prolapse occurred in 1 case, and the symptoms of conjunctival prolapse disappeared after the treatment with drugs and pressure dressing, and no case of exposure keratitis or other complications occurred. Conclusion: Modified combined fascial sheath suspension is an effective method on the treatment of recurrent severe blepharoptosis with the advantages of simple operation, less trauma, definite therapeutic effect, and fewer complications, which is worthy of clinical promotion and application.

目的：观察中药超声雾化联合针灸治疗睑板腺功能障碍(meibomain gland dysfunction，MGD)的临床疗效。方法：选取在新华医院就诊的77例(154眼)双眼MGD患者，随机分为对照组(27例54眼)、中药超声雾化治疗组(雾化组；25例50眼)和中药超声雾化联合针灸治疗组(联合治疗组；25例50眼)。对照组接受睑板腺按摩治疗，雾化组在睑板腺按摩的基础上行中药超声雾化治疗，联合治疗组为进一步加用针灸治疗，治疗周期为4周。治疗前后收集患者双眼泪膜破裂时间(tear breakup time，BUT)、双眼基础泪液分泌试验数据(Schirmer I test，SIT)、双眼角膜荧光素染色评分(fluorescent，FL)、睑板腺分泌物性状评分(Meibomian Glandyielding Secretion Score，MGYSS)、睑缘异常评分(Eyelid Margin Abnormality Score，EMAS)以及主观症状积分等资料，并评价临床疗效。结果：治疗前三组BUT、SIT、FL、MGYSS、EMAS和主观评价得分等组间差异均无统计学意义(均P>0.05)。治疗4周后，各组受试者的BUT、SIT、FL评分、MGYSS评分、EMAS评分和主观评价评分与治疗前相比差异均具有统计学意义(均P<0.05)；联合治疗组的上述指标分别与雾化组及对照组相比，差异均有统计学意义(P<0.05)。治疗后对照组的总有效率为51.85%(28眼/54眼)，雾化组为84%(42眼/50眼)，联合治疗组为96%(48眼/50眼)，联合治疗组总有效率与雾化组相比差异有统计学意义(P<0.05)。结论：中药超声雾化联合针灸治疗在改善MGD患者的睑板腺功能和减轻患者的干眼症状方面具有较好的临床疗效。

Objective: To observe the clinical efficacy of ultrasonic atomization fumigation of traditional Chinese medicine combined with acupuncture in the treatment of meibomian gland dysfunction (MGD). Methods: A total of 77 MGD patients (154 eyes) in Xinhua Hospital were selected and randomly divided into a control group (27 cases, 54 eyes), a ultrasonic atomization of traditional Chinese medicine group (atomization group; 25 cases, 50 eyes), and a ultrasonic atomization of traditional Chinese medicine combined with acupuncture group (combined treatment group; 25 cases, 50 eyes). The control group received meibomian gland massage, the atomization group received meibomian gland massage and ultrasonic atomization of traditional Chinese medicine, and the combined treatment group received additional acupuncture treatment. The treatment period was 4 weeks. Tear breakup time (BUT), basal tear secretion test data (Schirmer I Test, SIT), corneal fluorescein staining score (FL), and Meibomian Gland Yielding Secretion Score (MGYSS), Eyelid Margin Abnormality Score (EMAS), Subjective Symptom Score (SSS) were collected and conduct clinical efficacy were evaluated. Results: There were no significant differences in BUT, SIT, FL, MGYSS, EMAS and SSS among the three groups (all P>0.05). After treatment of 4 weeks, the BUT, SIT, FL, MGYSS, EMAS and SSS in each group were improved significantly compared to baseline (P<0.05). The above indicators in combined treatment group were significantly different from atomization group (P<0.05) and control group (P<0.05). The total effective rates after treatment were 51.85% (28/54) in control group, 84% (42/50) in atomization group, and 96% (48/50) in combined treatment group. The difference in total effective rate between combined treatment group and atomization group was significant (P<0.05). Conclusion: Ultrasonic atomization of traditional Chinese medicine combined with acupuncture presents good clinical effects in improving the meibomian gland function of patients with MGD and alleviating the dry eye symptoms.

眼肌型重症肌无力(ocular myasthenia gravis，OMG)是一种累及神经肌肉接头突触后膜的自身免疫性疾病。OMG波动性的临床特征易导致较高的漏诊率和误诊率，严重影响患者的生活质量。因此，检测方法在早期确诊OMG中发挥重要作用。本文围绕临床检查、新斯的明试验、自身抗体检测、电生理检测等方面对OMG检测方法作一综述，以期为OMG的早期确诊提供有益的指导。

Ocular myasthenia gravis (OMG) is an autoimmune disease involving the postsynaptic membrane of the neuromuscular junction. The fluctuation of OMG and the clinical characteristics of fatigue easily lead to a high rate of missed diagnosis and misdiagnosis, which seriously affects the quality of life of patients. Therefore, detection methods play an important role in the early diagnosis of OMG. In this paper, OMG detection methods were reviewed in clinical examination, neostigmine test, autoantibody detection, electrophysiological detection, and other aspects, in order to provide useful guidance for the early diagnosis of OMG.

睑板腺功能障碍(meibomian gland dysfunction，MGD)是眼科常见疾病，是蒸发过强型干眼的主要原因。基于人群流行病学的调查显示：MGD亚洲的发病率为46.2%~69.3%。目前，MGD治疗的方式包括眼睑清洁、热敷、睑板腺按摩、人工泪液、抗生素等，其中热敷为常用的家庭治疗方法。由于不同的热敷方式、温度、时间、频次及依从性，导致应用热敷治疗MGD到目前为止还没有统一标准。另外，热敷的不良反应如视物模糊、皮肤烫伤等，也没有引起临床足够重视。因此，为提高热敷的临床疗效及减少其不良反应，未来进行热敷的规范化指导或治疗很有必要。

Meibomian gland dysfunction (MGD) is a common ophthalmic disease, which is the main cause of evaporative dry eye. Population-based studies have suggested that the prevalence of MGD is high in Asia, with a reported incidence of 46.2% to 69.3%. Current modalities of MGD treatment include lid hygiene, warm compresses, massage, artificial lubricants, systemic and topical antibiotics, etc., among which warm compress is a common at-home treatment. Due to different eyelid warming methods, temperature, durations of heat application, frequency and compliance, there is no uniform standard for the application of warm compress to the treatment of MGD. In addition, adverse events of warm compress, such as blurred vision and thermal damage, have not attracted enough attention in clinical practice. Therefore, in order to improve the clinical efficacy of warm compress and reduce its adverse events, it is necessary to conduct standardized guidance or treatment of warm compress in the future. Based on the above considerations, this article will briefly review the application of warm compress to the treatment of MGD.

原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction，PANDO)是泪道阻塞性疾病中最常见的一类，好发于中老年女性，是眼科临床上的常见病、多发病，常继发急性或慢性泪囊炎的症状和体征，严重影响患者的日常工作和生活。本文对近年来PANDO可能的发病机制相关的研究进展、亟待解决的问题及未来研究的热点方向作一综述，旨在进一步加深对泪道阻塞性疾病发生发展的认识。

Primary acquired nasolacrimal duct obstruction (PANDO), which mainly occurs in the middle-aged and elderly women, is the most common type of obstructive diseases of the lacrimal duct, and it is also a common and frequently-occurring disease in ophthalmology. It constantly occurs secondary to various symptoms and signs of acute or chronic dacryocystitis, which seriously affects the daily work and life of patients. This article summarizes the research progress on the possible pathogenesis of PANDO in recent years, the urgent problems to be solved and the hot research directions in the future, aiming to further deepen the understanding of the occurrence and development of lacrimal obstructive diseases.

一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。

2. Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou 510630, China)