目的：构建、实施并评价眼科日间手术健康教育模式的有效性。方法：依托信息化手段和Teach-back法，构建眼科日间手术健康教育模式。选取2020年1月至2021年5月中山大学中山眼科中心日间手术患者177例为研究对象，采用历史对照研究法，对照组97例，观察组80例。对照组予常规健康宣教，观察组予基于信息化和Teach-back法的健康教育模式，比较2组患者健康教育知识掌握情况和围手术期护理满意度。结果：观察组健康教育知识自评得分和实际掌握程度得分均显著高于对照组(P<0.05)；2组患者体位护理知识得分和护理工作满意度得分之间的差异无统计学意义(P>0.05)。结论：构建基于信息化和Teach-back法的健康教育模式可以提高眼科日间手术患者健康教育知识掌握度，但对于患者体位护理知识掌握程度和护理工作满意度方面的影响还需要进一步研究。
Objective: To construct, implement and evaluate the effectiveness of the health education model for ophthalmic day surgery. Methods: The health education model for ophthalmic day surgery was constructed relying on information-oriented means and Teach-back method. A total of 177 patients with day surgery in Zhongshan Ophthalmic Center from January 2020 to May 2021 were selected as the research subjects and divided into a control group (n=97) and an intervention group (n=80) by historical comparative study. The intervention group was carried out with the health education model based on information-oriented means and Teach-back method, while the control group received the routine health education. The health education knowledge and perioperative nursing satisfaction were compared between the 2 groups. Results: The scores of self-evaluation and nurse evaluation for health education knowledge in the intervention group were significantly higher than those in the control group (P<0.05). There was no significant difference in body position nursing knowledge score and nursing satisfaction score between the 2 groups (P>0.05). Conclusion: The health education model based on information oriented means and Teach-back method can improve the health education knowledge level of patients with ophthalmic day care surgery. In the meanwhile, further studies will be needed to explore the effects on patients in body position nursing knowledge and nursing satisfaction.
外伤、感染、先天性疾病等均可能破坏角膜的组织结构和细胞稳态，同时造成角膜干细胞缺损，进而导致组织无法正常愈合，引起角膜盲，是世界范围内致盲的重要原因之一。目前已有多种干细胞相关的技术方法应用于重建功能性角膜组织，取得了瞩目的治疗效果。本综述以角膜缘干细胞缺乏症为主，旨在介绍多种来源的干细胞在角膜重建中的研究现状和最新进展，同时对不同干细胞的特异性标志物的研究进展进行阐述。
Trauma, infection and congenital diseases may disrupt the tissue structure and cellular homeostasis of the cornea, while causing impaired function of corneal stem cell defects, which in turn may even lead to corneal blindness caused by the inability of the tissue to heal properly. Corneal blindness is one of the major causes of blindness worldwide. Several stem cell-related techniques have been applied to reconstruct functional corneal tissue with impressive therapeutic results. This review focuses on corneal limbal stem cell deficiency and aims to present the current status and recent progress of research on stem cells from multiple sources in corneal reconstruction, as well as to describe specific markers of corneal stem cells.
目的：调查抗VEGF药物治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration, wAMD)5年的疗效。方法：2011年至2021年于北京医院眼科诊断为wAMD的患者共84人103只眼进行回顾性分析。抗VEGF治疗采用3+PRN方案。观察5年来的最佳矫正视力(best-corrected visual acuity，BCVA)、玻璃体腔注射次数、随访次数和病灶的解剖学变化。结果：治疗5年后平均BCVA为38.1个字母，与基线相比下降9.4个字母，差异有统计学意义(P<0.001)。23.3%的患眼5年后可维持初始视力。5年内平均注射次数为13.8次，第1年注射次数最多，平均为4.3次。5年内平均随访次数为24.3次，仅有34.0%的患眼可遵循每次随访间隔≤3个月。5年后有68.0%的患眼出现纤维瘢痕，27.2%的患眼出现地图样萎缩，69.0%(71/103)的患眼存在持续的色素上皮脱离(pigment epithelial detachment，PED)。年龄、基线BCVA、是否初始治疗、随访年限、注射次数、中心视网膜厚度 (central retina thickness，CRT)、地图样萎缩等对BCVA有显著影响。结论：多数患者在抗VEGF治疗1年内可维持视力，但5年以上维持效果不佳。早期诊治、提高注射频率，可能是未来改善预后的研究方向。
Objective:To investigate the efficacy of anti-VEGF injection in the treatment of wet age-related macular degeneration (wAMD) for 5 years. Methods: A total of 84 patients (103 eyes) wAMD diagnosed in Department of Ophthalmology in Beijing Hospital from 2011 to 2021 were analyzed retrospectively. 3 + PRN regimen was applied for anti-VEGF treatment. The changes of best corrected visual acuity (BCVA), the number of intravitreal injections and the number of follow-up visits, and the anatomical changes of the lesions in the past 5 years were collected. Results: The average BCVA after 5 years was 38.1 letters, indicating a decrease of 9.4 letters comparing to baseline, which was statistically significant (P<0.001). 23.3% of the eyes could maintain the baseline BCVA after 5 years. The average injection times within 5 years was 13.8, and the injection was concentrated in the first year, with an average of 4.3. The average number of follow-up visits within 5 years was 24.3, and only 34.0% of the affected eyes could keep the follow-up interval ≤3 months. After 5 years, 68.0% of the eyes developed fibrous scar, 27.2% developed geographic atrophy, and 69.0% (71/103) had consistent pigment epithelial detachment. Factors significantly affect BCVA include: age, baseline BCVA, initial treatment, follow-up time, injection times, central retinal thickness, geographic atrophy and so on. Conclusion: Most patients can maintain vision within the first year after anti-VEGF treatment, but the efficacy is poor for more than 5 years. Early diagnosis and treatment, and increased injection frequency may be the research direction for improving prognosis in the future.
将课程思政理念融入专业课程是落实立德树人根本任务和全面推进课程育人的重要途径。本文根据课程思政的内涵要求和发展实际，结合实验室技能培训课程特点，从知识点、人与社会、故事、案例辨析、实验操作5个方面进行思政探索和实践。通过优化教学设计、创新教学方法和丰富教学内容，切实将社会主义核心价值观教育贯穿专业课教育全过程，为眼科学及分子医学专业课相关课程的思政教学和高质量人才培养提供了有价值的参考。
Integrating ideological and political concepts of the curriculum into the professional curricula is an important way to implement the fundamental task of cultivating people with morality and comprehensively promote the education of people through the curriculum. Based on the connotation requirements and actual development of the integration of ideological and political education throughout curriculum, considering the features of laboratory skills training courses, this paper explores ideological and political education in 5 aspects. The 5 aspects include knowledge points, humans and society, stories, case analysis, and experimental operation. By optimizing teaching design, innovating teaching methods, and enriching teaching contents, the education of socialist core values should be effectively carried out throughout the whole process of professional course education, which provides a valuable reference for the ideological and political teaching in ophthalmology and molecular medicine related courses and for the cultivation of high-quality talents.
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1 165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±2.30D)，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：0.05~-2.03) 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：0.05~?24.04) 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：0.10~-21.63) 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 Eyestudy, a total of 1165 patients aged 30–80 years were recruited followed up longitudinally for 2 years. According tothe presence or absence of myopia [spherical equivalence (SE)≤-3 diopter (D)] and diabetics, the patients weredivided 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 multivariablemixed 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 thediabetes 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: 0.05 to -2.03) μm/year in the healthy group, which was 12 folds faster than those in the diabetes mellitus group [-1.21(95% CI: 0.05 to-24.04) μm/year, P<0.001] and 22 folds higher among those in diabetes mellitus + myopia group [-2.17 (95%CI: 0.10 to ?21.63) μm/year, P=0.009]. Conclusion: Both myopia and diabetes status accelerate macular ganglioncell layer and inner plexiform layer thinning in diabetic patients without diabetic retinopathy.
Background: Laser photocoagulation restricted to ablation of the avascular retina has been the conventional but not a completely effective treatment strategy in the management of threshold retinopathy of prematurity (ROP). The purpose of this study was to compare the structural outcomes of additional posterior to ridge diode laser compared to conventional diode laser to avascular retina alone in threshold stage III ROP.
Methods: This was a prospective, randomized study involving infants diagnosed with threshold stage III ROP in one or both the eyes. The infants were randomized into control and study groups. Infants under the control group underwent conventional laser to avascular retina alone while infants under the study group received additional two rows of laser posterior to the ridge in the vascular retina. The infants were followed up at 2 weeks, 1 month and up to 6 months after the laser procedure.
Results: During the study period of 1 year, 42 eyes of 24 infants were recruited into this study with 21 eyes in each group. The mean birth weight was 1,310.48±400.92 g in the test group and 1,341.9±396.2 g in the control group. The mean post conceptional age at the time of intervention was 36.43±2.79 weeks in test group and 36.29±2.55 weeks in the control group. At 1-month post laser, 19 eyes in the study group showed regression of neovascularization laser compared to 18 eyes in the control group. However at the end of 3 and 6 months post laser, both groups had showed similar rates regression of neovascularization (19 of 21 eyes in both groups). Five eyes in the study group and six in the control group required additional laser treatment. Two eyes in the study group and one eye in the control group developed post laser vitreous hemorrhage.
Conclusions: Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser.
Background: Laser photocoagulation restricted to ablation of the avascular retina has been the conventional but not a completely effective treatment strategy in the management of threshold retinopathy of prematurity (ROP). The purpose of this study was to compare the structural outcomes of additional posterior to ridge diode laser compared to conventional diode laser to avascular retina alone in threshold stage III ROP.
Methods: This was a prospective, randomized study involving infants diagnosed with threshold stage III ROP in one or both the eyes. The infants were randomized into control and study groups. Infants under the control group underwent conventional laser to avascular retina alone while infants under the study group received additional two rows of laser posterior to the ridge in the vascular retina. The infants were followed up at 2 weeks, 1 month and up to 6 months after the laser procedure.
Results: During the study period of 1 year, 42 eyes of 24 infants were recruited into this study with 21 eyes in each group. The mean birth weight was 1,310.48±400.92 g in the test group and 1,341.9±396.2 g in the control group. The mean post conceptional age at the time of intervention was 36.43±2.79 weeks in test group and 36.29±2.55 weeks in the control group. At 1-month post laser, 19 eyes in the study group showed regression of neovascularization laser compared to 18 eyes in the control group. However at the end of 3 and 6 months post laser, both groups had showed similar rates regression of neovascularization (19 of 21 eyes in both groups). Five eyes in the study group and six in the control group required additional laser treatment. Two eyes in the study group and one eye in the control group developed post laser vitreous hemorrhage.
Conclusions: Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser.
木村病(Kimura disease，KD)是一种罕见的、病因不明的、可能由免疫介导的慢性进行性炎症性疾病。本文分析1例8岁的男性患者，因左眼无痛性上睑下垂、影像学提示双眼泪腺占位、血象提示嗜酸性粒细胞及免疫球蛋白E(immunoglobulinE，IgE)水平升高、病理提示大量嗜酸性粒细胞浸润，被最终诊断为累及双侧泪腺的KD。行左眼眶肿物切除术后，对患者随访6个月期间未见复发。
Kimura disease (KD) is a rare chronic progressive inflammatory disease of unknown etiology that may be immunemediated. Herein, we analyze an 8-year-old male patient who was diagnosed with painless ptosis in the left eye, double tear glands on imaging, elevated levels of eosinophils and immunoglobulin E (IgE) on blood, and massive eosinophil infiltration on pathology. The final diagnosis was Kimura disease involving bilateral lacrimal glands. After resection of the left orbital tumor, no recurrence was observed in the six months postoperation follow-up
患者，女，62岁，自觉右眼突出2年就诊，高血压3年。专科体格检查：右眼上睑退缩约1.5mm，左眼上睑下垂约2.5mm。提上睑肌肌力右眼13mm，左眼9mm。完善眼眶CT及头颅磁共振，未见异常。查阅文献，初步诊断为假性正负眼睑综合征。假性正负眼睑综合征符合赫林定律。通过左眼抬高试验发现右眼上睑退缩明显好转，安排左眼手术。术中发现左眼提上睑肌腱膜撕脱约7mm，故行左眼提上睑肌前徙复位术，术后双眼上睑均回归正常位置且两边对称。假性正负眼睑综合征最常见的病因是重症肌无力，其他原因还包括甲状腺相关眼病、先天性上睑下垂、动眼神经麻痹、老年性上睑下垂及上睑成形术并发症等。临床工作中需抓住疾病的蛛丝马迹，真正做到诊疗如棋、破局而立，使患者得到精准的治疗。
A 62-year-old female patient presented with right eye protrusion for 2 years and hypertension for 3 years. Physical examination showed that the upper eyelid retraction of the right eye was about 1.5 mm, and the ptosis of left eye was about 2.5 mm. The levator upper eyelid muscle strength was 13 mm in the right eye and 9 mm in the left eye. Orbital CT and cranial MRI were completed, and no abnormalities were found. A preliminary diagnosis of pseudo plus-minus lid syndrome was made by literature review. Pseudo plus-minus lid syndrome conforms to the Herring’s law. The upper eyelid retraction of the right eye was significantly improved by the left eye elevation test. During the left eye surgery, it was found that the left levator aponeurotic was avulsed about 7 mm. so the left levator aponeurosis was repositioned. After the operation, the upper eyelids of both eyes returned to the normal position and both sides were symmetrical. The most common cause of pseudo Plus—Minus Lid Syndrome is myasthenia gravis. Other causes include thyroid-associated ophthalmopathy, congenital ptosis, oculomotor nerve palsy, senile ptosis, and complications of blepharoplasty. In clinical work, we need to grasp the clues of the disease, truly achieve the diagnosis and treatment like chess, break the game and stand, so that patients can get accurate treatment.
目的：研究“中山眼鼻相关疾病·内镜论坛”的培训效果及其影响因素。方法：采用调取平台数据和调查问卷的方法，研究2020年6月至2022年5月16期“中山眼鼻相关疾病·内镜论坛”的参与人员情况和培训效果反馈，并分析专业、职称、地域等因素对培训效果的影响。结果：学员合计7889人，27634人次，以副主任医师30.2%(2382人)和主治医师32.9%(2597人)为主。参与学员人数从第1期的269人，逐渐增加到第16期的2537人。学员参与人数最多和收获最大的主题均为应用解剖和影像学、甲状腺相关眼病、泪道疾病。通过调查问卷发现：75.4%(95/126)的学员认为所学内容对今后的临床工作具有非常大的作用；84.1%(106/126)的学员应用所学的知识改进了日常临床工作；96.0%(121/126)的学员愿意参加中山眼科中心举办的线下实操的眼鼻相关解剖学习班。对于所学知识在今后临床工作的作用，副主任医师和主治医师认为“非常有用”的比例明显高于主任医师。在是否将所学知识应用于日常临床工作方面，副主任医师和主治医师认为“是”的比例明显高于主任医师和住院医师。参与6~16次论坛的学员，培训效果明显优于参与1~5次的学员。结论：眼鼻相关疾病·内镜微创领域在眼科和鼻科领域关注度日益提升。“中山眼鼻相关疾病·内镜论坛”有助于学员理论知识的扩展和提升，对眼鼻相关疾病医生的日常临床工作具有很好的作用，主治医师和副主任医师职称的学员培训效果更好，参与论坛次数多的学员培训效果更好。
Objective: To assess the training effects of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” and its influencing factors, propose targeted suggestions for training focus and teaching methods, and improve the teaching quality. Methods: Statistics of live broadcast platform data and custom-designed questionnaires were used to inquire the participants enrolled in the 16 sessions of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” from June 2020 to May 2022 for their feedbacks on training effects. The influence of their professions, titles, regions and other factors on the training effects was analyzed. Results: A total of 7 899 participants were enrolled in “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums”, and the total live broadcast person-time was 27 634. Associate senior doctors (30.2%, 2 382) and attending doctors (32.9%, 2 597) accounted for the largest proportion. The number of participants gradually increased from 269 in the first session to 2 537 in the 16th. The topics with the largest number of participants and the greatest gains were applied anatomy and imaging, thyroid associated ophthalmopathy, and lacrimal duct diseases. Through the questionnaire study, 75.4% (95/126) of the participants thought that what they had learned in the forums was very important for their future clinical work; 84.1% (106/126) of the participants applied the knowledge to improve their daily clinical work; 96.0% (121/126) of the participants were willing to participate in the offline practice of eye and nose anatomy classes held by Zhongshan Ophthalmology Center. In terms of the role of the learned knowledge in the future clinical work, the proportion of associate senior doctors and attending doctors who thought "very useful" was significantly higher than that of senior doctors. In terms of whether to apply the knowledge learned to daily clinical work, the proportion of associate senior doctors and attending doctors thinking “yes” was significantly higher than that of senior doctors and residents. Participants who participated in 6–16 sessions had significantly better training results than those who participated in 1–5 sessions. Conclusion: Eye and nose related diseases are attracting increasing attention in ophthalmology and rhinology. “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” are conducive to the expansion and improvement of participants’ theoretical knowledge, and plays a good role in the daily clinical work of doctors with eye and nose related diseases. The training effect of attending doctors and associate senior doctors is better, and the training effect of participants who participate in the forum more times is better.
