医学教育
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
专家述评
Blepharoptosis is one of the most common diseases in oculoplastics. Due to the particularity of children in the stage of growth and development, non-standard diagnosis and treatment not only affect the appearance, but also lead to the retardation of visual function development. Currently, there are no uniform standards and consensus on the choice of surgical timing and methods for pediatric congenital blepharoptosis. Here through refined classification of congenital blepharoptosis, we try to elucidate the choice of surgical timing for congenital blepharoptosis patients combined with amblyopia caused by a variety of reasons. By comparing different surgical methods, we analyze their mechanisms and advantages, and illustrate the surgical indication for severe congenital blepharoptosis, so as to standardize the choice of surgical timing and methods for pediatric congenital ptosis, improve the surgical success rate, and reduce the occurrence of amblyopia.
发明与创新
Abstract To meet the needs of the postoperative position nursing after pars plana vitrectomy in the day surgery mode, this research team has designed a nursing chair [patent number: National Uutility Model Patent (ZL 2017 2 0942404. 1)] based on the original chair of ophthalmic day ward, adding the functions of postvitreous nursing and so on. The seat is made from steel spray plastic (or stainless steel), wood, sponge and artificial leather, and the structure mainly consists of the main body, the countertop for prone position, the junk basket, the storage rack, and the infusion rod sleeve. The seat can be made by simple materials. The seat is easy to operate and safe to use, which can not only meet the needs of clinical body position nursing care, but also save the ward’ space and facilitate the environmental management of the ward.
论著
Objective: To study the effects of cholesterol, the main component of drusen, on the expression plasma membrane Ca2+ ATPase 1 (PMCA1), L-type voltage-dependent calcium channel (LVDCC) and cell membrane sodium calcium exchange protein 1 (NCX1) of ARPE-19 cells. Methods: The ARPE-19 cell line was cultured in vitro, and the cells were divided into a control group and a cholesterol treatment group (2.5 mg/mL). The treatment time was 0, 6, 12, 24, 48, 72 hours. Real-time quantitative PCR was used to detect the expression of PMCA1, LVDCC and NCX1 at the mRNA level, and western blot was used to detect the expression at the protein level. Results: The mRNA and protein expression levels of PMCA1 which mainly responsible for the efflux of intracellular calcium ions, was down regulated under cholesterol treatment. Meanwhile, the expression of the mRNA and protein of the calcium inflow channel LVDCC and calcium stability regulatory protein NCX1 were significantly increased, and the time-dependency was present, which was up expressed to 24 or 48 h and then fell back. Among them, the LVDCC expression had a large number of times. Conclusion: Cholesterol, the main component of drusen, can affect the expression of calcium channels in human retinal pigment epithelial cells. The expression of PMCA1 was suppressed by cholesterol, and expression of LVDCC and NCX1 were up-regulated with cholesterol treatment, which may affect intracellular calcium efflux then cause calcium influx. Whether it can further cause intracellular calcium overload and cell death is worth exploring.
论著
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
论著
Objective: To analyze the status of medical emergencies of patients in ophthalmic hospitals and put forward suggestions on their prevention and control measures. Methods: The medical emergencies of 82 patients in ophthalmic hospitals in 2017 and 2018 was been analyzed retrospectively, and the characteristics and treatment of emergencies as well as the metastasis and progression of the disease in patients were analyzed specifically. Results: Medical emergencies were caused by druginduced adverse reaction (n=38, 46.3%), syncope (28.0%), cardiovascular emergency (8.3%), accidents (6.1%) in sequence. Fluorescein sodium (n=16, 42.1%) and local anesthesia drugs for nerve block (n=7, 18.4%) were the most common drugs related to drug adverse reaction. Most cases happened at 8:00—18:00 (n=74, 91.3%), and drug adverse reaction and cardiovascular and cerebrovascular emergencies were most common at 18:00—8:00. Medical emergencies happened in outpatient department (n=53, 64.6%), wards (22.0%) and operation rooms (11.0%). There were mild emergencies (92.7%), moderate emergencies (4.9%) and severe emergencies (2.4%) in patients. Among them, 50% of patients need first aid by doctors from general hospitals or to be transferred to the general hospital for further treatment. Conclusion: Through optimizing process, shortening the hospital stay, identifying potential risks and enhancing medical workers’ awareness of safety, the risk of medical emergencies can be reduced. We should give full play to the professional advantages of anesthesiologists, improve the emergency handling capacity of the hospital, and contract the emergency services of designated general hospitals to provide rapid, accurate and efficient rescue for patients to ensure the life safety of patients.
论著
Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods: Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion: Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore, the surgical method needs to be cautious and still requires clinical observation.
论著
Objective: To investigate the status of visual display terminal syndrome (VDTS) in civil aviation pilots and analyze the causes, so as to provide evidence for eye health care of pilots. Methods: A questionnaire survey was conducted among 1 631 pilots to understand the exposure time and to compare the incidence rate of discomfort in participants with different exposure intensities. Results: The average exposure time of pilots’ video terminals was (4.43±2.24) h. The incidence rate of VDTS and the detection rate of discomfort increased with the increase of exposure time. Conclusion: Prolonged exposure to video terminal is not conducive to eye health. The eye health education for pilots should be strengthened to avoid or reduce the health hazards caused by video terminal exposure.
论著
Objective: The aim of this study was to compare the consistency of objective optometry results between VX120 multi-diagnostic unit and TopconKR800 automatic optometer. Methods: A total of 24 patients (24 right eyes) admitted to our hospital from November 2019 to December 2019 for corneal refractive surgery were collected. Optometry was performed on 24 patients with TopconKR800 automatic optometer and VX120 multi-diagnostic unit, and got the results following: spherical mirror photometry (S), cylindrical lens luminosity (C), mean spherical equivalent (M), horizontal and vertical cylindrical lens luminosity (J0) and 45° cylindrical lens luminosity (J45). Compared T-test analysis was used to compare the parameters of the two devices, and the Bland-Altman 95% limits of agreement were performed. Results: The S measured by the VX120 multi-diagnostic unit with bright mode was (?3.90±3.06) D; M was (?4.41±3.24) D; J0 was (0.34±0.58) D; J45 was (?0.04±0.26) D. The S measured by TopconKR800 automatic optometer was (?3.77±2.88) D; M was (?4.15±3.07) D; J0 was (0.25±0.47) D; J45 was (?0.01±0.18) D. There was no statistically significant difference in S, M, and J45 measured by VX120 multi-diagnostic unit and TopconKR800 automatic optometer in bright mode, while there was statistically significant difference in J0 between VX120 multi-diagnostic unit and TopconKR800 automatic optometer (t=?2.24, P=0.04). Bland-Altman 95% consistency analysis showed that the data points of the two instruments were mostly distributed within the 95% confidence interval, indicating that the parameters measured by these two devices were in accord with each other. Conclusion: The objective optometry results of VX120 multi-diagnostic unit and TopconKR800 automatic optometer were consistent and can be substituted for each other in the refraction examination.
综述
Pathological myopia emphasizes the existence of fundus complications. Posterior staphyloma, considered as a hallmark of pathological myopia, is a partial extension of the posterior scleral wall, which is believed to be related to the scleral thinning and choroidal atrophy. In recent years, studies have indicated that the formation of posterior staphyloma may closely connected with localized inflammation and defects of Bruch’s membrane. With the rapid innovation of examination technologies such as optical coherence tomography (OCT) and the exploration of treatment for posterior staphyloma. The diagnosis and therapy will be more comprehensive in the future.