目的：通过对改良“Z”形无线结经巩膜缝线固定人工晶状体手术和传统有线结巩膜缝线固定人工晶状体手术治疗先天性晶状体脱位的比较来评价改良术式的临床疗效。方法：回顾性病例研究。纳入2018年1月—2021年3月期间于中山大学中山眼科中心行手术治疗的先天性晶状体脱位患者73例73眼，按手术方式不同将患者分为无线结组36例36眼和有线结组37例37眼。比较两组患者术前和术后1年的球镜度(DS)、柱镜度(DC)、等效球镜(SE)、最佳矫正视力(BCVA)、眼压(IOP)、眼轴长度(AL)、角膜内皮细胞计数和术后并发症的发生率。结果：两组患者术前各项观察指标组间比较差异无统计学意义(均P>0.05)。两组患者术后1年 BCVA 均较术前提高(均P<0.05)，SE均较术前降低(均P<0.05)。两组患者术后1年 BCVA 、DS、DC、SE、IOP、AL、角膜内皮细胞丢失率组间比较差异均无统计学意义(均P>0.05)。术后1年，有线结组有5例(13.5%)出现缝线暴露，无线结组未出现缝线暴露，组间比较差异有统计学意义(P<0.05)。结论：改良无线结 IOL 巩膜缝线固定手术可改善CEL患者的最佳矫正视力和屈光不正，有效减少缝线暴露及相关并发症。

Objective: To evaluate the clinical efficacy of modified “Z”-shaped knotless transscleral suture fixation intraocular lens (IOL) and traditional knotted transscleral suture fixation IOL in congenital ectopia lentis. Methods: A retrospective case study. A total of 73 eyes of 73 patients with congenital ectopia lentis who underwent surgical treatment in our hospital from January 2018 to March 2021 were included. According to different surgical methods, the patients were divided into the knotless group (36 eyes) and knotted group (37 eyes). Preoperative and postoperative of 1-year diopter sphere (DS), diopter cylinder (DC), spherical equivalent (SE), best corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL), corneal endothelial cell counts and the occurrence of postoperative complications rate were analyzed among two groups. Results: There was no significant difference in preoperative outcome measures between the two groups (P>0.05). BCVA at 1-year postoperative was significantly better (P<0.05), and SE at 1-year postoperative was significantly lower (P<0.05). There was no significant difference in BCVA, DS, DC, SE, IOP, AL, and corneal endothelial cell loss rate between the two groups at 1-year after operation (P>0.05). One year after the operation, there were 5 cases of suture exposure (13.5%) in the knotted group and no suture exposure in the knotless group, and the difference was statistically significant (P<0.05). Conclusions: The modified knotless IOL transscleral suture fixation can improve the best corrected visual acuity and alleviate ametropia of CEL patients, and reduce suture exposure and related complications effectively.

目的：对比玻璃体切割术(pars plana vitrectomy, PPV)联合或不联合注射地塞米松玻璃体内植入剂(dexamethasone intraveal implant, DEX)治疗特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)的临床疗效。
方法： 采用回顾性研究设计，收集2022年1月—2023年6月于惠州市中心人民医院就诊，被诊断为IMEM(Gass 2期)并行PPV联合phaco+IOL植入的患者49例(49只眼)。根据其治疗方案分为非联合注射DEX组(25例共25只眼)及联合注射DEX组(24例共24只眼)。记录所有患者术前术后的最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度(central macular thickness, CMT)、平均神经节细胞层(ganglion cell layer, GCL)厚度，椭圆体带(ellipsoidal zone, EZ)完整性。使用OCTA测量视网膜浅层毛细血管层(superficial capillary plexus, SCP)、中心区域血管密度(vessel densities, VDs)及中心凹无血管区(foveal avascular zone, FAZ)面积。使用非接触性眼压计测量患者眼压。随访至术后6个月，记录上述指标，其中BCVA及CMT随访至1年。使用SPSS 29.0软件进行数据的统计分析(独立样本t检验、Mann-Whitney U检验、Pearson χ2检验等)。使用重复测量方差检验分析各项指标的时间差异及交互差异性。采用线性回归分析CMT、平均GCL厚度、EZ完整性、VDs、FAZ面积及联合注射DEX与BCVA的相关性。
结果：本研究两组间性别、年龄、眼压及术前各项指标差异均无统计学意义(P>0.05)。两种术式均能改善黄斑区结构、功能及微循环障碍，术后的BCVA在两组患者中均较术前有所改善，且持续至术后6个月，CMT的变化趋势同BCVA有高度一致性，而平均GCL厚度于术后3个月时开始恢复，而SCP中心凹VDs及FAZ面积于术后6个月时才有明显恢复，两种术式术后以上各指标均具有时间差异及交互差异性(P≤0.015)，且6个月内联合注射DEX组表现更佳(P=0.036)。相较于非联合注射DEX组，只有联合注射DEX组在术后6个月时，EZ完整性的改善具有统计学意义(P=0.009)。但随访至1年时，两组之间BCVA及CMT差异均无统计学意义(P=0.079)。术后6个月内BCVA的改善与术后6个月的CMT、平均GCL厚度、SCP中心凹VDs、FAZ面积的改善及EZ完整性及是否注射DEX与术后6个月内BCVA的改善均有相关性。随访期间两组患者均未发生眼内炎、玻璃体积血、视网膜脱离等眼部或全身严重并发症。
结论：微创玻璃体切割术联合玻璃体内注射DEX治疗相较于非联合注射DEX治疗组在6个月内疗效更佳。联合单次注射DEX治疗方案与非联合注射DEX治疗方案相比，在手术1年后对BCVA及CMT的改善无明显差异。

Objective: To analyze the efficacy and safety of minimally invasive vitrectomy (PPV) with or without intraoperative injection of dexamethasone intravitreal implant (DEX) for the treatment of Idiopathic Macular Epiretinal Membrane (IMEM), by comparing the relevant indicators.

Methods: A retrospective study design was used to collect 49 patients (49 eyes) who were diagnosed with IMEM (Gass2) and underwent surgical treatment(PPV+phaco+IOL implantation) at Huizhou Central People’s Hospital from January 2022 to June 2023. According to their treatment plan, they were divided into a non-combined injection DEX group (25 cases, 25 eyes) and a combined injection DEX group (24 cases,24 eyes). All patients underwent comprehensive optometry before and after surgery, and their best corrected visual acuity (BCVA) was recorded. Scan the central macular thickness (CMT) within 6x6mm of the macular area, while scanning the average ganglion cell layer (GCL) thickness. Record whether the elliptical zone (EZ) within 1x1mm of the macular area is complete and continuous. Use OCTA mode to scan the superficial capillary layer (SCP) of the retina within a range of 6x6mm, and record the measurements of vascular density (VDs) in the central area and the area of the foveal avascular zone (FAZ). Measure the patient's intraocular pressure using a non-contact tonometer. Follow up for 6 months and record the above indicators, with BCVA and CMT followed up for 1 year. Perform statistical analysis of data using SPSS 29.0 software (Independent sample t-test, Mann Whitney U-test and Pearson χ2-test). Use repeated measures ANOVA to analyze the time differences and interaction differences of various indicators. Linear regression analysis was used to examine the correlation between CMT, mean GCL thickness, EZ integrity, VDs, FAZ area, and combined injection of DEX with BCVA.

Results: There were no statistically significant differences in gender, age, intraocular pressure, and preoperative indicators between the two groups (P>0.05). Both surgical methods can improve the structure, function, and microcirculation disorders in the macular area. The postoperative BCVA in both groups of patients improved compared to before, and persisted until 6 months after surgery. The trend of CMT changes was highly consistent with BCVA, while the average GCL thickness began to recover at 3 months after surgery. The SCP fovea VDs and FAZ area did not show significant recovery until 6 months after surgery. Both surgical methods showed time differences and interaction differences in the above indicators after surgery (P=0.015), and the combined injection of DEX group performed better within 6 months (P=0.036). Compared to the non combined injection of DEX group, only the combined injection of DEX group showed statistically significant improvement in EZ integrity at 6 months after surgery (P=0.009). However, at 1 year of follow-up, there was no statistically significant difference in BCVA and CMT between the two groups (P≥0.079). The improvement of BCVA within 6 months after surgery is correlated with the improvement of CMT, average GCL thickness, SCP fovea VDs, FAZ area, EZ integrity, and injection of DEX within 6 months after surgery. During this study, no serious ocular or systemic complications such as endophthalmitis, vitreous hemorrhage, or retinal detachment occurred in either group of patients at each follow-up time point.
Conclusions: The efficacy of PPV combined with intravitreal injection of DEX is better within 6 months compared to the non-combined injection of DEX treatment group. There was no significant difference in the improvement of BCVA and CMT after one year of surgery between the combined single injection DEX treatment regimen and the non-combined injection DEX treatment regimen.

目的：观察依镜有晶状体眼后房屈光晶体(phakic refractive lens,PRL)植入术矫正超高度近视的疗效和安全性。方法：纳入自2018年1月—2020年9月在深圳市眼科医院行依镜PRL植入术的超高度近视患者共24例39眼，进行自身对照研究。其中，男8例13眼，女16例26眼，平均年龄(31.15±6.33)岁。观察术后屈光度、视力[裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)]、眼压、角膜内皮细胞计数、拱高、手术并发症等指标。结果：中位随访时间为5.5(3.0，11.0)月。屈光度从术前(?22.29±4.96) D降低至术后(?0.28±1.01) D(t=24.421，P<0.001)，其中术后球镜度数±0.5 D占28眼(82.4%)，±1.0 D占31眼(91.2%)。LogMAR UCVA从术前1.40(1.30，1.70)改善至术后(0.28±0.20) D，LogMAR BCVA由术前0.40(0.22，0.70)改善至术后0.15(0.00，0.30)，差异均有统计学意义(均P<0.001)。术后BCVA较术前提高3.00(1.00，5.00)行，所有患者均无BCVA丢失。术前、术后1 d、末次随访眼压值比较差异有统计学意义(F=8.779 P=0.012)，其中术后1 d较术前眼压增高(Z=-3.401，P=0.001)，而末次随访较术后1 d眼压降低(Z=-2.685，P=0.007)，末次随访与术前眼压之间比较差异无统计学意义(Z=-0.894，P=0.371)。角膜内皮细胞计数从术前(2 782.20±296.30)个/mm²降低至术后(2 472.54±394.32)个/mm² (t=-5.437，P<0.001)，平均丢失角膜内皮细胞数11.2%。末次随访33眼平均拱高值为(379.00±283.27)μm，其中0~250 μm占12眼(36.4%)，250~750 μm占19眼(57.6%)，大于750 μm占2眼(6%)。21眼PRL术后3个月拱高值为(269.81±194.67)μm，较术后1个月拱高值(373.62±195.75)μm降低(t=?2.917，P=0.009)。术后并发症包括激素性青光眼(1例2眼)、PRL光学面裂痕(1眼)、黄斑出血(1眼)、PRL偏位(2例3眼)。结论：对于超高度近视患者，依镜PRL植入术是一种可供选择的安全、有效的眼内屈光手术方式，但其远期疗效及安全性仍需更长时间和更大样本量进一步观察。

Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm² to postoperative (2 472.54±394.32)/mm² (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia

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7 7例(154眼)双 眼MGD患者，随机分为对照组(27例5 4眼)、中药超声雾化治疗组(雾化组；2 5例5 0眼)和中药超声雾化联合针灸治疗组(联合治疗组；2 5例5 0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、F L、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、F L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.

目的：分析临床应用镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻的效果。方法：回顾性分析安康市中医医院2年期间，应用镜下改良眼轮匝肌手术治疗61例(112眼)儿童先天性下睑内翻，根据睑内翻程度决定缝线跨度、松紧度及去除肌皮瓣量，0/6缝线将睑缘下眼轮匝肌与下睑缩肌缝合，0/8缝线连续缝合皮肤伤口，并做好术后护理。结果：所有患儿随访6~24个月，刺激症状缓解，106眼治愈，2眼好转，4眼复发，总有效率达96.43%。结论：镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻美观、易操作、复发率低。

Objective: To analyze the clinical efficacy of modified orbicularis oculi surgery under microscope in the treatment of congenital lower eyelid entropion of children. Methods: Sixty-one cases (112 eyes) of children with congenital lower eyelid entropion treated by modified orbicularis oculi surgery in Ankang Hospital of Traditional Chinese Medicine from Aug 2020 to Sep 2022 were retrospectively analyzed. The suture span, tightness and the amount of myocutaneous flap removed were determined according to the degree of entropion. The orbicularis oculi muscle of lower eyelid margin was suturedwith 0/6 suture, and the skin wound was sutured continuously with 0/8 suture, and postoperative nursing was done well. Results: All children were followed up for 6–24 months, and the irritation symptoms were relieved, 106 eyes were cured, 2 eyes turned well, and 4 eyes relapsed. The total effective ratereached 96.43%. Conclusion: The modified orbicularis oculi surgery for treatment of children with congenital lower eyelid entropion conforms to visual aesthetics. In addition, it is easy to operate and have a low recurrence rate.