目的：结合医院小儿眼科常见病种调研国内儿童眼用制剂药物临床试验开展现状，为儿童眼用制剂药物临床试验的发展提供参考。方法：基于国家药物临床试验登记与信息公示平台和医院信息系统，结合郑州市第二人民医院儿童眼科病种，分析儿童眼科药物临床试验开展情况。 结果：医院门诊就诊患者以屈光不正最多（占68.49% ），其次是结膜炎（占11.25%），再次是斜视（占8.60%）。平台共检索到相关临床试验165项，儿科专用药物临床试验25项，其中延缓青少年近视方面试验24个，小儿结膜炎试验1个，其他病种药物临床试验检测结果为0；药物临床试验中以I期和Ⅲ期临床试验为主；延缓青少年近视方面试验已完成试验8项，其他都在进行中。结论：儿童眼科疾病的药物治疗尚有巨大的临床需求未满足，直接关系到了儿童健康权益保障与生命安全维护。当前国内儿童眼用制剂研发呈现企业参与度低、创新动力不足的现状，其核心制约因素在于项目少、难度大、涉及更多的伦理问题。建议通过政产学研协同创新，系统性推进儿童眼用制剂的研发进展，切实解决我国儿童眼病治疗用药难的问题，为儿童视觉健康提供有力保障。

Objective：Combined with the common diseases of pediatric ophthalmology in our hospital, the current situation of clinical trials of ophthalmic preparations for children in China was investigated to provide reference for the development of clinical trials of ophthalmic preparations for children in China. Methods：Based on the national drug clinical trial registration and information publicity platform and hospital information system, combined with the pediatric ophthalmic diseases in our hospital, the development of pediatric ophthalmic drug clinical trials was analyzed. Results：Among the outpatients in our hospital, ametropia was the most common ( 68.49 % ), followed by conjunctivitis ( 11.25 % ) and strabismus ( 8.60 % ). A total of 165 clinical trials and 25 clinical trials of pediatric drugs were retrieved from the platform, including 24 trials on delaying juvenile myopia, 1 trial on pediatric conjunctivitis, and 0 clinical trial on other diseases. Drug clinical trials were mainly phase I and phase III clinical trials. Eight trials have been completed to delay juvenile myopia, and others are in progress. Conclusions：There is still a huge clinical demand for the drug treatment of children 's eye diseases, which is directly related to the protection of children 's health rights and life safety. At present, the research and development of children 's ophthalmic preparations in China presents the current situation of low enterprise participation and insufficient innovation motivation. The core constraints are fewer projects, greater difficulty, and more ethical issues. It is suggested to systematically promote the research and development of ophthalmic preparations for children through the collaborative innovation of government, industry, university and research, so as to effectively solve the problem of difficult medication for children 's eye diseases in China and provide a strong guarantee for children 's visual health.

近视已成为全球性流行病，预计到2050年全球将有近半数人群发生近视，已成为全球性重大功能卫生问题。近视不仅影响视力，还增加黄斑病变、青光眼等致盲性疾病的风险。近视的发病机制尚未完全明确，但与环境、遗传因素及昼夜节律紊乱密切相关。昼夜节律通过调节光照、多巴胺代谢和视网膜信号传导等机制影响近视的发生和发展。光照是调节昼夜节律的关键，户外活动时的高光照强度能有效刺激多巴胺分泌，抑制眼轴增长，减少近视发生，而异常光照模式（如夜间光暴露）则会干扰此过程。其次，睡眠不足与儿童近视患病率呈负相关，眼部关键参数（如眼轴长度、玻璃体腔深度等）均呈现显著的昼夜节律性波动。多巴胺作为视网膜中的重要神经递质，受生物钟基因调控，具有抑制眼轴生长的作用。视网膜中的生物钟基因和光敏色素也参与调节眼球生长，自主神经系统则通过调节脉络膜厚度与血流灌注参与眼球生长调控。动物实验和临床研究表明，昼夜节律紊乱会导致眼轴增长和近视进展。未来研究应进一步探讨昼夜节律与近视的因果关系、多巴胺代谢的调控机制以及生物钟基因的功能，以制定有效的近视防控策略。

Myopia has become a global epidemic,with projections indicating that nearly half of the world’s population will be affected by myopia by 2050, positioning it has a significant global functional health concern.Beyond merely impairing vision, myopia also heightens the risk of blinding diseases such as macular degeneration and glaucoma. Although the pathogenesis of myopia is not yet fully elucidated, it is stongly associated with environmental factors, genetic predispositions, and circadian rhythm disruptions. The circadian rhythm plays a pivotal role in the onset and progression of myopia by goerning mechanism such as light exposure, dopamine metabolism, and retinal signaling. Light serves as a crucial regulator of the circadian rhythm. Specifically, high light intensity during outdoor activities can effectively stimulate dopamine secretion, thereby inhibiting axial elongaation and reducing the incidence of myopia. Conversely, abnormal light patterns, such as exposure to light at night, can disrupt this regulatory process. Moreover, insufficient sleep has been found to be negatively correlated with the incidence of myopia in children. Additionally, key ocular parameters, including axial length and vitreous cavity depth, exhibit pronounced diurnal rhythmic fluctuations. Dopamine,  an important neurotransmitter in the retina, is regulated by circadian clock genes and functions to inhibit axial elongation. Both the circadian clock genes and photosensitive pigments within the retina are involved in regulating eye growth. Meanwhile, the autonomic nervous system contributes to this regulation by modulating choroidal thickness and blood flow perfusion. Animal experiments and clinical studies have consistently demonstrated that disrupted circadian rhythms can lead to axial elongation and the progression of myopia. Future research should delve deeper into the causal relationship between circadian rhythm and myopia, the regulatory mechanisms underlying dopamine metabolism, and the functions of circadian clock genes. Such investigation will pave the way for the development of effective strategies for myopia prevention and control.

散光是儿童视力发育的重要威胁之一，很多情况下其发生与眼表疾病的进展密切相关。非先天性眼表疾病如睑缘炎相关性角结膜病变、春季角结膜炎、干眼、感染性角膜炎和眼外伤等可通过慢性炎症介导的眼表微环境失衡、角膜瘢痕产生、泪膜稳定性破坏及角膜生物力学结构异常重塑等途径，导致角膜表面不规则性的产生和角膜曲率的改变。先天性眼表疾病如圆锥角膜、睑内翻和眼表肿瘤等则可通过遗传或发育异常改变眼睑结构、改变角膜曲率的对称性和机械压迫角膜产生散光，例如遗传疾病圆锥角膜的进行性角膜变薄与发生春季角结膜炎时眼表微环境的炎症性改变可协同作用加剧散光进展。针对不同病因，局部糖皮质激素滴眼液、免疫抑制剂环孢素滴眼液等药物使用和手术治疗均可改善患儿本身的病情和散光情况，只是不同疾病的治疗和散光矫正方案不尽相同。现有研究虽指出了部分儿童眼表疾病与散光的关联，但对于儿童的特异性机制部分如发育过程中免疫系统的变化、角膜可塑性差异及各种因素交互作用效应尚未完全解析。

Astigmatism is a significant threat to children's visual development and is often closely linked to the progression of ocular surface diseases. Non-congenital conditions, such as blepharitis-associated keratoconjunctivitis, vernal keratoconjunctivitis, dry eye, infectious keratitis, and ocular trauma, can induce irregularities on the corneal surface and changes in corneal curvature. This occurs through mechanisms like the ocular surface microenvironment imbalance mediated by chronic inflammation, corneal scarring, tear film instability, and abnormal corneal biomechanical remodeling. Congenital disorders, including keratoconus, entropion, and ocular surface tumors, can also lead to astigmatism. These conditions do so by causing genetic or developmental abnormalities that alter the eyelid structure, disrupt corneal symmetry, or exert mechanical pressure. Notably, there can be synergistic effects between progressive corneal thinning seen in hereditary keratoconus and the inflammatory microenvironment changes associated with vernal keratoconjunctivitis. Therapeutic interventions, such as topical corticosteroids, cyclosporine eye drops, and surgical procedures, can improve both the primary conditions and the astigmatism. However, treatment strategies vary depending on the different etiologies. Current research has established associations between pediatric ocular surface diseases and astigmatism. Nevertheless, the specific developmental mechanisms, including the  maturation of the immune system, differences in corneal plasticity, and the interactive effects of multiple factors, remain incompletely understood.

目的: 探讨 ETDRS 对数视力表对儿童视力检查的可重复性及其影响的相关因素。

方法: 在流行病学调查的过程中, 随机使用 ETDRS 对数视力表, 为 250 位裸眼视力低于 0.5 和 98 位视力正常儿童进行裸眼视力重复检查。
结果: 两次视力测量之间差异的均数为0.004log^±0.07; Kappa 分析结果具有很好的一致性(k = 0.71) ; 性别与视力检查一致性无明显相关(P = 0.845) ; 年龄与视力检查一致性有显著相关性(P = 0.019) , 年龄越小视力检查一致性越差; 屈光不正与视力检查一致性也有显著相关性(P = 0.000) , 近视度数在- 1.00D～- 5.00D 之间的儿童视力检查一致性相对差, 而正视眼的视力检查一致性较好。

结论: 结果提示 ETDRS 对数视力表适合儿童视力检查, 建议推广使用。

Purpose: To evaluate repeatability of the ETDRS log MAR visual acuity measurementin children and the relative influence factors.

Methods: The children (n = 348) with visual acuity less than 0.5 ( equal to 0.3 logunit) in either eye,or one tenth in children with normal visual acuity were chosen todo repeatable uncorrected VA measurement with Bland-Altman analysis and Kappa analysis using ETDRS acuity chart.

Results: The mean difference of visual acuity was 0.004log^±0.07. There was a significant repeatability (k = 0.71) between two visual acuity examination. There were significant consistent results both on male and female patients (P = 0.845) . A significant relationship was found between age and VA repeatability(P = 0.019) . The VA repeatability could also be influenced by refractive error (P = 0.000) . The acuity measurement in children with emmetropia (k = 0.82) had a higher repeatability than in the children with myopia (k = 0.66) .

Conclusions: The ETDRS visual acuity chart can provide a repeatable measure of visual acuity in children. It is recommended for clinic examination of children. 

Ⅱ期人工晶状体(intraocular lens,IOL)植入常用于矫正先天性白内障摘除术后无晶状体眼状态。IOL屈光力计算是影响儿童Ⅱ期IOL植入术后视功能发育和改善的关键因素之一。现有IOL屈光力计算公式是基于成人有晶状体眼的数据研发，能准确预测成人眼IOL植入的屈光力，但是对儿童Ⅱ期IOL植入的屈光力预测准确性欠佳，主要原因包括：1)儿童II期植入术前为无晶状体眼，缺乏部分公式定义中的有晶状体眼的前房深度(是指从角膜前表面中央顶点到晶状体前表面的距离)和晶状体厚度。2)公式根据囊袋内植入IOL预测屈光力，但儿童Ⅱ期IOL睫状沟植入术在临床上应用更为广泛。当IOL植入睫状沟时有效晶状体位置发生前移，可能引起屈光预测误差。3)成人眼的发育已完成，目标屈光度多为正视或近视眼(-3.00 ~ +1.00 D)，但是儿童眼仍在发育，需针对其特性测算合适的远视目标屈光度(+0.50 ~ +12.00 D)以适应眼球发育引起的屈光变化。为使Ⅱ期IOL植入患儿达到术前预设的目标屈光度，对现有公式进行选择与优化至关重要。

Secondary intraocular lens (IOL) implantation is a common treatment for pediatric aphakia. The accurate prediction of IOL power calculation plays a pivotal role in the postoperative development and improvement of visual function for pediatric secondary IOL implantation. Current IOL power calculation formulas were developed based on data from adult phakic eyes and displayed good performance in adult population. However, the formulas showed poor performance in pediatric aphakic population due to the following reasons: 1) In these pediatric aphakic patients, the unavailability of phakic anterior chamber depth (the distance from corneal epithelium to the anterior surface of the lens) and lens thickness (LT) greatly limits the application of some IOL power calculation formulas. 2) IOL power calculation formulas predict the effective lens position on the basis of in-the-bag IOL implantation, whereas sulcus implantation is more widely used in pediatric secondary implantation. Effective lens position in capsular placement is more posterior to ciliary sulcus IOL placement. When applying the initial IOL power calculated for capsular implantation to sulcus implantation, it can lead to refractive errors. 3) Adult eyes have completed their development, with target refractions often being emmetropic or myopic (-3.00 ~ +1.00 D), while pediatric eyes are still developing, necessitating the calculation of an appropriate hyperopic (+0.50 ~ +12.00 D) target refraction to accommodate refractive changes due to ocular growth.To achieve the predetermined target refractive outcomes, the selection and optimization of IOL power calculation formulas is critically important for pediatric secondary IOL implantation.

目的：建立并评估儿童Ⅱ期人工晶状体(intraocular lens,IOL)植入术后青光眼相关不良事件(glaucoma-related adverse events,GRAEs)的预测模型。方法：选取于中山大学中山眼科中心行Ⅱ期IOL植入术的无晶状体眼患儿205例(356眼)，并在术后对其随访3年。采用Cox比例风险模型确定GRAEs的预测因子，并建立列线图预测模型。采用随时间变化的受试者工作特征(receiver operating characteristic,ROC)曲线、决策曲线分析、Kaplan-Meier曲线评估模型性能，并通过Bootstrapping的C指数和校准图进行内部验证。结果：行Ⅱ期IOL植入术时年龄较大(HR=1.50, 95% CI: 1.03 ~2.19)、术后一过性高眼压(HR=9.06, 95% CI: 2.97~27.67)和IOL睫状沟植入术(HR=14.55, 95% CI: 2.11~100.57)是GRAEs的危险因素(均P<0.05)，并据此建立了两个列线图预测模型。在术后1、2、3年，模型1的ROC曲线下面积(area under curve,AUC)分别为0.747(95% CI: 0.776 ~0.935)、0.765 (95% CI: 0.804 ~0.936)和0.748 (95% CI: 0.736~0.918)，模型2的AUC分别为0.881 (95% CI: 0.836 ~0.926)、0.895 (95% CI: 0.852 ~0.938)和0.848 (95% CI: 0.752~0.945)。在内部验证和评价中，两种模型均表现出良好的性能和临床净效益。Kaplan-Meier曲线显示两个不同的风险组在两个模型中都能被显著且稳健地区分。此外，本研究也构建了在线风险计算器。结论：两种列线图均能灵敏、准确地识别Ⅱ期IOL植入术后GRAEs的高危患儿，有助对其进行早期识别和及时干预。

Aims: To establish and evaluate predictive models for glaucoma-related adverse events (GRAEs) following secondary intraocular lens (IOL) implantation in paediatric eyes. Methods: 205 children (356 aphakic eyes) receiving secondary IOL implantation at Zhongshan Ophthalmic Center with a 3-year follow-up were enrolled. Cox proportional hazard model was used to identify predictors of GRAEs and developed nomograms. Model performance was evaluated with time-dependent receiver operating characteristic (ROC) curves, decision curve analysis, Kaplan-Meier curves and validated internally through C-statistics and calibration plot of the bootstrap samples. Results: Older age at secondary IOL implantation (HR=1.5, 95% CI: 1.03 to 2.19), transient intraocular hypertension (HR=9.06, 95% CI: 2.97 to  27.67) and ciliary sulcus implantation (HR=14.55, 95% CI: 2.11 to 100.57) were identified as risk factors for GRAEs (all p<0.05). Two nomograms were established. At postoperatively 1, 2 and 3 years, model 1 achieved area under the ROC curves (AUCs) of 0.747 (95% CI: 0.776 to 0.935), 0.765 (95% CI: 0.804 to 0.936) and 0.748 (95% CI: 0.736 to 0.918), and the AUCs of model 2 were 0.881 (95% CI: 0.836 to 0.926), 0.895 (95% CI: 0.852 to 0.938) and 0.848 (95% CI: 0.752 to 0.945). Both models demonstrated fine clinical net benefit and performance in the interval validation. The Kaplan-Meier curves showing two distinct risk groups were well discriminated and robust in both models. An online risk calculator was constructed. Conclusions: Two nomograms could sensitively and accurately identify children at high risk of GRAEs after secondary IOL implantation to help early identification and timely intervention.

目的：比较轻、中、重度近视患儿之间的视觉功能的差异，探索虚拟现实下的短期可塑训练对近视视觉功能的改善效果。方法：选择2022年6月—2022年9月就诊于苏州大学附属儿童医院的6~16岁儿童102例，按照屈光度分为正常对照组、轻度近视组和中重度近视组，进行眼科常规检查和视知觉功能检查，并进行视觉短期可塑训练。结果：近视患儿存在立体视功能缺损，近视程度与精细立体视功能损害呈正相关，各组之间比较差异具有统计学意义(P<0.05)，部分患儿存在中心凹抑制。训练后，轻度近视组的中距离精细立体视功能得到改善，比较差异具有统计学意义(P<0.05)。结论：近视患儿存在立体视功能异常和中心凹抑制，且立体视功能的损害随着近视程度的增加而加重。轻度近视患儿部分精细立体视功能经过虚拟现实短期可塑训练可得到改善，而中重度近视患儿精细立体视功能改善不明显。

Objective: To compare the difference of visual function among children with myopia in different diopter, and explore the effect of short-term plastic training of virtual reality on visual function improvement. Methods: The 102 children aged 6-16 years who admitted to Children's Hospital of SoochowUniversity from June 2022 to September 2022 were recruited and divided into control group, mild myopia group and middle and high myopia group according to diopter. Routine ophthalmologic examination and visual perception function examination were carried out, and short-term plastic training was implemented. After the training, visual perception function examination was completed again. Results: There were significant differences in stereoscopic function defect at different distances among myopic children, a negative correlation between myopia and stereoscopic function was found. while there were several cases have foveal suppression. After training, the fine stereopsis at medium distance of the mild myopia group was significantly improved with significance statistical difference. Conclusions: Myopia can lead to the abnormality of stereopsis and foveal suppression in children. The defect of binocular visual function increases with the increase of myopia. Short term plastic training of virtual reality can partially improve the fine stereoscopic function of mild myopia children whileshowsnosigni ficanceimprovementof the fine stereoscopic function in middle and high myopia group.

目的：利用儿童Glasgow受益调查问卷(Glasgow Children’s Benefit Inventory，GCBI)评估先天性上睑下垂手术后儿童健康相关生活质量(health-related quality of life，HRQOL)的受益，并探索受益的影响因素。方法：验证GCBI中文版评估先天性上睑下垂矫正术后长期患儿生活质量的信效度，并用其评估术后儿童HRQOL受益与性别、手术年龄、术后随访时间等相关性。结果：共178名先天性上睑下垂接受下垂矫正术后儿童完成问卷，结果显示不同性别、年龄均有正性受益，术后短期(<1年)受益更明显(P<0.05)。结论：GCBI中文版具有良好的信度和效度，适用于评估先天性上睑下垂儿童术后受益结果。先天性上睑下垂儿童接受下垂矫正术后不同性别均有正性受益，术后短期(<1年)受益更明显。

Objective: To explore the benefits of children’s HRQOL after congenital ptosis surgery using the Glasgow Children’s Benefit Inventory (GCBI) and the factors influencing the benefits. Methods: To verify the reliability and validity of the Chinese version of GCBI in evaluating the long-term life quality of children after correction of congenital ptosis, and to evaluate the correlation between the HRQOL benefit of children after surgery and gender, surgical age, postoperative follow-up time, etc. Results: A total of 178 children after congenital ptosis surgery completed the questionnaire. Different genders or ages of children with congenital ptosis both showed positive benefit after ptosis correction, and the short-term (<1 year) benefit was more obvious after surgery (P<0.05). Conclusion: The Chinese version of GCBI has good reliability and validity,and is suitable for evaluating the postoperative benefit results of children with congenital ptosis. All the children with congenital ptosis received positive benefit after ptosis correction, and the short-term benefit (<1 year) was more obvious.

上睑下垂是眼整形科最常见的疾病之一，由于儿童处于生长发育阶段的特殊性，不规范的诊疗不仅会影响外观，同时可能会导致视功能发育迟缓。目前关于儿童先天性上睑下垂的手术时机和手术方式的选择尚无统一的标准和共识，本文通过对儿童先天性上睑下垂分类细化，阐明合并不同原因导致弱视的患者手术时机的选择；对比不同手术方式，分析其原理及优缺点，进一步明确矫正重度儿童先天性上睑下垂的手术方式，以期规范儿童先天性上睑下垂手术时机和手术方式的选择，提高手术的成功率，减少弱视的发生。

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.

目的：调查眼病患儿家长在患儿手术前的健康教育需求，为责任护士开展个性化、高质量的健康教育提供依据。方法：采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查，并对调查结果进行统计分析。结果：家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05)；家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论：眼病患儿家长对患儿术前健康教育需求较高，医务工作者应丰富知识层面，加强专科学习及相关知识培训，把专科知识与健康教育有机地结合，并探索有效的线上健康教育方式，更好地为患者服务。

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.