综述

视网膜神经纤维层的定量评估在视网膜疾病中的应用

Application of quantitative assessment of retinal nerve fiber layer in retinal diseases

:253-259
 
视网膜神经纤维层是视网膜的最内层,主要由来自视网膜神经节细胞的无髓鞘轴突组成,此外还有神经胶质细胞与视网膜血管,其厚度与年龄、眼球增长、眼底结构改变等因素相关。光学相干断层扫描可以清晰展示角膜、视网膜、脉络膜、视神经等高分辨率断层图像,可以在活体上显示生物学组织的细微结构,在临床与科研中已获得广泛应用。在青光眼视神经病变中,光学相干断层扫描可以发现视野异常前的视网膜神经纤维层损害,已成为青光眼早期诊断与视神经损伤程度检测的重要手段。除视神经病外,越来越多的研究表明许多视网膜血管疾病、神经元变性疾病等视网膜疾病也有视网膜神经纤维层的损伤。探讨视网膜疾病与神经纤维层的关系,将有利于进一步推进对视网膜疾病发病机制及病理改变的认识。本文就视网膜神经纤维层的定量评估与多种视网膜疾病的关系展开综述,为其在视网膜疾病中的应用提供参考。
The retinal nerve fiber layer, the innermost layer of the retina, consists mainly of unmyelinated axons from retinal ganglion cells, as well as glial cells and retinal blood vessels , the thickness of which is related to factors such as age, ocular growth and fundus structure changes. Optical coherence tomography (OCT) can clearly display the cornea, retina, choroid, optic nerve and other high-resolution tomography images. It can show the fine structure of biological tissues in vivo, which has been widely used in clinical and scientific research. In glaucomatous optic neuropathy, OCT can detect the damage of retinal nerve fiber layer before abnormal visual field, which has become an important means of early diagnosis of glaucoma and detection of the degree of optic ner ve damage. In addition to optic neuropathy, more studies have shown that many retinal diseases such as retinal vascular diseases and neurodegenerative diseases also have retinal nerve fiber layer injury. Exploring the relationship between retinal diseases and nerve fiber layer will be beneficial to further promote the understanding of the pathogenesis and pathological changes of retinal diseases. This paper reviews the relationship between the quantitative evaluation of retinal nerve fiber layer and various retinal diseases, and provides reference for its application in retinal diseases.
新技术交流

YAMANE式后房型人工晶状体巩膜层间固定术的改良与应用(视频)

A modified YAMANE’s technique for posterior chamber intraocular lens intrascleral-fixation

:116-121
 
YAMANE式后房型人工晶状体巩膜层间固定术是近年出现的一种人工晶状体悬吊术式。该文介绍了笔者结合实际条件对其改良后的手术步骤,手术关键点及使用经验。在缺乏足够囊膜支撑的条件下,此手术方式微创、安全、有效,术后恢复快。在随访期间(最长5年),视力稳定,未出现人工晶状体脱位、移位、倾斜,人工晶状体夹持及人工晶状体襻暴露等并发症,值得临床推广应用。
The YAMANE intrascleral fixation of posterior chamber intraocular lens (IOL) is a new technique in recent five years for IOL suspension. This article introduces a modified YAMANE technique including surgical procedure, key points and using experience. In the absence of adequate capsular support, this procedure is minimally invasive, safe, effective and has a fast postoperative recovery. During the follow-up period (up to 5 years), the visual acuity was stable, and there were no complications such as luxation of lens, displacement, tilt of intraocular lens, intraocular lens clamping and IOL haptic exposure.

综述

婴幼儿眼病的人工智能应用

Artificial intelligence application for infantile eye diseases

:214-221
 
近年来随着医疗领域数字化、信息化建设的加速推进,人工智能的应用越来越广泛,在眼科医学方面尤为突出。婴幼儿处于视觉系统发育的关键时期,此时发生的眼病往往会造成不可逆的视功能损伤,带来沉重的家庭和社会负担。然而,由于婴幼儿群体的特殊性以及小儿眼科医生的短缺,开展大规模小儿眼病筛查工作十分困难。最新研究表明:人工智能在先天性白内障、先天性青光眼、斜视、早产儿视网膜病变以及视功能评估等领域已经得到相关应用,在多种婴幼儿眼病的早期筛查、诊断分期、治疗建议等方面都有令人瞩目的表现,有效解决了许多临床难点与痛点。但目前婴幼儿眼科人工智能仍然不如成年人眼科发展充分,亟须进一步的探索和研发。
In recent years, with the acceleration of digitalization and informatization in medical field, artificial intelligence (AI) is more and more widely applied, especially in ophthalmology. Infants are in the critical period of visual development, during which eye diseases can lead to irreversible visual impairment and bring heavy burden to family and society. Due to the particularity of infants and the shortage of pediatric ophthalmologists, it is challenging to carry out large-scale screening for eye diseases of infants. According to the latest studies, AI has been studied and applied in the fields of congenital cataract, congenital glaucoma, strabismus, amblyopia, retinopathy of prematurity, and evaluation of visual function, and it has achieved remarkable performance in the early screening, diagnosis stage and treatment suggestions, solving many clinical difficulties and pain points effectively. However, AI for infantile ophthalmology is not as developed as for adult ophthalmology, so it needs further exploration and development.
论著

EZ Prep 清洗液替代二甲苯在眼组织特殊染色中的应用

Application of EZ Prep cleaning solution as a xylene substitute in special staining of ocular tissues

:571-577
 
目的: 探讨EZ Prep清洗液替代二甲苯进行手工脱蜡制作特殊染色片的效果。 方法: 应用EZ Prep清洗液替代二甲苯脱蜡,选取中山大学中山眼科中心临床病理科石蜡标本100例进行回顾性研究,常规切片后切片一式两份,分别采用传统二甲苯和EZ Prep清洗液手工脱蜡后按实验室标准化操作流程进行特殊染色,并比较脱蜡时间和染色效果。 结果: EZ Prep清洗液手工脱蜡处理的切片在革兰染色(Gram's)、六胺银染色(GMS)、过碘酸—雪夫染色(PAS)、马松(Masson)三色染色、刚果红等多种特殊染色中的染色质量和二甲苯脱蜡处理的效果一致,两组间染色片优良率比较差异无统计学意义(Z=0. 32,P>0. 05),且平均脱蜡时间由(33.0±2.7) min缩短至(7.2±1.1) min,加快了染色出片时间。结论:EZ Prep清洗液可以替代二甲苯在眼组织特殊染色中脱蜡,并具有脱蜡时间短、环保的优点,值得推广应用。
Objective: To investigate the effect of EZ Prep cleaning solution as an alternative to xylene for manual deparaffinization in the preparation of special staining slides. Methods: EZ Prep cleaning solution was utilized to replace xylene for deparaffinization in a retrospective study involving 100 paraffin-embedded specimens from the Clinical Pathology Department of Zhongshan Ophthalmic Center, Sun Yat-sen University. Routine sections were prepared and duplicated, with one set deparaffinized using traditional xylene and the other using EZ Prep cleaning solution. Subsequent special staining was performed following standardized laboratory protocols. Deparaffinization time and staining outcomes were compared. Results: Slides treated with EZ Prep cleaning solution for manual deparaffinization demonstrated staining quality comparable to xylene treatment across various special stains, including Gram's, GMS, PAS, Masson's trichrome, and Congo red. The difference in the excellent rate between the two methods is not statistically significant (χ 2 = 0.33, P > 0.05). Moreover, the average deparaffinization time is significantly reduced from 33.0±2.7 minutes to 7.2±1.1 minutes, thereby speeding up the staining process. Conclusion: EZ Prep could replace xylene deparaffinized sections in special staining of ocular tissues with the advantages of shorter deparaffinized time and environmental protection, which is worthy of promotion and application.
综述

三维细胞培养在青光眼研究中的应用

Application of three-dimensional culture in the study of glaucoma

:409-415
 
青光眼是全球首位不可逆性致盲性眼病,其特征是视网膜神经节细胞(retina ganglion cells, RGCs)的退行性改变,对全球经济和健康造成了重大影响。其病理变化的分子及生物机制尚不明确,目前青光眼手术和药物治疗仍然局限于将眼压控制在正常范围。小梁网作为房水排出的重要途径,是眼压控制的关键一环。眼压改变引起的视网膜退行性改变是青光眼重要病理过程之一。小梁网及视网膜的体外模型构建是研究青光眼发生发展的主要研究方法。三维培养技术可以使细胞在体外形成一定的空间结构,有利于细胞-细胞及细胞-环境的相互作用,相比传统二维培养,三维培养更加接近体内细胞的生理环境,对于研究疾病的病理生理变化及高通量药物筛选具有重要意义,同时,三维培养更有利于对细胞空间构象变化及其力学性质改变进行研究。三维打印等新技术也在三维细胞培养中有所应用,为三维定制化培养提供技术基础。文章综述了小梁网及视网膜细胞三维培养在青光眼基础研究中的应用研究进展,旨在为进一步探究青光眼病理生理机制提供新的思路。
Glaucoma is the world's first irreversible blinding eye disease, characterized by degenerative changes in retinal ganglion cells (RGCs), which have a significant impact on the global economy and health. The molecular and biological mechanisms of its pathological changes are still unclear. At present, glaucoma surgery and drug therapy are still limited to controlling the intraocular pressure in the normal range. Three-dimensional culture technology can enable cells to form a certain spatial structure in vitro, which is conducive to cell-cell and cell-environment interactions. Compared with traditional two-dimensional culture, three-dimensional culture technology is closer to the physiological environment of cells in vivo, which is of great significance for the study of pathophysiological changes of diseases and high-throughput drug screening. This review discusses the application of trabecular mesh and three-dimensional culture of retinal cells in the basic research of glaucoma, aiming to provide new ideas for further exploring the pathophysiological mechanism of glaucoma.
综述

折叠式人工玻璃体球囊的临床应用及研究进展

Clinical application and research progress of foldable capsular vitreous body

:338-343
 
玻璃体替代物是玻璃体切割术后的必需品,用于填充玻璃体腔,恢复玻璃体的支撑视网膜、屈光和细胞屏障等功能。严重眼外伤及复杂视网膜脱离引起的视网膜/脉络膜脱离,如选用传统的玻璃体替代物(如硅油)填充,部分患者会出现硅油依赖眼或眼球萎缩,眼球难以保全。折叠式人工玻璃体球囊(foldable capsular vitreous body,FCVB)是我国独立研发的挽救眼球的人工玻璃体,属于国际首创,可以精细模拟自然玻璃体的结构,恢复玻璃体的部分功能。目前临床研究证实FCVB不仅可以有效避免硅油的并发症,还可以维持后房空间,缓慢恢复睫状体的功能,从而治疗硅油依赖眼,阻止眼球进一步萎缩。该文综述了FCVB的研究背景、结构特点、临床应用和拓展研究进展。
Vitreous substitutes are necessary after vitrectomy to fill the vitreous cavity and restore the vitreous to support retinal, refractive, and cellular barrier functions. Severe ocular trauma-induced retinal/choroidal detachment filled with traditional vitreous substitutes (e.g., silicone oil) can lead to silicone oil-dependent eyes and ocular atrophy in some patients, making it difficult to preserve the eye. Foldable capsular vitreous body (FCVB) is an artificial vitreous body independently developed in China to save the eye, which is the first of its kind in the world and can finely simulate the structure of natural vitreous body and restore some of the functions of vitreous body. It has been clinically proven that it can not only effectively avoid the complications of silicone oil, but also maintain the posterior chamber space and slowly restore the function of the ciliary body, thus treating silicone oil-dependent eyes and preventing further atrophy of the eye. This article reviews the research background, structural features, clinical applications and extended studies of FCVB.
新技术交流

人工晶状体夹持技术在白内障联合玻璃体视网膜手术后囊膜破裂中的应用(视频)

Capture of intraocular lens optic for posterior capsular rupture during combined anterior and posterior segment surgery

:122-126
 
玻璃体视网膜疾病并发白内障患者行玻璃体切割术联合超声乳化白内障摘除术,即前后节联合手术,是高效的手术方式,而后囊膜破裂(posterior capsular rupture,PCR)是超声乳化白内障摘除术的术中并发症之一,能够及时、有效地处理PCR,稳定、安全地植入人工晶状体(intraocular lens,IOL),对于顺利完成后段手术,减少术后并发症十分重要。本文将对前后段联合手术中后囊膜破裂的术中处理、以及IOL光学部夹持固定法植入IOL的手术技术要点进行总结。
Combined surgery of pars plana vitrectomy (PPV) and phacoemulsification is an effective and safe way for management of retinal diseases complicated with cataract. Posterior capsular rupture (PCR) is one of the common intraoperative complications of phacoemulsification, and it is thus very important to deal with it promptly and efficiently, and ensure the subsequent procedures of intraocular lens (IOL) implantation as well as PPV. We will summarize the key points of the surgical technique for management of PCR and capture of IOL optic during combined surgery.
论著

基于眼底图片的5G医疗眼科远程诊断中心的构建与应用

The construction and application of 5G remote ophthalmology diagnosis center based on fundus images

:1-8
 
目的:依托最新的第5代移动通信技术(5th generation wireless systems,5G),构建基于眼底图片的5G医疗眼科远程诊断平台,促进医疗资源上下贯通,提升基层服务能力及医疗服务体系整体效能。方法:基于5G时代医院的信息化发展战略,在海南省卫生健康委员会的资助与指导下,中山大学中山眼科中心海南眼科医院与中国联通通信集团海南有限公司等进行跨行业、多学科的技术力量研究开发,构建5G条件下的平台建设模块和技术路线,确定远程眼科诊断流程,并在海南省内多地区应用。结果:远程诊断平台运行良好。2020年12月至2021年11月,本研究共在海南省17个地区的186个卫生院中开展,共收集1561例患者眼底病图片数据,筛查阳性例数为185例,检出眼底病总阳性率为11.9%。其中有42例需要转诊治疗,转诊率为23%;143例不需要转诊治疗,非转诊率为77%。在1561例眼底图像中,采集异常的眼底图像有490例。排除490例异常眼底图像后,辅助诊断系统与人工诊断结果有1 002张眼底图像诊断相同,69张眼底图像诊断不同,其辅助诊断系统准确率为93.3%。结论:5G移动通信与远程医学影像结合,运用互联网科技催生新型医疗生产力,提高卫生经济的质量和效率,是医疗领域探索5G应用场景的一项应用典范。
Objective: Relying on the latest 5th generation wireless systems (5G), a remote primary ophthalmology care diagnosis platform based on fundus images was constructed in order to promote the connectivity of medical resources and improve the primary health service capabilities and the overall effectiveness of the medical service system. Methods: Based on the 5G informatization development strategy of hospitals, and under the funding and guidance of the Hainan Provincial Health Commission, the Hainan Eye Hospital of Zhongshan Ophthalmic Center and China Unicom Communications Group Hainan Co., Ltd. conducted a cross-industry, multi-disciplinary technical research. To build platform construction modules and technical routes under 5G networks, present the remote ophthalmological diagnosis process, and apply it in many regions in Hainan Province. Results: The performance of the remote diagnosis platform is well. From December 2020 to November 2021, this study was carried out in 186 health centers in 17 regions of Hainan Province. A total of 1 561 patients with fundus disease image data were collected. The number of positive screening fundus disease cases was 185. The total positive rate was 11.9%. Among them, 42 cases required referral for treatment, with a referral rate of 23%, and 143 cases did not require referral for treatment, with a non-referral rate of 77%. Among 1 561 cases of fundus images, 490 fundus images were excluded due to abnormal quality. Compared the results of the diagnosis platform system with manual diagnosis, 1 002 fundus images were identical, and 69 fundus images were different in diagnosis. The accuracy of the auxiliary diagnosis system was 93.3%. Conclusions: The collaboration of 5G mobile communication and telemedicine imaging, combined with internet technology to promote new medical productivity, improve quality and efficiency of the health economy. This study is an application model for exploring 5G application scenarios in the medical field.
综述

眼科成像设备在接触镜适配中的应用

Application of ophthalmic imaging modalities in contact lens fitting

:74-84
 
接触镜在全球的应用日益广泛,配适方法的不断进步是目前接触镜安全性、舒适性不断提高的原因之一。在接触镜适配过程中,越来越多的先进影像技术被运用于指导接触镜的配适,这些技术的出现简化了接触镜适配的过程,为临床医生进行简便、准确、个性化的接触镜适配提供了帮助,也为接触镜的个性化设计提供了参考数据。
Contact lens has been widely applied worldwide, and the advancement of fitting strategy is one of the reasons which improve the safety and comfort of contact lens fitting. During the contact lens fitting procedure, more and more ophthalmic imaging modalities have been applied to guide the contact lens fitting. These techniques simplify the contact lens fitting procedure, help optometrists accurately perform the customize contact lens fitting, and assist the personalized contact lens design technique.
论著

基于钉钉平台的全面质量管理模式在眼科教学中的应用

Application of a total quality management model based on the DingTalk platform in ophthalmology education

:527-532
 
目的:结合眼科住院医师规范化培训(住培)的特点,建立基于钉钉平台的全面质量管理模式(total quality management, TQM),探索一种高效的顺应时代特征的眼科教学管理模式。方法:研究团队依托中山大学中山眼科中心,选取82名眼科四证合一的住培一年级的学生作为研究对象,并将其随机分为两组,试验组41人采用基于钉钉平台的TQM模式进行全过程教学管理,采用全员参与、全程跟踪、全面评价的管理模式以保障教学质量。对照组41人接受传统的教学管理模式。观察指标为两组间教学前后测试分数、教学后满意度调查的问卷得分等。结果:通过对两组学生进行课前课后的测试,TQM模式组相较于传统模式组在学习成绩有所提升,课前课后分数的差值分别为40(30,40)分和30(20,50)分,比较差异有统计学意义(=0.031)。问卷调查结果显示,两组满意度总分比较差异无统计学意义[10(10,10) 分 vs. 10(9,10)分,=0.207],但在满意度分项内容掌握性上,TQM模式组分值高于传统模式组[5(5,5)分 vs5(4,5)分,=0.046]。结论:基于钉钉平台的TQM模式在眼科教学中能够有效提高住培的教学质量与学生满意度,相比传统教学管理模式具有更大的教学优势,可为眼科住培提供了一种创新且实用的教学管理模式,对于培养适应时代需求的高水平眼科医师具有重要意义。

Objective: To combine the characteristics of standardized training for ophthalmic resident physicians, establishes a Total Quality Management (TQM) model based on the DingTalk platform, and explored an efficient ophthalmic teaching management model that adapts to the characteristics of the times. Methods: The research team, based at Zhongshan Ophthalmic Center, selected 82 first-year postgraduate students undergoing the national standardized training for resident doctors (STRD) as participants, randomly allocating them into two groups. The experimental group consisting of 41 trainees received TQM-modeled online learning via the DingTalk platform, adopting a management model of full participation, full process tracking, and comprehensive evaluation to ensure teaching quality. While the control group, also comprising 41 trainees, underwent traditional offline instruction. The TQM group engaged in live streaming lectures on the DingTalk platform, whereas the conventional group continued with face-to-face teaching in classroom. Data including pre- and post-teaching scores, as well as scores from satisfaction surveys are analyzed. Results: Comparing pre- and post-teaching scores, significant statistical differences were found between the TQM and traditional groups, with mean score improvements of 40(30,40) points and 30(20,50) points, respectively, indicating statistical significance (=0.013). Furthermore, the questionnaire survey revealed that the TQM group scored higher than the traditional group in aspects such as course design, clinical relevance, content mastery, and instructor satisfaction. In addition, the questionnaire survey showed that there was no statistically significant difference in the total satisfaction score between the two groups (10(10,10) points vs. 10(9,10)points =0.207), but in terms of mastery of satisfaction sub items, the TQM model group scored higher than the traditional model group (5(5,5) points vs. 5(4,5) points, =0.046). Conclusions: The application of a TQM-based model on the DingTalk platform significantly enhances the teaching quality and student satisfaction in the residency training of ophthalmologists, demonstrating greater pedagogical advantages over traditional methods. This efficient ophthalmic teaching management model thus provides a promising solution for standardized residency training in ophthalmology, and holds considerable importance for nurturing highly competent ophthalmologists who can meet the demands of the current era.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
推荐阅读
出版者信息