论著

基于 OA-2000 测量的硅油取出联合白内障手术患者人工晶状体计算公式预测准确性分析

Prediction accuracy analysis of intraocular lens calculation formulas in patients undergoing silicone oil removal combined with cataract surgery based on OA-2000 measurement

:857-866
 
目的:在硅油取出联合白内障手术患者中,使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物测量,比较10种人工晶状体(IOL)屈光力计算公式的准确性。方法:回顾性分析2021年3月—7月于中山大学中山眼科中心接受硅油取出联合白内障手术的患者共62例(62眼),所有患者均使用扫频源光学相干断层扫描生物测量仪OA-2000进行生物学参数测量。计算并比较新公式[Barrett Universal II (BUII)、Emmetropia Verifying Optical(EVO) 2.0、Hill-Radial Basis Function (Hill-RBF) 3.0、Hoffer QST、Kane、Pearl-DGS]及传统公式(Haigis、Hoffer Q、Holladay 1、SRK/T)的预测准确性,主要评价指标为绝对预测误差中位数(MedAE)及平均绝对预测误差(MAE)。按眼轴长度≤23 mm(组1),>23 mm且≤26 mm(组2)与>26 mm(组3)进行亚组分析。结果:6个新公式、Haigis、SRK/T公式均出现近视漂移(-0.47 ~-0.27 D,P<0.05),而HofferQ及Holladay 1公式无系统误差(P>0.05)。Kane公式的MedAE(0.55 D)及MAE(0.81 D)最小,但公式间比较差异无统计学意义(P>0.05)。组1中所有公式均出现近视漂移(-1.46~ -1.25 D,P<0.05),而其他亚组比较差异无统计学意义(-0.32 ~ 0.41 D,P>0.05)。在组1中,Pearl-DGS公式的MedAE(0.97 D)及MAE(1.26 D)最小,且优于Hill-RBF 3.0(P=0.01)及SRK/T公式(P=0.02);组2中,Kane公式具有最小的MedAE(0.44 D)及MAE(0.66 D);组3各个公式屈光预测准确性比较差异无统计学意义(P>0.05)。结论:在使用OA-2000进行术前生物测量时,Kane公式在接受硅油取出联合白内障手术患者中的预测准确性较高;而眼轴长度≤23 mm时,Pearl-DGS公式可能更为准确。
Objective: To compare the accuracy of 10 intraocular lens (IOL) power calculation formulas in patients undergoing combined silicone oil removal and cataract surgery, biometry is performed using the swept-source optical coherence tomography biometer OA-2000. Methods: A retrospective analysis. A total of 62 patients (62 eyes) who underwent combined silicone oil removal and cataract surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from March to July in 2021 were enrolled. Preoperative biometry was performed by OA-2000 in all patients. New-generation formulas (Barrett Universal II [BUII], Emmetropia Verifying Optical [EVO] 2.0, Hill-Radial Basis Function [Hill-RBF] 3.0, Hoffer QST, Kane and Pearl-DGS) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) were evaluated. The median absolute prediction error (MedAE) and mean absolute prediction error (MAE) were the main parameters used to assess accuracy. Subgroup analyses were performed based on the axial length of 23 mm and 26 mm. Results: Six new-generation formulas, Haigis, and SRK/T showed myopic shift (-0.47 ~ -0.27 D, P<0.05), while no systematic bias was found in Hoffer Q and Holladay 1 displayed (P>0.05). The smallest MedAE (0.55 D) and MAE (0.81 D) were found in Kane formula, but there was no statistically significant difference compared with other formulas (P>0.05). The myopic shift (-1.46 ~ -1.25 D, P<0.05) in eyes shorter than 23 mm were found in all formulas, while there was no significant systematic bias (-0.32 ~ 0.41 D, P>0.05) in other subgroups. In axial length shorter than 23 mm, the Pearl-DGS formula stated the smallest MedAE (0.97 D) and MAE (1.26 D), and was significantly more accurate than Hill-RBF 3.0 (P=0.01) and SRK/T (P=0.02). In eyes with an axial length between 23 mm and 26 mm, the Kane formula had the lowest MedAE (0.44 D) and MAE (0.66 D). No significant difference was found in eyes longer than 26 mm. Conclusion: The Kane formula showed the highest accuracy in patients undergoing combined silicone oil removal and cataract surgery measured by OA-2000, whereas the Pearl-DGS formula could be more accurate in eyes with an axial length shorter than 23 mm.
论著

眼科成人日间手术患者病区护理管理的最佳证据总结

Nursing management of ophthalmic postoperative adult intra-day ward: a systemic review

:571-579
 
目的:评价并汇总眼科成人日间手术患者病区护理管理的最佳证据,提高临床护理质量。方法:检索国内外数据库建库至2022年6月的日间手术患者病区护理管理的相关证据,包括系统评价、临床决策、证据总结、指南及专家共识。由2名研究人员独立对文献进行质量评价后,根据主题对证据进行提取和汇总。结果:根据纳入标准,共筛选出13篇文献,包括5篇专家共识、3篇证据总结、1篇循证实践、2篇系统评价、1篇指南。通过文献阅读、证据提取和归类,从日间手术护士准入资质、制定临床护理路径、院前管理、病历标准化、手术当日术前管理、术后管理、出院评估、康复及随访指导8个方面形成17条最佳证据。结论:该项目总结了眼科成人日间手术患者病区护理管理的最佳证据,可为护理管理者制定眼科日间手术病区流程方案、实践标准提供循证依据。
Objective: To evaluate and summarize the evidences of nursing management of ophthalmic postoperative adult patients intra-day ward, and improve the quality of clinical nursing. Methods: The related databases were searched from the  establishment to June 2022. The searching contents include systematic review, clinical decision-making, evidence  summary, guidelines and expert consensus on nursing management in postoperative patients intra-day wards at home  and aboard. Based on the theme, the evidences were extracted and summarized after independent literature quality  evaluation was conducted by 2 researchers. Results: Base on the inclusion criteria, a total of 13 pieces of literature were  selected, including 5 expert consensus, 3 evidence summaries, 1 evidence-based practice, 2 systematic reviews and 1  guideline. Through literature review, evidence extraction and classification, a total of 17 pieces of evidence on 8 aspects  were summarized, including admission qualifications for daytime surgical nurses, development of clinical nursing path,  pre-hospital management, medical record standardization, preoperative management on the day of surgery, postoperative  management, discharge assessment, rehabilitation and follow-up guidance. Conclusion: This article summarized the  best evidence of nursing management for ophthalmic adult day surgery patients in intra-day ward,to provide scientific  evidences for nursing managers to develop ophthalmic intra-day ward guidelines and practical standards.
论著

开角型青光眼患者眼部用药规范化护理管理的最佳证据总结

Summary of the best evidence on standardized ocular medication management among open-angle glaucoma patients

:17-24
 
目的:检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据,为临床实践提供参考。方法:通过护理循证方法提出实践问题,按照循证证据检索数据库的“6S”分类模型,检索有关开角型青光眼患者眼部用药管理的所有证据资源类型,包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果:最终纳入12篇文献,包括4篇指南、3篇证据总结和5篇系统评价;汇总了19条有关开角型青光眼眼部用药管理的最佳证据,包括滴眼技术指导、依从性管理和信息提供3个方面。结论:总结开角型青光眼眼部用药管理的最佳证据,可为临床医务人员管理患者提供参考和借鉴,以达到患者规范用药、控制眼压和延缓疾病进展的目的。
Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.
论著

老年性糖尿病性白内障患者延续护理

Continuing Nursing Care of Patients with Senile and Diabetic Cataract

:116-118
 
目的:探讨老年性糖尿病性白内障患者治疗及延续护理的措施。
方法:对2014年1月~2014年12月142例老年性糖尿病性白内障患者随机平均分为A组和B组,A组接受常规的出院指导;B组接受常规的出院指导及加强延续护理,根据老年性糖尿病性白内障患者 的具体情况制定护理措施 (眼部的护理、用药指导、饮食护理、心理护理、自我监测指导、定期随访及复查等内容),并进行跟踪处理。
结果:实施延续护理一年后的患者,体重、空腹血糖、餐后2 h血糖与未实施延续护理的患者相比,差异有显著意义 (P<0.05)。
结论:护士对老年性糖尿病性白内障患者及家属进行用眼和糖尿病相关的知识宣教、针对性的心理护理、药物治疗护理及日常生活指导等,老年性糖尿病性白内障患者的遵医率提高,减少了因疾病而对生活工作的影响,生活质量有不同程度的提高。
Purpose: To explore the treatment and continuing nursing of patients diagnosed with senile and diabetic cataract.
Methods: In total, 142 patients diagnosed with senile and diabetic cataract admitted to Zhongshan Ophthalmic Center from January to December 2014 were randomly assigned into groups A and B. In group A, patients received conventional instruction after discharge, and those in group B additionally received continuing nursing care after discharge including ocular nursing, use of anti-diabetic drugs, psychological nursing,  diet nursing, self-monitoring guidance,  re-examination and regular follow-up according to the patients’ conditions.
Results: After one year of continuing nursing care, visual acuity of patients in group B was increased without complications. Body mass index, the fasting and 2h postprandial plasma glucose,  and the systolic and diastolic blood pressure were decreased significantly compared with those in group A (all P<0.05).
Conclusion: Continuing nursing care, including knowledge education related to ocular use and diabetes mellitus, targeted psychological nursing,  medication nursing and daily life guidance,  play a pivotal role in enhancing the compliance rate of the patients,  reducing the influence upon work and life and enhancing the quality of life to varying extent.
论著

不同病变阶段视网膜色素变性患者脉络膜血管状态的荧光血管造影特征

Characters of choroid in different stages of retinitis pigmentosa

:74-79
 
目的:探讨不同病变阶段视网膜色素变性患者的脉络膜血管状态。方法:回顾性分析云南省第二人民医院眼科2000年1月至2015年4月诊断为原发性视网膜色素变性的患者226例(452眼)的眼底特征,并复习相关文献,重点分析总结脉络膜血管情况。结果:31例(62眼)病变前期患者,荧光素眼底血管造影显示动脉期脉络膜血管及视网膜血管充盈正常,未出现充盈延迟或缺损现象。25例(50眼)病变早期患者,荧光素眼底血管造影显示动脉前期可见脉络膜背景荧光显示,部分脉络膜毛细血管未同时充盈,动脉期时上述部分完成充盈。106例(112眼)病变中期患者,荧光素眼底血管造影显示动脉期出现部分脉络膜毛细血管萎缩区,仅能看到残存的粗大脉络膜血管,随造影过程的进展,此区域并未出现充盈,即呈现永久的脉络膜毛细血管充盈缺损。64例(128眼)病变晚 期患者荧光素眼底血管造影显示,广泛的脉络膜毛细血管萎缩区,其间可见残存的脉络膜粗大血管,至造影晚期均呈现充盈缺损,萎缩区边缘随造影过程呈强荧光表现。结论:荧光素眼底血管造影可显示脉络膜血管萎缩变化情况,这一指标可作为反映不同病变阶段视网膜色素变性患者病情进展变化的重要依据。
Objective: To investigate clinical characteristics of choroid in different stages of retinitis pigmentosa. Methods: The characteristics of fundus, visual conditions and characters of choroid of 226 cases (452 eyes) patients with retinitis pigmentosa in No. 2 People’s Hospital of Yunnan Province from Jan.2000 to Apr.2015 were retrospectively analyzed. Results: Fundus fluorescein angiography of 31 cases (62 eyes) before early stage showed:  arterial choroidal and retinal vascular filling normal, filling delay or defect phenomenon does not be observed. Fundus fluorescein angiography 25 cases (50 eyes) patients in early disease showed: preliminary choroidal artery background fluorescence was displayed, at the same time, part of the choriocapillaris was not filling, the filling was completed in arterial stage. Fundus fluorescein angiography of 106 cases (112 eyes) patients in the medium-stage showed: arterial phase appears part choriocapillaris atrophy area, thick choroidal vessels can be seen, with the progress angiography procedure, filling was not be observed in this area, which presents permanent choriocapillaris filling defect. Fluorescein angiography of 64 cases (128 eyes) in patients in advanced stage showed widespread choriocapillaris atrophy area, during which thick choroidal vessels remaining filling defect in late stage, atrophic area with a contrast edge high fluorescence performance. Conclusion: Fluorescein angiography can show choroidal atrophy changes, it can be used as an indicator to assess the progression of retinal changes in patients with retinitis pigmentosa.
论著

泪道成形+义管植入日间手术患者的延续性护理

Continuous care of the patients with day surgery of lacrimal duct formed combined tube implantation

:84-87
 
目的:探讨完善泪道成形+义管植入日间手术患者的延续性护理对预防义管意外脱管的重要作用。方法:收集我科2016年1月至12月实施了标准延续性护理的泪道成形+义管植入日间手术患者的意外脱管情况。结果:泪道成形+义管植入日间手术患者随访期间没有发生医源性脱管,有9例9眼带管期间在院外发生脱管,意外脱管率为2.6%。结论:做好泪道成形+义管植入日间手术患者的延续性护理,有效降低义管意外脱出率,有利于患者康复。
Objective: To explore the important role of continuous nursing of the patients with day surgery of lacrimal duct forming combined tube implantation in the aspect of accident prevention to take off the tube. Methods: The information of the patients from Jan. to Dec. 2016 with accident the tube’s takeoff after carrying out the standard continuity of care were collected. Results: There was no iatrogenic but 9 eyes of 9 patients accidentally take off the tube during follow-up period. Accidental decannulation rate was 2.6%. Conclusion: Continuous care of the patients with day surgery of lacrimal duct forming combined tube implantation can effectively reduce the tube accidentally removal rate and be beneficial to patients’ recovery.
论著

甲状腺相关眼病患者的生活质量调查及护理对策

Investigation of quality of life and nursing of patients with thyroid associated ophthalmopathy

:80-83
 
目的:探讨与甲状腺相关眼病患者的生活质量,为做好个体化的护理提供理论依据。方法:采用甲状腺相关眼病的生活质量调查问卷进行调查,用R语言进行数据分析。结果:年龄与视功能评分成负相关(P<0.001,r=–0.504),与社会心理评分成正相关(P=0.002,r=0.327)。文化程度与视功能评分成正相关(P<0.001,r=0.391),与社会心理评分无相关关系(P=0.749)。不同症状的视功能评分之间差异有统计学意义(P<0.001)。结论:通过甲状腺相关眼病的生活质量调查问卷可知,年龄越大,视功能越差,不同症状的患者视功能情况不同,要关注年龄大、复视、视力差患者的安全;在护理上,要做好患者及其有甲状腺功能亢进史家属的健康宣教,尤其关注女性患者的社会心理状况。
Objective: To explore the factors related to the quality of life of patients with thyroid associated ophthalmopathy, and to provide theoretical basis for individual nursing. Methods: The quality of life questionnaire of thyroid associated ophthalmopathy was used to investigate, and the data were analyzed by R language. Results: There was a negative correlation between age and visual function score (P<0.001, r=-0.504), and positively correlated with social psychological score (P=0.002, r=0.327). There was a positive correlation between educational level and visual function score (P<0.001, r=0.391), and had no correlation with social psychological score (P=0.749). There were statistically significant differences in visual function scores among different symptoms (P<0.001).Conclusion: The quality of life of thyroid-related eye disease questionnaire showed that the older, the worse the visual function. Different symptoms of patients had different visual function. We should pay attention to the patients with older, diplopia and poor vision, do health education with the patients and family members with the history of hyperthyroidism as well, especially concern with the social and psychological status of female patients.
论著

2017~2023年期间眼科患者术前四项感染指标的结果分析

Analysis of four blood-borne pathogens in ophthalmic patients from 2017 to 2023

:1-9
 

目的:了解中国华南地区眼科患者近年术前四项指标的感染状况及阳性患者在不同眼病中的分布。方法:回顾性分析2017年1月~2023年12月在中山大学中山眼科中心进行乙型肝炎表面抗原(HBsAg)、丙肝肝炎病毒抗体(抗-HCV)、梅毒螺旋体抗体(抗-TP)、人类免疫缺陷病毒抗体(抗-HIV)指标筛查的门诊、手术和(或)住院患者资料,并记录和分析患者各项指标的阳性情况。结果:共纳入253 246例患者,HBsAg、抗-HCV、抗-TP和抗-HIV阳性率分别是9.00%、0.45%、1.55%、0.13%。两种或两种以上感染指标阳性的患者共有686例, HBsAg和抗HCV同时阳性的例数最高(57.29%),其次为抗-HIV和抗-TP(15.74%)。2017~2023年HBsAg阳性率逐年递减,而抗-HCV、抗-HIV、抗-TP阳性率变化不明显。男性的HBsAg、抗-HCV、抗-TP、抗-HIV阳性率均高于女性,差异均有统计学意义(<0.001)。HBsAg、抗-HCV、抗-TP、抗-HIV阳性率在不同年龄段比较差异均有统计学意义(<0.001)。在HBsAg、抗-HCV、抗-TP阳性患者中,晶状体病的病例数占比最高,分别为36.72%、39.12%、46.97%。其次是玻璃体/视网膜疾病,占比分别为22.52%、19.65%、19.69%。在抗-HIV阳性患者中,玻璃体/视网膜疾病的病例数占比最高,为42.99%,其次是晶状体病,占26.17%,葡萄膜炎占8.72%。结论:本研究揭示了眼科患者术前四项指标的感染情况及感染患者在不同眼病中的分布,这对于评估眼科手术风险、制定感染控制措施具有重要意义。

Objective: To understand the infection status of four blood-borne pathogens among ophthalmology patients in South China and the distribution of positive patients across different eye diseases. Methods: A retrospective analysis of data from outpatient and inpatient or surgical ophthalmic patients who underwent screening for hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (anti-HCV), treponema pallidum antibody (anti-TP) and human immunodeficiency virus antibody (anti-HIV) at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2017 to December 2023. The positivity rates of these markers were recorded and analyzed. Results: A total of 253246 patients were included in the study, with positivity rates for HBsAg, anti-HCV, anti-TP, and anti-HIV at 9.00%, 0.45%, 1.55% and 0.13%, respectively. Among these, 686 patients tested positive for two or more markers, with the highest co-positivity observed for HBsAg and anti-HCV (57.29%), followed by anti-HIV and anti-TP (15.74%). The positivity rate of HBsAg showed a yearly decline, while the rates for anti-HCV, anti-HIV, and anti-TP remained relatively stable from 2017 to 2023. Males had significantly higher positivity rates for HBsAg, anti-HCV, anti-TP, and anti-HIV compared to females (P < 0.001). Significant differences in positivity rates for these markers were also observed across different age groups (P < 0.001). In patients with positive HBsAg, anti-HCV, and anti-TP, the proportion of cases with lens diseases were the highest, at 36.72%, 39.12%, and 46.97%, respectively. Vitreoretinal diseases followed, with proportions of 22.52%, 19.65%, and 19.69%, respectively. Among patients with positive anti-HIV, the proportion of cases with vitreoretinal diseases was the highest, at 42.99%, followed by lens diseases at 26.17%, and uveitis at 8.72%. Conclusions: This study reveals the infection status of four blood-borne pathogens in ophthalmology patients and the distribution of infected patients across different eye diseases, which is significant for assessing the risks of ophthalmic surgery and formulating infection control measures.
论著

飞秒激光辅助角膜内皮移植术患者的护理

Nursing for the patients with femtosecond laser assisted corneal endothelial transplantation

:229-231
 
目的:探讨飞秒激光辅助角膜内皮移植(endothelial keratoplasty,EK)患者的护理。方法:对40例 行飞秒激光辅助EK术的患者做好术前心理护理,完善术前检查及术前准备,术后重点做好体位护 理、病情观察及出院指导。结果:4例患者术后发生植片移位,经再次复位后贴合良好,1例术后第1天气泡到后房行前房成形术;13例患者术后出现眼压升高,经治疗眼压得到控制;40例患者全 部治愈出院。结论:对EK术患者应做好术前及术后的护理,及时发现并发症并采取相应的治疗与护理措施,以提高手术的成功率。
Objective: To explore the nursing care of patients with femtosecond laser assisted endothelial transplantation. Methods: Forty patients were involved in this study. Preoperative psychological nursing, ocular examination, and surgical preparation were taken, and the main nursing postoperation focused on patients’ position and the discharge guidance. Results: TTe graffs in 4 cases were displaced, and were all in place affer resetting. The bubble was observed in posterior chamber in 1 case, this case was taken anterior chamber forming operation. Intraocular pressure was high in 13 cases, and those cases were treated with topical medicines. Conclusion: Completing the preoperative nursing of patients with corneal endothelial transplantation, observing the complications and taking corresponding treatment and nursing measures help improve the success rate of the operation.  

睡眠呼吸暂停综合征患者睡眠前后黄斑厚度改变的临床分析

The Change of Macular Thickness of SAS Before and After Sleep

:38-40
 

目的观察睡眠呼吸暂停综合征(Sleep apnea syndrome, SAS)患者睡眠前后黄斑厚度的改变。

方法选择 2003 年 8 月至 2007 年 1 月经确诊的在我院门诊和住院部治疗的 SAS 患者共 32 例(63 只眼),分别在上午 11:00 ~ 12:00(睡眠前)及患者晨起 20 ~ 30 分钟内(睡眠后)采用相干光断层扫描仪(Optical Coherence Tomography, OCT)进行黄斑中心凹厚度的测量。

结果睡眠前黄斑中心小凹平均视网膜厚度为(123.00 ± 19.98)μm,睡眠后黄斑中心小凹平均视网膜厚度为(134.25 ± 19.92)μm。睡眠后黄斑中心凹厚度比睡眠前厚度增加(11.25 ± 9.04)μm,95% 可信区间为(8.98,13.53)μm,差异有统计学意义(= 9.878,P < 0.05)。

结论睡眠呼吸暂停综合征患者睡眠时的缺血缺氧可以导致黄斑视网膜的水肿增厚。

Purpose: To observe the changes of macular thickness in patients with sleep apnea syndrome (SAS) before and after sleep.

Methods: Thirty-two patients (63 eyes) diagnosed as SAS from August 2003 to January 2007 were enrolled. Macular thickness was measured using Optical Coherence Tomography (OCT) at 11:00 ~ 12:00 evening (before sleep) and 20 ~ 30 minutes after sleep, respectively.

Results: The mean macular thickness was (123.00 ± 19.98) μm and (134.25 ± 19.92) μm before and after sleep, respectively. The mean difference was (11.25 ± 9.04) μm before and after sleep (t = 9.878, < 0.05), 95% CI (8.98, 13.53) μm.

Conclusions: The macular thickness of SAS is increased in SAS patients, which may be due to anoxia of SAS. 

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
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  • 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
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