文章报道了一例5岁女性Dandy-Walker综合征（Dandy-Walker syndrome，DWS）患儿的临床表现、眼科检查及影像学特征。该患儿在确诊DWS后行后颅窝蛛网膜囊肿部分切除术，然而术后视力仍进行性下降，眼科随访过程中发现视网膜神经纤维层（Retinal Nerve Fibers Layer，RNFL)进行性变薄，提示颅内压尚未有效控制，视神经损害在进一步发展。由于DWS病变位置特殊性，头颅磁共振成像（Magnetic Resonance Imaging，MRI）及常规腰椎穿刺未能确定幕上颅内高压，后经侧脑室直接测压，证实仍然存在颅压异常增高。行右侧脑室-腹腔分流术后，患儿双眼视力有所提高，双眼RNFL）厚度无继续变薄。目前DWS的治疗方式包括后颅窝囊肿切除术、脑脊液分流术及内镜下第三脑室造瘘术。 术后DWS患者的颅内压的测量有特殊性，幕上与幕下区域之间的脑实质内压力可能形成显著的压力梯度，腰椎穿刺测压可能无法准确反映颅内压，脑室内测压方法则创伤更大。此时需要眼科检查提供支持颅内高压的证据，如RNFL厚度进行性下降、视盘水肿及视网膜血管形态异常，这些检查无创、简便、可多次重复，是临床医生评估颅内压的有效手段，建议纳入DWS患者术后颅内压的常规管理中。
This article reports the clinical presentation, ophthalmologic examination, and imaging features of a 5-year-old girl with Dandy-Walker syndrome (DWS). She underwent partial resection of an arachnoid cyst in the posterior cranial fossa after the diagnosis of DWS. However, her visual acuity continued to deteriorate after the surgery, and the ophthalmologic follow-up revealed progressive thinning of the retinal nerve fibers layer (RNFL), suggesting that the intracranial pressure (ICP) had not yet been effectively controlled, and the damage to the optic nerve was further developing. However, due to the special pathological changes of DWS, MRI and routine lumbar puncture was not able to exactly identify the supratentorial ICP, subsequent ICP measurement through the lateral ventricle confirmed that increased ICP was still existed. After performing a right ventriculoperitoneal shunt, the child's binocular vision improved, and the thickness of the RNFL in both eyes remained stable. Current treatment modalities for DWS include cystectomy, cerebrospinal fluid shunt and endoscopic third ventriculostomy. The measurement of postoperative ICP in DWS patients is complicated, because there may be a significant pressure gradient between the supratentorial and infratentorial regions, which is not accurately reflected by lumbar puncture manometry, and intraventricular manometry is much more invasive. Ophthalmologic examinations including progressive decrease in RNFL thickness, optic disc edema, and abnormal retinal vascular morphology are required to provide evidences of increased ICP. These examinations are noninvasive, simple, and repeatable. They are an effective means of assessing ICP, and are recommended to be included in the routine management of ICP in patients with DWS after surgery.
本文报告两例单眼无痛性视力下降病例。病例1为47岁男性，表现为右眼亚急性视力下降，伴视盘水肿及黄斑区星芒状渗出，血清汉塞巴尔通体（Bartonella henselae）IgG抗体阳性（滴度1:256），结合猫接触史及跳蚤叮咬史，诊断为猫抓病相关视神经视网膜炎。经口服多西环素联合球周注射曲安奈德治疗后，视力显著恢复至1.0。病例2为33岁男性，表现为右眼急性视野缺损伴轻度视力下降，视盘水肿伴出血及棉绒斑。血清学检查示汉塞巴尔通体IgG阳性（滴度1:256）及梅毒螺旋体抗体阳性（TPPA+, TRUST+）。初始经验性抗猫抓病（多西环素+利福平）及抗梅毒（苄星青霉素）治疗无效，视力持续下降。随访1个月时光学相干断层扫描（OCT）显示视盘周围视网膜色素上皮（RPE）局灶性钉状突起，符合梅毒眼部特征性改变，结合患者抗汉塞巴尔通体治疗反应不佳，最终修正诊断为梅毒性视神经病变。继续抗梅毒治疗后视力稳定于0.63，但遗留视神经萎缩。两例病例提示感染性视神经病变的诊断需综合病史、临床表现、辅助检查、治疗反应及特征性体征进行鉴别，尤其需审慎解读汉塞巴尔通体抗体血清学阳性结果。
This paper reports two cases of unilateral painless vision loss. Case 1 involved a 47-year-old male presenting with subacute vision loss in the right eye, accompanied by optic disc edema and macular stellate exudates. Serological testing revealed positive IgG antibodies against Bartonella henselae (titer 1:256). Combined with a history of cat contact and flea bites, a diagnosis of cat scratch disease-associated optic neuroretinitis was made. After treatment with oral doxycycline combined with periocular triamcinolone acetonide injection, the patient's vision significantly improved to 1.0. Case 2 involved a 33-year-old male presenting with acute visual field defect in the right eye accompanied by mild vision loss, optic disc edema with hemorrhage, and cotton-wool spots. Serological tests showed positive IgG antibodies against Bartonella henselae (titer 1:256) and positive antibodies against Treponema pallidum (TPPA+, TRUST+). Initial empirical treatment for cat scratch disease (doxycycline + rifampicin) and syphilis (benzathine penicillin) was ineffective, with continued vision decline. Optical coherence tomography (OCT) at the one-month follow-up revealed focal spiculated protrusions of the retinal pigment epithelium (RPE) around the optic disc, consistent with characteristic ocular changes of syphilis. Considering the patient's poor response to anti-Bartonella henselae treatment, the diagnosis was revised to syphlitic optic neuropathy. After continued anti-syphilis treatment, the patient's vision stabilized at 0.63, but optic atrophy persisted. These two cases suggest that the diagnosis of infectious optic neuropathy requires comprehensive differentiation based on medical history, clinical manifestations, auxiliary examinations, treatment responses, and characteristic signs, with particular caution in interpreting positive serological results for Bartonella henselae antibodies.
目的：了解干眼患者相关知识、管理态度及防治行为的现状及影响因素，为临床制定针对性的干预措施提供依据。方法：采用便利抽样法，选取2025年1—3月在中山大学中山眼科中心干眼与眼表疾病门诊就诊的患者为研究对象。调查工具为一般资料调查表、中国干眼问卷及干眼患者知信行问卷。知信行问卷包括知识（16个条目）、态度（7个条目）、行为（9个条目） 3个维度，共32个条目。使用单因素分析及多元线性回归分析确定影响因素。 结果：有效回收调查问卷325份，325例干眼患者的知信行问卷平均得分为（62.89±9.00）分；标准分为（78.61±11.25）分，处于中等水平。其中知识维度平均得分为（9.89±4.88）分，134例（41.2%）处于较差水平；态度维度得分较高，总均分为（26.92±2.24）分，标准分（96.16±8.03）分，处于较高水平；行为维度总均分为（26.06±5.43）分，标准分（72.41±15.09）分，处于中等水平。单因素分析结果显示，不同年龄、文化程度、家庭人均月收入、是否经常使用电子设备、是否主动查询疾病知识的干眼患者，其知信行得分比较差异有统计学意义（P<0.05）。年龄、文化程度、是否主动查询疾病知识是干眼患者知信行得分的影响因素（P<0.05）。 结论：干眼患者知信行水平处于中等，表现为疾病知识掌握片面、防治态度较积极但行为水平有待提高，且受多因素影响，应制订精准、个性化健康教育内容，以提高干眼患者的知信行水平。
Objective: To investigate the current status and identify the influencing factors regarding the knowledge, attitudes, and practices related to dry eye disease (DED) among patients. This study aims to provide a solid foundation for the development of targeted clinical interventions. Methods: With convenience sampling, patients diagnosed with DED were selected at the Dry Eye and Ocular Surface Disease Clinic of Zhongshan Ophthalmic Center from January to March 2025 as study subjects. The survey tools consisted of a general information questionnaire, the Chinese Dry Eye Questionnaire, and the Knowledge, Attitudes, and Practices (KAP) Questionnaire for DED patients. The KAP questionnaire was structured into three dimensions: knowledge (16 items), attitudes (7 items), and practices (9 items), making a total of 32 items. Univariate analysis and multiple linear regression were employed to identify influencing factors. Results: A total of 325 valid questionnaires were collected. Among the 325 DED patients, the average KAP score was 62.89±9.00, and the standardized score was 78.61±11.25, indicating a moderate level. In the knowledge dimension, the average score was 9.89±4.88 and 134 patients (41.2%) had poor scores. The attitudes dimension showed a relatively high level, with a total mean score of 26.92±2.24 and a standardized score of 96.16±8.03, reflecting that the patients generally held positive attitudes towards the prevention and treatment of DED. For the practices dimension, the total mean score was 26.06±5.43, and the standardized score was 72.41±15.09, indicating a moderate level of behaviorial practices. Univariate analysis revealed significant differences in KAP scores among patients with different ages, education levels, monthly household income per capita, frequencies of electronic device use, and whether they actively sought disease-related knowledge (P<0.05). Further, age, education level, and proactive information-seeking behavior were identified as significant influencing factors for KAP scores (P<0.05). Conclusions: The KAP level of DED patients is moderate. Their disease knowlege is fragmented, while they exhibit positive attitudes toward prevention and treatment. However, their behavioral practices are subptimal and are influenced by multiple factors. Therefore, it is essential to develop tailored and personalized health education programs to enhance the KAP level of DED patients.
目的：分析日间病房模式下原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction, PANDO)患者行经鼻内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)的术后自我护理现状并进行早期效果评价。方法：纳入2021年11月—2022年8月在中山大学中山眼科中心眼整形与泪道科日间病房行En-DCR手术治疗的90例PANDO患者，术后常规给予术后自我护理指导。术后1个月复查，采用调查问卷的方式记录患者的术后自我护理情况及不适症状，评估患者手术效果，并进一步探究术后自我护理因素与手术效果及术后不适症状的相关性。结果：90例行En-DCR手术治疗的PANDO患者共计90眼，术后1个月手术总成功率为92.22%（其中治愈率为65.56%、好转率为26.67%）。术后自我护理与手术效果的特征分析显示，术后遵医嘱鼻腔冲洗每日至少1次（P = 0.002）、遵医嘱喷鼻每日至少1次（P = 0.008）、术后无上呼吸道感染（P = 0.047）的患者手术效果更好。术后自我护理与术后不适症状的特征分析显示，每日至少1次鼻腔冲洗（P = 0.006）和义管在位（P = 0.003）的患者术后不适症状较少。同时对置管患者进行心理负担相关性分析，结果显示置管不适与心理负担呈正相关（r = 0.421, P < 0.001）。结论：在日间病房模式下，医护人员对En-DCR术后患者进行详细的自我护理指导，有助于患者的术后恢复及保证良好的手术疗效。指导重点包括术后1个月内每日至少1次鼻腔冲洗，规律使用抗炎喷鼻剂并防止上呼吸道感染；另外应重点关注泪道置管患者术后局部不适症状，针对术后不适症状优化用药，使用互联网护理门诊或电话随访做好护理指导和心理疏导，促进患者术后康复。
Objective: To investigate postoperative self-care practices and evaluate the early outcomes of patients with Primary Acquired Nasolacrimal Duct Obstruction (PANDO) undergoing Endoscopic Dacryocystorhinostomy (En-DCR) in a day ward setting. Methods: 90 PANDO patients who underwent En-DCR surgery at the Oculoplastic and Lacrimal Surgery day ward at Zhongshan Ophthalmic Center, Sun Yat-sen University, between November 2021 and August 2022, were enrolled in this study. All patients received standardized postoperative self-care instructions. At the one-month follow-up, a questionnaire survey was used to record patients' self-care adherence to self-care practices, postoperative discomfort symptoms, and assess surgical outcomes. Furthermore, the correlation between self-care factors and surgical outcomes/discomfort symptoms was explored. Results: A total of 90 eyes from 90 PANDO patients undergoing En-DCR were included. The overall surgical success rate at one month was 92.22% , comprising a cure rate of 65.56% and an improvement rate of 26.67%. Analysis of self-care practices related to surgical outcomes showed significantly better results in patients who adhered to nasal irrigation at least once daily (P = 0.002), used prescribed nasal spray at least once daily (P = 0.008), and avoided upper respiratory tract infections (P = 0.047). Regarding postoperative discomfort, patients who performed nasal irrigation at least once daily (P = 0.006) and had the lacrimal stent (tube) in situ (P = 0.003) experienced significantly fewer symptoms. Furthermore, correlation analysis in stented patients indicated a positive correlation between stent discomfort and psychological burden (r = 0.421, P < 0.001). Conclusion: In the day ward model, detailed self-care guidance provided by healthcare professionals for En-DCR patients contributes to postoperative recovery and ensures favorable surgical outcomes. Key instructions include performing nasal irrigation at least once daily, using anti-inflammatory nasal spray regularly, and preventing upper respiratory infections during the first postoperative month. Additionally, particular attention should be paid to localized discomfort in patients with lacrimal stents. Optimizing medication regimens for discomfort, utilizing internet-based nursing clinics or telephone follow-ups for guidance and psychological support are crucial to promote postoperative rehabilitation.
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．
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.
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.
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.
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.
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（t = 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, P < 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.
