目 的: 比 较 不 同 能 量 氪 离 子 黄 绿 光 联 合 Nd ∶YAG 激 光 行 周 边 虹 膜 切 开 术 的 临 床 疗 效 和 对 眼压、血- 房 水 屏 障 的 影 响。

方 法: 使 用 激 光 蛋 白 细 胞 仪 及 压 平 式 眼 压 计 对 31 例(62 只 眼) 接 受 高 能 量 组 700 mW, 低 能量 组 400 mW的 氪 离 子 联 合 Nd: YAG 激 光 行 周 边 虹 膜 切 除 术 前、术 后 的 房 水 蛋 白 浓 度、前 房细 胞 数 和 眼 压 进 行 比 较。术 后 随 访 1 个 月。

结 果: 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅 无 闭 合, 无 角 膜 损 伤 及 晶 体 混 浊。 术 前 和 术 后1 h、3 d、7 d 及 1 个月的平均 Goldmann 眼压值在高能量组分别为 ( 15.68±2.41) 、(27.13±3.48) 、(20.97±5.27) 、(16.35±1.14) 、(15.06±2.02) , 在 低 能 量 组 分 别 为( 15.35±1.78) 、(22.77±3.26) 、(16.26±2.41) 、(15.68±2.06) 、( 15.06±1.36) 。术 前 和 术 后 3 d、7 d 及 1 个 月 的 平 均 房 水 闪 光 值在 高 能 量 组 分 别 为( 4.65±1.50) 、(10.41±2.47) 、(7.31±2.31) 、(6.15±2.16) , 在 低 能 量 组 分 别 为(4.45±1.19) 、(6.47±1.11) 、(4.81±0.55) 、(4.98±1.48) pc/ms; 前 房 细 胞 数 平 均 值 在 高 能 量 组 分别 为( 0.47±0.42) 、( 36.22±9.16) 、(18.54±3.60) 、( 6.29±0.98) , 在 低 能 量 组 分 别 为(0.58±0.52) 、(24.73±6.09) 、(10.61±1.70) 、(2.96±1.35) 。高 能 量 组 术 后 1 h 及 第 3 天 眼 压 的 升 高 幅 度 较 低能 量 组 高, 术 后 各 点 的 房 水 闪 光 值 和 前 房 细 胞 数 升 高 幅 度 均 较 低 能 量 组 明 显, 术 后 1 个 月 两组 前 房 细 胞 数 及 高 能 量 组 房 水 闪 光 值 仍 未 能 降 至 术 前 水 平, 差 异 有 显 著 性 意 义( P < 0.05) 。

结 论: 低 能 量 与 高 能 量 氪 黄 绿 激 光 联 合 Nd ∶YAG 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅, 临 床效 果 相 同; 低 能 量 组 术 后 一 过 性 眼 压 升 高 恢 复 至 正 常 较 快, 前 房 蛋 白 较 快 恢 复 正 常。提 示 在 进行 激 光 周 边 虹 膜 切 开 术 时 应 尽 可 能 用 低 能 量。两 组 术 后 1 个 月 前 房 仍 有 细 胞, 应 继 续 随 访。

Purpose: To compare the influence of krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy (LPI) on the intraocular pressure, blood-aqueous barrier and inflammatory of anterior chamber as well as the therapeutic effect.

Methods: Using a laser flare cell meter and Goldmann tonometer, the level of aqueous protein, the number of cells in the anterior chamber and intraocular pressure of 31 patients (62 eyes) who underwent krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy were examined and recorded preoperatively and postoperatively.

Results: The mean preoperative and 1-hour, 3-day, 7-day, 1-month postoperative intraocular pressure ( IOP) of the high power-density group were (15.68±2.41) , (27.13 ±3.48) , (20.97 ±5.27) , (16.35 ±1.14) and (15.06 ±2.02) mmHg, while those of the low were (15.35±1.78) , (22.77±3.26) , (16.26±2.41) , (15.68±2.06) and (15.06±1.36) mmHg. The mean preoperative and 3-day, 7-day, 1-month postoperative flare intensity of the high power-density group were (4.65±1.50) , (10.41±2.47) , (7.31±2.31) and (6.15±2.16) pc /ms, while those of the low were (4.45±1.19) , (6.47±1.11) , (4.81±0.55) and (4.98±1.48) pc/ms. The number of aqueous cells of the high was (0.47±0.42) , (36.22±9.16) , ( 18.54±3.60) and (6.29±0.98) , while that of the low was (0.58±0.52) , (24.73±6.09) , (10.61±1.70) and (2.96±1.35) . The mean 1-hour and 3-day postoperative IOP of the high was higher than that of the low. Both the mean flare intensity and the mean number of aqueous cells of the high power-density group were higher than those of the low. The differences were of statistical significance (P <0.05) . The mean flare intensity of the high power-density group in the 1-month postoperative follow-up was still higher than the baseline. The mean number of aqueous cells of both the high and the low power-density groups in the 1- month postoperative follow-up was still higher than the baseline. During 1-month follow-up, no obvious visual damage, diffuse corneal endothelial burns or corneal decompensation, lens injury and closure of the peripheral iris incision were observed.

Conclusion: When krypton laser combined with Nd: YAG laser peripheral iridotomy is under consideration, relatively low power-density krypton laser is recommended because it can achieve the similar therapeutic effects as high power-density krypton laser but leads to less complications and a briefer recovery. More follow-ups are needed after LPI, because the number of aqueous cells in 1-month follow-up was still abnormal. 

目的：分析有意愿接受准分子激光角膜屈光手术治疗近视的患者在术前检查后未行手术的原因。方法：选取2015年1月至2017年6月在安徽医科大学附属第一医院眼科激光中心检查的近视患者，分析其中未行激光手术的原因。结果：共2 875例患者准备接受准分子激光角膜屈光手术，其中821例(28.6%)检查后未进行手术，男462例(56.3%)，女359例(43.7%)，年龄18~51(23.69±5.85)岁。821例中社会心理因素影响484例(59.0%)，角膜薄或角膜厚度不足182例(22.2%)，超高度近视(>10.00 D)100例(12.2%)，高眼压19例(2.3%)，弱视13例(1.6%)，角膜曲率异常11例(1.3%)，眼底病变7例(0.9%)，角膜变性3例(0.4%)，其他2例(0.2%)。结论：近视治疗术前检查后未进行准分子激光角膜屈光手术的原因多种多样，其中社会心理因素及角膜厚度不足是最主要的原因。术前详细检查，严格掌握手术适应证和禁忌证以及充分医患沟通是手术安全的保障。

Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054 (71.4%) of them received refractive surgery. Among 821 (28.6%) patients who did not get laser refractive keratomileusis, 462 (56.3%) were male and 359 (43.7%) were female, aged 18–51 years (range, 23.69±5.85 years). The most common reason for not offering refractive surgery were social psychological factors (59.0%), low central corneal thickness (22.2%), high myopia (12.2%), high intraocular pressure (2.3%), poor corrected visual acuity (1.6%), corneal topography anomaly (1.3%), retinal disease (0.9%), corneal (0.4%) and other diseases (0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.

目的：探讨大泡性角膜病变(bullous keratopathy，BK)患者行飞秒激光辅助的角膜内皮移植术(endothelium keratoplasty，EK)的围手术期护理。方法：回顾性分析在南京总医院眼科行飞秒激光辅助角膜内皮移植的BK20例患者，分析并总结患者术前的心理疏导、术前准备、眼科检查、术中如何配合医生、术后特殊体位、高眼压的护理及如何正确用药和出院健康教育等。结果：患者得到及时、有效的护理，术后视力均有所提高，内皮贴伏好，无排斥反应及其他并发症的发生。结论：通过对患者围手术期的护理，可提高护理质量，缩短患者住院时间。

Objective: To observe the perioperative nursing of femtosecond laser-assisted corneal endothelial transplantation in the treatment of patients with bullous keratopathy. Methods: A retrospective analysis of 20 patients with bullous keratopathy with femtosecond laser-assisted corneal endothelial transplantation in our department. The preoperative psychological counseling, preoperative preparation, ocular examination, how to cooperate with the doctors in operation, nursing of special position, high intraocular pressure after surgery, how to use eye drops correctly and health education after discharge were summarized. Results: Nursing were performed to the patients timely and effectively. Postoperative visual acuity of all the patients were improved, the endothelial and corneal stroma bed are well combined and no graft rejection and other complications occurred in the patients postoperatively. Conclusion: We concluded that the quality of nursing was improved and the time of hospitalization was shortened after perioperative nursing.

青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼(primary angle closure glaucoma，PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy，LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔，解除PACG的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。

Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.

目的：比较水合氯醛和阿佛丁两种药物对小鼠的麻醉作用以及不同激光能量对脉络膜新生血管造模成功率的影响。方法：24只C57/BL6小鼠随机分为3组，分别予以200，300和400 mW的532 nm激光进行视网膜光凝；每组再按1:1分为2个亚组，随机使用4.3%水合氯醛或1.2%阿佛丁进行小鼠腹腔注射麻醉。在激光光凝后第4，7，1 0和1 4天进行视网膜荧光素造影(Fundus Fluorescein Angiography，FFA)、SD-OCT检查，在第1 4天时对脉络膜行IB4染色检查。结果：阿佛丁和水合氯醛诱导小鼠进入麻醉时间长分别为(120±30) s和(150±45) s，持续时间分别为(30±15) min和(50±20) min，差异均有统计学意义(均P=0.0001)；发生不可逆性白内障的比率分别为2/24和1/24，麻醉导致的死亡数分别为1和0只，差异均无统计学意义(P =0.551，P =0.300)。200，300和400 mW三个激光能量组的造模成功率分别为9.38%，37.5%和93.75%，差异有统计学意义(P=0.0001)。FFA显示：造模成功的小鼠在4 d时荧光素渗漏达到高峰，随后荧光素溢漏的面积逐渐减小。结论：与阿佛丁相比，水合氯醛对小鼠的麻醉维持时间长且不会增加病死率和不可逆性白内障的发生率；400 mW的532 nm激光能量是诱发CNV的较好设置。

Objective: To compare the narcotic effects of chloral hydrate and avertin in mouse models and the success rate of choroidal neovascularization (CNV) mouse model establishment with different energy hierarchy of laser. Methods: Twenty-four mice were randomized into 3 groups, the 532 nm laser was used with different power levels of 200, 300 and 400 mW for each group. In each group, the chloral hydrate was used for 4 mice and avertin for the other 4 mice at random. On day 4, 7, 10 and 14, all mice were tested by the fundus fluorescein angiography (FFA), SD-OCT, and the choroid was stained with the isolectin B4 conjugated AF488 on day 14. Results: The anesthesia induction time of avertin and chloral hydrate was (120±30) s and (150±45) s, and the duration of anesthesia was (30±15) min and (50±20) min, the differences were statistically significant (all P=0.0001); the incidence of irreversible cataract of avertin models and chloral hydrate models was 2/24 and 1/24, the number of death in two models was 1 and without statistical significance (P=0.551, P=0.300). With the increase of laser energy, the success rate of experiments was also gradually increased, from 9.38%, 37.5% to 93.75% (P=0.0001) in 200, 300 and 400 mW group, respectively. According to the results of FFA, the peak of fluorescence leaking was at day 4 after the laser burning, and was gradually reduced. Conclusion: Compared with avertin chloral hydrate can improve the duration of anesthesia without increasing the risk of cataract and mortality. As for the 532 nm laser, the 400 mW energy could be an optimal parameter for the laser-induced CNV.

目的：探讨分析联合应用氦氖激光、重组人干扰素α-2b抑菌软膏与加巴喷丁对急性眼周带状疱疹患者皮损愈合、睡眠、疼痛及病程的改善效果。方法：收集2017年1月至2020年1月在河南大学淮河医院就治的急性眼周带状疱疹患者60例。依据治疗方案不同将其分为实验组与对照组，实验组32例，对照组28例。对照组进行常规基础治疗包括抗病毒、营养神经、重组人干扰素α-2b抑菌软膏与加巴喷丁胶囊治疗，实验组较对照组加用氦氖激光治疗。收集皮疹消肿、止疱、结痂、脱痂与止痛时间，疼痛视觉模拟量表(Visual Analogue Scale，VAS)评分、睡眠时间、不良反应以及有无遗留后神经痛等情况并进行比较分析。结果：两组治疗前各项观察指标均无明显差别，差异无统计学意义(P>0.05)；经治疗后，实验组皮疹观察指标(消肿、止疱、结痂、脱疱)时间及止痛时间均明显少于对照组，治疗后4 d与7 d结痂率均明显高于对照组；治疗后两组患者睡眠时长均延长，VAS评分均降低，差异具有统计学意义(P<0.05)；对于缓解疼痛，延长睡眠时长实验组均优于对照组(P<0.05)。而治疗后2、14、28 d结痂率差异均无统计学意义(均P>0.05)。实验组有效率(93.75%)显著高于对照组(75%)，差异有统计学意义(P=0.047)；两组发生PHN与不良反应差异无统计学意义(P>0.05)。结论：氦氖激光联合重组人干扰素α-2b抑菌软膏与加巴喷丁治疗急性眼周带状疱疹安全有效，可明显缓解患者急性期疼痛，促进皮疹痊愈，改善睡眠质量，缩短病程，可在临床积极推广使用。

Objective: To investigate and analyze the effect of He-Ne laser, recombinant human interferon α-2b ointment and gabapentin on skin lesion healing, sleep, pain and disease course in acute herpes zoster ophthalmicus. Methods: Sixty patients with acute herpes zoster ophthalmicus were collected from January 2017 to January 2020 in our hospital. According to the different treatment, they were divided into an experimental group (32 cases) and a control group (28 cases). The patients in the control group received routine basic treatment including antiviral, neurotrophic therapy, interferon α-2b ointment and gabapentin, and the experimental group was treated with He-Ne laser on the basis of control group treatment. The time of detumescence, blister stopping, scab formation, scab removal and pain relief, Visual Analogue Scale (VAS) score, sleep time, adverse reactions, and postherpetic neuralgia were collected and analyzed. Results: Before treatment, there was no significant difference in the observation indexes between the two groups (P>0.05); after treatment, the observation indexes of skin rash (detumescence, blister stopping, scab formation, scab removal) and pain relief time in the experimental group were significantly less than those in the control group, and the scab removal rate on the 4th and 7th days post-treatment in the experimental group was significantly higher than that in the control group; after treatment, the sleep duration was prolonged, and the VAS score was decreased. For pain relief and prolonging sleep time, the experimental group was better than the control group, and the difference was statistically significant P<0.05).There was no significant difference in scab removal rate on 2, 14 and 28 days post-treatment (P>0.05). The effective rate in the experimental group (93.75%) was significantly higher than that in the control group (75%), and the difference was statistically significant (P=0.047); there was no significant difference in PHN and adverse reactions between the two groups (P>0.05). Conclusion: He-Ne laser combined with interferon α-2b ointment and gabapentin is safe and effective in the treatment of acute herpes zoster ophthalmicus. It can significantly relieve the acute pain, promote the recovery of rash, improve sleep quality, shorten the disease course, and can be actively promoted in clinical usage.

目的：观察视网膜激光光凝术(laser photocoagulation，LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity，ROP)的疗效。方法：收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症，分析不同手术方式的效果。结果：LP组20例(37只眼)行视网膜激光光凝治疗，术后未出现复发，首次治愈率100%；术后(3.42±1.57)周病情控制，术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗，39只眼行单次手术后病情控制，首次治愈率88.6%，5眼术后病情未控制。术后(2.95±2.58)周病情控制，术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论：视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效，IVR复发率较高，手术方式的选择需慎重。

Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.

目的：了解行全飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)患者围手术期的体验感受。方法：采用定性调查的方法，选取广东省某医院的15名行SMILE的患者，进行半结构式访谈，将患者围手术期体验归纳为顾虑、紧张、疼痛、担心、放松5个主题概念，用现象学分析法整理、分析资料。结果：把5种体验汇总制成韦恩图，通过韦恩图提炼发现有1人有围手术期5种感受，3位有紧张、疼痛、担心、放松4种心理感受，2位只有紧张的感受，而无其余感受。结论：行SMILE患者的围手术期具有多种体验感受，分析不同感受状态和因素，为眼科医护人员对于寻求SMILE手术的患者做好围手术期的服务提供依据。

Objective: To investigate the perioperative experience after small incision lenticule extraction (SMILE). Methods: A semi-structured interview was conducted in 15 patients who underwent SMILE surgery in Zhuhai People’s Hospital.The data were collected and analyzed by phenomenological analysis. Results: The perioperative feelings of patients were summarized into five categories: concern, tension, pain, worry and relaxation. These feelings were compiled and extracted by Venn diagram. One patient had all five categories of feelings during the perioperative period. Three patients experienced four psychological feelings of tension, pain, worry and relaxation, and 2 patients had only nervous feelings during the full femtosecond operation period. Conclusion: Patients undergoing SMILE have avariety of experience feelings during perioperative period. Analysis of different feeling states and factors will provide evidence for ophthalmic medical staff to provide perioperative services for patients seeking SMILE surgery.

目的：评估右美托咪定复合舒芬太尼用于老年青光眼患者经巩膜二极管激光睫状体光凝术 (transscleral diode laser cyclophotocoagulation，TDLC)术后自控静脉镇痛(patient-controlled intravenous analgesia，PCIA)的安全性和有效性。方法：选择行TDLC术老年青光眼患者80例，采用随机数字表法将患者分为SD组(n=40)和S组(n=40)。SD组术后PCIA采用舒芬太尼1.5μg/kg+右美托咪定1.5 μg/kg+托烷司琼4mg；S组采用舒芬太尼2μg/kg+托烷司琼4mg。将相应药物置入生理盐水配成100mL混合液加入电子镇痛泵，手术结束即刻行PCIA至术后24h。观察比较两组患者基本情况和手术情况，比较术前(T0)、术后即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、心率(heart rate，HR)、NRS疼痛评分、Ramsay镇静评分及非手术眼的眼内压(intraocular pressure，IOP)，比较术后恶心呕吐、呼吸抑制、躁动等不良反应及使用其他辅助镇痛药物的情况。结果：两组患者基本情况和手术情况的差异无统计学意义。两组各时点DBP、非手术眼IOP及NRS评分差异无统计学意义。SD组T3、T4时点SBP，T2、T3、T4时点HR以及T2、T3时点Ramsay评分均低于S组，差异有统计学意义(P<0.05)。两组患者发生不良反应的总例数差异无统计学意义，但SD组恶心呕吐(1例)和烦躁(2例)发生率均低于S组(分别为6例和9例)，差异有统计学意义(P<0.05)。两组患者呼吸抑制和眩晕嗜睡发生率以及使用其他辅助镇痛药物例数差别无统计学意义，SD组舒芬太尼使用量低于S组(P<0.05)。结论：采用右美托咪定1.5μg/kg复合舒芬太尼1.5μg/kg行PCIA时不影响非手术眼IOP，可安全有效地应用于老年青光眼患者TDLC术后镇痛。

Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC

目的：对比两种不同部位M22优化脉冲激光治疗方法治疗睑板腺功能障碍(meibomian gland dysfunction，MGD)所致干眼的疗效。方法：回顾性分析汕头博德眼科医院干眼门诊患者105例，包括常规治疗组和改良治疗组两个组别，常规治疗组激光部位为下睑，改良治疗组激光部位为联合上下睑，所有患者行M22优化脉冲光治疗一个疗程(每月1次，共3次)，治疗前后均采用keratograph 5M干眼分析仪分析评估患者的泪河高度情况、泪膜破裂时间(break-up time，BUT)、角膜荧光染色(corneal fluorescence staining，CFS)和睑板腺排出能力等参数。采用t检验分析对比治疗前后变化情况。结果：患者治疗后泪河高度较强脉冲光治疗前明显增高，BUT时间延长，角膜荧光染色和睑板腺排出能力评分均有好转，每组治疗后与治疗前差异有统计学意义(P<0.01)，两组间治疗前后各参数差异比较均没有统计学意义。结论：两种不同部位M22优化脉冲激光治疗方法在治疗MGD导致的干眼方面有较好的效果，是较安全有效地治疗方法，两种不同方法治疗效果无明显差异。

Objective: To study the efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction (MGD). Methods: A total of 105 patients collected from Shantou Balder Eye Hospital were divided into two groups. The treatment position of the conventional group was lower eyelid, the other group was combined with upper and lower eyelid. All patients accepted M22 Optimal Pulsed Technology treatment for three times, once a month. Keratograph 5M dry eye analyzer was used to assess the height of tears river, break-up time (BUT), corneal fluorescence Staining(CFS)and meibomian gland expressibility. The results before and after laser treatment were compared using t-test in this study. Results: After treatment, the height of tear river, BUT, CFS and meibomian gland expressibility were improved. There was a statistically significant difference between each group after and before treatment (P<0.01). There was no significant difference before and after treatment between the two groups. Conclusion: The two methods of M22 Optimal Pulsed Technology are effective in treating dry eyes caused by MGD. There is no significant difference in the therapeutic effect between two methods.