近年来随着人口老龄化的发展、人群用眼方式的改变，现有的眼科医疗资源正越来越难以满足日渐增长的医疗需求，亟需新型的诊疗模式予以补足。眼科人工智能作为眼科领域的新兴元素，在眼病的筛查诊断中发展迅速，主要表现为“眼部图像数据+人工智能”的模式。近年来，随着该模式在白内障、青光眼、糖尿病性视网膜病变(diabetic retinopathy，DR)等常见病中研究的深入，相关技术日渐成熟，表现出了较大的应用优势与应用前景，部分技术甚至成功转化并被逐渐应用于临床。眼科诊疗向智慧医学模式的过渡，有望缓解日益增长的医疗需求与紧缺的医疗资源之间的矛盾，从而提高整体的医疗服务水平。
The development of population aging and changes in the way people use their eyes over the recent years have increasingly challenged the existing ophthalmic medical resources to meet the growing medical needs, thus urgently calling for a novel diagnostic and treatment mode. Despite its status as an emerging sector in ophthalmology, ophthalmic artificial intelligence has developed rapidly in the screening and diagnosis of eye diseases, as can be seen in practices adopting the “eye imaging data + AI” mode. In recent years, with the intensified research on this mode with respect to common diseases such as cataract, glaucoma and diabetic retinopathy, relevant technologies have grown increasingly mature, presenting undeniable application superiority and prospects. Some of the relevant technical achievements have also been successfully transformed for practical usage, and are gradually being applied to clinical practices. Ophthalmic diagnosis and treatment are transitioning toward the era of intelligent medical services, which are expected to reduce the contradictions between the growing medical needs and the shortage of medical resources, as well as ultimately improve the overall experience of medical services.
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.
甲状腺相关眼病是一种器官特异性自身免疫性疾病，其发病机制复杂，是成人最常见的眼眶疾病，且发病率逐年升高。该病不仅会导致眼球突出、眼睑退缩、睑裂扩大、眼球运动障碍等外观上的变化，且患者往往伴发眼红、眼痛、干涩、异物感、复视、视力下降等不适症状，其中眼表疾病的发病率较正常人明显增高，但其具体发病机制尚待进一步挖掘。目前研究表明甲状腺相关眼病患者的眼表损伤主要与眼表暴露增加、炎症侵犯、激素改变有关。角膜、结膜、泪膜、睑板腺等组织受累发生病理改变是患者表现出不同临床症状的直接原因。文章通过分析近年来国内外关于甲状腺相关眼病与眼表疾病等方面的相关研究，针对甲状腺相关眼病眼表损伤的病理改变及机制研究进展做一综述。
Tyroid-associated ophthalmopathy is an organ-specifc autoimmune disease with complex pathogenesis. It is the most common orbital disease in adults, and its incidence increases year by year. Tis disease can not only lead to appearance changes such as eyeball protrusion, eyelid retraction, eyelid cleat enlargement, eye movement disorders, and patients are ofen accompanied by red eyes, eye pain, dryness, foreign body sensation, diplopia, vision loss and other uncomfortable symptoms, among which the incidence of ocular surface diseases is signifcantly higher than that of normal people, but its specifc pathogenesis needs to be further explored. Current studies have shown that ocular surface injury in patients with thyroid-associated ophthalmopathy is mainly related to increased ocular surface exposure, infammatory invasion, and hormonal changes. Te pathological changes of cornea, conjunctiva, tear flm, meibomian gland and other tissues involved are the direct causes of different clinical symptoms of patients. In this paper, through the analysis of recent domestic and foreign studies on thyroid-associated ophthalmopathy and ocular surface diseases, the pathological changes and mechanism of ocular surface injury in thyroid-associated ophthalmopathy were reviewed.
随着智能手机覆盖率的增加与可用性的提升，实现智能健康管理的应用程序成为新兴研究热点。新一代智能手机可通过追踪步数，监测心率、睡眠，拍摄照片等方式进行健康分析，成为新的医学辅助工具。随着深度学习技术在图像处理领域的不断进展，基于医学影像的智能诊断已在多个学科全面开花,有望彻底改变医院传统的眼科疾病诊疗模式。眼科疾病的常规诊断往往依赖于各种形式的图像，如裂隙灯生物显微镜、眼底成像、光学相干断层扫描等。因此，眼科成为医学人工智能发展最快的领域之一。将眼科人工智能诊疗系统部署在智能手机上，有望提高疾病诊断效率和筛查覆盖率，改善医疗资源紧张的现状，具有极大的发展前景。综述的重点是基于深度学习和智能手机的眼病预防与远程诊疗的进展，以糖尿病性视网膜病变、青光眼、白内障3种疾病为例，讲述深度学习和智能手机在眼病管理方面的具体研究、应用和展望。
With the increasing coverage and availability of smart phones, the application of realizing intelligent health management has become an emerging research hotspot. The new generation of smart phones can perform health analysis by tracking the step numbers, monitoring heart rate and sleep quality, taking photos and other approaches, thereby becoming a new medical aid tool. With the continuous development of deep learning technology in the field of image processing, intelligent diagnosis based on medical imaging has blossomed in many disciplines, which is expected to completely change the traditional eye diseases diagnosis and treatment mode of hospitals. The conventional diagnosis of ophthalmic diseases often relies on various forms of images, such as slit lamp biological microscope, fundus imaging, optical coherence tomography, etc. As a result, ophthalmology has become one of the fastest growing areas of medical artificial intelligence (AI). The deployment of ophthalmological AI diagnosis and treatment system on smart phones is expected to improve the diagnostic efficiency and screening coverage to relieve the strain of medical resources, which has a great development prospect. This review focuses on the prevention and telemedicine progress of eye diseases based on deep learning and smart phones, taking diabetic retinopathy, glaucoma and cataract as examples to describe the specific research, application and prospect of deep learning and smart phones in the management of eye diseases.
目的：评价海藻糖滴眼液对摘除眶内眶外泪腺的实验性大鼠干眼的疗效。方法：SD大鼠30只，随机分成正常组、对照组、实验组，每组10只(20只眼)。正常组不给予处置，实验组和对照组通过摘除大鼠主泪腺制作干眼动物模型。对照组和实验组于造模完成术后1周后分别给予生理盐水、海藻糖滴眼液点双眼，每天4次，治疗共4周。分别于造模术前和造模术后1，2，3，5周进行基础泪液分泌试验(Shirmer I test)，角膜上皮荧光染色评分检测；造模5周后将大鼠处死，采用免疫组织化学方法对结膜上皮细胞中Bcl-2和Bax凋亡基因蛋白表达进行检测，观察干眼动物模型结膜上皮细胞凋亡与眼表干眼病变及组织损伤的关系。结果：基础泪液分泌试验结果显示，对照组和实验组除术后第5周比较差异有统计学意义外(P<0.05)，其余时间点差异无统计学意义(P>0.05)，术后各时间点与正常组比较差异均有统计学意义(P<0.05)。造模术后第1周，对照组和实验组角膜荧光色染色评分明显高于正常组；术后第2周后，对照组和实验组评分差异无统计学意义(P>0.05)，随着时间的延长，术后第3周和第5周，两组评分差异均有统计学意义(P<0.05)，且实验组评分小于对照组。结膜上皮细胞免疫组织化学检测结果显示：正常组结膜上皮细胞Bax蛋白阳性表达的细胞数较对照组和实验组少，与对照组比较，差异有统计学意义(P<0.05)，与实验组比较差异无统计学意义(P>0.05)；正常组可见大量Bcl-2蛋白阳性表达，且多于实验组，差异无统计学意义(P>0.05)，多于对照组，差异有统计学意义(P<0.05)；对照组结膜上皮细胞中可见大量Bax蛋白阳性表达于细胞质，呈棕黄色颗粒，实验组中Bax蛋白阳性表达相对于对照组明显较少，两者差异有统计学意义(P<0.05)；实验组结膜上皮细胞中可见大量Bcl-2蛋白阳性表达，对照组Bcl-2蛋白表达相对于实验组明显减少，差异有统计学意义(P<0.05)。结论：海藻糖滴眼液可以减少角膜表层上皮脱落，对结膜上皮细胞有一定的保护作用，可以拮抗结膜上皮细胞的凋亡，从而增强角结膜上皮屏障功能，改善由干燥引起的眼表上皮的损伤。海藻糖溶液可用于眼表上皮疾病的潜在临床应用，为治疗眼表疾病如干眼症提供治疗选择。
Objective: To observe the efficacy of trehalose eye drops on experimental dry eye rat with removal of inside and outside lacrimal glands. Methods: A total of 30 SD rats were randomly divided into a normal group, a control group, and an experimental group, with 10 rats for each group (20 eyes). The normal group was not treated, and the experimental group and the control group were made into a dry eye animal model by removing the main lacrimal gland of the rat. The control group and the experimental group were given with normal saline and trehalose eye drops once a week after the completion of modeling, 4 times a day for 4 weeks. Shirmer I test and fluorescence staining test were carded before and 1, 2, 3, and 5 weeks after modeling. After 5 weeks of modeling, the rats were sacrificed and the expression of Bcl-2 and Bax apoptosis protein in conjunctival epithelial cells was detected by immunohistochemistry in order to observe the relationship between apoptosis of conjunctival epithelial cells and dry eye lesions and tissue damage in dry eye animal models. Results: Schirme I test results showed that there was no significant difference between the control group and the experimental group (P>0.05) except for the 5th week after operation (P<0.05). There was a statistical difference between the two groups and the normal group at each time point after surgery (P<0.05). At the first week after modeling, the corneal fluorescence staining scores of the control group and the experimental group were significantly higher than those of the normal group. After the second week after surgery, there was no significant difference between the control group and the experimental group (P>0.05). The prolongation of time, the 3 week and the 5th week after surgery, the difference between the two groups was statistically significant (P<0.05), and the score of the experimental group was smaller than the control group. The immunohistochemical results of conjunctival epithelial cells showed that the number of Bax protein positive cells in the normal conjunctival epithelial cells was less than that in the control group and the experimental group. The difference between the normal group and the control group was statistically significant(P<0.05). There was no significant difference between the two groups (P>0.05). There was a large amount of Bcl- 2 protein in the normal group, which was more than the experimental group. The difference was not statistically significant (P>0.05), which was more than the control group. The difference was statistically significant (P<0.05); a large amount of Bax protein was positively expressed in the cytoplasm and brownish-yellow particles in the conjunctival epithelial cells of the control group. The positive expression of Bax protein in the experimental group was significantly less than that in the control group, and the difference was statistically significant (P<0.05). A large amount of Bcl-2 protein was positively expressed in the conjunctival epithelial cells of the experimental group, and the expression of Bcl-2 protein in the control group was significantly decreased compared with the experimental group (P<0.05).Conclusion: Trehalose eye drops can reduce epithelial detachment of the cornea and have a protective effect on conjunctival epithelial cells, which can antagonize the apoptosis of conjunctival epithelial cells,thereby enhancing the keratoconjunctival barrier function and improving the ocular surface epithelium caused by dryness. The potential clinical application of trehalose solution for ocular surface epithelial diseases and provide treatment options for ocular surface diseases, such as dry eye.
一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
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.
目的：中重度甲状腺相关眼病内下壁骨性减压联合脂肪减压术的临床疗效观察。方法：回顾性分析25例(31眼)在浙江大学医学院附属第二医院眼科行内下壁骨性减压联合脂肪减压术治疗的甲状腺相关眼病患者，观察时间为2020年1月至2022年1月。术前所有患者均进行了眼眶CT检查，并对双眼视力、眼球突出、复视及双眼外观形态进行了测量。手术效果评价指标为：术后眼球突出度、视力和复视程度，并对相关数据进行统计和分析。结果：术后眼球突出度回退2~6 mm，平均回退(3.45±0.93)mm，切除眶内脂肪1.4~3.6 mL，平均切除(2.33±0.66)mL，外观恢复满意。4例患者术前存在复视，2例患者术后新发复视，术前已存在复视的患者，术后复视程度并未加重，新发的2例复视患者均为轻度复视。术后CT检查显示眼眶减压效果良好。结论：内下壁骨性减压与脂肪减压术联合，可以有效扩大眼眶容积，对眼球进行回纳，减少眼球突出程度，改善容貌外观，且手术切口隐蔽美观，具有较好的临床疗效果。
Objective: To observe the clinical efficacy of medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe thyroid associated ophthalmopathy (TAO). Methods: A retrospective analysis was performed on 25 patients (31 eyes) with moderate-to-severe TAO from January 2020 to January 2022 in Eye Hospital of Zhejiang University, who were treated with medial-inferior wall orbital decompression combined with fat decompression. All of patients were given orbital computed tomography to measure visual acuity, exophthalmos, diplopia and ocular appearance before operation. The preoperative and postoperative exophthalmos, visual acuity and diplopia before and after operation were taken as efficacy evaluating indicators. The related data was counted and analyzed statistically. Results: After operation, the reduction of exophthalmos was 2-6 mm, with an average of (3.45±0.93) mm, the volume of intrazonal fat-removal was 1.4-3.6 mL, with an average of (2.33±0.66) mL, with a satisfactory appearance. There were 4 cases of preoperative diplopia and 2 cases of new diplopia after operation, all of which were mild diplopia. Diplopia did not exacerbate after operation in the patients who had diplopia before operation. Conclusion: Medial-inferior wall orbital decompression combined with fat decompression in the treatment of moderate-to-severe TAO can effectively expand orbital volume, reduce exophthalmos, improve appearance with a concealed beautiful surgical incision, showing its good clinical efficacy.
系统性红斑狼疮(systemic lupus erythematosus, SLE)是一类累及多种器官的结缔组织病，且SLE的发病机制十分复杂，常引起关节炎、脑病、肾病、皮肤损害，眼部病变亦是SLE常见疾病，且常引起视力障碍，甚至致盲、致残。该文通过整理文献，浅谈SLE相关眼病的类型、病因、眼部表现，以及SLE常用的中医辨证论治。
Systemic lupus erythematosus (SLE) is a class of connective tissue diseases that affect a variety of organs. Moreover, the pathogenesis of SLE is very complex, often causing arthritis, encephalopathy, kidney disease and skin damage, ocular lesions are also common diseases of SLE, and it can often cause visual impairment, and even blindness and disability. By collating the literature, this paper discusses the types, etiology, and ocular manifestations of SLE-related eye diseases, as well as the dialectical treatment of SLE commonly used in traditional Chinese medicine.
青光眼不仅常见，而且严重损伤患者的视功能，被认定为全球首位不可逆致盲性眼病。仔细观察发现诊断不及时、治疗不合理、随诊不规律是导致青光眼患者致盲的常见原因。机会性筛查是临床早期发现青光眼患者的主要手段。为了提高筛查的效率，筛查时应当密切关注青光眼的高危人群，包括原发性青光眼患者的直系亲属、老年人群和高度近视患者。此外，要对发生青光眼全过程加深了解，无论是原发性闭角型青光眼，还是原发性开角型青光眼，其病情的进展都存在一个连续体概念。应当在青光眼患者出现症状或严重视功能损伤之前加以诊断。合理治疗应当包括应用适当的药物、激光或手术治疗，将每只患眼的眼压控制到与该眼的视盘和视野改变相适应的目标眼压范围内，尽量提高患者用药的依从性。对青光眼的持续性防治取决于是否有能力评估治疗效果以及发现病情的不稳定性状态，并加以恰当的处理。青光眼是可防可治的眼病。通过加强青光眼的早期诊断、合理治疗和长期随诊，可降低青光眼的致盲率，从而改变青光眼是首位致盲性眼病的现状。
Glaucoma not only is common, but also seriously damages the visual function of the patients, and is recognized as the first irreversible blinding disease in the world. After careful observation, we recognize that untimely diagnosis,unreasonable treatment and irregular follow-up are leading causes to blindness. Opportunistic screening is a main measure to early find the glaucoma in clinical practice. To improve the screening efficiency, the high-risk mass of glaucoma, such as immediate family members of glaucoma patients, older adults and high myopia should be closely focused. In addition, the ophthalmologists should understand the whole process of glaucoma. The development of the primary angle closure glaucoma or primary open angle glaucoma is a concept of continuum. We should make the diagnosis of glaucoma before the patients have any symptoms or serious damage of the visual function. Reasonable treatment should include controlling intraocular pressure in the scope of the target pressure adopting to the optic damage and visual field defect in that eye by drugs, laser or surgery, and as far as possible to improve the drug compliance. Sustained control of glaucoma management depends on the ability to assess the effect of treatment, and to find the instability of the disease and the appropriate management. Glaucoma is a preventable and treatable eye disease. We can decrease the blinding rate and change the current status of the first blinding eye disease for glaucoma.
