目的：了解湿性老年性黄斑变性(age-related macular degeneration,AMD)患者自我感受负担(self-perceived burden,SPB)现状及其影响因素。方法：采用方便抽样法选取2021年1月至11月在中山大学中山眼科中心就诊的204例湿性AMD患者为研究对象，采用一般资料调查表、SPB量表、家庭支持自评量表、医学应对问卷对其进行测评。结果：患者SPB得分是(21.98±6.68)分，总体属于轻度SPB。湿性AMD患者的SPB水平与家庭支出(r=?0.326, P<0.001)和面对应对(r=?0.365, P<0.001)呈负相关，与回避(r=0.456, P<0.001)及屈服(r=0.310, P<0.001)应对方式呈正相关性。多重线性回归显示，独居、高龄、自费、双眼患病及采用回避应对的患者的SPB更高，而高文化水平、高家庭支持的患者SPB较轻。结论：湿性AMD患者有轻度SPB，但仍存在改善空间，医护工作者在工作中应重点关注高龄、文化程度低、家庭收入低、自费、独居、双眼患病及低视力的患者，及时进行心理疏导，减轻患者的SPB水平。
Objective: To understand the current status and influencing factors of self-preceived burden (SPB) in patients with wet age-related macular degeneration (AMD). Methods: 204 patiens with wet AMD who were treated in Zhongshan Ophthalmic Center, Sun Yat-sen University from January to November 2021 were enrolled as the study subjects with convenience sampling method. A general information questionnaire, SPB scale, family support self-assessment scale, and medical coping questionnaire were collected from the subjects for assessment. Results: The patient’s SPB score was 21.98±6.68, which is generally mild SPB. The SPB level of patients with wet AMD was negatively correlated with family support (r=-0.326, P<0.001) and coping (r=?0.365, P<0.001), and were positively correlated with avoidance (r= 0.456,P<0.001), and surrender (r=0.310, P<0.001) coping style. Multiple linear regression showed that the patients who lived alone, were elder and self-funded, had binoclur diseases and used avoidance coping, had higher SPB. While the patients with high education and family support had lower SPB. Conclusions: It is still needed to pay attention to the patients with AMD having mild SPB. Medical workers should focus on patients with elder age, low education level, low family income, self-funded, living alone, binocular disease and low vision in their work, and provide timely psychological counseling to reduce the SPB level of patients.
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：观察健康中老年人群中心凹视觉敏感度阈值(foveal threshold，FT)及光相干断层扫描血管成像(optical coherence tomography angiography，OCTA)的双眼对称性。方法：横断面观察性研究。纳入33例66眼，测量并比较眼灌注压(ocular perfusion pressure，OPP)，FT，黄斑区3 mm × 3 mm范围内中心凹无血管区面积(non-flow area，NFA)，浅层视网膜血管密度(superior vessel density，SVD)和深层视网膜血管密度(deep vessel density，DVD)的双眼对称性；分析各指标双眼差值、均值及其比值与年龄、性别的相关性。结果：配对样本t检验结果显示除FT(t=?2.118，P=0.042)外，左右眼OPP，NFA，SVD和DVD差异均无统计学意义(P>0.05)；Pearson相关性分析和同类相关系数(intra-class correlation coefficient，ICC)检验结果显示5项指标左右眼测量值相关强度由强到弱为OPP>FT>NFA>DVD>SVD；Bland-Altman分析结果提示5项指标双眼间一致性良好。5项指标的双眼对称性不随性别、年龄改变。结论：健康中老年人群FT、黄斑区NFA，SVD及DVD的测量值具有双眼对称性。
Objective: To observe the interocular symmetry of foveal threshold (FT) and optical coherence tomography angiography (OCTA) parameters in healthy middle-aged and elderly subjects. Methods: Cross-sectional observational study. Sixty-six eyes from thirty-three subjects were enrolled to compare binocular ocular perfusion pressure (OPP), FT, non-flow area (NFA), superior vessel density (SVD) and deep vessel density (DVD) in a 3 mm × 3 mm OCTA scan of macula. The interocular symmetry of all the parameters was analyzed; the correlations of the differences (△), mean value (m) and the ratio of all the parameters with age and gender were analyzed. Results: There was no significant interocular difference revealed by paired-samples t-tests in all the parameters (P>0.05) except FT (t=?2.118, P=0.042), while the rank of Pearson’s correlation index and intraclass correlation coefffcient (ICC) from strong to weak was OPP > FT > NFA > DVD > SVD. The interocular symmetry of all the parameters was proved to be good with Bland-Altman plots, and it changed little with the variations of age and gender. Conclusion: Interocular symmetries of FT and OCTA parameters are observed in healthy middle-aged and elderly subjects.
目的：评估2.2 mm微切口白内障超声乳化摘除(phacoemulsification，Phaco)联合多焦点人工晶状体(multifocal intraocular lens，MIOLs)植入术治疗老年性白内障的临床安全性及疗效。方法：选取于2018年1月1日至2018年6月31日于佛山市第二人民医院行白内障Phaco联合人工晶状体植入的老年白内障患者。将其分为2组：A组31例35眼行2.2 mm微切口Phaco联合MIOLs植入术，B组31例38眼行3.0 mm标准切口Phaco联合单焦点IOLs植入术。2组患者均完善术前、术后的裸眼视力、角膜曲率、眼压、角膜内皮细胞数、离焦曲线等检查，同时记录其手术过程中的参数，进行比较。结果：A组与B组在手术过程中，总超乳时间、总超乳能量、超声乳化累积能量复合参数、有效超乳时间、平均超乳能量、总手术时间对比，差异均无统计学意义(均P>0.05)。2组患者术后较术前比较，角膜内皮细胞数均有所下降，差异有统计学意义(P<0.05)；2组患者间在各时间点的比较，差异均无统计学意义(均P>0.05)。2组患者手术中均未出现后囊膜破裂等并发症。2.2 mm切口与3.0 mm切口术后均增加了角膜散光，与术前比较差异均有统计学意义(均P<0.01)；2组间比较，差异无统计学意义(均P>0.05)。术后3个月，2组间裸眼远视力(uncorrected distance visual acuity，UCDVA)对比差异无统计学意义(t=?1.794，P=0.07)；裸眼近视力(uncorrected near visual acuity，UCNVA)对比差异有统计学意义(t=?25.147，P<0.01)。A组的离焦曲线有2个峰值，分别位于0 D和?3.5 D附近，两峰值间形成一个下降平缓的平台；B组的离焦曲线只有1个峰值，位于0~0.5 D之间，峰值两端下降趋势明显。A组的脱镜率为77.42%(24/31)，B组的脱镜率为12.90%(4/31)，差异有统计学意义(χ2 =26.050，P<0.01)；2组的总体满意度差异无统计学意义(χ2 =1.615，P=0.204)。结论：2.2 mm同轴微切口白内障手术在临床上安全性良好，联合植入MIOLs有较好的疗效，可于临床上广泛推广。
Objective: To evaluate the clinical safety and curative effect of phacoemulsification (Phaco) combined with multifocal intraocular lens (MIOLs) implantation in the treatment of senile cataract with 2.2 mm microincision cataract. Methods: The cataract patients who underwent phacoemulsification and intraocular lens implantation in our hospital were selected from January 1, 2018 to June 31, 2018. They were divided into two groups: group A with 31 patients (35 eyes) undergoing 2.2 mm micro-incision Phaco combined with MIOLs, while group B with 31 patients (38 eyes) undergoing 3.0 mm standard incision Phaco combined with single focus IOLs.The preoperative and postoperative uncorrected visual acuity, corneal curvature, intraocular pressure, corneal endothelium number, and defocus curve were recorded in both groups. The parameters during the operation were also recorded and compared. Results: There was no statistically significant difference in the parameters including total phacoemulsification time, total phacoemulsification energy, phacoemulsification cumulative energy compound parameters, effective phacoemulsification time, average phacoemulsification energy, total surgery time between group A and group B during the operation (all P>0.05). Compared with preoperative, the number of corneal endothelial cells decreased both in the two groups after surgery. The difference was statistically significant (P<0.05). There was no significant difference between the two groups at any time (all P>0.05). There were no complications such as posterior capsule rupture during operation in both groups. The corneal astigmatism was increased after operation both in the 2.2 mm incision and 3.0 mm incision, and the difference was statistically significant compared with pre-operation (both P<0.01). There was no significant difference between the two groups (all P>0.05). At 3 months postoperatively, there was no significant difference in uncorrected distance visual acuity (UCDVA) between the two groups (t=?1.794, P=0.07), and the difference was statistically significant in the uncorrected near visual acuity (UCNVA) (t=?25.147, P<0.01). Defocus curve: The defocus curve of group A had two peaks, which are located near 0 D and ?3.5 D, forming a flat platform with a descent between the two peaks.The defocus curve of group B had only one peak, located at 0–0.5 D, and the downward trend at both ends of the peak was obvious. The rate of off-glasses and satisfaction: the rate of off-glasses in group A was 77.42% (24/31),and the rate of dislocation in group B was 12.90% (4/31). The difference was statistically significant (χ2 =26.050,P<0.01). There was no significant difference in overall satisfaction between the two groups (χ2 =1.615, P=0.204).Conclusion: The 2.2 mm coaxial microincision cataract surgery yields high clinical safety, and the combined implantation of multi-focal intraocular lens has good curative effect and can be widely promoted in clinical practice.
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：观察健康中老年人群中心凹视觉敏感度阈值(foveal threshold，FT)及光相干断层扫描血管成像(optical coherence tomography angiography，OCTA)的双眼对称性。方法：横断面观察性研究。纳入33例66眼，测量并比较眼灌注压(ocular perfusion pressure，OPP)，FT，黄斑区3 mm × 3 mm范围内中心凹无血管区面积(non-flow area，NFA)，浅层视网膜血管密度(superior vessel density，SVD)和深层视网膜血管密度(deep vessel density，DVD)的双眼对称性；分析各指标双眼差值、均值及其比值与年龄、性别的相关性。结果：配对样本t检验结果显示除FT(t=?2.118，P=0.042)外，左右眼OPP，NFA，SVD和DVD差异均无统计学意义(P>0.05)；Pearson相关性分析和同类相关系数(intra-class correlation coefficient，ICC)检验结果显示5项指标左右眼测量值相关强度由强到弱为OPP>FT>NFA>DVD>SVD；Bland-Altman分析结果提示5项指标双眼间一致性良好。5项指标的双眼对称性不随性别、年龄改变。结论：健康中老年人群FT、黄斑区NFA，SVD及DVD的测量值具有双眼对称性。
Objective: To observe the interocular symmetry of foveal threshold (FT) and optical coherence tomography angiography (OCTA) parameters in healthy middle-aged and elderly subjects. Methods: Cross-sectional observational study. Sixty-six eyes from thirty-three subjects were enrolled to compare binocular ocular perfusion pressure (OPP), FT, non-flow area (NFA), superior vessel density (SVD) and deep vessel density (DVD) in a 3 mm × 3 mm OCTA scan of macula. The interocular symmetry of all the parameters was analyzed; the correlations of the differences (△), mean value (m) and the ratio of all the parameters with age and gender were analyzed. Results: There was no significant interocular difference revealed by paired-samples t-tests in all the parameters (P>0.05) except FT (t=?2.118, P=0.042), while the rank of Pearson’s correlation index and intraclass correlation coefficient (ICC) from strong to weak was OPP > FT > NFA > DVD > SVD. The interocular symmetry of all the parameters was proved to be good with Bland-Altman plots, and it changed little with the variations of age and gender. Conclusion: Interocular symmetries of FT and OCTA parameters are observed in healthy middle-aged and elderly subjects.
