目的：以提升进行住院医师规范化培训(住培)的眼科医生临床诊疗思维能力为导向，建立LRC渐进协作教学体系(LRC Stepwise Collaborative Learning Model)。方法：2023年7月—2023年12月，以26名进行眼科住培的医生为试验组的研究对象，采用小讲课(Lecture)、教学查房(Rounds)及病例讨论(Case discussion)的LRC渐进协作教学体系，通过定量分析方法评估教学效果。结果：实施LRC渐进协作教学模式后，住培医生平均成绩由培训前的50.00 (40, 50)分提高至培训后的90.00 (80, 100)分，差异具有统计学意义(P＜0.001)。问卷调查满分5分，小讲课、教学查房和病例讨论三种教学形式的满意度满分比例分别为92.3%(24/26)，84.6%(22/26)、76.9%(20/26)，三种教学形式的满意评分分别为5.00 (5.00, 5.00)、5.00 (5.00, 5.00)、5.00 (4.75, 5.00)分。结论：LRC渐进协作教学体系作为住培教学新体系，得到眼科住培医生的认可，促进临床诊疗思维的整体提升，有助于岗位胜任力的培养，为未来教学模式的设计与实施提供了重要参考。
Objective: To introduce the LRC Stepwise Collaborative Learning Model, a novel teaching approach designed to improve clinical thinking skills in ophthalmology training. Methods: From July 2023 to December 2024, 26 ophthalmology residents were included in the experimental group, underwent training using LRC Stepwise Collaborative Learning Model of Lectures, Rounds and Case Discussions. Their educational outcomes were quantitatively analyzed. Results: The LRC Stepwise Collaborative Learning Model improved average resident scores from pre-training [50(40, 50) points] to post-training [90(80,100) points], with a statistical significance (P < 0.001). The questionnaire survey had a maximum score of 5 points, and the rates of full marks for the three teaching forms of lectures, rounds, and case discussions were 92.3% (24/26), 84.6% (22/26), and 76.9% (20/26), respectively. The satisfaction scores for the three teaching forms were 5.00 (5.00, 5.00), 5.00 (5.00, 5.00), and 5.00 (4.75, 5.00) points, respectively. Conclusions: The LRC Stepwise Collaborative Learning Model, as a new training system for residency education, has been recognized by ophthalmology residents. It facilitates the overall improvement of clinical thinking, contributes to competency development, and provides valuable insights for future teaching model designs.
目的：分析高度近视有晶状体眼后房型人工晶状体植入术后孔源性视网膜脱离的临床特征及预后。方法：回顾分析2012年4月至2021年6月中山眼科中心收治的9例(9只眼)行后房型人工晶状体植入术后孔源性视网膜脱离患者的临床特征、手术方式及疗效，随访(4.96±4.78)个月。结果：患者年龄(30.44±20.11)岁，屈光手术至发病时间(32.10±17.80)个月。4例(44.4%)马蹄形裂孔，1例(11.1%)萎缩性裂孔，4例(44.4%)巨大裂孔；9眼裂孔均位于赤道部前，除2眼(22.2%)为单个巨大裂孔，1眼(11.1%)单个马蹄孔，余6眼(66.7%)均有视网膜周边变性区存在；视网膜脱离范围(3.0±1.12)个象限，8例累及黄斑；增殖性玻璃体视网膜病变C级以上4眼。视网膜初始复位率为77.8%，最终视网膜复位率100%。末次随访最佳矫正视力优于术前(P<0.05)。随访期间，2例硅油填充眼发生并发性白内障，4眼发生术后早期高眼压。结论：有晶状体眼后房型人工晶状体植入术前存在的视网膜变性或术后玻璃体牵引的存在可能是孔源性视网膜脱离发生的危险因素。
Objective: To analyze the clinical presentation, surgical management, and outcomes of rhegmatogenous retinal detachment (RRD) in patients with high-myopia corrected by posterior chamber phakic (PCP) intraocular lens (IOL) implantation. Methods: Nine eyes of 9 patients in whom RRD developed after PCPIOL implantation from April 2012 to June 2021 in Zhongshan Ophthalmic Center were retrospectively studied. Mean follow-up after retinal detachment surgery was (4.96±4.78)months. Results: Mean patient age was (30.44±20.11) years old. RRD occurred (32.10±17.80) months after PCPIOL implantation. Four (44.4%) breaks were horseshoe tear, 1 (11.1%) was atrophic hole and 4 participants (44.4%) had a giant retinal tear. Nine cases had causative breaks located anterior to the equator while peripheral retina lattice degeneration was found in 6 eyes. RRD extended from 1 to 4 quadrants (3.0±1.12 quadrants) and 8 cases were macula-off retinal detachments. Four eyes’ proliferative vitreoretinopathy were more severe than level C. Initial reattachment rate was 77.80%. Final retinal reattachment was 100%. Final follow-up BCVA was significantly better than baseline (P<0.05). Furthermore, concurrent cataract occurred in 2 eyes in which silicone oil was used as tamponade. Ocular hypertension was detected in 4 eyes after surgery. Conclusion: The existed lattice degeneration and postoperative vitreous traction may be risk factors for RRD after PCPIOL implantation.
