论著

并轨住院医师规范化培训的眼科专业学位硕士研究生科研能力现状与思考

Current situation and thinking of scientific researchability for postgraduates with professional degree inophthalmology under the mode of mergingresidency training

:468-476
 
 目的:了解医学专业学位硕士(专硕)研究生培养并轨住院医师规范化培训制度下的眼科专硕科研能 力现状,并提出提升科研能力的对策。方法:对哈尔滨医科大学三所附属医院眼科学76名不同年级 专硕研究生的科研能力现状、阻碍科研学习的因素、科研训练意愿等进行问卷调查。结果:在目前 的培养模式下,专硕科研和临床知识基础相对薄弱及临床学习任务繁重是科研学习的主要障碍。 结论:提出教学基地可以因需施教、提供多模式科研训练;强化临床诊疗培训为科研思维培养助 力;导师可以结合新时代发展背景优化科研选题策略、拓宽学生科研视野等措施。
Objective: To understand the current situation of scientific research ability of postgraduates with professional degrees in ophthalmology and put forward improvement measures. Methods: A questionnaire survey was conducted on the current situation of scientific research ability, scientific research obstacles and scientific research training willingness, 76 postgraduate students of different grades majoring in ophthalmology of three affiliated hospitals of Harbin Medical University were involved. Results: Under the merging residency training system, the foundation of scientific research and clinical knowledge of postgraduates is relatively weak, and the heavy clinical learning task were the main obstacles to scientific research of postgraduates. Conclusion: It is proposed that the teaching bases could provide multi-mode scientific research training to cater to students' individual needs. Not only clinical diagnosis and treatment training could be strengthened to cultivate students’ scientific research thinking, but scientific research topic selection strategy could be optimized by to meet the demand for development of times and broaden students’ scientific research vision.
综述

人工智能在白内障诊疗中的应用进展

Advances in the application of artificial intelligence in diagnosis and treatment of cataract

:85-90
 
人工智能(artificial intelligence,AI)在眼科领域的应用不断深入、拓展,目前在糖尿病性视网膜病变、白内障、青光眼以及早产儿视网膜病变在内的多种常见眼病的诊疗中逐渐成为研究热点。AI使医疗资源短缺、诊断标准缺乏、诊疗技术水平低下的现状得到改善,为白内障的诊疗开辟了一条“新赛道”。本文旨在综述AI在白内障诊疗中的应用现状、进展及局限性,为AI在白内障领域的进一步开发、应用及推广提供更多信息。
Artificial intelligence (AI) has been widely applied and promoted in ophthalmology, and has gradually become a research hotspot in the diagnosis and treatment of many common ophthalmopathies, including diabetic retinopathy, cataract, glaucoma, and retinopathy of prematurity. AI improves the shortage of medical care, the lack of diagnostic criteria and the low level of diagnosis and treatment technology, and explores a “new race track” for cataract diagnosis and treatment. The purpose of this article is to review the application status, progress and limitations of AI in the diagnosis and treatment of cataract, aiming to provide more information for further development, application and promotion of AI in the field of cataract.
综述

基于深度学习和智能手机的眼病预防与远程诊疗

Prevention and telemedicine of eye diseases based on deep learning and smart phones

:230-237
 
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.
综述

玻璃体切除术后白内障患者屈光预测误差来源的研究进展

Research progress on the sources of refractive prediction error in cataract patients after vitrectomy

:143-149
 
随着微创玻璃体切除术(pars plana vitrectomy,PPV)的广泛开展和手术技术的提高,患者对手术后视觉质量的要求越来越高。白内障是PPV术后最常见并发症,而具有玻璃体切除史的白内障患者屈光变异大,预测难度高。本文综述了生物测量误差、人工晶状体屈光力计算公式选择以及有效晶状体位置预测等影响有玻璃体切除手术史的白内障患者术后屈光误差的主要因素,旨在为降低这一类特殊人群白内障术后屈光误差提供参考。
With the widespread application of minimally invasive vitrectomy and the improvement of surgical techniques, the demands of patients for better postoperative visual quality are increasing. Cataract is the most common complication after vitrectomy, whereas the refractive outcomes of cataract patients with prior vitrectomy are viable and difficult to predict. In this paper, the main factors affecting postoperative refractive error of cataract patients with a history of vitrectomy, such as biometric error, selection of intraocular lens calculation formulas and prediction of effective lens position, were reviewed in order to provide reference for reducing postoperative refractive error of this special group of cataract patients.
经验交流

病原宏基因组测序技术在眼部感染性疾病中的应用与实验室经验分享

Application of pathogen metagenomic sequencing in ocular infectious diseases: laboratory experience and insights

:964-970
 

本文基于实验室实践经验,探讨病原宏基因组测序(metagenomic next-generation sequencing, mNGS)技术在眼部感染性疾病中的应用策略与挑战。尽管mNGS凭借无偏倚检测优势成为疑难感染诊断的重要工具,但受限于流程复杂、干扰因素多及解读门槛高,目前尚不宜作为一线常规检测手段。针对眼部标本微量、类型多样及背景复杂的特殊瓶颈,本文提出了湿实验环节保留人源核酸、构建本地化背景微生物库、以及利用宿主数据同步筛查肿瘤风险等关键解决方案。文章强调,通过强化临床与实验室的多学科协作(multidisciplinary teams, MDT),可有效提升结果解读的准确性,从而推动该技术在眼科诊疗中的规范化与精准化应用。

Based on laboratory experience, this article reviews the applications and challenges of metagenomic next-generation sequencing (mNGS) in ocular infectious diseases. While mNGS serves as a valuable tool for diagnosing difficult infections due to its unbiased detection capabilities, it is not yet suitable as a first-line routine test given its complex workflow and interpretation requirements. Ocular specimens, characterized by trace nucleic acid amounts, high diversity, and complex backgrounds, present unique technical bottlenecks. To address these, this article proposes key strategies, including retaining human nucleic acids during wet-lab processing, constructing a localized background microbial library, and utilizing host data for concurrent tumor screening. The study emphasizes that strengthening multidisciplinary teams (MDT) between clinical and laboratory departments is essential to promote the standardization and precision of mNGS applications in ophthalmology.

论著

喀什地区60岁以上人群晶状体与眼前房角结构的相关性分析

Correlation analysis of lens and anterior chamber angle structure in individuals aged 60 and above in Northwest China

:820-829
 
目的:探讨中国西北地区60岁以上人群晶状体厚度(lens thickness, LT)和晶状体相对位置(relative lens position,RLP)的影响因素以及与眼前房角结构的相关性,为探索晶状体在原发性闭角型青光眼疾病中的作用机制提供依据。方法:横断面研究,纳入2024年4—6月在新疆喀什地区英吉沙县社区人群中检查的60岁以上正常受检者,采用眼前节相干光断层扫描仪等,测量双眼眼球生物学参数。将患者右眼纳入研究范围,通过相关性分析和线性回归模型分析晶状体参数变化与房角结构的相关性。结果:性别、腰围和眼轴长度(axial length, AL)为RLP的独立预测因子。年龄越大,晶状体越厚,70岁前LT与AL呈正相关,眼轴、LT和RLP是眼前房角巩膜突前500 μm开放距离(AOD500)的独立预测因子,其多元线性回归方程为:AOD500=-2.501 4+0.083 3AL-0.115 7LT+7.0211RLP-0.0026Sex-0.0010身高。 结论:新疆喀什地区60岁以上人群中,女性、腰围大和眼轴短提示晶状体相对位置靠前,而晶状体厚度、相对位置以及眼轴显著影响眼前房角开放距离,成为闭角型青光眼发病的潜在危险因素。
Objective: To explore the influencing factors of lens thickness (LT) and relative lens position (RLP) in individuals aged 60 and above in Northwestern China, as well as their correlation with anterior chamber angle structure. The aim is to provide evidence for exploring the role of the lens in the pathogenesis of primary angle - closure glaucoma. Methods: A cross - sectional study was conducted. Normal subjects aged 60 and above were enrolled from community - based examinations in Yingjisha County, Kashi, Xinjiang, between April and June 2024. An anterior segment optical coherence tomography was used to measure ocular biological parameters of both eyes. Only the right eyes of the subjects were included in the analysis. The correlation between changes in lens parameter and angle structure was examined through correlation analysis and linear regression models. Results: Gender, waist circumference and axial length emerged as independent predictors of the relative lens position. As age increased, the lens became thicker. Before the age of 70, lens thickness was positively correlated with axial length. Axial length, LT and RLP were identified as independent predictors of the anterior chamber angle scleral spur anterior 500 - μ m - opening distance (AOD500). The multiple linear regression equation is as follows: AOD500 (mm) = -2.5014 + 0.0833AL (mm) - 0.1157LT (mm) + 7.0211RLP - 0.0026Sex - 0.0010Height (cm). Conclusions: Among individuals aged 60 and above in Northwest China, being female, having a large waist circumference, and a short axial length are indicative of a relatively anterior lens position Furthermore, lens thickness, its relative position, and axial length significantly affect the anterior chamber angle opening distance, potentially contributing to the pathogenesis of angle-closure glaucoma.
综述

MMP-2在单纯疱疹病毒性角膜炎中的研究进展

Research progress of MMP-2 in herpes simplex keratitis

:763-767
 
角膜因其特有的内部有序排列结构具有高度透明性,是眼前部重要的屈光间质,又因其缺乏血液供应,角膜疾病恢复周期较长、病情易反复出现,严重影响患者的视力和日常生活。基质金属蛋白酶(matrix metalloproteinase, MMP)通过参与组织蛋白降解重塑、血管生成、炎症免疫反应等,在肺纤维化、动脉粥样硬化等众多疾病中具有重要作用,其中MMP-2(明胶酶A)在眼部相关疾病中的作用也逐渐受到关注。单纯疱疹病毒性角膜炎具有高度致盲性,反复发作会导致角膜失去透明性,角膜混浊逐渐加重,最终导致失明。研究者通过对MMP-2在HSK、角膜溃疡中的病理作用机制进行分析研究,发现MMP-2的特异性抑制药物在角膜炎中具有一定的临床应用前景,未来或可从本文的研究角度出发,适当增加相关的药物治疗研发,解决目前治疗的局限性,以期为角膜疾病患者带来新的有效治疗方案。
The cornea has a high degree of transparency due to its unique internal orderly arrangement structure, and as a major refractive media in the anterior eye. However, due to its lack of blood supply, the recovery period of corneal diseases is long and the condition is prone to recurrence, corneal diseases seriously affecting the patient's vision and daily life. Matrix Metalloproteinases play an important role in many diseases, such as pulmonary fibrosis and atherosclerosis, by participating in tissue protein degradation and remodelling, angiogenesis, inflammatory immune response, etc. Among them, the role of MMP-2 in ocular diseases has also been gradually explored and studied. Herpes simplex virus keratitis is highly blinding, and repeated attacks can cause the cornea to lose transparency, gradually worsen corneal opacity, ultimately resulting in blindness. By analysing the mechanism of MMP-2 in herpesvirus keratitis and corneal ulcers, researchers were found that specific inhibitions of MMP-2 have certain clinical application prospects in keratitis. In the future, from the perspective of this study, it may be appropriate to increase the research and development of related drug treatments, solve the limitations of current treatments, and bring new effective treatment options for corneal disease patients.
综述

减重药物对眼部的影响

The effects of the weight-loss drugs on the eyes

:585-594
 
全球范围内,肥胖或超重问题持续加剧,据《2024年世界肥胖报告》及近期数据,预计2035年受超重或肥胖影响的成年人将达33亿,我国成人肥胖或超重患病率已超50%且呈上升趋势。肥胖会增加2型糖尿病、心血管疾病等多种疾病风险,减轻5%~15%体重可改善相关并发症,因此减重关注度日益提升,除运动和饮食控制外,减重药物与手术等手段不断涌现。然而减重药物在减轻体质量(体重)的同时,其潜在的危害不容忽视,有研究表明减重药物可对眼部产生不良影响:导致眼压升高使患者出现眼睛疼痛、视力模糊的症状;影响眼部血液循环和营养供应,发生炎症感染;出现眼睛疲劳干涩,对糖尿病性视网膜病变产生影响等。本文聚焦目前主流的三类减重药物——非中枢性减重药物(以脂肪酶抑制剂为代表)、中枢性减重药物(含拟儿茶酚胺类制剂和5-羟色胺受体激动剂)、兼有减重效果的降糖药物(包括GLP-1RA、GLP-1/GIP双受体激动剂、二甲双胍等),详细论述其应用及对眼部的不良反应。同时,也提及部分药物可能对眼部产生的益处,如二甲双胍、GLP-1RA或对青光眼、糖尿病视网膜病变有潜在保护作用。本文旨在为用药人群、相关医护及从业人员提供理论指导,强调使用减重药物时需警惕眼部风险,平衡疗效与安全性。
Globally, the problem of obesity or overweight continues to intensify. According to the "2024 World Obesity Report" and recent data, it is estimated that by 2035, the number of adults affected by overweight or obesity will reach 3.3 billion. In China, the prevalence of obesity or overweight among adults has exceeded 50% and is on the rise. Obesity increases the risk of various diseases such as type 2 diabetes and cardiovascular diseases. Reducing body weight by 5% to 15% can improve related complications. Therefore, the focus on weight loss is increasing. Besides exercise and dietary control, weight loss drugs and surgeries are constantly emerging. However, while weight loss drugs can reduce body weight, their potential harms should not be ignored. Studies have shown that weight loss drugs can have adverse effects on the eyes: causing increased intraocular pressure, leading to symptoms such as eye pain and blurred vision; affecting blood circulation and nutrient supply to the eyes, resulting in inflammation and infection; causing eye fatigue and dryness, and having an impact on diabetic retinopathy, etc. This article focuses on the three main types of weight loss drugs currently available - non-central weight loss drugs (represented by fat enzyme inhibitors), central weight loss drugs (including catecholamine-like preparations and 5-hydroxytryptamine receptor agonists), and hypoglycemic drugs with weight loss effects (including GLP-1RA, GLP-1/GIP dual receptor agonists, metformin, etc.), and elaborates on their applications and adverse reactions to the eyes. At the same time, it also mentions the potential benefits that some drugs may have on the eyes, such as metformin and GLP-1RA, which may have a protective effect on glaucoma and diabetic retinopathy. This article aims to provide theoretical guidance for drug users, related medical staff, and professionals, emphasizing the need to be vigilant about eye risks when using weight loss drugs and to balance efficacy and safety.
教学专栏

眼科住院医师规范化培训中人文素养培育的实践与探索

Practice and exploration of cultivating humanistic qualities in standardized training of ophthalmology residents

:402-407
 
在眼科住院医师规范化培训中,医学人文素质的培养对医患沟通能力与职业素养的塑造具有重要价值。医学人文不仅关乎医生的执业能力,更直接影响医疗服务的质量与患者满意度。文章分析了当前眼科住培医师人文素养教育现状及其重要性。在此基础上,提出了培养住培医师的人文素质的方法和途径:1)通过入培前的人文素养专题培训,强化住培医师的医患沟通意识,使其在进入临床实践前就树立正确的人文理念;2)借助医院服务中心的实践活动,让住培医师亲身参与患者服务,从而培养他们的同理心,更好地理解患者的需求与感受;3)开展医学人文读书活动,引导住培医师阅读经典人文著作,深化他们的人文情怀,提升职业素养;4)组织科室人文析议会,针对临床实践中常见的伦理困境进行研讨,帮助住培医师学会在复杂情境中做出合理决策;5)实施思政与医学人文融合的实践,拓展住培医师的人文视野,使其在专业技能提升的同时,不忘人文初心。该文旨在为眼科住培医师的人文素质培养提供理论支持和实践指导。通过这些方法的实施,期望培养出更多具备高人文素养的眼科医疗专业人才。
Strengthening medical humanities education is of vital significance in the standardized training of ophthalmology residents, as it contributes to enhancing their doctor-patient communication skills and professional ethics. This paper examines the current situation and significance of humanities education for ophthalmology residents. On this basis, the paper suggests five concrete methods and approaches for fostering residents' humanistic qualities, such as: (1) strengthening doctor-patient communication awareness through pre-training humanities courses to establish a proper humanistic mindset before clinical practice; (2) developing empathy by participating in hospital service center activities through hands-on patient service experiences; (3) deepening humanistic sentiment and enhancing professional ethics through medical humanities reading activities featuring classical works; (4) discussing clinical ethical dilemmas via departmental humanities analysis meetings to help residents develop decision-making skills in complex scenarios; (5) expanding humanistic horizons through the integration of ideological and political education with medical humanities practice, ensuring professional skill development aligns with humanistic principles. This paper aims to offer theoretical support and practical guidance for the humanities education of ophthalmology residents, with the objective of cultivating more ophthalmology professionals with both clinical excellence and high humanistic caliber.
论著

基于医院小儿眼科常见病种分析儿童眼科药物临床试验现状

Analysis of the current situation of clinical trials of ophthalmic drugs in children based on the common diseases of pediatric ophthalmology in hospital

:408-415
 

目的:结合医院小儿眼科常见病种调研国内儿童眼用制剂药物临床试验开展现状,为儿童眼用制剂药物临床试验的发展提供参考。方法:基于国家药物临床试验登记与信息公示平台和医院信息系统,结合郑州市第二人民医院儿童眼科病种,分析儿童眼科药物临床试验开展情况。 结果:医院门诊就诊患者以屈光不正最多(占68.49% ),其次是结膜炎(占11.25%),再次是斜视(占8.60%)。平台共检索到相关临床试验165项,儿科专用药物临床试验25项,其中延缓青少年近视方面试验24个,小儿结膜炎试验1个,其他病种药物临床试验检测结果为0;药物临床试验中以I期和Ⅲ期临床试验为主;延缓青少年近视方面试验已完成试验8项,其他都在进行中。结论:儿童眼科疾病的药物治疗尚有巨大的临床需求未满足,直接关系到了儿童健康权益保障与生命安全维护。当前国内儿童眼用制剂研发呈现企业参与度低、创新动力不足的现状,其核心制约因素在于项目少、难度大、涉及更多的伦理问题。建议通过政产学研协同创新,系统性推进儿童眼用制剂的研发进展,切实解决我国儿童眼病治疗用药难的问题,为儿童视觉健康提供有力保障。

Objective:Combined with the common diseases of pediatric ophthalmology in our hospital, the current situation of clinical trials of ophthalmic preparations for children in China was investigated to provide reference for the development of clinical trials of ophthalmic preparations for children in China. Methods:Based on the national drug clinical trial registration and information publicity platform and hospital information system, combined with the pediatric ophthalmic diseases in our hospital, the development of pediatric ophthalmic drug clinical trials was analyzed. Results:Among the outpatients in our hospital, ametropia was the most common ( 68.49 % ), followed by conjunctivitis ( 11.25 % ) and strabismus ( 8.60 % ). A total of 165 clinical trials and 25 clinical trials of pediatric drugs were retrieved from the platform, including 24 trials on delaying juvenile myopia, 1 trial on pediatric conjunctivitis, and 0 clinical trial on other diseases. Drug clinical trials were mainly phase I and phase III clinical trials. Eight trials have been completed to delay juvenile myopia, and others are in progress. Conclusions:There is still a huge clinical demand for the drug treatment of children 's eye diseases, which is directly related to the protection of children 's health rights and life safety. At present, the research and development of children 's ophthalmic preparations in China presents the current situation of low enterprise participation and insufficient innovation motivation. The core constraints are fewer projects, greater difficulty, and more ethical issues. It is suggested to systematically promote the research and development of ophthalmic preparations for children through the collaborative innovation of government, industry, university and research, so as to effectively solve the problem of difficult medication for children 's eye diseases in China and provide a strong guarantee for children 's visual health.
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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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