近年来，使用人工智能(artificial intelligence，AI)技术对临床大数据及图像进行分析，对疾病做出智能诊断、预测并提出诊疗决策，AI正逐步成为辅助临床及科研的先进技术。生物样本库作为收集临床信息和样本供科研使用的平台，是临床与科研的桥梁，也是临床信息与科研数据的集成平台。影响生物样本库使用效率及合理共享的因素有信息化建设水平不均衡、获取的临床及检验信息不完全、各库之间信息不对称等。本文对AI和区块链技术在生物样本库建设中的具体应用场景进行探讨，展望大数据时代智能生物样本库信息化建设的核心方向。

In recent years, artificial intelligence (AI) technology has been applied to analyze clinical big data and images and then make intelligent diagnosis, prediction and treatment decisions. It is gradually becoming an advanced technology to assist clinical and scientific research. Biobank is a platform for collecting clinical information and samples for scientific research, serving as a bridge between clinical and scientific research. It is also an integrated platform of clinical information and scientific research data. However, there are some challenges. First, clinical and laboratory information obtained is incomplete. Additionally, the information among different databases is asymmetric, which seriously impedes the information sharing among different Biobanks. In this article, the specific application scenarios of AI technology and blockchain in the construction of a Biobank were discussed, aiming to pinpoint the core direction of the information construction of an intelligent Biobank in the era of big data.

当下，我国眼科的发展存在失衡现象，大城市与农村及偏远地区在眼科相关诊疗设施水平、诊疗技术等方面存在巨大差异，仍需探寻新的智能诊疗模式以解决失衡问题。由于眼球是唯一可以直接观察人体血管和神经的器官，眼部可反映其他脏器的健康状态，部分眼科检查的医学图像可对眼部疾病做出诊断等特点，眼科开展人工智能(artificial intelligence，AI)具有独到的优势。此外，人工智能可在一定程度上提高跨时间空间传递信息的精准度及效率。人工智能在眼科及远程信息传递的优势为解决眼科发展失衡状况提供了助力。本文从眼科人工智能在眼科远程医疗相关应用的角度，主要分析并总结当下我国人工智能在眼科相关疾病远程医疗中的发展程度、所具优势以及存在问题，并讨论眼科人工智能在远程医疗的应用展望。

At present, there is an imbalance in the development of ophthalmology in China. There are huge differences in the level of ophthalmology related facilities, diagnosis and treatment technologies between big cities and rural, remote areas. New intelligent diagnosis and treatment models are still needed to solve the imbalance. Since the eye is the only organ that can directly observe the blood vessels and nerves of the human body, the eye can reflect the health status of other organs and diagnosis of eye diseases based on medical images of some ophthalmic examinations can be made as well as other characteristics. Therefore, the development of artificial intelligence in ophthalmology has unique advantages. In addition, artificial intelligence can improve the accuracy and efficiency of information transmission across time and space to a certain extent. The advantages of artificial intelligence in ophthalmology and telematics are helping to solve the imbalance in ophthalmology development. From the perspective of the application of ophthalmic artificial intelligence in telemedicine, this paper mainly analyzes and summarizes the development degree, advantages and existing problems of artificial intelligence in the telemedicine of ophthalmic diseases in China, and discusses the prospect of the application of ophthalmic artificial intelligence in telemedicine.

帕金森病(Parkinson’s disease，PD)是老年人常见的神经系统退行性疾病，眼部及视觉功能障碍是PD常见的非运动症状之一，进一步影响其生活质量。已有研究表明PD患者视网膜内存在多巴胺浓度的减少以及α突触核蛋白的沉积。目前，PD仍缺乏有效的早期诊断及病情评估工具，光学相干断层扫描及光学相干断层扫描血管成像技术可以显示视网膜各层微细结构及微血管的异常，应用该技术研究者发现PD患者视乳头旁视网膜神经纤维层及黄斑区视网膜的厚度均存在不同程度的变薄，视网膜浅层及深层毛细血管丛的毛细血管密度和复杂性下降。进一步研究者应用该技术在PD临床应用中进行了探索，并发现其可用于检测早期PD中发生的病理变化，反映疾病的病程及严重程度，并且在鉴别诊断中起到一定的作用。总而言之，视网膜相关检测可能成为评估PD患者脑病理严重程度的指标，并且帮助疾病诊断和监测疾病的进展，不过这仍需要大样本、多中心的重复研究以提供更多理论依据。

Parkinson’s disease is a common neurodegenerative disease in the elderly, and ocular and visual dysfunction is one of the common non-motor symptoms of PD, further affecting PD patients’quality of life. Reduced dopamine concentrations and deposition of α-synuclein in the retina of PD patients have been shown in studies. At present, there is still a lack of effective tools for early diagnosis and assessment of PD. Optical coherence tomography and optical coherence tomography angiography can reveal abnormalities in the microstructure and microvasculature of the retinal layers, and researchers applying these techniques have found that the thickness of the parapapillary retinal nerve fiber layer and the retina in the macula in PD patients have had varying degrees of thinning, and the density and complexity of capillaries in the superficial and deep capillary plexus of the retina have been reduced. Further, investigators have explored the clinical application of these techniques in PD and have found that they can be used to detect pathological changes occurring in early PD, reflect the course and severity of the disease, and play a role in differential diagnosis. In conclusion, retinal-correlated testing may be an indicator to assess the severity of brain pathology in PD patients and to aid in disease diagnosis and monitoring the progression of PD, although large sample, multicenter replication studies are still needed to provide more reliable results.

      迟发性眼前节毒性综合征（toxic anterior segment syndrome，TASS）是 TASS 的一种特殊类型，两者既有共同点又有区别，随着人们认识的深入，越来越多的迟发性 TASS 被报道。迟发性 TASS 较典型性 TASS 少见，流行病学特征因人工晶体不同而有差异。几乎所有可引起典型性 TASS 的因素都可以引起迟发性 TASS，此外铝元素在迟发性 TASS 的发生中可能有关键作用。迟发性 TASS 临床表现与典型性 TASS 类似，累及后段更为常见，激素治疗有效。

Late-onset toxic anterior segment syndrome (TASS) is a special type of TASS, which has both similarities and differences. With the deepening understanding, more and more late-onset TASS is reported. Late-onset TASS is less common than typical TASS, and the epidemiological characteristics are vary with intraocular lenses. Almost all the factors that can cause typical TASS can cause late-onset TASS, in addition, aluminum element may play a key role in the occurrence of delayed TASS. The clinical manifestations of late-onset TASS are similar to those of typical TASS, with the involvement of the posterior segment more common and hormone therapy effective.

      干眼是指以泪膜稳态失衡为主要特征并伴有眼部不适症状的多因素眼表疾病。目前干眼的主要治疗手段包括药物治疗（人工泪液替代疗法、抗炎治疗、免疫抑制治疗）和必要时的手术干预治疗。地夸磷索四钠属于 P2Y₂ 受体激动剂，是一种治疗干眼的新型药物。它通过刺激位于眼表组织的 P2Y₂ 受体，促进泪液、黏液、脂质分泌，增强泪膜稳定性，从而改善干眼的症状和体征。

Dry eye refers to a series of chronic and progressive ocular surface diseases characterized by imbalanced tear film accompanied with ocular discomfort symptoms. The available methods mainly include pharmacotherapy (artificial tears replacement, anti-inflammatory, immunosuppressive therapy) and ophthalmic surgery. P2Y₂ receptor agonist is a novel pharmaceutical agent for dry eye treatment, which could stimulate tear fluid secretion and mucin secretion through binding with P2Y₂ receptors on the ocular surface, so that improve tear film stability and alleviate symptoms of dry eye. 3% diquafosol ophthalmic solution is the only P2Y₂ receptor agonist available for dry eye.

目的：总结全身麻醉斜视矫正日间手术服务模式的创建与安全管理方法。方法：回顾 2015 年 10 月至 2018 年 10 月期间全身麻醉下行斜视矫正日间手术患者共 9 570 例。改革护理管理模式，实施医护一体化，在实施过程中对患者进行严密的术前、术后护理管理：术前评估，健康教育前移、加强核查制度、严格监测患者生命体征；术后病情严格交接，家属及患者同步术后指导、离院后回访。结果：全身麻醉斜视矫正日间手术的 9 570 例患者，均未发生手术并发症，术后不适 34 例，占 0.36%，其中 2 例患者离院时出现头晕，2 例发生尿储留，30 例出现恶心、呕吐。护理人力由开展前 16 人减少到 12 人，节约 25%；患者等候手术时间缩短了 8 d，满意度由 70% 提高到 90%，平均住院时间由 3.2 d 减少为 1 d。结论：全身麻醉斜视矫正日间手术模式是一种新的医疗模式，开展全身麻醉日间手术不但可以节省医疗资源，还可提高患者满意度。

Objective: To summarize the establishment and safety management methods of ambulatory strabismus surgery that can provide the basis for carrying out ambulatory surgery nursing under general anesthesia. Methods:We carried out ambulatory surgery management that reformed nursing management model and delivered the integration of medical care in 9 570 patients undergoing strabismus surgery under general anesthesia from October 2015 to October 2018. In implementation process, we carefully managed the patients before and after operation including performing preoperative assessment and health education in advance, strengthening the verification system, strictly monitoring vital signs of the patients, strict shifting state of patients after operation, providing postoperative guidance to patients and their families, and performing follow-up clinic visits after leaving the hospital. Results: No surgical complications occurred in any of our cases. 34 patients had postoperative discomfort, accounting for 0.36%. Among these 34 patients, 2 had dizziness, 2 had urinary retention and 30 had nausea and vomiting. After treatments, all patients were discharged on schedule. The number of nurses reduced from 16 to 12 that fell by 25%. Wait times for operation reduced by 8 days. Patient satisfaction was improved from 70% to 90%. The mean length of hospital stay was reduced from 3 days to 1 day. Conclusion: The management of ambulatory surgery under general anesthesia is a new medical care service model. Careful planning and strict preoperative and postoperative safety management can ensure the safe implementation of strabismus surgery. Ambulatory surgery under general anesthesia has benefits to save medical resources and improve patient satisfaction.

目的：探讨先天性瞳孔残膜围手术期的护理方法。方法：对 13 例（15 眼）先天性瞳孔残膜患儿围手术期给予心理护理、安全护理、优先安排术前检查、术后严密观察病情变化、延续性护理并观察其效果。结果：13 例（15 眼）先天性瞳孔残膜的患儿手术均顺利完成，术后均无出现并发症，其中 6 例患者术后视力较术前视力有所提高，住院满意度为92.3%（12 / 13）。结论：对先天性瞳孔残膜患儿围手术期给予针对性的心理护理、安全护理、延续性护理是瞳孔残膜围手术期的有效护理方法。

Objective: To explore the perioperative nursing methods of persistent pupillary membrane. Methods: In the perioperative period, 13 cases (15 eyes) with persistent pupillary membrane were given preoperative nursing care, psychological nursing, careful observation of the change of condition, safety nursing, continuous nursing and observation of its effect. Results: A total of 13 cases (15 eyes) with persistent pupillary membrane were successfully operated, among which 6 cases had improved postoperative visual acuity compared with preoperative visual acuity, and no postoperative complications occurred. The satisfaction rate of hospitalization was 92.3% (12/13). Conclusion: It is an effective nursing method to give psychological nursing, safety nursing and continuous nursing to children with persistent pupillary membrane in perioperative period.

真菌性眼内炎是临床上少见的眼内感染疾病。因为其诊断延迟和抗真菌药物的有效性有限，因此真菌性眼内炎常常导致视力严重损害。按照感染性途径，真菌性眼内炎包括内源性和外源性，其中外源性眼内炎常见，进展较快，眼部手术术后感染是常见原因之一。小梁切除术是抗青光眼滤过性手术，是目前手术治疗青光眼的有效方法之一。滤过泡相关性眼内炎是其并发症之一，对患者视功能的损害尤为严重。本文通过回顾 1 例滤过泡相关性真菌性眼内炎患者的临床病例资料，讨论及分析滤过泡相关性的真菌性眼内炎的危险因素及诊治方法。

Fungal endophthalmitis is a disease which is a rare kind of interocular infection in clinic. Fungal endophthalmitis often results in severe visual impairment because of delayed diagnosis and limited effectiveness of antifungal drugs. Fungal endophthalmitis includes endogenous and exogenous endophthalmitis which is common and progresses rapidly. Postoperative infection is one of the common causes of fungal endophthalmitis. Trabeculectomy is an antiglaucoma filtering operation, and it is one of the effective methods for glaucoma surgery at present. Glaucomafiltering bleb infection is one of the complications of trabeculectomy, which can lead to severe visual impairment. In this article, we analyzed and discussed the risk factors, diagnosis and treatment methods about the filtering bleb-associated fungal endophthalmitis.

医师规范化培训面临的主要问题是缺少规范化的培训模式和统一的培训评估标准。本研究通过客观结构化临床考试（objective structured clinical examination，OSCE）教学评估及问卷调查，探讨基于问题的学习（problem-based learning，PBL）教学模式在医师规范化培训中的应用效果，结果表明 PBL 是适应医师规范化培训特点的一种教学模式，而 OSCE 是一种规范化培训行之有效的评估模式。

The main problems faced by the standardized training of physicians are the lacking of standardized training mode and unified training evaluation standard. This study was designed to evaluate the effectiveness of employing problem-based learning （PBL） on the standardized training of ophthalmologic residents by objective structured clinical examination （OSCE） and questionnaire survey. The result shows that PBL training mode is eligible for the characteristics of standardized training of ophthalmologic residents, and OSCE is an effective estimate model.