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. 

囊袋缩窄综合征（capsule contraction syndrome CCS）是白内障超声乳化摘除人工晶体囊袋内植入术后少见的并发症。遵义医学院附属医院收治的 2 例植入蔡司 603P 人工晶体患者，均在术后 3 个月后自发出现非典型囊袋缩窄伴人工晶体偏斜移位，6 个月后行人工晶体置换术。本文通过回顾 2 例患者的病例资料，讨论及分析其囊袋缩窄的原因、危险因素及诊疗方法。

Capsule contraction syndrome （CCS） is a rare complication after cataract ultrasonic emulsification and implantation of intraocular lens. Two patients with implanted Zeiss 603p intraocular lens were treated in Zunyi Medical College Affiliated Hospital, they presented with spontaneous dislocation of intraocular lens by atypical CCS after 3 months. After 6 months, they received artificial lens replacement. By reviewing the clinical data of two patients, the causes, risk factors and diagnosis and treatment of the narrowing of the pouch were discussed and analyzed.

患者，男，54 岁，因“双眼异物感伴眼痒 2 周”在北京怀柔医院眼科就诊。自诉 1 d 前自行从眼内取出白色虫体 1 条。裂隙灯检查发现左眼结膜囊内可见白色虫体 2 条，用眼科镊子将其取出，并送病理科检查。就诊结束后嘱患者左氧氟沙星眼液滴左眼，4次/d 。后病理科证实虫体为结膜吮吸线虫。5 d 后患者复诊，诉左眼仍眼痒伴异物感，再次行裂隙灯检查检深部穹隆白色虫体 1 条，取出虫体，并使用生理盐水加压冲洗结膜囊，嘱患者局部抗生素点眼，门诊随访 3 周未见复发。

A 54-year-old patient was admitted to the Department of Ophthalmology in Beijing Huairou Hospital due to the itch of eyes for 2 weeks. He said that a white worm was removed from the eye the day before the visit. Two white worms were found in the conjunctival sac from the left eye and we removed them with the tweezers and then sent to pathology department for further examination. The patient was told to use the levofloxacin eye drop 4 times a day. After 2 days, it was confirmed that the worms were Thelazia callipaeda; after 5 days, the patient came back for further consultation and complained that the itching and foreign body sensation didn’t disappear. And then a white worm was found in the deep conjunctival sac from the left eye. The worm was removed, and the conjunctival sac was flushed with saline. The patient was told to continue using the levofloxacin eye drop. During 3-week followup, no recurrence was found.

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。 

Abstract Objective: To evaluate the clinical safety and curative effect of phacoemulsification （Phaco） combined withmultifocal 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. 

硅油是最常用的眼内填充物之一，在现代玻璃体视网膜手术中具有无可替代的地位。然而由于硅油的理化特性，其在眼内使用 3 个月至 1 年后会不可避免地影响眼球各组织的结构和功能，可导致角膜变性、继发性青光眼、并发性白内障、视网膜前膜等一系列并发症。

Silicone oil is one of the most common intraocular fillers. It has an irreplaceable position in the modern vitreoretinal surgery. However, due to the physicochemical properties of silicone oil, it will inevitably affect the structure and function of eyeball tissues from 3 months to 1 year after intraocular use, which can lead to a series of complications, such as corneal degeneration, secondary glaucoma, complicated cataract and retinal membrane.

      报告 1 例 2019 年 1 月因无色素性视网膜色素变性而就诊的病例。患者因发现视力差，常规眼科检查及全身的检查未发现异常，给予眼底荧光造影后确诊。给予眼底荧光造影后最终确诊为罕见的无色素性视网膜色素变性，防止了疾病的漏诊和误诊。对于缺乏视网膜色素变性典型的三联征的无色素性视网膜色素变性患者，临床要谨防漏诊，眼底荧光血管造影（fundus fluorescein angiography，FFA）可明确诊断。

We reported a case of achromatic retinitis pigmentosa admitted to the hospital in January 2019. The patient was diagnosed by fundus fluorescein angiography because of poor vision, and no abnormality was found by routine ophthalmological examination and general examination. After fundus fluorescein angiography (FFA), a rare nonpigmented retinitis pigmentosa was finally diagnosed, which prevented misdiagnosis and missed diagnosis of the disease. For the patients without typical triad of retinitis pigmentosa, we should pay attention to missing the diagnosis in clinical practice. FFA can make a definite diagnosis of retinitis pigmentosa.

目的：探讨专科护士培训方式以提高斜视病区护士的专业技能以及专科理论水平。方法：每次由护士长安排一名护士进入科主任所在的医疗小组进行为期 3 ~ 4 个月的培训，培训内容主要包括与医生一起出门诊、学习术前斜视专科检查、参加患者术前手术方案的制定和术后的查房，定期参加科室的理论培训。结果：实施斜视专科护士培训方法后，经过培训的护士掌握了斜视专科常用的检查方法，能解读本专科的相关检查报告，护士的专科工作能力、应对咨询能力有提高，医生、患者对护士的满意度均有提高。结论：斜视病区专科护士培训方法对临床护理工作有积极的影响，值得临床科室借鉴。

Objective: To improve the professional skills and theoretical level of the nurses, a new training method was adopted in strabismus ward. Methods: The head nurse arranged a nurse to participate in medical team the director of the department for 3–4 months. The medical works that the nurse had to follow included coperative outpatient medical work with the doctors, clinical examination before strabismus surgery, making individual surgical plans, nursing rounds of wards after surgery, and regular theoretical training of the department. Results:After implementing the training method of strabismus specialist nurses, the trained nurses mastered the common examination methods for strabismus patients, and could analyse the relevant examination reports. The ability of the nurses’professional work and consultative capacity were improved. Furthermore, the satisfaction of doctors and patients on nursing work was improved. Conclusion: The new training method of specialist nurses in strabismus ward exerts positive effect on clinical nursing work, which is worthy of application in clinical practice.