原发性开角型青光眼（primary open angle glaucoma，POAG）是一种慢性、进行性的视神经病变，其发病机制尚不明确。而眼内敏感区域[如小梁网邻管组织、筛板（lamina cribrosa，LC）等]的细胞外基质代谢异常在其中起关键作用。富含半胱氨酸的酸性分泌蛋白（secreted protein, acidic and rich in cysteine，SPARC）作为一种基质细胞蛋白在眼内广泛分布，具有沟通细胞与细胞外基质信号传递的作用。研究表明 SPARC 可通过多种途径参与并调控青光眼的发生发展过程，有望成为疾病治疗的新靶点。

Primary open angle glaucoma （POAG） is one of chronic and progressive optic neuropathies. Its pathogenesis remains to be clarified. The metabolic disturbance of extracellular matrix in some sensitive regions, such as the juxtacanalicular region and lamina cribrosa, may play a key role. Secreted protein, acidic and rich in cysteine （SPARC）, as one matricellular protein, is widely distributed inside the eye. It generally allows cells to modulate their attachments with and alter the characteristics of their surrounding extracellular matrix. Research shows that SPARC participates in the development of glaucoma through a variety of ways, and it may, therefore, become a new therapeutic target in the treatment.

      术前有效杀灭或减少眼表微生物的数量是降低术后眼内炎的重要措施。聚维酮碘消毒液和妥布霉素均能有效的降低眼科手术术后眼内炎发生率。笔者通过文献报道，综合分析聚维酮碘消毒液及妥布霉素滴眼液及注射液对眼科手术结膜囊微生物的控制能力，为眼科手术术前准备提供理论依据。

Effectively killing or reducing the number of ocular microbes before surgery is an important measure to reduce postoperative endophthalmitis. Both povidone-iodine disinfectant and tobramycin can effectively reduce the incidence of endophthalmitis after ophthalmic surgery. Through literature reports, the author comprehensively analyzes the control ability of povidone-iodine disinfectant and tobramycin eye drops and injection on the microscopy of conjunctival sac in ophthalmic surgery, and provides theoretical basis for preoperative preparation of ophthalmic surgery.

探讨“健康快车”在方言环境下开展白内障健康教育的问题和对策。本文回顾 2017 年 9 至 11 月“健康快车”在广西贺州站开展的 1227 台白内障扶贫手术，分析实施健康教育的难点，总结方法和技巧。最终 1227 例白内障手术顺利完成，患者均能配合手术；住院过程中无跌倒、坠床等不良事件发生。采用以基地医院为主，“健康快车”为辅，患者和家属共同参与的健康宣教模式，对保证在方言环境下“健康快车”大批量白内障扶贫手术顺利开展有重要作用。

This article aims to explore the issues and countermeasures for the development of health education in the dialect environment. We reviewed 1 227 cataract-free surgeries performed in the “Health Express” from September to November 2017 at Hezhou, Guangxi, and analyzed the difficulties in implementing health education and summarizes methods and techniques. Finally, 1 227 cataract operations were successfully completed, and patients could cooperate with doctors. Besides, no adverse events, such as falling happened during hospitalization. The model of health education was based on the local hospital, then supplemented by “Health Express”, and both patient and family members participated. This model has guaranteed the smooth implementation of the “Health Express” large-scale surgeries for cataract in the dialect environment.

目的：贯彻落实国家卫生与计划生育委员会颁布的《新入职护士规范化培训大纲（试行）》，探索眼科专科医院新入职护士规范化培训方案，为建设眼科特色的规范化培训体系提供依据。方法：根据《新入职护士培训大纲（试行）》要求，结合眼科专科医院特点制定新入职护士规范化培训方案，对 2016 年新入职的 12 名眼科护士采用课堂讲授、小组讨论、工作坊、操作培训、情景模拟、案例分享、亚专科轮转等方式进行规范化培训，2 年后进行结业考核，包括理论知识考试、临床实践能力考核、案例汇报。结果：12 名眼科新入职护士经过 2 年规范化培训，结业考核成绩合格，通过率 100%；其中理论知识考试（87.33±1.78）分，眼科护理技术操作（94.00±1.57）分，基础护理技术操作（92.17±2.90）分，案例汇报（92.56±3.23）分。结论：实施眼科新入职护士规范化培训方案，有利于系统性培训新入职眼科护士，对提高眼科专科新护士整体护理水平必不可少，合理、合适、实用的课程设置和培训方法可调动新入职护士参加培训的主动性、积极性。

Objective: To implement the National Health and Family Planning Commission’s standardized training program for newly employed nurses (trial), and to explore the standardized training program for new nurses in ophthalmology hospitals. To provide the basis for constructing the standardized training system of ophthalmology characteristics. Methods: According to the requirements of the new nurse training outline (trial) and the characteristics of the ophthalmology hospital, the standardized training program for the new entrant nurses was formulated. The 12 new ophthalmic nurses in 2016 were taught in class, discussed in group, and worked out in theworkshop. Operational training, situational simulation, case sharing, sub-specialist rotation and other methods for standardized training. After the completion of the examination, including theoretical knowledge examination, clinical practice assessment, case report. Results: After 2-year standardized training, 12 new ophthalmology nurses passed the examination, and the average score of theoretical knowledge examination was 87.33±1.78, the average score of ophthalmic nursing technique was 94.00±1.57, the average score of theoretical knowledge test was 87.33±1.78, the average score of ophthalmic nursing technique operation was 94.00±1.57, the average score of basic nursing operation was 92.17±2.90, and the average score of case report was 92.56±3.23. Conclusion:The implementation of standardized training program is beneficial to systematic training of new ophthalmic nurses. It is necessary, reasonable, appropriate and practical to improve the whole nursing level of new nurses in ophthalmology specialty. The curriculum and training method can arouse the initiative and enthusiasm of new nurses to participate in the training.

目的：比较水合氯醛和阿佛丁两种药物对小鼠的麻醉作用以及不同激光能量对脉络膜新生血管造模成功率的影响。方法：24 只C57/BL6 小鼠随机分为 3 组，分别予以 200，300 和400 mW的 532 nm激光进行视网膜光凝；每组再按 1:1 分为 2 个亚组，随机使用 4.3%水合氯醛或 1.2%阿佛丁进行小鼠腹腔注射麻醉。在激光光凝后第 4，7，10 和 14 天进行视网膜荧光素造影（Fundus Fluorescein Angiography，FFA）、SD-OCT检查，在第 14 天时对脉络膜行IB4 染色检查。结果：阿佛丁和水合氯醛诱导小鼠进入麻醉时间长分别为（120±30）s和（150±45）s，持续时间分别为（30±15）min和（50±20）min，差异均有统计学意义（均P=0.0001）；发生不可逆性白内障的比率分别为 2/24 和 1/24 ，麻醉导致的死亡数分别为1和0只，差异均无统计学意义（P=0.551，P=0.300）。200，300 和 400 mW三个激光能量组的造模成功率分别为 9.38%，37.5%和 93.75%，差异有统计学意义（P=0.0001）。FFA显示：造模成功的小鼠在4d时荧光素渗漏达到高峰，随后荧光素溢漏的面积逐渐减小。结论：与阿佛丁相比，水合氯醛对小鼠的麻醉维持时间长且不会增加病死率和不可逆性白内障的发生率； 400 mW的 532 nm激光能量是诱发CNV的较好设置。

Objective: To compare the narcotic effects of chloral hydrate and avertin in mouse models and the success rate of choroidal neovascularization (CNV) mouse model establishment with different energy hierarchy of laser.Methods: Twenty-four mice were randomized into 3 groups, the 532 nm laser was used with different power levels of 200, 300 and 400 mW for each group. In each group, the chloral hydrate was used for 4 mice and avertin for the other 4 mice at random. On day 4, 7, 10 and 14, all mice were tested by the fundus fluorescein angiography (FFA), SD-OCT, and the choroid was stained with the isolectin B4 conjugated AF488 on day 14. Results: The anesthesia induction time of avertin and chloral hydrate was （120±30） s and（150±45）s, and the duration of anesthesia was （30±15）min and （50±20） min, the differences were statistically significant （all P=0.0001）; the incidence of irreversible cataract of avertin models and chloral hydrate models was 2/24 and 1/24, the number of death in two models was 1 and without statistical significance （P=0.551, P=0.300）. With the increase of laser energy, the success rate of experiments was also gradually increased, from 9.38%, 37.5% to 93.75% （P=0.0001） in 200, 300 and 400 mW group, respectively. According to the results of FFA, the peak of fluorescence leaking was at day 4 after the laser burning, and was gradually reduced. Conclusion: Compared with avertin chloral hydrate can improve the duration of anesthesia without increasing the risk of cataract and mortality. As for the 532 nm laser,the 400 mW energy could be an optimal parameter for the laser-induced CNV.

视神经脊髓炎谱系疾病（neuromyelitis optica spectrum disorder, NMOSD）是一种罕见的中枢神经系统自身免疫性疾病，主要表现为视神经炎和纵向广泛性横贯性脊髓炎，复发率高，反复发作可导致不可逆的神经功能损害。文章报告了一例44岁女性的NMOSD患者，以反复发作的视神经炎为特征，经过长达11年的随访，共历经4次临床发作。患者首次发作时，因治疗过程中糖皮质（激素）减量过快和自行停药导致病情恶化，后续发作中采用了规范的急性期治疗和缓解期预防复发方案，包括大剂量激素冲击、免疫抑制剂（硫唑嘌呤、吗替麦考酚酯）和静脉注射免疫球蛋白（intravenous immunoglobulin, IVIG）等，显著延长了缓解期。最近一次复发中，患者首次使用了新型生物制剂伊奈丽珠单抗（CD19单克隆抗体）预防复发治疗。文章通过具体病例分析和文献综述，反映NMOSD急性期和缓解期预防复发治疗策略的时代变迁，并探索新型生物制剂使用过程中需要注意的问题。

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease that affects the central nervous system. It is predominantly characterized by optic neuritis and longitudinally extensive transverse myelitis. Given its high relapse rate, repeated attacks of NMOSD can result in irreversible nerve damage. The article details the case of a 44-year-old female patient with NMOSD, whose primary manifestion was recurrent optic neuritis.The patient was followed up over an 11-year span, during which she experienced a total of four clinical relapses. During the initial attack, the patient's condition deteriorated because of the rapid tapering of steroid therapy and her self-initiated discontinuation of medication. In subsequent attacks, standardized treatments for the acute phase and strategies for preventing relapses were implemented. These included high-dose steroid pulses, immunosuppressants (azathioprine, mycophenolate mofetil), and intravenous immunoglobulin (IVIG). These interventions significantly prolonged the remission period. During the most recent relapse, the patient received treatment with the novel biologic agent inebilizumab, which is  a CD19 monoclonal antibody. Through a comprehensive case analysis and a review of relevant literature , this report sheds light on the evolving treatment strategies for managing the acute phase and preventing relapses during remission in NMOSD. It also highlights key considerations in the practical application of the new biologic therapies.

目的：通过真实的临床病例，分析青光眼与非青光眼性视神经病变的不同表现，提高疾病的鉴别诊断能力。方法：采用病例研究与文献回顾方法，记录3例易误诊为正常眼压性青光眼（normal tension glaucoma, NTG）的神经眼科病例，通过视力、眼压、瞳孔对光反应、视盘形态、RNFL厚度、视野损害等特点，抽丝剥茧，得出诊断。结果：病例1视野呈弓形缺损，但视盘凹陷不深，且对侧眼“视盘拥挤”，随访期间发生急性前部缺血性视神经改变(anterior ischaemic optic neuropathy, AION)，最终确诊“AION遗留视神经萎缩”。病例2视力下降、视野缺损与视神经结构损害不相符，经完善MRI确诊为“左侧视神经鞘膜瘤”。病例3青年男性，中心视力下降，视盘凹陷不深，根据DNA结果确诊Leber遗传性视神经病变（Leber hereditary optic neuropathy, LHON）。结论：通过几个典型的神经眼科病例，掌握AION、视神经鞘膜瘤、LHON的结构和功能损害特征，如视盘凹陷不深、中心视力下降、视神经结构损害与视功能不相符，与NTG相鉴别。

Objective: To analyze the differentiating manifestations of glaucomatous and non-glaucomatous optic neuropathies using real clinical cases and to enhance the ability to make differential diagnosis. Methods: By using case study and literature review methods, we recorded three neuro-ophthalmic cases that were prone to being misdiagnosed as normal tension glaucoma (NTG). The diagnosis was established by extracting features related to visual acuity, intraocular pressure, pupillary light reflex, optic disc morphology, retinal nerve fiber layer (RNFL) thickness and visual field damage. Results: Case 1 presented with arcuate visual field defects, shallow optic disc cupping, and contralateral crowded discs. During follow-up, the patient subsequently developed acute anterior ischemic optic neuropathy (AION), and the final diagnosis confirmed was confirmed as optic atrophy secondary to AION. Case 2 exhibited a disproportionate visual acuity decline and visual field defects that were inconsistent with glaucomatous structural damage. MRI confirmed the diagnosis of left optic nerve sheath meningioma. Case 3 involved a young male who presented with central vision loss and shallow optic disc cupping. Genetic testing confirmed Leber's hereditary optic neuropathy (LHON). Conclusions: Through these representative neuro-ophthalmology cases, we illustrate the characteristic patterns of structural and functional damage associated with  AION, optic nerve sheath meningioma, and LHON, such as shallow optic disc cupping, central vision loss, and inconsistency between  optic nerve structural damage and visual function. These findings highlight the key differentiating features of these conditions from NTG.

        文章报道了一例5岁女性Dandy-Walker综合征（Dandy-Walker syndrome，DWS）患儿的临床表现、眼科检查及影像学特征。该患儿在确诊DWS后行后颅窝蛛网膜囊肿部分切除术，然而术后视力仍进行性下降，眼科随访过程中发现视网膜神经纤维层（Retinal Nerve Fibers Layer，RNFL)进行性变薄，提示颅内压尚未有效控制，视神经损害在进一步发展。由于DWS病变位置特殊性，头颅磁共振成像（Magnetic Resonance Imaging，MRI）及常规腰椎穿刺未能确定幕上颅内高压，后经侧脑室直接测压，证实仍然存在颅压异常增高。行右侧脑室-腹腔分流术后，患儿双眼视力有所提高，双眼RNFL）厚度无继续变薄。目前DWS的治疗方式包括后颅窝囊肿切除术、脑脊液分流术及内镜下第三脑室造瘘术。 术后DWS患者的颅内压的测量有特殊性，幕上与幕下区域之间的脑实质内压力可能形成显著的压力梯度，腰椎穿刺测压可能无法准确反映颅内压，脑室内测压方法则创伤更大。此时需要眼科检查提供支持颅内高压的证据，如RNFL厚度进行性下降、视盘水肿及视网膜血管形态异常，这些检查无创、简便、可多次重复，是临床医生评估颅内压的有效手段，建议纳入DWS患者术后颅内压的常规管理中。

This article reports the clinical presentation, ophthalmologic examination, and imaging features of a 5-year-old girl with Dandy-Walker syndrome (DWS). She underwent partial resection of an arachnoid cyst in the posterior cranial fossa after the diagnosis of DWS. However, her visual acuity continued to deteriorate after the surgery, and the ophthalmologic follow-up revealed progressive thinning of the retinal nerve fibers layer (RNFL), suggesting that the intracranial pressure (ICP) had not yet been effectively controlled, and the damage to the optic nerve was further developing. However, due to the special pathological changes of DWS, MRI and routine lumbar puncture was not able to exactly identify the supratentorial ICP, subsequent ICP measurement through the lateral ventricle confirmed that increased ICP was still existed. After performing a right ventriculoperitoneal shunt, the child's binocular vision improved, and the thickness of the RNFL in both eyes remained stable. Current treatment modalities for DWS include cystectomy, cerebrospinal fluid shunt and endoscopic third ventriculostomy. The measurement of postoperative ICP in DWS patients is complicated, because there may be a significant pressure gradient between the supratentorial and infratentorial regions, which is not accurately reflected by lumbar puncture manometry, and intraventricular manometry is much more invasive. Ophthalmologic examinations including progressive decrease in RNFL thickness, optic disc edema, and abnormal retinal vascular morphology are required to provide evidences of increased ICP. These examinations are noninvasive, simple, and repeatable. They are an effective means of assessing ICP, and are recommended to be included in the routine management of ICP in patients with DWS after surgery.

        本文报告两例单眼无痛性视力下降病例。病例1为47岁男性，表现为右眼亚急性视力下降，伴视盘水肿及黄斑区星芒状渗出，血清汉塞巴尔通体（Bartonella henselae）IgG抗体阳性（滴度1:256），结合猫接触史及跳蚤叮咬史，诊断为猫抓病相关视神经视网膜炎。经口服多西环素联合球周注射曲安奈德治疗后，视力显著恢复至1.0。病例2为33岁男性，表现为右眼急性视野缺损伴轻度视力下降，视盘水肿伴出血及棉绒斑。血清学检查示汉塞巴尔通体IgG阳性（滴度1:256）及梅毒螺旋体抗体阳性（TPPA+, TRUST+）。初始经验性抗猫抓病（多西环素+利福平）及抗梅毒（苄星青霉素）治疗无效，视力持续下降。随访1个月时光学相干断层扫描（OCT）显示视盘周围视网膜色素上皮（RPE）局灶性钉状突起，符合梅毒眼部特征性改变，结合患者抗汉塞巴尔通体治疗反应不佳，最终修正诊断为梅毒性视神经病变。继续抗梅毒治疗后视力稳定于0.63，但遗留视神经萎缩。两例病例提示感染性视神经病变的诊断需综合病史、临床表现、辅助检查、治疗反应及特征性体征进行鉴别，尤其需审慎解读汉塞巴尔通体抗体血清学阳性结果。

This paper reports two cases of unilateral painless vision loss. Case 1 involved a 47-year-old male presenting with subacute vision loss in the right eye, accompanied by optic disc edema and macular stellate exudates. Serological testing revealed positive IgG antibodies against Bartonella henselae (titer 1:256). Combined with a history of cat contact and flea bites, a diagnosis of cat scratch disease-associated optic neuroretinitis was made. After treatment with oral doxycycline combined with periocular triamcinolone acetonide injection, the patient's vision significantly improved to 1.0. Case 2 involved a 33-year-old male presenting with acute visual field defect in the right eye accompanied by mild vision loss, optic disc edema with hemorrhage, and cotton-wool spots. Serological tests showed positive IgG antibodies against Bartonella henselae (titer 1:256) and positive antibodies against Treponema pallidum (TPPA+, TRUST+). Initial empirical treatment for cat scratch disease (doxycycline + rifampicin) and syphilis (benzathine penicillin) was ineffective, with continued vision decline. Optical coherence tomography (OCT) at the one-month follow-up revealed focal spiculated protrusions of the retinal pigment epithelium (RPE) around the optic disc, consistent with characteristic ocular changes of syphilis. Considering the patient's poor response to anti-Bartonella henselae treatment, the diagnosis was revised to syphlitic optic neuropathy. After continued anti-syphilis treatment, the patient's vision stabilized at 0.63, but optic atrophy persisted. These two cases suggest that the diagnosis of infectious optic neuropathy requires comprehensive differentiation based on medical history, clinical manifestations, auxiliary examinations, treatment responses, and characteristic signs, with particular caution in interpreting positive serological results for Bartonella henselae antibodies.

目的：探讨术区旁角膜缘上皮移植治疗翼状胬肉的手术方法和临床效果。方法：对 69 例（ 82 眼）翼状胬肉行术区旁角膜缘上皮移植术，随访 1 年，观察手术效果。结果： 79 眼（96.34%）临床治愈， 3 眼（3.66%）复发。结论：术区旁角膜缘上皮移植治疗翼状胬肉是较好的手术方法。

Objective: To investigate the operation method and clinical effect of modified pterygium excision with limbalconjunctival flap grafting beside the operation area. Methods: Excision of pterygium and limbal conjunctival autografting were performed on 82 eyes of 69 cases. The surgical effects were observed after 1 year of follow-up. Results: A total of 79 eyes （96.34%） were cured and 3 eyes （3.66%） recurred. Conclusion: Modified pterygium excision with limbal-conjunctival flap grafting beside the operation area is a efficacious method in the treatment of pterygium.