病理性近视相对高度近视而言，更强调眼底并发症的存在。后巩膜葡萄肿(posterior staphyloma，PS)被认为是病理性近视的标志性特征，是眼球后巩膜壁的局部扩张，通常认为与巩膜变薄和脉络膜萎缩等因素相关。近年来研究认为P S的形成可能与局部炎症、Bruch膜缺失等因素密切相关。伴随OCT等检查技术的快速革新以及P S治疗手段的探索，诊断和治疗更加完善。
Pathological myopia emphasizes the existence of fundus complications. Posterior staphyloma, considered as a hallmark of pathological myopia, is a partial extension of the posterior scleral wall, which is believed to be related to the scleral thinning and choroidal atrophy. In recent years, studies have indicated that the formation of posterior staphyloma may closely connected with localized inflammation and defects of Bruch’s membrane.With the rapid innovation of examination technologies such as optical coherence tomography (OCT) and the exploration of treatment for posterior staphyloma. The diagnosis and therapy will be more comprehensive in the future.
视网膜微循环与脑小血管具有相似的特征。视网膜被认为是可检测到的“窗口”，以检测在神经退行性疾病中发生的微血管损伤。光学相干断层扫描血管造影(optical coherence tomography angiography，OCTA)是一种非侵入性成像方式，可提供视网膜、脉络膜和视神经中血流的深度分辨图像。现总结有关OCTA在与眼科相关的阿尔茨海默病、帕金森病、多发性硬化症及视神经退行性疾病等神经系统疾病中的应用，并讨论其可否作为早期诊断和监测神经退行性疾病的重要工具。
Retinal microcirculation shares similar features with cerebral small blood vessels. Thus, the retina may be considered as an accessible ‘window’ to detect the microvascular damage occurred during the development and progression of neurodegenerative disorders. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality providing in-depth and high-resolved images of blood flow in the retina, choroid,and optic nerve. In this review, we summarize the current advances in the application of OCT-A in neurological diseases associated with ophthalmology such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and optic nerve degenerative diseases. Future directions for evaluating whether OCTA can be used as an important tool to early diagnose and monitor the neurodegenerative disorders are also discussed.
目的：调查眼病患儿家长在患儿手术前的健康教育需求，为责任护士开展个性化、高质量的健康教育提供依据。方法：采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查，并对调查结果进行统计分析。结果：家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05)；家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论：眼病患儿家长对患儿术前健康教育需求较高，医务工作者应丰富知识层面，加强专科学习及相关知识培训，把专科知识与健康教育有机地结合，并探索有效的线上健康教育方式，更好地为患者服务。
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
目的：分析眼专科医院患者突发急症现状，并探讨防控措施。方法：回顾性分析2017—2018年中山眼科中心82例突发急症事件，具体分析突发急症事件的特点、处置情况及患者转归。结果：眼专科医院中最常见的突发急症事件为药物不良反应(n=38，46.3%)，其后依次是晕厥(28.0%)、心脑血管急症(8.3%)、意外事件(6.1%)，其中药物不良反应涉及的相关药物最多见于荧光素钠注射液(n=16，42.1%)、局部神经阻滞麻醉相关药物(n=7，18.4%)。突发急症事件集中分布于工作时段8:00—18:00(n=74，91.3%)，非工作时段多见于药物不良反应(n=3，42.9%)及心脑血管急症(n=3，42.9%)。门诊是突发急症事件最常发生的场所(n=53，64.6%)，其后依次是住院病房(22.0%)、手术室(11.0%)。患者突发急症危急程度轻、中、重度分别占92.7%，4.9%，2.4%。50%的患者需要综合医院急诊人员配合抢救或至综合医院进一步诊治。结论：通过优化患者诊治流程，缩短在院时间，医护人员提高预警意识，明确各岗位潜在急症风险，可降低突发急症事件发生风险。发挥麻醉师专业优势，提高院内应急处理能力，同时签约定点综合医院急救服务，为患者提供快速、准确、高效的救护，保障患者生命安全。
Objective: To analyze the status of medical emergencies of patients in ophthalmic hospitals and put forward suggestions on their prevention and control measures. Methods: The medical emergencies of 82 patients in ophthalmic hospitals in 2017 and 2018 was been analyzed retrospectively, and the characteristics and treatment of emergencies as well as the metastasis and progression of the disease in patients were analyzed specifically.Results: Medical emergencies were caused by druginduced adverse reaction (n=38, 46.3%), syncope (28.0%), cardiovascular emergency (8.3%), accidents (6.1%) in sequence. Fluorescein sodium (n=16, 42.1%) and local anesthesia drugs for nerve block (n=7, 18.4%) were the most common drugs related to drug adverse reaction. Most cases happened at 8:00—18:00 (n=74, 91.3%), and drug adverse reaction and cardiovascular and cerebrovascular emergencies were most common at 18:00—8:00. Medical emergencies happened in outpatient department (n=53,64.6%), wards (22.0%) and operation rooms (11.0%). There were mild emergencies (92.7%), moderate emergencies (4.9%) and severe emergencies (2.4%) in patients. Among them, 50% of patients need first aid by doctors from general hospitals or to be transferred to the general hospital for further treatment. Conclusion: Through optimizing process, shortening the hospital stay, identifying potential risks and enhancing medical workers’ awareness of safety, the risk of medical emergencies can be reduced. We should give full play to the professional advantages of anesthesiologists,improve the emergency handling capacity of the hospital, and contract the emergency services of designated general hospitals to provide rapid, accurate and efficient rescue for patients to ensure the life safety of patients.
目的：比较VX120多功能眼检查仪与Topcon KR 800全自动验光仪的客观验光结果的一致性。方法：收集2019年1 1月至2019年1 2月在我院就诊拟行角膜屈光手术的患者2 4例(24只眼)，所有患者均取右眼。采用Topcon KR 800全自动验光仪和VX120多功能眼检查仪分别对2 4例患者进行客观验光检查，分别得到球镜光度(S)、柱镜光度(C)、等效球镜光度(M)、水平和垂直方向的柱镜光度(J0)及45°柱镜光度( J45)。采用配对T检验对两种设备的测量值进行组间比较，并采用Bland-Altman 95%一致性界限法衡量其一致性。结果：VX120多功能眼检查仪在明视模式下所测S为(-3.90±3.06) D；M为(-4.41±3.24) D；J0为(0.34±0.58) D；J45为(?0.04±0.26) D；TopconKR800全自动验光仪所测S为(-3.77±2.88) D；M为(-4.15±3.07) D；J0为(0.25±0.47) D；J45为(-0.01±0.18) D。VX120多功能眼检查仪在明视模式与TopconKR800全自动验光仪所测得的S、M、J45差异无统计学意义，而J0两者之间差异有统计学意义(t=-2.24，P=0.04)。Bland-Altman95%一致性分析显示，两种仪器参数数据点多分布在95%可信区间内，一致性较好。结论：VX120多功能眼检查仪明视模式下与TopconKR800全自动验光仪的客观验光结果一致性较好，在屈光度检查上可以相互替代。
Objective: The aim of this study was to compare the consistency of objective optometry results between VX120 multi-diagnostic unit and TopconKR800 automatic optometer. Methods: A total of 24 patients (24 right eyes) admitted to our hospital from November 2019 to December 2019 for corneal refractive surgery were collected. Optometry was performed on 24 patients with TopconKR800 automatic optometer and VX120 multi-diagnostic unit, and got the results following: spherical mirror photometry (S), cylindrical lens luminosity (C), mean spherical equivalent (M), horizontal and vertical cylindrical lens luminosity ( J0) and 45° cylindrical lens luminosity ( J45). Compared T-test analysis was used to compare the parameters of the two devices, and the Bland-Altman 95% limits of agreement were performed. Results: The S measured by the VX120 multi-diagnostic unit with bright mode was (-3.90±3.06) D; M was (-4.41±3.24) D; J0 was (0.34±0.58) D;J45 was (-0.04±0.26) D. The S measured by TopconKR800 automatic optometer was (-3.77±2.88) D; M was (-4.15±3.07) D; J0 was (0.25±0.47) D; J45 was (-0.01±0.18) D. There was no statistically significant difference in S, M, and J45 measured by VX120 multi-diagnostic unit and TopconKR800 automatic optometer in bright mode, while there was statistically significant difference in J0 between VX120 multi-diagnostic unit and TopconKR800 automatic optometer (t=-2.24, P=0.04). Bland-Altman 95% consistency analysis showed that the data points of the two instruments were mostly distributed within the 95% confidence interval, indicating that the parameters measured by these two devices were in accord with each other. Conclusion: The objective optometry results of VX120 multi-diagnostic unit and TopconKR800 automatic optometer were consistent and can be substituted for each other in the refraction examination.
目的：调查民航飞行员视频终端疲劳综合征(visual display terminal syndrome，VDTS)的现状并分析其原因，为民航飞行员眼部保健工作提供依据。方法：对1 631名民航飞行员进行问卷调查，了解暴露时间，比较不同暴露强度人群的不适症状和发病率。结果：民航飞行员视频终端暴露时间为(4.43±2.24) h，VDTS发病率和不适症状检出率均随暴露时间增加而增加。结论：长时间视频终端暴露不利于眼健康。应加强对民航飞行员的眼保健教育，避免或减少视频终端暴露带来的健康危害。
Objective: To investigate the status of visual display terminal syndrome (VDTS) in civil aviation pilots and analyze the causes, so as to provide evidence for eye health care of pilots. Methods: A questionnaire survey was conducted among 1 631 pilots to understand the exposure time and to compare the incidence rate of discomfort in participants with different exposure intensities. Results: The average exposure time of pilots’video terminals was (4.43±2.24) h. The incidence rate of VDTS and the detection rate of discomfort increased with the increase of exposure time. Conclusion: Prolonged exposure to video terminal is not conducive to eye health. The eye health education for pilots should be strengthened to avoid or reduce the health hazards caused by video terminal exposure.
目的：观察视网膜激光光凝术(laser photocoagulation，LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity，ROP)的疗效。方法：收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症，分析不同手术方式的效果。结果：LP组20例(37只眼)行视网膜激光光凝治疗，术后未出现复发，首次治愈率100%；术后(3.42±1.57)周病情控制，术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗，39只眼行单次手术后病情控制，首次治愈率88.6%，5眼术后病情未控制。术后(2.95±2.58)周病情控制，术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论：视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效，IVR复发率较高，手术方式的选择需慎重。
Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.
目的：玻璃膜疣主要成分胆固醇对人视网膜色素上皮细胞ARPE-19中细胞膜钙ATP酶1(plasma membrane Ca2+ ATPase 1，PMCA1)、L型电压依赖性钙离子通道(L-type voltage-dependent calcium channel，LVDCC)和细胞膜钠钙交换蛋白1(sodium calcium exchange protein 1，NCX1)表达的影响。方法：体外培养ARPE-19细胞，将细胞分为对照组和胆固醇处理组(2.5 mg/mL)，取样时间为0、6、12、24、48、72 h。通过实时定量PCR检测PMCA1、LVDCC和NCX1 mRNA的表达水平，用蛋白质印迹法检测蛋白质的表达水平。结果：主要负责细胞内钙离子外排的PMCA1的mRNA和蛋白表达水平在胆固醇处理下出现下调。在胆固醇处理下，钙流入通道LVDCC和钙稳态调控蛋白NCX1的mRNA和蛋白表达明显增多，并且呈现时间依赖性，都是在24 h或48 h表达最多后出现回落。其中LVDCC表达上调倍数较大。结论：玻璃膜疣主要成分胆固醇可以影响人视网膜色素上皮细胞中钙转运通道蛋白的表达，PMCA1的表达受到胆固醇抑制， LVDCC和NCX1的表达受到胆固醇处理上调。这可能会影响细胞内钙离子外排，引起钙离子内流，是否能进一步导致细胞内钙超载而引起细胞凋亡，值得探讨。
Objective: To study the effects of cholesterol, the main component of drusen, on the expression plasma membrane Ca2+ ATPase 1 (PMCA1), L-type voltage-dependent calcium channel (LVDCC) and cell membrane sodium calcium exchange protein 1 (NCX1) of ARPE-19 cells. Methods: The ARPE-19 cell line was cultured in vitro, and the cells were divided into a control group and a cholesterol treatment group (2.5 mg/mL). The treatment time was 0, 6, 12, 24, 48, 72 hours. Real-time quantitative PCR was used to detect the expression of PMCA1, LVDCC and NCX1 at the mRNA level, and western blot was used to detect the expression at the protein level. Results: The mRNA and protein expression levels of PMCA1 which mainly responsible for the efflux of intracellular calcium ions, was down regulated under cholesterol treatment. Meanwhile, the expression of the mRNA and protein of the calcium inflow channel LVDCC and calcium stability regulatory protein NCX1 were significantly increased, and the time-dependency was present, which was up expressed to 24 or 48 h and then fell back. Among them, the LVDCC expression had a large number of times. Conclusion: Cholesterol, the main component of drusen, can affect the expression of calcium channels in human retinal pigment epithelial cells. The expression of PMCA1 was suppressed by cholesterol, and expression of LVDCC and NCX1 were up-regulated with cholesterol treatment, which may affect intracellular calcium efflux then cause calcium influx. Whether it can further cause intracellular calcium overload and cell death is worth exploring.
近5年来眼睑皮脂腺癌研究取得一系列成果。临床研究方面，明确了眼睑皮脂腺癌冰冻切缘控制显微手术的意义，提出了患者预后指标；在基础研究方面，描述了基因突变谱，揭示了3种相互独立的发病模式，以及提出了免疫及靶向治疗相关研究；我国眼肿瘤工作者也在眼睑皮脂腺癌研究方面树立了国际地位。本文对近5年国内外眼睑皮脂腺癌相关研究方面的主要成果进行总结分析，并展望治疗前景，为临床提供有益参考。
In recent 5 years, a series of studies have been made in the mechanism of onset of eyelid sebaceous carcinoma worldwide. In clinical research, the prognosis has made in predicting progression of patients with eyelid sebaceous carcinoma, and the significancy of frozen margin control in microsurgery was clarified. In field of basic research,from elucidation of mutational landscape to revelation of three independent pathogenesis patterns, from researches on immunotherapy to targeted therapy, efforts have been made to reveal the pathological mechanism to both aspect of its morbidity and development. This paper summarizes, analyzes and reviews the main achievements in recent 5 years on eyelid sebaceous carcinoma.
眼睑皮脂腺癌是起源于眼睑部位皮脂腺体的恶性上皮性肿瘤，易复发、转移，主要治疗方式仍以手术切除为主，但患者整体预后并不理想，早期正确诊断和靶向治疗是改善患者预后和改进治疗的关键。眼睑皮脂腺癌临床表现复杂，早期容易误诊或漏诊进而延误治疗，病理检查是其诊断的金标准。此外，目前关于眼睑皮脂腺癌发病机制未完全阐明，癌发生发展的分子生物学过程尚未明确。因此，多方面了解眼睑皮脂腺癌发病机制为靶向治疗提供理论基础是十分必要的。本文主要从眼睑皮脂腺癌发病机制包括遗传因素、表观遗传、外源病毒感染、免疫逃逸、端粒酶学说等方面对眼睑皮脂腺癌作一综述。
Eyelid sebaceous gland carcinoma is a malignant epithelial tumor originating from eyelid sebaceous glands, which is prone to relapse and metastasis. The treatment mainly depends on surgical excision, but the overall prognosis of patients is not ideal. Early diagnosis and targeted therapy are the keys to improve the prognosis of patients.Due to its complex clinical manifestations, early misdiagnosis or missed diagnosis is easy to delay treatment, and pathological examination is still the gold standard for its diagnosis. In addition, the pathogenesis of eyelid sebaceous gland carcinoma is still unclear, and the molecular biological process of the occurrence and development is less understood. Therefore, it is very necessary to understand the pathogenesis of eyelid sebaceous gland carcinoma in various aspects to provide a theoretical basis for targeted therapy. In this paper, the pathogenesis of eyelid sebaceous gland carcinoma was reviewed from the aspects of gene , epigenetic, viral infection, immune escape, , telomerase theory and so on.
