目的：调查临床医学5年制本科生对见习教学的满意度，并分析其影响因素。方法：采用匿名线上问卷调查，向中山大学2019级临床医学5年制4年级的结束所有临床科室见习的本科生发放见习满意度问卷。结果：共有75人完成了问卷调查。在最满意的见习课程中，眼科学见习满意度最高(39人，52%)，其次是外科学(18人，24%)和内科学(7人，9.33%)。教学满意度的影响因素综合得分排名前5位的选项分别是“A课程设置合理，临床见习重点突出”“B见习小课授课水平高”“C师资配备好，小组教学”“D临床资源丰富，利于见习教学”以及“E教学方法先进，方式灵活多样，新型教学形式丰富”。在选择排序第一(B 33.33%，A 25.86%，E 21.15%)和第二(E 26.92%，B 24.56%，A 24.14%)的影响因素时，前三位的选项均为A、B、E，学生对见习课程设置、见习小课水平和见习教学方式、方法非常重视。在学生从事眼科专业的意愿方面，5人(6.67%)表示非常愿意、32人(42.67%)表示有可能今后从事眼科专业，二者比例合计与眼科学获得最满意见习课程的比例非常接近。结论：见习课程设置、小课授课水平以及见习教学的方式、方法是见习教学满意度的重要影响因素。临床见习的满意度对学生的职业导向具有一定的影响。
Objective: To investigate the satisfaction of 5-year undergraduate students in clinical medicine with clerkship teaching and analyze its influencing factors. Methods: Anonymous online questionnaire survey was conducted. Satisfaction questionnaires were distributed to undergraduate students in the 4th year of the 5-year clinical medicine at Sun Yat- sen University who had completed clerkship in all clinical departments. Results: A total of 75 students completed the questionnaire survey. Among the most satisfactory clerkship courses, ophthalmology had the highest satisfaction rate (39 votes, 52%), followed by surgery (18 votes, 24%) and internal medicine (7 votes, 9.33%). Te top 5 options in terms of comprehensive scores for infuencing factors of teaching satisfaction are "A. Reasonable curriculum with prominent focuses", "B. High clerkship class teaching level", "C. Strong teaching staf", "D. Abundant clinical resources ", and "E. Advanced teaching methods ". When selecting the infuencing factors that rank frst (B 33.33%, A 25.86%, E 21.15%) and second (E 26.92%, B 24.56%, A 24.14%), the top three options are A, B, and E. Students atach great importance to the seting of clerkship courses, the level of clerkship courses, and the teaching methods. In terms of students' willingness to engage in ophthalmology, 5 students (6.67%) expressed great willingness, and 32 students (42.67%) expressed the possibility. Conclusions: Te seting of clerkship courses, the level of small class teaching, and the clerkship teaching method are important infuencing factors of clerkship satisfaction. Te satisfaction of clerkship has a certain impact on students' career selection.
目的：探讨以问题为导向的教学方法(problem-based learning，PBL)结合微课教学法在眼科学课堂中的应用。方法：将锦州医科大学眼科实习课的60名学生按照随机数字表法分为实验组与对照组。实验组采用PBL教学法结合微课教学法，对照组采用传统的教学方法，比较两种教学方法的教学效果。结果：实验组学生成绩优于对照组，差异有统计学意义(P<0.05)。结论：PBL结合微课教学法应用于眼科学生的临床实践，提高了学生的综合素质、创造性思维、综合分析和团队合作能力；调动学习积极性、提高学生学习效率、提高理论知识评估和临床操作考核成果并取得满意的教学效果。
Objective: To explore the application of problem-based learning (PBL) combined with micro-teaching method in ophthalmology class. Methods: Sixty students of the ophthalmology internship course of Jinzhou Medical University were randomly divided into an experimental group and a control group. The control group used traditional teaching methods to compare the teaching effects of the two teaching methods. Results: The scores of the experimental group were better than those of the control group, and the difference was statistically significant(P<0.05). Conclusion: PBL combined with micro-teaching method can be applied in the clinical practice of ophthalmology students, which improves students’ comprehensive quality, creative thinking, comprehensive analysis and teamwork ability. Besides, it also mobilizes learning enthusiasm, improves students’ learning efficiency,improves theoretical knowledge assessment and clinical operation assessment results, leading to satisfactory teaching effect.
患者女，60岁，因“右眼前黑影飘动1月，视力下降8天”就诊。视力：右眼0.1，不能矫正；左眼0.6矫正0.9。右眼眼底见视盘周围边界清晰不规则灰白色区，并波及中心凹。视野检查：右眼对应眼底病灶的视野缺损；左眼正常。光学相干断层成像术(optical coherence tomography，OCT)显示灰白色区域椭圆体带不规则、缺失，视网膜色素上皮(retinal pigment epithelium，RPE)层见数个指状隆起。眼底自发荧光(autofluorescence，AF)示：受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影(fundus fluorescein angiography，FFA)示：早期见荧光渗漏，晚期荧光着染、蓄积。吲哚菁绿血管造影(indocyanine green angiography，ICGA)示：见以视乳头为中心，边界清晰的低荧光区。诊断：右眼急性轮状外层视网膜病变。治疗：给予抗炎和改善血循环4周，眼底灰白色环状带消失，视力明显好转。随访6个月，患者病情控制良好。
A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography (OCT) showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium (RPE) layer. Fundus autofluorescence (AF): High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography (FFA): Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography (ICGA): A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously
本文报道2例诊断为后极部肉芽肿型弓蛔虫病的患者，病例1接受糖皮质激素及玻璃体切割联合剥膜手术，术后视力明显提高；病例2因错过治疗时机，致视力丧失。提示后极部肉芽肿型眼弓蛔虫病致视网膜前膜时，眼科医生应积极给予手术治疗，改善患者视功能。
We reported two cases of posterior pole granuloma toxocariasis with different prognosis to remind ophthalmologists to attach importance to the active treatment. Two patients were diagnosed with posterior pole granuloma toxocariasis. One patient received prednisolone and pars plana vitrectomy combined with peeling of retinal membrane, and his vision was improved significantly. The other patient missed opportunity to perform surgery and lost his vision. It is important to make accurate diagnosis and active treatment for posterior pole granuloma toxocariasis. Eyes with posterior pole granuloma toxocariasis should be treated with surgery without delay to avoid visual loss when epiretinal membrane causes the absence of normal macular structure.
目的：探究囊袋张力环(CTR)植入对五种新一代人工晶状体(IOL)计算公式[Barrett Universal Ⅱ (BUⅡ),Emmetropia Verifying Optical (EVO), Kane, Pearl-DGS和Hill-RBF 2.0]在高度近视患者中预测准确性的影响。方法：前瞻性病例对照研究。观察2020年12月—2021年9月于陕西省眼科医院就诊的眼轴长度(AL)≥27.00 mm行白内障联合IOL(AR40E, 美国强生)植入术的患者。术眼随机分为植入CTR组(A组)和未植入CTR组(B组)。术前根据IOL-Master 700测量眼部参数，使用BU Ⅱ公式计算所需IOL度数。记录术后1周、1个月及3个月实际等效球镜度(SE)，计算并比较五种公式预测误差(PE)和绝对屈光预测误差(AE)。将A组和B组分别分为A1组(27.00 mm ≤ AL ≤ 30.00 mm)和A2组(AL>30.00 mm)；B1组(27.00 mm ≤ AL ≤30.00 mm)和B2组(AL >30.00 mm)，分析不同AL范围内CTR植入对公式预测准确性的影响。结果：共纳入患者63例(89眼)，年龄(55.93±10.17)岁，术前AL为(30.30±2.18)mm。A组、A1组及A2组术后不同时间SE值比较差异均无统计学意义(P>0.05)，B组、B1组及B2组术后1周与1个月，术后1周与3月SE值分别比较差异有统计学意义(P<0.05)，术后1个月与3月无统计学差异(P>0.05)。A组、B组、A1组、A2组、B1组和B2组各组中五种公式的AE值比较差异均无统计学意义(H= 9.27, P= 0.06, H= 7.09, P= 0.13, H= 2.44, P= 0.66,H= 8.56, P= 0.07, H= 4.16, P= 0.39, H= 8.72, P= 0.07)。植入CTR后五种公式的预测误差变化比较差异无统计学意义(P>0.05)。结论：对于AL ≥27.00 mm的白内障患者，植入CTR组术后1周屈光度趋于稳定，未植入组术后1个月屈光度趋于稳定。CTR植入对五种公式预测准确性和选择无影响，五种计算公式均可正常选择。
Objective: To investigate the predictive accuracy andeffect of capsular tension ring (CTR) implantation with fivenew generation intraocular lens (IOL) calculation formulas [Barrett Universal Ⅱ (BU Ⅱ ), Emmetropia VerifyingOptical (EVO), Kane, Pearl-DGS and Hill-RBF 2.0] in high myopia patients. Methods: This is a prospectivecase-control study. The patients were enrolled with an axial length (AL)≥27.00 mm, and underwent cataract surgery with AR40E IOL implantation at the Shaanxi Eye Hospital from December 2020 to September 2021. Thepatients were randomly assigned to the CTR implantation group (group A) and the non-CTR implantation group(group B). With the ocular parameters measured by the IOL-Master 700, the IOL power was calculated with theBU Ⅱ formula before surgery. The postoperative actual equivalent spherical diopter (SE) were recorded,and the predicted error (PE) and absolute error (AE) using the five formulas were recorded and compared at 1 week, 1 month, and 3 months, repsectively. Group A was divided to A1 (27.00 mm ≤ AL ≤ 30.00 mm) and A2 (AL>30.00 mm), and group B was divided to B1 (27.00 mm ≤ AL ≤ 30.00 mm) and B2 (AL>30.00 mm). The effects of CTR implantation and the accuracy of the formulaswere analyzed with different AL ranges. Results: A total of 63 patients (89 eyes) were included, aged (55.93±10.17) years old, with preoperative AL (30.30± 2.18) mm. There was no statistically significant difference in SE between groups A, A1, and A2 (P>0.05) at different postoperative times. While there was a statistically significant difference in SE between groups B, B1, and B2 (P < 0.05) at 1 week and 1 month after surgery, and between 1 week and 3 months after surgery. There was no statistically significant difference between 1 month and 3 months after suergery (P>0.05). There was no significant difference in the AE using the five formulas among groups A, B, A1, A2, B1, and B2 (H= 9.27, P= 0.06, H= 7.09, P= 0.13, H= 2.44, P= 0.66,H= 8.56, P= 0.07, H= 4.16, P= 0.39, H= 8.72, P= 0.07). There was no statistically significant difference in prediction error changes among the five formulas after CTR implantation (P>0.05). Conclusion: For cataract patients with AL ≥27.00 mm, the refractionvalue in the CTR implantation group tended to stabilizeafter one week of surgery. While in the non-CTR implantation group, the refractionvalue tended to stabilize after one month. CTR implantation had no effect on the accuracy and selection of the five formula, and the five IOL calculation formulas can be normally selected.
目的：探讨标准操作程序在玻璃体腔内注药术护理中的应用效果。方法：选择2018年9至12月中山大学中山眼科中心眼底专科门诊504例玻璃体腔内注药术患者作为研究对象，对护理人力资源的整合、患者等待手术时间、患者和家属的满意度、医护人员满意度进行评价。结果：标准操作程序后明确护士岗位职责，护士操作水平和综合能力有效提升，患者手术等待时间由原来的预约2周缩短为2 d。患者和家属的满意度分别由92.0%和91.0%提高到98.5%和97.0%。医护人员满意度的评价由95%提到至98.4%。结论：玻璃体腔内注药术标准操作程序不仅提升了工作效率，更提升了患者和家属、医务人员的满意度，规范化的标准操作程序是玻璃体腔内注药的安全保障。
Objective: To investigate the effect of standard operation procedure in the intravitreal injection. Methods: A total of 504 patients visiting the fundus clinics of our hospital from September to December 2018 were selected in this study. The integration of nursing human resources, patient waiting time, patient and family satisfaction,and medical staff satisfaction were evaluated. Results: The nurses’ job responsibilities were clarified, and the nurses’ operation level and comprehensive ability were improved. The patients’ waiting time for surgery was shortened from 2 weeks to 2 days. Patient and family satisfaction increased from 92.0% and 91.0% to 98.5% and 97.0%, respectively. The evaluation of the satisfaction of medical staff was elevated from 95% to 98.4%.Conclusion: The standard operation procedure of intravitreal injection not only improves the work efficiency, but also significantly increases the satisfaction of patients and their families and medical staffs. Therefore, the standard operation procedure can guarantee the safety of intravitreal injection.
本文总结了15例自膨胀水凝胶眶内植入术患儿围手术期的护理要点。术前主要评估患儿是否完善术前检查，给予患儿及其家属个性化的心理护理，进行术前准备以及禁食禁饮的管理。术后主要给予患儿安全管理，饮食、疼痛、眼部用药以及弹力绷带包扎护理，关注有无并发症的发生及给予相应的护理，并对患儿及其家属做好出院指导。15例患儿均顺利完成手术，术后均出现术眼疼痛，2例出现眶压增高，1例出现呕吐，均得到妥善处理。术后随访3~18个月，患儿均获得了较为满意的眼部外观，生活质量得到了提高。
This paper summarized the nursing experience of 15 children with self-expanding hydrogel orbital implantation during perioperative period. Before operation, children were fully evaluated, given with psychological care, preoperative preparation and management of fasting and drinking. After the surgery, the patients were mainly given with safety management, diet, pain, medicine and elastic bandage dressing care. Nurses should pay attention to the occurrence of complications and give corresponding nursing care and offer useful discharge guidance for the children and their parents. All 15 children completed the operation successfully, postoperative eye pain occurred in 15 cases after operation, and the orbital pressure increased in 2 cases, 1 case vomited, and all cases were properly treated. After postoperative follow-up for 3–18 months, 15 children were satisfied with the appearance of the eye,and the life quality was improved.
青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼(primary angle closure glaucoma，PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy，LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔，解除PACG的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。
Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.
原发性干燥综合征(primary Sj?gren’s syndrome，SS)是一种主要累及外分泌腺体的自身免疫性疾病，患者通常因为严重的干眼症状首先就诊于眼科，大多数临床医师对原发性干燥综合征相关性干眼(Sj?gren’s syndrome dry eye disease，SS-DED)认识不足，可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展，将有助于发现SS-DED的真面目，并可能从新的角度阐释其发病机制，为其诊断、分类及治疗提供新的思路。SS-DED的治疗没有特效的药物，大多数患者需接受多种方法的治疗，以了解哪些方法最有效。
Primary Sj?gren’s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sj?gren’s syndrome probably leading to misdiagnosis or missing the diagnosis.The diagnosis of Sj?gren’s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment.
目的：探索斜视患者手术治疗后的眼表恢复状况。方法：选取2015年1月至2018年6月于如皋市广慈医院接受门诊手术治疗的92例水平性斜视患者为研究对象，共126眼，按照手术切口将患者分为3组，行角膜缘切口的42例52眼患者为A组，行跨肌止端切口的17例19眼患者为B组，行近穹窿切口的33例55眼患者为C组。再根据手术累及肌肉条数将患眼分为3组，行单条眼外肌的29眼手术者为单肌组，行2条眼外肌的42眼手术者为双肌组，行3条眼外肌的21眼手术者为三肌组。比较不同切口类型和肌肉累及数患者的眼表健康恢复时间。结果：A，B，C3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；A组首次泪膜破裂恢复时间(14.33±3.26) d和泪河高度时间(14.54±1.58) d显著低于B组和C组，差异具有统计学意义(F=4.876，P=0.032；F=4.612，P=0.036)。单肌组，双肌组及三肌组3组间首次泪膜破裂恢复时间、泪河高度时间差异有统计学意义(P<0.05)；单肌组的首次泪膜破裂恢复时间(13.42±3.57) d和泪河高度时间(8.65±1.62) d显著低于双肌组和三肌组，差异有统计学意义(F=4.975，P=0.028；F=5.024，P=0.025)。结论：手术累及的肌肉数和手术切口类型对术后眼表健康状况具有重要影响，近穹窿切口的手术方式和累及较少肌肉数量有助于患者术后眼部健康状况的恢复。
Objective: To explore the ocular surface recovery after surgical treatment of strabismus patients. Methods: A total of 92 patients (126 eyes) with strabismus who underwent surgery in our hospital from January 2015 to June 2018 were enrolled. The patients were divided into three groups according to the surgical incision, 42 patients (52 eyes)underwent limbal incision were in group A, 17 patients (19 eyes) underwent trans-muscle end-point incision in group B, and 33 patients (55 eyes) underwent proximal hernia incision in group C. According to the number of muscles involved in the operation, the sick eyes of patients were divided into three groups. The 29 eyes with a single extraocular muscle were a single muscle group, the 42 eyes with 2 extraocular muscles were a double muscle group, and the 21-eye treated with 3 extraocular muscles were a three-muscle group. The ocular surface health recovery time of patients with different incision types and muscle involvement were compared. Results: The first tear film rupture recovery time and tear river height time between group A, B, and C were significantly different,and the data were statistically significant (P<0.05); the first tear film rupture recovery time (14.33±3.26) d and tear river height time (14.54±1.58) d in group A were significantly lower than those in group B and C. The data were statistically significant (F=4.876, P=0.032; F=4.612, P=0.036). The first tear film rupture recovery time and tear river height time between the single, double and three muscle groups were significantly different, and the data were statistically significant (P<0.05); the first tear film rupture recovery time (13.42±3.57) d and tear river height time (8.65±1.62) d were significantly lower in the single muscle group than in the double muscle group and the third muscle group. The data were statistically significant (F=4.975, P=0.028; F=5.024, P=0.025). Conclusion:The number of muscles involved in the operation and the type of surgical incision have an important impact on the health of the ocular surface after surgery. The proximal ankle incision and less number of muscles involved would improve the postoperative recovery of eye health.
