目的：住院医师委托培养是我国医学教育标准化和国际化的重要举措。本研究采用客观考核和主观问卷两种方法评估我国眼科住院医师委托培养效果。方法：本研究对象为广东省深圳市政府于2012年8月至2015年7月期间委托中山大学中山眼科中心进行眼科住院医师规范化培训的9名学员。本研究对所有学员的基本信息、临床培训情况、以及考核成绩等客观指标进行统计分析，同时设 计了一份包含13个问题的调查问卷，对每位学员的培训情况进行主观评估。结果：本研究纳入9名研究对象，包括2名男性和7名女性，平均年龄为(26±3)岁，学历水平情况为学士7名和硕士2名，其中有7名毕业于国家重点医学院校。3年内人均轮转眼科亚专科超过10科，平均主管病人数及参加手术例数分别为736和1 219例，门诊工作总量人均6 274人次，所有学员均按规定至少完成综 述1篇。8名(88.89%)学员认为可以独立诊断并治疗大部分常见眼科疾病，而且能独立完成大部分眼科基本临床操作，5名(55.56%)学员可以单独完成翼状胬肉切除术、霰粒肿刮除术、前房穿刺术等。6名(66.67%)学员认为培训时间安排合理。8名(88.89%)学员对这次委托培养总体比较满意。 所有9名培训学员中，最终有7名(77.8%)顺利通过中山大学第一阶段住院医师规范化培训考核。结论：培训学员对现行的眼科住院医师规范化培训方案的接受程度较高，基本达到预期的培训效果，对常见眼病能独立进行诊治。委托培养学员的学历和学习能力的差异在一定程度上影响了最终的培训考核通过率。
Objective: The entrusted standardized training for residents is an important measure to gear the medical education in China to the international conventions. In this study, the effectiveness of standardized training for entrusted ophthalmic residents in China was evaluated both objectively and subjectively. Methods: Nine ophthalmic residents, commissioned by Shenzhen government of Guangdong Province, studied at Zhongshan Ophthalmic Center, Sun Yat-sen University during August 2012 to July 2015 were included in this study. The objective indicators of all participants were analyzed, including the basic information, clinical training, the score of examination, etc. The subjective self-assessment was also implemented thought a questionnaire including 13 designed questions.Results: All 9 participants included 2 males and 7 females, 2 medical masters and 7 bachelors, and the mean age was 26±3 years. Seven of them graduated from the national key medical universities. The mean number of rotated sub-clinical departments was 10.3, the mean number of managed inpatients and the participated operations were 736 and 1,219, respectively. The total number of managed outpatients was 6,274 in average. All participants completed at least one review article. Eight (88.89%) participants could independently diagnose and treat the most common ophthalmic diseases, they also could complete the basic clinical ophthalmic operation independently. Five (55.56%) participants could independently manage the pterygium excision, curettage of chalazion, anterior chamber penetration, etc. And 6 (66.67%) of the participants believed that the training length was reasonable. Eight (88.89%) of them were satisfied with the standardized training for residents on the whole. Finally, 7 participants successfully passed the first stage of standardized training program in Sun Yat-sen University. Conclusion: There was a high level acceptance rate of the standardized training programs for entrusted ophthalmic residents. The participants achieved the expected training effects, and could managed the diagnosis and treatment of common ophthalmic diseases independently. But the training effects and passing rate of examination were partly affected by the learning ability of the training students.
目的：探讨不伴明显视力下降的糖尿病视网膜病变（Diabetic retinopathy，DR）患者黄斑部形态和功能的改变。
方法：对 DR 0 期组（未发现 DR 改变）、I～II 期组及 III～IV 期组患者进行光学相干断层扫描（Optical coherence tomography，OCT）及多焦视网膜电图（Multifocal electroretinography，mfERG）检查，并与同年龄组正常人相比较。
结果：OCT 检查确定 DR I～II 期组有 3 眼（10.0%）及 DR III～IV 期组有 6 眼（23.1%）存在黄斑水肿。DR III～IV 期组各方位神经上皮层厚度比相应方位的正常组及 DR 0 期组增加（P < 0.05）。同正常对照组相比，mfERG 检查发现 DR 0 期组、DR I～II 期、DR III～IV 期组 P1、N1 波振幅下降，反应密度下降，差异有显著性（P < 0.05）；但 P1、N1 波潜伏期未见延迟（P > 0.05）。同 DR I～II 期组相比，DR III～IV 期组 P1 波及 N1 波潜伏期轻度延长、振幅下降、平均反应密度降低（P < 0.05）。
结论：视力无明显下降的 DR 患者中，随病情的加重，无论形态和功能上均已有异常，功能异常早于形态异常。
Purpose: To investigate the macular morphology and function in patients with diabetic retinopathy (DR) without apparent visual loss.
Methods: Multifocal electroretinograms (mfERG) and optical coherence tomography (OCT) examination were performed in the DR patients on phase 0, I to II, III to IV as well as the normal control non-diabetes subjects.
Results: Macular edema was detected in DR phase I and II (3 eyes, 10%) and DR phase III and IV group (6 eyes, 23.1%). In comparison with the normal control and DR phase 0 group, the thickness of retinal neuroepithelium increased in DR phase III and IV group (P < 0.05). The amplitude and the average density of P1 wave and N1 wave decreased in all DR groups in comparison with normal controls although the latency of P1 wave and N1 wave was not statistically significant (P > 0.05). However, comparing with the DR phase I and II group, the latency of P1 wave and N1 waves were longer whereas the amplitude and the average density decreased in DR phase III and IV group (P < 0.05).
Conclusion: In the patients with DR but without apparent visual loss, abnormalities of the macular morphology and function already develop. The changes of function appear to develop earlier than that of morphology.
目的：观察睡眠呼吸暂停综合征（Sleep apnea syndrome, SAS）患者睡眠前后黄斑厚度的改变。
方法：选择 2003 年 8 月至 2007 年 1 月经确诊的在我院门诊和住院部治疗的 SAS 患者共 32 例（63 只眼），分别在上午 11:00 ～ 12:00（睡眠前）及患者晨起 20 ～ 30 分钟内（睡眠后）采用相干光断层扫描仪（Optical Coherence Tomography, OCT）进行黄斑中心凹厚度的测量。
结果：睡眠前黄斑中心小凹平均视网膜厚度为（123.00 ± 19.98）μm，睡眠后黄斑中心小凹平均视网膜厚度为（134.25 ± 19.92）μm。睡眠后黄斑中心凹厚度比睡眠前厚度增加（11.25 ± 9.04）μm，95% 可信区间为（8.98，13.53）μm，差异有统计学意义（t = 9.878，P < 0.05）。
结论：睡眠呼吸暂停综合征患者睡眠时的缺血缺氧可以导致黄斑视网膜的水肿增厚。
Purpose: To observe the changes of macular thickness in patients with sleep apnea syndrome (SAS) before and after sleep.
Methods: Thirty-two patients (63 eyes) diagnosed as SAS from August 2003 to January 2007 were enrolled. Macular thickness was measured using Optical Coherence Tomography (OCT) at 11:00 ~ 12:00 evening (before sleep) and 20 ~ 30 minutes after sleep, respectively.
Results: The mean macular thickness was (123.00 ± 19.98) μm and (134.25 ± 19.92) μm before and after sleep, respectively. The mean difference was (11.25 ± 9.04) μm before and after sleep (t = 9.878, P < 0.05), 95% CI (8.98, 13.53) μm.
Conclusions: The macular thickness of SAS is increased in SAS patients, which may be due to anoxia of SAS.
目的：探讨多排 CT 对眼眶骨纤维异常增殖症（FD）的诊断价值及临床意义。
方法：回顾性分析 2002 年 4 月至 2009 年 8 月的我院（6 例）及中山大学中山眼科中心（12 例）收治的 18 例眼眶 FD 患者的多排 CT 表现，7 例取病变组织经病理证实，5 例经手术后病理证实，6 例具有典型的 CT 表现。
结果：本组眼眶 FD 可单发（5 例）、单骨多发（1 例）或多骨（12 例）发病，其中额骨 12 例，蝶骨 5 例，筛骨 2 例，颞骨 7 例。
结论：多排 CT 能在轴位、冠状位、矢状位上显示本病的病变特征及范围，有助于本病的早期诊断及指导临床制定合理的治疗方案。
Purpose: To evaluate the efficacy of multi-detector row CT (MDCT) findings in the diagnosis of fibrous dysplasia (FD) in orbital bone.
Methods: The MDCT manifestations of 18 cases of FD in orbital bone (6 cases from the 458th Hospital of PLA, 12 cases from the Zhongshan Ophthalmic Center of Sun Yat-sen University) collected from April 2002 to August 2009 were reviewed. Six cases were confirmed by biopsy, 5 cases were confirmed by operation and postoperative pathology, the remaining 6 cases were confirmed based on typical CT findings.
Results: FD in orbital bone could be originated from monostotic single lesion (5 cases), monostotic multiple lesions (1 case) or polyostotic multiple lesions (12 cases). Twelve lesions were originated in the frontal bone, 5 lesions in the sphenoid, 2 lesions in the ethmoid, 7 lesions in the temporal bone.
Conclusion: MDCT is very important in the diagnosis and treatment strategy of FD in orbital bone correctly. It helps identify the location and extension of the lesions based on the axial plane, coronal plane and sagittal plane view.
目的：探讨白内障小切口非超声乳化术向超声乳化术转型中的技术转变。
方法：对 2009 年 4 月 - 2009 年 12 月“光明工程”中白内障超声乳化手术转型期 193 例 193 眼的情况进行回顾性分析，同期行小切口非超声乳化吸除术患者 43 例 48 眼作对照。
结果：对照组术后第 1 日裸眼视力大于或等于 0.5 的比例高于治疗组（P < 0.05），术后第 1 周、 第 1 个月裸眼视力大于或等于 0.5 及术后第 1 个月最佳矫正视力大于或等于 0.5 的比例，两组比较差异无统计学意义（均 P > 0.05）。对照组术后主要并发症比率均低于治疗组（均 P < 0.05）。
结论：小切口非超声乳化术向超声乳化术转型中，由于技术差异较大，发生后囊破裂和角膜内皮水肿的几率较高，转型此手术要有熟练的显微手术基础、处理并发症的能力和一定的设备条件。
Purpose: To investigate the clinical outcome during the conversion from small incision sutureless cataract surgery (SICS) to phacoemulsification cataract surgery (phaco).
Methods: During the conversion period from SICS to phaco, 241 cataract cases were assigned to SICS and phaco surgery procedures. The intraoperative complications and early postoperative outcomes were assessed.
Results: The 1st day visual acuity outcome (VA 0.5 or better) was lower in the phaco group (P < 0.05); however, the visual acuity outcomes were no longer statistically different at 1 week and 1 month visits (P > 0.05 for each visit). Among 193 cases operated in the phaco group, 51 cases (26.4%) developed corneal edema at the 1 day visit, 13 cases (6.7%) had posterior capsular rupture, 5 cases (2.6%) had zonular rupture, and 5 cases (2.6%) failed to implant IOL. These rates were higher than those found in the SICS group.
Conclusion: The outcome of phaco cataract surgery is comparable with SICS during this conversion period. Techniques that the surgeons may pay attention to are also discussed.
目的：检测 2 型糖尿病患者眼房水中血管内皮生长因子（Vascular endothelial growth factor, VEGF）和白细胞介素-6（Interleukin-6, IL-6）的含量，并探讨其临床意义
方法：在白内障手术过程中获取 66 例 2 型糖尿病患者的房水，采用双抗体夹心酶联免疫吸附（ELISA）法测定 VEGF 和 IL-6 的含量。根据手术后散瞳眼底检查和眼底荧光素血管造影检查确定糖尿病视网膜病变的分期。实验组分为：无糖尿病视网膜病变组（NDR）21 例、单纯型糖尿病性视网膜病变组（BDR）26 例、增生型糖尿病性视网膜病变组（PDR）19 例，正常对照组为健康的老年性白内障患者 20 例。
结果：NDR 组、BDR 组、PDR 组的房水 VEGF 含量分别为（240.30 ± 26.15）pg/ml、（292.27 ± 58.91）pg/ml、（477.41 ± 91.01）pg/ml，IL-6 含量分别为（160.83 ± 33.41）pg/ml、（238.60 ± 62.23）pg/ml、（389.13 ± 90.35）pg/ml，对照组房水 VEGF 含量为（140.58 ± 26.27）pg/ml、IL-6 含量为（82.72 ± 21.53）pg/ml，对照组与实验组比较差异均有统计学意义（F = 113.67，P < 0.01；F = 106.53，P < 0.01）。实验组房水中的 VEGF 与 IL-6 含量有相关性（r = 0.995，P < 0.01）；糖尿病患者的病程与房水中 VEGF（r = 0.792，0.826，0.841 均 P < 0.01）、IL-6（r = 0.829，0.817，0.896 均 P < 0.01）含量有相关性。
结论：VEGF、IL-6 在糖尿病视网膜病变的形成过程中有重要作用，且两者之间有相关性。
Purpose: To explore the role of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in the aqueous humor in the pathogenesis of diabetic retinopathy (DR).
Methods: Aqueous humor samples were collected in type 2 diabetic patients during cataract surgery. The classification of DR was assigned based on the fundus examination and fluorescein angiography after cataract surgery. The experiment group included non-diabetic retinopathy (NDR, 21 cases), background diabetic retinopathy (BDR, 26 cases), and proliferative diabetic retinopathy (PDR, 19 cases). The control group was the healthy cataract patients (20 cases). The levels of VEGF and IL-6 in the aqueous humor were assessed using the ELISA technique.
Results: The level of VEGF in NDR, BDR, and PDR cases were (240.30 ± 26.15) pg/ml, (292.27 ± 58.91) pg/ml, and (477.41 ± 91.01) pg/ml, respectively. The level of IL-6 in NDR, BDR, and PDR cases were (160.83 ± 33.41) pg/ml, (238.60 ± 62.23) pg/ml, and (389.13 ± 90.35) pg/ml, respectively. The levels of VEGF and IL-6 in the aqueous humor from the control group were (140.58 ± 26.27) pg/ml, (82.72 ± 21.53) pg/ml. The levels of VEGF and IL-6 were significantly different in experiment and control groups (F = 113.67, P < 0.01; F = 106.53, P < 0.01). In the aqueous humor of diabetic patients increased significantly (P < 0.1). The levels of VEGF and IL-6 were significantly correlated with each other in the experiment group (r = 0.995, P < 0.01). The levels of VEGF (r = 0.792, 0.826, 0.841, P < 0.01) and IL-6 ((r = 0.829, 0.817, 0.896, P < 0.01) were also significantly correlated with the duration of DR.
Conclusion: VEGF and IL-6 play important roles in the development of DR. The levels of these two factors are correlated with each other in DR patients.
目的：评价玻璃体腔注射曲安奈德（IVTA）联合视网膜激光对糖尿病性黄斑水肿（DME）的疗效方法：将黄斑部出现微血管瘤的 DME 患者 25 例（32 眼）随机分为 A、B、C、D 组，每组 8 眼。A 组行单纯倍频 532 激光光凝治疗，B 组行倍频 532 激光光凝联合经瞳孔温热疗法，C 组行倍频 532 激光光凝联合曲安奈德玻璃体腔注射治疗，D 组行倍频 532 激光光凝、经瞳孔温热疗法加曲安奈德玻璃体腔注射治疗，C、D 组在激光治疗后 1 周行玻璃体腔注射曲安奈德 4 mg。观察 4 组治疗前及治疗后 1、3、6 个月视力、眼压、黄斑中心凹厚度（FT）。结果：4 组患者治疗前视力、眼压、黄斑中心凹厚度差异均无统计学意义（P > 0.05）；4 组治疗后 1、3、6 个月，视力、眼压、黄斑中心凹厚度：A 组与 B 组、C 组与 D 组差异无统计学意义（P > 0.05），A、B 组分别与 C、D 组比较差异有统计学意义（P < 0.05）。结论：激光联合曲安奈德玻璃体注射、激光、经瞳孔温热疗法联合曲安奈德玻璃体腔注射治疗 DME 效果优于单纯激光和激光联合经瞳孔温热疗法。
Objective: To evaluate the effect of intravitreal injection of triamcinolone acetonide (IVTA) combining with retinal laser treatment for diabetic macular edema (DME).
Methods: Twenty five patients (32 eyes) with DME who have microangioma in macula lutea were randomly divided into group A, B, C, and D (8 eyes each group). Eyes in group A were treated with laser photocoagulation. Eyes in group B were treated with multiplier-532 laser photocoagulation and transpupillary thermotherapy. Eyes in group C were treated with multiplier-532 laser photocoagulation and intravitreal triamcinolone acetonide. Eyes in group D were treated with multiplier-532 laser, transpupillary thermotherapy plus triamcinolone acetonide injection. Intravitreal injection of 4 mg triamcinolone acetonide was done 1 week after laser photocoagulation in group C and D. The visual acuity, intraocular pressure, macular thickness (foveal thickness) of the eyes in 4 groups were observed before and 1, 3, and 6 months after treatment.
Results: The visual acuity, intraocular pressure, and foveal thickness of the 4 groups before treatment showed no significant difference (P > 0.05). The visual acuity, intraocular pressure, macular thickness of eyes in group A, B were better than those of group C, D at 1, 3, and 6 months after treatment, and they had significant difference (P < 0.05), while they didn’t show significant difference between group A and B, group C and D (P > 0.05).
Conclusion: The effect of laser photocoagulation and intravitreal triamcinolone acetonide, laser photocoagulation combining with transpupillary thermotherapy plus triamcinolone acetonide injection treating for DME was better than laser photocoagulation alone, laser photocoagulation combining with transpupillary thermotherapy.
液相芯片技术是一种利用混悬在液相中的分类编码微球作为反应及信号检测载体，集合流式细胞技术、激光技术、数字信号处理技术及传统化学技术为一体的新型生物分子检测技术。它充分利用发展成熟的流式细胞术检测原理，对目标分子（如核酸、蛋白质等）进行高通量分析。目前已在生物医学研究中得到了广泛的应用。现就其技术原理、特点及其在泪液细胞因子检测中的应用作简要介绍。
Liquichip (Multiplexed microsphere-based flow cytometric assays) is a new biomolecular detection technology using encoded microspheres suspended in liquid as reaction and detection carrier, which is an integration of flow cytometry, laser technology, digital signal processing and traditional chemical technology. It is a high-throughput analyzer for the target molecular (e.g. nucleic acid and protein) based on the principles of flow cytometry. Liquichip is now widely used in biomedical analyses. This article briefly reviews the principle and characteristic of liquichip and its application in tear cytokine analysis.
目的：探讨全视网膜光凝及术后应用羟苯磺酸钙治疗糖尿病视网膜病变的疗效。方法：选取96例患者，共175只眼，随机分为对照组(48例，86只眼)和研究组(48例，89只眼)。两组均予全视网膜激光光凝治疗，其中研究组术后再予羟苯磺酸钙继续12周治疗。12周后，观察两组患者治疗前后视力、血液流变学的变化。结果：治疗后研究组在视力>1.0范围的患者明显多于对照组(χ2=6.779，P=0.009)， 而2组在视力≤0.4，0.4~0.6，0.7~1.0范围患者视力差异比较分别为( χ2=0.003，P=0.955)，(χ2=1.640，P=0.200)，(χ2=2.148，P=0.143)。治疗后研究组患者的血浆粘度、红细胞压积、红细胞变形指数、纤维蛋白原改善均优于对照组(P<0.05)。研究组总有效率89.9%，对照组75.6%，两组差异比较(χ2 =6.302，P=0.012)。结论：全视网膜激光光凝及术后应用羟苯磺酸钙治疗糖尿病性视网膜病，能有效提高视力及临床疗效，可能与改善患者血液流变相关。
Objective: To investigate the curative effect of the postoperative retinal laser photocoagulation and calcium dobesilate in the treatment of diabetic retinopathy. Methods: Selected 96 patients, 175 eyes, randomly divided into control group (48 cases, 86 eyes) and study group (48 cases, 89 eyes). Two groups were all given retinal laser photocoagulation treatment, while the study group continued to receive calcium dobesilate for 12 weeks after treatment. After 12 weeks, observed the eyesight, change of blood rheology of the two groups. Results: After the treatment, the patients with vision >1.0 in the study group were significantly more than the control group (χ2 =6.779, P=0.009), in the vision range of ≤0.4, 0.4~0.6, 0.7~1.0, the difference between the two groups was (χ2 =0.003, P=0.955), (χ2 =1.640, P=0.200), (χ2=2.148, P=0.143), respectively. After treatment, plasma viscosity, erythrocyte deposited, erythrocyte deformation index, fibrinogen in the study group were better than those in the control group (P<0.05). The total effectiveness in the study group was 89.9%, in the control group was 75.6%, the difference was statistically significant (χ2=6.302, P=0.012). Conclusion: The whole retinal laser photocoagulation and postoperative application of calcium dobesilate in treating the diabetic retinopathy can effectively improve eyesight and clinical curative effect, which may be associated with improving blood rheology.
