综述

折叠式人工玻璃体球囊的临床应用及研究进展

Clinical application and research progress of foldable capsular vitreous body

:338-343
 
玻璃体替代物是玻璃体切割术后的必需品,用于填充玻璃体腔,恢复玻璃体的支撑视网膜、屈光和细胞屏障等功能。严重眼外伤及复杂视网膜脱离引起的视网膜/脉络膜脱离,如选用传统的玻璃体替代物(如硅油)填充,部分患者会出现硅油依赖眼或眼球萎缩,眼球难以保全。折叠式人工玻璃体球囊(foldable capsular vitreous body,FCVB)是我国独立研发的挽救眼球的人工玻璃体,属于国际首创,可以精细模拟自然玻璃体的结构,恢复玻璃体的部分功能。目前临床研究证实FCVB不仅可以有效避免硅油的并发症,还可以维持后房空间,缓慢恢复睫状体的功能,从而治疗硅油依赖眼,阻止眼球进一步萎缩。该文综述了FCVB的研究背景、结构特点、临床应用和拓展研究进展。
Vitreous substitutes are necessary after vitrectomy to fill the vitreous cavity and restore the vitreous to support retinal, refractive, and cellular barrier functions. Severe ocular trauma-induced retinal/choroidal detachment filled with traditional vitreous substitutes (e.g., silicone oil) can lead to silicone oil-dependent eyes and ocular atrophy in some patients, making it difficult to preserve the eye. Foldable capsular vitreous body (FCVB) is an artificial vitreous body independently developed in China to save the eye, which is the first of its kind in the world and can finely simulate the structure of natural vitreous body and restore some of the functions of vitreous body. It has been clinically proven that it can not only effectively avoid the complications of silicone oil, but also maintain the posterior chamber space and slowly restore the function of the ciliary body, thus treating silicone oil-dependent eyes and preventing further atrophy of the eye. This article reviews the research background, structural features, clinical applications and extended studies of FCVB.
论著

基于眼底图片的5G医疗眼科远程诊断中心的构建与应用

The construction and application of 5G remote ophthalmology diagnosis center based on fundus images

:1-8
 
目的:依托最新的第5代移动通信技术(5th generation wireless systems,5G),构建基于眼底图片的5G医疗眼科远程诊断平台,促进医疗资源上下贯通,提升基层服务能力及医疗服务体系整体效能。方法:基于5G时代医院的信息化发展战略,在海南省卫生健康委员会的资助与指导下,中山大学中山眼科中心海南眼科医院与中国联通通信集团海南有限公司等进行跨行业、多学科的技术力量研究开发,构建5G条件下的平台建设模块和技术路线,确定远程眼科诊断流程,并在海南省内多地区应用。结果:远程诊断平台运行良好。2020年12月至2021年11月,本研究共在海南省17个地区的186个卫生院中开展,共收集1561例患者眼底病图片数据,筛查阳性例数为185例,检出眼底病总阳性率为11.9%。其中有42例需要转诊治疗,转诊率为23%;143例不需要转诊治疗,非转诊率为77%。在1561例眼底图像中,采集异常的眼底图像有490例。排除490例异常眼底图像后,辅助诊断系统与人工诊断结果有1 002张眼底图像诊断相同,69张眼底图像诊断不同,其辅助诊断系统准确率为93.3%。结论:5G移动通信与远程医学影像结合,运用互联网科技催生新型医疗生产力,提高卫生经济的质量和效率,是医疗领域探索5G应用场景的一项应用典范。
Objective: Relying on the latest 5th generation wireless systems (5G), a remote primary ophthalmology care diagnosis platform based on fundus images was constructed in order to promote the connectivity of medical resources and improve the primary health service capabilities and the overall effectiveness of the medical service system. Methods: Based on the 5G informatization development strategy of hospitals, and under the funding and guidance of the Hainan Provincial Health Commission, the Hainan Eye Hospital of Zhongshan Ophthalmic Center and China Unicom Communications Group Hainan Co., Ltd. conducted a cross-industry, multi-disciplinary technical research. To build platform construction modules and technical routes under 5G networks, present the remote ophthalmological diagnosis process, and apply it in many regions in Hainan Province. Results: The performance of the remote diagnosis platform is well. From December 2020 to November 2021, this study was carried out in 186 health centers in 17 regions of Hainan Province. A total of 1 561 patients with fundus disease image data were collected. The number of positive screening fundus disease cases was 185. The total positive rate was 11.9%. Among them, 42 cases required referral for treatment, with a referral rate of 23%, and 143 cases did not require referral for treatment, with a non-referral rate of 77%. Among 1 561 cases of fundus images, 490 fundus images were excluded due to abnormal quality. Compared the results of the diagnosis platform system with manual diagnosis, 1 002 fundus images were identical, and 69 fundus images were different in diagnosis. The accuracy of the auxiliary diagnosis system was 93.3%. Conclusions: The collaboration of 5G mobile communication and telemedicine imaging, combined with internet technology to promote new medical productivity, improve quality and efficiency of the health economy. This study is an application model for exploring 5G application scenarios in the medical field.
综述

碳点的特性及其在眼科疾病诊治中的研究进展

Research progress in the application of carbon dots in the diagnosis and treatment of ocular diseases

:210-219
 
碳点是一种新型荧光碳纳米材料,直径一般小于10 nm,具有自发荧光、高生物组织相容性、易于修饰、成本低廉等优点,在生物医学领域拥有广阔的应用前景。眼球因其独特的屏障结构,常规药物停留时间短、穿透性差,通过局部滴眼到达病灶的药物浓度有限,需要增加给药频次以保持药效。另外,糖尿病性黄斑水肿(diabetic macular edema,DME)、脉络膜新生血管(diabetic macular edema,CNV)等疾病的治疗给药则需依赖于玻璃体腔注射,该方法属于有创操作,有引起潜在并发症的可能,且需多次注射,给患者造成了沉重的心理和经济负担。优化眼部给药方法一直是眼科学领域的研究热点。基于碳点的优异特性,碳点在眼部药物递送、眼部成像、眼疾病诊疗中已展现出优秀的应用潜力。本综述将综合介绍碳点的特点及近十年来碳点在眼科疾病诊疗中的研究进展,旨在提供关于碳点在眼科应用现状的系统性认识,为未来研究提供方向。
Carbon dots is a new type of fluorescent carbon nanomaterial, which the diameter is generally less than 10 nm, has the advantages of self-fluorescence, remarkable biocompatibility, easy modification, low cost and so on, has a broad application prospect in the biomedical field. Due to the unique barrier of the eye, conventional drugs have a short residence time and poor penetration, so the concentration of drugs that can reach the lesions through local eye drops is limited, and for what to increase the frequency of administration to maintain efficacy. Up to now, the treatment of posterior eye diseases, such as diabetic macular edema (DME), choroidal neovascularization (CNV) and other diseases still rely on repeated vitreous injection, which is an invasive procedure with potential complications, and need multiple injections, causing a heavy psychological and economic burden on patients. Optimizing the method of ocular drug delivery has always been a hot topic in the field of ophthalmology. Carbon dots have shown excellent application potential in the ocular drug delivery, ocular imaging, and diagnosis and treatment of ocular disease based on its excellent characteristics. This review will systematically introduce the characteristics of carbon dots and the application of carbon dots in the diagnosis and treatment of eye diseases, aiming to provide a comprehensive understanding of the current situation of the application of carbon dots in ophthalmology and provide directions for future research.
综述

人工智能在白内障诊疗中的应用进展

Advances in the application of artificial intelligence in diagnosis and treatment of cataract

:85-90
 
人工智能(artificial intelligence,AI)在眼科领域的应用不断深入、拓展,目前在糖尿病性视网膜病变、白内障、青光眼以及早产儿视网膜病变在内的多种常见眼病的诊疗中逐渐成为研究热点。AI使医疗资源短缺、诊断标准缺乏、诊疗技术水平低下的现状得到改善,为白内障的诊疗开辟了一条“新赛道”。本文旨在综述AI在白内障诊疗中的应用现状、进展及局限性,为AI在白内障领域的进一步开发、应用及推广提供更多信息。
Artificial intelligence (AI) has been widely applied and promoted in ophthalmology, and has gradually become a research hotspot in the diagnosis and treatment of many common ophthalmopathies, including diabetic retinopathy, cataract, glaucoma, and retinopathy of prematurity. AI improves the shortage of medical care, the lack of diagnostic criteria and the low level of diagnosis and treatment technology, and explores a “new race track” for cataract diagnosis and treatment. The purpose of this article is to review the application status, progress and limitations of AI in the diagnosis and treatment of cataract, aiming to provide more information for further development, application and promotion of AI in the field of cataract.
论著

囊袋上经巩膜缝线固定IOL植入术治疗球形晶状体的有效性和安全性研究

The efficacy and safety of the application of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation in microspherophakia surgery

:92-100
 
目的:探讨超声乳化晶状体吸除联合囊袋上经巩膜缝线固定人工晶状体(intraocular lens,IOL)植入术治疗球形晶状体(microspherophakia,MSP)的有效性和安全性。方法:采用回顾性分析,选取2019年1月至 2020年6月期间在复旦大学附属眼耳鼻喉科医院进行治疗的MSP患者37例(37眼),随机分为两组,纳入行超声乳化晶状体吸除联合囊袋上巩膜缝线固定IOL植入术(supra-capsular and scleral-fixated intraocular lens implantation,SCSF-IOL)的MSP患者20例(20眼)和行超声乳化晶状体吸除联合改良型囊袋张力环植入术(transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation,MCTR-IOL)的MSP患者17例(17眼),观察两组术后最佳矫正视力及并发症等情况。结果:两组术后最佳矫正视力比术前均有改善(P<0.001),而组间比较差异无统计学意义(P=0.326)。两组的IOL倾斜度相当(P=0.216)。预防性Nd:YAG激光后囊膜切开术在SCSFIOL术后1周至1个月进行。在SCSF-IOL组,2眼(10.00%)需要重复激光治疗,1眼(5.00%)出现囊口偏心。后囊膜混浊是MCTR组最常见并发症(6眼,35.29%)。随访期间两组均未出现IOL脱位、继发性青光眼和视网膜脱离。结论:SCSF-IOL是治疗球形晶状体的简单易行的手术方式,疗效与MCTR-IOL相当。Nd:YAG激光后囊膜切开术是预防SCSF-IOL术后囊袋并发症的必要手段。
Objective: To investigate the efficacy and safety of phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens (IOL) implantation in the treatment of microspherophakia (MSP). Methods: by retrospective analysis, 37 MSP patients (37 eyes) who were treated in our hospital from January 2019 to June 2020 were randomly divided into two groups, including 20 MSP patients (20 eyes) who treated by SCSF-IOL and 17 MSP patients (17 eyes) who treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL). The best corrected vision and complications were observed. Results: the best corrected vision was significantly improved in both groups (P < 0.001), but there was no remarkable difference between the two groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd: YAG laser posterior capsulotomy was performed from 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment, and one eye (5.00%) had a decentered capsule opening. Posterior capsular opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up. Conclusions: SCSF-IOL is a simple and viable surgical option for managing MSP and is comparable with the MCTR-IOL. Nd: YAG laser posterior capsulotomy is a necessary mean to prevent residual capsule complications after the SCSF-IOL procedure.
综述

人工智能和区块链技术在生物样本库信息化建设的应用展望

Prospect of application of artificial intelligence and block chain in the information construction of Biobank

:91-96
 
近年来,使用人工智能(artificial intelligence,AI)技术对临床大数据及图像进行分析,对疾病做出智能诊断、预测并提出诊疗决策,AI正逐步成为辅助临床及科研的先进技术。生物样本库作为收集临床信息和样本供科研使用的平台,是临床与科研的桥梁,也是临床信息与科研数据的集成平台。影响生物样本库使用效率及合理共享的因素有信息化建设水平不均衡、获取的临床及检验信息不完全、各库之间信息不对称等。本文对AI和区块链技术在生物样本库建设中的具体应用场景进行探讨,展望大数据时代智能生物样本库信息化建设的核心方向。
In recent years, artificial intelligence (AI) technology has been applied to analyze clinical big data and images and then make intelligent diagnosis, prediction and treatment decisions. It is gradually becoming an advanced technology to assist clinical and scientific research. Biobank is a platform for collecting clinical information and samples for scientific research, serving as a bridge between clinical and scientific research. It is also an integrated platform of clinical information and scientific research data. However, there are some challenges. First, clinical and laboratory information obtained is incomplete. Additionally, the information among different databases is asymmetric, which seriously impedes the information sharing among different Biobanks. In this article, the specific application scenarios of AI technology and blockchain in the construction of a Biobank were discussed, aiming to pinpoint the core direction of the information construction of an intelligent Biobank in the era of big data.
综述

大型语言模型在眼科中的应用

The application of large language models in ophthalmology

:283-294
 
大型语言模型(large language models, LLMs)在眼科的应用为医疗领域带来了巨大的潜力,尤其是在提升诊断效率、优化医患沟通和促进个性化医疗方面。通过自然语言处理技术,LLMs可以协助医生进行临床数据的归纳和分析,可以结合患者的病史、影像资料和症状描述,提供精准的辅助诊断,并在复杂病例中提供参考。LLMs还可以帮助医生快速撰写病历报告,改善医疗记录管理效率。在医患沟通中,LLMs能够通过生成通俗易懂的解释,帮助患者理解疾病状况及治疗方案,缩短医生与患者之间的沟通障碍。在远程医疗场景下,LLMs可通过实时分析患者上传的图像文本信息,提供初步诊断建议,助力医生远程诊疗。个性化医疗也是LLMs的重要应用方向,借助患者的遗传数据和生活习惯,可以帮助医生制定更为精准的个性化治疗方案,并预测手术后的恢复情况。此外,LLMs可以通过与临床数据的不断交互进行自我优化,提升其在眼科诊疗中的智能化程度。尽管LLMs在眼科领域的应用前景广阔,但仍面临数据隐私、模型解释性、语言理解等方面的挑战。未来LLMs将继续作为医生的辅助工具,形成“人机协同”的诊疗新模式,为患者提供更好、更精准的医疗服务。
The application of Large Language Models (LLMs) in ophthalmology presents tremendous potential for the healthcare field, particularly in enhancing diagnostic efficiency, optimizing doctor-patient communication, and promoting personalized medicine. Through natural language processing technology, LLMs can assist doctors in summarizing and analyzing clinical data. They can integrate a patient's medical history, imaging data, and symptom descriptions to provide precise diagnostic support and reference for complex cases. LLMs can also help physicians quickly draft case reports, improving the management efficiency of medical records. In doctor-patient communication, LLMs can generate easy-to-understand explanations that help patients comprehend their conditions and treatment plans, thereby reducing communication barriers between doctors and patients. In telemedicine scenarios, LLMs can provide preliminary diagnostic suggestions by real-time analyzing images and textual information uploaded by patients, aiding doctors in remote diagnosis and treatment.
Personalized medicine is another significant application direction for LLMs. By utilizing patients' genetic data and lifestyle habits, LLMs can assist physicians in formulating more precise personalized treatment plans and predicting postoperative recovery outcomes. Additionally, LLMs can self-optimize through continuous interaction with clinical data, enhancing their intelligence in ophthalmic diagnosis and treatment. Despite the broad application prospects of LLMs in the field of ophthalmology, challenges remain, including data privacy, model interpretability, and language understanding. In the future,  LLMs will continue to serve as auxiliary tools for physicians, forming a new model of "human-machine collaboration" in diagnosis and treatment, ultimately providing better and more precise medical services to patients.
封面简介

Schlemm's canal 结构和功能调控的研究进展及其在青光眼治疗中的应用

Research progress on the structure and functional regulation of Schlemm's canal and its application in glaucoma treatment

:-
 
Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道,通过调节房水外排来维持眼内压的平衡,其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径,从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前,对SC发育和功能的调节机制的认识仍然有限,缺乏针对SC的特异性治疗策略。近年来,关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示,功能调控的关键分子靶标也相继被发现,这促进了对SC结构和功能调控的深入理解。此外,作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究,总结关键的分子和细胞学调控机制,归纳SC相关药物和手术疗法的最新进展,为青光眼的临床诊治提供了新的思路。
Schlemm管(Schlemm’ s canal, SC)作为房水流出的主要通道,通过调节房水外排来维持眼内压的平衡,其结构和功能的异常与高眼压及青光眼的发生发展密切相关。对SC的研究有助于阐明房水外排阻滞的发生机制、探索促进房水外排新的途径,从而为降低眼压和青光眼治疗的新药物开发提供理论基础。目前,对SC发育和功能的调节机制的认识仍然有限,缺乏针对SC的特异性治疗策略。近年来,关于SC细胞命运决定及其结构发育的细胞学机制逐渐被揭示,功能调控的关键分子靶标也相继被发现,这促进了对SC结构和功能调控的深入理解。此外,作为降眼压药物靶点和针对性手术的创新应用也在不断拓展。文章系统回顾SC的结构与功能研究,总结关键的分子和细胞学调控机制,归纳SC相关药物和手术疗法的最新进展,为青光眼的临床诊治提供了新的思路。
论著

像差和对比敏感度数据提取处理软件的开发和应用

Development and application of aberration and contrast sensitivity data extraction software

:95-99
 
目的:像差和对比敏感度检查结果数据繁多复杂。为了高效准确地完成检查数据提取工作,自主开发一款像差和对比敏感度数据提取处理软件(Aberrations and Contrast Sensitivity Helper,ACSH)。方法:参考其他同类软件的设计模式,结合我院科研实际,采用开发工具VB6.0编程实现。结果:ACSH在Windows的运行环境下,能够准确地在局域网环境下实现对iTrace,Zywave像差仪和Optec_6500对比敏感度测试仪的检查数据进行提取。像差仪信息包括病人基本信息、屈光度、眼别、瞳孔直径,各项像差Zernike系数,高阶像差和总高阶像差均方根RMS(Root Mean Square)。对比敏感度仪数据包括:病人基本信息、检查时间、检查时的模拟光照度和眩光强度、 各空间频率的对比敏感度数值。同时软件支持对已提取的数据进行浏览、查询及导出EXCEL等功能,并开放数据接口供电子病历等其他系统对接。结论:ACSH是一款能够有效辅助视光专科科研和临床工作的应用软件。
Objective: Aberration and contrast sensitivity test results data is various and complex. In order to complete efficiently and accurately the data extraction work, we developed an aberration and contrast sensitivity data extraction software Aberrations and Contrast Sensitivity Helper (ACSH). Methods: VB6.0 was used as a development tool after we referred to other similar software design pattern and combined the reality of our scientific research. Results: The ACSH under the Windows environment can accurately extract the results’ data of iTrace and Zywave aberration meter and Optec 6500 contrast sensitivity tester in local area network. Aberration instrument information include patients’ basic information, refraction, which eye, pupil diameter, the aberration  Zernike coefficients, the high-order aberration and total aberration Root Mean Square (RMS). Contrast sensitivity tester data included: patients’ basic information, time, the intensity of analog light and the glare ,the contrast sensitivity values of every spatial frequency. ACSH is able to browse and query extracted data and export to EXCEL, and open data interface for electronic medical records and other system. Conclusion: ACSH is an effective software which assists optical specialized scientific research and clinical work.
综述

叶黄素类物质对视觉功能的保护作用及其在青少年视力维护中的应用

Protective effect of xanthophylls on visual function and its application in adolescent vision maintenance

:171-175
 
      叶黄素类物质为膳食类胡萝卜素,主要存在于视网膜组织中,为黄斑色素发挥抗氧化活性和蓝光滤过作用。近年来,有研究证实,叶黄素类物质可降低色差,提高视力及对比敏感度等功能,并对于年龄相关性黄斑变性、视网膜光损伤等疾病具有防治作用。
Xanthophylls is a kind of dietary carotenoid, which is mainly located in retina, and plays an important role in antioxidant and blue light ffltration. Lutein, zeaxanthin and meso-zeaxanthin can enhance visual performance by decreasing chromatic aberration and enhancing contrast sensitivity, and they can also prevent age-related macular degeneration and retinal light-induced injury. 
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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