目的：了解干眼患者相关知识、管理态度及防治行为的现状及影响因素，为临床制定针对性的干预措施提供依据。方法：采用便利抽样法，选取2025年1—3月在中山大学中山眼科中心干眼与眼表疾病门诊就诊的患者为研究对象。调查工具为一般资料调查表、中国干眼问卷及干眼患者知信行问卷。知信行问卷包括知识（16个条目）、态度（7个条目）、行为（9个条目） 3个维度，共32个条目。使用单因素分析及多元线性回归分析确定影响因素。 结果：有效回收调查问卷325份，325例干眼患者的知信行问卷平均得分为（62.89±9.00）分；标准分为（78.61±11.25）分，处于中等水平。其中知识维度平均得分为（9.89±4.88）分，134例（41.2%）处于较差水平；态度维度得分较高，总均分为（26.92±2.24）分，标准分（96.16±8.03）分，处于较高水平；行为维度总均分为（26.06±5.43）分，标准分（72.41±15.09）分，处于中等水平。单因素分析结果显示，不同年龄、文化程度、家庭人均月收入、是否经常使用电子设备、是否主动查询疾病知识的干眼患者，其知信行得分比较差异有统计学意义（P<0.05）。年龄、文化程度、是否主动查询疾病知识是干眼患者知信行得分的影响因素（P<0.05）。 结论：干眼患者知信行水平处于中等，表现为疾病知识掌握片面、防治态度较积极但行为水平有待提高，且受多因素影响，应制订精准、个性化健康教育内容，以提高干眼患者的知信行水平。
Objective: To investigate the current status and identify the influencing factors regarding the knowledge, attitudes, and practices related to dry eye disease (DED) among patients. This study aims to provide a solid foundation for the development of targeted clinical interventions. Methods: With convenience sampling, patients diagnosed with DED were selected at the Dry Eye and Ocular Surface Disease Clinic of Zhongshan Ophthalmic Center from January to March 2025 as study subjects. The survey tools consisted of a general information questionnaire, the Chinese Dry Eye Questionnaire, and the Knowledge, Attitudes, and Practices (KAP) Questionnaire for DED patients. The KAP questionnaire was structured into three dimensions: knowledge (16 items), attitudes (7 items), and practices (9 items), making a total of 32 items. Univariate analysis and multiple linear regression were employed to identify influencing factors. Results: A total of 325 valid questionnaires were collected. Among the 325 DED patients, the average KAP score was 62.89±9.00, and the standardized score was 78.61±11.25, indicating a moderate level. In the knowledge dimension, the average score was 9.89±4.88 and 134 patients (41.2%) had poor scores. The attitudes dimension showed a relatively high level, with a total mean score of 26.92±2.24 and a standardized score of 96.16±8.03, reflecting that the patients generally held positive attitudes towards the prevention and treatment of DED. For the practices dimension, the total mean score was 26.06±5.43, and the standardized score was 72.41±15.09, indicating a moderate level of behaviorial practices. Univariate analysis revealed significant differences in KAP scores among patients with different ages, education levels, monthly household income per capita, frequencies of electronic device use, and whether they actively sought disease-related knowledge (P<0.05). Further, age, education level, and proactive information-seeking behavior were identified as significant influencing factors for KAP scores (P<0.05). Conclusions: The KAP level of DED patients is moderate. Their disease knowlege is fragmented, while they exhibit positive attitudes toward prevention and treatment. However, their behavioral practices are subptimal and are influenced by multiple factors. Therefore, it is essential to develop tailored and personalized health education programs to enhance the KAP level of DED patients.
中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy，CSC）是一种以脉络膜增厚、血管通透性增加为特征的脉络膜谱系疾病，所以对脉络膜的观察对于CSC的监测和治疗非常重要。随着光学相干断层扫描成像（optical coherence tomography，OCT）的发展，对脉络膜的认识有了显著提升，也让我们更深刻地理解了它在眼后段疾病中的重要作用，提高了对各种脉络膜视网膜疾病的诊断能力。近年来，随着扫频源光学相干断层扫描（swept source optical coherence tomography，SS - OCT）及扫频源光学相干断层扫描血流成像（swept source optical coherence tomography angiography，SS - OCTA）的发展，其扫描波长、深度、广度及扫描速度均显著提升，实现了对脉络膜结构的无创定量化评估，推进了对CSC等脉络膜谱系疾病的病理机制的认识和临床管理。文章就近年SS-OCT及SS-OCTA在 CSC 中的应用及研究进展进行总结。主要进展有：发现CSC脉络膜增厚不仅局限于黄斑区，且发现其脉络膜血管及基质成分均显著增加；CSC为双眼受累，而表现为单眼症状；涡静脉回流障碍机制在该疾病中起到关键作用；SS-OCT能进一步对后极部的视网膜下积液进行监测和分析；发现了急性与慢性CSC脉络膜相关参数的改变的不同；最后探究了巩膜机制在该疾病中可能起到的作用。
Central serous chorioretinopathy (CSC) is one of the choroidal spectrum diseases, characterized by choriod thickening and increased vascular permeability. Therefore it is very important to observe choroid, as this allows us to monitor it and formulate an appropriate therapeutic schedule. With the development of optical coherence tomography (OCT), our understanding of choroid has been significantly improved. We have got a deeper insight into its important role in posterior diseases, and also the diagnostic capability for choroidal and retinal diseases has also improved. In recent years, the development of swept source optical coherence tomography (SS-OCT) and swept source optical coherence tomography angiogrphy (SS-OCTA) has further advanced our ability to assess choroidal conditions. These technologies offer enhanced scanning wavelengths, depth, breadth, and scanning speed, enabling non-invasive quantitative assessment of choroidal structures. This has advanced our understanding of the pathophysiological mechanisms and clinical management of CSC and other choroidal spectrum diseases.This review summarizes the application of swept source optical coherence tomography (SS - OCT) and swept source optical coherence tomography angiography (SS - OCTA) in CSC and its research progress. The main advancements include: choroidal thickening in CSC is not limited to macular area, both choroidal vascular and stromal components are significantly increased; CSC can affect both eyes, although it often presents with unilateral symptoms; impaired vortex vein outflow plays a key role in the pathogenesis of this disease; SS-OCT can further monitor and analyze subretinal fluid accumulation in the posterior pole; differences in changes in choroidal parameters between acute and chronic CSC have been identified; and finally, the potential role of scleral mechanisms in this disease have been explored.
音乐作为一种非侵入性的感官刺激，凭借其独特的治疗价值在医疗领域的应用日益广泛。文章综述了音乐在眼底诊疗领域的应用现状及研究进展。大量临床研究表明，音乐干预可以显著降低患者在眼科诊疗过程中的焦虑水平，改善医疗体验。在玻璃体腔注射、早产儿视网膜病变筛查、视野检查等不同临床场景中，音乐的应用均显示出积极效果。此外，在眼科模拟手术操作研究中，背景音乐的存在不仅没有对医生的手术操作造成干扰，反而可能通过调节术者的心理状态，优化手术环境。虽然音乐干预效果存在个体差异，不同患者对音乐类型、节奏和音量的偏好各异，但总体而言，作为一种安全、经济且易于实施的辅助手段，音乐疗法在眼底临床实践中展现出良好的应用前景。目前已有初步研究表明，音乐在糖尿病视网膜病变合并抑郁症的大鼠实验模型中可减少细胞凋亡并改善抑郁。未来需要开展更多严谨的随机对照试验，建立标准化的音乐干预方案，以充分发挥音乐在眼科诊疗中的积极作用。同时，也应该重视个体化治疗原则，根据患者的个人喜好和具体临床情况，制定合适的音乐干预策略。
Music, as a non-invasive sensory stimulus, has been increasingly applied in medical fields due to its unique therapeutic value. This article reviews the current applications and research progress of music in fundus examination and treatment. Extensive clinical studies have demonstrated that music intervention can significantly reduce patients' anxiety levels during ophthalmic procedures and improve their medical experience. Positive effects have been observed across various clinical scenarios, including intravitreal injections, retinopathy of prematurity screening, and visual field examinations. Furthermore, studies on simulated ophthalmic surgical procedures have shown that background music not only does not interfere with surgeons' operational performance but may actually optimize the surgical environment by regulating the operator's psychological state. Although the effectiveness of music intervention varies among individuals, with patients showing different preferences for music types, rhythms, and volumes, music therapy generally demonstrates promising potential in fundus clinical practice as a safe, economical, and easily implemented auxiliary measure. Preliminary studies have demonstrated that music can reduce cell apoptosis and improve depression in rat models of diabetic retinopathy complicated with depression. Looking forward, more rigorous randomized controlled trials are needed to establish standardized music intervention protocols to maximize the positive effects of music in ophthalmic treatment. Meanwhile, emphasis should be placed on the principle of individualized treatment, developing appropriate music intervention strategies based on patients' personal preferences and specific clinical conditions.
巨噬细胞样细胞(macrophage-like cells, MLC)指起源、功能与巨噬细胞类似的免疫细胞，包括小胶质细胞、玻璃体细胞及巨噬细胞。将en face OCT显示层面设置在视网膜表明即可观测到视网膜表明的 MLC(epiretinal MLC, eMLC)，随后利用ImageJ软件即可对细胞进行提取和量化。研究表明，eMLC在炎症情况下均可出现细胞募集及活化现象，但在不同眼底病中各具特点。在糖尿病视网膜病变、视网膜静脉阻塞等视网膜缺血缺氧性疾病中，eMLC密度越高，黄斑水肿可能越严重。此外，eMLC密度更高的视网膜静脉阻塞患者抗VEGF疗效更差，视力预后不佳，提示基于en face OCT的eMLC不仅可用于评估视网膜炎情况，而且还能充当提示疾病疗效及预后的标志物。在葡萄膜炎等免疫炎症性疾病中，en face OCT亦可观测到eMLC密度、形态等改变。白塞病葡萄膜炎患者视网膜血管渗漏程度与eMLC密度相关性强，故eMLC密度可充当无创评估视网膜血管渗漏程度的新指标。然而，目前提取和量化eMLC的方法及标准不统一，降低了各研究间的可比性。因此，亟需制定统一的操作规范和评估标准。此外eMLC 所代表的具体细胞类型及功能仍需进一步探究。未来，研究者可以利用en face OCT对眼底炎症地进行无创评估。基于en face OCT的eMLC还能作为基础研究与临床研究之间的桥梁，为揭示疾病的致病机制提供重要参考。
Macrophage-like cells (MLC) refer to immune cells that originate from and function similarly to macrophages, including microglia, hyalocytes, and macrophages themselves. By setting the display level of en face OCT to the retinal surface, epiretinal MLC (eMLC) can be observed and subsequently extracted and quantified using ImageJ software. Studies indicate that eMLC can exhibit cell recruitment and activation in inflammatory conditions, each displaying distinct characteristics in different retinal diseases. In ischemic and hypoxic retinal conditions such as diabetic retinopathy and retinal vein occlusion, higher densities of eMLC are associated with more severe macularedema. Moreover, patients with retinal vein occlusion showing higher eMLC densities tend to have poorer responses to anti-VEGF treatments and worse visual prognoses, suggesting that eMLC identified via en face OCT can be used not only to assess retinal inflammation but also as biomarkers for disease efficacy and prognosis. In immune-inflammatory diseases like uveitis, changes in eMLC density and morphology can also be observed through en face OCT. Inpatients with Beh?et's disease, a strong correlation exists between the degree of retinal vascular leakage and eMLC density, making eMLC density a potential non-invasive marker for assessing retinal vascular leakage. However, the current methods and standards for extracting and quantifying eMLC are not unified, significantly reducing comparability between studies. Therefore, there is an urgent need to establish uniform operational protocols and assessment standards. Furthermore, the specific cell types and functions represented by eMLC observed via en face OCT require further investigation. In the future, en face OCT could be utilized for non-invasive assessment of retinal inflammation. eMLC based onen face OCT could also serve as a bridge between basic research and clinical studies, providing valuable insights into the pathogenic mechanisms of diseases.
CSNB是一组高度异质的遗传性视网膜疾病(inherited retinal disease, IRD)，主要由视网膜光感受器细胞和双极细胞间的信号传导障碍引发。其主要临床特征为静止性夜盲和暗适应功能障碍，常伴有早发性近视、眼球震颤、斜视和远视等症状，ERG在CSNB的诊断、分型及治疗指导中起着至关重要的作用。尽管CSNB发病率低，属于罕见病，但其真实发病率可能被低估，部分原因在于其症状轻微、眼底表现多不明显，且临床常忽视视网膜功能检查，导致较高的漏诊和误诊率。随着分子遗传学技术的进步，大量研究揭示了CSNB不同基因缺陷的致病机制，特别是与早发近视的关联机制，这些研究同也增加了对视网膜信号传导和近视发病机制的理解。然而，CSNB的基因治疗仍处于早期阶段。本综述旨在全面探讨CSNB的疾病谱，包括不同类型患者的临床表现、影像学和功能学表型特征，以及相关遗传学致病机制，并总结基因型与表型的关联。同时，综述最新研究成果与未来发展方向，旨在提高国内学者对CSNB的认识，为临床诊断和治疗提供参考，并为后续研究提供新思路。
Congenital Stationary Night Blindness (CSNB) represents a group of highly heterogeneous inherited retinal diseases (IRDs) primarily caused by impaired signal transmission between photoreceptor cells and bipolar cells in the retina. The main clinical features include stationary night blindness and dark adaptation dysfunction, often accompanied by early-onset myopia, nystagmus, strabismus, and hyperopia. Electroretinography (ERG) plays a crucial role in the diagnosis, classification, and therapeutic management of CSNB. Although CSNB is classified as a rare disease due to its low incidence, its true prevalence is likely underestimated, partly because of its mild symptoms, inconspicuous fundus manifestations, and frequent oversight of retinal function tests in clinical practice, leading to high rates of underdiagnosis and misdiagnosis. With advances in molecular genetics, extensive research has elucidated the pathogenic mechanisms of various genetic defects in CSNB, particularly those associated with early-onset myopia. These studies have also enhanced our understanding of retinal signal transduction and the pathogenesis of myopia. However, gene therapy for CSNB remains in its early stages. This review aims to comprehensively explore the disease spectrum of CSNB, including clinical manifestations, imaging and functional phenotypic characteristics across different subtypes, and associated genetic pathogenic mechanisms. We also summarize genotype-phenotype correlations, review the latest research advancements, and discuss future directions. By doing so, this review seeks to improve the understanding of CSNB among domestic researchers, provide guidance for clinical diagnosis and treatment, and offer new insights for future research.
“六要素，三个一”是眼底影像基础阅片工作中进行眼底疾病临床创新性研究的模式要点，即在眼底阅片过程中捕捉到1个异常的病例后，通过积累病例、提炼特征、文献检索、寻同查异，进而扩展到1组病例，最后通过思辨创新，提出或完善1种新的疾病或疾病表征。近二十年来，在此模式的指导下，团队在眼底疾病研究工作中取得了一些原创性的成果：比如息肉状脉络膜血管病变的认识及其在国人新生血管性年龄相关性黄斑变性中发病比例第一，提出点状内层脉络膜病变病灶国际分期和命名新亚型，年龄相关的吲哚菁绿血管造影晚期散在弱荧光点揭示潴留性视网膜色素上皮脱离的发病机制，发现急性黄斑神经视网膜病变是登革热患者视力下降的主要原因，在全球最大的持续性鳞状黄斑病变的病例系列中明确病灶层次等创新性成果。“六要素”框架规范眼底影像研究流程，强调研究过程的严谨性与渐进性，且多次循环后衍生发散出更多研究线索和思路，极大拓展研究深度和广度。“三个一”路径体现了研究的层次性，从个体现象(点)到群体规律(线)，最终构建疾病认知的立体网络(面)；指导眼底异常影像征象、罕见病、新病种研究，加速疾病谱系完善。以“六要素”为纲，以“三个一”为略，将继续推动眼底疾病临床研究的创新与突破。
The "6 Elements, 3 Ones" constitutes a methodological framework for conducting innovative clinical research of ocular fundus diseases in foundational fundus imaging interpretation. This model emphasizes: 1) identifying a single abnormal case during routine fundus evaluation; 2) systematically expanding this observation into a case series through case accumulation, feature extraction, literature review, and comparative analysis; and 3) ultimately proposing or refining novel disease entities or manifestations through critical thinking and innovation. Over the past two decades, guided by this paradigm, our research team has achieved several original breakthroughs in fundus imaging studies, including: establishing polypoidal choroidal vasculopathy as the predominant subtype of neovascular age-related macular degeneration in Chinese populations; proposing an international staging system and novel subtypes for punctate inner choroidopathy; elucidating the pathogenesis of retentional retinal pigment epithelial detachment through the sign of age-related scattered hypofluorescent spots on late-phase indocyanine green angiography; identifying acute macular neuroretinopathy as the primary cause of vision loss in dengue fever patients; and precisely localizing lesion in the world's largest case series of persistent placoid maculopathy. The "6 Elements" framework standardizes fundus disease research protocols, emphasizing methodological rigor and progressive investigation while generating multiple research trajectories through iterative cycles, thereby expanding both the depth and breadth of scientific inquiry. The "3 Ones" pathway embodies hierarchical research progression - transitioning from individual phenomena (point observations) to population-level patterns (linear correlations), ultimately constructing a multidimensional disease cognition network (planar integration). This approach guides investigations ranging from signs of common disease to rare disorders and novel disease entities, accelerating the refinement of disease taxonomies. By adhering to the "6 Elements" as the structural framework and implementing the "3 Ones" as the strategic pathway, we will continue to advance innovation and achieve breakthroughs in clinical fundus disease researches.
目的：研究IgG4相关性眼病(IgG4-related ophthalmic disease, IgG4-ROD)患者的影像学特征与外周血免疫球蛋白G4(IgG4)水平之间的相关性，为评估IgG4相关性疾病全身性严重程度提供新思路。方法：收集2023年8月—2024年9月在吉林大学第二医院眼科医院经术后组织标本病理确诊的29例IgG4-ROD阳性患者。回顾性分析患者眼眶影像学特点与血清IgG4水平相关性，探讨影像学中特征性表现包括泪腺肿大、三叉神经分支增粗、眼外肌增粗、鼻黏膜类炎症改变、眼睑软组织肥厚，以及其他眶内软组织增生等特征性影像学改变出现比例，并按照累及组织结构情况分级评分，评估特征性影像学改变与血清IgG4水平之间的相关性。结果：29例病理确诊IgG4-ROD患者中，泪腺均受累，占比100%；眼外肌受累17例，占比58.62%；三叉神经分支受累5例(4例眶下神经受累，3例额神经病受累，2例眶下神经与额神经同时受累)，占比17.24%眼睑软组织肥厚24例，占比82.76%鼻黏膜出现类炎症反应15例，占比51.72%；合并眶内其他软组织增生性病变2例，占比6.90%。影像学中特征性受累组织结构分级评分与血清IgG4水平呈正相关(P < 0.05)。结论：IgG4-ROD影像学中特征性组织结构受累及范围与血清IgG4水平明显相关，可以辅助评估IgG4相关性疾病全身性严重程度。
Objective: To investigate the correlation between the imaging characteristics of patients with IgG4-related ophthalmic disease (IgG4-ROD) and the serum immunoglobulin G4 (IgG4) levels, providing new insights for assessing the systemic severity of IgG4-related diseases. Methods: This study collected postoperative tissue samples from 29 patients with histopathologically conffrmed IgG4-ROD at the Ophthalmology Department of Jilin University Second Hospital from August 2023 to September 2024. TTis study retrospectively analyzed the correlation between patients' orbital imaging features and serum IgG4 levels, and explored the proportion of characteristic imaging changes including enlargement of the lacrimal gland, thickening of the trigeminal nerve branches, thickening of the extraocular muscles, inffammatory like changes of the nasal mucous membranes, hypertrophy of the eyelid soft tissues, as well as hyperplasia of other intraorbital soft tissues in the imaging. A grading score for affected tissue structures was established to evaluate the correlation between characteristic imaging changes and serum IgG4 levels. Results: Among the 29 patients diagnosed with IgG4-ROD, lacrimal gland involvement was observed in all patients (100%). Extraocular muscle involvement was present in 17 patients (58.62%). Five patients had involvement of the trigeminal nerve branches (including 4 with infraorbital nerve involvement and 3 with frontal nerve involvement, with 2 patients having simultaneous involvement of both nerves), accounting for 17.24% of the cases. Eyelid soff tissue hypertrophy was observed in 24 patients (82.76%), and nasal mucosal inflammatory responses were noted in 15 patients (51.72%). Additionally, two patients (6.90%) presented with other proliferative lesions within the orbit. The correlation analysis between the grading scores for imaging features and serum IgG4 levels demonstrated a significant positive correlation. Conclusions: The extent of characteristic structural involvement observed in the imaging features of IgG4-ROD is significantly correlated with serum IgG4 levels. TTis correlation can assist in evaluating the systemic severity of IgG4-related diseases and provides clinical evidence supporting the need for comprehensive systemic evaluations, such as PET-CT, in patients whose initial presentation is IgG4-related ophthalmic disease.
目的：了解中山大学中山眼科医院门诊重症疑难眼病会诊的现状，探讨门诊重症疑难眼病会诊亚专科的分布情况及会诊效果，为建立科学的门诊重症疑难眼病会诊体系提供支持和依据，同时也为合理安排会诊流程提供依据。方法：对中山大学中山眼科医院2016年3月至2017年4月收集的265例门诊重症疑难病例，通过时间、地区、性别、年龄、会诊原因、会诊亚专科、会诊后的转归及效果等方面进行统计分析，所有数据均通过Excel软件进行录入，根据分析目的和资料的类型，采用相应的统计指标进行描述，并进行统计推断，检验水准为α=0.05。结果：2016年3月至2017年4月期间中山大学中山眼科医院门诊重症疑难眼病会诊人数265例。在地区分布中，广东省地区最多，为145例，外国最少，为3例。人群分布中，男167例，女98例，男女比例为1.70:1。年龄分布中，30~44岁及45~59岁的病例数最多，均为53例(20%)，70岁以上老年病例最少，为13例(4.9%)。中山大学中山眼科医院门诊重症疑难眼病会诊中，2016年3月至2017年4月期间，各眼科亚专科共参加会诊714次，眼底外科参加会诊次数最多，为147次(20.5%)，结膜科参加会诊的次数最少，为1次(0.1%)。在分析会诊原因方面，因诊治涉及多个专科而会诊的病例数最多，为161例，因病因不明会会诊的病例最少，为20例；会诊后比会诊前明确治疗方案的病例数增加190例。结论：中山大学中山眼科医院门诊组织实施重症疑难眼病会诊使明确治疗方案率大幅提高，在提高疑难眼病治疗效果方面起到一定的促进作用。
Objective: To understand the current situation of the consultation for outpatients with severe eye disease in Zhongshan Ophthalmic Center, and to explore the distribution and effects of sub-specialty consultation for outpatients with severe eye disease. To set up a scientific system of the consultation for outpatients with severe eye disease, and also provide a basis for reasonable arrangement of consultation process. Methods: We analyzed 265 severe cases from March 2016 to April 2017 in Zhongshan Ophthalmic Center by time, region, gender, age, cause of consultation, sub-specialty, and outcomes after consultation. And all data was analyzed by Excel software, according to the purpose and the type of data, and the corresponding statistical index and statistical inference, inspection level for α=0.05. Results: There were 265 cases with severe eye disease from March 2016 to April 2017. As for the regional distribution, Guangdong province was the largest, with 145 cases, while the lowest number was from foreign countries, which was 3 cases. In the population distribution, 167 cases were males, 98 were females and the ratio was 1.70. In age distribution, patients aged from 30 to 44 years and 45 to 59 years predominated and the number of cases were both 53, accounting for 20% of the total number. Patients over 70 were the least which were 13 cases, accounting for 4.9% of the total number. From March 2016 to April 2017, all sub-specialties attended consultation for 714 times, as Ocular Fundus Department attended the most, accounting for 20.5% of the total number while Conjunctive Department attended the least, for only one, accounting for 0.1% of the total number. As for the reason of the consultation, the number of cases involving multiple specialties was the largest, with 161 cases, while the lowest number of cases due to unexplained causes, which were 20 cases. The number of cases of explicit treatment was increased by 190 after consultation. Conclusion: Consultations organized by Zhongshan Ophthalmic Center improves the treatment for outpatients with severe eye disease.
