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.
视网膜静脉阻塞（retinal vein occlusion, RVO）是导致视力损害的主要眼底疾病之一，常引发视网膜缺血、出血、液体渗漏和黄斑水肿，从而导致视力下降甚至永久丧失。目前，RVO继发黄斑水肿的主要治疗方法是玻璃体腔内注射抗血管内皮生长因子（vascular endothelial growth factor, VEGF）药物。然而，RVO的病理机制不仅限于VEGF，还涉及血管生成素-2（angiopoietin-2, Ang-2）的作用。在病理状态下，Ang-2通过破坏血管稳定性，诱导新生血管形成，并加剧炎症反应，进一步促进RVO的病程进展。法瑞西单抗（Faricimab）作为一种双特异性抗体药物，能够同时抑制VEGF-A和Ang-2这两条关键的病理通路，显示出在改善患者视力方面的潜在优势。文章对Faricimab在RVO治疗中的作用机制、临床应用、相关治疗药物对比及未来发展前景进行了详细论述，为其在眼科领域的进一步应用提供了理论依据和参考。
Retinal vein occlusion (RVO) is one of the leading retinal diseases causing vision impairment and is often associated with retinal ischemia, hemorrhage, fluid leakage, and macular edema, ultimately resulting in decreased vision or even permanent vision loss. Currently, the primary treatment for RVO-associated macular edema is intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. However, the pathological mechanisms of RVO are not limited to VEGF alone, but also involve angiopoietin-2 (Ang-2). Under pathological conditions, Ang-2 disrupts vascular stability, induces neovascularization, and exacerbates inflammatory responses, thereby accelerating the progression of RVO. Faricimab, as a bispecific antibody, can simultaneously inhibit both VEGF-A and Ang-2 pathways, which are critical in RVO pathogenesis, and has shown potential advantages in improving visual outcomes. The article provides a detailed discussion on the mechanism of action, clinical applications, comparison with related therapeutic agents, and future development prospects of Faricimab in the treatment of RVO, offering a theoretical basis and reference for its further application in ophthalmology.
先天性晶状体脱位(congenital ectopia lentis, CEL)是一种罕见的遗传相关性疾病，其主要临床特征是晶状体悬韧带先天性发育异常，导致晶状体偏离正常解剖位置。随着病情的进展，CEL可引起高度屈光不正甚至弱视外，还可能导致继发性青光眼和视网膜脱离等严重的并发症。目前，手术仍是改善CEL患儿视觉质量及防治并发症的主要手段。常用的手术方式包括晶状体摘除术、前房型人工晶状体(intraocular lens, IOL)植入术、囊袋支撑装置联合IOL植入术及经巩膜IOL固定术等，这些手术方式各具特点，但目前最佳手术方式仍未有定论。既往大量文献表明，手术能够显著改善CEL患儿视力，但随着眼球的生长发育，CEL患儿术后屈光状态常出现近视漂移。此外，术后并发症如缝线暴露，IOL瞳孔夹持、IOL脱位、视网膜脱离等仍有可能发生，需要长期的严密随访。这些因素都使得CEL的治疗具有挑战性。为此，文章就CEL的手术方式、视力预后、术后屈光变化及术后并发症进行综述，旨在为该疾病的临床诊断及治疗提供更为全面和深入的理解。
Congenital ectopia lentis (CEL) is a rare genetic disorder characterized by the displacement of the lens from its normal anatomical position due to abnormalities in the lens zonular. As the progression of the disease, CEL can lead to high refractive error, even amblyopia, as well as other serious complications such as secondary glaucoma and retinal detachment. Currently, surgical intervention remains the primary method to improve the visual quality and prevent complications in children with CEL.Common surgical options include lens extraction, anterior chamber intraocular lens (IOL) implantation, IOL implantation combined with capsular tension devices, and transcleral fixation of IOL. Each surgical approach has its own characteristics, but there is currently no consensus on the best surgical method. Previous literature has shown that surgery can significantly improve vision in children with CEL; however, due to the growth of the eye, postoperative refractive status often experiences myopic shift. Additionally, complications such as suture exposure, IOL pupil capture, IOL dislocation, and retinal detachment may still occur, necessitating long-term close follow-up. These factors make the treatment of CEL challenging. This article reviews the surgical approaches, visual prognosis, postoperative refractive changes, and postoperative complications associated with CEL, aiming to provide a more comprehensive and in-depth understanding for the clinical diagnosis and treatment of this disease.
近年来，眼部电流刺激(electrical stimulation,ES)在不同方向的研究中逐渐揭示了其在多种视网膜疾病中的潜在治疗价值。其中，经角膜电刺激(transcorneal electrical stimulation,TES)作为一种非侵入性的治疗方法，能对视网膜、视神经、眼底血管及其相关结构产生积极的影响。TES能够改善视力，在保护感光细胞和减缓疾病进展方面显示出积极效果，提高患者的生存质量，还能够在不损伤眼球的情况下调节大脑中的神经元活动，为视网膜疾病的治疗提供一种新的选择。该文对近年来TES在视网膜色素变性(retinitis pigmentosa,RP)、年龄相关性黄斑变性(age-related macular degeneration,AMD)、视网膜血管病、青光眼以及视神经病变等疾病中的应用研究进行了综述。研究发现，TES治疗是一种安全且无需手术的辅助治疗工具，具有广泛的应用前景。该文旨在为临床医师提供一个全面的TES研究概述，并深入探讨其在眼科学领域的潜在应用价值。然而，TES治疗的具体机制仍需进一步探讨，以便更好地应用于临床实践。同时，未来研究还应关注TES与其他治疗方法相结合的效果，以期为患者提供更多有效的治疗选择。
In recent years, electrical stimulation of the eye (ES) has gradually revealed its potential therapeutic value in a variety of retinal diseasesin different directions. Among them, transcorneal electrical stimulation (TES), as a non-invasive treatment, can have a positive effect on the retina, optic nerve, fundus vessels and related structures. TES can improve vision, show positive effects in protecting photoreceptor cells and slowing disease progression, improve the quality of life of patients, and can regulate neuronal activity in the brain without damaging the eyeball, providing a new option for the treatment of retinal diseases. The research on the application on TES on retinitis pigementosa (RP), age-related macular degeneration (AMD), retinal angiopathy, glaucoma and optic neuropathy are reviewed in this article. It is found in the study that TES therapy is a safe and surgery-free adjuvant therapy tool, and has a wide application prospect. The purpose of this article is to provide clinicians with a comprehensive overview of TES research,and to explore its potential application value in the field of ophthalmology. However, the specific mechanism of TES therapy still needs to be further explored in order to better apply in clinical practice. At the same time, future studies should also focus on the effect of combining TES with other treatment methods, in order to provide more effective treatment options for patients.
房角镜辅助的内路360°小梁切开术(Gonioscopy-Assisted Transluminal Trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术，是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm's管后，利用微导管张力全周切开小梁网及Schlemm's管内壁，重建生理性房水流出通道，避免小梁网阻力，实现房水从前房直接进入集液管，通过增加房水流出机制降低眼压。GATT适应证广泛，主要应用于开角型青光眼，包括原发型开角型青光眼和继发性开角型青光眼，同时可运用于闭角型青光眼。GATT微创、不依赖滤过泡、能明显减少降眼压药物的使用、中远期疗效稳定、安全性高、较少发生威胁视力的并发症，可作为开角型青光眼的首选手术方式。本文将对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述，以期为其临床运用提供参考。
As a modifed trabeculotomy, Gonioscopy-Assisted Transluminal Trabeculotomy (GAT) is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years. GAT inserts a microcatheter (iTrack) into the Schlemm's canal and advance the catheter through the canal circumferentially 360°, then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal. Tis method can reduce intraocular pressure by increasing the outfow of aqueous humor. Te physiological outfow pathway of aqueous humor is reconstructed, which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber. With a wide range of indications, GAT is mainly used in open-angle glaucoma, including primary open-angle glaucoma and secondary open-angle glaucoma, and is also used in primary closed- angle glaucoma. Additionally, GATT can be the preferred surgical modality for open-angle glaucoma, as it has the following advantages: minimally invasive, independent of fltration bleb, can signifcantly reduce the use of medications, stable medium- and long-term efcacy, high safety, and has fewer sight-threatening complications. In order to provide a reference for clinical application, this article reviews the indications, mechanism of action, surgical procedures, efectiveness, complication and factors afecting therapeutic efect.
报告一例视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)合并人体免疫缺陷病毒(human immunodeficiency virus,HIV)感染/获得性免疫缺陷综合征(acquired immune deficiency syndrome,AIDS)，并通过文献复习，总结其发病机制、临床特征、治疗及预后。检索文献包括7篇英文文献(8个病例)，1篇中文文献，共报道9例NMOSD合并HIV感染/AIDS病例，结合本文报道的1例共10例，其中5例为女性，5例为男性，3例HIV感染/AIDS为新发，其他病例的HIV感染/AIDS发病均早于NMOSD。临床表现上，7例均为视神经炎和脊髓炎同时或相继发生，2例表现为单相病程或复发性脊髓炎，1例仅表现为双眼相继发生的视神经炎，10例患者头或脊髓MRI均有典型的视神经或脊髓异常信号，伴或不伴强化。2例患者未进行水通道蛋白4(aquaporin protein-4,AQP4)抗体IgG检测，其余8例中5例AQP4抗体阳性、3例阴性。针对AIDS的治疗，10例患者中，8例接受了高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)。针对NMOSD的治疗，10例患者中，急性期有8例患者接受糖皮质激素冲击治疗、3例患者接受血浆置换、2例接受丙种球蛋白治疗，序贯治疗期有6例患者接受免疫抑制剂治疗，其中1例因高胆红素血症停药。发生视神经炎的7例中，2例患者经治疗仍失明、5例视力部分恢复，发生脊髓炎的8例中，5例患者遗留截瘫或轻瘫、3例肌力部分恢复。1例因严重并发症去世。NMOSD合并HIV感染/AIDS临床较罕见，预后差，往往遗留严重的视力障碍及瘫痪等，临床治疗较为棘手，糖皮质激素和免疫抑制剂并非使用禁忌证，但制定治疗决策前需要充分考虑风险与获益的平衡。
A case of neuromyelitis optica spectrum disorders(NMOSD) complicated with human immunodeficiency virus(HIV) infection/acquired immunodeficiency syndrome(AIDS) was reported, and the pathogenesis, clinical characteristics, treatment and prognosis were summarized through the literature review. The retrieved literatures included seven English literatures (eight cases) and one Chinese literature, in which a total of nine cases of NMOSD co-infected with HIV infection/AIDS were reported. Combined with the case reported in this paper, the total number of cases was ten, among which five cases were female and five cases were male, three cases of HIV infection/AIDS were newly developed, and the other cases had earlier onset of HIV infection/AIDS than NMOSD. In terms of clinical manifestations, seven cases all had simultaneous or sequential optic nerve and myelitis, two patients presented with a uniphasic course or recurrent myelitis, and one case presented only with bilateral optic neuritis occurring sequentially in both eyes. All ten patients had typical abnormal signals of the optic nerve or spinal cord with or without enhancement on cranial or spinal MRI. Two patients did not undergo AQP4 antibody IgG testing , and of the remaining seven cases, five were positive for AQP4 antibodies and three were negative. For AIDS treatment, eight of the ten patients received highly active antiretroviral therapy(HAART). For NMOSD treatment, among the ten patients, eight patients received intravenous methylprednisolone,three patients received plasmapheresis, and two patients received intravenous immunoglobulin in the acute phase. Six patients received immunosuppressive therapy during the sequential treatment period, and one of them was discontinued due to hyperbilirubinemia. Of the seven cases with optic neuritis, two patients remained blind after treatment and five had partial recovery of vision. Of the eight cases with myelitis, five patients were left with paraplegia or mild paralysis, and three had partial recovery of muscle strength. One case died due to serious complications.NMOSD combined with HIV infection/AIDS is rare in clinic and has a poor prognosis. Patients are often left with severe visual impairment and paralysis. Clinical treatment is quite difficult, hormones and immunosuppressive agents are not considered as contraindications. Treatment decisions need to be made with fully considered about the balance of risks and benefits.
马方综合征(Marfan syndrome,MFS)是与晶状体异位有关的常见的全身性疾病，约50%~80%的MFS患者存在晶状体异位。该文报道一例21岁的男性患者，因患有MFS致双眼晶状体半脱位伴双眼并发性白内障，先后实施白内障摘除人工晶状体植入合并囊袋张力环悬吊固定术，术后保留低度近视，随访期间未发现眼压升高、人工晶状体严重移位及囊袋皱缩等并发症。
Marfan syndrome (MFS) is a common systemic disease associated with lens heterotopia, and about 50%~80% of Marfan patients have lens heterotopia. This article reports a case of a 21-year-old male patient who suffered from bilateral lens subluxation and concurrent cataract due to MFS, who underwent cataract extraction and IOL implantation with CTR suspension fixation was performed to preserve low-grade myopia after surger y. No complications such as increased intraocular pressure, intraocular lens severely displacement and capsular bag shrinkage were found during follow-up.
眼健康是国民健康的重要组成部分，包括盲在内的视觉损伤严重影响人民群众的身体健康和生活质量，加重家庭和社会负担，威胁社会经济生产活动，是涉及民生的重大公共卫生问题和社会问题。弱视作为幼儿期起病的主要视觉障碍性疾病之一，是致使青少年低视力的首要因素，影响青少年自身学业和心理健康，增加致盲风险，故做好弱视的预防及康复工作刻不容缓。通过梳理研究发现，国内外对弱视的传统治疗方法有遮盖疗法、屈光矫正、压抑疗法等，知觉学习、视功能训练、电子视频游戏、针灸等则是近年逐渐新兴起并被广泛运用的弱视康复治疗方法，近年来关于年龄对弱视康复治疗影响的相关研究也较多。通过整理前人研究成果，提出建立儿童青少年视力档案、建立五位一体弱视康复治疗布局模式、进行联合临床治疗青少年弱视的对策，以期为青少年弱视提供康复治疗手段参考和选择，促进青少年弱视康复治疗眼健康事业发展。
Eye health is an important part of national health. Visual impairment, including blindness, seriously affects people’s physical health and quality of life, increases the burden on families and society, threatens social and economic production activities, and is a major public health and social problem related to people’s livelihood. Amblyopia,as one of the main visual disorders in early childhood, is the primary factor causing low vision in adolescents, which affects their academic and mental health and increases the risk of blindness. Therefore, it is urgent to do a good job in the prevention and rehabilitation of amblyopia. By summarizing existing studies, it is found that traditional treatment methods for amblyopia at home and abroad include occlusion therapy, refractive correction, and depressive therapy, while perceptual learning, visual function training, electronic video games, acupuncture and so on are gradually emerging in recent years and widely used in recent years. There are numerous studies on the impact of age on the rehabilitation of amblyopia. By sorting out the previous research results, this paper puts forward the countermeasures of establishing visual acuity files for children and adolescents, establishing the five- in-one rehabilitation treatment layout model, and combining clinical treatment for adolescent amblyopia, in order to provide reference and choice for the rehabilitation treatment of adolescent amblyopia, and promote the development of the eye health cause of adolescent amblyopia rehabilitation.
斜视作为眼科的常见疾病之一，多发生于儿童群体。传统的诊疗手段高度依赖医生的个人经验，效率欠佳，患者依从性差，极易延误病情，严重影响患儿视功能及身心发育。近年来，人工智能(artificial intelligence, AI)与虚拟现实(virtual reality, VR)技术作为数字智能技术中的前沿科技手段，已广泛应用于眼科疾病的筛查、诊断和治疗环节，并正推动斜视诊疗体系向智能化转型。AI技术凭借强大的图像识别与分析能力可自动检测斜视类型和角度，更全面地评估病情。同时，通过分析大量数据预测手术参数，辅助制定个性化的手术方案，并且评估手术效果，大幅提升了斜视诊疗的精准度和效率；而VR技术则通过眼动追踪和动态场景模拟，实现更全面的眼位测量和动态分析。在手术中为医生提供清晰全面的眼部视图，借助模拟试验提升操作精准度，降低手术风险。借助沉浸式的视觉训练有效优化了斜视的康复效果。本文系统地回顾了数字智能技术在斜视诊疗方面的创新应用实例，深入探讨了AI和VR在斜视诊疗中独特的技术优势以及显著的临床价值。AI与VR技术的协同创新，为斜视诊疗模式带来了智能化的变革，在未来，有望为眼科医疗领域的发展注入新的动力，推动整个行业迈向新的高度。
Strabismus is a prevalent ophthalmic disorder predominantly affects children. For a long time, its diagnosis and treatment have heavily relied on traditional methods, which are highly dependent on clinical expertise. This reliance often leads to inefficiency, poor patient compliance, and delayed treatment. These issues can severely impair visual function and hinder psychosocial development. Recently, there have been significant advancements in artificial intelligence (AI) and virtual reality (VR), both of which are cutting-edge digital technologies. These innovations have brought about a revolution in the screening, diagnosis, and treatment of ophthalmic diseases, driving the intelligent transformation of strabismus management. AI demonstrates remarkable capabilities in the automated detection of strabismus types and deviation angles. It achieves this through robust image recognition and analysis techniques, enabling a comprehensive evaluation of the disease. By analyzing vast amounts of data, AI can predict surgical parameters, assists in personalized surgical planning, and objectively assesses postoperative outcomes. This significantly enhances diagnostic accuracy and therapeutic efficiency. At the same time, VR technology enables holistic ocular alignment measurements and dynamic analysis via eye-tracking and simulated dynamic environments. During surgical procedures, VR offers surgeons an enhanced visualization of ocular structures and improves operational accuracy through simulated trials. As a result, it helps reduce surgical risks. After surgery, immersive VR-based visual training programs can optimize rehabilitation outcomes. This review systematically examines innovative applications of AI and VR in strabismus care, highlighting their unique technical advantages and clinical value. The synergistic integration of AI and VR has catalyzed an intelligent paradigm shift in strabismus management. This shift promises to inject new momentum into ophthalmic medicine and propel the field towards unprecedented advancements.
目的：评估显微射频消融术治疗异位睫毛的临床疗效和安全性。方法：回顾性分析接受显微射频消融术治疗的18例异位睫毛患者资料，均采用美国Ellman公司Surgitron射频刀进行治疗，术后随访至少3个月。观察指标包括异位睫毛清除率、达到治愈所需治疗次数、并发症、患者满意度。采用Spearman等级相关分析评估患者基线特征与治疗次数的相关性。结果：共纳入18例患者30眼。显微射频消融术的术后即刻异位睫毛清除率达100%。5眼（16.7%）经单次治疗后达到治愈，11眼（36.7%）需要2次治疗达到治愈，13眼（43.3%）需要3次治疗达到治愈，1眼（3.3%）需要3次以上治疗达到治愈。主要并发症包括干眼13眼（43.3%）、睑缘炎症1眼（3.3%），未发现睑缘畸形、瘢痕等严重并发症。患者满意度调查显示非常满意16例（88.9%），基本满意2例（11.1%），总体满意度（非常满意+基本满意）达100%。相关性分析提示倒睫数量与达到治愈的治疗次数呈显著正相关（rs=0.672, P=0.002）。结论：显微射频消融术治疗异位睫毛具有精确定位、有效破坏毛囊、治疗时间短、创伤小、恢复快、安全性高等优点，患者满意度高，是治疗异位睫毛的有效方法。
Objective: To evaluate the clinical efficacy and safety of microscopic radiofrequency ablation in treating of distichiasis and aberrant lashes. Methods: We performed a retrospective analysis on 18 patients with trichiasis (distichiasis and aberrant lashes) who underwent microscopic radiofrequency ablation treatment. All patients were followed up for a minimum of 3 months after the operation. The outcome measures included trichiasis clearance rate, the number of treatment sessions needed to achieve success, complications, and patient satisfaction. Spearman rank correlation analysis was used to evaluate the correlation between the baseline characteristics of patients and the number of treatment sessions. Results: The study included 18 patients with a total of 30 eyes. Immediately after the operation, the trichiasis clearance rate achieved through microscopic radiofrequency ablation was 100%. Among the eyes, 5 eyes (16.7%) were successful treatment after just one session, 11 eyes (36.7%) required 2 treatment sessions, 13 eyes (43.3%) needed 3 treatment sessions, and 1 eye (3.3%) required more than 3 treatment sessions to achieve success. The major complications included dry eye in 13 cases (43.3%) and eyelid margin inflammation in 1 case (3.3%). Notably, no severe complications such as eyelid deformity or scarring were observed. According to the patient satisfaction survey, 16 cases (88.9%) reported being very satisfied, and 2 cases (11.1%) were basically satisfied, resulting in an overall satisfaction rate of 100%. The correlation analysis indicated that the number of trichiatic eyelashes was significantly positively correlated with the number of treatment sessions (rs=0.672, P=0.002). Conclusions: Microscopic radiofrequency ablation for distichiasis and aberrant lashes treatment boasts serveral advantages, including precise localization, effective destruction of hair follicle, short treatment duration, minimal trauma, rapid recovery, and high safety. With a high level of patient satisfaction, it serves as an effective treatment method for distichiasis and aberrant lashes.
