该文报道一例30岁的男性患者因“双眼自幼视力不佳，强光下视物模糊加重4年余”就诊，经过眼部检查评估，诊断为双眼瞳孔残膜、双眼屈光不正。患者接受一期双眼瞳孔残膜切除、二期双眼行有晶状体眼后房型环曲面人工晶状体(toric implantable collamer lens,TICL)植入手术，术后视力恢复良好。文章回顾了该例患者的诊治过程，为临床屈光不正同时伴有瞳孔残膜患者的诊治提供参考。
A 30-year-old male patient presented at our institution with a history of poor vision in both eyes since childhood, exacerbated by blurriness under bright light for over four years. Following a comprehensive ophthalmic examination, the patient was diagnosed with bilateral pupillary membrane remnants and refractive errors. The patient underwent a two-stage surgical intervention, starting with the removal of the pupillary membrane remnants, followed by the implantation of toric implantable collamer lenses (TICL) in the posterior chamber of the lensless eyes. Postoperative outcomes were favorable, with significant improvement in visual acuity. This article reviews the therapeutic journey of the patient, offering insights into the diagnosis and management of individuals with concurrent refractive anomalies and pupillary membrane remnants, thereby contributing to the clinical discourse on the subject.
随着角膜疾病治疗技术的不断进步，前弹力层移植技术(包括Inlay和Onlay技术)已成为晚期圆锥角膜治疗的重要手段，能有效改善患者的角膜地形图和视力结果，稳定角膜扩张，提高患者的生活质量。该文综述了前弹力层移植技术的理论基础、移植物的来源与制备技术、手术技术、临床疗效以及相关并发症，为晚期圆锥角膜的治疗提供了新的视角。研究表明，这种先进的移植技术相较于传统方法，在减少手术风险、简化手术流程以及加快术后恢复方面具有明显优势，特别是在降低异体移植物排斥反应及手术并发症的风险上，前弹力层移植表现出色。Onlay技术作为一种近期开发的新方法，其独特优势是无需剖离角膜，更好地保护角膜结构。此外这种技术的高度适应性和可逆性，为患者提供了更多的治疗选择和更好的视觉恢复。尽管如此，技术细节如移植物的尺寸和形状定制、手术深度的最优化等方面仍需进一步研究和优化，以提高整体治疗效果。
With the continuous advancement of corneal disease treatment technology, Bowman layer transplantation (including Inlay and Onlay technology) has become an important means for the treatment of advanced progressive keratoconus, which can effectively improve the corneal topography and visual acuity of patients, stabilize corneal dilation, and improve the quality of life of patients. Tis article reviews the theoretical basis of Bowman layer transplantation, the source and preparation of grafs, surgical techniques, clinical efcacy, and related complications, which provides a new perspective for the treatment of advanced keratoconus. It is stated in the research that this advanced transplantation technique has significant advantages over traditional methods in reducing surgical risks, simplifying the surgical procedures, and improving postoperative recovery. Especially in reducing the risk of allograft rejection and surgical complications, the bowman layer transplantation performs excellently. As a novel developed method, Onlay technology has the unique advantage of eliminating the need to dissect the cornea, which beter protects the corneal structure. In addition, due to the highly adaptable and reversible nature of this technique, it provides patients with more treatment options and beter visual recovery. However, in terms of technical details such as customizing the size and shape of the transplant, optimizing the surgical depth, etc., it is needed to conduct further research and optimization to improve the overall treatment efect.
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.
超声睫状体成形术(ultrasound cyclo-plasty,UCP)，是一种新型的睫状体治疗手术，目前已应用于治疗不同类型的青光眼。UCP通过微型高强度聚焦超声(high-intensity focused ultrasounds,HIFU)设备，高度选择性作用于睫状体，实现温和可控、稳定的降眼压(intraocular pressure,IOP)效果。相较于传统的睫状体破坏手术，UCP具有操作简单、耗时短、可重复性高及安全性高的特点。该文从UCP的由来、结构特点、作用机制、疗效、特点及安全性对UCP治疗不同类型青光眼的研究进展进行综述。
Ultrasound cyclo-plasty (UCP) is a novel technique for ciliary body surgery, which has been applied to treat different types of glaucoma. UCP works on the cilary body highly and selectively with the micro high-intensity focused ultrasounds (HIFU) to achieve a mild, controllable, and stable intraocular pressure(IOP) effect. Compared with the traditional ciliary body destruction surgery, UCP is simple operation, efficiency, high repeatability, and high safety.This article reviews the research progress in the UCP treating various types of glaucoma, from its origin, structural characteristics, mechanism, efficacy, characteristics, and safety.
睑板腺功能障碍(meibomian gland dysfunction，MGD)是眼科常见疾病，是蒸发过强型干眼的主要原因。基于人群流行病学的调查显示：MGD亚洲的发病率为46.2%~69.3%。目前，MGD治疗的方式包括眼睑清洁、热敷、睑板腺按摩、人工泪液、抗生素等，其中热敷为常用的家庭治疗方法。由于不同的热敷方式、温度、时间、频次及依从性，导致应用热敷治疗MGD到目前为止还没有统一标准。另外，热敷的不良反应如视物模糊、皮肤烫伤等，也没有引起临床足够重视。因此，为提高热敷的临床疗效及减少其不良反应，未来进行热敷的规范化指导或治疗很有必要。
Meibomian gland dysfunction (MGD) is a common ophthalmic disease, which is the main cause of evaporative dry eye. Population-based studies have suggested that the prevalence of MGD is high in Asia, with a reported incidence of 46.2% to 69.3%. Current modalities of MGD treatment include lid hygiene, warm compresses,massage, artificial lubricants, systemic and topical antibiotics, etc., among which warm compress is a common at-home treatment. Due to different eyelid warming methods, temperature, durations of heat application, frequency and compliance, there is no uniform standard for the application of warm compress to the treatment of MGD.In addition, adverse events of warm compress, such as blurred vision and thermal damage, have not attracted enough attention in clinical practice. Therefore, in order to improve the clinical efficacy of warm compress and reduce its adverse events, it is necessary to conduct standardized guidance or treatment of warm compress in the future. Based on the above considerations, this article will briefly review the application of warm compress to the treatment of MGD.
目的：探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题，以期改进培训方式。方法：以2020年4月在中山大学中山眼科中心培训的154名学员为对象，进行问卷调查，采用SPSS 20.0统计学软件进行数据分析。结果：共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%；住培则显著高于前者，分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断，90.8%的专硕选择了临床诊断(P=0.007)，94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001)；而住培仅为去除囊壁(P<0.001)。结论：睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高，并根据各类型学员的临床能力和认知差异，进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
目的：探讨睑结膜乳头切除联合自体游离结膜瓣移植术治疗春季角结膜炎的临床效果。方法：在显微镜下对11例(22眼)春季角结膜炎患者行睑结膜乳头切除联合自体游离结膜瓣移植术，观察治疗效果。结果：术后随访36~48个月，11例(22眼)春季角结膜炎患者中，治愈19眼(86.36%)，有效2眼(9.09%)，无效1眼(4.55%)，总有效率95.45%。结论：睑结膜乳头切除联合自体游离结膜瓣移植术是治疗春季角结膜炎安全、有效的方法。
Objective: To evaluate the efficacy and safety of surgical resection of conjunctival papillae combined with autologous conjunctival graft in the treatment of vernal keratoconjunctivitis (VKC). Methods: All 11 cases (22 eyes) with VKC were treated with surgical resection of conjunctival papillae in combination with autologous conjunctival graft. Clinical efficacy and safety were evaluated. Results: After 36 to 48 months of follow-up, 19 eyes were cured (86.36%), 2 eyes were improved (9.09%), and 1 eye was ineffective (4.55%). The total effective ratewas 95.45%. Conclusion: Surgical resection of conjunctival papillae combined with autologous conjunctival graft is efficacious and safe in the treatment of VKC.
目的：观察黏膜瓣泪小点成形术用于治疗慢性泪小管炎的疗效。方法：回顾性病例系列研究。收集2018年1月至2020年12月中山眼科中心眼整形科就诊的44例慢性泪小管炎患者的临床资料，分析其性别、年龄、患病眼别、临床症状、泪道冲洗结果等临床特点。采用黏膜瓣泪小点成形术进行治疗，术后随访评估其疗效。结果：44例慢性泪小管炎患者以女性为主(男女比例1:3.9)，单侧发病，多累及下泪小管(上下泪小管比例1:3)，主要表现为分泌物增多、溢泪以及内眦部位红肿，结石阳性率为95.7%，病原微生物检查结果显示以放线菌感染为主(78.3%)。大部分患者术后1周内症状得到明显改善，其中1例上下泪小管炎患者于术后2个月出现上泪小管炎复发。总体治愈率为97.8%，随访时间为(20.7±10.9)个月。结论：黏膜瓣泪小点成形术治疗慢性泪小管炎的临床疗效确切，方法可靠。
Objective: To evaluate the efficacy of mucosal flap punctoplasty in patients with chronic canaliculitis. Methods: In this retrospective serial case study, the clinical data of 44 patients with chronic canaliculitis were collected from the Oculoplastic Department of Zhongshan Ophthalmic Center at Sun Yat-sen University between January 2018 and December 2020. Demographic data such as gender, age, affected eye, clinical presentations and lacrimal duct irrigation results were analyzed. The efficacy of the procedure, symptom resolution and complications were assessed. Results: Of the 44 patients, most (male:female 1:3.9) were female, and the disease most often (upper:lower 1:3) involved the lower lacrimal canaliculus of only one eye. Main symptoms included increased secretion, tearing, and swelling of the inner canthus. Stones were present in 95.7% of patients and Actinomyces israelli was found to be the most common pathogen (78.3%). Most patients’ symptoms improved significantly within 1 week after surgery. Only one patient, who had infections in both the upper and lower canaliculi, had recurrence of upper canaliculitis 2 months after the surgery. The overall cure rate was 97.8%, and the follow-up time was (20.7±10.9) months. Conclusion: Mucosal flap punctoplasty is an efficacious and reliable method in the treatment of chronic canaliculitis.
目的：观察和评价改良联合筋膜鞘(combined fascial sheath，CFS)悬吊术治疗复发性上睑下垂的可行性和临床效果。方法：纳入2017年3月至2020年3月于河北省眼科医院眼整形门诊就诊的26例复发性重度上睑下垂患者(32只眼)，均采用改良CFS悬吊术予以矫正。术后随访1年，分别于术后1个月、3个月、6个月及1年时复诊，对患者术后上睑缘中点到角膜反光点的距离(marginal reflex distance-1，MRD1)、眼皮折皱深度、长度、弧度和并发症等情况为主要观察指标给予记录和效果评估。结果：26例患者共32只患眼，临床治愈27只眼(84.4%)，改善4只眼(12.5%)，无效1只眼(3.1%)，对1只无效眼术后6个月进行再次调整，调整后达到临床治愈标准。1例出现结膜脱垂，经过药物与加压包扎治疗后结膜脱垂症状消失，无暴露性角膜炎或其他并发症发生病例。结论：改良CFS悬吊术矫正复发性重度上睑下垂，具有操作简单、创伤小、治疗效果确切、并发症少等优点，值得临床推广与应用。
Objective: To observe and evaluate the feasibility and clinical effect of modified combined fascial sheath (CFS) suspension on the treatment of recurrent severe blepharoptosis. Methods: A total of 26 patients (32 eyes) with recurrent severe ptosis treated in Hebei Eye Hospital from March 2017 to March 2020 were included. All patients were corrected by modified CFS suspension. The patients were followed up for 1 year, and returned to the hospital at 1 month, 3 months, 6 months and 1 year respectively. The marginal reflex distance-1 (MRD1), eyelid crease depth, length, radian, and complications were recorded as the main observation indexes and the effect was evaluated. Results: In the 32 eyes of 26 patients, 27 eyes (84.4%) were completely corrected, 4 eyes (12.5%) were improved, while 1 eye (3.1%) had no improvement, the invalid eye was adjusted again 6 months after operation, and reached the effective standard after adjustment. Conjunctival prolapse occurred in 1 case, and the symptoms of conjunctival prolapse disappeared after the treatment with drugs and pressure dressing, and no case of exposure keratitis or other complications occurred. Conclusion: Modified combined fascial sheath suspension is an effective method on the treatment of recurrent severe blepharoptosis with the advantages of simple operation, less trauma, definite therapeutic effect, and fewer complications, which is worthy of clinical promotion and application.
