在大力发展精准医疗的时代背景下，北京大学第三医院眼科中心率先建立干眼精准医疗平台。通过规范和优化干眼诊疗流程，为患者提供个性化的治疗方案和预防指导意见，有效提高了干眼诊断的精确性与治疗的有效性，同时提升了干眼门诊接诊效能，改善了患者就诊体验。本文将从干眼精准医疗平台体系的建设内容、标准化的检查流程、个性化的诊疗方案等方面进行阐述，并结合实际临床案例，综合分析北京大学第三医院在干眼精准医疗方面进行的探索，展望干眼精准医疗平台的前景与未来。
In the era of developing precision medicine, the Ophthalmic Center of Peking University Third Hospital has taken the lead in establishing a dry eye precision medical platform. By standardizing and optimizing the diagnosis and treatment process of dry eye, this center provides personalized treatment plan and prevention guidance for patients, effectively improves the accuracy of dry eye diagnosis and the effectiveness of treatment, at the same time,improves the reception efficiency of dry eye clinic, and improves the patient’s clinic experience. In this paper, the construction content, standardized inspection process and personalized diagnosis and treatment scheme of dry eye precision medicine platform system will be described. Combined with the actual clinical cases, the exploration of the Peking University Third Hospital in dry eye precision medicine will be comprehensively analyzed, and the future of dry eye precision medical platform will be prospected.
间充质干细胞由于其独特的自我更新和多向分化能力，成为了一种替代无效的常规治疗的新兴治疗方法。间充质干细胞通过免疫调节、促修复、抗新生血管机制和细胞替代作用在眼表疾病中发挥作用，而不同来源的间充质干细胞其作用机制也不完全相同。迄今为止，已有8项注册的间充质干细胞治疗的临床试验应用于干眼、角膜烧伤、圆锥角膜等眼表疾病。
Due to its unique self-renewal and multi-directional differentiation capabilities, mesenchymal stem cells (MSCs) have become an emerging therapy that replaces of ineffective conventional options in treating multiple diseases. It plays an important role in ocular surface illnesses through a variety of functions, including immunoregulation, promoting repairing, anti-angiogenesis mechanisms, and cell replacement. MSCs from different sources have different mechanisms.So far, 8 registered clinical trials of MSCs therapy have been applied to treat dry eye, ocular burn, keratoconus and other ocular surface diseases.
血源性滴眼液是治疗干眼的一种有效的治疗方法。来源可分为自体、供体，其中供体来源又可分为成人外周血及脐带血，并以血清、富血小板血浆、血小板来源生长因子以及血小板裂解产物的形式制成。由于各种血液制品的原理及适应症不同，本文将对不同血源性滴眼液制品的制备及面临的挑战的共识问题进行解读。
Blood-based eye drops can be used effectively in the treatment of dry eyes. The sources of blood-based eye drops can be divided into autologous and donor, and donor sources can be divided into adult peripheral blood and umbilical cord blood, which are prepared in the form of serum, platelet-rich plasma, platelet-derived growth facters and platelet lysate. Due to the different principles and indications of various blood products, the consensus issues on the preparation and challenges of different blood-based eye drop products are reviewed.
干眼是以泪膜稳态丢失及伴随眼部不适症状为特征的最常见眼表疾病，泪膜不稳定、泪液高渗透性、眼表炎症及感觉神经异常为其主要病因。地夸磷索钠是一种P2Y2受体激动剂，能刺激黏蛋白及泪液分泌，其独特的作用机制为干眼的治疗开辟了新的方向，本文就地夸磷索钠近年的临床及基础研究进展作一综述。
Dry eye is one of the most common ocular surface diseases. It is characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play major etiological roles. Diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that promotes mucin and aqueous tear secretion. The unique pharmacological mechanism of diquafosol tetrasodium opens up a new direction for the medical therapies of dry eye. This article reviews the clinical therapeutic effect and research progress of diquafosol tetrasodium for the past few years.
在热带和亚热带国家，真菌性角膜炎是角膜盲的一个重要原因。随着现代医学的进展，早期真菌性角膜炎通过药物或者手术治疗后治愈率有了显著改善，但是很多真菌性角膜炎患者由于缺乏及时合理的治疗，病情变得迁延难治，预后较差。随着无数学者的努力，近年来在难治性真菌性角膜炎领域在抗真菌药物、给药方式及其他治疗方式上有了一些新的进展，目前可选的难治性真菌性角膜炎治疗方式各有特点及优劣之处。了解目前可用的抗真菌治疗方式、其适应证及不良反应等，是处理难治性真菌性角膜炎病例的必要条件。
Fungal keratitis is a significant cause of corneal blindness in tropical and subtropical countries. With the development of modern medicine, the cure rate of early fungal keratitis has been significantly improved after medical or surgical treatment. However, due to the lack of timely and reasonable treatment for many patients with fungal keratitis, the disease has become difficult to treat and the prognosis is poor. With the efforts of numerous scholars, some new advances have been made in the treatment of recalcitrant fungal keratitis in recent years, such as antifungal drugs and administration methods. At present, the treatment methods of recalcitrant fungal keratitis have their own characteristics, advantages and disadvantages. It is necessary to understand the available antifungal therapies, their indications and side effects for the treatment of recalcitrant fungal keratitis.
青光眼睫状体炎综合征(Posner-Schlossman syndrome，PSS)表现为单眼反复发作性非肉芽肿性前葡萄膜炎，伴有眼压升高，可发展为慢性继发性青光眼，最终导致视神经损伤。尽管PSS总体预后良好，但仍有部分患者因反复眼压骤升造成视神经损伤持续进展，甚至导致失明。目前，PSS的确切病因尚不明确，治疗方式以控制炎症及眼压为主。本文将从病因及治疗两方面阐述PSS的研究现状，以期为PSS相关基础研究及临床诊治提供思路及参考。
Posner-Schlossman syndrome (PSS), also called glaucomatocyclitic crisis, is characterized by recurrent non-granulomatous anterior uveitis, accompanied by elevated intraocular pressure. It is able to develop into chronic secondary glaucoma and eventually lead to optic nerve injury. Although the overall prognosis of PSS is favourable, there are still some patients whose optic nerve injury continues to progress and even lead to blindness due to recurrent attacks of ocular hypertension. At present, the exact cause of PSS is not clear, and the treatment is mainly to control inflammation and intraocular pressure. This article will elaborate the research status of PSS from two aspects of etiology and treatment to provide ideas and reference for the basic research clinical diagnosis and treatment of PSS.
目的：探索基于眼外伤急诊救治胜任力的教学模式。方法：通过分析眼外伤急诊救治的教学现状，结合医学生岗位胜任力特征，构建基于眼外伤急诊救治胜任力的教学体系。结果：基于胜任力构建的眼外伤急诊救治教学体系的优势在于一切以临床实际需求为出发点，使学生在临床实践能力、思辨能力、团队合作、自我认知、医学人文素养等几个方面得到提升，从而更好地胜任临床工作。结论：基于胜任力的教学模式可以全面提高培训医师眼外伤急诊救治的实际能力。
Objective: To explore the teaching mode based on competency in emergency treatment of ocular trauma.Methods: By analyzing the teaching status of emergency treatment for ocular trauma and combining with the competency characteristics of medical students, a competency-based teaching system for emergency treatment of ocular trauma was constructed. Results: The advantage of the teaching system for emergency treatment of ocular trauma based on competency was that it took actual clinical needs as the starting point, which could improve students’ clinical practice ability, critical thinking ability, team work, self-cognition, medical humanistic quality and other aspects, so as to be better qualified for clinical work. Conclusion: The teaching mode based on competency can comprehensively improve the practical ability of training doctors in emergency treatment of ocular trauma.
近视是危害儿童青少年视力最常见的眼部疾病，高度近视对视功能造成极大的威胁。近年来，我国近视发病率逐年升高，对近视筛查与防控的需求也不断增加，随着人工智能理论与技术的不断发展与成熟，可以辅助眼科医生进行近视筛查、诊断与治疗。本文将简要介绍人工智能在近视的筛查、预测、检测、病理性近视以及角膜屈光手术中的应用，浅谈了目前人工智能在研究中存在的可比度较低、影像要求较高、可解释性较低及隐私保护等问题，并展望人工智能在近视相关领域的应用前景。
Myopia is the most common ocular disease that harms the vision of children and adolescents. High myopia poses a great threat to visual function. The incidence of myopia in China has been increasing in recent years, and the demand for myopia screening, prevention and control has also expanded. With the continuous development of artificial intelligence theory and technology, Artificial intelligence can assist ophthalmologists in myopia screening, diagnosis and treatment. This review will briefly introduce artificial intelligence in the screening, prediction, and detection of myopia; also, the application in pathological myopia and corneal refractive surgery. This review will discuss some problems of current artificial intelligence research, such as low comparability, high image requirements, low interpretability, privacy protection, and the application prospects of artificial intelligence in myopia.
近视性黄斑病变(myopic maculopathy，MM)是近视最常见的并发症，也是影响病理性近视视功能下降的主要原因。目前，MM的分类系统尚不能完全解释患者黄斑部发生的多种变化，迫切需要一个全面、统一的分类系统来协助沟通和比较临床试验以及国际多中心研究的结果。随着眼底成像技术的发展与应用，最新的近视性黄斑病变分类，即ATN分类系统[萎缩(A)、牵拉(T)、和新生血管(N)]结合眼底照片与光学相干断层扫描(optical coherence tomography，OCT)图片，把黄斑病变分为3类，每一类又根据其严重程度进行分级，这对MM的诊断和治疗提供了较大的临床价值。
Myopic maculopathy (MM) is the most common complication of myopia, which is also the main cause of poor visual function in pathologic myopia. Presently, the classification system of MM cannot properly explain the numerous changes that occur in the patient’s macula. Therefore, a comprehensive and unified classification system is urgently needed to facilitate in communicating and comparing the results of clinical trials and international multicenter studies. With the development and application of fundus imaging technology, the latest classification of MM, namely ATN (atrophy, A; traction, T; neovascularization, N) classificationsystem, which combines fundus photographs and optical coherence tomography (OCT) images, classifies macular lesions into 3 categories according to its severity, generating greater clinical value for the diagnosis and treatment of MM.
目的：探讨PDCA循环管理模式在优化白内障日间患者诊疗流程中的应用与成效。方法：选取中山大学中山眼科中心白内障病区2018年9月至2019年12月收治的白内障日间患者400例作为试验对象，选择2018年9月至2019年4月200例患者作为优化前组，选择实施PDCA循环管理模式后的2019年5月至2019年12月的200例患者作为优化后组。统计并比较两组患者实施前后的术前检查时长、住院时长、术后第1天复诊路径及患者满意度。结果：PDCA循环管理法实施了7个月后，患者术前检查时长由优化前的(2.94±2.12) h降至(2.09±0.93) h，住院时长由优化前的(22.73±1.14) h 降至(5.22±1.29) h，差异均具有统计学意义( P <0.001)；患者满意度由优化前的92%上升至96%(P<0.05)；术后第1天，患者复查所需行走的路径缩短，由以前的172 m降至129 m。结论：实施PDCA循环管理模式能有效地改善白内障日间患者的诊疗流程，缩短患者诊疗时间，提高患者的满意度，值得临床推广。
Objective: To explore the application and effect of Plan-Do-Check-Act (PDCA) cycle management mode in optimizing the diagnosis and treatment process of cataract patients with daytime surgery. Methods: A total of 400 cases of patients with daytime surgery admitted to Department of Cataract, Zhongshan Ophthalmic Center,Sun Yat-sen University from September 2018 to December 2019 were selected as the experimental subjects. 200 patients from September 2018 to April 2019 were selected as the pre-optimization group, and 200 patients from May 2019 to December 2019 after the implementation of the PDCA cycle management mode were selected as the post-optimization group. Time of preoperative examination, length of hospital stay, the follow-up path in the first day after surgery and patient satisfaction were statistically compared between the two groups before and after implementation. Results: Seven months after the implementation of PDCA cycle management mode, the preoperative examination time decreased from (2.94±2.12) h to (2.09±0.93) h, and the length of hospital stay decreased from (22.73±1.14) h to (5.22±1.29) h, and the differences were statistically significant (P<0.001); the patients’ satisfaction increased from 92% to 96% (P<0.05); the follow-up path in the first day after operation was changed from the 13th floor (172 m) to the 3rd floor (129 m). Conclusion: The implementation of PDCA cycle management mode can effectively improve the diagnosis and treatment process of cataract patients with daytime surgery, shorten the diagnosis and treatment time and improve the satisfaction of patients, so it is worthy of clinical promotion.
