目的：探讨思政引领教学法在五年制临床定向医学生眼科学见习中的应用效果。方法：研究于2023年3月在首都医科大学石景山教学医院进行，选取该年度参加见习的37名五年制临床定向医学生为研究对象。研究将见习课程随机分为两组：传统思政教学法组和思政引领教学法组。传统思政教学法组在第一次见习课中采用传统方式，涵盖眼的组织解剖、视神经和视路疾病、眼外肌疾病与弱视、眼外伤等内容；思政引领教学法组则在第二次见习课中采用新的教学方法，涵盖眼表疾病、外眼疾病、眼视光学、视网膜病等内容。见习结束后，通过试卷测试评估学生的眼科理论知识、见习技能及思政应用能力，并采用李克特十级量表评估学生对思政教学的认知及满意度。结果：思政引领教学法组在思政成绩(9.29±0.37 vs. 6.83±0.50)和总成绩(85.14±4.84 vs. 81.86±4.94)上均优于传统思政教学法组(P <0.05)，且在李克特十级量表6个维度的评分中均显著更高(P 均<0.001)；在眼科理论知识和见习技能方面，思政引领教学法组成绩均高于传统思政教学法组，但差异无统计学意义(P >0.05)。结论：思政引领教学法能显著提升学生对课程思政的认知、接受度和满意度，是一种有效的医学教育课程思政实践方式。通过将思政元素系统化地融入眼科见习课程，不仅可以增强学生的思政素养，还能提升其职业责任感和服务意识，为培养适应基层医疗需求的高素质医学人才提供了有力支持。
Objective: To explore the application effects of ideological and political education (IPE)-led teaching methods in ophthalmology clerkship among five-year clinical medicine students with directional training. Methods: The study was conducted in March 2023 in the Shijingshan Teaching Hospital of Capital Medical University. A total of 37 fiveyear clinical medicine students with directional training who participated in the clerkship in that academic year were selected as the research subjects. The clerkship courses were randomly divided into two groups: the traditional IPE teaching method group and the IPE - led teaching method group. The traditional IPE teaching method group adopted the traditional teaching approach in the first internship session, covering topics such as the histological anatomy of the eye, diseases of the optic nerve and visual pathway, extraocular muscle diseases and amblyopia, and ocular trauma. The IPE-led teaching method group employed a new teaching method in the second internship session, covering topics such as ocular surface diseases, external eye diseases, optometry, and retinal diseases. Following the clerkship, students' ophthalmology theoretical knowledge, practical skills, and IPE application abilities were assessed through written examinations, and their perceptions and satisfaction with the IPE teaching were evaluated using a 10-point Likert scale. Results: The IPE - led teaching method group demonstrated significantly higher scores in IPE performance (9.29±0.37 vs. 6.83±0.50) and overall performance (85.14±4.84 vs. 81.86±4.94) compared with the traditional IPE teaching method group (P < 0.05), and significantly higher ratings across all six dimensions of the 10-point Likert scale (all P < 0.001). In terms of ophthalmology theoretical knowledge and clinical skills during the clerkship, the IPE - led teaching method group achieved higher scores than the traditional IPE teaching method group, but the differences were not statistically significant (P > 0.05). Conclusions: The IPE-led teaching method significantly enhances cognition, acceptance, and satisfaction among students with IPE. This approach effectively integrates ideological and political elements into medical education. By systematically embedding them into the ophthalmology internship curriculum, it enhances students’ ideological literacy, professional responsibility, and service awareness, thereby supporting the cultivation of high-caliber medical talents equipped for grassroots healthcare.
背景：目前已有研究报道了一种MATLAB的定制算法，用于Triton光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)图像的中心凹无血管区(fovea avascular zone，FAZ)的自动测量。由于这种算法非开源，且难以获取，因而大大限制了其在临床实践和科学研究中的应用。本研究提出一种用于Triton OCTA图像的FAZ自动分割的开源算法，即Smooth Level Sets macro(SLSM)算法，并将其测量结果与MATL AB和人工方法相比较，评估该算法分割的准确性和可靠性。方法：纳入35位健康受试者的35只健眼，选用Triton OCTA机器中的3 mm×3 mm扫描模式，对其黄斑区进行连续4次扫描。分别用人工和自动方法(包括MATL AB和SLSM)，测量浅层毛细血管图像中FAZ的面积、周长和圆度。分析各种自动算法的准确性、重复性，以及与人工方法结果的一致性。结果：SLSM算法的准确性仅低于人工方法，而高于MATLAB算法(Dice系数：人工方法，0.9568；SLSM，0.9506；MATL AB，0.9483)。SLSM和MATL AB测量FAZ面积的重复性均很高[组内相关系数(intraclass correlation coefficient，ICC)：SLSM，0.987；MATLAB，0.983]。SLSM、MATLAB测量FAZ面积的结果均与人工方法呈很高的一致性(ICC：SLSM，0.973；MATL AB，0.968)。结论：SLSM在Triton OCTA图像的FAZ自动分割中的准确性高于MATL AB，其测量结果与人工测量结果很相近。作为免费和开源的资源，SLSM有望成为Triton OCTA图像中有效可靠的FAZ自动分割和测量方法。
Background: Previous studies have proposed an automated customized program named MATLAB used in the foveal avascular zone (FAZ) measurements in Triton optical coherence tomography angiography (OCTA) images. But it is not open-source and not easy to obtain, which will largely restrict its application in clinical practice and medical research. In this study, we aimed to investigate the feasibility of the Smooth Level Sets macro (SLSM), a free and open-source program, and compared with the manual measurements and MATLAB in the FAZ quantification in Triton OCTA. Methods: Thirty-five eyes of 35 healthy subjects were scanned four times continuously using Triton OCTA. Manual and automated methods including the SLSM and MATLAB were used in the FAZ metrics (area, perimeter, and circularity) of the superficial capillary plexus. The accuracy, repeatability of all methods, and agreement between automated and manual methods were analyzed. Results: The SLSM presented higher accuracy with a higher average Dice coefficient (0.9506) than MATLAB (0.9483), which was just second to the manual method (0.9568). Both the SLSM [intraclass correlation coefficient (ICC) =0.987; coefficient of variation (CoV) =3.935%] and MATLAB (ICC =0.983; CoV =4.165%) showed excellent repeatability for the FAZ area. They also had excellent agreement with manual measurement (SLSM, ICC =0.973; MATLAB, ICC =0.968). Conclusion: The SLSM exhibits better accuracy than MATLAB in the automated FAZ measurement in Triton OCTA, the results of which were comparable to those obtained by manual measurement. This free and open-source program may be an accessible and feasible option for automated FAZ segmentation on Triton OCTA images.
在感染性眼科疾病的诊疗过程中，商品化眼用制剂尚未能完全满足临床治疗需求，在治疗一些现有眼用制剂未能满足治疗需求的感染性眼病时，需要采用临时配制的滴眼液来进行治疗。由于目前国内尚无临时配制滴眼液的规范或者标准，广东省药学会眼科药学专家委员会组织相关专家讨论，制定了治疗感染性眼部疾病临时配制滴眼液专家共识，以提升临床所需临配制剂的可及性，供国内从事临时配制滴眼液相关工作的同行借鉴。
Commercial eye drops fail to fully meet the therapeutic requirements for infectious ocular diseases. When treating certain infectious ocular diseases where existing ophthalmic preparations are inadequate, extemporaneously prepared eye drops become necessary. Given the absence of regulations or standards for extemporaneously prepared eye drops in China, the Ophthalmic Pharmacy Expert Committee of the Guangdong Pharmaceutical Association organized relevant experts relevant experts to establish a standard for the extemporaneous preparation of eye drops after rigorous discussions. This initiative aims to enhance the accessibility of extemporaneously prepared eye drops and provide reference for ophthalmologists, pharmacy workers, and users of ophthalmic extemporaneously preparations.
随着人工智能(artificial intelligence，AI)技术的快速发展，基于深度学习(deep learning，DL)和机器学习的AI技术在医学领域上的应用受到了广泛的关注。AI在眼科的应用也逐渐向更全面更深入的层次发展，通过角膜断层扫描、光学相干断层扫描、裂隙灯图像等技术，AI在对角膜病变、结膜病变、白内障、青光眼等眼部疾病的诊断和治疗方面都表现出了良好的性能。然而AI在眼科的应用方面也存在一些诸如结果可解释性的欠缺、数据集标准化的缺乏、数据集质量的不齐、模型适用性的不足和伦理问题等挑战。在5G和远程医疗飞速发展的时代，眼科AI同时也有许多新的机遇。本文综述了AI在前段眼科疾病中的应用、临床实施的潜在挑战和前景，为AI在眼科领域的进一步发展提供参考信息。
With the rapid development of artificial intelligence (AI) technology, the application of AI technology based on deep learning (DL) and machine learning (ML) in the medical field has received widespread attention. The application of AI in ophthalmology is gradually being shifted to a more comprehensive and in-depth level. Trained on corneal tomography, optical coherence tomography (OCT), slit-lamp images, and other techniques. AI can achieve robust performance in the diagnosis and treatment of corneal lesions, conjunctival lesions, cataract, glaucoma and other ophthalmic diseases. However, there are also some challenges in the application of AI in ophthalmology, including the lack of interpretability of results, lack of standardization of data sets, uneven quality of data sets, insufficient applicability of models and ethical issues. In the era of 5G and telemedicine, there are also many new opportunities for ophthalmic AI. In this review, we provided a summary of the state-of-the-art AI application in anterior segment ophthalmic diseases, potential challenges in clinical implementation and its development prospects, and provides reference information for the further development of artificial intelligence in the field of ophthalmology.
视神经属于中枢神经的一部分，损伤后难以再生。视神经损伤通常伴随视网膜神经节细胞(retinal ganglion cells，RGCs)的持续性凋亡及视神经变性坏死，引起视力损害甚至完全失明。目前针对视神经再生的基础研究主要集中于保护和维持视神经损伤后RGCs的存活、促进RGCs轴突再生及重建视神经功能。本文以RGCs保护、轴突再生及视神经功能重建等为关键词，查询国内外最新视神经再生研究类文献，并分析整理，从抗氧化应激、提供外源性细胞因子、炎症刺激、抗胶质瘢痕、基因调控等方面阐述近年的视神经再生研究进展，以期对后续的基础研究开展及临床转化有所帮助。
Optic nerves are a part of the central nervous system, which is difficult to regenerate after injury. Optic nerve injury is usually accompanied by continuous apoptosis of retinal ganglion cells (RGCs) and degeneration or necrosis of optic nerves, resulting in visual impairment or even complete blindness. At present, the basic research on optic nerve regeneration mainly focuses on protecting and maintaining the survival of RGCs after optic nerve injury, promoting RGCs axon regeneration, and reconstructing optic nerve function. In this paper, RGCs protection,axon regeneration, and optic nerve function reconstruction are used as key words to collect the latest domestic and foreign literatures on optic nerve regeneration. The research progress of optic nerve regeneration in recent years was reviewed from the aspects of antioxidant stress, provision of exogenous cytokines, inflammatory stimulation, anti-glial scar, gene regulation and so on, in order to help the follow-up basic research and clinical translation.
目的: 探讨白内障手术患者围手术期非甾体抗炎药（non-steroidal anti-inflammatory drugs, NSAIDs）滴眼液应用的合理性，为优化临床用药方案提供依据。方法：采用回顾性研究方法，分析郑州市第二人民医院2024年100例（100眼）行白内障超声乳化并人工晶状体植入手术患者的临床数据，依据药品说明书、《我国白内障围手术期非感染性炎症反应防治专家共识(2015年)》《中国成人白内障摘除手术指南（2023年）》《中国激光角膜屈光手术围手术期用药专家共识（2024年）》等指南/共识制定评价标准，评价NSAIDs滴眼液的用药频次、疗程及术前预防性抗炎处理的规范性。结果：35%的病例存在用药不合理，共发现88项问题，包括用药频次错误（7.96%）、超疗程（22.72%）及术前用药不当（69.32%）。其中，65%糖尿病患者术前未启动NSAIDs预处理，41%非糖尿病患者术前1 d使用NSAIDs；溴芬酸钠滴眼液疗程超过10天者占20.45%，可能增加肝损伤风险。结论：医疗机构应采取积极有效措施，如制定个体化用药方案、加强合理用药培训、开展专项处方点评等，切实促进NSAIDs滴眼液在白内障手术患者围手术期的合理使用，保障患者的用药安全与治疗效果，提高医疗服务质量和患者满意度。
Objective: To investigate the rationality of perioperative application of non-steroidal anti-inflammatory drugs (NSAIDs) eye drops in patients undergoing cataract surgery, thereby providing evidence for optimizing clinical medication protocols. Methods: A retrospective study method was used to analyse the clinical data of 100 patients (100 eyes) who underwent cataract ultrasonoemulsification with IOL implantation in 2024 at the Second People's Hospital of Zhengzhou City, and the evaluation criteria were developed based on the instructions of the medication, the Chinese expert consensus on prevention and management of non-infectious inflammatory responses in the perioperative period of cataract surgery (2015), the Chinese guideline for cataract surgery in adults (2023), and the Chinese expert consensus on the perioperative medication in laser corneal refractive surgery(2024)" and other guidelines/consensus to develop evaluation criteria to evaluate the standardisation of NSAIDs eye drops in terms of frequency of dosing, duration of treatment, and preoperative prophylactic anti-inflammatory treatment. Results: Irrational medication use was identified in 35% of cases, with a total of 88 issues categorized as follows: incorrect dosage frequency (7.96%), prolonged treatment duration (22.72%), and inappropriate preoperative medication (69.32%). Notably, 65% of diabetic patients failed to initiate NSAIDs pretreatment preoperatively as recommended by guidelines, while 41% of non-diabetic patients received NSAIDs one day before surgery. Prolonged use of bromfenac eye drops (>10 days) was observed in 20.45% of cases, potentially increasing the risk of liver injury. Conclusions: Medical institutions should take active and effective measures, such as formulating individualised medication plans, strengthening training on rational use of medication, and carrying out special prescription reviews, etc., to effectively promote the rational use of NSAIDs eye drops in the perioperative period of patients undergoing cataract surgery, to safeguard the safety of patients' use of medication and therapeutic efficacy, and to improve the quality of healthcare services and patients' satisfaction.
目的：分析喉罩在肥胖患者眼科日间手术中的应用特点。方法：选择 2021 年 1 月— 2024 年 3 月在中山大学中山眼科中心行日间眼科手术 且体质量指数（body mass index，BMI）≥25 kg/m2的男性患者进行分析，将患者分为2组：超重组（BMI 25~<30 kg/m2）及肥胖组（BMI≥30 kg/m2）。比较两组患者入室时（T1）、诱导后（T2）、喉罩置入后（T3）、手术开始时（T4）、手术开始10 min（T5）、手术结束时（T6）、入麻醉恢复室（post-anesthesia care unit，PACU）（T7）、喉罩拔除时（T8）的血流动力学和血氧饱和度变化情况；并分析喉罩置入后（T3）、手术开始时（T4）、手术开始10 min（T5）、手术结束时（T6）和喉罩拔除时（T8）患者的呼吸参数变化情况，记录两组患者的喉罩通气成功率及复苏室的停留时间。结果：纳入 118 例患者，其中超重组 57 例、肥胖组 61 例。两组均未出现喉罩通气失败病例，肥胖组在T3、T4、T5、T6以及T8等时点气道峰压均高于超重组（P < 0.05）；肥胖组的呼吸道不良事件发生率高于超重组（P < 0.05）。两组患者围术期生命体征平稳（P > 0.05），复苏室停留时间在组间比较差异无统计学意义（P > 0.05）且均顺利日间手术离院。结论：喉罩通气下全身麻醉能安全应用在肥胖患者眼科日间手术中，高BMI与高气道峰压相关。
Objective: General anesthesia using laryngeal mask airway (LMA) ventilation can facilitate ambulatory ophthalmic surgery, however, there remains debates about the use of LMA for obese patients. This study retrospectively analyzed the application of LMA in obese patients for ambulatory ophthalmic surgery. Methods: In this retrospective study, we analyzed all patients with a BMI≥25 kg/m2 who underwent ambulatory ophthalmic surgery under general anesthesia at the Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2021 to March 2024. The patients were divided into two groups: overweight group (BMI 25~<30 kg/m2) and obese group (BMI ≥30 kg/m2) . We compared the changes in hemodynamics and oxygen saturation at the several time points, baseline after entering operating room (T1), anesthesia induction (T2), LMA insertion (T3), start of surgery (T4), 10 minutes after surgery (T5), surgery completion (T6), transfer to PACU (T7), and LMA removal (T8);and analyzed the changes in respiratory parameters of the patient at T3, T4, T5, T6, and T8 time points between both groups. We also observed the differences in success rate of LMA insertion and ventilation and PACU stay time as well as time to discharge home between two groups. Results: 118 cases were found suitable for the final analysis and divided into overweight group (n=57) and obese group (n=61). All patients in the two groups uneventfully completed the ophthalmic ambulatory surgery and discharged home under the laryngeal mask airway ventilation, none of patients in both group displayed LMA ventilation failure. The hemodynamics and oxygen saturation in both groups were stable during perioperative period(P > 0.05). The peak airway pressures in obese group were dramatically increased than in overweight group at T3, T4, T5, T6 and T8 time points (P < 0.05), and the incidences of adverse respiratory events in obese group were significant higher than in overweight group （P < 0.05）. The PACU stay time was comparable in both groups (P > 0.05). Conclusion: LMA can be safely used for obese patients undergoing ophthalmic surgery, high BMI is related to high peak airway pressures.
人工智能(artificial intelligence，AI)在白内障手术中的应用越来越广泛，二者结合对于白内障手术的术前诊断和分级管理、术中人工晶状体选择、位置预测及术后管理(视力预测、并发症预测及随访)、手术培训和教学方面均起到巨大的促进作用。诚然，AI在与白内障手术相关的管理、分析和研究中还面临着许多问题，但其广泛的应用前景不可忽视。现对AI在白内障手术治疗和教学中的应用做以总结，并对其未来的发展做出展望。
Artificial intelligence (AI) has been widely used in cataract surgery. The combination of the two can play a great role in improving preoperative diagnosis, grading management of cataract surgery, intraoperative intraocular lens selection and location prediction, postoperative management (vision prediction, complication prediction and follow-up), surgical training and teaching. It is true that AI still faces many problems in the management, analysis and research related to cataract surgery, but its broad application prospects cannot be ignored. This review summarizes the application of AI in cataract surgery and teaching, and the future prospects of AI.
目的：利用生物信息学方法分析与葡萄膜恶性黑色素瘤转移相关的非编码RNA，以及它们作为竞争性内源RNA的作用机制。方法：从癌症基因组图谱(The Cancer Genome Atlas，TCGA)数据库下载80例葡萄膜恶性黑色素瘤患者的RNA测序数据和临床资料，采用edgeR算法分析转移与非转移患者组织中差异表达(differentially expressed，DE)的长链非编码RNA(lncRNA)、微小RNA(miR)和mRNA，并构建lncRNA-miR-mRNA的竞争性内源RNA(competing endogenous RNA，ceRNA)调控网络，基因富集分析和通路分析研究网络中mRNA的生物学功能。Kaplan-Meier生存曲线分析ceRNA网络中核心RNA与生存率的关系。结果：从发生远处转移的葡萄膜恶性黑色素瘤样本中，共鉴定出346个上调的mRNA，118个下调的miR和45个上调的lncRNA。其中67个mRNA，7个miR和30个lncRNA相互组合形成616个ceRNA单元，并形成了一个具有181条边线ceRNA网络。基因富集分析表明：网络中的mRNA富集在肿瘤生成和转移相关的几个基因本体(Gene Ontology)和信号通路。拓扑分析确定了6个核心lncRNA(LINC00861、LINC02421、BHLHE40-AS1、LINC01252、LINC00513和LINC02389)和3个核心mRNA(UNC5D、BCL11B和MTDH)。 所有核心lncRNA、核心mRNA的表达水平和5个miR(miR-221、miR-222、miR-506、miR-507、miR-876)的表达水平均与总体生存率显着相关(均P<0.05)。结论：本研究揭示了几种lncRNA及其相关的ceRNA网络在葡萄膜恶性黑色素瘤转移中的作用，为进一步研究葡萄膜恶性黑色素瘤的发生和/或转移提供了新的方向。
Objective: To elucidate the expression of long non-coding RNAs (lncRNAs) and their roles as competing endogenous RNAs (ceRNAs) in uveal melanoma (UM) metastasis. Methods: RNA sequencing data and clinical information of 80 patients with UM were obtained from The Cancer Genome Atlas (TCGA) database. Differentially expressed (DE) mRNAs, microRNAs (miR), and lncRNAs between metastatic and non-metastatic individuals with UM were screened using the edgeR algorithm. Gene enrichment analysis was conducted for the DE mRNAs. LncRNA-miR-mRNA regulatory triples and a ceRNA network were constructed. Betweenness centrality was used to screen hub genes and lncRNAs for subnetwork analysis. Kaplan-Meier survival analysis was conducted to explore correlations between the expression of hub RNAs and overall survival in the TCGA UM cohort. Results: A total of 346 upregulated mRNAs, 118 downregulated miRs, and 45 upregulated lncRNAs were identified in samples with systemic metastasis. Among them, 67 mRNAs, 7 miRs, and 30 lncRNAs mapped to 616 ceRNA triples, thus forming an interconnected ceRNA network with 181 edges. Gene enrichment analysis revealed that mRNAs in the network were enriched in multiple gene ontology terms and pathways associated with carcinogenesis and metastasis. Topological analysis identified 6 hub lncRNAs (LINC00861, LINC02421, BHLHE40-AS1, LINC01252, LINC00513, and LINC02389) and 3 hub mRNAs (UNC5D, BCL11B, and MTDH). The expression levels of all hub genes and 5 DEmiRs (miR-221, miR-222, miR-506, miR-507, miR-876) were significantly associated with the overall survival probability. Conclusion: This bioinformatic study revealed the functions of several lncRNAs and their associated ceRNA network in UM metastasis. It provides a novel in silicon evidence for future experimental study on the pathogenesis of systemic metastasis in uveal melanoma, especially from the perspective of non-coding RNA.
目的：通过为青光眼患者提供安全、有效、经济、合理的规范化药学服务，探讨药物重整在青光眼患者中的临床应用价值，并评估药物重整服务在眼科专科用药方面的可行性。方法：采用前瞻性研究设计，纳入武汉大学附属爱尔眼科医院2023年8月-2024年1月青光眼住院患者308例, 临床药师通过收集用药史、医嘱审核、用药偏差纠正、用药教育等多种方式实施药物重整服务。结果：在308例患者中，104例患者存在需重整的用药问题，重整率为33.8%，重整医嘱共198条，在这些重整医嘱中，用药依从性问题占57.0%，用药安全性问题占18.1%，用药差错占24.9%。经过药物重整，患者用药依从性提升至95.1%(χ²=27.210，P<0.05)，安全性问题降至1.3%(χ²=22.565，P<0.05)，用药差错率降至1.9%(χ²=26.251，P<0.05)。结论：药物重整可提高青光眼患者的用药合理性及依从性，是保障患者用药安全、合理的有效药学服务手段。
Objective: To introduce medication reconciliation (MR) services for glaucoma patients, with the aim of delivering safe, effective, and cost-effective pharmaceutical care. This study also evaluates the clinical value of MR in glaucoma management and assesses its feasibility within ophthalmic specialized medication practices. Methods: In this prospective study, 308 hospitalized glaucoma patients were enrolled between August 2023 and January 2024. Clinical pharmacists conducted medication reconciliation using standardized procedures, which encompassed comprehensive medication history collection, medication order review, correction of discrepancies, and structured discharge counseling. Results: Among the 308 patients, MR interventions was required in 104 cases (33.80%), identifying 198 medication related issues. Of these, 57.0% pertained to medication adherence problems, 18.1% involved medication safety concerns, and 24.9% related to medication appropriateness. Following medication reconciliation, medication adherence improved to 95.1% (χ²=27.210, P<0.05), the incidence of adverse drug reactions declined to 1.3% (χ²=22.565, P<0.05), and medication appropriateness issues decreased to 1.9% (χ²=26.251, P<0.05). Conclusions: MR significantly enhances medication appropriateness and adherence in glaucoma management. This evidence-based pharmaceutical care model effectively ensures medication safety and therapeutic efficacy, offering practical insights for extending MR to other chronic ophthalmic conditions.
