近年来,使用人工智能(artificial intelligence,AI)技术对临床大数据及图像进行分析,对疾病做出智能诊断、预测并提出诊疗决策,AI正逐步成为辅助临床及科研的先进技术。生物样本库作为收集临床信息和样本供科研使用的平台,是临床与科研的桥梁,也是临床信息与科研数据的集成平台。影响生物样本库使用效率及合理共享的因素有信息化建设水平不均衡、获取的临床及检验信息不完全、各库之间信息不对称等。本文对AI和区块链技术在生物样本库建设中的具体应用场景进行探讨,展望大数据时代智能生物样本库信息化建设的核心方向。
In recent years, artificial intelligence (AI) technology has been applied to analyze clinical big data and images and then make intelligent diagnosis, prediction and treatment decisions. It is gradually becoming an advanced technology to assist clinical and scientific research. Biobank is a platform for collecting clinical information and samples for scientific research, serving as a bridge between clinical and scientific research. It is also an integrated platform of clinical information and scientific research data. However, there are some challenges. First, clinical and laboratory information obtained is incomplete. Additionally, the information among different databases is asymmetric, which seriously impedes the information sharing among different Biobanks. In this article, the specific application scenarios of AI technology and blockchain in the construction of a Biobank were discussed, aiming to pinpoint the core direction of the information construction of an intelligent Biobank in the era of big data.
当下,我国眼科的发展存在失衡现象,大城市与农村及偏远地区在眼科相关诊疗设施水平、诊疗技术等方面存在巨大差异,仍需探寻新的智能诊疗模式以解决失衡问题。由于眼球是唯一可以直接观察人体血管和神经的器官,眼部可反映其他脏器的健康状态,部分眼科检查的医学图像可对眼部疾病做出诊断等特点,眼科开展人工智能(artificial intelligence,AI)具有独到的优势。此外,人工智能可在一定程度上提高跨时间空间传递信息的精准度及效率。人工智能在眼科及远程信息传递的优势为解决眼科发展失衡状况提供了助力。本文从眼科人工智能在眼科远程医疗相关应用的角度,主要分析并总结当下我国人工智能在眼科相关疾病远程医疗中的发展程度、所具优势以及存在问题,并讨论眼科人工智能在远程医疗的应用展望。
At present, there is an imbalance in the development of ophthalmology in China. There are huge differences in the level of ophthalmology related facilities, diagnosis and treatment technologies between big cities and rural, remote areas. New intelligent diagnosis and treatment models are still needed to solve the imbalance. Since the eye is the only organ that can directly observe the blood vessels and nerves of the human body, the eye can reflect the health status of other organs and diagnosis of eye diseases based on medical images of some ophthalmic examinations can be made as well as other characteristics. Therefore, the development of artificial intelligence in ophthalmology has unique advantages. In addition, artificial intelligence can improve the accuracy and efficiency of information transmission across time and space to a certain extent. The advantages of artificial intelligence in ophthalmology and telematics are helping to solve the imbalance in ophthalmology development. From the perspective of the application of ophthalmic artificial intelligence in telemedicine, this paper mainly analyzes and summarizes the development degree, advantages and existing problems of artificial intelligence in the telemedicine of ophthalmic diseases in China, and discusses the prospect of the application of ophthalmic artificial intelligence in telemedicine.
帕金森病(Parkinson’s disease,PD)是老年人常见的神经系统退行性疾病,眼部及视觉功能障碍是PD常见的非运动症状之一,进一步影响其生活质量。已有研究表明PD患者视网膜内存在多巴胺浓度的减少以及α突触核蛋白的沉积。目前,PD仍缺乏有效的早期诊断及病情评估工具,光学相干断层扫描及光学相干断层扫描血管成像技术可以显示视网膜各层微细结构及微血管的异常,应用该技术研究者发现PD患者视乳头旁视网膜神经纤维层及黄斑区视网膜的厚度均存在不同程度的变薄,视网膜浅层及深层毛细血管丛的毛细血管密度和复杂性下降。进一步研究者应用该技术在PD临床应用中进行了探索,并发现其可用于检测早期PD中发生的病理变化,反映疾病的病程及严重程度,并且在鉴别诊断中起到一定的作用。总而言之,视网膜相关检测可能成为评估PD患者脑病理严重程度的指标,并且帮助疾病诊断和监测疾病的进展,不过这仍需要大样本、多中心的重复研究以提供更多理论依据。
Parkinson’s disease is a common neurodegenerative disease in the elderly, and ocular and visual dysfunction is one of the common non-motor symptoms of PD, further affecting PD patients’quality of life. Reduced dopamine concentrations and deposition of α-synuclein in the retina of PD patients have been shown in studies. At present, there is still a lack of effective tools for early diagnosis and assessment of PD. Optical coherence tomography and optical coherence tomography angiography can reveal abnormalities in the microstructure and microvasculature of the retinal layers, and researchers applying these techniques have found that the thickness of the parapapillary retinal nerve fiber layer and the retina in the macula in PD patients have had varying degrees of thinning, and the density and complexity of capillaries in the superficial and deep capillary plexus of the retina have been reduced. Further, investigators have explored the clinical application of these techniques in PD and have found that they can be used to detect pathological changes occurring in early PD, reflect the course and severity of the disease, and play a role in differential diagnosis. In conclusion, retinal-correlated testing may be an indicator to assess the severity of brain pathology in PD patients and to aid in disease diagnosis and monitoring the progression of PD, although large sample, multicenter replication studies are still needed to provide more reliable results.
睑缘炎是一种普遍存在的慢性眼部炎症,主要影响睑缘的皮肤和黏膜。患者常表现为眼部干痒、异物感等刺激症状,以及睑缘充血、肥厚和睫毛反复脱落等。睑缘清洁可以抑制部分眼表细菌生长,也可以去除睑缘油脂、分泌物、角化上皮细胞,清洁眼表环境,对治疗睑缘炎具有较好效果。为确保患者的治疗安全,并指导和规范临床眼科医护人员的操作,由中山大学中山眼科中心牵头,联合全国17所医疗机构进行反复修订,于2023年12月17日在全国团体标准信息平台发布《基于眼睑清洁仪的睑缘清洁操作流程》的团体标准。文章对该团体标准进行深度解读,详细解读睑缘清洁操作的适应证与禁忌证、具体操作的重点、难点与细节等内容,以更好地指导临床医护人员实施规范有效的治疗操作,保证患者治疗效果与确保患者治疗安全。旨在规范和推进基于眼睑清洁仪的睑缘清洁操作流程的精准化发展,更为促进我国眼前段疾病医学和护理精准应用的水平提供重要的标准依据。
Blepharitis is a common chronic eye inflammation that mainly affects the skin and mucosa of the eyelid margin. It is characterized by eye irritation symptoms such as dryness, itching, and foreign body sensation, accompanied by clinical manifestations such as eyelid congestion, thickening, and repeated eyelash loss. It can damage the conjunctival tissue even. Eyelid cleaning can inhibit the growth of some bacteria on the ocular surface, remove eyelid oil, secretions, and keratinized epithelial cells, clean the ocular environment, and have a good effect on treating blepharitis. In order to ensure the safety of patient treatment and guide and standardize the operation of clinical ophthalmic medical staff, led by the Zhongshan Ophthalmic Center, Sun Yat-sen University, and jointly revised by 17 medical institutions across the country, the group standard " Operation procedure of eyelid margin cleaning based on eyelid cleaning device" was released on the National Group Standard Information Platform on December 17, 2023. This article provides an in-depth interpretation of the group's standards, detailing the indications and contraindications, key points, difficulties, and details of eyelid cleaning procedures, in order to better guide clinical medical staff in implementing standardized and effective treatment procedures, ensuring patient treatment effectiveness and safety. Aiming to standardize and promote the precise development of eyelid margin cleaning procedures based on eyelid cleaning devices, and provide important standard basis for promoting the level of medical and nursing precision application of anterior segment diseases in China.
视网膜色素上皮脱离(pigment epithelial detachment, PED)是年龄相关性黄斑变性(age-related macular degeneration, AMD)的常见临床体征之一,也是反应患者视力预后的重要生物标志物。随着眼底影像技术的快速发展,PED分型依据从单一视角逐渐转变为多模式影像。眼底荧光素血管造影对PED分型进行了初探,吲哚菁绿血管造影的应用加强了对PED内血管成分的判断,光学相干断层扫描的问世使PED结构和内容物的可视化水平得到提高,多模式影像的应用则兼顾了对PED血管特性及内容物性质的判断,为进一步认识PED的发病机制和病程特征提供了重要支持,促进PED分型体系不断更新。PED现有分型种类繁多,概念之间存在交叉。文章通过回顾国内外关于AMD相关的PED研究现状,对分型系统、多模式影像特征及最新影像进展进行汇总,为PED的标准化诊疗和未来研究方向提供了系统参考,以期推动PED相关临床和研究的深入发展。
Pigment epithelial detachment (PED) is one of the common manifestations of age-related macular degeneration (AMD), posing a significant threat to the patients’ vision. With the rapid advancement of imaging technology, the visualization of PED structure and content has improved considerably. The diagnostic methods and classification systems of PED are also evolving, enabling researchers to further explore its pathogenesis and disease course. However, current PED classification systems are numerous, with overlapping concepts that may cause confusion. This article reviews existing relative literature on AMD-related PED, summarizing the classification systems, multimodal imaging features, and recent imaging advances. The objective of this article is to standardize the diagnosis and guide treatment of PED, to provide systematic reference to the future research, ultimately advancing both clinical and research efforts related to PED.
泪道阻塞是临床常见的眼科疾病,主要表现为溢泪、反复感染等症状,严重影响患者的生活质量。传统治疗方法主要采用硅胶或金属支架置入术,这些材料虽然能够暂时维持泪道通畅,但由于其不可降解性、容易移位、易形成生物膜导致感染等固有缺陷,往往需要二次手术取出,给患者带来额外的痛苦和经济负担。随着材料科学和生物医学工程的发展,新型支架材料的研发为解决这些问题提供了新的思路。文章聚焦新型材料如可降解材料、3D打印个性化支架、复合材料及表面改性技术等,这些材料可通过材料降解、精准适配或多功能整合提升临床疗效,但在降解速率调控、3D打印精度及成本方面仍面临诸多挑战。此外,这些新技术的长期安全性和有效性还需要更多临床数据的支持,在未来仍需不断探索,开发更精准的降解速率调控方法,优化3D打印流程以提高精度,降低材料制备的成本,探索更高效的复合材料制备技术。同时,要加强基础研究,推动更多创新技术在临床的应用,开发出更安全、更有效的新型泪道支架材料,为泪道阻塞患者提供更优质的治疗方案,推动泪道疾病治疗向精准微创化方向发展。
Lacrimal duct obstruction is a common clinical ophthalmic condition characterized by symptoms such as epiphora and recurrent infections, significantly impairing patients' quality of life. Traditional treatments primarily involve the implantation of silicone or metal stents. While these materials can temporarily maintain lacrimal duct patency, their inherent drawbacks—such as non-degradability, susceptibility to displacement, and tendency to form biofilms leading to infections—often necessitate secondary surgeries for removal, imposing additional physical and financial burdens on patients.Advances in materials science and biomedical engineering have introduced novel stent materials as potential solutions to these challenges. This article focuses on emerging materials such as biodegradable polymers, 3D-printed personalized stents, composite materials, and surface modification technologies. These innovations can enhance clinical outcomes through material degradation, precise customization, or multifunctional integration. However, challenges remain in regulating degradation rates, improving 3D printing precision, and reducing costs.Furthermore, the longterm safety and efficacy of these technologies require more clinical data for validation. Future research should explore more precise degradation rate control methods, optimize 3D printing processes to enhance accuracy, lower material production costs, and develop more efficient composite material fabrication techniques. Concurrently, strengthening fundamental research and promoting the clinical application of innovative technologies will be crucial to developing safer and more effective lacrimal duct stent materials. Such advancements will provide superior treatment options for patients with lacrimal duct obstruction and drive the field toward minimally invasive and precision medicine approaches.
目的:分析天津市某眼科医院急诊病例疾病谱,为规范疾病诊断流程、合理分配急诊医疗资源提供循证依据。方法 回顾性分析2019年1月~2023年12月在天津市某眼科医院急诊科就诊患者的临床资料,包括一般人口学资料、就诊时间、季节分布及初步诊断等。结果:共纳入26 077例眼科急诊患者,男女比例为1.12∶1,年龄为(36.82±15.44)岁,就诊年龄大多分布在<14岁(26.74%)及31~40岁(21.03%);日就诊时间分布中:10:00~12:00(11.06%)、14:00~16:00(10.41%)及20:00~22:00(10.43%)就诊人数较多,05:00~07:00(4.83%)就诊人数较少;4月就诊人数最少(3.87%),8月就诊人数最多(11.61%),夏季就诊人数(31.74%)显著多于其他3个季节;眼科急诊患者最常见的10种初步诊断中结膜炎占比最多(39.58%),其次为干眼症(14.32%);与2019年相比,2020年和2021年眼科急诊患者前10种初步诊断显著下降(均P<0.001,2020年95%CI为-0.98~-0.68、2021年95%CI为-0.54~-0.11);与春季相比,其他季节眼科急诊患者前10种初步诊断显著下降(P均<0.001,夏季95%CI为-0.32~-0.08、秋季95%CI为-0.39~-0.14、冬季95%CI为-0.54~-0.30)。其中在结膜炎病例中,与春、夏季相比,冬季结膜炎病例分布呈显著下降趋势(P均<0.001,95%CI分别为-0.08~-0.03]、为-0.08~-0.04);眼科急诊患者前10种初步诊断性别分布具有统计学意义(P<0.001);与14岁以下年龄段相比,其他年龄眼科急诊患者前10种初步诊断均呈下降趋势,(P均<0.001,14~20岁95%CI为-0.88~-0.43、21~30岁95%CI为-1.01~-0.65、31~40岁95%CI为-1.10~-0.82、41~50岁95%CI为-0.97~-0.66、51~60岁95%CI为-1.71~-1.38、61~70岁95%CI为-1.45~-1.08、71~80岁95%CI为-1.36~-0.80、>80岁95%CI为-1.44,-0.22)。结论:眼科急诊患者以儿童和中青年男性为主,14岁以下年龄段人群相比来说有较高风险;日就诊时间分布呈现出“三个高峰一个低谷”的显著特征,就诊高峰时段分别为10:00~12:00、14:00~16:00以及20:00~22:00,就诊低谷出现在05:00~07:00期间;眼科急诊中最常见的诊断主要是那些通常被认为是非紧急的诊断,即结膜炎和干眼症;结膜炎的发病呈现明显的季节性特征,春、夏季为高发期;与2019年相比,2020年和2021年眼科急诊就诊总量显著减少,其中以结膜炎和干眼症的就诊量减少尤为明显,2022年有一定程度的恢复。
Purpose:To analyze the disease spectrum of emergency cases at an ophthalmology hospital in Tianjin, offering evidence-based support for standardizing diagnostic procedures and rationing emergency medical resources. Methods: Reviewed clinical data of patients at the hospital's emergency department from January 2019 to December 2023, covering demographics, visit timings, seasonal distribution, and preliminary diagnoses. Results: A total of 26,077 ophthalmology emergency patients were included, with a male-to-female ratio of 1.12:1 and an average age of 36.82±15.44 years. Most patients were aged <14 years (26.74%) and 31~40 years (21.03%). Daily visits peaked at 10:00~12:00 (11.06%), 14:00~16:00 (10.41%), and 20:00~22:00 (10.43%), and were lowest at 05:00~07:00 (4.83%). April had the fewest visits (3.87%), August the most (11.61%), and summer accounted for the highest quarterly proportion (31.74%). The top 10 preliminary diagnoses were led by conjunctivitis (39.58%) and xerophthalmia (14.32%). Compared to 2019, the top 10 preliminary diagnoses dropped significantly in 2020 and 2021 (both P<0.001), 2020 95%CI[-0.98~-0.68]、2021 95%CI[-0.54~-0.11]. Similarly, these diagnoses were significantly lower in summer, autumn, and winter than in spring (all P<0.001), summer 95%CI[-0.32~-0.08]、autumn 95%CI[-0.39~-0.14]、winter 95%CI[-0.54~-0.30]. In conjunctivitis cases, winter incidence was significantly lower than in spring and summer (both P<0.001). Gender distribution in the top 10 diagnoses was statistically significant (P<0.001), 95%CI[-0.08~-0.03] and [-0.08~-0.04] . Compared to those aged <14, other age groups showed a downward trend in the top 10 preliminary diagnoses (all P<0.001), 14~20 95%CI[-0.88~-0.43]、21~30 95%CI[-1.01~-0.65]、31~40 95%CI[-1.10~-0.82]、41~50 95%CI[-0.97~-0.66]、51~60 95%CI[1.71~-1.38]、61~70 95%CI[-1.45~-1.08]、71~80 95%CI[-1.36~-0.80]、>80 95%CI[-1.44,-0.22].Conclusions: Ophthalmology emergency patients are mainly children and middle-aged men, with those <14 years old at higher risk. Visit times follow a "three-peak-one-valley" pattern. Most diagnoses are non-urgent conditions like conjunctivitis and xerophthalmia. Conjunctivitis shows marked seasonality, peaking in spring and summer. Total ophthalmology emergency visits declined in 2020 and 2021 versus 2019, particularly for conjunctivitis and xerophthalmia, partially recovering in 2022.
目的:回顾2型神经纤维瘤病(neurofibromatosis type 2, NF2)患者的眼部表现,分析NF2眼部病变的临床和影像学特征,以助该病的早期诊断。方法:收集来自深圳市眼科医院的1例和来自中山眼科中心的3例NF2患者完整的临床资料并进行总结分析。结果:这4例患者均因眼部异常首诊于眼科且符合曼彻斯特诊断标准。4例患者中,3例为NF2早发型(<20岁),1例为晚发型(>20岁),男女比例1∶1。3例患者因视力下降、1例患者因复视首诊于眼科。3例行眼底光学相干断层成像(optical coherence tomography, OCT)检查显示,视网膜错构瘤2例,视网膜前膜2例,视盘隆起2例,视网膜神经纤维层和节细胞层变薄1例。其他表现包括麻痹性斜视2例,复视1例,白内障1例,球后段视神经增粗1例,眼眶肿瘤1例。结论:NF2的眼部表现多种多样,可出现在神经症状和听力损失之前。详细的眼科检查及影像学检查对年轻患者的早期诊断非常有价值,有助于选择更好的治疗计划。
Objective: Review the ocular manifestations of patients with neurofibromatosis type 2 (NF2), and analyze the clinical and imaging features of the ocular lesions in NF2, so as to facilitate the early diagnosis of this disease. Methods: The complete medical records of 1 case from Shenzhen Eye Hospital and 3 cases of NF2 from Zhongshan Ophthalmic Center were collected. Results: All four patients were first diagnosed in ophthalmology due to eye symptoms and met the Manchester diagnostic criteria. Of the four patients, three were NF2 early hairstyles (<20 years old), one was late hairstyle (>20 years old), and the male-to-female ratio was 1:1. Three patients were first diagnosed in the ophthalmology department due to decreased visual acuity, and one patient was first diagnosed due to diplopia. Optical coherence tomography (OCT) examinations were performed on three patients, which showed that there were two cases of retinal hamartoma, two cases of epiretinal membrane, two cases of optic disc elevation, and one case of thinning of the retinal nerve fiber layer and ganglion cell layer. Other manifestations included two cases of paralytic strabismus, one case of diplopia, one case of cataract, one case of thickening of the retrobulbar optic nerve, and one case of orbital tumor. Conclusions: The ocular manifestations of NF2 are diverse and can precede neurological symptoms and hearing loss. Detailed ophthalmic examinations and imaging studies are highly valuable for early diagnosis in young patients, aiding in the selection of a better treatment plan.
小泪囊型慢性泪囊炎是泪道阻塞性疾病中的特殊亚型,目前尚无针对小泪囊的确切定义,传统内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗小泪囊型慢性泪囊炎因泪囊体积小手术操作难度大、术后吻合口易闭锁和成功率低而被视为相对禁忌。本研究通过CT泪囊造影(CT dacryocystography, CT-DCG)三维精准测量、定义小泪囊(水平径≤3 mm、前后径≤3 mm、垂直径≤6 mm),提出开放泪总管平面技术以扩大泪囊鼻腔吻合口,同时联合双管人工泪管植入术的En-DCR治疗方案,术后予以肾上腺皮质激素(激素)喷鼻剂辅助,显著提升手术疗效。研究纳入61例小泪囊型泪囊炎患者,术后9个月随访显示,解剖成功率达80. 33%(49/61),功能成功率为75.41%(46/61)。术中开放泪总管平面技术有效扩大手术窗口;短期双管人工泪管植入(术后3个月取出)联合激素喷鼻剂使用可降低吻合口闭锁风险同时未增加肉芽增生和感染风险。与传统治疗相比,该方案突破小泪囊手术禁忌,为患者提供更优选择。
小泪囊型慢性泪囊炎是泪道阻塞性疾病中的特殊亚型,目前尚无针对小泪囊的确切定义,传统内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗小泪囊型慢性泪囊炎因泪囊体积小手术操作难度大、术后吻合口易闭锁和成功率低而被视为相对禁忌。本研究通过CT泪囊造影(CT dacryocystography, CT-DCG)三维精准测量、定义小泪囊(水平径≤3 mm、前后径≤3 mm、垂直径≤6 mm),提出开放泪总管平面技术以扩大泪囊鼻腔吻合口,同时联合双管人工泪管植入术的En-DCR治疗方案,术后予以肾上腺皮质激素(激素)喷鼻剂辅助,显著提升手术疗效。研究纳入61例小泪囊型泪囊炎患者,术后9个月随访显示,解剖成功率达80. 33%(49/61),功能成功率为75.41%(46/61)。术中开放泪总管平面技术有效扩大手术窗口;短期双管人工泪管植入(术后3个月取出)联合激素喷鼻剂使用可降低吻合口闭锁风险同时未增加肉芽增生和感染风险。与传统治疗相比,该方案突破小泪囊手术禁忌,为患者提供更优选择。
双眼视,即双眼同时工作、协调和整合视觉信息的能力,能够产生单一、立体和深度感的视觉体验,近年来在认知心理学和神经科学研究中逐渐受到越来越多的重视,尤其是在探讨其与执行能力之间复杂关联的方面。执行能力作为一项至关重要的认知功能,涉及多个方面,包括注意力、工作记忆、决策和问题解决等,这些因素共同影响着个体在日常生活和工作中的表现和效率。当前的研究表明,双眼视不仅在视觉信息的处理上发挥着关键作用,还对个体的执行能力产生了显著的影响。双眼视异常群体(如斜视、弱视患者)在执行功能测试中普遍表现出反应抑制延迟、工作记忆容量降低等特征。然而,现有文献中关于双眼视与执行能力之间关系的研究,特别是基于神经机制及其临床影响的系统性分析仍显得相对不足。为此,本文通过对现有研究的综述,深入探讨双眼视在执行能力中的作用,详细分析其背后的神经机制,并讨论这些发现对临床实践可能产生的影响。此外,文章还提出了未来研究的方向,以期更全面地理解双眼视与执行能力之间复杂的交互关系,从而为相关领域的研究提供新的视角和思路,推动这一领域的进一步发展。
Binocular vision, the ability of both eyes to work simultaneously, coordinate, and integrate visual information, can produce a unified, three-dimensional, and depth-perceptive visual experience. In recent years, it has garnered increasing attention in cognitive psychology and neuroscience research, particularly in exploring its complex relationship with executive functions. Executive functions, as a crucial cognitive capability, encompass various aspects, including attention, working memory, decision-making, and problem-solving, all of which collectively influence an individual's performance and efficiency in daily life and work. Current research indicates that binocular vision plays a key role not only in processing visual information but also has a significant impact on an individual's executive functions. Groups with binocular vision abnormalities (such as strabismus and amblyopia patients) generally exhibit characteristics like delayed response inhibition and reduced working memory capacity in executive function tests. However, existing literature on the relationship between binocular vision and executive functions, especially systematic analyses based on neural mechanisms and their clinical implications, remains relatively insufficient. Therefore, this article reviews existing research to delve into the role of binocular vision in executive functions, analyzes the underlying neural mechanisms in detail, and discusses the potential clinical implications of these findings. Additionally, the article proposes future research directions to comprehensively understand the complex interplay between binocular vision and executive functions, aiming to provide new perspectives and ideas for research in related fields and promote further development in this area.