眼底影像专栏

中心性浆液性脉络膜视网膜病变的SS-OCT及SS-OCTA的应用及研究进展

Application and progress of swept source optical coherence tomography in choroid-related diseases

:464-470
 
中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是一种以脉络膜增厚、血管通透性增加为特征的脉络膜谱系疾病,所以对脉络膜的观察对于CSC的监测和治疗非常重要。随着光学相干断层扫描成像(optical coherence tomography,OCT)的发展,对脉络膜的认识有了显著提升,也让我们更深刻地理解了它在眼后段疾病中的重要作用,提高了对各种脉络膜视网膜疾病的诊断能力。近年来,随着扫频源光学相干断层扫描(swept source optical coherence tomography,SS - OCT)及扫频源光学相干断层扫描血流成像(swept source optical coherence tomography angiography,SS - OCTA)的发展,其扫描波长、深度、广度及扫描速度均显著提升,实现了对脉络膜结构的无创定量化评估,推进了对CSC等脉络膜谱系疾病的病理机制的认识和临床管理。文章就近年SS-OCT及SS-OCTA在 CSC 中的应用及研究进展进行总结。主要进展有:发现CSC脉络膜增厚不仅局限于黄斑区,且发现其脉络膜血管及基质成分均显著增加;CSC为双眼受累,而表现为单眼症状;涡静脉回流障碍机制在该疾病中起到关键作用;SS-OCT能进一步对后极部的视网膜下积液进行监测和分析;发现了急性与慢性CSC脉络膜相关参数的改变的不同;最后探究了巩膜机制在该疾病中可能起到的作用。
Central serous chorioretinopathy (CSC) is one of the choroidal spectrum diseases, characterized by choriod thickening and increased vascular permeability. Therefore it is very important to observe choroid, as this allows us to monitor it and formulate an appropriate therapeutic schedule. With the development of optical coherence tomography (OCT), our understanding of choroid has been significantly improved. We have got a deeper insight into its important role in posterior diseases, and also the diagnostic capability for choroidal and retinal diseases has also improved. In recent years, the development of swept source optical coherence tomography (SS-OCT) and swept source optical coherence tomography angiogrphy (SS-OCTA) has further advanced our ability to assess choroidal conditions. These technologies offer enhanced scanning wavelengths, depth, breadth, and scanning speed, enabling non-invasive quantitative assessment of choroidal structures. This has advanced our understanding of the pathophysiological mechanisms and clinical management of CSC and other choroidal spectrum diseases.This review summarizes the application of swept source optical coherence tomography (SS - OCT) and swept source optical coherence tomography angiography (SS - OCTA) in CSC and its research progress. The main advancements include: choroidal thickening in CSC is not limited to macular area, both choroidal vascular and stromal components are significantly increased; CSC can affect both eyes, although it often presents with unilateral symptoms; impaired vortex vein outflow plays a key role in the pathogenesis of this disease; SS-OCT can further monitor and analyze subretinal fluid accumulation in the posterior pole; differences in changes in choroidal parameters between acute and chronic CSC have been identified; and finally, the potential role of scleral mechanisms in this disease have been explored.
眼底影像专栏

急性黄斑神经视网膜病变中视网膜前巨噬细胞样细胞和视网膜脉络膜血流变化

Characterization of epiretinalmacrophage-like cells and retinochoroidal blood flow in acute macular neuroretinopathy

:454-463
 

目的:分析视网膜前巨噬细胞样细胞(epiretinal macrophage-like cellseMLC和视网膜脉络膜血流在急性黄斑神经视网膜病变(acute macular neuroretinopathyAMN)患眼的临床特征。方法回顾性分析202212—20235月在中山大学中山眼科中心就诊的病程2周内的AMN患者2137眼)及年龄匹配的健康对照组3338眼)的临床资料通过黄斑区内界膜上μmeface 光学相干断层扫描(optical coherence tomographyOCT)分层信息eMLC进行半自动分析提取和定量,同时测量OCT血管成像(optical coherence tomography angiographyOCTA6 mm x 6 mm 的黄斑区域内视网膜脉络膜血流参数进行分析对比。结果 AMN黄斑区eMLC数量329.78±77.38)个,密度为(9.16±2.15/mm2,均较对照组(202.63±41.72、(5.63±1.16/mm2增加P0.001)。AMN组浅层和深层视网膜血流密度分别为33.00±6.49)%和(32.59±7.41%,均较对照组(36.18±5.63)%和(37.08±5.65%减少(P0.05。视网膜全层中心凹无血管区(foveal avascular zoneFAZ面积、视网膜全层血流密度、脉络膜毛细血管和脉络膜大中血管血流密度在两组间比较差异无统计学意义(P0.05)。浅层及深层视网膜血流密度和FAZ面积对eMLC密度无影响(P0.05)。13AMN患者(231个月时的随访资料显示:AMN组末次随访时eMLC数量248.70±59.88)个、密度为6.91±1.66)个/mm2初次就诊时(307.87±82.98和(8.55±2.30)个/mm2减少(P0.001,但仍高于同期对照组(176.58±27.89和(4.91±0.77/mm2P0.001)。视网膜和脉络膜血流参数较初次就诊时比较差异无统计学意义(P0.05)。结论AMN患眼中eMLC异常增多和聚集,同时存在轻度的视网膜血流密度下降,但无脉络膜血流参数变化,且eMLC变化与AMN病程相关但与视网膜血流变化无关,提示eMLC所代表的炎症可能独立参与了AMN的发生

Objective: To investigate the clinical characteristics of epiretinal macrophage-like cells (eMLC) and retinochoroidal blood flow in eyes affected by acute macular neuroretinopathy (AMN). Methods: This retrospective case series study included 21 (37 eyes) patients diagnosed with AMN and 28 (33 eyes) healthy age-matched subjects. A 3 mm En-face optical coherence tomography (OCT) slab on the inner limiting membrane of the macular region was used to visualize and binarize the MLCs. The MLCs were binarized and quantified using a semiautomated method. Optical coherence tomography angiography (OCTA) was used to evaluate the perfusion status and obtain the structural data of macular within a 6 x 6 mm² macular region. Results: The number and density of macular eMLC in AMN eyes were significantly increased in comparison to control eyes: 329.78±77.38 vs. 202.63±41.72, (P0.001) and 9.16±2.15 cells/mm2 vs. (5.63±1.16) cells/mm2 (P0.001). In the macular region, both superficial and deep retinal vessel densities were significantly lower in the AMN eyes than in the control eyes: (33.00±6.49)% vs. (36.18±5.63)% (P=0.040); (32.59±7.41)% vs. (37.08±5.65)% (P=0.008). There were no significant differences in the vessel densities and foveal avascular zone (FAZ) area of full retina and choroidal vessel density between the two groups (P0.05). The eMLC density was not associated with the superficial and deep retinal FAZ area and vessel densities (all P0.05). At the one-month follow-up data of 13 patients (23 eyes), the number and density of macular eMLC were significantly lower in comparison to the initial visit: 248.70±59.88 vs. 307.87±82.98, P0.001 and (6.91±1.66) cells/mm2 vs. (8.55±2.30) cells/mm2 (P0.001). However, the number and density of macular eMLC are still noticeably higher than those of the control group during the same timeframe: 248.70±59.88 vs. 176.58±27.89 (P0.001) and (6.91±1.66) cells/mm2 vs. (4.91±0.77) cells/mm2 (P0.001). There was no significant difference in the vessel density of retina and choroidal during the follow-up (P0.05 ). Conclusions: The aggregation and activation of eMLC and a mild decrease in retinal blood flow density are observed in AMN, yet there is no corresponding shift in choroidal vessel densityThe changes of eMLC are linked to the course of AMN, but they are not related to retinal vessel density. The inflammatory response represented by eMLC might independently contribute to the pathogenesis and progression of AMN.

泪器病专栏

曲安奈德在治疗慢性泪囊炎鼻内镜术后造瘘口肉芽增生中的应用

Application of intralesional triamcinolone acetonide injections in the treatment of ostium granulomas following endoscopic dacryocystorhinostomy

:446-453
 

目的:分析慢性泪囊炎患者鼻内镜下泪囊鼻腔造瘘口术后的远期肉芽增生情况,评价物理清除联合曲安奈德(triamcinolone acetonide,TA)局部注射治疗慢性泪囊炎鼻内镜术后造瘘口肉芽组织增生的效果。方法:回顾性分析接受鼻内镜手术的慢性泪囊炎患者98例115眼。随访收集术后造瘘口肉芽组织增生发生情况,分析肉芽增生与无肉芽增生患者的临床特征。对有肉芽增生的患者26例31眼,根据治疗方式分为物理清除联合TA局部注射组13例16眼和单纯物理清除组13例15眼,比较2组间治疗有效率。结果:鼻内镜术后造瘘口肉芽增生病例共31眼(26.96%)。物理清除联合TA组的治愈率、好转率分别为93.75%、6.25%,物理清除组相应为60%、33.33%,组间比较差异有统计学意义(< 0.05)。结论:物理清除联合TA局部注射治疗泪囊炎鼻内镜术后造瘘口肉芽组织增生安全、有效。

Objective: This study aimed to analyze the formation of ostium granulomas following endonasal endoscopic dacryocytostomy (DCR) in patients with chronic dacryocystitis and to evaluate the efficacy of excision combined with triamcinolone (TA) injection for treating ostium granulosis after endoscopic dacryocystorhinostomy. Methods: A retrospective analysis was conducted on 98 patients (115 eyes) with chronic dacryocystitis who underwent endoscopic dacryocystorhinostomy.  Postoperative growth of the ostium granulomas was monitored, and clinical characteristics were compared between patients with and without ostium granulomas. Among these, 26 cases (31 eyes) of ostium granuloma were identified and randomly assigned to either an excision combined with triamcinolone injection group (13 cases with 16 eyes) or excision-only group (13 cases with 15eyes) based on the treatment method. The effective ratebetween two groups was compared. Results: Ostium granulomas occurred in 31 eyes (26.96%). The cure rate and improvement rate in the excision combined with TA group were 93.75% and 6.25%, respectively, whereas in the excision-only group, they were 60% and 33.33%. These differences were statistically significant (< 0.05).  Conclusion: Excision combined with intralesional triamcinolone acetonide injections proved effective in promoting the regression of ostium granuloma after DCR.

泪器病专栏

日间病房模式下行En-DCR的PANDO患者术后自我护理单中心回顾性分析

A single-center retrospective analysis of postoperative self-care in PANDO patients undergoing endoscopic nasal dacryocystorhinostomy (En-DCR) under the day-ward model

:437-445
 

目的分析日间病房模式下原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstruction, PANDO)患者行经鼻内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)的术后自我护理现状并进行早期效果评价。方法纳入2021年112022年8月在中山大学中山眼科中心眼整形与泪道科日间病房En-DCR手术治疗的90PANDO患者,术后常规给予术后自我护理指导。术后1个月复查采用调查问卷的方式记录患者术后自我护理情况及不适症状评估患者手术效果并进一步探究术后自我护理因素与手术效果及术后不适症状的相关性。结果90例行En-DCR手术治疗的PANDO患者共计90术后1个月手术总成功率为92.22%其中治愈率65.56%好转26.67%)。术后自我护理与手术效果的特征分析显示,术后遵医嘱鼻腔冲洗每日至少1次(= 0.002)、遵医嘱喷鼻每日至少1次(= 0.008)、术后无上呼吸道感染= 0.047)的患者手术效果更好术后自我护理与术后不适症状的特征分析显示每日至少1鼻腔冲洗(= 0.006)和义管在位(= 0.003)的患者术后不适症状较少同时对置管患者进行心理负担相关性分析结果显示置管不适与心理负担呈正相关(= 0.4210.001结论在日间病房模式下,医护人员En-DCR术后患者进行详细的自我护理指导,有助于患者的术后恢复及保证良好的手术疗效。指导重点包括术后1月内每日至少1鼻腔冲洗,规律使用抗炎喷鼻剂并防止上呼吸道感染;另外应重点关注泪道置管患者术后局部不适症状,针对术后不适症状优化用药使用互联网护理门诊或电话随访做好护理指导和心理疏导,促进患者术后康复

Objective: To investigate  postoperative self-care practices and evaluate the early outcomes of patients with Primary Acquired Nasolacrimal Duct Obstruction (PANDO) undergoing Endoscopic Dacryocystorhinostomy (En-DCR) in a day ward setting. Methods: 90 PANDO patients who underwent En-DCR surgery at the Oculoplastic and Lacrimal Surgery day ward at Zhongshan Ophthalmic Center, Sun Yat-sen University, between November 2021 and August 2022, were enrolled in this study. All patients received standardized postoperative self-care instructions. At the one-month follow-up, a questionnaire survey was used to record patients' self-care adherence to self-care practices, postoperative discomfort symptoms, and assess surgical outcomes. Furthermore, the correlation between self-care factors and surgical outcomes/discomfort symptoms was explored. Results: A total of 90 eyes from 90 PANDO patients undergoing En-DCR were included. The overall surgical success rate at one month was 92.22% , comprising a cure rate of 65.56% and an improvement rate of 26.67%. Analysis of self-care practices related to surgical outcomes showed significantly better results in patients who adhered to nasal irrigation at least once daily (= 0.002), used prescribed nasal spray at least once daily (= 0.008), and avoided upper respiratory tract infections (= 0.047). Regarding postoperative discomfort, patients who performed nasal irrigation at least once daily (= 0.006) and had the lacrimal stent (tube) in situ (= 0.003) experienced significantly fewer symptoms. Furthermore, correlation analysis in stented patients indicated a positive correlation between stent discomfort and psychological burden (= 0.421, < 0.001). Conclusion: In the day ward model, detailed self-care guidance provided by healthcare professionals for En-DCR patients contributes to postoperative recovery and ensures favorable surgical outcomes. Key instructions include performing nasal irrigation at least once daily, using anti-inflammatory nasal spray regularly, and preventing upper respiratory infections during the first postoperative month. Additionally, particular attention should be paid to localized discomfort in patients with lacrimal stents. Optimizing medication regimens for discomfort, utilizing internet-based nursing clinics or telephone follow-ups for guidance and psychological support are crucial to promote postoperative rehabilitation.

团体标准

广东省年龄相关性白内障手术操作及质量控制规范

Standard operating procedure and quality control standards for age-related cataract in Guangdong Province

:429-436
 
年龄相关性白内障是全球首位致盲性眼病,手术是治疗白内障唯一有效的手段。白内障手术后视力的良好恢复,除了患者自身的眼部条件外,还有赖于医疗机构的手术技术和质量管理水平。白内障摘除手术的规范操作、人工晶状体屈光力的精准测算和专业的围术期管理是白内障患者复明的关键。国家卫生健康委员会在《加强县医院白内障手术能力建设工作方案(2025—2027年)》中提出,通过加强设备设施建设、帮扶县级医院开展人员培训、建立标准化手术制度等方式,进一步提高县级医院开展白内障手术的能力,就近就便满足人民群众白内障复明需求。因此,为了规范化白内障手术操作、确保手术安全和减少手术并发症,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构35名权威专家共同起草,在参考国内外白内障手术标准的基础上,结合我省白内障手术的现状,共同讨论并最终确定了本团体标准。本标准系统地描述了年龄相关性白内障手术软件、硬件的基本要求、手术的适应证与禁忌证,制定了白内障手术的标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构开展白内障手术以及质量评估提供指导。
Age-related cataract is the leading blinding eye disease in the world, and surgery is the only effective treatment. The good recovery of vision after cataract surgery depends not only on the patients’ ocular conditions but also on the surgical technique and quality management level of medical institutions. Standard surgical procedures, the accurate measurement and calculation of intraocular lens (IOL) power, and professional perioperative management are the keys to restoring the sight of patients. In addition, the National Health Commission proposed in the "Work Plan for Strengthening the Cataract Surgery Capacity Building of County-level Hospitals (2025-2027)" that the ability of county-level hospitals to perform cataract surgery should be further improved by strengthening the construction of equipment and facilities, assisting county-level hospitals in carrying out personnel training, and establishing standardized surgical system. Therefore, in order to standardize cataract surgery procedures, ensure the safety of the surgery and reduce surgical complications, under the leadership of the Guangdong Medical Association, the Zhongshan Ophthalmic Center of Sun Yat-sen University, in conjunction with 21 other medical institutions in Guangdong Province and 35 authoritative experts, jointly drafted this group standard. On the basis of referring to the domestic and international standards for cataract surgery and combining with the current situation of cataract surgery in Guangdong Province, they jointly determined this group standard. This group standard systematically describes the basic requirements for the software and hardware conditions of age-related cataract surgery, the indications and contraindications of the surgery, formulates the standard surgical procedures and quality control standards for cataract surgery, and introduces the prevention and treatment of complications or adverse reactions, providing guidance for all qualified medical institutions at different levels to carry out cataract surgery and quality assessment.
团体标准解读

《基于眼睑清洁仪的睑缘清洁操作流程》团体标准解读

Operation procedure of eyelid margin cleaning based on eyelid cleaning device

:382-386
 
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.
眼底影像专栏

年龄相关性黄斑变性中视网膜色素上皮脱离的分型及影像学研究进展

Research progress on classification and advanced multimodal imaging features of pigment epithelial detachment in age-related macular degeneration

:371-381
 
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.
泪器病专栏

泪道支架材料的研究进展

Research progress on lacrimal duct stent materials

:363-370
 
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.
论著

天津市某眼科医院急诊病例疾病谱分析

Epidemiological analysis of emergency ophthalmic cases in a specialist hospital in Tianjin

:416-428
 
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.
论著

首诊眼科的 4 例 2 型神经纤维瘤病眼部病变特征

Characteristics of ocular alterations in four cases of neurofibromatosis Type 2 first diagnosed in ophthalmology

:1-6
 
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.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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