专家访谈

眼科器械实时回收及科室签收模块的设计与应用

Design and application of real-time counting and recovery of ophthalmic instrument and the receipt module by a certain department

:150-154
 

目的:开发眼科供应室质量管理追溯系统的实时回收、科室签收功能模块,实现消毒供应中心无纸化办公,提高工作效率。方法:通过构建眼科消毒供应中心质量管理追溯系统的实时回收、科室签收功能模块,消毒供应中心工作人员使用个人数字助理(personal digital assistant,PDA)与临床科室人员进行面对面的器械回收清点和下送物品的清点签收,通过实施该模块等数据信息进行前后比较以评价其应用效果。结果:通过使用 PDA 对眼科器械进行实时回收、物品签收,回收器械物品清点记录的差错率由原来的 3.32% 下降到 0.51%,实施前后因物品数目、名称等不符发生纠纷例数由原来的 14.39% 下降到 1.56%。结论:该模块实现了无纸化办公,提高了回收、下送物品的精准性,提高了工作效率;减少了与临床科室的纠纷,提高了临床科室对消毒供应中心的满意度。

Objective: To develop the function module of real-time recovery counting and department receipt signing of the quality management traceability system of the ophthalmic supply room, realize the paperless office of the disinfection supply center, and improve the work efficiency. Methods: Eye disinfection supply center is built with quality management traceability system of real-time collection, department to sign for function module, counting supply room staff use personal digital assistants (PDAs) and clinical departments personnel under the face-to-face equipment recycling counted and send goods receipt, counting of implementation process control, reducing disputes. Results: By using PDA to collect and count the ophthalmic instruments in real time and sign for the receipt of the articles, the accuracy of the recovery and delivery of the articles was improved, the disputes between the supply room and the clinical department caused by the difference in the quantity of the recovered and delivery of the articles were solved, and the paperless management was realized. Conclusion: The module realizes paperless office and improves work efficiency. It reduces the disputes with the clinical departments and improves the satisfaction of the clinical departments with the supply department.

海藻糖对实验性干眼病鼠结膜上皮细胞的影响

Effect of trehalose on conjunctival epithelial cells in a rat model of experimental dry eye

:141-149
 

目的:评价海藻糖滴眼液对摘除眶内眶外泪腺的实验性大鼠干眼的疗效。方法:SD 大鼠 30 只,随机分成正常组、对照组、实验组,每组 10 只(20 只眼)。正常组不给予处置,实验组和对照组通过摘除大鼠主泪腺制作干眼动物模型。对照组和实验组于造模完成术后 1 周后分别给予生理盐水、海藻糖滴眼液点双眼,每天 4 次,治疗共 4 周。分别于造模术前和造模术后 1、2、3、5 周进行基础泪液分泌试验(Shirmer I test),角膜上皮荧光染色评分检测;造模 5 周后将大鼠处死,采用免疫组织化学方法对结膜上皮细胞中 Bcl-2 和 Bax 凋亡基因蛋白表达进行检测,观察干眼动物模型结膜上皮细胞凋亡与眼表干眼病变及组织损伤的关系。结果:基础泪液分泌试验结果显示,对照组和实验组除术后第 5 周比较差异有统计学意义外(P < 0.05),其余时间点差异无统计学意义(P > 0.05),术后各时间点与正常组比较差异均有统计学意义(P < 0.05)。造模术后第 1 周,对照组和实验组角膜荧光染色评分明显高于正常组;术后第 2 周后,对照组和实验组评分差异无统计学意义(P > 0.05),随着时间的延长,术后第 3 周和第 5 周,两组评分差异均有统计学意义(P < 0.05),且实验组评分小于对照组。结膜上皮细胞免疫组织化学检测结果显示:正常组结膜上皮细胞 Bax 蛋白阳性表达的细胞数较对照组和实验组少,与对照组比较,差异有统计学意义(P < 0.05),与实验组比较差异无统计学意义(P > 0.05);正常组可见大量 Bcl-2 蛋白阳性表达,且多于实验组,差异无统计学意义(P > 0.05),多于对照组,差异有统计学意义(P < 0.05);对照组结膜上皮细胞中可见大量 Bax 蛋白阳性表达于细胞质,呈棕黄色颗粒,实验组中 Bax 蛋白阳性表达相对于对照组明显较少,两者差异有统计学意义(P < 0.05);实验组结膜上皮细胞中可见大量 Bcl-2 蛋白阳性表达,对照组 Bcl-2 蛋白表达相对于实验组明显减少,差异有统计学意义(P < 0.05)。结论:海藻糖滴眼液可以减少角膜表层上皮脱落,对结膜上皮细胞有一定的保护作用,可以拮抗结膜上皮细胞的凋亡,从而增强角结膜上皮屏障功能,改善由干燥引起的眼表上皮的损伤。海藻糖溶液可用于眼表上皮疾病的潜在临床应用,为治疗眼表疾病如干眼症提供治疗选择。

Objective: To observe the efficacy of trehalose eye drops on experimental dry eye rat with removal of inside and outside lacrimal glands. Methods: A total of 30 SD rats were randomly divided into a normal group, a control group, and an experimental group, with 10 rats for each group (20 eyes). The normal group was not treated, and the experimental group and the control group were made into a dry eye animal model by removing the main lacrimal gland of the rat. The control group and the experimental group were given with normal saline and trehalose eye drops once a week after the completion of modeling, 4 times a day for 4 weeks. Shirmer I test and fluorescence staining test were carded before and 1, 2, 3, and 5 weeks after modeling. After 5 weeks of modeling, the rats were sacrificed and the expression of Bcl-2 and Bax apoptosis protein in conjunctival epithelial cells was detected by immunohistochemistry in order to observe the relationship between apoptosis of conjunctival epithelial cells and dry eye lesions and tissue damage in dry eye animal models. Results: Schirme I test results showed that there was no significant difference between the control group and the experimental group (> 0.05) except for the 5th week after operation (< 0.05). There was a statistical difference between the two groups and the normal group at each time point after surgery (< 0.05). At the first week after modeling, the corneal fluorescence staining scores of the control group and the experimental group were significantly higher than those of the normal group. After the second week after surgery, there was no significant difference between the control group and the experimental group (> 0.05). The prolongation of time, the 3 week and the 5th week after surgery, the difference between the two groups was statistically significant (< 0.05), and the score of the experimental group was smaller than the control group. The immunohistochemical results of conjunctival epithelial cells showed that the number of Bax protein positive cells in the normal conjunctival epithelial cells was less than that in the control group and the experimental group. The difference between the normal group and the control group was statistically significant (< 0.05). There was no significant difference between the two groups (> 0.05). There was a large amount of Bcl-2 protein in the normal group, which was more than the experimental group. The difference was not statistically significant (> 0.05), which was more than the control group. The difference was statistically significant (< 0.05); a large amount of Bax protein was positively expressed in the cytoplasm and brownish-yellow particles in the conjunctival epithelial cells of the control group. The positive expression of Bax protein in the experimental group was significantly less than that in the control group, and the difference was statistically significant (< 0.05). A large amount of Bcl-2 protein was positively expressed in the conjunctival epithelial cells of the experimental group, and the expression of Bcl-2 protein in the control group was significantly decreased compared with the experimental group (< 0.05).Conclusion: Trehalose eye drops can reduce epithelial detachment of the cornea and have a protective effect on conjunctival epithelial cells, which can antagonize the apoptosis of conjunctival epithelial cells, thereby enhancing the keratoconjunctival barrier function and improving the ocular surface epithelium caused bydryness. The potential clinical application of trehalose solution for ocular surface epithelial diseases and provide treatment options for ocular surface diseases, such as dry eye.

论著

医护一体化管理模式在眼底病中心日间病房的应用

Application of the medical integration mode in the day ward of ophthalmic fundus center

:148-151
 
目的:探讨医护一体化管理模式在眼底病中心日间病房中的应用与成效。方法:2015年6月至2016年6月于眼底病中心实行医护一体化管理模式,通过问卷调查比较实施前后医生和患者对护理工作的满意度。结果:医护一体化管理模式实行后,医生满意度显著提高,差异有统计学意义(t=?4.412,P<0.01),患者满意度有所提高,差异有统计学意义(t=2.592,P=0.01)。结论:采用医护一体化管理模式对眼底病日间手术住院患者进行管理,加强医护沟通,可有效提高护理质量,保障患者医疗、护理的安全性。
Objective: To explore the effect of the medical integration mode applying in the day ward of ophthalmic clinical key specialty. Methods: The ophthalmic fundus center started to carry out the medical integration mode from June 2015 to June 2016. Doctors’ and patients’ satisfaction towards nurses were surveyed before and after the implementation. Results: The doctors’ satisfaction towards nurses was statistically higher than before (t=?4.412, P<0.01). TTe patients’ satisfaction also improved, and the difference was statistically signiffcant (t=2.592, P=0.01). Conclusion: The medical integration mode strengthens the communication with doctors and patients, improves the nursing quality, and ensures the medical safety.
中山眼科中心病例挑战专栏

4例具有挑战性且不寻常的视网膜病例临床精粹讨论

:232-239
 
      3位国际视网膜专家在中山眼科中心(Zhongshan Ophthalmic Center,ZOC)眼底病中心进行临床查房并讨论了4例具有挑战性且不寻常的视网膜病例:1)VHL病合并视网膜血管母细胞瘤的11年 随访观察;2)半剂量光动力疗法(photodynamic therapy,PDT)或微脉冲激光光凝治疗中心性浆液性视网膜病变(central serous chorioretinopathy,CSC)的观察;3)视神经缺陷儿童的诊断与治疗;4)合并虹膜晶状体脉络膜缺损的视网膜脱离(retinal detachment,RD)的治疗选择。通过讨论有助于我们更好地了解这四例视网膜疾病的发病机制和治疗方法,及其与全身疾病的关系。
论著

M22优化脉冲光对睑板腺功能障碍所致干眼的疗效

Effect of M22 Optimal Pulsed Technology in the treatment of dry eye caused by meibomian gland dysfunction

:223-228
 
目的:研究M22优化脉冲光技术治疗睑板腺功能障碍(meibomian gland dysfunction,MGD)所致干眼的疗效,并用keratograph 5M干眼分析仪分析评估患者治疗前后病情变化。方法:收集汕头博德眼科医院门诊患者46例,年龄31~85(55.39±14.02)岁,行M22优化脉冲光治疗1个疗程(每月1次,共3次),治疗前后均采用keratograph 5M干眼分析仪分析评估患者泪河高度情况、泪膜破裂时间(break-up time,BUT)、脂质层、睑板腺情况的变化,采用t检验分析对比治疗前后 变化情况。结果:患者治疗后泪河高度较强脉冲光治疗前明显增高,由(0.20±0.11) mm增加到(0.35±0.11) mm,BUT时间延长,由(4.98±2.13) s延长到(10.12±1.86) s,脂质层异常情况好转,有效率达93.48%,睑板腺阻塞情况减轻,有效率达84.78%以上,治疗后与治疗前差异有统计学意义(P<0.01)。结论:M22优化脉冲光技术在治疗MGD导致的干眼有较好的效果,没有出现并发症,是较安全有效地治疗方法,且keratograph 5M干眼分析仪可以较全面的对该病进行评估。
Objective: To study the efficacy of M22 Optimal Pulsed Technology in the treatment of dry eye caused by meibomian gland dysfunction and to evaluate the changes of patients affer treatment with keratograph 5M dry eye analyzer. Methods: Forty-six patients collected from Shantou Balder Eye Hospital receiving M22 Optimal Pulsed Technology treatment for three times, once a month, then using keratograph 5M dry eye analyzer to assess the height of tears river, break-up time (BUT), lipid layer, and meibomian gland. The results before and affer laser treatment were compared using t-test in this study. Results: Affer treatment, there was signiffcant effect than those of before treatment, the BUT time was prolonged from (0.20±0.11) mm to (0.35±0.11) mm, the abnormalities of the lipid layer were alleviated, the cure rate exceeded 93.48%, and the obstruction of the meibomian gland was reduced, the cure rate was higher than 84.78%. TTe difference before and affer corresponding treatment was statistically signiffcant (P<0.01). Conclusion: M22 Optimal Pulsed Technology has a good effect in the treatment of MGD-induced dry eye without complications. So M22 Optimal Pulsed Technology is a safe and effective treatment method. And keratograph 5M dry eye analyzer can deliver comprehensive assessment of dry eye. 

高度近视合并白内障患者术后有效晶状体位置的初步临床研究

Clinical study of effective lens position after cataract surgery in high myopia eyes

:136-140
 

目的:探讨高度近视合并白内障患者白内障术后有效晶状体位置的变化。方法:收集白内障超声乳化摘除联合人工晶状体植入术的高度近视合并白内障患者 21 例共 27 眼,记录术后 1 d、1 周、1 个月视力、屈光度、有效晶状体位置。结果:高度近视合并白内障患者术后 1 d、1 周、1 个月有效晶状体位置分别为(4.17±0.39),(4.09±0.38),(4.31±0.44) mm,且组间比较差异有统计学意义(P < 0.05)。有效晶状体位置的实际轴向运动为(0.19±0.13) mm,与晶状体厚度呈正相关(r = 0.648,P < 0.001),与术前眼轴无相关关系(r = 0.227,P = 0.255)。结论:高度近视合并白内障患者术后 1 d 至 1 周人工晶状体轻度前移而造成近视偏移,而术后 1 个月时则呈远视偏移,且术后有效晶状体位置位移与术前晶状体厚度相关。


Objective: To investigate the change and influencing factors of the effective lens position after cataract surgery in high myopia eyes. Methods: We collected 27 eyes of 21 patients with high myopia who underwent phacoemulsification and intraocular lens implantation. The visual acuity, diopter and effective lens position were recorded 1 day, 1 week, and 1 month after operation. Results: The effective lens position of high myopia combined with cataract patients at 1 day, 1 week, and 1 month was (4.17±0.39), (4.09±0.38), and (4.31±0.44) mm, respectively. The effective lens positions significantly differed between the groups after surgery (< 0.05). The ELPRMS was (0.19±0.13) mm. The ELPRMS was positively correlated with the lens thickness (0.648, < 0.001),whereas was not correlated with the preoperative axial length (r 0.227, P = 0.255). Conclusion: High myopic patients with cataract have a slight forward movement of the effective lens position from 1 day to 1 week after surgery, and a hyperopic shift from 1 week to 1 month. The displacement of effective lens position after surgery is correlated with the preoperative lens thickness.

论著

超广角眼底成像在近视患者周边视网膜病变的临床应用

Clinical application of ultra-wide field laser ophthalmoscope in peripheral retinopathy in myopic patients

:130-135
 

目的:评价欧堡 Daytona 200 度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法:本研究为前瞻性病例研究,收集爱尔眼科医院要求行屈光手术的近视患者 1 000 例(2 000 只眼),分别进行小瞳下欧堡 Daytona 200 度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查,记录检查结果并进行比较分析。结果:通过欧堡 Daytona 200 度超广角激光扫描检眼镜检查发现有周边视网膜病变共 230 例(310 只眼),检出阳性率为 15.50%;三面镜检查发现周边部视网膜病变共 242 例(322 只眼),检出阳性率为 16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性(Kappa 值 0.8~1.0)。结论:欧堡 Daytona 200 度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法,在屈光手术前筛查视网膜周边部病变,具有广阔的临床应用前景。

Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by threemirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery. 

封面故事
医学教育

以上睑下垂为例阐明教学查房在外眼疾病教学中的重要性

Importance of teaching rounds in the teaching of external eye diseases illustrated by taking blepharoptosis as an example

:126-128
 

教学查房是手把手教学的重要手段和具体表现,是让同学们把书本知识应用到医疗诊疗中的重要桥梁。眼科学具有形象生动、结构复杂、直观性和操作性强等特点。外眼疾病的特征更是显而易见,针对外眼疾病诊疗中的一些不规范的操作也更易暴露出来。本文以上睑下垂为例,旨在阐明教学查房在外眼疾病教学中的重要性。

Teaching rounds are an important means and concrete manifestation of hands-on teaching, and an important bridge for students to apply book knowledge to medical diagnosis and treatment. Ophthalmology has the characteristics of vivid image, complex structure, intuition and strong operability. The characteristics of external eye diseases are more obvious, and some non-standard operations in the diagnosis and treatment of external eye diseases are easier to expose. This article takes blepharoptosis as an example to illustrate the importance of teaching rounds in the teaching of external eye diseases.

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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