研究生导师的能力和水平是影响研究生教育质量的最关键因素之一。针对眼科学研究生专业基础 知识薄弱、动手实践机会缺乏、创新能力不足，导师队伍教学主动性不强、活力欠佳等问题，中 山眼科中心逐步建立了“行政+专家”的双重教学管理架构，引导激励教师积极主动参与、推动研 究生课程改革、科研创新能力培训、教学信息化建设、教学质控与学生管理等各项教学改革与决 策，通过不断完善教师参与教学改革共同治理的长效机制，打造高素质的教师队伍，实现高质量 的眼科学研究生培养。
The ability and level of postgraduate tutor is one of the key factors affecting the quality of graduate education. In view of the weak basic ophthalmic knowledge, lack of practical opportunities and the inefficiency in innovation ability among ophthalmology graduates, as well as the lack of initiative and vitality in teaching team, Zhongshan Ophthalmic Center, Sun Yat-Sen University has been gradually established the dual management structure of “administration and experts”. By guiding and encouraging the teachers participate in the curriculum reform of graduates, scientific research ability training, management informatization, the teaching quality control, student administration and so on. Through improving the long-term mechanism of teachers’ participation in teaching reform governance, the quality of teachers has been improved, which promote the high-quality development of ophthalmology graduate education.
视网膜退行性疾病的种类繁多、患病人口基数大，该病特征为终末期严重的视网膜细胞丢失。视网膜类器官(retinal organoid，RO)可通过3D干细胞体外分化培养技术大量获取，并拥有完整的各亚型视网膜细胞和经典的视网膜分层结构。因此，RO可作为最佳的视网膜退行性疾病建模方法之一，以便于发现潜在致病机制。目前，RO衍生物已被广泛用于视网膜细胞替代治疗的动物实验和临床研究，具体的成效参差不齐，可能的影响因素包括移植细胞数量、移植时间窗、移植工具等。随着RO相关研究的快速发展，视网膜退行性疾病在分子和个体上的诊断和治疗将进一步完善。
Retinal degenerative diseases, characterized by severe retinal cell loss at the end stage, are of various kinds and haunt vast amounts of patients. Retinal organoid (RO) with complete retinal cell subtypes and classic retinal stratification structures can be obtained in large quantities through stem cells in vitro 3D differentiation and culture method. Therefore, RO can serve as one of the best ways for retinal degenerative disease modeling to facilitate the decipherment of underlying pathogenic mechanisms. At present, RO derivatives have been widely used in animal experiments and clinical studies of retinal cell replacement therapy with varying results possibly affected by cell quantity, time window, or tools in terms of transplantation. With the booming progress of RO-related research, the diagnosis and treatment on molecular and individual level for retinal degenerative diseases will be further improved.
报道1例睫状体无色素上皮腺瘤(adenoma of nonpigmented ciliary epithelium，ANPCE)并进行相关文献复习。患者主要症状为左眼视力逐渐下降3个月，视物不清半个月。经眼部检查及左眼超声生物显微镜(ultrasound biomicroscopy，UBM)检查显示左眼虹膜周边隆起，边界清晰。予虹膜睫状体肿物切除术并行常规病理检查：光镜下肿瘤组织由分化好的上皮细胞组成，排列成腺泡状及条索状，细胞间可见红染无结构的基底膜样物；免疫组织化学表达：S-100(+)、Vimentin(+)、EMA(+)、CKpan(+)、Melan-A(+)；最终病理诊断ANPCE。手术后截至随访日期，术后3个月无疾病进展。
A case of adenoma of nonpigmented ciliary epithelium (ANPCE) was reported and relevant literatures were reviewed. The left eye visual acuity of the patient gradually decreased for 3 months, and half a month was blurred vision. The vision examination and ultrasound biomicroscopy (UBM) from the left eye examination revealed a bulge in the peripheral iris in the left eye, with the boundaries are clear. The left eye was treated with ciliary mass resections and routine pathological examination: microscopy showed that the tumor tissue consists of well-differentiated epithelial cells, the tumor cells were arranged in tubes and cords, between the cells were seen red-stained unstructured basement membrane; immunohistochemistry showed: S-100 (+), Vimentin (+), EMA (+), CKpan (+), Melan-A (+); the final pathological diagnosis was ANPCE. There was no progression of the disease during the 3 months following the surgery on the follow-up date.
视神经脊髓炎相关性视神经炎(neuromyelitis optica spectrum disorder optic neuritis，NMO-ON)是一种常见的视神经炎(optic neuritis，ON)类型。女性非白种人占优势，损伤严重，双侧受累较多，视力预后差。我国有很大部分特发性ON最终诊断为NMO-ON。在相关实验室、光学相干断层扫描(optical coherence tomography，OCT)、磁共振(magnetic resonance imaging，MRI)等技术支持下，目前对NMO-ON的认识有了很大的进步，治疗方式除了皮质类固醇外还有免疫球蛋白、血浆置换及免疫抑制剂等。但提高NMO-ON的诊疗水平还有很长的路，更好地认识NMO-ON有助于更快速的诊断、更规范的治疗、更良好的预后。我们可以联合神经科开展多中心大样本量前瞻性的临床对照研究。
Neuromyelitis optica spectrum disorder- optic neuritis (NMO-ON) is a common type of optic neuritis (ON). This affliction is predominant in female non-Caucasians, with severe injury, more bilateral involvement, and poor visual prognosis. In China, a large proportion of idiopathic ON is ultimately diagnosed as NMO-ON. Our understanding of NMO-ON has made great progress under the technical support, such as the relevant laboratory, optical coherence tomography (OCT), magnetic resonance imaging (MRI). In addition to corticosteroids, immunoglobulin, plasmapheresis and immunosuppressive agents are also available for treatment. However, there is still a long way to improve the diagnosis and treatment level of NMO-ON. A better understanding of NMO-ON contributes to faster diagnosis, more standardized treatment, and better prognosis. We should cooperate with the neurology department to conduct a multi-center, large sample size prospective clinical control study.
目的：探讨光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)在糖尿病性视网膜病变中的应用。方法：选取2021年中山大学附属第七医院眼科63例糖尿病患者为研究对象，分为无糖尿病性视网膜病变(T0，21眼)、轻度非增殖期(T1，21眼)、中重度非增殖期(T2，14眼)及增殖期(T3，7眼)。收集各组生化指标，包括空腹血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血清尿素氮、肌酐、尿素氮肌酐比值，及OCTA数据，即中心视网膜厚度、Angiography3×3及Angiography6×6血管线性密度及血管灌注密度等。采用单因素方差分析比较各组间差异。结果：T2组、T3组与T0组相比，T3组与T1组相比，糖尿病病程延长；T3组与其他各组相比，尿素氮升高；T1组、T2组、T3组与T0组相比，T3组与T1组相比，6 mm ×6 mm外层血流线性密度减少；与T0组相比，T1组、T2组及T3组6 mm ×6 mm完整血流线性密度减少；与T0相比，T2组、T3组6 mm ×6 mm外层血流灌注密度减少；与T0组相比，T3组6 mm ×6 mm完整血流灌注密度减少；T2组、T3组与T0组相比，T3与T1相比，3 mm ×3 mm内层血流线性密度明显减少；T3组与T0组及T1组相比，3 mm ×3 mm完整血流线性密度减少。结论：随着糖尿病性视网膜病变的进展，患者的尿素氮及肌酐逐渐升高，OCTA的血流线性密度及血流灌注密度逐渐减少。与血流灌注密度相比，血流线性密度对于早期糖尿病性视网膜病变筛查可能更为敏感。而利用Angiography6×6模式可能可以更早地发现糖尿病性视网膜病变的视网膜血流变化。
Objective: To explore the applications of optical coherence tomography angiography (OCTA) in diabetic retinopathy. Methods: A total of 63 diabetic patients in the Department of Ophthalmology, Seventh Affiliated Hospital of Sun Yat-sen University in 2021 were divided into 4 groups: the patients without diabetic retinopathy (T0, n=21), mild non-proliferative diabetic retinopathy (T1, n=21), moderate-to-severe non-proliferative diabetic retinopathy (T2, n=14) and proliferative diabetic retinopathy (T3, n=7). Biochemical Indicators were collected in all patients, such as fasting plasma glucose (FPG), glycated hemoglobin A1c (HbA1c), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), the blood urea nitrogen (BUN), creatinine (CRE) and the ratio of blood urea nitrogen and creatinine (BUN/CRE). The Macular Cube 521×128, Angiography3×3, and Angiography6×6 models of OCTA were used to obtain central retinal thickness (CRT), vascular density (VD) and perfusion density (PD) of each group. The data of all subjects was applied to do one-way ANOVA. Results: Prolonged duration of diabetes in T2 and T3 compared to T0 and in T3 compared to T1. Elevated BUN in T3 compared to all other groups. When T1, T2 and T3 were compared to T0, and T3 was compared to T1, the VD of the 6 mm ×6 mm outer layer decreased. Reduced VD of intact 6 mm ×6 mm region in T1, T2 and T3 compared to T0. Declining PD of the 6 mm ×6 mm outer layer in T2 and T3 compared to T0. Diminished PD of whole 6 mm ×6 mm area at T3 compared to T0. The VD of 3 mm ×3 mm inner layer was significantly reduced in T3 compared to T0 and T1. The VD of 3 mm ×3 mm intact area gradually dwindled in T3 compared with T0 and T1 (P<0.05). Conclusion: With the progression of diabetic retinopathy, the levels of BUN and CRE gradually increased, and the OCTA-derived vascular density and perfusion density gradually decrease. Vascular density may be more sensitive for early diabetic retinopathy screening than perfusion density.The use of the Angiography6×6 model may result in an earlier detection of changes in retinal blood flow in diabetic retinopathy.
泪膜是覆盖于眼球表面的一层液体薄膜，从内而外分为黏液层、水液层和脂质层，每层成分的改变都会导致泪膜不稳定，进而导致干眼的发生。在研究泪膜破裂方式及相关泪液成分改变的基础上，学者Yokoi及其团队分别在2012年和2013年提出了有关干眼治疗和诊断的新概念，称为泪膜导向治疗(tear film-oriented therapy，TFOT)和泪膜导向诊断(tear film-oriented diagnosis，TFOD)，就是根据泪膜破裂模式(tear film break-up pattern，TFBUP)的不同，推断出相应的泪膜成分改变，补充不足的泪膜成分，这种诊疗方法目前正逐渐被接受。本文对不同泪膜破裂方式与泪膜成分改变的关系做了汇总分析，旨在为干眼的诊断和治疗提供更为科学实用的指导方案。
Tear film is a layer of fluid film covering the surface of eye global, which is divided into mucus layer, aqueous layer and lipid layer from inside to outside. The change of each layer composition will lead to tear film instability, resulting in the occurrence of dry eye. On the basis of numerous studies on the correlation between tear composition and tear film break-up patterns, Yokoi and his team proposed new concepts on the diagnosis and treatment of dry eye called tear film-oriented therapy (TFOT) and tear film-oriented diagnosis (TFOD) in 2012 and 2013. That is according to different tear film break-up patterns (TFBUP), so changes in tear film composition can be deduced and supplemented, and this diagnosis and treatment method is gradually being accepted. In this paper, we summarized and analyzed the relationship between different tear film break-up patterns and changes in tear film composition to provide a more scientific and convenient guidance program for the diagnosis and treatment of dry eye.
Background: Laser photocoagulation restricted to ablation of the avascular retina has been the conventional but not a completely effective treatment strategy in the management of threshold retinopathy of prematurity (ROP). The purpose of this study was to compare the structural outcomes of additional posterior to ridge diode laser compared to conventional diode laser to avascular retina alone in threshold stage III ROP.
Methods: This was a prospective, randomized study involving infants diagnosed with threshold stage III ROP in one or both the eyes. The infants were randomized into control and study groups. Infants under the control group underwent conventional laser to avascular retina alone while infants under the study group received additional two rows of laser posterior to the ridge in the vascular retina. The infants were followed up at 2 weeks, 1 month and up to 6 months after the laser procedure.
Results: During the study period of 1 year, 42 eyes of 24 infants were recruited into this study with 21 eyes in each group. The mean birth weight was 1,310.48±400.92 g in the test group and 1,341.9±396.2 g in the control group. The mean post conceptional age at the time of intervention was 36.43±2.79 weeks in test group and 36.29±2.55 weeks in the control group. At 1-month post laser, 19 eyes in the study group showed regression of neovascularization laser compared to 18 eyes in the control group. However at the end of 3 and 6 months post laser, both groups had showed similar rates regression of neovascularization (19 of 21 eyes in both groups). Five eyes in the study group and six in the control group required additional laser treatment. Two eyes in the study group and one eye in the control group developed post laser vitreous hemorrhage.
Conclusions: Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser.
Background: Laser photocoagulation restricted to ablation of the avascular retina has been the conventional but not a completely effective treatment strategy in the management of threshold retinopathy of prematurity (ROP). The purpose of this study was to compare the structural outcomes of additional posterior to ridge diode laser compared to conventional diode laser to avascular retina alone in threshold stage III ROP.
Methods: This was a prospective, randomized study involving infants diagnosed with threshold stage III ROP in one or both the eyes. The infants were randomized into control and study groups. Infants under the control group underwent conventional laser to avascular retina alone while infants under the study group received additional two rows of laser posterior to the ridge in the vascular retina. The infants were followed up at 2 weeks, 1 month and up to 6 months after the laser procedure.
Results: During the study period of 1 year, 42 eyes of 24 infants were recruited into this study with 21 eyes in each group. The mean birth weight was 1,310.48±400.92 g in the test group and 1,341.9±396.2 g in the control group. The mean post conceptional age at the time of intervention was 36.43±2.79 weeks in test group and 36.29±2.55 weeks in the control group. At 1-month post laser, 19 eyes in the study group showed regression of neovascularization laser compared to 18 eyes in the control group. However at the end of 3 and 6 months post laser, both groups had showed similar rates regression of neovascularization (19 of 21 eyes in both groups). Five eyes in the study group and six in the control group required additional laser treatment. Two eyes in the study group and one eye in the control group developed post laser vitreous hemorrhage.
Conclusions: Posterior to ridge laser treatment for severe stage 3 ROP did not show any additional benefit compared to conventional laser.
目的：研究“中山眼鼻相关疾病·内镜论坛”的培训效果及其影响因素。方法：采用调取平台数据和调查问卷的方法，研究2020年6月至2022年5月16期“中山眼鼻相关疾病·内镜论坛”的参与人员情况和培训效果反馈，并分析专业、职称、地域等因素对培训效果的影响。结果：学员合计7889人，27634人次，以副主任医师30.2%(2382人)和主治医师32.9%(2597人)为主。参与学员人数从第1期的269人，逐渐增加到第16期的2537人。学员参与人数最多和收获最大的主题均为应用解剖和影像学、甲状腺相关眼病、泪道疾病。通过调查问卷发现：75.4%(95/126)的学员认为所学内容对今后的临床工作具有非常大的作用；84.1%(106/126)的学员应用所学的知识改进了日常临床工作；96.0%(121/126)的学员愿意参加中山眼科中心举办的线下实操的眼鼻相关解剖学习班。对于所学知识在今后临床工作的作用，副主任医师和主治医师认为“非常有用”的比例明显高于主任医师。在是否将所学知识应用于日常临床工作方面，副主任医师和主治医师认为“是”的比例明显高于主任医师和住院医师。参与6~16次论坛的学员，培训效果明显优于参与1~5次的学员。结论：眼鼻相关疾病·内镜微创领域在眼科和鼻科领域关注度日益提升。“中山眼鼻相关疾病·内镜论坛”有助于学员理论知识的扩展和提升，对眼鼻相关疾病医生的日常临床工作具有很好的作用，主治医师和副主任医师职称的学员培训效果更好，参与论坛次数多的学员培训效果更好。
Objective: To assess the training effects of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” and its influencing factors, propose targeted suggestions for training focus and teaching methods, and improve the teaching quality. Methods: Statistics of live broadcast platform data and custom-designed questionnaires were used to inquire the participants enrolled in the 16 sessions of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” from June 2020 to May 2022 for their feedbacks on training effects. The influence of their professions, titles, regions and other factors on the training effects was analyzed. Results: A total of 7 899 participants were enrolled in “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums”, and the total live broadcast person-time was 27 634. Associate senior doctors (30.2%, 2 382) and attending doctors (32.9%, 2 597) accounted for the largest proportion. The number of participants gradually increased from 269 in the first session to 2 537 in the 16th. The topics with the largest number of participants and the greatest gains were applied anatomy and imaging, thyroid associated ophthalmopathy, and lacrimal duct diseases. Through the questionnaire study, 75.4% (95/126) of the participants thought that what they had learned in the forums was very important for their future clinical work; 84.1% (106/126) of the participants applied the knowledge to improve their daily clinical work; 96.0% (121/126) of the participants were willing to participate in the offline practice of eye and nose anatomy classes held by Zhongshan Ophthalmology Center. In terms of the role of the learned knowledge in the future clinical work, the proportion of associate senior doctors and attending doctors who thought "very useful" was significantly higher than that of senior doctors. In terms of whether to apply the knowledge learned to daily clinical work, the proportion of associate senior doctors and attending doctors thinking “yes” was significantly higher than that of senior doctors and residents. Participants who participated in 6–16 sessions had significantly better training results than those who participated in 1–5 sessions. Conclusion: Eye and nose related diseases are attracting increasing attention in ophthalmology and rhinology. “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” are conducive to the expansion and improvement of participants’ theoretical knowledge, and plays a good role in the daily clinical work of doctors with eye and nose related diseases. The training effect of attending doctors and associate senior doctors is better, and the training effect of participants who participate in the forum more times is better.
目的：探讨外伤性视神经病变(traumatic optic neuropathy，TON)患者内镜下经蝶筛径路视神经管减压术(endoscopic trans-ethmosphenoid optic canal decompression，ETOCD)的整体护理。方法：选取中山大学中山眼科中心2020年1月至2021年3月收治的80例TON患者，回顾总结患者 ETOCD期间的护理措施及手术疗效。结果：所有患者经过综合护理后均顺利完成手术，未发生感染，出血、疼痛情况经治疗和护理后均改善，68.8%患者术后视力有提高。结论：针对TON患者ETOCD的特点，采取个体化的整体护理具有重要意义，有利于帮助患者顺利完成手术，降低并发症的发生率，促进患者康复。
Objective: To investigate the holistic nursing care of patients with traumatic optic neuropathy undergoing endoscopic trans-ethmosphenoid optic canal decompression (ETOCD). Methods: A total of 80 patients with traumatic optic neuropathy admitted to Zhongshan Ophthalmology Center of Sun Yat-sen University from Jan 2020 to Mar 2021 were selected as the subjects, and the nursing measures and surgical effect during ETOCD were reviewed and summarized. Results: All 80 surgical patients successfully completed the operation after comprehensive nursing without infection. The bleeding and pain were improved after treatment and nursing, and 68.8% patients presented with vision improvement. Conclusion: According to the characteristics of ETOCD in patients with traumatic optic neuropathy, it is of great significance to take individualized overall care, which is beneficial to help patients successfully complete the operation, reduce the incidence of complications, and promote the recovery of the patient’s healthy.
