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 three- mirror 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.
目的：研究调节抑制对不同单色光中豚鼠眼屈光发育的作用。方法：根据光照不同将豚鼠分成蓝光组(430 nm)、绿光组(530 nm)和白光组(色温5 000 K)，每组各8只。各组豚鼠右眼均点1%阿托品滴眼液，每天1次，持续6周。实验前后各测一次屈光度、角膜曲率半径以及眼轴各参数。结果：实验前各组豚鼠双侧眼间及组间同侧眼屈光度差异无统计学意义(约4.25 D，P >0.05)。但实验结束时蓝光组和绿光组双侧眼间屈光度差异显著(P=0.0003和P=0.028)，而白光组双侧眼间无显著差异(P=0.7486)。实验结束时各组左眼(P<0.05)、绿光组和白光组右眼(P=0.001)以及蓝光组和绿光组右眼(P <0.001)屈光差异有统计学意义。蓝光组和白光组右眼屈光差异无统计学意义( P =0.072)。实验开始时各组双侧眼间及各组间同侧眼玻璃体腔长度差异无统计学意义(约3.2 mm，P>0.05)。实验结束时，蓝光组和绿光组双侧眼间玻璃体腔长度差异有统计学意义(P=0.0017和P=0.0113)，但白光组双侧眼间差异无统计学意义(P=0.9371)。同时，各组间同侧眼玻璃体腔长度差异有统计学意义(P<0.01)。此外，实验前后各组双侧眼间及组间同侧眼角膜曲率半径、前节长度、晶状体厚度差异无统计学意义(P>0.05)。结论：1%阿托品加强530 nm单色光促进豚鼠眼玻璃体腔延长和近视形成的作用，但减弱430 nm单色光抑制豚鼠眼玻璃体腔延长和远视形成的作用。眼调节反应可能参与了单色光中豚鼠眼的屈光发育机制。阿托品影响单色光中豚鼠眼屈光发育的作用可能是通过抑制眼调节反应实现的。
Objective: To investigate the effect of inhibiting accommodation on ocular refractive development of guinea pigs in different monochromatic lights. Methods: Twenty-four pigmented guinea pigs were randomly divided into three groups with 8 animals per group: short-wavelength light (SL, 430 nm) group, middle-wavelength light (ML,530 nm) group and broad-band light (BL, 5 000 K color temperature) group. The right eyes of all animals were treated by 1% Atropine solution once a day for 6 weeks. Measurements of ocular refraction, corneal curvature, and axial length were performed at the start and the end of the study. Results: There was no significant difference in bilateral ocular refraction for all groups at the beginning of the experiment (about 4.25 D, P>0.05) and in ipsilateral ocular refraction among groups at the start of the experiment (P>0.05). But at the end of the experiment,significant differences were detected between binocular refraction of the ML group (P=0.028) and the SL group (P=0.0003), however, there was no significant difference between bilateral refraction in the BL group (P=0.7486).There were significant differences in refraction between the left eyes of any two groups (P<0.05), between the right eyes of the ML and BL group (P=0.001), and between the right eyes of the ML and SL (P<0.001) at 6 weeks.No significant refractive difference was detected between the right eyes of the SL and BL groups (P=0.072). The vitreous length was about 3.2 mm in bilateral eyes of all groups at the onset of the experiment (all inner- or inter-group P>0.05). After the experiment, the bilateral difference in vitreous length was significant in the ML group(P=0.0113) and the SL group (P=0.0017), but not significant in the BL group (P=0.9371). There were significant vitreous differences in right or left eyes among the groups at the end of the experiment (P<0.01). There were no significant inter-group (ipsilateral) or inner-group (bilateral) differences at any time in any of corneal radius of curvature, anterior segment length and lens thickness (P>0.05 for all comparisons). Conclusion: 1% atropine can strengthen the effect of vitreous elongation and myopic formation on guinea pig eyes in 530 nm monochromatic light. Moreover, atropine can weaken the effect of vitreous shortening and hyperopic formation on guinea pig eyes in 430 nm monochromatic light. Ocular accommodation response should involve in the mechanism of refractive development of guinea pig in monochromatic light. Atropine can influence the refractive development of guinea pig in monochromatic light possibly by inhibiting accommodation response.
一名47岁男性患者因双眼复视、左眼上斜2个月就诊。既往Graves病半年。门诊检查发现双眼眼球突出、左眼上斜视、左眼下转受限，遂以“甲状腺相关眼病”收入院。入院后发现患者双眼复视、左眼上斜视呈晨轻暮重的特点，结合患者眼眶MRI结果考虑眼肌型重症肌无力，进行眼肌型重症肌无力相关检查，新斯的明试验(+)、乙酰胆碱受体抗体(+)，确诊为甲状腺相关眼病合并眼肌型重症肌无力，予溴吡斯的明联合小剂量激素治疗。治疗4个月后双眼眼位正常，双眼眼球运动正常，复视消失。
A 47-year-old man presented with binocular diplopia and hypertropia of left eye for 2 months. He was diagnosed with Graves’ disease for half a year. The patient was protruding in both eyes with hypertropia and limited of infraduction in left eye. Therefore, the patient was admitted to our ophthalmology department with the diagnosis of thyroid-associated ophthalmopathy. After admitting to hospital, binocular diplopia and left eye hypertropia grew worse by the end of the day or after exertion, and improved in the morning of the day or upon rest. Combining with the orbital MRI results, the patient was considered with ocular myasthenia gravis. The related examination of ocular myasthenia gravis was performed. The following test results were: neostigmine test (+), acetylcholine receptor antibody (+). Therefore, the patient was diagnosed with thyroid-associated ophthalmopathy combined with ocular myasthenia gravis. The patient had marked improvement after treatment with pyridostigmine and oral glucocorticoid.
目的：探讨眼科住院医师规范化培训中睑板腺囊肿诊疗的培训效果及存在的问题，以期改进培训方式。方法：以2020年4月在中山大学中山眼科中心培训的154名学员为对象，进行问卷调查，采用SPSS 20.0统计学软件进行数据分析。结果：共76名专业型硕士(专硕)、78名住院医师培训(住培)学员完成了问卷调查。专硕具有睑板腺囊肿诊断、保守治疗及手术主刀经验的比例分别为40.8%、11.8%、7.9%；住培则显著高于前者，分别为79.5%(P<0.001)、60.3%(P<0.001)和21.8%(P=0.016)。对于关键诊疗环节的判断，90.8%的专硕选择了临床诊断(P=0.007)，94.9%的住培则选择治疗方案(P<0.001)。去除囊壁、术中意外与破溃皮肤的处理是专硕难以掌握的手术步骤(P<0.001)；而住培仅为去除囊壁(P<0.001)。结论：睑板腺囊肿诊疗水平在眼科住院医师规范化培训中亟待提高，并根据各类型学员的临床能力和认知差异，进行分级分类培训。
Objective: To explore the teaching effect of diagnosis and treatment on chalazion in the standardized training of ophthalmology residents and its existing problems, in order to improve the quality of the training systems. Methods: A self-designed questionnaire survey was conducted with 154 ophthalmology residents in Zhongshan Ophthalmic Center in April 2020, and the investigative data was analyzed using SPSS 20.0. Results: Totally 76 medical postgraduates and 78 ophthalmology residents completed the questionnaire survey. The proportions of medical postgraduates who had individual experience on diagnosis, conservative and surgical treatment of chalazion were 40.8%, 11.8%, and 7.9%. Compared to the former, ophthalmology residents had significantly higher proportion, with 79.5% (P<0.001), 60.3% (P<0.001), and 21.8% (P=0.016), respectively. For judging the important aspect of diagnosis and treatment process, the medical postgraduates chose the clinical diagnosis (90.8%) (P=0.007), while the ophthalmology residents paid more attention on treatment options (94.9%) (P<0.001). In the surgical procedures, removal of cyst wall, management of intraoperative accidents and skin ulcers are all their difficult skills to master for medical postgraduates (P<0.001), while only removal of cyst wall for residents (P<0.001). Conclusion: The training level of diagnosis and treatment of chalazion still needs to be improved in the standardized training of ophthalmology residents. The training should be carried out according to the clinical competence and cognition differences of various types of students.
目的：比较VX120多功能眼检查仪与Topcon KR 800全自动验光仪的客观验光结果的一致性。方法：收集2019年1 1月至2019年1 2月在我院就诊拟行角膜屈光手术的患者2 4例(24只眼)，所有患者均取右眼。采用Topcon KR 800全自动验光仪和VX120多功能眼检查仪分别对2 4例患者进行客观验光检查，分别得到球镜光度(S)、柱镜光度(C)、等效球镜光度(M)、水平和垂直方向的柱镜光度(J0)及45°柱镜光度( J45)。采用配对T检验对两种设备的测量值进行组间比较，并采用Bland-Altman 95%一致性界限法衡量其一致性。结果：VX120多功能眼检查仪在明视模式下所测S为(-3.90±3.06) D；M为(-4.41±3.24) D；J0为(0.34±0.58) D；J45为(?0.04±0.26) D；TopconKR800全自动验光仪所测S为(-3.77±2.88) D；M为(-4.15±3.07) D；J0为(0.25±0.47) D；J45为(-0.01±0.18) D。VX120多功能眼检查仪在明视模式与TopconKR800全自动验光仪所测得的S、M、J45差异无统计学意义，而J0两者之间差异有统计学意义(t=-2.24，P=0.04)。Bland-Altman95%一致性分析显示，两种仪器参数数据点多分布在95%可信区间内，一致性较好。结论：VX120多功能眼检查仪明视模式下与TopconKR800全自动验光仪的客观验光结果一致性较好，在屈光度检查上可以相互替代。
Objective: The aim of this study was to compare the consistency of objective optometry results between VX120 multi-diagnostic unit and TopconKR800 automatic optometer. Methods: A total of 24 patients (24 right eyes) admitted to our hospital from November 2019 to December 2019 for corneal refractive surgery were collected. Optometry was performed on 24 patients with TopconKR800 automatic optometer and VX120 multi-diagnostic unit, and got the results following: spherical mirror photometry (S), cylindrical lens luminosity (C), mean spherical equivalent (M), horizontal and vertical cylindrical lens luminosity ( J0) and 45° cylindrical lens luminosity ( J45). Compared T-test analysis was used to compare the parameters of the two devices, and the Bland-Altman 95% limits of agreement were performed. Results: The S measured by the VX120 multi-diagnostic unit with bright mode was (-3.90±3.06) D; M was (-4.41±3.24) D; J0 was (0.34±0.58) D;J45 was (-0.04±0.26) D. The S measured by TopconKR800 automatic optometer was (-3.77±2.88) D; M was (-4.15±3.07) D; J0 was (0.25±0.47) D; J45 was (-0.01±0.18) D. There was no statistically significant difference in S, M, and J45 measured by VX120 multi-diagnostic unit and TopconKR800 automatic optometer in bright mode, while there was statistically significant difference in J0 between VX120 multi-diagnostic unit and TopconKR800 automatic optometer (t=-2.24, P=0.04). Bland-Altman 95% consistency analysis showed that the data points of the two instruments were mostly distributed within the 95% confidence interval, indicating that the parameters measured by these two devices were in accord with each other. Conclusion: The objective optometry results of VX120 multi-diagnostic unit and TopconKR800 automatic optometer were consistent and can be substituted for each other in the refraction examination.
目的：观察视网膜激光光凝术(laser photocoagulation，LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity，ROP)的疗效。方法：收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症，分析不同手术方式的效果。结果：LP组20例(37只眼)行视网膜激光光凝治疗，术后未出现复发，首次治愈率100%；术后(3.42±1.57)周病情控制，术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗，39只眼行单次手术后病情控制，首次治愈率88.6%，5眼术后病情未控制。术后(2.95±2.58)周病情控制，术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论：视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效，IVR复发率较高，手术方式的选择需慎重。
Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.
近5年来眼睑皮脂腺癌研究取得一系列成果。临床研究方面，明确了眼睑皮脂腺癌冰冻切缘控制显微手术的意义，提出了患者预后指标；在基础研究方面，描述了基因突变谱，揭示了3种相互独立的发病模式，以及提出了免疫及靶向治疗相关研究；我国眼肿瘤工作者也在眼睑皮脂腺癌研究方面树立了国际地位。本文对近5年国内外眼睑皮脂腺癌相关研究方面的主要成果进行总结分析，并展望治疗前景，为临床提供有益参考。
In recent 5 years, a series of studies have been made in the mechanism of onset of eyelid sebaceous carcinoma worldwide. In clinical research, the prognosis has made in predicting progression of patients with eyelid sebaceous carcinoma, and the significancy of frozen margin control in microsurgery was clarified. In field of basic research,from elucidation of mutational landscape to revelation of three independent pathogenesis patterns, from researches on immunotherapy to targeted therapy, efforts have been made to reveal the pathological mechanism to both aspect of its morbidity and development. This paper summarizes, analyzes and reviews the main achievements in recent 5 years on eyelid sebaceous carcinoma.
眼睑皮脂腺癌是起源于眼睑部位皮脂腺体的恶性上皮性肿瘤，易复发、转移，主要治疗方式仍以手术切除为主，但患者整体预后并不理想，早期正确诊断和靶向治疗是改善患者预后和改进治疗的关键。眼睑皮脂腺癌临床表现复杂，早期容易误诊或漏诊进而延误治疗，病理检查是其诊断的金标准。此外，目前关于眼睑皮脂腺癌发病机制未完全阐明，癌发生发展的分子生物学过程尚未明确。因此，多方面了解眼睑皮脂腺癌发病机制为靶向治疗提供理论基础是十分必要的。本文主要从眼睑皮脂腺癌发病机制包括遗传因素、表观遗传、外源病毒感染、免疫逃逸、端粒酶学说等方面对眼睑皮脂腺癌作一综述。
Eyelid sebaceous gland carcinoma is a malignant epithelial tumor originating from eyelid sebaceous glands, which is prone to relapse and metastasis. The treatment mainly depends on surgical excision, but the overall prognosis of patients is not ideal. Early diagnosis and targeted therapy are the keys to improve the prognosis of patients.Due to its complex clinical manifestations, early misdiagnosis or missed diagnosis is easy to delay treatment, and pathological examination is still the gold standard for its diagnosis. In addition, the pathogenesis of eyelid sebaceous gland carcinoma is still unclear, and the molecular biological process of the occurrence and development is less understood. Therefore, it is very necessary to understand the pathogenesis of eyelid sebaceous gland carcinoma in various aspects to provide a theoretical basis for targeted therapy. In this paper, the pathogenesis of eyelid sebaceous gland carcinoma was reviewed from the aspects of gene , epigenetic, viral infection, immune escape, , telomerase theory and so on.
Merkel细胞癌(Merkel cell carcinoma，MCC)是一种少见的高度恶性的皮肤原发性神经内分泌癌，发生于眼睑的MCC更加罕见。本文对2例眼睑MCC患者的临床病史和治疗过程进行回顾和总结。1例初发患者经手术彻底切除，效果良好，随访7年，未再复发；1例患者在外院切除术后2个月，于眼睑原位复发，再次行手术彻底切除，2个月后同侧腮腺淋巴结及颈前淋巴结扩散，目前仍在肿瘤科进一步放化疗中。复习相关文献并结合本组病例提示，MCC诊断主要依靠病理检查，彻底切除病灶并结合术后放化疗是其治疗的主要手段，免疫治疗是目前新的发展趋势。
The Merkel cell carcinoma (MCC) is a rare highly malignant primary neuroendocrine carcinoma of the skin,especially in the eyelids. In this report, the clinical history and treatment course of 2 patients with MCC of the eyelid were reviewed and summarized. Patient 1 with primary MCC of eyelid was treated with complete surgical excision, with good results. Follow-up for 7 years had shown no recurrence. Patient 2 with the eyelid relapse in situ two months after resection in another hospital, was treated with complete surgical excision again, but the tumor metastasized to the ipsilateral lymphonodi parotidici and cervical lymph nodes two months after the surgery. The patient is now going through radiotherapy and chemotherapy in oncology department. According to the review of literatures, the diagnosis was based on the pathologic evidence. Complete removal of lesion combined with postoperative radiotherapy and chemotherapy is a major means of treatment for MCC. Immunotherapy will play a more important role in the future.
眼眶泪腺淋巴上皮癌是一种非常少见的恶性肿瘤。本例为一位46岁女性患者，表现为左眼睑红肿、眼球突出和视力下降，临床和影像学表现类似于泪腺炎型假瘤。手术完整切除后送检病理检查，其特征是未分化的癌巢之间有大量分化成熟的淋巴细胞、浆细胞浸润，确诊为淋巴上皮癌。术后行化学治疗和局部放射治疗，随访6.5年无复发。眼眶泪腺淋巴上皮癌的临床表现容易与泪腺炎型假瘤相混淆，应该进行病理学检查以明确其恶性表型，完整切除后辅助放化学治疗有较好的效果。
Lymphoepithelial carcinoma of the orbital lacrimal gland is a rare carcinoma. A 46-year-old female patient presented with red and swollen left eyelid, proptosis and blurred vision. The clinical and imaging manifestations were similar to inflammatory pseudotumor. Pathological examination was performed after complete resection.Pathological features showed undifferentiated carcinoma nests surrounded by obvious infiltration of non-neoplastic lymphocytes and plasma cells, which was consistent with the diagnosis of lymphoepithelial carcinoma.Chemotherapy and local radiotherapy were performed after the resection. The case did not relapse after 5 years of follow-up. The clinical manifestations of orbital lacrimal lymphoepithelial carcinoma were easily confused with inflammatory pseudotumor. Pathological examination should be performed to clarify its malignant phenotype.Adjuvant radiotherapy and chemotherapy after complete resection had a good effect.
