患者，男，54 岁，因“双眼异物感伴眼痒 2 周”在北京怀柔医院眼科就诊。自诉 1 d 前自行从眼内取出白色虫体 1 条。裂隙灯检查发现左眼结膜囊内可见白色虫体 2 条，用眼科镊子将其取出，并送病理科检查。就诊结束后嘱患者左氧氟沙星眼液滴左眼，4次/d 。后病理科证实虫体为结膜吮吸线虫。5 d 后患者复诊，诉左眼仍眼痒伴异物感，再次行裂隙灯检查检深部穹隆白色虫体 1 条，取出虫体，并使用生理盐水加压冲洗结膜囊，嘱患者局部抗生素点眼，门诊随访 3 周未见复发。

A 54-year-old patient was admitted to the Department of Ophthalmology in Beijing Huairou Hospital due to the itch of eyes for 2 weeks. He said that a white worm was removed from the eye the day before the visit. Two white worms were found in the conjunctival sac from the left eye and we removed them with the tweezers and then sent to pathology department for further examination. The patient was told to use the levofloxacin eye drop 4 times a day. After 2 days, it was confirmed that the worms were Thelazia callipaeda; after 5 days, the patient came back for further consultation and complained that the itching and foreign body sensation didn’t disappear. And then a white worm was found in the deep conjunctival sac from the left eye. The worm was removed, and the conjunctival sac was flushed with saline. The patient was told to continue using the levofloxacin eye drop. During 3-week followup, no recurrence was found.

目的：评估 2.2 mm微切口白内障超声乳化摘除（phacoemulsification，Phaco）联合多焦点人工晶状体 （multifocal intraocular lens，MIOLs）植入术治疗老年性白内障的临床安全性及疗效。方法：选取于 2018 年 1 月 1 日至 2018 年 6 月 31 日于佛山市第二人民医院行白内障Phaco联合人工晶状体植入的老年白内障患者。将其分为 2 组：A组 31 例 35 眼行 2.2 mm微切口Phaco联合MIOLs植入术，B组 31 例 38 眼行 3.0 mm标准切口Phaco联合单焦点IOLs植入术。2 组患者均完善术前、术后的裸眼视力、角膜曲率、眼压、角膜内皮细胞数、离焦曲线等检查，同时记录其手术过程中的参数，进行比较。结果：A组与B组在手术过程中，总超乳时间、总超乳能量、超声乳化累积能量复合参数、有效超乳时间、平均超乳能量、总手术时间对比，差异均无统计学意义（均P>0.05）。2组患者术后较术前比较，角膜内皮细胞数均有所下降，差异有统计学意义（P<0.05）；2 组患者间在各时间点的比较，差异均无统计学意义（均P>0.05）。2 组患者手术中均未出现后囊膜破裂等并发症。2.2 mm切口与 3.0 mm切口术后均增加了角膜散光，与术前比较差异均有统计学意义（均P<0.01）；2 组间比较，差异无统计学意义（均P>0.05）。术后 3 个月，2 组间裸眼远视力（uncorrected distance visual acuity，UCDVA）对比差异无统计学意义（t=−1.794，P=0.07）；裸眼近视力（uncorrected near visual acuity，UCNVA）对比差异有统计学意义（t=−25.147，P<0.01）。A组的离焦曲线有 2 个峰值，分别位于 0 D和−3.5 D附近，两峰值间形成一个下降平缓的平台；B组的离焦曲线只有1个峰值，位于0~0.5 D之间，峰值两端下降趋势明显。A组的脱镜率为 77.42%（24/31），B组的脱镜率为12.90%（4/31），差异有统计学意义（χ² =26.050，P<0.01）；2 组的总体满意度差异无统计学意义（χ² =1.615，P=0.204）。结论：2.2 mm同轴微切口白内障手术在临床上安全性良好，联合植入MIOLs有较好的疗效，可于临床上广泛推广。 

Abstract Objective: To evaluate the clinical safety and curative effect of phacoemulsification （Phaco） combined withmultifocal intraocular lens （MIOLs） implantation in the treatment of senile cataract with 2.2 mm microincision cataract. Methods: The cataract patients who underwent phacoemulsification and intraocular lens implantation in our hospital were selected from January 1, 2018 to June 31, 2018. They were divided into two groups: group A with 31 patients （35 eyes） undergoing 2.2 mm micro-incision Phaco combined with MIOLs, while group B with 31 patients （38 eyes） undergoing 3.0 mm standard incision Phaco combined with single focus IOLs.The preoperative and postoperative uncorrected visual acuity, corneal curvature, intraocular pressure, corneal endothelium number, and defocus curve were recorded in both groups. The parameters during the operation were also recorded and compared. Results: There was no statistically significant difference in the parameters including total phacoemulsification time, total phacoemulsification energy,phacoemulsification cumulative energy compound parameters, effective phacoemulsification time, average phacoemulsification energy, total surgery time between group A and group B during the operation （all P>0.05）. Compared with preoperative, the number of corneal endothelial cells decreased both in the two groups after surgery. The difference was statistically significant （P<0.05）. There was no significant difference between the two groups at any time （all P>0.05）. There were no complications such as posterior capsule rupture during operation in both groups. The corneal astigmatism was increased after operation both in the 2.2 mm incision and 3.0 mm incision, and the difference was statistically significant compared with pre-operation （both P<0.01）. There was no significant difference between the two groups （all P>0.05）. At 3 months postoperatively, there was no significant difference in uncorrected distance visual acuity （UCDVA） between the two groups （t=−1.794, P=0.07）, and the difference was statistically significant in the uncorrected near visual acuity （UCNVA） （t=−25.147, P<0.01）. Defocus curve: The defocus curve of group A had two peaks, which are located near 0 D and −3.5 D, forming a flat platform with a descent between the two peaks. The defocus curve of group B had only one peak, located at 0–0.5 D, and the downward trend at both ends of the peak was obvious. The rate of off-glasses and satisfaction: the rate of off-glasses in group A was 77.42% （24/31）, and the rate of dislocation in group B was 12.90% （4/31）. The difference was statistically significant （χ² =26.050, P<0.01）. There was no significant difference in overall satisfaction between the two groups （χ² =1.615, P=0.204）. Conclusion: The 2.2 mm coaxial microincision cataract surgery yields high clinical safety, and the combined implantation of multi-focal intraocular lens has good curative effect and can be widely promoted in clinical practice. 

硅油是最常用的眼内填充物之一，在现代玻璃体视网膜手术中具有无可替代的地位。然而由于硅油的理化特性，其在眼内使用 3 个月至 1 年后会不可避免地影响眼球各组织的结构和功能，可导致角膜变性、继发性青光眼、并发性白内障、视网膜前膜等一系列并发症。

Silicone oil is one of the most common intraocular fillers. It has an irreplaceable position in the modern vitreoretinal surgery. However, due to the physicochemical properties of silicone oil, it will inevitably affect the structure and function of eyeball tissues from 3 months to 1 year after intraocular use, which can lead to a series of complications, such as corneal degeneration, secondary glaucoma, complicated cataract and retinal membrane.

      报告 1 例 2019 年 1 月因无色素性视网膜色素变性而就诊的病例。患者因发现视力差，常规眼科检查及全身的检查未发现异常，给予眼底荧光造影后确诊。给予眼底荧光造影后最终确诊为罕见的无色素性视网膜色素变性，防止了疾病的漏诊和误诊。对于缺乏视网膜色素变性典型的三联征的无色素性视网膜色素变性患者，临床要谨防漏诊，眼底荧光血管造影（fundus fluorescein angiography，FFA）可明确诊断。

We reported a case of achromatic retinitis pigmentosa admitted to the hospital in January 2019. The patient was diagnosed by fundus fluorescein angiography because of poor vision, and no abnormality was found by routine ophthalmological examination and general examination. After fundus fluorescein angiography (FFA), a rare nonpigmented retinitis pigmentosa was finally diagnosed, which prevented misdiagnosis and missed diagnosis of the disease. For the patients without typical triad of retinitis pigmentosa, we should pay attention to missing the diagnosis in clinical practice. FFA can make a definite diagnosis of retinitis pigmentosa.

目的：探讨专科护士培训方式以提高斜视病区护士的专业技能以及专科理论水平。方法：每次由护士长安排一名护士进入科主任所在的医疗小组进行为期 3 ~ 4 个月的培训，培训内容主要包括与医生一起出门诊、学习术前斜视专科检查、参加患者术前手术方案的制定和术后的查房，定期参加科室的理论培训。结果：实施斜视专科护士培训方法后，经过培训的护士掌握了斜视专科常用的检查方法，能解读本专科的相关检查报告，护士的专科工作能力、应对咨询能力有提高，医生、患者对护士的满意度均有提高。结论：斜视病区专科护士培训方法对临床护理工作有积极的影响，值得临床科室借鉴。

Objective: To improve the professional skills and theoretical level of the nurses, a new training method was adopted in strabismus ward. Methods: The head nurse arranged a nurse to participate in medical team the director of the department for 3–4 months. The medical works that the nurse had to follow included coperative outpatient medical work with the doctors, clinical examination before strabismus surgery, making individual surgical plans, nursing rounds of wards after surgery, and regular theoretical training of the department. Results:After implementing the training method of strabismus specialist nurses, the trained nurses mastered the common examination methods for strabismus patients, and could analyse the relevant examination reports. The ability of the nurses’professional work and consultative capacity were improved. Furthermore, the satisfaction of doctors and patients on nursing work was improved. Conclusion: The new training method of specialist nurses in strabismus ward exerts positive effect on clinical nursing work, which is worthy of application in clinical practice.

原发性开角型青光眼（primary open angle glaucoma，POAG）是一种慢性、进行性的视神经病变，其发病机制尚不明确。而眼内敏感区域[如小梁网邻管组织、筛板（lamina cribrosa，LC）等]的细胞外基质代谢异常在其中起关键作用。富含半胱氨酸的酸性分泌蛋白（secreted protein, acidic and rich in cysteine，SPARC）作为一种基质细胞蛋白在眼内广泛分布，具有沟通细胞与细胞外基质信号传递的作用。研究表明 SPARC 可通过多种途径参与并调控青光眼的发生发展过程，有望成为疾病治疗的新靶点。

Primary open angle glaucoma （POAG） is one of chronic and progressive optic neuropathies. Its pathogenesis remains to be clarified. The metabolic disturbance of extracellular matrix in some sensitive regions, such as the juxtacanalicular region and lamina cribrosa, may play a key role. Secreted protein, acidic and rich in cysteine （SPARC）, as one matricellular protein, is widely distributed inside the eye. It generally allows cells to modulate their attachments with and alter the characteristics of their surrounding extracellular matrix. Research shows that SPARC participates in the development of glaucoma through a variety of ways, and it may, therefore, become a new therapeutic target in the treatment.

      术前有效杀灭或减少眼表微生物的数量是降低术后眼内炎的重要措施。聚维酮碘消毒液和妥布霉素均能有效的降低眼科手术术后眼内炎发生率。笔者通过文献报道，综合分析聚维酮碘消毒液及妥布霉素滴眼液及注射液对眼科手术结膜囊微生物的控制能力，为眼科手术术前准备提供理论依据。

Effectively killing or reducing the number of ocular microbes before surgery is an important measure to reduce postoperative endophthalmitis. Both povidone-iodine disinfectant and tobramycin can effectively reduce the incidence of endophthalmitis after ophthalmic surgery. Through literature reports, the author comprehensively analyzes the control ability of povidone-iodine disinfectant and tobramycin eye drops and injection on the microscopy of conjunctival sac in ophthalmic surgery, and provides theoretical basis for preoperative preparation of ophthalmic surgery.

探讨“健康快车”在方言环境下开展白内障健康教育的问题和对策。本文回顾 2017 年 9 至 11 月“健康快车”在广西贺州站开展的 1 227 台白内障扶贫手术，分析实施健康教育的难点，总结方法和技巧。最终 1 227 例白内障手术顺利完成，患者均能配合手术；住院过程中无跌倒、坠床等不良事件发生。采用以基地医院为主，“健康快车”为辅，患者和家属共同参与的健康宣教模式，对保证在方言环境下“健康快车”大批量白内障扶贫手术顺利开展有重要作用。

This article aims to explore the issues and countermeasures for the development of health education in the dialect environment. We reviewed 1 227 cataract-free surgeries performed in the “Health Express” from September to November 2017 at Hezhou, Guangxi, and analyzed the difficulties in implementing health education and summarizes methods and techniques. Finally, 1 227 cataract operations were successfully completed, and patients could cooperate with doctors. Besides, no adverse events, such as falling happened during hospitalization. The model of health education was based on the local hospital, then supplemented by “Health Express”, and both patient and family members participated. This model has guaranteed the smooth implementation of the “Health Express” large-scale surgeries for cataract in the dialect environment.

目的：贯彻落实国家卫生与计划生育委员会颁布的《新入职护士规范化培训大纲（试行）》，探索眼科专科医院新入职护士规范化培训方案，为建设眼科特色的规范化培训体系提供依据。方法：根据《新入职护士培训大纲（试行）》要求，结合眼科专科医院特点制定新入职护士规范化培训方案，对 2016 年新入职的 12 名眼科护士采用课堂讲授、小组讨论、工作坊、操作培训、情景模拟、案例分享、亚专科轮转等方式进行规范化培训，2 年后进行结业考核，包括理论知识考试、临床实践能力考核、案例汇报。结果：12 名眼科新入职护士经过 2 年规范化培训，结业考核成绩合格，通过率 100%；其中理论知识考试（87.33 ± 1.78）分，眼科护理技术操作（94.00 ± 1.57）分，基础护理技术操作（92.17 ± 2.90）分，案例汇报（92.56 ± 3.23）分。结论：实施眼科新入职护士规范化培训方案，有利于系统性培训新入职眼科护士，对提高眼科专科新护士整体护理水平必不可少，合理、合适、实用的课程设置和培训方法可调动新入职护士参加培训的主动性、积极性。

Objective: To implement the National Health and Family Planning Commission’s standardized training program for newly employed nurses (trial), and to explore the standardized training program for new nurses in ophthalmology hospitals. To provide the basis for constructing the standardized training system of ophthalmology characteristics. Methods: According to the requirements of the new nurse training outline (trial) and the characteristics of the ophthalmology hospital, the standardized training program for the new entrant nurses was formulated. The 12 new ophthalmic nurses in 2016 were taught in class, discussed in group, and worked out in theworkshop. Operational training, situational simulation, case sharing, sub-specialist rotation and other methods for standardized training. After the completion of the examination, including theoretical knowledge examination, clinical practice assessment, case report. Results: After 2-year standardized training, 12 new ophthalmology nurses passed the examination, and the average score of theoretical knowledge examination was 87.33±1.78, the average score of ophthalmic nursing technique was 94.00±1.57, the average score of theoretical knowledge test was 87.33±1.78, the average score of ophthalmic nursing technique operation was 94.00±1.57, the average score of basic nursing operation was 92.17±2.90, and the average score of case report was 92.56±3.23. Conclusion:The implementation of standardized training program is beneficial to systematic training of new ophthalmic nurses. It is necessary, reasonable, appropriate and practical to improve the whole nursing level of new nurses in ophthalmology specialty. The curriculum and training method can arouse the initiative and enthusiasm of new nurses to participate in the training.

目的：比较水合氯醛和阿佛丁两种药物对小鼠的麻醉作用以及不同激光能量对脉络膜新生血管造模成功率的影响。方法：24 只C57/BL6 小鼠随机分为 3 组，分别予以 200，300 和400 mW的 532 nm激光进行视网膜光凝；每组再按 1:1 分为 2 个亚组，随机使用 4.3%水合氯醛或 1.2%阿佛丁进行小鼠腹腔注射麻醉。在激光光凝后第 4，7，10 和 14 天进行视网膜荧光素造影（Fundus Fluorescein Angiography，FFA）、SD-OCT检查，在第 14 天时对脉络膜行IB4 染色检查。结果：阿佛丁和水合氯醛诱导小鼠进入麻醉时间长分别为（120±30）s和（150±45）s，持续时间分别为（30±15）min和（50±20）min，差异均有统计学意义（均P=0.0001）；发生不可逆性白内障的比率分别为 2/24 和 1/24 ，麻醉导致的死亡数分别为1和0只，差异均无统计学意义（P=0.551，P=0.300）。200，300 和 400 mW三个激光能量组的造模成功率分别为 9.38%，37.5%和 93.75%，差异有统计学意义（P=0.0001）。FFA显示：造模成功的小鼠在4d时荧光素渗漏达到高峰，随后荧光素溢漏的面积逐渐减小。结论：与阿佛丁相比，水合氯醛对小鼠的麻醉维持时间长且不会增加病死率和不可逆性白内障的发生率； 400 mW的 532 nm激光能量是诱发CNV的较好设置。

Objective: To compare the narcotic effects of chloral hydrate and avertin in mouse models and the success rate of choroidal neovascularization (CNV) mouse model establishment with different energy hierarchy of laser.Methods: Twenty-four mice were randomized into 3 groups, the 532 nm laser was used with different power levels of 200, 300 and 400 mW for each group. In each group, the chloral hydrate was used for 4 mice and avertin for the other 4 mice at random. On day 4, 7, 10 and 14, all mice were tested by the fundus fluorescein angiography (FFA), SD-OCT, and the choroid was stained with the isolectin B4 conjugated AF488 on day 14. Results: The anesthesia induction time of avertin and chloral hydrate was （120±30） s and（150±45）s, and the duration of anesthesia was （30±15）min and （50±20） min, the differences were statistically significant （all P=0.0001）; the incidence of irreversible cataract of avertin models and chloral hydrate models was 2/24 and 1/24, the number of death in two models was 1 and without statistical significance （P=0.551, P=0.300）. With the increase of laser energy, the success rate of experiments was also gradually increased, from 9.38%, 37.5% to 93.75% （P=0.0001） in 200, 300 and 400 mW group, respectively. According to the results of FFA, the peak of fluorescence leaking was at day 4 after the laser burning, and was gradually reduced. Conclusion: Compared with avertin chloral hydrate can improve the duration of anesthesia without increasing the risk of cataract and mortality. As for the 532 nm laser,the 400 mW energy could be an optimal parameter for the laser-induced CNV.