专栏导读：眼健康是国民健康的重要组成部分。随着我国经济社会的快速发展和眼科医疗卫生事业的快速发展，人民群众对眼健康的需求不断提高。推进眼健康事业，进一步提高人民群众的眼健康水平，是我们义不容辞的责任。结合当前我国眼病防治工作现状，本刊增设“眼健康”专栏，基于中山大学中山眼科中心的传播平台，筛选出较高质量的眼健康科普文章，以实现更大范围的眼健康教育与科学传播。

准妈妈们全身器官都会因为妊娠而发生变化，眼睛当然也不例外。妊娠期眼部的变化大部分是生理性的、无害的；但有些变化是病理性的，如高血压相关视网膜病变，可能是先兆子痫的征兆。笔者总结在孕期中准妈妈们的眼部变化，对如何区分生理性变化和病理性变化进行合理指导，以利于及时制定个体化的治疗或预防方案。

Pregnancy leads to physiological adaptations of the various maternal organs and systems, including the eyes. Most ocular changes in pregnancy are harmless. Some changes, however, are pathological changes and serious, such as retinal effects of hypertension, which can be a sign of pre-eclampsia. We summarize the physiological and pathological ocular changes during pregnancy, and provide reasonable guidance on how to discriminate pathological eye disease from physiological ocular changes to establish an individualized treatment or preventive plan.

目的：观察绷带型角膜接触镜在滞留型铁质角膜异物取出术后的临床疗效。方法：对角膜深层异物取出术后患者 105 例 105 眼，随机分为戴镜组与对照组，两组均为滞留型角膜异物，实施角膜异物取出术，比较两组患者术后 1，3，7 d 的眼部疼痛程度及术后 7 d 角膜上皮愈合情况。结果：术后 1，3，7 d ，两组患者眼部疼痛程度评分差异有统计学意义（P<0.05）；术后 7 d 两组患者角膜上皮缺损情况差异有统计学意义（P<0.05）。无感染患者。结论：配戴绷带型角膜接触镜能有效缓解滞留型角膜异物取出术后患者的眼部刺激症状，加速术后角膜创面修复。

Objective: To investigate the effects of bandage contact lenses on corneal irritation and wound healing after the removal of delayed corneal iron foreign body. Methods: A total of 105 patients （105 eyes） with delayed removal of corneal iron foreign body were divided into two groups. Patients in both groups received the removal of corneal foreign body. Patients in group 1 wore bandage contact lenses after surgery, and their counterparts in group 2 did not receive any further treatment after surgery except eye drops. The differences in eye irritation （at 1, 3 and 7 d） and corneal epithelial healing （at 7 d） were observed between two groups. Results: The mean pain score was significantly lower in group 1 than that in group 2 at 1, 3 and 7 d after surgery （all P<0.05）. The rate of complete corneal epithelial healing at 7 d was significantly higher in group 1 than that in group 2 （P<0.05）. Conclusion: Bandage contact lenses can accelerate the recovery of corneal wounds, improve the healthcare efficiency and effectively alleviate eye irritation.

目的：评估改良式提上睑肌腱膜切断术治疗中重度甲状腺相关眼病上睑退缩的疗效。方法：选取 2016 年 2 月至 2017 年 10 月宁波市眼科医院眼眶病眼整形专科收治的中重度静止期甲状腺相关眼病上睑退缩患者，应用改良式提上睑肌腱膜切断术进行矫正，观察术后眼部不适和外观的改善情况。结果：共计 15 例（25眼）上睑退缩患者接受了改良式提上睑肌腱膜切断术，其中男 8 例，女 17 例，双眼 10 例，术后 6 个月，15 例患者上睑退缩完全矫正，平均下降 6.09 mm，眼睑闭合不全、眼部不适、畏光、流泪等症状得到治愈或改善。结论：改良式提上睑肌腱膜切断术能有效矫正中重度上睑退缩，改善患者外观和治疗患者眼部不适。

Objective: To evaluate the effect of modified levator palpebrae superioris aponeurosis in the treatment of moderate and severe thyroid-associated ophthalmopathy. Methods: Patients with moderate and severe stationary stage of thyroid-associated ophthalmopathy with upper eyelid retraction from February 2016 to October 2017 in Orbital Eye Plastic Specialist of Ningbo Eye Hospital were selected and underwent, the modified levator palpebrae aponeurosis surgery. The postoperative eye discomfort and appearance improvement were observed. Results: A total of 15 patients (25 eyes) with upper eyelid retraction underwent modified levator palpebrae aponeurosis resection, including 8 males and 17 females. Both eyes were affected in 10 cases. At postoperative 6 months, the upper eyelid retraction was completely corrected by 6.1 mm on average in 15 patients. The lagophthalmos, eye discomfort, photophobia, tears and other symptoms were cured or improved. Conclusion: The modified levator palpebrae aponeurosis can effectively correct moderate and severe upper eyelid retraction, improve the eyelid appearance and treat the eye discomfort.

目的：探讨以问题为导向的教学方法（problem-based learning ，PBL）结合微课教学法在眼科学课堂中的应用。方法：将锦州医科大学眼科实习课的60名学生按照随机数字表法分为实验组与对照组。实验组采用PBL教学法结合微课教学法，对照组采用传统的教学方法，比较两种教学方法的教学效果。 结果：实验组学生成绩优于对照组，差异有统计学意义（P<0.05）。结论：PBL结合微课教学法应用于眼科学生的临床实践，提高了学生的综合素质、创造性思维、综合分析和团队合作能力；调动学习积极性、提高学生学习效率、提高理论知识评估和临床操作考核成果并取得满意的教学效果。

Objective: To explore the application of problem-based learning （PBL） combined with micro-teaching method in ophthalmology class. Methods: Sixty students of the ophthalmology internship course of Jinzhou Medical University were randomly divided into an experimental group and a control group. The control group used traditional teaching methods to compare the teaching effects of the two teaching methods. Results: The scores of the experimental group were better than those of the control group, and the difference was statistically significant （P<0.05）. Conclusion: PBL combined with micro-teaching method can be applied in the clinical practice of ophthalmology students, which improves students’ comprehensive quality, creative thinking, comprehensive analysis and teamwork ability. Besides, it also mobilizes learning enthusiasm, improves students’ learning efficiency, improves theoretical knowledge assessment and clinical operation assessment results, leading to satisfactory teaching effect.

      患者女，60 岁，因“右眼前黑影飘动 1 月，视力下降 8 天”就诊。视力：右眼 0.1，不能矫正；左眼 0.6 矫正 0.9。右眼眼底见视盘周围边界清晰不规则灰白色区，并波及中心凹。视野检查：右眼对应眼底病灶的视野缺损；左眼正常。光学相干断层成像术（optical coherence tomography，OCT）显示灰白色区域椭圆体带不规则、缺失，视网膜色素上皮（retinal pigment epithelium，RPE）层见数个指状隆起。眼底自发荧光（autofluorescence，AF）示：受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影（fundus fluorescein angiography，FFA）示：早期见荧光渗漏，晚期荧光着染、蓄积。吲哚菁绿血管造影（indocyanine green angiography，ICGA）示：见以视乳头为中心，边界清晰的低荧光区。诊断：右眼急性轮状外层视网膜病变。治疗：给予抗炎和改善血循环4周，眼底灰白色环状带消失，视力明显好转。随访6个月，患者病情控制良好。

    A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography （OCT） showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium （RPE） layer. Fundus autofluorescence （AF）: High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography （FFA）: Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography （ICGA）: A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously.

  本文报道 2 例诊断为后极部肉芽肿型弓蛔虫病的患者，病例 1 接受糖皮质激素及玻璃体切割联合剥膜手术，术后视力明显提高；病例 2 因错过治疗时机，致视力丧失。提示后极部肉芽肿型眼弓蛔虫病致视网膜前膜时，眼科医生应积极给予手术治疗，改善患者视功能。

     We reported two cases of posterior pole granuloma toxocariasis with different prognosis to remind ophthalmologists to attach importance to the active treatment. Two patients were diagnosed with posterior pole granuloma toxocariasis. One patient received prednisolone and pars plana vitrectomy combined with peeling of retinal membrane, and his vision was improved significantly. The other patient missed opportunity to perform surgery and lost his vision. It is important to make accurate diagnosis and active treatment for posterior pole granuloma toxocariasis. Eyes with posterior pole granuloma toxocariasis should be treated with surgery without delay to avoid visual loss when epiretinal membrane causes the absence of normal macular structure.

目的：观察玻璃体切除术后高度近视合并白内障患者行白内障摘除联合人工晶体植入术后悬韧带及囊袋的变迁。方法：选取 2016 年 6 月至 2018 年 3 月河南省省立医院收治的玻璃体切除术后高度近视合并白内障患者 80 例，依据白内障摘除联合人工晶体植入术是否联合囊袋张力环（capsular tension ring，CTR）植入将这些患者分为植入 CTR 组（植入组，n = 40）和未植入 CTR 组（未植入组，n = 40），统计分析2组患者术后 1 周、1 个月、3 个月的前囊开口直径、视力、眼压、术后并发症发生情况。结果：两组患者术后 1 周、1 个月、3 个月的前囊开口直径均逐渐增大（P < 0.05），术后 1 周、1 个月、3 个月植入组患者的前囊开口直径均显著大于未植入组（P < 0.05）。两组患者术后 1 周、1 个月、3 个月的视力均逐渐提升（P < 0.05），术后1周、1 个月、3 个月植入组患者的视力均显著高于未植入组（P < 0.05）。两组患者术后 1 周、1 个月、3 个月的眼压均逐渐降低（P < 0.05）；术后 1 周、1 个月、3 个月植入组患者的眼压均显著低于未植入组（P < 0.05）。植入组患者的术后并发症发生率 5.0%（2/40）显著低于未植入组 45.0%（18/40，P < 0.05）。结论：玻璃体切除术后高度近视合并白内障患者行白内障摘除联合人工晶体植入术联合 CTR 植入较未联合 CTR 植入效果好，更能有效增大患者的前囊开口直径，提升患者视力，降低患者眼压及术后并发症发生率，值得在临床推广使用。

Objective: To observe the changes of suspensory ligament and capsular bag after cataract extraction and intraocular lens implantation in patients with high myopia and cataract after vitrectomy. Methods: A total of 80patients with high myopia and cataract after vitrectomy were enrolled in our hospital from June 2016 to March 2018. The patients were divided into the implanted tension ring group (implanted group, n=40) and a nonimplantation tension ring group (non-implantation group, n=40), according to whether cataract extraction combined with intraocular lens implantation combined with tension ring implantation. Statistical analysis was performed between two groups at postoperative 1 week, 1 month, and 3 months. The anterior capsule opening diameter, visual acuity, intraocular pressure, and postoperative complications occurred. Results: The diameter of the anterior capsule in two groups was increased gradually at 1 and 3 months after operation (P<0.05). The diameter of the anterior capsule at 1 week, 1 month and 3 months after the operation was significantly greater than that in the non-implantation group (P<0.05). The visual acuity in two groups after 1 and 3 months was increased gradually (P<0.05). The visual acuity of the patients at 1 week, 1 month and 3 months after the operation was significantly higher than that in the non-implantation group (P<0.05). The intraocular pressure in two groups after 1 and 3 months was decreased (P<0.05), and the intraocular pressure of the patients in the implanted group at 1 week, 1 month and 3 months after the operation was significantly lower than that in the non-implanted group (P<0.05). The incidence of postoperative complications in the impanted group was 5% (2/40), which was significantly lower than 45% (18/40) in the non-implanted group (P<0.05). Conclusion: Cataract extraction, intraocular lens implantation combined with tension ring implantation in patients with high myopia and cataract after vitrectomy is more efficacious than that without the implantation of tension ring, which can effectively increase the diameter of the anterior capsule opening and improve the visual acuity. It can also reduce the intraocular pressure and the incidence of postoperative complications.

目的：了解 2014 — 2016 年成都市龙泉驿区高三学生近视现状。方法： 2014 — 2016 年在成都市龙泉驿区随机整群抽样调查 5 所高级中学，对其高三学生进行医学验光及问卷调查。结果：共调查在校高三学生 16 796 人，排除不合格 204 人，列入研究者共 16 592 人，其中 2014 年 5 438 人，2015 年 5 213 人，2016 年 5 941 人。调查结果表明：重点高中近视率明显高于普通高中（χ²=322.065，P<0.01），且重点高中学生的近视程度 (度数) 普遍高于普通高中（χ²=8.102，P<0.05）；2016 年近视率较 2014 及 2015 年明显增加（P<0.01）；学习时间 ≥1 h/次（P<0.01）、看电视时间 ≥2 h/d（P<0.05）是近视的危险因素；睡眠时间 ≥8 h/d（P<0.01）、体育锻炼 ≥1 h/d（P<0.01）、经常做眼保健操（P<0.05）为保护因素；学习时间是否大于 1 h（χ²=3.330）、看电视时间是否大于 2 h（χ²=0.176）、体育锻炼时间是否小于 1 h(χ²=0.904) 对近视程度的影响并不明显（P>0.05）；配镜不准确很可能会导致轻度近视向中度近视发展（χ²=108.218，P<0.01）；睡眠时间 <8 h/d（χ²=7.644）、不经常做眼保健操（χ²=6.396）均会导致近视程度的加深。结论：成都市龙泉驿区重点高中近视率及近视程度均高于普通高中。青少年的近视率的上升与学习压力大、学习时间过长、缺乏休息与户外运动等有密切关系，近视程度的加深与配镜不准确（家长不重视）关系显著。因此，改善学生的学习环境、提高心理素质、减轻学习压力，鼓励劳逸结合，并加强家长与学生本人对近视的认识和建立长期的医患随访关系，对降低成都市龙泉驿区近视率及近视发展具有重要意义。

Objective: To study the current status of myopia among high school students from 2014 to 2016 in Longquanyi District, Chengdu. Methods: Random cluster sampling of five senior high schools in Longquanyi Districtof Chengdu was conducted for three consecutive years. Medical optometry and questionnaire surveys were conducted for high school students. Results: A total of 16 796 high school students were investigated, 204 unqualified individuals were excluded, and a total of 16 592 students were included in the study, including 5 438 in 2014, 5 213 in 2015 and 5 941 in 2016. The survey results showed that the rate of myopia in key high schools was significantly higher than that in ordinary high schools（P<0.01）, and the degree of myopia of students in key high schools was significantly higher than that in ordinary high schools（P<0.05）; the rate of myopia was increased significantly in 2016 compared with those in 2014 and 2015 （both P<0.01）; learning time ≥1 h/time（P<0.01） and watching TV time ≥2 h/d（P<0.05） risk factors for myopia; sleep time ≥8 h/d （P<0.01）, sports exercise ≥1 h/d （P<0.01） and frequent eye exercises（P<0.05） were considered as protective factors. Whether the study time was longer than 1 h, whether the time of watching TV was longer than 2 h, and whether the physical exercise time was shorter than 1 h did not affect the degree of myopia significantly （P>0.05）; inaccurate glasses had a significant impact on the degree of myopia （P<0.01）; sleep time <8 h/d and infrequent eye exercises all resulted in a higher degree of myopia. Conclusion: The rate and degree of myopia in key high schools in Longquanyi District of Chengdu are higher than those in ordinary high schools. The increase in myopia among adolescents is closely correlated with the pressure of study, long learning time, lack of rest and outdoor sports, etc. The aggravation of myopia is significantly correlated with the inaccuracy of glasses. Therefore, there is an urgent need to improve students’ learning environment, improve their psychological quality, reduce learning pressure, encourage the coordination between work and leisure, strengthen parents’ and students’ understanding of myopia andestablish a long-term follow-up relationship between doctors and patients, thereby reducing the risk and progression of myopia.

目的：探讨佩戴 1 年及以上环曲面设计型夜戴型角膜塑形镜的青少年眼轴控制增长情况及眼轴增长因素分析。方法：回顾性病例研究。收集 192 人（372 眼）青少年近视患者，年龄（12.3±3.2）岁，按照佩戴的夜戴型角膜塑形镜的设计类型，分为普通设计组（302 眼）以及环曲面设计组（70 眼），收集佩戴前1天患者原始资料及佩戴 1 年后两组眼轴的变化，采用独立样本T检验方式分析两组间眼轴增长差异，采用多因素线性回归分析环曲面设计组眼轴增长因素。结果：普通设计组、环曲面设计组基线球镜分别为（−3.53±1.73）和（−3.96±1.69）D，基线柱镜为（−0.60±0.72）和（−1.41±0.91）D；两组基线眼轴分别为（25.01±1.04）和（25.26±1.17）mm，两组基线眼轴差异无统计学意义（P > 0.05）；戴镜 1 年后两组眼轴增长值分别为（0.09±0.24）和（0.10±0.20）mm，组间眼轴增长差异无统计学意义（P = 0.62）。多因素线性回归分析显示：佩戴初始年龄是影响环曲面设计组眼轴变化的主要因素，与眼轴变化呈负相关（t = −0.43，P < 0.01）。结论：对于合并中高度散光的近视患者，佩戴环曲面设计型夜戴型角膜塑形镜1年时间，能有效控制近视眼轴增长，延缓近视进展，佩戴初始年龄是参与影响环曲面夜戴型角膜塑形镜控制眼轴增长的重要因素。

Objective: To investigate the controllable growth of eye axial length and the factors of axial growth in adolescents wearing biaxial orthokeratology lens for 1 year or longer. Methods: Retrospective case studies. A total of 192 patients (372 eyes) with adolescent myopia, aged (12.3±3.2) years, were collected and classified into a general design group (n=302) and a biaxial-design group (n=70) according to the design type of the orthokeratology lens. Changes in the axial data of the patients 1 day before wear and 1 year after wear were collected. Differences in axial length between the two groups were analyzed by independent sample t-test. Multivariate linear regression analysis was used to analyze the factors of the axial growth in the design biaxial-design group. Results: Baseline mean spherical mirrors for the general design group and biaxial design group were (−3.53±1.73) and (−3.96±1.69) D, and the baseline diopter was (−0.60±0.72) and (−1.41±0.91) D; the baseline axial lengths were (25.01±1.04) and (25.26±1.17) mm; there was no significant difference in the baseline axial length between two groups (P>0.05). After wearing glasses for 1 year, the axial length in two groups was increased by (0.09±0.24) and (0.10±0.20) mm,  with no statistical significance (P=0.62). Multivariate linear regression analysis showed that the initial age of wearing glasses was the main factor influencing the change of the ocular axis in biaxial design group, and negatively correlated with the change of the ocular axis. Conclusion: For the myopic patients with high astigmatic myopia, wearing a biaxial-design orthokeratology lens can effectively control the growth of myopic axis and delay the progression of myopia. The initial age of glass wear is associated with the effect of biaxial-design orthokeratology is an influencing factor for the growth of the axial axis.

住院医师规范化培训是培养合格临床医师的重要方式，住院医师临床技能培养是提高临床胜任力的核心，是为基层医疗单位提供能独立、规范地承担本专业常见多发疾病诊疗工作临床医师的必由之路。在眼科专业住院医师规范化培训中，通过立体化培养策略，从多方位多角度强化临床技能的训练，将知识与临床之间形成有效交互的一张网，能够有效提高住院医师临床技能和思维水平。

Standardized training of resident physicians is an important way to train qualified clinicians. The training of clinical skills is the core of improving clinical competency. It is the only way to supply ophthalmological residency who could independently and regularly deal with the common diseases for primary medical units. In the standardized training, we should strengthen the training of clinical skills from multiple angles through stereoscopic culture strategy. It could form an effective network of interaction between knowledge and clinical practice, which can effectively improve the clinical skills and thinking level of residents.