暴发性脉络膜上腔出血(subchoroidal expulsive hemorrhage，SEH)是内眼手术中罕见且严重的并发症，广东省人民医院眼科收治1名因晶状体完全脱位继发青光眼的女性患者，73岁，其手术过程中发生SEH，现报告如下。通过回顾病例，讨论及分析SEH的原因、危险因素及治疗。

Subchoroidal expulsive hemorrhage (SEH) is one of the rarest and worst complications of intraocular surgery. We treated one patient with secondary glaucoma due to complete dislocation of the lens, who developed SEH during the surgery. In this case report, the causes, risk factors and treatment of subchoroidal expulsive were discussed and analyzed by reviewing the case.

目的：探讨大泡性角膜病变(bullous keratopathy，BK)患者行飞秒激光辅助的角膜内皮移植术(endothelium keratoplasty，EK)的围手术期护理。方法：回顾性分析在南京总医院眼科行飞秒激光辅助角膜内皮移植的BK20例患者，分析并总结患者术前的心理疏导、术前准备、眼科检查、术中如何配合医生、术后特殊体位、高眼压的护理及如何正确用药和出院健康教育等。结果：患者得到及时、有效的护理，术后视力均有所提高，内皮贴伏好，无排斥反应及其他并发症的发生。结论：通过对患者围手术期的护理，可提高护理质量，缩短患者住院时间。

Objective: To observe the perioperative nursing of femtosecond laser-assisted corneal endothelial transplantation in the treatment of patients with bullous keratopathy. Methods: A retrospective analysis of 20 patients with bullous keratopathy with femtosecond laser-assisted corneal endothelial transplantation in our department. The preoperative psychological counseling, preoperative preparation, ocular examination, how to cooperate with the doctors in operation, nursing of special position, high intraocular pressure after surgery, how to use eye drops correctly and health education after discharge were summarized. Results: Nursing were performed to the patients timely and effectively. Postoperative visual acuity of all the patients were improved, the endothelial and corneal stroma bed are well combined and no graft rejection and other complications occurred in the patients postoperatively. Conclusion: We concluded that the quality of nursing was improved and the time of hospitalization was shortened after perioperative nursing.

目的：探讨县级基层医院白内障患者术前焦虑情况，以便改善护理流程。方法：本研究为回顾性研究，收集河源光明眼科医院2017年1至9月2 182例行白内障复明手术患者的术前焦虑视觉模拟量表(The Anxiety Visual Analogue Scale，VAS-A)评分及阿姆斯特丹术前焦虑与信息需求表(Amsterdam Preoperative Anxiety and Information Scale，APAIS)评分，采用t检验和Spearman相关性检验进行术前焦虑情况分析。结果：2 182例白内障手术患者VAS-A焦虑评分为4.74±1.93，APAIS焦虑评分为6.46±1.66，男性患者术前焦虑程度低于女性患者，患者术前焦虑程度与年龄呈低度负相关。结论：两种术前焦虑评分均能反映患者术前焦虑程度，可根据其对麻醉或手术信息需求度的不同选择相应的护理对策，以缓解患者术前焦虑，改善护理质量。

Objective: To investigate the preoperative anxiety in patients with cataract in a township hospital. Methods: A retrospective study was conducted on preoperative anxiety of 2 182 patients with cataract according to the Anxiety Visual Analogue Scale (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) from Jan 1, 2017 to Sep 30, 2017 in Heyuan Guangming Eye Hospital. Student’s t-test and Spearman correlation were used to evaluate the preoperative anxiety. Results: The score of preoperative anxiety was 4.74±1.93 with the VAS-A and was 6.46±1.66 with the APAIS. The preoperative anxiety in male was lower than that in female, and the degree of the preoperative anxiety was negatively correlated with age. Conclusion:The preoperative anxiety of patients with cataract can be properly evaluated using either the VAS-A or the APAIS.The nursing care should be adjusted corresponding to patients’ different needs of the information about anesthesia and surgery in order to alleviate the preoperative anxiety and improve the nursing care.

目的：分析有意愿接受准分子激光角膜屈光手术治疗近视的患者在术前检查后未行手术的原因。方法：选取2015年1月至2017年6月在安徽医科大学附属第一医院眼科激光中心检查的近视患者，分析其中未行激光手术的原因。结果：共2 875例患者准备接受准分子激光角膜屈光手术，其中821例(28.6%)检查后未进行手术，男462例(56.3%)，女359例(43.7%)，年龄18~51(23.69±5.85)岁。821例中社会心理因素影响484例(59.0%)，角膜薄或角膜厚度不足182例(22.2%)，超高度近视(>10.00 D)100例(12.2%)，高眼压19例(2.3%)，弱视13例(1.6%)，角膜曲率异常11例(1.3%)，眼底病变7例(0.9%)，角膜变性3例(0.4%)，其他2例(0.2%)。结论：近视治疗术前检查后未进行准分子激光角膜屈光手术的原因多种多样，其中社会心理因素及角膜厚度不足是最主要的原因。术前详细检查，严格掌握手术适应证和禁忌证以及充分医患沟通是手术安全的保障。

Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054 (71.4%) of them received refractive surgery. Among 821 (28.6%) patients who did not get laser refractive keratomileusis, 462 (56.3%) were male and 359 (43.7%) were female, aged 18–51 years (range, 23.69±5.85 years). The most common reason for not offering refractive surgery were social psychological factors (59.0%), low central corneal thickness (22.2%), high myopia (12.2%), high intraocular pressure (2.3%), poor corrected visual acuity (1.6%), corneal topography anomaly (1.3%), retinal disease (0.9%), corneal (0.4%) and other diseases (0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.

目的：研究雌二醇(estradiol，E2)和丙酸睾酮(testosterone propionate，TP)对兔泪腺上皮细胞凋亡及对MMP-9蛋白表达的影响，探讨雌二醇及丙酸睾酮对干眼的作用机制。方法：体外培养兔泪腺上皮细胞，分别给予雌二醇及丙酸睾酮处理，双氧水(H₂O₂)诱导细胞凋亡，流式细胞仪检测细胞凋亡和免疫细胞化学法检测细胞MMP-9蛋白表达。实验分4组：凋亡对照组(AC组)、雌二醇组(E2组)、丙酸睾酮组(TP组)和空白对照组(BC组)。AC组只给予H₂O₂诱导凋亡，E2组给予1×10^-5mol/L雌二醇处理，TP组给予丙酸睾酮处理，BC组未加药物干预及未加H2O2诱导凋亡。结果：经H₂O₂诱导细胞凋亡后，泪腺上皮细胞早期凋亡率和MMP-9蛋白表达累积光密度值与BC组相比，AC组、E2组及TP组均显著增加；同比AC组，E2组及TP组细胞凋亡率和MMP-9蛋白表达量降低；E2组凋亡率及蛋白表达量比TP组明显降低；其差异均具有统计学意义(P<0.01)。结论：雌二醇和丙酸睾酮对H₂O₂诱导兔泪腺上皮细胞凋亡有一定的抑制作用，同时泪腺上皮细胞中MMP-9表达含量也降低，提示雌二醇和丙酸睾酮抑制兔泪腺上皮细胞凋亡的作用机制可能与MMP-9有关。

Objective: To investigate the effects of estradiol (E2) and testosterone propionate (TP) on apoptosis and matrix metalloproteinase-9 (MMP-9) expression in rabbit lacrimal gland epithelial cells. Methods: The rabbit lacrimal gland epithelial cells were cultured in vitro. H₂O₂ was used to induce apoptosis in cultured lacrimal gland epithelial cells and then treated with E2 and TP respectively. Cell apoptosis was detected by flow cytometer (FCM) and MMP-9 expression was evaluated by immunocytochemistry. There were four groups: apoptosis control group (AC), estradiol group (E2), testosterone propionate group (TP) and blank control group (BC) respectively. The cells of group AC were administrated with H₂O₂ only, group E2 and group TP with 1×10^_5 mol/L E2 and TP respectively and group BC in treated. Statistical analysis were performed with one-way analysis of variance (ANOVA test)using SPSS 16.0, P<0.05 was considered statistically significant. Results: Compared with group BC, the early cells apoptosis rate and integrated optical density of MMP-9 expression of lacrimal gland in group AC, E2 and TP increased significantly after the cells were induced by H₂O₂; Compared with group AC, group E2 and TP reduced; group E2 were significantly lower than group TP; the differences were all statistically significant (P<0.01). Conclusion: E2 and TP had a certain inhibitory effect on rabbit lacrimal gland epithelial cells apoptosis induced by H₂O₂. Meanwhile, MMP-9 expression of the lacrimal gland cells was decreased. These results indicated that E2 and TP on the apoptosis inhibitory mechanism of lacrimal gland cells may be related with MMP-9.