目的：依托最新的第5代移动通信技术(5th generation wireless systems，5G)，构建基于眼底图片的5G医疗眼科远程诊断平台，促进医疗资源上下贯通，提升基层服务能力及医疗服务体系整体效能。方法：基于5G时代医院的信息化发展战略，在海南省卫生健康委员会的资助与指导下，中山大学中山眼科中心海南眼科医院与中国联通通信集团海南有限公司等进行跨行业、多学科的技术力量研究开发，构建5G条件下的平台建设模块和技术路线，确定远程眼科诊断流程，并在海南省内多地区应用。结果：远程诊断平台运行良好。2020年12月至2021年11月，本研究共在海南省17个地区的186个卫生院中开展，共收集1561例患者眼底病图片数据，筛查阳性例数为185例，检出眼底病总阳性率为11.9%。其中有42例需要转诊治疗，转诊率为23%；143例不需要转诊治疗，非转诊率为77%。在1561例眼底图像中，采集异常的眼底图像有490例。排除490例异常眼底图像后，辅助诊断系统与人工诊断结果有1 002张眼底图像诊断相同，69张眼底图像诊断不同，其辅助诊断系统准确率为93.3%。结论：5G移动通信与远程医学影像结合，运用互联网科技催生新型医疗生产力，提高卫生经济的质量和效率，是医疗领域探索5G应用场景的一项应用典范。
Objective: Relying on the latest 5th generation wireless systems (5G), a remote primary ophthalmology care diagnosis platform based on fundus images was constructed in order to promote the connectivity of medical resources and improve the primary health service capabilities and the overall effectiveness of the medical service system. Methods: Based on the 5G informatization development strategy of hospitals, and under the funding and guidance of the Hainan Provincial Health Commission, the Hainan Eye Hospital of Zhongshan Ophthalmic Center and China Unicom Communications Group Hainan Co., Ltd. conducted a cross-industry, multi-disciplinary technical research. To build platform construction modules and technical routes under 5G networks, present the remote ophthalmological diagnosis process, and apply it in many regions in Hainan Province. Results: The performance of the remote diagnosis platform is well. From December 2020 to November 2021, this study was carried out in 186 health centers in 17 regions of Hainan Province. A total of 1 561 patients with fundus disease image data were collected. The number of positive screening fundus disease cases was 185. The total positive rate was 11.9%. Among them, 42 cases required referral for treatment, with a referral rate of 23%, and 143 cases did not require referral for treatment, with a non-referral rate of 77%. Among 1 561 cases of fundus images, 490 fundus images were excluded due to abnormal quality. Compared the results of the diagnosis platform system with manual diagnosis, 1 002 fundus images were identical, and 69 fundus images were different in diagnosis. The accuracy of the auxiliary diagnosis system was 93.3%. Conclusions: The collaboration of 5G mobile communication and telemedicine imaging, combined with internet technology to promote new medical productivity, improve quality and efficiency of the health economy. This study is an application model for exploring 5G application scenarios in the medical field.
目的：对兰州市中小学生的屈光状态进行调查分析，了解兰州市中小学生筛查性屈光不正的流行病学特征。方法：采用横断面研究方法，用随机分层抽样法抽取2021年4至12月在甘肃省兰州市47所学校的中小学生作为调查对象。以学校为单位，采用国际标准视力表检查视力，采用非睫状肌麻痹的电脑自动验光仪进行屈光检查。裸眼视力<0.8为视力低下，具体分为：近视为等效球镜度≥–0.75 DS；远视为等效球镜度≥+2.00 DS；散光为柱镜度≥1.00 DC；屈光参差为双眼屈光度数差值(等效球镜度)≥1.00 DS。比较不同年级不同屈光状态人数所占的百分比。结果：共纳入40 302人，其中男21 328人，女18 974人；汉族37 938人，少数民族2364人。小学、初中、高中各26 122、9346和4834人。视力低下的总检出率为59.1%(23 832/40 302)，小学、初中和高中年级视力低下的检出率分别为48.8%(12 748/26 122)，76.9%(7 189/9 346)和87.9%(4 250/4 834)。近视的总检出率为63.3%(25 521/40 302)，其中，小学、初中和高中筛查性近视的检出率分别为51.4%(13 438/26 122)，84.4%(7 888/9 346)和86.8%(4 195/4 834)。筛查性视力低下、远视、近视、散光及屈光参差的检出率在低中高年级间比较差异均有统计学意义(均P<0.001)。结论：兰州市中小学生视力低下和近视人群的检出率高于国家平均水平，且随着年级的增加检出率逐渐升高。
Objective: To investigate and analyze the refractive status of primary and secondary school students in Lanzhou City, and to understand the epidemiological characteristics of screening refractive errors among primary and secondary school students in Lanzhou City. Methods: Using the cross-sectional research method, primary and secondary school students from 47 schools in Lanzhou City, Gansu Province from April to December 2021 were selected as survey subjects by random stratified sampling method. Taking school as a unit, international standard visual acuity chart was used to check the eyesight and non-cycloplegia computerized autorefractor was used for refractive examination. Visual acuity ≥5.0 is considered normal; whereas visual acuity <4.8 is considered as poor vision. Poor vision is further divided into: short-sightedness with myopic spherical equivalent ≥0.75 DS; long-sightedness with telephoto spherical equivalent ≥+2.00 DS; astigmatism with cylinder mirror equivalent ≥1.00 DC; anisometropia with the difference of diopters between the two eyes (spherical equivalent) ≥1.00 DS. The percentage of the survey subjects with different refractive status in different grades were compared. Results: A total of 40 302 subjects were enrolled, including 21 328 males and 18 974 females. There were 37 938 Han and 2 364 ethnic minorities; 26 122 elementary, 9 346 middle and 4 834 high schools. The total detection rate of low visual acuity was 59.1% (23 832/40 302), and 48.8% (12 748/26 122) in primary school, junior middle school and senior high school, 76.9% (7 189/9 346) and 87.9% (4 250/4 834), respectively. The total detection rate of myopia was 63.3% (25 521/40 302), among which, the detection rate of screening myopia in primary school, middle school and high school was 51.4% (13 438/26 122), 84.4% (7 888/9 346) and 86.8% (4 195/4 834), respectively. The detection rates of screening low visual acuity, hyperopia, myopia, astigmatism and anisometropia were statistically significant in low, middle and high grades (all P<0.001). Conclusion: The detection rate of low vision and myopia among primary and secondary school students in Lanzhou is higher than the national average, and the detection rate increases gradually with the increase of grades.
目的：检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据，为临床实践提供参考。方法：通过护理循证方法提出实践问题，按照循证证据检索数据库的“6S”分类模型，检索有关开角型青光眼患者眼部用药管理的所有证据资源类型，包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果：最终纳入12篇文献，包括4篇指南、3篇证据总结和5篇系统评价；汇总了19条有关开角型青光眼眼部用药管理的最佳证据，包括滴眼技术指导、依从性管理和信息提供3个方面。结论：总结开角型青光眼眼部用药管理的最佳证据，可为临床医务人员管理患者提供参考和借鉴，以达到患者规范用药、控制眼压和延缓疾病进展的目的。
Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.
目的：分析眼科超说明书用药使用情况，为眼科临床合理用药提供有效、安全的循证参考依据。方法：考察并收集21家爱尔眼科医院集团眼科中心城市及省会级医院备案的超说明书用药情况，同时抽查处方、医嘱用药，对超说明书用药情况进行充分论证评估，参考广东省、山东省等超说明书用药共识、文献，进行统计、分析和归纳，并征求相关眼科临床专家意见。结果：梳理指南、共识及期刊论文等循证医学证据，得出超说明书用药推荐级别1级8项、2级29项、3级24项，并编写了供集团内使用的《眼科医院眼科超药品说明书用药参考目录(2021年版)》，便于临床参考使用。在眼科常用有32种超说明书药品，61项超说明书用药，其中超给药途径32项(52.5%)、超适应证用药13项(21.3%)、超适应证合并超给药途径14项(23.0%)。超说明书品种及超说明用药项目数均以抗菌药物最多，分别为13个(40.6%)品种，26项(42.6%)。结论：眼科因特殊的给药途径，超说明书用药比较普遍，而如抗菌药物注射剂使用眼内注射或滴眼等超说明书用药方式对某些急性眼内感染性疾病起到了很好的治疗效果。规范眼科超说明书用药，是防范医疗风险的必要措施。
Objective: To investigate off-label ophthalmic medications, and provide an effective and safe evidence-based reference for the rational use of ophthalmic drugs. Methods: On the basis of collecting the off-label drug use recorded in 21 Aier Eye Hospital Group which including ophthalmic central cities and provincial capital level hospitals, and spot checking the prescription and doctor’s order drug use, this article conducted full demonstration and evaluation of off-label drug use which referred to the off-label drug used consensus of Guangdong and Shandong, and other literature on the off-label drug use in ophthalmology. The paper conducted statistics, analysis and induction, and solicited the opinions of relevant ophthalmology clinical experts. Results: Sorting out the evidence of the guides,consensus, journal papers and other evidence-based medicine in ophthalmic medication, recommending 8 items of level 1, 29 items of level 2, and 24 items of level 3, we compiled the “Reference catalogue for the off-label drug use in ophthalmic hospital (2021 edition)” within the group which can providing reference for clinical use. There were 61 off-label drugs commonly used in ophthalmology, involving 32 drugs. Among them, 32 items (52.5%) were used by over administration route, 13 items (21.3%) were used by over indication, and 14 items (23.0%) were used by over indication and administration route. Antibacterial drugs were the most frequently used in the varieties and items of off-label drug use, accounting for 13 (40.6%) and 26 (42.6%) respectively. Conclusion: Ophthalmic off-label medications are common owing to the special route of administration. Such as intraocular injection or eye drop have played a good role in the treatment of some ocular infectious diseases. Standardizing the off-label drug use of ophthalmology is an effective measure to reducing medical risks.
慢性移植物抗宿主病(chronic graft-versus-host disease，cGVHD)是骨髓移植后最具有破坏性并发症之一。移植物抗宿主病(graft-versus-host disease，GVHD)发生在10%~80%的造血干细胞移植(hematopoietic stem cell transplantation)受者中，而眼睛是人身体最脆弱的器官之一，有40%~60%接受HSCT的患者发生眼部GVHD，它主要影响泪腺、睑板腺、角膜和结膜等。cGVHD相关性干眼(dry eye associated with chronic graft-versus-host disease，cGVHD-DE)是眼部GVHD最多见的表现形式。cGVHD-DE的长期治疗因涉及多学科、多重结合治疗，至今仍然具有挑战性，其除了全身免疫抑制和眼部润滑剂外，通常还使用局部类固醇、环孢霉素和他克莫司滴眼液。针对中度和重度cGVHD-DE的治疗干预包括使用自体血清滴眼液和佩戴巩膜镜等，新兴起的治疗方案包括重链透明质酸 (heavy chain-hvaluronan/穿透素(pentraxin 3)结膜下注射、间充质基质细胞静脉注射、抑制纤维化药物等。
Chronic graft-versus-host disease (cGVHD) is one of the most devastating complications following bone marrow transplantation. GVHD develops in 10–80% of patients after hematopoietic stem cell transplantation (HSCT). The eye is one of the most vulnerable organs of the human body. Ocular GVHD occurs in 40–60% of patients with GVHD undergoing HSCT, and it mostly affects the lacrimal glands, meibomian glands, cornea, and conjunctiva. The most common form of ocular GVHD is dry eye disease (DED). The long-term treatment of cGVHD-related dry eye syndrome remains challenging and involves a multidisciplinary approach. Besides systemic immunosuppression and ocular lubricants, topical steroids, topical cyclosporine, and topical tacrolimus are commonly prescribed. Newer therapeutic interventions for moderate and severe cGVHD-related DED include using serum eye drops and scleral contact lenses. Emerging treatment options include subconjunctival injection of heavy chain-hyaluronan (HC-HA)/ pentraxin 3 (PTX3), intravenous injection of mesenchymal stromal cells, antifibrotic drugs, etc. This article reviews the mechanisms, clinical findings, and treatment of cGVHD-related dry eye syndrome.
高度近视(high myopia，HM)作为一种特殊类型的屈光型眼病，不仅会导致进行性、退行性眼底改变，其视神经损伤的患病率也很高。青光眼是全球范围内最常见的一种不可逆致盲性眼病，原发性开角型青光眼(primary open-angle glaucoma，POAG)是最常见的青光眼类型。近年来的研究发现HM与POAG的病理改变存在相似之处。由于HM眼底改变与早期POAG眼底改变容易混淆，HM患者早期发现POAG对延缓或阻止疾病进展很重要。HM患者长期随访不仅要观察黄斑病变，视神经形态与结构改变的观察也不容忽视。
As a special type of refractive eye disease, high myopia (HM) not only causes progressive and degenerative fundus changes, but also has a high prevalence of optic nerve damage. Glaucoma is the most common form of irreversible blinding eye diseases worldwide, among which, primary open-angle glaucoma (POAG) is the most common type. In recent studies, HM is found to have similarities on pathological changes as that of POAG. And HM fundus changes are easily confused with early stage POAG fundus changes; thus, the early detection of POAG on HM patients is highly important on disease deferment or prevention of disease progression. Macular degeneration as well as optic nerve morphology and structural changes are to be observed in the long-term follow-up for HM patients.
眼健康是国民健康的重要组成部分，包括盲在内的视觉损伤严重影响人民群众的身体健康和生活质量，加重家庭和社会负担，威胁社会经济生产活动，是涉及民生的重大公共卫生问题和社会问题。弱视作为幼儿期起病的主要视觉障碍性疾病之一，是致使青少年低视力的首要因素，影响青少年自身学业和心理健康，增加致盲风险，故做好弱视的预防及康复工作刻不容缓。通过梳理研究发现，国内外对弱视的传统治疗方法有遮盖疗法、屈光矫正、压抑疗法等，知觉学习、视功能训练、电子视频游戏、针灸等则是近年逐渐新兴起并被广泛运用的弱视康复治疗方法，近年来关于年龄对弱视康复治疗影响的相关研究也较多。通过整理前人研究成果，提出建立儿童青少年视力档案、建立五位一体弱视康复治疗布局模式、进行联合临床治疗青少年弱视的对策，以期为青少年弱视提供康复治疗手段参考和选择，促进青少年弱视康复治疗眼健康事业发展。
Eye health is an important part of national health. Visual impairment, including blindness, seriously affects people’s physical health and quality of life, increases the burden on families and society, threatens social and economic production activities, and is a major public health and social problem related to people’s livelihood. Amblyopia,as one of the main visual disorders in early childhood, is the primary factor causing low vision in adolescents, which affects their academic and mental health and increases the risk of blindness. Therefore, it is urgent to do a good job in the prevention and rehabilitation of amblyopia. By summarizing existing studies, it is found that traditional treatment methods for amblyopia at home and abroad include occlusion therapy, refractive correction, and depressive therapy, while perceptual learning, visual function training, electronic video games, acupuncture and so on are gradually emerging in recent years and widely used in recent years. There are numerous studies on the impact of age on the rehabilitation of amblyopia. By sorting out the previous research results, this paper puts forward the countermeasures of establishing visual acuity files for children and adolescents, establishing the five- in-one rehabilitation treatment layout model, and combining clinical treatment for adolescent amblyopia, in order to provide reference and choice for the rehabilitation treatment of adolescent amblyopia, and promote the development of the eye health cause of adolescent amblyopia rehabilitation.
Ahmed青光眼引流阀植入术作为难治性青光眼的主要治疗方案，能很大程度控制眼压，且疗效和预后均优于常规滤过性手术。但是远期引流盘周围被纤维包裹后会阻塞房水流出，引起术后高眼压，导致手术失败。因此，解决引流盘纤维包裹能很大程度地提高青光眼阀植入术后远期成功率，这也是目前的研究热点。目前临床上主要采用术前预防及术后二次操作对纤维包裹进行干预，但长期效果欠佳。本文就青光眼引流阀纤维包裹发生的组织病理学及分子机制、临床目前解决方案、前沿研究进展以及对Ahmed青光眼阀门的材料改造的探索进行综述。
Ahmed glaucoma valve implantation, as the main treatment option for refractory glaucoma, can control intraocular pressure (IOP) to a large extent. And its efficacy and prognosis are superior to those of conventional filtration surgery. IOP is well-controlled in the early postoperative stages. However, long-term fibrosis of encapsulated bleb inhibits fluid exchange and causes elevated IOP, leading to surgical failure. Therefore, treating fibrosis of encapsulated bleb can improve the long-term success rate after glaucoma valve implantation, which is also a research hotspot. Currently, the main clinical interventions are preoperative prophylaxis and postoperative secondary operations for fiber wrapping, but its long-term efficacy is not satisfactory. This article reviews the occurrence, histopathology and molecular mechanism of fibrous encapsulation, treatment in a clinical setting, cutting-edge research progress, and exploration on material modification of Ahmed glaucoma valve.
圆锥角膜在眼科临床工作中是角膜疾病中较为熟知的病种。本文汇报1例角膜病变，女，33岁，无特殊诱因出现视物模糊，初步考虑圆锥角膜，但经过一系列检查后不能确诊该患者此次双眼角膜罹患何种眼疾，且该患者未行规律专科治疗，于家中全休2周后双眼不适症状消失，经甘肃省第三人民医院眼科检查角膜验光恢复正常，矫正视力均达正常。该患者自诉于2014年发作1次，且经过多院就诊，未能确诊，休息2~3周后症状消失。故整理此次就诊经过特汇报出来，供各位专家、同道参阅，以期得到明确诊断或者诊疗方向，为患者后续再次出现该类情况指导诊疗，缩短患者发病时长。
Keratoconus is a well-know disease in ophthalmology. This paper reports a case of keratopathy, female, 33 years old, had blurred vision without special inducement, and keratoconus was initially considered. However, after a series of examinations, diagnosis what kind of ocular disease the patient had in both eyes was not possible, and the patient had no regular specialist treatment, and the discomfort symptoms of both eyes disappeared after taking a full rest at home for 2 weeks, and the cornea was examined by Department of Optometry in Third People’s Hospital of Gansu Province returned to normal and corrected visual acuity was normal. The patient had a seizure in 2014, and after multiple hospital visits, the diagnosis could not be confirmed, after 2–3 weeks of rest, the symptoms disappeared. Therefore, after sorting out the special report of this visit, it is specially reported for the reference of all experts and colleagues to get a clear or direction of diagnosis and treatment, guide the diagnosis and treatment for patients who experience such similar situation in the future, and reduce the length of illness.
