2025年6月 第40卷 第6期

主管:中华人民共和国教育部
主办:中山大学
承办:中山大学中山眼科中心
主编:林浩添
团体标准

广东省年龄相关性白内障手术操作及质量控制规范

Standard operating procedure and quality control standards for age-related cataract in Guangdong Province

:429-436
 
年龄相关性白内障是全球首位致盲性眼病,手术是治疗白内障唯一有效的手段。白内障手术后视力的良好恢复,除了患者自身的眼部条件外,还有赖于医疗机构的手术技术和质量管理水平。白内障摘除手术的规范操作、人工晶状体屈光力的精准测算和专业的围术期管理是白内障患者复明的关键。国家卫生健康委员会在《加强县医院白内障手术能力建设工作方案(2025—2027年)》中提出,通过加强设备设施建设、帮扶县级医院开展人员培训、建立标准化手术制度等方式,进一步提高县级医院开展白内障手术的能力,就近就便满足人民群众白内障复明需求。因此,为了规范化白内障手术操作、确保手术安全和减少手术并发症,在广东省医学会的领导下,由中山大学中山眼科中心联合广东省内其他21所医疗机构35名权威专家共同起草,在参考国内外白内障手术标准的基础上,结合我省白内障手术的现状,共同讨论并最终确定了本团体标准。本标准系统地描述了年龄相关性白内障手术软件、硬件的基本要求、手术的适应证与禁忌证,制定了白内障手术的标准操作流程及其质量控制标准,并且介绍了并发症或不适的预防及处理,为广东省各级具有资质的医疗机构开展白内障手术以及质量评估提供指导。
Age-related cataract is the leading blinding eye disease in the world, and surgery is the only effective treatment. The good recovery of vision after cataract surgery depends not only on the patients’ ocular conditions but also on the surgical technique and quality management level of medical institutions. Standard surgical procedures, the accurate measurement and calculation of intraocular lens (IOL) power, and professional perioperative management are the keys to restoring the sight of patients. In addition, the National Health Commission proposed in the "Work Plan for Strengthening the Cataract Surgery Capacity Building of County-level Hospitals (2025-2027)" that the ability of county-level hospitals to perform cataract surgery should be further improved by strengthening the construction of equipment and facilities, assisting county-level hospitals in carrying out personnel training, and establishing standardized surgical system. Therefore, in order to standardize cataract surgery procedures, ensure the safety of the surgery and reduce surgical complications, under the leadership of the Guangdong Medical Association, the Zhongshan Ophthalmic Center of Sun Yat-sen University, in conjunction with 21 other medical institutions in Guangdong Province and 35 authoritative experts, jointly drafted this group standard. On the basis of referring to the domestic and international standards for cataract surgery and combining with the current situation of cataract surgery in Guangdong Province, they jointly determined this group standard. This group standard systematically describes the basic requirements for the software and hardware conditions of age-related cataract surgery, the indications and contraindications of the surgery, formulates the standard surgical procedures and quality control standards for cataract surgery, and introduces the prevention and treatment of complications or adverse reactions, providing guidance for all qualified medical institutions at different levels to carry out cataract surgery and quality assessment.
泪器病专栏

日间病房模式下行En-DCR的PANDO患者术后自我护理单中心回顾性分析

A single-center retrospective analysis of postoperative self-care in PANDO patients undergoing endoscopic nasal dacryocystorhinostomy (En-DCR) under the day-ward model

:437-445
 

目的分析日间病房模式下原发性获得性鼻泪管阻塞(primary acquired nasolacrimal duct obstructionPANDO)患者行经鼻内镜泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)的术后自我护理现状并进行早期效果评价。方法纳入2021年112022年8月在中山大学中山眼科中心眼整形与泪道科日间病房En-DCR手术治疗的90PANDO患者,术后常规给予术后自我护理指导。术后1个月复查采用调查问卷的方式记录患者术后自我护理情况及不适症状评估患者手术效果并进一步探究术后自我护理因素与手术效果及术后不适症状的相关性。结果90例行En-DCR手术治疗的PANDO患者共计90术后1个月手术总成功率为92.22%其中治愈率65.56%好转26.67%)。术后自我护理与手术效果的特征分析显示,术后遵嘱鼻腔冲洗每日至少1次(= 0.002)、遵医嘱喷鼻每日至少1次(= 0.008)、术后无上呼吸道感染= 0.047)的患者手术效果更好术后自我护理与术后不适症状的特征分析显示每日至少1鼻腔冲洗(= 0.006)和义管在位(= 0.003)的患者术后不适症状较少同时对置管患者进行心理负担相关性分析结果显示置管不适与心理负担呈正相关(= 0.4210.001结论在日间病房模式下,医护人员En-DCR术后患者进行详细的自我护理指导,有助于患者的术后恢复及保证良好的手术疗效。指导重点包括术后1月内每日至少1鼻腔冲洗,规律使用抗炎喷鼻剂并防止上呼吸道感染;另外应重点关注泪道置管患者术后局部不适症状,针对术后不适症状优化用药使用互联网护理门诊或电话随访做好护理指导和心理疏导,促进患者术后康复

Objective: To investigate  postoperative self-care practices and evaluate the early outcomes of patients with Primary Acquired Nasolacrimal Duct Obstruction (PANDO) undergoing Endoscopic Dacryocystorhinostomy (En-DCR) in a day ward setting. Methods: 90 PANDO patients who underwent En-DCR surgery at the Oculoplastic and Lacrimal Surgery day ward at Zhongshan Ophthalmic Center, Sun Yat-sen University, between November 2021 and August 2022, were enrolled in this study. All patients received standardized postoperative self-care instructions. At the one-month follow-up, a questionnaire survey was used to record patients' self-care adherence to self-care practices, postoperative discomfort symptoms, and assess surgical outcomes. Furthermore, the correlation between self-care factors and surgical outcomes/discomfort symptoms was explored. Results: A total of 90 eyes from 90 PANDO patients undergoing En-DCR were included. The overall surgical success rate at one month was 92.22% , comprising a cure rate of 65.56% and an improvement rate of 26.67%. Analysis of self-care practices related to surgical outcomes showed significantly better results in patients who adhered to nasal irrigation at least once daily (= 0.002), used prescribed nasal spray at least once daily (= 0.008), and avoided upper respiratory tract infections (= 0.047). Regarding postoperative discomfort, patients who peformed nasal irrigation at least once daily (= 0.006) and had the lacrimal stent (tube) in situ (= 0.003) experienced significantly fewer symptoms. Furthermore, correlation analysis in stented patients indicated a positive correlation between stent discomfort and psychological burden (= 0.421, < 0.001). Conclusion: In the day ward model, detailed self-care guidance provided by healthcare professionals for En-DCR patients contributes to postoperative recovery and ensures favorable surgical outcomes. Key instructions include performing nasal irrigation at least once daily, using anti-inflammatory nasal spray regularly, and preventing upper respiratory infections during the first postoperative month. Additionally, particular attention should be paid to localized discomfort in patients with lacrimal stents. Optimizing medication regimens for discomfort, utilizing internet-based nursing clinics or telephone follow-ups for guidance and psychological support are crucial to promote postoperative rehabilitation.

曲安奈德在治疗慢性泪囊炎鼻内镜术后造瘘口肉芽增生中的应用

Application of intralesional triamcinolone acetonide injections in the treatment of ostium granulomas following endoscopic dacryocystorhinostomy

:446-453
 

目的:分析慢性泪囊炎患者鼻内镜下泪囊鼻腔造瘘口术后的远期肉芽增生情况,评价物理清除联合曲安奈德(triamcinolone acetonide,TA)局部注射治疗慢性泪囊炎鼻内镜术后造瘘口肉芽组织增生的效果。方法:回顾性分析接受鼻内镜手术的慢性泪囊炎患者98例115眼。随访收集术后造瘘口肉芽组织增生发生情况,分析肉芽增生与无肉芽增生患者的临床特征。对有肉芽增生的患者26例31眼,根据治疗方式分为物理清除联合TA局部注射组13例16眼和单纯物理清除组13例15眼,比较2组间治疗有效率。结果:鼻内镜术后造瘘口肉芽增生病例共31眼(26.96%)。物理清除联合TA组的治愈率、好转率分别为93.75%、6.25%,物理清除组相应为60%、33.33%。组间比较差异有统计学意义(< 0.05)。结论:物理清除联合TA局部注射治疗泪囊炎鼻内镜术后造瘘口肉芽组织增生安全、有效。

Objective: This study aimed to analyze the formation of ostium granulomas following endonasal endoscopic dacryocytostomy (DCR) in patients with chronic dacryocystitis and to evaluate the efficacy of excision combined with triamcinolone (TA) injection for treating ostium granulosis after endoscopic dacryocystorhinostomy. Methods: A restrospective analysis was conducted on 98 patients (115 eyes) with chronic dacryocystitis who underwent endoscopic dacryocystorhinostomy.  Postoperative growth of the ostium granulomas was monitored, and clinical characteristics were compared between patients with and without ostium granulomas. Among these, 26 cases (31 eyes) of ostium granuloma were identified and randomly assigned to either an excision combined with triamcinolone injection group (13 cases with 16 eyes) or excision-only group (13 cases with 15eyes) based on the treatment method. The effective ratebetween two groups was compared. Results: Ostium granulomas occurred in 31 eyes (26.96%). The cure rate and improvement rate in the excision combined with TA group were 93.75% and 6.25%, respectively, whereas in the excision-only group, they were 60% and 33.33%. These differences were statistically significant (< 0.05).  Conclusions: Excision combined with intralesional triamcinolone acetonide injections proved effective in promoting the regression of ostium granuloma after DCR.

眼底影像专栏

急性黄斑神经视网膜病变中视网膜前巨噬细胞样细胞和视网膜脉络膜血流变化

Characterization of epiretinalmacrophage-like cells and retinochoroidal blood flow in acute macular neuroretinopathy

:454-463
 

目的:分析视网膜前巨噬细胞样细胞(epiretinal macrophage-like cellseMLC和视网膜脉络膜血流在急性黄斑神经视网膜病变(acute macular neuroretinopathyAMN)患眼的临床特征。方法回顾性分析202212—20235月在中山大学中山眼科中心就诊的病程2周内的AMN患者2137眼)及年龄匹配的健康对照组3338眼)的临床资料通过黄斑区内界膜上μmeface 光学相干断层扫描(optical coherence tomographyOCT)分层信息eMLC进行半自动分析提取和定量,同时测量OCT血管成像(optical coherence tomography angiographyOCTA6 mm² x 6 mm²的黄斑区域内视网膜脉络膜血流参数进行分析对比。结果 AMN黄斑区eMLC数量329.78±77.38)个,密度为(9.16±2.15/mm2,均较对照组(202.63±41.72、(5.63±1.16/mm2增加P0.001)。AMN组浅层和深层视网膜血流密度分别为33.00±6.49)(32.59±7.41%,均较对照组(36.18±5.63)(37.08±5.65%减少(P0.05。视网膜全层中心凹无血管区(foveal avascular zoneFAZ面积、视网膜全层血流密度、脉络膜毛细血管和脉络膜大中血管血流密度在两组间比较差异无统计学意义(P0.05)。浅层及深层视网膜血流密度和FAZ面积对eMLC密度无影响(P0.05)。13AMN患者(231个月时的随访资料显示:AMN组末次随访时eMLC数量248.70±59.88)个、密度为6.91±1.66)个/mm2初次就诊时(307.87±82.98和(8.55±2.30)个/mm2减少(P0.001,但仍高于同期对照组(176.58±27.89和(4.91±0.77/mm2P0.001)。视网膜和脉络膜血流参数较初次就诊时比较差异无统计学意义(P0.05)。结论AMN患眼中eMLC异常增多和聚集,同时存在轻度的视网膜血流密度下降,但无脉络膜血流参数变化,且eMLC变化与AMN病程相关但与视网膜血流变化无关,提示eMLC所代表的炎症可能独立参与了AMN的发生

Objective: To investigate the clinical characteristics of epiretinal macrophage-like cells (eMLC) and retinochoroidal blood flow in eyes affected by acute macular neuroretinopathy (AMN). Methods: This retrospective case series study included 21 (37 eyes) patients diagnosed with AMN and 28 (33 eyes) healthy age-matched subjects. A 3 mm En-face optical coherence tomography (OCT) slab on the inner limiting membrane of the macular region was used to visualize and binarize the MLCs. The MLCs were binarized and quantified using a semiautomated method. Optical coherence tomography angiography (OCTA) was used to evaluate the perfusion status and obtain the structural data of macular within a 6 x 6 mm² macular region. Results: The number and density of macular eMLC in AMN eyes were significantly increased in comparison to control eyes: 329.78±77.38 vs. 202.63±41.72, (P0.001) and (9.16±2.15) cells/mm2 vs. (5.63±1.16) cells/mm2 (P0.001). In the macular region, both superficial and deep retinal vessel densities were significantly lower in the AMN eyes than in the control eyes: 33.00±6.49 vs. 36.18±5.63 (P=0.040); 32.59±7.41 vs. 37.08±5.65 (P=0.008). There were no significant differences in the vessel densities and foveal avascular zone (FAZ) area of full retina and choroidal vessel density between the two groups (P0.05). The eMLC density was not associated with the superficial and deep retinal FAZ area and vessel densities (all P0.05). At the one-month follow-up data of 13 patients (23 eyes), the number and density of macular eMLC were significantly lower in comparison to the initial visit: 248.70±59.88 vs. 307.87±82.98, P0.001 and (6.91±1.66) cells/mm2 vs. (8.55±2.30) cells/mm2 (P0.001). However, the number and density of macular eMLC are still noticeably higher than those of the control group during the same timeframe: 248.70±59.88 vs. 176.58±27.89 (P0.001) and (6.91±1.66) cells/mm2 vs. (4.91±0.77) cells/mm2 (P0.001). There was no significant difference in the vessel density of retina and choroidal during the follow-up (P0.05). Conclusions: The aggregation and activation of eMLC and a mild decrease in retinal blood flow density are observed in AMN, yet there is no corresponding shift in choroidal vessel densityThe changes of eMLC are linked to the course of AMN, but they are not related to retinal vessel density. The inflammatory response represented by eMLC might independently contribute to the pathogenesis and progression of AMN.

中心性浆液性脉络膜视网膜病变的SS-OCT及SS-OCTA的应用及研究进展

Application and progress of swept source optical coherence tomography in choroid-related diseases

:464-470
 
中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)是一种以脉络膜增厚、血管通透性增加为特征的脉络膜谱系疾病,所以对脉络膜的观察对于CSC的监测和治疗非常重要。随着光学相干断层扫描成像(optical coherence tomography,OCT)的发展,对脉络膜的认识有了显著提升,也让我们更深刻地理解了它在眼后段疾病中的重要作用,提高了对各种脉络膜视网膜疾病的诊断能力。近年来,随着扫频源光学相干断层扫描(swept source optical coherence tomography,SS - OCT)及扫频源光学相干断层扫描血流成像(swept source optical coherence tomography angiography,SS - OCTA)的发展,其扫描波长、深度、广度及扫描速度均显著提升,实现了对脉络膜结构的无创定量化评估,推进了对CSC等脉络膜谱系疾病的病理机制的认识和临床管理。文章就近年SS-OCT及SS-OCTA在 CSC 中的应用及研究进展进行总结。主要进展有:发现CSC脉络膜增厚不仅局限于黄斑区,且发现其脉络膜血管及基质成分均显著增加;CSC为双眼受累,而表现为单眼症状;涡静脉回流障碍机制在该疾病中起到关键作用;SS-OCT能进一步对后极部的视网膜下积液进行监测和分析;发现了急性与慢性CSC脉络膜相关参数的改变的不同;最后探究了巩膜机制在该疾病中可能起到的作用。
Central serous chorioretinopathy (CSC) is one of the choroidal spectrum diseases, characterized by choriod thickening and increased vascular permeability. Therefore it is very important to observe choroid, as this allows us to monitor it and formulate an appropriate therapeutic schedule. With the development of optical coherence tomography (OCT), our understanding of choroid has been significantly improved. We have got a deeper insight into its important role in posterior diseases, and also the diagnostic capability for choroidal and retinal diseases has also improved. In recent years, the development of swept source optical coherence tomography (SS-OCT) and swept source optical coherence tomography angiogrphy (SS-OCTA) has further advanced our ability to assess choroidal conditions. These technologies offer enhanced scanning wavelengths, depth, breadth, and scanning speed, enabling non-invasive quantitative assessment of choroidal structures. This has advanced our understanding of the pathophysiological mechanisms and clinical management of CSC and other choroidal spectrum diseases.This review summarizes the application of swept source optical coherence tomography (SS - OCT) and swept source optical coherence tomography angiography (SS - OCTA) in CSC and it’s research progress. The main advancements include: choroidal thickening in CSC is not limited to macular area, both choroidal vascular and stromal components are significantly increased; CSC can affect both eyes, although it often presents with unilateral symptoms; impaired vortex vein outflow plays a key role in the pathogenesis of this disease; SS-OCT can further monitor and analyze subretinal fluid accumulation in the posterior pole; differences in changes in choroidal parameters between acute and chronic CSC have been identified; and finally, the potential role of scleral mechanisms in this disease has been explored.
论著

高效液相色谱法测定曲伏噻吗滴眼液中曲伏前列素有关物质

Determination of related substances of travoprost in travoprost and timolol maleate eye drops by HPLC

:471-482
 
目的:建立高效液相色谱法(high-performance liquid chromatography,HPLC)测定曲伏噻吗滴眼液中曲伏前列素有关物质。方法:采用Agilent SB-C18色谱柱(50 mm×2.1 mm,2.7 μm);以磷酸溶液(取磷酸2.0 mL,加水稀释并定容至1 000 mL,用氢氧化钠溶液调节pH至3.0)为流动相A,乙腈为流动相B,洗脱梯度;流速为每分钟3.0 mL;柱温为30 ℃;检测波长为220 nm;进样体积100 μL。结果:在该色谱条件下,曲伏前列素与各杂质均可良好分离;在酸、碱、氧化、高温和强光破坏条件下,曲伏前列素峰纯度合格,物料守恒。曲伏前列素、5,6-反式曲伏前列素和15-酮曲伏前列素分别在0.041~3.245 μg/mL(r=1.000 0)、0.040~3.229 μg/mL(r=1.000 0)、0.039~3.088 μg/mL(r=0.999 9)范围内线性关系良好,其最低检测限分别为0.020、0.020和0.020 μg/mL;6份样品中5,6-反式曲伏前列素的含量相对标准偏差(relative standard deviatio,RSD)为0.2% (n=6),15-酮曲伏前列素的含量RSD为0.3% (n=6),重复性良好;对照品溶液和供试品溶液在室温条件下放置100h稳定,5,6-反式曲伏前列素的平均回收率为95.2%,相对标准偏差RSD为0.5% (n=9),15-酮曲伏前列素的平均回收率为92.7%,RSD为1.2% (n=9)该方法重现性好。结论:本方法简便、快速、准确。适用于检测曲伏噻吗滴眼液中的曲伏前列素有关物质。
Objective: To develop a high-performance liquid chromatography (HPLC) method for the determination of related substances in Travoprost and Timolol Maleate Eye Drops, sepcifically focusing on Travoprost and its impurities. Methods: The analytic column used was an Agilent SB-C18 (50 mm × 2.1 mm,2.7 μm) . A phosphoric acid solution (prepared by diluting 2.0 mL of phosphoric acid with water tto final volume of 1,000 mL and adjust the pH to 3.0 with sodium hydroxide solution) was used as mobile phase A, while acetonitrile served as mobile phase B. The elution was performed using a gradient program at a flow rate of 3.0 mL/min. The detection wavelength was set at 220 nm, and the column temperature was maintained at 30 ℃. The injection volume is 100 μL. Results: Under the described chromatographic condition, Travoprost and its various impurities were well separated. The purity of the Travoprost peak was qualified, and the material remained stable under conditions of acid, alkali, oxidation, high temperature, and strong light exposure. The linear ranges for Travoprost, 5,6-trans-Travoprost, and 15-keto-Travoprost were determined to be 0.041~3.245 μg/mL(r=1.0000), 0.040~3.229 μg/mL(r=1.0000), 0.039~3.088 μg/mL(r=0.9999), respectively. The lowest detection limits for these compounds were all 0.020 μg/mL, The relative standard deviation (RSD) for the content of 5,6-trans-travoprost and 15 keto trovopros in six samples were 0.2% (n=6) and 0.3% (n=6), respectively, indicating good reproducibility. Both the reference solution and the test solution remained stable at room temperature for 100 hours,The average recovery rates for 5,6-trans-Travoprost and 15-keto-Travoprost were 95.2% (RSD 0.5%,n=9) and 92.7% (RSD 1.2%, n=9) respectively, further confirming the high reproducibility of the method. Conclusions: The developed HPLC method is simple, rapid, and accurate, making it suitable for the determination of related substances in Travoprost and Timolol Maleate Eye Drops.

眼解剖整合课程在眼科住院医师规范化培训教学中的应用

The application of the integrated course on ocular anatomy in the standardized training teaching of ophthalmology residents

:483-490
 
目的:探索和评价“线上教学-理论小课-Wetlab实操”眼解剖整合课程在眼科住院医师培范化培训(住培)教学中的应用和效果。方法:纳入中山大学中山眼科中心2023年新入培的住培学员93名,在岗前培训时进行眼解剖整合课程教学。在课程前后分别进行测试,评价课程教学效果,并在课程结束后采用匿名线下测试考核和满意度问卷调查的形式对课程的满意度进行调查。结果:培训前(T1)和培训后(T2)总分中位数分别是60分和70分,T1最低分、25%、75%和最高分分别是10、40、62.5和90,T2最低分、25%、75%和最高分分别是30、60、80和100,T2得分显著高于T1得分,差异具有统计学意义(P<0.000 1);T1和T2的自信度平均值分别为26.53±5.08、31.83±4.02,差异有统计学意义(P<0.001)。学员普遍表示对整合课程满意。结论:学员们接受整合课程培训后,对眼解剖学知识的掌握程度有明显提高,对整合课程满意度高。眼解剖整合课程有效性显著,是具有推广意义的教学改革。
Objective: To explore and evaluate the application and effect of an integrated   ocular anatomy course comprising three main components: ‘online preview,’ ‘lecture,’ and ‘Wetlab dissection training’in the standardized training teaching of ophthalmology residents (hereinafter referred to as "resident training"). Methods: A total of 93 new resident trainees from Zhongshan Ophthalmic Center of Sun Yat-sen University in 2023 were included in the integrated course on ocular anatomy during pre-job training. Tests were carried out before and after the course to evaluate the teaching effect of the course, and questionnaires were issued after the course to investigate the satisfaction of the course. It adopts the form of anonymous offline test and satisfaction questionnaire. Results: The median total scores before (T1) and after (T2) training were 60 and 70, respectively; the lowest scores, 25%, 75% and highest scores of T1 were 10, 40, 62.5 and 90, respectively; the lowest scores, 25%, 75% and highest scores of T2 were 30, 60, 80 and 100, respectively, and the scores of T2 were significantly higher than those of T1. The difference was statistically significant (P<0.000 1). The mean confidence of T1 and T2 were 26.53±5.08 and 31.83±4.02, respectively, and the difference was statistically significant (P<0.001). Participants generally expressed satisfaction with the integrated programme. Conclusions: After receiving the training of the integrated course, the students' mastery of the knowledge of ocular anatomy has been significantly improved, and the satisfaction of the integrated course is high. The integrated course on ocular anatomy is effective, and it is a teaching reform with popularization significance.
综述

眼表的微环境及其调节机制

The ocular surface microenvironment and its regulatory mechanisms

:491-498
 
眼表是一个复杂且精细的系统,包括角膜、泪膜和结膜等多个结构。作为眼部直接与外界接触的部分,眼表不仅负责起着保护眼睛的作用,还在视觉功能中扮演着至关重要的角色。眼表微环境(ocular surface microenvironment,OSM)的平衡对眼睛的健康至关重要,任何微环境的失衡都可能引发多种眼表疾病,如干眼症、角膜炎等。随着现代人群生活方式的改变,视屏终端综合征(Visual Display Terminal,VDT)发生率急剧上升,破坏了OSM的平衡,导致眼表疾病的发病率大大升高,特别是干眼症的发病率显著增加,严重影响了患者的生活质量,因此,深入研究维持OSM稳态的调节机制以及探索有效的治疗策略显得尤为紧迫。近年来,研究突破了传统的解剖学框架,揭示了OSM的多系统协同调控机制,为维持眼表微环境稳态提供了新的思路。神经、淋巴、免疫系统之间相互调节,不仅有助于深入挖掘眼表疾病的关键分子和信号通路,还为发现新的生物标志物以及潜在治疗靶点提供了新的方向。因此,本文章系统综述了近年来OSM调节机制的最新进展,重点讨论神经、淋巴和免疫调节在维持OSM稳态中的作用,并分析三者之间的相互影响,以期为眼表疾病的预防及诊疗提供新的思路。
The ocular surface is a complex and sensitive system composed of includes various structures including the cornea, tear film and conjunctiva. As the part of the eye directly exposed to the external environment, the ocular surface not only protects the eye, but also plays a vital role in vision. The balance of the ocular surface(OSM) is essential for eye health, and any disruption can lead to ocular surface diseases, such as dry eye and keratitis. With the evolving lifestyle of the modern population, the incidence of Visual Display Terminal (VDT) syndrome has significantly increased, disturbing the OSM balance and leading to a rise in ocular surface diseases, particularly dry eye disease, which severely impacts patients' quality of life. Therefore, it is crucial to conduct comprehensive research into the regulatory mechanisms that maintain OSM homeostasis and explore effective therapeutic strategies. Recent studies have moved beyond traditional anatomical frameworks, uncovering the multi-system coordinated regulatory mechanisms of OSM, providing new insights into maintaining ocular surface homeostasis. The interplay between the nervous, lymphatic, and immune systems not only helps identify key molecules and signaling pathways involved in ocular surface diseases but also offers new opportunities for discovering novel biomarkers and potential therapeutic targets. This article presents a systematic review of the latest advancements in OSM regulatory mechanisms, focusing on the roles of nervous, lymphatic, and immune regulation in maintaining OSM homeostasis and analyzing the interactions among these systems, with the goal of offering new insights for the prevention and treatment of ocular surface diseases.
经验交流

眼科研究型医院专职研究护士管理实践

Management practices of dedicated research nurses in an ophthalmic research hospital

:499-506
 
眼科研究型医院是推动医学创新与成果转化的核心平台。其中,专职临床研究护士(clinical research nurse,CRN)在提升临床研究的规范性及整体质量方面发挥着不可或缺的作用。然而,当前国内尚缺乏针对眼科领域CRN管理模式的系统总结和实践指导,制约了该群体专业价值的充分发挥和制度化建设的推进。本研究以中山大学中山眼科中心(三级甲等眼科研究型医院)2013—2024年间的CRN管理实践为样本,系统梳理其管理体系的构建路径与实施成效。研究发现,通过构建“准入-培训-双轨管理”体系和实践模式,能够显著提升CRN队伍的专业能力和研究项目的整体质量。机构质控数据显示,配备CRN后的研究项目质量评分由(67.5±17.2)分显著提升至(99.3±1.0)分(P<0.001),证实了该体系的有效性和可行性。研究结果还为我国眼科临床研究护理专业化发展提供了可复制的实践模板,还进一步分析提炼出CRN的三项核心职能:一是项目管理中的流程优化,保障研究环节高效协同;二是参与者管理,强化对受试者权益的保护;三是数据质量控制,确保研究数据的准确性与完整性。在此基础上,针对当前CRN发展中普遍存在的职责不清、培训缺失、政策滞后等问题,本文还提出推动“层级化培训常态化”“政策规范细则化”等优化建议,助力我国眼科临床研究由“经验驱动”向“体系驱动”转型,为临床研究护理专业化提供实践模板和决策参考。
Ophthalmic research hospitals serve as critical platforms for advancing medical innovation and translating research outcomes into practice. Dedicated Clinical Research Nurses (CRNs) play a pivotal role in enhancing the quality, compliance, and integrity of clinical research conducted within these settings. However, in China, there remains a lack of systematic models and practical guidance for CRN management specific to the field of ophthalmology, which has hindered the full realization of their professional value and the advancement of institutionalized development. This study examined CRN management practices at Zhongshan Ophthalmic Center, Sun Yat-sen University, a Grade A tertiary ophthalmic research hospital, between 2013 and 2024 as a case example to systematically examine the development pathway and outcomes of its CRN management system. The findings demonstrate that the implementation of a standardized system encompassing entry qualifications, tiered training, and structured practice models significantly enhanced both the professional competency of CRNs and the overall quality of clinical research projects. According to institutional quality control data, the quality score of clinical research projects increased significantly from 67.5±17.2 to 99.3±1.0 (P<0.001) following the integration of CRNs. Moreover, the study identifies three core functional domains of CRNs: (1) optimizing research processes to improve project coordination and efficiency; (2) managing research participants to safeguard ethical compliance and rights protection; and (3) ensuring data quality and integrity through rigorous oversight. In response to persistent challenges such as unclear role definitions, insufficient training systems, and lagging policy support, the study proposes actionable strategies, including the institutionalization of hierarchical and continuous training as well as the refinement of policy frameworks. These findings provide a scalable and evidence-based reference for promoting the professionalization and systemic development of ophthalmic clinical research nursing in China.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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