随着人工智能(artificial intelligence,AI)技术的快速发展，其在医疗领域的应用正带来革命性的变化。白内障作为全球范围内最常见的可逆性视力障碍之一，在管理和治疗方面依然存在着医疗资源不足、诊断精度低、转诊效率低等诸多实际问题。因此，利用AI技术强大的计算分析和智能决策能力，优化传统医疗实践方式，对于保障人们的视觉健康至关重要。该文探讨AI技术在推动白内障分级诊疗新模式方面的应用，包括白内障图像自动分析与识别、远程医疗和转诊支持等，这些应用能够为白内障患者、社会以及政府带来多方面的显著益处和重要影响，有助于提高白内障诊断和治疗效率，缓解医疗资源不均衡问题，优化医疗资源的配置和管理，推动社会健康进步。然而，AI技术的实际应用也面临风险和挑战，应当充分重视和保护患者数据隐私和安全，建立严格的监管和监督机制，并持续加强技术创新，全面评估AI算法的鲁棒性、公平性和可解释性，以进一步提高AI系统的准确度和可信度。

With the rapid development of artificial intelligence (AI) technology, its application in the field of healthcare is bringing revolutionary changes. Cataracts, as one of the most common reversible visual impairments worldwide, still face many practical issues in terms of limited medical resources, low diagnostic accuracy, and low referral efficiency. Therefore, it is crucial to utilize AI technology's powerful computational analysis and intelligent decision-making capabilities to optimize traditional medical practices and safeguard people's visual health.This article investigates the applications of AI technology on a new model of hierarchic diagnosis and treatment for cataracts, including automatic analysis and recognition of cataract images, remote healthcare, and referral support. These applications can bring significant benefits and important impacts to cataract patients, society, and governments. They can help improve the efficiency of cataract diagnosis and treatment, alleviate the imbalance of medical resources, optimize the allocation and management of healthcare resources, and promote societal health progress.However, the practical application of AI technology also faces risks and challenges. It is important to fully prioritize and protect patients' data privacy and security by establishing strict regulatory and oversight mechanisms. Additionally, continuous efforts should be made to enhance technological innovation and comprehensively evaluate the robustness, fairness, and interpretability of AI algorithms to further improve the accuracy and trustworthiness of AI systems.

目的：建立和验证一个涉及多级临床场景的白内障协作通用的人工智能(artificial intelligence,AI)管理平台，探索基于AI的医疗转诊模式，以提高协作效率和资源覆盖率。方法：训练和验证的数据集来自中国AI医学联盟，涵盖多级医疗机构和采集模式。使用三步策略对数据集进行标记: 1)识别采集模式；2)白内障诊断包括正常晶体眼、白内障眼或白内障术后眼；3)从病因和严重程度检测需转诊的白内障患者。此外，将白内障AI系统与真实世界中的居家自我监测、初级医疗保健机构和专科医院等多级转诊模式相结合。结果：通用AI平台和多级协作模式在三步任务中表现出可靠的诊断性能: 1)识别采集模式的受试者操作特征(receiver operating characteristic curve,ROC)曲线下面积(area under the curve,AUC)为99.28%~99.71%)；2)白内障诊断对正常晶体眼、白内障或术后眼，在散瞳-裂隙灯模式下的AUC分别为99.82%、99.96%和99.93%，其他采集模式的AUC均 > 99%；3)需转诊白内障的检测(在所有测试中AUC >91%)。在真实世界的三级转诊模式中，该系统建议30.3%的人转诊，与传统模式相比，眼科医生与人群服务比率大幅提高了10.2倍。结论：通用AI平台和多级协作模式显示了准确的白内障诊断性能和有效的白内障转诊服务。建议AI的医疗转诊模式扩展应用到其他常见疾病和资源密集型情景当中。

Objective: To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. Methods: The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three step strategy: (1)capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services. Results: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%–99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3)detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3%  of people be ’referred’, substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern. Conclusions: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.

目的：探讨眼科临床指南结合团队式学习(team-based learning,TBL)教学课程在眼科住院医师规范化培训中的应用及教学效果。方法：本研究选取2022年1月—2023年6月在广州医科大学附属第一医院眼科进行住院医师规范化培训的15名住院医师作为研究对象，先后交替使用自学讲课、TBL教学这两种教学模式进行眼科临床指南学习，通过填写满意度调查问卷及评估出科考通过率、学业水平测试成绩、结业考通过率，从主观及客观角度探讨临床指南结合TBL学习模式的教学效果。结果：住院医师对增加眼科临床指南学习具有较高评价，且不认为会增加其学习负担。开展指南学习后，住院医师出科考试及格率、学业水平测试通过率、结业考通过率均为100%。在培养团队合作能力、改善学习氛围两方面，TBL讲课的满意度均高于自学讲课(均P＜0.001)。93.3%(14/15)的住院医师更喜欢TBL教学模式。结论：眼科临床指南结合TBL教学是一种有效的教学模式，住院医师在主观满意度调查问卷及客观考试成绩的评估中，均达到满意的教学效果。

Objective: To investigate the application and teaching effect of clinical guidelines combined with team based learning(TBL) teaching courses in standardized training for ophthalmic residents. Methods: 15 residents who received standardized training in the ophthalmology department of the First Affiliated Hospital of Guangzhou Medical University were recruited from January 2022 to June 2023. Self-study teaching and TBL teaching were successively applied to teach the clinical guidelines of ophthalmology. The subjective and objective teaching effects were evaluated by satisfaction questionnaire, passing rate of phase examination, achievement of academic proficiency test and passing rate of final examination. Results: The clinical guidelines enjoy the high opinion in the residents, and would not be strengthen their learning burden. After the residents studied clinical guidelines, their passing rate of the phase exam, academic proficiency test and final examination were all 100%. In terms of cultivating teamwork ability and study atmosphere, the satisfaction of TBL lectures was significantly higher than that of self-study lectures (P< 0.001). 93.3% (14/15) of the residents preferred TBL lectures. Conclusions: The combination of ophthalmology clinical guidelines and TBL teaching was proved to be an effective teaching model. The residents achieved excellent teaching results in the subjective satisfaction questionnaire and objective examination scores.

目的：观察依镜有晶状体眼后房屈光晶体(phakic refractive lens,PRL)植入术矫正超高度近视的疗效和安全性。方法：纳入自2018年1月—2020年9月在深圳市眼科医院行依镜PRL植入术的超高度近视患者共24例39眼，进行自身对照研究。其中，男8例13眼，女16例26眼，平均年龄(31.15±6.33)岁。观察术后屈光度、视力[裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)]、眼压、角膜内皮细胞计数、拱高、手术并发症等指标。结果：中位随访时间为5.5(3.0，11.0)月。屈光度从术前(?22.29±4.96) D降低至术后(?0.28±1.01) D(t=24.421，P<0.001)，其中术后球镜度数±0.5 D占28眼(82.4%)，±1.0 D占31眼(91.2%)。LogMAR UCVA从术前1.40(1.30，1.70)改善至术后(0.28±0.20) D，LogMAR BCVA由术前0.40(0.22，0.70)改善至术后0.15(0.00，0.30)，差异均有统计学意义(均P<0.001)。术后BCVA较术前提高3.00(1.00，5.00)行，所有患者均无BCVA丢失。术前、术后1 d、末次随访眼压值比较差异有统计学意义(F=8.779 P=0.012)，其中术后1 d较术前眼压增高(Z=-3.401，P=0.001)，而末次随访较术后1 d眼压降低(Z=-2.685，P=0.007)，末次随访与术前眼压之间比较差异无统计学意义(Z=-0.894，P=0.371)。角膜内皮细胞计数从术前(2 782.20±296.30)个/mm²降低至术后(2 472.54±394.32)个/mm² (t=-5.437，P<0.001)，平均丢失角膜内皮细胞数11.2%。末次随访33眼平均拱高值为(379.00±283.27)μm，其中0~250 μm占12眼(36.4%)，250~750 μm占19眼(57.6%)，大于750 μm占2眼(6%)。21眼PRL术后3个月拱高值为(269.81±194.67)μm，较术后1个月拱高值(373.62±195.75)μm降低(t=?2.917，P=0.009)。术后并发症包括激素性青光眼(1例2眼)、PRL光学面裂痕(1眼)、黄斑出血(1眼)、PRL偏位(2例3眼)。结论：对于超高度近视患者，依镜PRL植入术是一种可供选择的安全、有效的眼内屈光手术方式，但其远期疗效及安全性仍需更长时间和更大样本量进一步观察。

Objective: To assess the efficacy and safety of phakic refractive lens (PRL) implantation for the correction of ultra-high myopia. Methods: This self-controlled case series study included 39 eyes of 24 patients with ultra-high myopia who underwent PRL implantation at Shenzhen Eye Hospital between January 2018 and September 2020. The study comprised 13 eyes in 8 males and 26 eyes in 16 females, with a mean age of (31.15 ± 6.33) years. Postoperative parameters, including refraction, visual acuity (UCVA, BCVA), intraocular pressure, corneal endothelial cell count,vault, and surgical complication were observed. Results: The median follow-up time was 5.5 (3, 11) months. The refraction significantly decreased from preoperative (-22.29±4.96) D to postoperative (-0.28±1.01) D (t=24.421, P<0.001). Postoperatively, 82.4% of eyes achieved a spherical degree within ±0.5 D, and 91.2% within ±1.0 D. LogMAR UCVA significantly improved from 1.40 (1.30, 1.70) preoperatively to (0.28±0.20) postoperatively. LogMAR BCVA significantly improved from 0.40 (0.22, 0.70) preoperatively to 0.15 (0.00, 0.30) postoperatively (P<0.001 for all). Postoperative BCVA improved by 3.00 (1.00, 5.00) lines compared with preoperative BCVA, with no instances of BCVA loss in any patient. Intraocular pressure values showed significant differences among preoperative, 1 day postoperative and last follow up (F=8.779, P=0.012). Intraocular pressure increased significantly 1 day after surgery compared to before surgery (Z=-3.401, P=0.001), but decreased significantly at the last follow-up compared to 1 day postoperatively(Z=-2.685, P=0.007), with no significant difference in intraocular pressure between preoperative and last follow-up (Z=-0.894, P=0.371). Corneal endothelial cell count decreased significantly from preoperative (2 782.20±296.30)/mm² to postoperative (2 472.54±394.32)/mm² (t=?5.437, P<0.001), with a mean loss of 11.2%. The average vault at the last follow-up was (379.00±283.27) μm, of which 0~250 μm in 12 eyes (36.4%), 250~750 μm in 19 eyes (57.6%), and > 750 μm in 2 eyes (6%). In 21 eyes, the vault at 3 months postoperative (269.81±194.67) μm was significantly lower than that at 1 month postoperative (373.62±195.75) μm (t=?2.917, P=0.009). Postoperative complications included steroid-induced glaucoma (2 eyes in 1 case), PRL optical surface crack (1 eye), macular hemorrhage (1 eye), and PRL decentration (3 eyes in 2 cases). Conclusions: PRL implantation is a safe and effective intraocular refractive surgery for ultra-high myopic patients. Nonetheless, it should be neccessary to observe for long-term efficacy and saff lens; high myopia

肥厚型脉络膜谱系疾病(pachychoroid disease spectrum,PCD)包括肥厚型脉络膜色素上皮病变(pachychoroid pigment epitheliopathy,PPE)、中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)、肥厚型脉络膜新生血管病变(pachychoroid neovasculopathy,PNV)、息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)、局灶性脉络膜凹陷(focal choroidal excavation,FCE)和盘周肥厚型脉络膜综合征(peripapillary pachychoroid syndrome,PPS)。有学者将PCD看作脉络膜功能障碍引发的一系列连续疾病过程，但关于PCD的发病机制、形态改变尚未明确。该文对PCD的脉络膜、涡静脉及巩膜相关改变做一综述。

Pachychoroid disease spectrum include pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, and peripapillary pachychoroid syndrome. Currently, some scholars regard pachychoroid disease spectrum as a series of continuous disease processes caused by choroidal dysfunction, but the pathogenesis and morphological changes of pachychoroid disease spectrum are not yet clear. This paper reviews the changes of choroid, vortex veins and sclera in pachychoroid disease spectrum.

据统计，目前全球有近14亿近视人口，近视已成为全球主要的健康问题。近视不仅影响个人的视力健康，还可能引发多种严重的并发症，如高度近视相关的黄斑变性和视网膜脱离等，严重时可导致失明。除了对个人健康的影响，近视还带来了巨大的经济负担，包括直接医疗成本(如眼镜、隐形眼镜、矫正手术等费用)和间接成本(如生产力下降、学习能力降低和生活质量的下降)。在中国，近视的问题尤其显著，近视患病率居高不下，这不仅对个人健康构成威胁，也对社会和经济造成重大影响。国际上，近视的经济负担研究涵盖了医疗直接成本、患者时间成本及生产力损失等方面，可以帮助政府和卫生部门了解近视疾病的经济影响，从而制定合理的公共卫生政策和资源分配策略，优化医疗资源使用，减少社会成本。该文从近视疾病经济负担的构成及其测算方式、国内外经济负担现况等方面对近视疾病经济负担进行简要综述，旨在提供一个关于近视疾病经济负担的综合性认识，指出当前研究的方向和成果，以及预防近视和减轻其经济负担的重要性，为未来研究提供方向和基础。

It is estimated that there are nearly 1.4 billion myopic people in the world, and myopia becomes a significant global health problem. Myopia not only affects visual health, but also leads to serious complications such as macular degeneration and retinal detachment, which can cause blindness in severe cases. Apart from its impact on health, myopia also imposes a substantial economic burden. This burden includes direct medical costs (e.g., expenses for eyeglasses, contact lenses, and corrective surgeries) as well as indirect costs (e.g., reduced productivity, learning abilities, and quality of life). The prevalence of myopia is particularly high in China, posing a threat not only to individual health, but also to society and the economy. International studies on the economic burden of myopia have examined the direct medical costs, patient time costs and productivity loss. These studies help governments and health authorities understand the economic impact of myopia to develop effective public health and resource allocation strategies.. By optimizing medical resources and reducing social costs, these measures aim to alleviate the economic burden. This article provides an overview of the economic burden of myopia, including its definition, measurement, current status at home and abroad, and the importance of prevention and alleviation. It also highlights the current research directions and findings, to provide focusing fields and foundations for future research.

近年来，眼部电流刺激(electrical stimulation,ES)在不同方向的研究中逐渐揭示了其在多种视网膜疾病中的潜在治疗价值。其中，经角膜电刺激(transcorneal electrical stimulation,TES)作为一种非侵入性的治疗方法，能对视网膜、视神经、眼底血管及其相关结构产生积极的影响。TES能够改善视力，在保护感光细胞和减缓疾病进展方面显示出积极效果，提高患者的生存质量，还能够在不损伤眼球的情况下调节大脑中的神经元活动，为视网膜疾病的治疗提供一种新的选择。该文对近年来TES在视网膜色素变性(retinitis pigmentosa,RP)、年龄相关性黄斑变性(age-related macular degeneration,AMD)、视网膜血管病、青光眼以及视神经病变等疾病中的应用研究进行了综述。研究发现，TES治疗是一种安全且无需手术的辅助治疗工具，具有广泛的应用前景。该文旨在为临床医师提供一个全面的TES研究概述，并深入探讨其在眼科学领域的潜在应用价值。然而，TES治疗的具体机制仍需进一步探讨，以便更好地应用于临床实践。同时，未来研究还应关注TES与其他治疗方法相结合的效果，以期为患者提供更多有效的治疗选择。

In recent years, electrical stimulation of the eye (ES) has gradually revealed its potential therapeutic value in a variety of retinal diseasesin different directions. Among them, transcorneal electrical stimulation (TES), as a non-invasive treatment, can have a positive effect on the retina, optic nerve, fundus vessels and related structures. TES can improve vision, show positive effects in protecting photoreceptor cells and slowing disease progression, improve the quality of life of patients, and can regulate neuronal activity in the brain without damaging the eyeball, providing a new option for the treatment of retinal diseases. The research on the application on TES on retinitis pigementosa (RP), age-related macular degeneration (AMD), retinal angiopathy, glaucoma and optic neuropathy are reviewed in this article. It is found in the study that TES therapy is a safe and surgery-free adjuvant therapy tool, and has a wide application prospect. The purpose of this article is to provide clinicians with a comprehensive overview of TES research,and to explore its potential application value in the field of ophthalmology. However, the specific mechanism of TES therapy still needs to be further explored in order to better apply in clinical practice. At the same time, future studies should also focus on the effect of combining TES with other treatment methods, in order to provide more effective treatment options for patients.

息肉样脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是一种以脉络膜异常分支血管网和血管末端息肉状脉络膜血管扩张灶为特征的眼底疾病。(indocyanine green angiography,ICGA)是诊断PCV的金标准，可见异常分支血管网、息肉样高荧光。(optical coherence tomography,OCT)可见色素上皮脱离(pigment epithelial detachments,PED)、双层征、指状突起、PED切迹、脉络膜增厚等。基于 OCT 的影像学研究表明，PCV属于肥厚型脉络膜谱系疾病(pachychoroid disease spectrum,PCD)，其特征是脉络膜增厚、脉络膜大血管层(Haller层)扩张，伴有毛细血管层(Ruysch层)和中血管层(Sattler层)变薄，其发病机制可能涉及脉络膜、涡静脉、巩膜等相关改变。