目的：通过分析基于眼底彩照的人工智能（artificial intelligence,AI）在糖尿病视神经病变（diabetic optic neuropathy,DON）中的参数特征，探索AI在DON诊断中的应用价值。
方法：收集2020年1月1日至2022年4月30日就诊于东莞东华医院、横沥医院及东莞市寮步镇社区卫生服务中心并诊断为糖尿病的患者，采集其一般信息并拍摄以黄斑为中心、图片边缘距离视盘中心超过1PD的50°眼底彩照。眼底彩照由人工智能诊断系统分析获得视盘及血管检测参数，由3-4名眼底专家阅片后分为DON(+)、DON(-)两组并作糖尿病视网膜病变（diabetic retinopathy,DR）分期诊断。比较两组间视盘、血管检测参数的差异性，并分析各项参数以及DR分期与DON发病的相关性。
结果：研究共纳入糖尿病患者526人（945眼），其中男性335人，女性191人；平均年龄为51.58±12.21岁，平均病程为5.51±5.20年。所有入组病例中，DON(+)组205眼，DON(-)740眼；根据专科医师判读结果，无DR 723眼，轻度非增殖期糖尿病视网膜病变（non-proliferrative diabetic retinopathy,NPDR）7眼，中度NPDR 184眼，重度NPDR 24眼，增殖期糖尿病视网膜病变（proliferrative diabetic retinopathy,PDR）7眼。AI检测的视盘及血管参数中，水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜静脉血管当量、B区视网膜动静脉比值在有或无DON组间存在显著差异；水平视盘直径、垂直视盘直径、弧形斑和视盘面积比、B区视网膜动脉当量在两组之间无显著差异。相关性分析发现，水平视杯直径、垂直视杯直径、水平杯盘比、垂直杯盘比、B区视网膜动静脉比值与DON患病呈负相关；B区视网膜静脉血管当量、DR分期则与其呈正相关。
结论：DON患者的视杯直径、杯盘比、B区视网膜静脉血管当量等基于眼底彩照的人工智能检测参数有显著改变；DON的发病与DR病变严重程度有关。
Objective: To explore the application value of artificial intelligence (AI) in the diagnosis of diabetic optic neuropathy (DON) by analyzing the parameter characteristics of artificial intelligence (AI) based on fundus color photos.
Methods: From January 1, 2020 to April 30, 2022, patients diagnosed with diabetes were collected in Dongguan Donghua Hospital, Hengli Hospital of Dongguan and Community Healthcare Center of Dongguan Liaobu. General information was collected and 50°field vision fundus images(centered on macula and the edge of the images were more than 1PD away from the center of the optic disc) were taken. All the images were divided into DON(+) and DON(-) groups by 3-4 ophthalmologists. All the parameters were detected and analyzed by AI system, and their differences between the two groups were compared. The correlation between each parameter and DR stage with the incidence of DON was analyzed as well.
Results: A total of 526 diabetic patients (945 eyes) were included in this study, including 335 males and 191 females. The mean age was 51.58±12.21 years, and the mean disease duration was 5.51±5.20 years. All the enrolled cases were divided into DON (+) group (205 eyes) and DON (-) group (740 eyes) . According to ophthalmologists’ interpretation, 723 eyes had no DR, 7 eyes had mild nonproliferrative diabetic retinopathy (NPDR), 184 eyes had moderate NPDR, 24 eyes had severe NPDR, 7 eyes had Proliferrative diabetic retinopathy (PDR). Among the parameters detected by AI, there were significant differences in horizontal and vertical optic cup diameter, horizontal and vertical C/D, retinal vein equivalent(RVE) in zone B, and retinal arteriole-to venule ratio(AVR) in zone B between DON(+) and DON(-) groups. There were no significant differences between the two groups in horizontal and vertical optic disc diameter, arc-shaped spot-to-disc area ratio, and retinal artery equivalent(RAE) in zone B. In the analysis of risk factors, horizontal and vertical optic cup diameter, horizontal and vertical C/D, and AVR in zone B were negatively correlated with the diagnosis of DON. RVE in zone B and the severity of DR were positively correlated with the diagnosis of DON.
Conclusions: The AI detection parameters based on fundus color photography have significant changes in the diameter of optic cup, C/D and RVE in zone B in DON patients. The incidence of DON is related to the severity of DR.
视神经炎(optic neuritis,ON)是指视神经的炎性脱髓鞘病变，是引起中青年人视力下降的主要原因。近年来，髓鞘少突胶质细胞糖蛋白抗体阳性视神经炎(myelin oligodendrocyte glycoprotein antibody-positive ON,MOG-ON)成为神经眼科领域的研究热点，国内外报道不断增加。2021年3月，中华医学会眼科学分会神经眼科学组制定了《中国脱髓鞘性视神经炎诊断和治疗循证指南(2021年)》，将MOG-ON作为新的视神经炎亚型纳入脱髓鞘性视神经炎的诊疗体系，给广大眼科医生提供了新的参考依据。因此，临床医生需要充分认识MOG抗体相关疾病和MOG-ON的临床特征和治疗进展，努力提高其诊断和治疗水平，使此类患者能够得到更多的获益，造福于更多的视神经疾病患者。
Optic neuritis(ON)is an inflammatory demyelinating disease of the optic nerve, which is the main cause of vision loss in young and middle-aged people. In recent years, myelin oligodendrocyte glycoprotein antibody-positive ON(MOG-ON)has become a research hotspot in the field of neuro-ophthalmology, and reports at home and abroad are increasing.In March 2021, the Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association formulated the Evidence-Based Guidelines for the Diagnosis and Treatment of Demyelinating Optic Neuritis in China(2021) , and included MOG-ON as a new optic neuritis subtype in the diagnosis and treatment system of myelinating optic neuritis providing a new reference for the majority of ophthalmologists. Therefore, clinicians need to fully understand the clinical features and treatment progress of MOG antibody-related diseases and MOG-ON, and strive to improve the level of diagnosis and treatment, so that such patients can get more benefits and benefit more patients with optic nerve diseases.
非器质性视力下降也称为心因性或功能性视力下降，除视力下降外，还可伴有视野缺损，多由于精神心理疾患导致的转换障碍引起，部分患者为诈病以获取利益。本文报道1例6岁的女性患者，主诉双眼反复视力下降1年余，早期被误诊为儿童视神经炎，给予糖皮质激素冲击治疗，治疗后稍有好转。通过本例患者误诊的教训，提醒我们在遇到儿童出现不明原因的视力下降时，在没有明确器质性疾病证据时要想到非器质性视力下降的可能，掌握识别非器质性视力下降的检查方法，不能忽略相对性传入性瞳孔障碍等基础的神经眼科检查。
Non-organic vision loss is also known as psychogenic or functional vision loss. In addition to vision loss, it can also be accompanied by visual field defect. It is mostly caused by conversion obstacles caused by mental and psychological diseases. Some patients cheat to obtain benefits. This paper reports a 6-year-old female patient who complained of repeated visual acuity decline for more than one year. She was misdiagnosed as pediatric optic neuritis in the early stage and was treated with glucocorticoid shock therapy, which her condition improved slightly after treatment. The misdiagnosis of this patient teaches us that when children have unexplained visual acuity decline, we should think of the possibility of non-organic visual acuity decline when there is no clear evidence of organic diseases, master the examination methods to identify non-organic visual acuity decline, and cannot ignore the basic neuro-ophthalmic examination such as relative afferent pupillary defect (RAPD).
视神经脊髓炎相关性视神经炎(neuromyelitis optica spectrum disorder optic neuritis，NMO-ON)是一种常见的视神经炎(optic neuritis，ON)类型。女性非白种人占优势，损伤严重，双侧受累较多，视力预后差。我国有很大部分特发性ON最终诊断为NMO-ON。在相关实验室、光学相干断层扫描(optical coherence tomography，OCT)、磁共振(magnetic resonance imaging，MRI)等技术支持下，目前对NMO-ON的认识有了很大的进步，治疗方式除了皮质类固醇外还有免疫球蛋白、血浆置换及免疫抑制剂等。但提高NMO-ON的诊疗水平还有很长的路，更好地认识NMO-ON有助于更快速的诊断、更规范的治疗、更良好的预后。我们可以联合神经科开展多中心大样本量前瞻性的临床对照研究。
Neuromyelitis optica spectrum disorder- optic neuritis (NMO-ON) is a common type of optic neuritis (ON). This affliction is predominant in female non-Caucasians, with severe injury, more bilateral involvement, and poor visual prognosis. In China, a large proportion of idiopathic ON is ultimately diagnosed as NMO-ON. Our understanding of NMO-ON has made great progress under the technical support, such as the relevant laboratory, optical coherence tomography (OCT), magnetic resonance imaging (MRI). In addition to corticosteroids, immunoglobulin, plasmapheresis and immunosuppressive agents are also available for treatment. However, there is still a long way to improve the diagnosis and treatment level of NMO-ON. A better understanding of NMO-ON contributes to faster diagnosis, more standardized treatment, and better prognosis. We should cooperate with the neurology department to conduct a multi-center, large sample size prospective clinical control study.
目的：探讨外伤性视神经病变(traumatic optic neuropathy，TON)患者内镜下经蝶筛径路视神经管减压术(endoscopic trans-ethmosphenoid optic canal decompression，ETOCD)的整体护理。方法：选取中山大学中山眼科中心2020年1月至2021年3月收治的80例TON患者，回顾总结患者 ETOCD期间的护理措施及手术疗效。结果：所有患者经过综合护理后均顺利完成手术，未发生感染，出血、疼痛情况经治疗和护理后均改善，68.8%患者术后视力有提高。结论：针对TON患者ETOCD的特点，采取个体化的整体护理具有重要意义，有利于帮助患者顺利完成手术，降低并发症的发生率，促进患者康复。
Objective: To investigate the holistic nursing care of patients with traumatic optic neuropathy undergoing endoscopic trans-ethmosphenoid optic canal decompression (ETOCD). Methods: A total of 80 patients with traumatic optic neuropathy admitted to Zhongshan Ophthalmology Center of Sun Yat-sen University from Jan 2020 to Mar 2021 were selected as the subjects, and the nursing measures and surgical effect during ETOCD were reviewed and summarized. Results: All 80 surgical patients successfully completed the operation after comprehensive nursing without infection. The bleeding and pain were improved after treatment and nursing, and 68.8% patients presented with vision improvement. Conclusion: According to the characteristics of ETOCD in patients with traumatic optic neuropathy, it is of great significance to take individualized overall care, which is beneficial to help patients successfully complete the operation, reduce the incidence of complications, and promote the recovery of the patient’s healthy.
视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders，NMOSD)是一种中枢神经系统炎性脱髓鞘性疾病，以视神经、脊髓和大脑受累为主要特征，该疾病易复发且致盲、致残率高，严重威胁人类视力和健康。目前NMOSD病因尚不明确，现有治疗方案也无法彻底治愈NMOSD，而动物模型是探索其发病机制与病理生理特点的重要工具。NMOSD动物模型主要建立在抗水通道蛋白4抗体(anti-aquaporin 4 immunoglobulin G，AQP4-IgG)致病基础上，主要包括破坏或绕过血脑屏障(blood brain barrier，BBB)被动转移AQP4-IgG或AQP4特异性T细胞等，目前还没有一种动物模型可以完整模拟人类NMOSD的临床和病理特征，因此在研究中选择合适的动物模型对相关研究至关重要。
Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory demyelinating disease of the central nervous system. It is mainly characterized by the involvement of the optic nerve, spinal cord and brain. The disease is prone to relapse and has a high rate of blindness and disability, which seriously threatens human vision and health. At present, the etiology of NMSOD is not clear, and the existing treatment schemes can’t completely cure NMOSD. Animal models are important tools to explore its pathogenesis and pathophysiological characteristics. NMOSD animals were mainly established on the basis of anti-aquaporin 4 immunoglobulin G (AQP4-IgG), including destroying or bypassing the blood-brain barrier and passively transferring AQP4-IgG or AQP4 specific T cells. At present, no animal model can completely simulate the clinical and pathological characteristics of human NMOSD. Therefore, it is important to select appropriate animal models for the study. This article reviews various animal models of NMOSD in recent years, and discusses the advantages and disadvantages of various models, in order to provide references for the study of the progress and treatment of NMOSD.
