在大力发展精准医疗的时代背景下，北京大学第三医院眼科中心率先建立干眼精准医疗平台。通过规范和优化干眼诊疗流程，为患者提供个性化的治疗方案和预防指导意见，有效提高了干眼诊断的精确性与治疗的有效性，同时提升了干眼门诊接诊效能，改善了患者就诊体验。本文将从干眼精准医疗平台体系的建设内容、标准化的检查流程、个性化的诊疗方案等方面进行阐述，并结合实际临床案例，综合分析北京大学第三医院在干眼精准医疗方面进行的探索，展望干眼精准医疗平台的前景与未来。

In the era of developing precision medicine, the Ophthalmic Center of Peking University Third Hospital has taken the lead in establishing a dry eye precision medical platform. By standardizing and optimizing the diagnosis and treatment process of dry eye, this center provides personalized treatment plan and prevention guidance for patients, effectively improves the accuracy of dry eye diagnosis and the effectiveness of treatment, at the same time,improves the reception efficiency of dry eye clinic, and improves the patient’s clinic experience. In this paper, the construction content, standardized inspection process and personalized diagnosis and treatment scheme of dry eye precision medicine platform system will be described. Combined with the actual clinical cases, the exploration of the Peking University Third Hospital in dry eye precision medicine will be comprehensively analyzed, and the future of dry eye precision medical platform will be prospected.

泪膜的不同组成成分通过相互作用共同维持眼球表面的湿润，从而维持眼部健康。当这些组成成分出现病理性改变，将会不同程度的影响泪膜稳态，从而导致干眼的发生。而瞬目运动一定程度上影响着泪膜组成成分的分布，随着对干眼相关机制研究的逐步深入，以泪膜为导向的诊断(tear-film-oriented diagnosis，TFOD)的新概念被提出，并被逐渐被接受。我们可以通过泪膜破裂方式来确定眼球表面所缺乏的组成成分，并在此基础上对干眼进行诊断，从而定向补充泪膜缺失成分，重新恢复泪膜稳态。本文将着重分析瞬目、泪膜形成及泪膜破裂机制之间的关系，从而进一步明确泪膜定向诊断的新概念及发展方向。

Different components of the tear film work together to maintain the wettability of the ocular surface, thus maintaining eye health. When the pathological changes of these components occur, the tear film homeostasis will be affected to varying degrees, leading to dry eye. Blinking movement affects the distribution of tear film components to some extent. With the continuous development of research and understanding of the concept and mechanism of dry eye, new concepts of tear-film-oriented diagnosis (TFOD) have been gradually proposed and widely accepted. We can determine the components lacking on the surface of the eye through the tear film  breakup patterns (BUPs). On this basis, dry eye is diagnosed, so as to replenish the lacking components of tear film directionally and restore the stability of tear film. This paper will focus on analyzing the relationship between blinking, tear film formation and tear film break-up mechanism, so as to further clarify the new concept and development direction of tear-film oriented diagnosis.

近视性黄斑病变(myopic maculopathy，MM)是近视最常见的并发症，也是影响病理性近视视功能下降的主要原因。目前，MM的分类系统尚不能完全解释患者黄斑部发生的多种变化，迫切需要一个全面、统一的分类系统来协助沟通和比较临床试验以及国际多中心研究的结果。随着眼底成像技术的发展与应用，最新的近视性黄斑病变分类，即ATN分类系统[萎缩(A)、牵拉(T)、和新生血管(N)]结合眼底照片与光学相干断层扫描(optical coherence tomography，OCT)图片，把黄斑病变分为3类，每一类又根据其严重程度进行分级，这对MM的诊断和治疗提供了较大的临床价值。

Myopic maculopathy (MM) is the most common complication of myopia, which is also the main cause of poor visual function in pathologic myopia. Presently, the classification system of MM cannot properly explain the numerous changes that occur in the patient’s macula. Therefore, a comprehensive and unified classification system is urgently needed to facilitate in communicating and comparing the results of clinical trials and international multicenter studies. With the development and application of fundus imaging technology, the latest classification of MM, namely ATN (atrophy, A; traction, T; neovascularization, N) classificationsystem, which combines fundus photographs and optical coherence tomography (OCT) images, classifies macular lesions into 3 categories according to its severity, generating greater clinical value for the diagnosis and treatment of MM.

目的：探讨PDCA循环管理模式在优化白内障日间患者诊疗流程中的应用与成效。方法：选取中山大学中山眼科中心白内障病区2018年9月至2019年12月收治的白内障日间患者400例作为试验对象，选择2018年9月至2019年4月200例患者作为优化前组，选择实施PDCA循环管理模式后的2019年5月至2019年12月的200例患者作为优化后组。统计并比较两组患者实施前后的术前检查时长、住院时长、术后第1天复诊路径及患者满意度。结果：PDCA循环管理法实施了7个月后，患者术前检查时长由优化前的(2.94±2.12) h降至(2.09±0.93) h，住院时长由优化前的(22.73±1.14) h 降至(5.22±1.29) h，差异均具有统计学意义( P <0.001)；患者满意度由优化前的92%上升至96%(P<0.05)；术后第1天，患者复查所需行走的路径缩短，由以前的172 m降至129 m。结论：实施PDCA循环管理模式能有效地改善白内障日间患者的诊疗流程，缩短患者诊疗时间，提高患者的满意度，值得临床推广。

Objective: To explore the application and effect of Plan-Do-Check-Act (PDCA) cycle management mode in optimizing the diagnosis and treatment process of cataract patients with daytime surgery. Methods: A total of 400 cases of patients with daytime surgery admitted to Department of Cataract, Zhongshan Ophthalmic Center,Sun Yat-sen University from September 2018 to December 2019 were selected as the experimental subjects. 200 patients from September 2018 to April 2019 were selected as the pre-optimization group, and 200 patients from May 2019 to December 2019 after the implementation of the PDCA cycle management mode were selected as the post-optimization group. Time of preoperative examination, length of hospital stay, the follow-up path in the first day after surgery and patient satisfaction were statistically compared between the two groups before and after implementation. Results: Seven months after the implementation of PDCA cycle management mode, the preoperative examination time decreased from (2.94±2.12) h to (2.09±0.93) h, and the length of hospital stay decreased from (22.73±1.14) h to (5.22±1.29) h, and the differences were statistically significant (P<0.001); the patients’ satisfaction increased from 92% to 96% (P<0.05); the follow-up path in the first day after operation was changed from the 13th floor (172 m) to the 3rd floor (129 m). Conclusion: The implementation of PDCA cycle management mode can effectively improve the diagnosis and treatment process of cataract patients with daytime surgery, shorten the diagnosis and treatment time and improve the satisfaction of patients, so it is worthy of clinical promotion.

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.

本文根据上海鹰瞳医疗科技有限公司的创新产品《糖尿病视网膜病变眼底图像辅助诊断软件》在国家药品监督管理局(NMPA，原CFDA)历时两年半的上市前创新申报与注册申报经历，介绍了人工智能类医疗器械产品的产品研发、注册申报流程及相关重点难点，并且列明了在整个过程中需要遵循和参考的法律法规，为此类产品的上市前注册工作提供参考。

Based on the NMPA premarket application through two and a half years for the computer aided diagnosis software using fundus images of diabetic retinopathy, which is an innovative medical device of Shanghai EagleVision Medical Technology Co., Ltd. (Airdoc), this article introduced the development process, the premarket application, and the key points in the application of this artificial intelligence device, also lists the related regulations and guidelines as references to provide some ideas for the follow-up premarketing application of such kind of products.

眶尖部肿瘤为眼科罕见疾病，但因其所处位置特殊，对机体，特别是视神经功能危害极大，错误的诊断、不规范合理的治疗不仅不能解决问题，甚至会对机体造成严重的不可挽回的损害。目前针对眶尖部肿瘤的诊断、治疗多建立在医生的主观认知与经验的基础上，尚未达成共识。本文通过分析眶尖部肿瘤的临床特点，结合以往漏诊、误诊、误治的临床案例，阐述眶尖肿瘤正确诊断的关键要点；同时，结合不同临床案例，客观分析治疗方案，尤其是手术方式、路径，为眶尖部肿瘤的合理化治疗提供依据，以期规范眶尖部肿瘤的诊断和治疗，提高治疗成功率。

Although orbital apical tumor is a rare ophthalmic disease, its special location can cause great harm to the body, especially to the function of the optic nerve. Misdiagnosis and improper treatment are not only unable to solve the problem, but also irretrievably harmful to the body. At present, there is no consensus on the diagnosis and treatment of orbital apical tumors, which are mostly based on subjective cognition and experience of doctors. In this paper, the clinical characters of orbital apical tumors were analyzed through the past clinical cases of misdiagnosis and mistreatment, and the key points of proper diagnosis of orbital apical tumors were expounded. Meanwhile, by combining with different clinical cases, the treatment plans, especially the surgical approaches, were analysed to provide a basis for the appropriate treatment of orbital apical tumors, in order to standardize the diagnosis and treatment of orbital apex tumor, and improve the success rate of treatment.

晶状体诱导性青光眼(lens-induced glaucoma，LIG)是因晶状体蛋白相关或解剖学异常引起的一类继发性青光眼。基于发病机制，分为晶状体溶解性青光眼、晶状体颗粒性青光眼、晶状体过敏性青光眼、晶体膨胀性青光眼、瞳孔阻滞性青光眼等几类，房角可能是开放或关闭的。高分子量晶状体蛋白、晶状体颗粒释放、瞳孔阻滞、晶体体积增大是引起青光眼的机制。其病因包括膨胀期、成熟期或过熟期白内障，眼部手术和外伤，各种晶体脱位等。流行病学在发达国家和发展中国家各不相同。以视力下降、眼红、单侧眼痛等为主要临床表现，可产生青光眼性不可逆视功能损害。眼部超声检查对其诊断有帮助。需要和急性闭角型青光眼、睫状环阻滞性青光眼、脉络膜上腔出血、外伤或术后眼内炎等疾病相鉴别。治疗方法是去除晶体刺激物质，从而控制眼压。

Lens-induced glaucoma (LIG) is a kind of secondary glaucoma caused by lens proteins or anatomic abnormality of the lens. Based on the pathogenesis, LIG is classified as phacolytic glaucoma, lens-particle induced glaucoma, phacoanaphylactic glaucoma, phacomorphic glaucoma, pupillary block glaucoma. The angle may be open or closed. High-molecular-weight lens protein, release of lens particles, and pupillary block, increase in the volume of the cataractous lens are the mechanisms of glaucoma. Its pathogensis includes intumescent cataracts, mature senile cataract, hyper-mature senile cataracts, surgery and trauma in eyes, and dislocation of lens. The epidemiology varies across developed and developing countries. The common symptom includes diminution of vision, redness of the eye, and unilateral eye pain. It can cause glaucomatous irreversible visual impairment. Ocular ultrasonography is helpful for its diagnosis. Differential diagnosis includes acute angle-closure glaucoma, ciliary block glaucoma, supra-choroidal hemorrhage, post-traumatic or postoperative endophthalmitis. The management is the removal of inciting lenticular matter to control intraocular pressure