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：探讨眼底外科医护一体组团合作模式在管理眼底病日间手术患者实践效果。方法：选取2022年1—6月进行日间手术的582例眼底病患者为对照组，2023年1—6月进行日间手术的633例眼底病患者为研究组，对照组实施责任制整体护理，研究组采取实施医护一体组团合作管理模式进行全流程患者管理。使用χ2检验和t检验比较两组患者围术期护理知识健康教育知晓度、满意度、出院24 h内眼科急症就诊率、出院24 h内随访率、护士职业获益感的差异。结果：研究组患者健康教育知晓度高于对照组，组间比较差异具有统计学意义(t=–18.47，P＜0.05)；研究组患者满意度高于对照组，组间比较差异具有统计学意义(t=–4.005，P＜0.05)；研究组患者出院24 h内随访率为100%，对照组为98.1%，两组比较差异有统计学意义(χ2=12.073，P＜0.05)；研究组患者出院24 h内眼科急症就诊率0.94%，对照组为1.89%，组间比较差异无统计学意义(χ2=1.951，P=0.222)；实施后护士职业获益感分值高于实施前，组间比较差异具有统计学意义(t=–6.637，P＜0.001)。结论：医护一体组团合作管理模式进行眼底外科日间手术患者围术期的全流程管理，改善患者就医感受，提升患者就医体验，提高眼底外专科日间手术患者的依从性，保障患者的安全，提高护士职业获益感。
Objective: To investigate the practical effect of the integrated group cooperation model in managing patients with fundus diseases in day surgery. Methods: 582 patients with fundus disease who underwent day surgery from January to June in 2022 were included as the control group, and 633 patients with fundus disease who underwent day surgery from January to June in 2023 were selected as the study group. The control group implemented the overall responsibility nursing system, while the study group carried out the collaborative management model, integrating medical and nursing for the entire process of patient management. Chi-square test and T-test were used to compare the differences of perioperative nursing knowledge, health education awareness, satisfaction, emergency ophthalmological consultation rate within 24 hours of discharge, follow-up rate within 24 hours of discharge, and nurses' sense of professional benefit between the two groups. Results: The awareness of health education in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–18.47, P<0.05). The satisfaction of patients in the study group was higher than that in the control group, and there was significant statistically difference between two groups (t=–4.005, P ＜ 0.05). The follow-up rate within 24 hours after discharge was 100% in the study group and 98.1% in the control group, and the difference was statistically significant (χ2=12.073, P<0.05). The incidence of ophthalmic emergencies within 24 hours of discharge in the study group was 0.94%, while in the control group it was 1.89%. There was no statistically significant difference between the two groups (χ2= 1.951, P=0.222). The perceived benefit score of nurses after implementation was higher than that before implementation, and there was statistically significant between two groups (t=–6.637, P<0.05). Conclusions: The medical and nursing integrated group cooperation management model is used to manage the entire perioperative process of patients undergoing day surgery in fundus surgery. This model can improve patients' medical experience, enhance their compliance with ophthalmic surgery, ensure their safety. At the same time, it can enhance the senses of professional benefits for nurses.
年龄相关性黄斑变性(age-related macular degeneration,AMD)是一种发生在黄斑区的退行性变，其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)以黄斑区新生血管为主要病理特征，是导致老年人视力受损甚至失明的重要原因，视网膜下纤维化是wAMD最常见的自然后遗症，可导致光感受器、视网膜色素上皮(retinal pigment epithelial,RPE)和脉络膜毛细血管受损，导致不可逆转的中心视力丧失。多种基线特征被发现是视网膜下纤维化的危险因素，可用于预测早期视网膜下纤维化的发生。迄今为止，还没有有效的抗纤维化治疗方法，抗血管内皮生长因子(anti-vascular endothelia growth factor, anti-VEGF)治疗是wAMD的一线治疗方案，该治疗方法不能改善视网膜下纤维化，但及时启动治疗可能有助于预防或延缓纤维化的进展，目前多种靶向分子药物正被研发用于抗纤维化的治疗。该文综述了wAMD视网膜下纤维化的临床表现及意义、预测纤维化形成的基线特征、基本发病机制及潜在的抗纤维化治疗方法，旨在为临床诊治工作提供参考。
Age-related macular degeneration (AMD) is a degenerative disease of the macular, and wet age-related macular degeneration(wAMD) is mainly characterized by macular neovascularization, which is an important reason of visual impairment or even blindness in the elderly. Subretinal fibrosis is the most common natural sequelae of wAMD, which can lead to irreversible central vision loss by damaging photoreceptors, RPE, and choroidal capillaries. Multiple baseline features have been identified as the risk factors for subretinal fibrosis, which can be used to predict the early subretinal fibrosis. Heretofore, no anti fibrotic treatment method is effective. Anti vascular endothelial growth factor (anti VEGF) treatment is the first-line treatment for wAMD. This therapy cannot improve subretinal fibrosis, but timely initiation of treatment may help prevent or delay the progression of fibrosis. Currently, multiple targeted molecular drugs are being developed for anti fibrotic treatment. This article reviews the clinical manifestations and significance of subretinal fibrosis in wet age-related macular degeneration, baseline features for predicting the formation of fibrosis, basic pathogenesis, and potential anti-fibrosis treatment methods,aiming to provide reference for clinical diagnosis and treatment.
目的：了解干眼患者自我护理能力水平并分析其影响因素。方法：选取2022年2月—6月在中山大学中山眼科中心就诊的干眼患者为研究对象，采用一般资料调查表、自我护理能力量表、一般自我效能感量表对患者进行调查分析。结果：共调查293例干眼患者，其自我护理能力评分为(113.34±9.98)分，处于中等水平。相关性分析中干眼患者的自我护理能力总分与自我效能感得分呈正相关(r=0.421，P<0.001)，多重线性回归分析显示，累计屏幕使用时间>10 h/d、合并全身疾病、低自我效能感评分是干眼患者自我护理能力的危险因素(P<0.05)。结论：干眼患者自我护理能力水平处于中水平，仍需加强。医护工作者在工作中应重点关注屏幕使用时间长、合并全身疾病及自我效能感低的患者，并制定相应的护理对策，以改善患者的自我护理能力水平。
Objective: To understand the self-care ability of patients with dry eye and analyze its infuencing factors. Methods: A total of 293 patients with dry eye were selected from Zhongshan University Zhongshan Ophthalmology Center from February 2022 to June 2022, the general data Questionnaire the general self-efcacy Scale and the self-care ability Scale survey were collected. Results: A total of 293 patients with dry eye were surveyed, and the self-care ability score was 113.34±9.98, which was at the medium level. The total score of self-care ability, the scores of self-concept, self-care responsibility, health knowledge level and self-care skills of patients with dry eye were positively correlated with the scores of self-efcacy (r=0.421, allP<0.001). Multiple linear regression analysis showed that cumulative screen usage time>10 hours/day, comorbid systemic diseases, and low self-efficacy scores were risk factors for self-care ability in patients with dry eye (P<0.05). Conclusions: Te self-care ability of patients with dry eye disease is at a medium level, and still needs to be strengthened. Medical workers should focus on patients with prolonged screen usage, comorbid systemic diseases, and low self-efficacy in their work, and tailor relevant nursing strategies to improve their self-care abilities.
目的：调查临床医学5年制本科生对见习教学的满意度，并分析其影响因素。方法：采用匿名线上问卷调查，向中山大学2019级临床医学5年制4年级的结束所有临床科室见习的本科生发放见习满意度问卷。结果：共有75人完成了问卷调查。在最满意的见习课程中，眼科学见习满意度最高(39人，52%)，其次是外科学(18人，24%)和内科学(7人，9.33%)。教学满意度的影响因素综合得分排名前5位的选项分别是“A课程设置合理，临床见习重点突出”“B见习小课授课水平高”“C师资配备好，小组教学”“D临床资源丰富，利于见习教学”以及“E教学方法先进，方式灵活多样，新型教学形式丰富”。在选择排序第一(B 33.33%，A 25.86%，E 21.15%)和第二(E 26.92%，B 24.56%，A 24.14%)的影响因素时，前三位的选项均为A、B、E，学生对见习课程设置、见习小课水平和见习教学方式、方法非常重视。在学生从事眼科专业的意愿方面，5人(6.67%)表示非常愿意、32人(42.67%)表示有可能今后从事眼科专业，二者比例合计与眼科学获得最满意见习课程的比例非常接近。结论：见习课程设置、小课授课水平以及见习教学的方式、方法是见习教学满意度的重要影响因素。临床见习的满意度对学生的职业导向具有一定的影响。
Objective: To investigate the satisfaction of 5-year undergraduate students in clinical medicine with clerkship teaching and analyze its influencing factors. Methods: Anonymous online questionnaire survey was conducted. Satisfaction questionnaires were distributed to undergraduate students in the 4th year of the 5-year clinical medicine at Sun Yat- sen University who had completed clerkship in all clinical departments. Results: A total of 75 students completed the questionnaire survey. Among the most satisfactory clerkship courses, ophthalmology had the highest satisfaction rate (39 votes, 52%), followed by surgery (18 votes, 24%) and internal medicine (7 votes, 9.33%). Te top 5 options in terms of comprehensive scores for infuencing factors of teaching satisfaction are "A. Reasonable curriculum with prominent focuses", "B. High clerkship class teaching level", "C. Strong teaching staf", "D. Abundant clinical resources ", and "E. Advanced teaching methods ". When selecting the infuencing factors that rank frst (B 33.33%, A 25.86%, E 21.15%) and second (E 26.92%, B 24.56%, A 24.14%), the top three options are A, B, and E. Students atach great importance to the seting of clerkship courses, the level of clerkship courses, and the teaching methods. In terms of students' willingness to engage in ophthalmology, 5 students (6.67%) expressed great willingness, and 32 students (42.67%) expressed the possibility. Conclusions: Te seting of clerkship courses, the level of small class teaching, and the clerkship teaching method are important infuencing factors of clerkship satisfaction. Te satisfaction of clerkship has a certain impact on students' career selection.
目的：探讨以问题为导向的教学方法(problem-based learning，PBL)结合微课教学法在眼科学课堂中的应用。方法：将锦州医科大学眼科实习课的60名学生按照随机数字表法分为实验组与对照组。实验组采用PBL教学法结合微课教学法，对照组采用传统的教学方法，比较两种教学方法的教学效果。结果：实验组学生成绩优于对照组，差异有统计学意义(P<0.05)。结论：PBL结合微课教学法应用于眼科学生的临床实践，提高了学生的综合素质、创造性思维、综合分析和团队合作能力；调动学习积极性、提高学生学习效率、提高理论知识评估和临床操作考核成果并取得满意的教学效果。
Objective: To explore the application of problem-based learning (PBL) combined with micro-teaching method in ophthalmology class. Methods: Sixty students of the ophthalmology internship course of Jinzhou Medical University were randomly divided into an experimental group and a control group. The control group used traditional teaching methods to compare the teaching effects of the two teaching methods. Results: The scores of the experimental group were better than those of the control group, and the difference was statistically significant(P<0.05). Conclusion: PBL combined with micro-teaching method can be applied in the clinical practice of ophthalmology students, which improves students’ comprehensive quality, creative thinking, comprehensive analysis and teamwork ability. Besides, it also mobilizes learning enthusiasm, improves students’ learning efficiency,improves theoretical knowledge assessment and clinical operation assessment results, leading to satisfactory teaching effect.
患者女，60岁，因“右眼前黑影飘动1月，视力下降8天”就诊。视力：右眼0.1，不能矫正；左眼0.6矫正0.9。右眼眼底见视盘周围边界清晰不规则灰白色区，并波及中心凹。视野检查：右眼对应眼底病灶的视野缺损；左眼正常。光学相干断层成像术(optical coherence tomography，OCT)显示灰白色区域椭圆体带不规则、缺失，视网膜色素上皮(retinal pigment epithelium，RPE)层见数个指状隆起。眼底自发荧光(autofluorescence，AF)示：受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影(fundus fluorescein angiography，FFA)示：早期见荧光渗漏，晚期荧光着染、蓄积。吲哚菁绿血管造影(indocyanine green angiography，ICGA)示：见以视乳头为中心，边界清晰的低荧光区。诊断：右眼急性轮状外层视网膜病变。治疗：给予抗炎和改善血循环4周，眼底灰白色环状带消失，视力明显好转。随访6个月，患者病情控制良好。
A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography (OCT) showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium (RPE) layer. Fundus autofluorescence (AF): High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography (FFA): Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography (ICGA): A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously
本文报道2例诊断为后极部肉芽肿型弓蛔虫病的患者，病例1接受糖皮质激素及玻璃体切割联合剥膜手术，术后视力明显提高；病例2因错过治疗时机，致视力丧失。提示后极部肉芽肿型眼弓蛔虫病致视网膜前膜时，眼科医生应积极给予手术治疗，改善患者视功能。
We reported two cases of posterior pole granuloma toxocariasis with different prognosis to remind ophthalmologists to attach importance to the active treatment. Two patients were diagnosed with posterior pole granuloma toxocariasis. One patient received prednisolone and pars plana vitrectomy combined with peeling of retinal membrane, and his vision was improved significantly. The other patient missed opportunity to perform surgery and lost his vision. It is important to make accurate diagnosis and active treatment for posterior pole granuloma toxocariasis. Eyes with posterior pole granuloma toxocariasis should be treated with surgery without delay to avoid visual loss when epiretinal membrane causes the absence of normal macular structure.
目的：探究囊袋张力环(CTR)植入对五种新一代人工晶状体(IOL)计算公式[Barrett Universal Ⅱ (BUⅡ),Emmetropia Verifying Optical (EVO), Kane, Pearl-DGS和Hill-RBF 2.0]在高度近视患者中预测准确性的影响。方法：前瞻性病例对照研究。观察2020年12月—2021年9月于陕西省眼科医院就诊的眼轴长度(AL)≥27.00 mm行白内障联合IOL(AR40E, 美国强生)植入术的患者。术眼随机分为植入CTR组(A组)和未植入CTR组(B组)。术前根据IOL-Master 700测量眼部参数，使用BU Ⅱ公式计算所需IOL度数。记录术后1周、1个月及3个月实际等效球镜度(SE)，计算并比较五种公式预测误差(PE)和绝对屈光预测误差(AE)。将A组和B组分别分为A1组(27.00 mm ≤ AL ≤ 30.00 mm)和A2组(AL>30.00 mm)；B1组(27.00 mm ≤ AL ≤30.00 mm)和B2组(AL >30.00 mm)，分析不同AL范围内CTR植入对公式预测准确性的影响。结果：共纳入患者63例(89眼)，年龄(55.93±10.17)岁，术前AL为(30.30±2.18)mm。A组、A1组及A2组术后不同时间SE值比较差异均无统计学意义(P>0.05)，B组、B1组及B2组术后1周与1个月，术后1周与3月SE值分别比较差异有统计学意义(P<0.05)，术后1个月与3月无统计学差异(P>0.05)。A组、B组、A1组、A2组、B1组和B2组各组中五种公式的AE值比较差异均无统计学意义(H= 9.27, P= 0.06, H= 7.09, P= 0.13, H= 2.44, P= 0.66,H= 8.56, P= 0.07, H= 4.16, P= 0.39, H= 8.72, P= 0.07)。植入CTR后五种公式的预测误差变化比较差异无统计学意义(P>0.05)。结论：对于AL ≥27.00 mm的白内障患者，植入CTR组术后1周屈光度趋于稳定，未植入组术后1个月屈光度趋于稳定。CTR植入对五种公式预测准确性和选择无影响，五种计算公式均可正常选择。
Objective: To investigate the predictive accuracy andeffect of capsular tension ring (CTR) implantation with fivenew generation intraocular lens (IOL) calculation formulas [Barrett Universal Ⅱ (BU Ⅱ ), Emmetropia VerifyingOptical (EVO), Kane, Pearl-DGS and Hill-RBF 2.0] in high myopia patients. Methods: This is a prospectivecase-control study. The patients were enrolled with an axial length (AL)≥27.00 mm, and underwent cataract surgery with AR40E IOL implantation at the Shaanxi Eye Hospital from December 2020 to September 2021. Thepatients were randomly assigned to the CTR implantation group (group A) and the non-CTR implantation group(group B). With the ocular parameters measured by the IOL-Master 700, the IOL power was calculated with theBU Ⅱ formula before surgery. The postoperative actual equivalent spherical diopter (SE) were recorded,and the predicted error (PE) and absolute error (AE) using the five formulas were recorded and compared at 1 week, 1 month, and 3 months, repsectively. Group A was divided to A1 (27.00 mm ≤ AL ≤ 30.00 mm) and A2 (AL>30.00 mm), and group B was divided to B1 (27.00 mm ≤ AL ≤ 30.00 mm) and B2 (AL>30.00 mm). The effects of CTR implantation and the accuracy of the formulaswere analyzed with different AL ranges. Results: A total of 63 patients (89 eyes) were included, aged (55.93±10.17) years old, with preoperative AL (30.30± 2.18) mm. There was no statistically significant difference in SE between groups A, A1, and A2 (P>0.05) at different postoperative times. While there was a statistically significant difference in SE between groups B, B1, and B2 (P < 0.05) at 1 week and 1 month after surgery, and between 1 week and 3 months after surgery. There was no statistically significant difference between 1 month and 3 months after suergery (P>0.05). There was no significant difference in the AE using the five formulas among groups A, B, A1, A2, B1, and B2 (H= 9.27, P= 0.06, H= 7.09, P= 0.13, H= 2.44, P= 0.66,H= 8.56, P= 0.07, H= 4.16, P= 0.39, H= 8.72, P= 0.07). There was no statistically significant difference in prediction error changes among the five formulas after CTR implantation (P>0.05). Conclusion: For cataract patients with AL ≥27.00 mm, the refractionvalue in the CTR implantation group tended to stabilizeafter one week of surgery. While in the non-CTR implantation group, the refractionvalue tended to stabilize after one month. CTR implantation had no effect on the accuracy and selection of the five formula, and the five IOL calculation formulas can be normally selected.
目的：探讨标准操作程序在玻璃体腔内注药术护理中的应用效果。方法：选择2018年9至12月中山大学中山眼科中心眼底专科门诊504例玻璃体腔内注药术患者作为研究对象，对护理人力资源的整合、患者等待手术时间、患者和家属的满意度、医护人员满意度进行评价。结果：标准操作程序后明确护士岗位职责，护士操作水平和综合能力有效提升，患者手术等待时间由原来的预约2周缩短为2 d。患者和家属的满意度分别由92.0%和91.0%提高到98.5%和97.0%。医护人员满意度的评价由95%提到至98.4%。结论：玻璃体腔内注药术标准操作程序不仅提升了工作效率，更提升了患者和家属、医务人员的满意度，规范化的标准操作程序是玻璃体腔内注药的安全保障。
Objective: To investigate the effect of standard operation procedure in the intravitreal injection. Methods: A total of 504 patients visiting the fundus clinics of our hospital from September to December 2018 were selected in this study. The integration of nursing human resources, patient waiting time, patient and family satisfaction,and medical staff satisfaction were evaluated. Results: The nurses’ job responsibilities were clarified, and the nurses’ operation level and comprehensive ability were improved. The patients’ waiting time for surgery was shortened from 2 weeks to 2 days. Patient and family satisfaction increased from 92.0% and 91.0% to 98.5% and 97.0%, respectively. The evaluation of the satisfaction of medical staff was elevated from 95% to 98.4%.Conclusion: The standard operation procedure of intravitreal injection not only improves the work efficiency, but also significantly increases the satisfaction of patients and their families and medical staffs. Therefore, the standard operation procedure can guarantee the safety of intravitreal injection.
