眼科人工智能技术在实践中不断发展,如大数据应用、图像信息分析、机器人时代等,现在又迈上促进生物识别精确化的新台阶,这些实践应用都能更好地保护视器官,使之具备正常视功能,展示出独特的视觉信息特色。眼科人工智能技术不断开辟新领域,取得了诸多新成就。
The application of artificial intelligence technology in ophthalmology has been on the agenda, and has continued to progress in practice, such as the application of big data, image information analysis, the era of robotics, and now it is on a new step to promote the accuracy of biometrics. These are protections for the visual organs and the vision, make they have normal visual function, and display unique characteristic of visual information. The “eye and artificial intelligence” has continuously opened up new fields and achieved new successes.
眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟,但眼科规培过程管理中仍存在诸多问题,包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等,很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善,配备更充足的教学资源,有一定的规培经验,是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式,注重规范化、标准化和个性化相结合,并通过借鉴香港及海外住院医师培训经验,丰富理论培训形式,优化操作培训环境,突出外语和科研能力训练,强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考,总结当前眼科专科医院规培现状,并提出对策和建议。
Standardized training for ophthalmology residents is an essential stage during the development of ophthalmologists. The standardized training system has become more and more mature, while problems still exist in the aspects of coordination between specialized hospitals and general hospitals, teacher resources, unevenness of trainees, combination of postgraduate education and residency standardized training, microsurgical skills training, and so on. Therefore, programs and strategies of standardized training are still under exploration. Eye hospitals, with the excellent disciplinary system, adequate resources, and advanced experience, play a key role in standardized training for ophthalmology residents. Joint Shantou International Eye Center has set up a training model in accordance with national requirements, focusing on the combination of standardization, normalization, and individuation. Besides, by learning from the oversea experience of residents training, Joint Shantou International Eye Center has enriched the training forms, optimized the skill training environment, and highlighted the training of foreign language, scientific research, and systematic clinical thinking. This paper, based on the 5-year experience and reflection on standardized training for ophthalmology residents in Joint Shantou International Eye Center, summarizes the current status of standardized training and put forward some measures and suggestions.
目的:评价手术视频辅助Wetlab眼睑手术教学的效果。方法:回顾性分析2021年4月至2021年9月在中山大学中山眼科中心住院医师规范化培训学员中使用全眼模型开展Wetlab外眼手术教学的情况。对照组(12人)采用传统教学方法,实验组(15人)在传统教学方法的基础上引入手术视频辅助教学,对学员第3、6、9次练习视频进行评分,分析教学效果。结果:2组学员的基线水平与学习曲线相似,练习第3次到第6次之间评分提高快(对照组P3~6=0.001,实验组P3~6<0.001),第6次到第9次之间提高速度放缓(对照组P6~9=0.007,实验组P6~9=0.012)。对照组学员在练习第3次用时更长[(80.3±16.1) min],随着练习次数增多,用时逐渐缩短并保持稳定(P3~6=0.040,P6~9=0.886,P3~9=0.020),而实验组学员在练习第3次用时更短[(71.7±15.0) min],练习过程中保持稳定(P3~6=0.568,P3~9=0.519)。结论:手术视频辅助教学有助于学员熟悉手术操作,提高练习效率。
Objective: To assess the efficacy of video-assisted Wetlab eyelid surgery teaching. Methods: From April 2021 to September 2021, the porcine orbit model was used to conduct a Wetlab teaching course on eyelid surgeries among trainees of standardized training for residents in Zhongshan Ophthalmic Center, Sun Yat-sen University. The control group (12 trainees) used conventional teaching methods. Video-assisted teaching was offered to the test group (15 trainees) based on conventional teaching methods. The videos records of the 3rd, 6th, and 9th practices were scored to analyze the teaching efficiency. Results: Trainees from the 2 groups showed a simila baseline and learning curve. Rapid improvement was found between the 3rd and 6th practice (P3–6=0.001 in control group, P3–6<0.001 in test group). The increment was slower between the 6th and 9th practice (P6–9=0.007 from control group, P6–9=0.012 from test group). Longer time was required by trainees from the control group at the 3rd practice [(80.3±16.1) min]. As they practiced more, the time required gradually decreased and remained stable (P3–6=0.040, P6–9=0.886, P3–9=0.020 from control group). Trainees from the test group spent less time at the 3rd practice [(71.7±15.0) min]. The time remained stable during all practices (P3–6=0.568, P3–9=0.519 from test group). Conclusion: Video-assisted teaching can help trainees get familiar with surgical operations and improve the efficiency of practices.
目的:了解近5年世界干眼研究的文献分布特征,并分析这一领域的研究趋势及研究热点。方法:以Web of Science核心数据库(WoSCC)为基础,采用文献计量学方法对干眼相关的全球研究趋势进行评估。通过VOSviewer v.1.6.16构建知识图谱,可视化了该领域的出版物、国家/地区分布、国际合作、作者、来源期刊和研究热点。另外,用CiteSpace IV来捕获爆发的关键词,探索热点的兴起和没落时间,以发现研究前沿。结果:在2016—2020年间共检索到2 567篇同行评议文章,其中美国是发表文献数量最多的国家,文献产量最高的机构是日本的庆应义塾大学。Kazuo Tsubota是该领域发表论文最多的作者,MA Lemp是被引次数最多的作者。Ocular Surface是干眼研究中发表文章最多的杂志。被引用最多的文献主要是TFOS Dr y Eye Workshop II发表的干眼系列报道。关键词聚类分析得出6大类:1)致病机制和病理生理;2)定义和分类;3)流行病学研究;4)治疗;5)继发性干眼;6)诊断。目前的研究前沿是眼痛、瑞巴派特、小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)手术和泪膜动力学。结论:本研究通过对国际干眼领域近5年的文献进行文献计量学分析,可视化呈现了最近这一领域的研究现状、热点及前沿。干眼研究的前沿主题是眼痛、瑞巴派特、SMILE手术和泪液动力学。
Objective: To understand the literature distribution characteristics of dry eye research in the world in the last 5 years, and to analyze the research trend and hotspots in this field. Methods: Based on the Web of Science Core Collection (WoSCC) database, a bibliometric analysis was conducted to evaluate the global research trends related to dry eye. Knowledge mappings were constructed by VOSviewer v.1.6.16 to visualize the publications, the distribution of countries, international collaborations, author productivity, source journals, and research hotspots in this fifield. In addition, CiteSpace IV was used to capture the keywords of outbreaks and to explore the rise and fall of hotspots. Research frontiers could be discovered by this analysis. Results: In total, 2 567 peer-reviewed articles were retrieved on dry eye research from 2016 to 2020. The United States ranked the highest among countries withthe most publications. The most productive institution was the Keio University. Kazuo Tsubota contributed the largest number of publications in this field, and MA Lemp was the most cited author. Ocular Surface was the most prolific journal in dry eye research. The top-cited references were mainly about the reports of the International Workshop on Meibomian Gland Dysfunction (MGD). The most cited literature was mainly dry eye series reports by TFOS Dry Eye Workshop II. Six categories were obtained by cluster analysis: 1) pathogenic mechanism and pathophysiology; 2) definition and classification; 3) epidemiological study; 4) treatment; 5) secondary dry eye; 6) diagnosis. Current research foreword is ocular pain, rebamipide, small incision lenticule extraction (SMILE) surgery, and tear film dynamics. Conclusion: Through the bibliometrics analysis of the international literature in the field of dry eye in the past five years, this study visualized the current research status, hotspots, and frontier in this field. Leading topics in dry eye research are eye pain, rebamipide, SMILE surgery, and tear dynamics.
目的:探讨多元化宣教在提高眼科日间手术患者眼部用药正确率及满意度的应用效果。方法:采用便利抽样的方法,选取中山大学中山眼科中心2020年10至12月收治的200例眼科日间手术患者眼部用药的执行者为对象,将10至11月收治的100例日间手术患者眼部用药的执行者纳入对照组,将12月收治的100例日间手术患者眼部用药的执行者纳入试验组。对照组采取传统宣教方式,试验组应用多元化宣教模式进行健康教育。采用自制的健康教育需求调查表调查眼部用药执行者的健康教育需求,采用眼部用药执行评价表、健康宣教满意度调查表评价干预效果。结果:采用多元化宣教方式干预后,试验组患者眼部用药正确率(94%)高于对照组(35%),差异具有统计学意义(P<0.05)。试验组对多元化宣教满意度得分明显高于对照组,差异具有统计学意义(P<0.05)。结论:多元化宣教模式可提高眼科日间手术患者眼部用药正确率,提高患者及家属的满意度,值得临床推广应用。
Objective: To explore the effect of diversified education on improving the accuracy and satisfaction of eye medication in patients undergoing ophthalmic ambulatory surgery. Methods: A total of 200 practitioners of administering eye medication after undergoing ambulatory surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from October to December 2020 were investigated by convenience sampling, 100 practitioners admitted from October to November were included in the control group, and 100 practitioners were included in the experimental group. The control group adopted the traditional method of education, while the experimental group applied diversified education mode to carry out health education. The health education needs of the patients were investigated by the self-made health education needs questionnaire, and the effect of intervention wasevaluated by the eye medication implementation evaluation form and health education satisfaction questionnaire. Results: After the intervention, the correct rate of eye medication in experimental group (94%) was higher than the control group (35%) with a statistical difference (P<0.05). The satisfaction score about diversified education in experimental group was significantly higher than the control group with a statistical difference (P<0.05).Conclusion: Diversified education model can improve the accuracy of administering eye medication in patientsundergoing ophthalmic ambulatory surgery, and the satisfaction in patients and their families is significantly improved. It is worthy of clinical application.
目的:建立高效液相色谱法(high-performance liquid chromatography,HPLC)测定盐酸丁卡因滴眼液中盐酸丁卡因和羟苯乙酯的含量。方法:采用Agilent Eclipse PLUS C18色谱柱(250 mm ×4.6 mm,5 μm);以1%三乙胺溶液(三乙胺10 mL,加水990 mL,用冰醋酸调节pH值至5.0±0.5)-乙腈(65 : 35)为流动相,流速为1.0 mL/min;柱温为30 ℃;检测波长为256 nm;进样体积20 μL。结果:盐酸丁卡因在0.05~0.36 mg/mL范围内线性关系良好( r =1.000),平均回收率为99.2%,相对标准偏差(relative standard deviation,RSD)为0.3%(n=9),羟苯乙酯在3.02~24.14 μg/mL范围内线性关系良好(r=1.000),平均回收率为98.2%,RSD为0.4%(n=9),该方法重现性好。对照品溶液和供试品溶液在室温放置24 h基本稳定;结论:本方法简便、快速、准确。适用于检测盐酸丁卡因滴眼液中盐酸丁卡因和羟苯乙酯的含量。
Objective: To establish a high-performance liquid chromatography (HPLC) method for the determination of tetracaine hydrochloride and ethyl hydrobenzoate in tetracaine hydrochloride eye drops. Methods: The analytic column was Agilent Eclipse Plus C18 (4.6 mm ×250 mm, 5 μm) and the mobile phase was 1% triethylamine solution (10 mL triethylamine and 990 mL water, pH adjusted to 5.0±0.5 with glacial acetic acid) - acetonitrile (65:35) at a flow rate of 1.0 mL/min. The detection wavelength was 256 nm and the column temperature was 30 ℃. The injection volume was 20 μL. Results: The linear range of tetracaine hydrochloride was well shown within 0.05–0.36 mg/mL (r=1.000). The average recovery rate of tetracaine hydrochloride was 99.2% with relative standard deviation (RSD) 0.3% (n=9). The linear range of ethyl hydrobenzoate was well shown within 3.02–24.14 μg/mL (r=1.000). The average recovery rate of tetracaine hydrochloride was 98.2% with RSD 0.4%(n=9). The method had high reproducibility. The reference solution and testing solution were stable for 24 h in room. Conclusion: The method is simple, quick and accurate, which is suitable for the determination of tetracaine hydrochloride and ethyl hydrobenzoate in tetracaine hydrochloride eye drops.
近年来,由于经济社会不断发展,社会压力增大,人们精神障碍和干眼的发病率不断增加,这既影响人们身心健康,也给社会经济造成一定负担。大量研究表明精神障碍与干眼显著相关,精神障碍是干眼的独立危险因素之一。然而在临床工作中,精神障碍与干眼间的关系在过去一直未受到重视,本文将从精神障碍与干眼关联性入手,探讨其中介作用,总结了精神障碍因素影响干眼症状和体征分离,并进一步倡导跨学科综合管理来治疗干眼,形成对干眼的正确感知并降低疼痛及健康焦虑水平,以期为干眼临床诊疗提供新的视角。
In recent years, due to the continuous development of economy and society and the increasing social pressure, the incidence rate of mental disorders and dry eyes is increasing, which not only affects people’s physical and mental health, but also creates a certain burden on the social economy. A large number of studies have shown that mental disorder is significantly related to dry eye, and mental disorder is one of the independent risk factors of dry eye. However, in clinical work, the relationship between mental disorder and dry eye has not been paid attention in the past. This paper will start with the correlation between mental disorder and dry eye, explore the mediating effects, summarize the mental disorder factors that affect the separation of symptoms and signs of dry eye, and further advocate interdisciplinary comprehensive management to treat dry eye, form a correct perception of dry eye and reduce the level of pain and health anxiety, In order to provide a new perspective for clinical diagnosis and treatment of dry eye.
目的:探讨角膜绷带镜对独眼白内障患者焦虑情绪及生活质量的影响。方法:选取中山大学中山眼科中心白内障科2020年12月至2021年7月收治的120例独眼白内障患者作为试验对象,采用便利抽样法分为实验组(佩戴角膜绷带镜)与对照组(未佩戴角膜绷带镜)。运用焦虑自评量表、视功能的生存质量量表来评估比较2组患者的焦虑程度、术后生存质量。结果:入院前2组患者的焦虑评分、生存质量评分差异无统计学意义(P>0.05),术后第1天实验组患者的焦虑评分明显低于对照组、生存质量评分明显高于对照组,差异有统计学意义(P<0.05)。实验组患者的焦虑评分由入院前的55.35±7.09降低至43.77±5.56,焦虑程度比入院前减轻20%;对照组患者焦虑评分由入院前的54.27±5.93降低至47.92±7.02,焦虑程度较入院前减轻12%;实验组患者生存质量评分由入院前的55.32±25.57增至术后第1天的81.01±13.74,增长了46%;对照组患者生存质量评分由入院前的56.38±14.43降低至术后第1天的36.15±17.97,降低了35%。结论:角膜绷带镜可以减轻独眼白内障患者的焦虑情绪,提高术后生活质量。
Objective: To investigate the effect of corneal bandage lens on anxiety and quality of life in patients with monocular cataract. Methods: A total of 120 patients with monocular cataract treated in our department from December 2020 to July 2021 were selected as the subjects. They were divided into an experimental group (wearing corneal bandage lens) and a control group (without corneal bandage lens) by convenient sampling method. Self-rating Anxiety Scale and Visual Function Quality of Life Scale were used to evaluate and compare the degree of anxiety and postoperative quality of life between the 2 groups. Results: There was no significant difference in anxiety score and quality of life score between the 2 groups before admission (P>0.05). On the first day after operation, the anxiety score of the experimental group was significantly lower than that of the control group, and the quality of life score was significantly higher than that of the control group (P<0.05). The anxiety score of patients in the experimental group decreased from 55.35±7.09 to 43.77±5.56, and the degree of anxiety decreased by 20% compared with that before admission. The anxiety score of patients in the control group decreased from 54.27±5.93 to 47.92±7.02, and the degree of anxiety decreased by 12% compared with that before admission. The score of quality of life in the experimental group increased from 55.32±25.57 before admission to 81.01±13.74 on the first day after operation, an increase of 46%. The quality of life score of patients in the control group decreased from 56.38±14.43 before admission to 36.15±17.97 on the first day after operation, a decrease of 35%.Conclusion: Corneal bandage lens can reduce the anxiety of patients with monocular cataract and improve the quality of life after operation.
Abstract: Myopia in children remains a major public health problem worldwide, especially in some Asian countries such as China, Singapore and Japan. Although many interventions have been attempted, few has been proven to be effective in controlling onset and progression of myopia in children. Environmental factors, genetic susceptibility or ethnic differences can affect the efficacy of these interventions. However, many questions remain unclear and even controversial for controlling myopia. China has the biggest population with myopia, especially for children myopia. Thus, it is of importance to present what achievements Chinese scientists have made in the field of myopia control in children. We summarize the current findings on myopia control in children from the Anyang Childhood Eye Study, including epidemiological data, clinical trials, systematic reviews and meta-analyses, and compare them with studies in other countries to find potential clues for controlling myopia in children.
Abstract: Myopia in children remains a major public health problem worldwide, especially in some Asian countries such as China, Singapore and Japan. Although many interventions have been attempted, few has been proven to be effective in controlling onset and progression of myopia in children. Environmental factors, genetic susceptibility or ethnic differences can affect the efficacy of these interventions. However, many questions remain unclear and even controversial for controlling myopia. China has the biggest population with myopia, especially for children myopia. Thus, it is of importance to present what achievements Chinese scientists have made in the field of myopia control in children. We summarize the current findings on myopia control in children from the Anyang Childhood Eye Study, including epidemiological data, clinical trials, systematic reviews and meta-analyses, and compare them with studies in other countries to find potential clues for controlling myopia in children.
目的:研究“中山眼鼻相关疾病·内镜论坛”的培训效果及其影响因素。方法:采用调取平台数据和调查问卷的方法,研究2020年6月至2022年5月16期“中山眼鼻相关疾病·内镜论坛”的参与人员情况和培训效果反馈,并分析专业、职称、地域等因素对培训效果的影响。结果:学员合计7889人,27634人次,以副主任医师30.2%(2382人)和主治医师32.9%(2597人)为主。参与学员人数从第1期的269人,逐渐增加到第16期的2537人。学员参与人数最多和收获最大的主题均为应用解剖和影像学、甲状腺相关眼病、泪道疾病。通过调查问卷发现:75.4%(95/126)的学员认为所学内容对今后的临床工作具有非常大的作用;84.1%(106/126)的学员应用所学的知识改进了日常临床工作;96.0%(121/126)的学员愿意参加中山眼科中心举办的线下实操的眼鼻相关解剖学习班。对于所学知识在今后临床工作的作用,副主任医师和主治医师认为“非常有用”的比例明显高于主任医师。在是否将所学知识应用于日常临床工作方面,副主任医师和主治医师认为“是”的比例明显高于主任医师和住院医师。参与6~16次论坛的学员,培训效果明显优于参与1~5次的学员。结论:眼鼻相关疾病·内镜微创领域在眼科和鼻科领域关注度日益提升。“中山眼鼻相关疾病·内镜论坛”有助于学员理论知识的扩展和提升,对眼鼻相关疾病医生的日常临床工作具有很好的作用,主治医师和副主任医师职称的学员培训效果更好,参与论坛次数多的学员培训效果更好。
Objective: To assess the training effects of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” and its influencing factors, propose targeted suggestions for training focus and teaching methods, and improve the teaching quality. Methods: Statistics of live broadcast platform data and custom-designed questionnaires were used to inquire the participants enrolled in the 16 sessions of “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” from June 2020 to May 2022 for their feedbacks on training effects. The influence of their professions, titles, regions and other factors on the training effects was analyzed. Results: A total of 7 899 participants were enrolled in “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums”, and the total live broadcast person-time was 27 634. Associate senior doctors (30.2%, 2 382) and attending doctors (32.9%, 2 597) accounted for the largest proportion. The number of participants gradually increased from 269 in the first session to 2 537 in the 16th. The topics with the largest number of participants and the greatest gains were applied anatomy and imaging, thyroid associated ophthalmopathy, and lacrimal duct diseases. Through the questionnaire study, 75.4% (95/126) of the participants thought that what they had learned in the forums was very important for their future clinical work; 84.1% (106/126) of the participants applied the knowledge to improve their daily clinical work; 96.0% (121/126) of the participants were willing to participate in the offline practice of eye and nose anatomy classes held by Zhongshan Ophthalmology Center. In terms of the role of the learned knowledge in the future clinical work, the proportion of associate senior doctors and attending doctors who thought "very useful" was significantly higher than that of senior doctors. In terms of whether to apply the knowledge learned to daily clinical work, the proportion of associate senior doctors and attending doctors thinking “yes” was significantly higher than that of senior doctors and residents. Participants who participated in 6–16 sessions had significantly better training results than those who participated in 1–5 sessions. Conclusion: Eye and nose related diseases are attracting increasing attention in ophthalmology and rhinology. “Zhongshan Eye and Nose Related Diseases and Endoscopy Forums” are conducive to the expansion and improvement of participants’ theoretical knowledge, and plays a good role in the daily clinical work of doctors with eye and nose related diseases. The training effect of attending doctors and associate senior doctors is better, and the training effect of participants who participate in the forum more times is better.