目的：探讨应用数字化广域成像系统RetCam3行婴幼儿口服荧光素钠眼底血管荧光造影(fluorescein fundus angiography，FFA)的护理。方法：选择2018年8月至2019年12月在广州中山大学中山眼科中心小儿眼病综合科就诊的眼底疾病婴幼儿78例，应用RetCam3进行口服法FFA检查及护理，将护理要点进行总结。结果：所有患儿安全、顺利完成检查，检查过程中均未发生异常病情变化或与检查、药物相关的并发症。经FFA确诊家族性渗出性玻璃体视网膜病变(familial exudative vitreoretinopathy ，FEVR)26例，早产儿视网膜病变(retinopathy of prematurity ，ROP)23例，色素失禁症患者6例；玻璃体积血患者3例；视网膜母细胞瘤患者3例；牵牛花综合征患者1例；视网膜色素变性患者3例；弓蛔虫眼病患者1例；原始永存玻璃体患者2例；不明原因眼底病变患者5例，单眼视网膜皱襞患者1例，先天性小眼球患者1例，巨细胞病毒感染患者1例，先天性黄斑发育不良患者1例；Coats病患者1例。结论：应用RetCam3行婴幼儿口服法FFA是一种安全、有效的检查方法。规范、恰当的护理配合能够保证检查准确、顺利地完成。
Objective: To share the nursing experience of RetCam3 ultra-widefield oral fluorescein fundus angiography (FFA) in infants with fundus diseases. Methods: Seventy-eight infants with fundus diseases admitted to General Department of Pediatric Ophthalmology in Zhongshan Ophthalmic Center, Sun Yat-sen University from August 2018 to December 2019 were recruited. Oral FFA was carried out using the 130-degree lens of RetCam3, and the key points of nursing were summarized. Results: No complications related to the examination and drugs occurred after oral FFA with an appropriate nursing manner. FFA confirmed 26 cases of familial exudative vitreoretinopathy,23 cases of retinopathy of prematurity and 6 cases of pigment incontinence. Vitreous hematoma was observed in 3 patients, retinoblastoma in 3 patients, Morning Glory syndrome in 1 patient, retinitis pigmentosa in 3 patients,Ascaris lumbricoides eye disease in 1 case, original permanent vitreous body in 2 patients, unexplained fundus lesions in 5 patients, monocular retinal fold in 1 patient, congenital micro-eyeball in 1 patient, cytomegalovirus infection in 1 patient, congenital macular dysplasia 1 patient and Coats disease in 1 patient. Conclusion: Oral FFA with RetCam3 is an effective and safe detection method for infants. Standard and proper nursing can ensure the examination can be performed accurately and smoothly.
结节性硬化症(tuberous sclerosis complex，TSC)是一种累及多系统的常染色体显性遗传病，早期呈单一表现，容易漏诊、误诊，以眼部症状为首发特征的新生儿期病例少有报道。本文报告1例早产男婴，出生后1 d眼底筛查发现右眼视网膜散在多个灰白色半透明隆起灶及脱色素斑，回溯胎儿期超声心动图异常高度怀疑TSC，进一步行头颅MRI检查及家族基因检测，在新生儿期明确了这一诊断。
Tuberous sclerosis complex is a multisystemic disease with an autosomal dominant inheritance pattern. Missed diagnosis and misdiagnosis are common for patients with single manifestation in the early stage. There are few documented neonatal cases with ocular symptoms as primary presentation. Here we report a newborn boy presented with retinal hamartoma, retinal achromic patch, fetal cardiac rhabdomyoma and subependymal nodules.Subsequent genetic tests confirm a diagnosis of TSC.
目前Wetlab眼科手术教学采用猪眼球作为教学模型，与实际手术差别较大，且无法满足外眼手术教学的需求。通过使用带有眼球、眼外肌、眶组织、眶骨及眼睑结构的全眼模型，可高度模拟真实手术场景，覆盖更多眼科手术教学需求。基于全眼模型构建多个眼科手术教学平台，依照培养阶段设计手术课程，创建新的评价体系，改变传统将“内眼”“外眼”分开的教学理念，可使年轻医师从一开始就建立眼科“分科而不分割”的整体思维，从而使眼科手术培训更加规范和完善。
Porcine eyes have been used as animal model in ophthalmic surgery training. However, it differs greatly from real surgery and cannot meet the needs of external eye surgery teaching. Porcine orbit model with eyeball, extraocular muscles, orbital tissue, bones and eyelids can be more realistic simulation of real surgeries and cover more needs for ophthalmic surgery teaching. By setting up ophthalmic surgery teaching platforms, designing staged course and creating new assessment methods based on porcine orbit model, the traditional concept about separation of internal and external eye is changed. This helps young doctors to establish a holistic view from the very beginning,that ophthalmic surgeries should not be split because of subspeciality. In this way, ophthalmic surgery training will become more standardized and perfected.
近些年来，眼科疾病的临床诊断治疗及其病理发展的研究对医学影像学技术的要求日益增高，磁共振技术已广泛应用于研究眼科疾病的发病机制、治疗和分析预后。基于体素的形态学分析(voxel-based morphometry，VBM)作为一种新型的磁共振图像的分析方式，VBM可以对活体脑进行无创的形态学研究，定量分析磁共振图像中每一个单独体素内的白质、灰质的密度和体积的变化，从而反映对应区域的解剖学结构差异，能发现常规MRI不能检测到的灰质和白质结构的细微改变。不同于那些只作用于预设的感兴趣区域的分析方法，VBM完全没有偏向性，它探测全脑的异常变化，无需对感兴趣区的先验性假设，不会被研究人员的主观思维影响。这提供了一种全新的方法来探索眼科疾病中的神经病理变化，尤其在青光眼和弱视的研究中应用最多。
With the increasing requirements for medical imaging technologies in clinical diagnosis, treatment and pathological basis research of ophthalmic diseases, magnetic resonance imaging (MRI) has been broadly used in the diagnosis and prognostic evaluation of ophthalmic diseases. As a novel analytic method of MR images, voxel-based morphometry (VBM) quantitatively analyzes the changes in brain gray, white matter density and volume in each individual voxel in MR images to reflect the differences of anatomical structures in the corresponding areas, and it provides a novel way to reveal the neuronal pathological changes in ophthalmic diseases.
病理性近视相对高度近视而言，更强调眼底并发症的存在。后巩膜葡萄肿(posterior staphyloma，PS)被认为是病理性近视的标志性特征，是眼球后巩膜壁的局部扩张，通常认为与巩膜变薄和脉络膜萎缩等因素相关。近年来研究认为P S的形成可能与局部炎症、Bruch膜缺失等因素密切相关。伴随OCT等检查技术的快速革新以及P S治疗手段的探索，诊断和治疗更加完善。
Pathological myopia emphasizes the existence of fundus complications. Posterior staphyloma, considered as a hallmark of pathological myopia, is a partial extension of the posterior scleral wall, which is believed to be related to the scleral thinning and choroidal atrophy. In recent years, studies have indicated that the formation of posterior staphyloma may closely connected with localized inflammation and defects of Bruch’s membrane.With the rapid innovation of examination technologies such as optical coherence tomography (OCT) and the exploration of treatment for posterior staphyloma. The diagnosis and therapy will be more comprehensive in the future.
视网膜微循环与脑小血管具有相似的特征。视网膜被认为是可检测到的“窗口”，以检测在神经退行性疾病中发生的微血管损伤。光学相干断层扫描血管造影(optical coherence tomography angiography，OCTA)是一种非侵入性成像方式，可提供视网膜、脉络膜和视神经中血流的深度分辨图像。现总结有关OCTA在与眼科相关的阿尔茨海默病、帕金森病、多发性硬化症及视神经退行性疾病等神经系统疾病中的应用，并讨论其可否作为早期诊断和监测神经退行性疾病的重要工具。
Retinal microcirculation shares similar features with cerebral small blood vessels. Thus, the retina may be considered as an accessible ‘window’ to detect the microvascular damage occurred during the development and progression of neurodegenerative disorders. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality providing in-depth and high-resolved images of blood flow in the retina, choroid,and optic nerve. In this review, we summarize the current advances in the application of OCT-A in neurological diseases associated with ophthalmology such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and optic nerve degenerative diseases. Future directions for evaluating whether OCTA can be used as an important tool to early diagnose and monitor the neurodegenerative disorders are also discussed.
目的：调查眼病患儿家长在患儿手术前的健康教育需求，为责任护士开展个性化、高质量的健康教育提供依据。方法：采用自制的眼病儿童手术前家长的健康教育需求调查问卷对2020年4月至2020年6月的眼病手术患儿家长进行问卷调查，并对调查结果进行统计分析。结果：家长对眼病患儿手术术前健康教育需求排名前3位的是手术治疗的效果、意义及眼病相关专科健康知识。医疗付费方式的差异、患儿年龄、疾病的差异及家长年龄、职业状态的差异对术前健康教育需求得分差异有统计学意义(P<0.05)；家长获取健康教育知识的途径以医务人员讲解和公众号等网络平台为主。结论：眼病患儿家长对患儿术前健康教育需求较高，医务工作者应丰富知识层面，加强专科学习及相关知识培训，把专科知识与健康教育有机地结合，并探索有效的线上健康教育方式，更好地为患者服务。
Objective: To investigate the health education needs of parents of children with eye diseases before operation, and to provide basis for more targeted and high-quality health education for primary nurses. Methods: A self-made questionnaire was used to investigate the health education needs of parents of children with ophthalmopathy before surgery from April 2020 to June 2020, and the results were statistically analyzed. Results: The top three of parents’ needs for preoperative health education of children with eye diseases were the effect and significance of the surgery and the related professional health knowledge of eye diseases. The differences of medical payment methods, children’s age, diseases, parents’ age, and occupational status was significant in the scores of preoperative health education needs (P<0.05). The main ways of parents obtaining health education knowledge were network platforms such as medical staff explanation and official accounts. Conclusion: The parents of children with eye diseases have a high demand for preoperative health education. Medical workers should enrich their knowledge, strengthen specialty learning and related knowledge training, organically combine professional knowledge with health education, and explore the methods of effective online health education to serve patients better.
目的：分析眼专科医院患者突发急症现状，并探讨防控措施。方法：回顾性分析2017—2018年中山眼科中心82例突发急症事件，具体分析突发急症事件的特点、处置情况及患者转归。结果：眼专科医院中最常见的突发急症事件为药物不良反应(n=38，46.3%)，其后依次是晕厥(28.0%)、心脑血管急症(8.3%)、意外事件(6.1%)，其中药物不良反应涉及的相关药物最多见于荧光素钠注射液(n=16，42.1%)、局部神经阻滞麻醉相关药物(n=7，18.4%)。突发急症事件集中分布于工作时段8:00—18:00(n=74，91.3%)，非工作时段多见于药物不良反应(n=3，42.9%)及心脑血管急症(n=3，42.9%)。门诊是突发急症事件最常发生的场所(n=53，64.6%)，其后依次是住院病房(22.0%)、手术室(11.0%)。患者突发急症危急程度轻、中、重度分别占92.7%，4.9%，2.4%。50%的患者需要综合医院急诊人员配合抢救或至综合医院进一步诊治。结论：通过优化患者诊治流程，缩短在院时间，医护人员提高预警意识，明确各岗位潜在急症风险，可降低突发急症事件发生风险。发挥麻醉师专业优势，提高院内应急处理能力，同时签约定点综合医院急救服务，为患者提供快速、准确、高效的救护，保障患者生命安全。
Objective: To analyze the status of medical emergencies of patients in ophthalmic hospitals and put forward suggestions on their prevention and control measures. Methods: The medical emergencies of 82 patients in ophthalmic hospitals in 2017 and 2018 was been analyzed retrospectively, and the characteristics and treatment of emergencies as well as the metastasis and progression of the disease in patients were analyzed specifically.Results: Medical emergencies were caused by druginduced adverse reaction (n=38, 46.3%), syncope (28.0%), cardiovascular emergency (8.3%), accidents (6.1%) in sequence. Fluorescein sodium (n=16, 42.1%) and local anesthesia drugs for nerve block (n=7, 18.4%) were the most common drugs related to drug adverse reaction. Most cases happened at 8:00—18:00 (n=74, 91.3%), and drug adverse reaction and cardiovascular and cerebrovascular emergencies were most common at 18:00—8:00. Medical emergencies happened in outpatient department (n=53,64.6%), wards (22.0%) and operation rooms (11.0%). There were mild emergencies (92.7%), moderate emergencies (4.9%) and severe emergencies (2.4%) in patients. Among them, 50% of patients need first aid by doctors from general hospitals or to be transferred to the general hospital for further treatment. Conclusion: Through optimizing process, shortening the hospital stay, identifying potential risks and enhancing medical workers’ awareness of safety, the risk of medical emergencies can be reduced. We should give full play to the professional advantages of anesthesiologists,improve the emergency handling capacity of the hospital, and contract the emergency services of designated general hospitals to provide rapid, accurate and efficient rescue for patients to ensure the life safety of patients.
目的：比较VX120多功能眼检查仪与Topcon KR 800全自动验光仪的客观验光结果的一致性。方法：收集2019年1 1月至2019年1 2月在我院就诊拟行角膜屈光手术的患者2 4例(24只眼)，所有患者均取右眼。采用Topcon KR 800全自动验光仪和VX120多功能眼检查仪分别对2 4例患者进行客观验光检查，分别得到球镜光度(S)、柱镜光度(C)、等效球镜光度(M)、水平和垂直方向的柱镜光度(J0)及45°柱镜光度( J45)。采用配对T检验对两种设备的测量值进行组间比较，并采用Bland-Altman 95%一致性界限法衡量其一致性。结果：VX120多功能眼检查仪在明视模式下所测S为(-3.90±3.06) D；M为(-4.41±3.24) D；J0为(0.34±0.58) D；J45为(?0.04±0.26) D；TopconKR800全自动验光仪所测S为(-3.77±2.88) D；M为(-4.15±3.07) D；J0为(0.25±0.47) D；J45为(-0.01±0.18) D。VX120多功能眼检查仪在明视模式与TopconKR800全自动验光仪所测得的S、M、J45差异无统计学意义，而J0两者之间差异有统计学意义(t=-2.24，P=0.04)。Bland-Altman95%一致性分析显示，两种仪器参数数据点多分布在95%可信区间内，一致性较好。结论：VX120多功能眼检查仪明视模式下与TopconKR800全自动验光仪的客观验光结果一致性较好，在屈光度检查上可以相互替代。
Objective: The aim of this study was to compare the consistency of objective optometry results between VX120 multi-diagnostic unit and TopconKR800 automatic optometer. Methods: A total of 24 patients (24 right eyes) admitted to our hospital from November 2019 to December 2019 for corneal refractive surgery were collected. Optometry was performed on 24 patients with TopconKR800 automatic optometer and VX120 multi-diagnostic unit, and got the results following: spherical mirror photometry (S), cylindrical lens luminosity (C), mean spherical equivalent (M), horizontal and vertical cylindrical lens luminosity ( J0) and 45° cylindrical lens luminosity ( J45). Compared T-test analysis was used to compare the parameters of the two devices, and the Bland-Altman 95% limits of agreement were performed. Results: The S measured by the VX120 multi-diagnostic unit with bright mode was (-3.90±3.06) D; M was (-4.41±3.24) D; J0 was (0.34±0.58) D;J45 was (-0.04±0.26) D. The S measured by TopconKR800 automatic optometer was (-3.77±2.88) D; M was (-4.15±3.07) D; J0 was (0.25±0.47) D; J45 was (-0.01±0.18) D. There was no statistically significant difference in S, M, and J45 measured by VX120 multi-diagnostic unit and TopconKR800 automatic optometer in bright mode, while there was statistically significant difference in J0 between VX120 multi-diagnostic unit and TopconKR800 automatic optometer (t=-2.24, P=0.04). Bland-Altman 95% consistency analysis showed that the data points of the two instruments were mostly distributed within the 95% confidence interval, indicating that the parameters measured by these two devices were in accord with each other. Conclusion: The objective optometry results of VX120 multi-diagnostic unit and TopconKR800 automatic optometer were consistent and can be substituted for each other in the refraction examination.
目的：调查民航飞行员视频终端疲劳综合征(visual display terminal syndrome，VDTS)的现状并分析其原因，为民航飞行员眼部保健工作提供依据。方法：对1 631名民航飞行员进行问卷调查，了解暴露时间，比较不同暴露强度人群的不适症状和发病率。结果：民航飞行员视频终端暴露时间为(4.43±2.24) h，VDTS发病率和不适症状检出率均随暴露时间增加而增加。结论：长时间视频终端暴露不利于眼健康。应加强对民航飞行员的眼保健教育，避免或减少视频终端暴露带来的健康危害。
Objective: To investigate the status of visual display terminal syndrome (VDTS) in civil aviation pilots and analyze the causes, so as to provide evidence for eye health care of pilots. Methods: A questionnaire survey was conducted among 1 631 pilots to understand the exposure time and to compare the incidence rate of discomfort in participants with different exposure intensities. Results: The average exposure time of pilots’video terminals was (4.43±2.24) h. The incidence rate of VDTS and the detection rate of discomfort increased with the increase of exposure time. Conclusion: Prolonged exposure to video terminal is not conducive to eye health. The eye health education for pilots should be strengthened to avoid or reduce the health hazards caused by video terminal exposure.
