患儿因“左眼红肿12 d”就诊。左上睑红肿(++++)，眼眶鼻侧可触及约黄豆大小硬结，界不清，质地中等，压痛(?)，伴上睑下垂，遮盖角膜下缘。双眼眼位正，左眼眼球外转轻度受限。眼眶及视神经MRI显示左眼上睑软组织肿胀，考虑炎性改变。入院诊断为左眼特发性眼眶炎性假瘤(Idiopathic orbital inflammatory pseudotumor，IOIP)。予以激素治疗后症状好转且随访期间无复发。本例患儿为拒绝外院活检而就诊于暨南大学附属第一医院的小儿IOIP病例，提示早期规范治疗是降低此病复发率的关键，尤其是儿童患者。
The pediatric patient was referred to our hospital with a 12-day history of left eye redness and swelling. On the orbital and nasal side of the eye, there was a firm, nontender mass about the size of soybeans, with unclear boundary, medium texture. Orbital examination showed left ptosis, covering limbus. Motility examination revealed both eyes were in normal position, and the left eye was slightly limited in extraocular rotation. Magnetic resonance imaging (MRI) revealed evidence of diffuse inflammation of left eyelid, and orbital inflammatory was considered. Excluding other etiologies, the child was diagnosed initially with idiopathic orbital inflammatory. The symptoms improved after hormone therapy and there was no recurrence during follow-up. This case was a case of IOIP in a child who was admitted to the First Affiliated Hospital of Jinan University for refusing biopsy from another hospital. The paper suggests that early standardized treatment is the key to reduce the recurrence rate of this disease, especially in children.
局部点药是眼部用药最常见的方式，但一般药物通过角膜困难，药物生物利用度低。纳米载体药物于8 0年代开始用于眼部，脂质体和类脂质囊泡(niosomes)与眼表的黏蛋白相互作用，延长药物在眼表的停留时间。纳米乳剂(nanoemulsion)的表面活性剂可以松解角膜上皮细胞紧密连接，形成转运开口，抑制细胞表面糖蛋白酶P(glycoprotein P，Pgp)降解药物活性蛋白。纳米粒子(nanoparticles)通过角膜上皮和结膜上皮而不会引起毒性。纳米胶囊(nanocapsules)更深地内化到角膜上皮(50 μm处)。聚合物胶束(polymeric micelles)自组装成核-壳纳米载体增强药物渗透角膜的能力。阴离子高代聚酰氨基胺(poly-amidoamine，PAMAM)树枝状大分子增强药物通透性，中性和阳离子低代树枝状大分子通过网格蛋白途径介导药物更高的通透性。纳米晶体(nanocrystal)，除增强药物溶解度和溶解速率之外，它的高黏附能力帮助药物保留和渗透到眼组织中。纳米结构材料与干眼关联密切，为干眼的治疗、诊断提供手段。
Topical administration is the most common method of ocular medication, but it is generally difficult for the drug to pass through the cornea, and the bioavailability of the drug is low. Nanocarrier drugs were used in eyes in the 1980s, and liposomes and lipoids vesicles (Niosomes) interacted with ocular surface mucins to prolong the residence time of the drug on the ocular surface. Nanoemulsion surfactants can release the tight junctions of corneal epithelial cells, form transport openings, and inhibit the degradation of pharmaceutically active proteins by cell surface glycoprotein P (Pgp). Nanoparticles pass through the corneal and conjunctival epithelium without causing toxicity. Nanocapsules internalize deeper into the corneal epithelium (at 50 μm). Polymeric micelles self-assemble into core-shell nanocarriers to enhance the ability of drugs to penetrate the cornea. Anionic high-generation poly-amidoamine (PAMAM) dendrimers enhance drug permeability. Neutral and cationic low-generation dendrimers mediate higher drug permeability through clathrin pathway. Nanocrystal, in addition to enhancing drug solubility and dissolution rate, its high adhesion ability helps drug retention and penetration into ocular tissues. Nanostructured materials are closely related to dry eye and provide a choice for the treatment and diagnosis of dry eye.
目的：探究特发性黄斑前膜(idiopathic macular epiretinal membrane，IMEM)患者在光学相干断层扫描(optical coherence tomography，OCT)的形态学改变与视力的相关性。方法：回顾性研究。基于OCT图像4级分级方案，纳入3级及以下的特发性黄斑前膜患者35例共37只眼进行OCT扫描，并借助第三方软件分析并获取每只眼在黄斑中心凹直径分别为1、3、6 mm共3个同心圆区域内视网膜各层的平均厚度值，并按照是否存在内核层(inner nuclear layer，INL)囊样改变分为两组。通过建立最小分辨角对数(minimum resolution angle in logarithmic，logMAR)最佳矫正视力(best corrected vision acuity，BCVA)与视网膜各层厚度值的多元线性回归方程，以及比较有INL囊样改变及无INL囊样改变两组的视力，分析视力与视网膜各层厚度值及INL囊样改变的关系。结果：多元线性回归分析显示，在直径1 mm的区域内，logMAR BCVA与神经纤维层(retina nerve fiber layer，RNFL)、INL的厚度值均呈正相关(均P<0.05)，而在直径3 mm和6 mm的区域内，logMAR BCVA仅与INL的厚度值呈正相关(均P<0.05)。与无INL囊样改变组相比，有INL囊样改变组视力及INL厚度差异均有统计学意义(均P<0.05)。结论：特发性黄斑前膜患者当前的视力主要与RNFL和INL厚度值相关。发生在INL层的囊样改变可能很好的提示INL增厚，其与视力具有相关性，具有这种囊样改变的患者往往视力也较差。
Objective: To investigate the morphological changes detected by spectral domain optical coherence tomography (OCT) and their relevance to vision in patients with idiopathic macular epiretinal membranes (IMEM). Methods: This is a retrospective study. OCT recorded 37 eyes with stage 3 and below IMEM according to the 4-level grading system based on OCT images among 35 patients. We managed to obtain thickness of all retina layers in three concentric circular regions with a diameter of 1 mm, 3 mm and 6 mm across macular fovea with the help of a third-party software. Plus we divided all 37 eyes into two groups according to whether there were cystic changes in the inner nuclear layer (INL). Multiple linear regression analyses were performed between thickness of all retina layers and current minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). The difference of BCVA between groups with cystic changes and without was also compared. Thus, the relationships between visual acuity and thickness of retina layers, cystic changes in INL were analyzed. Results: Multiple linear regression analyses revealed that thickness of both retina nerve fiber layer (RNFL) and inner nuclear layer have positive correlation with logMAR BCVA in the region with a diameter of 1 mm (P<0.05), while in regions of a diameter of 3 mm and 6 mm, only INL thickness remained positively relevant (all P<0.05). There were significant differences in BCVA and thickness of INL between groups with INL cystic changes and without (all P<0.05). Conclusion: Current visual acuity among preoperative IMEM patients was mostly associated with thickness of RNFL and INL. Cystic change in INL layer may be a good indicator of INL thickening and was visually correlated. Those with this change tend to have worse vision.
本文报告1例2 8岁男性青年患者，行飞秒制瓣准分子激光原位角膜磨镶术(laser-assisted situ keratomileusis，LASIK)术 后1个月视力进行性下降，小瞳下行电脑验光矫正视力，右眼为0.3(-0.25×86°)，左眼为0.2(-0.50×91°)。眼前节及眼底检查未见器质性病变，视觉电生理检查未见异常。视光专科检查示负相对调节/正相对调节(negative correlatione regulation/positive ccorrelation regulation，NRA/PRA)：+2.00 D/?10.00 D(行PRA时稍作停顿后又可看清)，Flipper拍检查：右眼(oculus dexter，OD) 10 cpm(+)，左眼(oculus sinister，OS) 22 cpm(+)，双眼(binocular，OU)12 cpm(+)，正镜片逐渐通过困难。隐斜检查：2△BO@D，13△BI@N。调节性集合与调节的比值(accommodation convergence/accommodation，AC/A)=1。患者PRA显著增高，Flipper检查正片通过困难，看近时外隐斜大于看远，提示可能存在“集合不足，调节超前”。给予托比卡胺滴眼液滴眼3次后验光：OD +1.00/-0.50×80°=1.0，OS +0.75/-0.25×65°=1.0，进一步证实了“调节痉挛”的诊断。给予托比卡胺滴眼液滴双眼，睡前1次，结合调节放松训练。4周后，裸眼视力及屈光度稳定在正常范围。临床上对于视力下降原因不明、排除眼部器质性疾病的患者，经过仔细询问病史、睫状肌麻痹检影和视功能检查“调节痉挛”不难诊断。除传统的睫状肌麻痹剂和近附加镜外，治疗方案建议加用视功能训练可使视力恢复并稳定。
A 28-year-old man was referred to our hospital because of blurred vision in both eyes after LASIK flap made by femtosecond laser surgery for 1 month. The best corrected visual acuity based on computerized optometry was 0.3 (-0.25×86°) in the right eye and 0.2 (-0.50×91°) in the left eye. Routine examinations were conducted to exclude eye diseases. Visual electrophysiological examination showed no abnormalities. Optometry specialty examination: negative relative accommodation (NRA) and positive relative accommodation (PRA) were +2.00 D/?10.00 D (when doing PRA, the patient could see clear slowly after a pause). Flipper examination showed: OD 10 cpm(+), OS 22 cpm(+), OU 12 cpm(+). Phoria-measurement showed 2 prism degree BO@D and 13 prism degree BI@N. AC/A=1. The patient’s high PRA, flipper examination results and convergence insufficiency at near distance indicated the possibility of “convergence insufficiency and accommodative spasm”. Cycloplegic refraction was planned to assess the real diopter. After instillation of cycloplegic drops, the UCVA improved to 1.0 and the refractive error to -0.25×93 in the right eye, in the left eye to 1.0 and the refractive error to -0.25×75. the BCVA was 1.0 (+1.00/-0.50×80°) in the right eye and 1.0 (+0.75/-0.25×65°) in the left eye. A diagnosis of accommodative spasm was made. The patient was counseled and continued cycloplegic drops one time daily before bedtime, participated in vision training for 4 weeks. This patient was a rare occurrence of accommodative spasm after FSLASIK surgery. Young patients with poor gain in UCVA can be subjected to a corrective procedure accidentally. Relaxation exercises and cycloplegic drops may cure accommodative spasm. For patients with unexplained causes of vision loss and excluded organic diseases of the eye, it is not difficult to diagnose “accommodative spasm” by careful medical history inquiry, ciliary muscle paralysis optometry and visual function examination. In addition to traditional ciliary palsy agent and reading glasses, it is suggested that visual function training can restore and stabilize the treatment effect.
近视是危害儿童青少年视力最常见的眼部疾病，高度近视对视功能造成极大的威胁。近年来，我国近视发病率逐年升高，对近视筛查与防控的需求也不断增加，随着人工智能理论与技术的不断发展与成熟，可以辅助眼科医生进行近视筛查、诊断与治疗。本文将简要介绍人工智能在近视的筛查、预测、检测、病理性近视以及角膜屈光手术中的应用，浅谈了目前人工智能在研究中存在的可比度较低、影像要求较高、可解释性较低及隐私保护等问题，并展望人工智能在近视相关领域的应用前景。
Myopia is the most common ocular disease that harms the vision of children and adolescents. High myopia poses a great threat to visual function. The incidence of myopia in China has been increasing in recent years, and the demand for myopia screening, prevention and control has also expanded. With the continuous development of artificial intelligence theory and technology, Artificial intelligence can assist ophthalmologists in myopia screening, diagnosis and treatment. This review will briefly introduce artificial intelligence in the screening, prediction, and detection of myopia; also, the application in pathological myopia and corneal refractive surgery. This review will discuss some problems of current artificial intelligence research, such as low comparability, high image requirements, low interpretability, privacy protection, and the application prospects of artificial intelligence in myopia.
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：探讨品管圈活动提升眼科带螺母器械清洗质量的效果。方法：中山大学中山眼科中心珠江新城院区自2020年8月1日到2020年9月3 0日消毒供应中心处理的眼科带螺母器械(以量规为例)共2 076件，8月31日前为对照组，按常规清洗流程处理；9月1日后为实验组，成立品管圈小组，针对器械结构制定相应清洗流程。结果：实验组的清洗合格率为98.7%，对照组的清洗合格率为93.4%，差异有统计学意义(P<0.01)。结论：实施品管圈活动可提升眼科带螺母器械的清洗质量。
Objective: To explore the effect of quality control circle activity on improving the cleaning quality of ophthalmic equipment with nuts. Methods: The object of the study was 2 076 pieces of ophthalmic equipment with nuts (taking gauge as an example) used from August 1, 2020 to September 30, 2020 in the central sterile supply department of the Zhongshan Ophthalmic Center of Sun Yat-sen University in Zhujiang New Town. The equipment used before August 31 was set as the control group and was dealt with common cleaning process. The equipment used after September 1 was set as experimental group and the quality control circle group was set up to develop corresponding cleaning procedures for the instrument structure. Results: The qualified rate of cleaning in the experimental group was 98.7%, and that in the control group was 93.4%. The difference was statistically significant (P<0.01). Conclusion: Quality control circle activity can improve the cleaning quality of ophthalmic equipment with nuts.
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：研究佛山市禅城区五年级、六年级近视儿童的心理健康及其影响因素，为解决其因近视产生的心理问题及近视防治工作提供依据。方法：选择佛山市禅城区3所小学，在其五年级、六年级选择2个班作为调查对象开展近视筛查、并使用儿童社交焦虑量表、孤独量表以及儿童自尊量表进行心理健康测量。结果：佛山市禅城区近视患病率52.0%，女性(57.5%)较男性(47.4%)有较高患病率，六年级患病率(57.6%)高于五年级(46.3%)。近视儿童均比正常视力儿童存在明显的社交焦虑、孤独感以及低自尊度(得分分别为5.53±4.04 vs 4.66±3.59，30.15±11.72 vs 27.29±10.40，97.97±12.73 vs 100.87±12.21)，差异均具有统计学意义(均P<0.05)。进一步分析显示，初发近视社会焦虑、孤独以及自尊方面比中度近视明显。性别、年龄等社会因素对于近视儿童心理健康影响不明显。根据矫正的不同方式分类，近视儿童中，戴角膜塑形镜者社交焦虑感较低(F=4.21，P=0.01)，戴框架眼镜者则较容易产生较低的自尊度(F=5.67，P=0.02)。结论：小学生近视问题是全社会普遍关心的问题，近视与其心理健康关系密切，这需要全社会密切配合，采取综合措施，且近视矫正方式的选择影响近视儿童的心理。
Objective: By studying the mental health and its influencing factors of myopia children in grade 5 and grade 6 in Chancheng District, Foshan City, this paper provided the basis for solving the psychological problems caused by myopia and the prevention and treatment of myopia. Methods: Three primary schools in Chancheng District,Foshan City were chosen. Two classes in grade 5 and grade 6 were selected to carry out myopia screening followed by evaluation of their mental health with children’s social anxiety scale, loneliness scale and children’s self-esteem scale. Results: The prevalence of myopia was 52.0% in Chancheng District, Foshan City. Females (57.5%) had a higher prevalence than males (47.4%). The prevalence in grade 6 (57.6%) was higher than that in grade 5 (46.3%).Children with myopia had obvious social anxiety, loneliness, and low self-esteem (scores of 5.53±4.04 vs 4.66±3.59,30.15±11.72 vs 27.29±10.40, 97.97±12.73 vs 100.87±12.21, respectively) than those with normal vision, whose difference was statistically significant (all P<0.05). Further analysis showed that social anxiety, loneliness, and self-esteem in children with primary myopia were more obvious than those with moderate myopia. Social factors such as gender and age had little effect on the mental health of myopic children. According to different correction methods, among myopic children, those who wore orthokeratology lenses had lower social anxiety (F=4.21, P=0.01), and those who wore spectacles were more likely to have lower self-esteem (F=5.67, P=0.02).Conclusion: The problem of myopia in primary school students, which is closely related to mental health, is ofgeneral concern to the whole society. This requires the whole society to cooperate closely and take comprehensive measures. The choice of myopia correction methods affects the psychology of myopic children.
