目的：探讨医用自交联透明质酸钠凝胶对鼻内窥镜下泪囊鼻腔吻合术(endonasal endoscopic dacryocystorhinostomy，En-DCR)后的影响。方法：将219例单侧慢性泪囊炎(chronic dacryocystitis CD)患者随机分为医用自交联透明质酸钠凝胶组(A组)和对照组(B组)。所有患者行En-DCR。A组将医用自交联透明质酸钠凝胶填充吻合口，B组不做任何处理。随访12个月。比较创面黏膜上皮化、肉芽形成情况、渗血情况及吻合口通畅成功率。结果：A组98例，B组102例。随访2周，A组86例患者鼻腔吻合口黏膜上皮完整，B组77例患者鼻腔吻合口黏膜上皮完整。随访12个月，A组有7例患者存在瘢痕(7.1%)，8例患者出现肉芽肿(8.2%)，而B组有17例患者存在瘢痕(16.7%)，18例患者出现肉芽肿(17.6%)。两组瘢痕形成及出现肉芽肿差异均有统计学意义(P<0.05)。A组的吻合口通畅成功率达到90.8%(89/98)，而B组的成功率为78.4%(80/102)(P<0.05)。B组患者术后渗血情况A组相当(P>0.05)。结论：医用自交联透明质酸钠凝胶填充吻合口可通过促进En-DCR术后吻合口黏膜上皮愈合和降低伤口瘢痕及肉芽肿生成率，提高En-DCR治疗CD的成功率。

Objective: To investigate the effect of medical self-crosslinking sodium hyaluronate gel on endonasal endoscopic dacryocystorhinostomy (En-DCR). Methods: A total of 219 patients with unilateral chronic dacryocystitis (CD) were selected and randomly divided into two groups: medical self-crosslinking sodium hyaluronate gel group (group A) and control group (group B). All patients underwent En-DCR. Group A received medical self-crosslinking sodium hyaluronate gel filling the ostium at the end of En-DCR, whereas group B received no treatment. Patients were followed-up for 12 months. The mucosal epithelialization of the wound, the granulation formation, bleeding, and the success rate of ostial patency were compared in the two groups. Results: Our study included 98 patients in group A and 102 patients in group B. After 2 weeks, the number of absorbable hemostatic patients who had intact mucosal epithelium lining the ostia was 86 in group A and 77 in group B. At 12 months follow up, there were 7 patients with scar (7.1%) and 8 patients with granuloma (8.2%) in group A, compared with 17 patients with scar (16.7%) and 18 patients with granuloma (17.6%) in group B. There were significant differences in scar formation and granuloma between the two groups (P<0.05). The success rate of anastomotic patency reached 90.8% (89/98) in group A whereas the success rate was 78.4% (80/102) in group B (P<0.05). The situation of postoperative bleeding in group B was similar to that in group A (P>0.05). Conclusion: The medical self-crosslinking sodium hyaluronate gel can improve the success rate of En-DCR treatment of CD through promoting the healing of anastomotic mucosa and reducing the rate of wound scar and granuloma formation.

目的：探讨连续锁边缝合联合角膜绷带镜在翼状胬肉手术中应用的效果。方法：采用前瞻性随机对照临床研究。选取2018年1月到2021年6月期间在我院行翼状胬肉切除联合自体角膜缘结膜瓣移植术的患者132例180眼，按结膜瓣固定方式随机分为A、B两组，其中A组患者(64例90眼)行间断缝合固定法，B组患者(68例90眼)行连续锁边缝合法，术毕两组患者均给与配戴角膜绷带镜。比较两组患者的术后眼部疼痛程度评分、术后效果及并发症。结果：术后1、3 d，B组疼痛评分明显低于A组，差异有统计学意义(P<0.01)；术后1、3、7 d两组间角膜染色评分差异无统计学意义(P>0.05)；术前、术后3个月两组间泪膜破裂时间(breakup time of tear film，BUT)差异无统计学意义(P>0.05)，但术后3个月组内的BUT较手术前有明显改善(P<0.05)。术前、术后2周两组间视力差异均无统计学意义(P>0.05)，术后2周两组组内视力较手术前均有明显改善(P<0.05)。随访3个月，两组患者主要术后并发症包括胬肉撕除后浅层基质损伤延迟愈合、线结处结膜增生、结膜植片松脱等，并发症发生率两组相当。结论：采用连续锁边缝合联合配戴角膜绷带镜治疗翼状胬肉可以促进角膜创面的修复，减轻患者的术后刺激症状，提高患者术后舒适度；连续锁边缝合时需要适当增加缝线跨度，可减少术后结膜植片的松脱。

Objective: To investigate the effect of continuous locking suture combined with corneal bandage lens in the operation of pterygium. Methods: A prospective randomized controlled clinical trial was conducted. From January 2018 to June 2021, 132 patients (180 eyes) who underwent pterygium excision combined with autologous limbal conjunctival flap transplantation were randomly divided into group A and group B according to the fixation of conjunctival fla. The patients in group A (64 cases, 90 eyes) were treated with intermittent suture and fixation, and the patients in group B (68 cases, 90 eyes) were treated with continuous locking suture. Both groups were given corneal bandage lenses at the end of the operation. The postoperative ocular pain score, postoperative effect and complications were compared between the two groups. Results: The pain score in group B was significantly lower than that in group A at 1 and 3 d after operation (P<0.01), and there was no significant difference in corneal staining score between the two groups at 1, 3 and 7 d after operation (P>0.05). There was no significant difference in breakup time of tear film (BUT) between the two groups before and 3 months after operation (P>0.05), but the BUT at 3 months after operation in the group was significantly better than that before operation (P<0.05). There was no significant difference in visual acuity between the two groups before and 2 weeks after operation (P>0.05). The visual acuity of the two groups was significantly improved 2 weeks after operation (P<0.05). During the follow-up of 3 months, the main postoperative complications of the two groups included delayed healing of superficial matrix injury after pterygium avulsion, conjunctival hyperplasia, conjunctival graft loosening and so on. Conclusion: Continuous locking suture combined with corneal bandage lens in the treatment of pterygium can promote the repair of corneal wound, reduce the postoperative irritation symptoms and improve the postoperative comfort of patients. It is necessary to increase the suture span during continuous locking suture, which can reduce the loosening of conjunctival graft after operation.

眼睛是人体最重要的感觉器官之一，主要由角膜和晶状体构成的屈光系统和视网膜构成的视觉神经系统2个部分构成。眼睛各组织的发育和功能异常都可影响视功能，甚至致盲。现有的致盲眼病的治疗方式均存在各自瓶颈问题，新的诊治方法亟待开发。近年来，得益于干细胞和组织工程学的发展，结合现有眼各组织的发育理论知识，研究者们利用多种来源的干细胞在体外成功诱导出具有组织特异结构和功能的眼类器官。眼类器官研究为利用干细胞研究眼组织发育和眼病发病机制、药物筛选以及替代治疗创造了新机遇，将干细胞治疗眼病的转化研究推向了一个更高平台。本文将对现有眼类器官的技术发展及应用进行综述。

Being one of the most important sensory organs, the eye is composed of the cornea, the lens, which are responsible for refraction, and the retina, which is the neural sensory part of the eye. Various kinds of developmental abnormalities and functional defects could lead to visual dysfunctions, and even blindness. Current treatments for blindness-causing eye diseases all have their own limitations, awaiting new efficient diagnostic and treating methods. Thanks to the development in stem cell biology and bioengineering, taking advantage of the rich knowledge accumulated on the mechanisms governing eye development, researchers have successfully generated various ocular organoids using multiple sources of stem cells in vitro, which resemble their counterparts in vivo on both the structural level and functional level. Ocular organoids provide valuable material and models for studying eye development, pathology, drug screening, and cell replacement therapy, pushing translational studies of ocular stem cell to a new era. Here, the paper reviews the development and application of ocular organoid technologies.

目的：探讨“破窗理论”在手术室护理安全管理中的应用，为构建手术期间质量安全保障体系提 供新的管理依据。方法：于2019年2月至2020年6月组织佛山市三水区人民医院手术室医护人员对 “破窗理论”进行学习，调查分析护理质量、护理满意度以及手术室护理中出现的安全问题，进 而分析“破窗理论”在手术室护理安全管理中的应用效果。结果：实施前不安全事件发生率高于 实施后(16.00% vs 4.00%，P<0.05)。实施后手术室护理安全管理、药物使用规范性、感染控制程 度、基础护理质量评分高于实施前(P<0.05)。与实施前相比，实施后手术医生、医护人员、患者 满意度明显上升(P<0.05)。结论：“破窗理论”在传统护理的基础上提供了一种更为积极的干预 模式，其在护理安全管理中的应用值得进一步推广应用。

Objective: To provide a new management system to increase the quality and safety during the operation through applicating the broken window theory in the operating room nursing quality management. Methods: From February 2019 to June 2020, we organized medical staff in the operating room to study the broken window theory, investigated the nursing quality, nursing satisfaction and safety problems in operating room nursing, and then analyze the application effect of the theory in the nursing safety management. Results: The incidence of unsafe events before implementation of the broken window theory were significantly higher than that after the implementation (16.0% vs 4.0%, P<0.05). After the implementation, the scores of nursing safety management, standardized drug use, infection control and basic nursing quality in the operating room were higher than those before the implementation (P<0.05). The satisfaction of surgeons, medical staff and patients increased significantly after implementation as compared with before implementation (P<0.05). Conclusion: The broken window theory effectively provides a more active intervention model than traditional care, and it deserves further application in nursing safety management.

目的：探索局部麻醉辅助小剂量丙泊酚联合瑞芬太尼镇静镇痛在成人斜视矫正术中的应用效果。方法：本研究为前瞻性队列研究，选取2020年10月1日至2021年5月31日于北京同仁医院行斜视矫正术的成年患者24例，单纯局部麻醉组、镇静镇痛组各12例。所有患者均应用2%利多卡因10 mL+0.1% 肾上腺素0.1 mL混合液进行眼部局部浸润注射，静脉滴注昂丹司琼8 mg。镇静镇痛组患者静脉滴注咪达唑仑1 mg、舒芬太尼5 μg，继之以丙泊酚0.6~3 mg/(kg·h)、瑞芬太尼0.01~0.05 μg/(kg·min)持续输注，使Ramsay镇静分级维持在II级。记录两组患者术中视觉模拟评分(visual analog scale，VAS)、脑电双频指数(bispectral index，BIS)、术者满意度评分及调节眼位配合度评分，术中恶心呕吐、眼心反射、呼吸抑制、血压心率等情况，以及丙泊酚、瑞芬太尼输注速度。结果：镇静镇痛组患者丙泊酚持续输注速度为0.6~1.8 mg/(kg·h)，瑞芬太尼持续输注速度为0.01~0.03 μg/(kg·min)。镇静镇痛组患者 术中VAS、BIS、心率增快发生率均低于单纯局部麻醉组(P<0.05)，术者满意度评分、血压下降发生率均高于单纯局部麻醉组(P<0.05)；两组患者术中恶心呕吐、眼心反射、呼吸抑制、血压升高发生率及调节眼位配合度评分差异均无统计学意义(P>0.05)。结论：在成人斜视矫正术中，局部麻醉辅 助小剂量丙泊酚联合瑞芬太尼镇静镇痛可有效减轻患者术中疼痛，作用安全可靠。

Objective: To explore the effect of local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil in adult strabismus surgery. Methods: This study was a prospective cohort study. Twenty-four adult patients who underwent strabismus surgery in Beijing Tongren Hospital from October 1, 2020 to May 31, 2021 were selected and divided into local anesthesia group, and sedation and analgesia group, eachwith 12 patients. All patients received local anesthesia with a mixture of 2% lidocaine 10 mL and 0.1% epinephrine 0.1 mL, and intravenous ondansetron 8 mg. Patients in the sedation and analgesia group received intravenous infusion of midazolam 1mg and sufentanil 5 μg, followed by continuous infusion of propofol 0.6–3 mg/(kg·h) and remifentanil 0.01~0.05 μg/(kg·min) to maintain Ramsay sedation score at grade II. Visual Analogue Scale (VAS), bispectral index (BIS), operator’s satisfaction score, patient’s coordination score, nausea and vomiting, oculocardiac reflex, respiratory depression, blood pressure, heart rate and the infusion rate of propofol and remifentanil during operation were recorded in these two groups. Results: In the sedative and analgesic group, the infusion rates of propofol and remifentanil were 0.6–1.8 mg/(kg·h) and 0.01–0.03 μg/(kg·min), respectively. VAS, BIS and the incidence of increased heart rate in the sedation and analgesia group were lower than those in the local anesthesia group (P<0.05); operator’s satisfaction score and the incidence of decreased blood pressure in the sedation and analgesia group were higher than those in the local anesthesia group (P<0.05); there was no significant difference in the incidence of intraoperative nausea and vomiting, oculocardiac reflex, respiratory depression, elevated blood pressure and patient’s coordination score between the two groups (P>0.05). Conclusion: In adult strabismus surgery, local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil can effectively relieve intraoperative pain, which is safe and reliable.

目的：观察盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术中的临床应用效果，评价盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术麻醉中的有效性和安全性。方法：选择2020年11月至2021年7月在佛山市第二人民医院择期行眼睑肿物刮除术的70例患儿，随机分为A组和B组，每组35例。A组采用七氟烷联合丙泊酚复合麻醉，B组采用盐酸艾司氯胺酮联合丙泊酚复合麻醉。记录两组患儿诱导时间、手术时间、苏醒时间、复苏总时间；监测麻醉前、麻醉后5 min、手术开始前、手术结束后患儿血流动力学及呼吸频率变化；记录两组患儿苏醒后即刻、返回病房即刻的东安大略儿童医院疼痛评分量表(Children’s Hospital of Eastern Ontario Pain Scale，CHEOPS)疼痛评分、躁动评分、恶心呕吐评分。结果：两组患儿麻醉诱导时间比较差异无统计学意义(P>0.05)；两组患儿麻醉过程中血流动力学水平、呼吸频率差异无统计学意义(P>0.05)；B组患儿苏醒时间、复苏总时间均明显低于A组(P<0.05)；B组患儿苏醒后即刻及返回病房即刻CHEOPS疼痛评分、躁动评分、恶心呕吐评分均明显低于A组(P<0.05)。另外，B组患儿术后出现恶心呕吐概率低于A组(P<0.05)。结论：盐酸艾司氯胺酮联合丙泊酚应用于小儿眼睑肿物刮除术麻醉，能提供良好麻醉镇痛效果，降低躁动反应和恶心呕吐的发生

Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.

目的：观察喉罩通气吸入七氟醚麻醉在小儿眼底荧光素造影检查(fundus fluorescein angiography，FFA)期间眼位情况、眼球运动的发生率和丙泊酚调整眼位的有效率。方法：回顾性分析2018年6月至2019年12月七氟醚麻醉下接受FFA的儿童的病例资料，记录检查开始时眼位分级、检查中眼球运动发生率、丙泊酚调整眼位的有效率、麻醉后恢复自主活动时间以及不良事件。结果：纳入1~9岁患儿54例，检查开始时42.6%(23/54)的患者眼位1级，51.9%(28/54)的患者眼位2级，5.6%(3/54)的患者眼位3级，检查中眼球运动发生率为61.1%(33/54)。13%(7/54)的患儿需丙泊酚干预，丙泊酚1 mg/kg纠正眼位的有效率为100%。患儿麻醉后恢复正常活动的平均时间为24.4 min，未发生不良事件。结论：喉罩复合七氟醚的麻醉可为门诊小儿眼底荧光造影提供相对满意的麻醉质量，患者在麻醉后可迅速恢复日常活动，丙泊酚可迅速纠正检查中眼位不正。

Objective: To observe the eye position, the incidence of eye movement and the efficacy of propofol on correcting eccentric eyeball position in children undergoing examination of outpatient fundus fluorescein angiography (FFA) with inhaled sevoflurane via laryngeal mask airway. Methods: Children undergoing FFA with sevoflurane anesthesia from June 2018 to December 2019 were retrospectively reviewed. Eye position at the beginning of examination, incidence of eye movement during examination, the efficiency of propofol on correcting eccentric eyeball position during procedure, the time to resume normal activities, and adverse events were recorded. Results: Fifty-four children aged 1–9 years were included in this study. The rates of eye position from grade one to grade three at the beginning of examination were 42.6% (23/54), 51.9% (28/54), and 5.6% (3/54), respectively. The incidence of eye movement during examination was 61.1% (33/54). 13% (7/54) of children with unsatisfactory eye-position needed intervention with propofol. The efficacy of propofol (1 mg/kg) in correcting eye position was 100%. The mean time to return normal activities was 24.4 min. There were no any adverse events during the peri-anesthetic period. Conclusion: Inhaled sevoflurane via LMA can provide appropriate anesthesia for outpatient FFA in children. Children can resume daily activities soon after anesthesia. Propofol can return the incorrect eye position during examination

目的： 探讨儿童双目视力筛查仪在先天性白内障中的应用。 方法： 本文为回顾性分析，选择 2017 年 7 月 至 2018 年 5 月在厦门市儿童医院眼科的 3 个月至 2 岁婴幼儿 336 例(672眼)，均由2个固定的医生分别采用小瞳孔红光反射及儿童双目视力筛查仪检查，同时详细记录病史资料。所有患儿均给予裂隙灯检查、复方托品卡胺散瞳后行眼底检查，对眼底无法窥入的者必要时给予眼部B超检查或眼部MRI检查，以排除眼底病变。结果：依据2009年出版的第5版《Harley’s小儿眼科学》的先天性白内障临床分类方法，本组病例中先天性白内障的类型依次为皮质(核)白内障2 7例(35眼)，其中胚胎核2例( 4眼)，板层2 3例(29眼)，核性2例( 2眼)；囊膜性白内障1 9例(28眼)，缝合性白内障2例( 4眼)，极性白内障3例( 6眼)，全白内障2例( 3眼)。儿童双目视力筛查仪筛查出先天性白内障的灵敏度为81.58%，特异度为79.87%，诊断符合率为80.06%；红光反射筛查的先天性白内障的灵敏度为51.32%，特异度为69.97%，诊断符合率为67.86%；两组结果比较均有统计学意义。儿童双目视力筛查仪对皮质(核)性白内障筛查率为97.14%，而红光反射的筛查率为37.14%，结果比较具有统计学意义。结论：儿童双目视力筛查仪在先天性白内障筛查中，具有低漏诊率和误诊率，较高的诊断一致性的优势，尤其对皮质(核)性白内障有高的检出率，将有利于在日常儿童眼保健的辅助筛查工作中，及早发现先天性白内障患儿。

Objective: To explore the application of children’s binocular vision screening instrument in screening congenital cataract. Methods: This was a retrospective analysis of 336 infants aged 3 months to 2 years (672 eyes) who were admitted to the Ophthalmology Department of Xiamen Children's Hospital from July 2017 to May 2018. They were examined by two fixed doctors with the pupil red light reflex and binocular vision screening instrument, and the medical history was recorded in details. All the children received slit lamp examination, compound tropicamide mydriasis and fundus examination. If necessary, the children who could not see fundus were given with B-ultrasonic examination or MRI examination. Results: According to the clinical classification of congenital cataracts published in the 5th edition of Harley’s pediatric ophthalmology in 2009, In this group, there were 27 cases (35 eyes) of congenital cataract, including 2 cases (4 eyes) of embryonic nucleus, 23 cases (29 eyes) of lamellar layer, 2 cases (2 eyes) of nuclear cataract, 19 cases (28 eyes) of capsular cataract, 2 cases (4 eyes) of suture cataract, 3 cases (6 eyes) of polar cataract and 2 cases (3 eyes) of total cataract. The sensitivity of children’s binocular vision screening instrument screening congenital cataract was 81.58%, the specificity was 79.87%, and the diagnostic coincidence rate was 80.06%; the sensitivity of red reflection screening congenital cataract was 51.32%, the specificity was 69.97%, and the diagnostic coincidence rate was 67.86%; the results of the two groups were statistically significant. The screening rate of children's binocular vision screening instrument for cortical (nuclear) cataract was 97.14%, while that of red reflex was 37.14%. The results were statistically significant. Conclusion: In the screening of congenital cataract, the binocular vision screening instrument for children has the advantages of low missed diagnosis rate, high misdiagnosis rate and high diagnostic consistency, especially for cortical (nuclear) cataract. It is helpful to find the congenital cataract early in the auxiliary screening of children’cares eye health