人工智能(artificial intelligence，AI)在白内障手术中的应用越来越广泛，二者结合对于白内障手术的术前诊断和分级管理、术中人工晶状体选择、位置预测及术后管理(视力预测、并发症预测及随访)、手术培训和教学方面均起到巨大的促进作用。诚然，AI在与白内障手术相关的管理、分析和研究中还面临着许多问题，但其广泛的应用前景不可忽视。现对AI在白内障手术治疗和教学中的应用做以总结，并对其未来的发展做出展望。
Artificial intelligence (AI) has been widely used in cataract surgery. The combination of the two can play a great role in improving preoperative diagnosis, grading management of cataract surgery, intraoperative intraocular lens selection and location prediction, postoperative management (vision prediction, complication prediction and follow-up), surgical training and teaching. It is true that AI still faces many problems in the management, analysis and research related to cataract surgery, but its broad application prospects cannot be ignored. This review summarizes the application of AI in cataract surgery and teaching, and the future prospects of AI.
人工智能(artificial intelligence，AI)为解决中国患者“看病难”问题提供了可行方案。眼科AI已实现为患者提供筛查、远程诊断及治疗建议等方面的服务，能显著减轻医疗资源不足的压力和患者的经济负担。而AI的应用过程中，给医疗管理带来的挑战应引起重视。本文从医疗管理的角度，总结分析AI在眼科医疗过程中，尤其是交接环节中出现的主要问题，提出对策与建议，并讨论AI在眼科医疗的应用展望。
Artificial intelligence (AI) has been proposed as a potential solution to address the shortage of ophthalmologists in China. With the increasingly extensive application of AI in the field of ophthalmology, many potential patients with eye diseases have access to a higher quality of medical services. At the same time, new challenges will emerge and proliferate with the advancement of AI application. This paper focuses on the patient handoffs process and discusses two challenges brought by the application of AI, namely “communication” and “standardization”. Natural language processing techniques and the development of standardized databases are proposed to solve each of these challenges. The application prospects of AI in ophthalmology are eventually discussed.
大麻二酚(Cannabidiol,CBD)为大麻提取物中的一种非成瘾性活性成分，是目前研究最热门的植物源性大麻素之一。内源性大麻素系统(endocannabinoid system,ECS)在眼表和视网膜中的研究也已经取得显著进展。CBD可以广泛存在于整个眼球，且其分布和功能具有组织特异性。近年来研究发现CBD具有良好的抗炎、抗损伤、降低眼压及神经保护作用。该文详细介绍了CBD在眼部疾病中的研究进展，以及其对各种眼部疾病的治疗潜力。此外，还讨论了CBD在临床眼科治疗中的应用面临的挑战和未来的发展方向。
Cannabidiol(CBD), a non-addictive active ingredient in cannabis extract, is one of the most popular plant-derived cannabinoids. The study on the endoenuous cannabionoid system (ESC) has made significant progress in the ocular surface and retina. CBD exists extensively in the eyeball, and its distrution and functions of anti-inflammatory,antiinjury, reducing intraocular pressure, and neuroprotective effects have been found. This article introduces the research progress in CBD in eye diseases and the therapeutic potential of cannabidiol for various eye diseases in detailed.Furthermore, the challenges and prospect for the application of CBD in clinical ophthalmology were discussed.
近5年来眼睑皮脂腺癌研究取得一系列成果。临床研究方面，明确了眼睑皮脂腺癌冰冻切缘控制显微手术的意义，提出了患者预后指标；在基础研究方面，描述了基因突变谱，揭示了3种相互独立的发病模式，以及提出了免疫及靶向治疗相关研究；我国眼肿瘤工作者也在眼睑皮脂腺癌研究方面树立了国际地位。本文对近5年国内外眼睑皮脂腺癌相关研究方面的主要成果进行总结分析，并展望治疗前景，为临床提供有益参考。
In recent 5 years, a series of studies have been made in the mechanism of onset of eyelid sebaceous carcinoma worldwide. In clinical research, the prognosis has made in predicting progression of patients with eyelid sebaceous carcinoma, and the significancy of frozen margin control in microsurgery was clarified. In field of basic research,from elucidation of mutational landscape to revelation of three independent pathogenesis patterns, from researches on immunotherapy to targeted therapy, efforts have been made to reveal the pathological mechanism to both aspect of its morbidity and development. This paper summarizes, analyzes and reviews the main achievements in recent 5 years on eyelid sebaceous carcinoma.
眼科病理学是系统组织病理学的重要分支，作为基础医学与临床医学之间的桥梁和纽带，对于深入认识和揭示眼部疾病的发病特点发挥着重要作用。眼科病理学在老一辈专家们的努力下奠定了坚实的基础。目前眼科病理学学科的发展随着眼科临床技术以及系统病理学的发展在不断的前进，细胞生物学及分子生物学的全方位结合和纵深应用带动并拓展了眼科病理学的研究领域，临床病理学及实验病理学的研究不断更新，新形势下眼科病理学的发展充满着机遇和挑战。
Ophthalmic pathology is an important branch of histopathology. As a bridge and link between basic medicine and clinical medicine, ophthalmic pathology plays an important role in understanding and revealing the characteristics of ocular diseases. The previous generations have laid a solid foundation for ophthalmic pathology with their hard work. Moreover, the advancement of ophthalmic clinical technology and systematic pathology in recent years have further facilitated the development of ophthalmic pathology. The comprehensive combination and in-depth application of cell biology and molecular biology have promoted and expanded the research field of ophthalmic pathology. In addition, new progress has been witnessed in the field of clinical pathology and experimentalpathology constantly. Under the new situation, the development of ophthalmic pathology is faced with both opportunities and challenges.
青光眼是全世界范围内不容忽视的致盲性眼病，其起病隐匿，视功能损害进展迅速，晚期预后不理想。长期发展且未行治疗的青光眼患者视神经呈进行性损害，引起视力急剧下降、视野不可逆性缺损，严重降低患者的生活质量。为了适应逐渐恶化的视功能，患者注视行为发生明显变化，由此在日常活动中引起步态行为随之改变，意外事故频繁发生。故目前对于青光眼的研究引起国内外广泛重视，虚拟现实技术(virtual reality，VR)作为青光眼早期诊断及康复治疗的新手段已被现代医学所尝试。本文具体阐述了青光眼的视觉损害与注视行为及运动行为间的联系，并总结了目前国内外关于VR诊断青光眼及作为康复治疗的相关研究。
Glaucoma is a blinding eye disease that cannot be ignored worldwide. Its onset is insidious, visual impairment is progressing rapidly, and the late prognosis is not ideal. Long-term untreated glaucoma patients show progressive damage to the optic nerve, causing a sharp decline in vision, irreversible visual field defects, and severely reducing the quality of life of the patients. In order to adapt to the gradual deterioration of visual function, the patient’s gaze behavior changes significantly, which causes the gait behavior to change in daily activities, and accidents occur frequently. Therefore, the current research on glaucoma has attracted wide attention in the nation and abroad,and virtual reality (VR) technology has been tried in modern medicine as a new method for early diagnosis and rehabilitation of glaucoma. This article specifically elaborates the relationship between the visual impairment of glaucoma and the gaze behavior and movement behavior, and summarizes the current domestic and foreign research on the diagnosis of glaucoma and the rehabilitation of VR technology.
目的：观察急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy，CSC)的自然病程中渗漏点的形态及变化。方法：本研究为前瞻性研究，使用光学相干断层扫描(optical coherence tomography，OCT)观察从发病到发病后5~13个月的CSC患者的渗漏点的OCT形态，测量并计算Hall层、脉络膜全层各自厚度及比值，并进行比较。结果：共20例患者[男14例，女6例，年龄33~59(中位数41)岁]纳入研究。随访时间为5~13个月。在19例患者中观察到微小视网膜色素上皮脱离(pigment epithelium detachment，PED)。1例患者可见视网膜色素上皮(retinal pigment epithelium， RPE)小凸起。在随访期间，仅1例患者的PED完全恢复，其他19例患者在视网膜下液被完全吸收时，RPE和Bruch膜之间仍存在微小分离。渗漏点处的Haller层/脉络膜厚度显著高于中央凹处(初诊时0.806±0.08 vs 0.863±0.06，P=0.003；最后1次随访时为0.801±0.07 vs 0.851±0.06，P=0.004)。结论：本研究观察到在急性CSC患者自然病程中，即使视网膜下液吸收，OCT显示渗漏点处仍存在持续的PED，更厚的Haller层及更薄的内层脉络膜，这些发现为CSC的发病机制提供了更多线索。
Objective: To observe the morphology and changes of leakage points in the natural course of acute central serous chorioretinopathy (CSC). Methods: This study was a prospective study, using optical coherence tomography to observe the OCT morphology of leakage points in CSC patients from onset to 5 to 13 months after onset, measuring the thickness and ratio of Hall layer and the whole choroid, and then compare them. Results: A total of 20 patients were included in the study, including 14 males and 6 females, aged from 33 to 59, with the median being 41 years old. The follow-up time ranged from 5 months to 13 months. Minute retinal pigment epithelial detachments (PED) were observed in 19 patients. A small bulge of retinal pigment epithelium (RPE) was observed in 1 patient. During the follow-up, only one patient totally recovered. Small separation between RPE and Bruch membrane still exit even subretinal fluid were absorbed completely in the other 19 patients. The thickness of Haller layer or choroid at the leakage point was significantly higher than that of the fovea (0.806±0.08 vs 0.863±0.06, P=0.003, at the first visit; 0.801±0.07 vs 0.851±0.06, P=0.004, at the last follow-up). Conclusion: This study observed that in the natural course of acute CSC patients, even if the subretinal fluid was absorbed, OCT still showed that there was persistent PED at the leakage point, thicker Haller layer and thinner inner choroid layer. These findings provided more clues to the pathogenesis of CSC.
内源性干细胞在组织的损伤修复过程中组织相容性好、致瘤风险低，相较于外源性干细胞具有不需要体外扩增和培养、疾病传播风险低的优点，在细胞治疗领域具有显著优势。现在已经有多种使用内源性干细胞进行疾病治疗的成熟方式，应用领域包括了全身各种器质性和功能性疾病。在眼组织中，晶状体具有终生生长的能力且便于观察，是实现再生修复的突破点。哺乳动物中晶状体再生的实现有赖于晶状体内源性干细胞的定位和改良手术方式，以保留晶状体干细胞，并创造适合晶状体再生的微环境。对再生后的晶状体蛋白质组成分析，发现其类似成熟晶状体，而非胚胎期的晶状体，提示晶状体再生的调控与胚胎期的诱导发生并不相同；而调控晶状体再生的策略不仅着眼于干细胞的激活和正确分化的诱导，对其上皮间质转化过程也需要进行调控。在未来，为将晶状体再生的经验应用于其他眼组织中，动员内源性干细胞并促进其生长，可以添加细胞有效成分，比如外泌体、线粒体、小分子化合物等，模拟细胞应激；此外，还可以通过手术或生物材料辅助，恢复晶状体结构和环境。
Endogenous stem cells have significant advantages in cell therapy for excellent histocompatibility, low tumorigenicity risk, unnecessity for in vitro expansion and culture, and low disease transmission risk. There have been some applications for endogenous stem cells in treating diseases, targeting some organic and functional diseases throughout the body. In ocular tissue, the lens is a breakthrough for regenerative therapy due to its potential to grow throughout life and observation accessibility. Achieving lens regeneration in adult mammals attributes to some prerequisites. Firstly, the location of endogenous stem cells in the lens has been identified. Then, surgical approaches have been advanced to preserve lens stem cells and create a microenvironment suitable for lens regeneration. Protein compositional analysis of the regenerated lens reveals that it is similar to a mature lens rather than an embryonic lens, suggesting that the regulation of lens regeneration is not the same as the induction of embryonic onset. The strategy for regulating lens regeneration needs to focus not only on the activation and proper differentiation of stem cells but also on regulating the process of epithelial mesenchymal transition (EMT). In the future, in order to apply the experiences of lens regeneration to other ocular tissues, to mobilize endogenous cells and promote their growth, some strategies could be used. These strategies include mimicking cellular stress via the addition of cellular active ingredients, such as exosome, mitochondria, and small molecular compounds. Additionally, we can also try to restore lens tissue structure and microenvironment through surgical or biomaterial assistance.
鼻内镜外科技术延伸到鼻眼相关疾病的诊断和治疗已经有二十余年的历史。随着鼻眼相关解剖研究、影像诊断技术和手术器械的进步和手术临床经验的积累，大量临床和基础研究不断涌现，逐渐形成了相对成熟的内镜鼻眼相关外科理论与实践体系。本文概述了内镜鼻眼相关外科的发展现状，对几种主要手术提供经验总结并提出展望。
Nasal endoscopic surgery technology has gradually developed and involved into the diagnosis and treatment of nose-eye related disease for more than 20 years. With the improvement of anatomical studies on nose-eye, imaging diagnostic technology and surgical instruments, the accumulation of surgical clinical experience, as well as the increasing emergence of a large number of clinical and basic studies on endoscopic rhino-orbital related surgery, a well-established theoretical and practical system of endoscopic nose-eye surgery has gradually been formed. This article summarized the development of endoscopic rhino-orbital surgery, and the advantages and limitations of several major surgical methods. Also, the further research was prospected.
