目的：在麻醉监测管理(monitored anesthesia care，MAC)中，通过与咪唑安定比较，观察右美托咪 定在玻璃体视网膜手术中应用的效果、安全性，探讨其应用可行性。方法：将择期玻璃体视网膜 手术患者40例随机双盲分入咪唑安定组(M组)和右美托咪定组(D组)。每组20例，两组患者均行球 后神经阻滞麻醉，连接脑电双频指数(bispectral index，BIS)监测仪监测并维持BIS值在70~90间， 观察和比较麻醉手术中及复苏期的平均动脉压(mean arterial pressure，MAP)、心率(heart rate， HR)、呼吸频率(respiratory rate，RR)、脉搏氧饱和度(oxygen saturation，SpO2)、Ramsay镇静评 分、疼痛数字评分法(Numerical Rating Scale，NRS疼痛评分)、手术医生和患者麻醉效果评分及不 良反应的差异。结果：与麻醉前比较，手术期D组用药后10 min内的心率、血压下降差异有统计学 意义(P<0.05)，且用药后10 min内D组心率下降幅度较M组更大(P<0.05)。在手术期和复苏期，D组 的NRS疼痛评分均显著低于M组且差异有统计学意义(均P<0.001)，而两组的Ramsay镇静评分差异 无统计学意义(P>0.05)。D组手术期患者的体动发生率和羟考酮使用率显著低于M组(均P<0.05)。 手术医生和患者的麻醉效果评分D组显著高于M组(均P<0.001)。结论：右美托咪定用于玻璃体视 网膜手术，较咪唑安定镇痛效果好且不良反应少，麻醉效果更好。

Objective: The aim of this study was to compare the efficacy and safety of dexmedetomidine versus midazolam for the monitored anesthesia care (MAC) management of patients undergoing vitreoretinal surgery. Methods: Forty patients undergoing selective vitreoretinal surgery were double-blind and randomly dividedinto midazolam group (group M) and dexmedetomidine group (group D), each group had 20 patients. Patients in both groups were anesthetized with posterior bulbous nerve block. Bispectral index (BIS) monitor was connected and the BIS value was maintained between 70 and 90. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), Ramsay sedation score, numerical rating scale (NRS), surgeon’s and patient’s anesthesia effect score and adverse reactions were recorded during anesthesia and recovery period. Results: Compared with the data of pre-anesthesia, there were statistical differences of the decrease of HR and MAP in group D within the 10 minutes after medication (P<0.05), and the decrease of HR in group D was greater than that in group M (P<0.05). The NRS pain score in group D was significantly lower than that in group M with statistical significance (P<0.001) during the operation and resuscitation, while there was no significant difference in Ramsay sedation score between the two groups during the operation and resuscitation (P>0.05). In terms of adverse reactions to anesthesia, the incidence of spontaneous movement and oxycodone utilization in group D were significantly lower than those in group M (P<0.05). The anesthesia effect scores of surgeons and patients in group D were significantly higher than those in group M (all P<0.001). Conclusion: Dexmedetomidine has better analgesic effect and less adverse reactions than midazolam in vitreoretinal surgery.

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.

小儿眼科麻醉的挑战是既要保障患儿的麻醉安全又要提高手术接台效率。麻醉前的充分评估和详细的准备可以有效地降低麻醉期间的并发症。在麻醉前访视期间，需要做到仔细地询问病史，全面的麻醉体格检查及必要的实验室检查或专科会诊，完成充分告知任务，从而提高小儿眼科麻醉安全性。

The challenge of pediatric ophthalmic anesthesia is how to balance the safety and efficiency of ophthalmic surgery. Careful pre-operative evaluation and preparation can effectively reduce potential complications during pediatric ophthalmic anesthesia. During the preoperative assessment, it’s necessary to gather information, perform a full physical examination, take required laboratory tests or consultations with specialties, and deliver appropriate information and consent to increase the safety of pediatric ophthalmic anesthesia

目的：分析临床应用镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻的效果。方法：回顾性分析安康市中医医院2年期间，应用镜下改良眼轮匝肌手术治疗61例(112眼)儿童先天性下睑内翻，根据睑内翻程度决定缝线跨度、松紧度及去除肌皮瓣量，0/6缝线将睑缘下眼轮匝肌与下睑缩肌缝合，0/8缝线连续缝合皮肤伤口，并做好术后护理。结果：所有患儿随访6~24个月，刺激症状缓解，106眼治愈，2眼好转，4眼复发，总有效率达96.43%。结论：镜下改良眼轮匝肌手术治疗儿童先天性下睑内翻美观、易操作、复发率低。

Objective: To analyze the clinical efficacy of modified orbicularis oculi surgery under microscope in the treatment of congenital lower eyelid entropion of children. Methods: Sixty-one cases (112 eyes) of children with congenital lower eyelid entropion treated by modified orbicularis oculi surgery in Ankang Hospital of Traditional Chinese Medicine from Aug 2020 to Sep 2022 were retrospectively analyzed. The suture span, tightness and the amount of myocutaneous flap removed were determined according to the degree of entropion. The orbicularis oculi muscle of lower eyelid margin was suturedwith 0/6 suture, and the skin wound was sutured continuously with 0/8 suture, and postoperative nursing was done well. Results: All children were followed up for 6–24 months, and the irritation symptoms were relieved, 106 eyes were cured, 2 eyes turned well, and 4 eyes relapsed. The total effective ratereached 96.43%. Conclusion: The modified orbicularis oculi surgery for treatment of children with congenital lower eyelid entropion conforms to visual aesthetics. In addition, it is easy to operate and have a low recurrence rate.

目的：探索白内障术眼低视力的原因。方法：对2011年10月至2013年3月在汕头国际眼科中心行白内障手术，术前无法窥清眼底，术后1周最佳矫正视力<0.3的患者进行视力、最佳矫正视力、眼压测量、裂隙灯检查、眼底镜检查、眼底照相及光学相干断层扫描(optical coherence tomography，OCT)，若未发现任何视网膜器质性病变，再进行视觉诱发电位检查及视野检查。由2位医生对检查结果进行分析，对不同的眼底病变做出诊断，统计分析白内障术眼低视力的原因。结果：共纳入行白内障手术患者5 608例，术后1周最佳矫正视力<0.3的患者共49例(共49眼)，其中男20例，女29例，右眼31只，左眼18只，年龄(69.11±12.05)岁。白内障术后低视力比例为0.87%。其中高度近视性脉络膜视网膜病变12例(24.5%)，椭圆体带连续性破坏10例(20.4%)，糖尿病性视网膜病变8例(16.3%)，黄斑孔5例(10.2%)，老年性黄斑变性4例(8.1%)，黄斑前膜3例(6.1%)，黄斑区视网膜厚度变薄1例(2.0%)，视网膜色素变性1例(2.0%)，视网膜劈裂症1例(2.0%)，视网膜分支动脉阻塞1例(2.0%)，白塞氏病1例(2.0%)，缺血性视神经病变1例(2.0%)，视网膜前膜1例(2.0%)。结论：在本组白内障术眼低视力的患者中，高度近视性脉络膜视网膜病变占主要部分，为24.5%，其次分别为椭圆体带连续性破坏、糖尿病性视网膜病变、黄斑孔、老年性黄斑变性和黄斑前膜。利用OCT可发现影响白内障术后视力的细微视网膜结构变化，对于白内障术前眼底可见的患者常规行OCT有利于判断手术预后，便于医患沟通，提高手术满意度。

Objective: To explore the causes of low vision after cataract surgery. Methods: Patients who underwent cataract surgery at Joint Shantou International Eye Center of Shantou University and the Chinese university of Hong Kong ( JSIEC) from October 2011 to March 2013, whose fundus status could not be seen before surgery, and the best corrected visual acuity <0.3 in the first week after surgery, underwent a series of detailed ocular examinations, including visual acuity, best corrected visual acuity, intraocular pressure, slit-lamp examination, fundus examination, fundus photography and optical coherence tomography. If no organic lesions of the retina were found, then visual evoked potential examination and visual field examination were performed. Two doctors analyzed the examination results of the examination, made the diagnosis of different fundus diseases, and statistically analyzed the causes of low vision after cataract surgery. Results: A total of 5 608 cataract surgeries were performed in our hospital from October 2011 to March 2013. A total of 49 patients (49 eyes) with best corrected visual acuity worse than 0.3 within postoperative 1 week 20 male and 29 female, 31 right eyes and 18 left eyes, aged (69.11±12.05) years on average. The proportion of low vision after cataract surgery was 0.87%. 12 cases (24.5%) of high myopic chorioretinopathy, 10 cases (20.4%) of ellipsoidal band defect, 8 cases (16.3%) of diabetic retinopathy, 5 cases (10.2%) of macular holes, 4 cases (8.1%) of age-related macular degeneration, 3 cases (6.1%) of macular epiretinal membrane, 1 case (2.0%) of thinning macular retinal thickness, 1 case (2.0%) of retinitis pigmentosa, 1 case of retinoschisis (2.0%), 1 case of branch retinal artery occlusion (2.0%), 1 case of Behcet’s disease (2.0%), and 1 case of ischemic optic neuropathy (2.0%), 1 case of epiretinal membrane (2.0%). Conclusion: Among patients with low vision after cataract surgery, high myopic chorioretinopathy accounts for 24.5%, followed by ellipsoidal band defect, diabetic retinopathy, macular hole, age-related macular degeneration, and macular epiretinal membrane. The use of optical coherence tomography can detect subtle microscopic retinal structural changes that affect vision after cataract surgery. For patients with visible fundus before cataract surgery, routine optical coherence tomography contributes to evaluating the prognosis of the operation, facilitating doctorpatient communication, and improving the degree of surgical satisfaction.

随着科学技术的提高、手术方式的改进，角膜屈光手术成为治疗近视的主要方式。角膜屈光手术后角膜形态及生物力学的变化对于尽早发现术后相关并发症及术后长期稳定性具有重要意义，不同的术式及术后不同的恢复阶段角膜表面非球面参数及生物力学指标的变化存在一定差异，明确其变化的原因及机制可对临床研究提供一定的参考。

With the improvement of science and technology and the improvement of surgical methods, corneal refractive surgery has become the main way to treat myopia. The changes of corneal morphology and biomechanics after corneal refractive surgery are of great significance for early detection of postoperative complications and also affect the long-term stability after corneal refractive surgery. There are some differences in the changes of aspheric parameters and biomechanical properties in different surgical procedures and different postoperative recovery stages. Clarifying the reasons and mechanisms of these changes can provide some reference for clinical research.

目的：总结大批量白内障扶贫手术的护理安全管理经验。方法：回顾性分析2013至2016年中山大学中山眼科中心医疗队完成大批量白内障扶贫手术的经验、针对下乡扶贫的特殊环境、患者入院时间短、手术量大、接台手术多以及患者自我管理能力差等情况，分析其安全隐患，并在护理过程中采取相应的安全措施。术前充分评估和准备，对患者进行健康指导；术中对手术环境规范管理；指导加强术后患者的自我管理。结果：8批次共1 064例白内障摘除联合人工晶体植入术顺利完成，无1例发生术后感染。结论：建立大批量白内障扶贫手术护理安全质量管理的规范流程是扶贫工作的重要环节，做好术前的评估和准备工作，落实患者的健康教育及术后患者自我管理指导，才能确保手术顺利进行。

To assess the safety of mass volume of cataract surgery and to identify the possible factors with enhanced patients’ safety. Methods: This is a retrospective case series. Clinical data of patients undergoing charity cataract extraction by surgeons from Zhongshan Ophthalmic Center between 2013 and 2016 was reviewed. The following factors were analyzed: safety management peri-operatively, educational interventions, intraoperative sterilization, and self-management after operations. Results: A total of 1064 patients (8 sessions) underwent cataract extraction and intraocular lens implantation. No evidence of endophthalmitis in any cases was observed. Conclusion: Establishment of standardized operation procedures for nursing safety management is essential for safety of mass volume of charity cataract surgery in China. Adequate assessment and peri-operative endeavor, educational interventions, nurse guided self-management should be empowered to enhance patients’ safety.