2020年3月 第35卷 第1期

主管:中华人民共和国教育部
主办:中山大学
承办:中山大学中山眼科中心
主编:葛坚 刘奕志
封面故事
论著

氦氖激光治疗喀什地区儿童弱视的随机对照研究

氦氖激光治疗喀什地区儿童弱视的随机对照研究

:2-7
 
目的:通过随机对照试验,观察氦氖激光在喀什地区弱视儿童中的治疗效果。方法:选取2016年2月至2018年11月期间就诊喀什地区第一人民医院符合纳排标准的弱视儿童,按随机数字表法,分为试验组(氦氖激光+弱视常规治疗组)与对照组(弱视常规治疗组),比较两组的弱视治疗效果。结果:本试验成功纳入弱视儿童111例(177眼),其中试验组61例(97眼),对照组50例(80眼)。与对照组相比,汉族试验组弱视儿童效果明显(P=0.023),维吾尔族试验组弱视儿童未见明显疗效(P=0.481);试验组与对照组在喀什地区不同年龄、不同弱视程度、不同弱视类型及不同弱视眼数儿童中未见明显差异(P>0.05)。结论:氦氖激光治疗喀什地区弱视儿童作用有限,为避免过度医疗,不建议在南疆地区开展。
Objective: To observe the therapeutic effect of helium-neon laser in amblyopia children in Kashgar by a randomized controlled trial. Methods: Amblyopia children who met eligibility criteria during February 2016 to November 2018 were selected and divided into two groups according to random number table: test group(helium-neon laser + conventional treatment for amblyopia) and control group (conventional treatment for amblyopia). The effects of amblyopia treatment were compared between two groups. Results: One hundred and eleven amblyopic children (177 eyes), including 61 children (97 eyes) of the test group and 50 children (80 eyes) of the control group were included in this study. The effect of helium-neon laser was significant in Han children (P=0.023), but not in Uygur children (P=0.481) in the test group compared with the control group.Conclusion: Helium-neon laser has limited effect in treating children with amblyopia in Kashgar region. To avoid over-treatment, it is not recommended to perform it in southern Xinjiang.

儿童双目视力筛查仪在筛查先天性白内障中的应用

Application of binocular vision screening instrument for children in screening congenital cataract

:8-14
 
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

两种不同部位强脉冲激光治疗方法对睑板腺功能障碍所致干眼的疗效

Efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction

:15-21
 
目的:对比两种不同部位M22优化脉冲激光治疗方法治疗睑板腺功能障碍(meibomian gland dysfunction,MGD)所致干眼的疗效。方法:回顾性分析汕头博德眼科医院干眼门诊患者105例,包括常规治疗组和改良治疗组两个组别,常规治疗组激光部位为下睑,改良治疗组激光部位为联合上下睑,所有患者行M22优化脉冲光治疗一个疗程(每月1次,共3次),治疗前后均采用keratograph 5M干眼分析仪分析评估患者的泪河高度情况、泪膜破裂时间(break-up time,BUT)、角膜荧光染色(corneal fluorescence staining,CFS)和睑板腺排出能力等参数。采用t检验分析对比治疗前后变化情况。结果:患者治疗后泪河高度较强脉冲光治疗前明显增高,BUT时间延长,角膜荧光染色和睑板腺排出能力评分均有好转,每组治疗后与治疗前差异有统计学意义(P<0.01),两组间治疗前后各参数差异比较均没有统计学意义。结论:两种不同部位M22优化脉冲激光治疗方法在治疗MGD导致的干眼方面有较好的效果,是较安全有效地治疗方法,两种不同方法治疗效果无明显差异。
Objective: To study the efficacy of two methods of M22 optimal pulsed technology in the treatment of dry eye caused by meibomian gland dysfunction (MGD). Methods: A total of 105 patients collected from Shantou Balder Eye Hospital were divided into two groups. The treatment position of the conventional group was lower eyelid, the other group was combined with upper and lower eyelid. All patients accepted M22 Optimal Pulsed Technology treatment for three times, once a month. Keratograph 5M dry eye analyzer was used to assess the height of tears river, break-up time (BUT), corneal fluorescence Staining(CFS)and meibomian gland expressibility. The results before and after laser treatment were compared using t-test in this study. Results: After treatment, the height of tear river, BUT, CFS and meibomian gland expressibility were improved. There was a statistically significant difference between each group after and before treatment (P<0.01). There was no significant difference before and after treatment between the two groups. Conclusion: The two methods of M22 Optimal Pulsed Technology are effective in treating dry eyes caused by MGD. There is no significant difference in the therapeutic effect between two methods.

角膜塑形镜使用中镜盒微生物污染的危险因素

Risk factors of micro-organisms contamination of lens cases in Ortho-K wearing

:22-27
 
目的:探究角膜塑形镜(OK镜)配戴者使用中的镜盒的葡萄球菌及假单胞菌污染状况以及其可能存在的危险因素。方法:于四川大学华西医院隐形眼镜门诊收集镜盒使用1个月及以上的O K镜复查患者,使用问卷调查其基本信息与日常配戴情况,并收集其镜盒。收集的镜盒于无菌操作台内取样后转移入葡萄球菌选择培养基与假单胞菌选择培养基,置于37 ℃恒温培养箱中培养48 h后观察微生物生长情况。结果:本研究共收集受试者52例,其中男15例,女37例,年龄(11.8±2.5)岁。在收集的镜盒中,葡萄球菌的检出率为42%(22例),其中金黄色葡萄球菌检出率为21%(11例);假单胞菌的检出率为12%(6例),未发现铜绿假单胞菌,总体微生物检出率为44%(23例)。存放于客厅或书房的镜盒微生物检出率为25%(5/20),日常存放于卧室或卫生间的镜盒(58%,18/31)。日常护理由家长完成的镜盒微生物检出率为31%(10/32),由戴镜儿童本人完成的镜盒微生物检出率为65%(13/20)。随着镜盒使用时间的增加,镜盒内微生物的检出率的增加差异无统计学意义。结论:OK镜戴镜者日常使用的镜盒中,葡萄球菌的污染率较高,其中相当一部分是金黄色葡萄球菌。日常护理操作人员、镜盒存放位置是镜盒污染的危险因素。镜盒使用的时间可能是镜盒微生物污染的危险因素,但是需要进一步的实验验证。
Objective: To investigate microbial contamination in Ortho-K wearer’s lens cases caused by Staphylococcus and Pseudomonas and to solicit its risk factors. Methods: Lens cases used for at least 1 month were collected from Ortho-K wearers coming back for after-care in West China Hospital and an interview using preset questionnaire about their demographic information and lens wearing was performed. Lens cases were sampled in clean bench and the samples were then transferred onto Staphylococcus selective agar plate and Pseudomonas selective agar plate, which were incubated at 37 ℃ for 48 h before observed. Results: A total of 52 subjects were recruited, including 15 male and 37 female, with an average age of (11.8±2.5) years. Contamination rate of Staphylococcus was 42% (n=22), in which 21% (n=11) were detected with Staphylococcus Aureus (SA). With no Pseudomonas Aeruginosa (PA) was detected, the general rate of microbial contamination was 44% (n=23). Contamination rate of cases stored in living room was 25% (5/20), significantly lower than cases stored in bedroom (58%, 18/31). And cases that daily cleaning operated by parents (31%) (10/32) were less contaminated than that operated by children themselves (65%) (13/20). The increase of detection rate of microorganism in lens cases didn’t reach a significant statistical difference with longer use. Conclusion: The contamination rate of Staphylococcus, in which a considerable part was contributed by SA, is high in Ortho-K lens cases. Personnel of daily cleaning and location of case storage are the risk factors of lens case contamination. Length of case use could be a potential risk of microbial contamination but remains to be proved by further research.

光学相干断层扫描血管成像观察玻璃体腔注射抗VEGF治疗视网膜分支静脉阻塞合并黄斑水肿的疗效

Optical coherence tomography angiography used to observe intravitreal injection of anti-VEGF on branch retina vein occlusion combined with macular edema

:28-32
 
目的:以光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗前后的变化。方法:回顾性收集从2017年1月至2018年1 2月在汕头国际眼科中心的确诊为BRVO合并黄斑水肿的患者共3 1例3 2眼。患眼行玻璃体腔注射抗VEGF药物治疗,记录治疗前和治疗后1个月的最佳矫正视力(best corrected visual acuity,BCVA),OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness,FMT)、黄斑区血流密度。比较治疗前后各指标的变化。结果:治疗后BCVA较治疗前显著提高,差异有统计学意义(P<0.001);FMT[(242.13±86.02) μm]较治疗前[(521.44±190.27) μm]明显下降,差异有统计学 意义(P<0.001);中心凹浅层血流密度[(18.44±4.98)%]及中心凹旁浅层血流密度[(44.83±3.19)%]均较治疗前[(25.46±9.21)%,(46.06±5.25)%]相比明显下降,差异有统计学意义(P <0.001)。结论:玻璃体腔注射抗VEGF治疗BRVO合并黄斑水肿效果显著;OCTA能有效评价抗VEGF治疗BRVO合并黄斑水肿的临床疗效。
Objective: To evaluate the efficacy in patients with macular edema due to branch retinal vein occlusion (BRVO) treated with intravitreal anti-VEGF drug. Methods: In this retrospective study, 32 eyes of 31 patients with BRVO combined with macular edema at Joint Shantou international eye center of Shantou University and TheChinese University of Hong Kong during January 2017 to December 2018 were enrolled in this study. All the affected eyes received intravitreal anti-VEGF drug injections. BCVA (best corrective visual acuity) and optical coherence tomography angiography (OCTA) were performed before and one month after intravitreal anti-VEGF drug injections. Foveal macular thickness (FMT), macular blood flow density was measured in all eyes and compared. Results: The BCVA before therapy was (0.77±0.46) LogMAR and increased to (0.46±0.30) LogMAR in one month after therapy, which showed a statistical difference (P<0.001). The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density before therapy were (521.44±190.27) μm, (21.85±6.17)% and (46.29±2.70)%, respectively. The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density decreased to (242.13±86.02) μm, (18.40±5.18)% and (44.75±3.40)%, respectively. There was significant statistical difference for them (P<0.001). Conclusion: Intravitreal injection of anti-VEGF is effective in the treatment of BRVO combined with macular edema. OCTA can effectively evaluate the clinical efficacy of anti-VEGF in the treatment of BRVO combined with macular edema.

亚太眼科学数据中心建设初探

Construction of Asia-pacific ophthalmology data center

:33-42
 
随着亚太眼科学会(Asia-Pacific Academy of Ophthalmology,APAO)永久会址和秘书处落户在中山大学中山眼科中心珠江新城院区眼科学国家重点实验室大楼(中国广州),在大数据时代背景下,建设先进的亚太级眼科学科学数据中心已成为亚太眼科创新战略发展的需要。通过建设科学数据中心,一方面缓解眼科学国家重点实验室项目科研数据增长压力,一方面为眼科大数据与人工智能等新兴科研项目开展提供保障平台,为亚太眼科学科建设打下坚实的数据基础。科学数据中心设计建设遵照国家《科学数据管理办法》实施,以加强和规范科学数据管理,保障科学数据安全,提高开放共享水平,更好支撑国家科技创新、经济社会发展和符合国家信息安全建设方针。
As the Asia-Pacific Academy of Ophthalmology (APAO) secretariat permanently located in the building of State Key Laboratory of Ophthalmology (Guangzhou, China). In big data time, it’s a problem for the development of the Asia-pacific ophthalmology innovation strategy to construct the Asia-pacific science data center of ophthalmology. Through the construction of science data center, alleviate the pressure of the state key laboratory of ophthalmology data growth, for big data and new research fields such as artificial intelligence to provide guarantee, provided a basis for the Asia-pacific eye subject construction. Science data center construction in accordance with national “scientific data management method”, to strengthen and standardize the scientific data management, to ensure the safety of scientific data, improve the level of open sharing, better support scientific and technological innovation, economic and social development and national security as a policy.
综述

糖尿病肾病血液透析治疗与糖尿病视网膜病变的关系

Relationship between the hemodialysis of diabetic nephropathy and the development of diabetic retinopathy

:43-47
 
糖尿病视网膜病变(diabetic retinopathy,DR)在糖尿病肾病(diabetic nephropathy,DN)人群,特别是终末期糖尿病肾病(end stage diabetic nephropathy,ESRD)患者中的发病率和严重程度明显高于糖尿病人群。其中ESRD的一项重要治疗手段——血液透析(Hemodialysis,HD)可能会增加机体氧化应激反应、出血风险以及视神经的缺血缺氧,加重DR的发生发展;但另一方面也可通过清除尿毒症毒素、控制血压以及清除多余体液等途径改善糖尿病和DN对眼部的损伤。
The incidence and severity of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN), especially those with end-stage renal disease (ESRD), were higher than those with diabetes. Hemodialysis (HD), an important treatment of ESRD, may aggravate DR by increasing the oxidative stress, fundus hemorrhage and hypoxia of the optic nerve. On the other hand, HD can improve the ocular damage caused by diabetes mellitus and DN by removing uremia toxin, controlling blood pressure and removing excess body fluid.

幽门螺杆菌感染作为中央浆液性脉络膜视网膜病变危险因素的研究进展

Research progress on Helicobacter pylori infection as a risk factor for central serous chorioretinopathy

:48-52
 
幽门螺杆菌(Helicobacter pylori,H P)感染是中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的一个危险因素,但是在HP感染和CSC相关性的研究仍存在争议,目前有两种观点:一是认为HP感染可能是CSC的一个危险因素,二是认为两者之间并没有相关性。本文将就对HP感染是否为CSC危险因素文献进行综述,同时探讨其发病机制。
Helicobacter pylori (HP) infection is a risk factor for central serous chorioretinopathy (CSC). But the existing studies tend to support two distinctively different trends regarding the link between HP infection and CSC. The first group tend to support that: HP infection may be a risk of CSC, and the second tend to claim to no correlation between the two. This paper will review the literature on whether HP infection is a risk factor for CSC and discuss its pathogenesis.
临床病例讨论

内源性念珠菌性眼内炎误诊1例

Misdiagnosis of endogenous Candida endophthalmitis: A case report

:51-53
 
临床上内源性真菌性眼内炎比较少见,其早期临床表现因类似于葡萄膜炎等常见眼病常常被误诊。武汉爱尔眼科医院汉口医院收治了1例49岁女性患者,首诊为葡萄膜炎,后前房穿刺送检确诊为内源性念珠菌性眼内炎。
Endogenous fungal endophthalmitis is easy to be misdiagnosed because it is quite rare and early clinical features resembling uveitis. A 48-year-old female patient was admitted to Wuhan Aier Eye Hospital Hankou Hospital, her first diagnosis was uveitis, and the posterior anterior chamber puncture was confirmed as endogenous Candida endophthalmitis.

虹膜劈裂1例

A case of iridoshcisis

:54-57
 
患者因“左眼视物模糊2 0余年”就诊,2 0余年前曾行左眼小梁切除术,视力:右眼(oculus dexter,OD)无光感(no light perception,NLP),左眼(oculus sinister,OS)光感(light perception,LP)光定位准确,右眼巩膜葡萄肿(鼻上),前房浅约1/4 CT,瞳孔固定散大,晶状体脱位于玻璃体腔,左眼结膜上方滤过泡扁平,前房浅,约1/4 CT,虹膜层状分离漂浮于前房,上方虹膜切口引流通畅,C/D:0.4。眼压(intraocular pressure,IOP)示:右眼13.0 mmHg,左眼16.0 mmHg。超声生物显微(ultrasound biomicroscopy,UBM)示:右眼各象限前房角狭窄,晶体脱位;左眼前房浅,颞侧前房角狭窄,其余象限关闭,虹膜层状分离。B超示:右眼晶体脱离。诊断:左眼虹膜劈裂;右眼晶体脱位。
The patient was treated with ‘left eye blurred vision for more than 20 years’. The patient underwent left trabeculectomy more than 20 years ago. Visual acuity oculus dexter (OD): no light perception (NLP), oculus sinister (OS): light perception (LP), and light positioning was accurate, right eye scleral staphyloma (nose), the anterior chamber was approximately 1/4 CT, the pupil was fixed and scattered, the lens was displaced into the vitreous cavity, and the left eye conjunctiva was filtered. The blister was flat, the anterior chamber was shallow, about 1/4 CT, and the iris layer was separated and floated in the anterior chamber. The upper iris incision led to smooth flow, C/D: 0.4. Intraocular pressure (IOP): R 13.0 mmHg, L 16.0 mmHg. Ultrasound biomicroscopy (UBM): in the right eye, anterior chamber angle was narrow in each quadrant, dislocation of the lens; anterior chamber of the left eye was shallow, anterior chamber angle of the temporal stenosis was narrow, the remaining quadrants were closed, iris lamellar separated. B-ultrasound: the right eye lens was displaced into the vitreous cavity. Diagnosis: left eye Iridoshcisis; right eye lens dislocation.
医学教育

中山大学五年制医学见习生直接检眼镜的教学效果调查

Investigation on the effect of direct ophthalmoscope training method for medical internships in Sun Yat-sen University

:58-63
 
纳入126名中山大学临床医学五年制4年级学生,对其接受为期1周的直接检眼镜见习教学后,进行问卷调查,了解学生对直接检眼镜学教学的看法以及学习过程中的操作难点。结果显示大部分学生认为直接检眼镜对临床工作有重要作用。但学生普遍反映学习过程难度大,师生视野无法共享,进而阻碍了师生直接的教学沟通。多数学生愿意接受更进一步的直接检眼镜教学。
A total of 126 senior of 5-year clinical medicine students in Sun Yat-sen University were recruited. After 1-week internship and direct ophthalmoscope training, a questionnaire survey was conducted to scrutinize students’ feedback about the training methods and learning difficulties during the internship. The results showed that most students thought that the direct ophthalmoscope played an important role in clinical work. However, students generally felt complicated and hard during the learning process due to the communication obstacle between teachers and students caused by the unavailability of vision sharing. In spite of this, most students are still willing to accept further direct ophthalmoscopy training.

有的放矢:全科医师培训过程中眼科轮转学习的初步探索

Shoot the arrow at the target: exploration of ophthalmologic training in the standardized training process of general practitioners

:64-68
 
全科医生对个人及其家庭所提供的基本、连续性、综合性及整体性的医疗服务。全科医生要求具备更为“广博”的知识结构。那么如何在有限的培训期内更好地完成亚专科的培训并获得社区卫生服务中切实需要的临床技能及知识储备,是目前亟待解决的问题。基于社区卫生服务的基本特点,全科医生规范化培训中培训眼科学的相关内容,强调重视眼与全身疾病、眼科急症及全身药物的眼部损害等,有助于全科医生迅速、准确地发现和判断在社区医疗机构就诊的各类眼部急危重症患者,及时向专业眼科机构转诊,避免延误诊治,为后续专业的眼科治疗赢得宝贵时间,从而使全科医生更好地胜任社区居民健康“守门人”的工作。
General practitioners provide basic, continuous, comprehensive and holistic medical services to individuals and their families, which requires them to have a more “extensive” knowledge structure. However, within the limited training period, how to successfully complete subspecialty training and acquire the clinical skills and knowledge needed in community health services is an urgent problem which need to be explored. Based on the basic characteristics of community health service, the ophthalmology training of the standardized training of general practitioners, focus on the eye and systemic diseases, ophthalmic emergency and side-effect of systemic drug on eye would help general practitioners rapidly and accurately find and diagnose all kinds of serious emergent ophthalmologic diseases, and then refer to professional eye institutions in time, which avoid delay in diagnosis and treatment and save more valuable time for subsequent professional treatment. It would make the general practitioners become good healthy gatekeepers for the local community residents.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
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