目的 探讨基于形成性评价(Formative assessment,FA)的微格教学法(Microteaching)在中医眼科临床实践课程教学中的应用效果.方法 将北京中医药大学东方医院眼科48名见习学生随机分为2组,进行眼科检查法实践教学.实验组采用微格教学法;对照组采用传统教学方法.采用形成性评价比较2组学生眼科检查法即时评价成绩、期末考核实践操作成绩以及教学满意度调查情况.结果 实验组即时评价成绩、期末考核实践操作成绩均高于对照组,差异有统计学意义(P＜0.01);实验组教学满意度亦高于对照组,差异有统计学意义(P＜0.01).结论 微格教学法较传统教学法更能提升眼科检查法的教学效果,激发学生的学习积极性,并能将思政教育融入教学过程中.

患者女，26岁。因四肢乏力伴双眼视物模糊3月余，加重2周于2021年2月8日就诊于河北大学附属医院神经外科。询问病史，2020年11月中旬，患者无明显诱因出现复视伴四肢乏力、腰部束带感，以右侧为重，未予重视；2020年12月中旬，患者因四肢乏力行走时摔倒出现右眼轻微视物模糊，但复视症状消失，于当地医院行头颅磁共振成像（MRI）检查未见明显异常，未予特殊治疗；其后右眼视力逐渐下降至眼前数指，四肢乏力进一步加重。就诊于河北大学附属医院神经外科门诊行头颅及脊椎MRI检查，提示脑积水、间质性脑水肿可能（ 图1A）；C2~C7椎体水平硬膜下脊髓外异常信号（ 图1B， 图1C， 图1D）。神经外科以"颈椎管硬膜下髓外占位"将患者收入院。等待手术过程中，患者左眼视力急性下降至眼前数指，请眼科会诊。眼部检查：右眼视力手动/5 cm，左眼视力数指/5 cm。眼底检查，双眼视盘水肿。腰椎穿刺检查，颅内压正常，考虑与脑积水相关。眼科会诊诊断：双眼视盘水肿。建议治疗原发病。2021年2月21日，患者于全身麻醉下行椎管内占位切除（C2~C7水平段）联合椎管成形手术。手术后病理检查结果提示椎管占位-神经鞘瘤，部分区域细胞增生活跃。手术后患者肢体症状基本恢复，于2021年3月7日出院。出院时右眼视力光感，左眼视力数指/1 m。手术后25 d复查，患者双眼视力无明显改善；光相干断层扫描（OCT）检查，双眼视盘仍有水肿（ 图2）。

"Wei' s triple nine needling therapy" is the crucial acupuncture prescription in treatment of eye diseases in Yanjing Wei' s academic school of ophthalmology, especially of optic nerve retinal degenerative diseases. Clinical practice shows that has certain curative effects. The author interpreted the origin of "Wei' s triple nine needling therapy", the principle of acupoint selection and the thinking of acupoint combination. The specific needling manipulations at different regions involved in the triple needling procedure were also expounded in detail. It also introduced the results of clinical research in recent years. Based on the theory of acupuncture and moxibustion, "Wei' s triple nine needling therapy" will be inherited and developed.

Leber遗传性视神经病变(LHON)是一种线粒体DNA位点突变引起的遗传性视神经疾病,归属于中医"青盲"范畴.韦企平教授认为本病发生,除先天禀赋不足外,主要与情志因素密切相关,治疗紧扣从肝论治.主张病证结合,分期论治LHON,认为临床主要有肝郁气滞、肝郁血虚、肝肾阴虚3型.对应的方药分别为韦氏逍遥散验方、青盲Ⅰ号化裁方、明目地黄汤加减.同时,重视疏肝解郁法在各个时期的运用,将其贯穿整个过程.本文将详细论述其治疗LHON的思路和临床选方用药经验.

青光眼是临床难治眼病,视神经病变贯穿于青光眼的发生发展过程,中医治疗具有一定优势.韦企平教授是"韦氏眼科学术流派"第四代中医眼科学术继承人,擅长视神经疾病的诊治.韦老结合多年临床经验,借助先进仪器、结合现代生活和工作环境及个体体质等延伸四诊,中西互参,并结合青光眼视神经病变的病因病机,以舒肝健脾补肾为基本治法,提倡针药并用——"青盲一号方"联合"韦氏三联九针"的治疗方法,为临床提供了新的诊疗思路.

儿童视神经炎和成人视神经炎比较,其病因、临床表现、预后及转归多有重叠和交叉,也有其特殊性和差异.随现代流行病学谱系的变化和神经眼科跨学科交流的增强,已认识到儿童视神经炎和成人类似.对初诊为视神经炎或疑似神经炎的儿童患者,在排查眼部或其比邻病因,以及遗传性疾病的基础上,应更关注其潜在的和中枢神经系统或其他系统相关的自身免疫性疾病.本文重点围绕和中枢神经系统脱髓鞘疾病密切相关的儿童视神经炎进行讨论.

目的 系统评价针刺治疗动眼神经麻痹的临床疗效及安全性.方法 检索2011年1月至2021年10月中国期刊全文数据库(CNKI)、万方数据知识服务平台(WanFang Data)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、PubMed、Embase等中英文数据库,收集有关针刺治疗动眼神经麻痹的临床对照试验.使用RevMan5.3软件进行Meta分析.结果 共纳入37篇文献,2475个病例,合并Meta分析结果显示,针刺治疗动眼神经麻痹能改善患者的眼裂[MD=1.29,95％CI(0.95,1.62),Z=7.45,P＜0.000 01];瞳孔大小[MD=-0.42,95％CI(-0.57,-0.27),Z=5.42,P＜0.000 01];复视评分[MD=-1.10,95％CI(-1.27,-0.93),Z=12.76,P＜0.000 01];斜视度[MD=-6.70,95％CI(-8.65,-4.75),Z=6.73,P＜0.000 01)];眼球活动度[MD=0.79,95％CI(0.47,1.10),Z=4.92,P＜0.000 01];总有效率[RR=1.32,95％CI(1.26,1.37),Z=13.38,P＜0.000 01)];且均优于对照组.结论 基于现有数据可证明,针刺疗法或针刺联合疗法治疗动眼神经麻痹临床效果显著.

AIM: To study the correlation between retinal nerve fiber layer(RNFL)thickness changes and long-term visual function in Leber hereditary optic neuropathy(LHON)patients with 11778 mutations, and evaluate the role of early RNFL thickness in predicting long-term visual function.METHODS: A retrospective analysis with 44 eyes from 23 LHON patients who were diagnosed with 11778 G>A/ND4 mutations by mt-DNA sequencing were included. The patients were divided into two groups based on whether BCVA is above LogMAR 0.5(equivalent to 0.3 decimal,WHO Low Vision standard)or not at 30mo follow up. Then, when the RNFL data of the two groups of patients at each predetermined time point(course of disease)were obtained, the candidate cutoffs of RNFL thickness were obtained by comparing the mean RNFL thicknesses of the two groups. Based on the obtained candidate cutoff values, the eyes with different RNFL values were divided into two groups for statistical analysis to determine whether the cutoff values can be used to predict prognosis of BCVA and visual field. Finally, the earliest cutoff value of RNFL thickness that can predict both BCVA and visual field is the target value. RESULTS: According to the distribution of mean RNFL values in the eyes of patients with different BCVA groups, the candidate cut-off values of RNFL were determined as: 130μm after 2mo, 100μm after 4mo, 80μm after 8mo, and 65μm after 12mo from onset. Further analysis revealed that the RNFL value exceeds 80μm of 8mo after onset can be a better cutoff value to distinguishes the long-term vision, and which can predict both MD and MS of visual field with good distinction(all P<0.05). It was found that the long-term BCVA of 100% of the eyes with RNFL values less than 80μm after 8 months from onset was lower than LogMAR 0.5(equivalent to 0.3 decimal); while for eyes with RNFL thickness higher than 80μm after 8mo from onset, 31% of patients had vision greater than LogMAR 0.1(equivalent to 0.8 decimal), and only 34% of patients had long-term prognosis of low vision. In addition, the BCVA, MD and MS of visual field of the eyes with RNFL value exceeded 80μm were significantly better than those with eyes with RNFL less than 80μm.CONCLUSION: In this study, whether the RNFL value exceeded 80μm after 8mo from onset can be used as the best predictive cut-off value for judging long-term BCVA and visual field.

目的 探讨韦氏三联九针治疗视神经萎缩的视功能预后效果.方法 将2018年3月至2019年12月就诊于北京中医药大学东方医院的90例视神经萎缩患者纳入本研究,采用随机数字表法分为试验组45例、对照组45例,试验组予韦氏三联九针加基础药物治疗,对照组予基础药物治疗,分析对比两组治疗前后最小分辨角对数(logarithm of mininal angle resolution,LogMAR)视力、视觉结果量表(visual outcome scale,VOS)评分、视野有效率.结果 治疗后,两组患者LogMAR视力均明显改善(P<0.01),试验组疗效优于对照组(P<0.05);在VOS评分方面,试验组视力评分至少提高1分者合计26例,视力提高率为57.7％;Linear-by-Linear Associ-ation分析结果显示,试验组治疗前后视力评分变化呈显著线性相关(P<0.01),对照组治疗前后视力评分变化无线性相关(P>0.05);视野有效率方面,试验组总有效率为53.3％,对照组总有效率为26.6％,试验组明显优于对照组(P<0.05).结论 韦氏三联九针可明显提高视神经萎缩患者视力、改善患者视野,且对不同程度的视力损伤均有一定程度的疗效.

糖皮质激素是临床各科常用的药物之一,超生理量的糖皮质激素具有抗炎、抗过敏和免疫抑制等多种药理作用,神经眼科常用此类药治疗视神经炎.尽管糖皮质激素临床应用广泛且疗效快而显著,长期应用具有较大副作用.中医学认为糖皮质激素为纯阳辛温之品,中医中药的整体调理在缓解其不良反应方面具有一定优势,如何在糖皮质激素依赖性疾病中发挥减毒增效的作用是多年来中医领域关注的重点.本文就中药如何参与糖皮质激素治疗特发性视神经炎的理论认识进行了初步回顾,并对相关中医药治疗的实践经验做初步介绍.

目的 观察不同剂量的血小板源性生长因子-B(PDGF-B)、不同剂量的黄芪注射液以及两者合用对体外高糖培养大鼠视网膜毛细血管周细胞(RMPs)生长的影响.方法 取体外培养第3代大鼠RMPs,饥饿培养24 h后,分为空白组(5.5 mmol/L葡萄糖的低糖DMEM)、对照组(50 mmol/L葡萄糖的高糖DMEM)、不同浓度PDGF-B组(0.25 ng/mL、0.50 ng/mL、1.00 ng/mL+高糖DMEM)、不同浓度黄芪注射液组(0.2 mg/mL、2 mg/mL、20 mg/mL、200 mg/mL+高糖DMEM)和PDGF-B+不同浓度黄芪注射液组(1.00 ng/mL PDGF-B+0.2 mg/mL、2 mg/mL、20 mg/mL、200 mg/mL黄芪注射液+高糖DMEM),培养48 h后,采用CCK8法检测各组RMPs增殖情况,并用免疫荧光法鉴定增殖后的细胞.结果 与对照组比较,不同浓度PDGF-B组,2 mg/mL、20 mg/mL、200 mg/mL黄芪注射液组及1.00 ng/mL PDGF-B+2 mg/mL、20 mg/mL、200 mg/mL黄芪注射液各组均能促进体外高糖培养的RMPs增殖,并在一定浓度内呈剂量-效应关系,差异均有统计学意义(P均<0.05);其中1.00 ng/mL PDGF-B组及200 mg/mL黄芪注射液组促增殖作用均优于1.00 ng/mL PDGF-B+200 mg/mL黄芪注射液组(P均<0.05).加药培养后各组细胞表达周细胞标志物α-平滑肌肌动蛋白(α-SMA)及血小板源性生长因子受体-β(PDGFR-β),不表达血管性血友病因子(vWF),几乎不表达胶质纤维酸性蛋白(GFAP).结论 PDGF-B及黄芪注射液均对体外高糖培养大鼠RMPs的生长有促进作用,短期内未使RMPs发生变异,单用PDGF-B或黄芪注射液促生长作用优于两者合用.

视神经脊髓炎谱系疾病 (neuromyelitis optica spectrum disorders,NMOSD)临床少见,以家族形式发病且首发症状不同的NMOSD 病例则更罕见,现将北京中医药大学东方医院眼科诊治视神经脊髓炎谱系疾病2例报告如下. 1 临床资料 病例1,患者王某,女,30岁,主因"右眼球转动痛伴视物模糊1周,加重3 d"于2017年9月25日就诊于我院. 患者1周前出现右眼眼球转动痛伴视物模糊,伴眼眶痛、偏头痛,无麻木感,就诊于当地医院, 未予特殊处理,3 d前症状加重, 眼科检查,视力:右眼0.02,矫正不提高;左眼1.0;右眼对光反射迟缓,RAPD (+);余眼前节检查未见异常;眼底:右眼视盘边界欠清,色淡红,C/D=0.3,黄斑中心凹反光不清.

Diabetic retinopathy(DR)is a common microvascular complication of diabetes caused by chronic hyperglycemia and ischemia, which can seriously impair the patient's vision or even cause blindness. The main causes of visual impairment include macular edema, vitreous hemorrhage and neovascular glaucoma. Retinal laser photocoagulation is one of the most important therapies for DR. The thermal effects of laser photocoagulation can denature proteins, coagulate and destruct tissue, and finally scars occur. The scar tissue which consumes very low oxygen replaces the cones and rod and reduces tissue oxygen consumption significantly, and relieves the retinal ischemia and hypoxia especially for the middle and peripheral part of retina. However, complications such as macular edema, vitreous hemorrhage, and visual field defects may occur easily following laser treatment. This article reviews recent literatures about the complications and preventions of laser photocoagulation in DR treatment.

"Wei 's triple nine needling therapy" is the crucial acupuncture prescription in treatment of eye diseases in Wei 's academic school of ophthalmology. "Wei 's triple nine needling therapy" includes the three points near to the eyes, the three groups of points for penetrating acupuncture around the eyes and the acupoint selection based on the general differentiation of syndrome. In this paper, the acupoint selection and the thinking of acupoint combination were introduced in the treatment of optic nerve disease on the base of the theory of "Wei 's triple nine needling" prescription. The specific needling manipulations at different regions involved in the triple needling procedure were explained in detail. It is proposed that the acupoints are combined and the correct needling manipulations selected rationally in compliance with the illness condition and the syndrome characteristics to ensure maximally the clinical effects of "Wei 's triple nine needling therapy".

目的 本研究运用聚类分析法探究视神经炎在使用糖皮质激素治疗前后的中医证候特点.方法 纳入视神经炎患者合计170例,填写视神经炎糖皮质激素治疗前后证候观察表记录患者治疗前及治疗后28 d的四诊信息,采用K-均值聚类分析探索视神经炎患者激素治疗前后的证候特点.结果 视神经炎患者糖皮质激素治疗前后症状、体征、舌脉均发生了不同程度变化,导致患者证型的改变.视神经炎患者糖皮质激素治疗前证型包括肝肾阴虚证、气血两虚证、脾肾阳虚兼有肝郁证、肝经实热兼有热盛伤阴证.视神经炎患者糖皮质激素治疗后证型包括阴虚火旺证(61.2％)、气血两虚兼有阴虚证(22.9％)、肾阴虚兼有肝郁证(15.9％).结论 研究表明糖皮质激素的大剂量长期使用对视神经炎患者的中医证型变化影响显著,尤其是阴虚火旺证是激素治疗后视神经炎患者的最常见的证型之一,临床需加以重视.

目的 观察注射用血塞通(冻干)治疗视网膜中央静脉阻塞瘀血阻滞证的有效性和安全性.方法 采取多中心、随机、双盲、阳性药与安慰剂平行对照的临床对照试验方法,按照随机数字表法将患者分为试验组、阳性对照组和安慰剂组.试验组采用注射用血塞通(冻干)静脉滴注,阳性对照组采用复方血栓通胶囊口服,安慰剂组采用复方血栓通胶囊模拟剂口服.15 d为1个疗程,共计2个疗程.主要疗效评价指标:眼底血管荧光造影视网膜循环时间;次要疗效评价指标:最佳矫正视力(BCVA)、眼底出血面积、无灌注区面积、有无新生血管生成、中医证候等.结果 (1)视网膜循环时间3组比较,差异无统计学意义(P=0.5658);(2)3组间BCVA比较差异有统计学意义(P=0.002),试验组、阳性对照组分别与安慰剂比较,2组差异均有统计学意义(试验组P=0.001,阳性对照组P=0.003),试验组与阳性对照组疗效比较,差异无统计学意义(P=0.826);(3)中医证候疗效结果,3组间比较差异有统计学意义(P<0.001);试验组、阳性对照组分别与安慰剂比较,2组差异均有统计学意义(试验组P<0.001,阳性对照组P=0.006),试验组与阳性对照组疗效比较,差异无统计学意义(P>0.05);(4)眼底出血面积、无灌注区面积、有无新生血管生成方面,3组间比较差异无统计学意义.结论 注射用血塞通(冻干)可以改善视网膜中央静脉阻塞瘀血阻滞证患者视力及中医证候,临床使用安全,注射用血塞通(冻干)治疗视网膜中央静脉阻塞(瘀血阻滞证)具有较好的临床应用前景.

痰瘀互结理论在中医发展中源远流长,并广泛应用于现代中医临床各科,提高了诸疑难杂症的疗效.韦企平继承先贤经验,结合自身多年临床所得,以痰瘀相关理论治疗眼科疾病,尤其是疑难杂症,颇具特色.文章通过阐述黄斑水肿、复发性或多发性麦粒肿和霰粒肿、Graves眼病、复发性葡萄膜炎辨证要点及结合病例举隅,对韦老师从痰瘀互结论治眼科杂病治疗思路进行归纳总结.

相对性传入瞳孔障碍(RAPD)是一项客观体征,是诊断不对称视神经功能障碍的可靠和敏感的指标,对于判断病情的发展变化亦有一定指导作用;临床上对RAPD的检测方法可以选择以交替光照检查法定性,以中性密度滤光片法定量;RAPD形成的原理来自于双眼视神经传入信号的不对称性,这种不对称性与双眼视功能的不平衡是否相关亦值得探讨.本文就RAPD的两种检查方法及其与视功能之间的联系进行介绍.

OBJECTIVE To examine the clinical manifestation and prognosis of neuromyelitis optica spec-trum disorders (NMOSDs) characterized by optic neuritis. METHODS Clinical information, including clinical fea-tures, treatment, pathologic process and prognosis, of 17 cases with NMOSDs characterized by optic neuritis was col-lected and analyzed. RESULTS The case of NMOSDs characterized by optic neuritis had high rate of relapse and unfavorable prognosis. It was effective to stabilize the disease and prevent recurrence by using Glucocorticoid, im-muno-suppressor and plasmapheresis. CONCLUSIONS The basic concept and diagnostic process of NMOSDs was very important for the diagnosis and treatment of NMOSDs characterized by optic neuritis. Chinese medicine can be used for the cases with poor effects or high rate of relapse in combination with western medical modalities, but its ef-ficacy needs to be further proved.

全科医学是综合性医学专业学科,全科医生是综合程度较高的医学人才.全科规培生不可能有足够的学习时间和实践机会达到专业眼科住院医师水平,如何在短时间内使全科规培生掌握眼科疾病诊疗技能,本文进行了综述.