The increasing environmental burden of micro/nanoplastics (M/NPs) has heightened concerns about their potential threat to ocular health, yet the molecular mechanisms underlying M/NPs-induced ocular surface injury remain largely unclear. In this study, we investigated the ocular toxicity of polystyrene nanoplastics (PS-NPs) with a focus on the involvement of endoplasmic reticulum (ER) stress. A mouse ocular exposure model and a human corneal epithelial (HCE-T) cell model were established. Multi-level analyses demonstrated that PS-NPs exposure induced ocular surface toxicity in mice, characterized by diminished tear secretion and corneal epithelial damage. At the cellular level, PS-NPs were internalized by HCE-T cells and accumulated near the ER. Mechanistic investigations revealed that PS-NPs exposure was associated with the activation of the ER stress response, which was accompanied by disrupted redox homeostasis, NF-κB–driven inflammatory activation, promoted apoptosis, and impaired epithelial barrier integrity. Notably, administration of the chemical chaperone 4-phenylbutyric acid (4-PBA), an ER stress inhibitor, substantially attenuated these adverse outcomes in vivo and in vitro. Together, this study establishes a significant association between PS-NPs exposure, ER stress activation, and ocular damage, identifying ER stress as a key and targetable cellular event in the toxicological response to NPs.

Primary ocular adnexal lymphoma (POAL) is the most common malignancy affecting para-ocular tissues, making prognosis and survival critical concerns. This study analyzed trends in five-year relative survival rates (RSR) to evaluate survival outcomes. This retrospective study included patients diagnosed with POAL from the Surveillance, Epidemiology, and End Results database. Five-year RSR was calculated for the periods 2005–2009, 2010–2014, and 2015–2019. Data were stratified by demographic and clinical characteristics. Model-based period analysis was conducted to assess RSR trends and project RSR for 2020–2024. The five-year RSR for POAL patients increased from 96.1

Micro/nanoplastics (M/NPs) have become pervasive environmental pollutants, posing significant risks to human health through various exposure routes, including ingestion, inhalation, and direct contact. This review systematically examined the potential impacts of M/NPs on ocular health, focusing on exposure pathways, toxicological mechanisms, and resultant damage to the eye. Ocular exposure to M/NPs can occur via direct contact and oral ingestion, with the latter potentially leading to the penetration of particles through ocular biological barriers into ocular tissues. The review highlighted that M/NPs can induce adverse effects on the ocular surface, elevate intraocular pressure, and cause abnormalities in the vitreous and retina. Mechanistically, oxidative stress and inflammation are central to M/NP-induced ocular damage, with smaller particles often exhibiting greater toxicity. Overall, this review underscored the potential risks of M/NPs to ocular health and emphasized the need for further research to elucidate exposure mechanisms, toxicological pathways, and mitigation strategies.

The relationship between iron status and visual field loss (VFL) remains unclear. This study aimed to explore the potential association between iron deficiency (ID) and the prevalence of VFL among females aged 40–49 in the United States. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008. Participants provided detailed information on iron status and visual field measurements. Several statistical approaches, including survey-weighted logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and sensitivity analysis, were employed to explore the association between iron status and VFL. After adjusting for potential confounding factors, a negative association was observed between transferrin saturation (TS) and the prevalence of VFL (odds ratio [OR] = 0.313, 95

PURPOSE:To report a case of β-thalassemia trait with iron deficiency anemia presenting as a combined central retinal vein and artery occlusion.METHODS:Case report. A 22-year-old woman presented with sudden-onset blurry vision in the left eye of 3-day duration.RESULTS:Best-corrected visual acuity was 20/20 and 20/1000 in right and left eyes, respectively. Fundus examination of the left eye revealed optic disk edema, macular whitening with a cherry-red spot, markedly dilated and tortuous retinal veins, and hemorrhages both around the disk and extending into the macula and the periphery. Fundus fluorescein angiography showed delayed filling of retinal vasculature, dilated and tortuous retinal veins, and blocked fluorescence around and beyond the optic disk. Optical coherence tomography scan at presentation showed hyperreflective inner retinal layers with neurosensory detachment. Optical coherence tomography angiography showed that the vessel densities of superficial and deep capillary plexus were remarkably reduced. A diagnosis of β-thalassemia trait combined with iron deficiency anemia was made after hematologic workup. The patient was treated with a course of oral iron supplements, vasodilator (compound Xueshuantong), inhalation of a mixture of 5% carbon dioxide and 95% oxygen, and a nutritional agent (compound anisoine). Six months later, her visual acuity improved to 20/60 in the left eye with complete resolution of all clinical signs.CONCLUSION:Combined central retinal vein and artery occlusion is a rare emergency leading to acute vision loss and can manifest in patients with β-thalassemia trait with iron deficiency anemia. Prompt diagnosis and early management is important to treat underlying systemic disorders and to prevent occurrence of a similar episode in fellow eye.

Objective:To analyze reasons of re-hospitalization and treatment methods of re-discharge in patients with penetrating keratoplasty(PKP).Methods:This was a cross-sectional study. From Jan.2017 to Dec.2021, 63 eyes of 56 patients who underwent PKP in the Second Affiliated Hospital of Guangzhou Medical University were included. Their primary diseases, direct causes of re-admission and treatment methods were analyzed.Results:Among the primary causes, 19 cases were ocular trauma (33.93%), 12 cases were corneal infection (21.43%), 9 cases were corneal leucoma (16.07%), 6 cases were corneal endothelium decompensation (10.71%), 3 cases were keratoconus (5.36%), 5 cases were corneal dystrophy (8.93%), and 2 cases were immune corneal ulcer (3.57%). Twenty-nine patients (51.79%) underwent re-hospitalization after operation. The reasons for re-hospitalization were as follows: corneal graft rejection in 10 cases (34.48%), recurrence of primary disease in 5 cases (17.24%), and infection after transplantation in 4 cases (13.79%), glaucoma in 3 cases (10.34%), chronic failure of corneal graft in 3 cases (10.34%), eyeball atrophy in 2 cases (6.90%), corneal suture removal in 1 case (3.45%), and incision leakage (hypotony) in 1 case (3.45%). The treatment methods of re-hospitalized patients were: corneal transplantation in 8 cases (27.59%), drug therapy in 14 cases (48.28%), glaucoma surgery in 2 cases (6.90%), enucleation in 1 case (3.45%), artificial vitreous implantation in 2 cases (6.90%), corneal suture in 1 case (3.45%) and corneal suture removal in 1 case (3.45%).Conclusion:The primary causes of PKP are ocular trauma and corneal infections. Rejection after corneal transplantation is the first cause of hospitalization, followed by recurrence of primary disease and postoperative infection. More than half of the re-hospitalized patients need reoperation.

患者男性,87岁,白内障术后右眼视物模糊10余年,查体可见角膜中央大片后弹力层皱褶,结合病史及前节OCT等辅助检查初步诊断为右眼陈旧性角膜后弹力层脱离,根据共聚焦显微镜结果判断褶皱区域无内皮细胞,于是先后行右眼后发性白内障联合残余皮质抽吸术以及右眼角膜后弹力层剪除和前房成形术,术后患者视力提高.本文结合病理检查分析了该患者大片后弹力层脱离后角膜透明的原因以及内皮代偿的方式,并总结了预防术源性角膜后弹力层脱离的要点以及注意事项.

To assess the clinical outcomes of two intravitreal injection regimens of Conbercept used to treat choroidal neovascularization secondary to pathological myopia (PM-CNV). A total of 72 eyes of 72 patients were treated: 39 eyes received a single injection followed by treatment pro re nata (1 + PRN); 33 eyes first received 3 consecutive monthly injections (3 + PRN) then followed by PRN. After initial injection, patients were followed up for 12 months. The mean age of 72 patients was 45.3 ± 5.1 years, with the mean diopter of -10.62 ± 3.24D. The best corrected visual acuity (BCVA) was 0.86 ± 0.23 LogMAR with 1 + PRN and 0.90 ± 0.19 LogMAR with 3 + PRN at baseline (P = 0.422), 0.36 ± 0.07 and 0.33 ± 0.05 LogMAR at month 3 (P = 0.026); and 0.33 ± 0.03 and 0.32 ± 0.02 LogMAR at month 12 (P = 0.096). The central retinal thickness (CRT) was 333.5 ± 22.7 μm with 1 + PRN and 341.2 ± 20.9 μm with 3 + PRN at baseline (P = 0.139), 281.53 ± 10.28 and 273.15 ± 13.24 μm at month 3 (P = 0.004); 266.83 ± 8.14 and 264.91 ± 9.27 μm at month 12 (P = 0.350). The number of injections in the 1 + PRN group was significantly lower than that observed in the 3 + PRN group (2.15 ± 1.06 versus 3.36 ± 0.74; P < 0.001). During the follow-up, no serious ocular complications and adverse reactions related to Conbercept and injections occurred. Both injection regimens resulted in similar visual outcomes in PM-CNV patients. The 1 + PRN regimen had fewer injections and might be more suitable in this patient population.

Microglial cells are the main immune cells of the retina. The primary culture of the retinal microglia is critically important in investigating the cells' properties and behaviors in neurodegenerative and inflammatory retinal disease. Here, we described a modified protocol of a microglial cell culture from the neonatal rat retina. In our culture protocol, the retina was isolated from the neonatal rat eye from postnatal day 1 to day 3 and trypsinized into a single-cell suspension. The cells were seeded into a T75 flask, which was pre-coated with poly-D-lysine (PDL) and cultured with dulbecco's modified eagle medium-F12 (DMEM/F12) that contained 10% fetal bovine serum (FBS) with different concentrations. Small bright rounded cells were observed on the top of mixed glial cells on the seventh day, and attained the maximum cell number on the 14th day. Then, the isolation was performed by a shaking method and isolated cells were identified with microglia markers ionized calcium-binding adaptor molecule 1 (IBA1), transmembrane protein 119 (TMEM119), cluster of differentiation 11b (CD11b), as well as astrocyte marker glial fibrillary acidic protein (GFAP) by immunofluorescence staining. Additionally, the initial plating ratio of the mixed glial cell, culture period of isolation, procedures of the isolation, as well as the purification procedure, were optimized for our primary microglial cell culture. The morphological changes and phagocytic function were performed after lipopolysaccharide (LPS) stimulation. Moreover, the release of pro-inflammatory cytokines at different time points of LPS activation were measured. In the present study, we found that the concentration of one retina/T75 flask could harvest the largest number of microglial cells. Besides, we continuously cultured the mixed glial cells as long as one month and isolated the mixed glial cells as much as three times. In our study, we used an isolation-shaking rate of 200 rpm for 2h, which guaranteed the steady rate and resulted in high purification of the primary retinal-microglial cells, with no need of an additional purification procedure. In conclusion, we provided a high-producing protocol for the primary culture of purified rat retinal-microglial cells.

目的 评估玻璃体腔注射康柏西普联合全视网膜激光光凝(PRP)治疗重度非增殖期糖尿病视网膜病(NPDR)合并糖尿病性黄斑水肿(DME)患者的疗效.方法 选取2018年5月-2019年12月中山市人民医院眼科收治的70例(80眼)NPDR的DME患者,随机分为两组.35例40眼患者纳入联合组,行康柏西普玻璃体腔注射联合PRP;35例40眼纳入PRP组,单纯行PRP.术后随访6个月,比较两组患者激光光凝及抗血管内皮生长因子(VEGF)治疗情况、黄斑中心凹下脉络膜厚度(SFCT),中央黄斑部视网膜厚度(CMT)和最佳矫正视力(BCVA).结果 联合组的激光能量、能量密度、光斑数量及激光次数均低于PRP组,差异有统计学意义(P＜0.05);术后6个月,联合组SFCT(143.56±70.02)μm、CMT(233.48±75.24)μm、BCVA(0.21±0.04)Log MAR 均优于 PRP 组,差异有统计学意(t=2.684、2.721、6.914,P＜0.05).结论 与单纯 PRP相比较,玻璃体腔注射康柏西普联合PRP治疗DME,能更有效减轻黄斑水肿、提高视力,明显改善患者社会功能.

目的:分析白内障患者对白内障手术不满意的影响因素及其对生存质量的影响,为白内障患者的术前评估及术后出现的相关问题提供临床参考.方法:选取2020年1月—12月我院186例白内障行白内障超声乳化吸除联合人工晶体植入术的患者,随访术后1周时的视觉功能(VF)、生存质量(QOL).分析患者对手术不满意的原因,比较满意组与不满意组患者生存质量的差异.结果:患者的年龄、性别、文化程度与患者是否满意手术差异无统计学意义(P>0.05);术后远视力差、合并眼底疾病、眼表疾病、术后屈光不正是患者对手术不满意的影响因素,差异有统计学意义(P<0.05),且这些因素使患者术后VF/QOL分值较低,差异有统计学意义(P<0.05).结论:多种因素都会使白内障患者对手术产生不满意情绪,且这些因素也在一定程度上影响了患者术后生存质量的提高.

我国儿童青少年近视发病率高、低龄化已经成为了一个危害青少年身心健康的广泛社会问题,儿童青少年近视的预防、控制工作变得空前重要.本文就2020年广州市青少年科技教育项目"青少年近视防控的科普教育",进行总结与分析,为青少年近视的防治科普工作提供参考和借鉴.

Background: The goal was to explore the protective effect and potential mechanism of amniotic membrane extracts (AME) on the ocular surface exposed to benzalkonium chloride (BAC). Methods: The human corneal epithelial cell (HCEC) line SD-HCEC1s was cultured in 5 groups: normal control (NC), NC + AME, BAC, BAC + NC, and BAC + AME. Cell viability analysis, flow cytometry analysis, real-time polymerase chain reaction (PCR), and western blot were employed to measure changes in cell function. Matrix metalloproteinases (MMPs) and inflammatory cytokines were assayed by enzyme-linked immunosorbent assay (ELISA) and activity assays. Results: Real-time PCR and western blot analysis demonstrated that the expressional level of caspase-8 was increased while the levels of Muc1, Muc4, and Muc16 were decreased after treatment with 0.02% BAC for 1 h. When the SD-HCEC1s were withdrawn from the BAC and switched to media containing 10% AME for 2 days, the expression level of capsase-8 was decreased while the levels of Muc1, Muc4, and Muc16 were increased. Real-time PCR and ELISA demonstrated that the mRNA and protein levels of MMP-1, MMP-3, MMP-13, CXCL1, interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α) were significantly increased after treatment with 0.02% BAC, whereas those of MMP-8 were decreased. When the 0.02% BAC was withdrawn and the SD-HCEC1s were cultured in 10% AME, the mRNA and protein levels of MMP-1, MMP-3, MMP-13, CXCL1, IL-1β, IL-6, and TNF-α were decreased, while those of MMP-8 were increased. MMP-8 activity assays confirmed that IL-1β and TNF-α downregulated the protein levels of MMP-8. Conclusions: AME protects SD-HCEC1s when stressed in BAC via upregulation of MMP-8 and downregulation of IL-1β and TNF-α. AME may have the potential functions to be employed as a topical adjunctive therapy in eyes chronically exposed to BAC.

Objective:To explore the difference in the proliferation, migration and ultraviolet radiation effect between double-head and unilateral pterygium fibroblasts (HPFs) cultured in vitro. Methods:Pterygium tissue was obtained from patients who underwent pterygium excision with conjunctival transposition from March 2017 to March 2018 in the Second Affiliated Hospital of Guangzhou Medical University.Nineteen cases with bilateral pterygium and 19 cases with unilateral pterygium were selected for this research.Twelve cases of normal conjunctival tissue were obtained from donor eyes.The fibroblasts were divided into HPFs-nasal (HPFs-N), HPFs-temporal (HPFs-T), unilateral HPFs and human conjunctiva fibroblasts (HCFs), which was taken from the nasal side of the bilateral pterygium, the temporal side of the bilateral pterygium, the unilateral pterygium and the normal conjunctiva, respectively.Human pterygium and normal conjunctival fibroblasts were isolated and cultured by tissue culture method.The fibroblasts were divided into an ultraviolet irradiation group and a normal light illumination group.The cell growth curve was detected by methyl thiazolyl tetrazolium (MTT) assay.The cell scratch healing rate was detected by the cell scratch test after 48 hours.The expression of α-smooth muscle actin αwas detected by immunofluorescence staining, and the number of positive cells in each group was compared.The fibroblasts cultured in vitro were irradiated with ultraviolet irradiation, and the cell scratch healing rate, growth curve and expression of α-SMA were observed.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University.Written informed consent was obtained from each subject. Results:The pterygium and conjunctival fibroblasts were spindle shaped, and the growth rate was gradually increased from day 1 to day 7.The growth rate of HPFs-N was the fastest, and the growth rate of HCFs was the slowest.The growth rate of the four types of fibroblasts was significantly increased after exposure to ultraviolet.There were significant differences in the cell scratch healing rates and α-SMA positive cell expression rates among the four fibroblast types under different lighting conditions ( Fgroup=158.064, P<0.05; Fcell type=326.582, P<0.05. Fgroup=4.731, P<0.05; Fcell type=172.813, P<0.05), of which the scratches healing rate in the HPFs-N cells after 48 hours under the normal light conditions was (79.67±0.86)%, which was significantly higher than HPFs-T ([54.04±0.33]%), unilateral HPFs ([64.12±0.21]%) and HCFs ([58.86±0.41]%), the α-SMA positive cell expression rate in the HPFs-N cells after 48 hours under the normal light conditions was (28.87±1.02)%, which was significantly higher than that in HPFs-T ([13.67±0.23]%), unilateral HPFs ([20.35±1.72]%) and HCFs ([5.12±0.45]%) (all at P<0.05); the cell scratch healing rates and α-SMA positive cell expression rates were significantly increased in the ultraviolet irradiation group than those in the normal light illumination group (all at P<0.05). Conclusions:The nasal side of double-head pterygium fibroblasts is more proliferous and more migratory than that of the unilateral pterygium, the expression of α-SMA is also increased, which can be further enhanced by ultraviolet irradiation.

PURPOSE:Human amniotic epithelial cells (HAECs) have regenerative properties and low immunogenicity, which have enabled their use without immune rejection in regenerative medicine applications, such as wound repair, corneal surgery and burn repair. The aim of this study was to explore the potential role of HAECs in the proliferation of human corneal endothelial cells (HCEnCs) and the possible mechanism of regulation.METHODS:HAECs and HCEnCs were isolated from donated tissue samples and were cultured; the collected HAEC culture medium (HAEC-Me) was added to the human corneal endothelium medium (CEM) to establish the HAEC-CM system. HCEnCs were cultured in CEM, 20%HAEC-Me, 20% HAEC-CM, 20% HAEC-CM supplemented with a GSK-3β inhibitor TWS119 or CEM supplemented with TWS119. Then, cell proliferation, apoptosis, cell cycle progression, telomerase activity, and Wnt/β-catenin pathway-related protein levels were assessed.RESULTS:We found that the HCEnCs cultured in the 20% HAEC-CM had increased proliferative capacity, telomerase activity and β-catenin and Tcf4 expression levels, and they had a decrease in the rate of apoptosis and α-SMA expression when they were compared with the HCEnCs cultured in the 20% HAEC-Me. After GSK-3β was inhibited by TWS119, HCEnCs cultured in CEM or 20% HAEC-CM had an increased proliferative capacity, telomerase activity, β-catenin/Tcf4 expression and a decreased α-SMA expression, and they had a decreased apoptotic rate.CONCLUSIONS:These data indicate that the human amniotic epithelial cells microenvironment can promote the proliferation of human corneal endothelial cells, which may be related to regulating telomerase activity and epithelial-to-mesenchymal transition (EMT) via the Wnt/β-catenin pathway.

眼科住院医师规范化培训是眼科医师成长阶段的一个重要内容,根据国家要求住院医师均需要接受严格的规范化培训.我国开始建立住院医师规范化培训制度时间较欧美发达国家晚,虽然要求临床医师要在医疗、教学、科研全面得到均衡发展,但尚处于探索阶段,与发达国家相比还存在着一定差距,其规培方案及其师资培训方案仍需要进一步完善.作者对比国内外眼科住院医师的培训现状,并结合我国人口多、人均医疗资源相对较少、规培对象多样化、眼科民营专科医院大量出现、以及眼科日间手术模式的大范围普及等情况,认为规培方案与具体措施也需要作出相应的调整,为我国培养优秀临床医生创造良好条件.

目的 研究分析真实世界中玻璃体腔注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物在新生血管性眼病中的应用疗效.方法 回顾性分析2016年10月至2018年6月在我科接受抗VEGF治疗的新生血管性眼病病例.所有病例均详细记录治疗前和治疗后1 d、治疗后1周的最佳矫正视力(LogMAR)、眼压、眼底情况.并对纳入病例的资料特征、所用药物、治疗方案、注药次数、疗效等指标进行分析比较.结果 纳入符合条件的临床病例227例313眼,其中93例163眼为糖尿病视网膜病变(diabetic retinopathy,DR),45例58眼为湿性年龄相关性黄斑变性(wet age-related macular degenera-tion,wAMD),26例29眼为息肉样脉络膜血管病变(polyloidal choroidal vasculopathy,PCV),39例39眼为视网膜静脉阻塞(retinal vein occlusion,RVO),13例13眼为病理性近视伴发脉络膜新生血管(myopic choroi-dal neovascularization,PM-CNV),4例4眼为特发性脉络膜新生血管(idiopathic choroidal neovascularization,ICNV),4例4眼为新生血管性青光眼(neovascular glaucoma,NVG),余3例3眼为其他眼病.单眼注药141例,双眼注药86例.22.0％的患眼实施了3+PRN方案,78.0％的患眼实施了1+PRN方案.雷珠单抗治疗的有152眼,康柏西普治疗的有140眼,有21眼在治疗过程中更换了药物.所有患者共计接受抗VEGF治疗544次,平均(1.8±1.0)次/眼.总体治疗后平均LogMAR视力(0.92±0.76)与基线(1.12±0.84)差异有统计学意义(P<0.001).结论 抗VEGF治疗确可有效促进患者视功能的恢复、减少视力损害,是临床上治疗新生血管性眼病的一线治疗用药.但在真实世界中,抗VEGF药物的应用仍然受多方面因素影响.

PURPOSE:To characterize retinal neurovasculature changes after small-incision lenticule extraction (SMILE) in myopic patients.SETTING:Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, China.DESIGN:Prospective interventional study.METHODS:The corrected distance visual acuity/uncorrected distance visual acuity, corrected intraocular pressure (CIOP), and corneal tomography were evaluated at baseline (PRE), postoperative day (POD) 1, and POD 7. Ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were measured. The vessel area densities (VADs, %), vessel skeleton densities (VSDs, %), vessel diameter index (VDI), and fractal dimensions (Dbox) of the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were measured in a circular area (ϕ 2.5 mm) centered on the fovea.RESULTS:A total of 38 myopic patients were recruited. The GCIPL thickness was increased after SMILE at POD 1 and POD 7 (P < .01) but no significant changes in the pRNFL thickness. The VAD, VSD, and Dbox of the SVP were decreased at POD 1 (P < .01), but not at POD 7. The VDI in small vessels of the SVP and DVP was decreased at POD 1 (P < .05) and increased at POD 7 (P < .05). Changes in CIOP were positively correlated with changes in the GCIPL thickness. Changes in CIOP were negatively correlated with changes in the VAD of small vessels and the Dbox of total vessels in the DVP. Changes in CIOP were negatively correlated with the VSD and VDI of small vessels in the DVP and changes in the VDI of big vessels in the SVP.CONCLUSIONS:The transient fluctuations in the retinal neurovasculature after SMILE may represent a characteristic homeostasis pattern in patients after refractive surgery.

目的 分析改良后的直接检眼镜教学方法的学习效率.方法 纳入该院在校大四临床医学专业的眼科见习学生56名,平均分为A、B两组,A组通过改良教学方法进行直接检眼镜教学,B组则通过常规方法进行直接检眼镜教学,比较两组学生能窥清视网膜血管、观察到视盘及黄斑区的人数,分析两组直接检眼镜的掌握情况及学习效率.结果 A、B两组能窥清视网膜血管的人数分别为24、8名,差异有统计学意义(P<0.05).能观察到视盘和黄斑区的人数A组分别为19、18名,B组均为3名,差异仍有统计学意义(P<0.05).结论 改良后的直接检眼镜教学方法能明显提高直接检眼镜的学习效率.