目的 探讨眼部前后节联合手术治疗黄斑裂孔合并白内障的临床疗效及安全性.方法 选取肇庆市高要区人民医院眼科2018年1月至2020年6月收治的黄斑裂孔合并白内障患者47例(47眼)为研究对象.所有患者均经眼部前后节联合手术治疗,比较患者治疗前及治疗后3个月、术后6个月的视力恢复,视网膜厚度及黄斑区形态结构变化情况,并观察患者手术后并发症发生情况.结果 患者手术前平均视力为0.23±0.04,明显低于术后3个月的0.30±0.10和术后6个月的0.45±0.12,差异均有统计学意义(P<0.05);术后6个月,有43例(91.49％)患者视力提高,其中提高2行及以上者34例(72.34％);所有患者术后6个月经检查发现黄斑区膜样反光全部消失;术后3个月、术后6个月患者部分恢复率分别为12.77％、8.51％,基本恢复率为76.60％、85.11％,均明显大于术前的0、0;扭曲率分别为10.64％、6.38％,明显小于术前的100.00％,差异均有统计学意义(P<0.05);手术前,患者黄斑区视网膜厚度为(484.34±42.73)μm,明显大于术后3个月及术后6个月的(294.34±25.43)μm,(275.32±23.39)μm,差异均有统计学意义(PP<0.05);患者在手术过程中,未出现晶体后囊膜破裂及医源性视网膜裂孔,有17例(36.17％)患者黄斑周围出现少许毛细血管性出血,无需治疗手术后均自行吸收.结论 眼部前后节联合手术治疗黄斑裂孔合并白内障可促进患者视力恢复,改善视网膜厚度及黄斑区形态结构,临床疗效显著且安全性高,值得临床推广应用.

目的:探讨PPV+Phaco+IOL植入+E-PRP术对糖尿病视网膜病变伴白内障的临床效果.方法:选取2018年1月-2019年6月在笔者所在医院行手术治疗的糖尿病视网膜病变伴白内障患者50例,按照随机数字表法将其分为观察组(n=25)和对照组(n=25).观察组行PPV+Phaco+IOL植入+E-PRP术联合手术治疗,对照组行PPV+晶体咬切+E-PRP+Ⅱ期人工晶体植入治疗.比较两组治疗前后裸眼视力、眼压水平及并发症发生情况.结果:治疗后3个月,两组裸眼视力、眼压水平均较治疗前明显改善,差异有统计学意义(P<0.05).治疗后3个月,观察组裸眼视力改善程度优于对照组,差异有统计学意义(P<0.05).观察组并发症发生率为4.0％,低于对照组的24.0％,差异有统计学意义(P<0.05).结论:PPV+Phaco+IOL植入+E-PRP联合手术治疗糖尿病视网膜病变伴白内障临床效果显著,可有效改善患者裸眼视力,降低术后并发症的发生.

目的 观察康柏西普玻璃体内注射辅助治疗视网膜分支静脉阻塞性黄斑囊性水肿的临床效果.方法 选取视网膜分支静脉阻塞性黄斑囊性水肿患者58例(58眼)为研究对象,随机分为两组,每组29例(29眼).对照组予以激光光凝治疗,观察组在对照组基础上联合康柏西普玻璃体内注射治疗.观察两组治疗有效率、视力水平及不良反应发生情况.结果经治疗3个月后,观察组总有效率为86.21％,高于对照组的62.07％(P<0.05);两组BCVA均较治疗前升高,且观察组上升幅度大于对照组,CMT均较治疗前降低,且观察组低于对照组(P<0.01);两组IOP水平与治疗前比较无显著差异(P>0.05);两组不良反应发生率无显著差异(P>0.05).结论 对视网膜分支静脉阻塞性黄斑囊性水肿患者采用康柏西普玻璃体内注射配合激光光凝疗法治疗临床效果显著,可改善患者视力水平,且安全性较高.

目的 观察拉坦噻吗治疗原发性开角型青光眼(POAG)的临床疗效和安全性.方法 选择2015年3月至2018年3月肇庆市高要区人民医院眼科收治的经临床确诊为POAG患者共150例(150眼)为研究对象,根据随机数表法分观察组和对照组,每组75例(75眼),观察组采用拉坦噻吗眼水治疗,对照组采用曲伏前列腺素眼水治疗,疗程均为12周.比较两组患者治疗前后眼内压(IOP)、视力、并发症的差异,并应用眼表疾病指数(OSDI)问卷、泪膜破裂试验(TBUT)、角结膜荧光染色、Schirmer试验评价两组患者的眼表症状.结果 观察组和对照组患者治疗2周[(20.51±5.32)mmHg vs(22.57±5.19)mmHg]、1个月[(16.02±2.67)mmHg vs(18.15±3.95)mmHg]、3个月[(14.02±1.95)mmHg vs(16.23±2.61)mmHg]眼压比较,观察组均低于对照组,差异均有统计学意义(P<0.05);两组患者治疗后的OSDI评分为(19.82±2.73)分,明显低于对照组的(26.02±4.02)分,差异有统计学意义(P<0.05);观察组患者治疗后的泪膜破裂时间为(12.36±2.99)s,明显长于对照组的(5.23±0.27)s,差异有统计学意义(P<0.05);观察组和对照组患者治疗后的颞上[(0.20±0.13)分vs(0.39±0.22)分]、颞下[(0.16±0.09)分vs(0.28±0.12)分]、鼻上[(0.27±0.13)分vs(0.39±0.12)分]、鼻下[(0.18±0.07)分vs(0.27±0.09)分]的结膜荧光染色评分比较,观察组均明显低于对照组,差异均有统计学意义(P<0.05);观察组治疗后患眼泪流量为(12.72±1.16)mm,明显多于对照组的(5.21±1.05)mm,差异有统计学意义(P<0.05);观察组患者的不良反应发生率为0,明显低于对照组的5.33％,差异有统计学意义(P<0.05).结论 相对于曲伏前列腺素,拉坦噻吗更能有效降低POAG患者眼内压,且能改善眼表症状,对眼表影响较小.

Objective To study the efficiency and accuracy of artificial intelligence (AI) system based on fundus photograph in diabetic retinopathy(DR)screening,and evaluate the clinical application value of AI system. Methods A diagnostic trial was adopted. Total of 13683 color fundus photos were collected in Zhaoqing Gaoyao People's Hospital from March,2017 to November,2018. The AI system for DR (ZOC-DR-V1) was established,based on transfer learning + NASNet algorithm,by training 4465 precisely labeled fundus images (2510 normal,and 1955 with any stage of DR). One thousand confirmed fundus images (300 normal and 700 with any stage of DR),diagnosed by AI ( AI group ) and doctors ( 3 ophthalmologist doctors and 3 endocrinologist doctors ) ( doctor group ) , respectively. Ophthalmologist group and endocrinologist group were both composed of primary,intermediate and senior physicians. The mean reading time of each image and the total time of 1000 images were recorded. The accuracy and efficiency of AI system and doctor groups were compared. The reading process was divided into two stages. The diagnostic coincidence rate and the average reading time of each group between the two parts were calculated and compared. This study protocol was approved by Ethic Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No. 2017KYPJ104). Results After training,the diagnostic coincidence rate of AI system (ZOC-DR-V1) in test set was 94. 7％,AUC was 0. 994. In this "man-machine to war",the diagnostic coincidence rate of primary,intermediate and senior endocrinologist was 94. 0％,91. 4％ and 93. 4％;the diagnostic coincidence rate of primary,intermediate and senior ophthalmologist was 92. 7％,94. 4％ and 95. 6％;the diagnostic coincidence rate of AI system was 95. 2％. There was no difference in the diagnostic coincidence rate between AI system and senior ophthalmologist ( P = 0. 749 ) . The mean reading time of each image of primary, intermediate and senior endocrinologists was (4. 63±1. 87),(3. 74±3. 47) and (5. 71±3. 47) seconds,and the total time of 1000 images of primary,intermediate and senior endocrinologists was 1. 29,1. 04 and 1. 58 hours;the mean reading time of each image of primary,intermediate and senior ophthalmologists was ( 7. 25 ± 6. 58 ) , ( 5. 18 ± 5. 01 ) and ( 5. 18 ± 3. 47 ) seconds,and the total time of 1000 images of primary,intermediate and senior endocrinologists was 2. 02,1. 44 and 1. 44 hours;the mean and total time of AI system was (1. 62±0. 67) seconds and 0. 45 hours,and the reading time of AI system was significantly shorter than that of the doctor groups (all at P=0. 000). The diagnostic coincidence rates between previous and posterior part of primary endocrinologist, primary and intermediate ophthalmologist were significantly different (χ2=11. 986,6. 517,10. 896;all at P<0. 05),and the mean reading time in the posterior part was significantly shorter than that in the previous part of intermediate and senior endocrinologist and primary ophthalmologist (t=4. 175,8. 189,5. 160;all at P<0. 01). While the reading time of AI system remained stable throughout the process(χ2=3. 151,P=0. 103;t=0. 038,P=0. 970). Conclusions The ophthalmic AI system based on fundus images has a good diagnostic efficiency,and its diagnostic coincidence rate can compare with senior ophthalmologist,providing a new method and platform for large-scale DR screening.

目的 探讨玻璃体腔内注射康柏西普联合玻璃体切除术(PPV)治疗增殖性糖尿病视网膜病变(PDR)的临床效果.方法 选择2016年6月至2018年9月肇庆市高要区人民医院收治的PDR患者56例(56只眼)为研究对象,以随机数表法将患者分为观察组与对照组各28例(28只眼),对照组给予常规PPV术,观察组给予玻璃体腔内注射康柏西普联合PPV手术治疗,比较两组患者术中出血发生率、手术时间、术中电凝止血率、术中医源性视网膜裂孔率、视力改变情况、再次手术率、激光补充治疗率及并发症情况.结果 观察组患者的手术时间为(72.11±9.81)min,明显少于对照组的(99.21±8.11)min,术中出血发生率为10.7％,明显低于对照组的50.0％、电凝止血发生率为7.1％,明显低于对照组的57.1％,医源性视网膜裂孔发生率为10.7％,明显低于对照组的46.4％,以上各项指标比较差异均有统计学意义(P<0.05);观察组与对照组患者术后最佳矫正视力(BCVA)分别为(3.99±0.56)D、(4.01±0.32)D,均明显高于术前的(2.56±0.32)D、(2.59±0.21)D,差异均有统计学意义(P<0.05),但术后两组患者的BCVA比较差异无统计学意义(P>0.05);观察组患者术后激光补充治疗(1.51±0.90)次,明显少于对照组的(2.54±0.82)次,并发症发生率为10.7％,明显低于对照组46.4％,差异均有统计学意义(P<0.05).结论 玻璃体腔内注射康柏西普联合PPV能够有效降低PDR手术治疗难度,同时能够减少术中出血,缩短手术时间,更好的改善患者术后视力,降低术后激光补充治疗率,且并发症少,手术安全性高.

目的 探讨翼状胬肉切除术结合自体角膜缘干细胞移植治疗翼状胬肉的效果及对复发率的影响.方法 选取2018年1～10月我院收治的82例翼状胬肉患者作为研究对象,按照随机数字表法分为对照组与研究组,各41例.对照组予以翼状胬肉切除术治疗,研究组予以翼状胬肉切除术结合自体角膜缘干细胞移植治疗.比较两组患者的疗效、结膜充血情况、复发情况、视力水平、散光程度、泪膜破裂时间(BUT)、泪液分泌量.结果 研究组患者的总有效率(97.56％)高于对照组(73.17％),结膜充血率(58.54％)、复发率(3.70％)低于对照组(80.49％、33.33％)(P＜0.05).研究组的不适症状持续时间、角膜上皮愈合时间及住院时间均显著短于对照组(P＜0.05).研究组治疗后的视力高于对照组,BUT长于对照组,泪液分泌量多于对照组,散光度低于对照组(P＜0.05).结论 翼状胬肉切除术结合自体角膜缘干细胞移植治疗翼状胬肉后的视力恢复情况及散光改善程度较好,能有效防止胬肉复发,且对泪膜功能影响较小.

目的:探究硅油填充术后视神经纤维层变化.方法:选取2014年3月-2016年8月本院收治的因视网膜脱离行玻璃体切除联合硅油填充术患者45例(45眼)为观察组及单纯行玻璃体切除患者45例(45眼)为对照组.比较两组术后1周及1、3、6个月的眼压、视力、神经纤维厚度(视盘及视盘上方象限、下方象限、鼻侧、颞侧).结果:术后1周及1、3、6个月,观察组眼压均低于对照组,视力均高于对照组,比较差异均有统计学意义(P<0.05);术后1周及1、3、6个月,观察组视盘及视盘上方象限、下方象限、鼻测、颞侧的神经纤维厚度均高于对照组,比较差异均有统计学意义(P<0.05).结论:玻璃体切除联合硅油填充术应用于视网膜脱离患者的治疗,能显著提升视力,降低眼压,促进视神经纤维层恢复,此方法值得应用与推广.

目的 比较结膜下注射曲安奈德和经球内注射曲安奈德治疗葡萄膜炎继发黄斑水肿的效果.方法 选择我院2015年10月～ 2016年10月收治的葡萄膜炎继发黄斑水肿患者60例,共78眼,按随机数表法分为研究组和对照组各30例,各为39眼.研究组患者给予结膜下注射曲安奈德,对照组患者给予球内注射曲安奈德.比较两组患者的治疗效果,治疗前后黄斑中心凹视网膜厚度、最佳矫正视力变化以及患者治疗后不良反应及复发的发生情况.结果 研究组的总有效率明显高于对照组,差异具有统计学意义(P＜ 0.05);治疗前,两组患者的黄斑中心凹视网膜厚度以及最佳矫正视力比较,差异均无统计学意义(P＞0.05),治疗后,研究组的黄斑中心凹视网膜厚度明显低于研究组,且最佳矫正视力高于对照组,差异比较具有统计学意义(P＜ 0.05);治疗后研究组的眼压情况、结膜下出血情况、炎性反应和视网膜脱落等与对照组比较,差异无统计学意义(P＞ 0.05),但研究组的复发率和总发生率明显低于对照组,差异均具有统计学意义(P＜0.05).结论 结膜下注射曲安奈德较经球内注射曲安奈德对葡萄膜炎继发黄斑水肿的治疗效果良好,对提高患者视力,改善患者黄斑水肿情况有很大作用,且可以降低不良反应发生率和复发率,值得在临床广泛应用.

AIM:To evaluation the retinal nerve fiber layer(RNFL)thickness in children from 4～10 years associated with myopia.METHODS:Forty Chinese children between 4 and 10 years of age in our hospital from January 2012 to May 2014 were selected as test subjects. Patients whose manifest refraction measurement values ranged 0D≤diopterRESULTS:The average RNFL thicknesses were 102.36±10.33μm in high myopia group, 112.66±9.79μm in low myopia group and 106.52±9.46μm in moderate myopia group. A statistically significant difference was found between high myopia and low myopia groups(P<0.05). There was no statistically significant difference found neither between high myopia and mild myopia groups, nor between moderate myopia and low myopia groups(P>0.05). In addition, RNFL thickness was decrease especially in the inferior quadrant in children with high myopia and moderate myopia compared with low myopia groups(P<0.05). CONCLUSION:The average RNFL thickness is significantly thinner in high myopic children relative to low myopic children. And, the average RNFL thickness of inferior quadrant is significantly thinner in high myopic and moderate myopia children relative to low myopic children. Therefore, when interpreting OCT results of RNFL thickness in the clinic, more attention should be given to changes associated with myopia.

Objective To analyze the risk factors relevant to xerophthalmia in myopic patients after LASIK surgery. Methods The correlation between the age, gender, diopter, usage time of hormonal eye drops and xerophthalmia after LASIK surgery was analyzed. Results In the same age group, the incidence of xerophthalmia in female was significantly higher than that in male(P 0.05).In the same gender group, the incidence in the group with more than 30 years old was significantly higher than that in the group with ≤ 30 years old(P 0.05). The incidence in patients with high myopia was higher than that in patients with low and middle myopia(P 0.05).The incidence in patients who used eye drops for less than 1 month was lower than that in patients who used eye drops for more than 1 month(P 0.05). Conclusion There is correlation between the age, gender, diopter, usage time of hormonal eye drops in myopic patients and incidence of xerophthalmia after LASIK surgery. Female patients over 30 years old with high myopia have increased susceptibility to xerophthalmia. Usage of hormonal eye drops for long time should be avoided after LASIK surgery.

目的 探讨不同方法治疗儿童轻中度弱视的疗效.方法 入选2009年1月至2011年1月我院收治的100例轻中度弱视儿童,均为单眼弱视,随机分为遮盖纽和阿托品组各50例,比较两组患者临床疗效和立体视建立情况.结果 遮盖组总治愈率为90.00％,阿托品组总治愈率为88.00％,两组比较差异无显著性意义(X2=0.76,P＞0.05);治疗前后,两组有无立体视比较,差异无统计学意义(x2=0.27,P＞0.05);两组显效时间和治愈时间均无显著性差异(均P＞0.05).结论 遮盖法和阿托品扩瞳法在治疗儿童轻中度弱视简单、可靠,易为患儿所接受,且都可取得较好的治疗效果,但阿托品法的依从性比遮盖法高,患者容易接受,应广泛用于临床.

目的 观察手术显微镜下斜视矫正手术的临床疗效.方法 选取2011年6月-2013年6月我院80例斜视患者,随机分为两组,试验组42例进行显微镜下斜视矫正手术,对照组38例进行传统手术治疗.观察两组患者临床疗效的差异,同时评价其手术方面及术后并发症情况.结果 试验组总有效率95.2％高于对照组的68.4％,差异有统计学意义(P＜0.05);试验组手术耗时及出血低于对照组,差异具有显著性(P＜0.05);试验组术后并发症发生率7.1％低于对照组的39.5％,差异具有统计学意义(P＜0.05).结论 显微镜下斜视矫正手术疗效显著,具有较高的临床治疗有效率,手术耗时及出血较少,术后的并发症发生率较低,具有安全性高、微创等优点,可显著提高患者生活质量及治疗依从性.

目的：研究阻塞性睡眠呼吸暂停综合征（ OSAS）患者视神经纤维层的厚度变化。方法选择OSAS患者30例，其中轻中度患者16例、重度患者14例，将其视神经纤维层平均厚度及四个象限的平均厚度与30例（30只眼）健康人群作对比。结果与健康对照比较，重度OSAS患者上方视神经纤维层平均厚度明显变薄（P＜0．05），重度OSAS其他各个象限及轻中度OSAS患者各象限视神经纤维层可见变薄，但差异无统计学意义（ P均＜0．05）。结论重度睡眠呼吸暂停可能造成上方视神经纤维层的缺失、变薄，OSAS可能与视神经纤维层的变薄相关。

AIM: To discuss the application of anastomosis in traumatic lacrimal canaliculi laceration. METHODS: Totally 21 patients of which nasal end can not be found out were treated with anastomosis combined dacryocystotomy and retrograde intubation. RESULTS: All the patients were followed up postoperatively for 1 year to 2 years. The total effective rate was 95.2%.CONCLUSION: The anastomosis with dacryocystotomy and retrograde intubation is a affirmative and available method in treatment of traumatic lacrimal canaliculi laceration.

Objective To evaluate clinical observation,therapy method,the effect of Fuchs syndrome.Methods A retrospective analysis was made for 53 patients(53eyes) diagnosed as Fuchs syndrome form May 2005 to September 2011.The clinical observation,therapy effect and prognosis of patients were analyzed.Results 53 cases were cured by drug therapy,and about 42 cases,clinical features were over,intraocular pressures were controlled,the follow-up was 12 months,no one recurred.Conclusion Drug therapy is more effective methods for treating Fuchs syndrome.Surgery is effective methods for treating Fuchs syndrome with Glaucoma or Cataract.But it is recur possibly.Close observation and long term follow-up is necessary.

Objective To evaluate clinical observation,the effect of Coats disease.Methods A retrospective analysis was made for 8 patients(10eyes) diagnosed as Coats disease form June 2004 to December 2011.The clinical observation,therapy effect and prognosis of patients were analyzed,compared with that of patients younger than 18 years old.Results 1 case had bilateral involvement(25.0%),The male to female ratio was 6:4,2 eyes had abnormal vessel in all retinal zone,1 eye had exudative retinal detachment(10%),visual acuity had obvious improvement after laser treatment,which was better than that of patients younger than 18 years old.Conclusion Coats disease in adult patients are more likely to have lower symptom than in children patients.

目的 观察糖尿病患者行白内障超声乳化吸出联合人工晶体植入术的临床效果及其安全性.方法 对37例56眼糖尿病患者行白内障超声乳化吸出联合人工晶体植入术,随机选择非糖尿病患者45例(68眼)作为对照组,两组手术方法相同,观察术中,术后的反应及术后的视力.结果 糖尿病组56眼术后术后1周矫正视力>0.5者46眼(82.1%),对照组68眼术后术后1周矫正视力>0.5者57眼(83.8%),差异无显著性(P>0.05),术后并发症亦无显著性差异(P>0.05).结论 糖尿病患者白内障行超声乳化吸出联合后房型人工晶状体植入术是安全的,有效的.

随着超声乳化技术的臻成熟,手术时间大大缩短.总结我科表面麻醉下行白内障超声乳化吸出及人工晶状体植入术176例(188眼)的临床资料,现报告如下.

Objective To evaluate safety and efficacy of excimer laser in situ keratomileusis (LASIK) for moderate hyperopia. Methods LASIK was performed on 16 eyes of 8 patients using the Schwind Esiris excimer laser. The range of preoperative spherical equivalent was +3.50～+6.00 D, and the average was (+5.18±1.00) D. All the cases were followed up for 12 months or longer. Results There was no serious complication during the operation. No eye lost more than 1 line of the best corrected visual acurity alter surgery. At 12 months, the mean postoperative spherical equivalent was (+1.52±1.23)D. 68.7% of eyes reached 0 to +1.00 diopter. 93.7% of eyes achieved an uncorrected far vision of ≥0.5. Conclusion The LASIK is a safe and effective technique for the treatment of moderate hyperopia. But its effect is not better than that of myopia.