Objective:To observe and analyze the structural characteristics of the optic discs in high myopia (HM) combined with primary open-angle glaucoma (POAG) and the optic disc parameters with diagnostic efficacy.Methods:A cross-sectional study. From August 2020 to March 2021, a total of 114 eyes of 68 patients with POAG, HM and healthy volunteers who were diagnosed by Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University were included in the study. Among them, 21 POAG patients (39 eyes) were divided into H+P group (9 patients, 18 eyes) and non-H+P group (12 patients, 21 eyes) according to whether or not HM was combined; 26 HM patients (37 eyes) were selected as HM group; 21 healthy volunteers (38 eyes) were selected as normal control group. The subjects included 31 males (51 eyes) and 37 females (63 eyes), whose average age was 36.93±12.60 years old. Diopter, central corneal thickness (CCT) and axial length (AL) were measured. There was no significant difference in age ( F=8.333), sex composition ratio ( χ2=0.863), and CCT ( F=1.425) among the four groups ( P>0.05); while, there were significant differences in AL ( F=69.956), diopter ( F=37.711), visual field index (VFI) ( F=43.254) and mean defect (MD) ( F=49.793) among the four groups ( P<0.01). Enhanced depth imaging using optical coherence tomography was used to obtain the tilt parameters, the disc rim parameters, the lamina cribrosa parameters and the retinal nerve fiber layer (RNFL) thickness. The tilt parameters included optic disc horizontal diameter, optic disc vertical diameter, optic disc ellipse index (horizontal diameter/vertical diameter); the disc rim parameters included Bruch’s membrane opening-minimal rim width (BMO), optic cup area, optic disc area, disc rim area, cup-disc area ratio; the lamina cribrosa parameters included anterior laminar insertion depth (ALID), prelaminar neural tissue (PLNT), and lamina cribrosa thickness. The pairwise comparison between groups were performed by ANOVA test. Pearson correlation analysis was used to analyze the correlation between disc tilt parameters, disc rim parameters, lamina cribrosa parameters and visual field parameters, as well as between disc rim parameters and RNFL thickness. According to receiver operating characteristic (ROC) curve and area under the curve (AUC), the predictive value of those above related factors for HM combined with POAG was evaluated. Results:Tilt parameters: compared with the optic disc horizontal diameter of non-H+P group, those of normal control group, HM group and H+P group were significantly decreased ( P<0.05), the ellipse indices of HM group and H+P group were significantly lower than those of normal control group and non-H+P group ( P<0.05). The results of correlation analysis showed that the optic disc horizontal and vertical diameters were negatively correlated with MD ( r=-0.302,-0.235; P=0.002, 0.017), and negatively correlated with VFI ( r=-0.291,-0.246; P=0.003, 0.013). Disc rim parameters: the disc cup area and cup-disc area ratio of non-H+P group and H+P group were significantly larger than those of normal control group and HM group ( P<0.05). The disc rim area and the average BMO of HM group, non-H+P group and H+P group were significantly smaller than those of normal control group ( P<0.05). The results of correlation analysis showed that the cup-disc area ratio ( r=-0.584), the average BMO ( r=0.650) had the highest correlation with the average RNFL thickness ( P<0.001). The superior, inferior, nasal and temporal BMO were all positively correlated with the corresponding quadrant RNFL thicknesses ( r=0.431, 0.656, 0.362, 0.375; P<0.05); the optic disc rim area, the average BMO were positively correlated with MD ( r=0.449, 0.618) and VFI ( r=0.449, 0.605) ( P<0.05), among which the correlation of the average BMO was the highest; the optic cup area and cup-disc area ratio were negatively correlated with MD ( r=-0.346,-0.559) and VFI ( r=-0.312,-0.548) ( P<0.001), among which the correlation of the cup-disc area ratio was the highest. Lamina cribrosa parameters: ALID of non-H+P group and H+P group were significantly deeper than those of normal control group and HM group ( P<0.05). LC of non-H+P group and H+P group were significantly thinner than those of normal control group and HM group ( P<0.05). The results of correlation analysis showed that ALID was negatively correlated with MD and VFI ( r=-0.402, P<0.001), VFI ( r=-0.405, P=0.001); LC was positively correlated with MD and VFI ( r=0.403, P<0.001), VFI ( r=-0.401, P=0.015). Comparison of diagnostic efficiency between various optic disc parameters: the results of ROC analysis showed that the cup-disc area ratio had the highest diagnostic performance (AUC=0.847, P=0.007), the maximum Youden index was 0.563, the sensitivity and specificity were 0.833 and 0.730, respectively, and the best critical value was 0.340. Conclusions:Optic disc tilt is more pronounced in HM combined with POAG; BMO in each quadrant could objectively reflect the disc rim defect of HM combined with POAG; the thinning and the backward shift of the lamina cribrosa were consistent with the aggravation of the visual field defect. Among them, the cup-disc area ratio had better diagnostic performance.

AIM: To evaluate the practical teaching effect of the doctor-patient communication ability training combined with Simulation-based Medical Education(SBME)pedagogy in the standardized training for ophthalmology residents through Mini-Clinical Evaluation Exercise(Mini-CEX). METHODS: From September 2015 to July 2017, sixteen residents from the Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University were selected as research subjects. Before and after the conventional teaching or SBME teaching with standardized patients(SP), real doctor-patient communications were completed respectively, which were evaluated through Mini-CEX.RESULTS: As to the Mini-CEX assessment of the standard training residents for the pre-intervention doctor-patient communication about the three common diseases of age-related cataract, primary open-angle glaucoma, and acute bacterial conjunctivitis, there was no significant difference in the average score of the seven items between the trainees in the control group and the experimental group(P>0.05). After the demonstration teaching and comment revision, the control group directly performed the post-intervention doctor-patient communication and Mini-CEX evaluation, and the experimental group performed the further SBME teaching and then the post-intervention doctor-patient communication and Mini-CEX evaluation. The scores of the seven items in the two groups after the intervention were significantly higher than those before the intervention(P<0.05). The excellent rates of the trainees in the control group and the experimental group with an average score of 7 or more increased from 37.5%(3/8)and 37.5%(3/8)to 87.5%(7/8)and 100%(8/8), respectively. After the intervention, in addition to physical examination skills and clinical judgment, the scores of other five items such as medical interview skills, humanistic care and professionalism, psychological counseling skills, organizational effectiveness and overall clinical competence, were significantly higher in the experimental group than the ones in the control group(P<0.05).CONCLUSION: SBME pedagogy with SP can improve the effectiveness of the doctor-patient communication training for ophthalmology residents. Mini-CEX can be used to evaluate the teaching efficiency easily, quickly and standardly. The combination of Mini-CEX and SBME can be widely used in the practice of the doctor-patient communication training for ophthalmology residents.

目的 分析青光眼相关OCT及功能无创性检查的研究现状.方法 对青光眼主要检测方法、OCT检查和功能无创性检查进行综合评述分析,总结其在临床发展中的优势与发展现状.结果 OCT具有分辨率高、非侵入性、可重复性及实时快速强等优点;VF和视觉电生理检查具有无创性、准确率高等特点在早期青光眼诊断中具有独特的优势.结论 OCT检查和功能无创性检查的灵敏性和特异性在青光眼的不同病程阶段是不同的,临床中需要将其联合,运用于青光眼的诊断中.

Non-arteritic anterior ischemic optic neuropathy (NAION) is a common clinical disease,which can lead to acute vision loss.It is suggested that NAION is caused by the abrupt poor perfusion in the optic papillae from the branches of the central retinal artery and the posterior ciliary artery,not due to the arteritis,which cause the characteristic structural and functional damages in the anterior segment of the optic nerve.The recent advanced optical coherence tomography angiography (OCTA),is a new technique for testing the microvascular perfusion in and around the optic disc and in the macula through the quantitative analyses of vessel density and blood flow rate.OCTA can be used to discriminate the different microvascular perfusion reduction in the different regions or depths of the optic disc or the macula in NAION,which is much better than the traditional examinations for the diagnosis,differential diagnosis and follow-up of NAION.It can also be used to detect the abnormal microvascular perfusion in different regions or depths of the optic disc or the macula in the high-risk eyes,which may provide the basis for the prevention of NAION.

Objective To investigate the time relationship of the change,and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG).Methods Totally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017,50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study.Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group.High-risk groups inclusion criteria:vertical C/D≥0.6;early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards,mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect);continuous repeatable results.The first field and OCT results in the absence of visual field defects and C/D≥0.6,which were conformed reliability indicators and removed learning effects as a baseline.When patients achieve POAG diagnosis criteria first time which was recorded as a turning point.And they were divided into early group meanwhile were ended of follow-up.After the last follow-up,the inspection data was segmented counted in yearly interval.The changes of LTF,thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed.The loss rate and change rate in each period were compared for the assessment of their trends with time.Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95％ specificity in each period.Results After last follow-up,totally 67 patients 67 eyes (early POAG group,37 males and 30 females) were entered the turning point.The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years.The average RNFL thickness was 79.05± 8.09 μm,GCC thickness was 71.58 ± 8.41 μm,LTF was -6.05 ± 7.02 dB in early POAG group.The average RNFL thickness was 93.49± 6.24 μrm,GCC thickness was 79.72± 6.32 μm,LTF was-0.31 ± 0.58 dB in the control group.The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=-5.97,-10.42,-5.60;P＜0.001).The AUC of RNFL,GCC thickness and LTF increased with time in the early POAG group.The sensitivity was gradually increased at 95％ specificity:5th year before to at turning point,RNFL thickness AUC was 0.15,0.65,0.71,0.77,0.85,0.92,and sensitivity was 20％,56％,61％,65％,70％,76％,respectively;GCC thickness AUC was 0.12,0.53,0.69,0.74,0.82,0.90,and sensitivity was 14％,53％,69％,74％,82％,90％,respectively;the AUC of LTF was 0.10,0.21,0.33,0.75,0.86,0.91,and sensitivity was 7％,17％,44％,65％,78％,87％,respectively.Conclusions The earliest time of structural functional damage of POAG is at the 4th year before confirmed,simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF.The earliest time of visual functional damage of POAG is at the 2th year before confirmed,simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC.

目的 探讨视网膜光阈值波动(light threshold fluctuation,LTF)在原发性开角型青光眼(primary open-angle glaucoma,POAG)高危人群中的诊断价值.方法 纵向队列分析.收集POAG高危人群319例(319眼)进行POAG筛查和随访追踪,根据随后是否被确诊为POAG分为确诊组和未确诊组,收集同期来我院体检的健康人群为对照组(50例50眼).研究对象在基线时视野、视盘显示正常,8 a的随访期内每6个月复查一次视野、OCT.当第一次出现具有可重复性的视野早期缺损迹象或视盘垂直杯盘比≥0.6时给予确诊并记录为转点.比较确诊组、未确诊组、对照组从基线到转点的视网膜LTF,探讨影响因素,计算受试者工作曲线下面积,观察随时间推移的变化规律.结果 转点时,确诊组(67眼)与未确诊组(252眼)、对照组的LTF分别为-14 ～3(-6.05±7.02)dB、-4 ～4(-0.53±2.66)dB、-3～3(-0.31±1.58)dB,三组相比差异有统计学意义(P＜0.OO1).确诊组中,LTF与视野指数、平均缺损呈负相关性,与模式标准差、垂直杯盘比呈正相关性(均为P＜0.05).在25～45岁低龄组,视野＞10°～ 20°时视网膜LTF最频繁,占64.9％.在转点前5 a、前4 a、前3 a、前2 a、前1 a及转点的受试者工作曲线下面积分别为0.10、0.21、0.32、0.75、0.86、0.91,95％可信区间敏感度分别为7％、19％、44％、65％、78％、87％.结论 视网膜LTF对POAG早期诊断具有较高价值,LTF可以作为POAG患者尚没有出现视野早期缺损迹象和垂直杯盘比扩大时的早期诊断敏感指标.对POAG高危人群密切关注视野检查的视网膜LTF,可以在POAG患者发生视野或视盘进展的前2 a识别POAG.

目的 观察案例教学与Seminar教学相结合用于眼科学本科临床实践教学的应用效果.方法 选择2011级临床专业本科学生作为研究对象,三、四大班为实验组(114人)采用案例教学法与Seminar教学法相结合的教学方式,五、六大班为对照组(112人)采用传统教学法.课程结束后向学生发放问卷进行调查,并对学生进行闭卷考试,结果采用SPSS进行分析.结果 问卷调查两个组分别就案例讨论对理解知识点的帮助、该教学方式的兴趣、该教学方式对提高自学能力的帮助以及是否激发创造性思维方面进行比较差异均有统计学意义(P＜0.05);对考试成绩进行比较差异有统计学意义(P＜0.05).结论 案例教学法与Seminar教学法相结合的方法优于传统教学法.

? AIM: To train the ability of clinical diagnosis and treatment by seminar teaching method combined with case - based teaching method for the undergraduate teaching in the Department of Ophthalmology.?METHODS:Grade 2011 clinical undergraduate students were the research objects. Three and four classes were divided into experimental group ( 114 students ) applied seminar teaching method combined with case - based teaching method. Five and six classes were divided into control group ( 112 students ) applied traditional teaching method. We asked the students to carry out a questionnaire and exam after the end of the course. The data were analyzed by SPSS 19. 0.? RESULTS: The comparison data of questionnaire included understanding the knowledge points, improving <br> learning interest, approving the self-learning ability. The expression ability, cultivation of clinical thinking and memory theoretical knowledge were statistically significant (P<0. 05). The comparison test scores of two groups were statistically significant (P<0. 05).?CONCLUSION:Seminar teaching method combined with case - based teaching method can help to cultivate students’ thinking ability of clinical diagnosis and treatment.

目的 探讨特发性脱髓鞘性视神经炎(IDON)患者视盘周视网膜神经纤维层(RNFL)厚度与视野缺损变化的关系,评估结构损害与视功能损害和恢复的相关性.方法 前瞻性对入院诊断为单眼IDON的65例患者的患眼和对侧眼,分别在糖皮质激素冲击与序贯治疗前和治疗后3、6、12个月进行Humphrey视野计标准自动视野检查,相干光断层扫描(OCT)视盘周各位点方向的RNFL厚度.将视野缺损计分与不同位点神经纤维层厚度分别进行对比,研究IDON患者结构和功能损害的特点,同时将结构与功能损害进行相关性分析.结果 ①治疗前患眼与对侧眼平均RNFL厚度组间差异无统计学意义(P =0.759),发病后3、6、12个月,患眼的平均RNFL及上、下、鼻、颞侧RNFL均进行性变薄(P＜0.05),而对侧眼的RNFL未见显著改变(P＞0.05).随访12个月后,患眼各钟点位出现RNFL受损比例不同,以视盘的上、下极纤维束区受损最为严重.②患眼视野计分在治疗前与治疗后3、6、12个月相比,差异有统计学意义(P＜0.05);而随访的3、6、12个月间差异无统计学意义(P＞0.05).③随访3、6、12个月的视野计分与下方RNFL厚度呈负相关(P＜0.05);6、12个月视野计分与平均RNFL呈负相关(P＜0.05);12个月时视野计分与上方RNFL呈负相关(P＜0.05).视野计分与鼻侧和颞侧RNFL变化均无相关性(P＞0.05).12个月后,视野计分与12、1、5、6、7的5个钟点位呈负相关(P＜0.05),其余各钟点位与视野计分无相关性(P＞0.05).视盘与视野损害在早期具有较高的一致性.④按照Garway-Heath视盘与视野分区对应关系,12个月时视盘与视野损害较一致性的区域以第Ⅵ和第Ⅰ区最多见,其次是第Ⅱ和第Ⅲ区,视野损害在乳斑束对应区及早期发生损害的区域有明显改善.结论 ①IDON患者在发病后RNFL进行性变薄,尤以3个月内变薄最明显,视盘上、下极偏颞侧最先出现可检测的RNFL损害,且下极先于上极出现损害,而视野的损害以中心暗点及偏上方的缺损为早发.RNFL的损害与视野缺损以神经纤维束性损害为主,两者损害存在结构-功能的良好对应关系.②治疗后视野可有幅度逐渐变小的改善,以3个月内最为明显.虽然RNFL在进一步变薄,但到12个月时视野改善幅度最大的区域可见于乳斑束对应区及早期发生视野改变的区域.

目的:探讨PBL结合循证医学(EBM)的教学方法运用于眼科学临床实践中的效果.方法:采用传统学习法的学生作为对照组,以PBL与EBM相结合的教学法的学生为实验组,在实习结束后对实验组进行新教学模式效果调查.结果:实验组各项考核成绩明显高于对照组,具有统计学意义.结论:联合教学法较传统教学法有明显优势,值得广泛推广.

AIM: To observe the clinical effects of the sutureless intraocular suspended implantation of foldable three-piece acrylic aspheric posterior chamber lens ( Tecnis ) through clear corneal incision. METHODS:A total of 21 patients (24 eyes) with non or unintact capsule that underwent the intraocular suspended implantation of foldable three-piece acrylic aspheric posterior chamber lens ( Tecnis ) through clear corneal incision were observed and compared clinically to evaluate the clinical effects of this operative method. The observation and comparison were made on the parameters including visual acuity, intraocular reaction and lens situation by ultrasound biomicrography ( UBM) before and after the operation. RESULTS:A 3-12 months (6.5 months on average) follow up shows significant improvement ( P<0.01 ) of both the uncorrected and corrected visual acuity of 24 eyes.The corrected postoperative visual acuity were 1.0-1.5 (8 eyes, 33.3%), 0.5-0.9 (13 eyes, 54.2%) and 0.1-0.4 ( 3 eyes, 12.5%), respectively. There was no statistical difference in the distance from the plane of artificial lens body to corneal endothelium, and the distance from ciliary process to corneal endothelia ( P>0.05) in UBM photos after operations.All of 24 eyes were successfully conducted intraocular lens implantation without serious, intraocular infections or inflammations, no complications like cyclodialysis or retinal detachment.Only a few cases present temporary increase of intraocular pressure. CONCLUSION: The sutureless intraocular suspended implantation of foldable three-piece acrylic aspheric posterior chamber lens ( Tecnis ) through 3.0-6.0mm clear corneal incision is an advisable remedy for capsule rupture failure during phaco -emulsification and an advisable operation for the dislocation of crystalline lens resulted from trauma or congenital cataract. The procedure can improve visual acuity safely and effectively without obvious complications.Its long-term effect needs long-term follow-up observation.

Secondary high intraocular pressure(IOL) is one of the most common complications after silicone oil tamponade.The mechanisms of elevated IOP secondary to silicone oil tamponade remains complex.Several factors could be involved such as:(1) excessive silicone oil tamponade ; (2) silicone oil emulsification ; (3) diffusion of silicone oil into the anterior chamber; (4) chronic toxic effects of silicone oil; (5) association with an other surgery ; (6) ocular traumatism ; (7) preoperative predisposing factors ;(8) postoperative medication and postoperative body position.This manuscript will review the different causes of IOP elevcotion after vitrectomy and silicone oil retinal tamponade.

Objective: To evaluate the relationship between damages of visual field and retinal nerve fibre layer(RNFL) thickness in primary open angle glaucoma(POAG)with high myopia. Design: Retrospective, case-controlled study. Participants: POAG group with high myopia (21 eyes of 17 cases), POAG group with non-high myopia(17 eyes of 16 cases), high myopia group without POAG (25 eyes of 20 cases) and normal control group (19 eyes of 17 cases). Methods: The static central visual fields were tested with Humphrey 750 automated perimetry and thickness of RNFL was measured with optical coherent tomography (OCT). Main Outcome Measures: Mean deviation (MD), pattern standard deviation (PSD) and mean sensitivity at upper, lower, nasal and temporal quadrants in total deviation probability plots. Thickness of RNFL at upper, lower, nasal and temporal quadrants. Results: There were more obvious general depression of sensitivity in total deviation probability plots of the early POAG with high myopia than those of POAG without high myopia, and the early visual field defects of glaucoma in pattern deviation probability plots of this group. MD of POAG with high myopia was more than those of others (P<0.05). The differences of MD, PSD and mean sensitivity between POAG with high myopia and others were significant (P<0.05). Mean sensitivities in each quadrant of POAG without high myopia were similar to those of high myopia (P> 0.05). The thickness of RNFL of POAG with high myopia was thinner than those of others and the thickness of RNFL of normality was thicker than that of others. The correlationship between mean sensitivity and the thickness of RNFL in each quadrant was significant(P< 0.05). Conclusion: Pattern deviation probability plots is an important favor for judgement of the visual field changes in POAG with high myopia. The relationship between RNFL thickness with OCT and visual field damage may provide clinically relevant information in diagnosis of POAG with high myopia.

Objective To evaluate the relationship between damages of visual field and retinal nerve fibre layer(RNFL)thickness in primary open angle glaucoma(POAG)with high myopia.Design Retrospective,case-controlled study.Participants POAG group with high myopia(21 eyes of 17 cases),POAG group with non-high myopia(17 eyes of 16 cases),high myopia group without POAG(25 eyes of 20 cases)and normal control group(19 eyes of 17 cases).Methods The static central visual fields were tested with Humphrey 750 automated perimetry and thickness of RNFL was measured with optical coherent tomography(OCT).Main Outcome Measures Mean deviation(MD),pattern standard deviation(PSD)and mean sensitivity at upper,lower,nasal and temporal quadrants in total deviation probability plots.Thickness of RNFL at upper,lower,nasal and temporal quadrants.Results There were more obvious general depression of sensitivity in total deviation probability plots of the early POAG with high myopia than those of POAG without high myopia,and the early visual field defects of glaucoma in pattern deviation probability plots of this group.MD of POAG with high myopia was more than those of others(P＜0.05).The differences of MD,PSD and mean sensitivity between POAG with high myopia and others were significant(P＜0.05).Mean sensitivities in each quadrant of POAG without high myopia were similar to those of high myopia(P＞0.05).The thickness of RNFL of POAG with high myopia was thinner than those of others and the thickness of RNFL of normality was thicker than that of others.The correlationship between mean sensitivity and the thickness of RNFL in each quadrant was significant(P＜0.05).Conclusion Pattern deviation probability plots is an important favor for judgement of the visual field changes in POAG with high myopia.The relationship between RNFL thickness with OCT and visual field damage may provide clinically relevant information in diagnosis of POAG with high myopia

原发性闭角型青光眼(PACG)和原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)的视野损害模式的存在差异。PACG视野损害程度与眼压值相关,与其不同发展阶段有关,急性发作时眼压升高的水平和持续时间与视野损害程度相关且后者关联更大。

In the course of follow-up analyses of visual field test,it should take more than two visual field tests that had similar results as baseline test,and some factors should be taken into account,such as accordant testing conditions,reliable indeces,test errors and fluctuation effects,and so on.The indeces of Mean Deviation(MD)and Pattern Standard Deviation(PSD)could reflect the whole change trend of follow-up visual field test,while sensitivity value of every point and their pattern deviations could help to analyse tiny changes of visual field tests.Those statistic softwares provided by automatic perimetry should be used adequately.Through the follow-up analyses of visual field test,glaucoma doctors could adjust therapy schemes in time in order to obtain objective intraocular pressure and stabilize visual field and glaucoma.