Objective:To explore the main reasons of ophthalmology elimination in the physical reexamination of flying candidates since the implementation of Medical Specification for Recruitment of Civil Aviation Airman Trainees MH/T 7013—2017 (issued in 2007), in order to provide reference for the ophthalmic medical specification in the physical reexamination of flying candidates in future. Methods:A total of 15 503 flying candidates of a civil aviation university who were recruited and reexamined during 2015 to 2020 were selected and the data of ophthalmology elimination diseases were retrospectively analyzed. The disease spectrum of ophthalmic elimination in the physical reexamination of flying candidates during 2017 to 2020 was compiled and the results were statistically analyzed.Results:During 2015 to 2020, the yearly elimination rate of ophthalmic diseases was 0.88%, 0.52%, 0.70%, 0.79%, 0.36% and 0.39%, respectively, with no significant difference ( P>0.05). From 2017 to 2020, 61 flying candidates were eliminated due to ophthalmic diseases, of which 42.62% were retinal diseases, 19.67% were diopter exceeding standards, 18.03% were corneal diseases, 9.84% were extra ocular muscle diseases, 8.20% were lens diseases, and 1.64% were uveal diseases in the physical reexamination of this university. The difference was statistically significant ( χ2=45.19, P<0.001). Conclusions:The elimination rate of ophthalmology in the physical reexamination of flying candidates of civil aviation university has been relatively stable from 2015 to 2020. After the implementation of new specification, the most common elimination diseases of ophthalmology in the physical reexamination of flying candidates are retinal diseases, that need to be paid enough attention in the physical reexamination of flying candidates.

Objective:To summarize the experience and improve the physical examination in civil aviation recruitment by retrospectively analyzing the preliminary inspection data and provide references for future appraisal.Methods:A total of 1 306 senior high school students who accepted the physical examination in Civil Aviation Medical Center from December of 2019 to May of 2021 were selected as the research objects. The results of disease elimination rates in different departments, elimination diseases constituent ratio and ophthalmology elimination diseases were statistically analyzed.Results:① A total of 1 306 senior high school students participated in the initial physical examination for recruitment, and 621 students were eliminated due to different diseases. The elimination rate was 47.5%. Among them, 92 students were eliminated from internal medicine, with an elimination rate of 7.0% and an elimination disease composition ratio of 14.8%; 85 students were eliminated from surgery, with an elimination rate of 6.5% and an elimination disease composition ratio of 13.7%; 392 students were eliminated from ophthalmology, with an elimination rate of 30.0% and an elimination disease composition ratio of 63.1%; and 52 students were eliminated from otorhinolaryngology, with an elimination rate of 4.0% and an elimination disease composition ratio of 8.4%. There were significant differences among the elimination rates and the constituent ratios of eliminated diseases from different departments ( χ2=552.99, 649.68, both P<0.001). ②Obvious oblique diseases, refractive index exceeding standard, retinal diseases, hidden oblique exceeding standard and lens diseases were the top 5 elimination diseases of ophthalmology. There was significant difference in the proportion of ophthalmic elimination diseases ( χ2=296.30, P<0.01). Conclusions:Attention should be paid to main diseases in the physical examination of pilot candidates. In the initial physical examination of civil aviation pilot candidates, the elimination rate of ophthalmology is the highest.

目的 回顾性调查并分析民航招收飞行学生中进行角膜屈光手术人员的体检鉴定特点.方法 收集2017年10月至2019年6月民航招飞学生体检鉴定中行角膜屈光手术者297例(580眼).依据2017版《民用航空招收飞行学生体检鉴定规范》眼科相关条目将受检者分为合格组与不合格组;依据不同手术方式对受检者分为准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)组、飞秒激光小切口角膜基质透镜取出术(femtosecond laser small incision lenticule extraction,SMILE)组、飞秒激光辅助准分子激光角膜原位磨镶术(femtosecond laser in kertomileusis,FS-LASIK)组和其他组(角膜表层及浅基质层的其他屈光手术方式组),比较不同手术方式下各组的手术年龄、术后时间、术前屈光度;合格组中比较各手术方式的手术年龄、术后时间、术前屈光度、术后裸眼视力、剩余角膜厚度;分析不合格组的淘汰原因.结果 各手术方式在合格组和不合格组组间比较显示,手术年龄、术前屈光度差异无统计学意义;合格组和不合格组中术后时间比较,SMILE组均明显低于LASIK组,差异有统计学意义(P=0.014);合格组中,手术年龄LASIK组明显低于SMILE组,差异有统计学意义(P＜0.05),术后时间LASIK术明显高于SMILE术,差异有统计学意义(P＜0.05);其余两组间差异无统计学意义.主要不合格原因构成比显示,术前屈光度大于-4.50 D 79例(48％)、手术年龄不达标20例(12％)、术后视力不达标16例(10％)、剩余角膜厚度小于460 μm 14例(9％)、视网膜病变14例(9％)、外斜视及外隐斜视11例(7％)、角膜混浊4例(2％)、术后未满半年2例(1％);不合格组中,各手术方式的主要不合格原因构成比比较,差异均无统计学意义.结论 行角膜屈光手术有招飞不合格的风险,拟行该手术的招飞学生应做好预判,个性化选择术式.

目的 分析150名(300眼)招飞学生初检及复检的屈光度及变化特点,探讨不同复检时间下其屈光状态的变化情况,为民航招飞眼科体检工作积累数据、总结经验.方法 收集在东北地区某民航医学中心参加招飞初检且进入复检的150名(300眼)招飞学生,记录初检时间、初检时屈光度(等效球镜)、复检时间及复检时屈光度(等效球镜),整理后经统计学软件进行分析.结果 初检屈光度分布情况:低度远视组2.00％(6/300),正视组55.70％(167/300),低度近视组36.00％(108/300),中度近视组6.30％(19/300);复检屈光度分布情况:低度远视组2.00％(6/300),正视组57.00％(171/300),低度近视组33.33％(100/300),中度近视组7.67％(23/300).初检屈光度与不同复检时间屈光度(4～6个月、7～9个月、10～12个月)比较,差异均有统计学意义(P＜0.05).初检、复检屈光度变化差值(绝对值):0≤SE＜0.25D组者55.00％(165/300),0.25D≤SE＜0.50D组者15.33％(46/300),0.50D≤SE＜0.75D者18.00％(54/300),≥0.75D者11.67％(35/300),与不同复检时间比较,差异均有统计学意义(P＜0.05).结论 招飞学生不同复检时间的屈光度及其变化幅度不同,变化幅度多小于0.25 D.

AIM: To investigate the prevalence on peripheral retinal degeneration and to provide theoretical support for the medical examination of civil aviation pilots recruitment. METHODS: Two thousand four hundred and fifty prospective flight students(Four thousand nine hundred eyes)who received medical examination in Civil Aviation General Hospital from February 2018 to May 2019 were divided into three groups according to diopter after fully mydriatic with tropicamide phenylephrine eye drops(Group A: +3.00 to RESULTS:There were five hundred and seventy five students with different types of peripheral retinal degeneration in 2 450 checked students, the prevalence was 23.5%. There was statistical difference in the prevalence of peripheral retinal degeneration in different diopter groups(χ2=65.386, P<0.01). There was statistical difference in the prevalence of different types of peripheral retinal degeneration(χ2=351.276, P<0.01). There was statistical difference in the prevalence of peripheral retinal degeneration in different parts(χ2=563.712, P<0.01). CONCLUSION: Peripheral retinal degeneration is not rare in civil aviation recruitment. The prevalence increases with the progression of myopia, and the lesions are mostly in bitamporal quadrant. It is suggested to identify according to different types.

目的 分析某高校招飞复检中不符合体检鉴定规范的眼科疾病,以提高航空体检鉴定的水平. 方法 以2017年10月至2017年11月某高校2 422名招飞复检的准飞行学员为研究对象,按照中国《民用航空招收飞行学生体检鉴定规范》进行眼部及其视功能检查,将眼科疾病分类汇总分析. 结果 在2 422名复检的准飞行学员中,共有16例(0.66％)不符合眼科体检鉴定规范,其中视网膜疾病8例(50.0％),眼屈光度超标4例(25.0％),显斜及隐斜超标2例(12.5％),角膜疾病2例(12.5％). 结论 招飞复检中不符合眼科体检鉴定规范的主要疾病为视网膜疾病及眼屈光度超标,体检医师在招飞初检中应当更加细致,因为在初检与复检的一定间隔时间内,也存在着疾病的发生发展过程.对于存在可疑病变或处于标准临界值的学员,应利用其它相应检查做最终确认.

目的 回顾性分析民航飞行员原发性翼状胬肉病例及文献,以期加强对该病的认识,提高诊断和鉴定水平. 方法 介绍3例民航飞行员原发性巽状胬肉的发生情况,分析并探讨该病的体检鉴定方法. 结果 3例患翼状胬肉申请人,发病年龄在47～54岁.1例体检鉴定合格,随访观察;2例胬肉切除术后地面观察3个月后评定为合格,其中包含行2次手术者1例. 结论 对原发性翼状胬肉的航空医学鉴定,应根据冀状胬肉的临床分型与分类、侵及角膜缘长度,结合电脑验光、视野及角膜地形图等检查进行综合评定,鉴定合格后应随访观察.

1临床资料 申请人,男,23岁,2017年5月某民航医院招飞初检上站人员.既往体健,否认眼部外伤及眼科疾病史,相关家族史不详.远视力(Landolt环形视力表):右眼0.8,左眼0.7;裂隙灯检查:双眼结膜无充血,角膜上皮及基质层透明,内皮层散在数处小的囊泡状改变,成簇分布,囊泡间内皮透明,其中左眼角膜内皮旁中央2点位弧形带状缺损,长约5 mm,宽约1.5 mm(图1,见封三),双眼KP(-),房闪(-),瞳孔等大正圆,光反射(+),虹膜纹理清,晶状体透明;非接触眼压OD 17 mmHg,OS18 mmHg;角膜内皮镜检查:右眼角膜内皮细胞平均密度2 515/mm2,细胞变异系数35,六角形细胞比例54％,左眼角膜内皮细胞平均密度2 485/mm2,细胞变异系数37,六角形细胞比例51％(图2).诊断双眼多形性角膜后层营养不良,建议其定期门诊复查,不适随诊.

目的 比较电脑验光与检影验光在民航招飞复检中屈光度值的差异,探讨电脑验光在民航招飞复检中应用的可行性. 方法 随机选取2015年10月-11月在中国民用航空飞行学院进行招飞复检的准飞行学员550人(1100眼),美多丽-p扩瞳后,分别进行电脑验光和检影验光,检测球镜值、柱镜值及柱镜轴位,并对检查结果进行统计学分析. 结果与检影验光相比,电脑验光球镜值和柱镜值结果均偏负,但其差异无统计学意义(P＞0.05);电脑验光柱镜轴位较检影验光略大,差异亦无统计学意义(P＞0.05). 结论 电脑验光与检影验光检测结果有较好的一致性,在民航招飞复检中可尝试椎广应用.

在最新修订的AC-67FS-001《空勤人员和空中交通管制员体检鉴定医学标准》中,针对角膜营养不良的鉴定标准发生了较大变化.本文主要从我国民航空勤人员角膜营养不良的体检鉴定现状、其他主要航空组织对本病的鉴定标准、新标准实施后的鉴定展望、空勤人员常见角膜营养不良的检查评估、鉴定原则以及处理意见等方面进行了探讨,以期在角膜营养不良的航空医学鉴定方面起到积极的作用.

目的 比较标准近视力表和交叉格子法在现役飞行员中对老视的诊断情况.方法 随机抽选某航空公司324名现役飞行员,共648眼,以标准近视力表和交叉格子法分别检测近视力,以配对卡方检验评估两种检测方法的优劣. 结果 以标准近视力表检出老视370眼,交叉格子法检出老视407眼,标准近视力表对老视的检出率明显低于交叉格子法(P=0.001);分层分析发现,标准近视力表在中国籍及40岁以下组和41～45岁组飞行员中对老视的检出率仍明显低于交叉格子法(P＜0.001、P=0.007和P=0.031),而在外籍和46岁以上组飞行员中,两种检测方法的检出率相当(P=0.345和P=0.607).结论 在现役飞行员中单纯应用标准近视力表评估近视力是不全面的,会低估老视的患病率,但在外籍和46岁以上的现役飞行员中,标准近视力表可以完全替代交叉格子法.

1 临床资料 患者,男性,32岁,飞行驾驶员,总飞行时间3 300 h.2008年参加招飞体检.全身状况良好,无早产及吸氧史,否认眼科疾病史及相关家族史.视力:Vod 1.0,Vos 1.0,交替遮盖:外向中移动.双眼前节未见明显异常,双眼玻璃体条索状混浊,动度较大,以左眼为重.左眼底颞侧及下方周边部见较大范围的色素性增殖,其后为大片灰黑色视网膜变性区.右眼颞侧及上方周边部见灰黑色变性区(图1,见封三).2014年6月6日眼科检查:①60°视野示:右眼视野大致正常,左眼周边部视野较右眼略小(鼻侧),视野缩小范围小于15°.

?AIM:To investigate and analyze the prevalence and the influencing factors on retinal arteriosclerosis in civil aviators of different ages.?METHODS:Two thousand seven hundred and seventy-eight commissioned civil aviators who received medical examination in Civil Aviation General Hospital from July 2014 to July 2015 were randomly divided into three groups: group A ( 1 311 aviators aged 22-39 ) , group B (618 aviators age 40-49 ), group C(849 aviators age 50-59). Aviators over 40 years old, were divided into two groups: group with retinal atherosclerosis and group without retinal atherosclerosis according to the results of fundus examination. Medical examination data of the aviators were analyzed.?RESULTS: Of 2 778 aviators, 334 ( 12. 02%) were detected with retinal arteriosclerosis, among which 318 aviators were classified as gradeⅠ, and 16 aviators as grade Ⅱ. The retinal arteriosclerosis prevalence of group A, B, and C increased with age, and the difference was statistically significant ( P < 0. 05 ). Biochemical tests showed that the prevalence of hypertension, hyperlipidemia, high fasting blood glucose and overweight increased in group with retinal arteriosclerosis compared with that in group without retinal arteriosclerosis, and the difference was statistically significant(P<0. 05).?CONCLUSION:The prevalence of retinal arteriosclerosis in commissioned civil aviators was 12. 02%, and most of&nbsp;the retinal arteriosclerosis was classified as grade Ⅰ. In aviators over 40 years old, hypertension, hyperlipidemia, high fasting blood glucose and overweight were important factors in the development of retinal arteriosclerosis.

1 临床资料 患者,男,34岁,某航空公司飞行员.全身状况良好,否认眼科疾病史及相关家族史.专科检查:视力:Vod 0.9,Vos 0.9,外眼正常,双眼前节未见明显异常,玻璃体透明,右眼视盘见1 PD肿物隆起约1D向下方延伸,棕黑色、边界稍欠清晰;左眼底未见明显异常.患者于某医院行眼底荧光血管造影(FFA)示:右眼视盘边界不清,表面毛细血管扩张,视盘下半部见团状低荧光隆起病灶,病灶表面可见异常动静脉吻合血管,迂曲呈袢状,晚期病灶表面轻微荧光渗漏.

目的 回顾共同性外显斜视飞行员在招飞体检中隐斜度数的分布情况,分析隐斜度数对共同性外显斜视发病的影响. 方法 随机选取2015年6月至2016年6月间参加年度体检的25～45岁飞行员120例,其中诊断为共同性外显斜视者60例,眼位正常者60例,分别记录其招飞体检中的隐斜度数分布,并加以分析. 结果 ①招飞体检隐斜度数分布在-3△～-5△者较分布在＜-3△者共同性外显斜视发病率高,差别有统计学意义;②招飞体检隐斜度数分布在＜-3△者,共同性外显斜视的发病率36～45岁高于25～35岁,差别有统计学意义;③招飞体检隐斜度数分布在-3△～-5△者,共同性外显斜视的发病率36～45岁与25～35岁差别无统计学意义. 结论 招飞体检中隐斜度数分布在-3△～-5△者更容易出现共同性外显斜视,在招飞过程中应当结合遮盖试验及三级视功能检查,从严把关,尽早预防.

目的 分析民航飞行员角膜屈光术后对比敏感度(CS)的影响因素,探讨对比敏感度在航空医学评定中的应用. 方法 利用Optec 6500视功能测试仪对22例角膜屈光术后飞行员和14例健康飞行员在昼间和夜间眩光条件下进行对比敏感度检查,分析角膜屈光手术方式、术前屈光度、术后观察时间、术后飞行时间、照明等因素对对比敏感度的影响. 结果 角膜屈光术后飞行员CS值在各空间频率均不低于健康对照组;术后一年以上者CS值在1.5 cpd、6 cpd和12 cpd显著高于术后一年以内者(P＜0.05);CS值随飞行时间增加而下降,但仅在1.5 cpd近一年飞行时间大于100 h者与小于100 h者有显著性差异;术前中度近视组CS值在3 cpd,6 cpd和12 cpd显著低于低度近视组(P＜0.05);昼间和夜间眩光条件下CS值在3 cpd有显著性差异. 结论 角膜屈光术后民航飞行员经地面观察6个月后,虽然其对比敏感度在空间频率均不低于健康对照飞行员,但可能受术后观察时间、术前屈光度、飞行时间、照明条件等因素的影响.角膜屈光术后飞行员进行航空医学评定时,对比敏感度作为视觉质量的重要评价指标,可为角膜屈光术后飞行员的航空医学评定提供参考.

AIM:To survey civil aviator contrast sensitivity ( CS) of different ages and analyze the characteristic of it in order to obtain the normal reference value. METHODS: Four hundred eyes of 200 commissioned civil aviators from Civil Aviation General Hospital from September, 2013 to July, 2014 were randomly divided into four groups:group A (age 20~29), group B (age 30~39), group C (age 40~49), group D (age 50~59), and 50 people in each group ( 100 eyes ) . All of the eyes naked vision had to be ≥1. 0, with no eye disease and associated systemic diseases. The CS of different spatial frequencies was measured with OPTEC 6500 under light and dark room. RESULTS:The CS curves of groups were all presented with inverted U shape, and the CS was highest in intermediate frequency area ( 3. 0c/d and 6. 0c/d ). Compared with that in the rest three groups, the values of CS at spatial frequency (6, 12 and 18c/d) under light room were decreased in group D, with statistical significance ( P<0.01 ) . Compared with that in the rest three groups, the values of CS at spatial frequency (1. 5, 3 and 6c/d) under dark room were decreased in group D, with statistical significance (P<0. 01). CONCLUSION: This survey objectively reflects the characteristics of civil aviator CS of different ages, and provides reference date for further study on civil aviator visual function characteristics and obtaining the normal reference value of civil aviator CS.

1 临床资料 患者,男,25岁,飞行学员.2012年12月因突发双眼视野缺损1周入院,查体:神志清,对答切题,颈软,听力正常,无面部感觉异常,四肢肌力V级,肌张力正常,生理反射存在,巴彬斯基征(-);眼部检查:右眼视力1.5,左眼视力1.5,双侧瞳孔等大等圆,直径约2.5mm,光反射(+),视野检查双眼颞侧偏盲,余无阳性体征.化验检查:血尿常规及生化全项正常,激素检查泌乳素为37.7 ng/ml,其他均属正常水平.

横纹肌样型脑膜瘤是脑膜瘤中少见的特殊亚型，临床经过具有侵袭性，组织学形态较为特殊，容易误诊。本文报道1例发生于左枕叶的横纹肌样型脑膜瘤，旨在提高临床病理工作者对该肿瘤的认识。

屈光性眼部手术根据手术部位不同一般分为三大类:即角膜屈光手术、巩膜屈光手术和眼内屈光手术.角膜屈光手术以准分子激光原位角膜磨镶术(laser-assisted in situ keratomileusis,LASIK)为代表,其治疗低、中度近视效果显著,但在治疗高度近视,尤其是超高度近视(一9.00D以上)时屈光矫正效果、预测性及稳定性均降低.此外,受角膜厚度的限制,-12.00D以上的超高度近视很少施行准分子激光手术治疗.巩膜屈光手术包括巩膜缩短术和巩膜加固术,这类手术通过缩短巩膜或用异体、自体组织加强巩膜,达到缩短眼轴,降低眼球屈光度,防止近视度数加深的效果,主要用于发展迅速的进行性近视和伴有后巩膜葡萄肿的高度近视,但其矫正近视的疗效尚不确切,预测性也较差[1-2].