Objective:Using bibliometrics to study the international literature on fat transplantation in recent 10 years, and to explore the research status, hot spots and development trend in this field.Methods:Literatures related to fat transplantation research from 2011 to 2020 were searched through the core collection of Web of Science database, and the literatures were screened strictly according to inclusion and exclusion criteria. Statistical analysis was conducted on the year, journal, first author, number of articles published by countries and institutions, and distribution of disciplines by bibliometrics. Citespace5.7.R5W software was used for co-citation analysis of the included literatures. Cooccurrence analysis and emergent word analysis were also carried out on the keywords in the literature. VOSviewer1.6.16 software was used to perform visual clustering of terms in the title and abstract of the included literature to reveal hot topics and research frontiers.Results:A total of 4 901 papers were included, and the number of annual publications continued to increase from 2011 to 2020. The top three publications during the study period were Plastic and Reconstructive Surgery (320 papers), Aesthetic Surgery Journal (171 papers), and PLoS One (113 papers). The first authors were Rafael Denadai (13 papers), Gentile Pietro(12 papers), Khouri Roger(6 papers). The most productive countries and institutions in this field were the United States (1 646 papers), China (853 papers), and Italy (383 papers). The organizations with the largest number of publications were the University of Pittsburgh (96 papers), Shanghai Jiao Tong University (78 papers), and Milan University (63 papers). There were 87 research categories in the literature related to fat transplantation, of which surgery was involved mostly. Visual analysis of Cites Pace5.7.R5W software showed that 4 901 references had established a co-citation network consisting of 381 nodes, 608 links and 12 clusters. There were 69 599 keywords in the literature, and the top five keywords from high to low were "transplantation" "adipose tissue" "stem-cell" "tissue" , and "obesity" . In the literature, the keywords with the highest intensity of outburst was "outcome" , and the keywords with the longest duration of outburst was "cartilage" . In recent years, the five keywords with outburst were "liver disease" "trial" "stromal vascular fraction" "outcome" , and " Akkermansia muciniphila" . VOSviewer1.6.16 software visualization clustering result showed that the application of fat transplantation in plastic surgery, the source of adipose tissue and its survival mechanism in vivo, and the laboratory research on fat regeneration were the three hot spots in the field of fat transplantation technology. Conclusions:The research on fat transplantation is on the rise in the world, and research institutions at home and abroad are conducting in-depth exploration on fat transplantation. Recent research focuses on improving the long-term survival rate of fat transplantation, and the research level is gradually in-depth at the molecular level.

Significance The automatic generation algorithm of optical coherence tomography (OCT) images based on generative adversarial networks (GAN) can generate a large number of simulation images by a relatively small number of real images, which can effectively improve the classification performance. Aim We proposed an automatic generation algorithm for retinal OCT images based on GAN to alleviate the problem of insufficient images with high quality in deep learning, and put the diagnosis algorithm toward clinical application. Approach We designed a generation network based on GAN and trained the network with a data set constructed by 2014_BOE_Srinivasan and OCT2017 to acquire three models. Then, we generated a large number of images by the three models to augment age-related macular degeneration (AMD), diabetic macular edema (DME), and normal images. We evaluated the generated images by subjective visual observation, Frechet inception distance (FID) scores, and a classification experiment. Results Visual observation shows that the generated images have clear and similar features compared with the real images. Also, the lesion regions containing similar features in the real image and the generated image are randomly distributed in the image field of view. When the FID scores of the three types of generated images are lowest, three local optimal models are obtained for AMD, DME, and normal images, indicating the generated images have high quality and diversity. Moreover, the classification experiment results show that the model performance trained with the mixed images is better than that of the model trained with real images, in which the accuracy, sensitivity, and specificity are improved by 5.56%, 8.89%, and 2.22%. In addition, compared with the generation method based on variational auto-encoder (VAE), the method improved the accuracy, sensitivity, and specificity by 1.97%, 2.97%, and 0.99%, for the same test set. Conclusions The results show that our method can augment the three kinds of OCT images, not only effectively alleviating the problem of insufficient images with high quality but also improving the diagnosis performance.

目的 探讨小角度后天性上斜肌麻痹引起复视的三棱镜矫正处方量及其相关性参数.方法 回顾性收集2015年1月-2019年3月小角度后天性上斜肌麻痹引起复视并接受三棱镜矫正的患者19例,分别予以Von Graefe棱镜分离、马氏杆、同视机行斜视度检查;三棱镜矫正以达到复视消除、可耐受的最小三棱镜度数作为最终处方量.对不同方法斜视度测量数据进行统计分析,以及对垂直斜视度测量结果与处方量进行线性相关分析.结果 (1)水平斜视度:Von Graefe棱镜分离(-0.74±1.99)△,马氏杆测量(-0.21±3.05)△,同视机测量(-0.73±4.03)△,三者比较差异无统计学意义(F=0.179,P=0.837);(2)垂直斜视度:Von Graefe棱镜分离(7.36±4.45)△,马氏杆测量(8.57±4.62)△,同视机测量(9.00±4.94)△,三者比较差异无统计学意义(F=0.623,P=0.540);(3)3种方法与处方量相关分析:棱镜处方量为(5.79±2.41)△.与棱镜处方量的线性相关关系分别为,Von Graefe棱镜分离(r=0.648,P=0.003)、马氏杆检查(r=0.613,P=0.005)、同视机(r=0.502,P=0.028),均有统计学意义;与棱镜处方量的差异,Von Graefe棱镜分离(Z=-1.746,P=0.081),无统计学意义,而马氏杆(Z=-3.066,P=0.002),同视机(Z=-2.976,P=0.003),均有统计学意义.结论 小角度后天性上斜肌麻痹患者以Von Graefe棱镜分离法测量的垂直斜视度可以作为三棱镜试戴的参考值,水平斜视度在处方中可以忽略.

目的 提出一种基于卷积神经网络(convolutional neural network,CNN)的眼科光学相干断层成像(optical coherence tomography,OCT)图像自动分类方法,实现对视网膜OCT图像的自动分类,缓解人工诊断依赖医生的临床经验、费时费力等问题.方法 基于公开的数据集2014_BOE_Srinivasan构建了2个样本数据集.其中样本数据集一为仅对数据集中的图像进行预处理后裁剪,样本数据集二为对取出测试集后剩余图像的裁剪过程中引入随机平移和水平翻转技术对图像进行扩充,并划分为训练集和验证集.搭建基于CNN的视网膜OCT图像分类网络,并分别使用两个数据集训练网络得到分类模型.最后使用独立的测试集对模型进行测试,并通过输出混淆矩阵查看模型对3种类别图像的分类情况.结果 通过混淆矩阵计算得出,使用扩充后的图像训练的分类模型的准确度为93.43％,灵敏度为91.38％,特异度为95.88％.结论 提出的基于CNN的视网膜OCT图像自动分类方法可以对老年性黄斑变性、糖尿病性黄斑水肿和正常3种类别的视网膜OCT图像进行分类.同时,数据扩充有助于提高分类算法的性能.

目的 探讨客观评价近视眼配镜过矫对人眼调节功能影响的价值.方法 收集2010年1月至2014年6月就诊于首都医科大学附属北京同仁医院北京同仁眼科中心视光学门诊的近视眼配镜过矫伴视疲劳患者16例(30只眼).其中,男性10例(19只眼),女性6例(11只眼),年龄14～38岁,平均年龄(23.7±7.2)岁.所有患者均进行视力检查、显然验光、复方托吡卡胺散瞳验光、原框架眼镜屈光度检查、主观调节幅度检查及客观调节功能检查.根据近视眼配镜过矫状态下患者主观调节幅度下降、客观调节不足、客观调节异常及客观调节微波动高频成分增加进行分组.使用均数±标准差描述年龄的分布情况;采用眼数和百分比描述各组的病例数量与病例分布情况.使用McNemar配对资料卡方检验和用Kappa一致性检验比较近视眼配镜过矫状态下主观调节幅度下降组与客观调节不足组、客观调节异常组及客观调节微波动高频成分增加组的差异.结果 近视眼配镜过矫伴视疲劳患者16例(30只眼)中,主观调节幅度正常者有8例(11只眼),占36.7％(11/30);主观调节幅度下降者有11例(19只眼),占63.3％(19/30);客观调节检查结果正常者有6例(7只眼),占23.3％(7/30);客观调节异常者有13例(23只眼),占76.7％(23/30);单纯客观调节不足者有3例(3只眼),占10.0％(3/30);单纯客观调节过度者有1例(2只眼),占6.7％(2/30);单纯客观调节紧张者有4例(7只眼),占23.3％(7/30);单纯客观调节痉挛者有1例(2只眼),占6.7％(2/30);客观调节不足伴调节紧张者有4例(7只眼),占23.3％(7/30);客观调节不足伴调节痉挛者有1例(2只眼),占6.7％(2/30).客观调节紧张者有7例(14只眼),占46.7％(14/30);客观调节不足者有8例(12只眼),占40.0％(12/30);客观调节微波动高频成分增加者有10例(18只眼),占60.0％(18/30).自身配对资料McNemar精确概率法卡方检验提示主观调节幅度下降组与客观调节不足组的差异有统计学意义(χ2=5.143,P<0.05).对比主观调节幅度下降组与客观调节异常组以及客观调节微波动的高频成分增加组的差异均无统计学意义(χ2=2.250,0.000;P>0.05).进一步经过Kappa一致性检验,主观调节幅度下降组与客观调节异常组有高度一致性(κ=0.689,P<0.05),而主观调节幅度下降组与客观调节微波动高频成分增加组一致性弱(κ=0.366,P<0.05).结论 近视眼配镜过矫常伴随调节功能异常的类型以调节不足和调节紧张为主.人眼调节功能客观检查可对近视眼配镜过矫视疲劳状态进行客观量化的评估.鉴于本研究中主观调节幅度下降组与客观调节异常组的高度一致性,推荐近视眼配镜过矫伴视疲劳患者中使用主观调节幅度检查作为客观调节功能详细检查的筛查指标.

目的 探讨复方托吡卡胺滴眼液和阿托品眼用凝胶在儿童验光检查中的应用效果及其相关性.方法 收集2016年1月至2019年3月于首都医科大学附属北京同仁医院眼科中心就诊儿童151例(302只眼)的资料.其中,男性68例(136只眼),女性83例(166只眼);年龄3～10岁,平均年龄(6.0±1.5)岁.根据屈光状态将患儿分为远视眼组、混合散光组及近视眼组.各组患儿均先后进行复方托吡卡胺和阿托品散瞳,而后检查并记录患儿的球镜值、柱镜值、轴向值及最佳矫正视力.所有指标经Kolmogorov-Smirnov正态性检验,不符合正态分布时,以中位数和四分位数描述.组内比较采用配对样本秩和检验.不同年龄患儿两种药物散瞳验光结果 中球镜差值的比较,采用独立样本秩和检验.患儿两种药物散瞳验光结果中球镜值间的关系,采用一元线性回归进行分析.结果远视眼组、混合散光组及近视眼组患儿分别有63例(126只眼)、41例(82只眼)和47例(94只眼).三组患儿性别间的比较,差异无统计学意义(χ2=0.171,P>0.05);三组患儿年龄间的比较,差异无统计学意义(F=1.399,P>0.05).远视眼组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为2.50(1.00,5.31)D、1.00(0.50,1.75)D、90(85,100)°及0.10(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及矫正视力分别为3.50(2.00,6.31)D、1.00(0.50,1.75)D、90(85,95)°及0.10(0.00,0.20).经配对样本秩和检验,各组患儿球镜值、柱镜值及最佳矫正视力的比较,差异有统计学意义(Z=9.692,-2.726,-2.483;P<0.05);但轴向值的比较,差异无统计学意义(Z=-0.173,P>0.05).混合散光组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-1.00(-2.00,-0.75)D、3.00(2.00,4.00)D、90(85,95)°及0.10(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-0.50(-1.25,0.00)D、3.00(2.00,4.00)D、90(85,95)°及0.10(0.00,0.20).经配对样本秩和检验,各组患儿球镜值和最佳矫正视力的比较,差异有统计学意义(Z=7.778,-2.826;P<0.05);但柱镜值和轴向值的比较,差异无统计学意义(Z=-1.098,-0.653;P>0.05).近视眼组患儿复方托吡卡胺散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-3.50(-6.00,-1.25)D、-1.38(-2.50,-0.50)D、90(85,95)°及0.00(0.00,0.20);阿托品散瞳验光结果中的球镜值、柱镜值、轴向值及最佳矫正视力分别为-3.13(-5.25,-1.00)D、-1.50(-2.50,-0.50)D、90(85,95)°及0.10(0.00,0.20).经配对样本秩和检验,各组患儿球镜值和最佳矫正视力的比较,差异有统计学意义(Z=8.388,-2.744;P<0.05);但柱镜值和轴向值的比较,差异无统计学意义(Z=0.511,-1.735;P>0.05).远视眼组、混合散光组及近视眼组患儿两种药物散瞳验光结果中的球镜值函数关系分别为y阿托品=1.068+0.976x复方托吡卡胺、y阿托品=0.775+0.999x复方托吡卡胺及y阿托品=0.248+0.949x复方托吡卡胺.远视眼组、混合散光组及近视眼组<6岁患儿的球镜差值分别为1.00(0.75,1.44)D、1.00(0.50,1.25)D及0.50(0.25,0.75)D;≥6岁患儿的球镜差值分别为0.75(0.50,1.00)D、0.50(0.25,0.75)D及0.25(0.00,0.50)D;经独立样本秩和检验,组内两者的比较差异有统计学意义(Z=-2.261,-4.160,-2.360;P<0.05).结论 各组两种药物散瞳后,年龄越小者验光结果差异越大.远视眼和混合散光患儿应采用阿托品散瞳验光,在特殊情况下对混合散光和年龄≤6岁的近视眼患儿可在复方托吡卡胺散瞳验光结果的基础上,再根据两者的函数关系修正为阿托品的验光结果,6岁以上近视眼患儿建议采用复方托品卡胺散瞳验光.

未分化多形性肉瘤 (Undifferentiated Polymor-phic Sarcoma,UPS)临床表现缺乏特异性,且发病率较低,易误诊误治,现报道1例未分化多形性肉瘤病例,结合文献复习,总结未分化多形性肉瘤的临床表现、辅助检查、病理和免疫组织化学,加强对该病的认识.

目的 对学龄期近视进展儿童进行调节功能的客观检查与分析,观察调节功能与近视进展之间的相关性.方法 选取2017年至2018年在首都医科大学附属北京同仁医院视光学门诊定期就诊的71名学龄期儿童为研究对象,根据受试者近年的屈光度进展速度,按≤0.50 D·a-1、＞0.50～1.00 D·a-1、＞1.00～1.50 D·a-1、＞1.50 D·a-1分为4组,使用人眼调节分析仪对受试者进行调节功能的客观测量与分析,记录不同调节刺激视标下4组的客观调节反应值和客观调节微波动值,并作对比.结果 在所有调节视标上,各组随着调节刺激幅度增加,客观调节反应值也逐渐增加,4组在不同调节刺激视标下的客观调节反应值及平均的客观调节反应值差异均无统计学意义(均为P＞0.05).≤0.50 D· a-1、＞0.50～1.00D·a-1、＞1.00～1.50D·a-1、＞1.50 D·a-1近视进展速度组调节微波动值分别为(62.2±5.6)D、(62.5 ±5.3)D、(66.5±6.0)D和(58.0±6.5)D,4组间差异有统计学意义(F =6.424,P=0.001),在+0.50～-0.50 D、-2.00 D调节刺激视标下,4组的客观调节微波动值比较差异均有统计学意义(均为P＜0.05),在其余调节刺激视标下差异均无统计学意义(均为P＞0.05).结论 对于学龄期儿童的近视进展速度,客观调节微波动值相对于客观调节反应值可能是一个更为敏感的相关指标.

Objective: To analyze the clinical features of acute acquired c oncomitant esotropia (AACE) type Ⅲ and the effect of prism correction, including three-stage visual function, stability and the degree of satisfaction.Methods: This was a self-control study. Patients with AACE (Ⅲ) were examined for strabismus with a von Graefe prism, Maddox rod and synoptophore. The fusion range was measured with a synoptophore, and a prism was prescribed. The changes in values before and after wearing the prism were analyzed, and a satisfaction survey was done. The data were analyzed by a paired t test. The follow-up period ranged from 2 months to 2 years (0.7±0.5 years). Results: The degree of distance and near strabismus with the von Graefe prism was 16.9△±7.0△ and 15.1△±7.5△; with Maddox rod it was 22.6△±8.5△, 16.3△±9.0△; and the degree of distance strabismus with a synoptophore was 18.0△±8.2△. The fusion range with synoptophore was 25.4°±8.8°. The prism preschiption was 6.4△±3.0△. The comparison of distance strabismus and near strabismus with the von Graefe prism separation was no significant difference before and after wearing the prism (t=0.266, P=0.792 and t=0.731, P=0.471). The comparison of distance strabismus and near strabismus with Maddox rod was no significant difference before and after wearing the prism (t=-0.040, P=0.969 and t=-0.587, P=0.562). The comparison of distance strabismus with the synoptophore was t=-0.523, P=0.606 before and after wearing the prism. There was no significant difference in the fusion range (t=-1.210, P=0.237) or the strength of the prescription (t=0.000, P=1.000). There was no difference in stereopsis before and after wearing the prism. After wearing the prism, diplopia disappeared and the subjective evaluation of the effect of the prism was satisfactory for 11％ and very satisfactory for 89％. Conclusions: AACE type Ⅲ has the clinical features of a wide onset age range, large strabismus degree, greater distant strabismus degree than near strabismus degree, fusion function and potential stereopsis function. Prism correction is a good method that can eliminate diplopia, and will not affect the degree of strabismus, fusion range, or stereopsis.

屈光不正,尤其近视,目前已成为全球密切关注的公共卫生问题.屈光不正的合理化矫正是视光医学发展和公共用眼健康的重要基石.本文中笔者在汇总近年来已发表的文献及结合自身临床经验的基础上,提出目前临床上常见屈光不正类型的矫正规律,并就儿童与成人远视眼、近视眼、散光及屈光参差的矫正和配镜原则进行深入探讨.旨在为视光医生及验光师提供可指导性的建议或意见.

目的:观察多个局部皮瓣联合应用修复鼻小柱与上唇瘢痕挛缩畸形的美学效果.方法:针对鼻唇中央瘢痕粘连挛缩引起的上唇外翻及鼻小柱短缩畸形,在上唇瘢痕区设计局部瘢痕瓣,将其向上推进重塑鼻小柱外形;在鼻小柱侧面分别设计"U"形皮瓣,将其旋转至鼻小柱下方形成对合皮瓣,重建鼻小柱基底;红唇缘复位后残留创面根据其大小分别选用直接缝合、游离皮片移植或下唇交叉皮瓣等进行创面闭合,矫正上唇外翻畸形.结果:鼻小柱与上唇瘢痕挛缩畸形采用上述方法修复后鼻、唇均恢复其解剖位,唇外翻畸形矫正效果好,人中、唇峰、唇红线流畅,对称性好,鼻小柱延长效果显著,伤口均一期愈合;随访6～18个月发现术区瘢痕隐蔽,术后效果满意.结论:多个局部皮瓣联合应用在鼻小柱与上唇瘢痕挛缩畸形修复中可兼顾上唇外翻和鼻小柱短缩畸形,能最大程度恢复鼻唇区美学外观,值得临床推广应用.

在门诊中如遇到患儿斜颈,通常会考虑两个因素:垂直斜视引起的代偿头位和儿童斜颈.前者是由于垂直斜视引起复视,患儿为避免复视,通过斜颈的代偿头位来减轻或消除复视,对于此类患儿要详细检查眼位和眼球运动;后者是儿童颈部肌肉发育不对称,引起颈部倾斜,可通过从背部观察患儿颈椎,以及触摸颈部两侧肌肉力量来予以评估,必要时到骨科会诊.

目的:探讨上下耳轮角皮瓣在Nagata二期耳廓再造颅耳角成形术中的应用及其临床效果.方法:2016年6月-2017年6月,对5例Nagata一期术后3～6个月的先天性单侧小耳畸形患者进行了二期耳廓成形及颅耳角重建:将耳廓支架掀起,软骨支架置入颅耳沟,耳后筋膜包裹,在乳突区设计两长条形上下耳轮角皮瓣,于贴近颅耳沟处相互拉拢,交叉间断缝合,余创面植皮.结果:本组5例患者,随访6～12个月,5例患者上下耳轮角皮瓣均全部成活,耳廓与头颅侧壁约成30°夹角,形成清晰明显的颅耳沟,临床效果满意.结论:Nagata二期耳廓再造术中应用肋软骨支架联合上下耳轮角皮瓣进行颅耳角重建可呈现满意的颅耳角结构,且操作相对简单,不增加手术次数,术后耳后皮片瘢痕挛缩率低,使其更具立体感,术后效果满意,值得临床推广应用.

目的 比较现场和远程主觉验光检查屈光度的一致性.设计诊断试验.研究对象 屈光不正志愿者49例(98眼).方法 现场和远程主觉验光在国家眼科诊断与治疗工程技术研究中心不同楼层的实验室内完成.同一受试者现场和远程主觉验光由同一专业验光师在不同日期(7天内)完成.用全自动综合验光仪做现场主觉验光,通过宽带网络远程操控全自动综合验光仪做远程主觉验光,由一名非医学背景的助手做电脑自动验光仪验光,结果通过蓝牙传送到平板电脑,再传至验光师电脑端,验光师通过宽带网络远程操控综合验光仪,并远程与受试者语音交流.根据屈光度不同分为近视组(等效球镜度≤-0.50 D)和远视组(等效球镜度≥+0.50 D),分别进行分析.利用MedCalc12.7软件进行Bland-Altman一致性分析,比较现场和远程主觉验光测得屈光度的一致性.主要指标 现场和远程主觉验光的球镜度数、柱镜度数、柱镜轴位、等效球镜度的95％一致性界限及95％一致性界限外点的比率.结果 所有眼现场和远程主觉验光的球镜度数、柱镜度数、柱镜轴位、等效球镜度的95％一致性界限分别为(0.00±0.54)D、(-0.02±0.34)D、(0.70±24.30)°、(0.00±0.52)D.所有眼球镜度数、柱镜度数、柱镜轴位、等效球镜度在95％一致性界限外点的比率分别为1.02％、4.84％、4.84％、2.04％.近视组和远视组球镜度数、柱镜度数、柱镜轴位及等效球镜的95％一致性界限分别为(-0.01±0.52)D、(-0.01±0.32)D、(1.10±18.40)°、(-0.01±0.51)D和(0.20±0.54)D、(-0.05±0.22)D、(-8.00±40.80)°、(0.18±0.53)D;95％一致性界限外点的比率分别为1.08％、3.51％、5.26％、2.15％、和0.00％、0.00％、0.00％、0.00％.结论 现场和远程主觉验光所有眼、近视组及远视组的球镜度数、柱镜度数和等效球镜度一致性高,但柱镜轴位一致性较差.

目的 探讨棱镜矫治急性共同性内斜视引起复视的棱镜处方量.设计 回顾性病例系列.研究对象 急性共同性内斜视所引起复视并进行棱镜矫正患者42例.方法 对急性共同性内斜视引起复视的患者分别予以马氏杆、同视机、Von Graefe棱镜分离、三棱镜加交替遮盖法行斜视度检查;同时行聚散力测量;给患者试戴棱镜,以达到复视消除、无不适效果的处方量作为棱镜最终处方量.分析各测量结果与处方量之间的相关性.主要指标 斜视度.结果 马氏杆测量患者平均斜视度(20.57±9.53)△;同视机测量(16.01±8.30)△;Von Graefe棱镜分离(15.95±7.07)△;三棱镜加交替遮盖(13.24±5.01)△;破裂点(5.17±4.20)△;回归点(9.14±5.76)△.棱镜处方量(6.92±3.49)△.马氏杆检查、同视机检查、Von Graefe棱镜分离、三棱镜加交替遮盖、破裂点、回归点与棱镜处方量的pearson相关系数分别为0.496、0.546、0.647、0.408、0.831、0.708.结论 由聚散力测量眼球外转的破裂点与棱镜处方量相关性最大,可以以破裂点作为棱镜试戴的起点.

未分化多形性肉瘤(undifferentiated pleomorphic sarcoma,UPS)也被称为多形性未分化肉瘤或恶性纤维组织细胞瘤,是一种极少见的软组织恶性肿瘤[1].现将我科收治的 1 例情况报告如下.

Objective Discuss the methods and clinical application ofrectangular gliding advanced skin flap on post aurem and mastoidregion in repairing skin defect of helix. Methods Since March 2015 to July 2016,7 patients with skin defect of helix received treatment of the improved operation(1 for traumatism, 3 for morsus humanus and 3 for tumour). They under went helix stump implantation on post aurem and mastoidregion in phase I. After 6 weeks, they under went skin flap pedicle division plasty and the skin defect on post aurem and mastoid region was repaired by rectangular gliding advanced skin flap. Results All cases were followed up for 3 to 15 months. We found that all the pedicle division flaps and advanced skin flaps were healed satisfactorily without the complication of hemodynamic disorder, infection and putrescence. The auricle got good shape and the outline of regeneratepinna was clear and smooth with similar thickness and colour with surrounding skin. The scar was not obvious on helix and post aurem and mastoidregion. The result was satisfactory. Conclusion The improved operation possessed the advantages of good shape and simple. Postoperative scars were not obvious. It is worthy of clinical application.

Objective To study the relationship between dry eye symptoms and lipid layer thickness (LLT) in dry eye patients.Design Retrospective case series.Participants 139 dry eye patients were selected from ophthalmology department Tongren Hospital from July 2015 to October (81 of females and 58 males,age range=18-77 years,mean age=37.75 ±12.86 years).Methods All patients were required to complete the Ocular Surface Disease Index (OSDI) questionnaire after which their LLTs were evaluated using a new interferometer (LipiView,TearScience Inc,Morrisville,NC).Based on the OSDI questionnaire scores,139 patients were divided into three groups:mild symptom group (0～20 scores),moderate symptom group (21～45 scores) and severe symptom group(46～100 scores).The relationship between the OSDI score and LLT,as well as the relationship between different degree symptoms and LLT were analyzed.Main Outcome Measures OSDI scorc and LLT.Results OSDI scorc was ncgativcly correlated with LLT (r=0.256,P=0.002),i.e.with the increase of OSDI score,lipid layer thickness decreased.OSDI questionnaire including 12 items,only foreign body sensation,painful or sore,watching TV or computer causing discomfort were correlated with LLT(r=-0.206,-0.232,-0.190,-0.179 respectively,all P＜0.05),the other 8 items had no relevance with LLT.Among three different severe groups,LLT was significantly different by analysis of variance,especially between the mild symptom group (64.89±16.403 nm) and the severe symptom group (54.65±14.481 nm)(F=10.092,P=0.027).There were 40％ of (14 people) patients with LLT≤60 nm in mild symptom group,while 70％ of (30 people) patients in severe symptom group;the proportion of the patients with LLT ≤ 60 nm in severe symptom group was significantly greater than mild symptom group(x2=6.953,P=0.008).Conclusion Dry eye symptoms have negative correlation with the lipid layer thickness of dry eye patients,especially foreign body sensation,painful or sore,watching TV or computer causing discomfort symptoms appear to be significantly associated with the lipid layer thickness,and as the symptoms increased lipid layer thickness decreased.The more serious of dry eye symptoms,the greater chance of lipid layer thickness was less than 60 nm.

本文从中西医结合的角度对屈光相关性视疲劳的诊疗进行了总结探讨.结合眼部症状和全身因素分析病因,对单纯屈光因素所致视疲劳要正确予以屈光检查和矫正以去除致病因素;对伴有中医证型的要以中医的全身调理为基础进行循序渐进的治疗,中西医结合可以更为有效地提高屈光相关性视疲劳的临床疗效.

目的 评估圆锥角膜患者长期配戴硬性透气性角膜接触镜(RGP)后的视觉相关生活质量.方法 收集2007年6月至2013年9月就诊于北京同仁医院眼科中心的37例初次配戴RGP治疗的圆锥角膜患者.采用美国国立眼科研究院视功能问卷(NEI-VFQ-25)中文版对纳入病人的视觉相关生活质量进行评定.对符合正态分布的数据采用两独立样本t检验,非正态分布的数据运用Wicoxon秩和检验.用Spearman等级相关分析双眼视力与各维得分的相关性.结果 纳入分析的37例问卷中,男性23例,女性14例,平均年龄(20.5±4.0)岁;轻中度圆锥角膜21例,重度圆锥角膜16例.男女组量表得分差异无统计学意义,轻中度和重度组患者在近距离活动、依赖程度、社会角色限制三项维得分的差异有统计学意义.总体视力、近距离活动、远距离活动、周边视力、社会功能、社会角色限制、精神健康、依赖程度这八项的得分与较好眼视力均有较强相关性(rs＞0.7,P＜0.05),各项维得分与较差眼视力的相关性无统计学意义.结论 配戴恰当的RGP镜片能显著提高圆锥角膜患者的视觉相关生活质量;视觉相关生活质量的问卷调查对临床上评估不同程度圆锥角膜患者配戴RGP镜片后的疗效有一定的补充作用.