云南省2012年“光明工程”项目实施期间白内障术后感染玻切手术能力现状调查

目的调查了解云南省16个州市168家开展2012＂光明工程＂防盲白内障手术项目的医院,掌握各级医院对白内障术后眼内炎开展玻切手术的应急处理能力,为防盲工作安全、顺利地开展提供有效的依据和保障。方法采用2012年云南省卫生厅所制定的《光明工程各州市定点医院开展玻切手术能力调查表》,对全省各州市内开展白内障手术的眼科进行调查。内容包括医院名称、有无玻切手术能力、能开展玻切手术的方式,开展人数,职称等。结果在调查的168家光明工程白内障实施医院中,能开展前后段玻璃体切割手术及有玻切设备的医院分布情况为：省级医院有4家,州级医院有7家,市级14家,私立医院12家,县级医院16家,部队医院2家。剩余7家区级医院及6家卫生院均不能开展玻切手术及不具有玻切设备。168家调查医院中有109名眼科医生能熟练开展玻切手术。结论掌握云南具备开展玻切手术能力的医院数量及分布情况,加强防盲术后感染应急处理能力,保障防盲工程安全顺利地实施。     

国家级继续教育项目（J50-09-08）“社区眼科及小切口无缝线白内障手术技术推广”学习班

温州医学院附属眼视光医院2006年11月份设立了防盲病区和办公室,目前达到每年开展2500例小切口白内障的手术规模,为推广温州白内障防盲模式及非超乳小切口白内障技术,将举办第四届＂社区眼科及小切口无缝线白内障手术技术推广＂学习班。     

河南省信阳市创建"白内障无障碍市"活动中白内障患病率调查——开展以白内障手术治疗为主的防盲治盲工作

目的 调查信阳市(含八县两区)白内障患病率,白内障致盲率,白内障手术负荷量;评价我市创建"白内障无障碍市",实施以白内障手术治疗为主的防盲治盲工作效果.方法 2006年12月～2007年7月,对全市眼病人群进行白内障的筛查.白内障定义为:至少1眼晶状体浑浊矫正视力＜0.6者,其中最好眼矫正视力＜0.05者为白内障盲人,矫正视力＜0.1眼为白内障手术对象.结果 眼病人群共3472例,接受检查3469例,总受检率99.91%,白内障患病率为65.84%,白内障致盲率为3.06%,白内障手术负荷量为30.18%.结论 白内障盲人所造成的社会负担较重,目前农村白内障致盲率较高,高质量增加白内障复明手术是防盲治盲的首要任务.     

在新形势下继续推进我国的防盲治盲工作

目前我国的防盲治盲工作正处于有利的时期,取得了一些重要进展。近5年来,我国实施了一系列的防盲治盲项目,白内障手术率显著提高;我国正在进行的医药卫生体制的改革有利于深入持久地开展防盲治盲工作;我国已有较好的条件和足够的技术力量来开展白内障复明手术为主的防盲治盲工作。但是,防盲治盲依然是我国眼科界面临的巨大挑战。我国盲和视力损伤的状况还没有从根本上得到改善,根治白内障盲的进展缓慢。因此,应当进一步推进我国防盲治盲工作,包括进一步提高对防盲治盲工作的认识,加强眼病防治和防盲治盲的网络建设,做好眼病的预防和控制工作,以及加强防盲治盲的科研工作。     

四川省整合防盲资源开展大规模白内障防盲手术的探讨

目的:探索四川省整合利用各种防盲资源,提高大规模白内障防盲手术项目的效率与质量的方法,推动防盲工作的发展。方法:分析比较2000年以来由卫生与残联各自单独与合作开展大规模白内障防盲复明手术项目效果。结果:四川省卫生与残联合作2004/2006高质高效完成8548例白内障防盲复明手术,取得了显著成果。手术质量与工作效率较卫生、残联各自单独开展有较大提高。结论:以政府为主导协调整合各方防盲资源开展防盲工作,是防盲工作可持续发展的方向。     

我国防盲治盲工作的进展

进入新世纪以来,我国继续将白内障盲的手术治疗作为防盲治盲的重点。全球最大的防盲项目“视觉第一中国行动”取得了重大成效。1997年至2001年的5年内施行了206万例白内障复明手术,实现了我国每年白内障手术数超过了白内障盲新发人数40万例的历史性转变。地方各级政府积极组织开展防盲治盲工作。白内障手术率明显提高。眼病流行病学研究取得了新的进展。目前防盲治盲中存在的最主要问题是根治白内障盲的进展缓慢,这是我国防盲治盲工作发展过程中的问题,是可以解决的。     

河南省信阳市创建“白内障无障碍市”活动中白内障患病率调查——开展以白内障手术治疗为主的防肓治肓工作

目的调查信阳市（含八县两区）白内障患病率，白内障致盲率，白内障手术负荷量；评价我市创建“白内障无障碍市”，实施以白内障手术治疗为主的防盲治盲工作效果。方法2006年12月-2007年7月，对全市眼病人群进行白内障的筛查。白内障定义为：至少1眼晶状体浑浊矫正视力〈0．6者，其中最好眼矫正视力〈0．05者为白内障盲人，矫正视力〈0．1眼为白内障手术对象。结果眼病人群共3472例，接受检查3469例，总受检率99．91％，白内障患病率为65．84％，白内障致盲率为3．06％，白内障手术负荷量为30．18％。结论白内障盲人所造成的社会负担较重，目前农村门内障致盲率较高，高质量增加白内障复明手术是防盲治盲的首要任务。     

南通市新城桥街道60岁及以上人群白内障流行病学调查

目的调查江苏省南通市城市人口中60岁及以上人群白障患病率、白内障盲人手术覆盖率和白内障人社会负担率,了解白内障患病情况及评价近十年来南通市实施以白内障手术治疗为主的防盲治盲工作效果。方法随机整群抽取新城桥街道14个社区中的8个,并对所有60岁及以上人群进行视力和眼部检查。了解接受白内障手术情况。结果3040例受检者中,白内障患病率为34.87%。2002年南通市城市人口60岁及以上人群白内障手术率为8553。以较好眼小孔视力<0.05为盲标准,白内障盲人手术覆盖率为60%,女性和文盲分别为50%和30%。白内障盲人社会负担率为2.14%,女性和文盲分别为2.63%和4.40%。以双眼日常生活视力<0.1为盲的标准,白内障盲人手术覆盖率为57.33%,女性和文盲分别为50%和31.82%。白内障盲人的社会负担率为2.47%,女性和文盲分别为2.99%和4.84%。结论白内障盲人所造成的社会负担率较重,在女性和文盲中,白内障是严重的公共卫生问题。防盲工作的首要任务仍是根治白内障盲。     

如何进一步提高我国白内障手术的数量与质量?

白内障手术复明是我国防盲治盲的首要任务。1984年全国防盲指导组成立以来,我国的白内障手术数量与质量有了大幅度提高。但与发达国家相比仍有较大差距。本文回顾了我国白内障手术的现状,分析了白内障手术数量与质量不高的原因,提出了如何进一步提高我国的白内障手术率和术后视觉质量的可能途径。     

表面麻醉在高原地区大规模白内障防盲手术中的应用

目的：评价表面麻醉小切口白内障囊外摘除联合人工晶体植入术在高原地区大规模白内障防盲手术中应用的有效性和安全性。方法四川省高原地区贫困白内障防盲手术患者457例（457眼）,在表面麻醉下行小切口白内障囊外摘除联合人工晶状体植入术,观察其麻醉效果、手术并发症及术后视力。结果所有患者均在表面麻醉下完成手术,均无严重的手术并发症。术后第1天,视力≥0.3者384眼,占84.03%。结论在高原地区大规模白内障防盲手术中应用表面麻醉小切口白内障囊外摘除联合人工晶体植入术安全、有效。     

发展中国家白内障手术的现状

随着人口的老龄化白内障的发病率也在升高,白内障已经成为发展中国家最常见的致盲眼病,在发展中国家中,盲和视觉损伤已经成为严重的公共卫生、社会和经济问题。虽然白内障手术是最具有成本效益的干预方式,但在发展中国家提供白内障手术服务仍存在很多问题和挑战,在过去10a中一些国家在治疗白内障时采用手法小切口白内障摘除术这种手术方式并取得了较好的效果。另外,制定不同的可持续发展的防盲模式在这些发展中国家也是一个挑战。本文就近年发展中国家的白内障手术情况做一综述。     

Eye health is everyone’s responsibility: China’s first Western-style eye hospital improves in the prevention of blindness

AIM: To investigate the relationship between China’s first Western-style eye hospital development and the prevention of blindness in China and determine the main factor influencing eye health today.METHODS: Data about eye health, blindness and cataract surgery rate of China from public website of World Health Organization (WHO), ORBIS International, Ministry of Health (MOH) of China, Pubmed center and Historical Archives of Zhongshan Ophthalmic Center (ZOC) were reviewed and analyzed.RESULTS: ZOC is China’s first Western-style eye hospital. In 2012, the ORBIS Flying Eye Hospital has chosen ZOC once again as one of its destinations, 30 years after ORBIS expanded internationally to train eye care professionals and treat underserved patients in developing countries in 1982. During the past 30 years, cataract surgery rate and public awareness of blindness prevention were improved greatly in China, in which ZOC plays a very important role.CONCLUSION: ZOC, as China’s first Western-style eye hospital,has improved in the prevention of blindness. Eye health has become everyone’s responsibility.     

To promote "Vision 2020" Initiative under the new situation in China

At present, the prevention of blindness in China is in the favorable period and got some important progress. Recent five years, Chinese government conducted a series of the program for prevention of blindness, cataract surgical rate is increasing. The reform of the medical system conducted by the government is favorable to the prevention of blindness. There have been better situation and enough technique and personnel to conduct cataract surgery. However, prevention of blindness is still a big challenge to Chinese ophthalmological society. Blindness and visual impairment is still a major public health problem in China. The cataract surgical rate is still quite low. Thus, Chinese ophthalmologists should further promote "Vision 2020" Initiative and prevention of blindness in China. They should further recognize the significance for prevention of blindness, strength the construction of the system for prevention of blindness and eye care, actively prevent and control the eye diseases and conduct the research work in the prevention of blindness.     

Epidemiology of cataract: accomplishments over 25 years and future directions

The purpose of this review is to highlight the advances made by epidemiologic research into cataract. Considerable progress has been made in characterizing phenotypes, determining the prevalence and incidence in various population groups, and understanding risk factors for cataract. Cataract surgery research has documented functional improvements following surgery and has identified aspects of surgery delivery that could be made. Cataract is an independent marker of early mortality, providing a possible system for studying the aging process. Promising future work in cataract epidemiology is highlighted. Despite the availability of cataract surgery, cataract is still the leading cause of blindness worldwide. From a public health standpoint, research that can identify ways to delay onset or progression, or achieve the holy grail of prevention of cataract, should remain a leading priority.     

白内障防盲行动中年轻医师的手术技能培养

眼科手术医师的技能培训多采用住院医师培训模式,其培训周期长、间断、技能重复训练率低、手术技能不稳定。我们探索的小切口白内障手术培训模式具备集中,实践性强,短时重复训练率高的特点。视频理论教学使学员对手术有整体连续性的认识;手术技巧训练顺序的合理安排使学员在保障手术安全性的条件下得到充分训练;PBL教学法有助于培养具有独立能力的手术者,安全控制机制的建立保障了患者手术安全性,也提高了学员的手术自信。     

Outcome and number of cataract surgeries in India: policy issues for blindness control

Purpose: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. Methods: In a population‐based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. Results: In the population‐based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery‐related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good‐quality cataract surgeries are needed every year during 2001?2005, increasing to over 14 million surgeries needed every year during 2016?2020 on persons most likely to go blind from cataract. Conclusions: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006?2010 if cataract blindness in India is to be eliminated.     

初级眼保健网络与防盲治盲工作方法的探讨

目的 探讨初级眼保健网络与防盲治盲工作的方法。方法 收集并回顾性分析南通市10年初级眼保健网络建设与防盲治盲工作资料。结果 10年建立了5级眼保健网络,举办各级培训班1007期,对6817259例人群进行了致盲眼病的调查,发现双眼盲13496例（0.20%）,并为83.16%的可治白内障盲患者做复明手术,脱盲率为98.22%。所辖的8个县均被评为全国防盲先进县。1997年南通市成为全国第一个防盲先进市。结论 初级眼保健是防盲工作的基础。结合初级卫生保健开展初级眼保健是切实可行的途径。复明手术经费的解决、质量的保证、查治结合是防盲治盲工作的关键。创建防盲先进县、市是开展防盲治盲工作的动力。     

The role of international non-governmental organisations in dealing with cataract blindness in developing countries

The international non-governmental organisations (INGOs) dealing with the prevention and cure of blindness in developing countries are closely networked with each other and are an integral part of the International Agency for the Prevention of Blindness (IAPE) and the World Health Organization (WHO) Global Programme for the Prevention of Blindness. As operable cataract accounts for more than half of world blindness. As operable cataract accounts for more than half of world blindness the INGOs have a particular interest in this blinding condition which took on major proportions with the eye camp movement in South Asia from the end of the 1960s. Despite this initiative, and the use of paramedic cataract surgeons in many African countries, the volume of cataract surgery is being outstripped by increased incidence arising from greater longevity as a product of improved general health. Among the options facing the INGOs in the 1991s are the increased utilisation of eye beds through year round surgery in South Asia and shorter post-operative hospital occupancy and the possibility of putting lens implantation surgery within the economic reach of INGOs and partner NGOs and governments.