程锦国基于“开导之后宜补论”治疗前部缺血性视神经病变的学术思想探析

《审视瑶函?开导之后宜补论》针对眼科疾病提出相应的治疗理论，程锦国主任将“开导之后宜补论” 运用于前部缺血性视神经病变的临床治疗中，根据邪正盛衰将疾病治疗分为早期和中后期，早期袪 邪为关键，以“开导通瘀”为主，中后期以顾护正气为主，标本兼治，以“补益气血，培补肝肾”为要， 兼顾开导通瘀。“开导之后宜补论”理论成熟，程锦国主任在临床运用中疗效显著，现结合病案探析 程锦国主任学术思想，为提高疾病救治成功率提供思路。     

AI辅助中国偏远基层社区老年人青光眼筛查对医疗费用和医保基金的影响：基于海南省昌江黎族自治县的卫生经济学分析

目的:预测中国偏远基层地区老年原发性闭角型青光眼(PACG)患者人群人工智能(AI)辅助筛查对医疗费用、医保基金支出的影响。方法:纳入海南省昌江黎族自治县19 395名65岁及以上老年人,借鉴浙江温州青光眼人群筛查的卫生经济学模型,将PACG按照严重程度分为原发性房角关闭可疑状态、原发性房角关闭、PACG、单眼致盲和双...     

息肉状脉络膜血管病变的新术语和非基于吲哚菁绿血管造影的诊断标准——2021亚太眼科影像学会专家共识解读与思考

息肉状脉络膜血管病变（PCV）发现之初至今的40年间，其命名和各成分术语随着眼底影像技术的飞速发展不断更迭，部分常用术语已经无法代表PCV病灶的本质；同时，以无创的检查手段诊断PCV的效能越来越受到关注。2021年，亚太眼科影像学会PCV工作组讨论并针对PCV两个重要成分的术语做出专家共识，并提出一套不基于吲哚菁绿眼底血管造影的PCV诊断标准，以期鉴别PCV与典型的新生血管性年龄相关性黄斑变性。该共识是对影像学和组织学报告的最新理解的凝练，概念明晰且精炼，值得临床推广应用。     

Prevalence and Causes of Visual Impairment and Blindness among Cocoa Farmers in Ghana

Purpose: To determine the prevalence and causes of visual impairment and blindness among cocoa farmers in Ghana in order to formulate early intervention strategies.

Methods: A cross-sectional study using multistage random sampling from four cocoa growing districts in Ghana was conducted from November 2013 to April 2014. A total of 512 cocoa farmers aged 40 years and older were interviewed and examined. The brief interview questionnaire was administered to elicit information on the demographics and socioeconomic details of participants. The examination included assessment of visual acuity (VA), retinoscopy, subjective refraction, direct ophthalmoscopy, slit-lamp biomicroscopy and intraocular pressure (IOP). For quality assurance, a random sample of cocoa farmers were selected and re-examined independently.

Results: Moderate to severe visual impairment (VA <6/18 to 3/60 in the better-seeing eye) was present in 89 participants (17.4%) and 27 (5.3%) were blind (presenting VA <3/60 in the better eye) defined using presenting VA. The main causes of visual impairment were cataract (45, 38.8%), uncorrected refractive error (42, 36.2%), posterior segment disorders (15, 12.9%), and corneal opacity (11, 9.5%).

Conclusion: The prevalence of visual impairment and blindness among cocoa farmers in Ghana is relatively high. The major causes of visual impairment and blindness are largely preventable or treatable, indicating the need for early eye care service interventions.     

Newer advances in medical management of glaucoma

The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients’ neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited     

KAB与KAP医学行为管理学模式在角膜塑形术治疗中的应用

医学行为管理学是从医学的角度出发对患者的心理活动及身体行动进行干预和管理的科学,包括“知识-态度-行为（knowledge-attitude-behaviour,KAB）”和“知识-态度-实践（knowledge-attitude-practice,KAP）”两种运行模式,即指在患者充分理解治疗原理的基础上,树立患者对疾病正确、积极的认知态度,并在整个实际治疗过程中最大程度上争取患者的心理及身体行为配合。目前此种医学行为管理模式主要应用于儿童治疗,目的是提高儿童患者的依从性,保障治疗的安全与有效。角膜塑形镜验配的各环节都渗透着对医学行为管理学介入的需求。本文将对医学行为管理学模式（KAB与KAP模式）在角膜塑形镜治疗中所发挥的指导性作用,从医患沟通、验配、摘戴教育、随访复查四大治疗环节方面进行论述。另外,统计分析患者接受验配医师讲解前后对角膜塑形术治疗认识、理解程度评分及验配医师对患者在医患沟通前后的依从性评分,验证医学行为管理对角膜塑形术治疗的积极导向作用。     

Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country – An online survey

Purpose:The aim of this study was to assess awareness about online classes and to assess if they can aid learning in the field of medicine amid lockdown.Methods:Online survey comprising a questionnaire related to the aspects of online teaching was undertaken. There were 16 questions, and responses were collected from undergraduates, postgraduates, and the teaching faculties.Results:Online classes were viewed favorably by the vast majority of respondents. Out of 412 respondents 79.9% actively attended the classes. While 42% felt the timings were inappropriate as they clashed with duty hours, a set of 35% had difficulty understanding the content and most of them were undergraduates. Poor internet connection was a main hindrance identified. In total, 69.2% respondents were happy with the feasibility of the classes and believed these classes had the advantage of being economical as they offered exposure to national and international faculty from the comfort of their homes.Conclusion:Conducting online classes on a national scale is a herculean task for a developing country because of poor internet connectivity and deficient access to high-speed broadband services. Nevertheless, their popularity among students during the current crisis shows that it is a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching.     

Comparative experimental study of 10% and 15% medical gelatin in the anterior chamber and in the posterior eye segment as a viscosubstance in the viscosurgery

This article discusses the possibility of application of 15% medical gelatin solution compared to 10% medical gelatin solution in the anterior chamber and in the posterior eye segment as a viscosubstance in the viscosurgery. The experimental investigations were performed on 24 Chinchilla rabbits, divided in two groups consisting of 12 each. 0.5 ml of 10% and 15% of medical gelatin were injected in the anterior chamber and 2 ml of 10% and 15% medical gelatin were injected in the vitreous body of the tested eyes. 2% methyl cellulose and 0.89% Sodium Chloride were injected in the vitreous body of the control eyes. Clinical, biomicroscopical, ophthalmoscopical, tonometrical, histological and electron-microscopical examinations were performed. It was established that when the eyes were injected with 10% and 15% medical gelatin, as well as with 0.89% Sodium Chloride, the intraocular pressure was not increased but when the eyes were injected with methyl cellulose the intraocular pressure was increased. We also found that 15% of medical gelatin has longer effect than 10% medical gelatin. Toxoallergic and inflammatory changes were not observed in the eyes injected with 10% and 15% medical gelatin. In the same eyes, histologically and by electron microscopy, were not found any changes in the layers of the cornea and retina. These substances could be used as viscosubstances and as instruments in surgical interventions of the anterior eye segment and in the posterior eye segment (vitrectomy).     

Clinical profile and magnitude of diabetic retinopathy: An electronic medical record–driven big data analytics from an eye care network in India

Purpose:This study aimed to describe the clinical profile and magnitude of diabetic retinopathy (DR) in patients presenting to a multitier eye hospital network in India.Methods:This cross-sectional hospital-based study included 263,419 individuals with diabetes mellitus (DM) presenting between February 2012 and February 2021 (9-year period). The data were collected using an electronic medical record (EMR). Patients with a clinical diagnosis of DR in at least one eye were included in the analysis. Severe nonproliferative DR/proliferative DR/diabetic macular edema (DME) were considered sight-threatening DR (STDR).Results:In the study period, 25% (n = 66,913) were new patients diagnosed with DR. The majority of patients were males (70%). The mean age of the patients was 57 ± 10 years. The risk factors for DR were increased age: 30 to 50 years (odds ratio [OR] = 2.42), and 51 to 70 years (OR = 3.02), increased duration of DM: 6 to 10 years (OR = 2.88) and >10 years (OR = 6.52), blindness (OR = 2.42), male gender (OR = 1.36), lower socioeconomic status (OR = 1.43), and rural habitation (OR = 1.09). STDR was seen in 58% (n = 38,538) of examined patients. Risk factors for STDR were increased age 31 to 50 years (OR = 3.51), increased duration of DM: 6 to 10 years (OR = 1.23) and >10 years (OR = 1.68), blindness (OR = 3.68), male gender (OR = 1.12), and higher socioeconomic status (OR = 1.09).Conclusion:Every fourth person with DM was found to have DR, and every second person with DR had STDR in this study cohort. These real-world big data might provide greater insight into the current status of DR. Additional big data from similar EMR-based sources will help in planning and resource allocation.     

Present and Future Training of Foreign Ophthalmologists in the USA: Perspective of Association of University Professors of Ophthalmology

A questionnaire entitled “Present and Future Training of Ophthalmologists in the USA” was sent to members of the Association of University Professors of Ophthalmology. Data obtained from the questionnaire indicate that: the complex regulations pertaining to training foreign medical graduates (FMGs) in the USA are often not fully understood by the chairmen, most programs are willing to accept but do not actively recruit FMGs, there are a number of obstacles encountered in selecting and training FMGs, and most resident and fellowship positions are filled by US graduates.     

浅谈电子病历系统对眼科临床教学的利弊

电子病历具有书写方便、保存时间长、节省资源、资料完整、易检索、可以实现资源共享等优势。它在眼科临床教学中提高了实习医师的工作效率,为教学提供了更多的临床资源。但同时它也带来了一些新的问题,比如病历质量下降,学生思维局限,临床医师带教意识减弱。针对这些利弊,我们结合眼科的临床特点,改进目前的临床教学思路与方法,从多方面正确引导学生发挥电子病历的优势,克服其局限性,提高眼科临床教学质量。（眼科, 2014, 23： 137-139）