目的：新型冠状病毒疫情期间，中山大学中山眼科中心在严格防控疫情的前提下及时开展免费线上“专家问诊”服务，眼科医师在线答疑以满足眼病诊疗需求。本研究对疫情期间眼科患者线上问诊的需求与模式进行分析，为眼科互联网诊疗体系的优化提供依据。

方法：前瞻性观察性研究。本研究分析了2020-02-01/03-15期间，使用中山眼科中心互联网医院“专家问诊”服务患者的基线特征。针对其中重复问诊的患者，随机抽取等量单次问诊患者作为对照，比较单次问诊与重复问诊患者的基线特征、就诊目的、疾病类型、眼病数量，并对患者问诊次数的影响因素进行分析。

结果：研究期间“专家问诊”共线上服务患者9 831人次，其中单次问诊3 919人次，5 912人次来源于1 967人的重复问诊。随机抽取1 967名单次问诊者与上述重复问诊者对比，单次问诊与重复问诊患者的年龄、性别分布无统计学差异(P=0.897， 0.482)。两组就诊目的均以“旧病复诊”占比最高(59.7%，64.9%)。从构成比上看，与单次问诊患者相比，重复问诊患者中，就诊目的为新发不适者较少，旧病复诊与术后复查者较多，眼表、眼底、葡萄膜疾病患者较多，患有两种及以上眼病者占比较多。回归分析显示屈光患者倾向单次问诊，而旧病复诊、术后短期复诊患者，眼底、葡萄膜疾病患者倾向重复问诊。旧病复诊、术后随访较新发不适患者重复问诊的次数更多； 晶状体与青光眼/疑似青光眼疾病重复问诊次数较少，眼表疾病重复问诊次数较多。

结论：疫情期间眼科患者线上就诊主要目的为旧病复诊。疾病种类、就诊目的与眼病数量均影响患者是否重复问诊及问诊次数，应根据患者的就诊需求与模式调整眼科不同亚专科线上接诊医生的数量与排班。互联网医疗对新发不适患者的诊疗能力有待进一步提高。

METHODS: Prospective observational study. The patients using “expert online consultation” provided by the Zhongshan Ophthalmic Center from February 1 to March 15, 2020 were enrolled. The baseline characteristics were analyzed. For the patients with repeated consultation, we randomly selected the same amount of patients with single consultation as comparison. The baseline characteristics, consultation purposes, disease types, and number of combined eye diseases between the patients with single and repeated consultation were compared, and the contributing factors of patients'consultation pattern were analyzed with statistical test and regression model.

RESULTS: The “expert online consultation” provided 9 831 consultations during the study, 3 919 of which were single consultation while 5 912 of which came from the repeated consultations of 1 967 patients. 1 967 patients with single consultation were randomly selected and compared with the repeated inquirers. The main consultation purposes in the both groups were “return visit”(59.7%, 64.9%). There was no significant difference in age and gender distribution between the patients with single online visit and repeated online visits(P=0.897, 0.482). Compared with the patients with single visit, the patients with repeated visit were less with the purpose of “new-onset discomfort”, more with the purpose of “return visit” and “follow-up after surgery”, more with ocular surface, fundus and uveal diseases, and more with two or more combined eye diseases. Regression analysis showed that the patients with ocular refractive issues tended to have a single consultation, while the patients inquired on previous eye disease and surgery, with fundus or uveal disease tended to have repeated consultations. The number of repeated visits for the patients with diagnosed ophthalmopathy and ophthalmic surgery was higher than that for the patients with new-onset discomfort; the number of repeated visits was lower for the patients with lens and anterior segment diseases, and was higher for the patients with ocular surface diseases.

CONCLUSION: During the COVID-19 epidemic, the main purpose of on-line ophthalmic consultation was return visit for the diagnosed eye diseases. Type of eye disease, consultation purpose and number of combined ophthalmopathies all affected whether the patients repeated the consultation and the repeated times. The arrangement of ophthalmologists in different sub-specialties should be adjusted according to the patients' needs and their consultation patterns.