黄斑区视网膜光敏感度与视力的相关性分析

目的研究黄斑区视网膜光敏感度、固视稳定和固视状态与视力的相关性。方法回顾分析150例192眼应用MP-1微视野计检查的资料,按最佳矫正视力分三组比较视网膜平均光敏感度、固视稳定性及中心固视与最佳矫正视力的关系。结果视网膜平均光敏感度(2°和12°)、固视稳定性(2°和4°)及中心固视均与最佳矫正视力有直线关系(r=0.624,0.587,0.456,0.436,0.434,P<0.001),三组间差别有统计学意义(F=46.395,42.836,37.404,33.917,29.815,P<0.001)。结论MP-1微视野计测得的视网膜光敏感度、固视稳定和固视状态与最佳矫正视力相关,MP-1微视野计在各种眼底病的应用中是可靠的。     

Topcon SBP—1000型自动视野计部分正常阈值的测定

Topcon SBP——1000型自动视野计具有静态阈上值及静态阈值两种功能,13项程序。背景照度为31.5asb,最大刺激亮度为425asb。附有自动记录,显示屏及限位固视监视电视装置,用光笔操作,迅速而准确。因各种自动视野计的背景照度及刺激亮度不一致。故所得结果也有差异,为了解本机的性能,今就对常用的环形10°,15°、20°及30°以内的子午线355°—175°(右)5°—     

应用Humphrey三区筛选法检查垂体大腺瘤患者的视野缺损

目的评价Humphrey三区筛选法检查垂体大腺瘤(pituitarymacroadenoma,PMA)患者视野缺损的临床价值.方法采用全自动Humphrey静态视野计的三区筛选法,对经MRI和CT确诊的128例PMA患者和门诊30例轻度近视患者,进行中心30°76个点视野检查.结果PMA组127例(99.2%)的患者有视野缺损,111例(86.7%)的患者以颞侧(包括单眼颞侧)视野缺损为主并且呈现或趋向中线垂直分界.其敏感性(相对检查例数的百分比)为99.2%,每眼视野平均检查时间(5.8±2.2)min,而采用全阈值方法检查中心30°76个点视野的平均检查时间为(14.8±2.8)min,两者比较差异有非常显著性(t=63.6396,P<     

驾照体检中使用Humphrey自定义程序评估单眼视力障碍人群的视野

目的：研究Humphrey视野计设置专用自定义检查程序在评估单眼视力障碍者视野检查中的作用。

方法：回顾性分析2016-07-01/2017-06-30因申请驾驶执照在我院眼科接受视野检查的单眼视力障碍受检者的资料,均采用Humphrey自定义功能设置覆盖了从颞侧90°到鼻部60°、水平中线上下30°区域的检查程序,并设置相应的可靠性检测试验(“1 EYE Screening”程序检查),综合分析受检者的视野范围和测试的可靠性。

结果：排除重复测量报告后,本研究纳入单眼视力障碍受检者618例,单眼视力障碍最常见的原因是眼外伤(49.7%)和弱视(29.3%),受检者中有497例(80.4%)通过了测试,121例未通过测试者中有85例(70.2%)是由于鼻视野受限(小于60°),12例是因为眼球震颤或配合欠佳导致固视丢失。与测试失败组相比,通过组受检者年龄更大,人均正确应答点数更多,人均测试时间更短(均P<0.05)。通过组中,等效球镜度<0.5D的受试者占比明显高于失败组中的(77.5% vs 62.8%, χ²=7.264,P=0.007)。

结论：Humphrey 自定义检查程序“1 EYE Screening”可用于判断单眼视力障碍的驾驶执照申请者视野是否达到150°。     

正常成年人中心固视点的微视野检测

目的 观察正常成年人中心固视点相对于眼底视盘的位置关系，以及固视稳定性的特点。方法 应用MP-1微视野计对60位正常成年人的120只眼作固视检查，测量中心固视点相对于视盘的坐标位置，并对中心固视点与年龄和屈光度作相关分析，对双眼的差距作t检验。 结果 正常成年人中心固视点距离视盘颞侧边中点的水平距离为14.48°±1.85°，垂直距离为－2.14°±1.26°，90%分布在一个二维正态椭圆内；固视目标时，眼位处于一种不断的微动状态，水平和垂直方向活动度的中位数分别是0.4°和0.3°。 结论 正常成年人中心固视点的分布特征为一个二维正态椭圆，固视目标时眼位在水平方向的移动大于垂直方向的移动幅度。     

轴性球后视神经炎静态视野阈值观察

应TOPCONSBP－1000型自动视野计，对39例60眼视力在0．5以上的球后视神经炎患者进行右眼175°～355°、左眼185°～5°子午线光阈值测定，结果显示：阈值光敏感度下降范围在鼻侧5°至颞侧15°之间，中心0°至颠倒10°下降最为显著，平均下降6～11dB，其中2眼中心光敏感度轻度下降，阈值曲线平坦，37眼中心低谷，21眼中心生理盲点间低谷。说明自动静态视野阈值检查对视神经受损有较精确的定位和定量意义。     

北京语言大学330例眼病患者视野检查结果分析

0引言视野检查在眼科疾病的诊断中有着不可替代的作用,对判断许多眼底病特别是青光眼和有关中枢神经系统的病变具有十分重要的意义。为了明确诊断我们对330名眼病患者进行了视野检查,现将结果报道如下。1临床资料北京语言大学1998-11/2006-03门诊眼病患者,共330例,其中男156例,女174例;教师186例,学生34例,其他110例。对每位患者均需做眼科常规检查,如视力、眼压、眼前节、眼底检查。采用QZS—100自动视野计定量程序检查视野。诊断标准:正常视野有两个含义:(1)视野的绝对边界达到一定范围;(2)全视野范围内各部位光敏感度属正常,除生理盲点…     

趋势导向视野检查与常规阈值视野检查的比较研究

目的比较趋势导向视野检查程序(Tendency Oriented Peri metrey,TOP)与常规视野检查程序对青光眼病人视野检查结果的差异,对IOP程序检查结果进行评价。方法用Ocutopus101电脑视野计对36例青光眼患者共46眼分别用常规阈值程序(Normal/Normal)和趋势导向(TOP)视野检查程序进行检查。将两种方法的视野检查结果进行分析比较。结果①36例青光眼患者共46眼,常规阈值程序检查均有视野损害,其中早期青光眼15眼,中晚期31眼。早期患者用TOP程序检查的阳性率为73%(11/15),中晚期患者TOP程序均能够发现视野损害,视野损害的部位两种程序有较高的一致性。②视野指数的比较,青光眼患者TOP程序和Normal程序检查MS分别为15.78±4.81,13.33±4.24,P=0.008;MD分别为13.36±4.89,14.31±4.18,P=0.02;LV分别为65.40±37.55,50.77±34.24,P<0.001;两种程序检查RF值均小于15%。③两种检查方法所费时间,TOP程序为4.10±0.59分Normal程序为11.01±3.15分。结论①TOP视野检查程序可大大地缩短检查时间,可用于大规模人群的筛查,但是TOP视野检查程序对早期青光眼检测敏感性偏低,仅为73%。②对中晚期病例,TOP程序与Normal程序相比较,MS高于正常阈值程序检查的结果,MD和LV低于正常阈值程序检查结果,也就是TOP视野检查程序的发现的视野缺损较小,暗点更浅。     

甲状腺相关眼病眼球运动异常的治疗

目的探讨甲状腺相关性免疫眼眶病引起的眼球运动异常的治疗方法及效果。方法2000年1月-2004年2月我院主诊甲状腺相关眼病有眼肌运动异常患者10例。就诊时的病情6例为活动期，4例为静止期，通过对不同时期患者经系统保守治疗，病情稳定眼部水肿有不同程度改善，眼球运动异常及复视仍然存在，病情稳定后，处于静止期的10例患者有8例选择手术治疗，采用的术式分别为后退下直肌，后退下直肌及对侧上直肌，术后患者代偿头位基本消失，正前方无明显斜度，在一定范围内恢复双眼视功能。结论甲状腺相关眼病不同时期分别采取不同的治疗方案，手术治疗甲状腺相关眼病引起的眼球运动异常可得到良好的临床效果。     

甲状腺相关眼病眼眶减压术的疗效分析

目的：探讨眼眶减压术在甲状腺相关眼病中治疗的价值。方法：回顾性分析中山眼科中心1993－2000年27例（30只眼）经全身和眼部临床检查（视力、视野或视觉诱发电位等）确诊为甲状腺相关眼病患者采用眼眶减压术（一壁、二壁及三壁减压）治疗的临床资料,观察其手术前和手术后患者视力、眼球突出度及眼球运动的变化。术后随访2个月至7年,平均13．7个月。结果：视力：19只眼（63．3％）明显提高;4只眼（13．3％）轻度提高,视力均保持在0．2－0．8;4只眼（13．3％）视力无变化,其中3只眼（10．0％）视力下降。24只眼（80．0％）眼球突出后退≥3．0mm,28只眼（93．3％）眼球突出后退≥2．0mm,平均眼球突出后退3．6mm。结论：眼眶减压术可提高甲状腺相关眼病患者的视力,减轻其眼球突出度。     

改良三壁眶减压术治疗重症甲状腺相关性眼病的疗效观察

目的观察改良三壁眶减压术治疗重症甲状腺相关性眼病的效果。方法对我院收治的3例(6眼)经内科治疗无效的重症甲状腺相关性眼病患者实施改良三壁眶减压术,观察患者术后视力、眼球突出度及外观情况。结果术后4眼视力轻度提高,2眼保持不变;眼球后退5.3～12.6mm,平均9.5mm;睑裂闭合不全者术后均闭合良好,外观满意;1眼出现少量眶内血肿,治疗后吸收;4眼出现双眼复视,均于1个月内消失;术后CT显示眼眶减压良好。结论改良三壁眶减压术可有效扩大眼眶容积,降低眶内压,还纳眼球,减少眼球突出,改善外观,对内科保守治疗、常规眶减压术无效的重症甲状腺相关性眼病患者安全有效。     

眼眶平衡减压术治疗甲状腺相关眼病

目的 探讨平衡眼眶减压术治疗甲状腺相关眼病的疗效和手术方法。方法 采用内外壁眼眶减压术治疗20例35眼甲状腺相关眼病患者。术后随访平均14个月。观察术后视力、眼球突出度和眼球运动等情况。结果 20例35眼中除1例行眶外壁减压外，其余均行内外壁平衡眼眶减压术。眼球突出度缓解3～11mm，其中3～4mm者5眼，5～9mm者28眼，10～11mm者2眼，平均6．32mm。视力从术前数指提高至0．1者6眼，提高2行以上者8眼，无变化21眼。术后眼球运动明显好转者9眼，运动障碍加重2眼。无视力丧失及术后感染。结论 平衡眼眶减压术是治疗甲状腺相关眼病的有效方法。     

High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroid-associated ophthalmopathy

PURPOSE: To compare the effectiveness of intravenous (i.v.) methylprednisolone pulse therapy and oral prednisone when used as the initial treatment of patients with mild or moderate thyroid-associated ophthalmopathy. METHODS: Thirty-three consecutive patients with thyroid-associated ophthalmopathy in Helsinki and Turku University Hospitals were randomly assigned either i.v. methylprednisolone pulse therapy (group A, n = 18) or oral prednisone (group B, n = 15). Treatment outcomes were measured by subjective changes in the grade of diplopia and quantitatively in several ophthalmic variables at 3 and 12 months. Any decision to proceed with additional treatment at 3 months was made on clinical grounds. The study was open in respect of both the initial treatment and the need for additional therapy. RESULTS: No significant differences in the grade of diplopia, proptosis or soft tissue activity scores were noted between groups A and B from 0 to 3 months. However, group A required additional forms of therapy at 3 months less frequently than did group B (p = 0.038). CONCLUSIONS: Our data suggest that i.v. methylprednisolone pulse therapy and oral prednisone are equally effective as initial treatments for thyroid-associated ophthalmopathy where diplopia, proptosis and signs of soft tissue inflammation are concerned. When additional treatment is required, i.v. methylprednisolone pulse therapy may be more effective than oral prednisone. However, the study's limitations meant that any decision to give additional treatment after the initial therapy was made on clinical grounds.     

小鼠眼眶成纤维细胞TLR4基因静默对甲状腺眼病的效应研究

目的：构建小鼠眼眶成纤维细胞TLR4的shRNA慢病毒干扰载体,研究TL4^-/-的成纤维细胞对甲状腺相关性眼病的治疗作用和机制。

方法：设计、构建、筛选小鼠眼眶成纤维细胞TLR4基因的最优干扰shRNA表达质粒,选择Gateway方法将质粒导入慢病毒表达载体中,使用重组慢病毒载体感染小鼠眼眶成纤维细胞,研究其对免疫炎性反应的负向调控能力,并在小鼠甲状腺眼病模型中采用沉默成纤维细胞TLR4基因的方法,观察其体内治疗效果。

结果：筛选出具有最好基因静默效果的shRNA序列,导入慢病毒载体,病毒滴度为1.5×10⁶TU/mL。转染慢病毒的Balb/c小鼠眼眶成纤维细胞能够负向调控免疫应答,抑制免疫炎症反应。在疾病动物模型中转染了干扰病毒载体实验组小鼠,其眼病发生发展情况均优于对照组。

结论：成功获得了小鼠成纤维细胞TLR4^-/-shRNA的慢病毒载体,转染了该载体的小鼠眼眶成纤维细胞能够抑制正向免疫应答,可以有效地抑制甲状腺眼病的发展,揭示干扰TLR4表达可能成为防治甲状腺眼病的生物诊疗措施。     

甲状腺相关视神经病变的研究进展

甲状腺相关视神经病变是甲状腺相关眼病的继发性病变，临床表现包括视力下降、色觉受损、相对性传入性瞳孔障碍、视盘水肿或萎缩等。眼科辅助检查表现为视野异常和视觉诱发电位异常等，影像学检查显示眶尖拥挤可辅助诊断。目前此病的发病机制未明，既往研究提出其与视神经压迫、牵拉和缺血有关。治疗方法包括大剂量糖皮质激素静脉冲击治疗、眼眶减压手术、眼眶放射治疗和生物制剂等。本文主要回顾流行病学特征、发病机制及临床诊治等方面的进展，以期为临床实践和研究提供参考。     

The pupil in dominant optic atrophy

PURPOSE. To compare visual and pupil afferent function in dominant optic atrophy (DOA). METHODS. Patients with DOA who belonged to families showing evidence of linkage to the locus on chromosome 3q28-qter were recruited from the Moorfields Genetic Register. Patients and healthy control subjects underwent visual and pupil perimetry using a modified automated perimeter (Octopus 1-2-3; Interzeag, Schlieren, Switzerland). Five stimulus locations were tested: fixation, and at 17 degrees eccentricity along the 45 degrees and 135 degrees meridians in all four quadrants. The visual deficit (difference in decibels between the patient's luminance threshold and that in age-matched healthy control subjects) was compared directly with the pupil deficit (difference in decibels between the stimulus intensity giving the patient's pupil response and that giving an equivalent pupil response in healthy control subjects) at each test location. RESULTS. Visual deficits and pupil afferent deficits were found at all five locations. The visual deficits were significantly greater than the pupil deficits at the four peripheral locations (median difference = 6.3 dB, P: < 0.001). At fixation, the difference was not significant (median difference = 2.3 dB, P: = 0.407). CONCLUSIONS. Pupil function appears less affected than visual function at four of five locations tested. This result provides evidence that the retinotectal fibers serving the pupil light reflex are less susceptible to damage from the OPA1 genetic defect than the retinogeniculate fibers serving vision.     

透明质酸与甲状腺相关眼病

甲状腺相关眼病中重要的病理表现为糖胺聚糖在眶后组织中的聚集,从而出现复视、眼球突出、上睑挛缩等各种临床表现,其中透明质酸作为糖胺聚糖的主要成分在甲状腺相关眼病的病理过程中发挥了重要作用。本文就透明质酸和甲状腺相关眼病的关系作一综述。     

下直肌后退联合下睑筋膜头分离复位在甲状腺相关眼病患者斜视矫正术的应用

目的探讨甲状腺相关眼病患者下直肌后退术中下睑退缩的防治措施。方法 回顾性病例研究。广州中山大学中山眼科中心2007年1月至2011年12月行下直肌后退术的甲状腺相关眼病患者24例,其中男18例,女6例;平均年龄（47.8±10.7）岁。甲状腺相关眼病患者下直肌后退术中除充分分离下直肌与下睑的联系外,同时将与下直肌相联的下睑筋膜头分离并标记,下直肌后退后将下睑筋膜头缝回到下直肌原肌止点处。结果 下直肌后退量2.5～8.0 mm,平均为（5.31±1.16）mm,仅5例在术后出现轻度的下睑退缩,术后下睑位置总量改变为0。2例患者显示下方巩膜暴露,但睑裂大小无改变。所有患者术后无下睑其他外观改变。结论 下直肌后退术中充分分离下睑与下直肌的联系,同时分离下睑筋膜头并缝回到下直肌原肌止点处可有效防治甲状腺相关眼病患者下直肌后退术后的下睑退缩。     

Comparative study of 2 classifications of glaucomatous perimetric deficits]

The purpose of this retrospectively study is to compare the results obtained using the unquestionable criteria, recommended by American Academy of Ophthalmology versus the minimum criteria proposed by HODAPP. The first are founded on the degree of the depth of the deficits in dB, the second take into account the statistically significant loss. One hundred glaucomatous visual fields screened with the Humphrey perimeter, with program 24-2, are retained for their correct indices of reliability, a MD better than -12 dB, and experience of the automated perimetry. This population was divided into two groups of 50:index MD greater than -6 dB. And index MD between -6 and -12 dB. The deficits were analyzed on the graph of individual deviation. Arcuate scotoma and nasal step were the majority of defects: 86 to 90% at the stage of mild deficit; 98% at the stage of moderate deficit. The deficits prevailed in the superior hemifield in 60% of cases. Nasal projection accounted for less than half of the deficits when MD was > -6 dB its frequency fell to less than 10% when MD worsened. Conversely the frequency of arcuate scotoma increased. The isolated deficits decreased with the MD aggravation, but even when the deficit was mild, they accounted for already less than half of the cases. Most of the associated deficits were located in the hemifield opposite to the principal defect. Defects were larger and more frequently multiple with the AAO classification than with the HODAPP. The minimum criteria of the classification of glaucomatous visual field defects proposed by HODAPP appear more specific than the unquestionable criteria of the AAO, and also appear easier to use.     

Effect on intraocular pressure of extraocular muscle surgery for thyroid-associated ophthalmopathy

PURPOSE: To study the effect of extraocular muscle surgery on intraocular pressure (IOP) in patients with thyroid-associated ophthalmopathy. DESIGN: Retrospective, observational case series. METHODS: The medical records of patients with restrictive myopathy secondary to thyroid-associated ophthalmopathy who underwent strabismus surgery from July 1, 1997 through July 31, 2003 were reviewed and analyzed retrospectively. Seventeen patients met the criteria and were included in this study. All patients were seen at the Thyroid Eye Center at the University of California, San Diego, a university-based tertiary referral center. The main outcome measure was IOP readings obtained before and after surgery in both primary gaze and upgaze. RESULTS: A statistically significant decrease in IOP in upgaze was noted after extraocular muscle recession. The mean IOP before surgery was 16.6 +/- 3.78 mm Hg in primary gaze and 23.2 +/- 7.27 mm Hg in upgaze. After strabismus surgery, the mean IOP after one month was 15.7 +/- 2.36 mm Hg (P = .215) in primary gaze and 18.9 +/- 2.96 mm Hg in upgaze (P = .001). CONCLUSIONS: Strabismus surgery resulted in a significant reduction in IOP in the early postoperative period in patients with restrictive myopathy secondary to thyroid-associated ophthalmopathy.