原发性开角型青光眼患者视野缺损和瞳孔的关系

目的：测量原发性开角型青光眼患者的瞳孔对光反射,探索青光眼患者视野缺损和瞳孔的关系。方法：连续选取2014－07／2015－10于我院就诊的原发性开角型青光眼患者86例115眼和健康个体16例23眼纳入本研究,所有受试者均接受全面的眼科检查、视野检查（ Humphrey , SITA Standard 24－2）和动态瞳孔测量（ MonCV3 Metrovision ）。依据视野检查结果和青光眼分期系统,将青光眼患者分为5个亚组,即1期亚组、2期亚组、3期亚组、4期亚组和5期亚组。瞳孔对光反射相关的测量指标包括：瞳孔直径（最小和最大瞳孔直径）、收缩和开大的潜伏时间、收缩和开大的持续时间、收缩和开大的速度、收缩幅度以及瞳孔收缩比例。使用SPSS 19．0统计软件包对测量结果进行统计分析。结果：青光眼组中4期亚组和5期亚组的最小瞳孔直径与对照组差异有统计学意义（P＝0．032,P＝0．014）;各组的瞳孔收缩速度相比,差异有统计学意义（ F＝648．675, P＜0．01）,其中5期亚组的瞳孔收缩速度小于其他亚组和对照组（P＜0．05）;3期、4期和5期亚组的瞳孔收缩比例与对照组差异有统计学意义（ P＜0．05）;瞳孔收缩速度、瞳孔收缩比例和最小瞳孔直径与青光眼的视野分期相关。结论：原发性开角型青光眼患者的瞳孔瞳孔收缩能力有所下降,瞳孔收缩能力的下降与视野缺损程度相关。     

Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation

A 25-year-old woman was diagnosed to have tubercular meningitis (TBM) with a right parietal infarct. She responded well to four-drug anti-tubercular treatment (ATT), systemic steroids and pyridoxine. Steroids were tapered off in one and a half months; she was put on two-drug ATT after two months. Six months after initial diagnosis she presented with sudden, bilateral visual loss. Vision was 3/200 with afferent pupillary defect and un-recordable field in the right eye; vision was 20/60 in the left eye, pupillary reaction was sluggish and the field showed a temporal hemianopia. On reintroduction of systemic corticosteroids vision improved (20/120 in right eye and 20/30 in left eye) within three days; the field defects improved sequentially to a left homonymous hemianopia, then a left homonymous inferior quadrantonopia. A diagnosis of TBM, on treatment, with bilateral optic neuritis, and right optic radiation involvement was made. Since the patient had been off ethambutol for four months, the optic neuritis and optic radiation lesion were attributed to a paradoxical reaction to tubercular allergen, corroborated by prompt recovery in response to corticosteroids. This is the first report of optic radiation involvement in a paradoxical reaction in neuro-tuberculosis in a young adult.     

小瞳孔白内障手术中虹膜拉钩与放射状瞳孔缘虹膜切开扩瞳的并发症及视力预后对比

目的 观察并对比小瞳孔白内障手术中虹膜拉钩与放射状瞳孔缘虹膜切开扩瞳的并发症及视力预后。设计 回顾性比较性病例系列。研究对象 2012年4月至2015年6月在广州市中西医结合医院接受超声乳化白内障吸出联合人工晶状体植入术的83例（90眼）小瞳孔白内障患者。方法 50眼行虹膜拉钩扩瞳（研究组）,40眼行放射状瞳孔缘虹膜切开扩瞳（对照组）,记录两组的围手术期指标、术后并发症及视力恢复情况。主要指标 超声乳化时间、手术时间、术中术后并发症及术后视力。结果 对照组平均超声乳化时间显著高于研究组（104.8±17.9 s 和 57.8±11.9 s）（t=12.835,P<0.001）;对照组平均手术总时间明显低于研究组（20.1±3.8 min 和29.2±5.8 min）（t=-6.468,P<0.001）;对照组术中虹膜损伤及出血显著高于研究组（P<0.001）;对照组术后1天矫正视力≥0.3者（40%）,低于研究组（72%）（χ2=9.328,P=0.002）,对照组术后3个月矫正视力≥0.3者（80%）,低于研究组（90%）（χ2=1.798,P=0.180）;研究组术后1天瞳孔变形率显著低于对照组（68%和95%）（χ2=10.125,P=0.001）;研究组术后1周瞳孔变形率显著低于对照组（20%和90%）（χ2=46.557,P<0.001）。研究组和对照组的角膜水肿率分别为86%和90%（χ2=0.331,P=0.565）,但两组的角膜水肿程度比较,差异有统计学意义（Z=11.318,P=0.003）;研究组前房反应率68%,显著低于对照组的95%（χ2=10.125,P=0.001）。结论 小瞳孔白内障手术中虹膜拉钩扩瞳,具有安全系数高、不易出血和引起炎症的优点,对术后瞳孔恢复形态和功能有积极意义。（眼科,2017, 26： 85-89）     

The post‐illumination pupil response of melanopsin‐expressing intrinsically photosensitive retinal ganglion cells in diabetes

Purpose: This study investigates the clinical utility of the melanopsin‐expressing intrinsically photosensitive retinal ganglion cell (ipRGC) controlled post‐illumination pupil response (PIPR) as a novel technique for documenting inner retinal function in patients with Type II diabetes without diabetic retinopathy. Methods: The PIPR was measured in seven patients with Type II diabetes, normal retinal nerve fibre thickness and no diabetic retinopathy compared to healthy age‐similar controls. A 488‐ and 610‐nm, 7.15‐diameter stimulus was presented in Maxwellian view to the right eye and the left consensual pupil light reflex was recorded. Results: The group data for the blue PIPR (488 nm) identified a trend of reduced ipRGC function in patients with diabetes with no retinopathy. The transient pupil constriction was lower on average in the diabetic group. The relationship between duration of diabetes and the blue PIPR amplitude was linear, suggesting that ipRGC function decreases with increasing diabetes duration. Conclusion: This is the first report to show that the ipRGC‐controlled PIPR may have clinical applications as a non‐invasive technique for determining the progression of inner neuroretinal changes in patients with diabetes before they are ophthalmoscopically or anatomically evident. The lower transient pupil constriction amplitude indicates that outer retinal photoreceptor inputs to the pupil light reflex may also be affected in diabetes.     

近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化

目的 探讨行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者优势眼与非优势眼的Kappa角、瞳孔大小及中心位置的动态变化.方法 选取2018年12月至2020年8月在延边大学附属医院眼科行飞秒激光制瓣准分子激光原位角膜磨镶术的近视患者117例(234眼)为研究对象.采用ALLEGRO Topolyzer角膜地形图仪(德国...     

准分子激光原位角膜磨镶术中瞳孔中心移位及眼球旋转的研究

目的探讨准分子激光原位角膜磨镶术(laser insitu keratomileusis,LASIK)患者术前检查位(坐位)与术中体位(卧位)改变引起眼球旋转的规律及瞳孔中心移位的特点。方法LASIK手术患者285例(565眼),术前在暗室坐位自然瞳孔状态下,应用wavescan wavefrontTM system进行波前像差检查和虹膜纹理识别,在LASIK术中卧位应用激光机进行虹膜定位追踪手术,显示瞳孔中心移位(565眼)及眼球旋转(562眼)情况。结果术中565眼全部发生了瞳孔中心移位,双眼均以鼻上方移位明显。右眼平均移位距离为(0.33±0.25)mm,左眼平均移位距离为(0.34±0.27)mm。双眼平均移位距离差异无统计学意义(P>0.05)。556眼(98.9%)发生眼球旋转,右眼平均旋转3.80°±3.95°,左眼平均旋转2.40°±2.95°,右眼旋转度数大于左眼,差异具有统计学意义(P<0.01)。右眼外旋明显,左眼内外旋几率基本相当。结论LASIK术中眼球的旋转运动和瞳孔中心移位是普遍存在的,屈光手术医生应高度重视,在准分子激光手术中应注意眼球旋转及瞳孔中心移位所引起的偏中心切削和欠矫问...     

Optical Coherence Tomography Angiography Features of Paradoxical Worsening in Tubercular Multifocal Serpiginoid Choroiditis

Purpose: To describe optical coherence tomography angiography (OCTA) features of lesions of tubercular multifocal serpiginoid choroiditis (TB MSC) that developed paradoxical worsening (PW).

Methods: In this prospective study, subjects with TB MSC who developed PW upon initiation of anti-tubercular therapy were included. Multimodal imaging was performed using OCTA, enhanced-depth imaging OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Morphologic changes in the retinochoroidal vasculature during progression of TB MSC were assessed on OCTA.

Results: Five subjects (4 males, 1 female) were included in the study. PW of the lesions was associated with increased areas of choriocapillaris flow void on en face OCTA in all eyes. The lesions showed partial healing in the center and continuous progression at the active edges. Two eyes showed development of vascular tufts on OCTA as the lesions progressed.

Conclusions: OCTA provides high-resolution imaging of progressive choriocapillaris hypoperfusion among TB MSC patients developing PW of the disease.     

先天性无虹膜症青光眼白内障手术后眼压持续升高

【摘要】 一例11岁男孩,6个月时因双眼先天性无虹膜症、青光眼而行双眼小梁切除术,10岁时行超声乳化晶状体吸出人工晶状体植入术。术后6个月非接触眼压32、34 mm Hg,超声测量中央角膜厚度（CCT）：右眼850、左眼827 μm。眼底C/D 0.2。此患者需要继续治疗吗？（眼科,2012,21：234-238）     

A fundamental step-transition in retinal function at low light intensities

There appears to be a fundamental step-transition in retinal function at low light intensities, close to the scotopic-mesopic transition. This step-transition is observed for elements of the retinal dark-light switch, which has been described in the chicken retina. Over the same range of light intensities, there is a step-transition in photoreceptor retinomotor movements and in the coupling of horizontal and All amacrine cells, which suggests a switch in retinal circuitry from rod-processing to cone-processing regimes. A similar step-transition in pineal function suggests that the retinal step-transition signals to the central circadian systems. Finally, this step-transition may also inhibit eye growth, and thus be responsible for the reported diurnal rhythm in eye growth. Disturbances to this step-transition may be the initial cause of disordered eye growth in the form-deprivation myopia paradigm.     

先天性白内障致病基因的研究进展

先天性白内障是导致儿童低视力和失明的主要原因,约1/3的先天性白内障患者是遗传所致.先天性白内障的病因不同,且表型多样.先天性白内障与特定的基因突变有关,其致病基因主要包括编码晶状体的结构蛋白、缝隙连接蛋白、膜蛋白、晶状体发育中的调节蛋白基因.定位和识别导致白内障形成的基因突变对了解先天性白内障的分子缺陷和病理生理的特点是必要的.随着分子遗传学技术的发展,先天性白内障发病的分子机制研究已取得了较大的进展,进一步了解遗传、环境及营养等因素对晶状体代谢的影响.就先天性白内障的致病基因及其分子发病机制的研究进展进行综述.