黄斑病变的多焦ERG特征

目的报告几种常见黄斑病变的多焦ERG特征.方法应用VERIS4.0视诱发反应图象系统检测黄斑裂孔、老年黄斑变性(干性型和湿性型)、中心性浆液性视网膜脉络膜病变、中心性渗出性视网膜脉络膜病变和Stargardt病于视网膜后极部26.6X22.1°内103个视网膜部位的反应曲线和立体功能图.结果;依据黄斑病变的病种和程度,反应曲线显示中心凹及黄斑区的反应降低或平坦,立体图显示峰值下降或凹陷.结论多焦ERG提供对黄斑病于黄斑区和后极部视网膜功能的定量和直观评价.     

Longitudinal assessment of type 3 macular neovascularization using 3D volume-rendering OCTA

ObjectiveTo investigate the evolution of treatment-naive type 3 macular neovascularization (MNV) undergoing anti-vascular endothelial growth factor (VEGF) treatment through volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA).DesignRetrospective observational study.ParticipantsPatients with type 3 MNV and age-related macular degeneration (AMD).MethodsIncluded subjects had three loading injections of an anti-VEGF agent. The OCTA volume data at baseline and follow-up were processed with a previously published algorithm in order to obtain a volume-rendered representation of type 3 MNV. Progressive changes in type 3 lesions were analyzed via 3D OCTA volume rendering.ResultsA total of 14 treatment-naive eyes with type 3 MNV from 11 AMD patients (7 females) were included. At both baseline and follow-up visits, a type 3 MNV complex was identifiable. Each complex was composed of a mean number of 2.5 ± 0.7 vascular branches at baseline and 1.4 ± 0.6 at the follow-up visit (p < 0.0001). The mean changes in central macular thickness and visual acuity were significantly correlated with modifications in the number of type 3 MNV branches (ρ = –0.533, p = 0.049, and ρ = –0.581, and p = 0.040, respectively).ConclusionsThis study demonstrated that type 3 lesions do not disappear completely after loading treatment, as indicated previously by histopathologic studies. Importantly, quantitative volume changes in type 3 lesions are directly associated with treatment response.     

The role of quantitative deep capillary plexus in the pathogenesis of type 3 macular neovascularization: an optical coherence tomography angiography study

Graefe's Archive for Clinical and Experimental Ophthalmology - To quantitatively investigate the role of deep capillary plexus (DCP) in patients affected by type 3 macular neovascularization...     

Clinical and morphological comparisons of idiopathic macular holes between stage 3 and stage 4

Graefe's Archive for Clinical and Experimental Ophthalmology - To compare clinical and morphological differences in idiopathic macular holes (IMHs) between stage 3 and stage 4. In this...     

Assessing the long-term evolution of type 3 neovascularization in age-related macular degeneration using optical coherence tomography angiography

Graefe's Archive for Clinical and Experimental Ophthalmology - To analyze the evolution of type 3 neovascularization in eyes with age-related macular degeneration during anti-vascular...     

The dye laser: experimental and clinical results in subretinal macular neovascularization

The tunable dye laser provides now a large assortment of monochromatic wavelengths that allow selective targeting on individual tissues in the retina, according to in vitro studies showing extinction coefficient of ocular pigments (xanthophyllic pigment, rhodopsin, melanin, lipofuschin, hemoglobin) for different laser wavelengths. Confluent heavy and juxtafoveolar laser burns in eyes of cynomolgus monkeys showed, after 38 days, similar lesions in all the wavelength studied (green, red, yellow, orange) at the level of the choriocapillaris, Bruch's membrane, pigment epithelium and photoreceptor's layers. However, the inner retina layers were discretely more damaged with yellow and orange than with green and red. In clinical approach, the effects of these different wavelength haven been compared in human eyes presenting with subfoveol new vessels and disciform age-related macular degeneration. After healing, the scar was similar biomicroscopically, and on fluorescein angiography with all wavelengths studied (green, red, yellow, orange). In conclusion, dye laser seems to be efficient and easily tunable for photocoagulation in macular area.     

Inferior limited macular translocation for subfoveal choroidal neovascularization secondary to age-related macular degeneration: 1-year visual outcome and recurrence report

PURPOSE: To report the 1-year visual outcomes and incidence of persistent and recurrent choroidal neovascularization (CNV) after limited macular translocation (LMT) for subfoveal CNV in patients with age-related macular degeneration (ARMD). DESIGN: Interventional case series. METHODS: Retrospective review of 102 consecutive eyes of 101 patients that had the inferior limited macular translocation procedure for subfoveal choroidal neovascularization secondary to ARMD. The outcome measures were visual acuity at 12 months after surgery, change in visual acuity from baseline, the proportion of eyes with moderate (3 or more lines) or severe (6 or more lines) visual acuity loss, and cumulative incidence of persistent or recurrent CNV and its impact on visual acuity. Cumulative incidence was estimated using Kaplan-Meier survival analysis methods. Association between persistence and recurrence of CNV and the Snellen visual acuity recorded at each follow-up visit was evaluated using the Wilcoxon rank-sum test. RESULTS: Eighty-six (84.3%) of 102 eyes completed the 1-year follow-up. By 12 months postoperatively, 35 (40.7%) of the 86 eyes achieved visual acuity of 20/100 or better while 34 (39.5%) of the 86 eyes experienced 2 or more Snellen lines of visual improvement. In the 52 eyes with effective translocation and complete laser photocoagulation of the CNV complex with sparing of the sensory fovea, the estimated incidence of recurrence was 34.6% at 12 months (95% confidence interval of 21%-48%). Sixty-five percent of the recurrences were subfoveal and caused a decrease in visual acuity. There was a trend toward worse median change in visual acuity in eyes with persistent or recurrent CNV. CONCLUSIONS: Limited macular translocation for the treatment of subfoveal CNV secondary to ARMD is associated with improvement in visual acuity in approximately 39.5% of eyes and enables complete laser photocoagulation of the neovascular complex with sparing of the sensory macula in approximately 60.4% of eyes that complete 1 year follow-up. Persistence and recurrence of CNV are common after LMT and are important causes of vision loss. Further studies are warranted to more precisely evaluate the risks and benefits of LMT in ARMD.     

黄斑部脉络膜新生血管的OCT图像特征及与视力的相关性

目的观察黄斑部脉络膜新生血管(choroidal neovascularization,CNV)的光学相干断层扫描(optical coherence tomo-graphy,OCT)图像特征,评估其与最佳矫正视力的相关性。方法 收集在我院经眼底荧光血管造影(fundus fluorescein angiogra-phy,FFA)及吲哚氰绿血管造影(indocyanine green angiography,ICGA)检查确诊为黄斑部典型性CNV高度近视(high myopia,HM)、年龄相关性黄斑变性(age-related macular degeneration,AMD)及中心性渗出性脉络膜视网膜病变(central exudative chori-oretinopathy,CEC)患者共34例36眼,经验光检查得到最佳矫正视力(best corrected visual acuity,BCVA);采用OCT仪检查并分析CNV的图像特征,并测量CNV突破RPE/脉络膜毛细血管复合层的基底部宽度、高度、离中心凹的距离及中心处视网膜神经上皮层组织厚度,分别评估其与视力改变的相关性。结果 CNV的OCT图像特征:RPE/脉络膜毛细血管层下见大小不等局限性增强隆起反射带;合并病灶周围视网膜神经上皮层组织下局限性无反射暗区或组织内反射增厚。AMD所引起的CNV基底部宽度、高度及中心处神经上皮层组织厚度值均最大。经直线相关分析统计显示:AMD和CEC所引起CNV的基底部宽度及中心处视网膜神经上皮层组织厚度均与BCVA具有负相关性(均为P<0.05),而HM所引起的CNV仅中心处视网膜神经上皮层组织厚度与BCVA具有负相关性(P<0.05)。结论 OCT能有效测量CNV的长度及黄斑水肿程度,在有效评估其与BCVA的相关性中具有重要作用。     

Intraocular triamcinolone acetonide for pseudophakic cystoid macular edema: optical coherence tomography and multifocal electroretinography study

PURPOSE: To evaluate pseudophakic cystoid macular edema (CME) by optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG) and determine the efficacy of intravitreal triamcinolone acetonide injections. METHODS: In this nonrandomized retrospective study, 14 eyes of 14 patients with persistent pseudophakic CME were treated with triamcinolone acetonide injection and were followed up for 1 year. All patients underwent complete ophthalmologic examination including determination of best-corrected visual acuity, slit-lamp examination, tonometry, and funduscopy. Results of OCT and mf-ERG were also recorded before and after the injection. RESULTS: Visual acuity and mf-ERG values increased in all patients after intravitreal triamcinolone acetonide injections. OCT showed improvement of the retinal thickness in the macular area. Temporary increase of intraocular pressure was controlled with topical use of antiglaucoma drops. CONCLUSION: Intravitreal triamcinolone acetonide injection is a promising therapeutic tool for chronic pseudophakic edema resistant to other medical treatment. However, further study is needed to assess the treatment's long-term efficacy, its safety, and the need for retreatment.     

多焦视网膜电图用于年龄相关性黄斑变性视网膜功能的研究

目的应用多焦视网膜电流图(MERG)探讨年龄相关性黄斑变性视网膜不同部位的功能改变。方法选用年龄相关性黄斑变性(ARMD)的患者共27例54眼,其中干性ARMD11眼、湿性ARMD21眼,正常组22眼。所有患者均对其双眼进行检查。应用Veris视网膜功能分析仪对后极部视网膜的局部反应振幅和潜伏期进行检测,分别记录刺激总体、四个象限和6个环的潜伏期及反应振幅值,应用SPSS统计软件中两个独立样本的t检验进行统计学分析。结果在干性ARMD组与正常组、湿性ARMD与正常组及干性ARMD组与湿性ARMD组之间分别对1环(0.0°),2环(2.7°),3环(5.5°),4环(9.0°),5环(13.1°)和6环(18.7°)的反应振幅及潜伏期值进行统计学分析,发现:1、干性ARMD组与正常组MERG的6个环的反应振幅的比较:P值均大于0.05均无显著性差异;6个环的潜伏期的比较:P值均大于0.05均无显著性差异。2、湿性ARMD与正常组间MERG的6个环的反应振幅比较:P值均小于0.01均有非常显著性差异;6个环的潜伏期的比较:1环、5环、6环无显著性差异(P>0.05)、2环、3环、4环有显著性差异(P<0.05)。3、干性ARMD组与湿性ARMD组间MERG的6个环的反应振幅的比较:1环、3环、4环有非常显著性差异(P<0.01)、2环、5环、6环有显著性差异(P<0.05);6个环的潜伏期的比较:1环无显著性差异(P>0.05)、2环、5环、6环有显著性差异(P<0.05)、3环、4环有非常显著性差异(P<0.01)。结论研究证实,MERG能够对视网膜功能进行评价,对视网膜黄斑区功能异常进行初步定位[1],其作为一种无损伤的检查手段,在ARMD的早期诊断、随访观察及视网膜功能评价中具有一定的意义。     

Bevacizumab (Avastin) in treatment of choroidal neovascularization secondary to age-related macular degeneration: a case report

The antiangiogenic drugs have been recently introduced in the therapeutic armamentarium of choroidal neovascularization. The purpose of this report is to describe a case of occult choroidal neovascularization with extensive retinal pigment epithelial detachment treated with intravitreal bevacizumab (Avastin). The efficacy of the medication was evaluated by means of visual acuity and complementary exams (fluorescein angiography, indocyanine green video angiography and optical coherence tomography). After three intravitreal injections of bevacizumab a satisfactory anatomic and visual response was achieved, showing benefits of the drug, despite the extensive retinal pigment epithelial detachment associated with occult choroidal neovascularization.     

Indications, technics and results of argon laser photocoagulation of macular subretinal neovascularization

New vessels in senile macular degeneration threaten central vision. To evaluate the effects of treatment a randomized prospective trial was undertaken between 1977 and 1981. This trial concerned destruction of subretinal new vessels by argon laser photocoagulation. The indications of photocoagulation depended on the location of new vessels in relation to the center of the fovea. New vessels amenable to this treatment were those that were clearly visible on angiography and located farther than 100 microns from the foveola. 60 patients were divided into 3 groups according to the distance of the new vessels from the fovea: 100-200 microns away; 200-400 microns away; and greater than 400 microns away from the center of the fovea. In each group patients were randomly assigned to treatment or no treatment. After at least one year follow-up, argon laser showed a statistically significant effect (p less of 0,01; Kolmogorow-Smirnov test) on the stabilization or the amelioration of visual acuity compared with the non treated group. There was no statistical difference in the 3 groups of new vessel location. In cases of failure, no differences in final visual acuity existed between the treated and the non-treated group.     

Vogt-Koyanagi-Harada综合征多焦视网膜电图研究

目的 观察VKH(Vogt-Koyanagi-Harada,VKH)综合征急性期与恢复期后极部视网膜功能的变化特点.方法 对15例(30只眼)VKH综合征患者的急性期与恢复期进行mfERG测定,并与正常对照比较.结果 急性期VKH综合征患者各环mfERGN1、P1波振幅均有降低、多数环峰时延长,变化有统计学意义(P<0.05);各区域振幅降低幅度不同,以中心凹1环处降低最为严重,P1波振幅仅有正常对照的25%,随离心度增加,振幅降低逐渐减轻;与急性期相比较,恢复期1～3环mfERG振幅提高(P<0.05),4～6环振幅改变无统计学意义.与正常对照相比较,恢复期各环振幅降低仍有统计学意义;发生渗出性视网膜脱离与否,两组患者之间mfERG差异无统计学意义(P>0.05).结论 VKH对后极部视网膜功能有严重影响,即使治疗后视力恢复较理想,视网膜功能仍有较大程度损害.黄斑是治疗前后功能变化较大的部位.