视网膜电图明视负向反应在视网膜静脉阻塞中的变化

目的 观察视网膜静脉阻塞(RVO)患者视网膜电图(ERG)明视负向反应(PhNR)的变化特点.方法 对间接检眼镜、荧光素眼底血管造影(FFA)检查确诊的RVO患者30例30只患眼以及对侧健康眼进行视力、视野、闪光ERG(FERG)检查,同时选取与其性别、年龄相匹配的正常人25例50只眼作为正常组进行FERG检查.所有检查均按常规方法进行.RVO患者中,视网膜中央静脉阻塞(CRVO)患者14例14只眼、视网膜分支静脉阻塞(BRVO)患者16例16只眼.根据其病史及FFA检查结果,将其按病程时间划分为小于1个月、1～3个月、大于3个月组;另外再根据RVO分型标准及具体检查结果,将RVO患者分为缺血型和非缺血型.对比分析RVO患眼与对侧健康眼以及正常眼PhNR振幅变化及ERG其他参数指标,包括振荡电位(Ops),视锥细胞反应(Cone-a、Cone-b),视杆细胞反应(Rod-b),暗适应眼的最大反应(Max-a、Max-b),30 Hz闪烁光反应(30 Hz)的差异以及PhNR振幅变化与RVO疾病缺血类型、病程的关系.结果 PhNR振幅在CRVO患眼为(28.20±5.80)μV,BRVO患眼为(36.96±4.71)μV,对侧健眼为(61.25±3.93)μV,正常眼为(59.33±16.92)μV.CRVO组与对侧健眼、正常组比较,差异有统计学意义(F=10.69,9.80;P＜0.001),BRVO组与对侧健眼、正常组比较,差异有统计学意义(F=9.69,9.75;P＜0.001).CRVO组中缺血型PhNR值为(22.77±5.73)μV,非缺血型为(36.63±12.91)μV,二者差异有统计学意义(t=6.54,P＜0.01);BRVO组缺血型PhNR值为(32.39±13.22)μV,非缺血型为(46.73±10.43)μV,二者差异无统计学意义(t=2.12,P＜0.05);病程小于1个月组CRVO与BRVO分别为(24.58±4.60)、(27.94±15.73)μV,1～3个月组分别为(50.39±13.80)、(58.69±12.43)μV,大于3个月组为(25.40±19.94)、(34.48±16.72)μV,CRVO中1～3个月组与大于3个月组差异有统计学意义(F=4.30,P＜0.01).结论 RVO患眼的PhNR振幅较对侧健康眼以及正常对照眼明显降低,缺血型较非缺血型降低,随病程变化呈现下降、上升、下降的变化趋势.     

The photopic negative response of the flash electroretinogram in retinal vein occlusion

The photopic negative response (PhNR) has recently been shown to be severely affected in central retinal artery occlusion (CRAO), despite relative preservation of the cone b-wave compared to that in the healthy unaffected fellow eye. The aim of this study was to test how the PhNR of the flash electroretinogram (ERG) is affected in human retinal vein occlusion. PhNR was elicited with red stimuli (1 cd s/m², 5 cd s/m², and 7 cd s/m² with 4 ms duration) and blue background (10 cd/m²). Standard Ganzfeld flash ERG was produced according to the ISCEV standard for the clinical electroretinogram (2004). Sixteen patients with central retinal vein occlusion (CRVO), 14 patients with branch retinal vein occlusion (BRVO), and 16 controls were analyzed. The amplitude of the PhNRs was significantly smaller in the CRVO and BRVO eyes than those in the unaffected fellow or control eyes (p = 0.000). There was a significantly greater reduction of PhNR amplitudes than that of other waves including the OPs, rod b-wave, combined a-wave and b-wave, cone a-wave and b-wave, and 30 Hz flicker ERG. Thus, PhNR amplitude in retinal vein occlusion is severely affected. There is a potential role for PhNR in assessing inner retinal damage and evaluating the effect of treatment.     

Inner neural retina loss in central retinal artery occlusion

Purpose  

To report morphologic retinal changes and visual outcomes in acute and chronic central retinal artery occlusion (CRAO).     

Visual prognostic value of photopic negative response and optical coherence tomography in central retinal vein occlusion after anti-VEGF treatment

Objective

To investigate the potential of optical coherence tomography (OCT) and photopic negative response (PhNR) for predicting visual outcome after intravitreal bevacizumab in patients with macular edema secondary to central retinal vein occlusion (CRVO).

Methods

Thirty-two consecutive patients with macular edema secondary to unilateral CRVO who were treated with three times of 6 weeks interval intravitreal bevacizumab were enrolled. LogMAR visual acuity (Va), OCT and PhNR were done before and 4 weeks after first and third injection. Stepwise multiple regression analysis was conducted between pre-treatment Va, central retinal thickness, b wave amplitude, PhNR amplitude, PhNR relative amplitude (affected eye/unaffected fellow eye,  % presentation) and post-treatment Va at 4 weeks after the third injection. The predictive values of pre-treatment parameters for good visual outcome (0.2 ≤ LogMAR Va) were assessed using receiver-operating characteristics (ROC) analysis.

Results

In multiple regression analysis, pre-treatment Va (β = 0.615, P = 0.001) and PhNR relative amplitude (β = ?0.352, P = 0.032) were correlated significantly with post-treatment Va. In ROC analysis, pre-treatment Va showed a 80 % sensitivity and 80 % specificity for predicting good visual outcome, at a cutoff value of 0.52 LogMAR. Pre-treatment PhNR relative amplitude demonstrated a 88 % sensitivity and 75 % specificity for predicting good visual outcome, at a cutoff value of 40.00 %.

Conclusions

The PhNR relative amplitude can be a useful prognostic factor for visual outcome after intravitreal bevacizumab therapy in patient with macular edema secondary to CRVO. Patients with larger pre-treatment PhNR relative amplitude with better pre-treatment Va showed a better post-treatment visual outcome.     

视网膜中央静脉阻塞黄斑水肿玻璃体腔注射曲安奈德后视网膜电图明视负向反应变化

背景玻璃体腔注射曲安奈德（TA）对于视网膜中央静脉阻塞（CRVO）患者黄斑区水肿的消退以及视力的维持和提高作用较明显,明视负向反应（PhNR）可以反映视网膜内层视网膜神经节细胞（RGCs）及其轴突的功能,两者间是否存在联系是尚待解决的问题。目的比较分析CRVO黄斑水肿患者玻璃体腔内注射TA前后视网膜电图（ERG）的PhNR的变化,探讨PhNR作为治疗过程中监测视网膜功能的价值。方法收集比较CRVO伴黄斑水肿者12例13眼,于玻璃体腔内注射TA（0．1ml,4mg）前1d及注射后4周分别用标准小数视力表、光学相干断层扫描仪（OCT）、德国Roland RETI scan3．15系统检查视力、黄斑区视网膜厚度和PhNR。结果接受TA玻璃体腔注射后4周,12例患者13眼中有12眼视力提高,1眼视力不变。与玻璃体腔注射TA前比较,玻璃体腔注射TA后4周OCT显示黄斑区神经上皮细胞层水肿明显减轻,厚度减小;闪光视网膜电图（F—ERG）显示PhNR在玻璃体腔注射TA后波形明显改善。玻璃体腔注射前后患眼的视力分别为0．32±0．12和0．48±0．09,差异有统计学意义（t=6．325,P=0．000）;玻璃体腔注射后患眼黄斑区神经上皮层厚度与注射前比较明显下降[（459．46±131．31）μmvs（297．54±43．31）μm],差异有统计学意义（t=5．961,P=0．000）,玻璃体腔注射前后患眼的PhNR平均振幅值分别为（61．28±20．16）μV和（80．23±22．96）μV,差异有统计学意义（t=4．438,P=0．001）。玻璃体腔注射TA前后黄斑区神经上皮层厚度与PhNR振幅间均无明显的相关性（注射前：r=0．587,P=0．035;注射后：r=一0．011,P=0．971）。结论CRVO黄斑水肿患者行玻穗蚀日奉内沣射TA后,PhNR可以做为监测患者内层视网膜功能变化的有效指标。     

Traumatic central retinal artery occlusion

A healthy 6-year-old boy with a clinical picture of central retinal artery occlusion (CRAO) of his left eye is presented here. The underlying cause was a trauma to the boy's left cheek some 6 months earlier. Possible pathophysiological mechanisms are discussed. To the best of our knowledge, the late onset of traumatic CRAO has not yet been reported in the literature.     

Migrainous central retinal artery occlusion

A 29-year-old man experienced a migrainous central retinal artery occlusion coincident with the initiation of propranolol therapy. The pharmacological effects of beta-blockade are discussed, and the use of beta-blockade in the acute management of anterior visual pathway migraine is examined.     

A case of central retinal vein occlusion accompanied by central retinal artery occlusion

A 81-year-old woman developed central retinal vein occlusion (CRVO) in her left eye subsequent to central retinal artery occlusion (CRAO). She noticed sudden visual loss in the left eye. At initial examination, her left visual acuity was 0.03, and only a small visual field was preserved at temporal area. The left fundus showed findings of mild non-ischemic CRVO. In addition white clouded retina was recognized at the left posterior pole which indicated CRAO. FAG showed remarkably prolonged arterial circulation, but no retinal capillary obliteration. Then retinal hemorrhage increased rapidly and her left eye developed hemorrhagic retinopathy. Two weeks after initial examination, FAG showed extensive retinal capillary obliteration. In this case it was supposed that central retinal artery occlusion due to arteriosclerosis produced ischemic capillaropathy and venous thrombosis, after which restoration of arterial circulation caused hemorrhagic retinopathy.     

Implications of central retinal artery occlusion

The purpose of this paper, was to discuss central retinal artery occlusion and its role in the patient's overall health. Several different causes of occlusion such as cardiovascular diseases, carotid artery disease, aortic arch disease and giant cell arteritis are discussed along with their symptomatology and clinical manifestations. Because of the importance of a proper diagnosis, the more common ophthalmoscopic pictures that are confused with the central retinal artery occlusions are also included. A case report of a central retinal artery occlusion secondary to a carotid artery stenosis is presented to acquaint the optometrist to the need of further testing after a vascular accident to the eye.     

视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系

目的探讨视网膜中央动脉阻塞（CRAO） 患者中心视力损害与病程、视网膜循环时间的关系。方法对99例99只眼CRAO患者的中心视力、发病病程、荧光素眼底血管造影 (FFA)检查视网膜循环时间等量化数值进行统计学分析。结果CRAO 患者不同病程时间(2~21 d)与中心视力损害程度差异无统计学意义（P＞0.05），视网膜循环时间中视网膜动脉荧光充盈间期与中心视力损害的关系差异有统计学意义（P＜0.05），臂 视网膜循环时间与中心视力损害差异无统计学意义（P＞0.05）。结论视网膜循环时间指标中视网膜动脉荧光充盈间期与中心视力损害相关，时间愈长视力损害愈重，值得关注。(中华眼底病杂志，2007，23：177-179)     

Chlamydia pneumoniae in central retinal artery occlusion

PURPOSE: There is increasing evidence that the common respiratory human pathogen Chlamydia pneumoniae has a causative role in atherosclerosis. We investigated the association of this pathogen with acute central retinal artery occlusion (CRAO). PATIENTS AND METHODS: Sera of 14 consecutive patients with CRAO and of 14 age- and sex-matched control subjects were examined. Antibodies against chlamydial lipopolysaccharide (LPS) and outer membrane proteins of C. pneumoniae were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: In the CRAO group, seven patients (50%) were found to be IgA positive, 12 (86%) were IgG positive and one (7%) was IgM positive for chlamydial LPS antibodies. In the control group 36%, 79% and 14% were IgA, IgG and IgM positive, respectively. The results showed no significant difference between the groups. In the CRAO group, IgA, IgG and IgM antibodies to C. pneumoniae were found in 43%, 79% and 0% of subjects, respectively. These findings did not differ significantly from those pertaining to matched controls. CONCLUSIONS: These data do not support an association between acute CRAO and current C. pneumoniae infection.     

Fundus changes in central retinal artery occlusion

PURPOSE: To investigate systematically the ophthalmoscopic fundus findings associated with central retinal artery occlusion (CRAO). METHODS: The study included 240 consecutive patients (248 eyes) with CRAO. The eyes underwent detailed fundus evaluation and stereoscopic color fundus photography at initial and follow-up visits. Patients without evidence of giant cell arteritis were advised to have carotid Doppler imaging and echocardiography to determine the source of emboli. CRAO was classified into 3 types: permanent CRAO (175 eyes), permanent CRAO with cilioretinal artery sparing (35 eyes), and transient CRAO (38 eyes). In the three types of CRAO, acute-phase and late-phase changes in the retina, optic disk, and retinal vessels were evaluated. RESULTS: The main findings during the initial examination in our clinic for permanent CRAO were retinal opacity in the posterior pole (58%), cherry-red spot (90%), box-carring (19%), retinal arterial attenuation (32%), and optic disk edema (22%) and pallor (39%). The most frequent findings identified at the late stage, based on survivorship curves, were optic atrophy (91%), retinal arterial attenuation (58%), cilioretinal collaterals (18%), and macular retinal pigment epithelial changes (11%). Compared with permanent CRAO, permanent CRAO with cilioretinal artery sparing was associated with a lower incidence of all macular and optic disk abnormalities. For transient CRAO, the incidence of initial findings varied greatly compared with the other types. Intraarterial emboli were observed in 20% of patients. Carotid Doppler evaluation identified carotid vascular plaques in 67% of patients tested and hemodynamically significant (>50%) obstruction in 32%. Four percent of CRAOs presented with simultaneous bilateral onset. CONCLUSIONS: The type and incidence of fundus findings at the initial visit and in the late phase of CRAO vary by its type. This study confirms that retinal opacity is predominantly evident in the posterior retina, that optic disk findings at presentation are common, that CRAO associated with normal-appearing retinal vessels and/or optic disk is not rare, and that observation of emboli is infrequent. Clinicians should be aware of the various presentation findings during the acute and late stages of CRAO and its various types. A complete picture of CRAO is provided by combined information of our clinical and experimental studies of CRAO.     

视网膜中央动脉阻塞的治疗进展

视网膜中央动脉(CRA)是视网膜神经上皮层内五层组织的血供来源。若CRA发生阻塞，可导致患眼视力骤降甚至永久性视力丧失。视网膜中央动脉阻塞(CRAO)患者的自然视力预后通常较差。虽然可用于CRAO治疗的手段多样，如眼球按摩、前房穿刺术、高压氧治疗(HBOT)以及组织型纤溶酶原激活剂(tPA)动脉内溶栓等，但尚未有基于循证医学证据的CRAO治疗指南被应用于临床。而这些治疗手段对于CRAO的疗效均存在争议或存在治疗风险。本文将对目前可应用于CRAO治疗的措施予以综述，并对其各自的安全性及有效性进行探讨。     

Visual recovery in combined central retinal artery and central retinal vein occlusion

We observed two patients who had combined central retinal artery occlusion and central retinal vein occlusion with severely reduced visual acuity and characteristic retinal changes. Over the course of several months, visual acuity and ophthalmoscopic appearance returned to normal. Both patients had a transient visual loss before their occlusive events and a mild nonconcurrent central retinal vein occlusion in their fellow eye. There was no evidence of inflammatory, vascular, or myeloproliferative disease.     

Cilioretinal artery occlusion with central retinal vein occlusion.

BACKGROUND: Combined cilioretinal artery and retinal vein occlusions are infrequently documented retinal vascular disorders of speculative origin. Occlusion of the cilioretinal artery is believed to result from either mechanical compression of the artery as a result of an increase in venous pressure or from a reduction in perfusion pressure in both the cilioretinal and retinal arteries. The ophthalmoscopic and angiographic features of this condition are reviewed. CASE REPORTS: Two cases of cilioretinal artery occlusion after central retinal vein occlusion are presented, one of which evolved to the development of iris neovascularization. DISCUSSION: The incidence of cilioretinal artery occlusions due to central retinal vein occlusions is infrequently reported in the literature. Excluding those with chronic cystoid macular edema, most patients have a favorable visual outcome. It is possible that the incidence of combined cilioretinal artery and central retinal vein occlusions is grossly underestimated.