Contribution of scanning laser ophthalmoscopy to the functional investigation of subjects with macular holes

A study was designed to validate a functional investigation performed with the scanning laser ophthalmoscope before surgery for macular holes in 12 eyes: The assessment included fundus examination, a functional examination resulting in evaluation of the preferred retinal lows, visual acuity and recording of visual evoked potentials. The preferred retinal locus was evaluated by presenting a small square area, and visual acuity was determined by means of calibrated figures. The visual evoked potentials were evoked by three alternating checkerboards (check size, 30, 2 Hz) centered over the hole and seen at an angle of 6.5 × 6.5°, 2.5 × 2.5° and 6.5 × 6.5° with central exclusion of 2.5 × 2.5°. The appearance of the fundus visualized by scanning laser ophthalmoscopy consisted of a clear central disk corresponding to the hole, surrounded by a very dark ring, associated with a second, less dark ring with unclear margins. Fixation was unstable in one case with a visual acuity of 20/70. In 11 cases, fixation was localized to the superior retina with a visual acuity superior to 20/70. The visual evoked potentials evoked by 6.5 × 6.5° were discernible in all 12 eyes; visual evoked potential by annular stimuli were discernible in 11 cases. The 2.5 × 2.5° stimulus evoked no response in eight cases, proving the area of the hole was nonfunctional. A response was recorded in the four other cases, where the dimension of the holes was less than 2°. The results of this scanning laser ophthalmoscopic assessment demonstrated a precise evaluation of the residual macular function in the cases of full-thickness macular holes.Abbreviations SLO scanning laser ophthalmoscope     

OCT and muti-focal ERG findings in spontaneous closure of bilateral traumatic macular holes

Purpose To report the spontaneous closure of bilateral traumatic macular holes in a young patient, followed up with optical coherence tomography (OCT), muti-focal electroretinogram (mfERG), and Humphrey visual field examination. Methods A 25-year-old male who suffered from bilateral blunt trauma to the eyes and developed traumatic macular holes was followed with ophthalmic examination, OCT, mfERG, and Humphrey visual field examination. Results The OCT results revealed spontaneous closure in both eyes 2 weeks after trauma, and the macular holes remained closed in the 7 months of follow-up. Visual acuity improved to 0.7 in right and 0.9 in left eye finally. Visual field examination and mfERG results improved slightly compared with the initial tests. However, there still were central scotomas in both eyes, especially in right eye at the end of follow-up, and the peaks of the retinal response density had not recovered in the macular area of the mfERG topography. Conclusions Spontaneous closure of unilateral traumatic macular hole is not uncommon, but there is no report of spontaneous closure of bilateral traumatic macular holes as yet. Since the traumatic macular holes may close spontaneously, traumatic macular holes may be observed for a period of follow-up.     

Visual evoked potentials in macular hole

Pattern reversal visual evoked potentials (VEPs) with checks of 50 and 12 were recorded in 15 patients with idiopathic unilateral macular hole. VEPs from the affected eyes were reduced in amplitude compared with those from the fellow eyes, especially with checks of 12 (percentage of the amplitude in the affected eye to that in the fellow eye was 86% ± 19% with checks of 50 and 61% ± 35% with checks of 12). The latencies showed no statistically significant difference between the affected and the fellow eyes, although a marked interocular delay was found in a few patients. The degree of amplitude reduction and interocular delay had no relation to the size of the macular hole or visual acuity. The effects of experimental scotomata of various sizes on the VEPs, which were evaluated in nine normal subjects, were also variable among the subjects. We conclude that although the macula predominantly participates in the pattern VEP, an estimation of the extent of macular pathology from the VEP changes may be difficult because the VEP changes induced by a macular hole have wide individual variation and have no relation to the size of the hole.     

Associations between subjective and objective visual function in patients with unilateral macular holes

Forty-six patients with uniocular macular holes and unaffected, fellow eyes were studied to evaluate inter- and intraocular associations between various objective tests of visual function and perceived visual ability. The affected eye had significant associations between visual acuity (VA) and the fovea threshold test, but for the fellow eye only VA and low-contrast VA 10% were associated. The reduction in visual acuity under low-contrast conditions relative to high-contrast did not differ between the affected eye and the healthy eye. Subjective visual ability seems to depend more on the visual acuity of the affected eye than the healthy eye.     

Local Electroretinogram and Pattern Visual Evoked Potential in Maculopathies

Purposes: To observe the characteristics of local electroretinogram (LERG) in normal subjects and patients with maculopathies, and to evaluate the applied worth of LERG and pattern visual evoked potential (PVEP) in maculopathies. Methods: LERGs at 5° and 15° macular regions were recorded from 27 normal subjects (54 eyes). The factors of age, different eyes and stimulate areas for LERG influence were observed. Meanwhile, the LERG and PVEP were recorded from 25 patients (35 eyes) with maculopathies for making contrast study. Results: In normal subjects, there was no significant influence of age to LERG. As the stimulated areas increased, the a- and b-wave amplitudes of LERG increased. In the patients with maculopathies, the a- and b-wave amplitudes of LERG at 5°, 10°and 15° macular regions were significantly lowered and the mean values of P1 latency were prolonged and N1-P1 amplitudes of VEP were lowered, comparing with the control group. In the nearing stimulated area (5°LERG and 14. 9×19°PVEP.),     

中心性浆液性脉络膜视网膜病变的PERG．PVEP

用自制的银氯化银钩形电极记录PERG,同步记录PVEP,对照组各波潜伏时,波幅与国外报告结果近似。中浆患眼40%P_m波下降,且与视力下降相关(r>r.05)。b波下降者仅15%,与视力不相关。两者反应的不同,提示PERG较少受外层视网膜病变的影响,能够直接反映内层视网膜的机能状态。但P_m波延迟者,b波多不延迟,未能证明视网膜内传导迟滞。     

黄斑裂孔的光学相干断层成像分析

目的 探讨黄斑裂孔的光学相干断层成像（ｏｐｔｉｃａｌ ｃｏｈｅｒｅｎｃｅ ｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征及ＯＣＴ临床应用价值。方法 １９９８年９～１２月临床诊断为黄斑裂孔者共３５例（３８只眼）。经双眼散瞳后进行ＯＣＴ检查,对获取的图像进行分析和测量。结果 １例（１只眼）ＯＣＴ显示为玻璃牵引：１例（１只眼）为黄斑前膜所致的性裂孔：３３例（３６只眼）为黄斑裂孔,其中３例累及双眼。３６只眼中,板层黄     

玻璃体切割联合白内障超声乳化术治疗黄斑裂孔

目的　评价闭合式玻璃体切割术联合超声乳化白内障吸出术治疗黄斑裂孔的疗效和意义。方法　将 2 0 0 0年 1月至 2 0 0 3年 4月在我院治疗的黄斑裂孔患者 64例 (67只眼 )随机分为两组 ,一组为分期手术组 ,2 8眼 ,先进行玻璃体切割术治疗 ,必要时再进行Ⅱ期经透明角膜超声乳化白内障吸出术 ;另一组为联合手术组 ,3 9眼 ,行玻璃体切割术联合经透明角膜超声乳化白内障吸出术治疗 ,并对其中视力有望明显提高的 3 4眼Ⅰ期植入了人工晶体。两组患者玻璃体切割术中都进行了剥除黄斑前膜或增厚的视网膜内界膜处理和全氟丙烷 (C3 F8)填充。对两组患眼术后疗效和并发症进行比较。结果　①在分期手术组中 ,术后两年内 ,术前晶状体透明的 5眼中有 4眼 (占 80 % )发展到了不同程度的白内障 ,全组 2 8眼中有 2 2眼 (占 78 6% )因白内障发展到了成熟期 ,又进行了Ⅱ期经透明角膜超声乳化白内障吸出术 ;②联合手术组术后黄斑裂孔闭合率 (94 9% )高于分期手术组(75 0 % ) ,差异具有显著性意义 (χ2 =3 96,P <0 0 5 )。③联合手术组术后患眼最佳矫正视力提高≥2行率 (84 6% )高于分期手术组 (60 7% ) ,差异具有显著性意义 (χ2 =4 92 ,P <0 0 5 )。④联合手术组术后并发症的发生率低于分期手术组 ,差异具有显著性意义 (     

Pattern electroretinogram plus visual evoked potential: A decisive test in patients suspected of malingering

Along the processing chain in the visual pathway the pattern electroretinogram (PERG) is a better indicator of the peripheral function than the visual evoked potential (VEP). Therefore the PERG and the VEP will be impaired equally by disturbances before the ganglion cell layer (e.g., blurred image or retinal disease) and differently by further centrally located diseases (e.g., tumor compression of the optic nerve). Thus in patients complaining of reduced visual acuity who show disturbed VEP but a normal PERG, malingering can be definitely ruled out. Representative combinations of PERG and VEP findings are described.     

玻璃体切割手术后继发黄斑裂孔的临床研究

目的研究玻璃体切割手术后继发黄斑裂孔(MH)的相关因素.方法对2007年3月至2011年2月收治的玻璃体切割手术后继发 MH 患者7例(7只眼)进行回顾性分析.结果7例继发性 MH 与一期玻璃体手术之间平均间隔7.4个月(2~15个月).按原发疾病分为视网膜脱离3例,增生性糖尿病视网膜病变4例.所有病例均于局麻下行玻璃体切割联合内界膜剥离手术,术后平均随访10.8个月(3~14个月).单次手术裂孔闭合率为71.4%(5只眼),2例未闭合患者均放弃继续治疗. MH 术前最佳矫正视力为0.02~0.2,平均0.13,术后最佳矫正视力为0.08~0.4,平均0.18.视力提高眼4只眼(57.1%),视力不变2只眼(28.6%),视力下降1只眼(14.3%).结论玻璃体切割手术后继发黄斑裂孔发病率较低,通过玻璃体切割联合内界膜玻璃体手术治疗可以取得令人满意的疗效.     

早期原发性开角型青光眼彩色图形视觉电生理改变分析

目的 探讨早期原发性开角型青光眼彩色图形视网膜电图（ＣＰ－ＥＲＧ）,彩色图形视觉诱发电位（ＣＰ－ＶＥＰ）的改变特征。方法 采用电生理方法记录早期原发性开角型青光眼（ＰＯＡＧ）患者在白／黑、红／黑、蓝／黑翻转图形刺激下的ＣＰ－ＥＲＧ、ＣＰ－ＶＥＰ,结果 （１）ＰＯＡＧ组ＣＰ－ＥＲＧ的ｂ波幅值下降,潜伏期延长;ＣＰ－ＶＥＰ的Ｐ１００波幅值下降,潜伏期延长;（２）ＰＯＡＧ组ＣＰ－ＥＲＧ和ＣＰ－ＶＥＰ的异     

灯盏花提取物对高眼压家猫图形视网膜电图及图形视觉诱发电位的影响

目的 评价中药灯盏花提取物对高眼压状态下视功能的保护作用.方法 40只家猫随机分为空白组、模型组、灯盏花素组、脑神经生长素对照组,每组10只动物,前房注射20 g·L-1甲基纤维素制作家猫急性高眼压模型,前肢静脉穿刺注射给药,于造模后第1天开始,每天1次,连续给药9 d,以图形视网膜电图(pattern electroretinogram,PERG)和图形视觉诱发电位(pattern visual evoked potential,PVEP)为评价手段,观察用药前后以上指标的变化.结果 高眼压能够严重损害家猫视神经功能,表现为PERG及PvEP各参数峰潜时明显延长,振幅降低,与术前相比差异具有显著统计学意义(P<0.01).灯盏花素组、脑神经生长素对照组均使高眼压家猫异常的P50、N95波峰潜时缩短,振幅提高,表现为:干预10 d后灯盏花素组、对照组P50波峰潜时缩短,振幅提高,与模型组比较差异均具有显著统计学意义(均为P<0.01);P50波峰潜时与干预前比较,灯盏花素组的缩短更显著(P<0.01);P50波振幅与干预前比较灯盏花素组、对照组均明显提高(P<0.01),其中灯盏花素组的作用优于对照组(P<0.05).干预10 d后灯盏花素组N95波峰潜时缩短,振幅提高,与干预前、模型组比较,差异均有显著统计学意义(均为P<0.01);灯盏花素组对N95峰潜时及振幅的改善作用均优于对照组(均为P<0.05).灯盏花素组、对照组对高眼压家猫PVEP之P100波具有改善作用,表现为干预10 d后P100波峰潜时明显缩短,两种药物组与模型组比较,差异均具有显著统计学意义(均为P<0.01);干预10 d后P100波振幅提高,其中灯盏花素组作用最明显,与干预前比较差异具有统计学意义(P<0.01),改善作用优于模型组及对照组(均为P<0.05).结论 中药灯盏花提取物能够使高眼压家猫异常的PERG及PVEP之P50、N95、P100波峰潜时缩短,振幅提高,对高眼压状态下视神经的保护有益.     

黄斑局部视诱发电位的记录和分析

目的　记录黄斑部闪光稳态视诱发电位 ,分析参数的稳定性 ,探索新的临床诊断项目。方法　系用美国 L KC公司 UTAS- E30 0 0型视觉电生理仪及 FCS- 5 0 0型局部刺激器 ,记录 18例 2 0眼正常人黄斑部闪光稳态视诱发电位。结果　黄斑局部闪光稳态视诱发电位的振幅为 2 .114± 0 .374μV(CV=0 .2 0 1) ,潜伏期为 32 .36± 8.113ms(CV=0 .2 5 1) ,相位 78.72 9± 40 .16 9degree(CV=0 .5 10 )。结论　黄斑部闪光稳态视诱发电位振幅、潜伏期的参数较稳定 ,可作为黄斑部、视神经病变新的检测项目。     

Pattern visual evoked potentials and pattern electroretinograms in hypothyroidism

This study reports the pattern visual evoked potential (PVEP) findings in 10 patients with idiopathic hypothyroidism. Eight of these patients also had pattern electroretinography (PERG) performed and six were additionally seen after treatment with thyroxine.Only one patient had definitely abnormal PVEPs at the time of initial recording. PERGs at this time were of abnormal latency and subnormal amplitude. Following treatment with thyroxine the patient became euthyroid. Repeat electrodiagnostic testing now showed both PERGs and PVEPs within the normal range, having markedly improved in both latency and amplitude. This suggests that the PVEP delay was probably secondary to reversible central retinal dysfunction.     

Clinical and electrophysiological findings in three patients with toluene dependency

We recorded the electrophysiological findings of three patients with toluene dependency who developed visual disturbance. In five of six eyes the peak latency of the pattern visual evoked cortical potential was prolonged as compared with that of normal subjects. The amplitude and the latency of the a-wave of the electroretinogram were decreased in five of the six eyes and prolonged in four. Those of the b-wave in patients were less affected than the a-wave: in one of six eyes the amplitude of the b-wave was decreased and in two the b-wave latency was prolonged. The amplitudes of the oscillatory potentials were decreased in three of six eyes. The electroretinogram was investigated in one patient and showed little increase in amplitude during light stimulation, so that a lowered light peak to dark trough ratio was obtained.Our findings suggest that any part of the visual pathway, including the distal part of the retina and retinal pigment epithelium, might be impaired by the chronic inhalation of toluene vapors.Abbreviations EOG Electrooculogram - ERG Electroretinogram - L/D light peak to dark trough ratio - OP Oscillatory potential - VECP Visual evoked cortical potential     

Pattern electroretinogram and visual evoked cortical potential in ethambutol optic neuropathy

Forty-one eyes in 21 cases of ethambutol optic neuropathy were investigated for the pattern visual evoked cortical potential (VECP) and the pattern electroretinogram (ERG).In 21 of the eyes the disappearance VECP responses were not detectable. In the other 20 eyes the peak latency and amplitude of the disappearance VECP were delayed and decreased significantly compared with normal eyes. The recovery of the peak latency of the disappearance VECP in ethambutol optic neuropathy was faster than that of the amplitude.Twelve eyes in six patients were studied by pattern reversal ERG. Though the mean peak latency of the pattern ERG was within normal limits, the mean amplitude was decreased significantly.Our investigations indicated that ethambutol optic neuropathy disturbed not only the optic nerve but also the retina.     

The pattern electroretinogram in optic nerve disease

Pattern evoked electroretinograms (PERG), diffuse flash electroretinograms (ERG) and visual evoked potentials were studied in patients with unilateral optic nerve disease. Patients with Snellen acuities of less than 6/30 did not have recordable PERGs in their affected eye, whereas their diffuse flash ERGs were normal. The VEPs were correspondingly reduced or absent when recorded from the poorer seeing eyes. A second group of patients with Snellen acuity between 6/6 and 6/30 in the involved eye showed reductions in the mean PERG amplitude of the affected as compared with the normal eyes. All affected eyes showed an abnormal contrast threshold measured with the PERG amplitude. Such results underscore the diagnostic value of the PERG in detecting even mildly affected cases of optic nerve disease.     

急性甲醇中毒后期的视觉电生理表现

报导了11例(22只眼)急性甲醇中毒后期的视觉电生理检查结果。其中发现闪光视网膜电图(FERG)的b波振幅、闪光视诱发电位(FVEP)、图像视网膜电图(PERG),图像视诱发电位(PVEP)的主波振幅和峰时呈显著异常,P<0.001。结果表明急性甲醇中毒后期不仅损伤视网膜外层,而且还波及视网膜内层的神经节细胞和视路。     

Abnormalities of visual-evoked potentials and pupillary light reflexes in a family with autosomal dominant occult macular dystrophy

Occult macular dystrophy (OMD) is an unusual inherited or sporadic macular dystrophy characterized by an essentially normal appearing ocular fundus and normal ocular circulation determined by fluorescein angiography but with a progressive decrease of visual acuity. We present a family with OMD who have a delay in the implicit times of both the visual-evoked potentials and the pupillary light reflexes. Because these delays are usually indicative of optic nerve disorders, deciding on a diagnosis between OMD and optic nerve disorder should be done carefully. We are not aware of any studies that have reported these findings in patients with OMD.     

黄斑裂孔合并周边裂孔视网膜脱离的临床分析

目的：为分析黄斑孔合并周边裂孔视网膜脱离病例病情特点、治疗方法及预后的影响因素。方法：对５７只眼选用单纯气液交换,环扎加压,或玻璃体切割联合眼内注气手术方法,部分病例予以激光辅助治疗。结果：患眼视网膜总复位率达８６％（４９／５７）,一次手术复位３８只眼（占６７％）。视力提高３６只眼（占６３％）,未变１０只眼,下降３只眼,激光治疗眼视力恢复无影响。结论：严重ＰＶＲ、术前病程长、高度近视、后极部裂孔、并发脉络膜脱离是影响手术成功的重要因素。术前检查不遗漏裂孔,选择合适的手术方式,及时封闭裂孔,预防膜增殖是成功的关键。