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.     

Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography

AIM: To investigate microvascular changes in eyes with central retinal vein occlusion (CRVO) complicated by macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes and best-corrected visual acuity (BCVA) and retinal thickness. METHODS: Twenty-eight eyes of 28 patients with macular edema caused by CRVO were included in this retrospective study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results of optical coherence tomography angiography (OCTA) automatic measurements of the vessel density in the superficial (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter (PERIM), the vessel density within a 300-μm wide ring surrounding the FAZ (FD-300), the acircularity index (AI), the choriocapillaris flow area, and retinal thickness were recorded before and at one month after treatment and compared with the results observed in age- and sex- matched healthy subjects. RESULTS: The vessel density in the SCP and DCP, the FD-300, and the flow area of the choriocapillaris were all significantly lower in CRVO eyes than in healthy eyes, while the AI and retinal thickness were significantly higher (all P<0.05). After treatment, retinal thickness was significantly decreased, and the mean BCVA had markedly improved from 20/167 to 20/65 (P=0.0092). The flow area of the choriocapillaris was also significantly improved, which may result from the reduction of shadowing effect caused by the attenuation of macular edema. However, there were no significant changes in SCP and DCP vessel density after treatment. The flow area of the choriocapillaris at baseline was negatively correlated with retinal thickness. CONCLUSION: OCTA enables the non-invasive, layer-specific and quantitative assessment of microvascular changes both before and after treatment, and can therefore be used as a valuable imaging tool for the evaluation of the follow-up in CRVO patients.     

光学相干断层扫描血流成像技术(OCTA)在视网膜静脉阻塞中的应用

光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)是一种近年来新兴的无创、快速、高分辨率的眼底血管成像技术.OCTA拥有分层观察不同层面的视网膜血管形态,量化血流灌注的独特优势,现广泛应用于各类眼底血管疾病的诊断及随访.视网膜静脉阻塞是一种常见的眼底血管病变,本文对OCTA在视网膜静脉阻塞的应用进行综述.     

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.     

Predominant loss of the photopic negative response in central retinal artery occlusion

PURPOSE: To determine how the photopic negative response (PhNR) is affected in central retinal artery occlusion (CRAO). DESIGN: Observational case series. METHODS: Seven patients with unilateral CRAO were included. Full-field scotopic and photopic electroretinograms (ERGs) including the PhNR were recorded. Each ERG amplitude in the affected eye was expressed as a percentage of amplitude of the corresponding wave in the unaffected eye. RESULTS: Mean of the PhNR amplitude was reduced to 12.3 +/- 11.7% of that of unaffected eyes whereas the cone b-wave amplitude was attenuated to only 73.4 +/- 30.4%. This reduction of the PhNR amplitude was more significant than that of other waves including the rod b-wave, maximum a-wave and b-wave, cone a-wave and b-wave, and 30 Hz flicker ERG (P <.005). CONCLUSIONS: The PhNR was severely affected in CRAO despite relative preservation of the cone b-wave, implicating massive loss of ganglion cells and their axons.     

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。     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion

AIM: To evaluate central macular thickness (CMT) and mean choroidal thickness (MCT) in eyes with branch retinal vein occlusion (BRVO), before and after ranibizumab treatment using spectral domain-optical coherence tomography (SD-OCT). METHODS: Forty-two patients with unilateral BRVO and macular edema were included in this study. There were 25 men and 17 women. Using SD-OCT, choroidal thickness was measured at 500 µm intervals up to 1500 µm temporal and nasal to the fovea. MCT was calculated based on the average of the 7 locations. All the eyes with BRVO were treated with intravitreal ranibizumab (0.5 mg/0.05 mL). Comparisons between the BRVO and fellow eyes were analyzed using Mann-Whitney U test. Pre-injection and post-injection measurements were analyzed using Wilcoxon test and repeated measure analysis. RESULTS: At baseline, there was a significant difference between the BRVO and fellow eyes in MCT [BRVO eyes 245 (165-330) µm, fellow eyes 229 (157-327) µm] and CMT [BRVO eyes 463 (266-899) µm, fellow eyes 235 (148-378) µm (P=0.041, 0.0001, respectively)]. Following treatment, CMT [295 (141-558) µm] and MCT [229 (157-329) µm] decreased significantly compared to the baseline measurements (P=0.001, 0.006, respectively). Also BCVA (logMAR) improved significantly (P=0.0001) in the BRVO eyes following treatment. After treatment CMT [BRVO eyes 295 (141-558) µm, fellow eyes 234 (157-351) µm] and MCT [BRVO eyes 229 (157-329) µm, fellow eyes 233 (162-286) µm] values did not reveal any significant difference in BRVO eyes and fellow eyes (P=0.051, 0.824, respectively). CONCLUSION: In eyes with BRVO, CMT and MCT values are greater than the fellow eyes, and decrease significantly following ranibizumab injection.     

Extrafoveal traction in retinal vein occlusion using spectral domain optical coherence tomography

Background  

To present extrafoveal vitreous traction membranes, and their prevalence and association with diffuse macular oedema in eyes with retinal vein occlusion (RVO), using 3-D spectral-domain optical coherence tomography (SD-OCT).     

Optical coherence tomography of branch retinal vein occlusion

PURPOSE: To evaluate the incidence of serous retinal detachment (SRD) secondary to a branch retinal vein occlusion (BRVO) by using optical coherence tomography (OCT). METHODS: Fourteen eyes of 14 patients with a BRVO underwent a detailed history, ophthalmoscopic examination, and fluorescein angiographic evaluation. They were also studied with OCT. RESULTS: The 14 patients included eight women and six men with a mean age of 73.6 +/- 10.5 years (range, 55-90 years). Four eyes were found to have cystoid macular edema by fluorescein angiography, whereas 10 cases were detected by OCT. SRD involving any portion of the macula was found in 10 (71.4%) of the 14 eyes, and SRD extending into the fovea was found in six (42.9%) eyes. Two (14.3%) of the 14 patients also showed a subfoveal hemorrhage that appeared to have gravitated inferiorly through the SRD to the dependent portion of the detachment. CONCLUSIONS: That few patients with SRD secondary to a BRVO discovered by ophthalmoscopy have been reported in the literature would suggest that this is an uncommon complication. The authors found with OCT that SRD commonly occurs in BRVO. In addition, subretinal hemorrhage may occur in the context of BRVO, and the authors propose that blood gravitates through the subretinal fluid to settle behind the retina.     

Macular edema in central retinal vein occlusion: correlation between optical coherence tomography, angiography and visual acuity

To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 μm) than in non-ischemic CRVO (mean, 440 μm, p < 0.01). In eyes with foveal thickness (central retinal thickness without subretinal fluid) of 700 μm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis (p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO.     

Optical coherence tomography in central retinal artery occlusion

CLINICAL CASES: Three eyes with central retinal artery occlusion (CRAO) have been studied. Optical coherence tomography (OCT) was performed in each of them. Ophthalmoscopic signs of CRAO were equivocal in the three eyes. However, the presence of a hyporeflective signal in the OCT scan could be seen clearly in each of them. DISCUSSION: The presence of a hyporeflective band between the neurosensory retina and the retinal pigment epithelium in OCT images, that persist for several months after a CRAO episode, is useful in establishing the diagnosis in these patients.     

Extended field imaging using swept-source optical coherence tomography angiography in retinal vein occlusion

Purpose

To evaluate the degree of ischemia in eyes with retinal vein occlusion (RVO) using swept-source optical coherence tomography angiography (SS-OCTA) with the extended field imaging (EFI) technique, which extends the area encompassed by SS-OCTA by scanning through trial frames fitted with a +20-diopter lens.

Study Design

Retrospective observational study.

Methods

Twenty-three consecutive eyes of 22 patients with RVO underwent 12?×?12 mm SS-OCTA imaging both with and without EFI for determination of extension rate. Two graders blinded to the clinical data evaluated the degree of retinal ischemia in paired EFI-SS-OCTA and fluorescein angiography (FA) images, and the concordance rates between the grades were statistically examined.

Results

One EFI-SS-OCTA image was not successfully obtained due to motion artifacts caused by the patient’s poor central vision, while SS-OCTA images without EFI were captured in all 23 eyes. The average extension rate of EFI-SS-OCTA over SS-OCTA was 1.39?±?0.06 and the average scanning area was enlarged by 76.4%. Two graders evaluated the degree of retinal ischemia by measuring nonperfusion areas as the sum of disc areas/diameters. Although their assessments of the EFI-SS-OCTA images were in complete agreement (Cohen’s Unweighted Kappa coefficient?=?1.00), concordance using FA images was only moderate (Cohen’s Unweighted Kappa coefficient?=?0.60).

Conclusion

EFI-SS-OCTA noninvasively produces wider field images of retinal vasculature with one capture and provides resolution sufficient to accurately evaluate retinal capillary nonperfusion in RVO.

     

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.     

视网膜中央静脉阻塞性黄斑水肿的OCT与ERG的对比分析

目的：观察视网膜中央静脉阻塞性黄斑水肿的黄斑区视网膜厚度与视网膜电图( electroretinogram, ERG )各项参数(Cone-a,Cone-b和30Hz)变化的关系。
　　方法：随机选择视网膜中央静脉阻塞患者25例25眼及25只对侧眼分别行明视闪光视网膜电图及光学相干断层扫描( optical coherence tomography,OCT)检查,明视闪光视网膜电图检查测各项参数的振幅和潜伏期, OCT测量黄斑区九部分的视网膜厚度,分析黄斑区形态参数与明视闪光视网膜电图各参数变化之间的关系。
　　结果：黄斑区除颞侧外七个部位视网膜厚度与 ERG 的Cone-b和30 Hz潜伏期相关。
　　结论：研究发现视网膜中央静脉阻塞患者的黄斑区视网膜厚度与内层视网膜功能密切相关。     

视网膜中央静脉阻塞黄斑损害的两种影像检查的观察

目的探讨视网膜中央静脉阻塞(centralretinalveinocclusion,CRVO)所致黄斑损害的光学相干断层成像(opticalcoherencetomography,OCT)的图像特征与眼底荧光血管造影(fundusfluoresceinangiography,FFA)的关系。设计回顾性研究。研究对象33例33眼的视网膜中央静脉阻塞患者。方法对33例33眼的视网膜中央静脉阻塞患者进行OCT和FFA检查。采用OCT对黄斑水肿的高度进行了测量。结果4眼OCT表现为弥漫黄斑水肿,其FFA表现为黄斑拱环毛细血管轻度扩张渗漏;21眼OCT表现为黄斑囊样水肿,其FFA表现为13眼为典型的花瓣样黄斑囊样水肿,另8眼毛细血管扩张,拱环结构破坏,荧光素渗漏显著;3眼OCT表现为神经上皮脱离伴有黄斑水肿,其FFA表现为毛细血管扩张,荧光素渗漏;4眼OCT表现为视网膜内和/或视网膜下大量出血,其FFA检查表现为黄斑拱环破坏,结构不清,有出血遮挡;1眼OCT黄斑中心凹形态大致正常,其FFA检查表现为黄斑区荧光素轻度渗漏。结论OCT对于黄斑组织结构改变的敏感性优于FFA,并且能精确地分析和追踪观察黄斑水肿的病程演变。而FFA在OCT表现正常时,仍能反映出色素上皮屏障的破坏。因此,OCT和FFA两种检查各有优缺点,同时采用可更加全面地了解CRVO所致黄斑损害情况。     

Longitudinal vasculature changes in branch retinal vein occlusion with projection-resolved optical coherence tomography angiography

Graefe's Archive for Clinical and Experimental Ophthalmology - To analyze vascular changes in branch retinal vein occlusion (BRVO) using projection-resolved optical coherence tomography...