Role of the beta(2) subunit of voltage-dependent calcium channels in the retinal outer plexiform layer

PURPOSE: Mutations in the alpha(1F) subunit of voltage-dependent calcium channels (VDCCs) have been shown to cause incomplete congenital stationary night blindness (CSNB2). The purpose of this study was to dentify which of the four beta subunits of VDCCs participates in the formation of this channel at the photoreceptor synapse and to determine how its absence affects visual processing. METHODS: Mice without each of the four known beta subunits of VDCCs were generated by gene targeting and transgenic rescue (CNS-beta(1), -beta(2)) or by gene targeting alone (beta(3)) or were obtained from a commercial provider (beta(4)). Retinal function and visual sensitivity were examined by electroretinography and an active avoidance behavioral test, respectively. The structure of the retina and expression of the alpha(1F) subunit were examined at the light microscopic level and by immunohistochemistry. RESULTS: Under dark-adapted conditions, CNS-beta(2)-null mice had a normal ERG a-wave, but did not have a normal b-wave. In addition, these mice showed decreased sensitivity to light. Both the a- and b-waves appear normal in the CNS-beta(1)-, beta(3)-, and beta(4)-null mice. Histologic analyses of all four mouse lines indicated that only the CNS-beta(2)-null mice had altered retinal morphology. Eyes of these mice had a thinner outer plexiform layer (OPL) than eyes of control animals. In addition, the labeling pattern of the alpha(1F) subunit in the OPL was altered in CNS-beta(2)-null mice. CONCLUSIONS: The normal distribution of the alpha(1F) subunit of the VDCCs in the OPL is dependent on the expression of the beta(2) subunit. The expression of both of these subunits is required for normal maintenance and/or formation of the OPL and synaptic transmission.     

计算机引导下的飞秒激光辅助白内障手术治疗对患者视力远期预后的影响及其安全性分析

目的　探讨计算机引导下飞秒激光（ｆｅｍｔｏｓｅｃｏｎｄｌａｓｅｒ,ＦＳＬ）辅助白内障手术治疗对患者视力远期预后的影响及其安全性。方法　收集２０１３年１月至６月于我院行手术治疗的白内障患者的临床资料,分为ＦＳＬ组（４５例６０眼）和传统组（４３例６０眼）。ＦＳＬ组采用计算机引导下ＦＳＬ辅助白内障手术治疗,传统组采用传统超声乳化白内障手术治疗。统计两组疗效、散光度、眼压,以及治疗前（Ｔ０）、治疗后１个月（Ｔ１）、６个月（Ｔ２）、１２个月（Ｔ３）和２４个月（Ｔ４）的远视力、近视力、裸眼视力、最佳矫正视力及术后并发症发生情况。结果　ＦＳＬ组总治疗有效率为９０．００％,高于传统组７６．６７％（Ｐ＜０．０５）。两组平均角膜散光度和眼压比较差异均无统计学意义（均为Ｐ＞０．０５）;两组术后眼压均低于术前（均为Ｐ＜０．０５）。与Ｔ０比较,两组Ｔ１、Ｔ２、Ｔ３、Ｔ４的远视力、近视力、裸眼视力、最佳矫正视力均提高（均为Ｐ＜０．０５）;与传统组比较,ＦＳＬ组Ｔ１、Ｔ２、Ｔ３、Ｔ４的远视力、近视力、裸眼视力、最佳矫正视力均提高（均为Ｐ＜０．０５）。ＦＳＬ组术后并发症发生率为８．３３％,低于传统组的２５．００％（Ｐ＜０．０５）。结论　计算机引导下ＦＳＬ辅助手术治疗白内障疗效佳,患者术后近期和远期视力恢复好且并发症发生少,具有良好的可行性和安全性,值得临床推广使用。     

Statistical evaluation of visual acuity

The statistical evaluation of the visual acuity has to be based on the non-parametric test as the decimal scale of the visual acuity forms a serial scale and not the intervallic one. From the theoretic point of view, the most advantageous approach uses the paremetric statistical tests. Visual acuity is measured on optotypic tables with log gradiation of the optotype size. At present time optotypes of this kind are not available in Czechoslovakia.     

双面复合设计渐进多焦点镜片配戴的视觉功能分析

目的 通过与单面设计渐进多焦点镜片的比较,研究老视患者配戴双面复合设计渐变多焦点镜片的视觉功能.方法 老视患者16例,年龄(57.9±7.66)岁,屈光状态为(-1.06±3.33)D,近附加(+1.97±0.34)D.单盲随机给予全天配戴两种设计的渐进多焦点镜片(单面渐变设计和双面复合渐变设计)各4周,于每幅镜片配戴的第4周末进行戴镜状态下的双眼4m和40cm高低对比度视力(100%、10%),双眼64cm(中距离)和40cm(近距离)清晰阅读范围、64cm(中距离)阅读速度的检测;问卷评分主观舒适度.对相关数据采用两阶段交叉的方差分析.结果 配戴双面复合设计渐进多焦点镜片后中近距离的视功能参数较单面设计有明显不同:(1)清晰阅读范围:64cm双面复合设计组(26.838±3.538)cm,较单面设计组范围大(F=12.305P=0.003);40cm双面复合设计组(21.009±3.584)cm,较单面设计组范围大(F=42.817P=0.000).(2)问卷评分:视野宽度评分中距离双面复合设计组(2.813±0.834)分较单面设计组高(F=7.298P=0.017);近距离双面复合设计组(2.875±0.885)分较单面设计组高(F=10.205P=0.006);中距离移动舒适度评分水平方向双面复合设计组(2.875±0.719)分较单面设计组高(F=9.000P=0.010);垂直方向双面复合设计组(2.813±0.655)分较单面设计组高(F=7.226 P=0.018);伏案工作舒适度评分双面设计组(2.938±0.772)分较单面设计组高(F=7.609P=0.015).远近高低对比度视力、64cm阅读速度及其他问卷评分结果不同设计组间均差异无统计学意义(P＞0.05).结论 双面复合设计渐进多焦点镜片较单面设计在不影响远近对比度视力和远用视野宽度的情况下,提供更宽的中近距离清晰阅读范围和更好的中近距离用眼舒适度,更加符合老视配戴者的视觉需求.

Abstract：

Objective To investigate visual function with double-multiple progressive addition lens (or PAL) by comparing with monofocal progressive addition lens. Methods Sixteen presbyopia with age of 57.9± 7.66, ametropia-1.06± 3.33D, addition+1.97± 0.34D were included. With mono-blind participants were randomly fitted with monofocal PAL and double- multiple PAL for whole day respectively for 4 weeks. Binocular high (100%)- and low (10%)-contrast visual acuity at 4m and 40cm; Binocular clear width of reading materials at 64cm (intermediate) and 40cm (near) and reading rate at 64cm (intermediate) were checked. Patients'comfort was measured by questionnaire. All of the measurements were taken at the end of the fourth week after every PAL. Cross-over measurement of variance analysis was used in analyzing related data. Results The data of visual function at intermediate and near showed significantly with double- mulriple progressive addition lens (1) The clear width of reading materials: At 64cm double-multiple PAL provided 26.838± 3.538cm,which was more wide than monofocal PAL (F =12.305, P =0.003). At 40cm double- multiple PAL provided 21.009± 3.584cm, which was more wide than monofocal PAL (F=42.817, P =0.000). (2) Qu estionnaire scale:The scale of visual filed at intermediate with double- multiple PAL was 2.813± 0.834, which was higher than monofocal PAL (F=7.298, P=0.017). The scale of visual filed at near with double- multiple PAL was 2.875±0.885 which was higher than monofocal PAL (F =10.205, P =0.006). The scale of visual shift horizontally at intermediate with double- multiple PAL was 2.875± 0.719, which was higher than monofocal PAL (F=9.000, P =0.010). The scale of visual shift vertically at intermediate with double- multiple PAL was 2.813 ± 0.655,which was higher than monofocal PAL (F =7.226, P =0.018). The scale of comfort for reading at desk with double- multiple PAL was 2.938± 0.772, which was higher than monofocal PAL (F =7.609, P =0.015). The contrast visual acuity and reading rate at 64cm and the other subjective score did not show a significant difference between the two PALs (P ＞0.05). Conclusions Double- multiple PAL provided more wide clear width of reading materials and better comfortability for intermediate and near visual task than monofocal PAL, but it dose not destroy the contrast acuity and visual field at distance. Double- multiple PAL do match the visual needs of patients with presbyopia.     

Every discrete, finite image is uniquely determined by its dipole histogram

A finite image I is a function assigning colors to a finite, rectangular array of discrete pixels. Thus, the information directly encoded by I is purely locational. Such locational information is of little visual use in itself: perception of visual structure requires extraction of relational image information. A very elementary form of relational information about I is provided by its dipole histogram DI. A dipole is a triple, ((dx, dy), alpha, beta), with dx and dy horizontal and vertical, integer-valued displacements, and alpha and beta colors. For any such dipole, DI((dx, dy), alpha, beta) gives the number of pixel pairs ((x1, y1), (x2, y2)) of I such that I[x1, y1] = alpha, I[x2, y2] = beta, and, (x2, y2) - (x1, y1) = (dx, dy). Note that DI explicitly encodes no locational information. Although DI is uniquely determined by (and easily constructed from) I, it is not obvious that I is uniquely determined by DI. Here we prove that any finite image I is uniquely determined by its dipole histogram, DI. Two proofs are given; both are constructive, i.e. provide algorithms for reconstructing I from DI. In addition, a proof is given that any finite, two-dimensional image I can be constructed using only the shorter dipoles of I: those dipoles ((dx, dy), alpha, beta) that have magnitude of dx < or = ceil((# columns in I)/2) and magnitude of dy < or = ceil((# rows in I)/2), where ceil(x) denotes the greatest integer < or = x.     

视力资料统计学处理的几个基本问题

目前采用的各种视力表均存在着不同的缺陷,由此造成眼科医师评估视力资料的困难。多数问题表现在对眼科临床科研中统计学分析方法的应用方面。不同的视力表中视力与视角间的数量关系不同,随之视力和视角的资料类型也不同,进而采用的统计学方法也不同。只有弄清上述问题,才能正确理解视力资料并进行合理的处理。（中华跟科杂志,2007,43：484-488）     

环戊硫酮治疗干眼的临床疗效评价

目的 探讨口服环戊硫酮对干眼的治疗效果.方法 采用前瞻性随机双盲对照研究方法,将2006年12月至2008年8月在厦门大学附属厦门眼科中心眼表疾病专科门诊确诊为干眼的80例患者(80只眼)随机分为两组:口服环戊硫酮组40例、口服维生素C安慰剂对照组40例,各组依评定标准再分为轻度干眼和中重度干眼两个亚组.两组均加用0.05%羧甲基纤维素钠眼液滴眼治疗;分别在治疗前和治疗后3、7、28 d各时间点检测并评定患者干眼主观症状、视力、角膜荧光素染色(F1)、泪膜破裂时间(BUT)及基础泪液分泌试验(SⅠT),治疗前后及两组的各亚组之间均进行重复测量多因素方差分析和样本均数或中位数差值分析.结果 除流泪和眼红外,治疗7 d后,两组的轻度干眼亚组其他干眼症状、F1染色、BUT及SⅠT值均较治疗前有所改善.治疗7 d后,除流泪和眼红外,仅环戊硫酮组中重度干眼亚组的样本均数差值[0.96(视疲劳)、1.26(干涩感)、0.82(异物感)、1.28(烧灼感)、1.05(畏光)、1.48(疼痛)],以及样本中位数差值[0.30(视力)、4.00(F1染色)、5.00(BUT)、5.00(SⅠT)],均较治疗前明显改善[F=15.30(视疲劳),15.68(干涩感),13.56(异物感),20.91(烧灼感),18.90(畏光),27.22(疼痛),10.54(视力),188.21(F1染色),261.76(BUT),269.05(SⅠT);均P<0.05].在全部28 d观察期间内,安慰剂组中重度干眼亚组的样本均数差值[0.10(视疲劳)、0.16(干涩感)、0.09(异物感)、0.38(烧灼感)、0.24(畏光)、0.36(疼痛)、0.23(眼红)],以及样本中位数差值[0.10(视力)、0.50(F1染色)、0.50(BUT)、0.50(SⅠT)],均较治疗前无明显改善[F=1.76(视疲劳),1.61(于涩感),1.02(异物感),2.39(烧灼感),2.42(畏光),2.73(疼痛),2.55(眼红),1.46(视力),2.35(F1染色),2.90(BUT),2.76(SⅠT);均P>0.05].环戊硫酮组SⅠT值较安慰剂组改善更为明显(F=13.77,P<0.05),SⅠT值达正常范围.结论 环戊硫酮可显著改善泪腺功能尚存的中重度十眼的症状和体征,具有临床应用价值.     

The accuracy of the amblyopia treatment study visual acuity testing protocol

PURPOSE: To study the accuracy of the newly proposed Amblyopia Treatment Study (ATS) visual acuity testing protocol for 3- to 6-year-old children. Because no "gold standard" is available for acuity testing in pediatric patients, accuracy was evaluated using computer simulations based on a psychometric model. METHODS: Monte Carlo simulations of ATS acuity data were generated using a psychometric model that accounts for true acuity, noise in the visual system, and the rate of inadvertent misses. We varied true acuity from 20/15 to 20/400 (-0.1 to 1.3 logMAR). Visual system noise was represented by the slope beta of the psychometric function and ranged from 1 (noisy) to 8 (not noisy). The rate of inadvertent misses ranged from 0% to 10%. Accuracy of the ATS protocol was evaluated in terms of precision, bias, and stimulus range limitations. The same model was fitted to experimental ATS acuity data, thus allowing us to study the distributions of acuity, visual system noise, and level of attentiveness in 126 children ages 3 to <7 years. RESULTS: For conditions with little noise in the visual system (beta > 2), precision was well within 0.1 logMAR (corresponding to one line on a logMAR letter chart), except for acuities worse than 1.2 logMAR, and decreased to 0.15 to 0.2 logMAR for beta = 1. Bias was negligible, except in noisy conditions, where the ATS protocol tended to overestimate acuity by one line at the poor end of the true acuity range and underestimate acuity at the good end of the true acuity range. Effects of the rate of inadvertent misses were small. Fits to the real data showed a wide range of slope parameters, but only 11% had beta < or = 2. The rate of inadvertent misses was < or = 2% in 89% of cases. CONCLUSION: The simulations suggest that the ATS protocol offers an accurate method for assessing visual acuity in children in the range of 3 to 6 years of age with both precision and bias within 0.1 logMAR for typical values of the psychometric parameters.     

The reliability of grading the fixation preference test for the assessment of interocular visual acuity differences in patients with strabismus.

PURPOSE: The purpose of this study is to test the reliability of the grading system of standard fixation preference testing compared with the logarithmic scale of the minimum angle of resolution (logMAR) interocular visual acuity difference of patients with manifest strabismus and to test the strength of association between the interocular visual acuity difference and the grade of alternation. METHODS: A total of 111 strabismic patients with large angle heterotropias (> 10 PD) were included in this study. The visual acuities of these patients were determined using the Snellen's, tumbling E, or Lea visual acuity charts as appropriate for the child's age and ability to cooperate. The results were converted to their logarithmic equivalents of minimum angle of resolution or recognition. Fixation preference was graded from 0 to 4 and was evaluated by observing the time-period through which fixation was maintained with the nonpreferred eye. RESULTS: The median value of interocular visual acuity difference for grade 4 was determined as 0.0, grade 3 as 0.097, grade 2 as 0.17, grade 1 as 0.3, and grade 0 as 0.8. The grade of fixation preference was found to be inversely related to the logMAR interocular visual acuity difference (P <.0001). There was a significant difference between every fixation grade except grade 1 and grade 2 (P <.005). CONCLUSIONS: The grades used in fixation preference testing correlate with the logMAR visual acuity differences in strabismic amblyopic patients. However, the grading system does not imply a linear function in terms of visual acuity difference. The difference between the logMAR values of patients with grade 0 and 1 are more profound compared with other grades.     

Molecular genetics of Oguchi disease, fundus albipunctatus, and other forms of stationary night blindness: LVII Edward Jackson Memorial Lecture

PURPOSE: To compare the clinical findings of the various forms of stationary night blindness caused by mutations in identified genes encoding proteins of photoreceptors or the retinal pigment epithelium. METHODS: Review of the visual acuities, visual fields, fundi, dark-adaptation curves, and electroretinograms from patients with stationary night blindness caused by mutations in the genes RHO, GNAT1, PDE6B, RHOK, SAG, RDH5, and CACNA1F, respectively encoding rhodopsin, the alpha subunit of rod transducin, the beta subunit of rod cGMP-phosphodiesterase, rhodopsin kinase, arrestin, 11-cis retinol dehydrogenase, and a retinal L-type calcium channel. RESULTS: In the evaluated forms of stationary night blindness, the time course of dark adaptation and the characteristics of the electroretinogram indicate that rod photoreceptors are present and that they function, although abnormally. In night blindness resulting from defects in rhodopsin, the alpha subunit of rod transducin, or the beta subunit of rod cGMP phosphodiesterase, rod photoreceptors respond only to light intensities far brighter than normal, and the sensitivity of rods to light is similar to that of normal individuals who are not dark adapted. In fundus albipunctatus and in Oguchi disease, the rod photoreceptors can achieve normal sensitivity to dim light but only after 2 or more hours of dark adaptation, compared with approximately 0.5 hours for normal individuals. In each of these forms of stationary night blindness, the poor rod sensitivity and the time course of dark adaptation correlate with the known or presumed physiologic abnormalities caused by the identified gene defects. Patients with some forms of stationary night blindness, such as fundus albipunctatus and Oguchi disease, may develop degeneration of the retina leading to severe loss of vision in later life. CONCLUSIONS: The identification of the mutant genes causing forms of stationary night blindness refines the classification of these diseases and enhances our understanding of the underlying physiologic defects. Ophthalmologists must be aware that although these diseases are traditionally categorized as "stationary," some of them lead to reduced visual acuity or constricted visual fields, especially in older patients. Efforts to develop therapies for these diseases should concentrate on these more severe forms.     

Clinical manifestations of a unique X-linked retinal disorder in a large New Zealand family with a novel mutation in CACNA1F, the gene responsible for CSNB2

PURPOSE: To describe the phenotype in a New Zealand family with an unusual severe X-linked retinal disorder with a novel I745T mutation in CACNA1F, the gene responsible for incomplete congenital stationary night blindness (CSNB2). METHODS: Members of the family tree were invited for clinical, psychophysical and electrodiagnostic evaluation. RESULTS: Male family members had severe non-progressive visual impairment, abnormal colour vision, congenital nystagmus, hyperopia and normal fundi. Some were intellectually disabled. Female family members had congenital nystagmus and decreased visual acuity frequently associated with high myopia. Electroretinograms (ERG) identified reduced rod and cone responses with negative waveform in male and female family members, with atypical features for CSNB2. CONCLUSIONS: Although there were similarities to CSNB2, distinctive features in male family members included severity of phenotype, and association of intellectual disability. Moreover, all female heterozygotes had clinical and ERG abnormalities. CACNA1F encodes the Ca(v)1.4 alpha1 subunit of a voltage-gated calcium channel, which may mediate neurotransmitter release from photoreceptors. Molecular analyses, reported separately, identified a novel I745T CACNA1F mutation that was associated in vitro with major alterations in gating and kinetics of the Ca(v)1.4 channel. It is speculated that the unique phenotype described in this family may reflect similarly altered function of Ca(v)1.4 channel activity in vivo.     

Report on the conservative treatment of melanoma of the uvea at the Lausanne University Ophthalmologic Clinic

A great number of techniques are currently available for the conservative treatment of uveal melanomas: ocular applicators emitting gamma rays 60Co, 125I) or high-energy beta rays (106Ru/106Rh), light photocoagulation, surgical excision, and accelerated proton beam irradiation. Life expectancy following conservative treatment is equal to or better than that following enucleation. This is demonstrated by nonrandomized comparative studies, and by the authors' own long-term results following the conservative treatment of melanomas by 60Co applicators: mortality due to metastases of small melanomas was 3% (V = smaller than 10 x 10 x 3 mm), with medium-size melanomas it was 12% (V = 10 x 10 x 3-15 x 15 x 5 mm), and with large melanomas 21% (V = larger than 15 x 15 x 5 mm). Accelerated proton beam irradiation of uveal melanomas is currently the method of choice for the conservative treatment of uveal melanomas. The sharp boundaries of the irradiated zone, the uniformly distributed irradiation dose, and beam-splitting are the main advantages of this technique. During the last three years, 310 cases of uveal melanoma have been treated in Switzerland with an accelerated proton beam. Of these, 214 were followed up for more than one year. Eight patients (3.9%) died of metastases. Visual acuity was identical or superior to initial visual acuity in 60.3% of the cases, while 39.6% exhibited a deterioration of vision or a functional loss. Favorable results achieved by conservative treatment of uveal melanomas considerably limited the indications for enucleation, which is now only performed in exceptional situations.     

Improving on ETDRS acuities: design and results for a computerised thresholding device

AIMS: All visual acuity data are subject to test-retest variability (TRV). This measurement error obscures true clinical change and reduces the statistical power of clinical trials using acuity as a primary outcome measure. This study was designed to assess whether a computerised system can reduce TRV by taking repeated acuity measurements and averaging them. A computerised system (PC-test) was developed for this purpose and compared in terms of TRV with the current Gold Standard ETDRS logMAR chart. METHODS: A total of 19 subjects with a mean acuity of +0.16 logMAR (range +0.49 to -0.10 logMAR) were recruited. The performance of two computerised tests (one averaging 10 repeats and one five) was compared with that of the ETDRS logMAR chart in terms of TRV and agreement of acuity data.Results The 10 and five repeat computerised tests (PC-tests) produced a TRV of +/-0.11 and +/-0.10 logMAR, respectively, compared with +/-0.18 logMAR for the ETDRS chart. No significant bias was observed between PC-test and ETDRS acuities. CONCLUSIONS: A computerised system that takes repeated acuity measurements and averages them is subject to less TRV than a single ETDRS acuity measurement. A reduced TRV of visual acuity data allows earlier detection of true clinical change in individual patients. It also allows smaller differences between groups to be detected in clinical trials for a given degree of statistical confidence and power.     

A novel CACNA1F gene mutation causes Aland Island eye disease

PURPOSE: Aland Island eye disease (AIED), also known as Forsius-Eriksson syndrome, is an X-linked recessive retinal disease characterized by a combination of fundus hypopigmentation, decreased visual acuity, nystagmus, astigmatism, protan color vision defect, progressive myopia, and defective dark adaptation. Electroretinography reveals abnormalities in both photopic and scotopic functions. The gene locus for AIED has been mapped to the pericentromeric region of the X-chromosome, but the causative gene is unknown. The purpose of this study was to identify the mutated gene underlying the disease phenotype in the original AIED-affected family. METHODS: All exons of the CACNA1F gene were studied by DNA sequencing. CACNA1F mRNA from cultured lymphoblasts was analyzed by RT-PCR and cDNA sequencing. RESULTS: A novel deletion covering exon 30 and portions of flanking introns of the CACNA1F gene was identified in patients with AIED. Results from expression studies were consistent with the DNA studies and showed that mRNA lacked exon 30. The identified in-frame deletion mutation is predicted to cause a deletion of a transmembrane segment and an extracellular loop within repeat domain IV, and consequently an altered membrane topology of the encoded alpha1-subunit of the Ca(v)1.4 calcium channel. CONCLUSIONS: Mutations in CACNA1F are known to cause the incomplete form of X-linked congenital stationary night blindness (CSNB2). Since the clinical picture of AIED is quite similar to CSNB2, it has long been discussed whether these disorders are allelic or form a single entity. The present study clearly indicates that AIED is also caused by a novel CACNA1F gene mutation.     

近视眼LASIK术后屈光回退的相关因素分析

目的 探讨影响准分子激光原位角膜磨镶术(LASIK)治疗近视术后疗效的相关因素.方法 采用LASIK对72例(141只眼)近视眼患者进行治疗.分别记录术前、术后第1周、第1个月、第3个月、第6个月和第12个月视力、屈光度、眼压、角膜厚度、角膜地形图检查所得的角膜后表面数据.根据术后第12个月裸眼视力和等效球镜屈光度分2组,Ⅰ组屈光回退组视力＜5.0且术后近视等效球镜屈光度＞1.00I),计35只眼;Ⅱ组视力正常组视力≥5.0,计106只眼.分析术后裸眼视力与i者多因素关系.结果 术后第12个月裸眼视力4.4～5.1,平均4.97±0.13,以术后第12个月裸眼视力为因变量(Y)与术前近视屈光度(X1)、角膜切削比(X2),术后第12个月角膜后表面最高点Diff值(X3),术后第12个月和术后第1周角膜厚度差(X4),术后第12个月和术后第1周角膜后表面屈光度差(X5)等进行逐步回归分析建立多元同归方程Y=5.09-0.034X1+1.785X2-2.216X3-0.002X4+0.081X5(F=21.474,19＜0.01).术后随访角膜厚度有不同程度增加,角膜后表面屈光度降低,角膜后表面Diff值增高,屈光回退组各指标不同阶段比较差异有统计学意义(分别F=8.56、4.68、2.49;均P＜0.05),变化尤以术后3个月内明显;正常眼组各指标不同阶段比较除角膜最薄处厚度有差异外,余均无统计学意义(角膜最薄厚度F=7.27,P＜0.01;其余均P＞0.05).结论 LASIK治疗近视是一种安全、有效的方法,但欲取得较好疗效,应考虑不同因素如术前近视屈光度、角膜切削比、术后角膜增殖、术后角膜后表面改变等因素的影响.     

七叶洋地黄双苷滴眼液对不同年龄段人工晶状体眼伪调节力的影响

目的研究七叶洋地黄双苷滴眼液对不同年龄段人工晶状体眼伪调节力的影响。方法选取2010年9月至2011年8月在我院行白内障超声乳化吸出联合单焦点人工晶状体植入术患者56例(60眼),随机分为2组(试验组30例、对照组26例),每组各30眼。试验组术后应用七叶洋地黄双苷滴眼液和双氯芬酸钠滴眼液滴眼,每天3～4次;对照组术后仅使用双氯芬酸钠滴眼液滴眼,每天3～4次。分别在术前、术后1周、4周检查患者的裸眼远视力、近视力、最佳矫正远视力下的近视力、矫正状态下的近视力,应用负镜片法测量人工晶状体眼的调节幅度,并对各项指标对比分析。结果试验组各年龄段人工晶状体眼术后4周的最佳矫正远视力为0.83±0.19,对照组最佳矫正远视力为0.81±0.16,2组比较差异无统计学意义(P>0.05);试验组最佳矫正远视力下的近视力为0.31±0.05,对照组的最佳矫正远视力下的近视力为0.20±0.05,2组比较差异有统计学意义(P<0.05)。术后4周,试验组各年龄段的人工晶状体眼的伪调节力均高于对照组,差异均有统计学意义(均为P<0.05),试验组各年龄段人工晶状体眼的伪调节力的影响与年龄增长呈负相关(r=-0.312)。结论七叶洋地黄双苷滴眼液可以增加人工晶状体眼的有效伪调节力,七叶洋地黄双苷滴眼液对人工晶状体眼的伪调节力的影响与年龄呈负相关关系。     

Converting visual acuity to utilities

BACKGROUND: Utility theory can be used to quantify dysfunction associated with various diseases and thus can represent a "hard" measure of quality of life. By determining utility values, one can compare the quality of life of patients with ocular disease to that of patients with non-ophthalmic problems. We performed a study to determine whether utility values from patients with ocular disease are associated with clinical variables, including visual acuity in the better-seeing eye, and to develop a mathematical method for converting visual acuity to utility value, if there is an association between the two. METHODS: Cross-sectional study. A total of 239 patients from a tertiary care retinal practice with various ocular conditions, including macular degeneration, cataract, glaucoma and diabetic retinopathy, were interviewed under standardized conditions to determine their utility values by the time trade-off technique. Visual acuity, duration of visual loss and number of concomitant conditions were also determined. Multiple linear regression was performed to determine which variables were associated with utility values. RESULTS: The mean acuity in the better-seeing eye was 0.479 (near 20/40 vision). The mean utility value was 0.72. Accordingly, the average patient in our series was willing to trade 2.8 of every 10 remaining years of life to obtain perfect vision in both eyes. Utility value was significantly associated with visual acuity in the better-seeing eye (F = 69.1, p < 0.001). Other variables were not significantly associated with utility value. The association with duration of visual loss approached statistical significance (p = 0.075). Utility values (U) for patients with ocular disease can be derived from the following formula: U = (0.374)(visual acuity in better-seeing eye) + 0.514. INTERPRETATION: Utility values from patients with ocular disease were strongly associated with visual acuity and could be estimated mathematically.     

球后视神经炎的游标高敏视力特征

目的:探讨球后视神经炎游标高敏视力的临床特征及其在临床诊断、治疗中的应用价值。方法:采用自行研究设计的游标高敏视力检查系统软件,对15例25只眼(急性球后视神经炎6例8只眼;慢性球后视神经炎9例17只眼)球后视神经炎患者治疗期间进行动态游标高敏视力检查,受检者按要求判断计算机显示屏上活动光标与固定光标的相对位置关系,并通过移动轨迹球调整光标,计算机自动分析活动光标和固定光标位置之偏差,得出平均阈值及其变异度。结果:球后视神经炎急性期的游标高敏视力阈值及其变异度与正常值相比差异有非常显著性(P<0.01);恢复期差异有显著性(P<0.05)。球后视神经炎急性期视力与游标高敏视力阈值的相关系数为-0.88(P<0.01);与阈值变异度的相关系数为-0.46(P<0.05)。球后视神经炎恢复期,游标高敏视力的阈值及其阈值变异度与急性期相比差异有非常显著性(P<0.01)。恢复期游标阈值与恢复期视力的相关系数为-0.93(P<0.01);阈值变异度与恢复期视力的相关系数为-0.84(P<0.01)。急性期游标阈值与恢复期游标阈值经相关性分析,其相关性无统计学意义(P=0.261);急性期视力与恢复期视力的相关性亦无统计学意义(P=0.11);急性期阈值变异度与恢复期阈值变异度的相关系数为0.67(P<0.01)。急性期游标阈值与恢复期游标阈值、     

多焦点人工晶状体植入术后早期全程视力和拟调节力的临床观察

目的 对比AcrySof多焦点人工晶状体和单焦点人工晶状体植入术后的早期临床疗效及拟调节力.方法 选取行白内障超声乳化摘出并人工晶状体植入术的年龄相关性白内障患者138例158眼,根据植入的人工晶状体不同,分为观察组和对照组.观察组60例73眼,植入AcrySof ReSTOR SN6AD1多焦点人工晶状体;对照组78例85眼,植入AcrySof Natural单焦点人工晶状体,比较术后1周、1个月和3个月两组患者的裸眼及最佳矫正远、中、近视力,并对比术后3个月时两组患者的拟调节力和生活质量调查评分.结果 术后1周、1个月和3个月两组患者均能获得满意的远视力,观察组裸眼中视力分别为0.49±0.19、0.72±0.21、0.77±0.23,对照组分别为0.24±0.21、0.27±0.22、0.28±0.24,两组比较差异均有统计学意义(均为P＜0.05);裸眼近视力观察组分别为0.47 ±0.20、0.70±0.22、0.80±0.24,对照组分别为0.21 ±0.23、0.23 ±0.19、0.26±0.18,两组比较差异均有统计学意义(均为P＜0.05);两组患者的裸眼远视力及最佳矫正远、中、近视力比较差异均无统计学意义(均为P＞0.05).术后3个月,观察组的视远拟调节力和视近拟调节力分别为(2.56±0.82)D、(3.19±1.13)D,对照组分别为(0.87±0.57)D、(1.03 ±0.59)D,两组比较差异均有统计学意义(均为P＜0.05).观察组患者VF-14量表评分和视近时戴镜评分分别为(92.21±4.22)分、(4.23±0.85)分,对照组分别为(71.23±3.96)分、(2.01±0.71)分,两组比较差异均有统计学意义(均为P＜0.05).结论 多焦点人工晶状体能够帮助患者获得全程视力,解决单焦点人工晶状体视中、视近的不足,改善拟调节力,提高患者的生活视觉质量.     

Peripapillary atrophy in elderly Chinese in rural and urban Beijing

PURPOSE: To determine peripapillary atrophy in elderly Chinese in an urban and rural regions of Beijing. METHODS: The Beijing Eye Study a population-based, cross-sectional cohort study, included 4,439 subjects out of 5,324 subjects who were asked to participate (response rate 83.4%). Mean age was 56.2+/-10.6 years (range, 40-101 years). Colour optic disc photographs (30 degrees ) were morphometrically examined. Peripapillary atrophy was divided into alpha zone and beta zone. RESULTS: Optic disc photographs were available for 4,027 (90.7%) subjects. Alpha zone and beta zone, respectively, were present in 2,867 (71.2%) subjects and 802 (19.9%) subjects, respectively, measuring 0.52+/-0.64 mm(2) and measuring 0.46+/-1.82 mm(2). Both zones were significantly widest and found significantly (P<0.001) most often in the temporal peripapillary region, followed by the temporal inferior region, the temporal superior region, and finally the nasal region. Size of both zones was significantly correlated with optic disc size (P<0.001), age (P<0.001), and myopic refractive error (P<0.001). Both zones increased significantly with decreasing uncorrected visual acuity (P<0.001) and decreasing best-corrected visual acuity (P<0.001). They did not vary significantly (P=0.10; and P=0.78) between male and female subjects. In multivariate analysis, the relationships between both zones and age, myopic refractive error, disc size, and uncorrected and best-corrected visual acuity remained statistically significant (P<0.001). CONCLUSIONS: Alpha zone and beta zone of peripapillary atrophy, respectively, occur in about 70 and 20%, respectively, of elderly Chinese. As peripapillary atrophy changes in glaucomatous optic neuropathy, these normative data may be helpful for glaucoma detection.