Evaluation of visual function and prognosis for patients with proliferative diabetic retinopathy with the low vision evaluator

Proliferative diabetic retinopathy (PDR) is a leading cause of visual loss in adults in industrialized countries. PDR patients with light perception (LP) or hand movement (HM) acuity due to severe vitreous hemorrhage require vitreous surgery. The purpose of this study was to determine whether the visual acuity of PDR patients with LP or HM can be graded into finer steps with the Low Vision Evaluator (LoVE). In addition, we determined whether the LoVE results are correlated with the amplitude of the electroretinogram (ERG), the presence of retinal detachment (RD), or postoperative visual prognosis. The LoVE instrument is a subjective device that measures the thresholds for light stimulus and is equipped with a pair of goggles with white light-emitting diodes as the stimulus. We measured the LoVE thresholds of 19 PDR patients, whose fundi could not be observed due to vitreous hemorrhage and whose visual acuity was LP or HM. The 13 patients with HM vision had LoVE thresholds that ranged from 25.0 and 40.0 dB, and the 6 patients with LP vision had LoVE thresholds that ranged from 20.0 and 40.0 dB. The LoVE thresholds of 9 patients with RD were significantly lower than those of 10 patients without RD (p < 0.001). The LoVE thresholds were correlated with the amplitude of the a- and b-waves of the ERG and the postoperative best-corrected visual acuity (BCVA) (a-wave: r = 0.70, p < 0.001; b-wave: r = 0.71, p < 0.001; postoperative BCVA: r = 0.46, p < 0.05). These results indicate that the LoVE is capable of grading the visual function of PDR patients with conventional LP and HM vision into finer steps. Thus, the LoVE is an invaluable device in predicting the postoperative visual acuity of patients with vitreous hemorrhage.     

关于严重眼外伤致无光感病例手术方式的探讨

目的：探讨关于严重眼外伤致无光感病例的手术原则和手术方式。方法：选择北京大学眼科中心自2010年7月-2011年1月收治的重症眼球破裂伤无光感病例36例,对其手术方式及治疗时机等进行回顾性分析,手术均为行经睫状体平坦部行闭合式玻璃体切除术及处理相应病变,并行硅油填充。结果：术后视力18例仍为无光感,18例为光感至0．25。术后36例患者中24例视网膜在位,眼压多数在8～33miD．Hg（1mmHg=0．133kPa）,经对症处理后眼压维持稳定。结论：部分眼外伤后无光感眼经及时的玻璃体视网膜手术治疗可获得一定的视力。玻璃体切除术可改善重症眼球破裂伤的预后,挽救部分患者的视功能。     

药物与视神经管减压治疗急性球后视神经炎疗效观察

目的探讨药物与视神经管减压手术治疗急性球后视神经炎疗效。方法回顾1988～2005年收治双眼急性球后视神经炎54例108眼,经药物治疗与视神经管减压手术治疗（以下简称减压治疗）并观察其疗效。结果54例108眼经药物治疗16～20d有46例（85．19％）95眼（87．96％）视力恢复到0．5—1．2,但仍有8例（14．81％）13眼（12．04％）视力无光感～2m数指。选择视力最差的无光感～30cm数指的8例8眼施行减压治疗,术后药物继续治疗16～20d,术后8眼视力恢复到0．3～0．7。经3年观察,术侧眼视力0．5～1．0,眼底视乳头色正常;而未手术侧的5眼视力光感-20cm数指,眼底视乳头苍白,血管细小,呈鲜明对比,疗效迥然不同。结论①球后视神经炎经药物治疗,大多数病例视力恢复较好。②经药物治疗2—3周少数病例视力仍无光感一眼前指数,视乳头淡白,经CT或MRI检查排除颅内病变,而球后视神经明显增粗的重症病例,应行减压治疗,可恢复较好视力。     

神经内镜下经筛蝶行视神经减压治疗创伤性视神经损伤的疗效及其预后的影响因素分析

目的 观察神经内镜下经筛蝶行视神经减压治疗创伤性视神经损伤（TON）的疗效,以及分析预后的影响因素。方法 回顾性分析该院2017年1月－2020年1月收治的21例24眼TON患者的临床资料,所有患眼均经筛蝶行视神经减压术。比较分析术后视力改善状况,以评估手术疗效,并对预后的影响因素进行分析。结果 术后未发生严重不良事件,有效率为54.17%。经单因素分析发现,术前视力是否存在光感和实施手术的及时性是影响预后的因素（P = 0.002,P = 0.013）。而年龄、视神经管骨折、意识状况、创伤类型、手术路径和是否存在脑脊液漏均与预后无明显相关性。结论 神经内镜下经筛蝶行视神经管减压术是治疗TON的有效手段,实施手术的及时性和术前是否存在光感是预后的影响因素。     

Penetrating eye injuries in road traffic accidents.

A review of all penetrating eye injuries treated by the Manchester Eye Hospital over four years (1 February 1982-31 January 1986) was undertaken. One hundred and ninety-six penetrating eye injuries were seen, of which 16 (8.2%) were due to road traffic accidents. Eight patients (nine eyes) were seen in the 12 months prior to the introduction of the seat-belt legislation on 1 February 1983. None of these patients was wearing a seat-belt whereas two of the eight patients (10 eyes) seen after the seat-belt legislation were. Both these patients suffered severe visual loss due to intraocular glass from shattered windscreens. Three patients had bilateral penetrating eye injuries, one before and two after the seat-belt legislation. Two of the nine eyes involved prior to the legislation and three of the 10 eyes after the legislation had an eventual visual acuity of 6/12 or better. In the majority of patients, failure to wear seat-belts or defective use is to blame. Flying glass from shattered toughened windscreens is a preventable danger. Nine of the 16 patients were first seen in the general accident and emergency department and, of these, seven did not have visual acuities recorded prior to referral to an ophthalmologist. The importance of measurement of the visual acuity and detection of an afferent pupillary defect is stressed based on these findings.     

高度近视巨大裂孔视网膜脱离的临床观察

目的 观察高度近视患巨大裂孔视网膜脱离(retinal detachment with a giant tear,RDWGT)的手术疗效。方法 回顾性分析我院自2000年10月至2002年10月手术治疗高度近视患RDWGT9例(10眼)。2例2眼行环扎、放液、外加压、冷冻术；7例(8眼)行标准三通道式玻璃体切除联合剥膜、全氟萘烷注入、眼内光凝及硅油注入，其中2例2眼联合巩膜环扎。术后均全身应用激素。结果 术后随访6—20个月(平均12．6个月)，7例(8眼)视网膜完全复位(80．0％)，未复位2例(2眼)均为外路手术；术后最终矫正视力光感—指数l眼，视力为0．01—0．052眼，0．06—0．12眼，0．2—0．53眼，0．6—1．02眼；与术前相比，视力提高6眼，视力不变4眼。结论 高度近视RDWGT应首选玻璃体视网膜手术，效果显，术中可以不进行巩膜环扎术。玻璃体视网膜术后使用皮质激素有助于预防术后增殖性玻璃体视网膜病变的发生。     

紫外光核黄毒角膜胶原交联疗法在圆锥角膜中的临床应用

[目的]评估角膜胶原交联疗法治疗圆锥角膜的疗效.[方法]对在本院接受角膜胶原交联疗法治疗的20例圆锥角膜患者（33眼）进行前瞻性研究,观察患者术后1周内术眼反应,以及术后6个月相关指标（视力、角膜、晶体、视网膜情况、眼压、角膜地形图、角膜内皮计数）变化情况,并进行统计学分析.[结果]所有患者术后1周内术眼反应轻微,术后6个月角膜、晶体、视网膜情况、眼压和角膜内皮计数稳定,30眼（18例患者）裸眼视力改善,矫正视力稳定,角膜曲率显著降低.有3眼（2例患者）角膜扩张仍有进展,并进行了再次交联治疗,最终获得改善.[结论]采用角膜胶原交联疗法治疗圆锥角膜具有有效率高,术后反应轻,无副作用的优点,大部分患者治疗后角膜曲率降低,裸眼视力改善.     

小切口白内障取出人工晶状体植入联合小梁切除治疗青光眼伴白内障疗效观察

目的 观察小切口白内障取出人工晶状体植入联合小梁切除治疗青光眼伴白内障的疗效.方法 选取46例(48只眼)青光眼伴白内障患者施行联合手术,术后进行为期3个月的随访,观察患者恢复效果.结果 随访结果:所有患者裸眼视力均提高,视力0.1～0.3之间者1例,视力0.3～0.5之间者2例,视力大于0.5者45例.结论 小切口白内障取出人工晶状体植入联合小梁切除治疗青光眼伴白内障取得良好的手术效果,值得临床推广应用.     

超声乳化白内障吸除联合人工晶体植入术治疗闭角型青光眼的临床观察

研究目的:探讨超声乳化白内障吸除联合折叠式人工晶体植入术治疗闭角型青光眼的效果。方法:闭角型青光眼患者12例16眼,均伴有晶状体混浊,矫正视力<0.3,行超声乳化白内障吸除联合折叠式人工晶体植入术,随访1~6个月,对手术前后视力、眼压、前房深度、前房角进行对比观察。结果:16眼患者术后眼压均控制在正常范围内,视力都有不同程度的提高。结论:超声乳化白内障吸除联合折叠式人工晶体植入术,是治疗伴有晶体混浊的闭角型青光眼的有效方法。     

Selective fovea-related deprived activation in retinotopic and high-order visual cortex of human amblyopes

Amblyopia is a visual disorder starting at early childhood and characterized by reduced visual acuity not of optical origin or due to any eye disease. One expression of such an anomalous early visual experience is abnormal foveal vision. In a previous fMRI study, faces that were presented to amblyopic eyes evoked little response compared to houses in high-order visual areas. Patients also demonstrated reduced recognition of facial expression, raising the possibility that these face-selective abnormalities are related to foveal vision deficit. Whether this deficit originates in low-level processing or is mediated by compromised activation in high-order visual areas is unresolved. In the present functional magnetic resonance imaging (fMRI) study, we explored the impact of amblyopia on the representation of object images presented in foveally biased central versus peripheral retinotopic eccentricities through manipulation of object size. Small and large pictures were correlated to visual acuities of 6/6 and 6/60, respectively. In low-level visual areas, the amblyopic eye showed significantly reduced activation for centrally placed, small pictures than the sound eye, while activation to large pictures was only slightly reduced. Similarly, in high-order visual areas, the amblyopic eye showed marked reduction in activation in the fusiform gyrus, with normal activation in the collateral sulcus. The center/periphery size-related amblyopic outcomes of this study support a "bottom-up" nature of the center-periphery effect observed in high-order visual areas. Taken together, these findings point to the regional extent and functional selectivity of fovea-related cortical reorganization that is related to abnormal visual development of one eye.     

Eye Injury Registry of Alabama (preliminary report): demographics and prognosis of severe eye injury

Each year an estimated 1.3 million Americans suffer eye injuries. There is little information in the literature regarding the prevalence, demographic characteristics, and prognosis of these patients. The Eye Injury Registry of Alabama (EIRA) serves as the first and only statewide system of its kind for the collection of information on serious eye injuries. We have analyzed 736 cases of serious eye injury (injury involving permanent structural or functional change) accumulated by the EIRA between August 1982 and May 1986. Prognosis was found to be related to early diagnosis and initial vision. Individuals with follow-up vision of 20/40 or better were found in all early diagnostic groups, and 13% of patients with no light perception on initial examination had some improvement on follow-up. The worst visual prognosis was among those patients suffering blunt eyeball rupture, of whom 40% had no light perception and 25% regained vision of 20/100 or better.     

囊袋张力环在不全脱位晶状体白内障手术中的应用

目的分析囊袋张力环在伴晶状体不全脱位白内障超声乳化手术中的应用价值。方法对12例（12眼）晶状体不全脱位白内障行囊袋内植入张力环联合超声乳化及后房型人工晶体植入。结果术后随访3月,12例人工晶体均正位,眼压在正常范围,术后视力均较术前提高,0．6以上6眼,0．4—0．5者3眼,0．3以下者3眼。无严重并发症。结论囊袋张力环能够保持白内障手术时晶状体囊袋的稳定性,拓宽了后房型人工晶体植入术的适用范围,防止术后人工晶体偏位,有助于患者视力的恢复。     

The Epidemiology and Diagnosis of Penetrating Eye Injuries

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.     

Abnormal cortical processing of pattern motion in amblyopia: evidence from fMRI

Converging evidence from human psychophysics and animal neurophysiology indicates that amblyopia is associated with abnormal function of area MT, a motion sensitive region of the extrastriate visual cortex. In this context, the recent finding that amblyopic eyes mediate normal perception of dynamic plaid stimuli was surprising, as neural processing and perception of plaids has been closely linked to MT function. One intriguing potential explanation for this discrepancy is that the amblyopic eye recruits alternative visual brain areas to support plaid perception. This is the hypothesis that we tested. We used functional magnetic resonance imaging (fMRI) to measure the response of the amblyopic visual cortex and thalamus to incoherent and coherent motion of plaid stimuli that were perceived normally by the amblyopic eye. We found a different pattern of responses within the visual cortex when plaids were viewed by amblyopic as opposed to non-amblyopic eyes. The non-amblyopic eyes of amblyopes and control eyes differentially activated the hMT+ complex when viewing incoherent vs. coherent plaid motion, consistent with the notion that this region is centrally involved in plaid perception. However, for amblyopic eye viewing, hMT+ activation did not vary reliably with motion type. In a sub-set of our participants with amblyopia we were able to localize MT and MST within the larger hMT+ complex and found a lack of plaid motion selectivity in both sub-regions. The response of the pulvinar and ventral V3 to plaid stimuli also differed under amblyopic vs. non-amblyopic eye viewing conditions, however the response of these areas did vary according to motion type. These results indicate that while the perception of the plaid stimuli was constant for both amblyopic and non-amblyopic viewing, the network of neural areas that supported this perception was different.     

应用硬性透氧性隐形眼镜矫正不规则散光的疗效观察

目的评价硬性透氧性隐形眼镜（RGP）矫正不规则散光的疗效。方法对23例（34眼）做眼科检查,包括视力,裂隙灯检查及验光,角膜地形图检查,确诊为不规则散光,排除隐形眼镜佩戴禁忌证,进行硬性透氧性角膜接触镜验配,对其最佳框架矫正视力及RGP矫正视力进行统计学比较。结果硬性透氧性角膜接触镜矫正不规则散光的最佳矫正视力（0．73±0．31）,显著高于框架镜矫正值（0．48±0．30）（P〈0．01）,随访观察6个月视力稳定,无明显不良并发症。结论RGP是矫正不规则散光有效安全方法,能够提高矫正视力及视觉质量。     

盲及低视力患者的视觉康复

本文报告115例(169眼)盲及低视力患者在戴用3倍远用双眼望远镜式助视器前后视力及对比敏感度的变化。戴助视器后视力有显著提高,对比敏感度函数(CSF)全频升高、峰值增加明显,所看到频率亦增多,因此说明光学助视器不仅可使患者视力提高,并可全面改善视功能。对双眼盲及低视力患者视力相同或相似需决定何眼使用助视器时CSF是一重要依据。因而作者等认为CSF的检查在盲及低视力患者康复中是一个重要的、不可忽视的手段。     

Bilateral eye injury caused by a high-pressure water jet from a fire hose

We present a case of bilateral eye injury caused by a high-pressure water jet from a fire hose. Eye injury secondary to high-pressure water jets are relatively rare, but invariably result in severe damage to all ocular structures. A 51-year-old woman was admitted to our ophthalmologic department for treatment following a direct hit in the face by a water jet from a fire hose from a distance of about one meter. The patient had bilateral extensive eyelid edema and ecchymosis, conjunctival chemosis with hemorrhage, vitreous hemorrhages in the right eye and iridodialysis with hyphema in the left eye, a transient decrease in intraocular pressure, bilateral superior commotio retinae with macular edema, and bilateral impairment of vision. The patient was treated with topical corticosteroids. Four months later she was re-admitted to our department for surgical repair of iridodialysis in the left eye. Iridodialysis had affected the entire superior nasal portion of the iris, and the pupil was displaced downward temporally. The iris partly obscured the visual axis. After surgical repair the visual axis was free. At a follow-up examination two years later, the ocular findings were the same. The best corrected visual acuity was 0.1 in the right eye and 0.3 in the left eye. Visual impairment was a consequence of permanent posttraumatic posterior fundus changes, particularly of the macula in both eyes. Intraocular pressure was within normal limits in both eyes. Injuries caused by high-pressure water jets are usually bilateral. The injuries are mainly confined to the lower anterior portions of the eye (Bell's phenomenon). Our patient had bent forward during the accident, therefore the central and upper chorioretinal portions were also affected. Such injuries usually cause severe damage to the anterior and posterior portions of the eyes and greatly reduce visual acuity in both eyes. Because of the risk of late complications (cataract, glaucoma, retinal detachment), long-term follow-up is recommended in such patients.     

透气性硬性接触镜和框架眼镜矫正中高度散光视觉质量的比较

目的比较中高度散光患者配戴框架眼镜和透气性硬性接触镜(RGPCL)的主客观视觉质量。方法选取2008年6月-2011年5月中高度角膜散光20例共40只眼进行角膜地形图、综合验光仪验光等检查后,选择合适试戴片作配适评估并定制RGPCL。要求患者戴镜后1周、1个月、3个月和6个月复查,记录矫正视力、镜片配适、眼部情况,并在第4次复查时进行对比敏感度视力检查及主观问卷调查。结果 RGPCL矫正视力优于框架眼镜,但两者对比敏感度视力在各空间频率均无明显差异。主观评分时,远视力两者无明显差别;中距离视力框架眼镜评分(3.825±0.245)分,RGPCL评分(3.525±0.302)分,差异有统计学意义(t=5.339,P=0.000);近距离视力框架眼镜评分(3.795±0.233)分,RGPCL评分(3.690±0.194)分,差异有统计学意义(t=3.462,P=0.030)。有45%患者选择RGPCL为主要配戴方式;40%患者选择RGP CL和框架眼镜交替使用的方式;10%患者选择仅在有特殊社交需求时使用RGPCL;另5%患者放弃使用RGPCL。结论 RGPCL和框架眼镜矫正中高度角膜散光均能取得较满意效果,在中近距离精细作业时框架眼镜矫正视力更为稳定清晰。但由于RGPCL在成像质量和外观上的优势,多数患者仍愿意坚持配戴RGPCL。     

Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

Endophthalmitis is the most serious complication of cataract surgery. A cluster of endophthalmitis is a devastating event for surgeons. Pseudomonas aeruginosa is the main causative pathogen of Gram-negative endophthalmitis, which can be suggestive of the occurrence of an outbreak.Ten patients diagnosed with endophthalmitis after cataract surgery performed by one surgeon were analyzed in this study. At presentation, five patients had obvious clinical findings of endophthalmitis with visual acuity of light perception, two patients had poor light perception/no light perception of vision complicated by concomitant keratitis, and three patients had earlier signs of infection (e.g., a lower degree of anterior chamber and vitreous cells, better presenting visual acuity, and greater visibility of the fundus). Investigations revealed that the source of infection was growth of P. aeruginosa on the phaco probe. All of the surgeries had been performed by the same contaminated probe without sterilization between surgeries. This finding emphasizes the importance of strict adherence to sterility protocols during high-risk surgeries such as intraocular surgeries. Additionally, this report aims to emphasize to surgeons that negligence of simple but vital steps of sterility for any reason, such as limitations in time or equipment, can lead to catastrophic events.     

Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

Objectiveto analyse cataract surgery outcomes and related factors in eyes presenting with good visual acuity.Subject and MethodsA retrospective longitudinal study of patients undergoing phacoemulsification between 2014 and 2018 in Moorfields Eye Hospital was conducted. Pre- and post-operative visual acuities were analysed. Inclusion criteria were age ≥40 years and pinhole visual acuity ≥6/9 pre-operatively. Exclusion criteria were no post-operative visual acuity data. The visual acuity change variable was also defined according to post-operative visual acuity being above or below the Snellen 6/9 threshold.Results2,720 eyes were included. The unaided logMAR visual acuity improved from 0.54 to 0.20 (p < 0.001), the logMAR visual acuity with glasses improved from 0.35 to 0.05 (p < 0.001), and the logMAR pinhole visual acuity improved from 0.17 to 0.13 (p < 0.001); 8.1% of patients had Snellen visual acuity <6/9 post-operatively. Mean follow-up period was 23.6 ± 9.9 days. In multivariate analysis, factors associated with visual acuity <6/9 post-operatively were age (OR = 0.96, 95% confidence interval [CI] [0.95, 0.98], p < 0.001), vitreous loss (OR = 0.21, 95% CI [0.08, 0.56], p = 0.002), and iris trauma (OR = 0.28, 95% CI [0.10, 0.82] p = 0.02).ConclusionsVisual acuity improved significantly, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss, and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.