拟诊黄斑微小锥细胞损伤初步研究

目的对一组视力下降而眼底及荧光素眼底血管造影(FFA)正常,只有频域相干光断层扫描(FD-OCT)才能发现的黄斑中心凹微小病变的患者进行归纳总结。设计回顾性病例分析。研究对象北京同仁医院眼科门诊12例(13眼)符合要求者。方法询问上述患者病史,并行视力、眼底彩色照相、FFA、FD-OCT、多焦视网膜电图(mfERG)、视野等检查。主要指标OCT图像上视网膜形态学改变。结果 4例患者有光损伤或手术史,8例病因未明。视力:0.06～0.2者3眼,0.3～0.5者3眼,0.6～1.0者7眼。患眼眼前节正常,5眼(38.5%)黃斑中心有一小黄色斑,其余正常。FFA正常。FD-OCT示患眼黄斑中心凹曲线正常,厚度正常,仅在黄斑中心凹处,视网膜内外感光层(IS/OS层)及外节与色素上皮绒毛连接部有极局限缺失区,范围<300μm,外界膜及视网膜色素上皮层正常。mfERG检查7例,4例正常3,例3眼中,1眼振幅密度中度下降,2眼轻度下降。视野检查4例,中心视野均正常。结论对由多种因素引起的视力下降而眼底及FFA正常,只有FD-OCT显示黄斑中心凹处视网膜有微小改变的一类疾病拟诊为黄斑微小锥细胞损伤。     

OCT在白内障超声乳化术后黄斑微小病变早期诊断中的应用

目的探讨应用光学相干断层成像术（optical coherence tomography,OCT）早期诊断白内障超声乳化术后低视力眼黄斑微小病变的作用。方法对行白内障超声乳化术后3d，最佳矫正视力低于0．3，排除眼前节和光学通路等并发症、眼底镜检查怀疑黄斑病变的患者31例31眼行黄斑OCT检查，对所得结果进行分析。结果黄斑OCT检查：16眼为黄斑水肿，其中并发视网膜前膜形成者7眼；13眼为黄斑板层裂孔；2眼为黄斑区视网膜劈裂。结论在影响白内障超声乳化术后视功能恢复的各种因素中，以视网膜特别是黄斑区视网膜微小病变为主，OCT作为一种新型的高分辨率的视网膜断层成像技术，对于白内障术后造成低视力的黄斑微小病变的早期诊断、病情追踪和治疗效果观察均具有指导作用。[眼科新进展2005；25（5）：434—435]     

特发性黄斑前膜的频域光相干断层扫描特征以及与视力的相互关系

目的 观察特发性黄斑前膜的光相干断层扫描（OCT）特征以及与患者视力的相互关系。方法 回顾分析2008年5月至12月间确诊的特发性黄斑前膜患者112例116只眼的临床资料。所有患者均进行最佳矫正视力、眼底和OCT检查。视力采用LogMAR视力表检查;眼底检查采用直接检眼镜和前置镜检查;OCT检查采用Zeiss HD-OCT,扫描速度27 000 A扫描/s, 扫描区域6.0 mm×6.0 mm,扫描模式为512×128。根据OCT检查所见的黄斑前膜对视网膜不同牵引情况对黄斑前膜进行分类,测量黄斑中心厚度（CFT）、体积、平均厚度以及黄斑中心凹厚度（FT）。采用SPSS16.0软件对患者的各项OCT检查指标和临床检查结果进行统计分析。结果 116只黄斑前膜眼可分为无视网膜牵引、切线方向或切线方向合并前后方向牵引3种情况,各自分别占本组患眼的9.48%、84.48%、6.04%。97只眼合并视网膜水肿,占总眼数的83.62%;水肿分别位于外核层(ONL),外网状层(OPL),内核层(INL)。14只眼合并视网膜神经纤维层(RNFL)劈裂,占总眼数的1207%;27只眼有视细胞内外节（IS/OS）损伤,占总眼数的23.28%。CFT与视力密切相关（P<0.05）,而体积、平均厚度和FT与视力无相关性（P＞0.05）。患者年龄、性别、不同种类的视网膜牵引、是否合并板层孔、IS/OS损伤和RNFL劈裂等与视力无相关性。结论 特发性黄斑前膜的OCT特征可表现为有无视网膜牵引以及视网膜水肿和视网膜神经纤维层劈裂。在CFT、体积、平均厚度以及FT等黄斑区OCT测量指标中,CFT与患者的视力关系最为密切。     

近红外眼底自发荧光联合OCT评估孔源性视网膜脱离巩膜扣带术后早期黄斑结构的改变

目的近红外眼底自发荧光检查（NIA）联合OCT对孔源性视网膜脱离巩膜扣带术后早期黄斑结构的评估价值。方法前瞻性系列病例研究。对21例（21眼）伴黄斑脱离的孔源性视网膜脱离患者行巩膜扣带术,于术后3个月行NIA及OCT检查。观察检查图像的异常和手术后视力的恢复情况。对视力的变化进行配对t检验,NIA与术后BCVA的相关性采用双向无序分类变量资料的关联性进行分析。结果NIA：16眼表现为弱荧光周围围绕着强荧光,5眼表现为不均匀的强荧光。OCT：20眼存在黄斑下液;中心凹视网膜神经纤维层的厚度6眼变薄,14眼正常,1眼增厚;21眼IS/OS反射异常。视力恢复情况：术后3个月与术后1 d比较,NIA表现为弱荧光周围围绕着强荧光者,视力差异有统计学意义（t=9.922,P<0.05）,NIA表现为不均匀强荧光者,视力差异无统计学意义（t=2.409,P>0.05）,黄斑NIA表现与术后BCVA变化高度相关（C=0.502,P<0.05）。结论孔源性视网膜脱离巩膜扣带术后早期,黄斑结构与功能均尚未完全恢复,需要我们加以重视。     

双眼隐匿性黄斑营养不良1例

27岁男性,因双眼视力下降2年余就诊,否认家族史.体格检查示双眼眼前节未见明显异常,全视野视网膜电图(ffERG)和图形视觉诱发电位(P-VEP)均正常.静态视野示双眼中心暗点,眼底光学相干层析成像(OCT)示双眼黄斑区椭圆体带及嵌合体带不连续,眼底自发荧光示双眼中心凹斑驳样改变伴淡强荧光环,多焦视网膜电图(mfERG...     

成年人型卵黄样黄斑营养不良的临床特征

目的研究成年人型卵黄样黄斑营养不良的临床和影像学特征。设计回顾性病例系列。研究对象北京同仁医院9例（13眼）成年人型卵黄样黄斑营养不良患者。方法分析患者的眼底表现、荧光素眼底血管造影（FFA）、相干光断层扫描（OCT）和自体荧光检查结果。主要指标FFA及OCT特征。结果所有患者均无家族史。视力在0．3及以上者8／13眼（61．5％）。所有患者均表现为黄斑区圆形卵黄样微隆起、边界清楚的、不超过1PD的视网膜下病变。FFA显示病变处呈遮蔽荧光,其旁无或显现荧光,在吸收过程中,荧光相应增加。OCT显示在视网膜色素上皮（RPE）光带前见一梭形均匀的高反射区,在吸收过程中,高反射区出现不均匀,或有小的无光反射暗区。结论黄斑区圆形卵黄样不超过1PD的视网膜下病变,无明显视网膜脱离及无病变破裂分层是本病的特点。FFA和OCT检查相结合有助于成年人型卵黄样黄斑营养不良的诊断。     

高度近视致单纯黄斑出血与继发CNV的黄斑出血之OCT图像鉴别

目的 观察高度近视所致单纯黄斑出血与继发脉络膜新生血管形成（CNV）的黄斑出血在相干光断层扫描（OCT）上的图像特征。设计 回顾性病例系列。研究对象  47例（47眼）高度近视黄斑出血的患者。方法 回顾性研究2009年7月-2013年5月就诊,并行最佳矫正视力、眼底彩照、荧光素眼底血管造影（FFA）、眼底自发荧光（FAF）、相干光断层扫描（OCT）检查的47例高度近视黄斑出血患者的47眼,对其视力及光学影像图像特征进行分析。主要指标  OCT,自发荧光结果及视力。结果  47眼高度近视黄斑出血中,通过FFA及吲哚青绿血管造影（ICGA）明确诊断继发于CNV的黄斑出血27眼,单纯的黄斑区出血20眼。继发于CNV的黄斑出血OCT图像特征为黄斑中心凹下较高反射信号的团块状影位于视网膜色素上皮（RPE）层之下,RPE层结构破坏、隆起,及RPE层上的中高反射信号影;单纯黄斑出血,其OCT图像特征为黄斑中心凹隆起,神经上皮层下三角形稍高反射信号影,其后信号略减弱,RPE层反射条带完整。继发于CNV的黄斑出血组,24/27眼IS/OS破坏,3/27眼IS/OS完整,仅表现IS/OS的隆起;而单纯黄斑出血组,7/20眼IS/OS破坏,13/20眼IS/OS完整（χ2=14.86,P=0.000）。FAF检查在继发于CNV的黄斑出血组可呈小片状中央弱自发荧光,周围环以强自发荧光或正常荧光;而在单纯黄斑出血组,自发荧光可呈正常或片状弱自发荧光。结论 OCT和眼底自发荧光检查可明确分辨高度近视黄斑出血是继发于CNV还是单纯黄斑出血。（眼科,2014, 23： 103-106）     

11例迟发性视锥细胞营养不良患者的临床特征观察

目的 观察迟发性视锥细胞营养不良（LOCD）患者的临床特征。方法 临床检查确诊的LOCD患者11例15只眼纳入研究。其中,男性7例,女性4例。年龄50～79岁,平均年龄60.2岁。患者畏光和昼盲症状不明显。视力≤0.05者4只眼;0.06～0.2者5只眼;0.3～1.0者6只眼。所有患者行视力、裂隙灯显微镜、间接检眼镜、闪光视网膜电图(F-ERG)、多焦视网膜电图（mfERG）检查。行荧光素眼底血管造影(FFA)检查11只眼、光相干断层扫描(OCT)检查13只眼,色觉检查6只眼。结果 行色觉检查的6只眼中,红绿色盲4只眼;色弱2只眼。15只眼中,眼底检查正常11只眼;黄斑色素紊乱4只眼。行FFA检查的11只眼中,正常5只眼;黄斑色素紊乱表现为荧光遮蔽及透见荧光点相间4只眼;黄斑卵圆形萎缩灶2只眼。F-ERG检查结果 显示,明视b波振幅下降6只眼。其中,轻度4只眼;中重度各1只眼。明视、暗视b波振幅下降9只眼。mfERG检查结果显示,距中心凹7°范围内的视锥细胞中心异常5只眼;中心、距中心凹7°范围以外的周边部分均异常10只眼。OCT检查结果 显示,黄斑色素上皮改变3只眼。黄斑中心凹视网膜厚度正常8只眼;黄斑薄变5只眼。黄斑薄变的5只眼,黄斑厚度83～111 μm。 结论 LOCD患者早期眼底黄斑区正常,晚期呈卵圆形萎缩。可有色觉异常。F-ERG检查表现为早期明视b波振幅下降或晚期明视、暗视b波振幅均下降。mfERG检查表现为视锥细胞中心和（或）周边部异常。     

非动脉炎性前部缺血性视神经病变患者眼底影像检查特征及其与视力、病程转归的关系

目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者的荧光素眼底血管造影(FFA)与光相干断层扫描(OCT)检查等影像特征.探讨其与视力、病程转归的关系.方法 回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料.所有患者均接受视力、眼底、视野等常规眼科检查.初诊时同时进行FFA和OCT检查.FFA及视野检查按常规方法进行;OCT检查分别选择线性和环形扫描方式,进行黄斑和视盘的扫描.其中35例NAION患者分别于发病后0.5、1、2、3、6个月时进行OCT复查.回顾分析时,以36例患者的对侧健眼作为对照组,对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系.结果 FFA检查结果显示,所有患眼均表现为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏,24只患眼在黄斑区出现强荧光渗漏.OCT检查结果显示,所有患眼视盘隆起,生理凹陷变窄或消失;视盘与黄斑(盘斑)之间神经上皮层组织增厚或神经上皮层隆起,下方有液性暗区.对照眼中,14只跟有正常视盘生理凹陷,22只眼无生理凹陷或较小的生理凹陷.NAION组0.5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度,视盘周围视网膜神经纤维层厚度均高于对照组,差异均有统计学意义(F＝6.51,26.12,75.49;P<0.05).2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时变薄.3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时明显变薄,低于对照组,差异有统计学意义(F＝75.49,37.92;P<0.05).视野检查结果显示,下方视野缺损21例,占45.7%.OCT检查结果显示,随病程进展,视盘上方神经纤维层厚度下降的程度更明显,与视野的表现相一致.视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系(r=-0.394,-0.424,-0.412,-0.464;P<0.05).结论 NAION患者FFA特征为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏;OCT特征为随病程发展,视网膜神经上皮层增厚,神经纤维层变薄.视盘形态及视网膜神经纤维层变化的OCT检查与视野检查结果一致;患者视力与神经上皮层厚度的OCT检查结果呈负相关关系.     

频域光学相干断层扫描黄斑光损伤表现的特点

目的 探讨频域光学相干断层扫描（fourier-domain optical coherence tomography,FD-OCT）应用于光损伤黄斑病变所表现出的特点及重要性.方法 回顾性研究.对光损伤黄斑病变7例（11只眼）进行FD-OCT检查.包括阳光导致视网膜病变2只眼,电弧光导致视网膜病变6只眼,激光损伤导致视网膜病变3只眼.所有患者均行散瞳眼底检查照相,部分患者行多焦视网膜电图检查.结果 所有患眼均有黄斑区病理改变.视力0.04 ～1.0.FD-OCT显示在视锥细胞内外节层局限性缺失7只眼,视网膜层间低反射暗腔3只眼,黄斑孔1只眼.揭示了光损伤黄斑病变缺损区域不仅存在于视细胞层,还存在于视细胞外节与色素上皮绒毛的连接处.激光损伤的黄斑病变可以表现为多种形态.结论 FD-OCT能够在不同类型光损伤黄斑病变患眼中显示出显著的形态学改变,FD-OCT更能发现视细胞外节与色素上皮绒毛连接处的特征性改变,提高了诊治效率.     

黄斑水肿的光相干断层扫描分析

目的 观察黄斑水肿的光相干断层扫描（OCT）图像特征；探讨黄斑中心凹厚度与最佳矫正视力之间的关系。 方法 对50例正常对照者以及47例54只经直接、间接检眼镜、三面镜及荧光素眼底血管造影（FFA）诊断为黄斑水肿的患眼进行OCT检查，通过黄斑中心凹的水平或垂直方向线性扫描，测量黄斑中心凹的厚度，对比分析两组受检者的黄斑形态及中心凹厚度值，根据形态学特点对黄斑水肿者的OCT图像进行分类并将其中心凹厚度与其最佳矫正视力进行相关分析。 结果 正常对照组与黄斑水肿组黄斑形态及中心凹厚度差异有显著性的意义。黄斑水肿患眼的OCT图像表现为3种特征，20只眼表现为黄斑区视网膜海绵样肿胀，占37.1%；26只眼表现为黄斑囊样水肿，占48.1%；8只眼表现为浆液性视网膜神经上皮脱离，占14.8%。黄斑水肿者黄斑中心凹厚度与其最佳矫正视力呈负相关（r=－0.569, P=0.000）。 结论 黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离。黄斑水肿患者的黄斑中心凹厚度明显增厚，黄斑中心凹厚度越厚，视力越差。 （中华眼底病杂志，2004，20：152-155）     

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier.

PURPOSE: To study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood-ocular barrier. METHODS: Sixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately. OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. RESULTS: Latanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. CONCLUSIONS: It is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood-ocular barrier.     

Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

OBjectives:To study the characteristics of optical coherence tomography(OCT) in idiopathic macular epiretinal membranes(IMEM)and the relationship between the thickness of fovea and the vision of affected eyes.Methods:A total of 67 cases(73 eyes)with clinical diagnisis of IMEM using direct indirect ophthalmoscope,three mirror contact lens,fundus color photography or nfundus fluorescein angiography(FFA) were examined with OCT.Results:Epiretinal membranes(ERMs)with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes,ERMs withmacular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7eyes.Based on OCT,the ERMs were clearly and partially seperated from the retinal (27 eyes,38.36%),the retinal thickness of the fovea was the thickest in the proliferative ERMs and the thinnest in the ERMs with laminar macular holes.The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454,P=0.000).Conclusion:There were four types of images of OCT in IMEM:ERMs with macular edema,proliferative ERMs,ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT,the poorer the vision acuity in the affected eyes with ERMs.     

特发性黄斑视网膜前膜的光学相干断层扫描

目的观察特发性黄斑视网膜前膜(idiopathic macular epireti nal membranes, IMEM)的光学相干断层扫描(optical coherence tomography, OCT)图像 特征,探讨IMEM患眼黄斑中心凹厚度与视力之间的关系。方法对67例73只经直接或间接检眼镜、三面镜、眼底彩色照相或荧光素眼底血管造影(fundus fluorescein angiogrphy, FFA)检查诊断为IMEM的患眼进行经黄斑中心凹的OCT线性扫描, 测量黄斑中心凹厚度,并与视力进行相关分析。结果32只眼表现为视网膜前膜(Epiretinal menmbrabces, ERMs)伴黄斑水肿;20只眼表现为增生性ERMs,14只眼表现为ERMs伴假性黄斑裂孔;7只眼表现为ERMs伴板层黄斑裂孔。73只眼中27只眼可见ERMs与视网膜内层分离,占38.36%。增生性ERMs者黄斑中心凹厚度 最厚,ERMs伴板层黄斑裂孔者黄斑中心凹厚度最薄。黄斑中心凹厚度与视力呈负相关(r=－0.454,P=0.000)。结论IMEM 的 OCT图像主要有ERMs伴黄斑水肿、增生性ERMs、ERMs伴假性裂孔与板层裂孔改变;ERMs患者黄斑中心凹厚度越厚视力越差。(中华眼底病杂志,2001,17:115-118)     

The correlation between optical coherence tomographic features and severity of retinopathy,macular thickness and visual acuity in diabetic macular edema

Purpose To investigate the correlation between the features of optical coherence tomography (OCT) and the severity of concurrent retinopathy, central macular thickness (CMT), and best-corrected visual acuity in clinically significant diabetic macular edema.Methods In a prospective study, OCT was performed in 55 eyes of 55 patients with clinically significant diabetic macular edema, in 58 eyes of 30 patients with diabetes without retinopathy, and in 40 eyes of 21 healthy control subjects. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; type 3, serous retinal detachment; and type 4, vitreofoveal traction.Results The CMT in eyes with diabetic macular edema was significantly higher than in eyes of healthy controls or in eyes of diabetic patients without retinopathy (P < 0.001). Visual acuity correlated with CMT in diabetic macular edema (r = 0.558, P < 0.001). The prevalence of OCT type 1 was significantly higher in eyes with mild-to-moderate non-proliferative retinopathy (NPDR) than in eyes with severe NPDR to proliferative retinopathy (PDR) (P = 0.0069). The prevalence of OCT types 3 and 4 was significantly higher in eyes with severe NPDR to PDR than in eyes with mild-to-moderate NPDR (P = 0.0056). OCT type 1 showed the least CMT (P < 0.001) and the best visual acuity (P = 0.002).Conclusions There was a significant correlation between OCT patterns of clinically significant diabetic macular edema and severity of retinopathy, CMT, and visual acuity.     

Foveal dysplasia evident by optical coherence tomography in patients with a history of retinopathy of prematurity

PURPOSE: To describe the optical coherence tomography (OCT) findings for patients with a history of retinopathy of prematurity (ROP). METHODS: Clinical records, fundus photographs, and OCT findings for consecutive patients aged 8 years and older who had a history of ROP were reviewed. The main outcome measures were best-corrected visual acuity, central foveal thickness (CFT), macular anatomy, and foveal contour by OCT. RESULTS: Twenty eyes of 12 patients (median age, 15 years) were studied. Median gestational age at birth was 25 weeks. Six eyes had received peripheral retinal ablation for threshold ROP. Median best-corrected visual acuity was 20/40 (range, 20/20 to counting fingers). CFT was >220 microm in 70% of eyes and >240 microm in 35% of eyes. In all eyes, foveal contour was abnormal, with foveal depression either absent (n = 7 [35%]) or shallow (n = 13 [65%]). Preservation of multiple inner retinal layers within the fovea was seen in 14 eyes (70%). Vitreomacular traction or subretinal fluid was not seen in any eye. CONCLUSIONS: Anomalies in foveal anatomy by OCT may be a vestige of prematurity, appear to be independent of prior retinopexy, and can still be associated with excellent visual acuity.     

儿童遗传性视网膜疾病的眼底自身荧光表现

目的 观察儿童遗传性视网膜疾病的眼底自身荧光(FAF)特征.方法 回顾性分析22例临床资料完整、年龄5～14岁之问的遗传性视网膜疾病患儿的FAF检查结果.其中,Best卵黄样病变8例16只眼,Stargardt病3例6只眼,视锥细胞营养不良3例6只眼,原发性视网膜色素变性(RP)5例10只眼,X连锁青少年型视网膜劈裂症3例6只眼.仔细询问现病史及家族史,行视力、裂隙灯显微镜眼前节检查,间接眼底镜检查,彩色眼底像和FAF照相,其中部分患儿接受了荧光素眼底血管造影(FFA)、视网膜电流图、眼电图、光相干断层扫描检查.对上述患儿的FAF结果特征进行归纳总结,并与其眼底照相和/或FFA结果进行比较分析.结果 3例Stargardt病患儿的6只眼及3例视锥细胞营养不良患儿的6只眼FAF检查显示黄斑区可见对称性的圆形、近圆形弱荧光或荧光缺如区,2例视锥细胞营养不良患儿的4只眼及1例Stargardt病患儿的2只眼可见弱荧光或荧光缺如区外缘环以强荧光;Best卵黄样病变患儿黄斑区可见一个强度均匀或不均匀的强FAF病灶;RP患儿后极部视网膜FAF增强,黄斑区周围可见宽度不等的环形强荧光带,拱环区FAF正常;3例X连锁青少年型视网膜劈裂症患儿中5只眼中心凹部位FAF检查可见蜂窝或颗粒状强荧光.结论 Stargardt病及视锥细胞营养不良患儿黄斑区为近圆形弱荧光,部分病变区外缘环以强荧光;Best卵黄样病变患儿黄斑区为强度均匀或不均匀的强FAF病灶;RP患儿后极部视网膜FAF增强,拱环区FAF正常,黄斑区周围可见宽度不等的环形强荧光带;X连锁青少年型视网膜劈裂症患儿中心凹部位为蜂窝或颗粒状强荧光.

Abstract：

Objective To observe the autofluorescence (AF) manifestation in children with hereditary retinal diseases. Methods The clinical data of 22 children (aged from 5 to 14 years) with hereditary retinal diseases were retrospectively analyzed. There were 8 children (16 eyes) with Best vitelliform macular dystrophy, 3 children (6 eyes) with Stargardt macular dystrophy, 3 children (6 eyes) with macular cone dystrophy, 5 children (10 eyes) with primary retinitis pigmentosa, and 3 children (6 eyes) with X-linked juvenile retinoschisis. The routine clinical examinations included present history, family history, visual acuity, silt-lamp microscopy, indirect ophthalmoscopy, color fundus photography and fundus autofluorescence angiography (FAF). Some patients received fundus fluorescein angiography (FFA),electroretinogram (ERG), electrooculogram (EOG), and ocular coherence tomography (OCT). The characteristics of AF in all the children were analyzed, and were compared with the images of color fundus and/or FFA. Results Symmetry round macular fluorescent weak or absent area was found in all Stargardt disease and cone dystrophy. Weak AF area with surrounded circular increased AF was found in 2 children (4 eyes) with cone dystrophy and 1 child (2 eyes) with Stargardt macular dystrophy. A central round area with regular or irregular intense AF was observed in Best vitelliform macular dystrophy. RP children showed increased AF out of the macular region. Cellular or granular strong AF was found in the fovea of 3 children (5 eyes) with X-linked juvenile retinoschisis. Conclusion The children with hereditary retinal diseases had special AF changes.     

Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms

PURPOSE: To determine the correlation between the tomographic features and the visual functions of eyes with diabetic macular edema. METHODS: Optical coherence tomographic (OCT) images and multifocal electroretinograms were obtained from 45 eyes of 25 patients with diabetic macular edema and from 21 eyes of 21 normal subjects. RESULTS: The OCT images showed cystoid macular edema in 18 eyes and diffuse retinal swelling without cystoid edema in the other 27 eyes. The fovea was significantly thicker in eyes with cystoid macular edema and in those with diffuse retinal swelling than in normal eyes. The fovea of eyes with cystoid edema was significantly thicker than the fovea of eyes with diffuse swelling. The best-corrected visual acuity and the electrical response density from the macular area were significantly reduced in eyes with diabetic macular edema, particularly in those with cystoid edema. The best-corrected visual acuity and macular response density of the multifocal ERGs were inversely correlated, and the implicit times were directly correlated with foveal thickness. CONCLUSION: The visual acuity was correlated significantly with morphological changes revealed by OCT and with multifocal ERGs. The combination of OCT and multifocal ERGs may provide objective criteria for the evaluation and assessment of diabetic macular edema.     

PASCAL激光一次性全视网膜光凝治疗增殖性糖尿病视网膜病变

目的：：探讨模式化激光扫描( pattern scan laser,PASCAL)激光一次性完成全视网膜光凝( pan-retinal photocoagulation, PRP)治疗增殖性糖尿病视网膜病变( proliferative diabetic retinopathy,PDR)的疗效及优势。方法：临床检查确诊的 PDR 患者28例42眼纳入研究。其中,视力≥0.1者36眼,<0.1者6眼;伴黄斑水肿者11眼。所有患眼均经PASCAL激光一次性完成 PRP 治疗。伴黄斑水肿者联合应用 PASCAL 单点模式和/或黄斑模式。随访时间1a,观察治疗前后视力、眼底、FFA、OCT、视野的变化情况。结果：选取的42眼患者治疗过程中均无明显疼痛不适。视力提高、稳定、下降者分别为6、28、8眼;视网膜新生血管消退18眼(43%);视网膜新生血管病灶稳定12眼(29%);视网膜新生血管病灶活动12眼(29%)。随访期间5眼(12%)因玻璃体积血行玻璃体切割手术治疗。治疗后黄斑中心凹厚度及视野平均光阈值敏感度与治疗前相比无统计学差异(P>0.05)。结论：应用PASCAL多点模式一次性完成PRP治疗PDR安全、有效、便利。     

局限性脉络膜凹陷39例的临床和OCT特征

目的:观察局限性脉络膜凹陷(focal choroidal excavation,FCE)的临床和光学相干断层扫描(OCT)特征.方法:收集2014-01/2016-01经OCT确定的FCE患者39例42眼,对其临床表现和OCT特点进行分析.所有患者均行系统的眼科检查,包括视力、屈光度、裂隙灯、检眼镜、OCT等.结果:患者39例中共有男24例26眼,女15例16眼(左眼20例,右眼16例,双眼3例)接受了检查.患者平均年龄50.4±16.7岁,屈光度为-2.51±2.60D,最佳矫正视力0.60±0.26,单眼发病36例(92%).39例42眼患者中共46个病灶,其中紧密型37个(80%),分离型9个(20%).病灶平均宽度为648.4±249.2μm,平均深度为128.0±50.4μm.黄斑中心凹下病灶16个(35%),其患者视力低于中心凹外FCE,有统计学差异(P<0.05).3例患者合并脉络膜新生血管(CNV)、1例合并黄斑前膜、1例合并黄斑裂孔伴前膜、1例合并黄斑板层孔伴前膜.运用直线回归方法,分别计算患者年龄、视力和FCE的宽度、深度,发现两两间没有相关性(均P>0.05).结论:FCE好发于轻中度近视的中老年人,单眼发生及紧密型多,可以合并黄斑裂孔、黄斑前膜以及脉络膜新生血管.FCE位于中心凹下可能影响患者视力,其发病原因需要进一步研究.