微视野计对糖尿病性黄斑水肿患者的视功能评估

目的 采用微视野检测对糖尿病性黄斑水肿(DME)患者视功能进行评估,并探讨微视野检测指标与视力之间的相关性.设计 回顾性病例系列.研究对象 2016年4月至2018年1月在中国人民解放军武汉总医院确诊为DME的患者164例(220眼).方法 患者均行最佳矫正视力(BCVA)检查(统计时结果转换为最小分辨角对数(logM...     

Characteristics of the macular microvasculature

The morphological appearance and the quantitative analysis of the structure of the macular microvasculature were investigated in 33 normal subjects by fluorescein angiography and stereoscopic mapping techniques. The foveal capillary network was formed by the anastomosis of 4 to 6 groups of terminal arteriolar and venous branches. The inner three rings of capillaries were a single layer of microangium. The apertures of the network differed in size and the closer to the foveal avascular zone, the larger were the apertures. The mean inner width of the capillaries in the fovea was 12.99 +/- 2.2 (SD) microns, and it was 24.55 +/- 6.51 microns on the edge of the fovea. There was a strikingly regular pattern of 4 to 6 arterioles with associated venules. The inner diameter of the smaller vessels on the edge of this area was 35.17 +/- 6.41 microns. In the external perifovea, the arterial and venous branches increased in number to more than 12 and the diameter of these vessels was 4.5 times larger than that of the capillaries in the fovea. The characteristics of the macular microcirculation provide a basis for studying macular disease, particularly the pathogenesis of vascular disorders.     

黄斑囊样水肿患者白发荧光与黄斑色素密度的关系

目的探讨黄斑囊样水肿（CME）眼底自发荧光与黄斑色素密度的相关性,以提供对其预后有临床价值的技术参数。设计回顾性病例系列。研究对象2009年8月至2010年7月于北京同仁医院确诊CME的视网膜中央静脉阻塞、视网膜分支静脉阻塞及糖尿病视网膜病变的患者18例（24眼）。24只正常眼选自年龄及性别相匹配者。方法对所有患眼及正常对照眼行彩色眼底照相、荧光素眼底血管造影（FFA）及相干光断层扫描（OCT）确诊CME。采用海德堡公司HRA一2共焦激光扫描系统的IR（infrared）及FA（不注入荧光素钠）模式进行眼底自发荧光及黄斑色素密度的检测。黄斑色素密度按Zhang等分期法分为完整的黄斑色素、部分黄斑色素及黄斑色素缺失三级。采用MonteCarlo精确检验说明不同分级的黄斑色素密度与自发荧光的相关性,线性相关卡方检验分析两个变量之间的变化趋势。主要指标眼底自发荧光的分布及形态、黄斑色素的分布及密度。结果24只CME眼自发荧光均为阳性（100％）,并在黄斑区呈花瓣样表现,而正常对照眼的黄斑自发荧光均为阴性。CME眼中黄斑色素缺失22眼（91．7％）,部分黄斑色素2眼（8．3％）;正常对照眼黄斑色素密度均为完整的黄斑色素（100％）。黄斑色素密度与自发荧光的出现在本次研究中呈现负相关（x2=45．123,P=0．0001）。结论CME患者中黄斑色素密度大小与黄斑区自发荧光呈负相关,黄斑区自发荧光可做为其随诊的临床评价指标。     

Contribution to the investigation macular function for the surgical treatment of idiopathic macular holes

We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 - sulfur hexafluoride). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. ANATOMICAL RESULTS: The primary closure of the IMD occurred in 29 (90%), the IMD was not closed, but it's edges were flattened in 2 eyes (6%), and once time the edges of the IMD were not flattened (3%). FUNCTIONAL RESULTS: The initial BCVA ranged from 0.1 to 0.5 (1.0 to 0.3 LogMAR). After one year of operations the visual acuity improved by 2 or more lines in 27 eyes (84%), of 3 or more lines in 18 eyes (56%), and 4 or more lines in 5 eyes (16%). PERG amplitudes (N95) in all eyes were between 4 to 9 microV (within the normal range of the laboratory), and was not found statistically significant difference between the values before surgery and 12 months after. Statistically significant difference (improvement) was found in the first and the second central ring of the MfERG. Improvement involved the values of P1 wave amplitude before surgery and 12 months after (Wilcoxon p < 0.01). The difference between the values of N1 and P1 latencies before surgery and month 12 was not statistically significant, as well as changes between the values of the amplitudes of waves N1 preoperatively and 12 months later. Due to the favorable anatomical and functional results we consider surgical treatment of macular holes through PPV with peeling MLI as a safe technique. When the indication to perform peeling is considered, there is a need to think about other factors, especially duration IMD, disease stage, type of intraocular tamponade and the patient's cooperation.     

Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—Deep and relative scotomas were detected in all 57 eyes with clinically defined full thickness macular holes. In contrast, among 49 eyes diagnosed with macular pseudoholes or impending macular holes, no deep and only one relative scotoma was observed. The sensitivity of the presence of a deep scotoma as an indicator of the clinical diagnosis of a full thickness macular hole was 100% (57 of 57), and the specificity was 100% (49 of 49). The sensitivity of the presence of a relative scotoma was 100% (57 of 57) and the specificity was 98.0% (48 of 49).
CONCLUSION—With SLO microperimetry, full thickness macular holes can be precisely and objectively distinguished from other conditions that mimic macular holes.

     

Restoration of macular structure as the determining factor for macular hole surgery outcome

Objective

The aim of this work is to evaluate the preoperative and postoperative spectral domain optical coherence tomography (SD-OCT) findings as predictors of visual acuity for macular hole (MH) surgery.

Methods

Fifty eyes of 46 patients diagnosed with MH and that had undergone 25-g vitrectomy with internal limiting membrane peeling were included in this retrospective study. A complete clinical examination and SD-OCT were performed before and after surgery. Three groups were considered on the basis of the postoperative integrity of photoreceptor inner and outer segment (IS-OS) junction and the external limiting membrane (ELM): group A (11 eyes, both lines disrupted), group B (ten eyes, disrupted IS/OS line and complete ELM), and group C (29 eyes, both lines restored).

Results

LogMAR BCVA improved significantly after surgery from an average 0.60?±?0.29 to 0.19?±?0.19 (p?p≥0.18). Postoperative BCVA was significantly better in group C compared to groups A and B (p?≤?0.01). A significant correlation was found between ELM restoration and postoperative BCVA (r?=?–0.63, p?r?=?–0.55, p?Conclusions Outer retina restoration seems to be the best determining factor for a good visual rehabilitation after MH surgery.     

The effect on the macular function of laser photocoagulation for diabetic macular edema

The benefit of focal and grid-laser photocoagulation in reducing the risk of visual loss from diabetic macular edema has been established. In order to investigate the effect of this treatment on macular function, 30 diabetics with macular edema and 1.0 visual acuity were tested before and after laser treatment at intervals of 1 week, and 1 and 3 months, respectively. The test was carried out by means of nyctometry, contrast sensitivity, hue discrimination and critical flicker frequency of blue cones. All patients had abnormal results in macular tests before treatment. During the follow-up, visual acuity remained stable and the macular tests did not statistically modify, except for nyctometry, which deteriorated at the 1-week follow-up (P=0.02)] and then increased to the basal values, and contrast sensitivity [improved at the last control (P=0.006)]. Clinical regression of macular edema was observed, but macular function tests never normalized. Patients with diabetic macular edema and good visual acuity should be monitored with many functional methods, and laser treatment should be performed before macular function deteriorates irreversibly. Offprint requests to: E. MidenaThis paper was presented at the XVII Meeting of the Club Jules Gonin, Lausanne, 2–6 September 1990     

Best's macular dystrophy with a macular hole

The occurrence of a macular hole with Best's dystrophy is an extremely rare finding with only one reported case in the literature. We wish to report two cases with typical Best's dystrophy in one eye and a macular hole in the contralateral eye. In one case the Pattern Reversal VER (PVER) was also recorded and graphed as an amplitude-check size function curve. The PVER changes in this case were grossly subnormal in both the eyes, suggesting a significant degree of bilateral macular impairment. This implies that a significant amount of functional impairment occurs at the vitelliform stage itself, though how this stage progresses to a macular hole is unclear.     

Use of a macular buckle in the treatment of exudative age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To evaluate a macular buckle for exudative choroidal neovascularization secondary to age-related macular degeneration (ARMD). PATIENTS AND METHODS: Forty-two eyes with choroidal neovascular membranes (CNVM) secondary to ARMD underwent surgical placement of a macular buckle. A Gore-Tex strip (2.0-2.5 mm wide) was button-holed through a 5 mm diameter silicone sponge (9 mm long) and placed behind the macula underneath the CNVM by the same surgeon (Dr Peyman) in all cases. Follow-up ranged from 7-76 months (mean, 20.9 months). RESULTS: Of 12 eyes with classic subfoveal CNVM: 4 (33%) gained 2 or more lines of Snellen visual acuity; 3 (25%) gained 1 line, remained the same, or lost 1 line; and 5 (42%) lost 2 or more lines (range + 6 to - 6 lines). Of 22 eyes with ill-defined subfoveal CNVM: 12 (54%) gained 1 line, remained the same, or lost 1 line; and 10 (46%) lost 2 or more lines (range + 1 to - 8 lines). Eight eyes with ill-defined juxtafoveal CNVM had the following visual acuity outcomes: 5 eyes (62%) maintained the same level of Snellen visual acuity (gained 1, 0, or lost 1 line); and 3 (38%) got worse (lost 2 or more lines of Snellen visual acuity, range + 1 to - 6 lines). Ten eyes (24%) bled subretinally during the follow-up period (average 11.5 months, range 14 days to 27 months), all outside the area of indentation of the macular buckle. CONCLUSIONS: The macular buckle treatment for exudative subretinal choroidal neovascular membranes in ARMD stabilized visual decline and displaced significant subfoveal hemorrhage.     

Closure of chronic macular holes using passive aspiration to the edges of the macular hole.

Full-thickness macular holes are characterized by central dehiscence of neurosensory tissue and a reduction in visual acuity. According to Gass (1) and then Johnson and Gass, (2) full-thickness macular holes are caused by progressive vitreous cortex condensation, resulting in tangential traction with centrifugal displacement of photoreceptor elements at the fovea.     

黄斑裂孔指数与特发性黄斑裂孔手术视力预后的相关性分析

目的 评价黄斑裂孔指数(MHI)与特发性黄斑裂孔(IMH)视网膜内界膜剥离手术后视力预后的相关性.方法 30例接受玻璃体切割联合视网膜内界膜剥离手术治疗的IMH患者的30只眼纳入研究.患者均进行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜及光相干断层扫描(OCT)检查确诊.OCT测量视网膜中心厚度,黄斑裂孔底径和高,计算黄斑裂孔高与底径比值,即MHI,并根据MHI大小将患者分为MHI≥0.5组和MHI＜0.5组.手术后随访3～24个月,平均随访时间10个月.将手术后BCVA与患者年龄、病程、MHI及手术前BCVA进行斯珀曼(Spearman)相关性分析,对MHI≥0.5组和MHI＜0.5组手术后BCVA差异进行独立样本设计定量资料t检验.结果 手术后30只眼黄斑裂孔闭合,闭合率为100%.患者手术后BCVA与MHI之间有相关性(r=0.852,P＜0.001),与年龄、病程等变量无相关性(r年龄=0.001,P=0.804;r病程=-0.001,P=0.579).MHI≥0.5组手术后视力好于MHI＜0.5组(t=5.552,P＜0.001).结论 MHI与IMH患者视网膜内界膜剥离手术后视力存在相关性,可作为其手术后视力的预测指标之一.     

Multimodal evaluation of macular function in age-related macular degeneration

Objective

To evaluate macular function using multimodality in eyes with age-related macular degeneration (AMD) at various stages.

Methods

Macular function in 20 control eyes (20 subjects), 17 eyes (17 patients) with large drusen, 18 eyes (18 patients) with drusenoid pigment epithelial detachment (PED), and 19 eyes (19 patients) with neovascular AMD was examined using a Landolt chart for visual acuity; retinal sensitivity was measured by microperimetry; and focal macular electroretinography (fmERG) was performed. In all of these eyes, retinal morphology was examined using optical coherence tomography.

Results

Eyes with neovascular AMD showed morphologic changes in the neurosensory retina as well as marked deterioration of macular function in all parameters measured with a Landolt chart, fmERG, and microperimetry. Eyes with large drusen showed only minimal morphologic changes in the neurosensory retina. In this large drusen group, although retinal sensitivity at the central point was significantly decreased (P = 0.0063), the other parameters of macular function were well preserved. In eyes with drusenoid PED, the structure of the neurosensory retina was well preserved, while the foveal thickness was significantly increased (P = 0.013). The macular function of these eyes was significantly deteriorated, with the VA, amplitude of the a-wave and b-wave, and retinal sensitivity being markedly decreased. In addition, the area of PED correlated with the latency of the a-wave and b-wave and with the retinal sensitivity within the central 4° or 8° region.

Conclusion

Multimodal evaluation demonstrated a significant decrease in macular function in drusenoid PED and in neovascular AMD.     

老年性黄斑变性的黄斑部光敏感度检测

目的　探讨老年性黄斑变性早期患者黄斑暗视敏感度的变化。方法　用Octopus10 1型视野计 ,对早期老年性黄斑变性组 2 0例 30眼 ,对照组正常人 2 1例 2 6眼进行暗视和明视敏感度检测 ,应用tM2 测试程序 ,将中心 30°视野内视网膜暗视和明视敏感度进行比较和分析。结果　老年性黄斑变性组暗视和明视敏感度较正常组均降低 ,且暗视敏感度降低值大于明视敏感度降低值 ,差异显著 (P <0 .0 5 )。结论黄斑暗视敏感度检测可作为老年性黄斑变性早期诊断和检测指标。     

Pathology of the hereditary macular dystrophies

THE HEREDITARY macular dystrophies are a small group of disorders, most of which are rarely encountered, that share certain features. The most common presentation is a history of slowly progressive visual loss that occurs early in life and is associated with a bilateral, often symmetric maculopathy. The ophthalmoscopic abnormalities are confined to the macula or posterior pole and visual function outside the central retina is normal. A positive family history should be sought by careful questioning and examination of appropriate family members.     

玻璃体注射雷珠单抗治疗老年性黄斑变性黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的 观察玻璃体注射雷珠单抗治疗老年黄斑变性黄斑水肿（AMD-ME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的短期临床效果。设计 回顾性病例系列。研究对象 2015年10月至2016年7月确诊为AMD-ME 及RVO-ME 的患者共30例（30眼）,各15例（15眼）。方法 患眼接受玻璃体注射雷珠单抗（0.5 mg/0.05 ml）治疗,采用1+PRN的注射方法,比较治疗前和治疗后 1 天、1个月最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹视网膜厚度（CMT）、注射后消除的水肿高度,评价每次随访时检查结果。主要指标 BCVA、CMT、消除的水肿高度、IOP。结果 AMD-ME组及RVO-ME 组注射雷珠单抗后1天、1个月的BCVA均较术前提高（P=0.000、0.000）。AMD-ME组 及RVO-ME 组每次治疗前和治疗后1个月CMT厚度均降低（P＝0.000、0.000）。治疗过程中患者眼压与治疗前比较并无明显变化 （P=0.096、0.066、0.213、0.088、0.240、0.337）。结论 玻璃体注射雷珠单抗治疗 AMD-ME 及 RVO-ME 在短期内均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。（眼科, 2017, 26： 120-124）