先天性眼球震颤脑血流SPECT断层显像

目的探索先天性眼球震颤（ＣＮ）的发病机理，了解其脑血流动力学的改变。方法应用单光子发射型计算机断层显像技术（ＳＰＥＣＴ），对２７例ＣＮ患者进行脑血流灌注显像及半定量分析。结果（１）跳动型ＣＮ：快相侧额叶皮质脑血流灌注量均减弱，慢相侧额叶脑血流灌注增强（占６６．６７％），其枕叶灌注量降低。（２）钟摆型ＣＮ：两侧额叶皮质脑血流灌注量均减少，皮质层变薄。结论提示ＣＮ患者大脑额叶、枕叶部分区域脑血流灌注异常，这可能造成该区神经功能不平衡，导致眼球运动中枢功能失调。     

青少年近视脑彩超检查临床意义

目的了解青少年近视脑血管血流速度改变，探索病因病理，寻求安全有效治疗方法。方法采用美国MT—1000型彩色经颅多普勒超声血流仪检测14例（28只眼）青少年近视患者脑血流速度与国内外正常值（青年组）比较。结果①近视患者大脑动脉诸血管参数高于正常值（P＜0．001）。②颈内动脉虹吸段，眼动脉参数低于正常值（P＜0．001）。③毛细血管弹性阻力基底动脉指数低于正常值（P＜0．001），椎动脉指数低于正常（P＜0．05）。④脑血管阻力基底动脉系数低于正常值（P＜0．05）。结论颈内动脉系、椎—基底动脉系血流动力学改变亦可影响眼球血供，周围血管血流量增加导致轴性近视。     

先天性眼球震颤眼球运动波形的相图特点分析

背景 先天性眼球震颤患者的眼球运动波形表现各异,其时间动力学的非线性特征复杂,常规的时间序列波形图不便于对患者进行临床诊断及评估.眼球运动系统是非线性反馈控制系统,而相图法是一 种用于描绘非线性系统运动特征的分析技术,但相图法在先天性眼球震颤检测中的应用尚未见报道. 目的尝试建立先天性眼球震颤眼球运动波形的相图法分析技术,为先天性眼球震颤的临床诊断与定量评估提供新的方法.方法 采用前瞻性病例观察设计,纳入2012年4月至2013年2月在天津市眼科医院就诊的25例先天性眼球震颤患者,其中先天性运动性眼球震颤(CMN)患者12例,隐性眼球震颤(LN)患者13例.所有患者行视频眼动图(VOG)检查,对VOG数据进行格式转换后,采用Matlab程序对数据进行处理,得到每个眼动波形周期的相位图,并从相位图上测得周期位移(CPS)、慢相峰值速度(SPV)及其标准化值(SSPV)、快相峰值速度(FPV)及其标准化值(SFPV).比较先天性眼球震颤波形速度递增型和速度递减型的测量参数.结果 先天性眼球震颤的眼球运动相图呈现周期性规律性往复运动轨迹,其慢相过程表现为密集带状轨迹,快相过程表现为稀疏环状轨迹.CMN的眼球运动波形以速度递增型为主,而LN的眼球运动波形以速度递减型为主,2种波形相图轨迹走行均呈顺时针方向.速度递增型CPS、SPV及FPV分别为(4.646±1.565)、(223.821±114.049)和(767.481±263.560)°/s,速度递减型CPS、SPV及FPV分别为(9.373±4.189)、(357.531±154.300)和(1 148.706±541.362)°/s;速度递增型中SPV和FPV与CPS间均呈显著正相关(rSPV-CPS=0.685,P=0.000;rFPV-CPS=0.680,P=0.000);速度递减型中SPV和FPV与CPS间均呈显著正相关(rSPV-CPS=0.783,P=0.000;rFPV-CPS=0.803,P=0.000).2种波形FPV均大于SPV,差异均有统计学意义(速度递增型:t=6.558,P=0.000;速度递减型:t=5.068,P=0.000).速度递增型SSPV为(48.062±15.365)°/s,略大于速度递减型的(41.099±17.027)°/s,但差异无统计学意义(t=1.070,P=0.296);速度递增型SFPV为(171.186±47.825)°/s,大于速度递减型的(125.317±38.266)°/s,差异有统计学意义(t=2.658,P=0.014).结论 相图法能够直观显示先天性眼球震颤眼球运动轨迹的周期性动态特征,便于测量其不同时相的运动幅度、速度等参数.     

先天性水平性眼球震颤的Parks理想眼位矫正术的疗效观察

目的 探讨Parks理想眼位矫正术治疗先天性眼球震颤的手术设计和效果。方法 对19例先天性水平性眼球震颤均采用Parks理想眼位矫正法手术治疗，并追踪观察术后疗效。结果 绝大多数患者相对休止眼位移至正前方，头位改善，视力提高。结论 采用Parks理想眼位矫正术，适合于伴或不伴斜视的先天性水平性眼球震颤。     

阻塞性睡眠呼吸暂停综合征基础脑血流评价

目的 探讨无创伤性方法评价阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者的基础脑血流速度及其意义。方法 采用彩色三维经颅多普勒（３Ｄ－ＴＣＤ）检测１３例ＯＳＡＳ病例组觉酷暑状态脑动脉血流速度并与正常对照组比较。结果 病例组大脑中动脉（ＭＣＡｓ）、基底动脉（ＢＡＳ）和椎动脉（ＶＡＳ）血流速度较正常对照组明显减慢（Ｐ〈０．０５）。结论 ＯＳＡＳ患者基础脑血流速度较正常减慢,用ＴＣＤ评价其变化具有很好的实用价     

先天性交替性旋转性眼球震颤伴原发性视网膜色素变性一例

先天性冲动性眼球震颤是一种常见的疾病,但先天性交替性旋转性眼球震颤临床上十分罕见,我们见到一例先天性交替性旋转性眼球震颤伴有原发性视网膜色素变性病人,现报告如下。患者男,10岁。诉5岁起发现双眼视力差,尤其是夜晚明显伴双眼不自主转动。7岁时曾在当地医院诊断为先天性眼球震颤,并验光配镜,但患儿不愿意佩戴,     

先天性眼球震颤的临床特征

背景 先天性眼球震颤是严重影响患者视觉功能的眼科疾病,但目前对其临床特征完整描述的相关报道尚少见. 目的 分析先天性眼球震颤的临床特征. 方法 采用回顾性病例分析的方法,对2005年1月至2011年8月在河南省眼科研究所就诊的先天性眼球震颤患者376例的临床资料进行归纳分析,包括患者家系的系谱分析、眼球震颤类型观察、斜视度测定、视力检查、检影验光、立体视觉测定和对患者有无震动幻觉的调查.结果 本组患者就诊的年龄分布以＞5～ 10岁及＞15～20岁者最多,分别占24.73％和24.20％.本组患者中知觉缺陷型眼球震颤172例,运动缺陷型眼球震颤204例.先天性眼球震颤患者中最常见的遗传方式为常染色体显性遗传;水平眼球震颤为最常见的眼球震颤类型,占73.94％,其次为垂直眼球震颤,占10.11％.本组先天性眼球震颤患者中斜视的患病率为66.36％,知觉缺陷型患者与运动缺陷型患者间斜视的患病率差异无统计学意义(x2=3.048,P=0.081).先天性眼球震颤患者的双眼最佳矫正远视力均较差,知觉缺陷型患者双眼最佳矫正远视力明显低于先天性特发性患者(0.27±0.11 vs 0.50±0.13),差异有统计学意义(t=16.495,P=0.000).先天性眼球震颤患者屈光不正的患病率为77.62％,知觉缺陷型患者与运动缺陷型患者间屈光不正患病率的差异无统计学意义(x2=1.337,P=0.248);散光患病率为75.17％,显著高于近视和远视的患病率.65.18％的先天性眼球震颤患者无立体视觉或立体视觉值在3000”以上,运动缺陷型患者有立体视觉者明显多于知觉缺陷型患者,差异有统计学意义(x2=7.058,P=0.008).313例5岁以上的患者中36例有震动幻觉. 结论 先天性眼球震颤患者最常见的遗传方式为常染色体显性遗传;水平眼球震颤为其最常见的震颤类型;眼球震颤患者的斜视患病率高,视力和立体视觉较差,特别是知觉缺陷型患者;少数先天性眼球震颤患者有震动幻觉.     

双眼先天性白内障合并多器官先天异常1例

0引言先天性白内障是儿童常见的致盲性眼科疾病,而先天性白内障同时合并先天性内斜视、眼球震颤、先天性房间隔缺损、动脉导管未闭、先天性腭裂等多器官先天性异常的病例则较罕见,现报告1例如下。1病例报告患儿,女,2(4/12)岁,以"发现左眼内斜视伴眼球震颤2a;发现左眼视力差伴强光下眯眼2mo"为代主诉入院。患者     

X链显性遗传先天性眼球震颤一家系

先天性眼球震颤（congnital nystagmus，CN）是指不伴有其他眼部明显畸形、仅有双侧性眼球震颤的患者，临床多为散发病例，有家族史者较少见。我们在工作中遇到一遗传家系，现报告如下。     

先天性眼球震颤二家系

先天性眼球震颤二家系陈林义本文报道先天性眼球震颤２家系共２４例患者，其中男性１１例，女性１３例，均为连续传代三代以上。除眼球震颤及矫正视力不良外，辨色力及眼部其他检查均无明显异常。２例先证者与２例同时来就诊的患者均为水平震颤，其中１例同时伴有摆头痉挛...     

The response of blood flow velocity in the ophthalmic artery and blood flow of the finger to warm and cold stimuli in glaucomatous patients

Vasospasm appears to be a probable risk factor in the development of glaucoma. Transcranial Doppler (TCD) can detect vasospasm in cerebral vessels. It gives reproducible readings for ophthalmic artery blood velocity measurements. We used the TCD to measure peak flow velocity, mean flow velocity, and end-diastolic flow velocity in the ophthalmic artery and a laser Doppler flow meter to measure blood flow in the fingers of 17 patients with chronic open-angle glaucoma (COAG), 13 patients with normal tension glaucoma (NTG), and 8 nonglaucomatous subjects with normal eyes (normals). The opposite hand to that in which the measurements were made was challenged with warm (40°) and cold (4°) water. Five measurements of the ophthalmic artery velocity and finger flow were recorded: the first at baseline, the second during warming of the hand, the third after warming of the hand, the fourth when the hand was immersed in iced water, and the fifth after the hand was removed from the cold water. There was no detectable change in the ophthalmic artery blood velocities but significant decreases in the finger flow measurements when the opposite hand was immersed in cold water. These changes were present in all three diagnostic groups (P<0.001 for COAG;P<0.005 for NTG;P<0.05 for normals). The findings suggest a reflex vasospasm to cold in the finger circulation of most persons but no measurable changes in the ophthalmic artery.     

Reduced cerebrovascular blood flow velocities and vasoreactivity in open-angle glaucoma

PURPOSE: To compare cerebral blood flow velocities between open-angle glaucoma (OAG) patients and controls, at baseline and during hyperoxia. DESIGN: Observational cohort study. METHODS: A prospective study was conducted in a single institution. Sixteen OAG patients and 15 normal subjects, matched for age, were enrolled. Patients and controls were studied at baseline, while breathing room air, and during 100% oxygen breathing. The eye with the more severe visual field defect was chosen in glaucoma patients, while in controls, the study eye was chosen randomly. Subjects with history of diabetes, cardiovascular, or respiratory disease were excluded. Measurements included brachial arterial pressure, heart rate, intraocular pressure and transcranial Doppler (TCD). Mean and peak velocity and pulsatility index of the ipsilateral middle cerebral artery (MCA) were measured by TCD. RESULTS: At baseline, MCA mean and peak systolic blood flow velocities were significantly lower in glaucoma patients compared with controls velocities were significantly lower in glaucoma patients compared with controls (mean velocity: 50.2 vs 65.3 cm/s, P <.05; peak velocity: 74.2 vs 96.8 cm/s, P <.05). Additionally, while hyperoxia significantly decreased both mean and peak systolic velocities in MCA of controls (mean velocity: 65.3 vs 57.7 cm/s, P <.05; peak velocity 96.8 vs 87.9 cm/s, P <.05), it did not cause any significant change in OAG patients. CONCLUSIONS: Glaucoma patients were found to have lower MCA blood flow velocities and an absence of vasoreactivity to hyperoxia, compared with controls. The relationship of these cerebral hemodynamic abnormalities to glaucoma pathogenesis and progression remains to be explored.     

Nocturnal blood pressure reduction: effect on retrobulbar hemodynamics in glaucoma

BACKGROUND:Several studies suggest that nocturnal reductions in systemic blood pressure (BP) may be associated with onset or progression of glaucomatous optic neuropathy. The present study aimed to find out whether reductions in nocturnal BP are linked to retrobulbar blood flow perturbations in glaucoma patients.METHODS:Fifteen patients with non-progressing glaucoma and 15 controls were studied in the evening ("baseline") and then at a point of significantly reduced arterial BP during the night. Flow velocities were measured with color Doppler imaging (CDI) in the ophthalmic, central retinal, and nasal and temporal short posterior ciliary arteries, and with transcranial Doppler (TCD) in the middle cerebral artery. BP, corrected for posture, was monitored throughout the night.RESULTS:Maximal posture-corrected nocturnal BP reductions were similar in patients and controls. The reductions were about 10% for each group ( P<0.01). At baseline, patients had lower peak systolic and end-diastolic velocity ( P<0.05) in the short posterior ciliary arteries than controls. Flow velocities in these arteries remained constant in glaucoma patients, while controls showed significant declines. Patients and controls demonstrated blood flow velocities unchanged from baseline in the central retinal, ophthalmic, and middle cerebral arteries during nocturnal BP reduction.CONCLUSIONS:In patients with non-progressing glaucoma there was no evidence of cerebral or retrobulbar hemodynamic abnormalities during nocturnal BP dips. Posterior ciliary arterial blood flow velocities were similar in glaucoma patients and controls during nocturnal BP dips.     

Effect of Hyperbaric Oxygen on Ophthalmic Artery Blood Velocity in Patients With Diabetic Neuropathy

To assess the relationship between blood flow and the complications of diabetes mellitus, we investigated the changes in the velocity of blood flow in the ophthalmic artery before and after hyperbaric oxygen therapy (HBO), one of the treatments for diabetic neuropathy. Color Doppler imaging was used before and after HBO. Seven diabetic neuropathy patients, 3 diabetics without neuropathy, and 7 normal, control subjects were enrolled. The patients were subjected to breathing 100% oxygen at 2.0 atmosphere absolute (ATA) for 1 hour. Hyperbaric oxygen therapy resulted in an average decrease in blood velocity by 15.0 ± 9.0% (mean ± SD) in normal subjects and 10.7 ± 8.6% in diabetics without neuropathy. Blood velocity returned to the baseline level 4 hours after discontinuation of HBO. In contrast, blood velocity increased by 20.6 ± 9.5% in diabetic patients with neuropathy irregardless of the severity of the diabetic retinopathy. The resistance index of the ophthalmic artery was not changed during HBO in the group with diabetic neuropathy, indicating that other mechanisms may be implicated, leading to the compensatory changes of blood flow. These results suggest that the increase in the blood velocity in the ophthalmic artery after HBO in diabetic neuropathy patients could be attributed to an imbalance in autonomic nervous function.     

非对称性糖尿病视网膜病变的发生原因分析

目的 探讨糖尿病性视网膜病变发生双眼非对称性改变的原因.方法 收集非对称性糖尿病性视网膜病变患者30例.根据双眼病变的不对称程度将患者分为轻度不对称和重度不对称两组.对每组病人分析可能引起非对称性病变的多种因素,包括:颈动脉粥样斑块检出率,双侧眼动脉血流速峰值,眼压,视网膜分支静脉阻塞的发生和是否行白内障手术.结果 在轻度不对称的病例组中,双侧颈动脉粥样斑块检出率相同,具有统计学意义的危险因素为眼动脉的血流速度减慢和眼压升高.在重度不对称病例组中,病变较重侧颈动脉粥样斑块检出率为64%,较轻侧为18%,颈动脉粥样斑块的形成是一个明显的危险因素,而且双侧眼动脉血流速度和眼压的不平衡程度亦更明显.两组患者中,视网膜分支静脉阻塞和是否行白内障手术均与病变的不对称程度无关.结论 双侧眼灌注的不平衡是发生非对称性糖尿病性视网膜病变的根本原因.而单侧颈动脉的血流障碍是加重双眼病变不对称程度的重要因素.     

Assessment of blood flow in the ocular circulation in type 2 diabetes patients with Color Doppler imaging

PURPOSE: Color Doppler assessment of blood flow in ocular circulation in type 2 diabetes patients. MATERIAL AND METHODS: Total of 56 patients were included in the study and divided into 3 groups: group I--control group, group II--type 2 diabetes patients without diabetic retinopathy, group III--type 2 diabetes patients with nonproliferative diabetic retinopathy. USG Color Doppler method was used in all patients to assess peak systolic blood velocity (PSV), end-diastolic blood velocity (ESV) and resistivity index (RI) in the following arteries: ophthalmic artery (OA), central retinal artery (CRA), short posterior ciliary artery (SPCA). In addition several clinical parameters including age, diabetes duration, blood pressure, body mass index (BMI) and blood glucose level with empty stomach were statistically analyzed. RESULTS: Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in ophthalmic artery (OA) in diabetic patients were significantly lower in comparison to the control group. Peak systolic blood velocity (PSV) and end-diastolic blood velocity (ESV) in central retinal artery (CRA) were significantly lower only in patients with diabetic retinopathy. In short posterior ciliary arteries (SPCA) only peak systolic blood velocity (PSV) was decreased in patients with diabetic retinopathy. Average age of patients was significantly higher in the group with diabetic retinopathy. Diabetes duration was significantly longer in group III in comparison to group II. CONCLUSIONS: Color Doppler imaging method is useful for assessing blood flow in ocular circulation. Blood flow in ophthalmic artery is decreased in patients with diabetes. Reduction of blood flow in central retinal artery and short posterior ciliary arteries can be significant in the development of diabetic retinopathy.     

中青年缺血性脑血管病患者OA和CRA血流动力学的研究

目的:探讨中青年眼动脉(ophthalmic artery,OA)和视网膜中央动脉(central retinal artery,CRA)血流动力学的变化与发生缺血性脑血管病(ischemic cerebrovasctlar disease,ICD)的关系。方法:采用彩色多普勒超声仪检测缺血性脑血管病患者OA和CRA的血流动力学数据,对获得的资料进行回顾性分析。结果:ICD组舒张期血流速度降低及RI,PI值均升高明显(P<0.01)。收缩期血流速度降低不明显(P>0.05)。结论:利用超声检测OA和CRA,是早期间接发现脑动脉缺血改变的可靠方法。     

颅内段颈内动脉狭窄与眼部动脉血流状态及视网膜血管形态的相关性

目的：探讨颅内段颈内动脉狭窄与眼部动脉血流状态及视网膜血管形态的相关性。

方法：选取2017-01/2018-06因疑似脑缺血来我院就诊的患者251例,根据颈内动脉狭窄程度分为无狭窄组(39例)、轻度狭窄组(80例)、中度狭窄组(83例)、重度狭窄组(49例)。比较四组患者眼部动脉血流动力学指标及视网膜血管管径,分析眼部血流参数与颅内段重度颈内动脉狭窄的相关性及诊断价值。

结果：重度狭窄组患者眼动脉(OA)、视网膜中央动脉(CRA)、睫状后动脉(PCA)的血管血流参数收缩峰流速(PSV)和舒张峰流速(EDV)均低于其他三组,且PSV、EDV与重度狭窄组患者颈内动脉狭窄率呈显著负相关,其中PCA PSV、PCA EDV对颅内段重度颈内动脉狭窄诊断最佳临界值分别为11.26、5.21cm/s。

结论：颅内段颈内动脉狭窄与眼部动脉PSV、EDV呈显著负相关,其中PCA PSV、PCA EDV对于颅内段颈内动脉狭窄最敏感。     

Cerebral hemodynamics in ocular hypertension

Purpose To evaluate the cerebral blood flow velocity in patients with ocular hypertension.Material and methods Twenty-four ocular hypertensive patients and 24 age- and sex-matched healthy volunteers were recruited in a prospective comparative study. All subjects had normal findings on full-threshold visual field tests and clinically normal optic nerves. All patients with ocular hypertension had an intraocular pressure (IOP) of >21 mmHg on three separate occasions without treatment. Systolic and diastolic blood pressure by cuff, heart rate by palpation, IOP by Goldmann applanation tonometry, central corneal thickness by ultrasound pachymetry, blood flow velocities, and pulsatility index of the ipsilateral middle cerebral artery by transcranial color Doppler were measured.Results Systolic and diastolic blood pressures (P=0.40 and P=0.45, respectively), heart rate (P=0.30), and central corneal thickness (P=0.23) were similar in each group. Peak and end-diastolic blood flow velocities in the middle cerebral artery did not differ between ocular hypertensives and controls (P=0.37 and P=0.87, respectively). In addition, pulsatility index did not significantly differ between ocular hypertensives and controls (P=0.61).Conclusions The results of this study suggest that ocular hypertension is not associated with reduction in blood flow velocity and elevation of resistance in the middle cerebral artery.The authors have no commercial or proprietary interest in any of the equipment mentioned in this study.     

Assessment of blood flow velocity in eyeball arteries in multiple sclerosis patients with past retrobulbar optic neuritis in color Doppler ultrasonography

PURPOSE: The aim of the study was to evaluate blood flow velocity in eyeball arteries in affected and unaffected eyes in patients with past retrobulbar optic neuritis in the course of multiple sclerosis (MS). MATERIAL AND METHODS: Evaluation of blood flow velocity in 16 eyes of 16 patients with unilateral retrobulbar optic neuritis was performed in ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA). In the arteries the following parameters have been assessed: peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), indicators of peripheral vascular resistance such as Gosling Index (PI) and Pourcelot Index (RI). The obtained values have been compared to values of blood flow in the same arteries of the control group. Using Shapiro-Wilk test, mode of distribution of each parameter was analyzed. The statistic analysis has been done between group of affected eyeballs (group 1) and control group and between group of unaffected eyeballs (group 2) in multiple sclerosis patients and control group (13 individual, 26 eyes), regarding the age. The assessment was performed with the assistance of t-Student test, and in case of lack of normal distribution, by U Mann-Whitney test. Statistically significant difference was established when p value was below 0.05 (p < or = 0.05). RESULTS: Among the analyzed parameters of blood flow velocity, statistically significant disturbances in the examined eyeball arteries were found. The most significant disturbances of blood flow were found in CRA and SPCA. The affected parameters were: diminished MV velocity in OA; PSV, MV, RI in CRA and PSV, EDV, MV and RI indices in SPCA. The similar blood flow velocity disturbances were also found in unaffected eyeball arteries. CONCLUSIONS: In MS patients with past optic neuritis disturbances of ocular circulation can be observed. The statistically significant diminishing blood flow velocity parameters and vascular resistance indices in eyeball arteries may indicate alterations of blood flow. Lowering of systolic and mean velocities and resistance indices of blood flow are most expressed in CRA and SPCA. Reduction in blood flow parameters in the examined arteries occur both, in the eyes previously affected by past optic neuritis and in contra lateral, unaffected eyes.