玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔疗？…

目的 探讨玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔的临床疗效。方法 玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔手术１４例（１５只眼），随访３￣１６个月，对裂孔封闭情况及视力、视野中心阈值、Ａｍｓｌｅｒ方格表、荧光素眼底血管造影及手术并发症进行观察。结果 ８６．７％的手术眼裂孔安全闭合，视力增加２行以上者占８６．７％；Ａｍｓｌｅｒ方格表异常者术后视力全部改善；视野中心阈值手术前后差异无显著     

单侧老年黄斑变性对侧眼的早期视功能变异

采用ＦＭ１００—色调试验仪、Ｈｕｍｐｒｅｙ视野分析仪黄斑阈值程序、Ｇｏｌｄｍａｎｎ－Ｗｅｅｋｅｒ暗适应仪及Ａｍｓｌｅｒ表对４６例单侧老年黄斑变性（ＡＭＤ）对侧眼和４６只正常眼进行检查。结果发现单侧ＡＭＤ对侧眼的色调分辨力、黄斑中心和６°光敏度及短期波动比对照组影响显著，暗适应锥体细胞敏感性降低显著，８例单侧ＡＭＤ对侧眼Ａｍｓｌｅｒ方格表有１７．３９％异常。认为单侧ＡＭＤ对侧眼视力正常时视功能已有变异。     

高通分辨视野检查法对原发性开角型青光眼的早期诊断价值

目的探讨高通分辨视野检查法对青光眼的早期诊断价值。方法参照Ｆｒｉｓéｎ所介绍的方法，利用微型计算机设计适合检测青光眼早期视野缺损的高通分辨视野检查仪。并对２２例（４４只眼）正常人、２７例（４１只眼）自动视野检查异常的原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）及１０例（１３只眼）自动视野检查正常的早期或可疑ＰＯＡＧ进行高通分辨视野测量。结果正常人的平均分辨阈值为右眼３．９６±０．５５ｄＢ，左眼３．９８±０．５５ｄＢ。高通分辨视野检查对检测青光眼视野损害的敏感性高于常规的自动视野计检查，敏感性为９３．７５％，特异性为９７．７％，青光眼早期视野损害可表现为分辨阈值升高。结论高通分辨视野检查法是检测ＰＯＡＧ早期视野损害的敏感方法之一，值得推广应用。     

玻璃体切除联合自体浓缩血小板封闭 特发性黄斑裂孔疗效观察

目的探讨玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔的临床疗效。方法玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔手术１４例（１５只眼）,随访３～１６个月,对裂孔封闭情况及视力、视野中心阈值、Ａｍｓｌｅｒ方格表、荧光素眼底血管造影及手术并发症进行观察。结果８６．７％的手术眼裂孔完全闭合,视力增加２行以上者占８６．７％;Ａｍｓｌｅｒ方格表异常者术后视力全部改善;视野中心阈值手术前后差异无显著性（Ｐ＝０．３４）;荧光素眼底血管造影显示部分患眼术后黄斑孔处中央低荧光,其外围以窗样透见荧光环;术中主要并发症为视网膜裂孔,术后主要并发症为白内障加重。结论玻璃体切除联合自体浓缩血小板封闭特发性黄斑裂孔可使大部分患眼裂孔闭合,视力改善,但尚需多中心、大样本研究及长期随诊后进一步加以验证     

全层黄斑裂孔的鉴别诊断

目的：探讨全层黄斑裂孔与板层黄斑裂孔以及囊样黄斑变性的诊断和鉴别诊断方法。方法：用Ａｍｓｌｅｒ方格表、Ｗａｔｚｋｅ征检查和激光瞄准光检查对３０例全层黄斑裂孔、１２例板层黄斑裂孔和８例囊样黄斑变性患者进行检查，其结果用四格表确切概率法进行统计分析。结果：Ａｍｓｌｅｒ方格表检查、Ｗａｔｚｋｅ征检查及５０μｍ激光瞄准光试验在全层黄斑裂孔组中阳性率均为１００％；板层黄斑裂孔和囊样黄斑变性组中分别为８５％、６５％及０。结论：对全层黄斑裂孔的诊断，Ａｍｓｌｅｒ表检查具有敏感性，但不具特异性；Ｗａｔｚｋｅ征敏感而且较特异；激光瞄准光检查非常敏感而且特异。这些检查有助于对全层黄斑裂孔的准确诊断。     

趋势导向视野检查法与常规阈值视野检查法的对比研究

目的 评价趋势导向视野检查法(tendency-oriented perimetry, TOP)在青光眼视功能检测中的应用价值。 方法 利用Octopus 101全自动视野计分别对20名正常人的20只正常眼、32例原发性开角型青光眼(primary open angle glaucoma, POAG)患者的32只患眼和14例可疑POAG患者的14只眼分别进行常规阈值视野检查(Normal/Normal程序)和TOP视野检查(TOP/Normal程序)。所有受检眼在2周内再次分别进行常规阈值视野检查和TOP视野检查。将两种视野检查的结果、视野检查指数、点对点阈值变异及视野缺损点数进行比较和分析。 结果 TOP视野检查正常人的阴性检出率为90%，POAG的阳性检出率为75%，其中检测中晚期POAG的阳性检出率达100％。2种视野检查的视野指数呈明显正相关，平均敏感度(mean sensitivity, MS)的相关系数为0.9335，平均缺损(mean defect, MD)的相关系数为0.9189，偏离缺失(loss variance, LV)的相关系数为0.9621。点对点阈值变异和视野缺损点数TOP视野检查结果略高于常规阈值视野检查结果，但二者间差异均无显著性的意义(P＝0.2019，P＝0.4448)。 结论 TOP视野检查指数与常规阈值视野检查指数呈明显正相关，其检测中晚期POAG的敏感性及可重复性高。 (中华眼底病杂志, 2002, 18: 169-272)     

多点静态定量视野计检查开角型青光眼

目的 比较采用多点静态定量视野分析仪（Ｆｒｉｅｄｍａｎｎ ｖｉｓｕａｌ ｆｉｅｌｄ ａｎａｌｙｓｅｒ,ＦＶＦＡ）与中心平面视野屏检查视野在青光眼诊断中的作用。方法 应用两种视野计对４８例（９５只眼）开角型青光眼患者进行视野检查。结果 ２６只眼在视野屏上用２／１０００视标查出小的视野缺损,而用ＦＶＦＡ检查出完全相似者２３只眼（８８％）;２６只眼在ＦＶＦＡ查出早期青光眼视野缺损,而在视野屏上必须用１／     

单侧老年黄斑变性对侧眼视功能变异的预后

目的探讨单侧老年黄斑变性（ＡＭＤ）对侧眼视功能变异与ＡＭＤ发病的危险性。方法对视力正常的单侧ＡＭＤ对侧眼患者３１例的黄斑光敏度（ＭＬＳ）、ＦＭ１００－色调试验及Ａｍｓｌｅｒ表检测结果进行５年临床观察。结果平均追踪５５个月，追踪期内发生ＡＭＤ眼１０眼，中心凹及黄斑６°光敏度的降低预见ＡＭＤ的发生，敏感性分别为８３．３７％及７７．７８％，特异性分别为８０．５５％及７５％。ＦＭ－１００色调试验全色区预见发生ＡＭＤ的敏感性８３．３３％，特异性６３．６７％；Ａｍｓｌｅｒ表异常预见发生ＡＭＤ的相对危险性是４．８（Ｐ＜０．００５）。结论采用ＭＬＳ、ＦＭ１００色调试验及Ａｍｓｌｅｒ表检测单侧ＡＭＤ对侧眼的视功能可预见ＡＭＤ的发生。     

倍频视野计与Humphrey视野计在青光眼诊断的对比研究

目的：评价倍频视野计（ＦＤＴ）在青光眼的视野诊断上能否达到Ｈｕｍｐｈｒｅｙ视野计（ＨＦＡⅡ）的诊断水平。材料与方法：对１４５只受检眼（５１例青光眼、３９例可疑青光眼和５５例正常对照）进行ＦＤＴ筛查、ＦＤＴ全阈值与ＨＦＡⅡ视野的对比研究，能过对ＦＤＴ的ＭＤ、ＰＳＤ在青光眼、可疑青光眼与正常人之间的方差分析，以及ＦＤＴ的ＭＤ、ＰＳＤ与Ｈｕｍｐｈｒｅｙ的ＭＤ、ＣＰＳＤ之间的相关分析，了解ＦＤＴ与ＨＦＡⅡ     

全视野暗视敏感度对原发性开角型青光眼的早期诊断价值

为评价全视野暗视敏感度（ｗｈｏｌｅ－ｆｉｅｌｄｓｃｏｔｏｐｉｃｓｅｎｓｉｔｉｖｉｔｙ，ＷＳＳ）测定对原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ－ａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）的早期诊断价值，经过３０分钟暗适应后，对１６例（１７只眼）早期ＰＯＡＧ，１２例（１４只眼）进展期ＰＯＡＧ，２５例（３２只眼）可疑ＰＯＡＧ及１５例（２０只眼）年龄匹配的正常人进行ＷＳＳ阈值测定。结果：这四组的平均ＷＳＳ阈值差异均具有显著性，分别为６．２４±２．４６ｄＢ，７．７９±２．１９ｄＢ，３．６３±２．４６ｄＢ，１．８５±１．６９ｄＢ。在可疑ＰＯＡＧ组中，随着危险因素的增加，ＷＳＳ阈值有上升趋势。ＷＳＳ阈值与ＰＯＡＧ患者的眼压最高水平值呈正相关（ｒ＝０．７６６，Ｐ＜０．００１）。结论：ＷＳＳ测定在青光眼的筛选中具有潜在性价值。     

Threshold Amsler grid testing in maculopathies

The Amsler grid is a suprathreshold target and thus may fail to detect relative scotomas. If the grid is viewed through two cross-polarizing filters creating low luminance conditions (threshold Amsler grid testing) the test is far more sensitive. Ten patients with disorders of the macula with normal standard white Amsler grid testing were studied with three other Amsler grid tests. Of the 15 involved eyes, 12 had visual field defects present with threshold Amsler grid testing. Tangent screen examination showed defects in 10 of these 12 eyes. The two red grids used were not as sensitive as the threshold grid. Three eyes had metamorphopsia with the white grid which became the site of a visual field defect with threshold testing. Threshold Amsler grid testing is a rapid and sensitive technique for the evaluation of the central 10 degrees of visual field in patients with maculopathies.     

Early detection of glaucoma by means of a novel 3D computer-automated visual field test

PURPOSE: A recently devised 3D computer-automated threshold Amsler grid test was used to identify early and distinctive defects in people with suspected glaucoma. Further, the location, shape and depth of these field defects were characterised. Finally, the visual fields were compared with those obtained by standard automated perimetry. PATIENTS AND METHODS: Glaucoma suspects were defined as those having elevated intraocular pressure (>21 mm Hg) or cup-to-disc ratio of >0.5. 33 patients and 66 eyes with risk factors for glaucoma were examined. 15 patients and 23 eyes with no risk factors were tested as controls. The recently developed 3D computer-automated threshold Amsler grid test was used. The test exhibits a grid on a computer screen at a preselected greyscale and angular resolution, and allows patients to trace those areas on the grid that are missing in their visual field using a touch screen. The 5-minute test required that the patients repeatedly outline scotomas on a touch screen with varied displays of contrast while maintaining their gaze on a central fixation marker. A 3D depiction of the visual field defects was then obtained that was further characterised by the location, shape and depth of the scotomas. The exam was repeated three times per eye. The results were compared to Humphrey visual field tests (ie, achromatic standard or SITA standard 30-2 or 24-2). RESULTS: In this pilot study 79% of the eyes tested in the glaucoma-suspect group repeatedly demonstrated visual field loss with the 3D perimetry. The 3D depictions of visual field loss associated with these risk factors were all characteristic of or compatible with glaucoma. 71% of the eyes demonstrated arcuate defects or a nasal step. Constricted visual fields were shown in 29% of the eyes. No visual field changes were detected in the control group. CONCLUSIONS: The 3D computer-automated threshold Amsler grid test may demonstrate visual field abnormalities characteristic of glaucoma in glaucoma suspects with normal achromatic Humphrey visual field testing. This test may be used as a screening tool for the early detection of glaucoma.     

Low-intensity grids improve sensitivity of amsler grid testing in diabetic patients without background retinopathy

We tested 22 eyes of 12 diabetic patients without retinopathy for visual loss using four types of Amsler grids. The Amsler grids, in order of decreasing intensity, were the standard white, bright red, fine red, and threshold (through cross-polarizing filters). The threshold grid detected the largest number of scotomas--16 versus 12, seven, and seven, respectively--and the largest total area of all scotomas--1594 degrees 2 of arc versus 1237, 994, and 927, respectively. In addition, metamorphopsia lessened as grid intensity decreased. These results demonstrate that the sensitivity of Amsler grid testing for visual loss in diabetics without retinopathy improves by decreasing the intensity of the grid used.     

Entoptic perimetry screening for central diabetic scotomas and macular edema

OBJECTIVE: The aim of this study was to compare entoptic perimetry, using conventional television, to Amsler grid and patient-reported visual loss for the detection of functional diabetic maculopathy and macular edema. DESIGN: Observational case series. PARTICIPANTS: A single eye from each of 104 consecutive patients with diabetes in an academic retina clinic. INTERVENTION: Each eye was screened by Amsler grid, entoptic perimetry, and Humphrey 10-2 threshold visual field testing (HVF 10-2; Humphrey Instruments Inc., San Leandro, CA) in random order. Eyes were then examined clinically. MAIN OUTCOME MEASURES: The presence or absence of new visual decline since the patient's last clinical examination, the presence or absence of central visual field abnormalities using an Amsler grid, entoptic perimetry, HVF 10-2, and the presence or absence of clinically significant macular edema (CSME). RESULTS: The sensitivities and specificities for the detection of central diabetic scotomas as evidenced by HVF 10-2 abnormalities were: subjective impression, 31 of 90 eyes (34.4%) and 11 of 14 eyes (78.6%); Amsler grid, 29 of 90 eyes (32.2%) and 13 of 14 eyes (92.9%); and entoptic perimetry, 58 of 90 eyes (64.4%) and 11 of 14 eyes (78.6%). Entoptic perimetry was statistically more sensitive than both subjective impression (P < 0.001) and Amsler grid (P < 0.001), but the specificities were statistically indistinguishable. The sensitivities and specificities for the detection of CSME were: subjective impression, 6 of 24 eyes (25.0%) and 52 of 80 eyes (65.0%); Amsler grid, 9 of 24 eyes (37.5%) and 59 of 80 eyes (73.8%); and entoptic perimetry, 17 of 24 eyes (70.8%) and 44 of 80 (55.0%) eyes. These results are also statistically significant, with entoptic perimetry being more sensitive and less specific than both subjective impression (P = 0.007 and P = 0.011, respectively) and Amsler grid (P = 0.008 and P < 0.001, respectively) in this subset of patients. CONCLUSIONS: Entoptic perimetry is 87% more sensitive than the subjective impression of visual decline (P < 0.001) and 100% more sensitive than Amsler grid (P < 0.001) for the detection of central scotomas in diabetic patients. For the detection of CSME, entoptic perimetry is 183% more sensitive than subjective impression (P = 0.007) and 89% more sensitive than Amsler grid (P = 0.008). Hence, entoptic perimetry, performed using conventional television, has the potential to be an effective, inexpensive, and widespread adjunct to surveillance examinations for the early detection of diabetic maculopathy.     

Comparison of threshold and standard Amsler grid testing in patients with established antimalarial retinopathy.

To evaluate the sensitivity of threshold Amsler grid testing in the detection of established antimalarial retinopathy, 30 eyes of 15 patients with bilateral, irreversible field defects were examined with the standard Amsler grid and the threshold Amsler grid. Four eyes (13%) showed significant enlargement of large relative scotomas on testing with the threshold Amsler grid. Although only a small proportion of the eyes demonstrated an increase in the size of the scotoma, the patients had established field defects of varying depth, in some cases absolute scotomas. A prospective study in patients with early disease (i.e., with small, shallow scotomas) may be worth while.     

Results of a multicenter clinical trial to evaluate the preferential hyperacuity perimeter for detection of age-related macular degeneration

PURPOSE: To compare the preferential hyperacuity perimeter (PHP) with an Amsler grid in detection of age-related macular degeneration (AMD). METHODS: Patients underwent refraction, visual acuity examination, PHP, Amsler grid examination, and macular photography. RESULTS: One hundred fifty patients participated in the trial. Of 19 eyes with neovascular AMD, 19 (100%) were positive on the PHP, and 10 (53%), on the Amsler grid. Of 27 eyes with geographic atrophy, 26 (96%) were positive on the PHP, and 12 (44%), on the Amsler grid. Of 20 eyes with intermediate AMD, 14 (70%) were positive on the PHP, and 4 (20%), on the Amsler grid. Of 51 eyes with early AMD, 21 (41%) were positive on the PHP, and 4 (8%), on the Amsler grid. Of 33 eyes with no AMD, 6 (18%) were positive on the PHP, and none, on the Amsler grid. Thus, 80 (68%) of 117 patients with AMD had a positive PHP, while 30 (26%) had positive results of Amsler grid examination (P < 0.001, McNemar test). CONCLUSION: The PHP had greater sensitivity, although with a relatively high rate of false-positive results for healthy individuals, than the Amsler grid in detecting AMD-related lesions.     

Comparison of the original Amsler grid with the modified Amsler grid: result for patients with age-related macular degeneration

PURPOSE: To compare the sensitivity of the original Amsler grid presenting white lines on a black background with that of the modified standard version of the grid presenting black lines on a white background in the detection of visual disturbances. PATIENTS AND METHODS: One hundred eighty-two patients (182 eyes) with dry and exudative age-related macular degeneration and a history of metamorphopsia were instructed to use an Amsler grid. None of the patients were familiar with an Amsler grid or had used it previously. If the disease was present in both eyes, one eye was chosen as the study eye by randomization. Both grid types were presented and used for documentation of central visual field changes. The sequence of presentation of the respective grid was also chosen by randomization. Original Amsler grid questions were used for grading ("metamorphomas" and "scotomas"). Visual acuity of patients ranged from 0.1 to 0.7. Subgroup analysis was performed based on the visual acuity levels. RESULTS: For the overall study population, the original Amsler grid provided significantly better results than the modified version. Evaluation of data for the different subgroups showed no significant difference between patients with visual acuity ranging from 0.1 to 0.3. For patients with visual acuity of 0.5 or better, the original Amsler grid was significantly more informative and reliable than the modified version. CONCLUSION: For patients with macular diseases, use of the original Amsler grid (white lines on a black background) should be recommended. This is particularly important for patients with visual acuity of 0.5 or better.     

Threshold Amsler grid testing in diabetic retinopathy

The Amsler grid is a suprathreshold target used to assess the central 10° of the visual field; thus, it may fail to detect relative central scotomas. Low luminance conditions can be created by viewing the white grid on a black background through two cross-polarizing filters that vary light transmission and change the procedure to a threshold Amsler grid (TAG) test, thereby increasing its sensitivity. A total of 26 patients with diabetic retinopathy were tested by standard Amsler grid, TAG, and tangent screen. Four scotomas were detected by Amsler grid testing; each of these scotomas expanded in size on retesting with the TAG. TAG testing revealed 22 scotomas more than five times the number seen with conventional Amsler grid testing; tangent-screen examination confirmed 9 of these defects. In many cases, fundus photography and fluorescein angiography revealed pathology that correlated with the scotomas detected only by TAG testing. It thus appears that the TAG test is a rapid, high-yield, and sensitive means of assessing the central visual field in patients with diabetic retinopathy. Offprint requests to: A.A. Sadun     

Scotomas of age-related macular degeneration detected and characterized by means of a novel three-dimensional computer-automated visual field test

PURPOSE: We used the recently devised three-dimensional computer-based threshold Amsler grid test to acquire and identify typical patterns of visual field defects (scotomas) caused by age-related macular degeneration (AMD). METHODS: Patients with AMD traced on a computer touch screen the borders of those areas on an Amsler grid that were missing from their field of vision. Scotomas were repeatedly outlined and recorded at different grid contrast levels. The resulting three-dimensional "hole" in the central 25 degrees of the visual field was further characterized by its slope, location, shape, and depth. The results were compared with fundus photographs and fluorescein angiograms. RESULTS: Twenty-five patients and 41 eyes were examined. The three-dimensional depictions consistently demonstrated central scotomas with "scallop"-shaped borders and steplike patterns, with either steep slopes or a combination of steep and shallow slopes. The steep slopes corresponded to nonexudative AMD, while the shallow slopes indicated exudative AMD. CONCLUSION: The three-dimensional computer-automated threshold Amsler grid test may demonstrate characteristic scotoma patterns in patients with AMD that conform to the respective fluorescein angiograms. The test shows promise as an effective tool in accurately evaluating, characterizing, and monitoring scotomas in patients with AMD. It may have the potential as a screening tool for the early diagnosis of AMD.