Regional cone dysfunction in retinitis pigmentosa evaluated by flicker ERGs: relationship with perimetric sensitivity losses

PURPOSE: To evaluate regional cone dysfunction in retinitis pigmentosa (RP) by recording focal electroretinograms (FERGs) from the central and paracentral retinal regions and to correlate the FERG with perimetric sensitivity losses. METHODS: Twenty-three typical patients with RP (age, 18-65 years; visual acuity, 20/100 to 20/20; kinetic visual field by size II/4e, 20-40 degrees ) and eight age-matched control subjects were evaluated. FERGs were recorded in response to either a central (eccentricity, 0-2.25 degrees ) or a paracentral annular (2.25-9 degrees ) field, presented on a light-adapting background. Fields' luminances (mean: 80 cd/m(2)) were sinusoidally modulated at different temporal frequencies (TFs; 10.3, 14, 21, 32, 41, and 52 Hz). Amplitude and phase of the responses' fundamental harmonic (1F) were measured. Perimetric sensitivity was measured by a visual field perimeter. For each patient, mean sensitivity losses were calculated for both the central (0-2.25 degrees ) and paracentral (2.25-9 degrees ) regions. RESULTS: On average, central and paracentral FERGs of patients with RP were reduced in amplitude (P 相似文献   

Focal electroretinograms and fundus appearance in nonexudative age-related macular degeneration

· Background: The aim of this study was to evaluate the focal electroretinogram (FERG), an objective indicator of outer retinal function, in nonexudative age-related macular degeneration (NE-AMD), and to compare FERG results with morphological lesions assessed by stereoscopic fundus photographs and fluorescein angiograms. · Methods: Twenty-five patients (25 eyes) with bilateral NE-AMD (visual acuity of the study eyes ≥0.4) as well as 10 age- and sex-matched control subjects (10 eyes) were evaluated. FERGs were recorded from the macular region (9°) in response to sinusoidal stimuli flickered at 32 Hz. Amplitude and phase angle of the Fourier-analyzed FERG fundamental component were measured. Fundus lesions were graded from color slides according to the Wisconsin age-related maculopathy grading system [15]. Fluorescein angiograms were evaluated by an image analysis technique to compute the area with pathological hyperfluorescence (associated with drusen and/or retinal pigment epithelial atrophy) within the macular (approximately 9°×9°) region. · Results: Compared to control eyes, NE-AMD eyes had a reduction in the mean FERG amplitude (57% loss, P<0.001) with no phase changes. Amplitudes of individual affected eyes were negatively correlated with either the Wisconsin grading score (r=–0.63, P<0.001) or the percentage area of pathological hyperfluorescence (r=–0.70, P<0.01). Eyes with minimal NE-AMD lesions (Wisconsin score ≤6) and normal acuity had a lower mean amplitude (47% loss, P<0.05) than that of control eyes. · Conclusions: The results indicate that, in NE-AMD, the FERG is altered in parallel with the extent and severity of fundus lesions. However, a functional impairment of outer macular layers, which is detected by FERG losses, could precede morphological changes typical of more advanced disease. Received: 6 March 1998 Revised version received: 5 June 1998 Accepted: 17 June 1998     

Effect of uncomplicated phacoemulsification on the central retina in diabetic and non-diabetic subjects

Background The purpose of this study was to evaluate the subclinical influence of uncomplicated cataract surgery on foveal thickness and volume in the early postoperative period.Methods In a prospective study, 108 eyes were assessed by optical coherence tomography preoperatively and 1 day, 1 week and 4 weeks after uncomplicated small incisional phacoemulsification with endocapsular intraocular lens (IOL) implantation under topical anesthesia. The study included 24 eyes of diabetic patients. Eyes with diseases predisposing them for postoperative macular edema, preexisting macular edema, and eyes that developed cystoid macular edema during follow-up were excluded. Main outcome measures were minimal foveal thickness (MFT) and foveal volume. Secondary outcome measure was VA.Results Visual acuity (LogMAR) increased significantly (p<0.001) from 0.43±0.21 to 0.11±0.15 4 weeks after surgery, with a significantly (p=0.001) higher increase in VA for nondiabetic subjects. MFT increased from 183±27 μm preoperatively to 191±37 μm 4 weeks after surgery (p=0.001), with diabetic patients showing a tendency toward a more pronounced increase in minimal retinal thickness than nondiabetic subjects (p=0.058). One day and 1 week after surgery, MFT measurements were not significantly different from preoperative results. Foveal volume showed a significant increase at 1 week and 4 weeks after surgery (p<0.001), independent of the presence of diabetes (p=0.565). The proportion of patients exhibiting subclinical macular swelling was about 1/5 in the nondiabetic group and 1/3 in the diabetic group. Mean duration of surgery was 11.5±6.6 min.Conclusion Foveal thickness and foveal volume demonstrate a subclinical increase within 4 weeks after uncomplicated cataract surgery in up to 1/3 of the patients. The amount and frequency of early postoperative subclinical retinal thickening was higher than expected.Proprietary interest, financial support: none for all authors.     

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。     

Macular function after PDT in myopic maculopathy: psychophysical and electrophysiological evaluation

PURPOSE: To evaluate the effects of photodynamic therapy (PDT) on macular function in myopic subfoveal choroidal neovascularization (CNV). METHODS: Fourteen eyes of 14 patients (mean age, 48.1 +/- 13.3 years) with myopic CNV (myopia ranging from -6.50 to -20 D) were enrolled. In each eye, at baseline and at 15 and 90 days after PDT with verteporfin, logMAR visual acuity (logarithm of the minimum angle of resolution VA), macular sensitivity by scanning laser ophthalmoscope microperimetry, and focal (central 9 x 9 degrees ) ERGs (FERGs) and pattern ERGs (PERGs) were assessed. RESULTS: At 15 days after PDT, myopic CNV eyes showed, in relation to baseline values, a significant (ANOVA, P < 0.01) reduction in the diameter of the lesion that correlated (Pearson test, P < 0.01) with the significant (ANOVA, P < 0.01) increase in FERG and PERG amplitudes, VA, and scanning laser ophthalmoscopy (SLO) microperimetry results obtained from the central 1 degrees to 2 degrees of the macular area (SLO-CM). At 90 days after PDT, myopic CNV eyes showed, in comparison with baseline values, a nonsignificant (ANOVA, P > 0.01) reduction in the diameter of the lesion, a nonsignificant increase in VA and SLO-CM, and a still significant increase in FERG and PERG amplitudes. CONCLUSIONS: In myopic CNV eyes, PDT induces an increase, though not significant, in VA and macular sensitivity. These changes may be related to a reduction in the diameter of the lesion, with an improvement in the function of both ganglionic and preganglionic elements of the macular region, as suggested by the improvement in FERG and PERG responses.     

Vitrectomy Seems to be Beneficial for Advanced Diffuse Diabetic Macular Oedema not Responding to Laser Treatment

Background: To evaluate the surgical efficacy of vitrectomy, with optical coherence tomography, in patients with non-ischemic and ischemic diffuse diabetic macular oedema not responding to laser treatment. Methods: Ten eyes from nine patients (aged 46.0 ± 20 years, diabetes duration 12.4 ± 4 years) operated with vitrectomy for diabetic macular oedema not responding to laser treatment were evaluated before and 6 months postoperatively. Retinal thickness was assessed with optical coherence tomography, OCT, measuring the mean values of the centre of fovea and the second and third concentric rings from foveola. Four patients with type 1 diabetes had ischemic and five patients (6 eyes) with type 2 diabetes had non-ischemic diffuse macular oedema diagnosed on fluorescein angiography (FA). All eyes had an attached vitreous diagnosed on OCT. Results: Mean foveal thickness for the three concentric rings from centre and out was significantly less 6 months postoperatively 437 ± 125 vs. 286 ± 67 μm; p = 0.027, 426 ± 105 vs. 308 ± 35 μm; p = 0.019 and 404 ± 69 μm vs. 318 ± 29 μm; p = 0.011 respectively. The decrease in foveal thickness was similar for eyes with and without signs of ischemic maculopathy. There was a trend toward improved visual acuity (VA) 6 months after surgery 0.4; range 0.2–0.6 compared to 0.3; range 0.1–0.5 before vitrectomy; p = 0.107). Conclusion: Vitrectomy seems to be a beneficial treatment for both ischemic and non-ischemic advanced diffuse diabetic macular oedema not responding to laser treatment.     

Central and paracentral corneal pachymetry in patients with normal tension glaucoma and ocular hypertension

Purpose The difference in central corneal thickness among subgroups of glaucoma patients, as well as its influence on Goldmann applanation tonometry, has been well documented in several clinical trials. In the present study, possible similarities and differences between central corneal thickness and corneal thickness of paracentral quadrants in patients with normal tension glaucoma (NTG) and ocular hypertension (OHT) were investigated. Methods Central and paracentral corneal thickness was measured by optical slit scan pachymetry (Orbscan II). Fourteen patients (28 eyes) with NTG and 11 patients (22 eyes) with OHT were included in this study. t-Test was performed for statistical analysis. To evaluate overall corneal topography, the mean and SD values of the differences between the central corneal thickness and each peripheral quadrant were analysed. Results The following data was obtained (μm): (central, upper, temporal, nasal, inferior paracentral quadrant): OHT group 617–695–663–687–660. NTG group 568–629–593–612–616. Corneal thickness of all four paracentral quadrants differed significantly between the OHT and NTG groups. There was a more heterogeneous intraindividual pattern of overall corneal topography in the OHT group, and a more heterogeneous pattern of corneal topography among the individuals of the NTG group (interindividual heterogeneity). Conclusions A comparison of central corneal thickness and paracentral corneal thickness revealed clinically relevant differences between the OHT and NTG groups. The presented data underlines the importance of correlating the site of applanation with the corresponding corneal thickness, especially in OHT patients. It further substantiates the necessity to obtain individual pachymetric data for each NTG patient.     

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background  To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO). Methods  Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later. Results  Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001). Conclusions  Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.     

Cyclosporin A treatment in two cases of corneal peripheral melting syndrome

In 24 patients suffering from pigmentary retinal degeneration the electro-retinograms to pattern stimulation (PERG) were recorded with a silver-cup electrode placed on the center of the lower eyelid skin referred to an electrode on the earlobe. The results were compared with the responses to flash stimulation (FERG) and pattern visual evoked cortical potentials. None of patients showed normal FERGs. Nineteen of 48 eyes showed subnormal FERGs. The PERG was recorded from those 19 eyes. In the remaining 29 eyes with flat FERG, 8 eyes showed clear PERGs. The peak latency of the first positive component of PERGs was found to be prolonged in these patients. PERGs seemed to be recordable in the patients whose visual acuity and central visual field were relatively well preserved.     

Influence of short-term antioxidant supplementation on macular function in age-related maculopathy: a pilot study including electrophysiologic assessment

PURPOSE: To evaluate the influence of short-term antioxidant supplementation on retinal function in age-related maculopathy (ARM) patients by recording focal electroretinograms (FERGs). DESIGN: Nonrandomized, comparative clinical trial. PARTICIPANTS: Thirty patients with early ARM and visual acuity >/=20/30, divided into two groups, similar for age and disease severity: antioxidant group (ARM-A, n = 17) and no treatment group (ARM-NT, n = 13). Eight age-matched normal subjects divided into antioxidant (N-A, n = 4) or no treatment (N-NT, n = 4) groups. METHODS: ARM-A patients and N-A patients had oral supplementation of lutein, 15 mg; vitamin E, 20 mg; and nicotinamide, 18 mg, daily for 180 days, whereas ARM-NT patients and N-NT patients had no dietary supplementation during the same period. Eight of the 17 ARM-A patients took supplementation for an additional 180-day period. In all patients and normal subjects, FERG assessment was performed at the study entry (baseline) and after 180 days. Further testing was performed at 360 days for the eight ARM-A patients taking supplements and for one ARM-A patient who had discontinued supplementation after 180 days. FERGs were recorded in response to a 41-Hz sinusoidally modulated uniform field (93.5% modulation depth) presented to the macular region (18 degrees ) on a light-adapting background. In a subgroup of patients (11 ARM-A and 5 ARM-NT), whose responses had suitable signal-to-noise ratios, FERGs were also recorded at different stimulus modulation depths between 8.25% and 93.5%. MAIN OUTCOME AND MEASURES: Amplitude (in micro V) and phase (in degrees) of the FERG fundamental harmonic component. FERG modulation thresholds, estimated from the value of log modulation depth yielding a criterion response. RESULTS: At 180 days, FERGs of ARM-A patients and N-A patients were increased in amplitude (mean change, 0.11 and 0.15 log micro V, respectively, P 相似文献   

Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane

The aim of this study was to analyze macular function by measuring the sensitivity of the macula with fundus-related microperimetry and to compare the results with the best corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT) in patients with idiopathic epimacular membrane. We prospectively reviewed 66 eyes with idiopathic epimacular membrane and 35 normal healthy eyes in patients who had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The mean retinal sensitivities in the central 10° (central microperimetry, cMP-1) and in the paracentral 10–20° (paracentral microperimetry, pMP-1) areas were determined and correlated with the BCVA and OCT-measured foveal thickness. Eyes with epimacular membranes showed significantly lower log MAR BCVA (P < 0.001) and cMP-1 microperimetry sensitivity (P < 0.001) and significantly higher OCT foveal thickness (P < 0.001) than control eyes. There was a significant correlation between the BCVA and mean retinal sensitivity in the cMP-1 (r ² = 0.26, P < 0.001) and the pMP-1 (r ² = 0.07, P = 0.008) areas. A significant negative correlation was observed between the foveal thickness and the mean retinal sensitivity in the cMP-1 (r ² = 0.13, P < 0.001) area. Retinal sensitivity in the central macular area determined by MP-1 microperimetry was significantly correlated with BCVA and with foveal thickness. The combination of OCT and microperimetry may help a better evaluation of the patients with idiopathic epimacular membrane.     

Efficacy and complications of intravitreal injection of triamcinolone acetonide for refractory cystoid macular edema associated with intraocular inflammation

Purpose  To assess the effects and complications of intravitreal injection of triamcinolone acetonide (IVTA) for posterior sub-Tenon injection of triamcinolone acetonide (PSTA)-resistant cystoid macular edema (CME) with intraocular inflammation. Methods  Medical records of eight eyes of six patients with PSTA-resistant CME were retrospectively examined. Each eye received a 4-mg IVTA, and an additional injection was performed when CME recurred. Visual acuity as logarithm of the minimum angle of resolution (logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were assessed before and after each treatment. Results  CME improved in six eyes (75%) with mean visual acuity recovering from 0.56 ± 0.29 to 0.41 ± 0.195 (logMAR, P = 0.13) and mean CMT decreasing from 470 μm (range, 275–660 μm) to 297 μm (range, 150–697 μm) (P = 0.04) 2 months after the initial IVTA. CME recurred an average of 9 months (range, 5–11 months) after IVTA. A higher dose (16-mg) IVTA was effective for two eyes refractory to repeated 4-mg IVTA. IOP was elevated in two eyes (25%), of which one required filtration surgery (12.5%). In phakic eyes, cataracts progressed and necessitated surgery. Conclusions  IVTA is effective for PSTA-resistant CME with intraocular inflammation, and its efficacy might be dose dependent.     

Correlation between functional and anatomical assessments by multifocal electroretinography and optical coherence tomography in central serous chorioretinopathy

To evaluate the correlation between functional and anatomical assessments with multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in patients with acute central serous chorioretinopathy (CSC). Thirty-four eyes of 34 patients with acute CSC underwent mfERG and OCT examinations. First-order mfERG N1 and P1 response amplitudes and latencies were analyzed. OCT parameters measured included central subretinal fluid (SRF) thickness, central retinal thickness, total central foveal thickness, vertical, and horizontal diameters of SRF, and macular volume. Correlation analyses were performed between best-corrected visual acuity (BCVA), mfERG parameters, and OCT measurements. Correlation analysis showed that logMAR BCVA was significantly correlated with mfERG N1 amplitudes of rings 1 and 2 (P = 0.006), N1 latency of ring 4 (P = 0.012), and P1 latency of ring 1 (P = 0.036). No significant correlation was observed between logMAR BCVA and any of the OCT measurements. For the correlation between mfERG parameters and OCT measurements, mfERG N1 and P1 latencies of the paracentral rings were significantly correlated with the central SRF thickness (P ≤ 0.024), diameters of the SRF (P ≤ 0.018), and macular volume (P ≤ 0.030). MfERG responses but not OCT measurements correlated with logMAR BCVA in patients with acute CSC. The amount of SRF nonetheless correlated with the mfERG N1 and P1 latencies of the paracentral rings, suggesting that impairment in the conduction of electrical responses in the paracentral macula is proportional to the severity of serous macular detachment in CSC. MfERG and OCT can complement each other in the functional and anatomical assessments in CSC.     

Foveolar Choroidal Blood Flow in Idiopathic Macular Hole

Purpose: To measure choroidal blood flow from foveal region in the eyes with idiopathic macular hole. Methods: Thirteen patients with macular hole and 20 age-matched healthy subjects were included into the study. While group 1 consisted of 13 eyes of idiopathic stage 4 macular hole, seven fellow eyes of the same patients with stage 1a macular hole formed the group 2. The control group (group 3) comprised the randomly selected eye of 20 age-matched healthy subjects. Mean values of blood perfusion parameters that were composed of volume, flow and velocity, were recorded from foveal region of fundus using Heidelberg Retinal Flowmeter (HRF). The differences between the three groups were compared with unpaired t-test, Wilcoxon Signed Rank and Fisher’s Exact test using statistical package program. Results: The mean blood volume and velocity in the eyes with stage 4 macular hole (group 1) and in the eyes with stage 1a macular hole (group 2) were both significantly lower than the eyes in control eyes (group 3) ( p < 0.05, unpaired t-test). Although, the mean blood “flow” parameter of group 2 was significantly lower than group 3 ( p < 0.05, unpaired t-test), there was no statistical difference in the “flow” parameter between group 1 and group 3 ( p > 0.05, unpaired t-test). The comparison between group 1 and group 2 revealed no significant difference in any perfusion parameter ( p > 0.05, Wilcoxon Signed Rank Test). Conclusion: Although, it may be result of macular hole, not necessarily the cause of it, these findings suggest that the eyes with idiopathic macular hole are associated with reduced foveolar blood flow. The measurement of the foveolar blood flow from choriocapillaris may be useful for identifying the subjects who have increased risk of development of macular hole in future. The study showed the association of a decrease in foveolar choroidal blood flow in eyes with idiopathic macular hole using HRF. Authors suggested that quantitative measurement of foveolar choroidal blood flow may be helpful for identifying the subjects who have increased risk of development of idiopathic macular hole. This study was presented at XIII. Congress of European Society of Ophthalmology in Istanbul in June, 4, 2001.     

远视性屈光参差性弱视儿童治疗前后黄斑区视网膜厚度的临床研究

目的:探讨远视性屈光参差性弱视儿童治疗前后黄斑各分区视网膜厚度、注视性质、最佳矫正视力(BCVA)、眼轴、等效球镜度数随着治疗时间延长发生的变化。方法:前瞻性纵向对照研究试验。选取2018-08/2019-08于我院确诊前未进行过弱视治疗的4~8岁单眼弱视的远视性屈光参差患儿共计40例(中心注视20例,旁中心20例),治疗前,治疗后6、12mo均行阿托品散瞳验光、眼底黄斑注视性质、眼轴、OCT视网膜厚度检查。用统计学分析远视性弱视眼的黄斑区视网膜厚度是否随治疗发生变化以及产生影响的相关因素,不同注视性质间是否存在差异。结果:治疗前,治疗后6、12mo中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度均有差异(P<0.01),黄斑区其余视网膜厚度均无差异(P>0.05);随着治疗时间延长中心注视组和旁中心注视组的中心凹视网膜厚度、内环鼻侧视网膜厚度变薄(均P<0.05)。相同测量时间中心注视组的中心凹和内环鼻侧视网膜厚度比旁中心注视组薄(均P<0.05),黄斑区其余视网膜厚度无差异(均P>0.05)。治疗前后弱视眼的眼轴、BCVA、等效球镜度数有差异(均P<0.01);随着治疗时间延长眼轴长度增加,BCVA升高,等效球镜度数降低。远视性弱视眼黄斑各分区视网膜厚度厚于对侧正常眼,眼轴长度小于对侧正常眼(均P<0.01)。弱视眼与对侧正常眼治疗前后眼轴长度变化有差异(P<0.05),弱视眼眼轴短于对侧正常眼眼轴,随着治疗时间的延长弱视眼与对侧正常眼眼轴长度都变长。结论:中高度的弱视眼黄斑区视网膜各分区厚度均大于对侧正常眼,眼轴小于对侧正常眼。治疗后随着最佳矫正视力的提高,中心注视、旁中心注视组黄斑区中心凹和内环鼻侧的视网膜厚度均变薄。     

Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.     

Correlation of quantitative three-dimensional measurements of macular hole size with visual acuity after vitrectomy

· Objective: The purpose of the study was to study the relationship of postoperative visual outcome with anatomical parameters of macular holes using confocal scanning laser tomography and to predict the postoperative visual results. · Design: Cohort study. · Intervention and participants: We evaluated the eyes of 44 patients undergoing macular hole surgery (10 men and 34 women aged 40–76 years, mean 59.1 years). All patients showed idiopathic full-thickness stage 3 macular holes. The duration of symptoms was 1–4 months (mean 2.7 months). · Main outcome measures: The area, volume, mean depth, and maximum depth of the macular holes and the areas of cuff and retinal striae were measured using the Heidelberg Retina Tomograph preoperatively. · Results: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. Postoperative visual acuity was significantly correlated with the area (r=0.822, P<0.0001), volume (r=0.840, P<0.0001), mean depth (r=0.842, P<0.0001), and maximum depth (r=0.831, P<0.0001) of the macular holes, area of cuff (r=0.625, P<0.0001), and area of retinal striae (r=0.648, P<0.0001 ). Multiple regression analysis showed that the combination of the preoperative mean depth of macular holes and logarithm of preoperative visual acuity was the strongest predictor of the postoperative visual acuity. · Conclusions: Postoperative visual results vary significantly with the size of macular holes in patients with stage 3 macular holes of duration 1–4 months. The use of the confocal scanning laser tomography may facilitate the evaluation of macular holes before surgery. Ability to predict the postoperative visual results would be helpful in treating patients with macular holes. Received: 24 July 1998 Revised version received: 30 September 1998 Accepted: 1 October 1998     

Macular sensitivity in eyes with central serous chorioretinopathy

PURPOSE: To determine macular sensitivity and fixation characteristics in eyes with central serous chorioretinopathy (CSC) using fundus-related microperimetry. METHODS: The authors reviewed 19 eyes with serous elevation within the central 10 degrees due to CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the fundus-related microperimeter, MP-1. The bestcorrected visual acuity (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10 degrees to 20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with that of control eyes. RESULTS: Eyes with CSC showed significantly lower logMAR BCVA (p<0.001), cMP-1, and pMP-1 sensitivity than control eyes (p<0.001, p<0.01, respectively). Eyes with CSC were not significantly different in fixation location (p=1.00) or fixation stability than control eyes (p=0.45). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 17 (89%) and relatively unstable in 2 (11%). CONCLUSIONS: Eyes with CSC showed significantly lower retinal sensitivity not only at the central but also in the paracentral area. Even with decreased BCVA and retinal sensitivity, our patients showed central and stable fixation in their affected eyes.     

Stereopsis after successful surgery for rhegmatogenous retinal detachment

Background

To evaluate stereopsis after successful surgery for unilateral rhegmatogenous retinal detachment (RD), and to investigate the relationship between stereopsis and clinical factors.

Methods

In 75 patients after RD surgery and 28 age-matched normal subjects, stereopsis was measured using the Titmus Stereo Test (TST) and TNO stereotest. Clinical data were collected, including age, gender, circumferential dimension of retinal tears, area and duration of RD, macular status, surgical procedures, postoperative spherical equivalent, and logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), low-contrast visual acuity, postoperative lens status (phakia/pseudophakia), and presence of postoperative epiretinal membrane (ERM), to determine the factors related to stereopsis.

Results

Stereopsis in patients after surgery was significantly worse than normal subjects (p?<?0.0001). Stereopsis in TST was significantly correlated with the area of RD (p?<?0.005), difference of postoperative spherical equivalent between two eyes (p?<?0.05), postoperative logMAR BCVA (p?<?0.005), difference of postoperative logMAR BCVA between two eyes (p?<?0.01), and low-contrast visual acuity (p?<?0.05). Stereopsis in TNO stereotest showed significant association with postoperative logMAR BCVA (p?<?0.05). Stereopsis in both stereotests were significantly worse in patients with macula-off RD than macula-on RD (p?<?0.005, p?<?0.01 respectively). No significant relationship was found between stereopsis and other factors. Multiple regression analysis revealed that macular status (on/off) had a significant correlation with both stereopsis in TST and TNO stereotest (p?=?0.028, p?=?0.019 respectively), whereas other clinical parameters were not relevant.

Conclusions

Stereopsis is significantly deteriorated in patients after RD surgery than in normal subjects. Stereopsis was associated with the difference in refraction between two eyes, postoperative visual acuity and contrast sensitivity, and preoperative macular status.     

Retinal function following transpupillary thermotherapy for occult choroidal neovascularization in age-related macular degeneration: a short-term study by focal electroretinography

PURPOSE: To assess short-term changes in macular function after transpupillary thermotherapy (TTT) in patients with occult subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), using focal electroretinography (FERG). METHODS: Twenty-five patients with occult subfoveal CNV due to AMD were treated with TTT delivered using an infrared (810 nm) diode laser (spot size 3.0 mm, laser power 400-600 mW, duration 60 seconds). All patients were clinically evaluated before, 1 and 6 weeks after treatment. Snellen visual acuity (VA) was measured at each visit. Fluorescein angiography (FA) was performed at baseline and 6 weeks after TTT. Focal ERGs were recorded in all patients immediately before and 1 week after TTT in response to an 18-degree diameter, 41 Hz flickering spot (630 nm) centred on the fovea, presented on a steady background in Maxwellian view. A subgroup of 12 patients was also re-tested by FERG at 6-weeks post-TTT. RESULTS: No significant changes in mean FERG amplitude and phase were observed across the different recording sessions before and after TTT. One week after TTT, four patients had significant (> 2 SD from baseline variability) increases in FERG amplitude and/or phase advances, one had a decrease in amplitude and four had phase delays, compared to baseline. The remaining 15 patients had stable FERGs. Six weeks after TTT, four patients had significant increases in FERG amplitude and/or phase advances, four had decreases in amplitude and/or phase delays, and four had stable FERGs, compared to baseline. Improvement in FERG parameters after TTT was always associated with an improvement in VA and a decrease in exudation. Patients with post-TTT FERG deterioration had stable or deteriorated clinical pictures. At either 1 or 6 weeks post-TTT, the FERG amplitude increase was inversely correlated (p < 0.05) with the baseline FERG amplitude and VA. CONCLUSIONS: Three major conclusions can be drawn: in a short-term follow-up, TTT was not found to be associated with significant changes in macular function; FERG improvement was associated with VA improvement, and the increase in FERG amplitude was greatest in patients with the worst baseline acuity.