Macular electroretinograms to flicker and pattern stimulation in lamellar macular holes

Steady-state macular (9° × 9°) electroretinograms in response to either sinusoidal flicker (focal electroretinogram) or counterphased sinusoidal gratings (pattern electroretinogram) were recorded in 14 patients with inner lamellar macular holes, in 4 patients with full-thickness macular holes and in 14 age-matched controls. Fourier analysis of focal and pattern electroretinograms yielded three main components: a first and a second harmonic to flicker, and a second harmonic to pattern. Recent evidence indicates that the first harmonic to flicker is of receptoral origin, whereas the flicker and pattern second harmonics represent, at least in part, the activity of different generators in the inner retina. When compared to controls, patients with inner lamellar holes showed significant amplitude reduction and phase delay for both flicker and pattern second harmonics, but not for the flicker first harmonic. Patients with full-thickness holes showed significant amplitude reduction also for the flicker first harmonic. These results indicate a prevalent functional involvement of the inner retina in lamellar macular holes, which can be clinically detected by evaluating focal and pattern electroretinogram second harmonics.Abbreviations ILH inner lamellar hole - OLH outer lamellar hole     

Assessment of macular function by multifocal electroretinogram before and after macular hole surgery

AIM: To evaluate macular function before and after successful surgical closure of idiopathic macular holes using multifocal electroretinogram (ERG). METHODS: 40 patients (40 eyes) with idiopathic macular holes were examined using multifocal ERG both before and after vitreous surgery. The postoperative period was from 1 to 12 months. RESULTS: Preoperatively, the electrical retinal response densities in the foveal and the perifoveal area were apparently decreased. After a mean postoperative period of 3-6 months, the foveal and perifoveal area electrical retinal response densities improved to two to four times the preoperative level and the improvement continued to 1 year after surgery. CONCLUSION: In macular holes, the decrease in retinal electrophysiological response was not limited to the fovea but involved an area of the perifovea of 1.6 disc diameters. The electrical retinal response density of these areas gradually improved after macular hole closure.     

Simultaneous macular and paramacular ERGs recorded by standard techniques

A technique for the simultaneous recording of two small-field electroretinograms (ERGs), macular and paramacular, employing standard apparatuses for stimulation and analysis is described. The stimuli consisted of two adjacent checks (6 deg/side) obtained by masking the display of a commercially available TV pattern stimulator. The checks were square-wave-modulated in counterphase at 3.12 Hz. The subjects fixated the center of one of two checks. In one stimulus cycle, two ERGs could be distinguished: one from the macular area and the other from the adjacent area. The macular ERG is about twice as large as the paramacular. ERGs recorded by this technique can be considered focal since (i) they show a sharp fall-off in amplitude when the stimulus is displaced from the fovea, and (ii) they are no longer recordable when the stimulus is centered on the optic disk or on a large macular scar.     

Submicrovolt full-field cone electroretinograms: artifacts and reproducibility

The clinical utility of submicrovolt full-field 30-Hz (cone) electroretinograms was assessed by quantifying their contamination by electrical and photoelectric artifacts from xenon-flash stimulators and their test-retest variation in patients with retinitis pigmentosa. Artifacts obtained in saline with four commonly used electrodes varied with electrode type and consisted of an early, brief electrical component and a superimposed, extended photoelectric component. Techniques for minimizing these artifacts are described. Electroretinogram recordings from patients with advanced retinitis pigmentosa or congenital rod monochromatism indicate that these artifacts can be virtually eliminated with bipolar lenses. To assess test-retest variation, narrow-band-filtered responses were obtained twice during 6 weeks from patients with amplitudes less than 1 μV; threshold criteria for signficant (p<0.05) change in amplitude with this technique were approximately 0.25 log unit for each of two different systems.     

糖尿病性黄斑水肿视网膜功能定量研究

目的:应用多焦视网膜电图评估糖尿病性黄斑水肿的视网膜功能.方法:选取2010-03/2014-03我院眼科经眼底血管造影检查确诊为糖尿病性黄斑水肿的患者30例48眼为观察组(其中局限性水肿18眼,弥漫性水肿24眼,囊样水肿6眼),选取视力0.8以上,经裂隙灯显微镜检查均未发现异常,全身情况无异常者15例30眼为对照组,两组研究对象均行多焦视网膜电图检查,并对其结果进行统计学分析.结果:糖尿病性黄斑水肿组多焦视网膜电图中心凹、黄斑区、黄斑外区a、b波的振幅密度与对照组相比均差异存在统计学意义(P＜0.01);中心凹处观察组和对照组a波的振幅密度分别为25.2±10.48、37.93±7.19nv/deg2,b波的振幅密度分别为77.16±27.97、113.42±11.79nv/deg2;黄斑区观察组和对照组a波的振幅密度分别为14.27±4.99、27.42 ±2.86nv/deg2,b波的振幅密度分别为43.14±14.77、69.99±10.07 nv/deg2;黄斑外区观察组和对照组a波的振幅密度分别为7.82±2.79、11.46±1.54nv/deg2,b波的振幅密度分别为19.85±6.5、31.56±6.0nv/deg2.中心凹处、黄斑区及黄斑外区多焦视网膜电图a、b波振幅密度在局限性黄斑水肿组与弥漫性黄斑水肿组和囊样黄斑水肿组间均存在统计学意义(P＜0.01).结论:糖尿病性黄斑水肿的多焦视网膜表现为a、b波振幅密度下降,潜伏期延长,振幅密度比潜伏期敏感.     

The differential effect of optic nerve disease on pattern and focal electroretinograms

We studied nine cases of retrobulbar neuritis with confirmed multiple sclerosis and six cases of optic atrophy from other causes. Pattern and focal electroretinograms (macular ERGs) were recorded with high (400 cd/m²) and low (40 cd/m²) intensity stimuli. Contrast sensitivity was also measured with a simple printed test.Luminance was not markedly important. High spatial frequency contrast sensitivity was significantly correlated with pattern ERG amplitude. Pattern and focal ERG amplitude ratio was usually reduced, but the effect was not correlated with contrast sensitivity or large enough to be useful clinically.In optic atrophy the pattern ERG (PERG) was clearly more severely reduced than the focal ERG (FERG). In retrobulbar neuritis both ERGs were equally and more severely reduced even though the visual losses were less. In unilateral cases the PERG increased then decreased after the initial attack, as previously described (Arden et al., 1982). The results suggest that retinal layers beyond the ganglion cells may be affected in retrobulbar neuritis, but proximally generated, pattern-specific ERG components are selectively lost in optic atrophy.     

玻璃体腔注射雷珠单抗联合激光治疗视网膜黄斑分支静脉阻塞继发黄斑水肿

目的：观察玻璃体腔注射雷珠单抗联合激光治疗视网膜黄斑分支静脉阻塞( MBRVO)继发黄斑水肿的临床疗效。
　　方法：回顾性研究。临床确诊为MBRVO继发黄斑水肿的患者33例33眼纳入研究。玻璃体腔注射10 mg/mL雷珠单抗0.05mL(含雷珠单抗0.5mg)。治疗后每月复查,复查时发现视力下降和OCT检查发现黄斑水肿复发者再次重复注射雷珠单抗。复查发现出血明显吸收及OCT复查发现黄斑水肿明显消退者,在原水肿部位进行视网膜光凝。观察治疗前与治疗后6 mo最佳矫正视力、黄斑中心凹视网膜厚度( central macular thickness,CMT)、多焦视网膜电生理检查P1波的振幅密度及潜伏期的变化。
　　结果：治疗前BCVA经LogMAR转换后为0.68±0.35,治疗后6mo为0.34±0.23,与治疗前相比差异有统计学意义(P<0.01)。其中,21眼(64%)BCVA提高2行及以上者,9眼(27%)维持于就诊时水平,无视力下降者。治疗前平均CMT 为487.30±63.58μm,治疗后6mo CMT 降为238.84±52.66μm,与治疗前相比差异有统计学意义( P<0.01)。治疗后6 mo患者1环、2环、3环的P1波振幅密度均有提高,与治疗前相比差异均有统计学意义( P<0.01);治疗后6 mo患者1环、2环、3环的P1波潜伏期均有缩短,与治疗前相比差异均有统计学意义( P<0.05)。玻璃体腔注射后2眼出现结膜下出血。
　　结论：雷珠单抗联合局部视网膜光凝治疗视网膜黄斑分支静脉阻塞继发黄斑水肿可有效减轻黄斑水肿,显著提高患者视力,改善视功能。     

视网膜血管瘤样增生和湿性年龄相关性黄斑病变的鉴别

视网膜血管瘤样增生(retinal angiomatous proliferation,RAP)是湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)的一种特殊类型,临床一般分三期,晚期有新生血管形成,但与起源于脉络膜的新生血管不同,多数学者认为RAP的新生血管起源于视网膜深层毛细血管网。目前对RAP和湿性AMD两者到底是同一种疾病的不同亚型还是独立的两种疾病还存在争议,由于两者的病程、预后及治疗存在差异,因此临床鉴别诊断十分重要。近年来,随着吲哚菁绿血管造影(indocyanine green angiography,ICGA)技术和新一代光学相干断层扫描(optical coherence tomography,OCT)技术的应用,对RAP和湿性AMD的鉴别取得了显著进步。本文就两者的临床表现、自然病程、治疗方法及预后等方面做一综述。     

Focal macular photopic negative response in patients with optic neuritis

Purpose

To investigate, by focal macular electroretinography (ERG), the change of photopic negative response (PhNR) in the recovery of visual function in patients with optic neuritis.

Methods

Focal macular ERG was recorded from nine patients with acute optic neuritis (38.6±10.2 years). The photostimulator device projected 15° visual angle spotlight onto the macula. Focal macular ERG recording was performed at the onset and at 1 month and 6 months after the onset of optic neuritis. The results were compared between each recording for seven of the patients.

Results

All patients decreased in the vision below 20/100 and had central scotoma. Vision improved more than 20/20 within 1 month and full-visual field recovered within 6 months after the onset in all patients. The amplitude of the a-wave, b-wave, and PhNR of focal macular ERG at the onset was significantly attenuated in eyes with optic neuritis (66.8±15.5, 65.8±17.7, and 65.2±14.4% of normal control, respectively). The amplitude of the a-wave and b-wave increased gradually after steroid pulse therapy. The increase in a-wave amplitude was significant at 6 months (P=0.046), whereas the PhNR amplitude did not show any significant change over 6 months after the onset of optic neuritis.

Conclusions

Our results suggest that inflammation at the onset of optic neuritis leads to functional deficits that extend to at least the inner nuclear layers of the retina, and that all but the ganglion cell layers of retina recover.     

The local cone and rod system function in early age-related macular degeneration

To compare cone and rod system function in patients with early age- related macular degeneration (ARMD) and control group using multifocal electroretinogram (MERG) and perimetry, to investigate whether there is rod system dysfunction in the central retina in ARMD. Cone-mediated MERG, photopic sensitivity, rod-mediated MERG, and scotopic sensitivity in 16 eyes of control subjects and 24 eyes of early dry-form ARMD were measured with VERIS Science ^TM 4.0 and Octopus 101 perimetry. The latencies and average response densities of the summed responses and five ring retinal regions, average sensitivity of all locus and eight ring retinal regions in control eyes were compared with those in ARMD. Mean scotopic and photopic sensitivity of ARMD patients were significantly lower than that of normal controls. Sotopic sensitivity reduced more than photopic sensitivity and the greatest deficit was 2.5–5.0°. The amplitudes of N₁ and P₁ wave in one ring (5.0°) of rod MERG were significantly lower of ARMD patients than that of normal subjects. Our results suggest that rod function decreased and the parafoveal rod cells were predominantly damaged in ARMD. The rod function testing in macula may be a useful tool to diagnose and measure the fundus dysfunction of ARMD.     

Simultaneous foveal and parafoveal electroretinograms in hereditary degeneration of the central retina

Simultaneous foveal and parafoveal electroretinograms (ERG) in response to two identical checks (6 degrees per side) alternating at constant mean luminance were recorded in 26 patients (52 eyes) affected by central hereditary chorioretinal diseases and in 14 age-matched normal subjects (14 eyes). Patients were divided into four groups according to clinical diagnoses: 1. Stargardt's disease; 2. cone dystrophy; 3. vitelliform degeneration; 4. pattern dystrophy. The amplitude and latency of the foveal ERG and the amplitude ratio between foveal and parafoveal ERG (FPF ratio) were measured. The mean foveal ERG amplitude was significantly lower than the control mean in all patient groups. The foveal ERG latency showed a trend to a increase in all pathological groups. However, this difference was not statistically significant. The mean value of FPF ratio was significantly reduced as compared with the control mean in Stargardt's disease and cone dystrophy only. In 46 of 52 affected eyes (88.5%) at least one of the electrophysiological parameters was abnormal. Our results suggest that the simultaneous foveal and parafoveal ERG recording may be a sensitive technique in hereditary degenerations of the central retina. This method may also contribute to a better understanding of cone degeneration pathophysiology.     

视杆细胞多焦视网膜电图记录条件及其敏感性研究

目的 :研究记录视杆细胞多焦视网膜电图 (multi focalelectroretinogram ,mfERG)的可行性 ,探讨临床检测的合适条件并研究其敏感性。方法 :受检者暗适应后用低强度光刺激记录mfERG ,刺激图形为等大六边形 ,蓝色刺激光(W4 7b) ,在同一区域连续两次刺激之间插入空白帧。改变m序列的长短、通频带、刺激强度、刺激频率以及背景光强度以获得最佳的临床检测条件。采用刺激屏幕多部位同时遮盖和刺激单元不给予刺激的方法 ,制造不同位置和大小的实验性暗点以检测视杆细胞mfERG敏感性。结果 :视杆细胞mfERG可以清晰、稳定地被记录 ,其波形由潜伏期短、振幅很收稿日期 :2 0 0 3 -0 9-2 3 ;修回日期 :2 0 0 3 -11-2 2作者简介 :陈长征 ( 1972 -) ,湖北洪湖人 ,医生博士 ,主治医师 ,研究方向 :视网膜疾病和视觉电生理 ,现在名古屋大学医学部做访问学者。E -mail:antony712 7@sina.com小的负相波和潜伏期长、振幅较大的正相波组成 ,正相波为双峰 ,正相波的时程、波形与全视野视杆细胞ERG相似。增加刺激频率、降低刺激光强度、减小刺激元素的大小、增加背景光的强度都可降低局部反应的振幅。视杆细胞mfERG可以发现一个刺激单元大小的实验性暗点 ,其敏感性与暗点相对于刺激单元的位置相关。结论 :视杆细胞mfERG能清晰地     

糖尿病性黄斑水肿激光治疗前后视网膜功能的定量研究

目的：探讨激光光凝对糖尿病黄斑水肿患者视网膜功能的影响。
　　方法：连续选取2010-03/2014-03我院眼科经眼底血管造影检查确诊为糖尿病性黄斑水肿行黄斑格栅光凝的患者19例30眼,于治疗前及黄斑格栅光凝治疗后3 mo均行多焦视网膜电图检查,并对其结果进行统计学分析。
　　结果：激光治疗后中心凹处 a、b 波振幅密度升高,与治疗前相比存在统计学差异( t=-3.7683, P<0.01;t=-3.6570,P<0.01);激光治疗前后a、b波潜伏期无统计学差异(t=1.7103,P>0.05;t=1.5623,P>0.05)。激光治疗后黄斑区a、b波振幅密度均升高,与治疗前相比存在统计学差异(t=4.8337,P<0.01;t=-2.0376,P<0.05);激光治疗后黄斑区a、b波潜伏期均延长,与治疗前相比均存在统计学差异( t=-2.1892, P<0.05;t=-3.5024, P<0.01)。激光治疗前后黄斑外区a、b波振幅密度均无统计学差异(t=-1.4387,P>0.05;t=-0.1766,P>0.05);激光治疗后黄斑外区a、b波潜伏期均延长,与治疗前相比均存在统计学差异(t=-2.0905,P<0.05;t=-2.5646,P<0.05 ) 。
　　结论：激光光凝治疗改善了中心凹处视网膜的功能,有益于视力的改善,但激光光凝治疗糖尿病性黄斑水肿对黄斑区和黄斑外区视网膜的功能有广泛的破坏作用。     

An Analysis of Metabolic Changes in the Retina and Retinal Pigment Epithelium of Aging Mice

PurposeThe purpose of this study was to present our hypothesis that aging alters metabolic function in ocular tissues. We tested the hypothesis by measuring metabolism in aged murine tissues alongside retinal responses to light.MethodsScotopic and photopic electroretinogram (ERG) responses in young (3–6 months) and aged (23–26 months) C57Bl/6J mice were recorded. Metabolic flux in retina and eyecup explants was quantified using U-¹³C-glucose or U-¹³C-glutamine with gas chromatography-mass spectrometry (GC-MS), O₂ consumption rate (OCR) in a perifusion apparatus, and quantifying adenosine triphosphatase (ATP) with a bioluminescence assay.ResultsScotopic and photopic ERG responses were reduced in aged mice. Glucose metabolism, glutamine metabolism, OCR, and ATP pools in retinal explants were mostly unaffected in aged mice. In eyecups, glutamine usage in the Krebs Cycle decreased while glucose metabolism, OCR, and ATP pools remained stable.ConclusionsOur examination of metabolism showed negligible impact of age on retina and an impairment of glutamine anaplerosis in eyecups. The metabolic stability of these tissues ex vivo suggests age-related metabolic alterations may not be intrinsic. Future experiments should focus on determining whether external factors including nutrient supply, oxygen availability, or structural changes influence ocular metabolism in vivo.     

Aging macular degeneration. Clinical features of treatable disease

Argon laser treatment reduces visual loss in patients with aged macular degeneration and extrafoveal subretinal neovascular membranes (SRNVM). Ophthalmologists must now educate patients concerning the symptoms of subretinal neovascularization and give them an Amsler grid. If a patient develops symptoms he should be examined promptly. High quality fluorescein angiograms and meticulous contact lens examinations of the macula should be performed to detect subtle neovascularization. Ophthalmologists must be familiar with the clinical and fluorescein angiographic changes of drusen, retinal pigment epithelial atrophy, and retinal pigment epithelial detachments in order to differentiate them from subretinal neovascular membranes.     

Macular electroretinograms and contrast sensitivity as sensitive detectors of early maculopathy

Eighteen patients with early maculopathies of various etiologies were tested with pattern and focal electroretinograms (macular ERGs), with high (400 cd/M²) and moderate (40 cd/M²) stimulus intensities and a four-alternative forced choice (4AFC) contrast sensitivity test in addition to intensive clinical examinations.High spatial frequency contrast sensitivity loss on the 4AFC test was the most striking and consistent feature of all cases. The only eyes not outside normal contrast sensitivity limits were three in which diagnosis was uncertain and the patients had not recognized any problem, including two marginal solar burns. Maculopathy also substantially reduced macular ERG amplitides. Criterion scores on these tests separated patients from normals more effectively than other noninvasive procedures and only missed one eye detected by contrast sensitivity. Latencies were affected but the delays were of no clinical significance in the individual case. Stimulus intensity was not critical.The results indicate that contrast sensitivity testing and macular ERGs are very reliable indices of central visual dysfunction at a stage when visible macular changes are too subtle for confident diagnosis. Contrast sensitivity has appeal because of its reliability, objectivity, simplicity, and noninvasive nature. It is equally applicable to children and adults. Pattern and focal ERGs can establish that the visual deficit has a retinal origin and can provide the most reliable objective confirmation.     

Fixation stability and reading speed in patients with newly developed macular disease.

BACKGROUND: Patients with macular disease and central scotomas must use a peripheral, preferred retinal locus (PRL) in place of their damaged fovea. This paper investigates the development of the PRL, with particular reference to the stability of fixation. METHODS: Twenty-five patients with age-related and juvenile macular disease were recruited. All patients had developed a scotoma in their better eye within the previous 2 weeks. Patients were assessed using a scanning laser ophthalmoscope and an infra-red gazetracker on four further occasions over the next 12 months. RESULTS: A linear relationship exists between reading speed and fixation stability for patients and control subjects. Fixation stability was not related to scotoma size, visual acuity or contrast sensitivity. Changes in fixation stability account for 54% of the variance in change in reading speed over the course of this study. CONCLUSIONS: The deficit in reading speed in patients with macular disease can be partially attributed to impairments in fixation stability.     

视网膜中央静脉阻塞性黄斑水肿的OCT与ERG的对比分析

目的：观察视网膜中央静脉阻塞性黄斑水肿的黄斑区视网膜厚度与视网膜电图( electroretinogram, ERG )各项参数(Cone-a,Cone-b和30Hz)变化的关系。
　　方法：随机选择视网膜中央静脉阻塞患者25例25眼及25只对侧眼分别行明视闪光视网膜电图及光学相干断层扫描( optical coherence tomography,OCT)检查,明视闪光视网膜电图检查测各项参数的振幅和潜伏期, OCT测量黄斑区九部分的视网膜厚度,分析黄斑区形态参数与明视闪光视网膜电图各参数变化之间的关系。
　　结果：黄斑区除颞侧外七个部位视网膜厚度与 ERG 的Cone-b和30 Hz潜伏期相关。
　　结论：研究发现视网膜中央静脉阻塞患者的黄斑区视网膜厚度与内层视网膜功能密切相关。     

视网膜静脉阻塞黄斑水肿的多焦视网膜电图与光学相干断层扫描分析

目的 探讨视网膜静脉阻塞(retinal vein occlusion,RVO)继发黄斑水肿(macular edema,ME)患者多焦视网膜电图(muhifocal electroretinogram,mf-ERG)和光学相干断层扫描(optical coherence tomography,OCT)的特征.方法 对38例(38眼)确诊为RVO继发ME患者进行mf-ERG及OCT检查,选取同期门诊中正常人23例(23眼)作为正常对照组.OCT用于测量直径1.0 mm黄斑中心圆形区的黄斑视网膜厚度(macular retinal thickness,CMT),mf-ERG评价黄斑部视网膜功能,并分析环1～环5中P1波振幅密度及P1、N1波潜伏期变化.结果 与正常对照组比较,BRVO组:P1波振幅密度在环2(35.95±17.04) nV·deg-2,环3(24.72±8.32)nV-deg-2,环4(19.28±6.38)nV-deg-2,环5(13.49 ±6.16)nV·deg-2显著下降(均为P ＜0.05);P1波潜伏期在环2(35.74±3.72)ms有明显延迟(P＜0.05);N1波潜伏期在环2(18.43±4.63) ms、环3(18.67±2.86) ms有明显延迟(均为P＜0.05).与正常对照组比较,CRVO组:P1波振幅密度在环1(81.58±43.15) nV·deg-、环2(33.71±9.81)nV·deg-2、环3(22.15 ±9.75)nV·deg-2、环4(16.65 ±6.38)nV·deg-2、环5(14.18±4.59)nV ·deg-2显著下降(均为P＜0.05);P1波潜伏期在环2(37.56±5.55)ms、环3(37.31 ±5.22)ms、环4(35.71±5.63)ms、环5(37.30 ±5.37)ms有明显延迟(均为P＜0.05);N1波潜伏期在环1(21.82±5.76) ms、环2(19.18 ±4.82)ms、环3(19.31±4.25) ms、环4(19.05±4.55) ms、环5(19.43±4.12)ms有明显延迟(均为P＜0.05).CRVO组CMT与mf-ERG环1中P1振幅密度呈负相关(r=-0.576,P＜0.05).结论 OCT与mf-ERG相结合能更好地反映RVO继发ME患者的黄斑部视网膜形态与功能变化.