眼底荧光血管造影在1期糖尿病视网膜病变诊断中应用价值

目的 探讨糖尿病视网膜病变(DR)国际临床分类法1期病变患者眼底荧光血管造影(FFA)表现,评价FFA对早期DR的诊断价值.方法 对76例(152只眼)诊断为糖尿病视网膜病变国际临床分级标准1期病变患者进行眼底及眼底荧光血管造影检查,分析其造影表现.结果 检眼镜下152只眼眼底全部未见异常表现,FFA正常48只眼(31.58%).FFA异常104只眼(68.42%),异常表现中单纯微动脉瘤(MA)强荧光56只眼(53.84%),MA合并毛细血管扩张15只眼(14.41%),MA合并黄斑水肿5只眼(4.81%),黄斑拱环破坏3只眼(2.87%),小片状毛细血管无灌注2只眼(1.92%),窗样缺损23只眼(22.15%).结论 被诊断为DR国际临床分类法1期的患者,大部分已经出现了不同程度的FFA异常表现.因此,FFA是DR早期诊断的较好方法,能提高对DR早期诊断的准确度.

Abstract：

Objective To investigate the fundus fluorescence angiography (FFA) performance of diabetic retinopathy (DR) according to the international clinical classification of period l's patients. To evaluate the diagnostic value of FFA in early DR. Methods Fundus and fundus fluorescence angiography examination were performed and analyzed in 76 of period 1 patients (152 eyes) for the diagnosis of diabetic retinopathy according to the international clinical classification standard of. Results All 152 eyes fundus had no abnormal performance under ophthalmoscope, FFA normal 48 eyes (31.58%); FFA abnormal 104 eyes (68.42%), abnormal performance among a simple micro-aneurysms (MA), high fluorescence 56 eyes (53.84%), MA merge in telangiectasia 15 eyes (14.41%), MA merge in macular edema 5 eyes (4.81%), macular arch ring had damaged 3 eyes (2.87%), small flake with capillary nonperfusion 2 eyes (1.92%), window defect 23 eyes (22.15%).Conclusions DR is diagnosed with period 1 patients according to the international clinical classification, most of the emergence of difference degrees abnormal performance of the FFA. Therefore, FFA is the better method in early diagnosis of DR. It can increase the accurate of diagnosis for DR.     

光学相干断层扫描在光动力疗法治疗中心性渗出性脉络膜视网膜病变的应用

目的 探讨光学相干断层扫描(optical coherence tomography,OCT)对光动力疗法(photodynamic terapy PDT)治疗中心性渗出性脉络膜视网膜病变(central exudative chorioretinopathy,CEC)脉络膜新生血管(choroidal neovascularization,CNV)的临床应用价值.方法 对CEC患者45例(46只眼)进行光学相干断层扫描,荧光素眼底血管造影(fundus fluorescein angiography,FFA),吲哚青绿脉络膜血管造影(indocyanine green angiography,ICGA)检查.根据FFA,ICGA和OCT检查结果,明确CNV位置、范围和大小.PDT治疗按维替泊芬PDT治疗(VIP)研究组的方法 进行.并对其疗效进行评价.结果 光动力疗法(PDT)治疗后视力提高者13只眼,占28.26%;视力稳定不变者22只眼,占47.82%;视力下降者11只眼,占23.92%.OCT复查结果 为14只眼(3044%)黄斑水肿消失;18只眼(39.13%)黄斑水肿减轻;10只眼(21.73%)无变化;4只眼(8.7%)黄斑冰肿加重.CNV消失15只眼(32.61%),CNV缩小24只眼(52.17%),CNV无变化4只眼(8.7%),CNV增大3只眼(6.52%).治疗后视网膜厚度明显变薄(P<0.01).黄斑中心凹视网膜神经上皮层厚度与视力呈负相关(r=0.4963,P<0.01).结论 OCT可客观、精确地显示CNV的位置、大小、范围及视网膜水肿的变化程度,对指导光动力疗法(PDT)治疗中心性渗出性脉络膜视网膜病变(CEC)脉络膜新生血管(CNV)的疗效评价有着重要价值.

Abstract：

Objective To verify the applicable significance of optical coherence tomography (OCT)photodynamic therapy (PDT) for central exudative chorioretinopathy (CEC) choroidal neovascularization (CNV). Methods Forty-five cases (46 eyes) of central exudative chorioretinopathy (CEC) were managed with PDT. Before and post-treatment, all cases underwent OCT, fiuorescein angiography (FFA) and indocyanine green angiography (ICGA). PDT treatment was in accordance with the PDT verteporfin therapy (VIP) Study Group methods. Results The visual acuities of last visit were compared with those before the treatment. The visual acuity was improved in 13eyes (28.26%), unchanged in 22 eyes (47.82%), and declined in 11 eyes (23.92%). OCT was re-done and compared with OCT images before PDT treatment. The macular edema was disappeared in 14 eyes (30.44%), decreased in 18 eyes (39.13%), unchanged in 10 eyes (21.73%), and increased in 4 eyes (8.7%). CNV was disappeared or decreased in 39 eyes (84.78%), unchanged in 4 eyes (8.7%),and progressed in 3 eyes (6.52%). The retinal thickness was decreased obviously (P ＜0.001). The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r =0.4963, P =0.001). Conclusions OCT can precisely show the location, size and changes of retinal thickness and has an important significance in PDT treatment for CEC.     

脉络膜新生血管性疾病中西药治疗的多焦视网膜电图及视野观察

目的 探讨脉络膜新生血管性疾病患者在接受中西药治疗后的视功能改变,客观评价多焦视网膜电图(mfERG)及视野在脉络膜新生血管膜形成(choroidal neovasculari-zation,CNV)病程临测中的应用价值.方法 收集中山大学中山眼科中心2007年至2009年经FFA及ICGA确诊湿性型AMD、特发性CNV患者接受中西药联合治疗共14例(16只眼),于治疗前、治疗后3个月、6个月分别行视力、眼底彩照、视野、多焦视网膜电图检查,分析治疗过程中的形态学和功能改变.结果 治疗后6个月中心30°视野平均缺损(MD)、丢失变异(LV)明显下降(P<0.05),中心10°视野LV明显下降(P<0.05);治疗后6个月mfERG第3环、第5环N1波振幅密度比治疗前明显增加,其差异有统计学意义(P(3R)=0.03,P(5R)=0.021);治疗后6个月mfERG第1环、第2环P1波振幅密度比治疗前明显增加,其差异有统计学意义(P(1R)=0.012,P(2R)=0.036).结论 中西药结合治疗对CNV患者的视功能有稳定或改善的作用.

Abstract：

Objective To evaluate visual function in patients with CNV treated with Chinesemedicine combined with antioxygen, and objectively assess the value of multifocal electroretinogram and visual field in the follow-up of patient with CNV.Methods Fourteen patients (16 eyes) with CNV treated with traditional Chinese medicine combined with antioxygen were enrolled from 2007 to 2009.Their BCVA, FFA and/or ICGA, visual field and mfERG were performed at baseline and at 3 months, 6 months to evaluate the effects of the treatment.Results The mean defect (MD) and the loss variance (LV) of central 30° visual field and the LV of central 10° visual field was significantly decreased at sixth month (P <0.05); The average response density of N1 and P1 in the first and second ring were increased than baseline (P, 1st ring = 0.012; P, 2nd ring = 0.031) in the follow up of 6 months.Conclusions The visual function of patients with CNV may be stable or improved with the combined treatment of traditional Chinese medicine and antioxigen.     

中心性浆液性脉络膜视网膜病变荧光素渗漏点的自身荧光改变

目的 观察中心性浆液性脉络膜视网膜病变(CSC)患者荧光渗漏点区域的眼底自身荧光(FAF)改变特点.方法 采用海德堡视网膜血管造影仪对CSC患者67例67只眼行荧光素眼底血管造影(FFA)检查.其中,年龄≤45岁者47只眼,＞45岁者20只眼;急性CSC患者25只眼,慢性或复发性CSC 患者42只眼.使用488 nm波长激光采集FAF图像,观察荧光渗漏点区域的FAF改变特点.结果 67只眼中,FFA荧光渗漏点位置FAF无异常者35只眼,占52.2%;FAF呈点状弱荧光者16只眼,占23.9%;FAF呈小片状弱荧光或斑驳荧光者10只眼,占14.9%;FAF呈强荧光者6只眼,占9.0%.年龄≤45岁的47只眼中,FFA荧光渗漏点区域FAF无异常者26只眼,占55.3%;FAF呈点状弱荧光者11只眼,占23.4%;FAF呈小片状弱荧光或斑驳荧光者7只眼,占14.9%.FAF呈稍强荧光者3只眼,占6.3%.＞45岁的20只眼中,FFA荧光渗漏点位置FAF无异常者9只眼,占45.0%;FAF呈点状弱荧光者5只眼,占25.0%;FAF 呈片状弱荧光或斑驳荧光者3只眼,占15.0%,FAF呈强荧光者3只眼,占15.0%.急性CSC 25只眼中,FFA荧光渗漏点位置FAF无异常改变者20只眼,占80.0%;FAF呈点状弱荧光者4只眼,占16.O%FAF 呈小片状弱荧光或斑驳荧光者1只眼,占4.0%.慢性或复发性CSC 42只眼中,FFA荧光渗漏点区域无异常改变者15只眼,占35.7%;FAF呈点状弱荧光者12只眼,占28.6%;FAF呈小片状弱荧光或斑驳荧光者9只眼,占21.4%;FAF呈强荧光者6只眼,占14.3%.结论 不同年龄和病程的CSC患者FFA荧光渗漏点位置具有特征性的FAF改变.

Abstract：

Objective To investigate the characteristics of fundus autofluorescence (AF) in the leakage site of central serous chorioretinopathy (CSC). Methods Sixty-seven CSC patients (67 eyes)underwent fundus fluorescein angiography (FFA) examination with a confocal scanning angiography (HRA2). Autofluorescence was elicited by the wavelength of 488 nm. The patterns of autofluorescence corresponding to the leakage site on FFA were observed. All the enrolled patients were grouped by age (age≤45 in 47 eyes and age ＞45 in 20 eyes) and courses (acute CSC in 25 eyes and chronic or recurrent CSC in 42 eyes). the patterns of autofluorescence were analyzed respectively. Results There are 4 patterns of AF in the leakage site on FFA of CSC patients: no AF changes, punctuate hypo-AF, expanded hypo-AF or speckled AF, hyper-AF. The percentages of those patterns in all 67 eyes are 52. 2%, 23. 9% , 14. 9% and 9.0% respectively. The percentages of those patterns in the group of age ≤45 (n=47) are 55.3%,23. 4% , 14. 9% and 6. 3% respectively. The percentages of those patterns in the group of age ＞45 (n=20)are 45. 0% , 25. 0% , 15. 0% and 15. 0% respectively. The percentages of those patterns in acute CSC (n=20) are 80.0%, 16.0%, 4.0% and 0% respectively. The percentages of those patterns in chronic or recurrent CSC (n=42) are 35.7%, 28.6%, 21.4% and 14.3% respectively. Conclusion There are different patterns of fundus autofluorescence in different age and courses of CSC patients.     

AccuMaP多焦视觉诱发电位客观视野检查在黄斑疾病视功能检测中的应用

目的 探讨AccuMap多焦视觉诱发电位(mfVEP)客观视野检查在黄斑疾病视功能检测中的应用价值.方法 临床确诊为黄斑疾病的37例患者46只眼纳入研究.采用AccuMap mfVEP客观视野计检测患者半径为2.0°、5.5°、10.0°、15.5°和24.0°中心视野的平均反应振幅值.应用概率灰度图和系统自动计算出的AccuMap视野损伤严重程度指数(ASI)表示视野区域缺失情况.同时,采用MP-1微视野计检测患者半径为2.0°、4.0°、6.0°、8.0°和10.0°中心视野的平均光敏感度(MS)和半径为10.0°中心视野的平均缺失敏感度(MD).对比分析患者最小视角对数(logMAR)最佳矫正视力(BCVA)、平均反应振幅、MS、ASI及MD之间的相关性.结果 AccuMap mfVEP客观视野计检测显示,46只患眼中43只眼ASI异常,且概率灰度图上有明确的视野缺失,占93.45%;3只眼ASI正常,且概率灰度图上无视野缺失,占6.55%.半径为2.0°、5.5°、10.0°、15.5°和24.0°中心视野的平均反应振幅值分别为(120.78±52.91)、(134.31±54.67)、(149.99±52.42)、(156.69±48.30)和(157.54±45.07)nV;ASI值平均为74.26±52.43.MP-1微视野计检测显示,半径为2.0°、4.0°、6.0°、8.0°和10.0°中心视野的MS值分别为(10.97±5.91)、(12.71±5.13)、(13.71±4.53)、(14.23±4.18)、(14.48±3.86)dB;半径为10.0°中心视野的MD值为(4.49±3.07)dB.ASI、各半径中心视野的平均反应振幅与患眼logMAR BCVA间均存在明显相关性(P＜0.05).半径为2.0°、5.5°、10.0°中心视野的平均反应振幅与半径为2.0°、6.0°和10.0°中心视野的MS呈明显正相关(r=0.477,0.432,0.433;P=0.001,0.003,0.003).ASI与半径为10.0°中心视野的MD呈明显正相关(r=0.729,P=0.000).结论 AccuMap mfVEP客观视野检查能客观反映黄斑功能改变,可应用于黄斑疾病的视功能检测.

Abstract：

Objective To evaluate the value of AccuMap multifocal visual evoked potential (mfVEP) objective perimetry in measuring visual function of macular diseases. Methods Forty-six eyes (37 patients)with macular diseases were studied. The mean mfVEP amplitudes of central visual field within radius 2.0°,5.5°, 10.0°, 15.5° and 24.0°were measured by AccuMap mfVEP objective perimetry. Automatically calculated AccuMap severity index (ASI) represented the visual field defects. Meanwhile, the mean sensitivity (MS) of central visual field within radius 2. 0°, 4.0°, 6.0°, 8. 0° and 10. 0° and mean defect (MD) of central visual field within radius 10.0° were assessed by MP-1 microperimeter. The correlations among those parameters including logMAR visual acuity, mean mfVEP amplitudes, MS, ASI and MD were analyzed. Results Among 46 affected eyes, AccuMap mfVEP objective perimetry showed abnormal ASI with visual field defects in 43 eyes (93.45%), normal ASI without visual field defects in three eyes (6. 55 %). The mean mfVEP amplitudes value of the central visual field within radius of 2.0°, 5.5°, 10. 0°,15.5°and 24.0° were (120.78±52.91), (134.31±54.67), (149.99±52.42), (156.69±48.30),(157.54±45.07) nV respectively. The mean ASI value was 74. 26±52.43. MP-1 showed that the MS values of central visual field within radius 2.0°, 4.0°, 6.0°, 8. 0° and 10. 0° were (10. 97±5.91), (12. 71±5. 13), (13. 71±4. 53), (14.23±4. 18), (14.48±3. 86) dB respectively. The MD value of central visual field within radius 10° was 4.49± 3.07. There was a significant correlation among ASI, the mean mfVEPamplitudes of central visual field with every radius and logMAR best corrected visual acuity (P＜0. 05). The mean mfVEP amplitudes of central visual field within radius 2. 0°, 5. 5°, 10.0° were positively correlated with the MS of central visual field within radius 2. 0°, 6. 0°, 10.0° (r=0. 477, 0. 432, 0. 433; P=0. 001,0. 003, 0. 003). Furthermore, ASI was also correlated with MD of central visual field within radius 10.0°(r=0. 729, P = 0. 000). Conclusions AccuMap mfVEP objective perimetry can reflect the changes of macular function objectively and can be used to assess the visual function of macular diseases.     

家族性渗出性玻璃体视网膜病变的荧光素眼底血管造影特征及其诊断价值

目的 观察家族性渗出性玻璃体视网膜病变(FEVR)的荧光素眼底血管造影(FFA)特征,评价FFA对FEVR的诊断价值.方法 经临床检查诊断为FEVR的患儿34例68只眼及其父母64名128只眼纳入本研究.所有受检者均采用裂隙灯显微镜检查眼前节、间接检眼镜检查眼底.患儿同时应用RetcamⅡ视网膜成像系统检查眼底,患儿父母同时行最佳矫正视力检查.根据以上检查表现,对患儿及其父母行FEVR分期.采用RetcamⅡ视网膜成像系统在全身麻醉状态下对患儿行FFA检查;用海德堡HR2眼底血管造影设备对患儿父母行常规FFA检查.观察患儿及其父母不同分期FEVR的FFA特征.结果 患儿68只眼中,正常者3只眼,占4.41%;1期4只眼,占5.88%;2期7只眼,占10.29%;3期2只眼,占2.94%;4期8只眼,占11.76%;5期44只眼,占64.71%.患儿父母128只眼中,正常者74只眼,占57.81%;1期51只眼,占39.84%;2期1只眼,占0.78%;A;5期2只眼,占1.56%.患儿FFA检查发现,1期主要表现为视网膜血管发育不完全,未发育至周边即终止,视网膜周边无灌注.2期在1期FFA表现的基础上,在视网膜异常吻合处有新生血管形成和(或)视网膜渗出异常.3期在2期FFA表现的基础上,存在玻璃体牵引诱发的周边视网膜脱离,但未累及黄斑.4期主要表现为累及黄斑的视网膜脱离.5期主要表现为全视网膜脱离.患儿父母FFA检查发现,1期主要表现为视网膜血管近赤道部突然中止,出现周边无灌注区.2期在1期FFA表现的基础上,在视网膜无灌注区附近有动静脉短路和新生血管形成和(或)视网膜下渗漏.5期主要表现为眼球萎缩.结论 不同分期的FEVR存在不同程度的FFA特征表现;FFA检查可以发现FEVR患者的早期眼底改变,具有重要的诊断价值.

Abstract：

Objective To investigate the characteristics and diagnostic value of fundus fluorescein angiography(FFA)for familial exudative vitreoretinopathy(FEVR).Methods 34 children(68 eyes)with FEVR and 64 parents(1 28 eyes)were included.All the clients were received examinations of slit-lamp biomicroscopy and indirect ophthalmoscopy.Meanwhile the children were examined by Retcam Ⅱ,the best corrected visual acuity of parents were recorded.The children and their parents were classified according to the ocular findings.Among 68 eyes of children,3 eyes(4.41% )were normal,4 eyes(5.88% )were in stage 1,7 eyes(10.29% )were in stage 2,2 eyes(2.94% )were in stage 3,8 eyes(11.76% )were in stage 4 and 44 eyes(64.71% )were in stage 5.Among 128 eyes of parents,74 eyes(57.81% )were normal,51eyes(39.84% )were in stage 1,1 eyes(O.78% )were in stage 2 and 2 eyes(1.56% )were in stage 5.FFA was performed on the children with RetcamⅡunder anesthesia and on the parents with HR2 in order to observe the FFA characteristics in different stage.Results FFA characte ristics in children included uncompleted vascularization of the periphery,peripheral avascular zone(stage 1);neovascularization and/or peripheral subretinal and intraretinal exudation(stage 2);subtotal retinal detachment with attached foyea (stage 3);subtotal retinal detachment with detached foyea(stage 4)and total retinal detachment(stage 5).FFA characteristics in parents included abrupt cessation of the peripheral retinal capillary network and a peripheral avascular zone(stage 1); abnormal peripheral arteriovenous shunts, neovascularization or exudation(stage 2)and atrophia bulbi(stage 5).Conclusions FEVR in different stage has different FFA characteristics.FFA plays an important role in early diagnosis of FEVR.     

眼底血管样条纹临床及荧光造影表现

目的 分析眼底血管样条纹(angioidstreaks,AS)的临床特征与眼底荧光血管造影(fundus fluorescein angiography,FFA)及吲哚青绿血管造影(fundus indocyanine green Angiography,ICG)表现.方法 对7例(14只眼)血管样条纹患者行眼科常规检查,眼底照相.其中6例(12只眼)患者行FFA及ICG检查.结果 眼底表现:14只眼眼底见视盘周围血管样放射状条纹,7只眼黄斑区视网膜下出血,黄白色硬性渗出,大小不一的灰黄色病灶(50.00%),3只眼见黄斑区萎缩瘢痕灶(21.43%);FFA表现:血管样条纹10眼表现为透见荧光(83.33%),2只眼表现为中央低荧光,两侧高荧光(16.67%),7只眼在黄斑区出现脉络膜新生血管(choroidalneovascularization,CNV)的强荧光(58.33%),3只眼黄斑区萎缩瘢痕灶晚期荧光着染(25.00%);ICG表现:12只眼血管样条纹表现为早期不显影,中期呈强荧光,7只眼CNV表现为强荧光,3只眼黄斑区萎缩瘢痕灶中2只眼见边界不清斑状CNV.结论 眼底血管样条纹患者的眼底较典型,FFA及ICG能进一步明确诊断,对疾病治疗有指导意义.

Abstract：

Objective To investigate the clinical manifestations, features of fundus fluorescein angiography(FFA)and fundus indocyanine green angiography(ICG)with angioid streaks. Methods Seven patients(14 eyes)with bilateral angioid streaks were examined by the routine ophthalmological examination, FFA and ICG. Colorfundus photographs were also taken. Results Fundus findings: angioid streaks were visualized in the posterior pole of 14 eyes and the macular areas of 7 eyes,(50.00%)had subretinal hemorrhages with neovascularization. FFA: streaks were hyperfluorescent in 10 eyes(83.33%), hypofluorescentareas between hyperfluorescent edges in 2 of the 12 eyes(16.67%), hyperfluorescent were seen in choroidal neovascularization (CNV)of macular in 7 eyes(58.33%). ICG: the result of streaks in 12 eyes showed hypofluorescence at the early phase and hyperfluorescence at the late phase, hyperfluorescent were seen in CNV of macular in 7 eyes, 2 eyes presented occult CNV. Conclusion In all eyes, angioid streaks are well visualized. FFA and ICG results may contribute to the diagnosis and treatment for patients with angioid streaks.     

Characteristics of central visual field defect after macular hole surgery

AIM: To investigate the characteristics of postoperative central visual field defect (cVFD) in patients with macular hole (MH). METHODS: Eighteen eyes from 18 MH patients were involved in this retrospective study which reviewed square root of loss variance (sLV) and mean defect (MD) of the visual field test in all subjects. The relationship between cVFD and MH stage, as well as the postoperative ellipsoid zone disruption were evaluated using Spearman’s correlation test. RESULTS: Our analysis determined Spearman coefficient is 0.705 for the correlation between sLV and MH stage (P<0.01), 0.877 for the correlation between sLV and postoperative ellipsoid zone disruption (P<0.01) and 0.721 for the correlation between MD and postoperative ellipsoid zone disruption (P<0.01). A significant relationship was also detected between postoperative ellipsoid zone disruption and MH stage (r=0.470, P<0.05). Univariate regression analysis indicated that sLV and MD were associated with postoperative ellipsoid zone disruption (P<0.01, P<0.01, respectively). CONCLUSION: Postoperative cVFD is highly correlated with MH stage and postoperative ellipsoid zone disruption in patients with MH.     

The Retinal Nerve Fiber Layer Defects in Patients with Anterior Ischemic Optic Neuropathy

Purpose: To demonstrate the effects of optic nerve ischemia on retinal nerve fiber layer (RNFL) and the associated visual dysfunction.Methods: 23 patients (25 eyes) with anterior ischemic optic neuropathy (AION) underwent fundus fluorescein angiography (FFA), and then red-free light pictures were taken via SE-40 exceiter filter. All pictures were printed for RNFL analysis. Humphrey central field analysis was conducted. All data obtained from FFA and visual field defects were analysed statistically.Results: The RNFL defects and the corresponding visual field defects were presented in 23 of 25 eyes (92%). The optic disc filling defects, RNFL defects and visual field defects were found to be highly correspondent to each other. The RNFL defects were mainly the local losses of RNFL which were correspondent to the ischemic regions.Conclusion: The poor optic disc filling or ischemia can result in the RNFL defects which cause the associated visual dysfunction. Because RNFL defects are irrever-siable changes, th     

SCANNING LASER DOPPLER FLOWMETRY OF NON PERFUSED REGIONS OF THE OPTIC NERVE HEAD IN GLAUCOMATOUS PATIENTS

Purpose: To examine the reliability of scanning laser-doppler flowmetry (SLDF) in measuring capillary flow in regions of the optic nerve head which are manifested differently by con-focal tomographic angiography. Perfused and non-perfused regions of glaucomatous optic nerves and documented related altitudinal visual field defects were compared using SLDF. Methods: The optic nerve head capillary blood flow was measured in 16 eyes of 13 glaucoma patients with moderate to severe visual field defect.     

Circumpapillary optical coherence tomography angiography differences in perimetrically affected and unaffected hemispheres in primary open-angle glaucoma and the preperimetric fellow eye

Purpose:Evaluation of circumpapillary vessel density (VD) and perfusion density (PD) on optical coherence tomography angiography (OCTa) in mild-moderate glaucoma patients having unilateral visual field defects, with their fellow eyes and controls.Methods:Both eyes of 24 patients having a definitive nasal step or arcuate scotoma in one hemisphere of one eye only, and 24 controls, underwent OCTa.Results:In eyes with a superior field defect, the superior/inferior quadrant ratios, (SQ/IQ) of 3 mm scan of VD and PD were significantly higher in eyes with a superior arcuate scotoma than fellow eyes (P = 0.03,0.02) as also controls, (P = 0.004,0.001). The mean percentage loss of inferior quadrant VD between control to fellow eyes, and superior nasal step eyes were similar, 20.19%/19.57% respectively, P = 0.85, while a loss in arcuate scotoma eyes was 38.81% (P = 0.001). The percentage decrease in inferior quadrant PD in fellow eyes was 14.70%, superior nasal step 23.39%, and an arcuate scotoma 34.74% (P = 0.02). Eyes with a superior nasal step had significantly lower VD and PD absolute values in the inferior quadrant OCTa in 3 mm and 6 mm circle scan only as compared to control eyes, VD, P = 0.03,0.04/PD, P = 0.008,0.02. Fellow eyes of superior field defects had significantly lower VD and PD absolute values in the inferior quadrant in 3 mm and 6 mm circle scan as compared to control eyes, VD, P = 0.006,0.04/PD, P = 0.01,0.03. Eyes with an isolated inferior field defect in only one eye, showed a significant decrease in both VD and PD in all quadrants as compared to fellow eyes and control eyes. A significant positive correlation was found between VD and RNFL thickness in peripapillary superior unaffected quadrants in eyes with superior field defects and inferior unaffected quadrants in inferior defects (P = 0.001 and 0.01).Conclusion:There was a statistically significant increasing SQ/IQ ratio and percentage loss of vascular parameters from control to fellow eyes, those with a superior nasal step, and those with a superior arcuate scotoma. Inferior VFDs appeared to be associated with a more generalized circulatory loss. The asymmetry between hemispheres and between eyes could be used as a biomarker for early glaucomatous neuropathy.     

Patterns of visual field defects in chronic angle-closure glaucoma with different disease severity

PURPOSE: To evaluate the patterns of visual field defects in patients with chronic angle-closure glaucoma (CACG) with varying extent of optic nerve damage. DESIGN: Prospective, consecutive, observational case series. PARTICIPANTS: One hundred forty-six Asian patients with well-controlled CACG. METHODS: Visual field tests were performed using program 24-2 of the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA) with the Swedish interactive thresholding algorithm standard. One hundred ten eligible visual fields were scored with the system adopted by the Advanced Glaucoma Intervention Study and were categorized into 4 groups accordingly: mild, moderate, severe, and end-stage. Each hemifield was divided into the nasal, paracentral, and arcuate areas, and field loss that involved respective areas was defined as nasal step, paracentral scotoma, and arcuate scotoma. MAIN OUTCOME MEASURES: The distribution of field defect patterns in each group was evaluated. The mean deviation (MD) was compared among the 3 areas within one hemifield and between each pair of corresponding areas across the median raphe. RESULTS: The nasal area was the most commonly damaged area in the mild group, being noted in 52% of eyes in the superior hemifield and 58% of eyes in the inferior hemifield. In the moderate group, field loss involving both the nasal and arcuate areas dominated the superior hemifield, whereas field loss involving all three areas dominated the inferior hemifield. The MD of the nasal area was the worst among the three areas in each hemifield of the mild and moderate groups, as well as in the inferior hemifield of the severe group (all P < 0.001). There were no significant differences in the MD of each area between the superior hemifield and their inferior counterparts. However, the superior hemifield as a whole showed a better MD than the inferior hemifield (P=0.034) in the mild group. CONCLUSIONS: Visual field loss that involved the nasal area was the most common pattern in the early stage of CACG. The MD of the nasal area was worse than those of the arcuate and the paracentral areas within the same hemifield in the mild, moderate, and severe groups of CACG patients.     

非动脉炎性前部缺血性视神经病变患者眼底影像检查特征及其与视力、病程转归的关系

目的 观察非动脉炎性前部缺血性视神经病变(NAION)患者的荧光素眼底血管造影(FFA)与光相干断层扫描(OCT)检查等影像特征.探讨其与视力、病程转归的关系.方法 回顾分析47例临床确诊的NAION患者47只眼的FFA、OCT检查资料.所有患者均接受视力、眼底、视野等常规眼科检查.初诊时同时进行FFA和OCT检查.FFA及视野检查按常规方法进行;OCT检查分别选择线性和环形扫描方式,进行黄斑和视盘的扫描.其中35例NAION患者分别于发病后0.5、1、2、3、6个月时进行OCT复查.回顾分析时,以36例患者的对侧健眼作为对照组,对比分析患眼FFA、视野、视盘OCT图像特征与视力、病程转归的相互关系.结果 FFA检查结果显示,所有患眼均表现为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏,24只患眼在黄斑区出现强荧光渗漏.OCT检查结果显示,所有患眼视盘隆起,生理凹陷变窄或消失;视盘与黄斑(盘斑)之间神经上皮层组织增厚或神经上皮层隆起,下方有液性暗区.对照眼中,14只跟有正常视盘生理凹陷,22只眼无生理凹陷或较小的生理凹陷.NAION组0.5个月时黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度,视盘周围视网膜神经纤维层厚度均高于对照组,差异均有统计学意义(F＝6.51,26.12,75.49;P<0.05).2个月时盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时变薄.3个月时视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度较0.5个月时明显变薄,低于对照组,差异有统计学意义(F＝75.49,37.92;P<0.05).视野检查结果显示,下方视野缺损21例,占45.7%.OCT检查结果显示,随病程进展,视盘上方神经纤维层厚度下降的程度更明显,与视野的表现相一致.视力与黄斑中心凹处神经上皮层厚度、盘斑间神经上皮层最大厚度、视网膜神经纤维层平均厚度、视盘颞侧视网膜神经纤维层厚度呈显著负相关关系(r=-0.394,-0.424,-0.412,-0.464;P<0.05).结论 NAION患者FFA特征为早期视盘充盈迟缓,晚期视盘呈强荧光渗漏;OCT特征为随病程发展,视网膜神经上皮层增厚,神经纤维层变薄.视盘形态及视网膜神经纤维层变化的OCT检查与视野检查结果一致;患者视力与神经上皮层厚度的OCT检查结果呈负相关关系.     

Retinal nerve fiber layer thickness in nonarteritic anterior ischemic optic neuropathy: OCT characterization of the acute and resolving phases

Background To evaluate longitudinal changes in retinal nerve fiber layer (RNFL) thickness in patients with nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography (OCT). Methods Prospective, observational case series study. Sixteen eyes from 15 consecutive patients affected with NAION were analyzed. The fellow unaffected eyes served as controls. Patients were divided into three different study groups: (1) patients with visual field (VF) defect confined to the inferior hemifield (five eyes), (2) patients with diffuse VF loss (seven eyes), and (3) patients with central or centrocecal scotoma (four eyes). The main outcome was peripapillary RNFL thickness measurement by Stratus-OCT. Results In group 1, OCT demonstrated RNFL involvement limited to the temporal , superior and nasal optic disc quadrants, both in acute and athophic stages. Diffuse RNFL damage involving all quadrants around the disc was observed in group 2 patients. Group 3, by contrast, revealed RNFL atrophy limited to the superior and temporal sectors of the disc. Conclusions OCT can identify different patterns of RNFL involvement specific to different classic VF defects in eyes with NAION. Our results corroborate previous histologic findings in optic nerves affected with NAION.     

早期原发性开角型青光眼倍频视野的改变

目的　探讨早期原发性开角型青光眼(POAG)倍频视野(FDP)的表现。 方法　应用FDP的N 30全阈值程序和HFA视野计(HFA)中心 30 2全阈值程序检查早期青光眼患者 35例 37眼、进展期青光眼患者 36例 43眼、晚期青光眼患者 6例 7眼;正常人 21例 25眼作为对照组。 结果　早期青光眼的FDP主要表现为相对性旁中心暗点和 /或相对性的弓状暗点,上方弓形区(尤其是 10°~20°的视野)和鼻侧视野在青光眼早期最易受到损害。FDP显示的视野损害与HFA的基本一致,但暗点的范围更大,部分早期青光眼病例HFA显示视野正常的部位FDP也可发现局限性暗点。早期青光眼FDP的三个视野指数(FMS、FMD、FPSD)与正常人比较差异有显著性意义,FDP的FMD与HFA的MD有较好的相关性(相关系数r=0 326,P=0 026)。 结论　早期青光眼FDP的改变与HFA有较高的一致性,在POAG早期诊断中FDP可作为一种快速敏感的视功能检测方法。     

[In Press] Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes.. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (p < 0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t = 3.65, p < 0.01, R2 = 0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t = 4.32, p < 0.01, R2 = 0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

Optical coherence tomography angiography of optic disc perfusion in non-arteritic anterior ischemic optic neuropathy

AIM: To compare the optic disc blood flow of non-arteritic ischemic optic neuropathy (NAION) eyes with normal eyes. METHODS: The optic disc blood flow densities of diagnosed non-acute phase NAION eyes (21 eyes, 14 individuals) and normal eyes (19 eyes, 12 individuals) were detected via Optovue optical coherence tomography angiography (OCTA). The optic disc blood flow was measured via Image J software. Correlations between optic disc perfusion and visual function variables were assessed by linear regression analysis. RESULTS: The average percentage of the optic disc non-perfusion areas in the non-acute phase NAION patients (17.84%±6.18%) was increased, when compared to the normal control eyes (8.61%±1.65%), and the difference was statistically significant (P<0.01). Moreover, there was a proportional correlation between the visual field mean defect (MD) and the optic disc non-perfusion area percentage, and the relationship was statistically significant (t=3.65, P<0.01, R2=0.4118). In addition, the critical correlation between the best corrected visual acuity (BCVA) and the optic disc non-perfusion area percentage was statistically significant (t=4.32, P<0.01, R2=0.4957). CONCLUSION: The optic disc non-perfusion area percentages detected via OCTA in NAION eyes were significantly increased when compared with the normal eyes. Both the BCVA and MD were correlated with the optic disc flow detected, revealing that OCTA may be valuable in the diagnosis and estimation of NAION.     

双眼非动脉炎性前部缺血性视神经病变患者的临床特点和预后分析

目的：研究双眼非动脉炎性前部缺血性视神经病变(nonarteritic ischemic optic neuropathy, NAION)患者的临床特点及其预后的影响因素。

方法：回顾2006年以来我院收治的双眼发病NAION患者的临床资料,包括发病特点、治疗方法、人口统计学特征、病史、视功能指标(视力、视野)等,并对影响视功能预后的相关因素进行统计分析。

结果：研究共纳入61例(122眼)双眼NAION患者,其中男性39例,女性22例,平均年龄58.0±11.0岁,就诊时平均病程12.5mo(IQR 4.75～26.5),初诊时最佳矫正视力中位数为0.7 LogMAR(IQR 0.2～1.3)。就诊时38眼仍有不同程度视盘水肿,76眼视盘色淡或苍白。典型的视野缺损类型分别为下方近水平半盲(38眼)、鼻上方缺损(21眼)、鼻下方缺损(16眼)、上方近水平半盲(13眼),以及近管状视野(12眼)。纳入患者中31例伴有高血压、高血脂、糖尿病或其他心脑血管疾病。患者随访时间的中位数为12mo(IQR 6.0～23.5),随访期间视力中位数由0.7 LogMAR(IQR 0.2～1.3)提高至0.4 LogMAR(IQR 0.175～1.1),其中45眼(36.9%)的视力提高了2行或以上。男性患者和女性患者的视力比较,初诊时及随访后两者均无统计学差异(Z=-0.521,-1.600,P>0.05)。伴有心脑血管疾病的患者与不伴心脑血管疾病者比较,初诊时两组患者视力无统计学差异(Z=-1.103,P>0.05),但末次随访时不伴有心脑血管疾病的患者的视力明显优于伴心脑血管疾病的患者(Z=-2.090,P<0.05)。首发眼和后发病眼的末次随访视力均优于初诊视力(P=0.003,0.019),且首发眼的视力在随访期间的提高幅度高于后发病眼的视力提高幅度(分别为0.2 LogMAR及0.1 LogMAR),但差异尚无统计学意义(P=0.195)。

结论：本研究统计分析了双眼NAION患者的人口统计学特征、发病率、病史、视功能指标(视力、视野)等,现有随访数据表明,不伴心脑血管疾病的双眼NAION患者视力改善幅度优于患心脑血管疾病者,且首发眼视力预后可能优于后发病眼。但目前尚缺乏足够证据,仍需进一步研究。     

视神经炎和前段缺血性视神经病变及视乳头水肿的视野改变分析

目的:比较特发性脱髓鞘性视神经炎(idiopathic demyelinating optic neuritis,IDON)、非动脉炎性前段缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)和视乳头水肿(papilledema,PE)患者的视野变化特点,分析其发生机制。方法:回顾性病例研究。收集2011-03/2012-05期间在中国医科大学附属第四医院眼科诊治的IDON,NAION和PE患者的视野资料,记录患者的年龄、性别组成、最佳矫正视力(BCVA)、瞳孔大小、完成视野检测的时间、视野缺损的类型、部位、平均缺损(MD)和模式缺损(PSD)情况,SPSS 12.0统计软件包比较三组患者之间的差异。结果:IDON患者17例20眼,NAION患者21例26眼,PE患者11例22眼。三组患者平均年龄、性别比例、BCVA、瞳孔大小、完成视野检测的时间、视野MD和PSD的差异均具有统计学意义(P<0.05)。结论:IDON,NAION和PE患者的视野表现复杂多样,但又各有特点,这与三种疾病的发病机制密切相关,为视神经疾病的鉴别诊断提供依据。     

放射性视神经病变临床分析

目的 探讨放射性视神经病变(RON)的临床特点、影响因素、诊治方法及其转归.方法 回顾性系列病例研究.对1999年6月至2010年10月中山大学中山眼科中心收治的35例(60只眼)RON住院患者的临床资料进行回顾性分析.结果 共收集35例(61只眼)RON患者的临床资料.所有患者均以进行性、无痛性单眼或双眼视力下降为主要表现.18例(51.4％)在完成放射治疗后3年内出现眼部症状.43只眼(70.5％)的患眼入院时中心最佳矫正视力＜0.05或视野0°.可窥见眼底的52只眼中,41只眼(78.8％)视乳头边界清晰,11只眼(21.2％)视乳头水肿和(或)出血、渗出.视乳头边界清晰的41只眼中,视乳头正常6只眼(14.6％),视乳头色较淡30只眼(73.2％),视乳头苍白5只眼(12.2％).14只眼有视野检查记录,主要表现为神经纤维束损害性视野缺损,其中7只眼(50％)表现为上方和(或)下方弓形暗点,3只眼(21.4％)出现中心和(或)旁中心暗点,2只眼伴生理肓点扩大,1只眼伴旁中心暗点,1只眼见鼻上象限缺损.23只眼有视网膜荧光血管造影检查结果,主要的改变为视乳头低荧光和视网膜毛细血管无灌注区.图形视觉诱发电位检查发现,83.3％出现振幅降低和(或)潜伏期延长.分别用糖皮质激素治疗、高压氧、高压氧联合糖皮质激素、视网膜激光光凝等治疗,只有10只眼(16.4％)视力有不同程度的改善.结论 RON潜伏期变异大,造成的视力和视野损伤重,视功能预后极差,主要眼部损伤为视网膜血管闭塞和不同程度视神经萎缩.目前针对并发症的保守治疗能短期改善视力.