眼肌深層鞏膜移植治療原發性視綱膜色素變性

目的探討手術治療原發性視網膜色素變性的療效及預後.方法采用眼肌鞏膜深層移植治療該病136例(272眼).結果術後2周餘出院時視力改善者中早期10祗眼,有效率為100%;中期109祗眼,有效率為91.74%;晚期153祗眼,有效率為90.2%.有16例患者術後3個月～1年復診,視力療效穩固,視覺電生理各參數指標有不同程度的改善,與臨床療效相平行.結論手術治療原發性視網膜色素變性,可得到較好的臨床療效,并經視覺電生理檢測各參數指標變化而證實.     

視網膜色素變性患者的三種視覺電生理指標分析

目的對視網膜色素變性(RP)患者進行F-ERG、P-VEP和EOG三項聯合檢查,以分析病程和作爲建立脈絡膜側枝循環手術的術后療效跟踪的客觀對照指標.方法采用常規無創傷視覺電生理描記術,測定暗視F-ERG、P-VEP和EOG.結果受檢的66名RP患者132只眼中,F-ERG爲"熄滅型"的爲63.6%,能記録到a-波的僅占1.5%,c-波爲3.0%,能記録到b-波與負后電位的分别爲30.3%和34.1%,無一例記録到完全正常的F-ERG.完全記録不到P-VEP的占35.1%,刺激中央6°視野能記録到低幅P100波的有49.1%,而刺激周邊視野則只有17.5%能記録到P-VEP,且波形多爲异常的"W"波.絕大部分RP患者的EOG曲綫平坦,光峰與暗谷均消失,Arden比和G比值均明顯下降,說明明、暗適應機能已經顯著受損.結論 RP患者的F-ERG、P-VEP和EOG都有不同程度的特有改變.     

視網膜色素變性(RP)患者的F-ERG特徵分析

目的對RP患者F-ERG進行檢查,以分析病程和作爲眼肌深層鞏膜移植術術後療效跟踪的客觀對照指標.方法采用常規無創傷視覺電生理描記術,測定暗視F-ERG.結果受檢的210名RP患者的420祗眼中,F-ERG爲"熄滅型"的爲67.9%,能記録到ERP的占19.8%,a-波爲28.3%,c-波僅爲4.0%,能記錄到b-波舆負後電位的分别爲10.7%和7.4%.說明RP患者視網膜對閃光刺激反應的機能已經顯著受損.結論 RP患者的F-ERG有不同程度的特有改變,在眼肌深層鞏膜移植術進行治療後,再復查F-ERG時,則觀察到某些波重現,或原有波的波幅增加和峰潜伏期縮短.     

糖尿病患者白内障摘除人工晶體植入術的臨床觀察

目的評價Ⅱ型糖尿病患者白内障摘除人工晶體植入術的療效.方法對17例21眼糖尿病患者行白内障摘囊外除後房型人工晶體植入術,以122例152眼非糖尿病患者同類手術為對照組,進行術後視力及并發癥的比較.結果糖尿病組術後視力較術前明顯提高(P＜0.05),與非糖尿病組無顯著性差异(P＞0.05),術後影響視力的主要原因是糖尿病性視網膜病變,手術前後血糖無顯著性差异(P＞0.05),未發生嚴重的眼部并發癥.結論糖尿病患者血糖控制穩定,實行ECCE+I0L治療白内障可改善視力,無全身及眼部并發癥,手術安全可靠.     

Nd:YAG激光清除人工晶體前纖維膜及殘留物

目的評價NdYAG激光治療白内障術後人工晶體前膜及殘留物的臨床療效.方法回顧性總結NdYAG激光治療白内障術後人工晶體前膜及殘留物共21例21眼;激光參數單次脉衝能量0.8～3.5mJ,擊發次數11～13次.結果所有患者一次治療均使瞳孔區透明,但有2例復發;術後視力提高率100%;術前視力平均0.22±0.17,術後平均0.42±0.12,激光治療前後視力差别非常顯著(P＜0.01).主要并發癥虹膜出血、人工晶體損傷和眼壓升高,各有2例,各占9.5%.結論NdYAG激光清除白内障囊外摘除術後人工晶體前膜及殘留物安全、有效.     

高度近視患者白内障術後的眼壓燮化觀察

目的觀察高度近視患者白内障術後的眼壓變化,評價手術方式對其的影響.方法高度近視白内障患者190例,分爲ECCE和PHACO兩組,分别觀察.結果術後随訪中,ECCE組眼壓升高25例,占21.93%,開角型青光眼3例,占2.63%;PHACO組眼壓升高3例,占3.94%,可疑開角型青光眼1例.結論高度近視白内障患者術後眼壓升高存在一過性升高和青光眼發作兩種情况,超聲乳化術後眼壓升高較少.     

非穿透性小梁切除聯合透明質酸鈉生物膠植入術療效觀察

目的探討非穿透性小梁切除聯合透明質酸鈉生物膠植入術的臨床療效.方法對30例開角型青光眼行NPT,術後進行裂隙燈觀察眼内變化、測量眼壓、房角鏡檢查以及視力視野復查.結果眼壓術後第一天平均眼壓低于10mmHg;術後第一周8～11 mmHg;術後一個月平均眼壓14.2±2.8 mmHg;術後三個月平均眼壓14.6±1.4 mmHg;術後一年平均眼壓15.0±1.1mmHg(1 mmHg=0.133KPa).視力視野術後一個月後視力較術前無變化或提高,視野平均擴大5～10度.房角鏡可見小梁網後有一减壓房存在.術後并發癥少.結論 NPT,是一種對開角型青光眼理想的手術術式,術後療效礎切.     

异體組織埋藏法治療視網膜色素變性療效觀察

目的觀察异體組織埋藏法治療視網膜色素變性的近期及中遠期療效.方法隨訪26例(52眼)接受异體組織埋藏法治療視網膜色素變性患者;術前、術後12周、術後6月和術後1年分别檢查視力、視野.結果術後近期(12周)患者視力顯著提高(X2=11.02,P<0.05),術後6月患者視力無繼績提高(X2=0.31,P>0.05),術後一年患者視力亦無繼續改善(X2=0.83,P>0.05);術後近期(12周)視野較術前明顯擴大(X2=7.90,P<0.05),術後6月視野舆術後12周視野相比無明顯改善(X2=1.14,P>0.05),術後一年視野和術後12周視野相比有進步,但無統計學意義(X2=0.42,P>0.05).結論异體組織埋藏法治療視網膜色素變性近期(12周)具有肯定療效;中遠期(6～12月)療效穩定.     

白内障超聲乳化摘出及人工晶狀體植入術在高度近視白内障患者中的應用

目的觀察高度近視患者白内障超聲乳化摘出及人工晶狀體植入術的療效.方法本組高度近視白内障患者(眼軸26.05～33.87mm)62例(65衹眼),采用鞏膜隧道切口及原位超聲乳化(分而治之或攔截甓裂法)吸出,囊袋内植入硬質人工晶狀體.結果術後3天矯正視力≥0.5者29祗眼( 44.62%),0.2～0.4者31衹眼(47.69%),≤0.1者5衹眼7 69%).術後1個月矯正視力≥0 5者41祗眼(63.08%).0.2～0.4者20衹眼(30.77%),≤0.1者4衹眼(6.15%).并發癥為虹膜損傷(1.54%)、後囊破裂(3.07%)及角膜水腫(30.76%).結論白内障超聲乳化聯合後房人工晶狀體植入術適合高度近視白内障.并能獲得良好的手術效果.     

特殊類型白内障超聲乳化人工晶體植入術

目的探討葡萄膜炎并發白内障,青光眼過術後白内障,外傷後并發白内障等特殊類型白内障超聲乳化及人工晶體植入術的可行性、手術技巧及術後并發癥的預防,并評價其療效.方法對34眼特殊類型白内障施行手術,術後隨訪1～6月.觀察視力,角膜内皮細胞計數,眼壓等并發癥.結果術後1月30眼(88.23%)有不同視力提高,視力≥0.3者18眼占52.94%角膜内皮細胞密度,平均面積,最大細胞面積,術前術後均未發生顯著性差异.六棱細胞比例和變异系數發生顯著性差异.除2例角膜水腫外無其他嚴重并發癥.結論選擇好適應癥,做好必要的術前檢查,熟練掌握白内障超聲乳化技術,對特殊類型白内障患者能够做到最大限度的提高術後視力.     

视网膜色素变性患者手术治疗45名

目的:评估视网膜色素变性患者的手术疗效。方法:对45名视网膜色素变性患者90眼进行手术治疗,术前和术后分别对这些患者进行了视锐度、自动视野计和三种视觉电生理指标(F-ERG、EOG和P-VEP)的检测。结果:术后3～22月,患者的视锐度得到了明显的改善,视野显著扩大,视野缺损减低。术前在90眼中有73眼(81.1%)的暗视F-ERG为熄灭型,在术后3～22月期间进行复查时,有些曾消失的F-ERG波复现,暗视F-ERG为熄灭型的眼下降至66(73.3%)只(P <0.05, t检验),一些原来残存的F-ERG波的波幅增加,峰潜伏期也缩短。EOG曲线变得更为弯曲,某些EOG的参数(如Arden比和G比值)也明显的增加(P <0.05, t检验)。用棋盘格翻转刺激中央6о视野时能够记录到P-VEP的患者数目,在45例中由术前的22例在术后增加到31例。这45例的残存P100波的平均振幅由术前的1.007μV增加到术后的2.236μV,有显著的统计学差异(P<0.005, t检验)。结论:手术治疗RP是有效和安全的,并能改善患者的视觉和阻止RP病程的发展。     

The electro-oculographic responses to alcohol and light in a series of patients with retinitis pigmentosa

PURPOSE: Alcohol produces changes in the electro-oculogram (EOG) similar to those caused by light, but indirect evidence indicates that alcohol directly affects the retinal pigment epithelium (RPE). An investigation of the alcohol-induced increase (termed the alcohol rise in this study) in patients with disease of the photoreceptors was therefore of interest. METHODS: Standard EOGs were recorded after oral administration of alcohol in a group of patients with retinitis pigmentosa (RP). RESULTS: The average response of 17 patients to alcohol was a slow decrease of potential, which contrasts with the normal alcohol rise. In patients with considerable residual peripheral field, alcohol produced a small increase of voltage, followed by a prolonged decrease. The slower decrease in the EOG voltage was evident in patients with small fields and could be seen even in those who had lost all visual function. Light caused small increments of EOG voltage (termed light rises), again related to the field size. CONCLUSIONS: It is probable that the intracellular signaling system that causes the alcohol and light rises is lost in RP.     

视网膜色素变性眼肌深层巩膜移植术患者图形视觉诱发电位分析

目的探讨视网膜色素变性(RP)患者的P-VEP特征及对RP患者眼肌深层巩膜移植术进行治疗前、后P-VEP变化加以比较,为跟踪疗效提供客观依据。方法采用MVT-3型多功能和多导程视觉电生理仪,分别测定棋盘格翻转刺激全视野、中央6°视野,以及遮盖中央、刺激6°以外周边视野时的P-VEP。结果在202例RP患者中有110例(54.5%),用上述3种刺激方式均记录不到P-VEP。全视野刺激能诱发P100波的为92例(45.5%),刺激中央视野可记录到P-VEP的为83例(41.1%),而刺激周边视野能记录到P-VEP的仅为48例(23.8%)。全视野刺激记录到的P100波平均振幅,RP组明显低于正常组的相应值,有非常显著的统计学意义(P<0.001)。用上述3种刺激方式从RP患者记录到的P100波峰潜伏期,与正常组的相应值相比,都明显延长,且都有显著的统计学意义(P<0.01)。施行了眼肌深层巩膜移植术的RP患者中,有42例在术后3～22(平均10.9)月,来院进行了P-VEP复查,手术前刺激中央视野能记录到P-VEP的为20例(47.6%),术后复查时已增加到26例(61.9%)(配对χ2检验,χ2=4.17,P<0.05)。不仅人数增加,而且振幅也明显增大。结论眼肌深层巩膜移植术使患者视力有明显好转,P-VEP也有明显改善。因此P-VEP可以作为对RP患者进行疗效评估的客观指标之一。     

Electro-oculogram of Retinal Vein Occlusion

Twenty five cases, including 26 eyes with retinal vein occlusion (RVO) were examined by means of the electro-oculogram. The results showed that 23 of the 26 eyes suffering from RVO exhibited abnormalities of the electro-oculogram (EOG). The potential difference and Arden ratio in the RVO eyes were lower than those in the normal eyes (P<0.01). The more the visual acuity of ill eyes was decreased, the higher the abnormal rate of EOG in ill eyes was. 14 eyes had the visual acuity less than 0.1, whose EOGs were abnortmal. Six eyes had the visual acuity from 0. 2 to 0. 4, in which the EOGs of 5 eyes were abnormal. Six eyes had the visual acuity more than 0. 5, a-mong which the EOGs of 4 eyes were abnormal. Based on the above observations, it may be considered that the circulatory disturbance resulting from RVO damages not only the internal layer but also the external layer of the retina. We suggest that EOG is a useful method for distingquishing lesions caused by RVO and may reflect the functional condition     

Symptomatic and asymptomatic visual loss in patients taking vigabatrin.

PURPOSE: To investigate the clinical, perimetric, and electrophysiologic findings in patients with visual field loss on long-term treatment with the antiepileptic medication vigabatrin. DESIGN: Consecutive observational case series. PARTICIPANTS: Forty-one consecutive subjects taking vigabatrin referred for screening ophthalmologic assessment were studied. Twelve subjects with evidence of peripheral visual field constriction are presented. METHODS: Twelve subjects with evidence of peripheral visual field constriction on 60-4 perimetry underwent central 30-2 and blue-on-yellow (B/Y) perimetry, as well as electroretinography (ERG), electro-oculography (EOG), and visual-evoked potential (VEP) testing. MAIN OUTCOME MEASURES: Visual acuity; fundus abnormalities; visual field loss; and ERG, EOG, or VEP abnormalities were the main outcome measures. RESULTS: Eight of the 12 subjects with constricted visual fields were asymptomatic. The central 30-2 perimetry demonstrated bilateral visual field constriction in 9 of 12 patients and the B/Y perimetry in 8 of 9 patients tested. Of the ten patients tested electrophysiologically, four had abnormal ERGs, five had abnormal EOGs, and three had delayed VEPs. CONCLUSIONS: The incidence of visual field constriction in patients taking vigabatrin may be higher, and asymptomatic visual field loss more common, than reported previously. The authors postulate a possible Muller cell dysfunction in the peripheral retina. Patients taking vigabatrin should have regular peripheral visual field examinations.     

Correction of EOG with eye movement measured by the eye mark recorder system]

The electrooculogram (EOG) is usually necessary for the subject to fixate two targets alternately at a fixed visual angle. However, in the patients with poor vision, it can be difficult to fixate exactly. In such case, the results can be improved by using both the measurement of real eye position and the measurement of EOGs in combination. In this study, we measured subject's eye position simultaneously with the potential changes around his eyes as the subject pursued alternately two on-and-off visual targets which were horizontally placed on the cylindrical screen at a regular visual angle in front of his eyes. The EOG is obtained from those potential changes. If the difference between the target position and the fixating point can be calculated from the net eye movement measured with an eye camera, the error potential can be derived from this difference. Therefore, exact potential changes are obtained by correcting the measured potentials with the above error potentials. The authors were able to confirm that the potential changes were approximately proportional to the amplitude of saccadic eye movements within about 30 degrees in front of the eyes. Therefore, the simultaneous measurement of the potential changes and the eye position enable measurement of EOG without pursuing the targets by transforming the measured potentials into the exact values corresponding to the constant amplitudes of saccades.     

Retinopathy caused by interferon alpha associated with ribavirin therapy and the importance of the electro-oculogram: a case report

AIM: Ophthalmological complications with interferon alpha (INF-alpha) have been described since 1992: toxic retinopathy with cotton-wool spots, retinal hemorrhages, visual evoked potential (VEP) modifications and visual field abnormalities. MATERIAL AND METHOD: In 2002, a 44-year-old woman was referred complaining of visual problems. In 1986, she had been diagnosed with chronic hepatitis C and underwent INF-alpha therapy for 6 months with no ophthalmological symptoms. In 2001, she began a second course of INF-alpha therapy along with ribavirin. After 5 months, in February 2002, she developed hypothyroidism induced by INF, received levothyroxine and her treatment for the hepatitis C was stopped. One month later, in March, she complained of visual difficulties in dim light. Clinical ophthalmological examination and Goldmann visual field testing, electroretinogram (ERG) and visual evoked potentials (VEP) were normal but the electro-oculogram (EOG) showed that the light-peak-to-dark-trough ratios were very low: 148% in the right eye, 156% in the left eye. The fluorescein angiography was normal. The patient was followed up 4 months later, in June 2002 (after 5 months without INF-alpha therapy), showing a slight improvement of the EOG and no visual symptoms. Two other follow-up examinations were done in September 2002 and January 2003: the slight improvement persisted but the EOGs remain below the normal range values. DISCUSSION AND CONCLUSION: A review of the literature brought out that an EOG is not usually done in the monitoring of patients taking INF-alpha, but we decided to do this examination because of her symptoms, the first case to our knowledge in a patient taking INF-alpha. This case report underlines the necessity of an EOG on patients with INF-alpha therapy. Until now, the pathogenesis of this retinal toxicity has been poorly understood. These results show that the retinal pigmented epithelium is probably implicated at an early stage in this retinal toxicity.     

Vigabatrin: longterm follow-up of electrophysiology and visual field examinations

BACKGROUND: To report the results of repeated electrophysiological and visual field examinations in patients with vigabatrin-associated visual field loss (VGB-VFL) and the relationship between these electrophysiological findings, the cumulative dose of vigabatrin and the extent of visual field loss. METHODS: Twenty-two eyes of 11 patients with VGB-VFL were studied. All patients underwent surgery for therapy-resistant epilepsy. Repeated electro-oculograms (EOGs) and flash electroretinograms (ERGs) were made and the cumulative dose of vigabatrin and the visual field loss were recorded after a period of 37-47 months. RESULTS: The visual field loss was stable in patients who had stopped vigabatrin at the time of the first examination. There was a slight increase in VFL in patients who continued vigabatrin. During the second EOG and ERG, abnormalities in scotopic and photopic a-wave latencies and in scotopic b-wave amplitude were found in more than 50% of patients. Only b-wave latency became normal, while EOG, a-wave latency, a-wave amplitude and b-wave amplitude stayed abnormal. The amount of VFL and the cumulative dose of vigabatrin were statistically correlated with the b-wave amplitude, mainly photopic, found during the first and second examinations. CONCLUSION: After 4 years, EOG, flash ERG and visual field loss had not improved in patients with VGB-VFL. The statistically significant correlation found during the first examination between the amount of VFL and the cumulative dose of vigabatrin with the (mainly photopic) b-wave amplitude remained constant.     

Electrooculogram in central retinal vein obstruction.

The electrooculograms (EOGs) of 24 patients with central retinal vein obstruction (CRVO) were correlated with fundus appearance and with the electroretinogram (ERG) b/a wave ratio. Of the 24, 17 (70.8%) showed abnormal EOGs [light peak versus dark trough ratio (Lp/Dt) of less than 1.85]. The EOG Lp/Dt ratio was abnormal in 64.7%, although the ERG b/a ratio was within normal limits. Though the exact mechanism is still not entirely clear, the EOG became abnormal in most patients with CRVO and correlated well with the severity of the disease.