老年性黄斑变性的早期诊断-Octopus自动视野计黄斑阈值临床价值的探讨

目的用Octopus-123视野计黄斑阈值程序检测早期AMD黄斑10°光敏感度,并讨论其对AMD早期诊断的临床价值.方法对早期AMD患者68眼,正常对照40眼分别检测了中央10°范围视网膜光敏度、Amsler表和FFA检查.结果早期AMD病人与正常对照组比较MLS有明显差异性.早期AMD病人MLS降低阳性率为50.77%,Amsler表检查阳性率为20%,FFA检查异常为35%.结论Octopus自动视野计黄斑阈值检查优于Amsler表中心视野检查及FFA检查,可为AMD的早期诊断提供有效的方法.     

可疑早期老年性黄斑变性黄斑光阈值短期波动的研究

目的 研究Octopus-123视野计对视力正常的可疑早期老年性黄斑变性(age-related macular degeneration,AMD)光阈值短期波动(short-term fluctuation,SF)的检测意义。 方法 对可疑早期AMD患者51例66只眼，正常对照32人40只眼，进行黄斑光阈值SF、Amsler表和中心视力的检测。 结果 可疑早期AMD患者与正常对照组的SF比较差异有显著性的意义，且较中心视力及Amsler表检查更为敏感。SF与玻璃膜疣的数量、部位和性质有关。 结论 部分中心视力正常、眼底有玻璃膜疣的可疑早期AMD，视功能已发生改变。 (中华眼底病杂志, 2002, 119-120)     

Humphrey视野分析仪在老年性黄斑变性黄斑中心6°视网膜光敏度的研究

采用Humphrey视野分析仪黄斑阈值程序测定了104例老年性黄斑变性(AMD)患者,65例正常人作为对照组。结果显示病人的黄斑光敏度(MLS)较正常对照组明显降低,湿性较干性患者降低显著,Amsler表检查异常的下降明显,MLS与视力相关。认为该仪器在AMD诊断中有重要作用。     

早期老年黄斑变性黄斑光敏度与Amsler表检查

Amsler表用于测定固视中心10°的视野,很多作者用来发现老年黄斑变性(SMD)的视网膜下新生血管膜(NVMS),并用于SMD的早期视功能监测,认为Amsler表在SMD的早期诊断具有一定价值。Fine等指出对已行光凝治疗的视网膜下NVMS形成的患者,为了早期发现复发,可用Am-sler表每日监测中心视野。本文对103例(121眼)早期SMD及晚期SMD患者采用Humphrey视野分析仪黄斑阈值测定,比较黄斑光敏度与Amsler表检查的关系。     

老年性黄斑变性的黄斑色阈值

老年性黄斑变性(Aging Macular Degeneration或Age-related Macular Degeneration简称AMD)是近来50岁以上老年人严重性致盲性疾病,由于其发病率逐渐增高,目前已为国内外所关注,早期发现AMD中心凹以外新生血管膜,可用氩激光治疗。因此早期诊断AMD甚为重要。研究表明,AMD早期视力虽然正常,但FM_(100)色彩分辩力,对比敏感度及眼电生理已有异常,视网膜敏感性降低。AMD早期眼底特征是黄斑区出现玻璃膜疣(drusen),虽然大多作者认为drusen是AMD发病的危险因素,但早期AMD的drusen与色觉功能改变尚缺乏研究,本文采用Humphrey视野分析仪黄斑色阈值程序,对65例视力正常,眼底有drusen的早期AMD病人进行检测,以探讨早期AMD颜色明度敏感性的改变及与drusen的关系,并评价黄斑色阈值在AMD早期诊断中的价值。     

早期老年黄斑变性玻璃疣变化的随访观察

目的 :探讨高危因素的黄斑drusen与AMD发生的关系。方法 :对视力正常 ,黄斑有drusen的早期AMD患者 3 2例 5 0眼进行了五年的视力 ,眼底检查 ,黄斑光阈值视野检查 ,莹光眼底血管造影随访观察。结果 :在平均随访 60个月后 ,视力由随访前的平均 1 0下降为 0 78,黄斑区 10°内的平均光敏度检查 3 0眼由随访前的 2 8 3±4 5dB下降为 2 5 1dB± 6 1dB ,眼底镜下检查发现黄斑drusen不断增加 18眼 ( 3 6% ) ,不断融合增大 12眼 ( 2 4% ) ,变为软性疣7眼 ( 14 % ) ,地图状萎缩 5眼 ( 10 % ) ,无变化 8眼 ( 16% ) ,眼底荧光血管造影检 3 6眼查发现drusen位于黄斑中心凹外的 2 6眼 ( 72 % ) ,随访中观察到 2 3眼 ( 88% )有快慢不一的发展 ,无明显改变 3眼 ( 12 % ) ,drusen位于黄斑中心凹的 10眼 ( 2 7% ) ,随访中观察到有改变 8眼 ( 80 % )。结论 :对黄斑drusen的动态观察 ,有助于我们对AMD病变发展及演变过程的认识。     

老年性黄斑变性的黄斑区密集点矩阵视野

目的：应用黄斑区密集点矩阵视野（dense matrix mapping in macula,DMMM）探讨老年性黄斑变性（age-related macular degeneration,AMD）功能变化及评价其在AMD早期诊断中的应用价值。 方法：用Humphrey-640视野计自行设计DMMM检测正常对照组16人24只眼，AMD干性组51例71只眼，湿性组23例27只眼。 结果：①黄斑区2.5°内DMMM各组平均光敏感度阈值（mean light sensitivity,MLS）:AMD干性组33.30±2.49，湿性组20.67±8.30,正常老年人组35.61±1.37，组间t检验均有高度显著差异。②黄斑区5°内MLS:AMD干性组32.95±1.82，湿性组22.11±7.74，正常老年人组34.93±1.46，组间t检验，均有高度显著差异。 结论：AMD干性组早期便有DMMM的MLS改变。DMMM评价AMD视功能早期改变的敏感性较高。 （中华眼底病杂志，1996，12：217-219）     

老年性黄斑变性的视功能评估方法

老年性黄斑变性(AMD)视功能评估包括远近视力、Amsler表、微视野、对比敏感度、视觉电生理检查以及调查问卷等.其中,早期治疗糖尿病视网膜病变研究组视力表、微视野计分别为远视力、视野检查的金标准;Amsler表检查简单廉价,常用于AMD的病情自我监测;多焦视网膜电图检查对测量环境、患者的注视性质和配合程度要求高;调查问卷反映AMD患者日常生活视功能的真实情况.根据各种评估方法的优缺点,合理选择多项评估方法联合应用,能更全面反映AMD病程变化和治疗干预结果,对提高AMD的临床诊断治疗水平具有重要的临床意义.     

弱视儿童黄斑阈值测定

目的　通过对弱视儿童中心视野 3°以内黄斑阈值的测定 ,观察弱视儿童黄斑区视野改变 ,为进一步研究弱视提供可靠的临床依据。方法　采用美国 Humphrey公司制造的全自动视野分析仪 75 0 - 型对 32名弱视儿童进行中心视野 3°以内黄斑阈值测定 ,对通过可信性指标的 2 9人进行分析 ,其中有 14人同时检测图形 VEP加以对照。结果　 47只弱视眼有 41只眼黄斑阈值降低 ,且弱视程度越重 ,黄斑阈值降低的范围越大。结论　黄斑阈值的测定较其他弱视诊断手段更为敏感 ,可作为研究弱视、诊断弱视及评判弱视治疗效果的可靠指标。     

老年性黄斑变性视网膜敏感性与眼底血管荧光造影的关系

本文对64例(82眼)早期老年性黄斑变性(早期AMD)及46例(46眼)AMD病人进行了黄斑阈值与眼底血管荧光造影(FFA)比较。结果显示,视网膜敏感性的降低与AMD 的病变类型和FFA 改变有关,湿性比干性AMD 的局部视网膜区敏感性损害显著;中心凹及傍中心凹区玻璃疣较无玻璃疣组的视网膜敏感性降低显著;而视网膜有AMD 晚期眼底改变的敏感性降低更为显著。     

微视野计对糖尿病性黄斑水肿患者的视功能评估

目的 采用微视野检测对糖尿病性黄斑水肿(DME)患者视功能进行评估,并探讨微视野检测指标与视力之间的相关性.设计 回顾性病例系列.研究对象 2016年4月至2018年1月在中国人民解放军武汉总医院确诊为DME的患者164例(220眼).方法 患者均行最佳矫正视力(BCVA)检查(统计时结果转换为最小分辨角对数(logM...     

Characteristics of the macular microvasculature

The morphological appearance and the quantitative analysis of the structure of the macular microvasculature were investigated in 33 normal subjects by fluorescein angiography and stereoscopic mapping techniques. The foveal capillary network was formed by the anastomosis of 4 to 6 groups of terminal arteriolar and venous branches. The inner three rings of capillaries were a single layer of microangium. The apertures of the network differed in size and the closer to the foveal avascular zone, the larger were the apertures. The mean inner width of the capillaries in the fovea was 12.99 +/- 2.2 (SD) microns, and it was 24.55 +/- 6.51 microns on the edge of the fovea. There was a strikingly regular pattern of 4 to 6 arterioles with associated venules. The inner diameter of the smaller vessels on the edge of this area was 35.17 +/- 6.41 microns. In the external perifovea, the arterial and venous branches increased in number to more than 12 and the diameter of these vessels was 4.5 times larger than that of the capillaries in the fovea. The characteristics of the macular microcirculation provide a basis for studying macular disease, particularly the pathogenesis of vascular disorders.     

黄斑囊样水肿患者白发荧光与黄斑色素密度的关系

目的探讨黄斑囊样水肿（CME）眼底自发荧光与黄斑色素密度的相关性,以提供对其预后有临床价值的技术参数。设计回顾性病例系列。研究对象2009年8月至2010年7月于北京同仁医院确诊CME的视网膜中央静脉阻塞、视网膜分支静脉阻塞及糖尿病视网膜病变的患者18例（24眼）。24只正常眼选自年龄及性别相匹配者。方法对所有患眼及正常对照眼行彩色眼底照相、荧光素眼底血管造影（FFA）及相干光断层扫描（OCT）确诊CME。采用海德堡公司HRA一2共焦激光扫描系统的IR（infrared）及FA（不注入荧光素钠）模式进行眼底自发荧光及黄斑色素密度的检测。黄斑色素密度按Zhang等分期法分为完整的黄斑色素、部分黄斑色素及黄斑色素缺失三级。采用MonteCarlo精确检验说明不同分级的黄斑色素密度与自发荧光的相关性,线性相关卡方检验分析两个变量之间的变化趋势。主要指标眼底自发荧光的分布及形态、黄斑色素的分布及密度。结果24只CME眼自发荧光均为阳性（100％）,并在黄斑区呈花瓣样表现,而正常对照眼的黄斑自发荧光均为阴性。CME眼中黄斑色素缺失22眼（91．7％）,部分黄斑色素2眼（8．3％）;正常对照眼黄斑色素密度均为完整的黄斑色素（100％）。黄斑色素密度与自发荧光的出现在本次研究中呈现负相关（x2=45．123,P=0．0001）。结论CME患者中黄斑色素密度大小与黄斑区自发荧光呈负相关,黄斑区自发荧光可做为其随诊的临床评价指标。     

Contribution to the investigation macular function for the surgical treatment of idiopathic macular holes

We evaluate annual anatomical and functional results of standard 20G pars plana vitrectomy for idiopathic macular hole, with peeling MLI (membrana limitans interna) and instillation of gas tamponade (20% SF6 - sulfur hexafluoride). The observed group consisted of 32 eyes of 32 patients (3 men and 29 women), mean age 69 years (range 59-76). There was no other ocular pathology besides idiopathic macular holes (IMD). Objectification of ocular anatomy was done with: anterior segment slit lamp, the biomicroscopy in artificial mydriasis and optical coherence tomography (Stratus OCT, Carl Zeiss). For examination of the central area of the retina was evaluated: the best corrected visual acuity in the distance (BCVA) with ETDRS optotype, BCVA in the near (Jaeger charts), multifocal electroretinography (MfERG) and pattern reversal electroretinography (PERG). For the statistical processing of results we used non-parametric Wilcoxon paired test. ANATOMICAL RESULTS: The primary closure of the IMD occurred in 29 (90%), the IMD was not closed, but it's edges were flattened in 2 eyes (6%), and once time the edges of the IMD were not flattened (3%). FUNCTIONAL RESULTS: The initial BCVA ranged from 0.1 to 0.5 (1.0 to 0.3 LogMAR). After one year of operations the visual acuity improved by 2 or more lines in 27 eyes (84%), of 3 or more lines in 18 eyes (56%), and 4 or more lines in 5 eyes (16%). PERG amplitudes (N95) in all eyes were between 4 to 9 microV (within the normal range of the laboratory), and was not found statistically significant difference between the values before surgery and 12 months after. Statistically significant difference (improvement) was found in the first and the second central ring of the MfERG. Improvement involved the values of P1 wave amplitude before surgery and 12 months after (Wilcoxon p < 0.01). The difference between the values of N1 and P1 latencies before surgery and month 12 was not statistically significant, as well as changes between the values of the amplitudes of waves N1 preoperatively and 12 months later. Due to the favorable anatomical and functional results we consider surgical treatment of macular holes through PPV with peeling MLI as a safe technique. When the indication to perform peeling is considered, there is a need to think about other factors, especially duration IMD, disease stage, type of intraocular tamponade and the patient's cooperation.     

Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—Deep and relative scotomas were detected in all 57 eyes with clinically defined full thickness macular holes. In contrast, among 49 eyes diagnosed with macular pseudoholes or impending macular holes, no deep and only one relative scotoma was observed. The sensitivity of the presence of a deep scotoma as an indicator of the clinical diagnosis of a full thickness macular hole was 100% (57 of 57), and the specificity was 100% (49 of 49). The sensitivity of the presence of a relative scotoma was 100% (57 of 57) and the specificity was 98.0% (48 of 49).
CONCLUSION—With SLO microperimetry, full thickness macular holes can be precisely and objectively distinguished from other conditions that mimic macular holes.