多焦视网膜电图对近视眼的临床研究

目的:测试近视眼患者的多焦视网膜电图的改变。方法:应用美国EDI公司生产的VERISScience4.2多焦视网膜电图检查仪对24例48眼近视患者,22例44眼正常者进行检测,分析其总体和6个环形视网膜区域的反应。结果:近视患者总体和6个环形视网膜区域的反应密度均低于正常者,潜伏期无明显改变。结论:近视患者多焦视网膜电图的反应密度下降,这种改变主要是由于视网膜感受器功能受损所致。     

Full-field electroretinogram findings in children in the atropine treatment for myopia (ATOM2) study

Background

The aims of this study were to determine the longitudinal effects of myopia on full-field electroretinogram (ffERG) in children, and whether there were any effects due to atropine treatment.

Methods

Fifty children, enrolled in the atropine treatment for myopia study, were randomly selected and 35 children consented to undergo ffERG at baseline (prior to atropine treatment), 24 months (at end of treatment) and 32 months (8 months after cessation of treatment). An extended ISCEV ffERG protocol was used for all recordings. The relationship between axial length (AL) and the following scotopic and photopic ffERG responses was analyzed: a- and b-wave amplitude and implicit time, saturated amplitude (V _max), and retinal sensitivity (logK).

Results

Reliable ffERG recordings with acceptable level of noise were obtained on all 3 visits from 29 children (mean age: 9.5 ± 0.8 years and mean spherical equivalent: ?5.0 ± 1.6 D). At baseline, the correlation detected between AL and logK was 0.37 (p = 0.047). There was no significant correlation between AL and V _max or any scotopic and photopic ffERG amplitude and implicit time measures. Longitudinal data suggested a reduction in photopic a- and b-wave and 30 Hz flicker response amplitudes over time. Multivariate analysis showed that the change in 30 Hz flicker response amplitude was likely to be associated with AL change. There was no evidence that changes in other responses were associated with age, baseline AL, or atropine dose used.

Conclusion

Retinal sensitivity was reduced in myopic children. There was a gradual decline in cone function over time which was not influenced by atropine treatment.     

低浓度阿托品治疗近视的临床研究进展

阿托品是毒蕈碱受体抑制剂,1％浓度滴眼可以抑制近视的发展及眼轴的增长,但是畏光、视近模糊等常见的副作用限制了其临床应用.近期研究者逐渐将兴趣转向低浓度阿托品（小于1％浓度）的临床研究,发现低浓度阿托品滴眼可以有效延缓近视发展,比1％浓度的阿托品副作用更小,疗效也更持久稳定.     

Multifocal electroretinogram

The paper presents current state of knowledge regarding multifocal electroretinography (mfERG). The theoretical basis of this technique, procedure, methods and examples of use in clinical diagnostics are presented.     

Multifocal electroretinogram in diabetic subjects

PurposeTo identify local retinal abnormalities and evaluate the nature and extent of retinal dysfunction in diabetics using full field electroretinogram (ERG) and multifocal ERG (MF-ERG) and to determine the correlation between features of optical coherence tomography (OCT) and MF-ERG.MethodsTwenty-eight normal subjects (Control Group; 56 eyes) and 37 patients (72 eyes) with diabetes mellitus (DM Group) were evaluated. In the DM Group, 17 eyes had no retinopathy (grade 1), 18 eyes had early non proliferative diabetic retinopathy (NPDR) (grade 3), 16 eyes had late NPDR (grade 4), 21 eyes had proliferative diabetic retinopathy (PDR) (grade 5). Full field ERG and MF-ERG, were used to assess the effects of diabetic retinopathy on retinal function. OCT and fluorescein angiography were used to assess and compare morphological changes with functional changes in diabetes mellitus.ResultsIn diabetic patients without retinopathy (17 eyes), the amplitudes of the second order component of MF-ERG were reduced and implicit times were delayed, while only implicit times of first order component of MF-ERG were delayed but the amplitudes of first order component were normal. In diabetic patients with retinopathy (55 eyes), the overall amplitudes were reduced and peak implicit time increased in the first order component and second order component.OCT of the DM Group showed the fovea of eyes with edema were thicker than the Normal Group. The fovea of eyes with cystoid macular edema (CME) were significantly thicker than the fovea of eyes with diffuse swelling. The implicit times of MF-ERG were directly correlated with foveal thickness.ConclusionMF-ERG reveals local retinal dysfunction in diabetic patients. MF-ERG offers the advantage of topographic mapping of retinal dysfunction. The magnitude of delay of MF-ERG implicit time reflects the degree of local clinical abnormalities in eyes with retinopathy. Local response delays found in eyes without retinopathy detects subclinical local retinal dysfunction in diabetics. The combination of OCT and MF-ERG may provide objective criteria for evaluation and assessment of diabetic retinopathy.     

视网膜色素变性的多焦视网膜电图分析

测试并比较视网膜色素变性患者和正常人多焦视网膜电图。方法 :应用美国EDI公司生产的VERISScience 4 2多焦视网膜电图检查仪对 8例视网膜色素变性患者 8只眼 ,12例正常人 12只眼进行检测 ,分析其 6个环形视网膜区域的反应。结果 :视网膜色素变性患者 6个环形视网膜区域的反应密度均低于正常人 ,5环和 6环的潜伏期显著延长。结论 :视网膜色素变性患者多焦视网膜电图的反应密度下降 ,周边视网膜潜伏期延长 ,这种改变主要是由于视网膜感受器功能受损并且周边视网膜首先受累所致。     

阿托品控制近视增长的研究进展

近年来青少年近视发生率逐年上升,并且呈低龄化趋势。目前,用于治疗和控制近视增长的方法很多,如框架眼镜、角膜塑形镜、药物等,治疗和控制效果各异。其中,阿托品在控制近视增长方面效果显著,高浓度（1%、0.5%、0.1%）阿托品可以有效抑制近视屈光度和眼轴的增长,但同时伴有一些由药物本身药理作用引起的不良反应,如畏光、视近模糊等,而低浓度（0.01%）阿托品在保留近视控制作用的同时,不良反应相对较轻,患者接受度较高。现就阿托品在控制近视增长方面的一些研究进展做一综述。     

The diluted atropine for inhibition of myopia progression in Korean children

AIM: To evaluate the efficacy and safety of three different concentrations of diluted atropine for the control of myopia in Korean children, and to assess the risk factors associated with rapid myopia progression. METHODS: A total of 285 children, with refractive errors within the range of -6 diopters (D) between 5 and 14 years of age were included. After using 0.01%, or 0.025%, or 0.05% atropine, for about 1y, changes in refraction, axial lengths and frequency of adverse events were analyzed. Logistic regression analyses were performed to evaluate the risk factors associated with rapid myopia progression. RESULTS: The changes in the mean spherical equivalent values were -0.134 D/mo in the before atropine group, -0.070 D/mo in the 0.01% atropine group, -0.047 D/mo in the 0.025% atropine group, and -0.019 D/mo in the 0.05% atropine group, with significant differences between the groups (P<0.001). The axial elongation was 0.046 mm/mo, 0.037 mm/mo, 0.025 mm/mo, and 0.019 mm/mo respectively, with significant differences between the groups (P=0.003). The incidence of photophobia and near vision difficulty was not different among the three atropine groups (P=0.425 and P=0.356, respectively). Multivariate logistic regression analyses showed that only highly myopic parents were a significant predictive factor of rapid myopia progression in Korean children (odds ratio, 8.155; 95% confidence interval, 3.626-18.342; P<0.001). CONCLUSION: Treatment with 0.01%, 0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner. Children with highly myopic parents preferentially shows a rapid myopia progression rate.     

共同性内斜视弱视眼的多焦视网膜电图分析

目的 与正常人多焦视网膜电图进行比较分析并探讨共同性内斜视弱视眼多焦视网膜电图特征.方法 采用德国Roland公司生产的RETI Scan多焦视觉电生理检查系统对13例20眼共同性内斜视弱视眼(研究组),10例20眼正常眼(正常对照组)进行检测,记录一阶反应的波形与数值,分析其5个环形视网膜区域的反应.结果 研究组3个环形视网膜区域环1、环2、环3的平均反应密度(75.06±22.68)nV·deg-2、(45.96±15.12)nV·deg-2、(32.24±9.49)nV·deg-2,低于正常组(136.15±29.08)nV·deg-2、(65.51±12.33)nV·deg-2、(43.15±11.02)nV·deg-2,振幅(1.12±0.41)μV、(0.89±0.27)μV、(0.89±0.38)μV、低于正常组(1.75±0.49)μV、(1.33±0.29)μV、(1.19±0.29)μV;潜伏期较正常人明显延长[研究组:(47.49±3.54)ms、(43.24±2.91)ms、(41.29±3.59)ms;对照组:(39.92±1.93)ms、(38.01±1.36)ms、(36.24±1.25)ms],2组环1、环2、环3相比差异有统计学意义(P均<0.01),2组环4、环5相比差异无统计学意义(P均>0.01),共同性内斜视弱视眼的视网膜损伤主要发生在黄斑区中心凹处.结论 共同性内斜视弱视眼的多焦视网膜电图反应密度与振幅均降低,潜伏期延长,黄斑中心凹处最为明显,说明共同性内斜视弱视的视网膜损害主要发生在黄斑区中心凹处,存在黄斑抑制,是中心视力损害的因素之一.     

正常人多焦图形视网膜电图的特征

目的　检测正常人多焦图形视网膜电图 (m PERG)特征。方法　 2 0只正常眼 ,罗兰视觉电生理仪行m PERG检查 ,重复测试 5次。记录波形成分并进行统计学处理。结果　P1、N1波 :第 1至 5环间的振幅密度值逐渐下降(P <0 0 1) ,差异无显著性 (P >0 0 5 ) ,颞侧视网膜的峰时较鼻侧延长峰时差异无显著性 (P >0 0 5 ) ,4个象限间的振幅密度值差异有极显著性 (P <0 0 1) ,上下半部视网膜的振幅密度值和峰时差异均无显著性 (P >0 0 5 )。N1波峰时 :颞上较鼻上、鼻下象限 ,颞下较鼻上、鼻下象限延长 (P <0 0 1)。结论　多焦视网膜电图能定位、定量地反映视网膜神经节细胞功能 ,为临床提供正常参考值     

黄斑病变患者多焦视网膜电图的变化

目的:观察黄斑病变多焦视网膜电图穴mERG雪特点,探讨mERG在黄斑功能测定中的有效性。方法:应用德国罗兰视觉诱发反应成像系统,对黄斑病变71 眼与正常人48眼进行mERG测定,记录103个视网膜部位的一阶反应(first orderkernel,FOK)比较分析视网膜后极部不同区域a波和b波的平均反应密度值和潜伏期,并观察其三维图的改变。结果:黄斑病变患者1～3环a、b波平均反应密度下降,与正常值比较有显著差异。5、6环平均反应密度下降,无显著差异。1～6环a、b波平均潜伏期较正常组明显延长,三维图形上主要特征为中心凹及黄斑振幅明显降低,严重者反应呈平坦。结论:mERG能客观地对黄斑病变局部视网膜功能进行定量定位测定,是评价黄斑病变的一种有效客观检测手段,为疾病诊断和治疗效果客观的测定提供了一种有效方法。     

Multifocal electroretinogram in occult macular dystrophy

PURPOSE: Occult macular dystrophy (OMD) is an unusual macular dystrophy presenting with an essentially normal fundus and fluorescein angiography but with progressive central visual loss. The authors studied the function of local retinal areas in the posterior pole of patients with OMD using multifocal electroretinograms (ERGs). METHODS: Multifocal ERGs were recorded using the Visual Evoked Response Imaging System with 61 hexagonal elements within a visual field of 30 degrees radius from 8 OMD patients and 20 age-matched, normal subjects. The amplitudes and implicit times of the patients and normal control subjects were compared at the various retinal eccentricities. RESULTs. The amplitudes of the multifocal ERGs in the OMD patients were markedly reduced in the central 7 degrees of the fovea. The difference of the ERG amplitudes between OMD and normal subjects became smaller toward the peripheral retina. Most OMD patients had slight but significantly delayed implicit times across the whole testing field, and the differences between the OMD and the normal subjects did not change with retinal eccentricity. CONCLUSIONS. Our results for multifocal ERG amplitudes support the idea that OMD patients have localized retinal dysfunction distal to the ganglion cells in the central retina. The delayed implicit times across the whole test field suggest that the retinal dysfunction has a broader boundary than expected by ERG amplitudes and psychophysical perimetric results.     

Multifocal electroretinogram in central serous chorioretinopathy

PURPOSE: To assess retinal function topographically in the affected eyes with central serous chorioretinopathy (CSC). PARTICIPANTS AND METHOD: We recorded multifocal electroretimogram (mERG) in 5 patients with unilateral CSC, and analyzed the topographical properties in the central visual field (rings #1 + 2). RESULTS: mERG amplitudes in the CSC eyes were significantly reduced compared with the fellow eyes, for P 1-N 1 (58.5 +/- 23.5%, p < 0.05) and for P 1-N 2 (47.5 +/- 15.0%, p < 0.05). mERG latencies in the CSC eyes were significantly increased compared with those in the fellow eyes, for N 1 (by 9.0 +/- 8.1%, p < 0.05) and for P 1 (by 8.4 +/- 7.0%, p < 0.05). mERGs in the CSC eyes gradually recovered in the follow-up period. However, the responses did not recover to normal value during follow-up, even when the subretinal fluid disappeared ophthalmoscopically. CONCLUSIONS: These results show that a topographical analysis of the mERG is useful for clinical observation of CSC.     

Multifocal electroretinogram in retinal vein occlusion

Purpose

To determine the effects of retinal vein occlusion (RVO) on multifocal electroretinogram (MF-ERG) parameters, to correlate MF-ERG and standard electroretinogram (ERG) and to correlate MF-ERG with findings of optical coherence tomography (OCT) in cases of RVO.

Methods

Both eyes of 50 patients with RVO and 50 eyes of 25 normal subjects were examined using MF-ERG, standard ERG, fluorescein angiography and OCT. The latency in millisecond (ms) and response density in nanovolt (nv/degenerations) were measured for each of four quadrant areas and central area. OCT was used to measure the foveal retinal thickness. Fluorescein angiography was used to measure retinal ischemia.

Results

Central retinal vein occlusion (CRVO) markedly affected all parameters of MF-ERG. In pathological quadrants in branch retinal vein occlusion, the response densities of MF-ERG were decreased and latencies of p-wave were prolonged. The MF-ERG responses obtained from eyes with RVO were significantly different (P > 0.05) from derived from the fellow eyes. The amplitude of MF-ERG were abnormal in 40 eyes and implicit times were delayed in 48 eyes compared with normal subjects. While 30 Hz flicker implicit were abnormal in only 24 eyes with RVO. Implicit times were prolonged in eyes with macular ischemia than in eyes without ischemia.There were significant correlation between foveal retinal thickness measured by OCT and P response density MF-ERG in cases of retinal vein occlusion.

Conclusion

MF-ERG is more susceptible than standard ERG to eye changes of RVO due to the multiple frequencies of stimulation used to record MF-ERG response. MF-ERG could be sensitive indicator of underlying disease affecting the retinal in eyes with RVO. MF-ERG is useful for detecting local retinal dysfunction in patients with RVO and sensitive to morphological changes and functional disorders induced by RVO.     

Further observations on use of atropine in the treatment of myopia

In order to further our observations on the effects of atropine eyedrops for the management of myopia, we conducted a retrospective study of seventy-nine (79) patients, followed over a ten-year period (1971 to 1980). The atropine sulfate drops were used daily in most cases, tapering the frequency in the later teenage years. In general, those children who showed a good initial response during their first year of treatment, continued to use them for several years. Bifocal or reading glasses were used and family acceptance was good. Those children who showed less favorable results in the first year or who had unconcerned parents, stopped the drops within a year or two and went back to glasses or later, contact lenses. The data support the fact that children with low refractive errors may well have "functional myopia," as opposed to the "axial myopia," that characterizes the higher levels of myopia. These low degree myopes are the best candidates for using atropine to reduce or diminish myopia changes.     

Multifocal electroretinogram in branch retinal vein occlusion

PURPOSE: To describe the response from multifocal electroretinography in branch retinal vein occlusion. DESIGN: Prospective observational case control series. METHODS: Multifocal electroretinography was recorded in 15 patients with temporal branch retinal vein occlusion and 21 control subjects using a visual evoked response imaging system. RESULTS: There were significant differences in mean amplitude (P =.01) and latency (P =.001) between thrombotic and nonthrombotic retina in the same eyes, as well as in patients compared with control subjects. CONCLUSION: Responses from multifocal electroretinography demonstrate retinal dysfunction in branch retinal vein occlusion; additional studies will demonstrate whether multifocal electroretinography has a prognostic value.     

白内障超声乳化吸出术后多焦视网膜电图变化

目的:采用多焦视网膜电图(multifocalelec-troretignroam,mfERG)评价年龄相关性白内障患者行超声乳化白内障吸出术后视网膜功能的改变。方法:应用法国Metrovision公司生产的VisionMonitor视觉诱发系统检测23例23眼年龄相关性白内障超声乳化术后及8例11眼同龄正常对照眼的mfERG,检测视野的水平视角±30°,垂直视角±23°,采用ERG-jet接触镜电极,于5min记录61个视网膜部位的反应。结果:与正常对照组比较,白内障术后组mfERG的N1波潜伏期在各视网膜半区、4个象限及第2～5环延长,差异有显著性意义;P1波潜伏期在视网膜上半区、颞侧区、颞上象限、颞下象限和第2～4环延长,差异有显著性意义;N2波潜伏期在视网膜下半区、颞下象限及第2～4环明显延长,差异亦有显著性意义。术后组N2波振幅密度在视网膜颞侧区、颞上和颞下象限降低,与对照组比较差异有显著性意义。结论:白内障术后眼mfERG的一阶kernal反应有明显改变,为进一步研究白内障患者视网膜的功能提供参考。     

0．05％阿托品控制儿童近视眼进展的研究

目的探讨0．05％阿托品控制儿童近视眼进展的效果。设计前瞻性病例系列。研究对象64例6～13岁患近视眼的学龄儿童。方法将64例临床诊断的近视眼学龄儿童按照随机数字表法随机分为两组：试验组30例,每晚睡前点用0．05％阿托品滴眼液;对照组34例,不做任何治疗。观察1年,每月1次,检查视力、屈光状态和眼轴,比较两组的差异。主要指标屈光度、眼轴。结果阿托品治疗组患者近视眼进展（-0．28±0．26）D／年,显著低于对照组（-0．75±0．35）D／年（P=0．008）。阿托品治疗组眼轴增长（0．30±0．28）mm也低于对照组（0．65±0．61）mm（P=0．004）。阿托品治疗组患者无畏光、视物不清,眼压、裂隙灯及眼底检查无异常。结论在至少1年规律应用的情况下,0．05％阿托品是控制多数学龄儿童近视眼进展的有效药物。