黄斑裂孔的游标高敏视力特征

目的　探讨游标高敏视力检测黄斑裂孔眼视功能的临床应用价值。方法　采用自行研究设计的游标高敏视力检查系统软件 ,对 2 7例 (2 7只眼 )黄斑裂孔患者进行游标高敏视力检查 (其中 16例 16只眼经手术前后对比 ) ,受检者按要求判断计算机显示屏上活动光标与固定光标的相对位置关系 ,并通过移动轨迹球调整光标 ,计算机自动分析活动光标和固定光标位置之偏差 ,得出平均阈值及其变异度。结果　黄斑裂孔组的游标高敏视力阈值与同龄正常组比较明显升高 ,阈值变异度增大 ,与正常眼比较差异均有非常显著性 (P<0 .0 1)。手术治疗组术前术后游标高敏视力比较 ,阈值的差异无显著性 (P>0 .0 5 ) ,阈值变异度差异有显著性 (P<0 .0 5 )。黄斑裂孔视力与游标视力阈值的相关系数为 - 0 .79,与游标视力阈值变异度的相关系数为 - 0 .85。结论　游标高敏视力的阈值及其变异度的高低是反映黄斑裂孔病变轻重的一个功能指标 ,对于辅助早期诊断、分类具有一定的临床应用价值。     

球后视神经炎的游标高敏视力特征

目的:探讨球后视神经炎游标高敏视力的临床特征及其在临床诊断、治疗中的应用价值。方法:采用自行研究设计的游标高敏视力检查系统软件,对15例25只眼(急性球后视神经炎6例8只眼;慢性球后视神经炎9例17只眼)球后视神经炎患者治疗期间进行动态游标高敏视力检查,受检者按要求判断计算机显示屏上活动光标与固定光标的相对位置关系,并通过移动轨迹球调整光标,计算机自动分析活动光标和固定光标位置之偏差,得出平均阈值及其变异度。结果:球后视神经炎急性期的游标高敏视力阈值及其变异度与正常值相比差异有非常显著性(P<0.01);恢复期差异有显著性(P<0.05)。球后视神经炎急性期视力与游标高敏视力阈值的相关系数为-0.88(P<0.01);与阈值变异度的相关系数为-0.46(P<0.05)。球后视神经炎恢复期,游标高敏视力的阈值及其阈值变异度与急性期相比差异有非常显著性(P<0.01)。恢复期游标阈值与恢复期视力的相关系数为-0.93(P<0.01);阈值变异度与恢复期视力的相关系数为-0.84(P<0.01)。急性期游标阈值与恢复期游标阈值经相关性分析,其相关性无统计学意义(P=0.261);急性期视力与恢复期视力的相关性亦无统计学意义(P=0.11);急性期阈值变异度与恢复期阈值变异度的相关系数为0.67(P<0.01)。急性期游标阈值与恢复期游标阈值、     

游标高敏视力预测玻璃体混浊视功能应用价值的研究

目的探讨游标高敏视力预测玻璃体混浊视功能的临床应用价值.方法采用自行研究设计的游标高敏视力检查系统软件,对14例(14眼)玻璃体混浊患者手术前进行游标高敏视力检查,受检者判断计算机显示屏上活动光标与固定光标的相对位置关系,按要求移动轨迹球调整这些光标之间的位置关系,通过计算分析活动光标和固定光标位置之偏差,得出平均阈值及其变异度;将检查值与术后视力结果进行对比、统计、分析.结果手术前、后游标视力阈值配对t检验,差异无显著性(t=0.52,P=0.612),其相关系数为0.85(P＜0.01);手术前、后游标视力阈值变异度配对t检验,差异也无显著性(t=0.431,P=0 674),其相关系数为0.97(P＜0.01).术前游标视力阈值与术后视力的相关系数为-0.74(P＜0.01);术前游标高敏视力阈值变异度与术后视力的相关系数为-0.95(P＜0.01).根据术前游标视力阈值及变异度建立的术后视力线性回归预测方程为Y=0.943-0.000116THv-0.00193SDv,预测方程的复相关系数为0.95.结论游标高敏视力在玻璃体混浊手术前后具有很好的一致性,能抵抗混浊玻璃体的干扰,是术前预测玻璃体混浊视功能的敏感指标之一.     

老年性黄斑变性黄斑部脉络膜血循环研究

目的 探讨老年性黄斑变性(aging macular degeneration,AMD)黄斑部脉络膜血循环改变。 方法 对86例AMD患者的86只患眼(其中渗出型AMD患者52例52只眼,萎缩型AMD患者19例19只眼,黄斑玻璃疣患者15例15只眼)以及正常对照者27例35只眼进行吲哚青绿血管造影(indocyanine green angiography，ICGA),对比观察黄斑部脉络膜血管充盈时间(choriocapillaris filling phase，CFP)及脉络膜充盈情况。 结果 渗出型AMD较正常对照组、萎缩型AMD及黄斑玻璃疣眼的CFP均显著延长(P＜0.05)。86只AMD患眼中有40只眼ICGA有局限性或广泛性脉络膜充盈不良或延迟，其中渗出型AMD24只眼，萎缩型AMD12只眼，黄斑玻璃疣4只眼。 结论 AMD及黄斑玻璃疣患者黄斑部CFP延长及脉络膜血管充盈异常。 (中华眼底病杂志, 2002, 18: 116-118)     

老年黄斑变性的ICGA，HRT，HRF检查与激光及药物治疗研究

目的：探讨老年黄斑变性（aging-macular degeneration,AMD)黄斑部脉络膜毛细血管血流动力学改变。方法：对86例121只AMD患眼进行吲哚青绿血管造影（indocyanine green angiography,ICGA)，包括渗出型AMD52例65只眼，黄斑玻璃疣15例30只眼及萎缩型AMD19例26只眼，分别观察黄斑部脉络膜毛细血管充盈时间（choriocapillaris filling phase,CFP)及脉络膜毛细血管灌注情况。结果：渗出型AMD较正常对照组，萎缩型AMD及黄下班疣眼的CFP显著延长（P＜0．05），ICGA早121只AMD患者眼中有40只眼ICGA有局部或广泛脉络膜充盈不良，其中渗出型AMD24只眼，萎缩型AMD12只眼，黄斑玻璃疣4只眼。结论：AMD及早期AMD黄斑发生CFP延长及脉络膜毛细血管灌注异常。     

Stulln滴眼剂对老年性黄斑变性眼血流动力学的临床应用研究

目的：以CDI技术探讨AMD眼血流动力学的变化及观察Stulln滴眼剂对眼血流动力学的影响。方法：应用CDI技术检测AMD患者33例66只眼(其中萎缩型50只眼，渗出型16只眼和正常对照组33例66只眼的眼动脉(OA)，颞、鼻侧睫状后短动脉(TPCA、NPCA)及视网膜中央动脉(CRA)血流。动脉血流指标为PSV、EDV、Vm、PI及RI。其中8例16只眼用施图伦滴眼剂前后行CDI检测。结果：①AMD组(萎缩型 渗出型)与正常对照组比较，CRA、TPCA、NPCA的血流速度均明显降低(P＜0．01)。②用施图伦后AMD患者的CRA、TPCA、NPCA眼血流速度明显提高(P＜0．01)。阻力指数(RI)亦降低。结论：①老年性黄斑变性的鼻、颞侧睫状后短动脉的血流速度均降低，表明AMD的脉络膜血流灌注不良。②老年性黄斑变性的视网膜中央动脉的血流速度降低，提示AMD除脉络膜灌注不良外，尚有较广泛的眼血流灌注异常或者为一种继发性的自主调节反应。③施图伦滴眼剂可改善眼血流，部分病人视力得到提高。     

老年黄斑变性的ICGA、HRT、HRF检查与激光及药物治疗研究

目的 探讨老年黄斑变性(aging-rnacular degeneration,AMD)黄斑部脉络膜毛细血管血流动力学改变。方法 对86例121只AMD患眼进行吲哚青绿血管造影(indocyanine green angiography, ICGA),包括渗出型AMD52例65只眼、黄斑玻璃疣15例30只眼及萎缩型AMD19例26只眼,分别观察黄斑部脉络膜毛细血管充盈时间(choriocapillaris filling phase, CFP)及脉络膜毛细血管灌注情况。结果 渗出型AMD较正常对照组、萎缩型AMD及黄斑玻璃疣眼的CFP显著延长(P<0.05)。ICGA早121只AMD患者眼中有40只眼ICGA有局部或广泛脉络膜充盈不良,其中渗出型AMD24只眼,萎缩型AMD12只眼,黄斑玻璃疣4只眼。结论 AMD及早期AMD黄斑发生CFP延长及脉络膜毛细血管灌注异常。     

共焦激光视网膜断层扫描在老年性黄斑变性检查中的应用

目的 观察共焦激光视网膜断层扫描在老年性黄斑变性(agedrelated macular degeneration, AMD)检查中的应用价值。 方法 应用德国海德堡共焦激光视网膜断层扫描仪(Heidelberg retinatomograph,HRT)对59例AMD患者的75只眼进行测量。其中渗出型AMD患者20例25只眼、萎缩型AMD患者16例25只眼、AMD玻璃疣患者23例25只眼。对比分析其扫描图像的Z轴面信号宽度、容积、最大深度的异同。 结果 渗出型AMD患眼黄斑部的Z轴面信号的宽度显著增宽，最大深度及容积大小与玻璃疣患眼比较，差异有显著性的意义(t值分别是2.787、4.487及3.054, P值分别是0.008、0.000及0.004);萎缩型AMD患眼黄斑部的Z轴面信号的宽度、最大深度及容积大小与玻璃疣患眼比较，差异有显著性的意义(t值分别是2.172、2.394及2.635, P值分别是0.041、0.020及0.015);渗出型AMD患眼黄斑部的容积显著大于萎缩型AMD患眼黄斑部容积(t=4.106, P=0)。 结论 渗出型AMD患眼黄斑部视网膜病变严重,HRT能够评价AMD患眼黄斑部视网膜病变的程度并监测其进展。 (中华眼底病杂志, 2002, 18: 262-265)     

老年黄斑变性共焦扫描激光多普勒视网膜血流分析

目的　以德国海德堡共焦扫描激光多普勒视网膜血流分析仪 (Heidelberg retinal flowmeter,HRF)探讨老年黄斑变性 (age- related m acular degeneration,AMD)的视盘及黄斑部视网膜血流动力学的变化及与吲哚青绿血管造影 (indo cyanine graen angiography,ICGA )中脉络膜毛细血管充盈时间 (choriocapillaris filling phase,CFP)的关系 ,评价施图伦 (Augentropfen Stulla Mono)滴眼剂对视盘及黄斑部视网膜血流动力学的影响。方法　对 42例(5 6只眼 ) AMD患者 ,38例 (38只眼 )正常对照组 ,其中渗出型 2 4例 (2 9只眼 ) ,萎缩型 18例 (2 7只眼 ) ,采用眼底彩色照像、眼底荧光素血管造影 (fundus fluorescein angiography,FFA)、ICGA及 HRF检查。结果　渗出型 AMD患眼视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均较对照组减低 ,血流量及流速差异均有显著性 (P <0 .0 5 ) ,红细胞移动速率及黄斑部视网膜的血流量差异均有非常显著性 (P <0 .0 1) ,萎缩型 AMD患眼视盘的血流量、流速及红细胞移动速率均较对照组减低 ,差异均有显著性 (P <0 .0 5 ) ;渗出型较萎缩型 AMD黄斑部视网膜的血流量非常显著减少 (P =0 .0 0 3) ;施图伦滴眼剂治疗后视盘血流量有一定程度的增加 (P =0 .0 5 2 ) ,视盘血流速、红细胞     

雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性患者的疗效观察

目的观察玻璃体腔注射雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性(AMD)患者的疗效。方法回顾性分析在我院确诊为渗出型AMD、最佳矫正视力(BCVA)<0.05并接受雷珠单抗玻璃体腔注射的46例患者(47只眼)的临床资料。所有患者均行玻璃体腔注射雷珠单抗治疗,治疗后随访1~8个月,平均随访(4.09±2.25)个月。对比分析玻璃体腔注射雷珠单抗治疗前后BCVA、黄斑中心视网膜厚度(CRT)、病变最厚处视网膜厚度(MRT)的变化及不良反应的发生情况。结果至末次随访时,47只眼中,视力提高29只眼,占61.7%;视力稳定15只眼,占31.9%;视力下降3只眼,占6.4%。治疗后,平均CRT由治疗前的(301.30±84.57)μm降低为(211.27±87.03)μm;与治疗前相比,平均CRT下降(90.03±33.99)μm,差异有统计学意义(t=4.336,P<0.01);MRT由(529.04±174.63)μm降低为(421.86±95.78)μm;与治疗前相比,平均MRT下降(107.17±42.46)μm,差异有统计学意义(t=3.984,P<0.01)。结论雷珠单抗治疗重度视力损害渗出型AMD患者具有较好的疗效。     

上海市静安区曹家渡街道年龄相关性黄斑变性的患病率调查

目的探讨上海市曹家渡街道≥50岁人群中年龄相关性黄斑变性(AMD)的患病情况。方法2002年9月至2003年6月间对上海市静安区曹家渡街道的目标人群进行AMD的流行病学调查。首先采取分层配额抽样;接着由调查队在当地眼科检查站对抽样人群进行外眼、角膜、瞳孔、晶状体检查,以及小瞳孔下直接检眼镜眼底检查,初筛出确诊和可疑AMD患者;然后于上海交通大学医学院附属第一人民医院对可疑患者采用眼底照相等方法进一步确诊。结果本调查共纳入1063人,实际受检1023人,受检率为962%。确诊AMD患者159例(254只眼),占受检人群的155%。确诊湿性AMD19例(30只眼)。在50～59、60～69、70～79、80岁以上各年龄段中,AMD的检出率分别为57%(12/212例)、135%(42/311例)、202%(77/381例)及235%(28/119例)(χ2=2797,P<001)。未发现影响不同AMD类型患病的因素。AMD致盲眼和致低视力眼的比例分别为51%和311%。湿性AMD致盲眼和低视力眼的比例(233%和400%)高于干性AMD致盲眼和低视力眼的比例(27%和72%)。结论AMD的患病率随着年龄增加而显著增加。AMD,尤其是湿性AMD对视力危害相当严重。(中华眼科杂志,2005,411519)     

Occurrence of drusen, pigmentary changes and exudative changes in the macula with reference to age-related macular degeneration. An epidemiological study of 1000 aged individuals

Macular changes in 60 to 80-year-old people i.e. drusen (DR), pigmentary changes (PC) and exudative changes (EXC) are assessed by fundoscopy in a random and age stratified population with 924 of the participants examined in both maculae (1848 eyes). DR, PC and EXC were found in 18.4%, 12.9% and 2.1% of all eyes with a rising frequency associated with increasing age. A separation was made between changes implying a visual acuity of 6/9 or less as criteria of age-related macular degeneration (AMD) and age related macular changes without visual impairment (AMCW). The occurrence of DR, PC and EXC from eyes with AMD showed an age related rise which was also found for DR, contrary to PC and EXC deriving from eyes with AMCW. The basic forms of AMD, atrophic and exudative, were represented in 78.6% and 21.4% of individuals or 80.9% and 19.1% of eyes with AMD. The predominant findings in AMD eyes were DR + PC in combination represented in 60.7% of atrophic and 66.8% of exudative AMD eyes, while in atrophic AMCW eyes DR as only finding was leading with 59.2%. It is concluded that in eyes with atrophic macular changes, DR, respectively PC as only finding involves no visual deterioration in 80.6%, respectively 72.6%, while DR + PC in combination, as well as the appearance of EXC, are found to be the most likely expression of AMD as long as a visual impairment of 6/9 or worse is included in the definition of AMD.     

老年黄斑变性合并白内障患者行超声乳化术疗效分析

目的 探讨老年黄斑变性合并白内障患者行超声乳化手术联合人工晶状体植入的临床效果及安全性、可行性.方法 对40例52只眼老年黄斑变性合并白内障患者,行超声乳化联合人丁晶状体植入术,其中干性老年黄斑变性者45只眼,湿性老年黄斑变性者7只眼.收集其资料进行回顾性分析,观察患者术后视力改善情况及有无并发症发生.结果 术后3月时,90.38%患者视力不同程度提高,视力无明显提高甚至下降者5只眼,均为湿性黄斑变性患者.最佳矫正视力0.3-0.6者12只眼(其中达0.6者8只眼),0.1-0.3者35只眼,<0.1者5只眼.4例术中后囊破裂,3例术后角膜雾状水肿.术后1年,7只眼湿性黄斑变性均有不同程度的加重,干性黄斑变性患者未发现眼底新生血管之类改变.结论 超声乳化联合人工晶状体植入术可明显提高老年黄斑变性合并白内障患者术后视力,但对于湿性黄斑变性患者手术应慎重.     

Repeated intravitreal injection of triamcinolone for exudative age-related macular degeneration

BACKGROUND: Intravitreal triamcinolone acetonide has been discussed as treatment for exudative age-related macular degeneration (AMD). Objectives: To give an updated report on repeated intravitreal injections of triamcinolone acetonide (IVTA) for the treatment of exudative AMD. METHODS: The case-series study included 24 patients (24 eyes) with progressive exudative AMD who had shown an increase in, or stabilization of, visual acuity after a first IVTA, and who eventually experienced a deterioration of visual acuity. The 24 (6.5%) eyes were selected out of a total group of 369 eyes who had received IVTA for exudative AMD within the last 5 years. All patients of the study received a second IVTA (approximately 20 mg) 3.7-38.5 months after the first injection. Main outcome measure was visual acuity. RESULTS: After the first injection, best corrected visual acuity improved significantly (p = 0.001) from 0.75 +/- 0.34 logMAR to a minimum of 0.58 +/- 0.30 logMAR during follow-up, with 10 (42%) eyes improving in visual acuity by two or more Snellen lines. Towards the end of follow-up after the first injection, best corrected visual acuity decreased significantly (p = 0.03) compared with the baseline value. After the second injection, visual acuity did not change markedly from baseline to a mean maximal visual acuity during follow-up. Comparing the last postoperative examination at the end of the follow-up after the second IVTA with the preoperative examination, a significantly (p = 0.001) higher number of eyes lost in visual acuity [19 (79%) eyes] than gained in visual acuity [3 (12%) eyes]. CONCLUSIONS: In selected eyes with an increase in visual acuity after a first IVTA (20 mg), repeated IVTA temporarily stabilizes visual acuity with a drop in visual acuity towards the end of follow-up.     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for exudative age-related macular degeneration

Purpose: To determine the incidence of and the risk factors for the development of retinal pigment epithelial (RPE) tears after intravitreal bevacizumab (Avastin) injection for the treatment of exudative age‐related macular degeneration (AMD). Methods: A retrospective, multicentre, consecutive interventional case series of all patients with subfoveal exudative AMD treated with intravitreal bevacizumab between August 2005 and April 2007. The main outcome measures were pre‐ and post‐RPE tear visual acuity and choroidal neovascular membrane lesion types, incidence of tears and time from first injection until development of the tear. Results: A total of 920 eyes with exudative AMD were treated with intravitreal bevacizumab. Fifteen eyes from 15 patients developed a RPE tear for an incidence of 1.6%. The average patient age was 79 years. Fourteen of the fifteen eyes (93%) had an occult subfoveal choroidal neovascular membrane. Forty‐seven per cent (7/15) of the RPE tears occurred within the first 6 weeks of treatment, and all tears occurred within the first 18 weeks of treatment initiation. The mean pre‐injection visual acuity was 20/100 with a mean post‐tear visual acuity of 20/200. In all 10 eyes in which the tear involved the fovea, the final visual acuity was poor. Six of the 15 eyes continued with bevacizumab/ranibizumab (Lucentis) injections after tear development, and four of these six eyes continued to have visual improvement. Conclusion: RPE tears occur after intravitreal bevacizumab injections for exudative AMD in approximately 1.6% of eyes and can cause severe vision loss. Maintenance of therapy may help preserve vision after RPE tear development.