Effect of citicoline on visual acuity in amblyopia: preliminary results

Background: Citicoline has been used to improve consciousness levels in cerebral trauma and as a complement for levodopa in Parkinson's disease. It has also been shown that severe glaucomatous visual field deficits improve for at least 4 months with the use of citicoline. In this paper, preliminary results are presented of an open and a double-blind study on the effect of citicoline in amblyopia.Methods: The open study was started in 1991. Fifty patients with amblyopia were treated with citicoline (1000 mg i.m. daily for 15 days). They were selected from an age group beyond the plastic period of the visual system. Occlusion or other types of anti-amblyopic treatment were never used at the same time as citicoline. A double-blind study was conducted on 10 more patients, randomly assigned to a treatment or placebo group and followed for 6 months. A statistical test for repeated measures was performed on all the results.Results: A statistically significant improvement in visual acuity was found both for the amblyopic and the sound eye in 46 of the 50 patients (92%). The behaviour was different for normal and amblyopic eyes. The improvement remained stable for at least 4 months. These results have been substantiated by the double-blind study. No side effects were observed.Conclusion: Citicoline improves visual acuity, at least temporarily, in amblyopic patients beyond the plastic period of the visual system. Our results suggest that trials of citicoline as a medical treatment of amblyopia are warranted.     

弱视治疗新进展

弱视是在视觉发育敏感期因双眼异常交互作用或形觉剥夺导致的最佳矫正视力低于正常值的疾病,可导致多种视功能损害。随着科学技术的发展,弱视治疗从传统屈光矫正加遮盖疗法演变出新的理念,即屈光矫正基础上进行遮盖疗法,辅助以视功能训练和药物疗法。且屈光矫正不再限于使用框架眼镜,还出现了角膜接触眼镜、角膜屈光手术和眼内屈光手术。遮盖疗法除了使用传统眼罩,还出现了Bangerter压抑膜、角膜接触镜、LED液晶眼镜等方法。视功能训练重在提高患者三级视功能、重新激发视觉皮质可塑性,在成人弱视治疗中尤为重要。而左旋多巴和胞磷胆碱等药物可以辅助于遮盖疗法以取得更佳疗效。我们应在众多方法中,根据患者具体情况采取多样化组合、个性化疗法,为患者设计最佳治疗方案。     

口服胞二磷胆碱治疗弱视的疗效观察

目的探讨口服胞二磷胆碱在弱视治疗中的临床效果。方法选择80例(80只眼)3~9岁的弱视患者,随机分为观察组和对照组各40例(40只眼)。观察组在传统治疗的基础上口服胞二磷胆碱,对照组为单纯传统治疗。比较两组患者治疗3个月后的视力变化情况。结果观察组总有效率70.0%,对照组总有效率42.5%,两组差异有统计学意义(P=0.003)。未见明显并发症。结论口服胞二磷胆碱在弱视治疗中有效、安全。     

胞二磷胆碱联合物理疗法治疗弱视的疗效观察

目的探讨胞二磷胆碱联合配镜、遮盖疗法、视近训练治疗弱视的临床效果。方法选择弱视门诊单眼患者8～16岁的268例(268眼),并随机分为观察组和对照组,每组各134例(134眼)。观察组在配镜、遮盖、视近训练物理疗法的基础上联合胞二磷胆碱患眼颞浅动脉旁皮下注射,对照组只用配镜、遮盖疗法物理疗法。随访3个月,观察视力并比较视网膜中央动脉收缩期峰值流速(peak systolic velocity,PSV)及舒张期阻力指数(diastolic resistance index,RI)变化情况。结果观察组134眼总有效率69.40%(93眼),对照组134眼有效率38.81%(53眼)。观察组中轻度、中度、重度弱视患者有效率分别为80.00%、65.52%、43.75%,对照组为50.00%、34.48%、12.50%,2组比较差异均有统计学意义(均为P<0.05)。观察组注射胞二磷胆碱后30min、1h、复查时PSV分别为:(9.61±0.75)mm·s-1、(9.95±0.78)mm·s-1、(9.53±0.65)mm·s-1,较注射前(8.32±0.69)mm·s-1增高(均为P<0.05)。观察组不同时段RI值相比较,差异均无统计学意义(均为P>0.05)。结论胞二磷胆碱联合配镜、遮盖疗法、视近训练治疗大龄弱视儿童能同时提高弱视眼和健眼视力,并且安全有效。     

The role of the NMDA receptors in the creating of amblyopia

The present state of knowledge concerning the etiopathogenesis of amblyopia is discussed. The morphological and functional changes taking place in the neuronal system of the Brodmann's 17th area during the amblyopia creation are described. The factors affecting the primary and secondary visual cortex are characterized. Special attention was focused on the N-methyl-D-aspartate (NMDA) receptors. Their structure and function is described. The role of the NMDA receptors in the formation of the visual cortex plasticity is discussed. The necessity of amblyopia treatment before the critical period is over has been pointed out. The possibilities of using the newest experimental results in amblyopia treatment are indicated.     

知觉学习在弱视治疗中的应用

弱视是儿童常见的眼科疾病,近年来人们为传统治疗效果不佳的患者不断探讨新的治疗方法。在视觉认知领域,一些电脑程序和视频游戏被广泛应用于提高视觉系统功能,基于知觉学习提出视频游戏、二分刺激、立体视训练等新兴方法治疗弱视,本文结合国内外研究对知觉学习等新兴疗法在弱视治疗中的应用进行了综述,分析了不同方法在弱视治疗方面的效果,结合现存的问题进一步探讨本领域未来的发展。     

Citicoline treatment increases retinal dopamine content in rabbits

Citicoline (exogenous cytidine-5'-diphosphocholine) was reported to enhance dopaminergic neurotransmission in the brain. A few clinical studies showed beneficial effects of this drug on the function of the visual pathway in patients with glaucoma or amblyopia. The present study was aimed at determining whether citicoline could influence retinal catecholamine levels in adult male Albino rabbits. The animals received the drug (50 mg/kg i.p., twice daily) or vehicle for 7 days, and retinal catecholamine concentrations were determined by HPLC. Compared to vehicle-treated controls, citicoline-treated animals displayed a significantly higher retinal dopamine concentration and a tendency toward an increase in adrenaline concentration, while the noradrenaline concentration remained unchanged. It is, therefore, conceivable that citicoline reinforces dopaminergic transmission in the retina.     

Amblyopia and quality of life: a systematic review

Amblyopia is a common condition, which can affect up to 5% of the general population. Health-related quality-of-life (HRQoL) implications of amblyopia and/or its treatment have been explored in the literature. A systematic literature search was undertaken during the period of 7-14 May 2010 to identify the HRQoL implications of amblyopia and/or its treatment. A total of 35 papers were included in the literature review. The HRQoL implications of amblyopia related specifically to amblyopia treatment, rather than to the condition itself. These included impact on family life, social interactions, difficulties in undertaking daily activities, as well as feelings and behaviour. The identified studies adopted a number of methodologies. The study populations included children with the condition, parents of children with amblyopia, and adults who had undertaken amblyopia treatment as a child. Some studies developed their own measures of HRQoL, and others determined HRQoL through proxy measures. The reported findings of the HRQoL implications are of importance when considering the management of cases of amblyopia. The issues identified in the literature review are discussed with respect to how HRQoL is measured (treatment compliance vs proxy measures), and whether HRQoL is taken from a child's or a parent's perspective. Changing societal views over glasses and occlusion therapy are also discussed. Further research is required to assess the immediate and long-term effects of amblyopia and/or its treatment on HRQoL using a more standardised approach.     

Recovery from monocular stimulus deprivation amblyopia in the kitten.

A review of experimental studies on recovery from monocular stimulus deprivation amblyopia in the kitten is presented. Physiologic, anatomic, and behavioral results are reported for two kinds of recovery experiments: (1) those in which reverse deprivation is employed and (2) those utilizing a recovery period of binocular vision. Data from these investigations are discussed in relation to current thinking regarding the role of synaptic competition during the development of the visual system. The conclusions drawn from these experimental studies of monocular deprivation suggest a possible approach to the treatment of human amblyopia.     

The use of choline in association with the Bangerter filters for the treatment of amblyopia

The study investigated the effects of choline combined with Bangerter filter in the treatment of amblyopia. All amblyopic subjects used a Bangerter filter on the corrective spectacle lens (1d over the left eye, 1d over the right eye). Choline was then administered orally to 39 patients once daily, five days per week for the entire study period. Subjects treated with the Bangerter filter showed a mean visual acuity of 0.27 logMAR; at 12mo of treatment, the mean visual acuity reached 0.09 logMAR. Patients treated with the Bangerter filter and citicoline showed a mean visual acuity of 0.35 logMAR; at 12mo of treatment, the mean visual acuity reached 0.01 logMAR. No significant changes in the angle of deviation were observed in both groups. Subjects in both forms of amblyopia therapies demonstrated an increase in visual acuity. However, these effects were markedly enhanced when coupled with the administration of choline. Findings suggest that the effects are particularly relevant in the more severe amblyopic cases.     

A new visual evoked potential system for vision screening in infants and young children

INTRODUCTION: With a prevalence of 3-5%, amblyopia represents a major public health problem. Effective treatment depends on early detection, and a broad consensus of professional opinion supports vision screening of infants and young children. No single method of screening has been demonstrated to be superior in detecting amblyopia and all methods have significant limitations. METHODS: We assessed a new, "child-friendly" visual evoked potential (VEP) system (ENFANTtrade mark II, Diopsys Corp., Metuchen, NJ) for use in screening. We studied 122 children, aged 6 months to 5 years, comparing test results in a masked fashion to results of standard ophthalmologic examinations. A statistical program analyzed VEP differences between fellow eyes to determine a "pass" or "fail" for each child. For verbal patients, clinical amblyopia was defined as an interocular difference of two or more lines in best-corrected visual acuity. For preverbal patients, clinical amblyopia was defined by the clinician's decision to treat with occlusion or atropine penalization. Preverbal children with significant refractive errors or structural eye pathology were also considered clinically abnormal. RESULTS: The test was completed by 94% of the study group, each child requiring an average of 10 minutes to complete testing of both eyes. The sensitivity was 0.973, the specificity 0.808, the positive predictive value 0.706, and the negative predictive value 0.984. CONCLUSION: With its easy electrode placement and rapid, attractive stimulus, the new system overcomes technical difficulties which were associated with older VEP techniques. The test shows promise as a screening tool for detecting amblyopia and other visual deficits in young children.     

充分矫正及"家中遮盖法"治疗儿童远视性弱视

目的：总结小儿远视屈光不正性弱视的发病及治疗特点。讨论散瞳条件下确定屈光度数、配戴充分矫正眼镜的治疗特点及家中遮盖法治疗屈光参差性弱视的优越性。方法：观察１２０ 例２３８ 眼（ 远视７６ 例１５０ 眼,远视散光眼４４ 例８８ 眼） 远视屈光不正性弱视眼治愈时间。结果：远视性弱视不同时间的治愈率：６ 个月为４５．３３％ ,１２ 个月达８２．６７ ％ ,２４ 个月达９４ ．６７％ ,３６ 个月达９６．６７％ 。远视散光性弱视治愈率：６、１２、２４ 、３６个月分别为４３．１８％ ;７９．５５％ ;９３．１８％ ;１００％ 。结论：远视屈光不正性弱视是可以治愈的疾病,应及早发现,不失时机予以治疗。     

弱视视觉抑制的心理物理学研究进展

近年来动物实验、心理物理学研究发现,弱视视皮层结构上为双眼,视觉抑制使其功能上表现为单眼,并认为视觉抑制是引起弱视视觉功能损害的重要机制.本文主要对心理物理学领域视觉抑制在弱视视觉系统的重要作用和视觉抑制的测量、调控,以及针对视觉抑制的双眼平衡治疗模式的研究做一总结.     

Experimental Amblyopia

ABSTRACT The current literature concerning experimentally-induced strabismic, deprivation and anisometropic amblyopia is reviewed. It is demonstrated that there are at least two types of experimental strabismic amblyopia—one in which the retina is the initial locus of the amblyopia, and the other in which behaviourally measured acuity loss in cats is accompanied by normal retinal ganglion cell acuities. Classical theories are discussed in the light of new data.     

Amblyopia revisited: Evidence for the heterogeneity of the syndrom

Functional amblyopia has been considered as a homogeneous syndrom for the last decade or so, mainly on the basis of animal experiments. Recently, important differences have been shown to exist between strabismic and anisometropic as well as deprivation amblyopia. Even strabismic amblyopia may be subdivided in different classes. These statements are supported with experimental and clinical data. Clinical relevance of the heterogeneity of amblyopia is discussed particularly in the view of the concept of its cure.     

Active treatments for amblyopia: a review of the methods and evidence base

Treatment for amblyopia commonly involves passive methods such as occlusion of the non‐amblyopic eye. An evidence base for these methods is provided by animal models of visual deprivation and plasticity in early life and randomised controlled studies in humans with amblyopia. Other treatments of amblyopia, intended to be used instead of or in conjunction with passive methods, are known as ‘active’ because they require some activity on the part of the patient. Active methods are intended to enhance treatment of amblyopia in a number of ways, including increased compliance and attention during the treatment periods (due to activities that are interesting for the patient) and the use of stimuli designed to activate and to encourage connectivity between certain cortical cell types. Active methods of amblyopia treatment are widely available and are discussed to some extent in the literature, but in many cases the evidence base is unclear, and effectiveness has not been thoroughly tested. This review looks at the techniques and evidence base for a range of these methods and discusses the need for an evidence‐based approach to the acceptance and use of active amblyopia treatments.     

Amblyopia

New knowledge of the pathophysiology of amblyopia has evolved through animal research over the past 30 years. We now know that development and treatment of amblyopia have a critical and sensitive period. After more than a millennium, patching of the dominant eye remains the cornerstone of amblyopia treatment, and compliance plays an important role in its effectiveness. Compliance can now be measured objectively with an occlusion monitoring device. The first successful attempts have been made to pharmacologically influence the plasticity of the human visual system.     

斜视性弱视发病机制的研究进展

随着脑科学的蓬勃发展,弱视神经机制的研究进入到一个崭新阶段。研究证实:发育早期异常视觉经验可影响皮层神经元的空间特性,弱视视功能损害涉及多个脑区并与皮层神经元空间特性的异常密切相关,弱视是视觉神经通路多方位、多层次损害的综合。在此我们对斜视性弱视发病机制的研究进展作一综述。     

弱视的临床影像学研究进展及其评述

近年来脑成像技术、偏振激光扫描技术以及相干光断层扫描技术等影像学技术在弱视的临床研究中得到较为广泛的应用,促进了相关研究的进展.本文结合目前影像学技术在弱视临床研究中的初步应用情况,对于弱视临床影像学研究的进展进行总结,并且对于磁共振成像、脑磁图、单光子发射计算机断层显像、正电子发射型计算机断层显像、功能磁共振、弥散张量成像技术、偏振激光扫描技术、相干光断层扫描等影像学检查手段在应用于弱视临床研究时的优缺点进行比较及评述.     

图形视觉诱发电位自律空间频率刺激治疗弱视的临床研究

目的:评价图形视觉诱发电位(P-VEP)自律空间频率进行手、眼、脑联合训练法,辅以后像法、红光闪烁法、遮盖疗法等综合疗法治疗儿童弱视的疗效。方法:所有患儿随机分两组,对照组:遮盖疗法+精细作业+红光闪烁疗法。实验组:上述常规方法加国产DV-100视觉诱发电位P-VEP分析系统P-VEP自律空间频率剌激训练。结果:治疗并随访24mo,自律空间频率刺激疗法基本治愈率较遮盖疗法+精细作业+红光闪烁疗法的疗效好,差异有统计学意义(P<0.05)。结论:自律空间频率刺激等综合疗法对儿童弱视有较好的疗效。