服用羟氯喹者的视觉电生理检查

目的 对服用羟氯喹者进行视网膜电图和眼电图检查,评价用药安全性.方法 选择正在服用羟氯喹的180例自身免疫病患者,行视力、眼压、眼前节及散瞳眼底检查,其中55例患者行视网膜电图和眼电图检查.每6个月复诊1次.结果 180例患者的视力、眼压、眼底均正常,55例患者按用药时间分组,各用药时段组Arden比、a波、b波峰时和a波平均振幅及30 Hz反应差异均无统计学意义(P>0.05),而在用药13～24月组,-15dB光刺激强度下的b波平均振幅较未用药组和用药3～12月组差异均有统计学意义(P<0.05).结论 使用低剂最的羟氯喹具有良好的眼部安全性.     

Multifocal electroretinographic features of central retinal vein occlusion

PURPOSE: To determine the features of wide-field multifocal electroretinography (WF-mfERG) recorded in patients with central retinal vein occlusion (CRVO) and to compare WF-mfERG responses of the affected and fellow eyes. In addition, WF-mfERG responses were also compared by using standard electroretinography (ERG). METHODS: WF-mfERG and ERG responses were recorded from both eyes of 56 patients with CRVO. The WF-mfERG responses, obtained using a custom-built system were grouped into central and peripheral rings. The P1 amplitudes, and P1 and N1 implicit times were grouped and averaged within both rings. Nonparametric statistical analysis was used to compare the ERG results from the affected and fellow eyes. The results were also compared with normative data (5% to 95% confidence limits). RESULTS: CRVO markedly affected all the parameters of the WF-mfERG. In the affected eyes, 98% of the central and 91% of the peripheral P1 implicit times fell outside the normal range, as opposed to 35% of the 30-Hz flicker implicit times. The WF-mfERG responses obtained from eyes with CRVO were significantly different (P<0.01) from those derived from the fellow eye. The central and peripheral P1 implicit times were also abnormal in 59.2% and 46.9% of the fellow eyes, respectively. CONCLUSIONS: WF-mfERG is more susceptible than the standard ERG to changes in the nonlinear dynamics of the eye due to the multiple frequencies of stimulation used to record WF-mfERG responses. WF-mfERG could be a sensitive indicator of the underlying disease affecting the retina in eyes with CRVO and may have a role in the clinical setting.     

Multifocal electroretinography evaluation for early detection of retinal dysfunction in patients taking hydroxychloroquine

PURPOSE: To evaluate macular function using multifocal electroretinography (mfERG) in a cohort of asymptomatic patients taking hydroxychloroquine and a patient with maculopathy secondary to hydroxychloroquine treatment. METHODS: mfERG recordings were obtained for both eyes of 11 patients taking hydroxychloroquine without clinical signs of toxicity and 1 patient with toxic maculopathy. Initially, the classic m-sequence paradigm for the first-order kernel (103 hexagons; 2.7 candela x seconds/m2 peak luminance) was recorded. After that, another special stimulation mode was applied, which emphasized second-order adaptational effects (modulated multifocal flashes with interleaved global flashes, MF0F0 paradigm). RESULTS: The patient with toxic maculopathy and one patient without toxicity had multiple areas of decreased retinal responses bilaterally (classic m-sequence). The patient with toxicity and another three patients without toxicity presented with multiple areas of decreased retinal function in both eyes with the second-order component of the MF0F0 paradigm. Repeated recordings of 1 patient 8 months after the initial recording demonstrated evidence for reproducibility of the second-order adaptive effects. CONCLUSION: Clinically asymptomatic patients receiving hydroxychloroquine treatment can have substantial local decreases in their retinal function, as reflected by the changes in mfERG recordings, possibly indicating a preclinical stage of drug-related toxicity.     

Evaluation of vitreoretinal interface changes in patients receiving intravitreal anti-VEGF therapy

Purpose

To study the effects of repeated intravitreal injection of anti-VEGF drug bevacizumab on the vitreoretinal interface (VRI).

Methods

Patients undergoing intravitreal injection of bevacizumab were enrolled. Eyes with media haze, uveitis, high myopia, history of cataract surgery or laser capsulotomy in last 6 months and complicated pseudophakia were excluded. VRI evaluation was done monthly for a minimum of 6 months. The nature and timing of the change(s) event was recorded.

Results

A total of 100 eyes were evaluated. Thirty-seven eyes developed new vitreoretinal interface change event (VICE). Pseudophakia (OR = 5.23, 95% CI = 1.99–14.07, p = 0.001), pre-injection VRI abnormality (OR = 2.63, 95% CI = 1.13–6.14, p = 0.024) and older age at enrollment (62.6 ± 13.9 vs. 56.3 ± 14 years) were risk factors for development of VICE. Eighty percent of interface events occurred in the first 3 months of therapy. Eight needed surgical intervention for consequences of vitreoretinal separation.

Conclusion

VICE is not infrequent in eyes receiving anti-VEGF therapy though rarely need surgical intervention. The first 3 months are the critical months to watch out for these events. The treating ophthalmologists must keep the risk factors for development of in mind and monitor and counsel patients accordingly.

     

Multifocal electroretinographic evaluation of macular function in acute posterior multifocal placoid pigment epitheliopathy

Background

In acute posterior multifocal placoid pigment epitheliopathy (APMPPE), little is known about the long-term outcome of electroretinographic macular function. The purpose of this study was to report 2-year follow-up results of multifocal electroretinography (mfERG) in a 26-year-old Japanese woman diagnosed with APMPPE.

Methods

Clinical and electrophysiological investigations of a single patient.

Results

Best-corrected visual acuity at initial examination was 1.5 and 0.5 in her right and left eyes, respectively. In addition to characteristic fundus lesions bilaterally, fluorescein angiography demonstrated diagnostic early blockage and late staining of the lesions. Optical coherence tomography revealed a hyperreflective spot (corresponding to the lesion) in the outer retinal layer in the right eye and intraretinal fluid in the left eye. On mfERG, the amplitudes were generally preserved, but markedly reduced amplitudes were detected in the central region of the left eye and in the paracentral region of the right eye. Five days later, visual acuity improved to 1.0, and the intraretinal fluid spontaneously disappeared without medication in the left eye. Light-to-dark ratios on electrooculography were 2.68 and 2.23 in the right and left eyes, respectively, both within the normal range. Two years later, visual acuity was 2.0 in both eyes, and ophthalmoscopically, there were neither retinal nor retinal pigment epithelial (RPE) abnormalities. mfERG revealed that the amplitudes were considerably improved (nearly normal level) in both eyes.

Conclusions

The outcome suggests that longitudinal macular function in both visual acuity and mfERG may be favorable, unless areas of retinal or RPE alteration remain.     

Management of patients undergoing hydroxychloroquine (Plaquenil) therapy

The quinolines, hydroxychloroquine (Plaquenil) and chloroquine are used primarily for their anti‐inflammatory effects in the treatment of auto‐immune conditions such as rheumatoid arthritis. Another common use of these drugs is the prophylaxis and suppression of malaria. The use of quinolines may cause several ocular side‐effects. The most significant complication is irreversible macular damage resulting in both visual acuity and visual field loss. However, the Royal College of Ophthalmologists, UK (RCO) recently recommended against the monitoring of patients receiving quinoline therapy as it was deemed to be too costly, given the low incidence of retinal complications. In this article, we present a case of hydroxychloroquine retinopathy, describe the ocular changes associated with quinoline therapy and recommend an optometric review schedule for patients who are currently taking these drugs. Furthermore, we recommend a proactive approach toward medical practitioners prescribing these drugs for optometric‐based monitoring of these patients.     

Multifocal ERG changes in glaucoma

The multifocal electroretinogram (MERG) can assess regional retinal responses using analysis which gives both first-order and second-order nonlinear responses from multiple retinal regions. The retinal responses from both types of analysis showed amplitude reduction in glaucoma, suggesting that the outer and inner retinal layers are affected. These findings are in accord with the damage which has been reported in advanced glaucoma. The macular response showed a larger amplitude reduction in b-waves (first-order response) and N2P (second-order response) than did peripheral retinal responses. This indicates that loss of macular response is an important sign in glaucoma.     

Retinal functional changes measured by frequency-doubling technology in patients treated with hydroxychloroquine

Background  

Antimalarial drugs such as chloroquine (CQ) and hydroxychloroquine (HCQ) are mainly used in the treatment of rheumatologic diseases, and their use may be associated with irreversible retinal toxicity. Previous studies indicate early paracentral visual field loss (Humphrey 10-2) in patients taking HCQ". These paracentral defects appear before changes in other clinical parameters as visual acuity and fundoscopy. The mechanism of CQ toxicity remains unclear. It was reported that toxic doses of CQ administered for as long as 4.5 years to Rhesus monkeys caused an initial dramatic effect on ganglion cells, followed later by photoreceptors and RPE degeneration. The purpose of this study is to explore early retinal functional changes measured by frequency-doubling technology (FDT) in patients treated with hydroxychloroquine (HCQ).     

Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study

Graefe's Archive for Clinical and Experimental Ophthalmology - We aimed to find earlier morphological and functional alterations in the retinas of patients treated with hydroxychloroquine...     

共聚焦显微镜观察圆锥角膜行角膜胶原交联术后早期组织形态学变化

目的探讨进展期圆锥角膜行角膜胶原交联术后早期共聚焦显微镜下的组织形态学改变。方法回顾性病例系列研究。应用共聚焦显微镜观察2017年9月至2019年3月于解放军总医院眼科行角膜胶原交联术的进展期圆锥角膜患者23例(32只眼), 其中男性15例(24只眼), 女性8例(8只眼);年龄(26±10)岁。所有患者于术前和术后1周、1个月、3个月应用共聚焦显微镜观察角膜组织结构改变、定量记录角膜上皮下神经纤维、基质细胞、内皮细胞密度和基质结构改变的深度并进行对比分析。不同时间的总体差异比较采用重复测量资料的方差分析或Friedman检验, 不同时间的差异的多重比较采用LSD-t检验或Bonferroni校正。结果角膜胶原交联术后1周, 角膜上皮细胞处于修复期, 表现为上皮基底细胞核增大、反射增强, 上皮下可见活化细胞, 浅基质肿胀呈海绵状, 深基质肿胀呈不均匀斑块状或条索状, 反射强。术后1个月, 上皮基底细胞恢复, 上皮下神经开始生长, 浅基质持续呈海绵状肿胀, 反射进一步增强, 深基质肿胀呈更粗大的斑块或条索样结构并持续至术后3个月。术前与术后3个月内, 角膜上皮下神经纤维密度差异有统计学意义(F=233.30, P<0.001), 术后1周、1个月、3个月角膜上皮下神经纤维密度分别为(0.51±0.31)、(3.65±2.21)、(8.50±4.02)mm/mm², 与术前的(14.60±2.57)mm/mm²相比均明显降低(均P<0.05);不同时间点角膜前部基质细胞密度比较, 差异有统计学意义(χ²=92.48, P<0.001), 术后1周、1个月、3个月角膜前部基质细胞密度分别为2.00(1.00, 5.75)、2.50(1.00, 5.75)、79.00(64.25, 94.00)个/mm², 与术前的347.00(345.00, 395.75)个/mm²相比均明显降低(均P<0.05)。术后3个月内角膜基质结构改变的深度范围为(400.56±86.12)μm:术后1周、1个月、3个月分别为(402.13±89.20)、(399.88±85.92)、(399.69±85.94)μm, 差异无统计学意义(F=0.80, P=0.455)。术前和术后不同时间角膜后部基质细胞密度[术前为(260.6±33.2)个/mm², 术后1周、1个月、3个月分别为(264.4±44.5)、(263.9±37.6)、(266.3±40.2)个/mm²]和内皮细胞密度[术前为(2 707.1±152.6)个/mm², 术后1周、1个月、3个月分别为(2 704.2±148.5)、(2 705.6±152.6)、(2 704.5±150.1)个/mm²]比较, 差异均无统计学意义(F=1.38, 1.01;P=0.259, 0.351)。结论圆锥角膜行角膜胶原交联术后早期, 共聚焦显微镜下可见角膜上皮和上皮下神经的改变呈现损伤修复的过程;角膜浅基质呈均匀的蜂窝状肿胀, 深基质呈不均匀斑块状或条索状肿胀;术后早期角膜基质结构改变的深度相对稳定。     

共聚焦显微镜观察圆锥角膜行角膜胶原交联术后早期组织形态学变化

目的探讨进展期圆锥角膜行角膜胶原交联术后早期共聚焦显微镜下的组织形态学改变。方法回顾性病例系列研究。应用共聚焦显微镜观察2017年9月至2019年3月于解放军总医院眼科行角膜胶原交联术的进展期圆锥角膜患者23例(32只眼), 其中男性15例(24只眼), 女性8例(8只眼);年龄(26±10)岁。所有患者于术前和术后1周、1个月、3个月应用共聚焦显微镜观察角膜组织结构改变、定量记录角膜上皮下神经纤维、基质细胞、内皮细胞密度和基质结构改变的深度并进行对比分析。不同时间的总体差异比较采用重复测量资料的方差分析或Friedman检验, 不同时间的差异的多重比较采用LSD-t检验或Bonferroni校正。结果角膜胶原交联术后1周, 角膜上皮细胞处于修复期, 表现为上皮基底细胞核增大、反射增强, 上皮下可见活化细胞, 浅基质肿胀呈海绵状, 深基质肿胀呈不均匀斑块状或条索状, 反射强。术后1个月, 上皮基底细胞恢复, 上皮下神经开始生长, 浅基质持续呈海绵状肿胀, 反射进一步增强, 深基质肿胀呈更粗大的斑块或条索样结构并持续至术后3个月。术前与术后3个月内, 角膜上皮下神经纤维密度差异有统计学意义(F=233.30, P<0.001), 术后1周、1个月、3个月角膜上皮下神经纤维密度分别为(0.51±0.31)、(3.65±2.21)、(8.50±4.02)mm/mm², 与术前的(14.60±2.57)mm/mm²相比均明显降低(均P<0.05);不同时间点角膜前部基质细胞密度比较, 差异有统计学意义(χ²=92.48, P<0.001), 术后1周、1个月、3个月角膜前部基质细胞密度分别为2.00(1.00, 5.75)、2.50(1.00, 5.75)、79.00(64.25, 94.00)个/mm², 与术前的347.00(345.00, 395.75)个/mm²相比均明显降低(均P<0.05)。术后3个月内角膜基质结构改变的深度范围为(400.56±86.12)μm:术后1周、1个月、3个月分别为(402.13±89.20)、(399.88±85.92)、(399.69±85.94)μm, 差异无统计学意义(F=0.80, P=0.455)。术前和术后不同时间角膜后部基质细胞密度[术前为(260.6±33.2)个/mm², 术后1周、1个月、3个月分别为(264.4±44.5)、(263.9±37.6)、(266.3±40.2)个/mm²]和内皮细胞密度[术前为(2 707.1±152.6)个/mm², 术后1周、1个月、3个月分别为(2 704.2±148.5)、(2 705.6±152.6)、(2 704.5±150.1)个/mm²]比较, 差异均无统计学意义(F=1.38, 1.01;P=0.259, 0.351)。结论圆锥角膜行角膜胶原交联术后早期, 共聚焦显微镜下可见角膜上皮和上皮下神经的改变呈现损伤修复的过程;角膜浅基质呈均匀的蜂窝状肿胀, 深基质呈不均匀斑块状或条索状肿胀;术后早期角膜基质结构改变的深度相对稳定。     

正常SD大鼠视网膜电图敏感度功能的发育

目的纵向研究正常SD大鼠视网膜电图（ERG）敏感度功能的发育。方法实验研究。SD大鼠22只（22眼）,分别在出生后16 d、18 d、（30±2）d和（64±2）d记录暗适应ERG。暗适应后用逐渐递增的白光刺激记录一系列的ERG。通过曲线拟合获得饱和a波波幅（Rmp3）和敏感度（S）。通过曲线回归获得最大b波波幅（Vmax）和敏感度（σ）。采用方差分析检验ERG参数在各时间点之间的差异。结果随着生长发育S和logσ逐渐增高。Rmp3在出生后18 d时最高,以后随着生长发育逐渐下降。Vmax在出生后（30±2）d时最高,以后随着生长发育逐渐下降。结论ERG的敏感度随着生长发育而增高,反映了SD大鼠视杆细胞功能的发育特点。