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1.
Richard W. Hertle MD Edmond J. FitzGibbon MD John M. Avallone MD CDR MC USN Edward Cheeseman MD E. Katarina Tsilou MD 《Ophthalmology》2001,108(12):3424-7; discussion 2307-8
PURPOSE: To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. DESIGN: Retrospective, observational, case series. PARTICIPANTS: Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. INTERVENTION: Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. MAIN OUTCOME MEASURES: Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10 degrees /second. RESULTS: One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10 degrees /second and an overall decreased intensity (amplitude/frequency) of the nystagmus. CONCLUSIONS: Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved. 相似文献
2.
François J Malecaze Christophe S Gazagne Michel C Tarroux Jean-Marie Gorrand 《Ophthalmology》2001,108(12):2165-2171
Objective
To evaluate the safety and effectiveness of surgery using scleral expansion bands.Design
Prospective, noncomparative, small case series.Participants
Six subjects were enrolled. Four subjects received implants in one eye and two subjects received implants in both eyes.Methods
Implantation of the scleral expansion bands (SEB) was performed using Schachar’s standard technique. Subjects were observed at six postoperative examination intervals through 1 year.Main outcome measures
The key efficacy measures were distance-corrected near visual acuity (at 40 cm and 60 cm) and subjective amplitude of accommodation (push-up, push-down, and minus lens procedures).Results
Distance visual acuity was similar before and after surgery. The near visual acuity and the subjective amplitude of accommodation were temporarily improved in three eyes. However, in the other five eyes, we did not note any improvement of accommodation or near vision after the scleral expansion surgery.Conclusions
In this study, the outcome of the SEB intervention was characterized by inconsistent and unpredictable results with a low level of patient satisfaction. 相似文献3.
Friberg TR 《Ophthalmology》2000,107(12):2233-2239
Objective
To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen.Design
Retrospective noncomparative case series.Participants
Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS).Intervention
Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons.Main outcome measures
Visual acuity, anatomic hole closure.Results
Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen (P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes (P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes.Conclusions
A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent. 相似文献4.
Maberley DA Yannuzzi LA Gitter K Singerman L Chew E Freund KB Noguiera F Sallas D Willson R Tillocco K 《Ophthalmology》1999,106(12):2248-52; discussion 2252-3
Objective
To examine the association between previous radiation exposure and idiopathic perifoveal telangiectasis (IPT).Design
A multicentered, individually matched, case-control study design was used.Participants/controls
Sixty-five case subjects were matched with 175 control subjects. Individuals with unequivocal evidence of angiographically confirmed IPT were included as cases. Control subjects were matched for center, age, and gender.Main outcome measure
The main exposures of interest were a history of therapeutic head or neck irradiation and environmental radiation exposure.Methods
A standardized questionnaire was administered to case and control subjects. Data were collected for the main exposures of interest as well as pertinent covariates. Conditional logistic regression was used to evaluate therapeutic and environmental radiation as risks for IPT.Results
On univariate analysis, head or neck irradiation was associated with IPT (odds ratios [OR] = 4.15, 95% confidence interval [CI] = 1.30–13.24). While controlling for diabetes and family history of diabetes, IPT was found to be associated with both head or neck irradiation (OR = 4.06, 95% CI = 1.20–13.76) and with environmental irradiation (OR = 6.73, 95% CI = 1.06–42.74).Conclusions
This study presents a previously unreported association between prior radiation exposure and IPT. 相似文献5.
Purpose
Central retinal vein occlusion (CRVO) often produces significant and permanent loss of vision in the affected eye. The purpose of this study was to determine if patients with vision loss secondary to CRVO treated with retinal vein cannulation and infusion of tissue plasminogen activator (t-PA) experienced recovery of visual acuity.Design
Prospective, noncomparative, interventional case series.Participants
Thirty eyes of 30 consecutive patients with CRVO underwent the procedure, but two were subsequently excluded. The remaining 28 eyes of 28 patients with CRVO for an average of 4.9 months before intervention (range, 0.25–30 months) and best-corrected visual acuity 20/63 or worse were included in the study.Intervention
All patients underwent pars plana vitrectomy with cannulation and infusion of t-PA into a branch retinal vein.Main outcome measures
Change in visual acuity and the development of complications such as vitreous hemorrhage and neovascular glaucoma were monitored.Results
Twenty-two of 28 patients (79%) experienced at least one line of visual improvement during the follow-up period (average, 11.8 months; range, 3–24 months), and the same number had this level of improvement at the last follow-up examination. Fifteen patients (54%) gained 3 or more lines of acuity within 6 months after the procedure, and 14 (50%) had acuity at last follow-up at least 3 lines better than baseline acuity (average, 6.8 lines). Seven patients had postoperative vitreous hemorrhages ranging from 1 week to 11 months after the procedure; two cleared spontaneously. One patient had a postoperative retinal detachment from a peripheral retinal break that was repaired successfully with pneumatic retinopexy. No other serious intraoperative or early postoperative complications were noted.Conclusions
Vitrectomy with retinal vein cannulation and infusion of t-PA is a relatively safe procedure that may improve vision in eyes with CRVO. 相似文献6.
Purpose
Uveitis is often a chronic disease requiring long-term medical therapy. In this report, we describe a pilot safety and efficacy trial of a novel sustained drug delivery system containing fluocinolone acetonide to treat patients with severe uveitis.Design
Prospective, noncomparative, interventional case seriesParticipants
Patients with severe uveitis.Methods
Sustained drug delivery devices designed to release fluocinolone acetonide for at least 2.5 years were implanted through the pars plana into the vitreous cavity of seven eyes of five patients. All patients had severe uveitis not well controlled with, or intolerant to, repeated periocular corticosteroid injections, systemic corticosteroids, nonsteroidal immunosuppressive agents, or a combination thereof at the time of device implantation. Before device implantation, patients underwent complete evaluation including history, ophthalmologic examination, fluorescein angiography, visual field testing, and electroretinography. After surgery, patients were reexamined at 1 week, 2 weeks, 4 weeks, and at 1- to 3-month intervals. Visual fields, electroretinograms, and fluorescein angiography were repeated at 3- to 6-month intervals.Main outcome measures
Preoperative and postoperative visual acuity, ocular inflammation, anti-inflammatory medication use, and intraocular pressure.Results
Patients had a diagnosis of Behçet’s syndrome (two eyes), or idiopathic panuveitis (five eyes, including two with necrotizing retinitis, two with progressive chorioretinitis, and one with iridocyclitis and intermediate uveitis). Patients were observed an average of 10 months (range, 5–19 months). All eyes had stabilized or improved visual acuity after device implantation, and four of seven eyes had an improvement of three lines or more. The mean initial visual acuity, measured by Snellen chart, was 20/207, and the mean final visual acuity was 20/57 (P = 0.02). After surgery, at the final visit, no eye had clinically detectable inflammation, and all seven eyes had a marked reduction in systemic, topical, and periocular anti-inflammatory medication use. Four eyes had increased intraocular pressure 6 weeks to 6 months after device implantation. Intraocular pressure has been controlled on topical medications. No patient experienced intraoperative complications.Conclusions
A fluocinolone acetonide sustained drug delivery device is a promising new therapy for the treatment of severe uveitis. Intraocular pressure must be carefully monitored long after device implantation. Based on these data, a randomized study of a larger group of patients is warranted. 相似文献7.
Ramin Tadayoni Michel Paques Pascale Massin Soraya Mouki-Benani Jacqueline Mikol Alain Gaudric 《Ophthalmology》2001,108(12):2279-2283
Purpose
To report the appearance of the fundus, that is seen frequently after removal of an idiopathic epiretinal membrane and which we refer to as the dissociated optic nerve fiber layer appearance.Design
Interventional, noncomparative retrospective case series.Participants
One hundred consecutive patients with an epiretinal membrane who underwent pars plana vitrectomy and epiretinal membrane peeling in one eye.Methods
Only patients with an idiopathic epiretinal membrane or a membrane associated with a peripheral retinal tear, but without retinal detachment, were considered for this study. Sixty-one patients met these criteria for one eye. Preoperative and postoperative best-corrected visual acuity and preoperative and postoperative blue filter fundus photographs were reviewed. Histopathologic specimens of epiretinal membranes were available for 14 eyes.Main outcome measures
The postoperative incidence of the dissociated optic nerve fiber layer appearance on blue filter photographs, visual acuity changes, and the presence of internal limiting membrane in epiretinal membrane specimens.Results
The postoperative incidence of this feature on blue filter fundus photographs was 43%. No difference was found between eyes with or without this feature concerning the average preoperative and postoperative best-corrected visual acuity or the average change in visual acuity. Internal limiting membrane was present in all 14 epiretinal membrane specimens available. Five of these 14 patients concerned exhibited a dissociated optic nerve fiber layer appearance and 9 did not.Conclusions
The dissociated optic nerve fiber layer appearance occurred frequently after removal of an epiretinal membrane. As far as we know, this feature has not been previously reported. It consisted of numerous arcuate striae within the posterior pole in the direction of the optic nerve fibers and slightly darker than the surrounding retina. This feature had no functional effect noticeable by the patient and did not preclude good visual recovery. The small number of histologic samples and the impossibility of quantifying the area of internal limiting membrane peeled off did not allow us to supply proof that this feature is due to the extensive peeling of the internal limiting membrane, although this is the most likely hypothesis. 相似文献8.
Adam S Hassan Mark W Johnson Todd E Schneiderman Carl D Regillo Paul E Tornambe Lon S Poliner Barbara A Blodi Susan G Elner 《Ophthalmology》1999,106(10):1900-1907
Objective
To investigate the efficacy and safety of treating thick submacular hemorrhages with intravitreous tissue plasminogen activator (tPA) and pneumatic displacement.Design
Retrospective, noncomparative case series.Participants
From 5 participating centers, 15 eligible patients had acute (<3 weeks) thick subretinal hemorrhage involving the center of the macula in eyes with pre-existing good visual acuity. Hemorrhages were secondary to age-related macular degeneration in 13 eyes and macroaneurysm and trauma in 1 eye each.Methods
The authors reviewed the medical records of 15 consecutive patients who received intravitreous injection of commercial tPA solution (25–100 μg in 0.1–0.2 ml) and expansile gas (0.3–0.4 ml of perfluoropropane or sulfur hexafluoride) for thrombolysis and displacement of submacular hemorrhage. After surgery, patients maintained prone positioning for 1 to 5 days (typically, 24 hours).Main outcome measures
Degree of blood displacement from under the fovea, best postoperative visual acuity, final postoperative visual acuity, and surgical complications.Results
In 15 (100%) of 15 eyes, the procedure resulted in complete displacement of thick submacular hemorrhage out of the foveal area. Best postprocedure visual acuity improved by 2 lines or greater in 14 (93%) of 15 eyes. After a mean follow-up of 10.5 months (range, 4–19 months), final visual acuity improved by 2 lines or greater in 10 (67%) of 15 eyes and measured 20/80 or better in 6 (40%) of 15 eyes. Complications included breakthrough vitreous hemorrhage in three eyes and endophthalmitis in one eye. Four eyes developed recurrent hemorrhage 1 to 3 months after treatment, three of which were retreated with the same procedure.Conclusions
Intravitreous injection of tPA and gas followed by brief prone positioning is effective in displacing thick submacular blood and facilitating visual improvement in most patients. The rate of serious complications appears low. Final visual outcomes are limited by progression of the underlying macular disease in many patients. 相似文献9.
Atsuo Tomidokoro Koichi Soya Kazunori Miyata Bastanfard Armin Sumiyoshi Tanaka Shiro Amano Tetsuro Oshika 《Ophthalmology》2001,108(12):2209-2212
Objective
To investigate the relation between contrast sensitivity and corneal irregular astigmatism in eyes after photorefractive keratectomy (PRK).Design
Prospective observational case series.Participants and controls
Seventy-nine eyes without corneal haze 6 months or more after PRK and 30 normal control eyes.Methods
Videokeratography was taken with TMS-1 (Computed Anatomy Inc. New York, NY), and contrast sensitivity for day and night vision was measured using a Multivision Contrast Tester 8000 (Vistech Consultants, Inc., Dayton, OH).Main outcome measures
Regular and irregular astigmatism (asymmetry and higher order irregularity components) were computed using Fourier series harmonic analysis of the videokeratography data. Area under the log contrast sensitivity function (AULCSF) was calculated from the contrast sensitivity data taken at five spatial frequencies.Results
After PRK, AULCSFs were significantly smaller for day vision (P = 0.007, unpaired t test) and night vision (P = 0.020) compared with normal controls. AULCSFs for day vision were significantly negatively correlated with asymmetry (Pearson’s correlation coefficient, R = ?0.23, P = 0.049) and higher order irregularity (R = ?0.33, P = 0.004) components but not with the regular astigmatism component (P > 0.3). AULCSF for night vision correlated significantly with asymmetry (R = ?0.31, P = 0.013) and higher order irregularity (R = ?0.30, P = 0.016) components but not with the regular astigmatism component (P > 0.3).Conclusions
Corneal irregular astigmatism after PRK significantly influences contrast sensitivity. 相似文献10.
Objective
To determine the relationship between high-altitude retinopathy (HAR) and other altitude-related illnesses and establish a classification system for HAR.Design
Observational case series.Participants
All 40 climbers among 3 Himalayan expeditions who ascended to altitudes between 16,000 and 29,028 feet above sea level (summit of Mt. Everest) were examined for signs of HAR and altitude illness (AI).Methods
All subjects had dilated fundus examinations before the ascent, intermittent fundus, and medical examinations during the climb and a dilated fundus and medical examination within 2 days after attaining their highest altitude.Main outcome measures
Careful fundus drawings or fundus photography or both were obtained for all participants. All subjects gave a subjective assessment of their symptoms of acute mountain sickness (AMS) and were assessed clinically for signs of high-altitude cerebral edema (HACE).Results
Nineteen of 21 climbers who ascended above 25,000 feet developed HAR. Fourteen of 19 climbers who attained altitudes between 16,000 and 25,000 feet were found to have retinopathy. A grading system for HAR describing the severity of the retinopathy was developed. Correlation of the retinopathy with other AI showed that AMS was endemic and that a statistically significant correlation exists between HAR and HACE (P = 0.0240).Conclusion
Recognizing advancing grades of HAR may allow physicians to recommend initiating empiric treatment with oxygen, steroids, diuretics and immediate descent to prevent HAR progression, macular involvement, or potentially fatal HACE. High-altitude retinopathy is both a significant component of and a predictor of progressive AI. 相似文献11.
Growth Hormone Antagonist for Proliferative Diabetic Retinopathy Study Group 《Ophthalmology》2001,108(12):2266-2272
Objective
This study investigated whether the growth hormone receptor antagonist pegvisomant could produce regression of diabetic retinal neovascularization.Design
A prospective, single-group, open-label, phase IIa multicenter trial was conducted.Participants
Twenty-five patients with diabetes mellitus (13 with type 1 and 12 with type 2) and proliferative diabetic retinopathy aged 21 years or older were enrolled.Methods
Patients received an initial loading dose of 100 mg pegvisomant by subcutaneous injection, followed by self-administered injections of 20 mg daily for 12 weeks. The treatment period was followed by a 12-week period during which patients were observed off treatment.Main outcome measure
The effect of treatment on diabetic retinopathy was evaluated from fundus photographs that were graded at a central reading center.Results
Regression of retinopathy was not observed in any patient. At the end of the treatment period, the extent of neovascularization in the study eye was unchanged in 16 patients (9 of 13 with type 1 and 7 of 12 with type 2) and had progressed in 9 patients (4 of 13 with type 1 and 5 of 12 with type 2). The maximum reduction from baseline per patient in the insulin-like growth factor-I (IGF-I) serum level averaged 55%; 17 (68%) of the 25 patients had a greater than 50% reduction in IGF-I. After treatment was discontinued, IGF-I levels returned to baseline.Conclusions
This study did not find evidence that pegvisomant could produce regression of diabetic retinal neovascularization. 相似文献12.
Hideo Torii Keizo Takahashi Fumiaki Yoshitomi Kazunori Miyata Yasuo Ishii Tetsuro Oshika 《Ophthalmology》2001,108(12):2182-2185
Objective
To investigate the incidence of spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule and to explore the possibility of surgical separation of the anterior hyaloid membrane.Design
Prospective nonrandomized interventional comparative trial and comparative human tissue study.Participants
Thirty-eight eyes of 32 patients undergoing primary pars plana vitrectomy combined with cataract extraction and intraocular lens implantation and 3 eye bank eyes for histopathologic examination.Methods
The anterior hyaloid membrane and posterior lens capsule were observed with a fiberoptic endoscope. Surgical separation of the anterior hyaloid membrane was attempted by either the hydrodissection method before cataract extraction (18 eyes) or the direct suction method after cataract extraction (20 eyes). In eye bank eyes, histopathologic examination was performed with (one eye) and without (two eyes) surgical separation of the anterior hyaloid membrane.Main outcome measures
Incidence of spontaneous detachment and success rate of surgical detachment of the anterior hyaloid membrane.Results
No eye displayed spontaneous detachment of the anterior hyaloid membrane. Using the hydrodissection method, complete detachment of the anterior hyaloid membrane was achieved in 10 eyes (55.6%), partial detachment was attained in 2 eyes (11.1%), and detachment was not induced at all in 6 eyes (33.3%). With the direct suction method, the anterior hyaloid membrane was completely separated from the posterior lens capsule in 10 eyes (50%), partially detached in 10 eyes (50%), and not detached at all in any eye. The direct suction method had a significantly higher success rate than the hydrodissection method (P < 0.001, chi-square test). In eye bank eyes, the surgical manipulation induced complete separation of the anterior hyaloid membrane from the lens capsule.Conclusions
Spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule is very rare. Under endoscopic observation, surgical detachment of the anterior hyaloid membrane was possible in half of the patients. 相似文献13.
Laser in situ keratomileusis for correction of myopia and astigmatism after penetrating keratoplasty
Eric D Donnenfeld Howard S Kornstein Abha Amin Mark D Speaker John A Seedor Paul D Sforza Lori M Landrio Henry D Perry 《Ophthalmology》1999,106(10):1966-1975
Purpose
To determine the safety and effectiveness of laser in situ keratomileusis (LASIK) for visual rehabilitation of residual myopia and astigmatism after penetrating keratoplasty.Design
Prospective, noncomparative case series.Participants
LASIK was performed on 23 eyes of 22 patients unable to wear glasses or contact lenses after penetrating keratoplasty due to anisometropia, high astigmatism, and/or contact lens-intolerance.Methods
All patients underwent LASIK for visual rehabilitation after penetrating keratoplasty. Uncorrected visual acuity and best spectacle-corrected visual acuity, degree of anisometropia, and corneal transplant integrity were recorded before surgery, as well as at 1 month, 3 months, 6 months, and 12 months after LASIK surgery.Results
The mean spherical equivalent before surgery was ?7.58 ± 4.42 diopters (D), which was reduced to ?1.09 ± 2.01 D, ?0.79 ± 1.84 D, ?0.77 ± 1.25 D, and ?1.57 ± 1.20 D, respectively, at 1, 3, 6, and 12 months after LASIK. The mean cylinder before surgery was 3.64 ± 1.72 D, which was reduced to 1.98 ± 1.15 D, 1.64 ± 1.14 D, 1.48 ± 0.92 D, and 1.29 ± 1.04 D, respectively, at 1, 3, 6, and 12 months after LASIK. Spherical equivalent anisometropia was reduced from a mean of 6.88 ± 4.4 D to 1.42 ± 1.05 D at the final examination. Best-corrected visual acuity remained the same or improved in 21 of 23 eyes and decreased by 1 and 3 lines in 2 patients. There were no surgical flap or corneal transplant complications.Conclusions
LASIK is a viable treatment alternative for myopia and astigmatism after penetrating keratoplasty in patients who are contact lens-intolerant. LASIK is more effective in treating myopia than astigmatism after penetrating keratoplasty. 相似文献14.
Objective
Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed.Design
A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients’ symptoms.Participants
One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997.Intervention
All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic.Main outcome measures
Relief or reduction of epiphora and discharge.Results
One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week–9 months), and the mean postoperative follow-up was 8 months (range, 2–24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms.Conclusions
Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube. 相似文献15.
Early Manifest Glaucoma Trial: design and baseline data 总被引：8，自引：0，他引：8
Objectives
The Early Manifest Glaucoma Trial (EMGT) will evaluate the effectiveness of reducing intraocular pressure (IOP) in early, previously untreated open-angle glaucoma. Its secondary aims are to explore factors related to glaucoma progression and to study the natural history of the disease. This article describes the EMGT design and presents baseline data.Design
Randomized, clinical trial.Participants
Newly diagnosed patients 50 to 80 years of age with early glaucomatous visual field defects were mainly identified from a population-based screening of more than 44,000 residents of Malmö and Hel-singborg, Sweden. Exclusion criteria were advanced visual field loss; mean IOP greater than 30 mmHg or any IOP greater than 35 mmHg; visual acuity less than 0.5; and inability to complete follow-up protocols.Interventions
After informed consent, patients were randomized to treatment or no initial treatment with close follow-up. Treated patients had laser trabeculoplasty and started receiving topical betaxolol twice daily in eligible eyes. Follow-up visits include computerized perimetry and tonometry every 3 months and fundus photography every 6 months. Decisions to change or begin treatment are made jointly with the patient when EMGT progression occurs and also later if clinically needed.Main outcome measures
The EMGT progression is defined by sustained increases of visual field loss in three consecutive C30-2 Humphrey tests, as determined from computer-based analyses, or by optic disc changes, as determined from flicker chronoscopy and side-by-side comparisons of fundus photographs performed by masked, independent graders.Results
A total of 255 patients were randomized between 1993 and 1997 and will be followed for at least 4 years. All had generally good health status; mean age was 68.1 years, and 66% were women. At baseline, mean IOP was 20.6 mmHg and 80% of eyes had IOP less than 25 mmHg.Conclusions
The Early Manifest Glaucoma Trial is the first large randomized, clinical trial to evaluate the role of immediate pressure reduction, as compared to no initial reduction, in patients with early glaucoma and normal or moderately elevated IOP. Its results will have implications for: (1) the clinical management of glaucoma; (2) understanding the role of IOP and the natural history of glaucoma; and (3) evaluating the rationale for glaucoma screening. 相似文献16.
《Ophthalmology》1999,106(12):2239-2247
Objective
To determine the efficacy of external beam radiation therapy on choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD).Design
Multicenter, parallel, randomized, double-masked clinical trial performed at nine ophthalmic and radiotherapeutic centers.Participants
Two hundred five patients were randomly assigned either to treatment with 8 fractions of 2 Gy external beam irradiation (n = 101) or to control with 8 fractions of 0 Gy (sham treatment, n = 104). Both patients and ophthalmologists were masked with regard to applied treatment. Patients with subfoveal classic or occult CNV, visual acuity of 20/320 or greater on the Early Treatment Diabetic Retinopathy Study chart, lesion size of 6 disc areas or less, history of visual symptoms of 6 months or less, and absence of foveal hemorrhage were recruited.Intervention
In the treatment group, external beam irradiation with 8 fractions of 2 Gy was performed, whereas in the control group, sham treatment with 8 fractions of 0 Gy was applied.Main outcome measures
Primary outcome measure was the difference in visual acuity between baseline and after 1 year of follow-up.Results
One hundred eighty-three patients (89.3%) completed the 1-year follow-up. The mean reduction in visual acuity was 3.5 ± 4.7 lines in 88 patients of the 8- × 2-Gy treatment group and 3.7 ± 3.8 lines in 95 patients of the 8- × 0-Gy control group. This difference was not statistically significant (P = 0.53, Mann-Whitney U test). At 1 year, 51.1% of treated patients and 52.6% of control subjects lost three or more lines (P = 0.88). Visual acuity in the presence of classic CNV dropped by 3.7 ± 4.4 lines in 33 patients of the treatment group versus 4.3 ± 3.9 lines in 36 patients of the control group (P = 0.47). Visual acuity in 114 patients with occult CNV dropped by 3.4 ± 4.9 in the treatment group (55 patients) versus 3.4 ± 3.8 lines in the control group (59 patients) (P = 0.80).Conclusions
In this randomized study, radiation therapy at a dose of 16 Gy applied in 8 fractions of 2 Gy provided no benefit as a treatment for subfoveal CNV secondary to ARMD at 1 year. 相似文献17.
John P. Kelly James O. Phillips Avery H. Weiss 《Documenta ophthalmologica. Advances in ophthalmology》2017,134(1):37-44
Purpose
The relationship between eye movements and the visual evoked potential (VEP) response was examined in two subjects with infantile nystagmus syndrome (INS). Changes in VEP amplitude were compared between periods of foveation versus periods of high-frequency nystagmus. An analysis is proposed that improves extraction of the checkerboard reversal VEP signal from subjects with INS.Methods
INS subjects were 2 healthy children (12–13 years old) with 20/40 or better corrected acuity. Optical coherence tomography confirmed the optic nerves, retina, and fovea were within normal variation. VEPs were recorded to checkerboard reversal and to onset/offset of horizontal gratings while simultaneously recording the electrooculogram (EOG). VEP epochs underwent Fourier analysis, and epochs were examined for phase consistency with the mean. Foveation periods were compared to video-oculography recordings from a separate session.Results
Optic nerve misrouting, such as crossed VEP asymmetry seen in albinism, or ipsilateral VEP asymmetry seen in achiasma, was not detected in either subject. By averaging only epochs in which EOG epochs showed foveation, VEP amplitude could be increased ≥59%. Averaging the VEP only on epochs with consistent phase at Oz increased VEP amplitude by ≥twofold; subsequent EOG epochs after this analysis mostly contained foveation periods or minimal EOG activity. Latency varied <14 ms across all analyses.Conclusions
The checkerboard reversal VEP signal is dependent on foveation periods in subjects with INS despite good visual acuity. Reduction in VEP amplitude due to retinal image motion induces noise and/or lack of phase locking in the VEP epochs. Selective averaging of epochs based on phase consistency improves the extraction of a VEP signal, likely when retinal image motion is minimized.18.
Francesco Carones Pier Giorgio Gobbi Luca Vigo Rosario Brancato 《Ophthalmology》1999,106(10):1976-1983
Purpose
To characterize the refractive changes after excimer laser photorefractive keratectomy for the correction of hyperopia over a follow-up up to 3 years and to assess refractive stability and changes in astigmatism.Design
Noncomparative, nonrandomized, retrospective, interventional case series.Participants
Thirty-eight hyperopic eyes of 28 patients (age range, 33–62 years) with refraction in the range +1.00 to +8.00 diopters (D). Mean attempted correction was +3.33 ± 0.98 D (range, +1.00 to +4.00 D). Data were compared to those from 216 eyes treated for myopia in the range ?1.00 to ?12.70 D.Intervention
The hyperopic correction was made using an erodible mask inserted in the laser optical pathway to produce a circular ablation measuring 6.5 mm in diameter. An axicon was then used to create a blend transition zone from 6.5 mm up to 9.4 mm in diameter. Eyes were evaluated 3 to 11 times (5.5 ± 2.4) over a 3- to 34-month follow-up (16.8 ± 8.4 months).Main outcome measures
Vector analysis of refractive error, applying a nonlinear statistical model fitting the spherical equivalent, and the sphere component data. The fit parameters were the long-term error at stabilization (ε∞), the amount of regression (ε0), being the difference of refractive errors immediately after surgery and at stabilization, and the time constant (T) giving the temporal scale length by which the overcorrection halves (regression half-life). Cylinder was analyzed by a linear regression.Results
The initial overcorrection was much larger after hyperopic treatments than myopic ones (ε0 = ?3.26 ± 0.35 D vs. +1.43 ± 0.35 D), and it takes typically four times longer to regress (T = 3.30 ± 0.91 months). Refractive stabilization is reached after more than 1 year, with a satisfactory refractive result. The hyperopic treatment induces a mean astigmatism of 1.00 D, which remains constant throughout the follow-up, and tends to be aligned along the with-the-rule meridian.Conclusions
The advantages of a reasonably well-designed algorithm to correct hyperopia (ε∞ = + 0.20 ± 0.23 D) are counterbalanced by the long time to refractive stabilization and by the induced astigmatism. 相似文献19.
Manami Kawai Toshiaki Goseki Hitoshi Ishikawa Miki Hoshina Nobuyuki Shoji 《Japanese journal of ophthalmology》2018,62(6):659-666
Purpose
We evaluated the background and characteristics of elderly patients with binocular diplopia including diseases caused by abnormalities in orbital pulleys.Study design
Retrospective.Methods
The participants were 236 patients aged 60 years or older who visited Kitasato University Hospital complaining of binocular diplopia. We classified strabismus by types and investigated the causes for each group. We diagnosed orbital pulley disorders using magnetic resonance imaging (MRI). Patients with orbital pulley disorders exhibited esotropia and/or vertical strabismus and did not present with cranial nerve palsy, systemic illness, or ocular injury.Results
Classification of strabismus types was: exotropia (24.2%); esotropia (25.0%); vertical strabismus (30.1%), combined strabismus (20.8%). There were 50.9% cases of strabismus associated with vertical deviation. The causes of disease in each group were as follows: in the exotropia group, 50.9% convergence insufficiency exotropia, 21.1% basic exotropia; in the esotropia group: 35.6% orbital pulley disorder 33.9% sixth cranial nerve palsy; in the vertical strabismus group: 32.4% forth cranial nerve palsy, 31.0% orbital pulley disorder; in the combined strabismus group: 28.6% orbital pulley disorder, 28.6% forth cranial nerve palsy.Conclusions
About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was often caused by orbital pulley disorders. It is the first epidemiological study focusing on orbital pulley disorders diagnosed on the basis of MRI.20.
Intermittent oscillopsia in a case of congenital nystagmus. Dependence upon waveform 总被引：1，自引：0，他引：1
Spontaneous reports of oscillopsia are rare in cases of congenital nystagmus (CN). We examined the relationship between nystagmus waveform characteristics and oscillopsia in one such case. To reduce the patient's nystagmus, she was fitted with contact lenses. We examined the effects of tactile feedback by applying local anesthetic while she wore the lenses. When she was without lenses, we provided tactile feedback by applying gentle finger pressure to one eyelid. She was also asked to look at a peripheral afterimage. Nystagmus was analyzed for frequency, amplitude, foveation duration, and drift velocity, if foveation was not perfectly stable. Perceived target stability was recorded. The patient noted oscillopsia during the initial baseline recording and with lid pressure. The image was stable with contact lenses with and without anesthesia and during the second session baseline; at these times, drift velocity was less than 4 degrees/sec and foveation duration was greater than 100 msec. No oscillopsia of the afterimage in dark was noted; she perceived it moving with her gaze as she attempted to look at it. It appears that in some CN patients, the suppression of oscillopsia operates only within fixed limits of foveation stability and duration. When, because of internal or external factors, their nystagmus exceeds these, oscillopsia results. 相似文献