中心性浆液性脉络膜视网膜病变OCT与mfERG图像的相关性

目的利用光学相干断层扫描（OCT）与多焦视网膜电图（mfERG）分析中心性浆液性脉络膜视网膜病变（csc）患者的OCT与mfERG图像的关系。方法横断面研究。应用德国CarlZeissCirrusHD-OCT及美国EDI VERIS Science^TM4．9视诱发反应图像系统对40只急性期CSC眼（40例）进行检查。将CSC患者OCT黄斑厚度图三个环的视网膜平均厚度与相对应的多焦视网膜电图（mfERG）的1＋2环、3环、4环的N1、P1波的平均反应密度和峰时间进行比较,并将黄斑区体积、总的黄斑中心凹的厚度、视网膜下液高度、视网膜下液范围和中心凹神经上皮厚度与mfERG6个环的N1、P1波反应密度和潜伏期比较分析。采用Spearman秩相关进行数据分析。结果CSC患者OCT内环、中环、外环的视网膜平均厚度与mfERG1＋2环、3环、4环的N1、P1波的峰时间呈正相关。黄斑区体积、总的黄斑中心凹的厚度、视网膜下液高度和视网膜下液范围与mfERG的N1、P1波反应密度和峰时间有显著的相关性。结论CSC患者的黄斑平均视网膜厚度及积液情况与mfERG之间有一定的相关性,可用OCT测量黄斑区视网膜下液的积液量,尤其是用积液范围来评估黄斑区视网膜功能的改变。OCT与mfERG的检测可以综合评价CSC患者的形态与功能的变化。     

Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane

The aim of this study was to analyze macular function by measuring the sensitivity of the macula with fundus-related microperimetry and to compare the results with the best corrected visual acuity (BCVA) and foveal retinal thickness measured by optical coherence tomography (OCT) in patients with idiopathic epimacular membrane. We prospectively reviewed 66 eyes with idiopathic epimacular membrane and 35 normal healthy eyes in patients who had undergone fundus-related microperimetry and OCT. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The mean retinal sensitivities in the central 10° (central microperimetry, cMP-1) and in the paracentral 10–20° (paracentral microperimetry, pMP-1) areas were determined and correlated with the BCVA and OCT-measured foveal thickness. Eyes with epimacular membranes showed significantly lower log MAR BCVA (P < 0.001) and cMP-1 microperimetry sensitivity (P < 0.001) and significantly higher OCT foveal thickness (P < 0.001) than control eyes. There was a significant correlation between the BCVA and mean retinal sensitivity in the cMP-1 (r ² = 0.26, P < 0.001) and the pMP-1 (r ² = 0.07, P = 0.008) areas. A significant negative correlation was observed between the foveal thickness and the mean retinal sensitivity in the cMP-1 (r ² = 0.13, P < 0.001) area. Retinal sensitivity in the central macular area determined by MP-1 microperimetry was significantly correlated with BCVA and with foveal thickness. The combination of OCT and microperimetry may help a better evaluation of the patients with idiopathic epimacular membrane.     

Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study

AIM: To evaluate short term safety of an enhanced photodynamic therapy (PDT) protocol with half dose verteporfin for treating chronic central serous chorioretinopathy (CSC). METHODS: 20 eyes of 18 patients with symptomatic chronic CSC underwent PDT using 3 mg/m2 verteporfin. Verteporfin was infused over 8 minutes followed by indocyanine green angiography guided laser application 2 minutes later. Serial optical coherence tomography (OCT) and multifocal electroretinography (mfERG) recordings were performed before PDT, at 4 days, 2 weeks, and 1 month after PDT. The best corrected visual acuity (BCVA), OCT central retinal thickness, and mean mfERG response amplitudes and peak latencies were compared longitudinally. Subgroup analysis was further performed for eyes with or without pigment epithelial detachment (PED). RESULTS: At 1 month after PDT, the median BCVA improved from 20/40 to 20/30 (p = 0.001). The mean central retinal thickness also reduced from 276 microm to 158 microm (p < 0.001) and 17 (85%) eyes had complete resolution of serous retinal detachment and/or PED. MfERG showed no significant changes in the mean N1 and P1 response amplitude and latency for all eyes. Subgroup analysis demonstrated that eyes without PED had a significant increase in the mean central mfERG P1 response amplitude with reduction in P1 peak latency at 1 month post-PDT. For eyes with PED, transient reduction in the mean central P1 response amplitude was observed at 4 days post-PDT. CONCLUSIONS: The modified safety enhanced PDT protocol with half dose verteporfin appeared to be a beneficial treatment option for patients with chronic CSC, especially in eyes without serous PED. Further controlled study is warranted to demonstrate the long term safety and efficacy of this treatment option.     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.     

25G玻璃体切除联合空气填充治疗特发性黄斑裂孔

目的:观察对于特发性黄斑裂孔行25G玻璃体切除联合空气填充治疗后的解剖和视功能结果.方法:前瞻性干预性分析.27例(30眼)特发性黄斑裂孔患者接受25G经睫状体平坦部玻璃体切除术,同时行白内障超声乳化抽吸联合人工晶体置入和玻璃体腔无菌空气填充.所有患者在术前和术后3mo进行最佳矫正视力(logMAR视力)、视野检查和多焦视网膜电流图(multifocal electroretinography, mfERG)检查,使用OCT明确黄斑裂孔闭合情况.结果:首次手术后28眼的黄斑裂孔闭合,平均logMAR视力由术前的0.72±0.22提高到术后的0.29±0.18(P<0.001).中心10°视野检查中,平均偏差(mean deviation, MD)由术前的-3.59±1.83 dB减少到术后的-2.51±1.36 dB (P<0.001),平均模式标准差(pattern standard deviation, PSD)由术前的1.86±0.68 dB减少到术后的1.33±0.32 dB (P=0.001).MfERG中可见术后中心凹和旁中心凹区域的平均振幅明显升高,而4-6环区域的平均潜伏期明显延长(P<0.05).疾病病程长短(P<0.001)和1环区域的术前N1波振幅(P=0.001)对术后最佳矫正视力有预测作用.结论:特发性黄斑裂孔患者行25G玻璃体切除联合空气填充,术后保持1d的面向下体位,有很好的解剖成功率和视功能结果.     

Outcomes of 25-gauge vitrectomy with air tamponade for idiopathic macular hole repair surgery

AIM: To evaluate the anatomic and visual outcomes of 25-gauge vitrectomy combined with air tamponade for the treatment of idiopathic macular hole (IMH). METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study. All patients underwent 25-gauge pars plana vitrectomy (PPV) combined with phacoemulsification and air tamponade. Best corrected visual acuity [BCVA; logarithm of the minimum angle of resolution (logMAR)], perimetry and multifocal electroretinography (mfERG) were conducted before and after the operation. Anatomical changes were evaluated with optical coherence tomography (OCT). RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy. The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively (P<0.001). In the visual field of central 10°, the average mean deviation (MD) decreased from -3.59±1.83 dB preoperatively to -2.51±1.36 dB postoperatively (P<0.001) and the average pattern standard deviation (PSD) decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively (P=0.001). The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly too (P<0.05). The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA (P<0.001, P=0.001, respectively). CONCLUSION: The 25-gauge PPV and air tamponade with 1d prone positioning produced favorable anatomic and functional outcomes.     

In diabetic retinopathy, foveal thickness of 300 μm seems to correlate with functionally significant loss of vision

Purpose To study the relationship between foveal thickness assessed by optical coherence tomography (OCT) and foveal function measured with multi focal electroretinography (mfERG) in patients with non-proliferative diabetic retinopathy, and with no previous laser treatment. Methods Twenty-six eyes from 18 diabetic patients (13 men), aged 59 years, (range 28–79 years), diabetes duration 15 years, (range 2–27 years), with a macular thickness between 200 and 600 μm were evaluated by mfERG, visual acuity (ETDRS score) and OCT. Mean amplitudes and implicit times of the mfERG responses were analyzed within the four innermost (14 degrees) of the six concentric rings. For comparison with the results from the OCT (diameter of measured area = 6 mm) we analyzed the summed response from the first and second ring (central zone), corresponding to the central area of the OCT. The third(zone 2) and fourth (zone 3)of the four innermost of the six concentric rings measured by the mfERG corresponding to the second and third area of OCT. Results An increased macular thickness in the central area of the OCT correlated to reduced amplitudes (r = −0.541; P = 0.004) and prolonged implicit times (r = 0.548; P = 0.004) in the central zone of the mfERG, and inversely correlated with visual acuity, −0.49; P = 0.045. Retinal thickness in the second area was correlated to prolonged implicit times in the second mfERG zone (r = −0.416; P = 0.034). No correlations were found for the third area of the OCT. When macular thickness exceeded 300 μm the decrease of amplitudes and prolonged implicit times, measured by mfERG, seemed to be more pronounced. Conclusion In conclusion increased macular thickness is correlated with reduced amplitudes and prolonged implicit times on the mf ERG and worse visual acuity.     

Structural and functional outcomes after treatment of uveitic macular oedema: an optical coherence tomography and multifocal electroretinogram study

Background: The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema. Methods: Thirty‐three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed. Results: The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT‐measured central foveal thickness decreased significantly from 434 ± 135 µm before treatment to 267 ± 92 µm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = ‐0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = ‐0.56, p = 0.001). Also, there was no correlation between the final VA and pre‐treatment OCT and mfERG measurements. Conclusion: This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function.     

Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values

AIM: To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS: This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS: There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1 and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose group (P<0.05). CONCLUSION: Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups were efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.     

Macular sensitivity in eyes with central serous chorioretinopathy

PURPOSE: To determine macular sensitivity and fixation characteristics in eyes with central serous chorioretinopathy (CSC) using fundus-related microperimetry. METHODS: The authors reviewed 19 eyes with serous elevation within the central 10 degrees due to CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the fundus-related microperimeter, MP-1. The bestcorrected visual acuity (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10 degrees to 20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with that of control eyes. RESULTS: Eyes with CSC showed significantly lower logMAR BCVA (p<0.001), cMP-1, and pMP-1 sensitivity than control eyes (p<0.001, p<0.01, respectively). Eyes with CSC were not significantly different in fixation location (p=1.00) or fixation stability than control eyes (p=0.45). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 17 (89%) and relatively unstable in 2 (11%). CONCLUSIONS: Eyes with CSC showed significantly lower retinal sensitivity not only at the central but also in the paracentral area. Even with decreased BCVA and retinal sensitivity, our patients showed central and stable fixation in their affected eyes.     

Comprehensive evaluation of intravitreal conbercept versus half-dose photodynamic therapy for chronic central serous chorioretinopathy

AIM: To compare the safety and efficacy of conbercept intravitreal injection and half-dose photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS: This study was retrospective. Thirty-seven patients (37 eyes) with chronic CSC received conbercept injections while 57 patients (57 eyes) were treated with half-dose PDT. All subjects were followed in 6mo. Outcome measures included change in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS: There was no adverse event observed in either treatment group. At the 6-month follow-up, 26 eyes (70.3%) in the conbercept group and 54 eyes (94.7%) in the half-dose PDT group (P<0.05) reached full resolution of SRF. The mean logarithm of the minimum angle of resolution (logMAR) BCVA significantly improved (P<0.001) in both treatment groups with better outcome at early phase in the half-dose PDT group (2wk, 1, and 2mo, P<0.05). All subjects experienced significant CMT improvement (P<0.001) with no statistical difference between the two groups (P>0.05). The SFCT also improved in all subjects (P<0.001) with better outcome in the half-dose PDT group (P<0.05). CONCLUSION: Both intravitreal conbercept and half-dose PDT are safe to use in treating chronic CSC. By 6mo, both treatment groups are efficacious in improving BCVA, reducing CMT and SFCT, and resolving SRF in eyes with chronic CSC. Half-dose PDT may show better outcome at initial phase of treatment in chronic CSC. Longer follow-up period is necessary to study for long-term effect and safety.     

Correlations among metamorphopsia test scores,optical coherence tomography findings and multifocal electroretinogram responses in epiretinal membrane patients

Purpose

To quantify metamorphopsia with a novel objective method in patients with epiretinal membrane (ERM) and to compare the relationships among metamorphopsia scores, spectral-domain optical coherence tomography (OCT) findings, and multifocal electroretinogram (mfERG) results.

Methods

This study included 52 eyes of 52 patients with idiopathic ERM who underwent comprehensive ophthalmologic examinations, including measurement of best-corrected visual acuity (BCVA), OCT, and mfERG. The degree of metamorphopsia was quantified using MonPack One® (Metrovision, Perenchies, France). On the topographic map of the early treatment diabetic retinopathy (ETDRS) grid, retinal thickness in the central, superior, inferior, nasal, and temporal subfields were measured, and metamorphopsia scores for each corresponding subfield were also obtained. The amplitudes and implicit times of mERG were elicited from each subfield. Then, the correlations among metamorphopsia scores, OCT findings, and mfERG responses were analyzed.

Results

The mean age of the patients was 65.3?±?18.5 y, and the average metamorphopsia score of the individual subfields was 2.03?±?1.18. Initial BCVA was 0.50?±?0.12 logMAR, but there was no significant correlation between metamorphopsia scores and BCVA. The metamorphopsia scores from the central subfields showed significant correlations with central retinal thickness (CRT) (p?=?0.001). The mean metamorphopsia scores in the central subfield showed a significant relationship with the mean N1 and P1 amplitudes (p?=?0.001, p?=?0.048, respectively), while no relationship was observed between metamorphopsia scores and mfERG amplitudes in other subfields.

Conclusions

The degree of metamorphopsia in patients with ERM could be objectively quantified in each subfield using a novel metamorphopsia test. The metamorphopsia scores were significantly correlated with retinal thickness, especially at the central subfields, and the scores in the central subfields were significantly correlated with the N1 and P1 amplitudes of mfERG. Thus, the metamorphopsia test can be a useful method to evaluate metamorphopsia symptoms for patients with ERM.

     

Histological observation of trabecular meshwork in a patient with Axenfeld-Rieger syndrome—a new theory for the mechanism of ectropion uvea in congenital glaucoma

AIM: To analyze the clinical efficacy of intravitreal injection of ranibizumab on diabetic macular edema (DME) with multifocal electroretinography (mfERG) and optical coherence tomography (OCT). METHODS: A total of 41 patients (41 eyes) with DME were treated with intravitreal injection of ranibizumab (IVR). The best corrected visual acuity (BCVA), mfERG results, and OCT were analyzed to compare to the baselines, 1wk, 1 and 3mo after operation. RESULTS: The BCVA was significantly improved in all eyes at each time point (P<0.001). The macular area leakage and edema were reduced 1wk and 1mo after IVR, and the central fovea thickness (CFT) was significantly reduced compared to baseline (P<0.001). The mfERG, two-dimensional and three-dimensional images all showed that the macular fovea (1 ring) response density decreased, and the fovea and macular area spikes significantly decreased or disappeared. The amplitude density of the P1 wave was increased, and the latency of the P1 wave was shortened than preoperation (P<0.001). At 1wk and 1mo after the operation, there was a negative correlation between the amplitude density of P1 waves and CFT. CONCLUSION: OCT and mfERG fully demonstrate the importance of IVR for DME patients from the macular morphology and function, especially the significance of mfERG in this disease.     

First and second-order kernel multifocal electroretinography abnormalities in acute central serous chorioretinopathy

Purpose To evaluate the first and second-order kernel multifocal electroretinogram (mfERG) response abnormalities in patients with acute central serous chorioretinopathy (CSC). Methods This was a cross-sectional observational study in which 45 eyes of 45 patients with acute CSC underwent mfERG recordings. Peak amplitudes and implicit times of the first and second-order kernel responses were analyzed and compared with 20 age-matched normal controls. Correlation analyses were performed between the patients’ visual acuity and the first and second-order amplitudes and implicit times. Results The first-order N1 and P1 mfERG amplitudes in the central three concentric rings were reduced in eyes with acute CSC compared with controls (P < 0.05). The first-order P1 implicit times of the central four rings were also delayed (P < 0.05). For the second-order mfERG response, there were significant reductions in the second-order P1 and N1 amplitudes in rings 3–5 compared with controls (P < 0.05). No significant difference between the second-order P1 and N1 implicit times was found compared with controls (P > 0.05). Correlation analyses showed significant correlations between visual acuity and the first-order N1 response amplitudes of rings 1 and 2, and for the first-order N1 and P1 implicit times of rings 1–4 (P < 0.05). Conclusion Both first and second-order mfERG response abnormalities occur in eyes with acute CSC. These results suggest that in acute CSC, while outer retinal dysfunction is mostly localized to the central macula, there might be more widespread impairment in adaptive mechanisms of the inner retina or outer plexiform layer dysfunction in the more peripheral macula. Presented in part in the 44th annual symposium of the International Society of Clinical Electrophysiology of Vision (ISCEV), Fontevraud, France, June 2006.     

Multifocal electroretinogram in normal emmetropic subjects: correlation with optical coherence tomography

Aim of the Study:

To establish the normative database for multifocal electroretinogram (mfERG) parameters in a normal emmetropic population. To correlate the data so obtained with the central macular thickness obtained using the optical coherence tomography (OCT) scan.

Materials and Methods:

mfERG data were obtained from 222 eyes of 111 emmetropic subjects. The amplitude (nv/deg²) and implicit times (ms) of the first-order kernel mfERG responses (N1, P1, and N2 waves) were obtained and grouped into five rings (Ring 1: Central 2°, Ring 2: 2–5°, Ring 3: 5–10°, Ring 4: 10–15°, Ring 5: >15°). The central macular thickness (CMT) was obtained using the macular thickness scan protocol of the OCT.

Results:

The mfERG data obtained were used to create a normative database. The amplitudes of the mfERG waves were maximum in the fovea and progressively decreased with increasing eccentricity (P = 0.0001). The latencies of the P1 and N2 waves were longest in the central ring and progressively shortened with eccentricity (P = 0.0001). No statistically significant correlations were observed between central ring 1 parameters and the CMT.

Conclusion:

This study establishes normative database for mfERG parameters in an emmetropic population. No statistically significant correlation was noted between CMT and mfERG parameters.     

复杂性视网膜脱离的多焦视网膜电图研究

目的 探讨多焦视网膜电图（mfERG）对复杂性视网膜脱离（RD）视功能客观评价的意义。方法 应用VERIS ScienceTM 4．2mfERG检测仪对80例复杂性RD患者的双眼进行检测,并与正常对照组比较。结果 复杂性RD患者的对侧眼、患眼在6个环的N1波、P1波振幅密度较正常对照组降低,潜时延长,差异均有统计学意义（P〈0．01）。有严重玻璃体积血组的N1、P1波振幅密度在2～6环高于无严重玻璃体积血组,差异均有统计学意义（P〈0．05）。重度PVR组的N1、P1波振幅密度低于轻度PVR组,在6个环差异均有统计学意义（P〈0．05）。黄斑裂孔组在所有6个环的N1、P1波振幅密度较正常对照组降低,潜时延长,差异均有统计学意义（P〈0．01）。结论 mfERG能客观定量评价复杂性RD患者的视功能。严重的玻璃体积血、黄斑裂孔、PVR对视功能有明显影响。     

两种光凝术治疗中心性浆液性脉络膜视网膜病变效果比较

目的:比较577 nm微脉冲激光与传统激光视网膜光凝治疗急性中心性浆液性脉络膜视网膜病变(CSC)的临床效果。方法:前瞻性临床随机对照研究。2017年7月至2018年6月郑州大学第一附属医院临床确诊的急性CSC 45例(54只眼)纳入本研究。患者随机分为两组,A组,23例(29只眼)进行577 nm微脉冲激光光凝,B组,22例(25只眼)进行传统激光光凝。随访观察两组治疗效果。结果:两组治疗后视力(BCVA)较治疗前均有提高(P<0.05);黄斑中心区厚度(CMT)及视网膜下液(SRF)均较治疗前降低(P<0.05)。但治疗前、治疗后1及3个月,两组之间BCVA、CMT及SRF比较差异均无统计学意义(P>0.05)。在末次随访中,A组眼底检查及OCT检查中均未发现激光斑或视网膜色素上皮损伤;而B组眼底检查中13只眼(52.00%,13/25)可见激光处脱色素改变或轻微色素上皮增生,OCT检查中6只眼(24.00%,6/25)可见局部视网膜色素上皮不规则样改变或缺损。结论:577 nm微脉冲激光及传统激光视网膜光凝治疗急性CSC均有效,可提高患者BCVA,降低CMT及SRF,但577 nm微脉冲激光损伤轻。     

Macular function by multifocal electroretinogram in diabetic macular edema after intravitreal triamcinolone acetonide injection

PURPOSE: The purpose of this study was to assess macular function by multifocal electroretinography (mfERG) in eyes with diabetic macular edema (DME) after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: Fifteen eyes of 15 patients with DME scheduled for 4 mg IVTA injection were prospectively recruited. The response to treatment was monitored functionally by visual acuity (VA) measurement and mfERG and anatomically by foveal thickness measured by optical coherence tomography (OCT). The first-order kernel P1 mfERG responses from 0 to 7 degrees (central) and 7 to 25 degrees (peripheral) were grouped and analyzed. Changes in functional parameters (VAs and the P1 mfERG response amplitudes and peak latencies) and morphometric parameters (OCT foveal thickness) in eyes with DME 1 and 3 months after IVTA injection were compared with baseline values by Student t test. RESULTS: The mean baseline logMAR value for VAs of the patients before treatment was 0.49+/-0.26. After treatment, it was 0.27+/-0.23 at 1 month and 0.26+/-0.18 at 3 months, and differences from pretreatment values were significant (for each, p<0.001). There were statistically significant decreases in the mean foveal thickness at 1 and 3 months after treatment compared with pretreatment values (for each, p<0.001). There were also statistically significant increases in the mean P1 response amplitude for both central and peripheral groups at all examinations compared with pretreatment (for each, p<0.001). The mean P1 peak latencies for both the central and peripheral groups were shortened, but not significantly. CONCLUSIONS: As well as the reduction in DME and improvement in VA, IVTA injection improves macular function as assessed by mfERG in diabetic patients.     

Multifocal electroretinogram findings after intravitreal bevacizumab injection in choroidal neovascularization of age-related macular degeneration

Purpose

To evaluate the changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) after intravitreal bevacizumab injection in the treatment of age-related macular degeneration (AMD).

Methods

Twenty-one eyes with choroidal neovascularization secondary to AMD were studied before and after intravitreal bevacizumab injection for best corrected visual acuity (BCVA), OCT, and mfERG.

Results

The BCVA improved, while central macular thickness and total macular volume in OCT decreased after intravitreal bevacizumab injection (p = 0.03, 0.01, and 0.01, respectively). In mfERG, the amplitude of P1, and implicit time of P1 and N1 indicated a statistically significant improvement of retinal response after intravitreal bevacizumab injection.

Conclusions

There is a potential role for mfERG in evaluating the effect on retinal function of intravitreal bevacizumab injection.     

四苓散治疗急性中心性浆液性脉络膜视网膜病变的疗效

目的:观察使用中药四苓散治疗急性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的临床效果.方法:回顾分析急性CSC患者48例48眼的临床资料,其中24例患者口服四苓散(治疗组),另外24例患者不接受治疗(对照组).获取和比较两组患者基线值和随访1,3mo的临床数据,包括最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)及视网膜下液最大高度(SRF).结果:治疗组1mo时的BCVA与基线相比无统计学差异(P>0.05),3mo时的BCVA比基线值有改善(P<0.05),3mo较1mo时的BCVA有所好转(P<0.05);而对照组的BCVA在3mo内无明显变化(均P>0.05).两组BCVA在基线,1,3mo时均无明显差异(P>0.05).治疗组1,3mo的CMT和SRF均较基线值降低,且差异均具有统计学意义(P<0.05),3mo较1mo时的CMT和SRF也明显降低(均P<0.05).对照组1mo时的CMT和SRF与基线相比,变化无统计学差异(均P>0.05),3mo的CMT和SRF较基线明显降低,差异有统计学意义(均P<0.05),3mo较1mo时的CMT和SRF也明显降低(均P<0.05).1,3mo时治疗组的CMT和SRF均较对照组明显降低,且差异有统计学意义(均P<0.05).结论:口服四苓散具有治疗急性CSC的潜能,但在其提高视功能、缩短病程、减少复发等方面的作用仍需进一步研究.