老年黄斑变性的局部视网膜电图研究

目的:观察老年黄斑变性(AMD)对视网膜黄斑部电活动影响特征,并对局部视网膜电图(LERG)的敏感性作出评价。方法:对80例AMD患者99只眼进行了黄斑区三个范围局部视网膜电图(LERG)测定,并与患者的视力及相应检测范围病损面积进行了对比研究。结果:黄斑区2.5°、5°、7.5°范围内,干性AMD组LERG平均振幅降低,但与正常对照组间无显著性差异(P>0.05),湿性AMD组LERG平均振幅显著降低(P<0.01)。湿性AMD LERG b波振幅与病人视力呈正相关性,与相应范围病灶面积呈负相关。干性AMD玻璃膜疣数量对LERG尚无影响。结论:不同类型AMD对于黄斑功能损害程度不同,湿性型损害大于干性型;中心凹功能损害大于旁中心凹。LERG在AMD的黄斑功能测定方面是较敏感的电生理方法。眼科学报 1996;12:93—97。     

Photodynamic Therapy for Age-related Macular Degeneration

PrefaceAge鄄relatedmaculardegeneration(AMD)isanimportantchallengetoophthalmologistsinthe21stcentury.Worldwide,itisthemostcom鄄moncauseoflegalblindnessamongindividualsolderthan60years[1].ItisknownthatseverevisionlossinmajorityofpatientswithAMDisduotochoroidalneovascularization(CNV).Laserphot鄄ocoagulationistheonlylong鄄termtreatmentoptionforneovascularAMDandisindicatedforextrafovealorjuxtafoveallesion.Inthesecaseslasertreatmentcancauseirreversibledamagetotheretinalpigmentepitheliumandsens…     

B型超声检查对渗出型老年性黄斑变性的诊断价值

目的:探讨渗出型老年性黄斑变性(Age-related macular degeneration,AMD)的B型超声影象特征。方法:采用NIDEKUS-3300型超声诊断仪,对31例(54只眼)渗出型AMD进行了观察。结果:视网膜色素上皮脱离时,眼内后极部出现膜状弧形回声,光带与眼球壁之间,可见一个梭形透声区;渗出或出血未完全吸收阶段,呈混合性回声;渗出或出血逐渐吸收并为瘢痕组织所替代时,可见实体性小隆起物,强回声,形状似凸透镜或三角形,凸起端指向球后,玻璃体腔面平坦。结论:B型超声在渗出型AMD的诊断、治疗随访观察中具有实用价值。眼科学报1999;15:233-235。     

老年黄斑变性线粒体DNA缺失的初步研究

目的:研究与衰老和氧化磷酸化功能缺陷有关的细胞线粒体DNA(mtDNA)突变,从基因水平探讨老年黄斑变性(ARMD)的发病机理。方法:应用聚合酶链反应(PCR)对20例老年黄斑变性(ARMD)病人之血细胞线粒体DNA(mtDNA)缺失进行了初步研究。结果:有6例湿性ARMD扩增出2条异常DNA片段,提示在mtDNA位点7901～13650之间存在有2种mtDNA缺失,其缺失片段大小分别为5.0kb和5.2kb。另有5例湿性ARMD扩增出1条1.2kb的异常片段,提示在mtDNA位点8531～13400之间还存在1种长度为3.67kb的缺失片段,10例对照均未扩增出异常mtDNA片段。结论:提示在湿性ARMD病人血细胞mtDNA存在有包括与年龄相关的长度为5.0kb在内的多重缺失,mtDNA突变与ARMD发病机制的关系还需进一步深入研究。眼科学报 1997;13:52     

老年性黄斑变性的研究进展

综述了老年性黄斑变性（AMD）近几年的研究现状,包括AMD的流行病学,病因学,病理机制和中西医治疗等。其中AMD的发病与年龄,人种,遗传史,吸烟,环境等因素有关;病理机制与视网膜色素上皮的代谢障碍和慢性非特异性炎症性病变有关;治疗方法主要有激光光凝,光动力学,手术,放射,基因,药物等。由于目前对AMD的治疗尚无确切疗法,应用中医药进行治疗是一个值得探索的方向。     

Characteristics of Indocyanine Green Angiography in Exudative Age—related Macular Degeneration

Objective: To observe the characteristics of indocyanine green angiography (ICGA) in exudative age-related macular degeneration (AMD).Methods: Thirty-one cases (39 eyes) were diagnosed as exudative AMD by ocular examination, fundus color photography, fundus fluorescein angiography (FFA) and ICGA. Their ages ranged from 50 to 82 years and visual acuities from FC/30cm to 0. 7. We analyzed and compared the characteristics of ICGA and FFA in these patients. Results: Of 26 eyes with occult choroidal neovascularization (CNV) by FFA, 15 (57. 7% ) had classic CNV by ICGA. Of 4 eyes with serous retinal pigment epithelial detachment (FED) without CNV by FFA, 1 had serous FED with classic CNV by ICGA. The hyperfluorescence of the scar staining was detecfed by ICGA. Conclusion ? ICGA adds clinically useful information and is an important adjunct in the evaluation, classification, and laser treatment of patients with occult CNV in AMD. Eye Science 1999; 15: 156 - 161.     

Farnsworth-Munsell100色彩试验在老年性黄斑变性早期诊断中的价值

采用FM100-色彩试验仪,测定了中心视力正常(≥1.0)、眼底有drusen 早期AMD 病人60例(87眼)和正常对照组51例(73眼)。结果显示,早期AMD 与正常组相比,色彩分辨力明显异常,且损害程度与drusen 数量及形态有关。此外,对侧眼有晚期AMD 较对侧眼没有晚期AMD 色彩分辩力损害更重。提示FM100-色彩试验可作为AMD 的早期诊断手段。     

老年黄斑变性发病机理的研究

目的:探讨老年黄斑变性(AMD)的发病机理,以利对其早期预防及治疗。方法:对AMD患者及对照组作血红细胞酶及血清无机元素、抗视网膜抗体测定和患者视网膜下新生血管膜的电镜和免疫组织化学观察,并作动物光照射实验。结果:AMD患者的血红细胞超氧化物歧化酶和过氧化氧酶均降低,血清锌也降低,铜锌比增高,其视网膜抗体反应均较正常人高,新生血管膜呈炎症性肉芽肿表现。结论:AMD除与年龄有关外,并可能与光损伤,个体防卫系统改变及慢性炎症过程有关。眼科学报 1996;12:58—63。     

正常眼和老年黄斑变性眼的局部视网膜电图

以全视野亮背景及４５′视角的红色闪光作刺激，采用带中孔的角膜接触镜电极，记录了局部视网膜电图。测得２２只正常眼的黄斑中心对盲点区的局部ＥＲＧ振幅之比值为３．５４±１．３５，而３１只老年黄斑变性眼的比值是１．３９±０．５４，两者差异显著（Ｐ＜０．０１），两组全视野明适应ＥＲＧ间无意义，表明此法建立的局部ＥＲＧ记录技术对早期老年黄斑变性病人具有一定诊断价值。     

Fundus Autofluorescence and Progression of Age-related Macular Degeneration

Fundus autofluorescence imaging is an imaging method that provides additional information compared to conventional imaging techniques. It permits to topographically map lipofuscin distribution of the retinal pigment epithelial cell monolayer. Excessive accumulation of lipofuscin granules in the lysosomal compartment of retinal pigment epithelium cells represents a common downstream pathogenetic pathway in various hereditary and complex retinal diseases including age-related macular degeneration (AMD). This comprehensive review contains an introduction in fundus autofluorescence imaging, including basic considerations, the origin of the signal, different imaging methods, and a brief overview of fundus autofluorescence findings in normal subjects. Furthermore, it summarizes cross-sectional and longitudinal fundus autofluorescence findings in patients with AMD, addresses the pathophysiological significance of increased fundus autofluorescence, and characterizes different fundus autofluorescence phenotypes as well as fundus autofluorescence alterations with disease progression.     

The Natural History of Dry Type of Age-related Macular Degeneration

To study the natural history of dry type of age-related macular degeneration (AMD) and search for a sensitive method for detecting the development of the disease, the fundus fluorescein angiography, visual acuity, electroretinogram and FM 100-hue test were used to examine 75 eyes, 147 eyes, 73 eyes, and 94 eyes respectively. These examinations were taken at least twice during the follow-up periods. The average age was 63.2 years (50-80 years ). The average follow-up was 29.8 months with a range of 3-74 months. It was shown that there were not any statistically significant difference in the macular lesions and electroretinogram between the initial examinations and after follow-up (P>0.05). 91.14% of the eyes maintained good visual acuity during the follow-up. Subretinal neovascularization developed only in one of the eyes. The total error score of FM 100-hue test had a statistically significant difference between the initial test and the test taken two years afterwards (P<0.01). It was suggested that most of the dry type of AMD had a favorable prognosis and that color visual test was a sensitive method for monitoring the development of dry type of AMD.     

抗氧化营养素与老年性黄斑变性的防治

老年性黄斑变性(Age-related macular degeneration,AMD)是老年人视力损伤和致盲的主要原因。视网膜的高耗氧性,高长链多不饱和脂肪酸含量,作为氧自由基的靶点和暴露于可见光的特性使其易产生氧化应激。大量研究均显示抗氧化营养素有助于老年性黄斑变性的防治,本文就其最新研究进展进行综述。眼科学报2007;23:193-198.     

Cardiovascular Risk and Antiangiogenic Therapy for Age-related Macular Degeneration

The neovascular form of the age-related macular degeneration (AMD) causes most cases of severe blindness. Because vascular endothelial growth factor (VEGF) plays a leading role in this disorder, several inhibitors of this molecule are being used in its treatment. However, VEGF has important functions in vascular pathophysiology. It enhances the development of collateral vessels that may supply blood to areas whose arteries are severely affected by atherosclerotic lesions. Additionally, it may promote restoration of the damaged endothelium, a vessel layer that protects against the development of atherothrombosis, and it has hypotensive effects. In contrast, VEGF may stimulate the formation of microvessels inside the atherosclerotic plaque. These vessels may become disrupted and cause intraplaque hemorrhage, stimulating disease progression. VEGF also has a role in thrombus formation. The effects of anti-VEGF therapy may therefore compromise patient safety. When administered systemically to cancer patients, the main cardiovascular adverse effects of these compounds have been thrombosis, hemorrhage and hypertension. As patients with AMD constitute a high-risk population for cardiovascular events, the safety of new anti-VEGF therapies must be assessed. In this review we analyze the effects of VEGF on atherosclerosis and the cardiovascular safety of anti-VEGF therapies in AMD.     

Scotopic Sensitivity of Central Retina in Early Age-Related Macular Degeneration

Purpose: To test scotopic sensitivity and investigate whether there is rod system dysfunction in the central retina in early age - related macular degeneration (AMD). Methods: Scotopic(450 nm stimulus) and photopic (white light stimulus) sensitivity in 24 patients with early AMD was measured at 81 loci in central 25° of retina, and compared with the age - match normal controls.Results: Mean scotopic sensitivity of AMD patients was significantly lower than that of the normal controls. The patients of reduced scotopic sensitivity were more than those of reduced photopic sensitivity. Scotopic sensitivity deficit decreased with increasing eccentricity with the greatest deficit was 2. 5° to 5. 0°.Conclusions: Scotopic sensitivity was decreased in the early stage of AMD. The parafoveal rod cells were selectively damaged in AMD. Scotopic sensitivity testing in macula may be a useful tool to diagnose and measure the fundus dysfunction of AMD. Eye Science 2003; 19: 15 - 19.     

Prevalence of Age-Related Macular Degeneration in Thailand

Purpose: To determine the prevalence of age-related macular degeneration (AMD) in Thailand.

Methods: In this population-based study, data of participants in the Thailand National Survey of Visual Impairment in 2006–2007 were analyzed. Participants selected for this study were more than 50 years old, and were recruited from 42 districts of 21 provinces. They were interviewed, tested for visual acuity, examined for eye screening, and measured for intraocular pressure. They had digital fundus photographs taken using a nonmydriatic fundus camera through dilated pupils. The diagnosis of AMD, according to the standard international grading system, was made from the interpretation of the digital images by at least 2 retinal specialists. The observed data were used for predicting estimates of the prevalence of AMD in Thailand.

Results: Data from 10,788 participants were analyzed. There were 321/10,788 (3%, 95% CI: 2.7–3.3%) participants diagnosed as having AMD. The mean age was 62.1 (range 50–98, SD 8.8) years old. There were 294 (2.7%) and 27 (0.3%) participants with early AMD (38.4% male) and late AMD (74.1% male) respectively. Of the late AMD, 20 (74.1%) were wet AMD and 7 (25.9%) were geographic atrophy. Based on the population census of Thailand, this could be translated into 351,000 and 39,000 patients with early and late AMD respectively.

Conclusions: Based on these data, it is projected that Thailand will have a large number of late AMD sufferers. This makes it imperative to develop new strategies for the national public health system, aiming to incorporate already available late AMD treatment.     

The Relationship Between Angiotensin Converting Enzyme Insertion/deletion Polymorphism and Age-related Macular Degeneration

Background: To assess the role of serum angiotensin converting enzyme (ACE) levels and ACE insertion /deletion (I/D) genetic polymorphism in Turkish age-related macular degeneration (AMD) patients and control subjects.

Methods: This prospective study consisted of 78 patients with AMD and 68 control subjects. The I/D polymorphism of the ACE was carried out by polymerase chain reaction. Serum ACE levels were determined by using the ELISA method.

Results: There was no significant difference in the mean serum values of ACE between the control and patient groups (p = 0.107). The genotypic frequencies of ACE polymorphism in the control and patient groups were not significantly different either (p?=?0.218).

Conclusion: We could not show a significant role of serum ACE levels and ACE I/D genetic polymorphism in the etiopathogenesis of AMD in the Turkish population, and our findings did not support the idea that serum ACE levels and ACE DD genotype were risk factors for AMD.     

The Prevalence of Age-Related Macular Degeneration in Italy (PAMDI) Study: Report 1

Purpose: The present study aimed to estimate prevalence and risk factors associated with age-related macular degeneration (ARMD) in an Italian population and to analyze differences between urban and rural communities.

Methods: We conducted a population-based cross-sectional study among elderly residents in Northeast Italy. Participants were divided into urban and rural groups based on whether they lived in the city of Padova or the villages of Teolo and Torreglia, respectively. Fundus photographs were graded according to the International Classification for Age-related Maculopathy.

Results: A total of 1162 randomly selected subjects aged 61 years or more were invited to participate in the study. We examined 885 subjects, and 845 were eligible for fundus photograph grading. ARMD was estimated to affect 62.7% of the whole population (drusen 63–124 μm?=?48.3%; drusen ≥125 μm?=?10.4%; advanced ARMD?=?4.1%). Age was confirmed as a risk factor for drusen ≥125 μm and advanced ARMD (Odds Ratio [OR]?=?1.47, 95% Confidence Interval [CI] 1.28–1.69 and OR?=?1.62, 95% CI 1.28–2.05, respectively, for a 5-year increase in age). The rural group appeared to be at a higher risk of developing large drusen compared to the urban sample (OR?=?1.61, 95% CI 1.01–2.63) when adjusting for age and gender.

Conclusions: The results confirmed that ARMD affects a high percentage of the elderly population in Italy. This study does not support the hypothesis that living in a rural environment or belonging to a population of the Mediterranean basin may be protective against the intermediate stages of the disease.     

Vision Rehabilitation of Persons with Age Related Macular Degeneration

As the population of the United States ages, there is an increase in the number of persons with age related macular degeneration (ARMD). Even as new prevention and treatment techniques are developed, the vision loss associated with ARMD may lead to loss of independence and quality of life. Low vision is a rehabilitative process designed to improve visual function and restore independence. This paper is a review of the current research related to low vision in the areas of magnification, contrast and illumination, reading, training, driving and outcomes assessment.     

Effects of Vitreomacular Traction on Ranibizumab Treatment Response in Eyes with Neovascular Age-related Macular Degeneration

PurposeTo investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD).MethodsA retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection.ResultsOne month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 µm and 121.68 µm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up.ConclusionsVA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.     

Alcohol- and Light-induced Electro-oculographic Responses in Age-related Macular Degeneration & Central Serous Chorioretinopathy

The non-photic electro-oculographic (EOG) response induced by alcohol has been proposed as an indicator of retinal pigment epithelial (RPE) integrity, and reported to be abnormal in age-related macular degeneration (ARMD). To evaluate this proposal, we have measured the alcohol-EOG as well as the ISCEV-standard EOG in patients with ARMD (n=11 patients, 4 eyes with drusen, 8 eyes with ‘dry’ and 7 eyes with ‘wet’ lesions) and central serous chorioretinopathy (CSC, n=11 patients, 7 eyes with active and 6 eyes with inactive lesions), compared with 29 normal controls. We recorded the alcohol-induced EOG response after a single oral administration of ethanol at 160 mg/kg, followed by an ISCEV-standard EOG. Blood alcohol levels were monitored with a breath analyzer. We found that neither the alcohol-EOG nor the light-induced EOG response showed any difference between either ARMD or CSC patients and normal controls. Nor was there difference among eyes of different ARMD or CSC subgroups. In addition, blood alcohol concentrations near the time of the alcohol-EOG peak showed no obvious relationship with peak/baseline ratios. These data suggest that neither the alcohol- nor the light-induced EOG is a sensitive indicator of these diseases.