视网膜电图b波振幅和刺激光强关系研究

应用视觉电生理记录分析系统，记录5个对数单位范围的刺激光强作用下，20例(30只眼)新西兰大白兔和20例(30只眼)正常成人的系列光强视网膜电图，求出视网膜电图b波的光强-振幅函数关系和曲线方程。结果：在低和中等刺激光强下，b波振幅和刺激光强的函数关系为“S”型曲线，曲线方程符合Naka-Rushton等式：R／Rmax=1^n／(I^n K^n)。在较强刺激光强下，曲线出现第二上升支。该第二上升支是视网膜视杆系统反应和视锥系统反应共同作用的结果。     

复方血栓通胶囊对叔丁基过氧化氢诱导人视网膜色素上皮细胞氧化损伤保护作用

目的 探讨复方血栓通胶囊对叔丁基过氧化氢(t-BHP)诱导体外培养的人视网膜色素上皮细胞(hRPE)氧化损伤的保护作用.方法 原代培养hRPE细胞后取第3～5代进行实验.应用MTT法筛选复方血栓通的最佳药物浓度;再分别用MTT及Annexin V/PI双染法检测复方血栓通及其各单方药物对细胞氧化损伤的保护作用.hRPE细胞分为正常对照组、t-BHP模型组和t-BHP+复方血栓通(0.25mg/ml)组,倒置相差显微镜和Hoechst33258染色观察各组细胞的形态和细胞核;MitoSOX染色检测活细胞线粒体中ROS的产生;JC-1染色检测线粒体膜电位的变化;ELISA法检测细胞分泌的VEGF浓度.结果 500μmol-BHP干预6h后,模型组细胞存活率下降到(49.9±6.3)%,而不同浓度的复方血栓通组细胞存活率均较模型组升高,且以0.25mg/ml的保护作用最佳;细胞存活率、凋亡及坏死率的结果显示复方血栓通较各单方药物的保护作用更为明显;模型组多数细胞肿胀、变圆、漂浮和核固缩,复方血栓通组损伤的细胞明显减少,线粒体内ROS的产生、线粒体膜电位的下降、分泌的VEGF均较模型组明显减少.结论 复方血栓通胶囊对t-BHP诱导hRPE细胞的氧化损伤具有保护作用,且其保护作用较各单方药物更为明显,其作用机制为清除ROS,阻止线粒体膜电位的下降,抑制VEGF的分泌,从而抑制细胞凋亡和坏死,提高细胞存活率.     

复方血栓通胶囊治疗视网膜静脉阻塞的效果观察

目的：观察复方血栓通胶囊治疗视网膜静脉阻塞的临床疗效。方法：对39例已确诊为视网膜静脉阻塞的患者给予口服复方血栓通胶囊3粒/次,3次/d,服用30～90d。根据视力恢复情况、视网膜出血吸收、黄斑水肿吸收情况等眼底变化以及自觉症状有无改善进行观察。结果：患者39例中：显效12例（31%）、有效21例（54%）、无效6例（15%）,总有效33例（85%）。治疗中未发现毒副作用。结论：复方血栓通胶囊是治疗视网膜静脉阻塞安全有效的药物。     

复方血栓通胶囊对高海拔视网膜病变大鼠的保护作用

目的:探讨复方血栓通胶囊对高海拔视网膜病变大鼠的保护作用及其作用机制。方法:雄性SD大鼠24只随机分为6组,分别饲养于模拟高海拔5000m的高原舱内2、4、6、10、24、72h,观察各组大鼠视网膜组织形态,HIF-1α的表达和入舱前后大鼠视网膜电图中暗适应最大反应b波振幅的变化;雄性SD大鼠24只随机分为4组,分别予安慰剂,大花红景天口服液,肌苷片及复方血栓通胶囊灌胃喂药7d后,饲养于模拟海拔为5000m模拟舱内10h,观察各组大鼠视网膜组织形态,HIF-1α的表达和入舱前后大鼠视网膜电图中暗适应最大反应b波振幅的变化。结果:高海拔视网膜病变SD大鼠模型中,结果显示随着各实验时间的增加,神经节细胞层细胞肿胀明显,HIF-1α在神经节细胞及内核层细胞胞浆表达增高,均在10h时最为明显。各组SD大鼠进舱自身前后F-ERG暗适应最大反应b波振幅变化分析,4、6、10、72h组F-ERG暗适应最大反应b波振幅显著降低(P<0.05);2h组和4h组(P=0.007)、6h组(P=0.008)、10h(P=0.002)有差异,24h组和4h组(P=0.035)、6h(P=0.040)、10h组(P=0.012)有差异。复方血栓通对SD大鼠高海拔视网膜病变预防作用研究中,结果显示与安慰剂组相比较,复方血栓通组、红景天组及肌苷组的视网膜水肿均明显减轻,但复方血栓通组与红景天组视网膜水肿程度明显低于肌苷组;复方血栓通组及红景天组HIF-1α在神经节细胞层及内核层表达明显下降;各组SD大鼠进舱后F-ERG暗适应最大反应b波振幅比较显示,安慰剂组与复方血栓通组(P=0.032),红景天组(P=0.001)均有差异。结论:在模拟高海拔环境下,复方血栓通可能是通过抑制HIF-1α的表达对大鼠高海拔视网膜病变有保护作用,但是具体作用机制有待我们进一步研究。     

视网膜色素变性（RP）患者的F—ERG特微分析

目的 对RP患F-ERG进行检查,以分析病程和作为眼肌深层巩膜移植术术后疗效跟踪的客观对照指标。方法 采用常规无创伤视觉电生理描记术,测定暗视F-ERG。结果 受检的210名RP患的420祗眼中,F-ERG为“熄减型”的为67.9%。能记录到ERP的占19.8%,a-波为28.3%,c-波仅为4.0%,能记录到b-波与负后电位的分别为10.7%和7.4%。说明RP患视网膜封闪光刺激反应的机能已经显受损。结论 RP患的F-ERG有不同程度的特有改变,在眼肌深层巩膜移植术进行治疗后,再复查F-ERG时,则观察到某些波重现,或原有波的波幅增加和峰潜伏期缩短。     

视网膜色素变性的多焦视网膜电图分析

测试并比较视网膜色素变性患者和正常人多焦视网膜电图。方法 :应用美国EDI公司生产的VERISScience 4 2多焦视网膜电图检查仪对 8例视网膜色素变性患者 8只眼 ,12例正常人 12只眼进行检测 ,分析其 6个环形视网膜区域的反应。结果 :视网膜色素变性患者 6个环形视网膜区域的反应密度均低于正常人 ,5环和 6环的潜伏期显著延长。结论 :视网膜色素变性患者多焦视网膜电图的反应密度下降 ,周边视网膜潜伏期延长 ,这种改变主要是由于视网膜感受器功能受损并且周边视网膜首先受累所致。     

复方血栓通胶囊对视网膜分支静脉阻塞病灶微循环的影响

目的 评价复方血栓通胶囊治疗视网膜分支静脉阻塞的临床效果及其对病变区视网膜微循环的影响。 设计 临床对照研究。研究对象 连续收集自然病程为3~6个月的视网膜分支静脉阻塞患者90例,随机分为复方血栓通治疗组和对照组各45例。方法 治疗组患者接受复方血栓通胶囊1.5 g 每日3次和卵磷脂络合碘1.5 mg 每日3次;对照组接受曲克芦丁120 mg 每日3次和卵磷脂络合碘1.5 mg 每日3次。所有患者连续观察6个月,每3个月复查一次荧光素眼底血管造影,定性描述病变区毛细血管无灌注区（NPA）及侧枝循环的形成情况。当患者NPA >5 PD时给予病变区激光光凝。 主要指标 患者激光治疗率（NPA形成率）,侧枝循环形成率。 结果 观察期内,治疗组中31例（68.89%）因FFA显示NPA>5 PD或发现视网膜新生血管而接受激光治疗,对照组中33人（73.33%）接受激光治疗,两组间激光治疗率差异无统计学意义（P=0.816）。至随访期结束,治疗组中34例（75.56%）FFA显示侧枝循环建立,而对照组中24例（53.33%）FFA显示侧枝循环建立,两组间侧枝循环形成率差异具有统计学意义（P=0.047）。结论 复方血栓通胶囊有助于视网膜分支静脉阻塞病灶视网膜血管与正常视网膜血管间建立侧枝循环。     

激光联合复方血栓通胶囊治疗CSC的疗效

目的:探讨复方血栓通胶囊联合激光治疗中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)疗效。方法:选取38例40眼CSC患者,随机分为治疗组和对照组两组,每组20眼,治疗组采用激光联合复方血栓通胶囊治疗,对照组采用激光治疗,比较两组在治疗效果和复发率方面的差异。结果:治疗组与对照组比较,治疗后1wk视力显著提高,两组间比较差异有显著性(P<0.05);治疗1mo后黄斑区水肿明显吸收,总有效率治疗组优于对照组,两组比较差异有统计学意义(P<0.05)。结论:激光联合复方血栓通胶囊治疗CSC,能够快速减轻症状,提高视力,减少复发,起到良好临床效果。     

复方血栓通胶囊治疗外伤性前房积血

目的观察复方血栓通胶囊治疗外伤性前房积血的临床效果。方法对外伤性前房积血给予复方血栓通胶囊口服为主之治疗,前房有炎症反应者辅以皮质类固醇口服,伴有高眼压者辅以甘露醇静脉滴注。结果前房积血吸收时间：Ⅰ级者3d左右,Ⅱ级者5d左右,Ⅲ级者10d左右。除2例Ⅲ级前房积血合并玻璃体积血视力无提高外,其余患眼均恢复到原有视力。结论复方血栓通胶囊治疗外伤性前房积血是有效的。     

激光联合复方血栓通胶囊治疗视网膜静脉阻塞的临床观察

目的：观察激光联合复方血栓通胶囊治疗视网膜静脉阻塞的临床疗效。

方法：将64例视网膜静脉阻塞患者随机分为激光治疗组(对照组,32例)和激光联合复方血栓通胶囊治疗组(观察组,32例),观察对比两组治疗后的视力、视网膜黄斑厚度和有效率。

结果：观察组临床总有效率和视力进步比例均显著高于对照组,两组间差异具有统计学意义(P<0.05或P<0.01); 两组治疗后1、3、6mo的黄斑中心凹厚度均较治疗前显著降低(P<0.05),但观察组治疗后1、3、6mo的黄斑中心凹厚度均明显小于对照组同期(P<0.05)。

结论：激光联合复方血栓通胶囊治疗视网膜静脉阻塞伴黄斑水肿有较好的疗效,能有效提高视力,降低视网膜黄斑厚度,值得进一步研究。     

视网膜色素变性的多焦视网膜电图

目的研究视网膜色素变性（ＲＰ）的多焦视网膜电图（ＥＲＧ）特性和评价多焦ＥＲＧ应用价值。方法检测了 １２例（２４眼）ＲＰ患者的多焦 ＥＲＧ,测试野为２６．６°×２２．１°,记录 １０３个部位的反应,同时检测全视野 ＥＲＧ。结果ＲＰ眼在各个环的ａ波和ｂ波潜伏期、ｂ波振幅密度和振幅之和均较正常值有显著延长和降低（Ｐ＜０．０５或Ｐ＜０．０１）。５０％患眼在第１环可记录到潜伏期正常、振幅密度和总和均降低的ｂ波,而７５％患眼的全视野ＥＲＧ呈平坦反应。结论 多焦ＥＲＧ能更有效地评价ＲＰ的黄斑区功能。     

Flicker electroretinogram in retinitis pigmentosa

Electroretinograms (ERGs) were recorded as a function of flicker frequency from 5 to 50Hz for 14 retinitis pigmentosa (RP) patients, 12 normal subjects and 1 rod monochromat. Data were analyzed by measuring the angular position of the response maximum, i.e. the phase, as a function of pulse-train frequency. Flicker ERGs obtained from the RP patients showed non-linear, frequency-dependent phase shifts when compared to the normal data. These phase shifts were simulated in a normal observer by attenuating the stimulus luminance by 1 log unit. However, the shape of the waveforms recorded from the normal differed markedly from those recorded from the RP patients. The differences, but not the ratios of the times-to-peak of the positive and negative ERG wavelets were longer in the RP patients than in the normal. These data suggest that the temporal anomalies in the RP flicker ERG are most likely due to changes in the amplitudes and time constants of the ERG components, and not simply to a reduced quantum catch or photoreceptor loss.Supported by research and core facility grants from the National Institutes of Health (EY-01791 and EY-01765)     

视网膜色素变性的视网膜电图与光学相干断层扫描的观察分析

目的:观察视网膜色素变性(retinitis pigmentosa,RP)的全视野视网膜电图(global electroretinogram,ERG)、多焦视网膜电图(multifocal electroretinogram,mfERG)及视网膜光学相干断层扫描(optical coherence tomography,OCT)的图像特征及临床意义。方法:对临床确诊的RP患者组15例30眼和正常对照组15例30眼进行全视野ERG,mfERG与OCT检查,并对数据进行统计分析。结果:RP患者组全视野ERG显示b波潜伏期与正常对照组相比显著延长且b波振幅与正常对照组相比显著降低;mfERG各环的反应密度均低于正常对照组,且有显著性差异,3～5环的潜伏期与正常对照组相比显著延长。RP患者组OCT显示视网膜黄斑中心凹厚度平均值低于正常对照组,但二者比较,差异无统计学意义。结论:ERG可有效评价RP患者黄斑区及周边视网膜的功能,RP患者OCT断层扫描像与其已知的视网膜病变特点相一致。     

Light rise of the human electroretinogram is normal in retinitis pigmentosa

Aim: To determine if the electroretinogram (ERG) light rise is reduced below normal in patients with retinitis pigmentosa (RP) and whether it is greater in patients with smaller ERG. Methods: Both eyes of 31 normal subjects and 59 subjects with RP had photopic ERGs on ISCEV standard and brighter backgrounds, before and after dark adaptation. Recordings <2.5 µV were excluded. Results: Ratios of amplitudes before and after dark adaptation varied little. The b‐wave averaged 1.88 (SD 0.41) in normal subjects and 1.66 (SD 0.62) in RP subjects, and a‐waves averaged 1.44 (SD 0.42) and 1.31 (SD 0.73), respectively. None of eight t?tests were significant (<2.4). There was a positive (not negative) correlation between RP subjects’ initial b‐wave amplitude and light rise but not for a‐waves. A‐wave light rises were smaller. Conclusion: Retinitis pigmentosa does not reduce the light rise of recordable ERG. The light rise of the ERG is larger in those RP subjects with larger initial b‐waves. This confirms previous findings. The difference between a‐ and b‐waves in RP suggests post‐receptoral processes are involved.     

Principal components' analysis of multifocal electroretinogram in retinitis pigmentosa

Aims:

To determine waveforms of multifocal electroretinogram (mfERG) in patients with retinitis pigmentosa (RP) contributing significantly to the overall retinal response by using principal components’ analysis.

Settings and Design:

Prospective, non-randomized, single-visit, observational, case-control study from a single tertiary ophthalmic center.

Materials and Methods:

Patients with various forms of RP underwent mfERG testing for a period of one year. The first-order kernel responses of RP cases were compared with concurrently recruited healthy controls.

Statistical Analysis Used:

Parametric data was analyzed using the unpaired t test for differences between the implicit time and amplitudes of cases and controls. Principal components’ analysis was done for each implicit time and amplitude in cases with RP using the Varimax rotation method.

Results:

From March 2006 to March 2007, 24 cases with typical RP (56%, 47 eyes) were included in the final analysis. Their mean age was 33.7 years (19-69 ± 15.5 years). Comparison of latencies and amplitudes among RP cases with log MAR acuity ≤ 0.18 and those > 0.18, revealed significant difference in the implicit time (P1) in Ring 2 only (P=0.028). Two components (predominently from Ring 1 and 2) each contributing 66.8% and 88.8% of the total variance in the data for latencies and amplitudes respectively, were seen.

Conclusions:

The first two rings of the mfERG contributed to the variance of waveforms in RP, irrespective of the visual acuity and poor visual field results.     

散发性视网膜色素变性的流行病学及临床表型特征调查

背景 视网膜色素变性(RP)是一种累及视网膜光感受器细胞及色素上皮细胞的单基因遗传性致盲性眼病,发病机制及临床特征复杂,目前对其临床表型特征及流行病学调查的研究较少,尤其是散发性RP患者.目的 了解散发性RP的流行病学及临床表型特征,为临床诊疗提供可靠的依据.方法 采用前瞻性队列研究设计.纳入2010年7月1日至2011年11月10日在第三军医大学西南眼科医院确诊为散发性RP的患者130例,对其进行问卷调查和临床检查,包括检眼镜下眼底检查、验光检查、最佳矫正视力(BCVA)、视野、视网膜电图(ERG)和彩色眼底照相检查,对各种类型的RP临床特征进行分型. 结果 共收集散发性RP患者130例,其中男66例,女64例;平均年龄(36.9±14.4)岁,平均发病年龄(21.2±18.4)岁;有家族近亲结婚史者7例,占5.38％;合并全身疾病者13例,占10.00％;RP病例中从事户外工作者44例,占33.85％;从事户内工作者86例,占66.15％;眼底分型中最常见的是典型型RP 89例,占68.5％,其次是中心性RP 16例,占12.3％,无色素性RP 16例,占12.3％;全视野ERG检查五项反应均记录不到波形99例,占76.15％.发现典型型RP患者夜盲史最长,中心性RP患者BCVA最差.结论 本研究结果发现散发性RP发病年龄以≤10岁组最高,其主要临床表型变异大、分型多、诊断特异性差,但全视野ERG结果有一定的规律可循.     

视网膜色素变性黄斑区视网膜FD-OCT及mfERG观察

目的　利用频域光学相干断层扫描（ｆｒｅｑｕｅｎｃｙｄｏｍａｉｎｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＦＤ-ＯＣＴ）及多焦视网膜电图（ｍｕｌｔｉ-ｆｏｃａｌｅｌｅｃｔｒｏｒｅｔｉｎｏｒｇｒａｍ,ｍｆＥＲＧ）观察视网膜色素变性（ｒｅｔｉｎｉｔｉｓｐｉｇｍｅｎｔｏｓａ,ＲＰ）患者黄斑区视网膜图像特征。方法　选取临床确诊的ＲＰ患者３０例（３０眼）作为ＲＰ组,年龄相匹配的健康人３０人（３０眼）作为对照组。采用ＦＤ-ＯＣＴＲＴＶｕｅ的Ｅ-ＭＭ５扫描模式对５ｍｍ×５ｍｍ范围的黄斑中心视网膜进行检测,获取视网膜厚度及内、外层视网膜容积,同时采用ＲＥＴＩｐｏｒｔ视觉电生理系统测量ｍｆＥＲＧ,对两组测量结果进行比较分析。结果　ＲＰ组视网膜黄斑中心凹厚度为（１４０．８０±１９．２５）μｍ,对照组为（１６５．９１±１４．３９）μｍ,差异无统计学意义（Ｐ＞０．０５）。ＲＰ组黄斑区外层视网膜体积为（３．６１±０．１８）ｍｍ３,低于对照组（４．５９±０．１１）ｍｍ３,差异有显著统计学意义（Ｐ＜０．００１）。ＲＰ组黄斑区内层视网膜体积为（２．２８±０．１０）ｍｍ３,对照组为（２．３０±０．１０）ｍｍ３,两组比较差异无统计学意义（Ｐ＞０．０５）。ＲＰ组ｍｆＥＲＧ各环Ｎ１、Ｐ１波反应密度值均低于对照组,且差异均有统计学意义（均为Ｐ＜０．０５）。ＲＰ组Ｎ１、Ｐ１波３～５环的潜伏期较对照组显著延长,差异均有统计学意义（均为Ｐ＜０．０５）。结论　ＦＤ-ＯＣＴ和ｍｆＥＲＧ相结合可有效评价ＲＰ患者视网膜功能及形态特点。     

S-cone electroretinogram to Ganzfeld stimuli in patients with retinitis pigmentosa

Cone electroretinograms (ERGs) elicited by different chromatic stimuli were recorded from patients with typical retinitis pigmentosa (RP) younger than 50 years of age. Ganzfeld color flashes on a bright white background illumination were used to elicit short-wavelength-sensitive (S-), and mixed long- (L-) and middle- (M-) wavelength-sensitive cone ERGs. Three patients with dominant inheritance, 22 patients with non-dominant inheritance, and 27 age-similar normal subjects were compared. Although the b-wave amplitudes of both the S- and L,M-cone ERGs were reduced in the RP patients, the S-cones were reduced to a greater degree than the L,M-cones. No significant difference in the S-cone reduction was observed between patients with dominant inheritance and those with non-dominant inheritance. The selective reduction of the S-cone system, reported previously in psychophysical studies, may be attributable not only to the macular region but also to the entire retina. This revised version was published online in July 2006 with corrections to the Cover Date.     

Properties of electroretinographic intensity-response functions in retinitis pigmentosa

Dark-adapted electroretinogram (ERG) b-wave amplitudes and implicit times were recorded as a function of stimulus luminance for 15 retinitis pigmentosa (RP) patients and 15 normal subjects. B-wave amplitude as a function of log stimulus luminance was fit by non-linear regression with the Naka-Rushton equation, which has 3 independent parameters: The maximum response (R_max), slope (n) and half-saturation constant (K). B-wave implicit-time as a function of log stimulus luminance was fit by linear regression. Compared to normal, the RP R_max values were markedly reduced, suggesting response compression; the RP K values were elevated by an average of 0.76 log unit, suggesting relatively small losses in retinal sensitivity. There was no correspondence between R_max and visual field area for the RP patients (coefficient of correlation = -0.02). All but 2 of the 15 RP patients had normal or shallower-than-normal implicit-time intensity-response functions, indicating that over most of the dynamic range of the ERG, the implicit-times were either normal or faster-than-normal. These results are discussed in terms of possible RP disease mechanisms.Presented at the annual meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Florida, 1981.Supported by research and core facility grants from the National Eye Institute (EY-01791 and EY-01765).Research to Prevent Blindness, Foreign Scholar Fellowship recipient; from Capital Hospital, Chinese Academy of Medical Sciences, Beijing, Peoples Republic of China.     

视网膜色素变性1基因在常染色体显性遗传视网膜色素变性家系中的突变分析

目的:研究常染色体显性遗传视网膜色素变性(autosomal dominant retinitis pigmentosa,ADRP)家系中视网膜色素变性1(retinitis pigmentosa-1,RP1)基因的突变特征及其在RP发病机制中的作用。方法:运用聚合酶链反应和直接测序方法,对6个ADRP家系的47例成员和50例对照者进行了RP1基因全编码区和邻近剪切位点的内含子区域序列突变的筛选与检测。运用单因素分析、多因素Logistic回归分析研究RP1基因点突变在RP发病中的作用。结果:ADRP家系成员和对照组RP1基因第4外显子上检测出2个变异位点。在1691和1725密码子存在杂合的两种类型的密码子(S1691P,Ser-Pro,TCT→CCT;Q1725Q,Gln-Gln,CAA→CAG)。ADRP家系成员中Ser-1691-Pro及Gln-1725-Gln位点突变率显著高于正常对照组(χ2=11.202,P<0.05)。结论:RP1基因Ser-1691-Pro及Gln-1725-Gln位点多态性可增高RP的危险性,具有潜在的致病性,考虑为ADRP家系的易感基因。