原发性开角型青光眼HRT视盘结构参数与视野缺损相关性研究

目的探讨出现视野缺损与未出现视野缺损的原发性开角型青光眼视盘结构参数的异同及视盘参数与视野平均缺损（MD）的相关性。方法应用海德堡视网膜断层扫描仪（HRT-Ⅱ）和Octopus101视野G2程序对29例（50只眼）原发性开角型青光眼患者进行检查，对出现视野缺损与未出现视野缺损的原发性开角型青光眼视盘结构参数进行比较，检测结果进行t检验；对出现视野缺损的原发性开角型青光眼组的视盘各参数与视野平均缺损进行简单相关分析。结果视野出现缺损组与未出现缺损组的原发性开角型青光眼患者的视盘参数除视盘面积和轮廓线高度变化值外，其余各视盘参数间差异均有显著性（P〈0．01）；对出现视野缺损的原发性开角型青光眼患者HRT视盘各参数与MD进行相关分析显示，盘沿面积与MD间相关性最强（r=0．65，P=0．001）。结论HRT视盘参数能够较准确反映与视野损害相一致的青光眼性视盘改变，盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

海德堡视网膜断层扫描仪在开角型青光眼视盘检测中的意义

目的 探讨海德堡视网膜断层扫描仪(HRT)检测开角型青光眼视盘参数与视野损害的关系。评价HRT在早期诊断青光眼中的意义。方法 正常人26例(41只眼)，高眼压11例(16只眼)、原发性开角型青光眼28例(38只眼)。采用Humphrey全自动视野计、HRT分别进行视野、视盘形态检测。比较正常组、高眼压组、青光眼组HRT视盘检测参数．分析青光眼组视野检测的平均缺损(MD)与HRT视盘检测参数的关系。结果 正常组、高眼压组、青光眼组视杯面积、杯／盘面积比、盘沿面积、视杯形态测量指数、视网膜神经纤维层厚度差异有显著性。青光眼组的盘沿面积、杯／盘面积比、视杯形成测量指数、视网膜神经纤维层厚度与视野检测的平均缺损有显著相关。结论 HRT能够反映青光眼视盘改变，为临床早期诊断青光眼提供更多的信息。     

应用海德堡视网膜断层扫描仪检测开角型青光眼的视盘改变

目的探讨海德堡视网膜断层扫描仪(Heidelberg retinal tomography,HRT)检测青光眼性视盘改变是否与视野损害的部位相一致,了解正常眼压性青光眼(normal tension glaucoma,NTG)与原发性开角型青光眼(primary open angle glaucoma,POAG)早或中期视盘形态是否异同.方法对64例(64只眼)仅有半侧视野异常的开角型青光眼(POAG27只眼、NTG37只眼)患者进行HRT检测,将Humphery视野与HRT的检测结果以0°～180°为界,分成上下两部分进行对应分析.结果与正常半侧视野对应的1/2视盘比较,显示异常半侧视野对应的1/2视盘HRT参数中,杯盘面积比、视杯形态测量值显著增大,而盘沿面积、视网膜神经纤维层厚度及视网膜神经纤维层横断面积值显著减少 (t=-2.625～3.025,P=0.003～0.05);NTG眼和POAG眼对应与异常半侧视野的HRT视盘参数差异无显著性(t=-0.98～1.511,P=0.14～0.97).结论 HRT参数能较准确反映与视野损害相一致的视盘变化,其中尤以杯盘面积比、盘沿面积、视杯形态测量、平均视网膜神经纤维厚度及视网膜神经纤维层横断面积测量值较为准确.NTG和POAG眼的视盘形态相似,可能具备某些相似的视神经损害发生机制.     

多种视觉电生理联合视野检查对原发性开角型青光眼早期诊断的敏感性

目的 探讨多种视觉电生理联合全自动视野计检查对原发性开角型青光眼早期诊断的敏感性，为临床早期诊断提供客观敏感的指标。方法 选择10例(20眼)原发性开角型青光眼患者和正常对照者10例(20眼)分别进行闪光视网膜电图(F-ERG)、图形视网膜电图(P-ERG)、图形视诱发电位(P-VEP)检查；还对正常对照组、青光眼组中各5例10眼进行多焦视网膜电图(mERG)检查；青光眼组10例(20眼)和正常对照组8例(16眼)行蓝黄视野(B／Y)、标准视野(W／W)检查。结果 P-ERG的N95潜伏期延长较敏感；P-VEP的P100波振幅降低，潜伏期延长但与对照组无明显差异；mERG二阶反应振幅下降，并随离心度的增大而明显降低；B／Y视野检查的视野异常阳性率显著高于W／W视野。结论 B／Y视野检查联合多种视功能检查对原发性开角型青光眼早期诊断较敏感。在眼底杯／盘比未出现改变的早期诊断中，B／Y视野和PERG敏感性较高。     

正常眼与原发性开角型青光眼的OCT视盘参数分析的对比研究

目的使用OCT评估正常眼与原发性开角型青光眼(primary open angle glaucoma,POAG)视盘(opticnerve head,ONH)的差异。方法选择具有青光眼性视神经损害或RNFL缺损、相应的视野缺损的开角型青光眼60例(60只眼),另选择正常眼60例(60只眼)作为正常对照组。对二组患者进行详细的眼科检查,并使用光学相干断层扫描仪(optical coherence tomography,OCT)测定视盘形态。OCT检查采用视盘扫描模式,评估数据包括视盘面积、视杯面积、盘沿面积、垂直盘沿面积(vertical integrated rim area,VIRA)、水平盘沿容积、平均杯盘比、水平和垂直杯盘比以及视杯容积。比较二组视盘参数,并比较平均误差(mean deviation,MD)和校正模型标准变异(correc-ted pattern standard deviation CPSD)与青光眼组的视盘参数有无相关。结果原发性开角型青和正常组之间视盘参数的比较具有显著性差异。正常眼、POAG比较分别为:视盘面积(211 /-0.5,2.62 /-0.4)mm2,(P<0.01),视杯面积(0.65 /-0.5,1.79 /-0.6)mm2,(P<0.01),盘沿面积(1.44 /-0.4,0.89 /-0.4)mm2,(P<0.01),VIRA(1.53 /-0.4,1.11 /-0.3)mm2,(P<0.01),盘沿容积(0.42 /-0.1,0.26 /-0.1)mm3,(P<0.061),杯盘比(0.31 /-0.2,0.62 /-0.2),(P<0.01)。结论OCT在开角型青光眼的早期诊断中具有重要价值。     

原发性开角型青光眼 HRT 视盘参数与视野缺损计分的关系

目的探讨原发性开角型青光眼(primary open an-gle glaucoma,POAG)病例的海德堡视网膜断层扫描仪(Hei-delberg retinal tomoscanner,HRT-Ⅱ)视盘参数与视野缺损计分的关系。方法对29例(30眼)POAG患者采用HRT-Ⅱ进行视盘检测;采用Humphrey视野计进行视野检查,运用AGIS计分系统并稍加改动对视野缺损情况进行计分,HRT参数包括视盘面积、视杯面积、盘沿面积、视杯容积、杯盘面积比、线性杯/盘比、平均视杯深度、视盘最大深度、平均视网膜神经纤维层厚度、视杯形态测量,将HRT视盘参数与视野计分进行相关统计学处理。结果HRT视盘参数中盘沿面积、视杯容积、杯盘面积比、平均视网膜神经纤维层厚度、视杯形态测量与视野缺损计分有直线相关关系。对视盘参数与视野计分进行逐步回归筛选变量时盘沿面积被选入,建立回归方程Y=12.351-5.123X(Y表示视野缺损计分,X表示盘沿面积)。结论POAG的视盘参数中盘沿面积与视野缺损计分关系最密切,视野缺损计分能对视野损害程度进行准确量化。     

倍频视野计对开角型青光眼正常半侧视野的检测结果

目的　了解倍频视野计 (frequency doublingperimetry ,FDP)检测早期青光眼视野异常的能力。方法　对Humphery视野计检测结果仅为半侧视野异常的 4 9例 (49只眼 )开角型青光眼患者 ,进行FDP(C 2 0阈值程序检测 )及海德堡视网膜断层扫描仪 (Heidelbergretinaltomography ,HRT)检测。根据检测结果 ,将患者分成FDP正常组及异常组 ;再将两组的HRT检测参数进行比较分析。结果FDP检测的平均光敏感度与HRT视野检测结果的平均偏差有显著相关性 (r =0 5 83,P <0 0 0 0 )。Humphery检测的异常半侧视野 ,FDP检测显示正常的仅占 2 0 % (1/ 4 9)。而Humphery检测的正常半侧视野 ,FDP检测显示异常的为 4 0 8% (2 0 / 4 9) ,与其相对应视乳头的HRT检测参数相比 ,FDP异常组的视杯面积和杯 /盘面积比值较FDP正常组的检测值大 (t=2 36 0和 2 4 39,P <0 0 5 ) ,而盘缘面积和盘缘容积则较FDP正常组小 (t=2 32 9和 2 5 79,P <0 0 5 )。结论　FDP不仅能检测出HRT发现的视野缺损 ,而且能显示HRT尚未能检测出的早期青光眼视野异常 ;FDP检测结果与HRT检测参数显示的青光眼性视乳头变化相一致。     

HRT-Ⅱ、PERG及PVEP在原发开角青光眼早期诊断中的应用

目的 :评价海德堡视网膜断层扫描仪 (HRT -Ⅱ )、图形视网膜电图 (PERG)、图形视诱发电位 (PVEP)计算机视野等检测方法在原发开角型青光眼早期诊断中的临床意义。方法 :选择原发开角型青光眼 18例 (3 2眼 ) ,可疑青光眼 19例 (3 2眼 ) ,正常对照者 2 6例 (3 2眼 ) ,分别进行HRT -Ⅱ、PERG、PVEP、计算机视野检测 ,并对检查结果进行统计学分析 ,计算每种方法的敏感性、特异性。结果 :正常组、可疑组、青光眼组间对比 ,HRT -Ⅱ、PERG、PVEP的检查指标有统计学差异P <0 0 1,视野检测正常组与可疑组无统计学差异P >0 0 5 ,而正常组与青光眼组对比P <0 0 1。各方法早期诊断的临床价值 :PERG >HRT -Ⅱ >PVEP >视野。结论 :PERG、HRT -Ⅱ较为敏感 ,联合多种检查方法对原发开角型青光眼的早期诊断具有较好意义。     

原发性开角型青光眼HRT视盘参数和视野缺损的关系

目的 :探讨原发性开角型青光眼视盘参数和视野平均缺损之间的关系。方法 :用海德堡视网膜断层扫描仪和自动视野计测定 5 5名原发性开角型青光眼患者的视盘参数 (杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度 )和静态光阈值。视盘参数与视野平均缺损作相关分析和多元线性回归分析。结果 :盘沿面积与平均缺损显著相关 (r =0 3 5 0 ,P <0 0 5 )。盘沿面积每减少 1mm2 ,视野缺损绝对值增加 8 0 81dB。本研究没有发现其它 6个参数与平均缺损相关关系的显著性。结论 :盘沿面积在HRT众多参数中最能反映青光眼的视野平均缺损程度。     

联合多种视功能检查对原发性开角型青光眼早期诊断的意义

了解原发性开角型青光眼视觉电生理和计算机自动视野检查结果的变化特征并对其视功能状况进行综合分析以寻找比较敏感和特异的参数，为原发性开角型青光眼较早期和早期诊断提供依据。方法：对３６例原发性开角型青光眼患者，８例可疑性青光眼患者，３０例正常对照者分别进行视网膜振荡电位，视网膜电图，视诱发电位和Ｈｕｍｐｈｅｒｙ计算机自动视野检查。     

Strabisme Alternant - Etude clinique - traitement

The author defines motor and sensory alternation: the term alternation should not be used in isolation, it should always be accompanied by the name of the parameter concerned. Sensory alternation is always found together with motor alternation but the reverse is not true.The examining criteria for a diagnosis of sensory alternation are given, sensory alternation must not be confused with alternating inhibition. Working from clinical observations of cases of motor alternating strabismus, the author selects 2 types of binocular sensory relations which allow one to differentiate between:- cases of primary alternating strabismus- cases of secondary alternating strabismusThese forms will develop in different ways; in both cases a cure is possible providing that the right treatment is prescribed and once prescribed carefully followed, etc. It is always a case of serious forms of strabismus whose developmental period is spread over several years.According to the authors, the frequency of cases of true primary strabismus is from 1–3%, the frequency of cases of secondary alternating strabismus varies according to the type of therapy practised on cases of monocular strabismus with amblyopia. These latter will become cases of alternating strabismus under the influence of certain types of therapy carried out over several years (penalization, rocking, alternated occlusion, etc...).Experimental data on kittens confirm clinical data; kittens placed in abnormal environments during the sensitive period will show modification in the distribution of cortical cells and the absence of binocular cells (either because the excitation of the two eyes was not simultaneous, or not identical: artificial strabismus, occlusion, opaque glasses). This disturbances become irreversible after a certain period of exposure (a function of age, length of exposure, etc...).It is thus necessary to bear in mind: 1) the iatrogenic risks of certain orthoptic treatments, 2) the necessity for a binocular form of treatment as soon as possible, as once a certain stage is passed, cortical plasticity diminishes and the elaboration of normal binocular relations becomes impossible.

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Current Thoughts on the Aetiology of Ocular Changes during Contact Lens Wear

ABSTRACT: Contact lenses are known to produce changes to the ocular tissues, and this review attempts to give a comprehensive assemblage of the knowledge on the aetiology of such changes. To achieve this result, the changes are categorized by structure and function, and discussed according to the temporal nature of occurrence where appropriate. Although assessment of the importance of a particular tissue change is difficult, this overview enables some degree of judgement to be made on the aetiology of the major side-effects of contact lens wear. This gives a basis on which to modify aspects of contact lens wear to ultimately increase the success rate.     

The detection of motion in chromatic stimuli: first-order and second-order spatial structure

This study provides evidence for the existence of a low-level chromatic motion mechanism and further elucidates the conditions under which its operation becomes measurable in an experimental stimulus. Observers discriminated the direction of motion of amplitude modulated (AM) gratings that were defined by luminance or chromatic variation and masked with spatiotemporally broadband luminance or chromatic noise. The size and retinal location of the stimuli were varied and the effects of broadband noise and grating masks were both compared with the cohort of stimuli. Some significant disparities in the published literature were well explained by the results. In conclusion, evidence for a chromatically sensitive motion mechanism that evades the, detrimental effects of a luminance mask was found only at the fovea and only when the stimulus was small and centrally placed.     

Local chemotherapeutic agents for the treatment of ocular malignancies

We critically analyze available peer-reviewed literature, including clinical trials and case reports, on local ocular cancer treatments. Recent innovations in many areas of ocular oncology have introduced promising new therapies, but, for the most part, the optimal treatment of ocular malignancies remains elusive.