Stargardt病的FFA和ICGA同步造影释义

目的：了解Stargardt病在同步进行的眼底荧光血管造影（fundus fluorescein angiography,FFA)和吲哚青绿血管造影(indocyanine green angiography,ICGA)过程中,不同时期的荧光表现。方法：使用海德堡共焦激光眼底扫描系统（Heidelberg Retina Angiography,HRA),对7例14眼典型的Stargardt病患者进行FFA和ICGA同步造影检查,对所摄取的同步图像进行同期对比分析。结果：14只眼的FFA检查均表现出明显的脉络膜湮没征（choroidal silence sign or dark choroid),ICGA则能显现脉络膜血管,但有10只眼的脉络膜血管影像比正常的暗。黄斑部病变在FFA检查中,14只眼均表现为典型的横椭圆形强烈的透见荧光,而在ICGA检查中,早期14只上均表现出比周期更强的脉络膜血管荧光,晚期(＞20分钟）有8只眼发现围绕黄斑病灶有一环形的弱荧光晕,8只眼除黄斑病灶外还伴有黄色斑点,在FFA检查中,黄色斑点大部分表现为高荧光斑,而在ICGA检查中则在大部分表现为低荧光斑,偶而有散在的高荧光点。结论：FFA和ICGA同步造影可以帮助我们了解同一病变部位,在同一时刻,不同造影的不同荧光表现,其联合应用可以加深对Stargardt病病理的认识和理解。     

少年儿童Stargardt病的荧光素眼底血管造影观察

目的探讨少年儿童Stargardt病荧光素眼底血管造影改变与临床表现的联系。方法总结分析11例22眼Stargardt病的临床和荧光素眼底血管造影资料。结果0．1以下者4眼,0．1～0．5的13眼,0．5以上的5眼,眼底改变可见中心凹反射消失、色素紊乱、金箔样萎缩病灶及黄白色渗出斑点。FFA所见：黄斑区园盘状、环状或椭圆形的1．5～2．5PD大小透见荧光8眼,有点状荧光遮蔽黄斑区不规则透见荧光5眼,散在点状高荧光3眼,背景荧光不均6眼,11例均有脉络膜背景荧光遮蔽现象。结论此病FFA检查对早期诊断有重大意义。     

糖尿病视网膜病变前期视网膜电图和视觉诱发电位分析

目的:分析糖尿病视网膜病变(diabetic retinopathy,DR)前期闪光视网膜电图(flash electroretinogram,FERG)和图形视觉诱发电位(pattern visual potential,PVEP)各参数的变化,寻找DR前期的诊断指标。方法:采用国际标准法对20例(40眼)正常人进行闪光视网膜电图(FERG)和图形视觉诱发电位(PVEP)检测,对20例(40眼)糖尿病(diabetes mellitus,DM)进行眼底荧光血管造影(fluorescence fundus angiography,FFA)、FERG和PVEP检测。结果:DM患者FERG、PVEP与对照组之间有差异,表现为Rod-R a,b波幅值、Max-R a,b波幅值、Cone-R a波幅值显著降低(P<0.01);Cone-R b波幅值,OPs总幅值、P100波幅值降低(P<0.05);P100波潜伏值的延迟(P<0.01)。结论:DM组在眼底尚无病变前,其FERG,PVEP已出现异常,因此FERG,PVEP是DR前期诊断的重要指标。     

65例Stargardt病及眼底黄色斑点症临床和眼底荧光素血管造影分析

目的 观察Stargardt病及眼底黄色斑点症(fundus flavimaculatus，FF)的临床表现及荧光素眼底血管造影(fundus fluoreseein angiography，FFA)特征。方法回顾分析65例Stargarclt病及FF患者130只眼的眼底和FFA检查资料。结果 Stargardt病及FF患者59．0％的患眼视力在0．1以下；90．8％的患眼检眼镜检查可见黄斑区呈“金箔样”反光，其中67．8％的患眼黄斑区视网膜色素上皮呈椭圆型萎缩，萎缩灶范围在1～2个视盘直径(disc diameter，DD)之间，FFA检查黄斑区均表现为横椭圆形强透见荧光，其中52．3％的患眼合并有暗脉络膜背景荧光；23．1％的患眼同时有黄斑及后极部的黄色斑点，FFA检查表现为斑驳状荧光。结论 stargardt病及FIF的临床特征为低视力、黄斑“金箔样”反光，FFA表现为黄斑区横椭圆形透见荧光及斑驳状荧光。     

Stargardt′s病的临床观察（附69例报道）

目的：探讨Stargardt′s病的临床表现，方法：回顾性分析69例138眼Stargardt′s病的临床和眼底荧光素血管造影（fundus fluorescein angiography FFA)资料，分析其视力损害程度，年龄分布状态及病灶表现形状。结果：视力0．02－0．1者115眼（83．33％），0．2－0．5者23眼（16．66％）；近视力最高Jr=2、最低Jr=0。其中10眼前起病者33例、11－20岁起病者26例，21－30岁起病4例、31－40岁起病6例，病灶形态：（1）单纯黄斑病灶型24例48眼。（2）黄斑病灶联合眼底黄色斑点型29型54眼；（3）黄斑病灶与后极部色素脱失相融合型16眼32眼。第三型病灶形态与前两型病灶在起病年龄与病程长短方面差别无明显意义（P＞0．05）。三种病灶形态的病变程度差别亦无意义（P＞0．05）。结论：（1）Stargardt′s病对视力的影响较大，但暂未见到视力全部丧失的病人；（2）Stargardt′s病主要出现于青少年时期，亦可在成年人后期发病；（3）黄斑病灶与后极部色素脱失融合为一体的特殊病灶可能是Stargardt′s病的另一种特殊的FFA变异形态。     

垂体腺瘤对视功能损害的临床观察

目的：探讨垂体腺瘤对眼视功能损害的临床表现。方法：对126例（252只眼）垂体腺瘤患者进行视力、视野、荧光眼底血管造影（Fundusfluoresceinangiography，FFA）、图形视诱发电位（Patternvisualevokedpotential，PVEP）及眼底检查。结果：视力下降186只眼，占73．8％。眼底原发性视神经萎缩130只眼，占51．6％。视野缺损156只眼，占69．6％。PVEP异常160只眼，占88．9％。26．2％的患者以眼部异常为首诊症状．其中16．7％曾被诊断为眼科疾病。结论：垂体腺瘤可引起视功能的损害，充分认识垂体腺瘤在眼部的临床特点，有助于早期诊断及时治疗。     

特发性黄斑裂孔眼底自发荧光成像研究

目的比较分析特发性黄斑裂孔（IMH）患者眼底自发荧光（FAF）图像及荧光素眼底血管造影（FFA）图像的特征。方法对33例（36眼）IMH患者应用共焦激光扫描检眼镜进行检查,分析FAF图像与FFA图像。另外选取16例正常人作为对照。利用MIG2000图像测量系统对黄斑中心凹进行自发荧光强度测定。结果33例（36眼）IMH患者中,全层黄斑裂孔26眼（72．2％）,板层黄斑裂孔10眼（27．7％）。黄斑自发荧光的特征：正常眼底中心凹FAF呈局部低荧光;黄斑裂孔表现为高荧光,与FFA的图像相似。6例板层裂孑LFAF、FFA均未见异常,其余4例板层孔中心凹处FFA表现为轻度增强的透见荧光,相应部位FAF见轻度增强的自发荧光。全层黄斑裂孔在裂孔处有明显增强的FAF,FFA的“窗样缺损”,在位置、面积、形状上与FAF一致。结论FAF检测为黄斑裂孔的诊断提供了一个新的、快速、非创性检查手段。     

高度近视眼后极部眼底病理改变

目的：通过眼底荧光血管造影(FFA)和吲哚青绿血管造影(ICGA)观察21例高度近视眼底后极部漆裂纹状病变、黄斑出血、Fuchs斑，以探讨高度近视眼底后极部的病理改变。方法：回顾分析21例(42只眼)，屈光度为-6D以上的高度近视眼底。均行彩色眼底照相、FFA、ICGA检查。将病例分为黄斑无出血组、黄斑出血组。结果：无出血组29只眼在FFA检查中4只眼有漆裂纹，占13．79％，在ICGA检查中有漆裂纹者9只眼，占31．03％，其中ICGA所见漆裂纹比FFA中数目更多且更长。出血组13只眼中FFA显示有漆裂纹7只眼占53．85％，ICGA显示有漆裂纹9只眼，占69．23％，该组中有1只眼ICGA未发现有脉络膜新生血管膜与漆裂纹。另有3例黄斑出血的对侧眼有眼底后极部萎缩斑或Fucks斑。结论：高度近视眼黄斑出血是病程发展的自然过程，漆裂纹常预示有出血产生的可能。黄斑出血由于脉络膜新生血管向视网膜生长；也可能只有视网膜黄斑部毛细血管出血而非脉络膜新生血管形成。晚期新生血管膜机化，色素上皮细胞增殖、聚集形成Fuchs斑。     

荧光素眼底血管造影在眼挫伤诊断中的应用

目的分析眼挫伤后荧光素眼底血管造影（FFA）的临床表现。方法对68例（78眼）眼球挫伤行眼底血管荧光造影检查。结果视网膜震荡43眼中33眼FFA表现为视网膜动脉静脉稍迂曲、黄斑区点状透见荧光。10眼FFA表现为低荧光，无荧光渗漏。视网膜出血8眼FFA表现出血区荧光遮蔽。脉络膜裂伤9眼FFA表现为血管下方弧形弱荧光、造影晚期呈高荧光。黄斑孔6眼：其中板层孔4眼，FFA未见异常荧光；全层孔2眼FFA显示为黄斑区圆形透见荧光。视神经挫伤12眼FFA表现视盘毛细血管扩张及渗漏，晚期呈强荧光；其中1眼视盘灌注时间晚于视网膜中央动脉灌注。结论眼底血管荧光造影能及时准确地了解眼球挫伤后损伤部位和程度，为指导临床诊疗提供依据，应作为眼球挫伤的常规检查。     

病理性近视黄斑出血的眼底荧光素血管造影、吲哚青绿血管造影及相干光断层扫描的影像学改变分析

目的分析病理性近视（PM）黄斑出血的荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）及相干光断层扫描（OCT）的影像学特征及临床意义。方法对病理性近视黄斑出血28例（31只眼）进行FFA、ICGA及OCT检查,并对比分析其检查图像。结果单纯型出血15只眼（48.4%）,FFA表现：出血部位遮蔽荧光,其中8只眼（53.5%）可见漆样裂纹透见荧光;ICGA表现：造影期间出血部位为淡的低荧光,晚期均可见漆样裂纹性条状低荧光;OCT表现：9只眼（60%）在神经上皮层下和4只眼（26.7%）在色素上皮（RPE）下可见中高反射光团,周围神经上皮无水肿增厚,其下脉络膜光带连续,其中2只眼（13.3%）OCT无明显改变;新生血管（CNV）型出血16只眼（51.6%）,FFA表现：14只眼（87.5%）为典型性CNV,2只眼（12.5%）为隐匿性CNV;ICGA表现：14只眼（87.5%）为焦点状CNV,无明显染料渗漏,2只眼（12.5%）未见CNV改变;OCT表现：14只眼（87.5%）为RPE光带断裂,RPE上梭形或类圆形中、高反射光团,2只眼（12.5%）为RPE层断裂伴不规则增厚中高反射信号,神经上皮层均增厚水肿。结论病理性近视黄斑出血分为单纯型和新生血管型,新生血管多表现为典型CNV,不同类型的出血其FFA、ICGA、OCT的改变各具特征,合理选择检查方法可提高诊断率,节省费用。     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Proximal and accommodative convergence and age

The authors have estimated the phoria for distant and near fixation in two groups of subjects (mean age 27.5 ± 4.4 and 59.2 ± 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower in presbyopic than in nonpresbyopic subjects. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.     

Anesthesia and preoperative and postoperative medications

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Anesthesia and preoperative and postoperative medications

Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti-inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Estrogen and progesterone receptors and human conjunctiva

Freshly frozen conjunctival tissue from premenopausal and postmenopausal women and male subjects were processed for estrogen and progesterone receptors by using monoclonal antibodies and a peroxidase-antiperoxidase technique. No immunocytochemical staining was localized in the nuclei of the cells treated with the monoclonal antibodies to human estrogen receptor or human progesterone receptor in any of the conjunctival specimens, in contrast to the strongly positive staining in breast adenocarcinoma controls. Immunocytochemical staining disclosed no evidence for estrogen or progesterone receptors on cells of the ocular surface.