Contrast sensitivity during provoked visual impairment in multiple sclerosis

Many patients with multiple sclerosis have subjective visual complaints that are intensified by exercise (Uhthoff's symptom). We report a case demonstrating the utility of contrast sensitivity testing in such visual complaints. Contrast sensitivity was measured before and after exercise in a multiple sclerosis patient with Uhthoff's symptom and in two healthy control subjects. A short exercise period reduced the patient's contrast sensitivity for some target sizes, but had no effect on his visual acuity; a longer exercise period produced a greater, more uniform loss of contrast sensitivity and also reduced visual acuity. Contrast sensitivities and visual acuities of the control subjects were not affected by exercise.     

先天性无虹膜患者的临床分析

目的探讨先天性无虹膜患者的l临床表现及其治疗。方法为回顾性系列病例研究。选择1984年1月至2007年1月于我科就诊的8例（16只眼）先天性无虹膜患者,均为双眼患病,矫正视力均低于1．0。8例患者均伴不同程度白内障;其中5只眼伴青光眼,均为难治性青光眼;4只眼伴弱视;8只眼伴眼球水平震颤。根据病情不同分别行囊外白内障摘除术和人工晶状体植人术、小梁切除术、睫状突激光光凝术、戴镜行弱视训练、配戴角膜接触镜等治疗。结果6只晶状体明显混浊眼行白内障手术后视力有不同程度提高,无手术并发症。5只青光眼中,1只眼行小梁切除术,但术后眼压仍然不能控制于正常范围内,又行睫状突光凝术;3只眼仅行睫状突光凝术;1只眼局部使用降眼压药物治疗。此5只青光眼中,3只眼眼压得到控制,另2只眼仍不能控制于正常范围内。4只弱视眼经配镜、弱视训练后视力均有一定提高,2只眼配戴角膜接触镜后畏光症状得到缓解。结论先天性无虹膜患者眼部表现多种多样,虽治疗棘手,但经适当的治疗后可改善视力和临床症状。（中华眼科杂志．2008,44：46-49）     

Boeck's disease with unilateral optic nerve involvement

A rare symptom of Boeck's disease is involvement of the fasciculus opticus. This paper reports on a patient with sarcoidosis who developed cerebral symptoms during the course of the disease; some months later he suffered an acute deterioration of vision in his right eye, with central scotoma but without papilledema. The difficulty of distinguishing this condition from bulbar neuritis in cases of multiple sclerosis is discussed.     

Evaluation of visual acuity and color vision in normal human eyes with a sutureless temporary amniotic membrane patch

PURPOSE: To evaluate how sutureless amniotic membrane patches may affect visual functions in normal human eyes. DESIGN: Prospective intervention study. METHODS: Ten sets of sutureless amniotic membrane patch manufactured as PROKERA were inserted in one eye of six normal patients. Four sets (one each) were inserted in four patients, while six sets (three each) were inserted in two patients. Uncorrected distant and near visual acuities, color vision, amniotic membrane thickness measured by pachymetry, and total symptom scores were compared before and after insertion. RESULTS: Within 30 minutes after insertion, mean distant visual acuities decreased from -0.22 +/- 0.06 to 0.92 +/- 0.45 logarithmic minimum angle of resolution (logMAR). Among 10 sets of PROKERA inserted, the largest optotype (1.0 logMAR) of the near vision chart could not be recognized in five, but color vision evaluated by Panel D-15 was still preserved in all. Total symptom scores increased to 47.8 +/- 9.1 points (maximum, 100 points). Among symptoms, total scores for foreign body sensation (17.8 +/- 3.6) and blurred vision (17.8 +/- 4.4) were high. Loss of distant visual acuity and increases of symptom scores were not correlated with amniotic membrane thickness, of which the mean was 67.6 +/- 25.2 mum. However, amniotic membrane that was less opaque tended to provide relatively good visual acuities. CONCLUSION: Because of the relative non-transparency of sutureless amniotic membrane patches in PROKERA, distant and near visual acuities decreased in normal human eyes. The foreign body sensation noted after insertion is primarily derived from the rigid supporting skirt.     

50例Array多焦点人工晶状体的临床应用分析

目的　探讨 Array多焦点人工晶状体的临床价值。方法　对 5 0例 (5 0只眼 )白内障患者实施超声乳化并植入 Array多焦点人工晶状体 (MIOL ) ,对照组 5 0只眼植入眼力健单焦点人工晶状体 (SIOL ) ,观察术后 1周裸眼远视力、矫正远视力、裸眼近视力、视远矫正度数矫正近视力、中间距离视力、对比敏感度、视觉症状及 MIOL组术前术后散光变化 ;随访 3月 ,观察后发障的发生率。结果　两组裸眼远视力、矫正远视力无明显差异 (P >0 .0 5 ) ;裸眼近视力、视远矫正度数矫正近视力及中间距离视力 ,MIOL组明显优于 SIOL组 (P <0 .0 5、 P <0 .0 1) ;后发障 MIOL组 13只眼 (2 6 % ) ,SIOL组 5只眼 (10 % ) ,二者具有统计学意义 (P <0 .0 5 ) ;MIOL组手术前、后的散光状态无明显变化 (P >0 .0 5 ) ;MIOL组对比敏感度明显下降。结论　 MIOL在保证远视力的同时 ,又获得很好的中、近视力 ,取得近似“天然”的全程视力 ,使白内障术后患者生活质量显著提高。     

Visual evoked potentials in the diagnosis of multiple sclerosis

A three-year collaborative study was done on 96 patients presenting with signs of neurological dysfunction suggestive of multiple sclerosis. All were tested using Visual Evoked Potentials, with the final diagnosis not known to the tester. Patients with bilateral Visual Evoked Potential P1 wave conduction delays were more likely to have a subsequent diagnosis of MS, than those with unilateral delays, or normal VEPs. The average delay between the onset of the first symptom, and a definitive diagnosis of MS was 3.5 years. The most frequent initial symptom was paresthesias of the lower extremities, followed by blurred vision. This study suggests that the presence of Visual Evoked Potential abnormalities may be useful in the longitudinal diagnostic evaluation of patients with a presumptive diagnosis of multiple sclerosis.     

Reduction of symptoms in binocular anomalies using computerized home therapy—HTS™

BackgroundAsthenopic symptoms often are associated with various accommodative/vergence disorders. Recent studies have found that symptoms associated with convergence insufficiency are reduced by in-office vision therapy with supplemental home therapy. No studies have used standardized symptom questionnaires to evaluate the effectiveness of either in-office or home-based vision therapy in binocular anomalies other than convergence insufficiency. This retrospective study was designed to evaluate the changes in symptoms using an automated, home computer vision therapy program (HTS?) in accommodative/vergence disorders.MethodsA retrospective study of 43 prepresbyopic patients who completed the HTS was performed. Before and immediately after treatment all patients in this study completed a 15-question symptom questionnaire (Convergence Insufficiency Symptom Survey). Treatment consisted of various accommodative and vergence activities.ResultsInitial symptoms scores on the scaled questionnaire were 32.8 (SD = 8.1); after therapy they were 20.6 (SD = 11.5). These changes were both clinically and statistically significant. Forty percent were “normalized” and 55% improved. Convergence amplitude improved from 22Δ to 53Δ after treatment, and divergence amplitudes improved from 15Δ to 25Δ. These findings were clinically significant. Lastly, more than 75% of the patients finished the program by 40 sessions (equivalent to 8 weeks).ConclusionAutomated vision therapy delivered by the HTS system improved convergence and divergence amplitudes with a concomitant reduction in symptoms. The HTS system should be used on those patients with symptoms associated with an accommodative/vergence anomaly when in-office vision therapy supplemented with home therapy is not practical.     

Fluctuations of visual evoked potential amplitudes and of contrast sensitivity in Uhthoff's symptom

Visual evoked potentials (VEPs) to pattern reversal and psychophysical contrast sensitivity (CS) were tested in five patients with Uhthoff's symptom before and after exercise. Four of the cases were related to a demyelinating disease and one patient had a severe brain injury. Uhthoff's symptom occurred also in neuropathies without previous clinical neuritis and in eyes with normal latency time of the VEPs. A depression of CS was observed by all five patients after exercise; a transient overshoot of CS following the depression was present in three of the patients. VEP amplitudes were reduced by exercise in three cases. Responses by stimulation with small checks were more affected. Paradoxical increased VEP amplitudes after exercise in the presence of a loss of psychophysical CS were found in one case.     

LASIK术后外伤性角膜瓣移位的治疗

目的 观察LASIK术后外伤性角膜瓣移位复位术的疗效情况.方法 对12例（12眼）LASIK术后因外伤导致角膜瓣移位及时进行角膜瓣复位术,同时佩戴亲水性角膜接触镜,观察术后视力、角膜瓣恢复情况以及眼部症状.结果 术后1周内9例视力提高至0.8～1.0,2例视力提高至0.6,1例视力提高至0.3;角膜瓣均无皱褶、移位、上皮植入或角膜融解;眼部疼痛、畏光、流泪症状较术前明显改善.随访3个月其中视力0.3的1例提高至0.5,其余患者视力无波动;全部患者角膜瓣亦均恢复良好,未再发生皱褶、移位或上皮植入.结论 LASIK术后发生角膜瓣移位及时行角膜瓣复位手术对视力及角膜瓣恢复具有良好的疗效.     

Blurred vision during sexual arousal associated with narrow-angle glaucoma

PURPOSE: To describe three women with narrow-angle glaucoma who had transient blurred vision during sexual arousal. METHOD: Case reports. RESULTS: Three women, aged 37, 45, and 55 years, were seen with bilateral narrow-angle glaucoma and were treated with bilateral laser iridotomy. In each patient, additional surgery was required to control the glaucoma. After establishing a rapport with her physician, each patient described transient blurred vision, from a few minutes to several hours in duration, which began during sexual arousal. This symptom resolved after peripheral iridotomy and, in one patient, after laser iridoplasty. CONCLUSION: The association of transient blurred vision with sexual activity may delay presentation of patients with symptomatic narrow-angle glaucoma.     

The visual deficit in optic neuritis

Patients with optic neuritis often complain of two things; first that their vision appears to be ‘washed-out’ or ‘blurred’ and secondly that they experience visual difficulty at high levels of background illuminances. These two symptoms are investigated in terms of contrast threshold for grating targets of different spatial frequency. The first symptom is explicable in terms of the contrast processing anomaly which is present above threshold in optic neuritis. The second symptom is not explicable in these terms and this suggests one inadequacy of using grating stimuli to assess vision.     

Reversible visual impairment caused by leukemic fundus changes (author's transl)]

Monocular impaired visual acuity was the initial symptom of chronic myeloic leukemia in a 41 year old man. A subretinal infiltration had caused foveal retinal thinning. 3 1/2 months after the onset of therapy retinal thickness had normalized and the vision was fully restored.     

Disturbance of central vision after carbonmonoxide poisoning

Background: Cerebral achromatopsia is a disturbance of colour perception which may be complete or partial.
Clinical record: A 28-year-old male patient presented five months after carbon monoxide poisoning with achromatopsia. The achromatopsia was unaccompanied by an inability to recognise faces (prosopagnosia) nor was there any disorder of form or depth perception.
Results: Magnetic resonance imaging showed bilateral sharply defied areas of haemorrhagic infarction in the globus pallidus with extensive infarction involving temporal and occipital lobes and with apparent partial sparing of the visual cortex, presumably due to arterial insufficiency. The disturbance of central colour vision resolved spontaneously after a further period of 6 months.
Conclusion: The symptom of achromatopsia is analysed with particular reference to the recent work of Professor Zeki on disturbance of central colour vision following CO poisoning and the unusual MRI findings.     

Orbital metastases as the first manifestation of lung adenocarcinoma

Reduction in visual acuity due to orbital metastasis is rarely the first sign of lung cancer and very few cases have been published in the literature. Here we report a rare case of lung adenocarcinoma with orbital metastasis as the first presenting sign. The incidence of primary tumors that metastasize to the orbit is approximately 7%. In 19% of the cases, there is no history of cancer when the patient presents with ophthalmic symptoms, and in 10%, the primary site remains obscure despite intensive systemic evaluation. Our patient showed a partial improvement in vision after successful combination of chemotherapy and radiotherapy. Blurred vision due to orbital metastasis as the primary symptom of lung cancer is very uncommon. A great index of suspicion is essential when an orbital lesion appears.     

表麻下小切口非超声乳化白内障摘除联合IOL植入术的临床研究

目的:探讨表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术的临床效果和安全性。方法:对2007-01/2008-01在我院住院治疗的白内障患者105例113眼实施表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术,观察临床效果。结果:术中麻醉效果明显,显效共107眼(94.7%),有效6眼(5.3%),总有效率达100%,无病例因疼痛无法承受手术而改行球后或球周麻醉。术后第1d裸眼视力≥0.5者65眼(57.5%),>0.8者22眼(19.5%);术后1wk裸眼视力≥0.5者85眼(75.2%),>0.8者17眼(15.0%),随访1mo未发现明显视力下降。术后1wk视力<0.5者1例(0.9%),为糖尿病视网膜病变。术后角膜内皮水肿7眼(6.2%),高眼压4眼(3.5%),经处理后症状均消失。结论:表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术的临床效果确切,安全性高,值得推荐应用。     

The VF-14 index of visual function in recipients of a corneal graft: a 2-year follow-up study

PURPOSE: To assess visual functioning and other health-related quality of life outcomes after corneal grafting.DESIGN: A cohort study of corneal graft recipients observed for a minimum of 2 years after transplantation.METHODS: Repeated measurements were obtained by telephone interviews preoperatively and later at 1 and 2 years post-corneal transplantation in 217 patients with the following questionnaires: visual function index (VF-14), visual symptom score and global measures of trouble with vision, dissatisfaction with vision, ocular pain, and discomfort. Demographic, past ocular history, repeated best-corrected visual acuity (BCVA), and detailed eye examination data were also collected.RESULTS: Grafted eyes gained a mean of more than four lines of vision on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart 1 year after transplantation. The mean visual function index (VF-14) score improved from 68% +/- 26% preoperatively to 81% +/- 21% at 1 year. Average visual acuity (VA) and VF-14 values were unchanged at 2 years. The activities of daily living that showed the largest and most significant improvement were reading small print, driving in daytime, and watching television. A number of subjects (9%) presented with a maximum VF-14 score preoperatively, leaving no room for improvement with this outcome index. The VF-14 was especially responsive for corneal graft candidates with low levels of vision before surgery. Blurry vision, pain and discomfort scores, and the global measures of trouble and dissatisfaction with vision also improved after corneal grafting.CONCLUSION: The VF-14 index of functional visual impairment is a responsive and useful outcome index in recipients of a corneal graft.     

三种方式准分子激光近视矫正术术后视觉质量的调查分析

目的比较LASIK,LASEK与Epi-LASIK 3种不同的准分子激光手术术后患者视觉质量的差异。方法对在我院行LASIK,LASEK或Epi-LASIK矫正近视的58例术后3月复查时做问卷调查,其中LASIK 35人,70眼;LASEK 19人,38眼;Epi-LASIK 4人,8眼。问卷内容包括日常生活及驾驶汽车时的视觉改善状况,一共18个问题,每个问题的回答由感觉较差到满意分别对应取1～5分,满分90分。应用统计软件SPSS11.5对所得数据进行组间方差分析并做两两比较。结果全部患者术后3个月时裸眼视力均达到或超过术前最佳矫正视力,无危害视力的并发症出现。3种手术方式日常生活视觉质量问题和驾驶视觉问题的得分总分均数间无统计学差异。结论3种手术方式都能取得一样令人满意的疗效。术后视觉效果不满意处主要集中在视物易疲劳,酸胀感,眩光及重影以及夜视力下降等方面。     

Influence of pathologic scotopization on the extended Rayleigh Match

Pathologic scotopization, an important symptom of retinal disease, can be studied by means of the Nagel II anomaloscope. This method is called the micro-screw method. The micro-screw method was performed in 14 congenital and 13 acquired colour vision defective individuals. The method proves to be useful in detecting symptoms of rod intrusion in colour vision under photopic conditions.     

Marathon Runner’s Retinopathy

Purpose: To report a case of an unusual retinopathy in an otherwise healthy 25-year-old marathon runner.

Methods: Case report.

Results: A 25-year-old female marathon runner developed sudden onset of monocular vision loss during a routine training run. The retinal features included a large, central, subhyaloid hemorrhage, multiple intraretinal hemorrhages, disc edema and venous dilation and tortuosity resembling characteristics of both valsalva retinopathy and nonischemic central retinal vein occlusion. Work up for underlying systemic cause was negative. However, the patient did participate in endurance exercise.

Conclusion: Strenuous exercise increases activated platelets and other clotting factor elements. During exercise, this increase in clotting factors in the coagulation cascade is usually balanced by activation of key elements in the fibrinolysis cascade as well. However, certain individuals, especially those who already have a predisposition to clotting or other thrombogenic risk factors may disrupt the balance between coagulation and fibrinolysis during strenuous exercise favoring coagulation which places them at risk for thrombus formation.     

视疲劳的原因分析

目的 :分析视疲劳发生的原因及特点。方法 :通过观察 132例视疲劳患者的病史、病因、症状特点、年龄等因素及随诊情况 ,进行比较分析。结果 :视疲劳为多因素所致 ,以屈光不正、操作电脑 (VDT)引起最为常见 ,年龄以及工作强度为视疲劳的重要相关因素。结论 :视疲劳症状繁多 ,原因复杂 ,必须全面分析病史 ,详细检查 ,综合治疗。