Neuritin蛋白在单眼形觉剥夺成年大鼠视皮层表达的研究

目的 研究正常、单眼形觉剥夺和反转缝合成年大鼠视皮层Neuritin蛋白的表达,探讨成年大鼠视皮层是否具有可塑性。方法 实验研究。35只健康Wistar大鼠随机分为正常对照(N90)组,单眼形觉剥夺(MD)组和反转缝合(RS)6、12、24、48 h组和RS1周组,每组5只。两种照度昼夜明暗交替时间约为12 h/12 h。MD组和RS组于出生后14 d制作右眼形觉剥夺模型,RS组大鼠单眼形觉剥夺至90日龄时进行反转缝合后并持续暴露于光中6h、12 h、24h、48 h和1周,其余两组大鼠至90日龄时直接取左侧大脑视皮层。采用免疫组织化学方法检测Neuritin蛋白在正常、单眼形觉剥夺和反转缝合成年大鼠视皮层中的表达变化。Neuritin蛋白的A值和Neuritin阳性细胞数在7组大鼠视皮层中表达的总体差异比较采用单因素方差分析,组间的多重比较采用LSD-t检验。结果 N90、MD、RS6h、RS12h、RS24h、RS48 h、RS1周组Neuritin蛋白平均吸光度分别为0.1097±0.0136、0.0259±0.0057、0.04751±0.0069、0.05189±0.0057、0.0649±0.0055、0.0835±0.0097、0.0845 +0.0098(F=105.57,P＜0.05),染色阳性细胞数分别为163.90±5.82、142.00±3.65、150.00±5.46、152.10±5.04、156.40±5.25、156.40±6.04、155.80±6.54(F=15.39,P＜0.05)。MD组大鼠视皮层中Neuritin蛋白的表达量均低于N90组。RS6、12、24、48 h组和RS1周组大鼠视皮层中Neuritin蛋白的表达量均明显高于MD组。结论 Neuritin蛋白在单眼形觉剥夺成年大鼠和反转缝合不同时间大鼠视皮层表达呈动态变化,提示年龄超过视觉发育敏感期的单眼形觉剥夺成年大鼠的视皮层仍具有一定程度的可塑性。     

屈光不正性弱视患者多焦视网膜电图一阶反应P1波特征分析

目的 研究屈光参差性弱视患者mfERG一阶反应P1波特征,探讨mfERG在弱视诊断中的应用价值.方法 采用罗兰RETIscan型电生理仪检测一组(15例)屈光参差性弱视患者mfERG,选择一阶反应第一环P1波为指标,计算其平均振幅密度(nV·deg-2)及潜伏期(ms),采用配对t检验比较弱视眼与对侧健眼的统计学差异.结果 弱视眼P1波平均振幅密度为(164.7±73.1)nV·deg-2,对侧健眼为(227.0±61.3)nV·deg-2,差异有统计学意义(t=2.554,P=0.016);弱视眼P1波平均潜伏期为(30.3±4.3)ms,对侧健眼为(34.4±3.2)ms,差异有统计学意义(t=2.92,P=0.007).结论 屈光参差性弱视患者弱视眼mtERG一阶反应第一环P1波有明显改变,提示弱视眼存在视网膜开-双极细胞功能及视觉信息传导异常,mfERG有可能用作弱视的诊断的客观指标.     

1006例弱视集中治疗的疗效分析

目的观察弱视患者集中式综合治疗的疗效,探讨提高弱视治疗效果的方法。方法收集2006年2月至2008年2月间在我院就诊并集中进行弱视综合治疗的患者1006例（1870眼）,年龄3-18岁,进行遮盖、精细目力训练及增视仪、同视机、多媒体等综合治疗,每个疗程15d,定期复查（1年到3年不等）。按弱视程度、性质以及注视性质等进行分组,对各组的治疗效果行x2检验。结果经过弱视集中式训练后,总有效率为81．0％。轻、中度弱视及弱视中的屈光不正性患者治疗效果明显优于其他类型弱视（P〈0．05）。不同年龄段患者的治疗有效率不一致,14岁及以下患者明显比14岁以上者高（P〈0．05）。结论集中式综合治疗是弱视患者提高视力的有效方法,需要早期发现和早期治疗。     

Laser in situ keratomileusis for treated myopic anisometropic amblyopia in children

Purpose

To evaluate the effects of laser in situ keratomileusis (LASIK) in decreasing myopic anisometropia in children with spectacles or contact lens intolerance and its validity in facilitating treatment of resultant myopic anisometropic amblyopia.

Patients and methods

LASIK was performed in 18 eyes of 18 children having myopic anisometropic amblyopia not successfully treated with the standard amblyopia treatment for 6 months. Children were followed up at 1 week, 1, 2, 6, 12, 18 and 24 months. Postoperative amblyopia therapy was continued with occlusion of the dominant eye for 6 h daily for the first 3 months and then for 4 h per day as long as possible.

Results

The mean spherical equivalent refraction in the operated eye had reduced significantly from −9.08 ± 1.86D preoperatively to −0.97 ± 1.16D at 2 years postoperatively. The mean spherical equivalent in the non-operated fellow eye was −1.0 ± 1.15D preoperatively and −2.50 ± 1.15D at 2 years. The mean spherical equivalent myopic anisometropia was −7.75 ± 2.25D preoperatively and −0.50 ± 0.31D at 2 years, representing a 93.5% reduction in myopic anisometropia. The mean regression value was −2.28 ± 1.62D, however, 18 eyes (72%) were within 3.0D of the fellow eye. The mean BCVA was significantly improved from 0.72 ± 0.13 preoperatively to 0.47 ± 0.17 by 2 years after LASIK with amblyopia treatment.

Conclusion

LASIK is a safe and effective alternative method for correcting myopic anisometropic amblyopia, especially in children with spectacles or contact lens intolerance, with more better visual acuity and binocular vision.     

弱视患者自适应光学系统矫正高阶像差前后视觉行为变化的研究

目的 探讨单眼弱视眼通过自适应光学系统矫正高阶像差（higher order aberrations, HOAs）前后视觉行为的变化。 方法 分别测量10名单眼弱视患者通过自适应光学系统矫正弱视眼高阶像差前后的视力(visual acuity, VA)及对比敏感度(contrast sensitivity, CS)阈值,并分析视力和对比敏感度阈值的变化。 结果 弱视眼矫正高阶像差后视力提高（P=0.005）;弱视眼矫正高阶像差后对比敏感度阈值降低(P<0.001),这一进步主要发生于24 cpd的空间频率（spatial frequency, SF）上（P=0.018）。 结论 弱视眼在矫正高阶像差后视觉功能提升,高阶像差的存在对弱视患者高空间频率上对比敏感度功能的下降具有一定的作用。     

儿童屈光不正性弱视视中枢功能激活的功能磁共振成像研究

目的 采用3.0 T功能磁共振成像（fMRI）技术,评价屈光不正性弱视儿童在规范弱视训练后,脑皮层视觉运动觉功能区的恢复情况。方法 前瞻性研究。初诊屈光不正性弱视患儿9例,组块式设计,弱视治疗1周、2周及4周时复查fMRI。视觉刺激选择对比度接近100%的8 Hz圆环形旋转棋盘格。采用基于Matlab 7.12的SPM8软件包对数据进行离线处理,利用假设驱动法获得每个治疗阶段的矩阵数据,采用配对t检验对治疗前后各组视皮层功能区激活的程度进行比较。结果 弱视训练2周后,双侧枕叶（右侧BA18区Mean t=1.236 1;左侧BA18区Mean t=1.521 1;右侧BA19区Mean t=1.684 5;左侧BA19区Mean t=1.591 7,P<0.005）较1周时激活强度增加;视觉联合区,即V5区（右侧BA37区Mean t=1.201 4;右侧BA21区Mean t=1.145 0,P<0.005）开始激活,至第4周时,激活范围及程度较2周时下降（右侧BA18区Mean t=1.002 4;左侧BA18区Mean t=1.743 1;右侧BA19区Mean t=1.225 3;左侧BA19区Mean t=1.181 3,P<0.005）。结论 大龄儿童屈光不正性弱视功能训练早期,重建视中枢视觉运动觉的功能较困难,且不稳定。     

儿童屈光不正性弱视的疗效观察

目的探讨儿童屈光不正性弱视的临床疗效及预后。方法排除器质性眼病和病理性斜视,对105例屈光不正性弱视儿童进行散瞳、验光、配镜、遮盖及精细目力训练等。结果本组年龄越小治愈率越高,弱视程度越轻治疗效果越好,弱视的性质不同疗效亦不同,屈光参差性弱视疗效最差,重度性弱视几乎无治愈。结论儿童在视觉发育期屈光不正性弱视预后较好。关键在于早期发现,及时和正确治疗,绝大多数视力可提高,一部分可获得正常视力。     

Application of the quick contrast sensitivity function in visual function assessment北大核心CSCD

The contrast sensitivity function (CSF) describes visual sensitivity at different contrasts and spatial scales, which provides a fundamental characterization of spatial vision, important for basic and clinical applications, but its long testing time has prevented the easy and widespread assessment. The quick contrast sensitivity function (qCSF) method is a novel Bayesian adaptive procedure for rapid measurement of the CSF, which can greatly improve the efficiency of CSF assessment. In the normal eyes, amblyopia, myopia and a low vision population, the high sensitivity, high precision and high test-retest reliability of the qCSF method have been verified. The qCSF method also shows higher CSF efficiency and lower costs in a large sample. Currently, the qCSF method has been implemented on iPad, and medical devices using this program have also been applied in some clinical institutions in the United States and Germany, which has a good prospect in clinical application. In this review, the application of the qCSF in visual function assessment was reviewed. Copyright © 2018 by the Chinese Medical Association.     

婴幼儿先天性白内障术后视功能评价

目的 综合评价婴幼儿先天性白内障术后的视功能发育情况.方法 为回顾性系列病例研究.将先天性完全白内障患儿41例(62只眼)按年龄分为4组.A组:＜0.5岁,13例(20只眼);B组:≥0.5且＜1岁,11例(16只眼);C组:≥1岁且＜2岁,9例(15只眼);D组:≥2岁,8例(11只眼).均施行白内障吸除及双撕囊联合前段玻璃体切除手术,术后3 d使用Mini刺激器行闪光视觉诱发电位(F-VEP)检查,术后1周用维视顿视功能治疗和检查系统评价视力情况,随后配戴合适框架眼镜,遮盖健眼进行增视训练,12周后再次使用Mini刺激器行F-VEP检查以及视力检查.结果 4组患儿增视功能训练12周后的P100潜伏时分别为(90.28±1.59)、(111.30±1.59)、(125.28±1.97)、(147.87±1.46)ms,与术后3 d[(144.61±2.25)、(150.05±1.92)、(153.89±1.12)、(164.15±1.48)ms]比较明显缩短(t=43.75,32.77,31.61,65.04;P＜0.01).4组患儿增视功能训练12周后P100振幅分别为(12.65±0.25)、(10.56±0.05)、(9.06±0.40)、(8.71±0.02)Μv,与术后3 d[(3.41±0.06)、(4.60 ±0.10)、(4.70±0.27)、(5.00±0.01)Μv]比较明显增加(t=-376.05,-91.64,-507.77,-399.41;P＜0.01).视力检查亦显示,增视功能训练12周后视力(0.471 ±0.021、0.462 ±0.033、0.410±0.027、0.390 ±0.033)较术后1周(0.112±0.0127、0.107 ±0.013、0.117 ±0.014、0.120±0.014)明显提高(t=20.983,10.607,15.036,7.488;P＜0.05),且年龄段越小其视功能恢复越好,以A组患儿视功能恢复情况最好.结论 先天性白内障患者应尽早行手术治疗,术后配戴合适眼镜以及合适的增视功能训练,对于患者视功能的发育及重建具有重要意义.     

Learning to identify near-threshold luminance-defined and contrast-defined letters in observers with amblyopia

We assessed whether or not the sensitivity for identifying luminance-defined and contrast-defined letters improved with training in a group of amblyopic observers who have passed the critical period of development. In Experiment 1, we tracked the contrast threshold for identifying luminance-defined letters with training in a group of 11 amblyopic observers. Following training, six observers showed a reduction in thresholds, averaging 20%, for identifying luminance-defined letters. This improvement transferred extremely well to the untrained task of identifying contrast-defined letters (average improvement = 38%) but did not transfer to an acuity measurement. Seven of the 11 observers were subsequently trained on identifying contrast-defined letters in Experiment 2. Following training, five of these seven observers demonstrated a further improvement, averaging 17%, for identifying contrast-defined letters. This improvement did not transfer to the untrained task of identifying luminance-defined letters. Our findings are consistent with predictions based on the locus of learning for first- and second-order stimuli according to the filter-rectifier-filter model for second-order visual processing.