弱视儿童黄斑微视野的研究

目的用黄斑微视野计方法分析儿童弱视治疗前后黄斑区视网膜光敏感度及固视性能变化,探讨黄斑区视网膜功能与弱视之间的关系。方法对22例（26眼）弱视儿童治疗前后1个月进行40个位点刺激的黄斑微视野检测。分析黄斑10°以内区域的光敏感度及固视程度变化。治疗前后检查最佳矫正视力。结果治疗1个月后21眼光敏度增加,视网膜黄斑10°内光敏感度与视力变化呈正相关（r=0．451,P=0．010）,光敏度值变化越大,视力提高越明显。22眼注视稳定程度显著提高（t=-2．540,P=0．018）。结论黄斑微视野仪检查提示：儿童弱视与黄斑区视网膜功能有一定相关性。     

Functional and morphological changes in diabetic macular edema over the course of anti‐vascular endothelial growth factor treatment

Purpose:  To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti‐vascular endothelial growth factor (VEGF) treatment with Ranibizumab. Methods:  A consecutive series of 39 study eyes with centre‐involving DME were included in this study. In all subjects, best‐corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD‐OCT) cross‐sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross‐sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Results:  Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = ?1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = ?3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = ?4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = ?1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = ?0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = ?2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. Conclusions:  ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti‐VEGF therapy with Ranibizumab in patients with DME.     

特发性黄斑前膜患者的光学相干断层扫描血流成像和微视野检查指标与视力的相关性

目的　观察特发性黄斑前膜（IMEM）患者微视野和光学相干断层扫描血管成像（OCTA）的微血管变化及与视力的相关性。方法　横断面研究。选择2019年10月至2020年10月来我院就诊的IMEM患者37例（72眼）,根据Gass分期分为A组（2期IMEM 23眼）和B组（0期、1期IMEM 25眼）及C组（健康对侧眼24眼）。另选择健康对照组13人26眼为D组。利用OCTA检测所有受试者视网膜厚度、黄斑区中心凹视网膜浅层血流密度（FSVD）、黄斑中心凹视网膜厚度（CMT）、黄斑中心凹脉络膜厚度、黄斑中心凹无血管区（FAZ）面积和FAZ 300 μm宽度内血流密度（FD-300）。微视野计检查各组受检眼黄斑中心6°范围的视觉敏感度（MS）,分析不同组别受检眼OCTA检测指标、MS与视力的相关性。结果　A组患眼BCVA大于B组、C组和D组,B组大于D组;A组患眼CMT大于B组,B组大于C组、D组;5个方位视网膜厚度中央视网膜厚度A组大于B组、C组和D组,B组大于D组,上方、下方、鼻侧、颞侧视网膜厚度A组大于B组、C组和D组。5个方位MS A组小于D组。A组FSVD大于B组;各组间黄斑中心凹下脉络膜厚度无显著差异;FAZ面积A组、B组小于C组、D组;A组FD-300大于B组、C组和D组,B组大于D组。BCVA（logMAR）与视网膜中央厚度和FD-300均呈正相关（r=0.719,P<0.01;r=0.407,P<0.01）,与视网膜中央MS呈负相关（r=-0.564,P<0.01）,与FSVD不相关（r=0.267,P=0.066）,与FAZ面积不相关（r=-0.004,P=0.978）。IMEM患眼中央、上方、颞侧、下方、鼻侧视网膜厚度与其所对应的MS均呈负相关（均为P<0.05)。结论　IMEM引起的黄斑区视网膜厚度和血流改变会导致患者视力和MS的改变。     

单纯性高度近视黄斑区视网膜敏感度与血流密度的关系

目的：观察单纯性高度近视黄斑区视网膜敏感度与血流密度的变化规律,并探讨其相关性。方法： 描述性研究。收集2019年3─9月在南昌爱尔眼科医院就诊的患者及志愿者共80例（80眼）,其中单 纯性高度近视47例（47眼）作为高度近视组,低度近视及正视33例（33眼）作为对照组。采用光学相 干断层扫描血管成像（OCTA）测量黄斑区3 mm×3 mm视网膜浅层血流密度（SVD）及深层血流密 度（DVD）,黄斑功能评估仪（MAIA）微视野计测量黄斑区10°视网膜敏感度（RS）。根据糖尿病视网 膜病变早期干预研究将RS图划分为与血流图相对应的6个区域（颞、上、鼻、下、中、旁中区）。2组 间数据比较采用独立样本t检验。RS与眼轴、等效球镜度、SVD和DVD的相关性采用Pearson相关 分析。结果：与对照组相比,高度近视组RS除鼻侧外,其余各区均明显下降（均P<0.05）,且高度近 视组DVD总、旁中、上、下均明显降低（均P<0.05）。无论总体受检者还是高度近视组,RS与等效 球镜度呈正相关（r=0.382,P<0.001;r=0.435,P=0.002）、与眼轴呈负相关（r=-0.429,P<0.001;r= -0.382,P=0.008）、与DVD呈正相关（r=0.286,P=0.010;r=0.344,P=0.018）、与SVD无相关性。高 度近视组RS与SVD在中、旁中、颞及鼻区呈正相关（r=0.386,P=0.015;r=0.292,P=0.046;r=0.435, P=0.006;r=0.319,P=0.048）,RS与DVD在中、旁中、上及下区呈正相关（r=0.330,P=0.040; r=0.358,P=0.025;r=0.294,P=0.045;r=0.437,P=0.005）。结论：单纯性高度近视眼RS和DVD下降, 且呈现出区域性差异。RS的下降可能与DVD降低有关。     

Progressive sector retinitis pigmentosa due to c.440G>T mutation in SAG in an Australian family

ABSTRACT

Background

Heterozygous c.440 G > T mutation in the S-antigen visual arrestin (SAG) gene has been described as a cause of autosomal dominant retinitis pigmentosa (adRP) in a series of patients of Hispanic origin. This study presents the early and late clinical features and disease progression rates in an Australian family with SAG adRP.     

脉络膜新生血管经TTT治疗前后微视野变化

目的 应用微视野检查技术评价经瞳孔温热疗法（TTT）治疗脉络膜新生血管（CNV）前后的视功能变化.方法 12例13只经荧光素眼底血管造影证实有CNV的年龄相关性黄斑病变（AMD）和高度近视患眼,在接受TTT治疗前后分别行微视野检查.结果 TTT治疗前,6眼有相对暗点,7眼有绝对暗点.治疗后与治疗前相比较,6眼TTT前检出相对暗点的患眼中,治疗后视力提高者4眼,1眼视力下降,1眼视力无明显变化;6眼中5眼TTT治疗后激光照射处视网膜的光敏度提高,1眼降低.所有被检出有绝对暗点的患眼治疗后视力均无明显变化,视网膜的光敏度不变.结论 微视野检查能客观评估TTT治疗CNV的疗效.     

Combined use of SLO microperimetry and OCT for retinal functional and structural testing

Background This study compared SLO microperimetry scotoma size measurements with the sizes of lesions assessed with OCT in the areas of scotoma.Methods SLO microperimetry was performed on eight patients to assess the location and extent of scotoma areas. An SLO microperimetry master image was used to localize the scotoma areas in the real time OCT fundus image and to center OCT cross scans on the areas of scotoma. The sizes of the morphological changes measured by OCT were compared with the scotoma size measurements.Results In each patient, OCT revealed a morphological change located in the area of scotoma. Scotoma sizes ranged from 465 to 3180 μm horizontally and from 570 to 2550 μm vertically. The corresponding lesion sizes ranged from 461 to 2660 μm horizontally and from 523 to 2282 μm vertically. The average difference between SLO and OCT measurements was 2.4% horizontally and 4.9% vertically. There were significant correlations between horizontal and vertical SLO and OCT measurements (Horizontal: R _sq=0.955, P<0.0001; Vertical: R _sq=0.898, P=0.0003).Conclusion SLO microperimetry scotoma size measurements and OCT lesion size measurements are similar to each other. Combining retinal functional testing with morphological testing provides information about the underlying causes of scotoma.     

Time in range as a useful marker for evaluating retinal functional changes in diabetic retinopathy patients

AIM: To elucidate the relationship between macular sensitivity and time in range (TIR) obtained from continuous glucose monitoring (CGM) measures in diabetic patients with or without diabetic retinopathy (DR). METHODS: This was a cross-sectional study including 100 eyes of non-DR patients and 60 eyes of DR patients. An advanced microperimetry was used to quantitate the retinal mean sensitivity (MS) and fixation stability in central macular. TIR of 3.9-10.0 mmol/L was evaluated with CGM. Pearson coefficient analysis and multiple linear regression analysis were used to assess the correlation between TIR and retinal sensitivity. RESULTS: In a comparison of non-DR patients, significant differences (P<0.05) were found in HbA1c, TIR, coefficient of variation (CV), standard deviation of blood glucose (SDBG) and mean amplitude of glucose excursion (MAGE) values in DR patients. Besides, those DR patients had significantly poor best-corrected visual acuity (BCVA, logMAR, P=0.001). In terms of microperimetry parameters, retinal mean sensitivity (MS) and the percentages of fixation points located within 2° and 4° diameter circles were significantly decreased in the DR group (P<0.001, P<0.001, P=0.02, respectively). The bivariate contour ellipse area (BCEA) encompassing 68.2%, 95.4%, 99.6% of fixation points were all significantly increased in the DR group (P=0.01, P=0.006, P=0.01, respectively). Correlation analysis showed that MS were significantly correlated with HbA1c (P=0.01). TIR was positively correlated with MS (r=0.23, P=0.01). SDBG was negatively correlated with MS (r=-0.24, P=0.01) but there was no correlation between CV and MAGE with MS (P>0.05). A multivariable linear regression analysis was performed to prove that TIR and SDBG were both independent risk factors for MS reduction in the DR group. CONCLUSION: TIR is correlated with retinal MS reduction in DR patients, suggesting a useful option for evaluating DR progression.     

Retinal Complications of Juvenile Idiopathic Arthritis-related Uveitis: A Microperimetry and Optical Coherence Tomography Study

Purpose: To evaluate ocular complications of juvenile idiopathic arthritis (JIA)-related uveitis; to study macular morphology and sensitivity.

Methods: Retrospective chart review of 67 patients. Fourteen consecutive patients (24 eyes) observed from January to December 2008 were submitted to optical coherence tomography study (OCT) and microperimetry MP-1 examination.

Results: Most frequent complications were posterior synechiae (63.0%), band keratopathy (53.9%), and cataract (31.8%). Posterior complications were documented in 37.0% of eyes: 13.8% macular edema, 12.0% papillitis, 6.8% epiretinal membranes, 2.5% retinal vasculitis, 1.7% retinal detachment. At OCT examination 25.0% of eyes presented macular edema; macular sensitivity by MP-1 was ≤16.5 dB in 25.0% of eyes.

Conclusions: Visual prognosis is good despite ocular complications. Incidence of macular edema seems to be higher when using OCT. Microperimetry may represent a useful tool in detecting alteration in retinal sensitivity that may supplement visual acuity in the follow-up of macular edema.