Characteristics of central visual field defect after macular hole surgery

AIM: To investigate the characteristics of postoperative central visual field defect(cVFD) in patients with macular hole(MH).METHODS: Eighteen eyes from 18 MH patients were involved in this retrospective study which reviewed square root of loss variance(sLV) and mean defect(MD) of the visual field test in all subjects. The relationship between cVFD and MH stage, as well as the postoperative ellipsoid zone disruption were evaluated using Spearman's correlation test. RESULTS: Our analysis determined Spearman coefficient is 0.705 for the correlation between sLV and MH stage(P<0.01), 0.877 for the correlation between sLV and postoperative ellipsoid zone disruption(P<0.01) and 0.721 for the correlation between MD and postoperative ellipsoid zone disruption(P<0.01). A significant relationship was also detected between postoperative ellipsoid zone disruption and MH stage(r=0.470, P<0.05). Univariate regression analysis indicated that sLV and MD were associated with postoperative ellipsoid zone disruption(P<0.01, P<0.01, respectively). CONCLUSION: Postoperative cVFD is highly correlated with MH stage and postoperative ellipsoid zone disruption in patients with MH.

Retinal Functional Changes Measured by Microperimetry after Intravitreal Ranibizumab Injection and Sulfotanshinone Sodium Injection for Macular Edema Secondary to Retinal Vein Occlusion

Objectives: To study the visual field changes after intravitreal ranibizumab (IVR) injection and sulfotanshinone sodium (SS) injection for macular edema (ME) secondary to retinal vein occlusion (RVO), and discuss the value of microperimetry as a routine diagnostic test in the follow-up of RVO patients. Methods: This was a retrospective, interventional, case-series study. Twelve eyes of 12 RVO patients, including 6 eyes with central RVO (CRVO) and 6 eyes with branch RVO (BRVO) were included. The eyes were treated with IVR (0.5 mg) injections and SS injections (20 mg per day, one week consecutively in one month). The outcomes measured included best corrected visual acuity (BCVA), central retinal thickness (CRT), mean defect (MD), pattern standard deviation (PSD), macular light sensitivity of the central 16 points in CRVO group and the central 8 points in BRVO group before and after the treatment. Statistical analyses were then performed on the main outcome measures. Results: An improvement of BCVA was found in all patients after treatment with significant difference (t = 7.74, p p p p > 0.05). All RVO patients had their macular light sensitivity of the involved part improved significantly (t = 5.03, p p p < 0.01). The Pearson’s correlation was calculated among BCVA, MD, macular light sensitivity and CRT. No obvious significance was found between CRT and BCVA outcomes, whereas MD and mean macular light sensitivity outcomes were closely related to BCVA results in the BRVO group and the latter showed a more intimate correlation. No similar correlation was found in RVO and CRVO group. Conclusion: IVR injection and SS injection together could effectively improve the therapeutic effect in RVO patients with ME. Microperimetry could be used as a routine diagnostic test and a possible valuable tool in the follow-up of patients with RVO, especially in BRVO.

A virtual model of the retina based on histological data as a tool for evaluation of the visual fields

Background:To settle the fundamentals of a numerical procedure that relates retinal ganglion-cell density and threshold sensitivity in the visual field.The sensitivity of a generated retina and visual pathways to virtual stimuli are simulated,and the conditions required to reproduce glaucoma-type defects both in the optic-nerve head(ONH)and visual fields are explored.Methods:A definition of selected structural elements of the optic pathways is a requisite to a translation of clinical knowledge to computer programs for visual field exploration.The program is able to generate a database of normalized visual fields.The relationship between the number of extant receptive fields and threshold sensitivity is plotted for background sensitivity and corresponding automated perimetry.A solution in two planes to the 3D distribution of axons in the ONH is proposed.Visual fields with induced damage in the optic disc are comparable in pattern and quantity to glaucomatous records.Results:The two-level simulation of the ONH facilitates the analysis of optic-cup/retinal defects.We can generate the virtual optic pathways tailored to the age and morphology of the patient’s eye,and it is possible to reproduce glaucomatous damage by“reverse engineering”engineering.The virtual cortical model renders a quantitative relationship between visual defect and neural damage.Conclusions:A two-level computing of the retina/optic nerve facilitates the analysis of neuroretinal defects and can be incorporated to automatic perimeters to facilitate visual field analysis.

晚期青光眼患者视野缺损程度影响因素分析

目的探讨晚期青光眼患者视野缺损程度的影响因素。方法选择2019年1月至2023年1月在新乡医学院第一附属医院就诊的晚期青光眼患者206例(206眼)为研究对象,回顾性分析患者的临床和随访资料,依据其视野缺损程度分为颞侧视岛组(n=134)和管状视野组(n=72),采用单因素和多因素logistic回归分析晚期青光眼患者视野缺损程度的危险因素。结果单因素分析结果显示,患者是否合并高度近视眼、青光眼类型、随访眼压峰值、随访眼压平均值、用药种类、累计用药种类与晚期青光眼视野缺损程度有关(P<0.05)。多因素logistic回归分析结果显示,合并高度近视眼、慢性原发性闭角型青光眼(CPACG)、随访眼压峰值≥21 mm Hg(1 mm Hg=0.133 kPa)为晚期青光眼患者视野缺损程度的危险因素(P<0.05)。结论晚期青光眼患者颞侧视岛的发生率较高,应对高度近视眼、CPACG、随访眼压峰值≥21 mmHg的患者加强眼压监控及相关眼健康教育,以改善视野缺损程度。

脑后动脉梗死患者局部缺血性病变程度预测视野缺损改善的临床价值

目的 研究大脑后动脉(PCA)梗死患者局部缺血性病变程度(rEIL)预测视野缺损(VFD)改善的临床价值。方法 2020年9月—2023年7月,前瞻性纳入PCA缺血性梗死引起的半侧VFD患者38例,上象限VFD 35例,下象限VFD 29例。利用弥散加权成像计算视觉皮层rEIL。将随访3个月时视野评分(VFS)改善20%定义为VFD显著改善。利用Spearman相关性和Logistic回归模型评估预测半侧VFD或上/下象限VFD改善的相关因素。受试者工作特征(ROC)曲线分析对组合不同的变量亚组进行多变量分类测试。结果 22例(57.89%)半侧VFD显著改善,上象限VFD和下象限VFD显著改善率分别为40.00%和44.83%。经Spearman分析,舌回和距状回rIEL(%)与半侧/上象限/下象限ΔVFS均呈负相关,另外楔状回rIEL(%)与半侧ΔVFS也呈负相关(P<0.05)。经单因素和多因素Logistic回归分析,舌回和距状回rEIL(%)可能是半侧VFD或上象限VFD改善较差的独立预测因素(P<0.05)。ROC结果显示,临床变量(年龄+入院时NIHSS+基线VFS+梗死体积)联合舌回和距状回rEIL可提高VFD改善结局的预测效能,曲线下面积由0.767(95%CI:0.618~0.916)增加至0.963(95%CI:0.891~1.000)。结论 基于单独皮层的rEIL可相对准确地预测VFD的改善。将舌回和距状回rEIL数据补充到临床变量中可以提高PCA梗死后VFD预测模型的效能。

经鼻蝶垂体瘤切除手术前后视野分析

目的通过对垂体瘤患者术前及术后3个月视野进行分析,探讨经鼻蝶垂体瘤切除术后患者视野变化的特点以及可能的影响因素。方法收集瑞金医院神经外科行经鼻蝶垂体瘤切除术且有完整随访资料的36例患者,分析术前及术后3个月视野变化。结果入组患者中,视野缺损组与视野正常组垂体瘤的诊断年龄以及肿瘤大小比较差异有统计学意义(P<0.05);经鼻蝶垂体瘤切除术后,8例术前双眼视野正常患者中有1例出现了单眼视野缺损;术前存在不同程度视野缺损的28例患者中,视野缺损改善者18例;视野缺损未明显改善者8例,视野缺损较前严重者2例(单眼)。结论垂体瘤患者出现视野缺损的概率、视野缺损的严重程度与诊断年龄以及肿瘤大小有关;经鼻蝶垂体瘤切除术后大部分患者视野得到改善,视野改善与诊断年龄等相关。

视盘黑色素细胞瘤病例报道1例并文献回顾

视盘黑色素细胞瘤(MCOD)是临床罕见的疾病,容易和脉络膜黑色素瘤相混淆,两者治疗方式截然不同,MCOD为良性疾病,存在恶性转化可能,因此与恶性疾病进行鉴别,及时发现肿瘤恶性转化对后续治疗至关重要。本文报道1例体积较大的右眼MCOD,最佳矫正视力为20/20,眼底照相可见右眼视盘区近似椭圆形的黑色肿物,边界不清,呈羽毛状;眼部B型超声可见右眼视盘上圆顶状隆起占位病灶;视野弓形缺损;光学相干断层扫描成像提示右眼神经节细胞层变薄;光学相干断层扫描血管成像提示右眼血流密度增高,脉络膜血流缺损。诊断考虑为MCOD,未进行干预治疗,观察随访4个月后,瘤体无明显变化,嘱患者每年定期复查。分析检查结果发现:弓形视野缺损区域与患眼神经节细胞变薄区域有一致性,与脉络膜血流缺损、视网膜黄斑区血管密度增高具有相关性。通过对此病历进行总结归纳,并回顾文献研究,为临床医生提供诊断依据。

纸膜双层缺陷检测的视觉成像光场设计

为实现包装盒纸质基底层和透明膜层缺陷的同步检测,开展了对纸和膜缺陷的同步成像研究。首先,分别建立了标准球面积分光场、椭球面积分光场和弧面积分光场模型,并利用COMSOL Multiphysics 5.6对3类光场进行射线仿真,对比分析了球面积分光场下射线角度均匀性及辐照均匀性,通过正交仿真优化椭球面积分光场参数;其次,在椭球面积分光场环境、亮场前打光环境、暗场前打光环境下对包装盒成像。与此同时,对包装盒的油污、抵触、开口、泡皱、破损5项常见缺陷依次进行物理检测和机器视觉检测,验证缺陷成像的有效性。试验结果表明,在椭球面积分光场下成像,图像对纸质基底层缺陷特征、透明膜层缺陷特征均有较好的呈现效果,图像上油污、抵触、开口、泡皱、破损的物理检出率分别为96.2%、92.5%、100%、95%、92%,异常检出率分别为98.6%、97.5%、100%、100%、98.4%,缺陷类别检出率分别为97.6%、96%、100%、97%、96%。研究结果表明,椭球面积分光场光路角度和辐照强度均匀,覆透明膜包装盒的缺陷特征呈现清晰,满足工业生产的检测要求。

老年青光眼伴视野缺损患者反刍性沉思调查、危险因素及护理对策研究

目的:探讨老年青光眼伴视野缺损患者反刍性沉思调查现状、危险因素及护理对策。方法:选取2021年4月—2022年10月安阳市眼科医院收治的126例老年青光眼伴视野缺损患者作为研究对象。所有患者均接受事件相关反刍性沉思问卷(ERRI)调查,并进行单因素分析与多元线性回归分析。结果:126例老年青光眼伴视野缺损患者的ERRI得分为(29.95±5.73)分;意外伤害频率≥3次、低心理韧性水平、低社会支持度水平、未接受机能保健患者的目的性反刍性沉思得分更低,差异有统计学意义(t=2.617、4.224、2.492,P<0.05),意外伤害频率≥3次、家庭月收入<5000元、文化水平初中及以下、有焦虑情绪、低心理韧性、低社会支持度、未接受机能保健患者的侵入性反刍性沉思得分更高,差异有统计学意义(t=5.289、2.899、7.149、9.902、5.617、9.917、2.410,P<0.05);多元线性回归分析结果显示,意外伤害频率高、家庭月收入低、低文化水平、有焦虑情绪、低心理韧性、低社会支持度、未接受机能保健是影响老年青光眼伴视野缺损患者反刍性沉思的独立危险因素(P<0.05)。结论:老年青光眼伴视野缺损患者的反刍性沉思处于中等水平,其危险因素包括意外伤害频率高、家庭月收入低、低文化水平、有焦虑情绪、低心理韧性、低社会支持度、未接受机能保健,需根据上述因素制定针对性的护理对策进行干预。

Neuroimaging in atypical normal tension glaucoma:debating routine implementation in the absence of classic neurological findings

●AIM:To assess the necessity of neuroimaging in patients with neurological or atypical findings of normal tension glaucoma(NTG)who do not exhibit typical glaucoma manifestations.●METHODS:A retrospective analysis was conducted on 90 atypical NTG patients who underwent cranial magnetic resonance imaging(MRI)due to atypical symptoms.The demographic characteristics,clinical parameters,and radiological findings were recorded.●RESULTS:Among the patients,66.7%had abnormal radiology results,with the most common findings being gliosis(34.4%),sequelae of cerebrovascular events and vascular malformations(14.4%),and benign intracranial mass lesions(11%).Non-glaucomatous visual field defects were more frequently observed in patients with abnormal neuroimaging results.However,there were no significant differences in intraocular pressure,optic disc parameters,retinal nerve fiber layer thickness,and visual field indices between patients with normal and abnormal radiological results.The mean age of the patients was 58.74y.Interestingly,there was a significant age difference,with the abnormal radiology group having a higher median age(P=0.021).●CONCLUSION:The study highlights the importance of cranial imaging in older NTG patients to detect underlying pathologies and prevent misdiagnosis.It suggests that neuroimaging may be warranted in NTG patients with atypical visual field defects incompatible with glaucoma.However,routine neuroimaging in all NTG patients without classic neurological signs may not be necessary.

高度近视并发症眼底病变的研究进展

高度近视患病率逐年升高,并导致多种眼部并发症的发生,其中病理性近视成为全球不可逆性致盲性眼病的一大病因。高度近视患者视网膜灌注减少,并发生不同程度的视野缺损。高度近视对眼底造成了不可逆性的损害,导致青光眼易感性增加及近视性黄斑病变等的发生发展。因此,深入了解高度近视眼底及并发症的特点对于减缓高度近视进展、遏制其并发症的发生具有重大临床意义。本文将从高度近视眼底灌注、视野缺损以及高度近视并发症等方面详细介绍高度近视的危害性,指导临床医师早发现、早诊断、早干预高度近视及其并发症,从而减少高度近视患病率及致盲率,提高广大人民群众的视觉和生活质量。

脑卒中后视野缺损患者干预方案范围综述

目的:系统分析脑卒中后视野缺损患者干预方案的相关研究,识别、归纳及总结干预的具体内容、结局指标和干预效果,为临床实践及未来该领域研究提供参考。方法:采用范围综述研究框架,系统检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Web of Science、Embase、CINAHL、Cochrane Library共9个数据库。检索时限为建库至2024年4月10日。对纳入文献进行筛选、汇总和分析。结果:最终纳入12篇文献,总结脑卒中后视野缺损患者干预方法及结局指标,干预方法包括替代性干预、补偿性干预、恢复性干预等,结局指标包括日常生活活动能力、日常生活扩展活动能力、阅读表现、视野检查等。结论:目前针对脑卒中后视野缺损患者的干预方案内容多样化、证据质量较低、结局指标不统一,有待进一步开展高质量研究探索最佳训练计划和规范结局指标。未来应不断改进、优化康复策略,建立最佳的多学科结构,制定科学、系统、个性化方案。

Incomplete fluid-air exchange technique for idiopathic macular hole surgery

AIM: To explore an improved procedure involving incomplete fluid-air exchange for idiopathic macular hole(IMH), and the closure rate, visual function, and the visual field of macular holes(MHs) were evaluated.METHODS: This prospective randomized controlled study, included 40 eyes of 40 patients with IMH who were treated with pars plana vitrectomy and peeling of the internal limiting membrane. They were grouped by random digital table. Twenty-one eyes underwent incomplete fluidair exchange(IFA) and 19 eyes underwent traditional complete fluid-air exchange(CFA) as the control group. Outcomes included best-corrected visual acuity(BCVA), intraocular pressure, and optical coherence tomography, light adaptive electroretinography, and visual field evaluations.RESULTS: All MHs <400 μm were successfully closed. BCVAs before and 6 mo after surgery were 0.82±0.41 logMAR and 0.28±0.17 logMAR in IFA group and 0.86±0.34 logMAR and 0.34±0.23 logMAR in CFA group, respectively. The electroretinogram analysis of patients in IFA group revealed increases in b-wave amplitudes at 1, 3, and 6 mo after surgery. Additionally, patients in IFA group showed an amplitude increase of 28.6% from baseline at 6 mo(P<0.05), while no obvious improvements were noted in CFA group. Although there were no statistically significant improvements in either group, the IFA group showed a slight increase in mean sensitivity(P>0.05).CONCLUSION: IFA is a reliable method that offers comparable closure rate to CFA and facilitates improvements in visual function.

Visual Allesthesia in a Patient with Glioblastoma Multiforme

Purpose: To report a rare case of visual allesthesia in a patient with glioblastoma multiforme. Material - Methods : A 46 – year old male presented in emergency ophthalmologic department complaining for difficulties in performing tasks related to color discrimination in his occupation (PC technician). The patient underwent a thorough ophthalmological examination and then he was referred to the neurological department for further evaluation. Results: The patient presented an atypical pattern of color perception disturbance. His best corrected visual acuity decreased progressively during hospitalization. He also experienced visual allesthesia paroxysmally (illusory left homonymous transpositions of subjects viewed in the right homonymous visual field). The visual field evaluation revealed homonymous left hemianopsia. Magnetic resonance imaging revealed glioblastoma multiforme confirmed by biopsy. Conclusions: A thorough ophthalmological and neuro-imaging control is suggested in patients with sudden color perception disturbance. Patients with temporal or occipital cortex damage may experience visual allesthesia.

基于FPGA的结构缺陷交流电磁场可视化实验系统

现有的无损检测仪器的信号直观表现能力差,且系统封闭不具备二次开发能力,无法满足当前无损检测教学和科研需求。该文以现场可编程门阵列(FPGA)为核心,开发结构缺陷交流电磁场可视化实验系统,研制高灵敏度阵列交流电磁场检测探头,并在FPGA内部实现锁相放大、滤波和显示等逻辑算法,以实时可视化的方式显示金属结构缺陷形貌。实验结果表明:基于FPGA的结构缺陷交流电磁场可视化实验系统可实时显示缺陷形貌的彩色图像,具备灵活的信号处理算法二次开发能力,丰富了无损检测教学内容,提高了无损检测实验和教学品质,兼具实验教学与科研价值。

认知行为护理在青光眼术后患者中的应用效果

目的:观察认知行为护理在青光眼术后患者中的应用效果。方法:选取2019年2月至2020年2月该院收治的100例青光眼患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各50例。两组均接受激光虹膜切除术治疗,术后对照组给予常规护理,观察组在对照组基础上给予认知行为护理。比较两组护理前后自护能力[自我护理能力量表(ESCA)]评分、视野缺损、眼压、视力水平和护理满意度。结果:护理后,两组健康知识、自我概念、自我责任感、自我护理技能等各项ESCA评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);两组视野缺损、眼压均低于护理前,且观察组低于对照组,两组视力水平均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组护理满意度为98.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。结论:认知行为护理应用于青光眼术后患者,可提高其自护能力,改善视力和眼压,减轻视野缺损,提高护理满意度,效果优于单纯常规护理。

针刺治疗视野缺损的研究进展

视野缺损患者在生活和工作上极其不方便,对家庭及社会产生很大的负担。引起该病的原因多种多样,但是该病在西医治疗上尚无特效治疗方法,针刺治疗该病,可直接刺激眼部周围穴位,属近部取穴,使气至病所,气至而有效。针灸在治疗该病时操作简便,疗效显著,副作用小,值得临床上推广实行。

Anti-inflammatory effect of miR-125a-5p on experimental optic neuritis by promoting the differentiation of Treg cells

Methylprednisolone pulse treatment is currently used fo r optic neuritis.It can speed visual recovery,but does not improve the ultimate visual outcomes.Recent studies have repo rted that miR-125 a-5 p has immunomodulatory effects on autoimmune diseases.However,it remains unclear whether miR-125 a-5 p has effects on optic neuritis.In this study,we used adeno-associated virus to overexpress or silence miR-125 a-5 p in mice.We found that silencing miR-125 a-5 p increased the latency of visual evoked potential and aggravated inflammation of the optic nerve.Ove rexpression of miR-125 a-5 p suppressed inflammation of the optic nerve,protected retinal ganglion cells,and increased the percentage of Treg cells.Our findings show that miR-125 a-5 p exhibits anti-inflammatory effects through promoting the diffe rentiation of Treg cells.

视盘旁脉络膜空腔的研究进展

视盘旁脉络膜空腔(PICC)是一种较常见的高度近视眼底病变,其在眼底彩色照相中的典型表现是边界清楚的橘黄色病灶,常发生于近视弧的下方,在OCT中显示为脉络膜内的弱反射空腔。随着OCT技术的发展和广泛应用,研究者对PICC的影像学特征、发病机制及临床意义有了更清楚的认知。现就PICC的定义、影像学特征、发病机制及其和青光眼的关系进行介绍,为进一步阐明PICC的发病机制和临床意义提供新思路。

枕极脑梗死病变导致不典型视野缺损一例

后视路病变是视交叉以后的视觉通路其本身或毗邻结构发生病变,引起视觉功能改变的一类疾病。神经眼科医生比较熟悉枕叶病变引起的对称性同侧偏盲,但枕极(纹状皮质的最后部分)的病变产生中心性对称性同向盲点,此类视野改变容易被忽略或误诊。该文报道一例老年男性患者,因双眼视觉清晰度下降、视物变形就诊。眼科检查:最佳矫正视力:右眼0.8,左眼1.0,FM-100检查提示重度色觉异常,颅脑磁共振成像(magnetic resonance imaging,MRI)提示双侧枕叶脑梗死(右侧枕极部,左侧纹状皮质前部),24-2 Humphrey视野检查可见双眼同向暗点趋势(不典型),10-2 Humphrey视野检查可见双眼中心视野同向偏盲(暗点),故而确诊。后视路病变可引起多种特征性的视野改变,可伴有高级视功能异常及其他神经系统症状和体征,是神经眼科的重要组成部分。该例枕极脑梗死病变产生对称性同向性盲点伴色觉改变患者的诊治过程,提示需关注后视路病变视野改变的多样性及其他视觉功能异常,提高早期诊断率,改善患者预后。