眼压与全身血压的纵向前瞻性研究:BeaverDam眼科研究

Aim: To investigate the relation between change in systemic blood pressures an d change in intraocular pressure. Methods: This was a population based study of people 43-86 years old living in Beaver Dam, Wisconsin. Measurements at baselin e (1988-90) and 5 year follow up of systemic blood pressures, intraocular press ures, and history of use of blood pressure medications. Results: Intraocular pre ssures were significantly correlated with systolic and diastolic blood pressures at both baseline and follow up. There were significant direct correlations betw een changes in systemic blood pressures and changes in intraocular pressure. The re was a 0.21 (95%CI: 0.16 to 0.27) mm Hg increase in IOP for a 10 mm Hg increa se in systolic and 0.43 (0.35 to 0.52) mm Hg increase in IOP for a 10 mm Hg incr ease in diastolic blood pressure. Further adjustment for diabetes and medication use did not alter these associations. Decreased systolic or diastolic blood pre ssures of more than 10 mm Hg over 5 years were significantly associated with dec reased IOP. Conclusions: Reduced systemic blood pressure is associated with redu ced intraocular pressure. T5his finding should be evaluated in other studies, es pecially with respect to the possibility of resultant decreased risk of open ang le glaucoma.

泪液弯液面水平作为诊断鼻泪管阻塞的依据

Purpose: To quantitate the normal level of the tear meniscus, and to determine whether it is an accurate diagnostic indicator of nasolacrimal drainage obstruction. Methods: We performed a retrospective, controlled, case series study on patients evaluated from 2000 to 2002 for epiphora. The height of the tear meniscus was measured using the slit lamp by one experienced observer. Nasolacrimal outflow status was assessed by probing and irrigation. Patency on the nontearing eye was also confirmed by probing and irrigation, and the corresponding tear meniscus levels comprised one control group (59 sides of 62 patients). Tear meniscus levels in patients with ptosis or dermatochalasis without epiphora comprised the second control group (78 sides of 39 patients). The 2 control groups were combined to determine the normal tear meniscus level and ratio between the two sides. The control tear meniscus levels and ratios in patients without epiphora were compared with the tear meniscus levels and ratios in patients with nasolacrimal obstruction (65 sides of 62 patients). Results: The 2 control groups examined did not statistically differ with respect to tear meniscus height (P=0.06). The control median tear meniscus level (0.2mm) significantly differed from the obstructed median tear meniscus level (0.6 mm) (P< 0.0001). The control median ratio between the two sides (1.0) significantly differed from the obstructed ratio (2.5) (P< 0.0001). The absolute tear meniscus level and the tear meniscus ratio were both accurate indicators of obstruction. The percent change in absolute tear meniscus level after lacrimal surgery was- 58.3% . Conclusions: To our knowledge, a quantitative analysis of the tear meniscus height has not been previously documented in the literature. Patients with nasolacrimal system stenosis or obstruction have elevated tear meniscus levels and ratios relative to control subjects. The absolute tear meniscus level and ratio tests are excellent diagnostic indicators of nasolacrimal obstruction and its resolution after successful lacrimal surgery.

增殖性糖尿病视网膜病变患者玻璃体内血管生成素2和血管内皮生长因子含量研究

PURPOSE: To investigate the levels of angiopoietin-2 (Ang2)and vascular endot helial growth factor (VEGF) in the vitreous fluids of patients with proliferativ e diabetic retinopathy (PDR)and to ascertain their involvement, if any, in angio genesis of PDR. .DESIGN: Retrospective case-control study. METHODS: Forty-one eyes of 41 patients with proliferative diabetic retinopathy and 18 eyes of 18 pa tients with nondiabetic ocular diseases (control group). Nondiabetic control eye s included 11 with idiopathic macular hole and 7 with idiopathic epiretinal memb rane. Vitreous fluid samples were obtained at vitrectomy, and the levels of Ang2 and VEGF were measured by enzyme-linked immunosorbent assay. RESULTS: Vitreous level (mean ±SD) of Ang2 was significantly higher in patients with PDR (1,753 ±3,213 pg/ml) than in control patients (112 ±.113 pg/ml) (P< .0001). The vitre ous concentration of VEGF was also significantly higher in patients with PDR (81 2 ±1,108 pg/ml) than in control patients (1.7 ±4.4 pg/ml) (P< .0001). Both Ang 2 and VEGF levels in eyes with active PDR were significantly higher than in thos e with inactive PDR. The vitreous concentration of Ang2 correlated significantly with that of VEGF in eyes with proliferative diabetic retinopathy ([correlation coefficient] r=0.497, P=.001). CONCLUSIONS: These data demonstrate an increase of Ang2 in the vitreous fluid of patients with PDR and suggest an association of Ang2 and VEGF with angiogenic activity in PDR.

皮质盲:可逆性后大脑白质病综合征的临床及放射学特征——病例报道及文献回顾

Purpose: To alert ophthalmologists to the recognition of cortical visual loss as the presenting feature in patients with reversible posterior leukoencephalopathy syndrome (RPLES). Unique radiologic findings are paramount to the diagnosis. Design: Interventional case report. Methods: A patient was seen with perioperative bilateral cerebral visual loss that was misinterpreted initially as an irreversible ischemic event. Further detailed analysis of the radiologic findings and clinical history led to the correct diagnosis. Main Outcome Measures: Visual acuity and magnetic resonance imaging (MRI) of the brain. Results: Recognition of the correct diagnosis of RPLES led to the institution of antihypertensive therapy and recovery of normal vision. Conclusions: The diagnosis of RPLES should be considered in all patients with acute cerebral visual loss, especially in the setting of recent surgery, blood transfusion, chemotherapy, immunosuppressant use, hypertension, eclampsia, or seizures. Prompt diagnosis requires close collaboration with a radiologist and an emergent MRI study, which ideally should include diffusion- weighted imaging with calculation of an apparent diffusion coefficient map. Differentiation from acute cerebral ischemia is important in order to avoid permanent visual loss by prompt and vigorous treatment of exacerbating factors such as intermittent hypertension. Prompt diagnosis will also help to avoid potentially dangerous invasive procedures such as thrombolytic therapy.

遗传对眼内压的作用:Beaver Dam眼科研究

PURPOSE. To investigate a potential genetic contribution to intraocular pressure (IOP), we performed a complex segregation analysis on 2337 individuals in 620 extended pedigrees ascertained through a population- based cohort, the Beaver Dam Eye Study (BDES). IOP is a principal risk factor for primary open- angle glaucoma (POAG) a leading cause of blindness worldwide. METHODS. Segregation analysis is an analytical method that provides statistical evidence supporting the involvement of a major gene or polygenes in a particular phenotype. Detailed medical histories and eye examinations were performed on all participants. From the two eyes, the higher IOP measurement was used as a continuous trait after adjustment for covariates. Agenome- wide scan(GWS) using affected sib pair linkage analysis was performed on 218 sibling pairs. RESULTS. In this segregation analysis the model that allowed for an unmeasured major environmental effect plus a polygenic/ multifactorial effect provided the best fit and was the most parsimonious model. The lack of an adequate fit for the Mendelian single- gene models is consistent with a multifactorial model of inheritance that may include multiple genes and environmental factors that contribute to IOP. The results of the GWS yielded two novel loci as potential linkage regions for IOP on chromosomes 6 (P=0.008) and 13 (P=0.0007). Neither of these regions has previously been identified in GWS of POAG. CONCLUSIONS. The segregation and familial correlation analyses of IOP suggest a polygenetic component with environmental influences. The pilot linkage study further con- firms the heterogeneity of IOP with the identification of two novel genetic loci.

Beaver Dam眼科研究视网膜血管直径的家族聚集性

PURPOSE. To describe familial correlations of retinal vessel measurements. METHODS. A standardized examination and interview was administered to a population- based cohort of adults aged 43- 86 years. Blood pressure was measured, and family relationships, current smoking status, and photographs of the retina were obtained. Computer- assisted grading was done to determine central retinal arteriole (CRAE) and venule equivalents (CRVE), and the arteriole- to- venule ratio (AVR)- was computed. Familial correlations were calculated using FCOR in the SAGE software package. Analysis was done on the right eye measures for 871 sibling, 341 parent- child, 1362 cousin, 554 avuncular, and 887 spousal pairs. RESULTS. After adjustment for age, gender, mean arterial blood pressure, and current smoking status, the correlations (and 95% confidence interval) between siblings for the CRVE, CRAE,and AVR were 0.23 (0.16, 0.31), 0.20 (0.12, 0.28) and 0.13 (0.05, 0.20), respectively. Parent- child correlations were very similar, and the avuncular correlations were about half as great. The cousin correlations were about half the avuncular correlations. Spousal correlations of 0.03, 0.04, and 0.01 for CRVE, CRAJE, and AVR, respectively, were not significantly different from 0. CONCLUSIONS. Retinal vessel equivalents were more highly correlated between relatives than between unrelated individuals. The relative magnitudes of these correlations were likely the result of shared genes. Because the vessel measurements have been shown to be predictive of cardiovascular and other systemic diseases, understanding the determinants of these familial relationships could have important health benefits.

视网膜分支静脉阻塞患者格子样光凝术后黄斑水肿吸收延迟伴浆液性视网膜脱离

Purpose To study the detailed process of macular edema (ME) absorption after grid laser photocoagulation in patients with branch retinal vein occlusion (BRVO ). The influence of pretreatment serous retinal detachment (SRD) at the fovea on patient outcome was also evaluated. Design Retrospective, interventional, compa rative case series. Participants Thirty seven BRVO patients presenting with sev ere ME. Methods Patients were treated with grid laser photocoagulation with 6 mo nths of follow up examinations. Baseline and post treatment examinations inclu ded measurements of visual acuity (VA), fluorescein angiography, and detailed im aging of ME by optical coherence tomography (OCT). Macular thickness was defined as the distance from the inner retinal surface to the outer border of the senso ry retina (foveal retinal thickness) and also to the inner border of the retinal pigment epithelium including the SRD (total foveal elevation). Main outcome mea sures Post reatment macular thickness with OCT, VA converted to the logarithm of the minimum angle of resolution, and absorption of SRD, and correlations of mac ular thickness and VA both before and after treatment. Results Total foveal elev ation and VA were significantly improved at 1, 3, and 6 months after treatment. There was also a significant correlation between reduction of total foveal eleva tion and increase in VA. Fourteen eyes (37.8%) displayed SRD, as evidenced by O CT at the baseline. In eyes without SRD, foveal retinal thickness and VA had sig nificantly improved in a time dependent manner. However, although SRD itself was almost absorbed 6 months af ter treatment, the improvement of both VA and total foveal elevation in eyes wit h pretreatment SRD was not significant compared with baseline conditions. Both p ost treatment total foveal elevation and VA of eyes with SRD tended to be worse than eyes without SRD. Conclusion The presence of subfoveal SRD retards the abs orption of ME and recovery of VA after grid laser photocoagulation in patients w ith BRVO.

人工晶体边缘设计与前囊覆盖度对后囊混浊的影响比较

Purpose To determine whether lens edge design or anterior capsule overlap on the intraocular lens (IOL) has greater effect on posterior capsule opacification (PCO). Design Retrospective cohort clinical study. Methods Retrospective. SETTING: Academic clinical practice.PATIENT POPULATION: The patient population consisted of 259 uncomplicated surgical patients (259 eyes) with no confounding comorbidity and at least 1 year of follow- up after surgical placement of a silicone or hydrophobic acrylic lens. OBSERVATION PROCEDURES: Digital retroilluminated photographs were taken to ascertain PCO, anterior capsular opacification (ACO), previous neodymium:YAG capsulotomy and degree of anterior capsule overlap on the IOL optic. MAIN OUTCOME MEASURES: PCO, ACO, YAG capsulotomy rate, and anterior capsule overlap on the IOL optic. Results One hundred forty- eight digital images (74 silicone and 74 acrylic) were measurable for both anterior capsule overlap and PCO. Complete 360 degrees of anterior capsule overlap on the IOL was associated with decreased PCO (P< .001). A significant negative correlation was found between the degree of anterior capsule overlap and PCO (P< .001). Evaluation of PCO, and YAG capsulotomy rates were similar between acrylic and silicone lenses. Minimal anterior capsule overlap may also be associated with PCO prevention. Conclusions Implanting a lens with complete anterior capsule overlap on the IOL was found to significantly reduce PCO, which advantage appeared to be greater than PCO prevention by a truncated, sharp edge IOL design.

维替泊芬光动力疗法治疗有症状的息肉状脉络膜血管病变:前瞻性病例1年的研究结果

Objective To determine the efficacy of photodynamic ther-apy(PDT)with verteporfin as a treatment for s ymptomatic polypoidal choroidal vasculopathy(PCV).Design Prospective consecutive,2-centered,noncomparative in-terventional case series.Particip ants Twenty-one Asian patients with 22eyes presenting with serosanguinous maculopathy due to PCV and an initial best-corrected vi-sual acuity(BCVA)of 20/40or worse were recruited prospectively.All patients had angiographic leakage seen on fluorescein angiograms (FAs )and features of PCVseen with indocyanine green(ICG)angiography.Methods In-travenous infusion of verteporfin a t a dose of 6mg /m 2 of body surface area over 10minutes was administered.Five minutes after the completion of infu sion,a 689-nm laser was applied for 83seconds,with a lig ht dose of 50J /cm 2 .The laser spot size was chosen to cover the polyps and the surrounding abnormally dilated choroidal vessels shown on ICG angiography plus an extra 1000-μm margin.Photo-dynamic therapy retreatment was performed if leakage from the polyps was found on both repeat FA s and ICG an-giography at regular 3-month follow-up intervals.Main outcome measures The proportion of e yes with stable or improved vision at a 1-year follow-u p.Secondary outcome measures included change in mean BCV A and the changes in clinical and angiographic featur es in FAs and ICG an-giography.The total number of PDT se ssions and any complications were also recorded.R esults Stable or im-proved vision was achieved in 21(95%)of the 22eyes at the 1-year follow-up.Ten(45%)eyes had a moderate gain in vision(improved by≥3lines),whereas 1(5%)eye suffered a moderate visual loss(decrease by≥3lines).The mean BCVA improved from a logarithm of the minimum angle of resolution(logMAR)of 0.73to 0.60,an equivalent of 1.3lines of improvement.The change in logMAR BCVA at 12months was statisti cally significant (Wilcoxon signed-ranks test,P=0.009).Complete ab-sence of leakage in FAs and total regression of the polyps in ICG angiography were observed in 20(91%)and 21(95%)eyes,respectively.Severe loss of v ision due to massive subretinal hemorrhage occu rred in 1eye;other-wise,there were no other serious tre atment-related adverse events.Conclusions The 1-year resu lts of PDT in treating PCV of the macular type with serosanguinous presentations are encouraging.Further studies wi th longer follow-up and randomized controlled trials are wa rranted to assess the long-term safety and efficacy of PDT relative to observation or other treatment modalities.

青光眼视网膜及视乳头处的缺氧诱导因子1α

Objective: To examine tissue hypoxia in the retina and optic nerve head of gla ucomatous eyes by the assessment of a transcription factor, hypoxia-inducible f actor 1α(HIF-1α), which is tightly regulated by the cellular oxygen concentra tion. Methods: Using immunohistochemical analysis, the cellular localization of HIF-1αwas studied in the retina and optic nerve head of 28 human donor eyes wi th glaucoma compared with 20 control eyes from healthy donors matched for severa l characteristics. The relationship between the retinal regions that exhibited i mmunostaining for HIF-1αand functional damage was examined using visual field data. Results: There was an increase in the immunostaining for HIF-1αin the re tina and optic nerve head of glaucomatous donor eyes compared with the control e yes. In addition, the retinal location of the increased immunostaining for HIF- 1αin some of the glaucomatous eyes was closely concordant with the location of visual field defects recorded in these eyes. Conclusions: Because the regions of HIF-1αinduction represent the areas of decreased oxygen delivery and hypoxic stress, information obtained from this study provides direct evidence that tissu e hypoxia is present in the retina and optic nerve head of glaucomatous eyes, an d hypoxic signaling is a likely component of the pathogenic mechanisms of glauco matous neurodegeneration. Clinical Relevance: These findings support the presenc e of tissue hypoxia in the retina and optic nerve head of glaucomatous patients.

拉坦前列素和非拉坦前列素治疗患者经虹膜切除术后虹膜的组织病理学特征研究

Objectives: To examine the histopathologic features of iridectomy specimens from patients undergoing glaucoma surgery and to compare histologic abnormalities in a group of patients with a history of latanoprost therapy with those in a group of patients who had no history of prostaglandin therapy (controls). Methods: Iridectomy specimens and patient history forms were submitted to the central Latanoprost Pathology Center. These were independently examined by 3 ophthalmic pathologists in a masked fashion. Specimens were evaluated for malignant, premalignant, and other changes including differences in levels of pigmentation, degrees of cellularity, inflammation, vascular abnormalities, and changes in the iris pigment epithelium. Results: Specimens were received from 449 patients with a history of latanoprost treatment and 142 patients who had no history of treatment with latanoprost or other prostaglandin analogues. No evidence of malignant or premalignant changes was found. In latanoprost- treated irides, the prevalence of iris freckles was higher (P=.001) than in control irides, as was the combined number of stromal fibroblasts and melanocytes (P < .001). In a subgroup of specimens received through June 2002, there was no significant difference in mean melanocyte counts (P=.35)- obtained by immunohistochemical staining techniques between the latanoprost- treated and control groups. Conclusions: These findings support previous studies indicating that latanoprost- in- duced eye color changes are due to an increased amount of melanin within the iris stromal melanocytes. The increased numbers of freckles may be a focal manifestation of this effect.

采用倍频技术和标准自动化视野计对青光眼视野损害进展的纵向前瞻性研究

PURPOSE.To compare frequency- doubling technology (FDT) perimetry with standard automated perimetry (SAP) for detecting glaucomatous visual field progression in a longitudinal prospective study. METHODS. One eye of patients with open- angle glaucomawas tested every 6 monthswith both FDT and SAP. A minimum of 6 examinations with each perimetric technique was required for inclusion. Visual field progression was determined by two methods: glaucoma change probability (GCP) analysis and linear regression analysis (LRA). For GCP, several criteria for progression were used. The number of locations required to classify progression with FDT compared with SAP, respectively, was 1:2 (least conservative), 1:3, 2:3, 2:4, 2:6, 2:7, 3:6, 3:7, and 3:10 (most conservative). The number of consecutive examinations required to confirm progression was 2- of- 3, 2- of- 2, and 3- of- 3. For LRA, the progression criterion was any significant decline in mean threshold sensitivity over time in each of the following three visual field subdivisions: (1) all test locations, (2) locations in the central 10° and the superior and inferior hemifields, and (3) locations in each quadrant. Using these criteria, the proportion of patients classified as showing progression with each perimetric technique was calculated and, in the case of progression with both, the differences in time to progression were determined. RESULTS. Sixty- five patients were followed for a median of 3.5 years (median number of examinations, 9). For the least conservative GCP criterion, 32 (49% ) patients were found to have progressing visual fields with FDT and 32 (49% ) patients with SAP. Only 16 (25% ) patients showed progression with both methods, and in most of those patients, FDT identified progression before SAP (median, 12 months earlier). The majority of GCP progression criteria (15/27), classified more patients as showing progression with FDT than with SAP. Contrary to this, more patients showed progression with SAP than FDT, when analysed with LRA; e.g., using quadrant LRA 20 (31% ) patients showed progressionwith FDT, 23 (35% ) with SAP, and only 10 (15% ) with both. CONCLUSIONS. FDT perimetry detected glaucomatous visual field progression. However, the proportion of patients who showed progression with both FDT and SAP was small, possibly indicating that the two techniques identify different subgroups of patients. Using GCP, more patients showed progression with FDT than with SAP, yet the opposite occurred using LRA. As there is no independent qualifier of progression, FDT and SAP progression rates vary depending on the method of analysis and the criterion used.

眼周基底细胞癌的眼眶浸润

Objectives: To present a large series of patients with orbital invasion by per iocular basal cell carcinoma (BCC). Design: Retrospective, noncomparative, inter ventional case series. Patients: All cases diagnosed with orbital invasion by pe riocular BCC between January 1985 and July 2004 in 3 Orbital Units in Australia. Methods: The clinical records of all patients were reviewed. Main Outcome Measu res: Patients’demographics, clinical presentation, histologic subtypes, treatme ntmodalities, recurrence rate, and tumor-related death. Results: There were 64 patients (49 males) with a mean age of 70±13 years. Most tumors (84.4%) were r ecurrent or previously incompletely excised, and the medial canthus was most fre quently involved (56.2%). Signs suggestive of orbital involvement included a ma ss with bone fixation (35.7%), limitation of ocular motility (30.4%), and glob e displacement (17.6%). There were no signs suggestive of orbital invasion in 3 5.7%. Most patients (51.6%)-had infiltrative histologic findings, and perineu ral invasion was present in 19.3%. Treatment modalities were mainly exenteratio n alone or combined with radiotherapy. During a mean follow-up period of 3.6 ye ars, 3 cases of recurrence (4.7%)were diagnosed. Only 1 patient (1.6%) died fr om tumor-related causes. Conclusions: Orbital invasion by periocular BCC is an uncommon event that may be associated with significant ocular morbidity and, rar ely, death. Because orbital invasion may often be clinically silent, clinicians need to be alert to the possibility in high-risk tumors and consider appropriat e imaging. Surgical treatment with exenteration or excision, with or without rad iotherapy, results in a low recurrence and mortality rate.

多基因影响屈光不正的理论支持

PURPOSE. Refractive errors, myopia, and hyperopia are common conditions requiring corrective lenses. The familial clustering of myopia has been well established. Several chromosomal regions have been linked to high myopia (12q, 17q, and 18q), to quantitative refraction among twins (3q,4q, 8p, and 11p), and to families with moderate myopia (22q). This study examined the familial aggregation and pattern of inheritance of ocular refraction in an adult population, by using data from the Beaver Dam Eye Study. METHODS. Familial correlations were examined and segregation analysis was performed on the average refractive error measurements in the right and left eyes after adjustment for age, sex, and education. Analyses were based on 2138 individuals in 620 extended pedigrees with complete data on age, sex, education, and spherical equivalent. RESULTS. Substantial positive correlation was found between siblings (0.33), parents and offspring (0.17), and cousins (0.10) and lower correlation among avuncular pairs (0.08) after adjustment for age, sex, and years of education. The results of this segregation analysis do not support the involvement of a single major locus throughout the entire range of refractive error. However,models allowing for familial correlation, attributable in part to polygenic effects, provided a better fit to the observed data than models without a polygenic component, suggesting that several genes of modest effect may influence refractive error, possibly in conjunction with environmental factors. CONCLUSIONS. These results support the involvement of genetic factors in the etiology of refractive error and are consistent with reports of linkage to multiple regions of the genome.

用非散瞳状态下的数码相机和标准眼底胶片相机检查老年性黄斑变性

Objective: To compare gradings of lesions associated with age- related macular degeneration (AMD) from digital and stereoscopic film images. Design: Instrument validation study. Participants: Sixty- two subjects (124 eyes) with varying degrees of AMD, including no AMD. Methods: Images of the optic disc and macula were taken using a 45° digital camera (6.3 megapixels) through dark- adapted pupils and pharmacologically dilated pupils. In addition, 30° stereoscopic retinal film images were taken through pharmacologically dilated pupils of the same eyes. All images were graded for drusen size, type, and area; pigmentary abnormalities; geographic atrophy; and neovascular lesions using the modified Wisconsin Age- Related Maculopathy Grading System. Exact agreement and unweighted κ .scores were calculated for paired gradings resulting from digital and film images. Main Outcome Measure: Agreement between gradings obtained from stereoscopic slide transparencies and digital nonstereoscopic images. Results: Exact agreement between gradings of digital and stereoscopic film images taken through pharmacologically dilated pupils was 91% (κ .=0.85) for the categories of none, early AMD, and late AMD. Exact agreement for gradings of digital images taken through dark- adapted pupils compared with gradings of film images was 80% (κ .=0.69). Exact agreement for gradings of digital images captured through dark- adapted and pharmacologically dilated pupils was 86% (κ =0.78). In addition, κ scores for agreement between different approaches for individual lesions were moderate to almost perfect. Conclusions: Gradings resulting from high- resolution digital images, especially when the pupil is pharmacologically dilated, are comparable with those resulting from film- based images. We conclude that digital imaging of the retina is useful for epidemiological studies of AMD.

经正电子发射断层摄像术检查出的一例伴同侧偏盲的多发性硬化病例

Background: To demonstrate the efficacy of positron emission tomography (PET) for examining multiple sclerosis (MS) patients with hemianopia. Case: A 20- year-old man visited us with a complaint of left homonymous hemianopia and headache. Observations: The patient’ s visual acuity was 1.2 (n.c.) OD and 0.9 (1.0) OS. Magnetic resonance imaging (MRI) showed a mass in the temporoparietal lobe. A pathological diagnosis of MS was made by brain biopsy. Low glucose metabolism in the lesion and visual cortex was observed by PET with 18F-fluorodeoxy glucose. PET with 11C-flumazenyl revealed a reduction of 11C-uptake in the demyelinated optic radiation, and only a slight reduction of 11C-uptake in the primary visual cortex. The results of 11C-flumazenyl PET suggested a slight reduction of neuronal density. In 2 years, the visual field recovered to the normal state. Conclusion: PET can be a useful tool for estimating the visual outcome of patients with hemianopia in MS.

视功能降低与用γ-乙烯氨基丁酸治疗婴儿性痉挛有关

PURPOSE. To use visual evoked potential (VEP) testing to determine whether visual deficits are present in children with a history of vigabatrin use. METHODS. Contrast sensitivity and visual acuity were assessed by visual evoked potential testing and compared between 28 children (mean age,4.90± 4.92 years) with seizure disorders who had taken vigabatrin and 14 typically developing children (mean age, 3.14± 1.70 years). Exclusion criteria were heritable eye disease, suspected cortical visual impairment, nystagmus, and prematurity>2 weeks. The effects of the following factors on contrast sensitivity and visual acuity were examined: type of seizure (infantile spasms versus other), ERG result, duration of vigabatrin therapy, cumulative dosage of vigabatrin, and other seizure medications (other versus no other medication). RESULTS. Contrast sensitivity and visual acuity were reduced in vigabatrin- treated children with infantile spasms compared with vigabatrin- treated childrenwith other seizure disorders and typically developing control subjects. The other factors examined had no significant effect on contrast sensitivity or visual acuity, with adjustment for seizure type. CONCLUSIONS. Children with infantile spasms on vigabatrin may have compromised visual function, even in the absence of suspected cortical visual impairment. The children tested in the present study have reduced vision, probably associated with infantile spasms rather than vigabatrin.

眶底骨折的碎骨引起眼内异物

PURPOSE: To describe the ophthalmoscopic and radiologic findings of a patient who sustained blunt orbital trauma. A piece of bone from the fractured orbital wall caused an intraocular foreign body. DESIGN: Case report. METHODS: An 18-yea r-old man underwent full ophthalmoscopic examination 1 week after sustaining bl unt ocular trauma to the right eye while playing basketball. B-scan ultrasonogr aphy and computed tomography of the orbits were also performed. RESULTS: Visual acuity, intraocular pressure, and anterior segment examination were normal. Fund uscopic examination revealed a fragment of bone that had penetrated the sclera, choroid, and retina. A hole in the sclera was visible. No treatment was performe d. Three months later, the patient had no ocular complaints or complications as a result of this injury. CONCLUSION: Bone from a patient’s orbit may cause an i ntraocular foreign body that may be followed conservatively in certain circumsta nces.

应用巩膜瓣移植修补术治疗迟发性滤过泡并发症的结果

BACKGROUND AND OBJECTIVE: To describe the results of bleb revision with scleral patch graft for late-onset bleb-related complications. PATIENTS AND METHODS: A retrospective case series between October 1996 and March 2003. RESULTS: Fourteen patients had surgery for bleb leak, hypotonous maculopathy, dysesthesia, or bleb-associated infections after initial trabeculectomy or thermal sclerostomy. The preoperative intraocular pressure was3.3± 2.6 mm Hg, and the final intraocular pressure was 11.6± 3.4 mm Hg after 10.1± 6.8 months. Seven eyes required no further bleb revision or glaucoma smedications. Visual acuity improved in 10 of 14 eyes. A second scleral patch graft revision was necessary in3 eyes, but bleb leaks and hypotony resolved in all 14 eyes at last follow-up. Complications included bleb failure, bullous keratopathy progression, cataract progression, and ptosis. CONCLUSION: Bleb revision with scleral patch graft is effective for treating late-onset bleb complications, resulting in improvement in visual acuity and resolution of hypotonous maculopathy, bleb leaks, and dysesthesia.

巨细胞病毒性视网膜炎的视网膜下出血

A case of subretinal hemorrhage associated with cytomegalovirus (CMV) retinitis in a human immunodeficiency virus-positive woman is described. The patient was found to have an exudative retinal detachment involving the fovea, subretinal hemorrhage, cottonwool spots, and active CMVretinitis temporal to the exudative detachment. No evidence of systemic coagulopathy was found. Although unusual, subretinal hemorrhage may be observed in association with CMV retinitis in the absence of a systemic coagulopathy.