标准化眼眶回波描记检查证实的疑难性眼部失调患者存在隐匿性甲状腺相关眼病

Purpose:To describe the clinical presentation,orbital echography(OE)findings,and neuroimaging results of patients with chronic unexplained ocular misalignment,which includes patients with clinically occult thyroid eye disease(TED)that is identifiable through a characteristic OE appearance.Design:Retrospective observational case series.Methods:Seventy eight patients with chronic ocular misalignment suspected of TED because of a history of systemic thyroid disease,proptosis,dysmotility,positive forced ductions,or eyelid retraction or lag were categorized as TED positive,negative,and indeterminate with the use of standardized OE.Demographic,clinical,OE,computed tomography,and magnetic resonance imaging information was collected.Analyses determined the prevalence of TED and differences between TED positive,negative,and indeterminate groups.Results:Fifty-five percent of the findings were suspicious for and most consistent with TED(TED positive);26% of the findings were TED negative,and 19% of the findings were TED indeterminate.Of 30 patients with newly diagnosed TED by OE,70% had no lid retraction,and 20% had no other findings of TED.The inferior rectus followed by the superior rectus/levator complex,medial rectus,and lateral rectus muscles were the most frequently involved muscles.Neuroimaging that was performed in only 26 of 78 patients(33%)did not appear to yield additional diagnostic information.Conclusion:TED is a potential cause of chronic unexplained ocular misalignment in a substantial proportion of patients.These patients frequently present in an occult fashion without other clinical findings that are typical of TED.In these patients,a diagnosis of TED by OE can reduce further costly evaluation.OE appears to have significant clinical usefulness in the diagnosis of TED in patients with unexplained ocular misalignment.

VLGR1基因突变(USH2C)引起的Usher综合征表达与USH2A表型的比较研究

PURPOSE. To investigate the retinal disease expression in USH2C, the subtype of Usher syndrome type 2 recently shown to be caused by mutation in the VLGR1 gene, and compare results with those from USH2A, a more common cause of Usher syndrome. METHODS. Three siblings with USH2C and 14 patients with USH2A were studied. Visual function was measured by kinetic perimetry, static chromatic perimetry, and electroretinography (ERG). Central retinal microstructure was studied with optical coherence tomography (OCT). RESULTS. The siblings with VLGR1 mutation showed abnormal photoreceptor- mediated function in all retinal regions, and there was greater rod than cone dysfunction. USH2A had a wider spectrum of disease expression and included patients with normal function in some retinal regions. When abnormalities were detected, there was more rod than cone dysfunction. Retinal microstructure in both USH2C and USH2A shared the abnormality of loss of outer nuclear layer thickness. Central retinal structure in both genotypes was complicated by cystic macular lesions. A coincidental finding in an USH2C patient was that oral intake of antihistamines was associated with temporary resolution of the macular cystic change. CONCLUSIONS. USH2C and USH2A manifest photoreceptor disease with rod- and cone- mediated visual losses and thinning of the outer nuclear layer. An orderly progression through disease stages was estimated from cross- sectional and limited longitudinal data. Intrafamilial and interfamilial variation in retinal severity in USH2A, however, suggests that genetic or nongenetic modifiers may be involved in the disease expression.

间断性头痛作为亚急性闭角型青光眼的首发症状

Subacute angle closure causes intermittent episodes of transiently elevated intraocular pressure. Headache is often the chief complaint, which may lead to misdiagnosis. The authors examined headache characteristics and consequences of delayed diagnosis. Patients presenting with headaches have a substantial delay in diagnosis, contributing to permanent ocular damage and glaucoma. Patients with subacute angle closure misdiagnosed with migraine are older and have shorter-duration headaches than patients with typical migraine.

动静态自动组合的视野检查法:神经性眼病和青光眼标准视野检查法的替代方法

Objectives:To create a fully automated,combined perimetry program consisting of a static examination and a kinetic examination,and to compare the results of this test with standard static and kinetic visual fields(VFs).Methods:Fifty-six patients(74 eyes)undergoing neuroophthalmic or glaucoma evaluationwho had standard static or kinetic perimetry examinations underwent the combined perimetry test.This automated,combined test,performed on the Octopus 101 perimeter,consisted of a static tendency-oriented perimetry examination and a preprogrammed kinetic examination.Three masked physician reviewers independently classified all of the VFs.The VF pairs were considered a match if the consensus descriptions of the standard and combined VFs matched.Results:Thirty seven eyes underwent evaluation for neuroophthalmic disease(comparison standard test,20 static and 17 kinetic)and 37 for glaucoma(comparison standard test,17 static and 20 kinetic).The VP pairs matched in 32 eyes(86%)in the neuroophthalmic group and 28(76%)in the glaucoma group.On inspection by a fourth reviewer,many of the nonmatching VF pairs were those for which a consensus was not reached,but still conveyed similar information.Two glaucomatous eyes demonstrated central scotomata not delineated by the combined examination findings.Two subtle nasal steps were detected solely by the combined examination.The combined test ranged in time from 6 to 12 minutes per eye.Conclusions:The Octopus 101 perimeter can be used to create an automated test that combines the advantages of static and kinetic perimetry and produces equivalent results while not requiring examiner expertise.

高血压在年龄相关性黄斑变性中对中心凹脉络膜血流的影响

Aim: To investigate the effect of systemic hypertension (SH) on the foveolar choroidal circulation in patients with age related macular degeneration (AMD). Methods: This study included 163 study eyes with early AMD characteristics of 124 AMD patients. Study eyes had visual acuity of 20/40 or better, drusen ≥ 63 μ m, and/or RPE hypertrophy. 56 of the AMD patients had a history of SH and 47 of these patients were receiving antihypertensive medications. Laser Doppler flowmetry (Oculix) was used to assess relative choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) in the centre of the fovea of the study eyes. Differences in the mean haemodynamic parameters between groups of eyes were assessed using analysis of variance (ANOVA) and a test of linear trend, with adjustment for the correlation between eyes of the same patient. Results: AMD patients with SH showed decreased ChBFlow in comparison with those without SH (ANOVA, p = 0.02). This association was maintained after adjustments for multiple factors (p=0.04). Conclusions: AMD patients with SH have lower ChBFlow than those without SH. This decrease in choroidal blood circulation may help explain the mechanism by which systemic hypertension may contribute to the progression of AMD and the development of choroidal neovascularisation.

眼科临床研究中双眼数据的处理

目的：描述如何选择合适的统计方法来分析眼科研究中的两眼数据。方法：针对在眼科研究中常用的两眼设计与配对设计中所产生的两眼数据，我们介绍了可用来分析两眼数据的各种统计方法，包括比较均值，比较两组中位数，两组率及两组生存率。并以不适合的和适合的统计分析方法比较了〈60岁与≥60岁患者的双眼眼压作为例子。结果：一只眼睛数据的分析只会导致偏差或降低比较效率。没有考虑两眼相关性的统计方法所得的P值（P=0．02）比考虑两眼相关性的统计方法的P值（P=0．098）小。结论：当两只眼睛的数据均适合用来分析时，应使用适当的统计分析方法来调整双眼间的相关性。只用单眼数据或者忽略双间眼相关分析可能会导致不正确的结论。

Wide-field ophthalmic space-division multiplexing optical coherence tomography

High-speed ophthalmic optical coherence tomography(OCT)systems are of interest because they allow rapid,motion-free,and wide-field retinal imaging.Space-division multiplexing optical coherence tomography(SDMOCT)is a high-speed imaging technology that takes advantage of the long coherence length of micro electro mechanical vertical cavity surface emitting laser sources to multiplex multiple images along a single imaging depth.We demonstrate wide-field retinal OCT imaging,acquired at an effective A-scan rate of 800,000 A-scans/s with volumetric images covering up to 12.5 mm×7.4 mm on the retina and captured in less than 1 s.A clinical feasibility study was conducted to compare the ophthalmic SDM-OCT with commercial OCT systems,illustrating the high-speed capability of SDM-OCT in a clinical setting.