ObjectiveTo evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.MethodsA prospective, uncontrolled and non-randomized study. From April 2017 to April 2018, 21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study. There were 9 males (9 eyes, 42.86%) and 12 females (12 eyes, 57.14%), with the mean age of 35.1±13.2 years. The mean diopter was −11.30±2.35 D and the mean axial length was 28.93±5.68 mm. All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN). Regular follow-up was performed before and after treatment, and BCVA and MAIA micro-field examination were performed at each follow-up. BCVA, macular integrity index (MI), mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed. The fixation status was divided into three types: stable fixation, relatively unstable fixation, and unstable fixation. The paired-sample t-test was used to compare BCVA, MI and MS before and after treatment. The x2 test was used to compare the fixation status before and after treatment.ResultsDuring the observation period, the average number of injections was 3.5. The logMAR BCVA of the eyes before treatment and at 1, 3, and 6 months after treatment were 0.87±0.32, 0.68±0.23, 0.52±0.17, and 0.61±0.57, respectively; MI were 89.38±21.34, 88.87±17.91, 70.59±30.02, and 86.76±15.09, respectively; MS were 15.32±7.19, 21.35±8.89, 23.98±11.12, 22.32±9.04 dB, respectively. Compared with before treatment, BCVA (t=15.32, 18.65, 17.38; P＜0.01) and MS (t=4.08, 3.50, 4.26; P＜0.01) were significantly increased in the eyes 1, 3, and 6 months after treatment. There was no significant difference in the MI of the eyes before treatment and at 1, 3, and 6 months after treatment (t=0.60, 2.42, 2.58; P＞0.05). Before treatment and at 1, 3, and 6 months after treatment, the proportion of stable fixation were 28.57%, 38.10%, 38.10%, 33.33%;the proportion of relatively unstable fixation were 47.62%, 47.62%, 52.38%, 57.14% and the proportion of unstable fixation were 23.81%, 14.28%, 9.52%, 9.52%, respectively. The proportion of stable fixation and relatively unstable fixation at 1, 3 and 6 months after treatment were higher than that before treatment, but the difference was not statistically significant (x2=1.82, 1.24, 1.69; P＞0.05).ConclusionBCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.
Objective To detect the difference of the light sensitivity in the central visual field between normal people and type Ⅱ diabetic patients without diabetic retinopathy, and evaluate the effect of perimetric examination in early diagnosis of diabetic retinopathy. Methods The light sensitivity at the 80 locations in the central field was measured by Dicon field analyzer (model TKS-4000) in 76 normal eyes of 44 normal volunteers aged from 45 to 72 years and 75 eyes of 40 type Ⅱ diabetic patients without retinopathy aged from 46 to 71 years. Results For the diabetic patients without diabetic retinopathy, the light sensitivity of locations decreased by 4-8 dB,and there were some decreased light sensitivity areas. The mean light sensitivity of three zones of the central field had significant reduction in the diabetic patients as compared with the control group(Plt;0.001). Conclusion The retinal neurosensory function of diabetic patients is damaged in some degrees before diabetic retinopathy occured, and no relationship is found between the decrease of retinal light sensitivity and localized blood-retinal barrier leakage. It is suggested that examination of central field with computerized perimetry has certain clinical significance in early diagnosis of diabetic retinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 218-220)
Objective To study the visual field defects and its correlation factors in nonarteritic anterior ischemic optic neuropathy (NAION). Methods One hundred and thirty-nine patients of NAION with complete visual field examination results were included in this study. There were 65 males （46.7%）and 74 females （53.3%），with an average age of （56.2plusmn;10.8） years. All the patients had undergone the examinations of visual acuity，refraction，refractive media, slit lamp ophthalmoscope, color fundus photography, visual field, blood pressure, blood routine test and blood biochemistry test. Fundus fluorescein angiography (FFA) was carried out in 125 patients. The visual field characteristics and its correlation factors were statistically analyzed, and the FFA and visual field results of 77 eyes were comparatively analyzed. Results The visual field examination showed typical inferior defect in 48 eyes (34.5%), arcuate scotoma in 24 eyes (17.3%), atypical arcuate scotoma in 24 eyes (17.3%), defuse defect in 20 eyes (14.4%), superior defect in 10 eyes (7.2%), superior defect with inferior arcuate scotoma in five eyes (3.6%), inferior defect with superior arcuate scotoma in eight eyes (5.8%). The mean defect （MD）value ranged from -3.0 to -32.0，with an average of -17.9plusmn;7.9. Among 77 eyes with FFA data, the FFA and visual field defect area were highly consistent seven eyes (9.1%), consistent in 26 eyes (33.8%), some kind of consistent in 39 eyes (50.6%), completely inconsistent in five eyes (6.5%). Multiple lineal regression analysis showed that mean red cell volume (MCV) (beta;=0.203，t=2.005) and cholesterol level (CHOL) (beta;=0230，t=2.244) were correlation factors of MD (P＜0.05). Conclusion The visual field defect of NAION shows a variety of patterns which may be mainly influenced by MCV and CHOL.
Microperimetry is a procedure to assess retinal sensitivity while fundus is examined directly. It is a psychophysical method which is rapid, safe and non-invasive. It combines analysis of function and morphology and has an eye tracking system that can improve the fixation stability of patient with eccentric fixation and fixation instable. Microperimetry is supplement to visual function, perimetry, and other visual function parameters. As deepening of research, its clinical application value in ocular fundus diseases including age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, Stargardt's disease, macular hole, rhegmatogenous retinal detachment and central serous chorioretinopathy needs to be further explored.
Objective To observe the clinical features and visual function of recurrent neuromyelitis optica (NMO). Methods Thirty-four patients with NMO were enrolled in this retrospective case series study. The patients included two males and 32 females. The average first onset age was (35.03plusmn;14.56) years old and the average recurrent rate were (4.24plusmn;2.45) times. The recurrent rate of optic neuritis (ON) ranged from two to 12 times. The recurrent rate of ON was two times in 15 eyes of 10 patients, ge;three times in 37 eyes of 24 patients. Vision acuity, direct ophthalmoscope, fundus pre-set lens examination, visual field and visual evoked potential (VEP) were evaluated. Clinical features were observed. The abnormal rate of optic nerve including optic edema and atrophy; abnormal rate of visual field including decreasing retinal sensitivity, central and paracentral scotoma, ring scotoma, half field defects, tunnel visual field, visual field centrality constriction; abnormal rate of VEP including Prolonged latent phase and/or decreasing amplitude of P100 wave from patients of first episode or recurrence was analyzed. Serum NMO-IgG was detected from 28 patients by indirect immunofluorescence technique to observe its positive rate. Results All patients were characterized by repeated episodes of ON and myelitis. The main clinical feature of ON was visual loss, and the main clinical features of myelitis included sensory disability, dyskinesia and vesicorectal disorder. Blindness rate was 41.67% after the first attack of ON, 33.33% after two relapses, and 64.86% after ge; three relapses. The difference of blindness rate between first attack and two episodes was not significant (chi;2=0.270,P=0.603). However, the blindness rate in patients having ge; three episodes was significantly higher than those having two episodes (chi;2=4.300,P=0.038). With recurrence rate increasing, the abnormal rate of the optic nerve (chi;2=6.750,P=0.034）and VEP（chi;2=6.990,P=0.030）increased. But the abnormal rate of visual field did not increase along with recurrent rate (chi;2=0.660,P=0.718). Seropositive rate of NMO-IgG did not differ significantly between patients with first attack ON and that with recurrent ON (chi;2=1.510,P=0.470). But the seropositive patients had significantly higher bilateral blindness rate than seronegative patients (chi;2=5.063,P=0.027). Conclusions NMO are characterized by recurrent ON and myelitis. Visual loss, sensory disability, dyskinesia and vesicorectal disorder are the main clinical features. With recurrence rate increasing, the blindness rate, abnormalities the optic nerve and the abnormity rate of VEP increase. Seropositive recurrent NMO patients have higher bilateral blindness rate than seronegative patients.
ObjectiveTo observe the changes of retinal morphology and function of macular-off rhegmatogenous retinal detachment (RRD) after scleral bulking. MethodsIn this prospective study, 42 eyes of 41 patients who underwent scleral bulking were enrolled. There were 26 males (27 eyes) and 15 females (15 eyes), with an average age of (33.78±11.21) years. Best corrected visual acuity (BCVA), intraocular pressure, indirect ophthalmoscope, visual fields, optical coherence tomography (OCT) and B scan of ocular ultrasound were measured for all patients. The average BCVA was 0.29±0.18. The retinal detachment time was (21.12±3.71) days. The mean visual field defect (MD) was (13.54±6.44) dB. The mean loss variance (LV) was (8.43±2.11) dB. All the patients were performed cryotherapy and sub-choroidal fluid drain out. The mean follow-up was 12.4 months (from 6 to 24 months). At two weeks, 1, 3, 6, 12 months after surgery, the changes of BCVA, visual fields, retinal morphology and subretinal fluid were observed. ResultsIndirect ophthalmoscope combined with B scan showed the time of retinal reattachment was (7.32±2.53) days. Subretinal fluid was found completely absorbed by OCT with a mean of (7.82±3.52) months. At 12 months after surgery, subretinal fluid was completely absorbed in 37 eyes (88.10%). In these 37 eyes, 15 eyes had normal retinal microstructure, 5 eyes had neuroepithelial cystoid edema; 12 eyes had disrupted inner segment/outer segment (IS/OS) junction, and 5 eyes had disrupted IS/OS and external limiting membrane (ELM). BCVA at 6 months after surgery was no significant difference with that at 12 months after surgery (t=-0.636, P=0.529). At 12 months after surgery, there were 4 retinal patterns on OCT examination, including normal retinal microstructure, neuroepithelial cystoid edema, IS/OS line disruption, and IS/OS and ELM disruption. The BCVA difference among these 4 groups was significant (F=52.42, P < 0.05). The BCVA difference between eyes with or without residual subretinal fluid was significant (t=-5.747, P=0.000). At 1, 2 weeks and 1, 3, 6, 12 months after surgery, the MD were (11.38±2.53), (10.14±2.19), (9.17±2.13), (6.63±1.70), (5.71±1.89), (5.14±1.69) dB respectively, with a significant difference between these time-points (F=63.528, P=0.00). However, the MD at 6 months after surgery was no significant difference with that at 12 months after surgery (t=1.442, P=0.157). At 12 months after surgery, there were 12 eyes with normal MD, 30 eyes with higher MD. There was no significant difference between surgery eyes with higher MD and fellow eyes in MD (t=-1.936, P=0.06). The MD value was positively correlated to the time of retinal detachment in patients with normal retinal microstructure (r=0.84, P=0.00). There were differences in LV during different periods after surgery (F=57.25, P=0.00). ConclusionsThe retinal microstructure, visual acuity, visual fields were gradually improved after scleral bulking. The patients had better vision with normal retinal microstructure. The time of retinal detachment positively correlated with visual fields damage.
ObjectiveTo observe the correlation between the thickness of foveal ganglion cell-inner plexiform layer (GCIPL) and visual field mean defect before and after gamma knife treatment in patients of sellar region tumors with optic chiasmal compression. MethodsThis was a prospective case series. 72 eyes of 37 consecutive patients suffering from optic chiasmal compression of sellar region tumors treated with gamma knife were enrolled in the study. According to the change of visual field before and after gamma knife treatment, the patients were divided into three groups. There were 13 eyes of 7 patients in group 1 with no vision defect pre-and post-treated, 34 eyes of 17 patients in group 2 with improvement of visual field defect after treatment, 25 eyes of 13 patients in groups 3 with no improvement or reorganization of visual field defect after treatment. Overall average thickness of GCIPL, and of the superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal retina were measured with the Cirrus high-definition spectral domain optical coherence tomography, and mean deviation (MD) with the Humphrey field analyzer before and 6 months after treatment. There was no significant difference in MD values between group 2 and 3 pre-treated (t=1.471, P=0.084). There was significant difference between all the groups in total average value of GCIPL thickness and the 6 quadrant GCIPL thickness values pre-treated (P < 0.05). Logistic regression model was applied to analysis of the correlation between GCIPL thickness and the improvement of visual field after treatment. ResultsThe MD values of the group 1, 2 and 3 were (-2.96 ±0.75), (-10.24 ±1.31), (-20.2 ±5.88) dB at 6 months after treatment. There was significant difference between group 2 and 3 of MD value after treatment (t=6.974, P=0.000). In group 1, there was no significant difference in mean GCIPL thickness and the 6 quadrant GCIPL thickness values between pre-and post-treated (t=0.882, P=0.395).The mean thickness of GCIPL, superonasal and inferonasal GCIPL was increased than pre-treated in group 2, and the difference was statistically significant (t=2.438, 4.630, 4.457; P=0.035, 0.001, 0.001). The mean thickness of GCIPL, superonasal and inferonasal GCIPL was decreased than pre-treated in group 3, and the difference was statistically significant (t=-2.387, -4.603, -4.975; P=0.041, 0.002, 0.001).Logistic regression analysis showed that the greater of the value of average GCIPL thickness of patients with visual field defect pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between the value of superonasal or inferonasal GCIPL and the improvement of the visual field post-treated (OR=5.374, 4.693; P=0.000, 0.000). There was no significant correlation between the value of superotemporal or upper or lower or inferotemporal GCIPL and the improvement of the visual field post-treated (OR=1.058, 1.101, 1.074, 1.056; P=0.183, 0.080, 0.162, 0.186). ConclusionsIn patients with optic chiasmal compression of sellar region tumor, the greater of the average GCIPL thickness pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between superonasal or inferonasal value of the GCIPL thickness and the improvement of visual field defect post-treated.
When macular diseases involves the fovea, patients' central vision is significantly reduced. A central dark spot appears in the visual field, and their visual function indicators, such as reading speed and fixation stability, are significantly impaired, which seriously affects the patients' quality of life. The human body's response to the damage of the fovea region is a spontaneous adaptation strategy adopted by the brain. The brain will select the paracentral region as the pseudo fovea to serve as the fixation site of the eye, however, the development of patient's own residual vision is not maximized by this adaptation behavior. In recent years, through continuous research, it has been discovered that the automatic eye position recognition and automatic eye tracking system in the microperimeter can accurately detect specific retinal sites, combined with the biofeedback training mode, and can combine fundus examination with biofeedback training. It can help patients with age-related macular degeneration, pathological myopia macular degeneration, Stargardt's disease, macular hole and other macular diseases to choose the best retinal site as an eye movement benchmark, maximize the patient's residual vision and improve the patient's visual function.
Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P＜0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P＜0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P＞0.05) and MD value (t=−0.560, −0.337; P＞0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P＜0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P＜0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P＞0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P＞0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
ObjectiveTo observe the clinical efficacy of oral glucocorticoids in the treatment of acute non-arteritic anterior ischemic optic neuropathy (NAION).MethodsA prospective clinical study. From December 2017 to June 2020, 40 eyes of 40 patients with acute NAION who were diagnosed in Department of Ophthalmology of Tengzhou Central People's Hospital were included in the study. All the affected eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination of optic disc; 35 eyes (BCVA≥0.1) underwent visual field examination at the same time. The BCVA examination was carried out using the international standard decimal visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The static visual field inspection was performed with Humphrey automatic perimeter to obtain the average mean deviation (MD) value. The thickness of peripapillary retinal nerve fire layer (pRNFL) around the optic disc of the affected eye was measured with an OCT instrument. According to the wishes of patients, they were divided into hormone treatment group and control group. All were given vitamin B1 and methylcobalamin orally; the hormone treatment group was given oral prednisone acetate treatment, 60 mg/d (regardless of body weight); after 2 weeks, the dose was reduced by 5 mg every 5 days, and the dose was reduced to 40 mg and maintained until optic disc edema subsides; thereafter, the dose was quickly reduced until the drug was stopped. Three and 6 months after treatment, the same equipment and methods were used for related examinations before treatment to observe the thickness changes of BCVA, MD, and pRNFL. The thickness of BCVA, MD, and pRNFL between the two groups was compared by Mann-Whitney U test. The thickness of BCVA, MD, and pRNFL before and after treatment within the group was compared by rank analysis of variance. ResultsAmong 40 eyes of 40 cases, 21 eyes were in the hormone treatment group, and 19 eyes were in the control group. There were differences in age, sex composition, course of disease, associated systemic risk factors, BCVA, MD, and pRNFL thickness between the two groups. There was no statistical significance (P＞0.05). At 3 and 6 months after treatment, the average logMAR BCVA of the eyes of the hormone treatment group and the control group were 0.26±0.32, 0.26±0.34, 0.28±0.30, 0.25±0.32, respectively. The visual field MD were －15.52±6.87, －15.55±6.04 dB and －14.82±7.48, －15.18±6.40 dB; pRNFL thickness was 70.38±10.22, 73.79±11.82 μm and 65.67±10.07, 69.26±10.85 μm. LogMAR BCVA (Z=－0.014, －0.315; P=1.000, 0.768), visual field MD (Z=－0.041, －0.068; P=0.979, 0.957), pRNFL thickness (Z= －0.965, －1.112; P=0.347, 0.270), the difference was not statistically significant. ConclusionCompared with the control group, oral glucocorticoid treatment of acute NAION fail to improve the visual function and morphological prognosis during the 6-month follow-up period.