目的:观察波及黄斑区的孔源性视网膜离术后各时期黄斑区相干光断层扫描图像特征及孔源性视网膜脱离患者眼轴长度与手术后视网膜下液吸收的关系,分析其与视力恢复过程的相关性。方法:对 53例(53眼)波及黄斑区的孔源性视网膜脱离经巩膜外加压术后视网膜复位的患者分别于术后1周、1月、3月、6月进行相干光断层扫描检查,观察黄斑区形态变化及黄斑区视网膜下液残留情况,并将检查结果与患者病程、眼轴长度以及手术后视力恢复情况等临床资料进行了对比分析。 结果:术后1周,所有病例均残留程度不等的视网膜下液,随着时间的延长,积液不断吸收。与之相对应,患者视力逐渐提高。术后3月,黄斑区视网膜下积液全部吸收累计33例, 其中眼轴长度大于26 mm患者视网膜下液吸收速度较慢,差异有统计学意义(P＜0.05)。术后6月,43例患者黄斑区视网膜下积液全部吸收,仍有 7例神经上皮浅脱离,3例局限性神经上皮脱离。术后6月时患者最佳矫正视力lt;0.05者7眼,005~03者17眼,≥0.3者29眼。结论:光学相断层扫描能从微观角度清晰地显示视网膜复位后黄斑区形态结构的变化。巩膜外加压术后视网膜复位的患者黄斑区仍残留少量的视网膜下积液,视网膜下积液的逐步吸收能较好地解释术后视力的恢复过程。眼轴长度大于26mm患者视网膜下液吸收速度较慢。
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.
Objective To observe the effects of local macular foveal photoreceptor defects on visual acuity.Methods Thirty-one patients (31 eyes) with photoreceptor defect in macular fovea (case group) diagnosed by spectral domain optical coherence tomography (SD-OCT) and 30 patients (30 eyes) age- and diopter- matched normal subjects (control group) were enrolled in this study. There were 22 eyes with full photoreceptor defects and 9 eyes with outer segment defects in case group. All subjects were examined for best corrected visual acuity (BCVA), slit-lamp microscopy, direct ophthalmoscope and SD-OCT. Independent sample t-test was used to compare central foveal thickness (CFT) between case group and control group. Difference of logMAR BCVA, CFT, maximum width and height of photoreceptor defects, defected area and residual retinal thickness in macular between patients with full photoreceptor defects and outer segment defects were also compared.Results The CFT of case group and control group were (225.32plusmn;19.70),(240.02plusmn;10.70) mu;m, the difference was not statistically significant (t=-1.96, P＞0.05). In full photoreceptor defects and outer segment defects patients, the mean logMAR BCVA were 0.22plusmn;0.31, 0.32plusmn;0.43; the mean CFT were (224.09plusmn;20.57), (228.33plusmn;18.17) mu;m; the maximum width of photoreceptor defects were (131.32plusmn;108.18), (143.22plusmn;66.93) mu;m; the mean defected area were (0.022plusmn;0.054), (0.019plusmn;0.019) mm2; the mean maximum height of photoreceptor defects were (77.41plusmn;6.62), (44.89plusmn;4.26) mu;m; the mean residual retinal thickness were (87.00plusmn;20.31), (128.33plusmn;23.54) mu;m respectively. There was no statistical significance between full photoreceptor defects and outer segment defects patients in the mean logMAR BCVA, CFT, maximum width of photoreceptor defects and defected area (t=-0.76, -0.538, -0.305, 0.166; P＞0.05), but there were significant difference in mean maximum width of photoreceptor defects and residual retinal thickness (t=12.72, -4.91;P＜0.05). Conclusions The local photoreceptor defects in macular fovea can lead to decrease of visual acuity. The wider the photoreceptor defects, the worse the visual acuity.
Objective To investigate the causes of blindness and low vision of the people over 50 years old in Binhu Area of Wuxi City. Methods Cluster sampling was used in randomly selected individuals over 50 years old in 28 villages. The oculopathy related to blindness and low vision of the people over 50 years old were analyzed. The vision acuity lt;0.05 was defined as blindness, while 0.05-0.3 was defined as low vision. SPSS 17.0 software was used to analyze the data. Results Totally 6150 individuals were examined. The bilateral blindness and low vision was found in 47 and 84 individuals, unilateral blindness and low vision was found in 201 and 214 individuals. Among 201 unilateral blindness individuals, there were 55 individuals have low vision in the other eye. In the 295 blind eyes, there are 116 eyes (39.32%) with cataract, 31 eyes (10.51%) with high myopia macular degeneration, and 28 (9.49%) eyes with atrophy eyeballs. In the 437 low vision eyes, there are 223 eyes (51.03%) with cataract, 41 (9.38%) eyes with high myopia macular degeneration, and 41 (9.38%) eyes with age-related macular degeneration. Conclusion Cataract is the first cause leading to blindness and low vision, followed by age-related macular degeneration, high myopia macular degeneration and atrophy eyeballs.
Objective To observe the etiologies and vision outcomes of inpatients with no light perception (NLP). Methods A total of 367 inpatients (430 eyes) with NLP in Zhongshan Ophthalmic Center were enrolled in this study. The visual acuity examination followed the international standard methods. NLP was detected by torch light in a dark room and the pupil light reflection state was also considered. The patients included 208 males (235 eyes) and 159 females (195 eyes). Sixtythree patients (126 eyes) were bilateral and 304 patients (304 eyes) were unilateral cases including 159 right eyes and 145 left eyes. The patients' ages ranged from 2.5 to 86.0 years, with a mean age of (40.85plusmn;18.03) years. All the patients were treated according to their diseases. The ratio of different eye disease and visual outcome were recorded and analyzed. Results Among 430 eyes, there were 157 eyes (36.5%) with optic neuritis, 68 eyes (15.8%) with uveitis, 54 eyes (12.6%) with retinal vascular disease, 35 eyes (8.1%) with ischemic optic neuropathy, 29 eyes (6.7%) with traumatic optic neuropathy, 28 eyes (6.5%) with optic atrophy, 18 eyes (4.2%) with trauma, 17 eyes (4.0%) with radiation optic neuropathy, 10 eyes (23%) with glaucoma, five eyes (1.2%) with retinal detachment, four eyes (0.9%) with compressive optic neuropathy, two eyes (0.5%) with orbital apex syndrome, two eyes (0.5%) with hysteria, and one eye (0.2%) with orbital cellulitis. After active treatment, 269 eyes (62.6%) remained NLP, 161 eyes (37.4%) got improved visual acuity, including light perception- 0.02 in 74 eyes (17.2%), ge;0.02-＜0.05 in 25 eyes (5.8%), ge;0.05 -＜0.1 in 14 eyes (3.3%), ge;0.1 -＜0.3 in 11 eyes (2.6%) and ge;0.3 in 37 eyes (8.6%). Conclusions The main causes of nonsurgical and non-trauma NLP are retinal disease and optic neuropathy. Some patients with NLP may restore useful vision if they received prompt referral and active intervention.