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重视视力性质分析，增强视功能评价相关临床研究的科学性：与“甲钴胺联合糖皮质激素治疗视神经炎74例临床疗效观察”一文作者商榷

编者按 视力性质的认识、判断、分析涉及眼科基础和临床研究的层面较多，本期刊发夏德昭教授针对这一问题提出的商榷一文，就是希望读者、作者在临床和研究工作中就此问题引起更多关注和重视，以进一步增强与视功能评价相关研究工作的科学性。

Fixation features of foveoschisis in pathological myopia

　　Objective　To observe the fixation features of foveoschisis in pathological myopia patients. Methods　36 patients (42 eyes) with gt;6.00 D myopic degree and foveoschisis who diagnosed by optical coherence tomography were included. The patients were divided into foveoschisis with retinal detachment group (11 eyes), foveoschisis with macular hole group (12 eyes) and only foveoschisis group (19 eyes). Micro-perimeter MP-1 was used to identify the fixation location and fixation stability. Results　The eccentric fixation were formed above the fovea in the foveoschisis with retinal detachment and foveoschisis with macular hole group, the fixation location was formed on fovea in the only foveoschisis group. The fixation stability of the foveoschisis with retinal detachment, foveoschisis with macular hole and only foveoschisis group were (23plusmn;4)%,(59plusmn;6)%,(91plusmn;11)% respectively, the difference was statistically significant (F=243.47，P＜0.01). Conclusions　The fixation location is formed on fovea in the patients with foveoschisis in pathological myopia. The eccentric fixation is formed above the fovea in the patients who has foveoschisis with retinal detachment and macular hole in pathological myopia.

Ophthalmoscopic image characteristics and relation with vision and course of disease in nonarteritic anterior ischemic optic neuropathy

　　Objective　To observe the characteristics of fundus fluorescein angiography（FFA）and optical coherence tomography（OCT）in nonarteritic anterior ischemic optic neuropathy (NAION),and investigate its relation with visual acuity and course of disease.Methods　The clinical data of 47 patients (47 eyes) with NAION were retrospectively analyzed. All the patiens had undergone visual acuity，fundus and visual field examination，meanwhile FFA and OCT were carried out at first visit. FFA and visual field were carried out by routine. OCT was carried out by line and circle shape scanning in macula and optic disc. Thirtyfive NAION patients were checked with OCT at half, one, two, three and six month after onset in respectively. Take the healthy fellow eyes of 36 NAION patiens as control group.The FFA,visual field,OCT characteristics and relation with visual acuity and course disease were comparatively analyzed.ResultsFFA showed that all the eyes appear as delayed filling of the optic disc in early stage and hyperfluorescence leakage of the optic disc in late stage，besides hyperfluorescence presented to macular area in 24 eyes. OCT showed that optic papilla swelling and physiological depression narrow or nearly disappearance, neuroepithelial layer thickening or neuroepithelial layer eminence and subretinal fluidity area opaca between optic disc and macula. There were 14 eyes with normal physiological depression and 22 eyes with small physiological depression or non physiological depression in control group. Half month after onset，the neuroepithelial layer thickness of macula fovea, the maximum thickness of neuroepithelial layer between optic disc and macula，and the average retinal nerve fiber layer（RNFL）thickness in NAION group were higher than those in the control group，the difference were statistically significant (F=6.51，26.12，75.49；P＜0.05).Two months after onset，the maximum thickness of neuroepithelial layer between optic disc and macula, the average RNFL thickness, and the RNFL thickness of temporal optic disc in NAION group were significant thinner, but the elevated height of the optic disc in NAION group were near those of the control group. Three months after onset，the average RNFL thickness and the RNFL thickness of temporal optic disc in NAION group decreased continually, they were lower than those of the control group, the difference were statistically significan（F=75.49，37.92；P＜0.05）.Visual field showed that inferior defect were found in 21 eyes (45%). With progress, the superior RNFL thickness obviously decreased, coincidence with appearance of visual field. It indicate that the superior optic atrophy serious. Visual acuity had significant negative correlation with the neuroepithelial layer thickness of macula fovea, the neuroepithelial layer maximum thickness between optic disc and macula, the average RNFL thickness, the RNFL thickness of temporal optic disc(r=-0.394,-0.424,-0.412,-0.464；P＜0.05).Conclusions　FFA showes that hyperfluorescence leakage appearanced in part macula. OCT showes that RNFL becomes thinner as the disease duration increases. The results of OCT and visual field examinaion in the configuration of optic disc and changes of RNFL are accordant.

Changes of retinal nerve fiber layer thickness and its correlation with visual field mean defects in early Parkinson′s disease

　　Objective　To observe the changes of retinal nerve fiber layer (RNFL) thickness and its correlation with visual field mean defects（MD）in Parkinsonprime;s disease (PD).Methods　Fifteen eyes of 15 PD patients in early stage and 18 eyes of 18 normal controls undertook RNFL examination by Stratus OCT3. Circular scans (diameter is 3.46 mm) were taken around the optic nerve head including eight quadrants (superior, inferior, temporal, nasal, temporalsuperior, temporalinferior, nasalsuperior and nasalinferior). The RNFL thickness in different quadrants in the two groups was analyzed. The visual field of PD patients was measured by central 302 program of Humphery750 visual field analyzer, and the MD was recorded. The correlation between RNFL thickness and MD was analyzed by linear correlation and regression analysis.Results　RNFL thicknesses of superior, inferior, temporal, nasal, temporalsuperior, temporalinferior, nasalsuperior, nasalinferior and average RNFL thickness in the control group were (132.7plusmn;17.4), (141.5plusmn;15.3) ,（83.2plusmn;17.5）, (83.7plusmn;22.3) ,（120.8plusmn;21.2）, (117.9plusmn;24.5) ,（109.6plusmn;20.6）,（110.2plusmn;27.7）, and（109.9plusmn;8.5）mu;m respectively, while in the PD group they were (128.1plusmn;25.3) , (128.6plusmn;13.2) , (68.7plusmn;13.5) , (76.5plusmn;17.8) ,（102.6plusmn;23.7）, (103.3plusmn;14.1) ,（101.2plusmn;20.9）,（96.6plusmn;15.0）,（102.3plusmn;11.9） mu;m. Compared with each other, the differences of RNFL thickness of inferior, temporal, temporalsuperior, temporalinferior and average RNFL thickness were statistically significant（t=2.595，2.700，2.330，2.153，2.131；P=0.014，0.011，0.026，0.040，0.041）. There was a close negative relationship between average RNFL thickness and MD in PD patients (r=-0.933，P＜0.0001). Conclusions　RNFL thickness was significantly thinner in PD patients than that in the normal controls. There was a negative relationship between RNFL thickness and MD in PD patients.

Functional MRI for patients with visual pathway diseases

　　Objective　To observe the results of function MRI and perimetry in patients with visual pathway diseases.Methods　Three patients (6 eyes) with pituitary adenoma and craniopharyngioma diagnosed via pathological examination and three healthy volunteers aged from 24 to 30 were collected. The best corrected visual acuity was nonlight perception1.0 in the 6 sick eyes and 1.0 in the healthy eyes; all the involved individuals had no other ocular diseases except myopia and without any contraindications of MRI. Common tests including the best visual acuity, fundus test by direct or indirect ophthalmoscope, center static visual field tested by Octopus 101 perimeter, program 32, tendency oriented perimetry were performed. The visual stimulation subtended a field of view of about 12 degrees，consisted of high contrast and drifting checkerboards. MRI parameters: GE signa VH/i 30T scanner. Functional data: GRE-EPI sequence，20 slices lying perpendicular to the calcarine sulcus. Anatomical data was obtained using 3DSPGR sequence to acquire high resolution. The cortical surface was unfolded and then cut and inflated. Functional data was presented to the inflated surface and subsequently analyzed by AFNI software.Results　In six eyes, three had temporal defects, two had upper temporal visual field defects, and the other one did not finish the visual field test. The retinotopic representations of health adults were obtained by using the phaseencoded visual stimulation. The Eccentricity coordinate maps showed that foveal representations lay in the occipital poles and the representations appeared further anterior as eccentricity increased. The polar angle coordinate maps showed that early retinotopically organized areas had a representation of visual field. The visual cortex beneath the calcarine sulcus matched with the upper visual field of the opposite side and which upon the calcarine sulcus matched with the under visual field of the opposite side. Less or no visual cortex response was revealed in the patients′ function MRI or the response in injury side was vanished. The visual cortex response related with the visual field defects could not be induced in function MRI.Conclusion　There is a good correlation between function MRI data and the results of perimetric evaluation. The function MRI can show the visual cortex response correlated with the visual field defects of the patients with visual pathway diseases.

非器质性视力下降的临床特征分析

蓝黄色视野检查在老年性黄斑变性中的应用

　　蓝黄色视野检查(B/YP)又称短波视野检查(SWAP)，是一种将色觉与视野检查结合形成的新视野检查方法，与常规视野检查结果有较好的一致性，而且检查出的缺损面积更大，缺损深度更深，对视野缺损的检出更为敏感，可以比传统方法更早检测出老年性黄斑变性（AMD）的视野丢失，是一种快速、非侵入性且易于被AMD患者掌握的检测方法，能为临床早期发现、诊断及治疗AMD提供较可靠的依据。

Correlation between the central macular thickness and the visual function in patients with macular edema

Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) were retrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes，branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT，MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1. The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r＝－0.429，P=0.069) as well as the correlation between CMT and MS (r＝－0.433，P=0.058). The difference of CMT between the unstable and stable group was significant (F=3.262, P=0.039）. The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3.173, P=0.044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location.changes, and PRL occurs.

Ⅲ型Usher综合征一例

Preferred retinal locus of eccentric fixation in eyes with high myopia

Objective　To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia.Methods　A total of 40 highly myopic patients (54 eyes ) with eccentric fixation were examined by MP1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between ldquo;desirablerdquo; and ldquo;undesirablerdquo; PRL were tested by analysis of variance.Results　In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes ( 35.19% ) had a leftfield PRL; 6 eyes ( 11.11% ) had an upperfield PRL; and 5 eyes ( 9.26% ) had rightfield PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lowerfield PRL in 7 （50.00%）, leftfield PRL in 5 （35.71%）, and upperfield PRL in 1 patient （7.14%）. The difference of visual acuity between lower and leftfield PRL group and right and upperfield undesirable PRL group was not statistically significant（F=0.144, Pgt;0.05）. Conclusions　The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.