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 characteristics of fundus autofluorescence (AF) in short wavelength AF (SW-AF) and Near Infrared AF (NIR-AF), and their relationship with visual fields. Methods Twelve patients (24 eyes) with primary RP were enrolled in this study. The patients included nine males (18 eyes) and three females (six eyes). The patients aged from 15 to 69 years, with a mean age of (35.33plusmn;15.03) years. All the patients were examined for color photography, SW-AF, NIR-AF, visual fields and optical coherence tomography examination. Results There were hyper-AF ring of varying sizes in posterior pole by SW-AF and NIR-AF examinations. The area of hypo-AF which located in SW-AF hyper-AF ring had a positive correlation with the area of hyper-AF in the NIR-AF (r=0.662，P＜0.05). OCT showed that outside the hyper-AF ring, there were disconnected inner segment/outer segment (IS/OS) junction and external limiting membrane, and thinned outer nuclear layer and retinal pigment epithelium. Peripheral retinal osteocytes-like pigmentation showed non fluorescence in SW-AF and NIR-AF. The plaque-like area showed mottled and low fluorescence examined by SW-AF. SW-AF hyper-AF ring had a positive correlation with visual fields (r=0.492，P＜0.05). Conclusions The area of hypo-AF inside of the SW-AF hyper-AF ring is related to visual fields in RP patients. The retinal structures in the hypo-AF area inside of the SW-AF hyper-AF ring, and in the NIR-AF hyper-AF region are normal.
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.
Objective To observe the microperimetry performance of macular function in pathologic myopia patients. Methods The clinical data of 90 patients (142 eyes) with pathologic myopia were retrospectively analyzed. All patients were asked in details about history, and take examinations of best corrected visual acuity (BCVA), refractive dioptre, eye axis, fluorescent fundus angiography (FFA), indirect ophthalmoscopy and optical coherence tomography (OCT). According to the test results, patients were divided into non-pathological macular group (20 patients, 24 eyes) and pathological macular group (70 patients, 118 eyes). Retinal imaging and macular microperimetry were measure by MP-1 Microperimeter.The mean retinal sensitivities (MS) and fixation stability in the central 10deg;, fixation rate and fixation position in the central 2deg; and 4deg;were determined.Results The MS of pathological and non-pathological macular group were(16.39plusmn;2.12), (10.80plusmn;4.53) dB respectively, the difference was statistically significant(F=15.044,t=-9.314;P=0.000). Among 24 eyes of non-pathological macular group, fixation was stable in 19 eyes (79.17%), relative unstable in five eyes (20.83%); among 118 eyes of pathological macular group, fixation was stable in 45 eyes (38.14%), relative unstable in 52 eyes (44.07%), unstable in 21 eyes (17.79%), the difference was statistically significant(chi;2=13.56, P=0.000). The differences of 2 deg;and 4 deg;fixation rate between those two groups are statistically significant (F=5.773, 13.230; t=-4.110,-5.465;P=0.000) . Among 24 eyes of non-pathological macular group, center fixation occurred in 23 eyes (95.83%), weak center fixation occurred in one eye (4.17%); among 118 eyes of pathological macular group, fixation center occurred in 81 eyes (68.64%), weak center fixation occurred in 16 eyes (13.56%)，eccentric fixation occurred in 21 eyes (17.80%), the difference was statistically significant (F=9.618,t=-5.773；P=0.000).Conclusion Pathological myopia patients with pathological macular changes have decreased retinal sensitivity, decreased fixation stability and eccentric fixation points.
Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)
Objective To evaluate the diagnosis of blue-on-yellow perimetry and macular threshold perimetry in early primary glaucoma. Methods Humphrey II 750 automatic perimetry was used to test 60 eyes of 60 cases in normal control group and 63 eyes of 63 cases in early primary glaucoma group with white-on-white perimetry (W/W), blue-on-yellow perimetry (B/Y)，and macular threshold perimetry (M TP). The results of the visual field defects detected by the three perimetries were compared and analyzed.Results The differences of mean sensibility of W/W, B/Y and MTP between the two groups had statistical significance［t=-3 .01, P=0.0054 (W/W); t=-2.95, P=0.006 3 (B/Y); t=-2.59,P=0. 0150 (MTP)］. In the diagnosis of early primary glaucoma, the sensitivity of MTP was the highest (83%), B/Y was the second (65%), and W/W was the lowest (48%). When B/Y and MTP were combined, the sensitivity was improved to 94% using parallel testing, and the specificity was improved to 87% using serial testing.Conclusions B/Y and MTP are valuable in diagnosis of early primary glaucoma, and the sensitivity and specificity of the diagnosis can be improved when B/Y and MTP are combined. (Chin J Ocul Fundus Dis，2003，19：102-105)
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 investigate the characteristic of the multifocal visual evoked potentials(MVEP)and the visual function across the visual field in anisometropic amblyopes and isometropic amblyopes. Methods MVEP from 32 anisometropic amblyopic eyes and 31 control eyes were tested. Results In anisometropic amblyopic eyes,the latencies of MVEP were significantly prolonged．The amplitudes of MVEP were significantly attenuated in the central region of the visual field,and these phenomena gradually reduced with the increase of the eccentricity． Conclusion The visual function of anisometropic amblyopic eyes is reduced more significantly in the central region than in the peripheral region of the visual field. (Chin J Ocul Fundus Dis,20000,16:27-29)
Objective To investigate the distribution properties of multifocal pattern visual evoked potential across visual field. Methods Multifocal pattern visual evoked potentials(VEP) of 14 normals were measured with VERIS ScienceTM4.0The visual stimuli were dart board 60 with patterns which consisted of 60 patches arranged in dart board configuration spanning a 26deg; vis ual field. The temporal modulation of each patch was controlled by a special type of pseudorandom sequence called binary m-sequence. The electrodes were placed at equal distances 2 cm inferior to and 2 cm superior to and straddling the inion. The first slice of the second order kernel for each stimulus patch was analysed. The 60 patches were grouped into several sectors. The summed responses of these sectors were analysed and compared. Results Compared with that of the lower hemifield , the polarity of the multifocal VEP of the upper hemifield was reverse, and the latency delayed, the response density decreased. With the eccentricity increased, the response density of the multifocal VEP decreased. The properties of the multifocal VEP of the horizontal sectors were different from that of the vertical sectors. Conclusion VEP of many locations within visual field could be recorded simultaneously in a short time with the method of mutifocal VEP. The multifocal VEP showed different properties in different sectors within visual field. (Chin J Ocul Fundus Dis, 2001,17:280-283)
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.