Results of laser photocoagulation in patients with diabetic retinopathy developed as a complication of diabetes type 2

PURPOSE: Laser photocoagulation is a widely used method of treatment of diabetic retinopathy. The purpose of the work was to analyze the results of laser photocoagulation of the retina in patients with diabetic retinopathy, as a result of diabetes type 2. MATERIAL AND METHODS: The examined group consisted of 129 patients with diabetes type 2, treated in the Regional Centre of Diabetology and Metabolic Diseases in Lód?, who underwent laser photocoagulations as a treatment of diabetic retinopathy. Patients age were 30 to 82 years old (mean age 61), had been treated for diabetes from 1 year to 47 years (mean 17 years). Laser photocoagulations were performed in 258 eyes. The evaluation of results was based on 6 months follow-up examinations after laser treatment and comprised functional results and condition of the eye fundus. RESULTS: In the examined groups simple non proliferative diabetic retinopathy was recognized in 36 eyes (13.95%), preproliferative retinopathy in 158 eyes (61.24%) and proliferative retinopathy in 64 eyes (24.8%). Focal photocoagulations were performed in 103 eyes. Improvement in visual acuity was noted in 82 eyes (79.61%) and stabilization or improvement in the state of the eye fundus in 92 eyes (89.32%). "Grid" photocoagulation was carried out in 73 eyes, improvement in visual acuity was noted in 53 eyes (72.60%) and stabilization or improvement in the state of the eye fundus in 58 eyes (79.45%). Panretinal photocoagulation was performed in 82 eyes. Improvement or stabilization of visual acuity was observed in 46 eyes (46.10%) and stabilization of state of the eye fundus in 54 eyes (65.85%). In cases of patients with non proliferative diabetic retinopathy stabilization of visual acuity was observed in 86.11% of eyes and stabilization of the eye fundus in 94.44% of eyes. In patients with preproliferative diabetic retinopathy stabilization of visual acuity was found in 71.52% of eyes and stabilization of state of the eye fundus in 80.38% of eyes. In cases of patients with proliferative retinopathy the percentages amounted to 57.81% and 67.19%, respectively. CONCLUSIONS: The best functional results of laser photocoagulations, as well as stabilization of state of the eye fundus were achieved in patients with non proliferative retinopathy and after focal laser photocoagulations. The least favourable results were achieved in patients with proliferative diabetic retinopathy and in patients after panretinal photocoagulations. It probably results from the intensity of retinal lesions, which were an indication for these types of photocoagulations. The achieved improvement was greater regarding anatomical results, when compared to functional results. In order, to prevent the development of diabetic lesions in the eye fundus, it is necessary to carry out regular ophthalmologic check-ups, to qualify patients for laser photocoagulations, as early as possible.     

Progression of nonproliferative diabetic retinopathy and visual outcome after extracapsular cataract extraction and intraocular lens implantation.

Twenty-one patients with symmetric nonproliferative retinopathy who underwent extracapsular cataract extraction and intraocular lens implantation were followed up postoperatively for an average (+/- standard deviation) of 18 +/- 7 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity, and factors predictive of progression of retinopathy and final visual acuity. Progression of retinopathy, defined as the development of clinically significant macular edema, an increase in intraretinal hemorrhages or hard exudate, or the development of proliferative diabetic retinopathy, was assessed in both eyes of 19 patients; in two remaining patients, dense preoperative cataract in the fellow eye precluded comparison of retinopathy progression in the operated-on eye to progression in the fellow eye. Overall, retinopathy progressed in 14 of 19 operated-on eyes (74%). Cataract extraction was highly associated with asymmetric progression of nonproliferative retinopathy; it progressed only in the operated-on eye in seven of 19 patients (37%), but in no patients did progression occur in the fellow eye alone (P = .0078). Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men (P = .005). Visual acuity improved in 19 of 21 operated-on eyes (86%); however, only 11 eyes (52%) achieved a visual acuity of 20/50 or better and only six eyes (14%) achieved a visual acuity of 20/25 or better. In only five eyes was the final visual acuity in the operated-on eye more than two lines better than the final visual acuity in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)     

黄斑玻璃膜疣预防性激光治疗后视功能变化

目的 研究预防性激光治疗大的黄斑玻璃膜疣后视功能的变化.方法 双眼黄斑部有多个(>10个)大的(直径>63μm)玻璃膜疣者16例.随机选择1只眼行激光治疗,氪黄激光"C"型光凝其黄斑区.另外1只眼不治疗而作为对照.随访治疗组和对照组最佳矫正视力、黄斑光敏度、彩色眼底像和眼底荧光造影.结果 激光治疗组8只眼玻璃膜疣减少,7只眼玻璃膜疣无明显变化,1只眼玻璃膜疣增加.对照组0只眼玻璃膜疣减少,10只眼玻璃膜疣无明显变化,6只眼玻璃膜疣增加.最佳矫正视力和黄斑光敏度,治疗组没有变化,对照组下降.结论 氪黄激光对大的黄斑玻璃膜疣预防性治疗可以促进玻璃膜疣吸收,并使其视功能保持稳定.     

急性区域性隐匿性外层视网膜病变的诊断和鉴别诊断

目的探讨急性区域性隐匿性外层视网膜病变(acute zonal occult outer retinopathy, AZOOR)的临床特征、诊断和鉴别诊断特点。方法对近2年来就诊于本院和外院门诊经反复检查确诊为AZOOR的患者6例,进行眼部常规检查和荧光素眼底血管造影、视觉电生理、视野及血常规、免疫和神经系统相关检查,收集患者所有病史和检查资料,进行综合分析。结果6例(12只眼) AZOOR患者中,女性5例,男性1例;年龄26～42岁,平均35岁,均为双眼发病。随访时间4～18个月,平均(7．5±3．2)个月。6只眼发病前有近视。3只眼发病时有眼前闪光感,视力轻度下降,仅有1只眼视力为指数／40 cm。所有患者至少1只眼视野检查发现视野缺损或局部敏感度下降,其中1只眼双眼生理盲点扩大。4只眼见眼前段活动性炎性病变,10只眼伴有玻璃体轻度炎性改变。4只眼可见眼底后极部黄白色斑点状病灶,6只眼为后极部至中周部视网膜灰白色斑点状病灶,病灶位于视网膜外层或色素上皮-玻璃体-脉络膜毛细血管复合体层。1只眼荧光素眼底血管造影显示眼底脱色素改变,其余患者为眼底高荧光斑。1只眼伴黄斑-脉络膜新生血管。所有患者视网膜电图检测均有不同程度异常。在随访过程中除1只眼视力下降外,其他患者症状与初诊相似。5只眼视野无明显改变,1只眼视野缺损范围增大。1例双眼视网膜斑点增加,1例双眼视网膜病灶减少。1例双眼视网膜斑点消失,其他患者随访眼底无明显改变。6例患者初次诊断与随访诊断均不一致。结论AZOOR属于少见眼部疾病,青年女性多见,具有眼前闪光感、视野缺损、视网膜电图改变,眼底轻微病变是AZOOR的共同特点。其鉴别诊断复杂,容易误诊、漏诊。     

Contrast sensitivity in amblyopia: the fellow eye of untreated and successfully treated amblyopes.

PURPOSE: We sought to investigate contrast sensitivity on the fellow eyes of amblyopic and successfully treated amblyopic subjects. METHODS: Contrast sensitivity was tested monocularly on both eyes of 48 amblyopic patients (mean age, 11.51 years) and of 22 successfully treated amblyopic subjects (visual acuity 20/20 in each eye; mean age, 11.22 years). Inclusion criteria were visual acuity in the amblyopic eye 20/40 or better (mild amblyopia) and 20/20 or better in the fellow eye, steady fixation, no signs of congenital, latent or manifest/latent nystagmus on clinical examination. Twenty normal subjects (20 eyes) were used as age-matched controls. RESULTS: Contrast sensitivity functions from the fellow eye of the 48 amblyopic patients, even those who had never been treated with occlusion therapy before, were significantly decreased (P < 0.001) compared with control subjects. Both the previously amblyopic and the fellow eye of the 22 "cured" amblyopic subjects demonstrated significantly lower values (P < 0.001) compared with control patients. CONCLUSIONS: We suggest that the nonamblyopic, "normal" eye of amblyopic patients behaves abnormally when evaluated for contrast sensitivity functions. Neither the previously amblyopic nor the fellow eyes of successfully treated subjects were comparable with controls. Occlusion therapy may not be implicated for depressed contrast sensitivity of the fellow eye in amblyopia. The assessment of contrast sensitivity can provide important information on the visual function and the influence of occlusion therapy in amblyopia.     

黄斑玻璃膜疣预防性激光治疗效果分析

目的 分析预防性激光治疗对大的黄斑玻璃膜疣的效果.方法 黄斑部有多个(>10个),大的(直径>63μm)玻璃膜疣者23例.其中7例对侧眼为湿性年龄相关性黄斑变性,对玻璃膜疣眼进行激光治疗.另外16例为舣眼玻璃膜疣,随机选择一只眼行激光治疗.氪黄激光"C"型光凝该23只眼的黄斑区.随访最佳矫正视力、彩色眼底像和眼底荧光造影(FFA).结果 激光治疗后,14只眼玻璃膜疣减少,7只眼玻璃膜疣无明显变化,2只眼玻璃膜疣增加.最佳矫正视力提高7只眼,不变6只眼,下降10只眼,最佳矫正视力术前术后统计分析无显著性差异.激光治疗眼并未出现脉络膜新生血管等并发症.结论 氪黄激光对大的黄斑玻璃膜疣预防性激光治疗可以促进玻璃膜疣吸收,并使其视力保持稳定.     

5039例出生42天婴儿眼病筛查

目的：早期发现婴儿眼病。方法对受检婴儿进行外眼检查,对光刺激反应,瞳孔对光反射,手持裂隙灯眼前节检查,带状光检影镜检查瞳孔红光反射、屈光状态,眼底检查。结果筛查出先天性泪囊炎83例（93眼）,新生儿脓漏眼8例（16眼）,先天性上睑下垂3例（4眼）,眼球震颤4例,先天性白内障4例（7眼）,先天性小眼球小睑裂3例（4眼）,其中1例伴有虹膜脉络膜缺失,先天性无眼球1例（双眼）,先天性青光眼1例（双眼）,屈光异常467例（934眼）,早产儿视网膜病变2例（4眼）。结论早期发现婴儿眼病及干扰视觉功能正常发育的因素,对早期干预,减少视力损害有积极意义。     

Accommodative hyperemia of the ciliary body as one of the pathogenetic factors in myopia

Thermometry of 40 eyes before and after visual work at near with different correction of ametropia and tonography of 20 eyes with progressive myopia and 20 eyes with stationary myopia conducted before and after 15-minute reading load under full correction have revealed that visual work at near is accompanied by working hyperemia of ciliary body (rise of temperature in the anterior segment of the eye ball) and hyperproduction of intraocular fluid. In eyes with stationary myopia, hyperproduction is fully compensated by improvement of aqueous outflow from the eye. In eyes with progressive myopia, ophthalmic hypertension takes place because of insufficient improvement of the outflow facility coefficient. It is likely that working hyperemia of the ciliary body and hyperproduction of intraocular fluid under conditions of visual work at near can be realized as a factor of myopization of the human eye in case of a certain predisposition: in eyes with a not fully formed angle of the anterior chamber or in eyes with anomalous development of the angle.     

Asymmetric responses in cortical visually evoked potentials to motion are not derived from eye movements.

PURPOSE: Normal neonates and many adults after abnormal visual development have directional preferences for visual stimulus motions; i.e., they give better responses for optokinetic nystagmus (OKN) and visually evoked potentials (VEPs) in one direction than to those in the opposite direction. The authors tested whether the VEP responses were asymmetrical because of abnormal eye movements. METHODS: VEPs were recorded from the visual cortices of five macaque monkeys: one normal, one neonate, and three reared with alternating monocular occlusion (AMO). They were lightly anesthetized, followed by paralysis to prevent eye movements. They then had "jittered" vertical grating patterns presented in their visual fields. The steady state VEPs were analyzed with discrete Fourier transforms to obtain the amplitudes and phases of the asymmetries. RESULTS: The normal, control monkey had small, insignificant amplitudes of its asymmetrical Fourier component and random phases that were not 180 degrees out of phase across the left and right eyes. The neonatal monkey and the AMO monkeys all had large, significant asymmetries that were approximately 180 degrees out of phase between the left and right eyes. CONCLUSIONS: The neonate and abnormally reared monkeys continued to have asymmetrical responses even after their eyes were paralyzed. Therefore, eye movements cannot be the source of the asymmetrical amplitudes of the VEPs, and the visual cortex is at least one source responsible for asymmetries observed in neonates and adults reared under abnormal visual inputs.     

Case of Unilateral Peripheral Cone Dysfunction

Purpose

Peripheral cone dystrophy is a subgroup of cone dystrophy, and only 4 cases have been reported. We present a patient with unilateral peripheral cone dysfunction and report the functional changes determined by electrophysiological tests and ultrastructural changes determined by spectral domain optical coherence tomography (SD-OCT).

Case

A 34-year-old woman complained of blurred vision in both eyes. Our examination showed that her visual acuity was 0.05 OD and 0.2 OS. A relative afferent pupillary defect was present in her right eye. The results of slit-lamp examination, ophthalmoscopy, and fluorescein angiography were normal except for pallor of the right optic disc. SD-OCT showed a diffuse thinning of the retina in the posterior pole of the right eye. A severe constriction of the visual fields was found in both eyes but more in the right eye. The photopic full-field electroretinograms (ERGs) were reduced in the right eye but normal in the left eye. The multifocal ERGs were severely reduced throughout the visual field except in the central area of the right eye. The multifocal ERGs from the left eye were normal. The pattern visual evoked responses were within the normal range in both eyes. She had a 5-year history of sniffing paint thinner.

Results

Although the visual dysfunction was initially suspected to be due to psychological problems from the results of subjective tests, objective tests indicated a peripheral cone dysfunction in the right eye. The pathophysiological mechanism and the relationship with thinner sniffing were not determined.

Conclusions

Our findings indicate that peripheral cone dysfunction can occur unilaterally. Electrophysiology and SD-OCT are valuable tests to perform to determine the pathogenesis of unusual ocular findings objectively.Key Words: Tunnel vision, Electroretinogram, Multifocal ERG, Optical coherence tomography, Pattern visual evoked potentials     

Axial length in branch retinal vein occlusion

To determine the effects of axial length on the development of branch retinal vein occlusion (BRVO), determination of the affected eye, development of surgical complications, and visual prognosis, axial length was measured in 27 eyes each in surgical, non-surgical and control group and in 54 eyes each in occlusion (surgical + non-surgical group), non-affected eye (non-affected eyes of occlusion group), and non-occlusion group (both eyes of the control group). The average axial length was 22.61 mm in surgical, 22.48 mm in non-surgical, 23.09 mm in control, 22.55 mm in occlusion, 22.56 mm in non-affected eye, and 23.11 mm in non-occlusion group. The axial length showed a statistically significant difference between surgical and control group (p = 0.018), between non-surgical and control group (p = 0.002), and between occlusion and non-occlusion group (p < 0.001); however, no statistically significant difference was seen between surgical and non-surgical group, between non-affected eyes of surgical and non-surgical group, and between occlusion and non-affected eye group. Also, in such as BRVO groups as surgical, non-surgical, and occlusion groups, no correlation was present between axial length and degree of visual acuity recovery and final visual acuity. Although the possibility of developing BRVO is higher in those with short axial length, the axial length may have no relationship with the determination of the affected eye, visual prognosis and development of surgical complications.     

The site and nature of suppression in squint amblyopia

A significant percentage of humans have a misaligned eye (squint) due to a disruption of early visual development. In later adult life these people do not experience double vision because the visual information from their misaligned eye is actively suppressed within their visual system. Here I utilize a phenomenon called spatial adaptation which is known to have its site in the striate cortex to answer the question "is the site of suppression before, at, or after the site of adaptation?" Strabismic amblyopes who display spatial adaptation when viewing monocularly with their amblyopic eye fail to display adaptation through their amblyopic eyes under binocular viewing conditions. The lack of adaptation depends on the orientational difference between the adapting stimuli seen by each eye under binocular viewing conditions. These results suggest that suppression occurs at rather than before or after the first site of adaptation.     

Reversal of optic canal stenosis in osteopetrosis after bone marrow transplant

PURPOSE: To describe a patient with infantile osteopetrosis and optic atrophy secondary to optic canal stenosis who demonstrated optic canal enlargement after bone marrow transplant. METHODS: Case report. A 3-month-old infant with infantile "malignant" osteopetrosis underwent ophthalmic examination, including visual evoked potentials, electroretinogram, and computed tomography (CT). Bone marrow transplant was performed at 8 months of age. RESULTS: Examination revealed visual loss and optic atrophy, left eye greater than right eye, secondary to optic canal stenosis. Flash visual evoked potentials revealed a normal waveform in both eyes with increased latency in the left eye. Electroretinogram was normal in both eyes. CT after bone marrow transplant showed enlargement of the optic canals. Vision remains stable 43 months after bone marrow transplant. CONCLUSIONS: Bone marrow transplant in infantile osteopetrosis may be followed by reversal of optic canal stenosis and preservation of vision.     

儿童期睑腺炎并发眼表疾病68例分析

目的 探讨与儿童期睑腺炎相关的青少年眼表疾病及其对视觉发育的影响以及诊断和治疗.方法 对儿童期患睑腺炎以眼表疾病就诊的患者68例117只眼,行日常生活视力及眼前节检查,干眼患者行洞膜三项检查;对症治疗,部分睑缘炎患者口服四环素;随访至少6周.结果 并发的眼表疾病主要有结膜炎117只眼(100%),边缘性角膜炎62只眼(53.0%),干眼48只眼(41.0%),睑缘炎43只眼(36.8%).对症治疗可以改善症状,提高视力.但部分患者视力仍不能达最佳.结论 睑腺炎患儿具有眼表疾病高发的特点,易被误诊,复发性强,影响视觉发育,应引起临床医生的特别关注.     

玻璃体切割术治疗孔源性视网膜脱离伴玻璃体积血的临床研究

目的:探讨孔源性视网膜脱离伴玻璃体积血的发病原因、临床特征和玻璃体切割术的治疗效果。方法:回顾分析24例24眼因孔源性视网膜脱离伴玻璃体积血接受玻璃体切割手术治疗患者的临床资料。结果:年龄<45岁的青年组共11例;年龄45～59岁的中年组共9例;年龄>60的老年组4例。21例为马蹄形裂孔,其中马蹄形裂孔<1PD者2例,1PD～<2PD者14例,2PD～<1象限者5例;圆形裂孔者3例,均<1PD。裂孔位于视网膜颞上方者13例,颞下方者8例,鼻上方者3例;视网膜脱离范围:颞上方者10例,鼻上者2例,全脱者1例,下方者11例。病程和术后视力:1mo组16例,视力0.2～0.4者13例,≥0.5者3例;2mo组5例,视力0.01～0.1者3例,0.2～0.4者2例;3mo组1例,视力0.01～0.1;>3mo组2例,视力手动1例,数指1例。结论:孔源性视网膜脱离伴玻璃体积血尽早明确诊断并及时行玻璃体切割手术能够取得较好疗效。     

猫斜视性弱视治疗前后视皮质17区神经生长因子的表达

目的　观察斜视性弱视猫治疗前后视皮质 (VisralCortex ,VC) 17区神经生长因子(NGF)表达改变 ,探讨神经生长因子与视觉发育可塑性的联系。方法　普通 4周龄家猫 18只 ,随机分为正常对照组、斜视组和斜视治疗组 ,每组各 6只 ,后两组 4周龄时行右眼外直肌切断术 ,术后 4周经P -VEP检测确定形成弱视后立即将治疗组 6只猫行对侧眼睑暂时缝合。三组猫全部于 12周龄处死 ,取右脑半球VC17区脑组织 ,应用免疫组织化学染色法观察 17区NGF免疫阳性细胞密度。结果　斜视组与正常组相比 :免疫阳性细胞数量明显减少 (P <0 0 5 ) ,P -VEP的P1波潜时延迟 ,波幅降低 ;治疗组和斜视组相比 ,免疫阳性细胞增加 (P <0 0 5 ) ,P1波潜时缩短 ,波幅增大。结论　斜视性弱视猫VC17区NGF表达特性发生改变 ,通过遮盖对侧眼 ,增加弱视眼的视觉信息输入量 ,NGF表达增加 ,和P -VEP的改变相符合 ,遮盖治疗使实验猫弱视眼的视功能得到一定的改善。NGF作为一种细胞功能的调控因子 ,在视觉系统发育的可塑性方面发挥重要作用。     

透明质酸面部微整形致视功能障碍的临床观察

目的　观察使用透明质酸进行面部微整形所致视功能障碍患者的临床表现、治疗效果等。方法　回顾性分析2013年1月至2017年12月我院眼科诊治的因面部微整形行透明质酸注射所致视功能障碍患者13例13眼的临床资料,包括一般情况、病史、临床检查结果、治疗效果及危险因素等。结果　13例患者全是女性,年龄21~40岁,平均26.7岁。注射部位位于眉间者7例、鼻部者4例、额部者2例。13例全是单眼发病,突然发病者10眼;严重视功能障碍者9眼,包括无光感4眼,光感2眼,手动1眼,数指2眼;另外4眼视力0.1。经眼底照相和荧光素眼底血管造影确诊为眼动脉阻塞者3眼、视网膜中央动脉阻塞者4眼、视网膜分支动脉阻塞者1眼、睫状后动脉阻塞者2眼、视网膜中央动脉阻塞合并睫状后动脉阻塞者1眼和眼底动脉血管痉挛者2眼。6例患者合并眼球运动障碍或面部外观异常。经治疗后,视力从0.1恢复到0.3、0.5、0.6者各1眼,光感恢复到手动者1眼,其他9眼视力未见改善。结论　透明质酸面部微整形所致视功能障碍多发生于年轻女性,多数突然发病,视功能障碍严重,主要是眼底动脉阻塞。治疗后多数患者视功能恢复效果不明显。     

Results of a filtering procedure in low tension glaucoma

Twenty-six eyes of twenty patients with established low tension glaucoma, who had either a double flap Scheie filtering operation or a trabeculectomy, were followed over a period ranging from one to ten years, with a median of three years. These 26 eyes include two second eyes that served as a contralateral control eye until the visual field deteriorated. All 26 eyes showed progression of visual field defects preoperatively, while postoperatively only 2 eyes showed further progression. Of the 16 nonoperated contralateral eyes, 7 showed progression of visual field defects over the same follow-up period. Two of these 7 eyes had to be operated during the study-period. The difference in progression between the operated and the non-operated eyes was significant (P<0.01). The diltering procedure provided a reduction in IOP of 20% or more in 21 of 26 eyes. There was a significant difference in the mean intraocular pressure (IOP) between the operated and the non-operated contralateral eye of 6.8 mmHg (37%) at one year postoperatively. The diurnal variation decreased highly significantly from 4.3 to 2.1 mmHg (P<0.001). It is concluded that filtering surgery in low tension glaucoma may result not only in a significant lowering of IOP, but is also effective in slowing further deterioration of the visual fields.Supported in part by a grant from De Rotterdamse Vereniging Blindenbelangen.Presented in part by N. de Jong at the 180th Meeting of the Netherlands Ophthalmological Society, Apeldoorn, March 1986.     

Curiosidades sobre el sistema visual de los invertebrados

Objective

To communicate relevant and striking aspects about the visual system of some close invertebrates.

The regulation of eye growth and refractive state: an experimental study of emmetropization

During growth the vertebrate eye achieves a close match between the power of its optics and its axial length with the result that images are focused on the retina without accommodative effort (emmetropia). The possibility that vision is required for the regulation of eye growth was studied experimentally in chicks made myopic or hyperopic by different visual manipulations. After discontinuing these visual manipulations, the eyes returned quickly to emmetropia mainly by adjusting the growth of their vitreous chambers; growth stopped in eyes recovering from myopia and continued in eyes recovering from hyperopia. Because both hyperopic and myopic eyes were already larger than normal controls, the difference in growth indicates that refractive error, rather than eye size per se, guides the eye toward emmetropia. Evidence is also presented for nonvisual shape-related control of eye growth, but this is slow-acting and cannot explain the emmetropization from induced refractive errors. Both the visually guided and shape-related mechanisms work even in eyes with the optic nerve cut, indicating that the two mechanisms are local to the eye. Although the optic-nerve-sectioned eye can sense the sign of a refractive error and initially adjust growth accordingly, it eventually overshoots emmetropia and reverses the sign of the initial refractive error. Whether this is due to loss of feedback from the central nervous system or retinal ganglion cells is unclear.