Anterior segment autonomic dysfunction in ocular hypertension

Autonomic nerve function in the anterior segment of the eye was assessed by measurement of the pupil cycle time in 189 patients with ocular hypertension and 70 age- and sex-matched control subjects. Parasympathetic dysfunction was significantly present in ocular hypertensive patients with narrow irido-corneal angles, though not in wide-angle subjects. The results are discussed, with particular reference to the accumulating evidence implicating autonomic dysfunction as a significant factor in the pathogenesis of the primary glaucomas.     

The prevalence of autonomic neuropathy in the primary glaucomas

The results of systemic autonomic nerve function studies in patients with closed-angle glaucoma and ocular hypertension are reviewed. Autonomic neuropathy has been demonstrated in 58% of patients with closed-angle glaucoma and 42% of ocular hypertensive subjects, with significantly increased prevalence in ocular hypertensives with narrow iridocorneal angles. The implications are discussed, with particular reference to the pathogenesis of raised intraocular pressure.     

Sympathetic denervation hypersensitivity of the iris in ocular hypertension

Sympathetic denervation hypersensitivity of the iris was assessed in 51 patients with ocular hypertension and 36 age- and sex-matched control subjects. Significantly increased pupillary dilatation in response to topically-applied 0.5% phenylephrine hydrochloride, suggesting sympathetic denervation hypersensitivity of the iris, was present in the ocular hypertensive group (p < 0.003). The effects of autonomic nerve function on aqueous dynamics are reviewed, and the association between autonomic dysfunction and ocular hypertension is discussed.     

Systemic autonomic function in subjects with primary angle-closure glaucoma: a comparative study of symptomatic and asymptomatic disease presentation

BACKGROUND: Autonomic dysfunction is thought to be a contributory factor in primary angle-closure glaucoma (PACG) by precipitating pupil block in anatomically predisposed eyes. This study aimed to compare systemic autonomic function between subjects who had suffered a previous episode of acute angle closure (symptomatic PACG), those who had asymptomatic PACG, and age and sex-matched controls. METHODS: Tests for systemic parasympathetic function included the heart-rate response to standing (30:15 ratio), heart-rate variation during deep breathing, and the ratio of the heart rate at phases IV and II of the Valsalva manoeuvre (Valsalva ratio). For assessment of the sympathetic nervous system, blood pressure was recorded supine and then after 2 and 5 min of standing. A modified sweat test, the sympathetic skin response, was recorded on the palm and sole. RESULTS: A total of 30 subjects were examined: eight previous symptomatic PACG, eight asymptomatic PACG and 14 control subjects. The mean ages were similar, and all except one subject were Chinese. None of the subjects had evidence of systemic dysautonomia. There was no significant difference found between the groups for the 30:15 ratio, heart-rate variation during deep respiration and the Valsalva ratio. No significant orthostatic hypotension was detected in subjects with PACG. Abnormal sympathetic skin response was not more common in PACG subjects compared to control subjects. CONCLUSIONS: This study identified no systemic autonomic dysfunction in people with PACG.     

A Case of Synchronised Pupillary and Nasal Cycling: Evidence for a Central Autonomic Pendulum?

We previously reported that some healthy individuals show alternating anisocoria. We now describe one such individual who also exhibits a classic nasal cycle (alternating periods of nasal congestion and decongestion). We made measurements of his pupil asymmetry and nasal asymmetry at 21 different time points and found that these variables were always synchronised such that greater nasal airflow was invariably found on the same side as the larger pupil. We hypothesise that a common central oscillator may be responsible for co-modulating the sympathetic outflow to both nasal vessels and iris dilator muscles in some healthy individuals.     

The painless eye: Neurotrophic keratitis in a child suffering from hereditary sensory autonomic neuropathy type IV

Hereditary sensory autonomic neuropathy (HSAN) is a group of inherited disorders (total 5 types) that are associated with sensory dysfunction and varying degrees of autonomic dysfunction. HSAN type IV (HSAN-IV) or congenital insensitivity to pain and anhidrosis (CIPA) is a rare genetic disorder inherited in an autosomal recessive manner. We report a case of this very rare genetic disease in a 3-year-old girl child, born to a family in north India with ocular features of neurotrophic keratitis. The diagnosis was made clinically based on the hallmark features of insensitivity to pain and temperature, anhidrosis, self-mutilating behavior with multiple recurrent oral ulcers, nasal bleeds, multiple trophic ulcers over joints, and decreased intellect.     

Pupil cycle time and contrast sensitivity in type II diabetes mellitus patients: a pilot study

Context:

Pupil cycle time (PCT) has been widely used for examination of ocular diabetic autonomic neuropathy (DAN).

Aims:

The primary aim of this study was to evaluate the difference of contrast sensitivity according to PCT results, and the secondary aim was to determine the factors associated with PCT difference for type II diabetes patients.

Settings and Design:

A clinical pilot study that included a total of 60 eyes of 60 type II diabetes patients.

Materials and Methods:

We divided all patients into three groups according to PCT results. Group A and Group C were composed of patients who had upper one third PCT and lower one third PCT, respectively. We analyzed difference of age, diabetes duration, hypertension duration, mean best corrected visual acuity (BCVA), mean spherical equivalent (SE), HbA1C, glomerular filtration rate (GFR), stage of diabetic retinopathy, and Cardiac Autonomic Function Score (CAFS). Contrast sensitivity and decrease of visual acuity by glare were also estimated and analyzed for 28 eyes of 28 non-proliferative diabetic retinopathy (NPDR) patients. Group [NPDR] A and Group [NPDR] C were defined as those who had lower one third PCT and upper one third PCT, respectively.

Statistical Analysis:

Statistical analysis was done using SPSS 17.0 software.

Results and Conclusions:

Each group contained 20 eyes. Significant differences between Group A and Group C were observed in duration of diabetes and CAFS (P ≤ 0.001 and P <0.001, respectively). Contrast sensitivity in Group [NPDR] A was significantly more than in Group [NPDR] C at all cpds (all P ≤ 0.001). We found that PCT can influence contrast sensitivity or glare in diabetes patients and also confirmed a significant correlation of PCT with CAFS and duration of diabetes.     

Ocular Features in Neurosarcoidosis

Background/aims: To determine the type of ocular involvement in patients with neurosarcoidosis, and evaluate whether the type of eye involvement may help in the diagnosis of neurosarcoidosis. Methods: Retrospective, case history study. We reviewed the medical records of 46 patients who attended the sarcoidosis clinics at the Royal Brompton and Moorfields Eye Hospital over a 4-year period with a diagnosis of definite and probable neurosarcoidosis supported by laboratory investigations and exclusion of other causes for the neurological symptoms. Results: Cranial nerve involvement was the most common neurological manifestation in this series. Among the 27 patients with cranial neuropathy, lower motor neurone facial palsy was the most frequently seen in 19 patients (70.4%). Diplopia was seen in four patients (14.9%). In three patients, this was because of common oculomotor nerve paresis. Uveitis was the most common intraocular manifestation in patients with neurosarcoidosis. The majority of these patients (9, 64.3%) suffered from anterior uveitis, but in 35.7% of them the inflammatory process involved the posterior segment. Conclusions: We found a higher incidence of ocular manifestations, including intraocular inflammation in neurosarcoidosis compared to that in systemic sarcoidosis elsewhere. The most common ocular complication seen in our series was anterior uveitis; however there were no associated clinical features of the uveitis in these series that could contribute to the differential diagnosis between neurosarcoidosis and other autoimmune disorders with neuro-ophthalmic features such as multiple sclerosis. Patients with neurological symptoms and associated intraocular inflammation should have a routine work-up for sarcoidosis. Investigations should include MRI scan of the brain and orbits and lumbar puncture in selected cases. Tissue biopsy should be attempted when clinically accessible lesions are available i.e., conjunctiva or lacrimal gland.     

双面复合设计渐进多焦点镜片配戴的视觉功能分析

目的 通过与单面设计渐进多焦点镜片的比较,研究老视患者配戴双面复合设计渐变多焦点镜片的视觉功能.方法 老视患者16例,年龄(57.9±7.66)岁,屈光状态为(-1.06±3.33)D,近附加(+1.97±0.34)D.单盲随机给予全天配戴两种设计的渐进多焦点镜片(单面渐变设计和双面复合渐变设计)各4周,于每幅镜片配戴的第4周末进行戴镜状态下的双眼4m和40cm高低对比度视力(100%、10%),双眼64cm(中距离)和40cm(近距离)清晰阅读范围、64cm(中距离)阅读速度的检测;问卷评分主观舒适度.对相关数据采用两阶段交叉的方差分析.结果 配戴双面复合设计渐进多焦点镜片后中近距离的视功能参数较单面设计有明显不同:(1)清晰阅读范围:64cm双面复合设计组(26.838±3.538)cm,较单面设计组范围大(F=12.305P=0.003);40cm双面复合设计组(21.009±3.584)cm,较单面设计组范围大(F=42.817P=0.000).(2)问卷评分:视野宽度评分中距离双面复合设计组(2.813±0.834)分较单面设计组高(F=7.298P=0.017);近距离双面复合设计组(2.875±0.885)分较单面设计组高(F=10.205P=0.006);中距离移动舒适度评分水平方向双面复合设计组(2.875±0.719)分较单面设计组高(F=9.000P=0.010);垂直方向双面复合设计组(2.813±0.655)分较单面设计组高(F=7.226 P=0.018);伏案工作舒适度评分双面设计组(2.938±0.772)分较单面设计组高(F=7.609P=0.015).远近高低对比度视力、64cm阅读速度及其他问卷评分结果不同设计组间均差异无统计学意义(P＞0.05).结论 双面复合设计渐进多焦点镜片较单面设计在不影响远近对比度视力和远用视野宽度的情况下,提供更宽的中近距离清晰阅读范围和更好的中近距离用眼舒适度,更加符合老视配戴者的视觉需求.

Abstract：

Objective To investigate visual function with double-multiple progressive addition lens (or PAL) by comparing with monofocal progressive addition lens. Methods Sixteen presbyopia with age of 57.9± 7.66, ametropia-1.06± 3.33D, addition+1.97± 0.34D were included. With mono-blind participants were randomly fitted with monofocal PAL and double- multiple PAL for whole day respectively for 4 weeks. Binocular high (100%)- and low (10%)-contrast visual acuity at 4m and 40cm; Binocular clear width of reading materials at 64cm (intermediate) and 40cm (near) and reading rate at 64cm (intermediate) were checked. Patients'comfort was measured by questionnaire. All of the measurements were taken at the end of the fourth week after every PAL. Cross-over measurement of variance analysis was used in analyzing related data. Results The data of visual function at intermediate and near showed significantly with double- mulriple progressive addition lens (1) The clear width of reading materials: At 64cm double-multiple PAL provided 26.838± 3.538cm,which was more wide than monofocal PAL (F =12.305, P =0.003). At 40cm double- multiple PAL provided 21.009± 3.584cm, which was more wide than monofocal PAL (F=42.817, P =0.000). (2) Qu estionnaire scale:The scale of visual filed at intermediate with double- multiple PAL was 2.813± 0.834, which was higher than monofocal PAL (F=7.298, P=0.017). The scale of visual filed at near with double- multiple PAL was 2.875±0.885 which was higher than monofocal PAL (F =10.205, P =0.006). The scale of visual shift horizontally at intermediate with double- multiple PAL was 2.875± 0.719, which was higher than monofocal PAL (F=9.000, P =0.010). The scale of visual shift vertically at intermediate with double- multiple PAL was 2.813 ± 0.655,which was higher than monofocal PAL (F =7.226, P =0.018). The scale of comfort for reading at desk with double- multiple PAL was 2.938± 0.772, which was higher than monofocal PAL (F =7.609, P =0.015). The contrast visual acuity and reading rate at 64cm and the other subjective score did not show a significant difference between the two PALs (P ＞0.05). Conclusions Double- multiple PAL provided more wide clear width of reading materials and better comfortability for intermediate and near visual task than monofocal PAL, but it dose not destroy the contrast acuity and visual field at distance. Double- multiple PAL do match the visual needs of patients with presbyopia.     

Ocular surface disorders and tear function changes in patients with chronic renal failure

BACKGROUND: Ocular surface changes, mainly squamous metaplasia of the conjunctival epithelium and corneoconjunctival calcification of unknown etiology, may develop in patients with chronic renal failure undergoing hemodialysis. An association between squamous metaplasia and corneoconjunctival calcification has been suggested. The purpose of this study was to investigate the relation between ocular surface disorders and tear function changes in patients with chronic renal failure undergoing hemodialysis. METHODS: In this prospective case-control study, 42 patients with chronic renal failure and 20 age- and sex-matched control subjects underwent full ophthalmologic examination, tear function tests (including Schirmer's test, tear film break-up time [BUT] test and rose bengal staining) and impression cytology to determine the degree of conjunctival squamous metaplasia. They also responded to a questionnaire regarding subjective ocular complaints. Corneoconjunctival calcification was graded on a scale of 0 to 5 according to the system proposed by Porter and Crombie. Impression cytology samples were graded on scale of 0 to 3 according to the Nelson classification. The relation between ocular surface disorders and tear function changes was evaluated. RESULTS: Of the 42 patients, 12 (28%) had grade 0 calcification, 10 (24%) had grade 1, 14 (33%) had grade 2, and 6 (14%) had grade 3 or higher. Four patients (10%) had grade 0 squamous metaplasia, 22 (52%) had grade 1, 12 (28%) had grade 2, and 4 (10%) had grade 3. The difference between the patient and control subjects in squamous metaplasia grades and corneoconjunctival calcification grades was statistically significant (p < 0.001 and p = 0.022 respectively). Abnormal tear film BUT (p = 0.002) and abnormal rose bengal staining (p = 0.023) were significantly more frequent in the patient group than in the control group. The grade of conjunctival squamous metaplasia was correlated with abnormal rose bengal staining (tau = 0.79, p < 0.001) and with the existence of subjective ocular complaints (tau = 0.32, p = 0.026). There was no correlation between corneoconjunctival calcification and tear function changes. INTERPRETATION: Abnormal rose bengal staining and the presence of subjective ocular complaints may be used as follow-up criteria for ocular surface disorders in patients with chronic renal failure regularly undergoing hemodialysis.     

Comparison of aberrations in different types of progressive power lenses

Recently, computer numerically controlled machines have permitted the manufacture of progressive power lenses (PPLs) with different designs. However, the possible differences in optical performance among lens designs are not yet well established. In this work, the spatially resolved aberrations, at 20 relevant locations, of three PPLs with different designs were measured with a Hartmann-Shack wavefront sensor. The wavefront aberration (WA), its root mean square error (RMS) and the point-spread function were obtained. Spatially resolved plots are shown for all aberrations, astigmatism alone, and for higher order aberrations. The average RMS of all zones is also compared, and the standard deviation is used as a parameter to evaluate the level of hard-soft design. We find differences in the spatial distribution of the aberrations but not in the global RMS, indicating that current PPLs are rather similar to a waterbed, with the aberrations being the water: they can be moved but they cannot be eliminated.     

Bilateral anterior ischaemic optic neuropathy and acute renal failure: a case report

A patient who developed acute renal failure and subsequent bilateral non-arteritic anterior ischaemic optic neuropathy is described, The case was atypical in that the condition affected both eyes simultaneously, occurred in a young patient and was not associated with a recognised cause of renal failure or preexisting condition. Optic atrophy in the form of optic disc cupping, an unusual feature of non-arteritic optic neuropathy, was also present.     

渐进多焦点眼镜对青少年近视眼作用的研究

目的了解渐进多焦点眼镜对学龄青少年近视眼近视的作用。方法2组病例,每组50例,符合下列务件:年龄6-12岁,近视度数-1.25-4.50D(为扩瞳后电脑验光度数的等效球镜值),双眼散光绝对度数<1.5D'屈光参差<1.0D,每个病例详细记录过去史及家族史,进行规范验光后分别配戴普通近视眼镜和渐进多焦点眼镜。每隔0.5a进行随访观察,la后选取右眼对其近视度数上升值进行比较。结果1a后渐进多焦点眼镜组共有42例完成随访,近视度数平均上升(0.70±0.49)D;普通眼镜组有44例完成随访,近视度数平均上升(0.85±0.61)D,2组差别无显著性(t=1.575,P=0.118)。但当在2组中删除有高度近视家族史的病例后,渐进多焦眼镜组(35例)平均近视度数上升(0.60±0.50)D,普通近视眼镜组(42例)平均近视度数上升(0.85±0.61)D,差异有显著性(t=2.04,P=0.043)。结论渐进多焦点眼镜对青少年近视度数的发展可能有一定的控制作用,但其控制近视的详细机理有待进一步证实。     

影响2型糖尿病患者瞳孔散大的因素

目的：探讨影响2型糖尿病患者瞳孔散大的因素。

方法：收集2016-04/08在我院内分泌科住院确诊的2型糖尿病患者85例85眼,用复方托吡卡胺滴眼液进行散瞳,共3次,30min后测量瞳孔直径,根据糖尿病的病程、糖化血红蛋白水平、眼底病变程度及周围神经病变进行分组,比较各组中瞳孔散大水平。

结果：糖尿病病程5a以下组、5～10a组和10a以上组瞳孔散大水平分别是6.98±0.78、6.18±0.67、6.00±0.73mm,三组间差异有统计学意义(P<0.01)。非增殖期糖尿病视网膜病变组瞳孔散大水平(6.05±0.92mm)明显低于临床前期组(6.75±0.76mm),两组间差异有统计学意义(P=0.001)。踝-膝传导速度正常组瞳孔散大水平(6.70±0.84mm)明显大于传导速度异常组(6.23±0.81mm),两组间差异有统计学意义(P<0.05)。糖化血红蛋白水平<8.4%组、8.4%～13.4%组和>13.4%组瞳孔散大水平分别是6.60±0.82、6.53±0.86、6.73±0.73mm,三组间差异无统计学意义(P=0.708)。

结论：影响2型糖尿病患者瞳孔散大因素有糖尿病病程、糖尿病视网膜病变及周围神经的病变。要改善糖尿病对瞳孔的影响,必须尽早发现糖尿病并及时治疗。对瞳孔不易散大的糖尿病患者,需更加注重对眼底的检查,以免糖尿病视网病变的漏诊。     

渐变多焦点视力镜防治青少年近视的初步观察

目的：探讨多焦点视力镜防治青少年近视的疗效。方法：6～23岁青少年近视1597例,屈光度由-1．00～-6．00D。分为治疗组876例和对照组721例。前组应用渐变多焦点视力镜进行治疗,对照组配戴普通树脂镜片。治疗组根据其年龄与屈光度细分为4小组。所有病例每月复诊1次,并以8mo后复诊结果作为统计数据。结果：治疗组876例中多数近视程度得到有效控制,与对照组721例结果有显性差异。其中近视未得到控制共计18例,占治疗组病例的2．1％。该18例中有6例近视进展超过-1．00D。结论：渐变多焦点视力镜对控制青少年中低度近视的发展有较好的效果。     

Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy

Background  Vitreous concentration of vascular endothelial growth factor (VEGF) rises significantly during proliferative diabetic retinopathy (PDR). Bevacizumab (Avastin) is a humanized monoclonal antibody to VEGF. Intravitreal administration of bevacizumab (IVB) has recently been shown to be effective in some ocular neovascularizations, including PDR. In this study we evaluate the efficacy of IVB in eyes with active, progressive PDR. Methods  In an interventional prospective case series, eyes with active, progressive PDR underwent one to three IVB injections (1.25 mg) at intervals of either 6 or 12 weeks. Complete ophthalmic examinations and color fundus photography were performed at baseline and 1, 6, 12, and 20 weeks after the first injection. Fluorescein angiography (FA) was performed before injection and 20 weeks after. The primary outcome measures were clearing of vitreous hemorrhage (VH) and regression of active fibrovascular tissue (FVT). The secondary outcomes were any change in best-corrected visual acuity (BCVA) and any incidence of adverse events. Results  Thirty eight eyes of 38 patients with a mean age of 54.7 ± 10.1 years were included in the study. VH resolved significantly after 1 week (P = 0.014), 12 weeks (P = 0.0001), and 20 weeks (P = 0.002). The vascular component of FVT regressed, though the FVT area did not change. Mean BCVA improved significantly compared to baseline at all follow-up examinations. Two cases showing moderate fibrous proliferation developed traction retinal detachment (TRD). Conclusions  IVB has significant therapeutic effect on eyes with active, progressive PDR: the treatment causes a significant amount of VH resolution and neovessel regression. At the same time, this procedure may increase the risk of TRD in eyes with fibrous proliferation. The authors have no proprietary interest in this study. The authors have full control of all primary data, and they agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

屈光手术前个体眼高阶像差与中间视觉状态下瞳孔大小

目的:研究眼高阶像差的分布(HOAs)和mesopic瞳孔的大小在个体中筛选的屈光手术。 方法:我们采用Zywave像差分析仪（博士伦）分别对患有近视、近视散光和复性近视散光患者1240例2458眼和患有远视、远视散光和复性远视散光患者110例215眼的高阶像差和瞳孔大小进行检测。所有患者屈光不正均可矫正,无屈光手术史或潜在疾病。HOAs的均方根值、总球面像差、总斜射球面像差和中间视觉状态下瞳孔的大小进行了分析,眼高阶像差测量均在瞳孔≥6.0mm,且瞳孔大小的测量均为在中间视觉状态下进行。 结果:HOAs均方根值、总球面像差和总斜射球面像差在近视眼组与远视眼组分别为0.369±0.233μm、0.133±0.112μm、0.330±0.188μm;0.418±0.214μm、0.202±0.209μm、0.343±0201μm。与近视患者相比,远视患者的总HOAs和总球面像差更大(P均＜0.01)。年龄匹配分析显示在远视眼组只有总球面像差较高（P=0.05）。近视眼组的中间视觉状态下瞳孔大小较大（P≤0.05）。 结论:实验结果表明两组的HOAs的水平有显著差异,这对于将行屈光手术的伊朗人很重要。远视眼组的总球面像差显著高于近视眼组,中间视觉状态下瞳孔大小在近视眼组较大。     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

渐进多焦眼镜对青少年近视眼隐斜的影响

目的探讨渐进多焦眼镜对青少年近视眼隐斜的影响。方法用Von Graefe法测定50例单光眼镜配戴者及50例渐进多焦近视眼镜配戴者在配戴初,配戴后3、6月隐斜量。结果与单光眼镜相比,青少年近视患者在配戴渐进多焦眼镜前后隐斜量的改变无显著性差异(P>0.05)。结论与单光眼镜相比,渐进多焦近视眼镜的配戴不会增加青少年近视患者的外隐斜量。