正常有色素家兔眼的视网膜功能研究

目的通过分析正常有色素家兔的mfERG的特征,了解其视网膜的功能特性。方法对9只兔18眼正常有色素家兔同时检测mfERG,并与正常成人的18只眼的检测结果对照分析。结果正常有色素家兔mfERG的P1波振幅密度三维地形图特点,可见黄斑区高峰,但较人黄斑区高峰为低,其他部分呈颞侧高鼻侧低的斜坡状,象限野mfERG颞侧半可见P1波振幅密度、P1波振幅、N1波振幅比鼻侧增高;也高于正常成人眼的颞侧值。五个环形野mfERG,P1波振幅密度,第1环最大,由1环到5环依次递减,P1和N1波振幅以4环和5环最大;与人相比环1的P1波振幅密度和振幅降低,环4和环5增高。结论兔眼颞侧视网膜功能高于鼻侧。兔眼视网膜存在类人黄斑区,但其黄斑中心视功能不如人眼,中心外视功能高于人眼。     

糖化血红蛋白与糖尿病视网膜病变黄斑区厚度的关系

目的:研究早期糖尿病视网膜病变患者黄斑区视网膜厚度与相关生化指标糖化血红蛋白(HbA1C)的关系。方法:糖尿病组20例40眼,男12例,女8例;糖尿病病程为5~10年;对照组20例40眼,男14例,女6例,应用光学相干断层扫描(OCT)测量黄斑区视网膜厚度,应用相关生化仪检测糖尿病组的糖化血红蛋白比(HbA1C)。比较两组黄斑区视网膜的厚度,包括黄斑中央厚度(CPT),黄斑中心凹下厚度(SCMT),黄斑容积(TMV),分析糖尿病组黄斑区厚度与相关生化指标的HbA1C关系。结果:糖尿病组所选患者黄斑区厚度比正常组大t=4.0772(P0.01),黄斑区视网膜厚度与糖化血红蛋白(HbA1C)比呈正相关t=3.927(P0.05)。结论:对于糖尿病视网膜病变的患者,检测糖化血红蛋白(HbA1C)变化,有利于预测早期糖尿病视网膜病变并发症的发生。     

兔眼孔源性视网膜脱离手术复位后视功能以及超微结构的变化

目的对比研究兔眼视网膜脱离后选择不同时期手术复位视功能的变化情况,为临床手术时机的选择及预测术后视功能的恢复情况提供理论与实验依据。方法利用家兔制备孔源性视网膜脱离模型,成模后1 d、7 d1、4 d时经手术达解剖复位,采用多焦视网膜电流图检测复位后视网膜的功能,数据处理应用SPSS软件。制备组织病理学切片。结果多焦视网膜电流图显示1 d、7 d、14 d的RRD手术复位后P1波平均象限反应密度(QAP1,nV/deg2),P1波幅值(AP1,μV),N1波幅值(AN1,μV),P1波潜伏期(TP1,ms),N1波潜伏期(TN1,ms)各项数值差异有显著性(P<0.05)。光镜电镜显示视网膜脱离复位后组织病理学改变。结论视网膜脱离手术复位后视网膜细胞功能的恢复与脱离时间有明显的负相关性;多焦视网膜电流图对于局部视网膜功能的评价有重要意义;组织病理学研究提供了解释视功能变化的重要依据。     

糖尿病性黄斑水肿3D-OCT与mERG检查结果的相关性研究

目的:探讨糖尿病性黄斑水肿的三维光学相干断层扫描技术(3D-OCT)与多焦视网膜电图(m ERG)检查结果的相关性。方法:随机选择糖尿病性黄斑水肿患者40人60只眼,经荧光造影检查示黄斑部有持续性的荧光渗漏、囊样水肿,3D-OCT示黄斑中心凹厚度大于170um,对黄斑中心凹旁上、下、鼻、颞约750um处视网膜神经上皮层处厚度进行OCT自带软件的分析测量。随机选择18人35只年龄相配的正常眼为对照组以同样方法行3D-OCT黄斑旁四个方位的神经上皮厚度测量。两组用同种方法行常规黄斑部m ERG检查。所有数据应用SPSS13.0统计软件进行处理,分析3D-OCT与m ERG在影像学方面的相关性。结果:两组被检查者检查结果经统计学处理后对比发现:被检查者黄斑中央5°、10°区域N1、P1波反应密度绝对值与黄斑中心凹神经上皮层厚度具有显著的相关性(P0.05)。结论:糖尿病性黄斑水肿的神经上皮厚度的改变与黄斑区m ERG的改变具有显著相关性,主要表现为黄斑中央5°和10°区域m ERG各波反应密度的改变,且有神经上皮厚度增加的越大,m ERG各波反应密度的降低的幅度也随之变大的趋势。     

离子导入疗法对防治糖尿病视网膜病变及改善症状的临床研究

目的：探讨离子导入疗法对糖尿病视网膜病变患者进行护理的临床效果。方法：选取88例（122眼）糖尿病视网膜病变患者,随机分为照组和实验组,其中对照组44例（58眼）,给予常规护理治疗;实验组44例（64眼）,在对照组基础上采用离子导入疗法进行护理。观察患者视网膜改变、视力的改善及自觉症状改善情况。结果：实验组实施干预后,视网膜改变、视力的改善、自觉症状的改善显效率明显高于对照组,差异有统计学意义（P〈0．01）。结论：离子导入疗法有助于改善糖尿病视网膜病变患者眼底血液循环。促进出血点吸收、改善临床症状,操作简单易行,患者易于接受。     

雷珠单抗玻璃体内注射对早产儿视网膜病变患儿临床疗效及视网膜功能发育的影响

目的:探讨雷珠单抗玻璃体内注射对早产儿视网膜病变(ROP)患儿临床疗效及视网膜功能发育的影响。方法:收集2014年6月～2018年6月我院收治的80例ROP患儿,随机分为对照组和观察组各40例,对照组患儿采用激光治疗方案,观察组患儿采用雷珠单抗玻璃体内注射治疗方案。比较治疗后两组疗效和复发情况;随访6个月,采用闪光视网膜电图(F-ERG)检查治疗后视网膜功能的发育状况。结果:治疗后,观察组病变控制率明显高于对照组,病变进展率和复发率明显低于对照组(P0.05);F-ERG检查结果显示,对照组视杆细胞系统反应振幅较观察组明显降低,潜伏期较观察组明显延长,最大混合反应a、b波振幅明显低于观察组(P0.05);两组间最大混合反应波振幅比值b/a、潜伏期比较差异无统计学意义(P0.05)。两组间视锥细胞反应a波潜伏期及a、b波振幅比较差异无统计学意义(P0.05);对照组视锥细胞反应b波潜伏期明显比观察组延长,震荡电位(Ops)比观察组明显降低(P0.05)。结论:雷珠单抗玻璃体内注射治疗ROP患儿,疗效确切,操作简单且快速,视网膜功能的发育比激光治疗更趋向正常,适用于ROP患儿。     

雷珠单抗联合视网膜激光光凝术对BRVO继发黄斑水肿患者视网膜电图P1波及生活质量的影响

目的:探讨雷珠单抗联合视网膜激光光凝术对视网膜分支静脉阻塞(BRVO)继发黄斑水肿患者视网膜电图P1波及生活质量的影响。方法:选取2017年1月~2019年8月期间我院收治的BRVO继发黄斑水肿患者60例,根据随机数字表法分为对照组(n=30)和研究组(n=30),对照组患者予以雷珠单抗治疗,研究组则在对照组的基础上联合视网膜激光光凝术治疗,比较两组患者疗效、视网膜电图P1波、生活质量及不良反应。结果:研究组治疗后6个月的临床总有效率为93.33%(28/30),高于对照组的70.00%(21/30)(P<0.05)。两组患者治疗后1个月、治疗后3个月、治疗后6个月健康调查简表(SF-36)评分均升高,且研究组高于对照组(P<0.05)。两组治疗后6个月视力升高,黄斑中心视网膜厚度(CMT)、眼压降低(P<0.05);研究组治疗后6个月视力高于对照组,CMT、眼压低于对照组(P<0.05)。研究组治疗后6个月1环、2环、3环的P1波振幅密度高于对照组(P<0.05);而1环、2环、3环的P1波潜伏期低于对照组(P<0.05)。两组不良反应发生率对比无差异(P>0.05)。结论:BRVO继发黄斑水肿患者经视网膜激光光凝术联合雷珠单抗治疗后,疗效显著,可有效提高视力及生活质量,改善黄斑水肿及病变区域的视网膜功能,且不增加不良反应发生率。     

消栓通络胶囊辅助治疗单纯型糖尿病视网膜病变的临床疗效研究

目的：探讨消栓通络胶囊治疗单纯型糖尿病视网膜病变的临床效果。方法：选取68例（68眼）糖尿病视网膜病变患者,随机分为照组和试验组,其中对照组34例（34眼）,给予基础治疗;试验组34例（34眼）,在对照组基础上加用消栓通络胶囊口服进行治疗。观察两组患者治疗后视网膜改变、视力的改善及自觉症状改善情况,并检测两组患者视网膜黄斑厚度及血流变指标。结果：治疗后,两组自觉症状的改善率比较差异无统计学意义（P〉0．05）,试验组视网膜改变、视力改善的总有效率显著高于对照组（P〈0．05）,视网膜黄斑厚度显著小于对照组（P〈0．05）,血流变指标的改善率显著高于对照组,差异均有统计学意义（P〈0．05）。结论：消栓通络胶囊辅助治疗单纯型糖尿病视网膜病变的患者疗效好,能改善患者的眼底血液循环,促进出血点、黄斑吸收。     

红参粉末治疗糖尿病视网膜病变的临床观察

目的：观察红参粉末治疗糖尿病视网膜病变的临床效果。方法：随机选取2012年1月至2012年12月在我院接受治疗的2型糖尿病合并糖尿病视网膜病变（Diabetic Retinopathy,DR）患者103例。其中30例（57眼）仅采用常规方法治疗,即对照组;其余73例（125眼）在常规治疗的基础上加用红参粉末,即观察组。治疗180天后,观察并比较两组患者的视力、眼底镜、荧光血管造影等检查结果的变化情况。结果：在观察组中,患者经红参粉末治疗后的视力与治疗前相比有所提高,差异具有统计学意义（P〈0．05）;而对照组中,患者治疗前后的视力变化无统计学意义（P〉0．05）;观察组治疗有效率为76．7％,而对照组治疗有效率为46．7％,差异有显著意义（P〈0．05）。观察组中,男性DR患者治疗有效率为68．8％、女性为92．0％;早期DR治疗有效率为85．4％、晚期为65．1％;糖尿病病程不超过10年的DR患者治疗有效率为88．9％、超过10年的为64．9％,差异均具有统计学意义（P〈0．05）。结论：尽早的发现和及时的治疗可减少糖尿病患者视网膜病变的发生率,从而避免因视网膜病变而引起的严重的视力下降,甚至失明。红参粉末治疗糖尿病视网膜病变有显著的临床效果,特别是对早期糖尿病视网膜病变的疗效更佳,值得临床推广。     

玻璃体腔注药联合微创玻璃体切除治疗糖尿病视网膜病变的临床疗效研究

目的:探讨玻璃体腔注药联合微创玻璃体切除治疗糖尿病视网膜病变的临床疗效。方法:选择2014年1月至2016年1月在我院确诊并治疗的增生性糖尿病视网膜病变患者80例,共83只患眼,随机分为A、B两组。A组共42例患眼,接受25 G玻璃体微创手术;B组共41例患眼,在A组治疗的基础上给予玻璃体腔注射康柏西普。比较两组患者的手术情况、治疗前后最佳视力的矫正(Best-corrected visual acuity,BCVA)情况、视网膜厚度以及术后1个月不良反应的发生情况。结果:B组患者的手术时间较A组显著缩短(P0.05),且术中使用电凝的患眼、术中出血以及术中发生医源性裂隙的患眼比例显著低于A组(P0.05),新生血管消失的患眼比例显著高于A组(P0.05)。B组患者术后1个月和3个月的BVCA显著高于A组(P0.05),且术后视网膜的厚度显著薄于A组(P0.05),术后发生玻璃体积血和前方出血的患眼比例显著低于A组(P0.05)。结论:玻璃体腔注射康柏西普联合25G玻璃体微创切除术治疗增生性糖尿病视网膜病变的临床疗效显著,有利于患者术后视力以及视网膜恢复。     

Association between retinal neuronal degeneration and visual function impairment in type 2 diabetic patients without diabetic retinopathy

The changes in retinal thickness and visual function in type 2 diabetic patients without clinical evidence of diabetic retinopathy were evaluated. A total of 141 diabetic subjects without retinopathy and 158 healthy subjects were enrolled in this study. Superior macular ganglion cell complex thicknesses were significantly decreased in diabetic cases, and no significant peripapillary retinal nerve fiber layer thickness changes were observed. The contrast sensitivities at all space frequencies were significantly different between diabetic patients and controls. The mean P50 amplitude from pattern electroretinogram results was reduced significantly in the diabetic group. In the diabetic group, average superior ganglion cell complex thicknesses positively correlated with both contrast sensitivities at high spatial frequencies and P50 amplitudes. The results indicated that ganglion cell complex thickness and visual function changes could be observed in diabetic subjects before the onset of any significant diabetic retinopathy. Macular ganglion cell complex reduction occurred much earlier than peripapillary retinal nerve fiber layer thinning in diabetic patients without retinopathy.     

N70 and P100 can be independently affected in multiple sclerosis

We have studied the relationship between N70 and P100 of the pattern visual evoked potential in 98 patients with multiple sclerosis and in 59 controls. In patients with multiple sclerosis, P100 was either absent or had prolonged latency in 121 eyes (61.7%), while N70 was absent or prolonged in 97 eyes (49.5%). The total number of eyes with either N70 and/or P100 abnormalities was 137 (69.9%). Eighty eyes (40.8%) had abnormal latency of both P100 and N70, while 41 eyes showed P100 delays without corresponding N70 changes. Seventeen eyes had abnormal N70, but normal P100 latency. N70 and P100 appear to be more often absent in the definite rather than in the possible multiple sclerosis group. These data show that N70 and P100 can be independently affected in patients with MS.     

单眼远视性弱视儿童P-VEP检查的临床研究

目的:分析单眼远视性弱视儿童图形视觉诱发电位(P-VEP)检查情况,探讨外周发病机制,为临床诊疗提供依据。方法:选取2013年1月到2015年10月我院收治的单眼远视性弱视儿童75例(75只眼),另选取同期正常儿童32例(64只眼)为对照组,根据病情将弱视儿童分为轻度(A组)和对侧健眼组(B组),中度(C组)和对侧健眼组(D组),重度(E组)和对侧健眼组(F组),应用P-VEP检查各组P100波及振幅。结果:A组、C组、E组P100波潜伏期较B组、D组、F组和对照组延长(P0.05),振幅较B组、D组、F组和对照组降低(P0.05),A组、C组和、E组P100波潜伏期和振幅比较具有统计学意义(P0.05),B组、D组、F组P100波潜伏期与对照组无统计学意义(P0.05),B组、D组、F组振幅显著低于对照组(P0.05),B组、D组、F组P100波潜伏期和振幅比较无统计学意义(P0.05)。结论:单眼远视性弱视儿童弱视眼会出现P100波潜伏期延长,振幅降低,对侧健康眼会出现振幅降低。     

Apoptotic factors (Bcl-2 and Bax) and diabetic retinopathy in type 2 diabetes

The expression of apoptotic factors Bcl-2 and Bax were studied in the conjunctiva of diabetic patients with and without retinopathy. All patients underwent a complete ophthalmic examination including ocular fundus and retinal fluorescein angiography. The indirect immunoperoxidase method was performed on 15 normal conjunctiva taken during cataract surgery (group 1), on 40 eyes of 40 patients with type 2 diabetes without diabetic retinopathy (group 2) and 13 eyes of 13 patients with diabetic retinopathy (group 3). In normal human conjunctiva, Bax showed positive expression in epithelial, vascular and stromal cells whereas Bcl-2 staining was negative. In the conjunctiva of diabetic patients without diabetic retinopathy, Bax was widely, and strongly, expressed in epithelial cells, vascular endothelial cells, fibroblasts and infiltrating cells such as macrophages. For patients with diabetic retinopathy, Bax was consistently strong to very strong. Bcl-2 protein expression became weak to negative for diabetic patients both with and without diabetic retinopathy. Immunoreactivity was not correlated between Bcl-2 and Bax in the conjunctiva of diabetic patients. Bax was always localized in tissues characterized by a high rate of apoptosis, whereas, Bcl-2 was absent. Our results suggest that diabetic human conjunctiva, with its inflammatory phenomena, is considered as a privileged target for programmed cell death.     

Adhesion molecules (ICAM-1 and VCAM-1) and diabetic retinopathy in type 2 diabetes

The expression of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) were studied in the conjunctiva of diabetic patients with and without retinopathy. All patients underwent a complete ophthalmic examination including ocular fundus and retinal fluorescein angiography. The indirect immunoperoxidase method was performed on 15 normal conjunctivas taken during cataract surgery (group 1), on 40 eyes of 40 patients with type 2 diabetes without diabetic retinopathy (DR) (group 2) and 13 eyes of 13 patients with DR (group 3). ICAM-1 and VCAM-1 are located in epithelial cells, vascular endothelial cells and in stromal cells. Our results show a statistically significant increase in the immunohistochemical expression of these proteins in the conjunctiva of diabetic patients with and without DR in comparison with normal conjunctiva (P = 0.001). Noteworthy, ICAM-1 and VCAM-1 are upregulated in the conjunctiva of diabetic patients with and without retinopathy, reflecting the inflammatory nature of this condition and suggesting a possible role for these mediators in the pathogenesis of diabetic microangiopathy.     

贝伐单抗辅助的23G玻璃体切割术治疗严重增生性糖尿病视网膜病变的疗效观察

目的：2011年,我国糖尿病患者人数高达9240万。糖尿病视网膜病变（diabeticretinopathy,DR）作为糖尿病患者的常见并发症,在糖尿病人群中的患病率为37％,是导致成人获得性盲的最主要原因之一。严重增生性糖尿病视网膜病变以牵拉性视网膜脱离、玻璃体出血为特征,具有致盲率大,手术难度高等特点。针对与此,本文主要探讨术前注射贝伐单抗对23G玻璃体切割手术治疗严重增生性糖尿病视网膜病变患者效果的影响。方法：回顾性病例对照研究。共收集严重增生性糖尿病视网膜病变患者70例,药物辅助手术组（A组）21例,术前3—7天行玻璃体腔注射贝伐单抗（1．25mg／O．05mL）;单纯手术组（B组）49例,行23G玻璃体切割术。分析两组术前及术后视力、手术时间、医源性裂孔、电凝、术后出血的不同。结果：在术后3月,两组视力提高有统计学意义（P〈O．05）。A组平均手术时间为74分钟,而B组平均手术时间为85分钟（P〉0．05）。医源性裂孔在A组中有1例,而B组中有16例（P〈0．05）,在A组中有3例使用电凝,B组中有25例使用电凝（P〈0．05）。A组有1例出现术中及术后出血,B组为20例（P〈O．05）。结论：在这个回顾性研究中,我们发现对于严重增生性糖尿病视网膜病变的病人,术前玻璃体腔注射1．25mg／O．05ml贝伐单抗可以显著减少医源性裂孔的发生,减少术中电凝使用及术中术后出血的发生。     

Implicit Processing of the Eyes and Mouth: Evidence from Human Electrophysiology

The current study examined the time course of implicit processing of distinct facial features and the associate event-related potential (ERP) components. To this end, we used a masked priming paradigm to investigate implicit processing of the eyes and mouth in upright and inverted faces, using a prime duration of 33 ms. Two types of prime-target pairs were used: 1. congruent (e.g., open eyes only in both prime and target or open mouth only in both prime and target); 2. incongruent (e.g., open mouth only in prime and open eyes only in target or open eyes only in prime and open mouth only in target). The identity of the faces changed between prime and target. Participants pressed a button when the target face had the eyes open and another button when the target face had the mouth open. The behavioral results showed faster RTs for the eyes in upright faces than the eyes in inverted faces, the mouth in upright and inverted faces. Moreover they also revealed a congruent priming effect for the mouth in upright faces. The ERP findings showed a face orientation effect across all ERP components studied (P1, N1, N170, P2, N2, P3) starting at about 80 ms, and a congruency/priming effect on late components (P2, N2, P3), starting at about 150 ms. Crucially, the results showed that the orientation effect was driven by the eye region (N170, P2) and that the congruency effect started earlier (P2) for the eyes than for the mouth (N2). These findings mark the time course of the processing of internal facial features and provide further evidence that the eyes are automatically processed and that they are very salient facial features that strongly affect the amplitude, latency, and distribution of neural responses to faces.     

Auditory event-related potentials in adult patients with Gilles de la Tourette's syndrome in the oddball paradigm

In 20 Tourette patients and 20 control subjects auditory event-related potentials evoked in an oddball paradigm were studied in 2 conditions: a non-motor condition (NMC) in which subjects had to attend tones, and a motor condition (MC) in which they had to press a microswitch to deviant tones. In the NMC patients had a reduced P2 in response to the standards. The deviant-standard subtraction wave forms of the NMC showed a discernible MMN-P165-N2b-P3 complex in the controls, whereas in the patients only the P3 was well developed. In the MC patients had a reduced N1 to the standards. Both groups showed in the deviant-standard subtraction wave forms a clear MMN-P165-N2b-P3 complex, N2b being reduced in the patients. In the patients the P2 amplitude and latency to the standards and in the controls the N2b amplitude in the deviant-standard subtraction wave form were larger in the MC than in the NMC. Both groups also showed a larger P3 and a larger parietal slow positive wave in the MC than in the NMC.The results are discussed in relation to behavioural and neuropsychological disturbances found in Gilles de la Tourette's syndrome.