糖尿病性视网膜病变早期mfERG的研究

目的:探讨糖尿病患者糖尿病性视网膜病变早期多焦视网膜电图(multifocal electroretinogram,mfERG)的特点。方法:应用德国ROLAND公司RETIscan系统对24例40眼糖尿病患者,同时对27例40眼正常对照眼记录mfERG。按机器的默认值一阶反应进行记录。整个记录过程中可以分为12个时段,每个时段记录为时间47秒。结果:mERG测得的糖尿病患者组1～5环所在位置的P1波的振幅密度随离心度的增加而降低,P1波和N1波幅值降低和潜伏时延迟。各象限的P1、N1波振幅密度、波幅值降低,潜伏时延迟。结论:糖尿病性视网膜病变受累的区域多发生在黄斑部,功能上的改变早于形态学的变化;病变的早期功能改变最先出现于视网膜的后极偏颞上方;糖尿病患者在未出现眼底改变时各个象限视网膜的外层已经严重受累。     

黄斑部视网膜前膜患者手术前后黄斑区结构变化及与视功能预后的关系

目的:探讨黄斑部视网膜前膜患者手术前后黄斑区域结构变化情况,及其与患者术后视功能的关系。方法:对2014年2月-2016年8月间在我院进行手术治疗的黄斑部视网膜前膜患者60例(60眼)的临床资料进行回顾性分析。所有患者均进行光学相干断层扫描(OCT)检查,观察黄斑中心凹及各方位视网膜厚度变化,同时记录患者手术前后最佳矫正视力(BCVA),分析其相关性。结果:术后53例(53眼)患者视力提高,占88.33%,7例(7眼)患者视力不变,占11.67%。术前患者BCVA为(0.18±0.07),术后3个月BCVA为(0.38±0.12),术后3个月BCVA较术前显著提高(P0.05)。患者术后黄斑中心凹厚度、内环颞侧厚度、内环鼻侧厚度、内环上方厚度、内环下方厚度、外环颞侧厚度、外环鼻侧厚度、外环上方厚度、外环下方厚度较术前均显著降低,差异具有统计学意义(P0.05)。经Pearson相关分析显示,患者术前黄斑中心凹厚度、内环颞侧厚度、外环颞侧厚度、术前后黄斑中心凹厚度差值、术前后内环颞侧厚度差值、术前后外环颞侧厚度差值与术后BCVA呈负相关(P0.05)。结论:玻璃体切除术可以显著降低黄斑部视网膜前膜患者黄斑区视网膜厚度,提高患者视功能,术前黄斑区域形态对患者术后视力恢复有一定影响。     

OCTA用于检测不同屈光人群的黄斑区视网膜密度和厚度及其相关性分析

目的:采用光学相干断层扫描血管成像技术(OCTA)检测不同屈光人群的黄斑区视网膜密度及厚度并分析其相关性。方法:选取2016年2月～2018年2月我院收治的近视患者200例为研究对象,根据等效球镜度数的差异将其分为轻度近视组(-0.50～-2.75D)52例、中度近视组(-3.00～-5.75D)46例、高度近视组(-6.00～-8.75D)48例、超高度近视组(≤-0.90D)54例。所有患者均进行OCTA检测,比较各组患者黄斑区不同区域视网膜血管密度以及厚度的差异。结果:轻度近视组、中度近视组、高度近视组、超高度近视组等效球镜均呈逐渐降低趋势,而眼轴长度均呈逐渐升高趋势,各组间对比差异有统计学意义(P0.05)。超高度近视组患者中心凹、中心凹旁、颞侧、上方、鼻侧、下方视网膜血管密度和中心凹、中心凹旁、颞侧、上方、鼻侧、下方视网膜厚度相比轻度近视组、中度近视组、高度近视组均显著降低(P0.05)。经Pearson相关性结果显示:近视屈光人群的黄斑中心凹以及上方视网膜血管密度以及视网膜厚度呈正相关关系(P0.05)。结论:采用OCTA检测不同屈光人群的黄斑区视网膜密度及厚度,结果表明近视屈光度患者的黄斑区视网膜密度增加以及黄斑区视网膜厚度的增厚呈正相关关系。     

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。     

经直接与间接通路的视动震颤(OKN)眼动反应

采用鼻向及颞光栅图形刺激猫的半侧视网膜,以探讨鼻侧半神网膜至视束核的视动震颤直接通路及颞侧半视网膜经皮层至ＮＯＴ的间接通路对ＯＫＮ眼动反应的神经控制特性。实验结果显示：高速度刺激的闭环ＯＫＮ反应及开环ＯＫＮ反应均对鼻向运动刺激有明显的方向选择性;半侧视网膜刺激时,鼻侧半视网膜的鼻向ＯＫＮ增益明显高于颞侧半视网膜的鼻向增益,说明猫的ＫＯＮ眼动反应以跟踪鼻向运动为主,并且这种对鼻向运动刺激选择性主要来     

不同方向撕除内界膜方式对特发性黄斑裂孔术后视网膜位移的影响

目的:比较玻璃体切割切术中不同方向撕除内界膜对特发性黄斑裂孔愈合后视网膜位移、视功能的影响。方法:纳入特发性黄斑裂孔患者25例(25眼),按照术中内界膜(ILM)撕除方向,以1:1随机分为NS-TI组(13眼)和TI-NS组(12眼)。NS-TI组患者接受内界膜撕除方向为鼻上起瓣,向颞下方向撕除ILM;TI-NS组患者接受内界膜撕除方向为颞下起瓣,向鼻上方向撕除ILM。术前、术后1月、术后3月采集患者自发荧光照相,通过影像学上血管标记点或交叉点的位置计算黄斑视盘距离(FMD)、颞侧血管至视盘距离(T-OD)、鼻侧血管至视盘距离(N-OD)、黄斑区垂直血管距离(VIAD)、黄斑区水平血管距离(HIAD)、黄斑区面积(PMA)。对比两种撕膜方式后术后1月、3月视网膜位移(包括FMD、T-OD、N-OD、VIAD、HIAD、PMA)、裂孔闭合率,术后最佳矫正视力,分析两种撕膜方式的异同。结果:术后1月及3月,两组患者的视网膜皆向视盘方向偏移,表现为FMD、T-OD、N-OD、VIAD、HIAD、PMA五项指标均较术前增大(p 0.05)。术后1月及3月,NS-TI组和TI-NS组FMD、T-OD、N-OD、VIAD、HIAD、PMA、黄斑裂孔愈合率(皆100%)和最佳矫正视力比较差异均无统计学意义(P0.05)。结论:不同方向撕除内界膜不是特发性黄斑裂孔术后视网膜位移的影响因素。     

氩激光光凝建立兔视网膜静脉阻塞模型及其评价

目的制备视网膜中央静脉阻塞的动物模型,为视网膜中央静脉阻塞疾病的研究提供稳定的模型。方法采用氩激光直接光凝法封闭兔眼视网膜静脉建立视网膜静脉阻塞模型,利用HE染色法观察正常兔及造模后3周兔视网膜组织中视网膜新生血管的增生情况,利用免疫组化法观察正常兔及造模后3周兔视网膜组织中血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达,并检测造模前及造模后3周闪光视网膜电流图(flash electroretinogram,FERG)。结果兔视网膜静脉阻塞(retinal vein occlusion,RVO)眼可见明显的视网膜新生血管增生,缺血视网膜及新生血管组织中VEGF不同程度表达增强,FERG-b波的振幅明显下降(P<0.01)。结论采用氩激光直接光凝法建立视网膜静脉阻塞模型是成功的。     

眼科常用实验动物视网膜血管的比较

目的比较眼科常用实验动物视网膜血管尤其是视网膜毛细血管的情况,为实验时正确选择动物模型提供基础。方法取猕猴、家猪、新西兰大白兔、犬、猫、SD大鼠、C57小鼠以及豚鼠的正常眼球数个,完整剥离整个视网膜,用ADPase法进行血管染色,对视网膜血管进行形态学的比较。结果猕猴视网膜大血管从视盘穿出,分成四支分别供应视网膜四个象限,每条血管逐级分支最后成为毛细血管,其毛细血管呈网状分布,在赤道处分成两层,至周边变成一层,且有发育良好的黄斑区毛细血管拱环结构。家猪视网膜大血管由视盘发出后放射状走行,毛细血管也呈网状分布,无黄斑拱环结构。兔仅视盘两侧部分视网膜可见血管,毛细血管网状不明显。犬的视网膜血管也放射状走行,但迂曲明显,毛细血管不成网状。猫、大鼠、小鼠的视网膜大血管均由视盘发出,猫的分成上、鼻下、颞下三支,大鼠、小鼠的各方向均有,区域性不明显,三者的毛细血管网均发育良好,至周边部仍很密集,呈两层分布。豚鼠视网膜无可见的血管。结论用于研究人视网膜血管尤其是毛细血管时,可选用猕猴、家猪、猫、大鼠和小鼠作为动物模型;但要研究人黄斑区血管时,仅可选用猕猴等灵长类动物。     

玻璃体腔联合注射赖氨酸－纤溶酶原和瑞替普酶诱导兔眼玻璃体后脱离的有效性

目的:探讨兔眼玻璃体腔联合注射赖氨酸-纤溶酶原和瑞替普酶诱导玻璃体后脱离(PVD)的有效性。方法:选取30只健康的新西兰白兔,以白兔右眼作为实验眼,左眼作为对照眼。随机分为A、B、C三组(每组10只),三组实验眼分别联合应用1万U瑞替普酶+125μg赖氨酸—纤溶酶原、2万U瑞替普酶+125μg赖氨酸—纤溶酶原、3万U瑞替普酶+125μg赖氨酸—纤溶酶原进行玻璃体腔内注射,对照眼均注射平衡盐溶液。应用视网膜电图、扫描电镜及光镜观察、比较各组诱导PVD的效果。结果:三组实验眼均形成不同程度PVD。A组实验眼注药前与注药后24 h、注药后2周的最大混合反应a波振幅、b波振幅比较均无明显差异(P0.05);B组实验眼注药后24 h的a波振幅、b波振幅均有轻度下降,2周后均恢复正常,注药前后的a波振幅、b波振幅比较均无明显差异(P0.05)。C组实验眼注药后24 h的a波振幅、b波振幅均明显低于注药前和对照眼,注药后2周的b波振幅均明显低于注药前和对照眼(P0.05)。光学组织切片观察显示:A组实验眼及所有对照眼、B组实验眼、C组实验眼的视网膜组织细胞形态正常,结构清晰,但B组神经节内核层、细胞层细胞略有减少,C组神经节内核层及细胞层细胞明显减少。结论:玻璃体腔内联合注射赖氨酸-纤溶酶原和瑞替普酶能有效诱导PVD,1万U瑞替普酶+125μg赖氨酸-纤溶酶原可诱导实现完全性PVD,不会对视功能、视网膜结构造成损害。     

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。     

Human Electroretinal Responses to Grating Patterns and Defocus Changes by Global Flash Multifocal Electroretinogram

The electrical response of the retina was examined as a function of retinal region, using stimuli of various spatial frequencies in the first experiment. In the second experiment, the regional response of the retina to defocus at high and low spatial frequencies was investigated. Twenty three subjects were recruited for global flash multifocal electroretinogram (mfERG) in experiment 1. Black and white gratings (printed on plastic transparent sheets) of four spatial frequencies (SF), 0.24, 1.2, 2.4 and 4.8 cycle per degree were presented in front of the mfERG stimulation. The amplitudes and implicit times of the direct (DC) and induced (IC) components of mfERG responses were pooled into six concentric rings for analysis. There was low amplitude DC at low SF, which increased with increasing SF, and which decreased with increasing eccentricity. The IC was high in amplitude at all SF and reduced in amplitude with increasing eccentricity. Our findings suggested that outer and inner retina had different characteristics in processing spatial details. In experiment 2, Twenty-three young adults were recruited for mfERG measurement. The retinal electrical responses for low (0.24cpd) and high (4.8cpd) SF under fully corrected conditions of short-term negative defocus (-2D) and short term positive defocus (+2D) conditions were measured. There was a sign-dependent response to defocus in the DC response, mainly in peripheral regions. The sign dependent response at low SF was more obvious than that at high SF, and was located more peripherally. The IC response showed no clear trends for either defocus condition. The human retina seems to have a decoding system for optical defocus, which was tuned for low spatial frequency, and was located in the retinal near periphery.     

Demyelinating optic neuritis: Optical coherence tomography and multifocal electroretinography data correlation

Optical coherence tomography (OCT) and multifocal electroretinography (mfERG) data using 61 hexagons are presented in three groups of patients: (1) with multiple sclerosis (MS) and optic neuritis (ON) (14 patients), (2) with ON of unknown etiology (19 patients), and (3) with ON of infectious etiology (12 patients). In the patients with MS, the correlation of the latency of the P1 component of mfERG in the parafovea with the retinal thickness in the central zone in all the quadrants of the fundus (except for the superior one) and with the total macular volume has been revealed, which makes it possible to use this mfERG parameter as a marker of MS progression. The results of the current study have demonstrated that the density ratio R₁/R _x may be used as an additional marker of the acute stage in diagnostic process. Patients with ON of infectious etiology were characterized by a decrease in the retinal thickness in the parafoveal zone of the temporal and inferior quadrants and reduction in the density and amplitude of P1 in all the rings.     

Effect of Lycium Barbarum (Wolfberry) Polysaccharides on Preserving Retinal Function after Partial Optic Nerve Transection

Lycium Barbarum Polysaccharides (LBP) are the active components of Wolfberry (a traditional Chinese medicine) which has long been used for improving visual function. This study aims to investigate localized changes of retinal function in a partial optic nerve transection (PONT) model, and effects of LBP on visual function. The multifocal electroretinograms (mfERG) were obtained from 30 eyes of 30 Sprague-Dawley rats. The rats were divided into 6 groups (five treatment groups and one control group). Starting from the first day of the experiment, the rats in the (PONT+LBP) group and the (LBP) group were dosed with LBP; rats in the (PONT+PBS (phosphate buffered saline)) group and the (PBS) group were dosed with PBS via nasogastric tube every day until euthanized. The dorsal part of the optic nerve was transected in the (PONT), (PONT+LBP) and (PONT+PBS) groups at the end of week 1 (day 7 after LBP or PBS feeding began). The mfERG was measured at three time points: week 2, week 3 and week 5. Significant reduction of P1 and PhNR amplitudes of the mfERG were observed in all retinal regions a week after PONT. Feeding with LBP prior to PONT preserved retinal function. All mfERG responses returned to the normal range in the superior retina, which corresponds to the transected dorsal region of the optic nerve, while most of the inferior retinal responses were significantly increased at week 4 after PONT. The ventral part of the retina had secondary degeneration which was not only limited to the ganglion cell layer, but is a widespread effect affecting the outer retina. LBP altered the functional reduction caused by PONT by regulating the signal from the outer retina.     

The skeleton of the eye: II. Overlap of the scleral ossicles of the domestic fowl

The scleral ossicles, a ring of overlapping membrane bones, lie just outside the corneal margin in the eyes of domestic fowl. Eighty percent of the bony rings contain 14 bones; less than 1% have 13 bones; 19% have 15 bones; about 1% have 16 bones. Each bone is foreshadowed during development by a transient papilliform thickening in the overlying conjunctival epithelium. These conjunctival papillae appear on the eighth day of incubation and disappear on the twelfth day, when the corresponding preosseous membranes begin to ossify. Observations, and experiments involving the removal of specific papillae early or late in their maturation (in order to delete, or to reduce the size of, individual bones), demonstrated the following constraints on the morphogenesis of the scleral ossicular ring. (1) The number of ossicles is a function, not only of the number of papillae, but also of the distance between adjacent papillae; when two papillae lie close together, a single ossicle may arise beneath the pair. (2) There are three regions in the ring: nasal, dorsal (in both of which the bones overlap in one direction) and temporal (in which the bones overlap in the opposite direction). (3) The determinants of the direction of overlap between adjacent bones are extrinsic to the ossicles themselves and are distributed throughout each region, rather than confined to the discrete locations within each region where overlap normally occurs. (4) The three places in the ring where these regions meet are characterized by the loss (in 13-membered rings) or the addition (in 15- and 16-membered rings) of papillae and of their corresponding bones, and by transitions in the direction of overlap between the bones.     

ADPβS evokes microglia activation in the rabbit retina <Emphasis Type="Italic">in vivo</Emphasis>

To investigate whether stimulation of purinergic P2Y(1) receptors modulates the activation of microglial and Müller glial cells in the rabbit retina in vivo, adenosine 5'-O-(2-thiodiphosphate) (ADPbetaS; 2 mM in 100 mul saline), a non-hydrolyzable ADP analogue, was intravitreadly applied into control eyes or onto retinas that were experimentally detached from the pigment epithelium. Both retinal detachment and application of ADPssS onto control retinas induced phenotype alterations of the microglial cells (decrease of soma size, retraction of cell processes) and had no influence on microglial cell density. ADPssS application onto detached retinas accelerated the process retraction and resulted in a strongly decreased density of microglial cells. The effects of ADPssS on microglia density and phenotype in detached retinas were partially reversed by co-application of the selective inhibitor of P2Y(1) receptors, MRS-2317 (3 mM in 100 mul saline). ADPssS apparently did not influence Müller cell gliosis, as determined by electrophysiological and calcium imaging records. It is concluded that rabbit retinal microglial cells express functional P2Y(1) receptors in vivo, and that activation of these receptors stimulates phenotype alterations that are characteristical for microglia activation.     

Age-related decrease in rod bipolar cell density of the human retina: an immunohistochemical study

During normal ageing, the rods (and other neurones) undergo a significant decrease in density in the human retina from the fourth decade of life onward. Since the rods synapse with the rod bipolar cells in the outer plexiform layer, a decline in rod density (mainly due to death) may ultimately cause an associated decline of the neurones which, like the rod bipolar cells, are connected to them. The rod bipolar cells are selectively stained with antibodies to protein kinase C-α. This study examined if rod bipolar cell density changes with ageing of the retina, utilizing donor human eyes (age: 6–91 years). The retinas were fixed and their temporal parts from the macula to the mid-periphery sectioned and processed for protein kinase C-α immunohistochemistry. The density of the immunopositive rod bipolar cells was estimated in the mid-peripheral retina (eccentricity: 3–5 mm) along the horizontal temporal axis. The results show that while there is little change in the density of the rod bipolar cells from 6 to 35 years (2.2%), the decline during the period from 35 to 62 years is about 21% and between seventh and tenth decades, it is approximately 27%.