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 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 investigate the correlation of microperimetric parameters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME) eyes. Methods It is a prospective, no controlled, open study. Twenty-four consecutive patients (40 eyes) with DME were included. There were 10 males (18 eyes),14 females (22 eyes); aged from 41 to 79 years, with the mean age of (56.84±8.96) years. All the patients were type 2 diabetes, the average duration of diabetes was 8 years. BCVA was evaluated using the international Snellen E vision test chart, and then recorded as logarithm of the minimum angle of resolution (logMAR). CRT was measured by Cirrus HD-OCT4000. MAIA microperimetric parameters were evaluated, including average threshold (AT) of retinal sensitivity, macular integrity index (MI), fixating points within a circle of 1° (P1) and 2° of radius (P2), bivariate contour ellipse area (BCEA) considering 63% and 95% of fixating points (A63,A95), and horizontal and vertical axes of that ellipse (H63,H95,V63,V95). Pearson correlation analysis was performed to evaluate the association between these variables. The independent factor influenced the type of fixation was analyzed by multiple linear regression analysis. Results Strong correlations of logMAR BCVA with CRT (r=0.58,P=0.000), V63 (r=0.44,P=0.004), V95 (r=0.41,P=0.008), MI (r=0.36,P=0.024), AT (r=−0.61,P=0.000), P1 (r=−0.41,P=0.009), P2 (r=−0.38,P=0.015) were found. AT was correlations with P1 (r=0.53,P=0.000), P2 (r=0.51,P=0.001), A63 (r=−0.39,P=0.012), A95 (r=−0.40,P=0.012), V63 (r=−0.53,P=0.000), V95 (r=−0.46,P=0.003), MI (r=−0.50,P=0.001). There was no correlation between AT and CRT (r=−0.21,P=0.190). Forty eyes were included in this study, 8 eyes (20%) had stable fixation,14 eyes (35%) had relatively unstable fixation,18 eyes (45%) had unstable fixation. Multiple linear regression analysis showed that fixation classification was independently affected by P1. Conclusions In DME eyes, logMAR BCVA was positively correlated with CRT, negatively correlated with AT, P1 and P2. There is no correlation between AT and CRT. The fixation classification was independently affected by P1.
Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR). Methods A prospective clinical studies. Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No. 306 Hospital of PLA during January 2014 and December 2015 were included in this study. Among them, 21 eyes of NPDR and 20 eyes of PDR; 13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group). All eyes underwent best corrected visual acuity (BCVA), fundus color photography, fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations. The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field). The BCVA of DR eyes was 0.81±0.28; the VFI and MD values were (89.8±8.4)% and −7.5±3.85 dB, respectively. The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27, the VFI were (90.86±7.86)% and (87.46±9.41)%, the MD values were −6.86±3.43 and 8.87±4.48 dB. PRP was performed on eyes using 577 nm krypton laser. The changes of VFI, MD and BCVA were observed at 1, 3, and 6 months after treatment. Results Compared with before treatment, the VFI of DR eyes decreased by 12.0%, 12.3% and 14.8% (t=7.423, 4.549, 4.79; P＜0.001); the MD values were increased by −4.55, −4.75, 6.07 dB (t=−8.221, −5.313, −5.383; P＜0.001) at 1, 3 and 6 months after treatment, the differences were statistically significant. There was no difference on VFI (t=1.090, −0.486; P＞0.05) and MD value (t=−0.560, −0.337; P＞0.05) at different time points after treatment. Compared with before treatment, the BCVA was significantly decreased in DR eyes at 1 month after treatment, the difference was statistically significant (t=2.871, P＜0.05). Before and after treatment, the BCVA of the DME group was lower than that of the non-DME group, the difference were statistically significant (t=4.560, 2.848, 3.608, 5.694; P＜0.001); but there was no differences on the VFI (t=1.209, 0.449, 0.922, 0.271; P＞0.05) and MD values (t=1.582, 0.776, 0.927, 1.098; P＞0.05) between the two groups. Conclusion The range of 30° visual field loss is about 12%-14.8% after 577 nm krypton laser PRP for DR. VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.
Objective To observe the characteristics of multifocal microperimetry and its relationship with visual acuity and multifocal ganglion cell complex (GCC) in nonarteritic anterior ischemic optic neuropathy (NAION). Methods A retrospective case study. A total of 38 patients (54 eyes) with NAION were enrolled in this study. 25 NAION eyes (25 patients) and 29 contralateral health eyes (29 patients) were randomly selected into case group and control group respectively. All eyes underwent best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscope, color fundus photography, optical coherence tomography (OCT), visual field and multifocal microperimetry. Logarithm of the minimum angle of resolution (logMAR) was used to calculate BCVA. There were no significantly differences on age (t=−0.647), gender, dominant eyes ( χ2=0.128, 0.099), intraocular pressure (t=0.376) between two groups (P>0.05). Macular GCC thickness, superior and inferior GCC thickness were measured by OCT, focal loss volume (FLV) and global loss volume (GLV) were obtained at the same time. Microperimetry were measured by macular integrity assessment instrument (MAIA microperimetry), and mean retinal sensitivities (MS) in macular area 10° and fixation rate in the macular central 2° and 4° were determined. The relationship between MS, macular GCC and BCVA were analyzed by Spearman correlation analysis. Results The mean logMAR BCVA of case group and control group were 0.68±0.79 and 0.07±0.06, respectively. There was significantly statistical difference in MS between two groups (t=−2.507, P=0.037). There were no significantly statistical difference in mean GCC (t=−1.245, P=0.259), superior and inferior GCC (t=−1.336, −1.024; P=0.230, 0.346), FLV (t=1.058, P=0.331) and GLV (P=0.182) between two groups. The correlation between BCVA and MS (r=−0.809, P=−0.005) was observed. However, there were no correlation between BCVA and GCC, superior and inferior GCC, FLV, GLV (r=−0.98, −0.466, −0.061, 0.442, 0.442; P=0.817, −0.244, 0.885, 0.273, 0.273). And also, there were no correlation between MS and GCC, superior and inferior GCC, FLV, GLV (r=0.238, 0.524, 0.286, 0.643, −0.619; P=0.570, 0.183, 0.493, 0.086, 0.102). Conclusions MS reduced in early stage NAION eyes, which did not correlate with macular GCC.
ObjectiveTo investigate the correlation of visual sensitivity, best corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME).MethodsA retrospectives study. Forty-five eyes of 30 patients in DME were included. There were 20 eyes of 16 males, 25 eyes of 14 females, with an average age of 54.49±7.45 years. All the patients had type 2 diabetes; the average duration of diabetes was over 10 years. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithmic logarithm (logMAR) visual acuity. The following parameters provided by the MAIA microperimetric device were evaluated, including average threshold (AT), macular integrity index (MI), fixation indexes (P1 and P2), bivariate contour ellipse area (BCEA) for 63% and 95% of points, and horizontal and vertical axes of the ellipse of fixation (H63, H95, V63, V95). The CRT was measured and the integrity of the ellipsoidal band was observed by optical coherence tomography (OCT). The integrity of the ellipsoid band was divided into continuous smooth (group A): fully visible; part of the light band was interrupted (B group): not completely visible; missing light band (C group): completely invisible. Pearson correlation analysis was used to analyze the correlation between the factors; non-parametric tests were used to compare the logMAR BCVA, AT, and CRT between the different ellipsoid zone integrity groups; multiple linear regression analysis was used to analyze factors related to AT.ResultsPearson correlation analysis showed that the logMAR BCVA was positively correlated with MI (r=0.303, P=0.04) and CRT (r=0.342, P=0.02), negatively correlated with AT (r=−0.59, P=0.00) and P1 (r=−0.38, P=0.01). There was negative correlation between AT and MI (r=−0.55, P=0.00). The result of multivariate linear regression analysis showed that the logMAR BCVA is inversely correlated with AT (t=−3.53, P=0.001). Group A, B and C were 23, 17 and 5 eyes in the 45 eyes, respectively. There were significant differences in logMAR BCVA, AT, and CRT between the three groups of eyes (P=0.045, 0.049, 0.018).ConclusionsIn DME patients, the logMAR BCVA was positively correlated with CRT, negatively correlated with AT and P1. The logMAR BCVA is inversely correlated with AT. Microperimetry combined with OCT and visual acuity can be used to assess the visual function of patients with DME.
ObjectiveTo evaluate visual field changes in early mild Parkinson's disease. Methods A total of 66 eyes of 33 cases with early mild Parkinson's disease and 72 eyes of 36 age-matched normal individuals were enrolled into the study. Humphrey Field Analyzer II was applied for central visual field test. The visual field indices of mean deviation (MD) and pattern standard deviation (PSD) were analyzed to evaluate the location and the characteristics of visual field defect in this study. ResultsVisual field indices MD (-3.4±2.5) dB was significantly changed in patients with PD when compared to the controls (-0.6±1.7) dB. PSD (4.3±2.6) was significantly higher in patients with PD than that in the control group (2.1±1.8) dB. Glaucoma hemifield test (GHT) assessment was within normal limits in the controls. Of the 33 patients (66 eyes) in PD, GHT showed outside normal limits in 31 eyes, borderline in 8 eyes, and within normal limits in 27 eyes. 31 eyes outside normal limits appeared glaucomatous visual field defects, in which 16 with nasal step and 5 with arcuate defect. ConclusionsVisual field indices including MD and PSD in early mild patients with PD were significantly worse than that in the controls group. GHT abnormalities could be found in early mild PD patients with visual field defects, including pericentral scotoma and nasal step, which mimicked glaucomatous changes.
Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation. Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group. There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group, with an average age of (7.0±1.28) years. The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks, the birth weight (BW) of (1402.33±369.61) g and the number of laser burns was (517.86±277.40). The control group included 7 females (13 eyes) and 6 males (12 eyes), with an average age of (7.17±0.96) years. The age (t=0.691) and gender (χ2=1.425) were comparable between the two groups (P=0.491, 0.233). The data of patients and controls were retrospectively analyzed including best corrected visual acuity, refractive examination, automated perimetry test. The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed. ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB), mild VF loss group (MD≤6 dB) and moderate VF loss group (MD＞6 dB) according to the results of automated perimetry test, the differences of gestational age (GA), PA, BW, number of laser burns and SE between these groups were comparatively observed. Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27±3.34 dB, respectively; the difference between the two groups was statistically significant (t=–4.01,P＜0.001). The subgroup analysis showed that BW, number of laser burns, and SE were significantly different between no VF loss group and VF loss group (t=2.074, –1.996, –2.162;P=0.042, 0.026, 0.034); while the GA was not significantly different between these two groups (t=1.973,P=0.052). The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002). For refractive outcomes, the BW and ROP stage correlated with SE significantly (r=–0.304, –0.387;P=0.015, 0.002). The mean BCVA in ROP group was 0.84±0.23, and 59 eyes (91.2%) with BCVA better than 0.5. Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss, with good visual outcome.
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.
ObjectiveTo observe the correlation between the thickness of foveal ganglion cell-inner plexiform layer (GCIPL) and visual field mean defect before and after gamma knife treatment in patients of sellar region tumors with optic chiasmal compression. MethodsThis was a prospective case series. 72 eyes of 37 consecutive patients suffering from optic chiasmal compression of sellar region tumors treated with gamma knife were enrolled in the study. According to the change of visual field before and after gamma knife treatment, the patients were divided into three groups. There were 13 eyes of 7 patients in group 1 with no vision defect pre-and post-treated, 34 eyes of 17 patients in group 2 with improvement of visual field defect after treatment, 25 eyes of 13 patients in groups 3 with no improvement or reorganization of visual field defect after treatment. Overall average thickness of GCIPL, and of the superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal retina were measured with the Cirrus high-definition spectral domain optical coherence tomography, and mean deviation (MD) with the Humphrey field analyzer before and 6 months after treatment. There was no significant difference in MD values between group 2 and 3 pre-treated (t=1.471, P=0.084). There was significant difference between all the groups in total average value of GCIPL thickness and the 6 quadrant GCIPL thickness values pre-treated (P < 0.05). Logistic regression model was applied to analysis of the correlation between GCIPL thickness and the improvement of visual field after treatment. ResultsThe MD values of the group 1, 2 and 3 were (-2.96 ±0.75), (-10.24 ±1.31), (-20.2 ±5.88) dB at 6 months after treatment. There was significant difference between group 2 and 3 of MD value after treatment (t=6.974, P=0.000). In group 1, there was no significant difference in mean GCIPL thickness and the 6 quadrant GCIPL thickness values between pre-and post-treated (t=0.882, P=0.395).The mean thickness of GCIPL, superonasal and inferonasal GCIPL was increased than pre-treated in group 2, and the difference was statistically significant (t=2.438, 4.630, 4.457; P=0.035, 0.001, 0.001). The mean thickness of GCIPL, superonasal and inferonasal GCIPL was decreased than pre-treated in group 3, and the difference was statistically significant (t=-2.387, -4.603, -4.975; P=0.041, 0.002, 0.001).Logistic regression analysis showed that the greater of the value of average GCIPL thickness of patients with visual field defect pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between the value of superonasal or inferonasal GCIPL and the improvement of the visual field post-treated (OR=5.374, 4.693; P=0.000, 0.000). There was no significant correlation between the value of superotemporal or upper or lower or inferotemporal GCIPL and the improvement of the visual field post-treated (OR=1.058, 1.101, 1.074, 1.056; P=0.183, 0.080, 0.162, 0.186). ConclusionsIn patients with optic chiasmal compression of sellar region tumor, the greater of the average GCIPL thickness pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between superonasal or inferonasal value of the GCIPL thickness and the improvement of visual field defect post-treated.