| Part I:Research on the visual function evaluation of patients with advanced glaucomaPurpose:To discuss the characteristics of visual function of bilateral advanced glaucoma with temporal islet field and to identify a more accurate detection to evaluate the visual function.Methods:16outpatients with bilateral advanced glaucoma with temporal islet field from the ENNT Hospital of Fudan University from Feb.2011to Feb.2013were enrolled in the research. The research collected their data of visual acuity, contrast sensitivity, visual field, color vision, optical coherence tomography, visual electrophysiology, fMRI, and the score of the LVQOL questionnaire. The data of visual function were expressed in mean and standard deviation by SPSS11.5. Multiple regression analysis was used to analyze the relationship between the daily visual function and each visual function data. Mathematical modeling will be made to judge the variance proportions and fitting effect.Results:Measured with LogMAR visual chart, the mean subjects’visual acuity was0.042±0.018. With the Matlab physipsychological program, the mean visual acuity under100%contrast sensitivity was0.049±0.019, the mean visual acuity under50%contrast sensitivity is0.048±0.020, the mean visual acuity under25%contrast sensitivity is0.038±0.021, the mean visual acuity under12.5%contrast sensitivity is0.024±0.022. Automatic contrast sensitivity detection indicated that the mean contrast sensitivity threshold is10.359±5.867of6.3°visual angle,11.278±9.133of4.0°visual angle,6.073±6.345of2.5°visual angle,3.363±3.541of1.6°visual angle,0.801±1.873of1.0°visual angle, and0.468±1.297of0.7°visual angle. Goldman kinetic perimetry and Octopus manual peripheral visual field detections showed that all the subjects suffered a10°central scotoma. Microperimetry detection showed that all the subjects have reformed a new fixation point at the non-macular area in the eyes with the better visual acuity, and all the new fixation points are within5°area of nasal optic nerve head. Testing the visual sensitivity threshold within10°area of the fixation point, the mean of the total threshold was434.125±211.242. The results of Panel D-15color vision detection showed that3subjects (18.75%) were total correct,6(37.5%) of minor mistakes,5(31.25%) of red-green abnormal,2(12.5%) of achromatopsia, and no one in the16subjects have yellow-blue abnormal. Retina thickness detection showed that total retina thickness was240.688±22.011um, inner retina thickness with74.063±12.699um, and outer retina thickness with166.625±12.795um. The mfERG detection showed that the N1wave latency was30.694±2.772ms and its value was-10.125±3.138nV/deg2, as well as the P wave latency was42.031±1.971ms and its value was12.250±4.683nV/deg2. fMRI showed that the Beta value of the1st zone of ROI in the primary visual cortex was0.888±0.669,2nd zone with1.140±0.553,3rd zone with1.380±0.532,4th zone with1.390±0.562,5th zone with0.936±0.661, and6th zone with0.543±0.575. The score of LVQOL questionnaire was74.875±16.024. Multiple regression analysis indicated that the N1wave latency of mfERG and the contract sensitivity of6.3°visual angel had statistically significant difference on the effect of the daily visual function, and the optimum regression equation was y=183.817-4.018x1+1.389x2(x1:N1wave latency of mfERG, x2:the contract sensitivity of6.3°visual angel)(R2=0.817, F=28.977, P=0.0000).Conclusions:Visual electrophysiology and contrast sensitivity detection are with the great significance of guidance in evaluating daily visual function of patients with bilateral advanced glaucoma with temporal islet field. Part II:Research on the cortical reorganization mechanism of patients with advanced glaucomaPurpose:To explore the cortical reorganization mechanism in patients with the central scotoma through the observation of the adaptability change of retina and visual cortex in patients with bilateral advanced glaucoma with temporal islet field as well as the comparison of glaucoma patients with unilateral temporal islet field and normal subjects.Methods:36Subjects were enrolled in the study and were divided into three groups. Group A:12patients with bilateral advanced glaucoma with temporal islet field, Group B:12glaucoma patients with unilateral temporal islet field and Group C:12normal subjects. The research detected all subjects’ retina thickness and retinal potential with optical tomography and visual electrophysiology, respectively. Meanwhile, the degree of activation of the primary visual cortex with active task and passive stimulation was observed by means of fMRI. All the data were analyzed by SPSS11.5and expressed in mean and standard deviation. The statistical difference of the means between the groups was analyzed by ANOVA, and further cleared the exact differences between the groups by Bonferrioni analysis. The student t test was used to analyze the statistical difference of the activation degree of primary visual cortex on the condition of active task and passive stimulation. The Spearman analysis was used to clear the correlation between the LVQOL value and Beta values in each ROI.Results:Compared between the groups, there were no statistically significant differences in all three group subjects’thickness of the full, outer and inner retina (P=0.413, P=0.088,P=0.964). Moreover, compared between any groups, there were also no statistically significant differences in all subjects’latencies and values of the N1and P wave in their mfERG(P=0.544, P=0.154, P=0.177, P=0.059). Compared between groups, there were statistically significant differences in Beta value of all three group subjects’1st,2nd,3rd and4th ROI zones in primary visual cortex while performing active tasks (P=0.001, P=0.000, P=0.000, P=0.018). However, there were no significant differences in the Beta value of the5th and6th ROI zone (P=0.208, P=0.229). Through furthering analysis the Beta value of the1st,2nd and3rd ROI zone between the groups by Bonferroni analysis, it indicated that there are statistically significant differences between group A and B, group A and C in the three ROI zones. Nevertheless, there is no significant statistical difference in the Beta between group B and C. On the other hand, there are no statistical differences in the Beta values of all three group subjects’ six ROI zones in primary visual cortex while performing passive stimulus (P=0.365, P=0.520, P=0.349, P=833, P=0.779, P=0.313). Compared with active task and passive stimulus, there are statistically significant differences in group A subjects’ Beta values of all six ROI zones in primary visual cortex (P=0.000, P=0.000, P=0.000, P=0.004, P=0.009, P=0.005). There were no significant statistical differences in the Beta value of all ROIs in group B and C while comparing active task and passive stimulus. On active tasks condition, there was a significant correlation between the Beta value of ROI1and the LVQOL score (r=0.622, P=0.031), while no significant correlation were found between the Beta values of ROI2-6and the LVQOL scores.Conclusions:Compared with glaucoma patients with unilateral temporal islet field and normal subjects, patients with bilateral advanced glaucoma with temporal islet field showed no differences in retinal thickness and potential. Nevertheless, they had much more activation in primary visual cortex with active task and it do exist LPZ activation. All these indicate the existence of the cortical reorganization. Part Ⅲ:Research on the visual training of patients with advanced glaucomaPurpose:To discuss the characteristics of fixation stability in patients with bilateral advanced glaucoma with temporal islet field, and clear the value of fixation stability and visual acuity training in patients with bilateral advanced glaucoma with temporal islet field.Methods:6patients with bilateral advanced glaucoma with temporal islet field were enrolled in the research. They received fixation stability training with the biofeedback system of MP-1. The bivariate contour ellipse area (BCEA) was used to quantified the fixation stability. The training lasted one hour a day for one week. Their fixation stability was redetected one day, forty-five days and ninety days respectively after the fixation stability training. After finishing the fixation stability training, patients’visual acuity was detected with the program of visual acuity (made by MATLAB) under different contrast, and the patients were continually trained with the same system. The followed training lasted one hour a day for two weeks in hospital and another10weeks back home. Three months after the training, the patients received the second fixation stability detection. What’s more, all the subjects filled the LVQOL and HAD questionnaires before and after the training in order to analyze their quality of life and mental state. All the data were analyzed by SPSS11.5and expressed in mean and standard deviation. ANOVA was used to analyze the statistically significant difference of fixation stability before and after the training, and Bonferrioni analysis was used to further clear the exact differences between groups. The paired t test was used to analyze the statistically significant difference of visual sensitivity, LVQOL and HAD questionnaire before and after the training.Results:There was a statistically significant difference before and after the training in the BCEA value when patients were gazing at circle (F=4.617, P=0.013), cross ((F=6.345, P=0.003), letter (F=6.124, P=0.004), and number (F=6.361, P=0.003). The further analysis of the fixation stability at two different time points by using Bonferroni indicated that there were significant differences between pre-training and one day post-training, pre-training and forty-five days post-training, and ninety days post-training. On the other hand, there are no statistical differences between any two of one day post-training, forty-five days post-training, and ninety days post-training. On the test of gazing at different tasks, there were no statistically significant differences in patients’ BCEA values of fixation stability between any two of pre-training (F=0.896, P=0.461), one day post-training (F=1.117, P=0.366), forty-five days post-training (F=1.496, P=0.246), and ninety days post-training (F=2.451, P=0.093). While further analysis the visual stability in the test of gazing at different tasks, there were no significant differences between any two groups by using Bonferroni analysis. Before the training, patients’ visual acuity is0.045±0.015with100%contrast sensitivity, and0.043±0.016with50%,0.034±0.018with25%,0.018±0.016with12.5%respectively. After three months of the training, their visual acuity is0.099±0.034with100%contrast sensitivity, and0.089±0.032with50%,0.073±0.027with25%,0.025±0.016with12.5%respectively. There were statistically significant differences before and after the training in the visual acuity with100%contrast sensitivity (t=4.604, P=0.006), with50%contrast sensitivity (t=4.604, p=0.006), with25%contrast sensitivity (t=4.546, P=0.006), and with12.5%contrast sensitivity (t=6.804, P=0.001). The patients’ LVQOL scores were82.333±11.944and87.667±8.262before and three months after the training respectively, and it showed statistically significant difference (t=3.200, P=0.024). There were statistically significant differences in HAD scores,15.167±2.137pre-training and11.833±3.430three months post-training respectively (t=-5.976, P=0.002).Conclusions:Fixation stability and visual acuity training in patients with bilateral advanced glaucoma with temporal islet field can improve their visual function, increase the quality of life and reduce the adverse psychological state. |
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