Lardenoye C W, Probst K, DeLint P J, Rothova A
Department of Ophthalmology, F. C. Donders Institute, University Hospital Utrecht, The Netherlands.
Invest Ophthalmol Vis Sci. 2000 Nov;41(12):4048-53.
The irreversible loss of visual acuity in macular edema is usually attributed to permanent loss of photoreceptor cells, although there is hardly any information on changes in photoreceptor function in macular edema. The purpose of this study was to assess photoreceptor function in various stages of macular edema and to relate the findings to visual acuity and angiographic changes.
Directional sensitivity (optical Stiles-Crawford effect) and visual pigment density of foveal cones was measured with a custom-built scanning laser ophthalmoscope (SLO) in 19 eyes of 19 patients. Twelve eyes exhibited macular edema: five of inflammatory origin, and seven of diabetic origin. Seven eyes with an intraocular inflammatory disease without clinical or angiographic evidence of edema were also included (four of which had previous macular edema and one of which had shown development of macular edema at the 1-year follow-up). Results of SLO measurements were related to findings using fluorescein angiography and Snellen visual acuity, both assessed at the time of SLO measurement and 6 months thereafter.
Eyes with macular edema exhibited diminished directional sensitivity of photoreceptor cells in the fovea compared with eyes without (P = 0.02). Visual pigment density of eyes with macular edema was decreased and associated with both initial and follow-up visual function and with the angiographic macular edema grade at follow-up. Abnormal directional sensitivity and pigment density were already present in eyes with slight edematous changes and normal visual acuity.
Eyes with inflammatory or diabetic macular edema showed decreased directional sensitivity and visual pigment density in the macular area. These findings may support a role for SLO measurements in detecting retinal damage due to macular edema.
黄斑水肿导致的视力不可逆丧失通常归因于光感受器细胞的永久性丧失，尽管关于黄斑水肿时光感受器功能变化的信息几乎没有。本研究的目的是评估黄斑水肿不同阶段的光感受器功能，并将结果与视力和血管造影变化相关联。
使用定制的扫描激光检眼镜（SLO）测量了19例患者19只眼中中央凹视锥细胞的方向敏感性（光学斯泰尔斯-克劳福德效应）和视色素密度。12只眼表现出黄斑水肿：5只由炎症引起，7只由糖尿病引起。还纳入了7只患有眼内炎症疾病但无临床或血管造影水肿证据的眼睛（其中4只曾有黄斑水肿，1只在1年随访时出现黄斑水肿）。SLO测量结果与荧光素血管造影和斯内伦视力的结果相关，这两项检查均在SLO测量时及之后6个月进行评估。
与无黄斑水肿的眼睛相比，有黄斑水肿的眼睛中央凹光感受器细胞的方向敏感性降低（P = 0.02）。有黄斑水肿的眼睛视色素密度降低，且与初始和随访时的视觉功能以及随访时血管造影黄斑水肿分级相关。方向敏感性和色素密度异常在有轻度水肿变化且视力正常的眼睛中就已存在。
炎症性或糖尿病性黄斑水肿的眼睛黄斑区方向敏感性和视色素密度降低。这些发现可能支持SLO测量在检测黄斑水肿导致的视网膜损伤中的作用。
