Fortune Brad, Wang Lin, Bui Bang V, Cull Grant, Dong Jin, Cioffi George A
Discoveries in Sight, Devers Eye Institute, Portland, Oregon 97232, USA.
Invest Ophthalmol Vis Sci. 2003 Oct;44(10):4567-79. doi: 10.1167/iovs.03-0200.
To assess the structural and functional consequences of local ganglion cell (GC) loss in an experimental model of a retinal nerve fiber layer (NFL) bundle defect. To evaluate and compare three commonly used multifocal electroretinogram (mfERG) stimuli, as well as the standard transient pattern-reversal ERG (pERG) and the photopic full-field ERG, for detection of local GC damage.
Intraretinal axotomy was achieved by multiple treatments with a diode laser adapted to a slit lamp biomicroscope. Retinal laser burns were applied along an arc, subtending approximately 60 degrees, about one disc diameter superotemporal to the optic nerve. Functional measures were acquired before laser application and at numerous time points thereafter. These included mfERGs for three different stimuli: a standard fast m-sequence flicker, a global-field flash paradigm (MOFO), and a slowed m-sequence (with seven dark frames inserted to each m-step [7F]). pERGs were measured for a 24 degrees x 32 degrees checkerboard stimulus (0.56 cyc/deg, 90% contrast, 75 cd/m(2), 5 reversals/s). Photopic full-field ERGs were measured for red flashes (0.42 log photopic cd-s/m(2)) on a blue rod-saturating background (30 scotopic cd/m(2)). Retinal photography, fluorescein angiography and postmortem histologic evaluation of the optic nerve, NFL, and retinal tissues were performed.
After six laser sessions, the NFL bundle defect appeared to be complete and contiguous and was visible both proximal to and distal to the site of the photoablation by clinical examination of the fundus and stereoscopic photographs. Histologic evaluation demonstrated localized loss of GC axons, confirmed at the level of the retrobulbar optic nerve. Retinal cross sections in the temporal retina (distal to the axotomy) showed loss of GC soma and NFL degeneration, whereas all other layers appeared intact. mfERGs showed loss of high-frequency components (HFCs) for responses located within the arcuate region corresponding to the NFL defect. Local GC damage was most easily detected using the slowed 7F m-sequence stimulus. This stimulus elicited relatively large HFCs that were significantly reduced from local responses after axotomy and that were tetrodotoxin (TTX)-sensitive in a control experiment. Low-frequency component loss with the 7F stimulus did not reach statistical significance. The photopic full-field ERG was not significantly affected. pERG amplitudes declined significantly from baseline but remained within normal limits.
Focal loss of GC function in the macaque retina is most easily detected using the slowed-sequence mfERG. Local 7F HFCs depend on intact GC function.
在视网膜神经纤维层(NFL)束状缺损的实验模型中评估局部神经节细胞(GC)丢失的结构和功能后果。评估并比较三种常用的多焦视网膜电图(mfERG)刺激,以及标准瞬态图形翻转视网膜电图(pERG)和明视全视野视网膜电图,以检测局部GC损伤。
使用适配于裂隙灯生物显微镜的二极管激光进行多次治疗,以实现视网膜内轴突切断术。沿着一条弧施加视网膜激光烧灼,该弧在视神经上方颞侧约一个视盘直径处,所对视角约为60度。在激光治疗前及之后的多个时间点进行功能测量。这些测量包括针对三种不同刺激的mfERG:标准快速m序列闪烁、全视野闪光范式(MOFO)以及减慢的m序列(每个m步插入七个暗帧[7F])。针对24度×32度棋盘格刺激(0.56周/度,90%对比度,75坎德拉/平方米,5次翻转/秒)测量pERG。在蓝色视杆饱和背景(30暗视坎德拉/平方米)下针对红色闪光(0.42对数明视坎德拉-秒/平方米)测量明视全视野视网膜电图。对视神经、NFL和视网膜组织进行视网膜摄影、荧光素血管造影及死后组织学评估。
经过六次激光治疗后,NFL束状缺损似乎已完全且连续,通过眼底临床检查和立体照片可在光凝部位近端和远端均观察到。组织学评估显示GC轴突局部丢失,在球后视神经水平得到证实。颞侧视网膜(轴突切断术远端)的视网膜横切面显示GC胞体丢失和NFL变性,而所有其他层似乎完整。mfERG显示对应于NFL缺损的弓形区域内的反应高频成分(HFC)丢失。使用减慢的7F m序列刺激最容易检测到局部GC损伤。该刺激引发相对较大的HFC,在轴突切断术后局部反应中显著降低,且在对照实验中对河豚毒素(TTX)敏感。7F刺激导致的低频成分丢失未达到统计学显著性。明视全视野视网膜电图未受到显著影响。pERG振幅从基线显著下降,但仍在正常范围内。
使用减慢序列mfERG最容易检测到猕猴视网膜中GC功能的局灶性丧失。局部7F HFC依赖于完整的GC功能。