Department of Ophthalmology, University Hospital Principe de Asturias, University of Alcalá, Alcalá de Henares, Madrid, Spain.
Exp Eye Res. 2010 Nov;91(5):578-83. doi: 10.1016/j.exer.2010.07.012. Epub 2010 Aug 6.
The aim of the study was to investigate the survival of melanopsin-expressing retinal ganglion cells (mRGCs) and the functional integrity of the retinohypothalamic tract in patients with bilateral advanced glaucomatous optic neuropathy by measuring the neuroendocrine light response of the pineal gland. Nine patients with bilateral advanced primary open-angle glaucoma (glaucoma group) and nine normal control subjects (control group) were included in this pilot observational, prospective, case-control study. The best-corrected visual acuity logMAR, standard automated perimetry mean deviation, and the retinal nerve fiber layer thickness determined by optical coherence tomography and multifocal electroretinography were used to evaluate the changes. Melatonin was analyzed in the saliva by radioimmunoassay before and after exposure to bright light (600 lux) for 60 min at night. The advanced glaucoma group did not have any significant nocturnal melatonin suppression after exposure to bright light (14.28 ± 3.07 pg/ml pre-light melatonin concentration vs. 15.22 ± 3.56 pg/ml after light exposure; p = 0.798) unlike the marked melatonin suppression in the control group (22.43 ± 4.37 pg/ml pre-light melatonin concentration vs. 11.25 ± 1.89 pg/ml after light exposure; p < 0.002). Response density estimates by the scalar product amplitude measure for the interval 0-80 ms of the first-order kernel responses were similar in both groups, indicating that outer retinal function was significantly unchanged in the glaucoma group (5.95 ± 0.54 nV/dg^2) compared with the control group (6.20 ± 0.22 nV/dg^2) (p = 0.689). Our findings are consistent with the interpretation that the rhythmic secretion of melatonin was affected in advanced glaucoma, suggesting that attention should be paid to non-image-forming visual functions, such as control of circadian rhythm and the clinical impact in patients with glaucoma.
这项研究的目的是通过测量松果腺的神经内分泌光反应来探讨双侧晚期青光眼视神经病变患者中表达黑视素的视网膜神经节细胞（mRGC）的存活情况和视丘脑束的功能完整性。本研究为前瞻性、观察性病例对照研究，共纳入 9 例双侧晚期原发性开角型青光眼（青光眼组）和 9 例正常对照受试者（对照组）。采用最佳矫正视力 logMAR、标准自动视野平均偏差和光学相干断层扫描及多焦视网膜电图确定的视网膜神经纤维层厚度评估变化情况。通过放射免疫分析法检测唾液中的褪黑素，在夜间暴露于强光（600lux）60min 前后进行分析。与对照组（光照前褪黑素浓度 22.43±4.37pg/ml，光照后 11.25±1.89pg/ml；p<0.002）相比，晚期青光眼组在暴露于强光后并未出现明显的夜间褪黑素抑制（光照前褪黑素浓度 14.28±3.07pg/ml，光照后 15.22±3.56pg/ml；p=0.798）。两组第一级核响应的 0-80ms 间隔的标量乘积幅度测量的响应密度估计值相似，表明青光眼组的外视网膜功能明显没有改变（5.95±0.54nV/dg2）与对照组（6.20±0.22nV/dg2）（p=0.689）。我们的发现与这样的解释一致，即褪黑素的节律分泌在晚期青光眼中受到影响，这表明应该关注非成像视觉功能，如昼夜节律的控制及其对青光眼患者的临床影响。
