Messias André, Ramos Filho José Afonso, Messias Katharina, Almeida Felipe P P, Costa Rogério A, Scott Ingrid U, Gekeler Florian, Jorge Rodrigo
Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery-School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Doc Ophthalmol. 2012 Jun;124(3):225-36. doi: 10.1007/s10633-012-9322-5. Epub 2012 Mar 29.
To evaluate changes in electroretinographic (ERG) findings after panretinal photocoagulation (PRP) compared to PRP plus intravitreal injection of ranibizumab (IVR) in eyes with high-risk proliferative diabetic retinopathy (PDR). Patients with high-risk PDR and no prior laser treatment were assigned randomly to receive PRP (PRP group; n = 9) or PRP plus IVR (PRPplus group; n = 11). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session (week 0) in the PRPplus group. Standardized ophthalmic evaluations including (ETDRS) best-corrected visual acuity (BCVA), and fluorescein angiography to measure area of fluorescein leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). ERG was measured according to ISCEV standards at baseline and at week 48 (±2). At 48 weeks, 2,400-3,000 laser spots had been placed in eyes in the PRP group, while only 1,400-1,800 spots had been placed in the PRPplus group. Compared to baseline, there was a statistically significant (P < 0.05) FLA reduction observed at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 ± 5% (P < 0.05) of baseline in the PRP group and 64 ± 6% (P < 0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (P = 0.024; t Test). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4% in the PRP group and 62 ± 5% in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (P = 0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. These results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, in particular for rod-driven post-receptoral responses, than treatment with PRP alone.
为评估在高危增殖性糖尿病视网膜病变（PDR）患者中，全视网膜光凝（PRP）与PRP联合玻璃体内注射雷珠单抗（IVR）后视网膜电图（ERG）结果的变化。将未接受过激光治疗的高危PDR患者随机分为接受PRP治疗组（PRP组；n = 9）或PRP联合IVR治疗组（PRPplus组；n = 11）。PRP分两个阶段进行（第0周和第2周），PRPplus组在第一次激光治疗阶段结束时（第0周）注射IVR。在基线、第16周（±2周）、32周（±2周）和48周（±2周）进行标准化眼科评估，包括（ETDRS）最佳矫正视力（BCVA）和荧光素血管造影以测量荧光素渗漏面积（FLA）。根据国际临床视觉电生理学会（ISCEV）标准在基线和第48周（±2周）测量ERG。在48周时，PRP组的眼睛接受了2400 - 3000个激光光斑照射，而PRPplus组仅接受了1400 - 1800个光斑照射。与基线相比，两组在所有研究访视时FLA均有统计学意义的降低（P < 0.05），且在第48周时PRPplus组的降低幅度显著大于PRP组。PRP组的视杆细胞b波振幅显著降低至基线的46 ± 5%（P < 0.05），PRPplus组为64 ± 6%（P < 0.05）。PRP组的这种降低幅度显著大于PRPplus组（P = 0.024；t检验）。暗适应联合反应（CR）b波振幅也观察到类似结果，与基线相比，PRP组在48周时降低了45 ± 4%，PRPplus组降低了62 ± 5%；PRP组CR b波振幅的降低幅度显著大于PRPplus组（P = 0.0094）。CR a波、振荡电位、视锥细胞单次闪光和30Hz闪烁反应在组内有统计学意义的降低，但组间分析无差异。这些结果表明，用PRP联合IVR治疗高危PDR对PDR的控制有效，且与单独使用PRP相比，允许使用范围较小的PRP，进而导致较少的视网膜功能丧失，特别是对视杆细胞驱动的感受器后反应而言。
