Sandberg Michael A, Pearce Elizabeth N, Harper Shyana, Weigel-DiFranco Carol, Hart Lois, Rosner Bernard, Berson Eliot L
Berman-Gund Laboratory for the Study of Retinal Degenerations, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston.
Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts.
JAMA Ophthalmol. 2014 Oct;132(10):1209-14. doi: 10.1001/jamaophthalmol.2014.1726.
Current treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) are not always effective, may lead to adverse effects, and may not restore visual acuity. The present research lays the rationale for evaluating whether an iodine supplement could reduce CME in RP.
To determine whether central foveal thickness (CFT) in the presence of CME is related to dietary iodine intake inferred from urinary iodine concentration (UIC) in nonsmoking adults with RP.
DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional observational study of 212 nonsmoking patients aged 18 to 69 years referred to our institution for RP with visual acuity of no worse than 20/200 in at least 1 eye.
Retinitis pigmentosa with or without CME.
With the eye as the unit of analysis, the relationship of log CFT measured by optical coherence tomography to UIC measured from multiple spot samples and represented as a 3-level classification variable (<100, 100-199, and ≥200 µg/L), assigning greater weight to patients with more reliable UIC estimates.
Analyses were limited to 199 patients after excluding 11 who failed to return urine samples for measuring UIC and 2 outliers for UIC. Of the 199 patients, 36.2% had CME in 1 or both eyes. Although log CFT was inversely related to UIC based on findings from all eyes (P = .02), regression of log CFT on UIC separately for eyes with and without CME showed a strong inverse significant relationship for the former group (P < .001) and no significant relationship for the latter group (P = .66) as tested. For the eyes with CME, CFT ranged from a geometric mean of 267 µm for a median UIC of less than 100 µg/L to a geometric mean of 172 µm for a median UIC of 200 µg/L or greater. In contrast, we found no significant association between CME prevalence and UIC based on the entire sample as tested (odds ratio, 1.01 [95% CI, 0.38-2.67]; P = .99).
A higher UIC in nonsmoking adults with RP was significantly associated with less central foveal swelling in eyes with CME. Additional study is required to determine whether an iodine supplement can limit or reduce the extent of CME in patients with RP.
目前用于治疗视网膜色素变性（RP）患者黄斑囊样水肿（CME）的方法并不总是有效，可能会导致不良反应，且可能无法恢复视力。本研究为评估补充碘是否可以减轻RP患者的CME奠定了理论基础。
确定患有CME的非吸烟RP成年患者的中心凹厚度（CFT）是否与通过尿碘浓度（UIC）推断的膳食碘摄入量相关。
设计、地点和参与者：我们对212名年龄在18至69岁之间、至少一只眼睛视力不低于20/200、因RP转诊至我院的非吸烟患者进行了一项横断面观察性研究。
伴有或不伴有CME的视网膜色素变性。
以眼睛作为分析单位，通过光学相干断层扫描测量的对数CFT与从多个随机样本测量的UIC之间的关系，并将UIC表示为一个三级分类变量（<100、100 - 199和≥200 μg/L），对UIC估计值更可靠的患者给予更大权重。
在排除11名未返回尿液样本用于测量UIC的患者和2名UIC异常值后，分析仅限于199名患者。在这199名患者中，36.2%的患者一只或两只眼睛患有CME。尽管基于所有眼睛的结果，对数CFT与UIC呈负相关（P = 0.02），但分别对有和没有CME的眼睛进行对数CFT对UIC的回归分析显示，前一组有很强的负相关关系（P < 0.001），而后一组无显著关系（P = 0.66）。对于患有CME的眼睛，CFT范围从UIC中位数小于100 μg/L时的几何平均值267 µm到UIC中位数为200 μg/L或更高时的几何平均值172 µm。相比之下，基于整个样本进行检验，我们发现CME患病率与UIC之间无显著关联（优势比，1.01 [95% CI，0.38 - 2.67]；P = 0.99）。
患有RP的非吸烟成年人中较高的UIC与患有CME的眼睛中较小的中心凹肿胀显著相关。需要进一步研究以确定补充碘是否可以限制或减轻RP患者的CME程度。
