Arya Bharti, Westcott Mark, Robson Anthony G, Holder Graham E, Pavesio Carlos
Medical Retina and Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Department of Electrophysiology, Moorfields Eye Hospital NHS Foundation Trust, London, UK UCL Institute of Ophthalmology, London, UK.
Br J Ophthalmol. 2015 Jul;99(7):973-8. doi: 10.1136/bjophthalmol-2014-306003. Epub 2015 Jan 30.
To investigate deterioration in serial Humphrey visual fields (HVFs) using pointwise linear regression (PLR) analysis in patients with birdshot chorioretinopathy (BCR) monitored with full field electroretinography (ERG).
Retrospective review of the case notes, HVFs and ERG of patients under treatment for BCR at Moorfields Eye Hospital between 1998 and 2014. Eyes with ERG recorded using protocols to incorporate International Society for Clinical Electrophysiology of Vision standards and at least five reliable Swedish Interactive Testing Algorithm standard 24-2 HVFs were included. HVFs were analysed by PLR analysis of luminance sensitivity using the Progressor software and linear regression analysis of mean deviation (MD).
202 HVFs from 31 eyes of 16 patients were analysed. Mean follow-up was 60.25 months. MD remained stable in all eyes. PLR analysis detected progressive field loss in 10 eyes (seven patients). The mean (SD) slope of change at progressing points was -1.83 (0.90) db/year (p<0.05). ERG worsened in 3 of the 10 eyes with field loss. Although there was no clear relationship between patterns of field loss and electrophysiological dysfunction, more extensive field loss was associated with more marked ERG abnormalities and rod system involvement.
This study demonstrates that PLR analysis can identify field loss despite a stable MD and stable and even normal electrophysiology in BCR, thus establishing a role for regular standardised monitoring of visual fields as an adjunct to electrophysiology in order to facilitate more accurate characterisation of retinal dysfunction and hence enabling better-informed treatment decisions and monitoring of treatment efficacy.
在接受全视野视网膜电图（ERG）监测的鸟枪弹样脉络膜视网膜病变（BCR）患者中，使用逐点线性回归（PLR）分析来研究系列Humphrey视野（HVF）的恶化情况。
回顾性分析1998年至2014年间在穆尔菲尔德眼科医院接受BCR治疗的患者的病历、HVF和ERG。纳入使用符合国际临床视觉电生理学会标准的方案记录ERG且至少有五次可靠的瑞典交互式测试算法标准24-2 HVF的眼睛。使用Progressor软件通过对亮度敏感度进行PLR分析以及对平均偏差（MD）进行线性回归分析来分析HVF。
分析了16例患者31只眼中的202次HVF。平均随访时间为60.25个月。所有眼睛的MD均保持稳定。PLR分析在10只眼（7例患者）中检测到进行性视野缺损。进展点处变化的平均（标准差）斜率为-1.83（0.90）dB/年（p<0.05）。10只出现视野缺损的眼中有3只ERG恶化。尽管视野缺损模式与电生理功能障碍之间没有明确关系，但更广泛的视野缺损与更明显的ERG异常和视杆系统受累相关。
本研究表明，PLR分析可以在BCR患者中识别出尽管MD稳定且电生理稳定甚至正常但仍存在的视野缺损，从而确立了定期标准化监测视野作为电生理辅助手段的作用，以便更准确地描述视网膜功能障碍，从而做出更明智的治疗决策并监测治疗效果。
