Kaur Manpreet, Saxena Rohit, Singh Digvijay, Behari Madhuri, Sharma Pradeep, Menon Vimla
Squint and Neuro-Ophthalmology Section, Dr. Rajendra Prasad Centre for Ophthalmic Sciences (MK, RS, DS, PS, VM), All India Institute of Medical Sciences, New Delhi, India; and Department of Neurology (MB), Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
J Neuroophthalmol. 2015 Sep;35(3):254-8. doi: 10.1097/WNO.0000000000000240.
To evaluate structural changes in the retina and correlate those with visual function measurements in patients with Parkinson disease (PD).
A cross-sectional comparative study of 20 patients with PD and 20 age-matched healthy controls was conducted. Visual acuity, color vision, contrast sensitivity, visual fields, pattern visual-evoked response (VER), and multifocal electroretinogram were recorded to determine functional change, whereas structural changes were evaluated with retinal nerve fiber layer (RNFL) thickness, macular thickness, macular volume, and ganglion cell-inner plexiform layer complex (GCL-IPL) thickness using spectral domain ocular coherence tomography (SD-OCT).
PD patients ranged from Stage 1-3, with median Stage 2 (Hoehn and Yahr Classification) with mean Unified Parkinson Disease Rating Scale III score of 19 ± 10.42, and average disease duration of 5.8 ± 2.78 years. Visual acuity, color vision, and visual fields were unaffected but contrast sensitivity was significantly worse than controls (P < 0.001). Multifocal electroretinogram values in the central 2° field revealed decreased foveal electrical activity, with increased pattern VER amplitude and latency. Significant RNFL thinning was observed in the average RNFL (P = 0.033), superior (P = 0.018), and temporal (P = 0.036) quadrants. Significant ganglion cell layer loss was captured on SD-OCT with average, minimum GCL-IPL, and all 6 sectors showing thinning (P ≤ 0.003). The functional changes correlated significantly with structural changes, disease duration, and severity. There was no correlation between structural changes in the retina and disease duration or severity.
Subclinical visual dysfunction was observed in patients with PD with good structural-functional correlation. GCL-IPL thinning may be a more reliable parameter than RNFL thickness for structural alterations of the retina in patients with PD.
评估帕金森病（PD）患者视网膜的结构变化，并将这些变化与视觉功能测量结果相关联。
对20例PD患者和20例年龄匹配的健康对照者进行横断面比较研究。记录视力、色觉、对比敏感度、视野、图形视觉诱发电位（VER）和多焦视网膜电图以确定功能变化，而使用光谱域光学相干断层扫描（SD-OCT）评估视网膜神经纤维层（RNFL）厚度、黄斑厚度、黄斑体积和神经节细胞-内丛状层复合体（GCL-IPL）厚度来确定结构变化。
PD患者处于1-3期，中位数为2期（Hoehn和Yahr分级），统一帕金森病评定量表III平均评分为19±10.42，平均病程为5.8±2.78年。视力、色觉和视野未受影响，但对比敏感度明显低于对照组（P<0.001）。中央2°视野的多焦视网膜电图值显示中央凹电活动降低，图形VER振幅增加和潜伏期延长。平均RNFL（P = 0.033）、上方（P = 0.018）和颞侧（P = 0.036）象限观察到显著的RNFL变薄。SD-OCT显示神经节细胞层明显丢失，平均、最小GCL-IPL以及所有6个扇区均显示变薄（P≤0.003）。功能变化与结构变化、病程和严重程度显著相关。视网膜结构变化与病程或严重程度之间无相关性。
在PD患者中观察到亚临床视觉功能障碍，结构与功能具有良好的相关性。对于PD患者视网膜的结构改变，GCL-IPL变薄可能是比RNFL厚度更可靠的参数。
