Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy.
G.B. Bietti Foundation, IRCCS, Rome, Italy.
Retina. 2018 Apr;38(4):841-848. doi: 10.1097/IAE.0000000000001600.
To investigate retinal sensitivity in eyes with all the clinical stages of Best vitelliform macular dystrophy (VMD).
Thirty-two patients affected by VMD in subclinical, vitelliform, pseudohypopyon, vitelliruptive, and atrophic stages were enrolled in this prospective cross-sectional study. Patients underwent a complete ophthalmologic examination, including determination of best-corrected visual acuity (BCVA), staging of the disease (Gass's classification), and microperimetry by means of the macular integrity assessment microperimeter. The primary outcome measure was to describe the alterations in the retinal sensitivity of eyes affected by VMD in different stages. Secondary outcome measures included correlations between retinal sensitivity and best-corrected visual acuity and the correlation between the VMD stage and the specific microperimetry pattern.
Mean retinal sensitivity was reduced in all the VMD stages. Nevertheless, vitelliform, pseudohypopyon, and vitelliruptive stages turned out to be very similar, especially within 10°. Fixation was classified as stable in 27 eyes (44.2%), relatively unstable in 16 eyes (26.2%), and unstable in 18 eyes (29.5%). Fixation stability correlated both with the disease stage and best-corrected visual acuity.
VMD is characterized by complex microperimetric abnormalities, involving the whole macular area. Microperimetry may contribute to the global clinical assessment of patients affected by VMD and could be used in future therapeutic approaches.
研究所有临床阶段的 Best 型类卵形黄斑营养不良（VMD）患者的视网膜敏感性。
本前瞻性横断面研究纳入了 32 名患有 VMD 的患者，包括亚临床、类卵形、假性前房积脓、类卵形破裂和萎缩期。患者接受了全面的眼科检查，包括最佳矫正视力（BCVA）的测定、疾病分期（Gass 分类）和黄斑完整性评估微视野计的微视野检查。主要观察指标是描述不同分期 VMD 眼的视网膜敏感性变化。次要观察指标包括视网膜敏感性与最佳矫正视力之间的相关性，以及 VMD 分期与特定微视野模式之间的相关性。
所有 VMD 分期的平均视网膜敏感性均降低。然而，类卵形、假性前房积脓和类卵形破裂期非常相似，尤其是在 10°以内。27 只眼（44.2%）的固视被分类为稳定，16 只眼（26.2%）为相对不稳定，18 只眼（29.5%）为不稳定。固视稳定性与疾病分期和最佳矫正视力均相关。
VMD 的特征是整个黄斑区域存在复杂的微视野异常。微视野检查有助于对 VMD 患者进行全面的临床评估，并且可能在未来的治疗方法中得到应用。
