Resident in Psychiatry, Cleveland Clinic, Cleveland, OH, United States.
Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd, St. Louis, MO 63104, United States.
Schizophr Res. 2018 May;195:3-12. doi: 10.1016/j.schres.2017.07.018. Epub 2017 Jul 27.
In addition to being a critical component of the visual system, the retina provides the opportunity for an accessible and noninvasive probe of brain pathology in neuropsychiatric disorders. Several studies have reported various retinal abnormalities in schizophrenia, some primary and others iatrogenic. There is now increasing evidence supporting the existence of retinal anomalies in schizophrenia across structural, neurochemical and physiological parameters. Here, we review the types of retinal pathology in schizophrenia and discuss how these findings may provide novel insights for future research into the neurodevelopmental neurobiology of this syndrome, and possibly as useful biomarkers.
Using the keywords schizophrenia, retina, pathology, electroretinogram (ERG), and/or optical coherence tomography (OCT) on PubMed, all studies using the English language within 30years were reviewed. Methods were examined, and common themes were identified, tabulated, and discussed.
We classified the reports of retinal pathology into primary and secondary. The major secondary retinal pathology is related to the iatrogenic effects of a once widely prescribed first generation antipsychotic (thioridazine), which was found to be associated with retinal pigment deposits, decreased visual acuity, and suppression of dark adapted ERG responses. The primary retinal findings were obtained via different measures primarily using ERG, OCT, and microvascular imaging. The most consistent findings were 1) decreased ERG wave amplitudes, 2) reduced macular volume, 3) thinning of retinal nerve fiber layer, and 4) widened venule caliber.
The abnormal pathobiological findings of the retina in schizophrenia may represent an important avenue for elucidating some of the neurodevelopmental aberrations in schizophrenia. The well replicated retinal anomalies could serve as biomarkers for schizophrenia and perhaps an endophenotype that may help identify at-risk individuals and to facilitate early intervention.
除了是视觉系统的关键组成部分外，视网膜还为神经精神疾病中的脑病理学提供了一种可及且非侵入性的探测机会。几项研究报告了精神分裂症中的各种视网膜异常，有些是原发性的，有些是医源性的。越来越多的证据支持精神分裂症存在视网膜异常，涉及结构、神经化学和生理参数。在这里，我们综述了精神分裂症中的视网膜病理学类型，并讨论了这些发现如何为该综合征的神经发育神经生物学的未来研究提供新的见解，并可能作为有用的生物标志物。
使用 PubMed 上的关键词“精神分裂症、视网膜、病理学、视网膜电图（ERG）和/或光学相干断层扫描（OCT）”，对 30 年内使用英语发表的所有研究进行了综述。检查了方法，并确定、制表和讨论了共同的主题。
我们将视网膜病理学的报告分为原发性和继发性。主要的继发性视网膜病理学与一种曾经广泛应用的第一代抗精神病药物（氯丙嗪）的医源性作用有关，该药物与视网膜色素沉积、视力下降和暗适应 ERG 反应抑制有关。原发性视网膜发现是通过不同的测量方法获得的，主要使用 ERG、OCT 和微血管成像。最一致的发现是 1）ERG 波幅降低，2）黄斑体积减小，3）视网膜神经纤维层变薄，4）小静脉口径增宽。
精神分裂症视网膜的异常病理生物学发现可能代表阐明精神分裂症中一些神经发育异常的重要途径。复制良好的视网膜异常可以作为精神分裂症的生物标志物，也许是一种内表型，可以帮助识别高危个体，并促进早期干预。
