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改善稳定型黄斑病变患者生活质量的方法——一项新研究的初步结果

Methods of improving the quality of life in patients with stable maculopathy-pilot results of a new study.

作者信息

Nekolová J, Kremláček J, Kuba M, Středová M, Morávková D, Drtílková K, Jirásková N

出版信息

Cesk Slov Oftalmol. 2019 Summer;75(3):130-135. doi: 10.31348/2019/3/3.

Abstract

PURPOSE

To present pilot results of the project in which the primary goal is to optimize way how to increase the quality of life of patients with the stable maculopathy by implanting intraocular Scharioth macular lens (SML) and modulating visual plasticity by a transcranial electrical stimulation (tES) together with a visual rehabilitation.

MATERIALS AND METHODS

The study will include 20 patients with stable maculopathy (mainly age-related macular degeneration - AMD) who underwent cataract surgery in past and are eligible for SML implantation. The duration of the project is 3 years. During the first year of the project 17 patients were screened, SML implantation was recommended to 4 of them. They met the indication criteria of SML implantation and SML was implanted into the better seeing eye. The third postoperative day, the tES sessions started and were applied 20 times in the first month after SML implantation. The stimulation was delivered in double blind design (a stimulated and a shame group). Visual exercises and rehabilitation took place during the tES. The patients were examined ophthalmologically and also using electrophysiological methods.

RESULTS

Before the implantation, the best corrected distance visual acuity was 0.23. At near it was Jaeger number 15 uncorrected, with +3.0 sphere dioptres J.No.10.5 and with +6.0 sph dpt J.No. 4.5. After the surgery and visual rehabilitation BCVA was 0.13 after 3 weeks, 0.2 after 2 months and 0.14 after 6 months. At near it was uncorrected J.No.7.5 after 3 weeks, J.No.7 after 2 months and J.No.5 after 6 months.

CONCLUSION

According to a few participants, the impact of SML implantation together with intensive visual rehabilitation on vision at near and on satisfaction of patients with AMD could not be significantly established. Nevertherless, these patients are limited in their daily activities and SML is one of the solutions for them. The project is ongoing and blinded still, there is also a need of more participants to assess the effect of tES on vision, the results will be presented. We have proven the safety of methods used in the project.

摘要

目的

介绍该项目的初步结果,该项目的主要目标是通过植入眼内施里奥思黄斑透镜(SML)并结合经颅电刺激(tES)调节视觉可塑性以及进行视觉康复,来优化提高稳定型黄斑病变患者生活质量的方法。

材料与方法

该研究将纳入20例稳定型黄斑病变患者(主要为年龄相关性黄斑变性 - AMD),这些患者既往接受过白内障手术且符合SML植入条件。项目为期3年。在项目的第一年,对17例患者进行了筛查,其中4例被推荐植入SML。他们符合SML植入的指征标准,SML被植入视力较好的眼睛。术后第三天开始进行tES治疗,在SML植入后的第一个月进行20次。刺激采用双盲设计(一个刺激组和一个假刺激组)。在tES治疗期间进行视觉训练和康复。对患者进行眼科检查以及使用电生理方法检查。

结果

植入前,最佳矫正远视力为0.23。近视力在未矫正时为耶格视力表15级,+3.0球镜度时为耶格视力表10.5级,+6.0球镜度时为耶格视力表4.5级。手术和视觉康复后,3周时最佳矫正视力(BCVA)为0.13,2个月时为0.2,6个月时为0.14。近视力在3周时未矫正为耶格视力表7.5级,2个月时为耶格视力表7级,6个月时为耶格视力表5级。

结论

根据少数参与者的情况,无法显著确定SML植入联合强化视觉康复对近视力以及AMD患者满意度的影响。然而,这些患者在日常活动中受到限制,SML是为他们提供的解决方案之一。该项目仍在进行且处于盲态,还需要更多参与者来评估tES对视力的影响,届时将公布结果。我们已证明该项目所采用方法的安全性。

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