Nishimura Tomoharu, Machida Shigeki, Hara Yuji
Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
Doc Ophthalmol. 2020 Oct;141(2):137-147. doi: 10.1007/s10633-020-09758-z. Epub 2020 Feb 25.
To determine the changes in the cone-driven functions in patients with age-related macular degeneration (AMD) treated with intravitreal aflibercept.
We studied 44 eyes of 44 patients diagnosed with AMD whose mean age was 75 years. The contralateral unaffected eyes served as controls. All patients were initially treated with 3 consecutive monthly intravitreal aflibercept injections and thereafter with bimonthly injections for 12 months. Full-field cone electroretinograms (cone ERGs) were recorded at the baseline and at 3, 6, and 12 months after beginning the intravitreal aflibercept injections. The cone ERGs were elicited by red stimuli on a blue background. The focal macular ERGs (fmERGs) were elicited by 15 degrees white stimulus spot centered on the fovea. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sum of the oscillatory potentials (ΣOPs, sum of OP1-3 amplitudes) were analyzed. In addition, the implicit times of the a- and b-waves were also analyzed.
The amplitudes and implicit times of all components of the fmERGs were significantly improved compared to the baseline at 3 months after beginning the intravitreal aflibercept injections (P < 0.0005-0.05). The amplitudes of the a-waves and PhNRs were further increased during the maintenance phase (P < 0.005-0.01). On the other hand, the amplitudes of the full-field a-waves and PhNR of the cone ERGs were significantly reduced at 6 and 12 months compared to the baseline.
The macular function improved continuously during the maintenance phase of the intravitreal aflibercept injections. In contrast, the cone-driven functions of the more peripheral retina decreased with repeated injections suggesting adverse effects of the intravitreal aflibercept injections on the function of the more peripheral normal retina.
确定接受玻璃体内注射阿柏西普治疗的年龄相关性黄斑变性（AMD）患者视锥细胞驱动功能的变化。
我们研究了44例诊断为AMD的患者的44只眼睛，这些患者的平均年龄为75岁。对侧未受影响的眼睛作为对照。所有患者最初每月连续3次玻璃体内注射阿柏西普，此后每两个月注射一次，持续12个月。在开始玻璃体内注射阿柏西普后的基线以及3、6和12个月时记录全视野视锥细胞视网膜电图（视锥细胞ERG）。视锥细胞ERG由蓝色背景上的红色刺激诱发。黄斑局部视网膜电图（fmERG）由以中央凹为中心的15度白色刺激光斑诱发。分析a波和b波的振幅、明视负反应（PhNR）以及振荡电位总和（ΣOPs，OP1 - 3振幅总和）。此外，还分析了a波和b波的隐含时间。
在开始玻璃体内注射阿柏西普3个月后，与基线相比，fmERG所有成分的振幅和隐含时间均有显著改善（P < 0.0005 - 0.05）。在维持阶段，a波和PhNR的振幅进一步增加（P < 0.005 - 0.01）。另一方面与基线相比，在6个月和12个月时，视锥细胞ERG的全视野a波和PhNR的振幅显著降低。
在玻璃体内注射阿柏西普的维持阶段，黄斑功能持续改善。相比之下，随着重复注射，视网膜周边部视锥细胞驱动功能下降，提示玻璃体内注射阿柏西普对视网膜周边部正常功能有不良影响。
