Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Neuromodulation. 2021 Aug;24(6):992-1002. doi: 10.1111/ner.13414. Epub 2021 May 13.
To systematically identify and summarize the effectiveness and the parameters of electrical stimulation (ES) for the preservation of visual function in major retinal degeneration and optic neuropathy.
A systematic review of clinical studies, using ES therapy in patients with blind leading retinal degenerations, including retinitis pigmentosa (RP), age-related macular degeneration (AMD), glaucoma, retinal vein occlusion (RVO), retinal artery occlusion (RAO), and optic neuropathy was conducted. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for relevant interventional studies including randomized controlled trials (RCTs) and observational studies.
A total of 10 RCTs and 15 observational studies were included. Transcorneal ES (TcES), transpalpebral ES (TpES), transdermal ES (TdES), and repetitive transorbital alternating current stimulation (rtACS) were used for the treatment of the patients. ES using 20 Hz biphasic pulses with current strength at 150%-200% of individual electrical phosphene threshold (EPT) for RP patients showed improved retinal function detected by visual acuity (VA), visual field (VF), or electrical retinal graphs (ERG). rtACS on patients with optic neuropathy showed significant preservation of VA and VF. Clinical studies on AMD, RAO, and glaucoma indicated promising protective effects of ES on the visual function, though the amount of evidence is limited.
ES treatment has promising therapeutic effects on RP and optic neuropathy. More large-scale RCT studies should be conducted to elucidate the potential of ES, especially on AMD, RAO, and glaucoma. A comparison of the effects by different ES methods in the same disease populations is still lacking. Parameters of the electric current and sensitive detection method should be optimized for the evaluation of ES treatment effects in future studies.
系统地确定和总结电刺激（ES）在主要视网膜变性和视神经病变中保存视觉功能的效果和参数。
对使用 ES 疗法治疗盲性主要视网膜变性患者（包括色素性视网膜炎（RP）、年龄相关性黄斑变性（AMD）、青光眼、视网膜静脉阻塞（RVO）、视网膜动脉阻塞（RAO）和视神经病变）的临床研究进行了系统评价。检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 中的相关干预性研究，包括随机对照试验（RCT）和观察性研究。
共纳入 10 项 RCT 和 15 项观察性研究。经角膜 ES（TcES）、经眼睑 ES（TpES）、经皮 ES（TdES）和重复经眶交流电刺激（rtACS）用于治疗患者。使用 20 Hz 双相脉冲，电流强度为个体电闪光阈值（EPT）的 150%-200%，治疗 RP 患者的视网膜功能，表现为视力（VA）、视野（VF）或视网膜电图（ERG）的改善。rtACS 治疗视神经病变患者，VA 和 VF 明显保留。AMD、RAO 和青光眼的临床研究表明，ES 对视觉功能具有有希望的保护作用，尽管证据有限。
ES 治疗对 RP 和视神经病变有很好的治疗效果。应进行更多的大规模 RCT 研究，以阐明 ES 的潜力，特别是在 AMD、RAO 和青光眼方面。不同疾病人群中不同 ES 方法的效果比较仍缺乏。在未来的研究中，应优化电流参数和敏感检测方法，以评估 ES 治疗效果。
