早期增殖性糖尿病视网膜病变全视网膜光凝术后的多焦视网膜电图变化
Multifocal electroretinogram changes after panretinal photocoagulation in early proliferative diabetic retinopathy.
作者信息
Elsalhy Fathy Mohamed Abo Elftouh, Ali Mahmoud Mohammed Ahmed, Morsy Mahmoud Fawzy Zaky, Khattab Abdelrahman Ahmed Ali, Ibrahim Ezzat Nabil Abbas, Mohammed Hazem Elbadry Mohammed, Elgohary Ramadan Mohamed Abdelrahman, El Baz Hossam El Din Hassan El Sayed, Abouzeid Mohamed Sayed Taha
机构信息
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Department of Ophthalmology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
出版信息
Med Hypothesis Discov Innov Ophthalmol. 2024 Oct 14;13(3):121-128. doi: 10.51329/mehdiophthal1503. eCollection 2024 Fall.
BACKGROUND
Panretinal photocoagulation (PRP) impacts macular function in eyes with early proliferative diabetic retinopathy (PDR). Herein, we used the multifocal electroretinogram (mfERG) to objectively investigate this concept.
METHODS
In this prospective interventional case series, we enrolled patients with treatment-naive early PDR, absence of clinically significant macular edema, and requirement for PRP. All participants underwent detailed ocular examinations. We measured the best-corrected distance visual acuity (BCDVA), conducted optical coherence tomography imaging to measure central macular thickness (CMT), and performed mfERG at baseline and 3 months post-PRP. Amplitude and latency of the mfERG response were evaluated within the innermost four of the five concentric rings.
RESULTS
We enrolled 29 eyes of 23 patients with a mean (standard deviation) age of 54.3 (8.8) years and male-to-female ratio of 1:1.3. The mean BCDVA was unchanged post-treatment ( > 0.05), and the BCDVA in 26 eyes (89.7%) was either improved or unchanged, whereas in three eyes (10.3%) it decreased. The mean CMT was unchanged post-PRP ( > 0.05). Concerning the mfERG, the mean P1 amplitudes decreased significantly in all four concentric rings from the foveola at 3 months post-PRP compared with baseline values (all < 0.05); however, the latencies were unchanged (all > 0.05). At baseline, BCDVA correlated significantly with both the amplitude (r = + 0.55; < 0.05) and latency (r = - 0.38; < 0.05) of the mfERG in the central ring, whereas a significant correlation was detected with only the amplitude at 3 months post-PRP (r = + 0.52; < 0.05).
CONCLUSIONS
Macular function was decreased 3 months post-PRP in patients with early PDR, as indicated by decreased amplitude of the mfERG, whereas the functional and anatomical parameters were stable. The mfERG served as an objective tool for measuring retinal function and predicting visual outcomes post-PRP in eyes with early PDR. A higher amplitude in the mfERG correlated substantially with a better visual outcome post-PRP. Further multi-center longitudinal studies with robust designs including different PDR severity levels may reveal additional objective after-effects of PRP
背景
全视网膜光凝（PRP）会影响早期增殖性糖尿病视网膜病变（PDR）患者眼睛的黄斑功能。在此，我们使用多焦视网膜电图（mfERG）来客观地研究这一概念。
方法
在这个前瞻性干预性病例系列中，我们纳入了未经治疗的早期PDR患者，这些患者不存在临床上显著的黄斑水肿且需要进行PRP治疗。所有参与者都接受了详细的眼部检查。我们测量了最佳矫正远视力（BCDVA），进行光学相干断层扫描成像以测量中心黄斑厚度（CMT），并在基线时以及PRP治疗后3个月进行mfERG检查。在五个同心环最里面的四个环内评估mfERG反应的振幅和潜伏期。
结果
我们纳入了23例患者的29只眼睛，平均（标准差）年龄为54.3（8.8）岁，男女比例为1:1.3。治疗后平均BCDVA无变化（P>0.05），26只眼睛（89.7%）的BCDVA改善或未改变，而3只眼睛（10.3%）的BCDVA下降。PRP治疗后平均CMT无变化（P>0.05）。关于mfERG，与基线值相比，PRP治疗后3个月时，所有四个同心环中来自中心凹的平均P1振幅均显著降低（均P<0.05）；然而，潜伏期未改变（均P>0.05）。在基线时，BCDVA与中心环mfERG的振幅（r = +0.55；P<0.05）和潜伏期（r = -0.38；P<0.05）均显著相关，而在PRP治疗后3个月仅与振幅存在显著相关性（r = +0.52；P<0.05）。
结论
早期PDR患者在PRP治疗后3个月黄斑功能下降，表现为mfERG振幅降低，而功能和解剖参数稳定。mfERG可作为测量早期PDR患者视网膜功能和预测PRP治疗后视觉结果的客观工具。mfERG中较高的振幅与PRP治疗后更好的视觉结果密切相关。进一步开展包括不同PDR严重程度水平的设计严谨的多中心纵向研究，可能会揭示PRP更多的客观后遗症。
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