CAJ | 학술논문

背景玻璃体腔注射曲安奈德(TA)对于视网膜中央静脉阻塞(CRVO)患者黄斑区水肿的消退以及视力的维持和提高作用较明显,明视负向反应(PhNR)可以反映视网膜内层视网膜神经节细胞(RGCs)及其轴突的功能,两者间是否存在联系是尚待解决的问题.目的比较分析CRVO黄斑水肿患者玻璃体腔内注射TA前后视网膜电图(ERG)的PhNR的变化,探讨PhNR作为治疗过程中监测视网膜功能的价值.方法收集比较CRVO伴黄斑水肿者12例13眼,于玻璃体腔内注射TA(0.1 ml,4 mg)前1 d及注射后4周分别用标准小数视力表、光学相干断层扫描仪(OCT)、德国Roland RETI scan 3.15系统检查视力、黄斑区视网膜厚度和PhNR.结果接受TA玻璃体腔注射后4周,12例患者13眼中有12眼视力提高,1眼视力不变.与玻璃体腔注射TA前比较,玻璃体腔注射TA后4周OCT显示黄斑区神经上皮细胞层水肿明显减轻,厚度减小;闪光视网膜电图(F-ERG)显示PhNR在玻璃体腔注射TA后波形明显改善.玻璃体腔注射前后患眼的视力分别为0.32±0.12和0.48±0.09,差异有统计学意义(t=6.325,P=0.000);玻璃体腔注射后患眼黄斑区神经上皮层厚度与注射前比较明显下降[(459.46±131.31)μm vs(297.54±43.31)μm],差异有统计学意义(t=5.961,P=0.000),玻璃体腔注射前后患眼的PhNR平均振幅值分别为(61.28±20.16)μV和(80.23±22.96)μV,差异有统计学意义(t=4.438,P=0.001).玻璃体腔注射TA前后黄斑区神经上皮层厚度与PhNR振幅间均无明显的相关性(注射前:r=0.587,P=0.035;注射后:r=-0.011,P=0.971).结论 CRVO黄斑水肿患者行玻璃体腔内注射TA后,PhNR可以做为监测患者内层视网膜功能变化的有效指标.
배경 파리체강주사곡안내덕(TA)대우시망막중앙정맥조새(CRVO)환자황반구수종적소퇴이급시력적유지화제고작용교명현,명시부향반응(PhNR)가이반영시망막내층시망막신경절세포(RGCs)급기축돌적공능,량자간시부존재련계시상대해결적문제.목적 비교분석CRVO황반수종환자파리체강내주사TA전후시망막전도(ERG)적PhNR적변화,탐토PhNR작위치료과정중감측시망막공능적개치.방법 수집비교CRVO반황반수종자12례13안,우파리체강내주사TA(0.1 ml,4 mg)전1 d급주사후4주분별용표준소수시력표、광학상간단층소묘의(OCT)、덕국Roland RETI scan 3.15계통검사시력、황반구시망막후도화PhNR.결과 접수TA파리체강주사후4주,12례환자13안중유12안시력제고,1안시력불변.여파리체강주사TA전비교,파리체강주사TA후4주OCT현시황반구신경상피세포층수종명현감경,후도감소;섬광시망막전도(F-ERG)현시PhNR재파리체강주사TA후파형명현개선.파리체강주사전후환안적시력분별위0.32±0.12화0.48±0.09,차이유통계학의의(t=6.325,P=0.000);파리체강주사후환안황반구신경상피층후도여주사전비교명현하강[(459.46±131.31)μm vs(297.54±43.31)μm],차이유통계학의의(t=5.961,P=0.000),파리체강주사전후환안적PhNR평균진폭치분별위(61.28±20.16)μV화(80.23±22.96)μV,차이유통계학의의(t=4.438,P=0.001).파리체강주사TA전후황반구신경상피층후도여PhNR진폭간균무명현적상관성(주사전:r=0.587,P=0.035;주사후:r=-0.011,P=0.971).결론 CRVO황반수종환자행파리체강내주사TA후,PhNR가이주위감측환자내층시망막공능변화적유효지표.
Background Intravitreal injection of triamcinolone acetonide (TA) can effectively eliminate central vein occlusion macular edema and improve visual acuity, and photopic negative response (PhNR) can reflect the inner retinal function of RGCs and their axons. It is possible there is a correlation between these two observations.Objective This study was to evaluate the changes of PhNR of flash electroretinogram (F-ERG) after intravitreal injection of TA for macular edema in central retinal vein occlusion ( CRVO ). Methods Thirteen eyes of 12 patients with macular edema caused by CRVO received an injection of 0. 1 ml (4 rg) of TA. PhNR,visual acuity and retinal thickness of macular area were assessed with Roland RETI scan 3. 15 system,decimal visual chart and Stratus optical coherence tomography (OCT) before and 4 weeks after the administration of TA. Written informed consent was obtained from each subject before any medical procedure. Results Visual acuity was improved in 12 eyes and stable in 1 eye 4 weeks following the intravitreal injection of TA. OCT showed that the retinal thickness of the macular area was reduced ;meanwhile,elevation of the amplitude of PhNR also was seen in the F-ERG after the administration of TA in comparison with before the administration of TA. The calculated results determined that the visual acuities were 0. 32t0. 12 and 0. 48±0. 09 (t=6. 325 ,P=0. 000) ,and the retinal thickness values of the macular area were (459.46± 131.31 ) μm and ( 297.54 ±43.31 ) μm ( t = 5.961, P = 0. 000 ), and the average amplitude of PhNR were ( 80. 23±22.96 ) μV and (61.28 ±20. 16 ) μV ( t = 4. 438, P = 0. 001 ) before and after the intravitreal injection of TA, respectively,showing significant differences. No significant correlation was found between PhNR amplitude and retinal thickness of the macular area both before and after the administration of TA ( before: r = 0. 587, P = 0. 035; after:r=-0. 011 ,P = 0. 971 ). Conclusion PhNR can be used for evaluating the status of inner retina after intravitreal injection of TA for macular edema of CRVO.