CAJ | 학술논문

背景应用多焦视网膜电图(mfERG)评价急性期Vogt-Koyanagi-Harada(VKH)病的视网膜功能已有研究和报道,但VKH病恢复期mfERG如何变化文献报道不多.目的观察及随访VKH病急性期与恢复期视力及mfERG的变化特点.方法为回顾性临床对照研究设计,纳入在中山大学中山眼科中心确诊为VKH病急性期患者18例35眼,对患者的视力、mfERG及荧光素眼底血管造影(FFA)检查,并对VKH恢复期患者随访18个月,重复上述检查4次,对正常人、VKH急性期和恢复期患者的mfERG结果进行比较.结果本组急性期VKH病患者视力在0.01～1.0之间,仅1眼(2.86%)视力为1.0,91.4%(32/35眼)视力＜0.6,较正常对照组视力下降,差异有统计学意义(P＜0.01).正常对照组、VKH急性期组和恢复期组患者mfERG 1～6环的N1、P1波反应密度的总体差异比较均有统计学意义(P＜0.05);与正常对照组比较,VKH急性期组和恢复期组患者mfERG 1～6环的N1、P1波反应密度均明显降低,差异有统计学意义(P＜0.05),但各环振幅降低的幅度不同,以1～3环降低最为严重,1环P1波振幅仅有正常对照的22%,随离心度增加,振幅降低逐渐减轻.与VKH急性期组相比较,恢复期组(2个月)患者视力为0.1～1.2之间,50%视力≥1.0,mfERG N1、P1波反应密度的提高以1～2环显著,与急性期相比差异均有统计学意义(P＜0.05);但各环mfERG N1、P1波反应密度仍与正常有很大差异,总体仅及正常振幅的44%.VKH恢复期患者4次随访结果显示,患眼各期视力稳定,mfERG各波振幅有轻度下降趋势,但差异无统计学意义(P＞0.05);3环内N1、P1隐含时缩短,4次随访总体差异有统计学意义(P＜0.05).结论 VKH对患者视力及后极部视网膜功能有严重影响,黄斑区是疾病影响最为严重且治疗前后功能变化较大的部位.治疗后即使视力恢复较理想,但mfERG结果证实视网膜功能仍有较大程度损害.
배경 응용다초시망막전도(mfERG)평개급성기Vogt-Koyanagi-Harada(VKH)병적시망막공능이유연구화보도,단VKH병회복기mfERG여하변화문헌보도불다.목적 관찰급수방VKH병급성기여회복기시력급mfERG적변화특점.방법 위회고성림상대조연구설계,납입재중산대학중산안과중심학진위VKH병급성기환자18례35안,대환자적시력、mfERG급형광소안저혈관조영(FFA)검사,병대VKH회복기환자수방18개월,중복상술검사4차,대정상인、VKH급성기화회복기환자적mfERG결과진행비교.결과 본조급성기VKH병환자시력재0.01～1.0지간,부1안(2.86%)시력위1.0,91.4%(32/35안)시력＜0.6,교정상대조조시력하강,차이유통계학의의(P＜0.01).정상대조조、VKH급성기조화회복기조환자mfERG 1～6배적N1、P1파반응밀도적총체차이비교균유통계학의의(P＜0.05);여정상대조조비교,VKH급성기조화회복기조환자mfERG 1～6배적N1、P1파반응밀도균명현강저,차이유통계학의의(P＜0.05),단각배진폭강저적폭도불동,이1～3배강저최위엄중,1배P1파진폭부유정상대조적22%,수리심도증가,진폭강저축점감경.여VKH급성기조상비교,회복기조(2개월)환자시력위0.1～1.2지간,50%시력≥1.0,mfERG N1、P1파반응밀도적제고이1～2배현저,여급성기상비차이균유통계학의의(P＜0.05);단각배mfERG N1、P1파반응밀도잉여정상유흔대차이,총체부급정상진폭적44%.VKH회복기환자4차수방결과현시,환안각기시력은정,mfERG각파진폭유경도하강추세,단차이무통계학의의(P＞0.05);3배내N1、P1은함시축단,4차수방총체차이유통계학의의(P＜0.05).결론 VKH대환자시력급후겁부시망막공능유엄중영향,황반구시질병영향최위엄중차치료전후공능변화교대적부위.치료후즉사시력회복교이상,단mfERG결과증실시망막공능잉유교대정도손해.
Background Researches showed that multifocal electroretinogram (mfERG) is able to assess the retinal function in the eyes with acute Vogt-Koyanagi-Harada ( VKH ) syndrome. But the mfERG characteristics of convalescence stage of VKH are still below clear. Objective Present study was to compare and follow up the variation process of visual acuity and mfERG in acute and recovery stages of VKH syndrome. Methods This was a clinic-based retrospective study. Visual acuity, mfERG and fundus fluorescence angiography ( FFA ) were recorded from 35 eyes of 18 acute VKH cases. The period of follow-up in recovery stage lasted about 18 months with the repetitive recording results for 4 times. Results In this study, the visual acuity range in acute stage VKH was 0. 01 to 1.0, and 91.4% (32/35 eyes) was below 0.6. Compared with normal control group, the visual acuity was significantly decreased (P＜0.01). The response densities (amplitudes) of N1 ,P1 waves of the first-order kernel were significantly lowed in all the 6 rings,and the implicit times of 1-4 rings of both waves were significantly prolonged in acute VKH eyes(P＜0. 05). The abnormalities of retinal function showed a regional difference at the posterior pole retina with the dominant change in the first ring,showing a cutting off78% in the P1 amplitude. The abnormal degree of mfERG was more serious as the the increase of retinal eccentricity. In 2 months of convalescence after glucocorticosteroids therapy,the range of visual acuity were 0. 1-1.2 ,and the amplitudes of N1, P1 of 1-2 rings were greatly elevated in comparison with acute on-set (P＜0. 05 ). However, there was still a remarkable difference in the amplitudes of from 1 through 6 rings,comparing with normal. The response density of P1 wave from whole recording region was only 44% of normal. Though the visual acuity was stable during the follow-up duration, a decreasing tendency in N1 and P1 amplitudes were seen. The implicit times of both wave shortened only in 1-3 rings in recovery stages of VKH (P＜0.05). Conclusion VKH syndrome cause serious damage of posterior retinal function.Macular region is the site with greater retinal functional lesion and restore before and after medication. This hardly recovery of retinal function can last over one and half year,even satisfied visual acuity is stable after proper treatment.