多焦视网膜电图在Vogt一小柳原田病急性期及恢复期随访中的应用  

Follow-up study on multifocal electroretinogram of acute and convalescence stage of Vogt-Koyanagi-Harada syndrome

作　　者：罗光伟[1] 江福钿[1] 文峰[1] 黄时洲[1] 刘彩娇[1] 关天芹[1] 龙时先[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华实验眼科杂志》2011年第8期718-723,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家重点基础研究发展计划项目（2007CB512206）

摘　　要：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mfERG1～6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mfERG1—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，mfERGN1、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mfERGN1、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 wassignificantly decreased （ P〈0. O1 ）. The response densities （amplitudes） of N,, PI 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 off 78% in the PI 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 ,Pl 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 Pl 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 NI and PI amplitudes were seen. The implicit times of both wave shortened only in 1-3 rings in recover

关 键 词：Vogt一小柳原田病 视力 多焦视网膜电图 

分 类 号：R77[医药卫生—眼科]