光动力疗法治疗病理性近视CNV前后mfERG的变化

Changes of multifocal electroretinography after photodynamic therapy of CNV in pathological myopia

目的采用多焦视网膜电图（multifocal electroretinogram,mfERG）动态观察病理性近视合并脉络膜新生血管（choroidal neovascularisation,CNV）患眼光动力疗法（photodynamic therapy,PDT）治疗后早期视网膜功能的改变。方法经FFA/ICGA、OCT检查确诊的继发于病理性近视黄斑下活动性CNV患者30例（30眼）行PDT治疗,分别在治疗前及治疗后1周、1个月和3个月行mfERG检查,并与未行PDT治疗的对照组12例（13眼）进行同期的对比分析。结果治疗组PDT治疗后不同时间点与治疗前反应密度值比较：治疗后1周、1个月和3个月mfERG3-5环N1波、3-5环不等P1波振幅密度值比治疗前明显提高（P〈0.05）;治疗组与对照组组间同期反应密度值比较：治疗前两组组间同期反应密度值和潜伏期的比较无显著统计学差异（P〉0.05）。1周后3环、5环N1波和5环、6环P1波振幅密度值比对照组明显提高（P〈0.05）,1个月后3-5环N1波、4-5环P1波振幅密度值比对照组明显提高（P〈0.05）,3个月后3-5环N1波、4-5环P1波振幅密度值比对照组明显提高（P〈0.05）。结论mfERG一阶反应的振幅密度值反映了PDT治疗对于稳定CNV患眼黄斑区视网膜功能及改善CNV患眼黄斑中心凹旁的视功能具有一定的意义。

Objective To observe the changes of retinal function at the early stage for patients with pathological myopia （PM） combined with choroidal （CNV） after the treatment of photodynamic therapy （PDT） with multifocal electroretinogram （mtERG）. Methods Thirty eases （30 eyes） diagnosed as active CNV eaused by PM with FFA, ICGA and OCT examination were treated with PDT. mtERG of those patients were tested pre-treatment and at 1 week, 1 month, 3 months post-treatment, respectively. The latencies and average response densities were determined and compared with control group （12 cases,13 eyes） without PDT treatment. Resuits h the PDT group, the amplitude densities of N1 wave in ring 3 to ring 5 and P1 waves obviously improved at 1 week, 1 month or 3 months post-treatment compared with those of pre-treatment （ P 〈 0.05 ）. The lateneies of N1 and P1 waves in all 6 rings of PDT group did not change statistically compared with control group at the corresponding period （ P 〉 0.05 ）. The amplitude densities of N： wave in ring 3 and ring 5 and P1 wave in ring 5 and ring 6 improved significantly at 1 week post-treatment compared with those of control group （ P 〈 0.05 ）. And the amplitude densities of N1 wave in ring 3 to ring5 and P1 wave in ring4 to ring 5 improved obviously at 1 month or 3 months post-treatment compared with those of control group（ P 〈 0.05 ）. Conclusion Improvement in macular function could be demonstrated as mtERG recordings. There is no significant evidence sttggesting an adverse effect from PDT for classic CNV in PM on the outer retinal function in the early stage of treatment.