视网膜中央静脉阻塞黄斑水肿玻璃体腔注射曲安奈德后视网膜电图明视负向反应变化

Changes of photopic negative response after intravitreal injection of triamcinolone acetonide for macular edema caused by central retinal vein occlusion

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（0．1ml，4mg）前1d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 scan3．15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）μmvs（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=一0．011，P=0．971）。结论CRVO黄斑水肿患者行玻穗蚀日奉内沣射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。

Background Intravitreal injection of triamcinolonc 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 e｜ectroretinogram （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 rag） of TA. PhNR,visual acuity and retinal thickness of maeular 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 0.32±0. 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.