视感知觉学习对年龄相关性黄斑变性患者多焦视网膜电图变化影响研究

Changes of multifocal electroretinography after treatment of visual perceptual learning for age-related macular degeneration

目的探讨视感知觉学习对年龄相关性黄斑变性患者多焦视网膜电图变化的影响。方法临床病例对比研究。对2012年10月至2014年6月在重庆市中医院眼科应用视感知觉学习系统对AMD低视力患者20例25只眼进行视觉刺激、对比敏感度、视觉辨识等三项视感知觉训练，以多焦视网膜电图（mf-ERG）做为疗效评估的客观手段，对患者训练前后所得波型进行分析，所有mf-ERG反应曲线均以第一个大的正波即b波为分析对象，进行b波反应密度测量，以各波一阶反应振幅密度（nv／deg2）表示。记录以黄斑中心凹为中心呈同心圆排列的5个环区，自内至外分别是l环（2．18度）．2环（7．46度），3环（12．36度），4环（19．66度）和5环（29．75度）的b波反应振幅密度，应用SPSS17．0软件，统计学处理方法采用配对f检验。结果25只眼视感知觉训练前后视力差异无统计学意义（P〉0．05），但训练3个月后视力为（0．59±0．18）LogMAR，较训练前视力（0．67±0．21）LogMAR有所提高。mf-ERGb波反应振幅密度值在以黄斑中心凹为中心呈同心圆排列的5个环区中，各环训练前后的差异均无统计学意义（P〉0．05），但是2环的振幅密度值有提高。结论视感知觉训练干预有助于旁中心注视的稳定形成，可以帮助AMD患者更好地利用残余视力。

Objective To explore the changes of multifocal electroretinography after treatment of visual perceptual learning for age-related macular degeneration. Methods Application of visual per- ceptual leaming system for AMD patients with low vision visual were 20 cases of 25 eyes stimula- tion, contrast sensitivity, and visual identification three kinds of visual perceptual training project. With multifocal electroretinography as objective way to curative effect evaluation of patients before and after the training the wave type analysis, mf - ERG response curve were all in the first big pos- itive wave or b wave as the analysis object, b wave response density measurement, numerical to the wave amplitude density first-order reaction said. 5 rings were reorded by 1 ring （2.18°）, 2 ring （7.46°）, 3 ring （12.36°）, 4 ring （19.66°）, and 5 ring （29.75°） separately. Application of SPSS 17. 0 software, statistical processing methods using matching t test. Results Twenty-five eye isual acuity sense perception was no significant difference before and after training （P 〉0.05）, but three months after training visual acuity （0.59± 0.18） LogMAR, mean visual acuity compared with before train- ing （0.67 ± 0.21） LogMAR increased.Mf- ERG b wave response amplitude density values in the macular fovea centered in concentric circles of five ring area, the ring the difference before and af-ter the training had no statistical significance ue increase. Conclusions Visual perception center of attention, can help make better use （P 〉0.05）, but there were 2 ring amplitude density val- training intervention helps to form a stable next to the of AMD patients residual vision.