黄斑色素密度与年龄相关性黄斑变性视功能改变的研究

Clinical observation of macular pigment optical density changes on visual functions in patients with age-related macular degeneration

目的分析不同类型年龄相关性黄斑变性(AMD)患者及药物干预后黄斑色素密度(MPOD)的改变、多焦视网膜电图(mf-ERG)的变化,从而探讨黄斑色素对视功能的影响,进而为黄斑变性患者的预防、诊断、治疗后的监控及随访提供新的临床指标。方法收集2015年2月至2016年5月在我院通过眼底荧光血管造影(FFA)和光学相关断层扫描(OCT)确诊为AMD的患者48例52眼,其中干性AMD患者24例24眼,视为A组;湿性AMD患者24例28眼,视为B组;其中男性28例,女性20例。视力0.1~0.5。根据是否口服叶黄素,随机分为A1(补充叶黄素)、A2、B1(补充叶黄素)、B2组,A1、B1为口服叶黄素组。所有患者补充叶黄素3个月。通过ZEISS Visucam 500免散瞳眼底照相机MPD模式测量治疗前及治疗后的平均色素密度。同时,mf-ERG采用德国罗兰公司的视网膜电生理仪P1波1环振幅。评估黄斑色素对AMD患者视功能的影响。采用SPSS17.0统计软件进行统计分析。计量资料比较采用t检验,以P≤0.05为差异有统计学意义。结果治疗前A1、A2组的MPOD分别为(0.223±0.135)du、(0.213±0.142)du,两组差异无统计学意义(P>0.05)。治疗后A1、A2组的MPOD分别为(0.266±0.189)du、(0.204±0.127)du,较治疗前差异有统计学意义(P<0.05)。治疗前B1、B2组的MPOD分别为(0.169±0.103)du、(0.157±0.137)du,两组差异无统计学意义(P>0.05)。治疗后B1、B2组的MPOD分别为(0.201±0.122)du、(0.132±0.097)du,较治疗前差异有统计学意义(P<0.05)。治疗前A1、A2组的P1波1环振幅分别为(60.42±18.545)、(58.45±20.13),两组差异无统计学意义(P>0.05)。治疗后A1、A2组的P1波1环振幅分别为(75.53±19.86)、(62.72±20.31),较治疗前差异有统计学意义(P<0.05)。治疗前B1、B2组的P1波1环振幅分别为(47.44±16.58)、(47.26±16.08),两组差异无统计学意义(P>0.05)。治疗后B1、B2组的P1波1环振幅分别为(58.11±16.22)、(50.49±14.41),较治疗前差异有统计学意义(P<0.05)。结论 AMD随病变程度加重,黄斑色素密度降低,mf-ERG振幅降低;应用叶黄素,可有效改善黄斑色素密度,保护AMD患者视觉功能。

Objective To analyze the macular pigment optical density（ MPOD） and the multifocal ERG（ mf-ERG） changes after pharmacological intervention on variant types of age-related macular degeneration（ AMD） patients,and to investigate the impact of macular pigment on visual functions thus providing new clinical indicators in prevention,diagnosis and post-treatment monitoring as well as follow-up visit for AMD patients. Methods Fifty-two eyes（ 48 cases） patients undergoing fluorescence fundus angiography（ FFA）and optical coherence tomography（ OCT） were identified as Age-Related Macular Degeneration（ AMD） in our hospital from Feb,2015 to May,2016. Twenty-four eyes of 24 cases with dried AMD were treated as group A and 28 eyes of 24 cases with wet AMD were treated as group B. There were 28 male cases and 20 female cases with the eyesight from 0. 1 to 0. 5. According to whether lutein supplement,All cases were divided randomly into group A1（ lutein）,A2,B1（ lutein）,and B2. Lutein was administered for 3 months. The MPOD were measured by the MPD mode of the non-mydriatic fundus camera ZEISS Visucam 500 before and after treatment. And The P1 wave and the 1 loop amplitude of the mf-ERG were measured by retinal electrophysiology manufactured by German Roland Company. The impact of macular pigment on visual function of AMD patients were evaluated and statistical analysis was made with SPSS17. 0 statistical software. The measurement data were compared with t test and P 0. 05 showed the difference was statistical significant. Results The MPOD of group A1 and group A2 before treatment were（ 0. 223 ± 0. 135） du and（ 0. 213 ± 0. 142） du respectively,with no statistical difference（ P 0. 05）. The post-treatment MPOD of group A1 and group A2 were（ 0. 266 ± 0. 189） du and（ 0. 204 ± 0. 127） du respectively,with statistical difference compared with the prior treatment（ P 0. 05）. The prior-treatment MPOD of group B1 and group B2 were（ 0. 169 ± 0. 103） du and（ 0. 157 ± 0. 137） du respectively,with no statistical difference（ P 0. 05）. The post-treatment MPOD of group B1 and group B2 were（ 0. 201 ± 0. 122）du,（ 0. 132 ± 0. 097） du respectively,with statistical difference compared with the prior treatment（ P 0. 05）. The P1 wave 1 loop amplitude of group A1 and group A2 before treatment were（ 60. 42 ± 18. 545） and（ 58. 45 ± 20. 13） respectively,with no statistical significance of difference（ P 0. 05）.The post-treatment P1 wave 1 loop amplitude of group A1 and group A2 were（ 75. 53 ± 19. 86） and（ 62. 72 ± 20. 31） respectively,with statistical difference compared with the prior treatment（ P 0. 05）. The prior-treatment P1 wave 1 loop amplitude of group B1 and group B2 were（ 47. 44 ± 16. 58） and（ 47. 26 ± 16. 08） respectively,with no statistical difference in two groups（ P 0. 05）. The post-treatment P1 wave 1 loop amplitude of group B1 and group B2 were（ 58. 11 ± 16. 22） and（ 50. 49 ± 14. 41） respectively,with statistical difference compared with the prior treatment（ P 0. 05）. Conclusion AMD aggravates with the severity of lesions,the density of macular pigment decreases,and mf-ERG amplitude is lowered. The application of lutein can effectively improve the density of macular pigment and protect the visual function of patients with AMD.