ETDRS视力及mfERG在评估病理性近视合并黄斑CNV疗效中的应用

Application of ETDRS chart and mf ERG in assessing pathologic myopia combined with macular CNV after treatment

目的:以ETDRS视力和多焦视网膜电图(Multifocal ERG,mf ERG)比较抗血管内皮生长因子(VEGF)与光动力疗法(PDT)对病理性近视(PM)并发脉络膜新生血管(CNV)的治疗效果。方法:将临床上经FFA、ICGA及OCT确诊为PM合并黄斑CNV的43例45眼患者纳入观察。以ETDRS视力表记录最佳矫正视力(BCVA),并进行mf ERG检查。患者被随机分为两组进行治疗,20例22眼行玻璃体腔注射雷珠单抗,23例23眼行PDT。治疗后每月复查一次,随访12mo,根据复诊情况,按需行重复治疗。以末次随访为疗效判定时间点,记录并分析患者治疗前后ETDRS视力和mf ERG的变化。结果:治疗前两组基线ETDRS视力及中心凹1环和2环N1波潜伏期、P1波潜伏期及P1波反应密度值无显著差异,治疗后12mo雷珠单抗组视力39.23±20.06字母,较治疗前明显提高5.88±9.03字母(P<0.05);PDT组视力37.38±16.95字母,与治疗前比,未明显改善0.33±6.94字母(P>0.05)。两组患者mf ERG的N1波、P1波的潜伏期及P1波反应密度值与治疗前比较,差异均无统计学意义(P>0.05)。结论:对PM并发CNV的治疗,抗VEGF疗法与PDT治疗具有相似的稳定黄斑功能的作用,在视力改善上,抗VEGF疗效优于PDT治疗。

AIM：To evaluate the efficacy of anti- vascular endothelial growth factor（VEGF）and photodynamic therapy（PDT）on pathological myopia（PM）combined with choroidal neovascularization（CNV）using ETDRS chart and multifocal electroretinogram（mfERG）. METHODS： Forty-three patients（45 eyes）diagnosed by fundus fluorescein angiography（FFA）, indocyanine green angiograph（ICGA）and optical coherence tomography（OCT）with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab（20 patients, 22 eyes）and PDT（23 patients, 23 eyes）. After treatment, all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity（BCVA）was recorded with the ETDRS chart and mfERG. At the last follow-up, the therapy efficacy was determined by ETDRS numbers and mfERG and analyzed. RESULTS：Before treatment, there was no significant difference on the baseline in ETDRS and mfERG latency of N1 wave, latency and the density values of P1 wave between ranibizumab group and PDT group. After 12mo treatment, the ETDRS number in ranibizumab group（39.23±20.06）significantly increased to the baseline by 5.88±9.03（P〈0.05）, and in PDT group（37.38±16.95）was not significantly improved by 0.33±6.94（P〉0.05）. There was no significant difference in latency of N1 wave, latency and the density values of P1 wave from treatment response of mfERG in the two groups（P〉0.05）. CONCLUSION： In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT, while similar on macular.