增生型糖尿病视网膜病变治疗后的多焦视网膜电图特征及其与视力的相关性

Multifocal electroretinogram characteristics of proliferative diabetic retinopathy after treatment and their correlation with vi⁃sual acuity

目的观察治疗后增生型糖尿病视网膜病变(PDR)患眼的多焦视网膜电图(mfERG)特征并分析其与视力的相关性。方法采用病例对照研究方法,将2021年12月至2022年5月安徽医科大学第一附属医院眼科确诊为PDR,并治疗后稳定3个月的患者29例(39眼)作为PDR组,同时选取年龄匹配且无明显糖尿病视网膜病变眼底表现的2型糖尿病(T2DM)患者33例(53眼)作为T2DM组纳入研究。受检者均行最佳矫正视力(BCVA)、mfERG及光学相干断层扫描(OCT)检查,观察两组对象mfERG的P1波、N1波振幅密度与潜伏期、视盘周围视网膜神经纤维层(pRNFL)厚度,分析各个指标与视力的相关性。结果与T2DM组比较,PDR组1~6环P1波及N1波振幅密度均降低(P<0.05),2~6环的P1波潜伏期和5~6环N1波潜伏期均延长(P<0.05),而1环P1波及1~4环N1波潜伏期差异无统计学意义(P>0.05)。PDR组各个象限P1波振幅密度均下降以及潜伏期均延长(P<0.05),并且颞上、颞下和鼻下方的N1波潜伏期均延长(P<0.05),而各个象限N1波振幅密度和鼻上方N1波潜伏期差异均无统计学意义(P>0.05)。PDR组pRNFL颞侧厚度较T2DM组增加(P<0.05),pRNFL上方、鼻侧、下方及平均厚度差异均无统计学意义(P>0.05)。PDR组BCVA与4个象限N1波振幅密度均成负相关关系(|r|值均>0.4,P<0.05),其中鼻下方N1波振幅密度与BCVA的相关性最强(r=-0.597,P<0.05),BCVA与年龄成正相关(r=0.322,P<0.05)。结论不同离心度潜伏期的变化及不同象限N1波振幅密度的变化可能对定量评估PDR术后视功能更有价值。mfERG可敏感反映PDR治疗后的视网膜功能特征,其中N1波振幅密度可用于定量评估治疗后的BCVA,为PDR的康复随访提供一定的指导。

Objective To observe the multifocal electroretinogram(mfERG)characteristics in eyes with proliferative diabetic retinopathy(PDR)after treatment and analyze its correlation with visual acuity.Methods This was a case-control study,which included 29 postoperative patients(39 eyes)with inactive proliferative diabetic retinopathy(PDR)and 33 patients(53 eyes)with type 2 diabetes mellitus(T2DM)without visible diabetic retinopathy in the First Affiliated Hospital of Anhui Medical University from December 2021 to May 2022.Eyes were examined by best-corrected visual acuity(BCVA),mfERG and optical coherence tomography(OCT).We observed BCVA,P1/N1 amplitude density,P1/N1 implicit time and peripapillary retinal nerve fiber layer(pRNFL)thickness in each group.The correlations between each index and visual acuity was analyzed.Results Compared with the T2DM group,ring 1~6 of P1 and N1 amplitude density were decreased(P<0.05)and ring 2~6 of P1 implicit time and ring 5~6 of N1 implicit time were delayed(P<0.05)in the PDR group.There was no significant difference in ring 1 of P1 implicit time and ring 1~4 of N1 implicit time between T2DM group and PDR group(P>0.05).In the PDR group,P1 amplitude density and P1 implicit time were abnormal for each quadrant.(P<0.05),and N1 implicit time was delayed for the superior temporal,inferior temporal and inferior nasal quadrants(P<0.05).There was no difference in each quadrant of N1 amplitude density and the superior nasal quadrant of N1 implicit time(P>0.05).The temporal thickness of pRNFL in the PDR group was higher than that in the T2DM group(P<0.05).No group,there was a negative correlation between BCVA and N1 amplitude density in each quadrant(all|r|>0.4,P<0.05).Besides,BCVA was positively correlated with age(r=0.322,P<0.05).Conclusions Changes in implicit time at different centrifugal degrees and changes in N1 am‐plitude density at different quadrants might be more valuable for quantitative assessment of postoperative visual function in patients with PDR.Multifocal electroretinogram can sensitively reflect the retinal function characteristics in postoperative patients with proliferative diabetic reti‐nopathy,in which N1 amplitude density can be used to quantitatively evaluate BCVA after treatment and provide guidance for the rehabilita‐tion of proliferative diabetic retinopathy.