阿柏西普治疗糖尿病性黄斑水肿患者多焦视网膜电图明视负反应变化

Changes of photopic negative response of multifocal electroretinogram after treatment with Aflibercept in patients with diabetic macular edema

目的:观察糖尿病性黄斑水肿(DME)患者接受阿柏西普治疗前后多焦视网膜电图(mf-ERG)明视负反应(PhNR)的变化。方法:回顾性队列研究。收集2019-05/2022-06在武汉大学附属爱尔眼科医院(武汉爱尔眼科医院)就诊的DME患者37例37眼,每月注射阿柏西普0.05mL,连续注射3mo。并选取排除相关眼部疾病的体检正常者20例20眼作为对照组。比较两组参与研究者治疗前后mf-ERG的PhNR振幅,最佳矫正视力(BCVA)(LogMAR)、中央视网膜厚度(CRT)、黄斑区毛细血管丛血管密度(CPVD)。结果:治疗前DME患者mf-ERG PhNR振幅(201.69±80.92nV)明显低于正常对照组(398.87±77.92nV)(P<0.01)。治疗后6mo DME患者mf-ERG的PhNR平均振幅与治疗前明显升高(P=0.036),但在治疗后6mo时仍明显低于正常对照组(P=0.031)。治疗后6mo DME患者BCVA(LogMAR)从0.64±1.33提高到0.37±1.39(P=0.021),CPVD较治疗前明显增加(P=0.029)。治疗后6mo DME患者mf-ERG PhNR振幅与治疗后6mo的CPVD正相关性(r=0.448,P=0.043)、与BCVA(LogMAR)和CRT负相关(r=-0.647,P=0.011;r=-0.337,P=0.032)。结论:DME患者的mf-ERG PhNR平均振幅在接受阿柏西普治疗后可以出现明显升高,mf-ERG PhNR振幅可以用来观察及评估DME患者视网膜神经节细胞的功能变化。

AIM:To observe the changes of photopic negative response(PhNR)of multifocal electroretinogram(mf-ERG)in patients with diabetic macular edema(DME)before and after treatment with Aflibercept.METHODS:A total of 37 patients(37 eyes)with DME who visited the Aier Eye Hospital of Wuhan University(Wuhan Aier Eye Hospital)from May 2019 to June 2022,and 0.05 mL of aflibercept was injected per month for consecutive 3mo were included in this retrospective cohort study.Another 20 cases(20 eyes)with normal physical examination to exclude related eye diseases were selected as the control group.The PhNR amplitude of mf-ERG,best-corrected visual acuity(BCVA;LogMAR),central retinal thickness(CRT),capillary plexus in macular area and vessel density(CPVD)of the participants between the two groups were compared before and after treatment.RESULTS:The PhNR amplitude of mf-ERG in DME patients before treatment(201.69±80.92nV)was significantly lower than that in the normal control group(398.87±77.92nV;P<0.01),and the average PhNR amplitude of mf-ERG in DME patients at 6mo after treatment was significantly higher than that before treatment(P=0.036),but it was still significantly lower than the normal control group at 6mo after treatment(P=0.031).In addition,the BCVA(LogMAR)of DME patients increased from 0.64±1.33 to 0.37±1.39(P=0.021)at 6mo after treatment,and CPVD significantly increased compared to that before treatment(P=0.029).Meanwhile,the PhNR amplitude of mf-ERG in DME patients at 6mo after treatment was positively correlated with CPVD at 6mo after treatment(r=0.448,P=0.043),and negatively correlated with BCVA(LogMAR)and CRT(r=-0.647,P=0.011;r=-0.337,P=0.032).CONCLUSION:The PhNR amplitude of mf-ERG in DME patients increased significantly after receiving aflibercept,and it can be used to observe and evaluate the functional changes of retinal ganglion cells in DME patients.