The Relationship of Central Foveal Thickness to Urinary Iodine Concentration in Retinitis Pigmentosa With or Without Cystoid Macular Edema
The Relationship of Central Foveal Thickness to Urinary Iodine Concentration in Retinitis Pigmentosa With or Without Cystoid Macular Edema
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DOI：
10.1001/jamaophthalmol.2014.1726
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发表时间：
2014-10-01
影响因子：
8.1
通讯作者：
Berson, Eliot L.
中科院分区：
文献类型：
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作者：
Sandberg, Michael A.;Pearce, Elizabeth N.;Berson, Eliot L.
重要性：目前治疗色素性视网膜炎（RP）的囊样黄斑水肿（CME）并不总是有效，可能导致不良反应，并且可能无法恢复视力。本研究为评估碘补充剂是否可以减少RP中的CME提供了理论依据。目的研究非吸烟成年RP患者尿碘浓度（UIC）推断的CME存在时中央中央凹厚度（CFT）是否与膳食碘摄入量有关。设计、环境和参与者：我们对212名年龄在18 - 69岁、至少一只眼视力不低于20/200的非吸烟患者进行了一项横断面观察性研究。暴露：视网膜色素变性伴或不伴CME。以眼睛为分析单位，光学相干断层扫描测量的对数CFT与多个点样本测量的UIC的关系，并表示为3级分类变量（= 200 μ g/L），对UIC估计更可靠的患者赋予更大的权重。结果：在排除11例未返回尿液样本测量UIC的患者和2例UIC异常值后，分析仅限于199例患者。199例患者中，36.2%的患者单眼或双眼有CME。尽管基于所有眼睛的结果，log CFT与UIC呈负相关（P = 0.02），但经测试，log CFT分别对有和无CME的眼睛的UIC进行回归显示，前一组有很强的显著负相关（P < 0.001），后一组无显著相关（P = 0.66）。对于有CME的眼睛，CFT的几何平均值为267 μ m，中位UIC低于100 μ g/L，几何平均值为172 μ m，中位UIC为200 μ g/L或更高。相比之下，我们发现CME患病率与UIC之间没有显著关联（优势比为1.01 [95% CI, 0.38-2.67]; P = 0.99）。结论和相关性：非吸烟成人RP患者较高的UIC与CME患者较少的中央中央凹肿胀显著相关。需要进一步的研究来确定碘补充剂是否可以限制或减少RP患者CME的程度。
IMPORTANCE Current treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) are not always effective, may lead to adverse effects, and may not restore visual acuity. The present research lays the rationale for evaluating whether an iodine supplement could reduce CME in RP.OBJECTIVE To determine whether central foveal thickness (CFT) in the presence of CME is related to dietary iodine intake inferred from urinary iodine concentration (UIC) in nonsmoking adults with RP.DESIGN, SETTING, AND PARTICIPANTS We performed a cross-sectional observational study of 212 nonsmoking patients aged 18 to 69 years referred to our institution for RP with visual acuity of no worse than 20/200 in at least 1 eye.EXPOSURE Retinitis pigmentosa with or without CME.MAIN OUTCOMES AND MEASURES With the eye as the unit of analysis, the relationship of log CFT measured by optical coherence tomography to UIC measured from multiple spot samples and represented as a 3-level classification variable (= 200 mu g/L), assigning greater weight to patients with more reliable UIC estimates.RESULTS Analyses were limited to 199 patients after excluding 11 who failed to return urine samples for measuring UIC and 2 outliers for UIC. Of the 199 patients, 36.2% had CME in 1 or both eyes. Although log CFT was inversely related to UIC based on findings from all eyes (P = .02), regression of log CFT on UIC separately for eyes with and without CME showed a strong inverse significant relationship for the former group (P < .001) and no significant relationship for the latter group (P = .66) as tested. For the eyes with CME, CFT ranged from a geometric mean of 267 mu m for a median UIC of less than 100 mu g/L to a geometric mean of 172 mu m for a median UIC of 200 mu g/L or greater. In contrast, we found no significant association between CME prevalence and UIC based on the entire sample as tested (odds ratio, 1.01 [95% CI, 0.38-2.67]; P = .99).CONCLUSIONS AND RELEVANCE A higher UIC in nonsmoking adults with RP was significantly associated with less central foveal swelling in eyes with CME. Additional study is required to determine whether an iodine supplement can limit or reduce the extent of CME in patients with RP.