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Doctoral Thesis
DOI
Document
Author
Full name
Diego Vinicius Lopes Decleva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Ventura, Dora Selma Fix (President)
Costa, Marcelo Fernandes da
Damico, Francisco Max
Martins, Cristiane Maria Gomes
Sano, Ronaldo Yuiti
Souza, Givago da Silva
Title in Portuguese
Avaliação funcional de fotorreceptores na degeneração macular relacionada à idade 
Keywords in Portuguese
Células ganglionares intrinsecamente fotossensíveis (ipRGC)
Degeneração macular relacionada à Idade (DMRI)
Eletrorretinograma (ERG)
Reflexo pupilar à luz
Visão de cores (CCT)
Abstract in Portuguese
A Degeneração Macular Relacionada à Idade (DMRI) é a principal causa de cegueira e perda de visão central em pessoas acima dos 50 anos nos países desenvolvidos. O diagnóstico da DMRI é geralmente realizado em consulta de rotina na qual, através da biomicroscopia de fundo, é detectada a presença de drusas, exsudatos subrretinianos ou atrofias geográficas na retina. Embora o diagnóstico seja razoavelmente simples, sua fisiopatologia é complexa, não está totalmente elucidada e envolve os sistemas antioxidante, imune e vascular, afetando principalmente a mácula, área responsável pela acuidade visual e visão de cores. Assim, nosso objetivo foi avaliar a atividade dos fotorreceptores em pacientes com DMRI através de testes psicofísicos e eletrofisiológicos. Para isto, foram incluídos 49 participantes, 19 no grupo controle (71,6 ± 4,8 anos) e 30 no grupo com DMRI seca (69,2 ± 7,7 anos). Os participantes foram submetidos a teste de visão de cores (Cambridge Colour Test - CCT), a pupilometria cromática para verificar a integridade da retina externa e interna e eletrorretinografia (ERG) com flicker heterocromático. Os resultados obtidos no CCT apresentaram uma pior discriminação de cores nos eixos Protan, Deutan e Tritan dos sujeitos portadores de DMRI comparados com os controles. Na pupilometria cromática, constatamos integridade da retina externa, mas houve redução da amplitude da resposta do estímulo às células ipRGC da retina interna. No ERG, não foram observadas diferenças nas respostas correspondentes a atividade das vias magno- e parvocelular. Estes resultados indicam que há preservação de função das vias magno- e parvocelulares na DMRI inicial, assim como das respostas pupilares mediadas pelos fotorreceptores, e que a discriminação de cores pode ser um instrumento sensível para revelar alterações iniciais na DMRI
Title in English
Functional assessment of the visual system of patients with age-related macular degeneration
Keywords in English
Age-Related Macular Degeneration (AMD)
Color vision (CCT)
Electroretinogram (ERG)
Intrinsically Photosensitive Ganglion Cells (ipRGC)
Pupillary Light Reflex
Abstract in English
Age Related Macular Degeneration (AMD) is the leading cause of blindness and loss of central vision in people over 50 in developed countries. The AMD diagnosis is usually performed in a routine examination in which the presence of drusen, subretinal exudates or geographic atrophy in the retina is detected through background biomicroscopy. Although the diagnosis is simple, its pathophysiology is complex, not fully elucidated and involves the antioxidant, immune and vascular systems, mainly affecting the macula, region responsible for visual acuity and color vision. Thus, our objective was to evaluate the photoreceptor activity in patients with AMD through psychophysical and electrophysiological tests. For this, 49 participants were included, 19 in the control group (71.6 ± 4.8 years) and 30 in the dry AMD group (69.2 ± 7.7 years). Participants underwent color vision test (Cambridge Colour Test - CCT), chromatic pupilometry to verify the integrity of the external and internal retina, and electroretinography (ERG) with heterochromatic flicker. The results in the CCT showed worse color discrimination in the Protan, Deutan and Tritan axes of subjects with AMD compared to controls. The Tritan results is positively correlated to alteration on EPR-Bruchs membrane. In chromatic pupilometry, we observed external retinal integrity, but there was a reduction in the response amplitude of the stimulus to ipRGC cells of the internal retina. On ERG, no differences were observed between the groups in the activity of the magno- and parvocellular pathways. These results indicate preservation of magno- and parvocellular pathways function in initial AMD, as well as photoreceptors-mediated pupillary responses, and that color discrimination might a sensitive instrument to reveal initial changes in AMD
 
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decleva_corrigida.pdf (5.54 Mbytes)
Publishing Date
2019-11-12
 
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