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Abstract：
BACKGROUND: Nutritional visual defects are apparently uncommon nowadays in developed nations. Retinal change-related visual defects caused by hypovitaminoses may be underdiagnosed.
OBJECTIVE: To investigate the retinal structural and functional changes in a patient with multivitamin deficiency before and during vitamin supplementation.
METHODS: A 51-year-old female had been on vegetarian diet as a child, and on restrict vegan diet during the last 2 years, developing severe bilateral deterioration of visual function and polyneuropathy. Blood test revealed low levels of vitamin A, B6 and D. The patient underwent examinations with optical coherence tomography (OCT), computerized visual field examination (VF), electroretinography (ERG), visual evoked potentials (VEP) and neurography before and after vitamin supplementation.
RESULTS: Visual acuity (VA) was 20/1000 and VF examination showed central scotoma in both eyes. Color vision was significantly affected. Full-field ERG showed normal rod and cone function, but a clearly reduced central peak was registered in multifocal ERG (mf-ERG), indicating impaired fovea function. VEP showed delayed latency and low amplitude of P100 in both eyes. Neurography showed sensory polyneuropathy. OCT showed significant thinning of macular ganglion cell plus inner plexiform layer (GCIPL) with rapid progression. Retinal nerve fiber layer (RNFL) was preserved and normal, which is in contrast to neuroinflammatory conditions. After 2.5 years of multivitamin supplementation, the visual functions were improved. GCIPL thickness was stable without further deterioration.
CONCLUSIONS: Multivitamin deficiency results in progressive thinning of GCIPL with severe visual deterioration. In contrast to neuroinflammation, RNFL is preserved and normal. Stabilized GCIPL during vitamin supplementation was associated with improved visual function. OCT provides a sensitive and objective measure for differential diagnosis, monitoring retinal change and response to therapy.
OBJECTIVE: To investigate the retinal structural and functional changes in a patient with multivitamin deficiency before and during vitamin supplementation.
METHODS: A 51-year-old female had been on vegetarian diet as a child, and on restrict vegan diet during the last 2 years, developing severe bilateral deterioration of visual function and polyneuropathy. Blood test revealed low levels of vitamin A, B6 and D. The patient underwent examinations with optical coherence tomography (OCT), computerized visual field examination (VF), electroretinography (ERG), visual evoked potentials (VEP) and neurography before and after vitamin supplementation.
RESULTS: Visual acuity (VA) was 20/1000 and VF examination showed central scotoma in both eyes. Color vision was significantly affected. Full-field ERG showed normal rod and cone function, but a clearly reduced central peak was registered in multifocal ERG (mf-ERG), indicating impaired fovea function. VEP showed delayed latency and low amplitude of P100 in both eyes. Neurography showed sensory polyneuropathy. OCT showed significant thinning of macular ganglion cell plus inner plexiform layer (GCIPL) with rapid progression. Retinal nerve fiber layer (RNFL) was preserved and normal, which is in contrast to neuroinflammatory conditions. After 2.5 years of multivitamin supplementation, the visual functions were improved. GCIPL thickness was stable without further deterioration.
CONCLUSIONS: Multivitamin deficiency results in progressive thinning of GCIPL with severe visual deterioration. In contrast to neuroinflammation, RNFL is preserved and normal. Stabilized GCIPL during vitamin supplementation was associated with improved visual function. OCT provides a sensitive and objective measure for differential diagnosis, monitoring retinal change and response to therapy.
摘要：
背景：如今，营养视觉缺陷在发达国家显然并不常见。与视网膜变化相关的视力缺陷可能是由低维生素D引起的诊断不足。
目的：研究复合维生素缺乏患者补充维生素前后视网膜结构和功能的变化。
方法：一名51岁的女性从小就开始吃素，在过去的两年里限制素食，发展严重的双侧视觉功能恶化和多发性神经病。验血显示维生素A含量低,B6和D.患者接受了光学相干断层扫描（OCT）检查，计算机视野检查（VF），视网膜电图（ERG），补充维生素前后的视觉诱发电位（VEP）和神经造影。
结果：视力（VA）为20/1000，VF检查显示双眼中央暗点。色觉受到显著影响。全场ERG显示棒和锥功能正常，但是在多灶性ERG（mf-ERG）中记录了明显减少的中心峰，表明中央凹功能受损。VEP显示两只眼睛的P100延迟潜伏期和低振幅。神经造影显示感觉多发性神经病。OCT显示黄斑神经节细胞和内网状层（GCIPL）明显变薄，进展迅速。视网膜神经纤维层（RNFL）保存正常，这与神经炎症相反。补充多种维生素2.5年后，视觉功能得到改善。GCIPL厚度是稳定的而没有进一步劣化。
结论：多种维生素缺乏导致GCIPL逐渐变薄，并伴有严重的视力下降。与神经炎症相反，RNFL保存正常。补充维生素期间稳定的GCIPL与改善的视觉功能有关。OCT为鉴别诊断提供了一种灵敏而客观的方法，监测视网膜变化和对治疗的反应。
目的：研究复合维生素缺乏患者补充维生素前后视网膜结构和功能的变化。
方法：一名51岁的女性从小就开始吃素，在过去的两年里限制素食，发展严重的双侧视觉功能恶化和多发性神经病。验血显示维生素A含量低,B6和D.患者接受了光学相干断层扫描（OCT）检查，计算机视野检查（VF），视网膜电图（ERG），补充维生素前后的视觉诱发电位（VEP）和神经造影。
结果：视力（VA）为20/1000，VF检查显示双眼中央暗点。色觉受到显著影响。全场ERG显示棒和锥功能正常，但是在多灶性ERG（mf-ERG）中记录了明显减少的中心峰，表明中央凹功能受损。VEP显示两只眼睛的P100延迟潜伏期和低振幅。神经造影显示感觉多发性神经病。OCT显示黄斑神经节细胞和内网状层（GCIPL）明显变薄，进展迅速。视网膜神经纤维层（RNFL）保存正常，这与神经炎症相反。补充多种维生素2.5年后，视觉功能得到改善。GCIPL厚度是稳定的而没有进一步劣化。
结论：多种维生素缺乏导致GCIPL逐渐变薄，并伴有严重的视力下降。与神经炎症相反，RNFL保存正常。补充维生素期间稳定的GCIPL与改善的视觉功能有关。OCT为鉴别诊断提供了一种灵敏而客观的方法，监测视网膜变化和对治疗的反应。
