早期原发性开角型青光眼彩色图形视觉电生理改变分析

目的 探讨早期原发性开角型青光眼彩色图形视网膜电图（ＣＰ－ＥＲＧ）,彩色图形视觉诱发电位（ＣＰ－ＶＥＰ）的改变特征。方法 采用电生理方法记录早期原发性开角型青光眼（ＰＯＡＧ）患者在白／黑、红／黑、蓝／黑翻转图形刺激下的ＣＰ－ＥＲＧ、ＣＰ－ＶＥＰ,结果 （１）ＰＯＡＧ组ＣＰ－ＥＲＧ的ｂ波幅值下降,潜伏期延长;ＣＰ－ＶＥＰ的Ｐ１００波幅值下降,潜伏期延长;（２）ＰＯＡＧ组ＣＰ－ＥＲＧ和ＣＰ－ＶＥＰ的异     

定量测量视网膜神经纤维层厚度联合视觉电生理检查开角型青光眼

目的 比较光学相干断层成像术（ＯＣＴ）测量视网膜神经纤维层（ＲＮＦＬ）厚度与视觉电生理检查在原发性开角型青光眼（ＰＯＡＧ）早期损害中的敏感性并分析其间相互关系。方法 对早期、进展期或晚期ＰＯＡＧ患者２６例（５０眼）联合进行ＯＣＴ及ＰＥＲＧ、ＰＶＥＰ和ＯＰｓ的检查。结果 ＯＣＴ测量ＲＮＦＬ厚度在ＰＯＡＧ早期中的异常率为４０．９１％,低于ＰＥＲＧ（７８．９５％）和ＰＶＥＰ的异常率（６４．６４％）,高于ＯＰｓ（２８．５７％）。ＲＮＦＬ百度与ＰＶＥＰ和ＰＥＲＧ振幅显著正相关,与ＰＶＥＰ潜伏期负相关,与ＯＰｓ总值不相关。结论 联合ＯＣＴ测量ＲＮＦＬ厚度与视觉电生理检查更有利于青光眼的早期诊断。     

开角型青光眼图形视诱发电位与定量静态视野联合检测研究

目的 观察原发性开角型青光眼眼压、视野与Ｐ－ＶＥＰ Ｐ１００波潜时之间的关系。通过改变空间频率（１２０′、６０′、３０′）选择青光眼电生理学诊断最佳刺激参数。方法 对２４例（３０只眼）原发性性开角型青光眼进行眼压、定时静态视野及Ｐ－ＶＥＰ检测。分析眼压、定时静态视野Ｐ－ＶＥＰ Ｐ１００波潜时关系。检测结果进行统计学分析。结果 眼压、定时静态视野缺损程序与Ｐ－ＶＥＰ Ｐ１００波潜时变化呈正相关。高空     

慢性青光眼的图形视诱发电位

目的探索图形视诱发电位（ｐａｔｅｒｎ－ｖｉｓｕａｌｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ，Ｐ－ＶＥＰ）对慢性青光眼的诊断价值。方法对７０眼慢性青光眼采用Ｐ－ＶＥＰ检测，以Ｐ１００波峰潜伏期及杯／盘面积比作为观察指标。结果杯／盘面积比（ＳＣ／Ｄ）＞０．２与ＳＣ／Ｄ≤０．２两者Ｐ－ＶＥＰ潜伏期阳性检出率，差异有高度显著性（Ｐ＜０．０１），ＳＣ／Ｄ与Ｐ－ＶＥＰ潜伏期之间呈正相关关系（ｒ＝０．５０３８，Ｐ＜０．０１）。结论Ｐ１００波峰潜伏期延长与青光眼视功能损害程度密切相关；青光眼损害轻时，Ｐ－ＶＥＰ潜伏期阳性率低，而青光眼损害重时，Ｐ－ＶＥＰ潜伏期阳性率较高。提示应用Ｐ－ＶＥＰ检查对青光眼的病情追踪观察及疗效评估有一定价值。     

早期原发性开角型青光眼彩色图形视网膜电图的特征

目的观察早期原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎａｎｇｌｅｇｌａｕｃｏｍａ，ＰＯＡＧ）彩色图形视网膜电图（ｃｏｌｏｒｐａｔｔｅｒｎｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ，ＣＰ－ＥＲＧ）的改变特征。方法对２９例（４８只眼）ＰＯＡＧ，１０例（１６只眼）高眼压症及３３例（４８只眼）年龄匹配的正常人做ＣＰ－ＥＲＧ检测，并进行统计学比较及多因素分析。结果早期ＰＯＡＧ的ＣＰ－ＥＲＧ的Ｐ１、Ｎ２波幅下降，红黑Ｎ２与蓝黑Ｐ１峰时间延长；部分高眼压症已出现Ｎ２波幅下降。采用多因素逐步判别分析方法，筛选出对早期ＰＯＡＧ诊断有判别能力的５项指标：蓝黑Ｎ２波幅、红黑Ｐ１波幅、红黑Ｎ２波幅、红黑Ｎ２峰时间及白黑Ｐ１波幅与Ｎ２波幅的比值，同时建立了判别函数。结论ＣＰ－ＥＲＧ是检测早期ＰＯＡＧ视网膜功能改变的有效方法，有助于早期ＰＯＡＧ的诊断。     

老年性黄斑变性早期图形视诱发电位检测

对早期ＡＭＤ眼和对照组眼进行了Ｐ－ＶＥＰ测定。结果显示，早期ＡＭＤ组与对照组之有间显著性差异，表现为Ｐ１００潜伏期延长和Ｐ１００波幅值降低，异常检出率分别为３７．８％和４３．５％，说明在早期ＡＭＤ眼中，尽管视力正常，但已有视功能变化，Ｐ－ＶＥＰ的检测在了解视功能损害中有一定意义。     

原发性青光眼红细胞免疫功能的研究

测定１０３例ＰＧ患者ＲＢＣ免疫粘附功能及血清中ＲＢＣ免疫调节因子的活性，同时测定外周血Ｔ淋巴细胞亚群、ＬＴＴ，ＩｇＡ、ＩｇＭ、ＣＨ５０、Ｃ３ＣＩＣ等。结果显示ＲＣ６ｂＲＲ、ＲＦＥＲ，Ｅ／Ｉ，ＣＤ３，ＣＤ４，ＣＤ４／ＣＤ８，ＩｇＭ，ＣＨ５０，Ｃ３下降；ＲＩＣＲ，ＲＦＩＲ，ＩｇＧ，ＣＩＣ升高ＲＣ３ｂＲＲ与ＣＤ４，ＣＤ４‘／ＣＤ８呈正相关，与ＣＩＣ呈负相关。     

RAPD在青光眼早期诊断中的应用

青光眼患者早期诊断以及治疗对患者有效视力的长期维持尤为重要。虽然青光眼是双眼疾病,但双眼早期的临床体征通常表现不一致,这种不一致在瞳孔表现上可能出现相对传入性瞳孔障碍（ｒｅｌａｔｉｖｅａｆｆｅｒｅｎｔｐａｐｉｌｌａｒｙｄｅｆｅｃｔ,ＲＡＰＤ）。目前对青光眼的诊断更多的是关注眼压及视野缺损,而眼压及视野检查结果的可靠性与患者的主动配合息息相关,且需要仪器配合。相对的,ＲＡＰＤ的检查在临床上却能够更加简便、快捷。对ＲＡＰＤ及其对青光眼早期诊断的价值应得到充分认识。本文主要对ＲＡＰＤ的检查方法与其灵敏性和特异性,以及ＲＡＰＤ与青光眼其他检查方式的相关性进行综述。     

国产青光眼新药地匹福林的临床应用

观察３７例７３只开角型青光眼和高眼压症患者用０．１％地匹福林（ｄｉｐｉｖａｌｙｌｅｐｉｎｅｐｈｒｉｎｅ，ＤＰＥ）的临床效果，并对１７例３４只开角型青光眼和高眼压症患者滴１％肾上腺素（ｅｐｉｎｅｐｈｒｉｎｅ，ＥＰＩ）做为对ＤＰＥ降眼压效果的对比，结果表明二者降眼压作用时间和持续时间相似，０．１％ＤＰＥ的降眼压作用相当于１％ＥＰＩ的效果。虽然ＤＰＥ使瞳孔扩大，但对血压、脉搏无明显影响，较ＥＰＩ副作用小。     

青光眼和高眼压症的象限图形视觉诱发电位

目的：探讨青光眼患者视觉电生理与视野改变的关系。 方法：对青光眼30例50眼、高眼压症14侧28眼、正常对照组35人70眼进行象形图形视觉诱发电位(象限PVEP)检测及视野检查。 结果：青光眼各象限LP₁₀₀延长、AP₁₀₀下降，高眼压症患者有部分眼各象限LP₁₀₀延长，青光眼组鼻上、鼻下LP₁₀₀的异常串高于颞上，颞下，高眼压症组鼻上、颞上_^LP100的异常率高于鼻下、颞下。．象限PVEP的变化与视野、杯盘直径比(C/D)改变程度相关． 结论：年限PVEP易改变部位与早期青光眼视野缺损的部位相符。象限PVEP检测对青光眼病情估计，随访有一定意义。 （中华眼底病杂志，1996，12：114-115）     

Electrophysiological evidence that early glaucoma affects foveal vision

The pattern electroretinogram (PERG) and visual evoked potential (PVEP) were recorded simultaneously using a 1.1 cpd pattern which was counterphase modulated at 1 Hz. The responses of ocular hypertensive (OHT) eyes (with normal visual fields) and eyes with early glaucoma (with early visual field defects and/or early cupping of the optic nervehead) were compared to age-matched normal observers. All patients (26 eyes) and normal observers (14 eyes) had normal transient flash electroretinograms. Delays were seen in mean PERG latency in both OHT and early glaucoma eyes, while mean PERG amplitude was significantly reduced only in the early glaucoma eyes. The PVEP responses were unmeasurable in 11/26 patient eyes because the waveforms were grossly abnormal in shape, making it impossible to identify the N- and P-components. The data were categorized in this manner: a patient response was considered abnormal if latency or amplitude exceeded normal limits (PERG or PVEP) or if the waveform was unmeasurable due to its shape (PVEP only). Of the 26 patient eyes, we found that 8 eyes had normal PERG and PVEP, 11 eyes had abnormal PERG and PVEP, one eye had an abnormal PERG and a normal PVEP, and 6 eyes (3 patients) had a normal PERG and an abnormal PVEP. These data support the proposition that foveal vision (as assessed by the PVEP) may be affected by early glaucomatous damage. The relationship between the PERG and PVEP also was evaluated using a new measurement which we call the latency window. Using this measurement, 15/26 patient eyes were abnormal - 9 of these had unmeasurable PVEPs. This measurement could be useful in classifying W-shaped PVEPs as normal or abnormal.This study was supported in part by Grants EY01708 and EY01867 from the National Eye Institute, Bethesda, MD, by Fight For Sight Grant-in-Aid G-274, and by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY.     

联合多种视功能检查对原发性开角型青光眼早期诊断的意义

了解原发性开角型青光眼视觉电生理和计算机自动视野检查结果的变化特征并对其视功能状况进行综合分析以寻找比较敏感和特异的参数，为原发性开角型青光眼较早期和早期诊断提供依据。方法：对３６例原发性开角型青光眼患者，８例可疑性青光眼患者，３０例正常对照者分别进行视网膜振荡电位，视网膜电图，视诱发电位和Ｈｕｍｐｈｅｒｙ计算机自动视野检查。     

几种视觉电生理检查对原发性开角型青光眼早期诊断的意义

目的：评价几种视觉电生理检查在原发性开角型青光眼早期诊断中的价值,为临床青光眼早期诊断提供客观敏感的指标。方法：选择36例（70眼）原发性开角型青光眼患者、8例（12眼）可疑性青光眼患者和30例（60眼）正常对照者分别进行闪光视网膜电图（FERG）、视网膜振荡电位（OPs）、闪烁光视网膜电图（FLERG）、图形视网膜电图（PERG）、图形视诱发电位（PVEP）检查,并与视野指数、眼压、视力等进行多元相关分析。结果：原发性开角型青光眼PERG、PVEP、OPs表现异常,与正常对照组相比差异有显著性意义（p＜0.05）。FLERG振幅降低,但和FERG同样与正常对照组相比差异无显著性意义（p＞0.05）。在原发性开角型青光眼早期（特别是视野改变出现前）,PERG的异常率较高。原发性开角型青光眼患者OPs与C／D负相关,与视野指数、眼压、视力不相关。PERG振幅与视野指数和眼压负相关,与C／D和视力不相关。PVEP潜伏期与视野指数和C／D正相关,而与眼压不相关。结论：统计学结果表明,对原发性开角型青光眼不同的表现形式,可选用不同的检查指标。在早期眼底改变出现前（C／D不大）,如眼压升高,PERG应为比较敏感的指标;而一旦眼底发生改变,尽管眼压不高,可选用OPs或PVER作为观察指标。对早期和中晚期青光眼,PERG诊断和监测价值较好。联合多种视功能检查对原发性开角型青光眼的早期诊断具有较好的意义。     

Correlation between morphological and functional retinal impairment in patients affected by ocular hypertension, glaucoma, demyelinating optic neuritis and Alzheimer's disease

In this article the correlations between the morphological evaluation of the nerve fiber layer (NFL) thickness (by OCT) and retinal functional assessment (by Pattern ERG recordings) performed in patients affected by ocular hypertension (OHT), glaucoma (OAG), demyelinating optic neuritis (MSON), and Alzheimer's disease (AD) are reported. In OHT eyes with ocular hypertension we observed that the inter-individual variation in NFL thickness is correlated with the variability of the PERG responses (the thinner the layer, the worse the visual function). In our OAG, MSON and AD eyes we observed a significant reduction in NFL thickness when compared with controls. In OHT, OAG, MSON and AD eyes abnormal PERG responses with delayed implicit times and reduced amplitudes were found. The impairment in the PERG parameters was significantly correlated to the reduction in NFL thickness. Our results suggest that in patients affected by ocular hypertension, glaucoma, demyelinating optic neuritis, and Alzheimer's Disease there is a reduction of NFL thickness evaluated "in vivo" by OCT, and this morphological involvement is correlated with electrophysiological responses assumed to be originating from the innermost retinal layers.     

Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) in the early stages of Alzheimer’s disease

Alzheimer’s disease (AD) is one of the most common causes of dementia in the world. Patients with AD frequently complain of vision disturbances that do not manifest as changes in routine ophthalmological examination findings. The main causes of these disturbances are neuropathological changes in the visual cortex, although abnormalities in the retina and optic nerve cannot be excluded. Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) tests are commonly used in ophthalmology to estimate bioelectrical function of the retina and optic nerve. The aim of this study was to determine whether retinal and optic nerve function, measured by PERG and PVEP tests, is changed in individuals in the early stages of AD with normal routine ophthalmological examination results. Standard PERG and PVEP tests were performed in 30 eyes of 30 patients with the early stages of AD. The results were compared to 30 eyes of 30 normal healthy controls. PERG and PVEP tests were recorded in accordance with the International Society for Clinical Electrophysiology of Vision (ISCEV) standards. Additionally, neural conduction was measured using retinocortical time (RCT)—the difference between P100-wave latency in PVEP and P50-wave implicit time in PERG. In PERG test, PVEP test, and RCT, statistically significant changes were detected. In PERG examination, increased implicit time of P50-wave (P < 0.03) and amplitudes reductions in P50- and N95-waves (P < 0.0001) were observed. In PVEP examination, increased latency of P100-wave (P < 0.0001) was found. A significant increase in RCT (P < 0.0001) was observed. The most prevalent features were amplitude reduction in N95-wave and increased latency of P100-wave which were seen in 56.7% (17/30) of the AD eyes. In patients with the early stages of AD and normal routine ophthalmological examination results, dysfunction of the retinal ganglion cells as well as of the optic nerve is present, as detected by PERG and PVEP tests. These dysfunctions, at least partially, explain the cause of visual disturbances observed in patients with the early stages of AD.     

Detecting early functional damage in glaucoma suspect and ocular hypertensive patients with the multifocal VEP technique

PURPOSE: To determine whether the multifocal visual evoked potential (mfVEP) technique can detect early functional damage in ocular hypertensive (OHT) and glaucoma suspect (GS) patients with normal standard achromatic automated perimetry (SAP) results. PATIENTS AND METHODS: Twenty-five GS patients (25 eyes), 25 patients with OHT (25 eyes), and 50 normal controls (50 eyes) were enrolled in this study. All GS, OHT and normal control eyes had normal SAP as defined by a pattern standard deviation and mean deviation within the 95% confidence interval and a glaucoma hemifield test within normal limits on the Humphrey visual field 24-2 program. Eyes with GS had optic disc changes consistent with glaucoma with or without raised intraocular pressure (IOP), and eyes with OHT showed no evidence of glaucomatous optic neuropathy and IOPs >or=22 mm Hg. Monocular mfVEPs were obtained from both eyes of each subject using a pattern-reversal dartboard array with 60 sectors. The entire display had a radius of 22.3 degrees. The mfVEPs, for each eye, were defined as abnormal when either the monocular or interocular probability plot had a cluster of 3 or more contiguous points with P<0.05 and at least 2 of these points with P<0.01. RESULTS: The mfVEP results were abnormal in 4% of the eyes from normal subjects. Abnormal mfVEPs were detected in 20% of the eyes of GS patients and 16% of the eyes of OHT patients. Significantly more mfVEP abnormalities were detected in GS patients than in normal controls. However, there was no significant difference in mfVEP results between OHT patients and normal controls. CONCLUSIONS: The mfVEP technique can detect visual field deficits in a minority of eyes with glaucomatous optic disks and normal SAP results.     

图形视网膜电图检测原发性开角型青光眼视网膜功能的意义

目的 观察原发性开角型青光眼图形视网膜电图的改变及其特点,了解ＰＥＲＧ在检测ＰＯＡＧＰＹ视网膜功能方面的意义。方法 对３６例（５９只眼）ＰＯＡＧ及３２例（５９只眼）年龄相匹配的正常人进行ＰＥＢＧ检测。结果 ＰＯＡＧ患者ＰＥＲＧ的ＡＰ１、ＡＮ２、ＡＮ１、ＡＮ２／ＡＰ１下降;运用ＡＮ２＋ＡＰ１〈２．７及ＡＮ２／ＡＰ１下降;运用ＡＮ２＋ＡＰ１〈２．７及ＡＮ２／ＡＰ１〈０．７的方法,对已确认的ＰＯＡＧ进行     

Neural conduction in the visual pathways in ocular hypertension and glaucoma

Background: The aim of our work was to evaluate neural conduction in visual pathways in subjects with ocular hypertension and glaucoma. Methods: We assessed simultaneous recordings of pattern electroretinograms (PERG) and visual evoked potentials (VEP) in 16 subjects with ocular hypertension (OHT), in 16 subjects with primary open-angle glaucoma (POAG) and in 15 age-matched controls. The visual stimuli were checkerboard patterns (the check edges subtend 15 min of visual arc; contrast 70%) reversed at the rate of 2 reversals/s. Results: In OHT and POAG patients we found PERG and VEP latencies signficantly longer than in controls. The P50-N95 PERG amplitudes were significantly reduced in OHT and POAG eyes. VEP amplitudes were significantly reduced in POAG eyes, while in OHT they were similar to controls. The retinocortical time (RCT; difference between VEP P100 latency and PERG P50 latency) was longer in POAG patients than in controls; no differences between patients with OHT and controls were observed. Moreover, we observed that in POAG the longer RCT was inversely related to the PERG amplitude. Conclusion: Our results suggest that involvement of the innermost retinal layers in POAG is accompanied by slowed neural conduction in the visual pathways.Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1995