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。

The significance of different kinds of electrophysiology tests on the early diagnosis of primary open angle glaucoma

The study was designed to analyze different kinds of electrophysiological tests in primary open angle glaucoma(POAG)in order to find some more abstract and sensitive parameters in early diagnosis of patients with POAG.Methods:Thirty-six(70 eyes)patients with POAG,eight(12 eyes)suspected people and 30 normal subjects(60 eyes)underwent flash electroretinogram(FERG),flick electroretinogram(FLIERG),pattern electroretinogram(PERG),oscillatory potentials(OPs),and pattern visual evoked potentials(PVEP)tests.Results:The results of PERG,PVEP and OPs were abnormal in patients with POAG when they compared with those of normal people(P<0.05),but there were no significant difference of FERG and FLERG between patients with POAG and normal controls (P>0.05).The abnormal rate of PERG was the highest among the three electrophysiological tests in suspected people.In the correlation analysis of patients with POAG,the amplitude of PERG had negative correlated with IOP and visual indices,but no correlation with C/D and VA;OPs had negative correlated with C/D,and no correlation with visual fields indices,intraocular pressure(IOP),visual acuity(VA);the latency of PVEP had positive correlation with visual fields indices and C/D,but no correlation with IOP.Conclusion:Statistical results showed different parameters could be selected according to different appearance of POAG.Before the visual field was abnormal,PERG would be a more sensitive indictor when C/D was normal but IOP was high;once C/D was abnormal,OPs and PVEP would be the better parameters in spite of normal IOP.In the advanced stage of POAG,the PERG was better for diagnosis and monitoring the disease process.It was significant in combination of many visual function tests on early diagnosis of POAG.