眼挫伤的视网膜电流图和视觉诱发电位改变

为探讨眼挫伤的视网膜电流图(ERG)和视觉诱发电位(VEP)改变特征,对50例单眼挫伤患者电生理检测结果进行了分析研究.结果表明:(1)眼挫伤ERG改变以a波下降(P<0.001)、b波延迟(P<0.05)为明显,ERG异常病例的视力多在0.1以下.(2)VEP检测视力0.1以下者的P_1波明显延迟(P<0.05).     

白内障术前行相关检查对视功能评估及视网膜疾病检出的有效性探索

目的:评价闪光视觉诱发电位(FVEP)、闪光视网膜电图(FERG)或图形视网膜电图(PERG)、眼底照相、眼部B超和光学相干断层扫描(OCT)应用于白内障术前对视功能的评估及对视网膜疾病检出的有效性观察。方法:对148例196眼白内障患者术前应用眼科电生理仪、眼底照相、眼部B超和OCT,根据FVEP和FERG(或PERG)、眼底照相、OCT、眼部B超检查结果的阳性率进行分析。结果:患者148例196眼中,B超检查显示玻璃体混浊165眼(84.2%),无法获取B超图像31眼(15.8%);成功获取眼底照相图像161眼(80.6%),无法获取图像35眼(19.4%);获得有价值VEP、ERG 58眼(29.6%),VEP、ERG未见明显异常138眼(70.4%);成功获取OCT图像167眼(85.2%),无法获取OCT图像29眼(14.8%)。结论:视觉电生理检查、眼底照相、眼部B超和光学相干断层图像结果可对白内障患者术前的视功能状况进行综合评估,多种检查方法相互配合,可进一步提高白内障手术前对视网膜疾病以及其他眼科疾病的检出率。     

视觉电生理在眼挫伤检查中的意义

目的 观察眼挫伤后伴有视网膜振荡及视神经挫伤的F-ERG、F-VEP、P-VEP的变化特点.方法 应用眼电生理仪检测临床诊断为眼挫伤658眼,分别行F-ERG和P-VEP或F-VEP检查,记录ERG b波潜伏期和振幅,P100或P2潜伏期和振幅.结果 视网膜振荡者ERG b波振幅降低,潜伏期延长;神经挫伤者P100或P:潜伏期明显延长,振幅降低;二者合并存在时ERG b波振幅降低,潜伏期延长,P100或P2潜伏期明显延长,振幅降低.结论 F-ERG与VEP的联合应用对眼挫伤的诊断、预后估计、指导治疗及伤情鉴定有临床应用价值.     

视觉电生理检查在眼挫伤中的应用

目的 探讨视觉电生理检查在眼挫伤中的应用价值。方法 1999年3月－2000年9月无屈光间质障碍的眼挫伤患者31例34眼,除了常规视力、诊断性验光、裂隙灯及眼底检查外,全部做了视觉电生理检查,包括视网膜电流图（ERG）、眼电图（EOG）及视诱发电位（VEP）。结果 凡伤后视力下降,用其他临床检查方法无法解释或眼前段及眼底未见明显异常者,视觉电生理检查均有异常。结论 电生理作为一种判断视功能的客观检查方法,对眼挫伤患者的视功能检测以及临床治疗、随诊观察和预后判断等均有重要意义。     

正常及光感受器损伤兔眼视网膜下芯片植入后的电生理结果

目的 观察视网膜下芯片所引起的光感受器损伤及正常兔眼的电生理改变。 方法 青紫蓝兔共30只，其中22只兔NaIO3生理盐水溶液静脉 注入后眼光感受器受到损伤。将一个由90个微光电二极管组成的阵列和相连电极构成的直径约3mm的芯片通过巩膜切口植入4只正常及22只注药后光感受器损伤兔右眼的视网膜下腔或脉络膜中，左眼为对照眼 ；分别检测芯片眼及对照眼局部闪光视觉诱发电位（F-VEP）、局部闪光视网膜电图（F-ERG）、全视野闪光VEP及全视野闪光ERG。另外4只兔双眼摘作病理检查。 结果 22只色光感受器损伤兔中有11只芯片眼的局部ERG主波振幅明显大于对照眼；4只正常兔中，2只芯片眼的局部ERG主波振幅大于对照眼。1只芯片眼表面视网膜出现破孔不能引出任何波。局部VEP及全视野闪光VEP重复性较差，全视野闪光ERG未见明确差别。 结论 植入的芯片在受到光刺激 后可刺激局部视网膜并引起局部视网膜的电活动。 (中华眼底病杂志, 2006, 22: 324-327)     

伴视网膜脱离的高度近视眼m-ERG和传统视觉电生理改变

目的 观察高度近视患者视网膜脱离术前的视觉电生理改变，了解视功能损害程度。方法 回顾我院住院手术的高度近视患者视网膜脱离29例，与对侧高度近视眼、正常人48只眼对照组进行A／B超、传统视觉电生理F—ERG、F—VEP、多焦视网膜电图(一阶反应，first orderkernel，FOK)联合检测。结果 高度近视患者视网膜脱离眼轴比正常对照组眼眼轴长；F—ERG表现为振幅下降明显，同时潜伏期下降，甚至呈熄灭型，F—VEP P100改变无明显差异。m—ERG高度近视视网膜脱离眼及对侧眼中心凹振幅密度下降，a、b波振幅下降，但对侧高度近视眼潜伏期无改变。结论 联合应用A／B超、传统视觉电生理、多焦视网膜电图，为观察其眼轴变化，视功能受损提供了敏感客观依据，能定量、定性评价黄斑部后极部视网膜、视神经功能。     

眼外伤异常电生理临床分析（附100例报告）

具有异常电生理改变的100例单眼外伤中,14眼仅VEP PT延长,显示黄斑、黄斑旁或视神经的钝伤,由FFA及视野加以证实.10眼VEP PT延长,PA下降或消失者显示黄班或视神经挫伤严重,可合并颅脑伤,视力严重下降或无光感.38例同时伴有FERGb波下降,显示损伤广泛而严重,可有眼球破裂、视网膜玻璃体及前房的出血,晶体混浊等.10眼VEP ERG波形全消失,则为眼球严重挫伤及伤后感染、眼球萎缩.28眼仅有FERGb波异常,则显示损伤不在中心区.     

屈光参差性弱视同步记录多焦视觉诱发电位和多焦视网膜电图的对比研究

目的探讨弱视发病的可能机制。方法采用VERIS Science^TM4．2多焦电生理系统对24例屈光参差性弱视患者双眼分别进行多焦图形视觉诱发电位(VEP)、视网膜电图(ERG)同步记录和多焦闪光VEP、ERG同步记录,并与30例正常对照的结果进行比较。结果在不同视网膜区域弱视眼多焦图形VEP、ERG反应和多焦闪光VEP、ERG二阶反应振幅均降低,VEP特征峰潜时延长,ERG潜时无改变。弱视眼多焦闪光一阶反应VEP、ERG的反应振幅密度均降低,潜时无明显改变。多焦图形VEP波形异常程度中心区大于周边区,且与弱视眼的视力异常程度有相关性。弱视眼多焦图形和闪光二阶反应的视网膜．皮层传导时间(RCT)显著延长,闪光一阶反应RCT三组无明显差异。结论弱视眼的mVEP和mERG具有明显的特征性改变,表明弱视眼的视网膜、视觉传导通路和视皮层都存在明显损害,且中心区损害重于周边区,中枢损害重于视网膜。(中华眼科杂志,2005,41：41-46)     

视觉电生理检查在眼挫伤视力减退医学鉴定中的临床意义

目的　探讨在眼球钝挫伤后主诉视力减退而临床检查没有阳性体征患者的医学鉴定中 ,视觉电生理检查的临床意义。方法　对 5 0例 (5 0只眼 )眼挫伤患者进行了视觉电生理检查。结果　除 2例 VEP异常外 ,其余 4 8例的 F- ERG、F- VEP、P- VEP均正常。 VEP异常 2例在 3个月后复查眼底视乳头呈苍白色 ,其它 4 8例中有 4 0例复查时视力在正常范围 (包括矫正视力 )。 8例没来复查。结论　 VEP检查在视力减退的医学鉴定中有重要作用     

眼挫伤VEP、ERG联合检查的意义

目的 探讨VEP、ERG在眼挫伤中应用的意义。方法 对我院近3年来无屈光间质障碍的眼挫伤患者68例68眼，除行常规视力、裂隙灯和眼底检查外，予行VEP、ERG检查。结果对伤后视力下降，矫正不佳，常规检查又未能查出明显异常者，VEP或ERG均有异常。结论 VEP、ERG联合应用是眼挫伤后早期诊断及视功能评价的客观检测手段。     

A case of localized retinal damage in thallium poisoning

Purpose: To determine the cause of visual impairment and to document the late eye disturbances in a case of thallium poisoning. Patient: A 44-year-oldwoman presented with a history of repeated attacks of complete alopecia over a period of several months, diffuse pain in both legs, transient gastrointestinal disturbances, abasia with a progressive paraparesis, paresthesia in the fingertips, and polyneuropathy. She complained of slowly progressive visual deterioration in both eyes which began about six months after the first attack of alopecia. The optic discs showed distinct signs of temporal atrophy together with a deep temporal excavation. The Goldmann perimetry revealed an absolute central scotoma. Traces of thallium were found in the urine and in the serum. The district attorney later discovered that her husband had been trying to poison her with thallium. Methods: The clinical and electrophysiological examinations included visual evoked potentials (VEP) and electroretinography (flash ERG, multifocal ERG and pattern ERG). Results: The VEP showed a reduction in amplitude and a prolonged latency indicating a conduction block. The pattern ERG was initially normal. At a follow-up examination 6 years later, a slight amplitude reduction in the pattern ERG was found. The multifocal ERG showed a diminished amplitude in the center of the retina (up to± 10° visual angle). Conclusions: The electrophysiological investigations in our patient – who had an optic atrophy – indicated a conduction block of the retinal nerve fibers (VEP) and an additional lesion at or before the retinal bipolar cells (multifocal ERG),localized in the central ± 10°. These findings suggest that thallium poisoning can lead to a combined lesion of the retinal nerve fibers and the neural retina. This revised version was published online in August 2006 with corrections to the Cover Date.     

Non-simulator-based techniques in teaching direct ophthalmoscopy for medical students: a systematic review

Non-simulator-based examination methods of the fundal examination have shown to be cost-effective.We reviewed different non-simulator-based direct fundoscopy examination methods used in undergraduate curricula and their outcomes.PubMed(MEDLINE) and Cochrane Database of Systematic Reviews were searched using standard Medical Subject Heading(MeSH) terms ophthalmoscopy,medical education,undergraduate medical education,medical student,educational assessment and learning.The search included publications until 28^thFebruary 2019.We obtained 34 articles after screening abstracts;of them,12 articles were included in the qualitative synthesis.The studies were comprised of diverse teaching methods which included fundal photograph matching with corresponding eye,continuous education using community-based eye clinics,formal instructions and demonstrations prior to skills training,ophthalmoscopy skills practice using eye pathologies,teaching versus conventional ophthalmoscopy and group-based teaching.We concluded that non-simulator-based techniques such as use of fundal photograph matching of an eye of a volunteer,introduction to eye pathologies,smaller student groups and formal instructions with video demonstrations prior to skills training were highly effective in teaching direct ophthalmoscopy for undergraduate medical students.     

视神经挫伤60例的视觉诱发电位分析

目的:探讨视觉诱发电位(visual evoked potential,VEP)对视神经挫伤临床诊断的作用。方法:对我科近两年临床诊断为视神经挫伤的患者60例(72眼)进行VEP检查。结果:P-VEP正常30眼;P100波潜伏时延迟22眼;P-VEP无波,F-VEP振幅降低12眼;P-VEP、F-VEP均无波8眼。结论:VEP检查是视神经挫伤的客观检查手段之一。     

Multivariate approach for quantification of morphologic and functional damage in glaucoma

PURPOSE: To determine the usefulness of confirmatory factor analysis in examination of morphometric, electrophysiological, and psychophysical quantitative methods that measure the extent of global glaucomatous damage without referring to a preselected gold standard. METHODS: In a cross-sectional clinical study, 406 eyes of 203 glaucoma patients and 200 eyes of 100 normal control subjects 18 to 70 years old underwent optic disc morphometry, automated perimetry, measurement of temporal contrast sensitivity by a full-field flicker test, blue-on-yellow visually evoked potential (VEP), and black-and-white pattern-reversal electroretinogram (ERG). Diagnosis of glaucoma was based on a qualitative classification of the optic nerve head and retinal nerve fiber layer independent of intraocular pressure and visual field. Confirmatory factor analysis was performed in the patient group as a whole and in a subgroup showing moderate to advanced glaucomatous optic nerve head damage. RESULTS: The confirmatory factor analysis models explained the data satisfactorily (P > 0.18, all patients; P > 0.34, subgroup). Global glaucomatous damage was quantified best by the mean defect of automated perimetry (r = 0.81; r = 0.87), followed by the area of the neuroretinal rim (r = 0.64; r = 0.73), the full-field flicker test (r = 0.59; r = 0.65), the pattern-reversal ERG amplitude (r = 0.54; r = 0.55), and the VEP peak time (r = 0.55; r = 0.54). CONCLUSIONS: Confirmatory factor analysis allows quantification of the validity of established and new procedures that measure global glaucomatous damage using cross-sectional data. The results are not dependent on the preselection of a specific gold standard. Psychophysical testing and morphometry quantified glaucomatous damage best, compared with electrophysiological procedures.     

Acute macular neuroretinopathy--case report

PURPOSE: The aim of this study is to present rare retinal disease of unknown origin. MATERIAL AND METHODS: 27-years-old man was diagnosed because of poor vision in the left eye, which lasted 4-5 weeks. Following examinations were performed: Visual acuity, contrast sensitivity, color perception, visual field, fluorescein angiography (AF), visual evoked potentials (VEP), full-field flash electroretinography (flash ERG), focal-foveal electroretinography (focal ERG), multifocal electroretinography (multifocal ERG). Follow-up 1.5 year. RESULTS: Visual acuity of right eye was 1.25 (-0.1 log MAR) and left eye 1.0 (0.0 log MAR). In left eye between optic disc and macula irregular lesion with dots of retinal pigment epithelium atrophy and little edema was seen. AF revealed small "window" defects. In visual field of the left eye paracentral relative scotoma occurred and in stereokampimetry central relative scotoma was found about 5 degrees from the fixation point. In VEP latency of P100 was delayed and amplitude was reduced in both eyes. In flash as well as focal ERG small reduction of cone function and delayed implicit time of b-wave were found in left eye. In general examination no focal inflammation and no abnormalities in laboratory tests were found. The patient was treated with steroids for 3 weeks. After ten days of general steroid treatment visual acuity improved to 1.25 and subjective improvement of vision occurred. Control examination after 1.5 year revealed no patient's complains, visual acuity 1.25, no change in visual field, VEP improvement. In left eye flat irregular area with pigment epithelium atrophy was seen. CONCLUSIONS: Acute macular neuroretinopathy may be diagnosed after detail examination. Prognosis is generally good, recovery is slow, but despite of local retinal atrophy subjective complains disappear completely.     

Clinical and experimental study on traumatic optic nerve lesion

Background: Traumatic optic nerve lesions (TONL) range from temporary affection of vision to avulsion of the optic nerve; often they are associated with more complex injuries. Usually Tonl are not regarded as an emergency. Up to now, we lack knowledge on the dependency of strength and duration of optic nerve lesions and the point of no return for afferent disorders of the visual pathway. Materials and methods: We performed a prospective study on 50 patients with severe midface and skullbase fractures in order to find characteristic ophthalmological, computer tomographic und electrophysiological findings as indicators of TONL, independent of patient cooperation. We used an animal model (Wistar rats; n = 117) to study calibrated optic nerve lesions and the resulting neurodegeneration in the retinal ganglion cell (RGC) layer quantitatively. Results: The electrophysiological investigation of the visual system (flash VEP/ERG) proved to be highly specific (0.97) and sensitive (1.0) for detecting TONL (n = 18). In the rat model, we could demonstrate a linear relationship between total neuron number reduction and strength and duration of calibrated optic nerve lesion. Conclusions: Experimental results indicate that optic nerve decompression is useful only within the first hours after TONL to reduce secondary optic nerve lesion. Indication for optic nerve decompression requires early detection of TONL, which is made possible by the combination of flash VEP/ERG.      

Pattern-reversal electroretinograms and visual evoked cortical potentials in multiple sclerosis.

Pattern-reversal and flash electroretinograms (ERG) and visual evoked cortical potentials (VECP) were recorded from 15 patients with definite multiple sclerosis (MS). All patients had prolonged VECP latency, indicating demyelination of one or both optic nerves. The pattern-reversal ERG amplitude was reduced below the level of normal variation (mean -2 SD) in 11 of the 22 eyes with prolonged VECP latency and in one of the eight eyes with normal VECP latency. The mean pattern-reversal ERG amplitude from eyes with prolonged VECP latencies was significantly lower than the mean amplitude from the normal controls. No abnormalities were observed in the flash ERGs. Degeneration of retinal ganglion cell axons has been demonstrated in MS patients. The amplitude reduction in the pattern-reversal ERG, observed in some 50% of the eyes with prolonged VECP latencies, is supposed to reflect retinal ganglion cell dysfunction or degeneration secondary to demyelination of the optic nerve.     

川芎嗪对兔缺血性视网膜疾病的疗效

目的:分析川芎嗪对缺血性视网膜疾病的治疗效果。方法:将1μmol/L内皮素(endothelin,ET-1),10μL注入兔眼后部玻璃体腔中,制成缺血性视网膜疾病的动物模型。治疗组(n=15)给予川芎嗪(20mg/kg,iv,1次/d),对照组(n=15)给予等量的生理盐水。7d后分别检测两组闪光视网膜电图(F-ERG),闪光视觉诱发电位(F-VEP),眼底荧光血管造影(FFA),视网膜环核苷酸(cAMP,cGMP)的含量。结果:玻璃体腔内注射ET-1,2d后F-ERGa,b波振幅均下降(P<0.05)。F-VEPP波幅值下降,峰值潜伏期时延长(P<0.01)。FFA显示:视网膜血管变细。视网膜cAMP,cGMP浓度和cAMP/cGMP比值均下降。与对照组相比,川芎嗪则显著改善了上述病变。结论:川芎嗪对缺血性视网膜疾病有明显的治疗作用。     

Electroretinogram and visual-evoked potentials in children with optic nerve coloboma

The aim was to evaluate alterations in Visual-Evoked Potentials (VEP) and Electroretinogram (ERG) and discover whether these tests are useful for determining residual visual acuity in cases where a patient is unable to collaborate. Flash and, when possible, Transient Pattern Reversal Visual-Evoked Potentials and Maximal Response ERG were recorded in 8 children (under three years old) affected by different aspects of optic nerve coloboma. None of them had visual acuity evaluated because of poor collaboration. All examinations were carried out using skin electrodes. Amplitude of the a and b component of ERG, amplitude, morphology and latency of the major components of Flash VEP and amplitude and latency of P100 Pattern Reversal VEP were evaluated. Four of the patients were examined three years later and visual acuity was compared with the previous electrofunctional results. Alterations in ERG were found only in the case of significant retinal anomalies (great coloboma, retinal detachment), huge alterations were found in both Flash VEP and in Pattern Reversal VEP. The retrospective study of VEP traces and visual acuity showed a good correlation between electrofunctional data and visual capability. Electrofucntional examinations can identify important conductive retinocortical anomalies. The possibility of correlating electrophysiological results with residual visual acuity is important for rehabilitative management in such optic disc malformations. This revised version was published online in July 2006 with corrections to the Cover Date.