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     

图形视觉诱发电位鉴别伪盲的临床应用研究

目的　用图形视觉诱发电位（ｐａｔｔｅｒｎｖｉｓｕａｌｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ,Ｐ-ＶＥＰ）来评价客观视力以及用来鉴别伪盲的临床应用价值。方法　取志愿受检者１５８例（１５８眼）患黄斑病变或视神经病变眼,其中６５眼为黄斑病变组（Ａ组）,９３眼为视神经病变组（Ｂ组）,通过多元回归分析Ｐ-ＶＥＰ波幅和潜伏期与最佳矫正视力的关系。由此得出最佳关系方程,进而得出１５８眼Ｐ-ＶＥＰ推算视力（ＰＶＥＰ-ＶＡ）,以及５３只伪盲眼（包括２１眼黄斑病变及３２眼视神经病变）的ＰＶＥＰ-ＶＡ,最后用受试者工作特征曲线（ＲＯＣ曲线）得出可接受ＰＶＥＰ-ＶＡ及主观视力差值范围,从而鉴别伪盲。结果　在１５′视角黑白棋盘格刺激下引出的Ｐ-ＶＥＰ波形,该波形的Ｐ１００波幅（记录为Ａｍｐ１５′）与主观视力的相关性最好,Ａｍｐ１５′与主观视力显著相关（Ａ组:Ｐ＝０．０１６;Ｂ组:Ｐ＜０．０００１）。Ａｍｐ１５′的对数［ｌｏｇ（Ａｍｐ１５′）］与主观视力（ｌｏｇＭＡＲ）的回归方程为:Ａ组:ｙ＝１．８６７－１．１００ｘ,Ｐ＜０．０００１,Ｂ组:ｙ＝１．５０２－０．７９９ｘ,Ｐ＜０．０００１［ｘ为ｌｏｇ（Ａｍｐ１５′）,ｙ为ｌｏｇＭＡＲ］。利用回归曲线和ＲＯＣ曲线可以得到Ａ组辨别伪盲的截断值为０．３９７２时,其诊断敏感性为７３．３％,特异性为６８．０％;Ｂ组辨别伪盲的截断值为０．４１５０,其诊断敏感性为９０．５％,特异性为６７．５％。结论　Ｐ-ＶＥＰ的Ａｍｐ１５′用来判断客观视力最有效,对于鉴别伪盲也很有意义。     

中西医结合治疗急性球后视神经炎的临床观察

中药丹枝逍遥散合桃红生四物汤加减，配合静脉滴注脉络宁治疗急性球后视神经炎１２例１３眼。以视力、眼底检查、结合图形视觉诱发电位（Ｐ－ＶＥＰ）、对比敏感度（ＣＳＦ）、眼底荧光血管造影（ＦＦＡ）、视野等检查。结果作为综合分析评价疗效的标准。结果治愈５例５眼，占３８．４６％；显效４例５眼，占３８．４６％；有效２例２眼，占１５．３８％；无效１例１眼，占７．６９％；总有效率９２．３１％。治疗后有１０眼视力≥１．０，Ｐ－ＶＥＰＣＳＦ，视野均有不同程度的改善。     

图形视诱发电位在弱视诊断及治疗中的应用

研究图形视诱发电位（Ｐａｔｔｅｒｎ Ｖｉｓｕａｌ－Ｅｖｏｋｅｄ Ｐｏｔｅｎｔｉａｌ，ＰＶＥＰ）在弱视诊断和治疗中的应用价值，探讨弱视发病的机制。检测对象分为弱视组（１０８只眼）、正常对照组（１８０只眼）和美多巴治疗组（２６只眼）。以日本光电公司产ＭＥＢ－５１００型诱发反应记录仪进行检测，视觉刺激采用黑白翻转方格，视角为３０’，６０’和９０’，叠加１２８次。弱视组Ｐ１波潜伏时延长，振幅降低。３０’视     

多发性硬化及其视觉诱发电位的临床表现

本文报导了１１例多发性硬化（ＭＳ）和它们的视觉诱发电位（ＶＥＰ）。在２２眼中２１眼为ＭＳ视神经炎，１眼视功能正常。２１眼ＭＳ视神经炎的ＶＥＰ全部异常，另１眼ＶＥＰ正常。ＭＳ视神经炎的ＶＥＰ检查结果是：１．ＰＶＥＰ６眼不能记录到波形，１２眼的Ｐ１００成分峰时延迟（１２４．６±９．７ｍｓ，Ｐ＜０．００１）、振幅降低（７．６±２．８μｖ，Ｐ＜０．００１）；２．ＦＶＥＰＰ１的峰时全部延迟（８６．５±８．９ｍｓ，Ｐ＜０．０５），振幅降低（１０．４±６．５μｖ，Ｐ＜０．０５），具有统计学的差异。     

低体重儿P—VEP改变及影响因素的研究

为研究低体重儿（ＬＢＷＩ）视功能发育状态及影响因素，用日本ＮｅｕｒｏｐａｃｋⅡ电生理仪，对３～１０岁１３８例ＬＢＷＩ进行图形视诱发电位（Ｐ－ＶＥＰ）检查，３１例３～１０岁足月正常体重儿作对照组，记录１４６’、７３’、３６．５’三种空间频率的Ｐ１００潜伏期和Ｎ１－Ｐ１振幅。结果：ＬＢＷＩ三种空间频率潜伏期均较对照组延长，其中中、高空间频率组与对照组比较差异有显著性（Ｐ＜０．０５）；三种空间频率的振幅值明显低于对照组，差异有非常显著性（Ｐ＜０．００１）；潜伏期延长和振幅降低主要集中在胎龄＜３２周、体重＜２．０ｋｇ组。多元回归分析示ＬＢＷＩＰ－ＶＥＰ改变与出生体重、胎龄及围产期窒息、脑损害和眼部病变等因素有关。无眼、脑合并症的早产ＬＢＷＩ组的Ｎ１－Ｐ１振幅与对照组比较仍存在统计学差异。结论：ＬＢＷＩ具有视觉发育障碍的高风险，应给予视功能发育的早期监测及随访。     

正常组儿童图形视觉诱发电位的研究

对１１０名年龄在３５岁至６５岁之间正常儿童在不同空间频率下的图形视觉诱发电位（ＰＶＥＰ）进行了研究。在３５岁与６５岁之间的正常组儿童ＰＶＥＰ的振幅和潜伏期基本与年龄无关，最优空间频率下的振幅在２７μＶ左右，Ｎ１、Ｐ２和Ｎ２波的潜伏期分别为６５ｍｓ、１０５ｍｓ、１５３ｍｓ左右；左右眼ＰＶＥＰ的有关参数值无显著区别；女性儿童ＰＶＥＰ的振幅略高于男性。以上结果为弱视儿童ＰＶＥＰ的诊断提供了正常参照值     

黄斑部病变的局部视网膜电图和图形视觉诱发电位

目的观察黄斑病变局部视网膜电图（ｌｏｃａｌｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ，ＬＥＲＧ）和图形视觉诱发电位（ｐａｔｅｒｎｖｉｓｕａｌｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ，ＰＶＥＰ）的变化，评价二者的临床应用价值。方法对２７例（５４只眼）正常人进行黄斑部视角５°、１０°和１５°ＬＥＲＧ测定，并对２５例（３５只眼）黄斑病变患者进行ＬＥＲＧ和ＰＶＥＰ的测定。结果黄斑病变患者５°、１０°和１５°ＬＥＲＧ的ａ、ｂ波振幅均值较正常对照组均有显著性降低（Ｐ＜０．０１），３６．５′、７３′及１４６′ＰＶＥＰ的Ｐ１波潜伏期及振幅均值分别较正常对照组明显延长和降低（Ｐ＜０．０１）。在ＬＥＲＧ（１５°）与ＰＶＥＰ（１４．８°×１９．０°）刺激野相近的条件下，黄斑病变ＬＥＲＧ异常率为６２．２％、ＰＶＥＰ的异常率分别为４８．５％（１４６′）、５４．５％（７３′）及４８．５％（３６．５′），ＬＥＲＧ和ＰＶＥＰ的异常率差异均无显著性（Ｐ＞０．０５）。结论ＬＥＲＧ与ＰＶＥＰ的异常率相接近。由于ＬＥＲＧ不受视路功能的影响，故认为此项检查是一种较有效和较直接的黄斑功能测定方法     

脑震荡患者视路损害的视诱发电位检查

目的 寻找脑震荡后评价视路损害的客观指标。方法 对６８例视诱发电位检查结果进行分析，并与２０例正常人对照。结果 ６８例中Ｐ－ＶＥＰ异常率２８％，Ｆ－ＶＦＰ异常率５８％；Ｎ１，Ｐ１，Ｎ２波峰潜时均延迟，Ｐ１波振幅明显降低。结论部分脑震荡患者视路传输速度和反应强度均明显下降。视诱发电位可作为评价脑震荡患者视路损害的客观指标。     

随机点立体图刺激引起的立体视觉诱发电位

应用自制电视静态随机点立体图（ＴＶ－ｓｔａｔｉｃｒａｎｄｏｍｄｏｔｓｓｔｅｒｅｏｇｒａｍ，ＴＶ－ＳＲＤＳ）作视差刺激，记录了３５例正常人用三棱镜破坏与不破坏立体视时，１６．５６＇视差刺激的ＶＥＰ和２８例立体视盲者该视差刺激的ＶＥＰ。结果：（１）３３例正常人于刺激后恒定出现一负正复合波；（２）用三棱镜破坏立体视，ＶＥＰ波形消失；（３）立体视盲组，除１例麻痹性斜视外，均未记录到电位变化。作者认为：本实验条件下ＴＶ－ＳＲＤＳ刺激产生的ＶＥＰ是与视差刺激相关的特异性ＶＥＰ，ＴＶ一ＳＲＤＳ是以电生理方法客观测定立体视的有效刺激，是探讨立体视觉的发生、发育的一种方法。     

Color visual evoked potentials in children with type 1 diabetes: relationship to metabolic control

PURPOSE: To examine the association between metabolic control (HbA(1c)) and the chromatic mechanisms of children with type 1 diabetes (T1D), by using the color visual evoked potential (VEP). METHODS: Fifty children with T1D (age range, 6-12.9 years) and 33 age-matched control subjects were tested. VEPs were recorded by placing five electrodes on the scalp according to the International 10/20 System of Electrode Placement. Active electrodes O1, O2, and Oz were placed over the visual cortex. Short-wavelength (S), and long- and medium-wavelength (LM) color stimuli consisted of vertical, photometric isoluminant (1 cyc/deg) gratings presented in a pattern onset (100 ms)-offset (400 ms) mode. Achromatic vertical gratings were presented at 3 cyc/deg. Primary outcome measure was VEP latency. The relationship between S, LM, and achromatic VEP latency, and HbA(1c) was determined by ANCOVA regression. RESULTS: S-, LM-, achromatic VEP latencies were not associated significantly with HbA(1c). Pubertal status, however, was associated significantly (P = 0.0114) and selectively with S-VEP latency. Pubertal children with T1D had delayed (mean delay, 9.5 ms) S-VEP latencies when compared with the prepubertal children with T1D. However, there was no statistically significant difference (P = 0.1573) in the effect of pubertal status on S-VEP latency between the T1D and control groups. CONCLUSIONS: Pubertal status rather than HbA(1c) appears to affect selectively the S-VEP latency of preteen children with T1D. Further study is warranted to determine whether the delay in S-VEP latency in pubertal children with T1D changes over time and whether this change could be a predictive marker for future development of background diabetic retinopathy.     

Comparison of techniques for detecting visually evoked potential asymmetry in albinism.

PURPOSE: We compared techniques for analyzing visually evoked potential (VEP) asymmetry in children with albinism to find one that could be used effectively and efficiently. METHOD: Subjects included 21 child volunteers, ages 10 months to 6 years (control group) and 21 children with albinism, ages 2 months to 6 years (albinism group). Five-channel flash VEP was performed on all subjects. Electrodes were positioned at Oz, O1, O2, O3, and O4 (10/20 system). Data were analyzed by use of techniques previously described. These included inspection of the VEP waveforms, measurement of hemispheric waveform parameters, calculation of an asymmetry index, and use of a bipolar derivation between left and right hemispheric responses (interhemispheric difference potential). In addition, we quantified the interhemispheric difference potential by use of Pearson's correlation coefficient. Measurements of sensitivity and specificity determined the success of the 5 analysis paradigms. The accuracy of each paradigm represented the ability to classify the data according to volunteer or albinism group and is derived from both sensitivity and specificity measures. RESULTS: Measurement of hemispheric differences in VEP waveform parameters was the least sensitive measure method for detecting multichannel VEP asymmetry in albinism. Comparison of left and right eye interhemispheric difference potential increased accuracy to 67%. Nonquantitative inspection of waveform demonstrated an accuracy of 76%. The asymmetry index and Pearson's correlate measure yielded accuracy rates of 79% and 83%, respectively. CONCLUSION: The efficiency and capability of Pearson's correlate measure in quantifying interhemispheric difference potentials to detect albinotic misrouting makes this a useful and practical technique in a pediatric clinic.     

Comparison of pattern VEPs and preferential-looking behavior in 3-month-old infants

Studies of visual acuity in human infants between 1 and 6 months of age using the visual-evoked potential (VEP) and forced-choice preferential looking (FPL) have shown that acuity is one to two octaves higher by VEP estimates than by FPL estimates. In an attempt to study these differences, the authors obtained both VEP and FPL data from 26 3-month-old infants. VEP data were obtained with gratings of 0.31, 0.62, 1.25 and 2.50 cycles/deg, which were counterphase alternated at 2 Hz. FPL data were obtained for stationary gratings using either the method of constant stimuli or a staircase procedure. Our study revealed three major findings: (1) recordable VEPs can be obtained for spatial patterns that are below threshold by behavioral measures; (2) the use of different scoring criteria that yields comparable VEP and FPL group mean acuities does not yield a significant correlation between VEP amplitude acuity and FPL acuity for individual infants, probably because of the inherent "noise" in each technique; and (3) when VEP latency rather than amplitude is used to estimate acuity, there is a significant correlation between electrophysiology and behavior.     

屈光不正性弱视多导视觉诱发电位地形图的特点

目的：研究屈光不正性弱视多导视觉诱发电位地形图变化的特点。方法：选取13.7'、27.5'及55'三种方格对正常儿童（88眼）及屈光不正性弱视儿童（44眼）进行多导视觉诱发电位地形图的研究,分析枕区五个导联位的P1潜时及N1P1振幅,并观察每一例地形图。结果：13.7'及27.5'方格,弱视眼的P1潜时同正常组相比显著延迟,弱视眼的N1P1振幅在枕区导联降低;在55'方格两组间P1潜时及N1P1振幅差异显著性意义,N1P1振幅的分布同正常组改变。地形图：枕区高电位活动不对称分布增多。结论：屈光不正性弱视P1潜时入N1P1振幅的异常,主要发生在高空间频率,P通道可能受到了视觉发育敏感期异常视觉经验的影响。     

Stereoscopic visual evoked potentials in normal subjects and patients with open-angle glaucomas

Purpose To evaluate stereoscopic visual evoked potentials (S-VEP) in normal controls and in patients with glaucomatous optic nerve damage.Methods Computer-generated dynamic random-dot stereograms were used to elicit cortical visual evoked potentials using wireless electric liquid crystal shutter glasses. Normal subjects (n=22) and patients with glaucoma (n=22) were investigated using five different disparities from 9 to 40 arc min. Statistical dependency of measurements with different stimulus at identical patients was adjusted for.Results Peak times of onset and offset response of S-VEP can be significantly delayed in glaucomas. A general linear regression model confirmed that differences between patients and normals depend on disparity. S-VEP onset shows no significant difference between controls and glaucomas at 9 arc min disparity. At high disparities, however, peak time of the onset response was significantly (p<0.01) delayed in glaucomas when compared with normals (normals: 125.8±13 ms, glaucomas: 148.2±25.6 ms at 40 arc min).Conclusions Visual evoked potential elicited by the onset of a random-dot stereogram can be used for objective measurement of stereoacuity in a clinical setting. Differences between controls and glaucomas in high and low disparities could indicate a stereo-specific deficit in glaucoma.The authors have no commercial interest in the equipment used in this work. This paper was presented at the ARVO 2000 in poster form     

人重组睫状神经营养因子对大鼠视神经不全损伤后功能恢复的影响

目的　探讨人重组睫状神经营养因子 (recombinanthumanciliaryneurotrophicfactor,rhCNTF)对大鼠视神经不全损伤后功能恢复的作用。方法　采用无创血管夹在成年鼠造成视神经不全损伤 ,治疗组玻璃体腔内注射rhCNTF ,对照组注射等量双蒸水。在损伤前、损伤后即刻及伤后 1、2、4、8和 12周检测伤眼闪光视觉诱发电位。结果　视神经损伤后即刻 ,闪光视觉诱发电位波形几近熄灭。伤后 1周 ,潜伏期 (LP1) 2组基本恢复至损伤前水平 ,与损伤前比较无显著性差异 (P >0 .0 5 ) ,组间比较无显著性差异 (P >0 .0 5 )。振幅 (AP1 N2 )恢复缓慢 ,伤后 1～ 2周治疗组与对照组比较无显著差异 (P >0 .0 5 ) ;4周以后 2组间差异非常显著 (P <0 .0 1)。 8周时对照组恢复至损伤前的30 .84 % ,而治疗组恢复至 5 0 .35 % .结论　rhCNTF对大鼠视神经不全损伤后神经传导功能的恢复有明显的促进作用     

The effect of retrobulbar anaesthesia on visual evoked responses

BACKGROUND: Retrobulbar anaesthesia in ocular surgery leads to a temporary sensory blockade of the nervus opticus. The purpose of this study was to investigate the effect and duration of this anaesthesia on the visual system and to find out whether there is any relation to the patient's age, oral premedication, time of oculopression and the axial length of the operated eye. MATERIALS AND METHODS: A total of 57 patients with a mean age of 77.4 +/- 9.5 years were included in the study. All patients received retrobulbar injection of 4cc Xylonest(R) 2 %/Dur-Anest(R) 1 % (3 : 1). Visual evoked potential (VEP) was recorded before and shortly after retrobulbar anaesthesia and several times after cataract surgery (45 min to 6 hours after surgery). The latency period and amplitude of the P100 deflection of the VEP were analysed. A possible correlation to the above-mentioned variables was evaluated statistically. RESULTS: Directly after retrobulbar injection of the anaesthetic and at the first postoperative VEP recordings the VEP recordings showed a decreased amplitude and an increased latency period. All measured values returned to normal within 2 hours after the retrobulbar injection, proving that the conductivity block of the optic nerve was temporary. There was a poor correlation between patients' age, ocular length of the operated eye and the degree of reduction of the recorded VEP. No correlation could be found between time of oculopression, premedication and the alteration of the VEP. CONCLUSION: Retrobulbar anaesthesia with 4cc of a mixture of Xylocain/Dur-Anest leads to a temporary conductivity block in the optic nerve for about 2 hours.     

视觉诱发电位在挫伤眼视神经损伤的应用

目的探讨视觉诱发电位（VEP）对挫伤眼的视神经损伤诊断和鉴定的意义。方法对单侧眼挫伤59例（59眼）进行视力检查及VEP检查，以自体健侧眼为对照。按视力与VEP结果是否相符分为两组，相符者为A组，40例，占67．80％；不相符者为B组，19例，占32．20％。分析两组间VEPP100波幅值及P100峰潜时值。结果A组中伤眼VEPP100波幅明显降低，P100峰潜时明显延长，差异有统计学意义。B组有16例证实为伪盲，另3例伤眼眼睑、球结膜肿胀减退后视力好转。结论VEP对挫伤眼的视神经损伤的诊断和鉴定有重要价值。     

Impairment of optic path due to radiotherapy for nasopharyngeal carcinoma

Purpose: To evaluate the impairment of optic path caused by radiotherapy for nasopharyngeal carcinoma (NPC). Methods: Visual evoked potential was used to evaluate the functional impairment of optic path by an 8 MV linear accelerator or ⁶⁰Co -ray radiotherapy in 63 (23 women and 40 men) patients with nasopharyngeal carcinoma before radiotherapy, at the end of radiotherapy, 6 months and 1, 2 and 3 years after their radiotherapy respectively. Results: In the female group, the latency of VEP elicited by the three types of elements significantly delayed 2 and 3 years after radiotherapy than that before radiotherapy, at the end of radiotherapy, 6 months and 1 year after radiotherapy; there were no significant difference among VEP amplitudes elicited by the three types of elements before and after radiotherapy. In the male group, the latency of VEP elicited by the medium and the small elements significantly delayed 1 year after radiotherapy than that before radiotherapy and at the end of radiotherapy, the VEP latency elicited by the small elements was significantly prolonged 3 years after radiotherapy compared to that just after radiotherapy, while the VEP amplitude elicited by the large elements was significantly attenuated 1 year after radiotherapy compared to those before and just after radiotherapy. Conclusions: In the female group, the significant prolongation of VEP latency happened at the end of radiotherapy and lasted for 3 years, while the VEP amplitude did not change significantly during the 3 years after radiotherapy. It indicates that the sustained impairment by radiation within the female visual nerve system starts at the end of radiotherapy, but the impairment was mild. In the male group, the significant prolongation of VEP latency mostly happened 1 or 2 years after radiotherapy. It was shown that the radiotherapy for nasopharyngeal carcinoma certainly injured the optic path, and there was difference in the impairment between the two sexes.     

严重视神经损伤后视觉诱发电位变化分析

目的 利用视觉诱发电位（ＶＥＰ）判断严重神经损伤的预后。方法 回顾分析３０例严重视经损伤的ＶＥＰ检测及临床治疗资料,按伤后视力分为Ａ、Ｂ两组,统计学分析两组ＶＥＰ变化及治疗效果。结果 闪光视诱发电位（ＦＶＥＰ）是两组差异显著的指标,Ａ、Ｂ组ＦＶＥＰ平均波幅下降率分别为７９％、４３％,治疗后有效率分别为１３％、８０％,两组间存在显著差异（Ｐ〈０．０１）。结论 ＦＶＥＰ对于判断严重视神经损伤的视力预后