多焦视网膜电图检测糖尿病早期视功能的变化

目的：了解多焦视网膜电图（mfERG）在糖尿病患早期视功能的变化规律。方法：将所有被检分为正常对照组（33例）、糖尿病无视网膜病变组（63例）以及单纯期糖尿病视网膜病变组（43例）。采用mfERG对上述3组进行检测,比较3组mfERG一阶反应N1波与P1波的潜伏期与反应密度。结果：在糖尿病无视网膜病变组中,N1波与P1波反应密度低于正常对照组,异常范围位于环1一环3。其中P。波反应密度在单纯期糖尿病视网膜病变组中进一步降低。N1波与P1波的潜伏期在糖尿病无视网膜病变组中的变化无统计学意义,在糖尿病视网膜病变组中延长,异常范围扩大到环4与环5。结论：mfERG在糖尿病视网膜病变出现之前已发生异常变化,且能够定量地反映随着病情的进展,视功能的损害程度及范围。     

糖尿病视网膜1期病变多焦视网膜图变化分析

目的 通过检测糖尿病视网膜1期病变患者多焦视网膜电图(multifocal electroretino-gram,mfERG),评价1期糖尿病视网膜病变患者早期视功能的变化.方法 检测正常对照组31只眼,1期糖尿病视网膜病变组46只眼的mtERG在视野30°的测试范围内6个不同离心度的环形区N1、P1波潜伏期、P1波反应密度改变.结果 在视野30°的测试范围内6个不同离心度的环形区,1期糖尿病视网膜病变组(DR组)与正常对照组之间比较N1、P1波潜伏期显著延长;环1、2区DR组与正常对照组之间比较P1波反应密度显著降低.结论 尚未出现肉眼可见眼底改变的1期糖尿病视网膜病变即可出现视功能的异常,mfERG能够定量的检测1期糖尿病视网膜病变的局部视功能变化,为糖尿病视网膜病变的早期诊断提供有效方法.     

重度非增生型糖尿病视网膜病变mfERG的定量分析

目的研究重度非增生型糖尿病视网膜病变（NPDR）多焦视网膜电图（mfERG）的特征及临床意义。方法30例（40眼）重度NPDR患者为NPDR组和35例（35眼）正常人为对照组。以国际分期作为NPDR诊断纳入标准,mfERG记录过程遵循国际临床视觉电生理学会的标准化方案,每个受试者在接受检查前均取得知情同意。结果与对照组相比,NPDR组患者mfERG2～5环的P1波、N1波反应密度明显下降,差异均有统计学意义（P〈0.05～0.01）;mfERG第Ⅱ象限和第Ⅲ象限的P1波、N1波反应密度明显降低,差异均有统计学意义（P〈0.05～0.01）。NPDR患者mfERG3～5环P1波、N1波隐含时较对照组明显延长,差异均有统计学意义（P〈0.05～0.01）;第Ⅰ象限和第Ⅲ象限隐含时显著延迟,差异均有统计学意义（P〈0.05～0.01）。结论NPDR可导致视网膜黄斑区视功能的损伤,mfERG能够客观、定量地反映黄斑区功能损害的程度。     

多焦视网膜电图及彩色多普勒在糖尿病视网膜病变早期诊断中的应用比较

目的 比较多焦视网膜电图（mfERG）与彩色多普勒在糖尿病视网膜病变（DR）早期诊断中的应用.方法 采用横断面研究,运用mfERLG检测正常对照组22例（22眼）、糖尿病无DR组52例（52眼）及DR单纯期组32例（32眼）.在上述患者中运用彩色多普勒测量视网膜中央动脉（CRA）的血流.采用单因素方差分析方法以及S-N-K法进行统计学分析.结果 糖尿病患者中,无DR组mfERG环1至环3中P1波反应密度低于正常对照组（P＜0.05）;CRA的血流则无异常变化（P＞0.05）.在DR单纯期组,mfERG除上述指标异常以外,Pt波潜伏期也出现延长（P＜0.05）.CRA的流速比正常对照组及无DR组降低（P＜0.05）.结论 在DR的临床早期诊断中,mfERG比彩色多普勒检测CRA血流的方法更敏感.     

复杂性视网膜脱离的多焦视网膜电图研究

目的 探讨多焦视网膜电图（mfERG）对复杂性视网膜脱离（RD）视功能客观评价的意义。方法 应用VERIS ScienceTM 4．2mfERG检测仪对80例复杂性RD患者的双眼进行检测,并与正常对照组比较。结果 复杂性RD患者的对侧眼、患眼在6个环的N1波、P1波振幅密度较正常对照组降低,潜时延长,差异均有统计学意义（P〈0．01）。有严重玻璃体积血组的N1、P1波振幅密度在2～6环高于无严重玻璃体积血组,差异均有统计学意义（P〈0．05）。重度PVR组的N1、P1波振幅密度低于轻度PVR组,在6个环差异均有统计学意义（P〈0．05）。黄斑裂孔组在所有6个环的N1、P1波振幅密度较正常对照组降低,潜时延长,差异均有统计学意义（P〈0．01）。结论 mfERG能客观定量评价复杂性RD患者的视功能。严重的玻璃体积血、黄斑裂孔、PVR对视功能有明显影响。     

无黄斑水肿的NPDR患者中心凹区mfERG与视网膜厚度的研究

目的：分析非增生性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)无黄斑水肿的患者黄斑中心凹区视网膜功能及厚度间的关系。

方法：选取NPDR患者20例35眼患眼为糖尿病视网膜病变(diabetic retinopathy,DR)组,行多焦视网膜电图(multifocal electronic retinography, mfERG)及Spectralis 相干断层扫描(Spectralis optical coherence tomography,Spectralis OCT)检查。以15例20眼正常眼为OCT对照组,以19例20眼正常眼为mfERG对照组,OCT对照组做Spectralis OCT检查,mfERG对照组做mfERG检查。

结果：与对照组相比,DR组黄斑中心凹mfERG1环的P1波反应密度减小,P1波及N1波隐含期改变无统计学意义; DR组无水肿的黄斑中心凹视网膜厚度、神经上皮层厚度仍有显著增加。

结论：应用mfERG可以在视网膜无可见明显结构改变之前发现视网膜功能上的异常变化; Spectralis OCT可以测量视网膜各层厚度,反映视网膜精细结构变化,验证视网膜功能上的异常改变,二者联合应用为极早期发现糖尿病视网膜病变视功能改变提供有效的证据,并为及时治疗提供资料。     

特发性视网膜前膜患者的多焦视网膜电图改变

目的:应用多焦视网膜电图(multifocalelectroretinogram,mfERG)对正常对照眼和特发性视网膜前膜眼进行检测并比较两者之间的差异。方法:用VERISScience4.0视诱发反应图像系统对17例(20只眼)正常对照者和15例(19只眼)特发性视网膜前膜患者进行检测。结果:特发性视网膜前膜患者皆出现程度不同多焦视网膜电图异常,与正常对照组的比较显示视网膜前膜组1～6环的P1波反应密度值和1～6环的N1波潜伏期与正常对照组有显著性差异,视力与第一环振幅无相关但与第一环的潜伏期存在相关。结论:多焦视网膜电图可用于对特发性视网膜前膜患者进行视功能评估。     

亚临床期糖尿病视网膜病变的 mfERG 及危险因素的临床观察

目的（1）应用多焦视网膜电图（mfERG）的一阶反应研究亚临床期糖尿病视网膜病变（DR）患者与正常人的视网膜功能,分析两组之间的差异。（2）探讨糖化血红蛋白、血脂及糖尿病病程与mfERG异常变化之间的关系,筛选出亚临床期DR患者的相关危险因素。方法选择已确诊为2型糖尿病的患者40例（75只眼）为实验组,健康体检者20例（36只眼）作为对照组。所有受检者均行多焦视网膜电图检查并且对40WGQJ2型糖尿病患者行糖化血红蛋白、血脂等相关指标检测,对结果进行统计学分析。结果（1）亚临床期DR患者P1波的振幅表现为环1到环5明显降低,P1波的潜伏期表现为环3到环5显著延迟。（2）亚临床期DR患者的N1波振幅表现为环3及环4振幅降低,N1波潜伏期表现为环5显著延迟。（3）糖化血红蛋白、总胆固醇与亚临床期DR患者mfERG振幅的降低相关。结论（1）mfERG在亚临床期DR中表现为振幅降低及潜伏期延长,mfERG能在早期客观的评价视网膜的功能。（2）mfERG P1波振幅的降低与糖化血红蛋白、总胆固醇相关,故亚临床期DR 患者糖化血红蛋白、血脂的控制,对于预防及延缓DR的发生发展有重要作用。     

不同类型糖尿病性黄斑水肿的多焦视网膜电图分析

背景了解糖尿病患者的视网膜功能变化对于指导临床治疗非常重要。目前对糖尿病性黄斑水肿（DME）患者的研究包括荧光素眼底血管造影（FFA）、多焦视网膜电图（mfERG）等,但对不同类型DME患者mfERG特征的研究较少。目的探讨不同类型DME患者的mfERG改变。方法病例对照研究。对确诊糖尿病视网膜病变（DR）合并临床显著黄斑水肿的40例57眼进行mfERG和FFA检查,同时对年龄和性别相匹配的正常对照组35例35眼行mfERG检查,并进行比较。依照FFA表现将DME分为局限型DME13例16眼、弥漫型DME17例22眼和囊样型DME12例17眼,分析各类型DME患者mfERG的特征。结果与正常对照组比较,局限型DME组患者mfERG1环的P．波反应密度显著下降,P。波4环、5环隐含时明显延迟,差异均有统计学意义（t=2．170,P=0．038;t=2．519,P=0．017;t=2．451,P=0．020）;4环N1波隐含时明显延迟,差异有统计学意义（t=2．858,P=0．008）。弥漫型DME组患者1、3、5环P。波反应密度显著下降,1、3、4、5环N1波反应密度显著下降,差异均有统计学意义（P〈0．05）;3环、4环P,波隐含时明显延迟,差异均有统计学意义（t=2．446,P=0．019;t=2．759,P=0．009）。与正常对照组比较,囊样型DME组患者1～5环P,波反应密度显著下降,1、3、4、5环N．波反应密度显著下降,差异均有统计学意义（P〈0．05）;3、4、5环P。波隐含时明显延迟,4环N,波隐含时明显延迟,差异均有统计学意义（P〈0．05）。黄斑区功能在中心凹处严重受损,外环功能虽有不同程度下降,但均较中心凹功能下降程度轻。结论不同类型DME的局部视网膜功能改变程度与FFA的形态学表现结果一致,各型DME患者中黄斑中心凹功能受累程度由重至轻依次为囊样型DME、弥漫型DME及局限型DME。FFA与mfERG联合诊断可以全面、多角度地反映糖尿病患者黄斑区功能的变化情况。     

早期开角型青光眼患者多焦视网膜电图的研究

目的探讨早期开角型青光眼(POAG)患者多焦视网膜电图(mfERG)的改变和在视网膜不同象限及六个环的分布特性。方法对早期POAG36例(36只眼),正常对照组40例(40只眼)行mfERG检测,记录不同视野区域和6个环的一阶、二阶反应N1波、P1波的振幅密度和潜时,并与正常对照者进行比较。结果一阶反应鼻上(SN)、鼻下(IN)、颞下(IT)、颞上(ST)4个象限N1、P1波的振幅密度值与潜时,两组之间均无显著差异。二阶反应鼻上(SN)、颞下(IT)、颞上(ST)P1波的振幅密度值,青光眼组显著降低(P<0.05)。随偏心度增大,两组mfERG一阶反应、二阶反应P1波、N1波振幅密度逐渐减小,青光眼组与对照组振幅密度的差值在5环(视野周边)较大,在1和2环(视野中央)较小。青光眼组患者的mfERG指标与视力无线性相关关系。结论早期POAG患者mfERG有明显改变,证实了POAG患者早期视神经损害的特点,为早期POAG的诊断提供有效的依据。     

PFCL and ILM peeling in macular hole with retinal detachment

To investigate the early changes of retinal function in diabetic patients detected by multifocal electroretinogram (mfERG). ·METHODS: The first-order kernel responses of mfERG were recorded fromeyes of 33 normal control subjects, 63 diabetic patients without retinopathy and 43 diabetic patients with background retinopathy. The response densities and implicit times of N₁ and P₁ were compared among the control, diabetic patients without retinopathy and diabetic patients with retinopathy. ·RESULTS: The response densities of N1 and P1 in central 3 rings were reduced significantly in diabetic eyes with and without retinopathy. And the implicit times of N₁ and P₁ were delayed significantly only in diabetic eyes with retinopathy. ·CONCLUSION: mfERG can detect the early changes of retinal function quantitatively in diabetic patients. Analysis of response densities and implicit times of N₁ and P₁ can reflect the progress of local retinal dysfunction in diabetes     

Early changes of retinal function in diabetic patients detected by multifocal electroretinogram

To investigate the early changes of retinal function in diabetic patients detected by multifocal electroretinogram (mfERG). ·METHODS: The first-order kernel responses of mfERG were recorded fromeyes of 33 normal control subjects, 63 diabetic patients without retinopathy and 43 diabetic patients with background retinopathy. The response densities and implicit times of N₁ and P₁ were compared among the control, diabetic patients without retinopathy and diabetic patients with retinopathy. ·RESULTS: The response densities of N1 and P1 in central 3 rings were reduced significantly in diabetic eyes with and without retinopathy. And the implicit times of N₁ and P₁ were delayed significantly only in diabetic eyes with retinopathy. ·CONCLUSION: mfERG can detect the early changes of retinal function quantitatively in diabetic patients. Analysis of response densities and implicit times of N₁ and P₁ can reflect the progress of local retinal dysfunction in diabetes     

眼底无可见视网膜病变的糖尿病患者多焦视网膜电图特征

目的 检测眼底无视网膜病变糖尿病患者的多焦视网膜电图(multifocol electmretinogram, mf-ERG),评价其在糖尿病患者早期视网膜功能改变中的作用.方法 应用mf-ERG检测30例(56只眼)正常对照组和32名(58只眼)无眼底镜下可查见的视网膜病变的糖尿病患者.对两组mf-ERG中a波和b波的潜伏期、振幅总和以及b波的振幅密度进行分析比较.结果 在糖尿病组,除0环和颞下象限之外.b波的潜伏期均明显延迟,而a波和b波振幅总和及b波的振幅密度减低主要集中在黄斑周围区域(0～1环)和颞上象限,差别有统计学意义(P<0.05).结论 mf-ERG能在DR出现之前客观定量地评定视网膜功能的变化程度和范围.     

Retinal function in normal and diabetic eyes mapped with the slow flash multifocal electroretinogram

PURPOSE: It has been suggested that late components of the standard multifocal electroretinogram (mfERG) are preferentially affected by diabetes mellitus. The slow-flash (sf-)mfERG stimulates with flashes separated by dark periods, facilitating interpretation of late first-order response components compared with standard multifocal stimulation. Retinal function and response component changes were examined using the sf-mfERG in diabetic subjects with and without diabetic retinopathy. METHODS: Eighteen control subjects, 12 diabetic patients without retinopathy and 17 diabetic patients with nonproliferative diabetic retinopathy (NPDR), were tested monocularly. A total of 103 areas of the central 45 degrees were stimulated by pseudorandom 100-cd/m2 flashes separated by at least 53.3 ms. Major components and the amplitude of the first-order sf-mfERGs were examined. Each subject's N1, P1, and N2 implicit times (ITs) and scalar product amplitudes (SPs) were measured at all 103 retinal locations and converted into z-scores based on the control values. Abnormalities were defined as z-scores greater than 2.33 (P < 0.01). RESULTS: Local functional abnormalities were found in both the diabetic patients with NPDR and in those without retinal disease. In both groups of diabetic patients, most abnormalities occurred more frequently in the inferior retina. Later components (P1 and N2) of the local sf-mfERGs were not preferentially affected by diabetes. The local SP and P1 IT measures distinguished the subject groups better than N1 IT and N2 IT. CONCLUSIONS: Local functional retinal abnormalities in diabetic persons with or without NPDR can be detected and mapped by the sf-mfERG. Diabetes and NPDR do not, however, preferentially affect the late P1 and N2 response components.     

Multifocal electroretinogram delays predict sites of subsequent diabetic retinopathy

PURPOSE: To examine the potential of abnormal mfERGs to predict the development of diabetic retinopathy at corresponding retinal locations 1 year later. METHODS: One eye of 11 diabetic patients with nonproliferative diabetic retinopathy (NPDR) and 11 diabetic patients without retinopathy were retested 12 months after initial testing. At each time, mfERGs were recorded from 103 retinal locations, and fundus photographs were taken within 1 month of each recording. Local mfERG implicit times were measured and their z-scores were calculated based on results obtained from 20 age-matched control subjects. mfERG abnormalities were defined as z-scores of 2 or more for implicit time and z-scores of -2 or less for amplitude (P < or = 0.023). mfERG z-scores were mapped onto fundus photographs, and the relationship between baseline abnormal z-scores and new retinopathy at follow-up was examined. RESULTS: New retinopathy developed in 7 of the eyes with NPDR after 1 year. In these eyes, 70% of the mfERGs in areas of new retinopathy had abnormal implicit times at baseline. In contrast, only 24% of the responses in regions that remained retinopathy free were abnormal at baseline. Relative risk of development of new retinopathy over 1 year in the areas with abnormal baseline mfERG implicit times was approximately 21 times greater than that in the areas with normal baseline mfERGs (odds ratio = 31.4; P < 0.001). Eyes without initial retinopathy did not develop new retinopathy within the study period, although 4 of these 11 eyes had abnormal implicit times at baseline. mfERG implicit times tended to be more delayed at follow-up than at baseline in NPDR eyes, but not in eyes without retinopathy and control eyes. mfERG amplitudes had no predictive power. CONCLUSIONS: Localized functional abnormalities of the retina reflected by mfERG delays often precede the onset of new structural signs of diabetic retinopathy. Those functional abnormalities predict the local sites of new retinopathy observed 1 year later.     

Assessment of optical coherence tomography angiography and multifocal electroretinography in eyes with and without nonproliferative diabetic retinopathy

Purpose:To examine (i) the retinal structure and function using optical coherence tomography angiography (OCTA) and multifocal electroretinography (mfERG), respectively, in eyes with and without nonproliferative diabetic retinopathy (NPDR), (ii) and their interrelationship between retinal structure (OCTA) and function (mfERG) in the two groups independently.Methods:This was a prospective observational study. One hundred twenty-one eligible participants with type 2 diabetes with No DR (n = 89), or with mild or moderate NPDR (n = 32) underwent ophthalmic examination, ultrawide field-view fundus photography, OCTA, and mfERG. Group differences were assessed using a Mann–Whitney U test. Correlations were assessed using Spearman''s rho.Results:There were no significant differences in OCTA measures between the two groups. The mfERG P1 implicit times (rings 1–6) were significantly delayed and P1 response densities in rings 5 and 6 were significantly lower in participants with NPDR compared to those with No DR. In those with No DR, P1 implicit times in almost all rings were delayed in relation to lower vessel density and perfusion (maximum variance noted was 13%). In individuals with NPDR, the P1 response density in rings 2 and 3 showed a positive nonsignificant correlation with macular perfusion.Conclusion:In those with diabetes with No DR, retinal neuronal function is influenced by lower macular vessel density and perfusion. The retinal neuronal function is abnormal in individuals with NPDR compared to those with No DR and is not correlated with OCT angiometric measures, suggesting the likelihood of a different retinal structural correlate.     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.