多焦视网膜电图在青光眼早期诊断中的应用

多焦视网膜电图（multifocalelectroretinogram，mfERG）在眼科领域的应用是视觉电生理学的一项重要新进展，用它评价视网膜外层和中层功能障碍（如视网膜营养不良）的价值已得到肯定。但用多焦视网膜电图检测主要以内层视网膜损害为主的青光眼，尤其是用于早期诊断，仍存在许多问题有待解决。本文介绍了多焦视网膜电图的基本原理、正常人多焦视网膜电图特征、青光眼及高眼压症多焦视网膜电图的改变以及多焦视网膜电图与青光眼视野缺损的关系。     

多焦视网膜电图及其在青光眼早期诊断中应用

多焦视网膜电图(multifoca elelectroretinogram,mfERG)在眼科领域的应用是视觉电生理的一项重要新进展.用它评价视网膜外层和中层功能障碍(如视网膜营养不良)的价值已得到肯定.但用多焦视网膜电图检测主要以内层视网膜损害为主的青光眼,尤其是用于早期诊断,仍存在许多问题有待解决.此文介绍了多焦视网膜电图的基本原理、正常人多焦视网膜电图特征、青光眼及高眼压症多焦视网膜电图的改变以及多焦视网膜电图与青光眼视野缺损的关系.     

图象翻转视网膜电图在原发性开角型青光眼早期诊断方面的应用

图象翻转视网膜电图（Ｐ－ＥＲＧ）是近十几年兴起的电生理检查项目，起源于视网膜神经节细胞层，与原发性开角型青光眼视神经损害部位一致，故对原发性开角型青光眼有重要的诊断学意义。本文从开角型青光眼视神经损害机理、Ｐ－ＥＲＧ起源及与开角型青光眼视神经损害关系、Ｐ－ＥＲＧ检查条件及波型分析、Ｐ－ＥＲＧ对开角型青光眼早期诊断意义四方面复习综述了Ｐ－ＥＲＧ在原发性开角型青光眼早期诊断方面的应用。     

以视网膜中央静脉阻塞为首发症的原发性开角型青光眼

报告2例以视网膜中央静脉阻塞为首发症的原发性开角型青光眼病例。2例患者均以视网膜中央静脉阻塞收治，住院后进一步检查诊断为开角型青光眼，我们对原发性开角型青光眼与视网膜中央静脉阻塞这两种眼病的关系进行了讨论。 （中华眼底病杂志，1994，10：180-181）     

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。     

多种视觉电生理联合视野检查对原发性开角型青光眼早期诊断的敏感性

目的 探讨多种视觉电生理联合全自动视野计检查对原发性开角型青光眼早期诊断的敏感性，为临床早期诊断提供客观敏感的指标。方法 选择10例(20眼)原发性开角型青光眼患者和正常对照者10例(20眼)分别进行闪光视网膜电图(F-ERG)、图形视网膜电图(P-ERG)、图形视诱发电位(P-VEP)检查；还对正常对照组、青光眼组中各5例10眼进行多焦视网膜电图(mERG)检查；青光眼组10例(20眼)和正常对照组8例(16眼)行蓝黄视野(B／Y)、标准视野(W／W)检查。结果 P-ERG的N95潜伏期延长较敏感；P-VEP的P100波振幅降低，潜伏期延长但与对照组无明显差异；mERG二阶反应振幅下降，并随离心度的增大而明显降低；B／Y视野检查的视野异常阳性率显著高于W／W视野。结论 B／Y视野检查联合多种视功能检查对原发性开角型青光眼早期诊断较敏感。在眼底杯／盘比未出现改变的早期诊断中，B／Y视野和PERG敏感性较高。     

原发性开角型青光眼视盘及视网膜血流的研究

目的探讨原发性开角型青光眼患者和正常人视盘及其周边视网膜血液供应是否存在差异.方法本研究采用了一种新型共焦扫描激光多普勒血流仪--海德堡视网膜血流仪(heidelberg retina     

图象翻转视网膜电图在原发性开角型青光眼早期诊断方面的应用

图象翻转视网电图（Ｐ－ＥＲＧ）是近十几年兴起的电生理检查项目，起源于视网膜神经节细胞层，与原发性开角型青光眼视神经损害部位一致，故对原发性开角型青眼有重要的诊断学意义。本从开角型青光眼视神经损害机理、Ｐ－ＥＲＧ起源及与开角型青光眼视神经损害关系，Ｐ－ＥＲＧ检查条件及波型分析、Ｐ－ＥＲＧ对开角型青光眼早期诊断意义四方面复习综述了Ｐ－ＥＲＧ在原发性开角型青光眼早期诊断方面的应用。     

高眼压和青光眼的多焦视网膜电图表现

目的 评价多焦视网膜电图（MERG）在青光眼早期诊断中的价值。方法 测定28例35眼正常对照者、7例7眼高眼压者和11例14眼开角型青光眼者的全视野ERG最大反应及MERG。结果 青光眼和高眼压组的MERG一阶kernel反应P1波反应密度低于正常组,P1波峰时无明显延长,全视野ERG最大反应各组无显著差异。结论 MERG的一阶kernel反应在高眼压和青光眼均有改变。     

图形视诱发电位和图形视网膜电图在开角型青光眼诊断中的应用

图形视诱发电位和图形视网膜电图在开角型青光眼诊断中的应用上海市第六人民医院眼科宋玉英，杨建国应用图形视诱发电位（ＰＶＥＰ）和图形视网膜电图（ＰＥＲＯ）检测青光眼是一种比较敏感有效的方法，特别在开角型青光眼的早期诊断中具有积极的意义。现将我院眼科从１９...     

明视负波反应在青光眼早期诊断中的临床意义

视网膜电图的明视负波反应(PhNR)是在明适应条件下,用亮光刺激时,在正向b波后记录到缓慢的负向电位,但当用色光作背景和色光作为刺激光时,PhNR反应明显增大。动物实验证实PhNR产生于视网膜神经节细胞及其轴突,在实验性青光眼的视野轻度缺失时出现PhNR振幅下降。PhNR可以在开角型青光眼患者中呈特征性的振幅降低,并在可疑开角型青光眼中表现PhNR振幅降低。提示PhNR可以作为早期开角型青光眼损伤或者其青光眼损伤进展的一个视功能评价指标。     

Atypical retinitis pigmentosa masquerading as primary open angle glaucoma

PURPOSE: This study was conducted to describe a case of atypical retinitis pigmentosa initially diagnosed with primary open angle glaucoma. METHODS: Complete ophthalmologic examination, visual field examination, electroretinogram, and Heidelberg Retinal Tomograph were performed. RESULTS: Visual field examination showed arcuate defects extending to large temporal defects OU. Electroretinogram showed significant abnormalities with reduced b wave amplitudes and prolonged implicit times. Heidelberg Retinal Tomograph revealed a small central cup with no neuroretinal rim thinning or nerve fiber layer dropout OU. CONCLUSIONS: The present report suggests that visual field defects atypical for glaucoma should be carefully scrutinized for other etiologies.     

图形视网膜电图与视网膜神经纤维厚度检测在青光眼早期诊断中的临床意义

目的:比较图形视网膜电图(patter nelectroretinograms,PERG)、图形视诱发电位(pattern visual evoked potenlials,PVEP)、光学相干断层成像术(optical coherence tomo-graphy,OCT)测量视网膜神经纤维厚度的方法在原发开角型青光眼和正常眼压型青光眼早期诊断中的临床意义。方法:选择36例(72眼)早、中晚期青光眼患者,其中包括原发性开角型青光眼22例(44眼),正常眼压型青光眼14例(28眼)进行PERG,PVEP和OCT及视野检查,并对检查结果进行统计学分析,配对χ2检验比较各种检查方法在青光眼早期诊断中的敏感性。结果:PERG与PVEP差异具有显著性意义(P<0.01),PERG与OCT差异具有显著性意义(P<0.01),PVEP与OCT差异无统计学意义。PERG,PVEP和OCT检查在早期青光眼的异常率分别为80%,37%和33%。结论:在青光眼的早期诊断中,PERG的敏感性高于OCT和PVEP,但PERG在诊断中的特异性可受到其他眼疾和多种因素的影响,但OCT对眼底的检查有其特异性,所以联合多种检查方法对青光眼的早期诊断和监测具有一定的临床意义。     

New directions in the treatment of normal tension glaucoma

Glaucoma is a progressive optic neuropathy that causes characteristic changes of the optic nerve and visual field in relation to intraocular pressure (IOP). It is now known that glaucoma can occur at statistically normal IOPs and prevalence studies have shown that normal tension glaucoma (NTG) is more common than previously thought. While IOP is believed to be the predominant risk factor in primary open angle glaucoma (POAG), IOP-independent risk factors, such as vascular dysregulation, are believed to play an important part in the pathogenesis of NTG. Though certain distinguishing phenotypic features of NTG have been reported, such as an increased frequency of disc hemorrhages, acquired pits of the optic nerve and characteristic patterns of disc cupping and visual field loss, there is much overlap of the clinical findings in NTG with POAG, suggesting that NTG is likely part of a continuum of open angle glaucomas. However, IOP modification is still the mainstay of treatment in NTG. As in traditional POAG, reduction of IOP can be achieved with the use of medications, laser trabeculoplasty or surgery. Studies now show that the choice of medication may also be important in determining the outcomes of these patients. Though it is likely that future treatment of NTG will involve modification of both IOP and IOP-independent risk factors, current efforts to develop IOP-independent neuroprotective treatments have not yet proven to be effective in humans.     

重视原发性青光眼的早期诊断和干预

原发性青光眼是严重的不可逆转的致盲性眼病之一,早期诊断和干预是防止青光眼患者视功能严重丧失的关键措施。近年来,原发性青光眼的基础和临床研究均取得了重要进展,如对原发性闭角型青光眼（PACG）分类的认识,对PACG发病危险因素的认识,对PACG的处理,对原发性开角型青光眼（POAG）视乳头改变的认识,处理原发性青光眼中目标眼压概念的提出等,均有利于原发性青光眼的早期诊断和干预。加强对眼科医师青光眼早期诊断和干预的继续教育,向公众普及青光眼的防治知识,通过公共卫生的途径早期筛查原发性青光眼等措施,将使大量的原发性青光眼患者得到早期诊断和干预,从而降低青光眼的致盲率。     

Twenty-year follow-up of visual field defects in primary glaucoma eyes

PURPOSE: The time course of visual field defects in patients with primary glaucoma was investigated for 20 or more years. METHODS: The subjects were 51 eyes of 29 patients (open angle glaucoma, 40 eyes of 21 patients angle closure glaucoma, 11 eyes of 8 patients). The mean intraocular pressure of these subjects was within 21 mmHg during the follow-up periods. All the eyes were monitored with Goldmann's perimetry, and the visual field was graded using Kozaki's classification. RESULTS: At the 20-year follow-up, 68% of the open angle cases and 45% of the angle closure cases had significant progression of visual field defects. There was no significant difference in average intraocular pressure during the follow-up period between the progression group and the stable group. CONCLUSION: These results suggested that, in a follow-up of twenty years, visual field defects both in primary open angle glaucoma and chronic angle closure glaucoma can progress frequently, even if the intraocular pressure of these patients was well controlled.     

图形视觉诱发电位振幅与峰潜伏时比值对开角型青光眼早期诊断价值

目的 探讨图形视觉诱发电位(PVEP)的振幅/峰潜伏时(A/LT)比值在开角型青光眼(POAG)早期诊断中的应用.方法 检测可疑开角型青光眼56例(84只眼)、早期POAG患者62例(90只眼)及上正常对照组40例(80只眼)PVEP及A/LT比值.结果 可疑POAG及早期POAG患者PVEP检测阳性率均高于正常对照组,可疑POAG及早期POAG患者PVEP检测阳性率之间差异无统计学意义.可疑POAG及早期POAG患者A/LT比值分别为1.16和1.29,两者差异有统计学意义.结论 PVEP的A/LT比值分析在POAG早期诊断中有较好地临床应用前景.

Abstract：

Objective To study the primary open angle glaucoma by relative value of amplitude/latency through pattern visual evoked potential examination (PVEP) for early diagnosis.Methods Fifty-six cases (84 eyes) doubtful primary open angle glaucoma,62 cases (90 eyes) of early primary open angle glaucoma and 40 cases (80 eyes) of normal controls were tested for relative value of amplitude/latency.Results The abnormal ratio of doubtful and early primary open angle glaucoma was higher than that in normal controls.The abnormal ratio of doubtful and early primary open angle glaucoma was different,which was insignificant.Relative value of amplitude/latency in doubtful and early primary open angle glaucoma were 1.16 and 1.29,the difference was statistically significant (P＜0.05).Conclusion Relative value of amplitude/latency has a better perspective of clinical application in early diagnosing open angle glaucoma.     

Risk factors for primary open angle glaucoma progression: what we know and what we need to know

PURPOSE OF REVIEW: Recent literature is reviewed in order to identify possible risk factors leading to primary open angle glaucoma progression and blindness. RECENT FINDINGS: Several risk factors have been suggested to be important for progression of open angle glaucoma. Intraocular pressure appears to be an important risk factor for progression of glaucoma. It is still not clear if intraocular pressure fluctuation and central corneal thickness are related to progression. Myopia might be related to glaucoma progression as well as optic disc hemorrhages. Vascular factors appear to be related to progression also. Genetics seem to play an important role in open angle glaucoma. SUMMARY: Identifying risk factors associated with progression of patients with primary open angle glaucoma is essential to our clinical practices. The level of understanding regarding those risks is suboptimal at this point. Prospective long-term studies are needed if we wish to better understand the disease and help those patients at greater risk of progression and blindness.     

加强原发性青光眼的机会性筛查工作

早期发现和确诊原发性青光眼患者有利于减少青光眼引起的盲和视力损伤.开展机会性筛查工作是更早、更及时地发现原发性青光眼患者的有效方法.机会性筛查是指一些人因为健康体检或者其他问题来眼科就诊时,眼科医师有意识地进行青光眼方面的必要检查而发现的有关青光眼的情况,这应当是眼科临床工作的一部分.由于原发性闭角型青光眼与原发性开角型青光眼是两种不同类型的青光眼,具有明显不同的发病机制和临床特征,因此所采用的机会性筛查方法应当不同.作为眼科医师应当明确认识原发性闭角型青光眼和原发性开角型青光眼的发生和发展是一个连续体的概念,注意筛查试验和诊断试验的重要区别,选择筛查试验方法要力求简便、易行,重视防治青光眼人力资源的开发和应用,这对于做好机会性筛查工作十分重要.     

加强原发性青光眼的机会性筛查工作

早期发现和确诊原发性青光眼患者有利于减少青光眼引起的盲和视力损伤.开展机会性筛查工作是更早、更及时地发现原发性青光眼患者的有效方法.机会性筛查是指一些人因为健康体检或者其他问题来眼科就诊时,眼科医师有意识地进行青光眼方面的必要检查而发现的有关青光眼的情况,这应当是眼科临床工作的一部分.由于原发性闭角型青光眼与原发性开角型青光眼是两种不同类型的青光眼,具有明显不同的发病机制和临床特征,因此所采用的机会性筛查方法应当不同.作为眼科医师应当明确认识原发性闭角型青光眼和原发性开角型青光眼的发生和发展是一个连续体的概念,注意筛查试验和诊断试验的重要区别,选择筛查试验方法要力求简便、易行,重视防治青光眼人力资源的开发和应用,这对于做好机会性筛查工作十分重要.