糖尿病性黄斑水肿视网膜功能定量研究

目的:应用多焦视网膜电图评估糖尿病性黄斑水肿的视网膜功能.方法:选取2010-03/2014-03我院眼科经眼底血管造影检查确诊为糖尿病性黄斑水肿的患者30例48眼为观察组(其中局限性水肿18眼,弥漫性水肿24眼,囊样水肿6眼),选取视力0.8以上,经裂隙灯显微镜检查均未发现异常,全身情况无异常者15例30眼为对照组,两组研究对象均行多焦视网膜电图检查,并对其结果进行统计学分析.结果:糖尿病性黄斑水肿组多焦视网膜电图中心凹、黄斑区、黄斑外区a、b波的振幅密度与对照组相比均差异存在统计学意义(P＜0.01);中心凹处观察组和对照组a波的振幅密度分别为25.2±10.48、37.93±7.19nv/deg2,b波的振幅密度分别为77.16±27.97、113.42±11.79nv/deg2;黄斑区观察组和对照组a波的振幅密度分别为14.27±4.99、27.42 ±2.86nv/deg2,b波的振幅密度分别为43.14±14.77、69.99±10.07 nv/deg2;黄斑外区观察组和对照组a波的振幅密度分别为7.82±2.79、11.46±1.54nv/deg2,b波的振幅密度分别为19.85±6.5、31.56±6.0nv/deg2.中心凹处、黄斑区及黄斑外区多焦视网膜电图a、b波振幅密度在局限性黄斑水肿组与弥漫性黄斑水肿组和囊样黄斑水肿组间均存在统计学意义(P＜0.01).结论:糖尿病性黄斑水肿的多焦视网膜表现为a、b波振幅密度下降,潜伏期延长,振幅密度比潜伏期敏感.     

Stargardt病的临床视觉电生理检测评价

目的探讨视觉电生理检测在临床诊断Stargardt病时的作用以及评价视网膜功能的意义。方法对一组14例28眼眼底表现为黄斑变性的Stargardt病患者进行眼电图、局部视网膜电图、暗适应视网膜电图检测,各参数同正常对照组比较。结果Stargardt病患者的眼电图Arden比值显著下降;局部视网膜电图的平均振幅显著下降,平均峰时明显延长;暗适应视网膜电图a波、b波振幅和峰时和正常对照比较无显著差异。结论临床上联合运用眼电图、局部视网膜电图、暗适应视网膜电图检测Stargardt病患者可以较全面评估视网膜功能,反应病变的层次和范围。     

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.     

多焦视网膜电图在亚临床期糖尿病视网膜病变中的变化

目的:探讨多焦视网膜电图(multifocal electroretinogram,mf-ERG)的一阶(first order kernel,FOK)和二阶(second order kernel,SOK)反应在亚临床期糖尿病视网膜病变的变化.方法:回顾性分析,选取2014-06/2015-05确诊为2型糖尿病,但眼底无糖尿病视网膜病变患者32例58眼作为糖尿病组,进行多焦视网膜电图一阶反应、二阶反应检查,并与同期门诊检查的正常组对照.结果:与正常对照组相比,糖尿病组FOK总和反应b波潜伏期无明显延迟,而b波的振幅降低,差异有统计学意义(t=3.099,P=0.012).糖尿病组SOK总和反应b波的峰时延迟,差异有统计学意义(t=2.643,P=0.025),且b波的振幅降低,差异有统计学意义(t=4.833,P<0.01).糖尿病组a波在FOK和SOK中的振幅和潜伏期变化差异均无统计学意义.将b波振幅、潜伏期分别与糖尿病病程行相关性分析,结果显示b波振幅与病程呈负相关,而b波潜伏期与病程无相关性.结论:在亚临床期糖尿病视网膜病变中FOK、SOK均有变化,主要反映在b波的振幅变化.     

眼球钝挫伤后视网膜电图的改变

对３９例眼球钝挫伤患者进行了视网膜电图检查。眼底有改变组与眼底末发现改变组ａ、ｂ波振幅均降低，与对侧健眼比较，有显著性差异。提示ＥＲＧ检查对眼球钝挫伤后眼底末发现改变患者的诊断意义。     

中药复明片对视网膜脱离术后患者视网膜电图的影响

目的:评价益气养阴、活血利水之复明片对视网膜脱离复位术后患者视网膜电图(electroretinogram,ERG)的影响。方法:将386例视网膜脱离复位术的患者,术前常规检查后,通过抽签随机分为复明片治疗组、益脉康片对照组和常规疗法对照组。各组患者均行视网膜脱离复位术,术后常规抗炎、止血治疗,术后1d开始分别服用复明片、益脉康片,常规疗法对照组不另服药。术后随访6wk。记录并对比分析3组患者视力、视网膜电图的变化情况。结果:治疗组视力的有效率为90.0%,与益脉康片对照组(80.6%)及常规疗法对照组(50.4%)比较统计学上有极显著性差异(P<0.01)。复明片组与益脉康组及常规疗法组比较,在治疗后暗适应和明适应ERGa,b波振幅及治疗前后暗适应和明适应a,b波振幅的差值有极显著性意义(P<0.01),治疗后a,b波振幅提高,潜时较短。结论:复明片能改善视网膜复位术后患者的ERG,促进其视功能的恢复。     

1型糖尿病患者早期视觉诱发电位和视网膜电图分析

目的：探讨1型糖尿病患者早期的视觉电生理变化情况,分析糖尿病视网膜病变的早期与视觉诱发电位和视网膜电图改变的相关性。
　　方法：观察组60例1型糖尿病患者,男女比例均等,平均年龄19.42依7.78岁,病程小于5a,矫正视力5.0,平均空腹血糖7.8依3.6mmol / L。进行图形视觉诱发电位和闪光视网膜电图检查。对照组60例正常人,男女比例均等,平均年龄17.2依6.52岁,矫正视力5.0,进行图形视觉诱发电位和闪光视网膜电图检查;记录两组 PVEP 参数P100波潜伏期和 P100波振幅值,FERG 参数 a 波潜伏值、b 波潜伏期、a 波振幅值、b 波振幅值。
　　结果：观察组的参数 P100波振幅值、P100波潜伏期与对照组比较,有显著统计学意义(P<0.01),均有振幅值降低,潜伏期延长;观察组的参数 a 波潜伏期、a 波振幅值、b波潜伏期、b 波振幅值与对照组比较差异有显著统计学意义(P<0.01);观察组平均空腹血糖控制稳定,PVEP P100的振幅值、FERG a、b 波的振幅值与糖尿病程无关,而 PVEP P100的潜伏值、FERG a、b 波的潜伏值与糖尿病程有关。
　　结论：图形视觉诱发电位提示糖尿病患者视神经元损伤较为敏感;闪光视网膜电图是早期发现糖尿病患者视网膜 Müller 细胞和双极细胞损害的理想手段;图形视觉诱发电位参数 P100波振幅值、闪光视网膜电图参数 b 波振幅值可能是糖尿病视网膜临床前期最敏感的诊断指标。     

正常眼多焦视网膜电图特征的初步探讨

目的 :初步分析正常人眼多焦视网膜电图 (m ERG)测量值 ,并探讨正常眼视网膜后极部不同部位的电生理功能。方法 :对 19例 (2 5眼 )散瞳正常眼作多焦视网膜电图检查 ,记录 6 1个部位反应波形图 ,分析视网膜后极部不同区域的a波 (第 1个负波 )和b波 (第 1个正波 )的潜伏期、振幅值及振幅密度。结果 :视网膜后极部中心环 (第 1环 )振幅密度为最高 ,a波为 (33.92± 18.95 )nV/deg2 ,b波为 (6 8.78±19.84 )nV/deg2 ,随着离心度的增加 ,各振幅密度逐渐下降 ,差异有显著性 (P <0 .0 1)。a波及b波潜伏期、振幅及振幅密度在四个象限的差异均无显著性 (P >0 .0 5 )。结论 :多焦视网膜电图能客观、定位、定量地测定视网膜后极部不同部位的视功能 ,其测定的正常值为临床研究提供了参考数值     

运用多焦视网膜电流图评价羟氯喹对黄斑中心视功能的影响

目的:运用多焦视网膜电流图(MFERG)评估服用羟氯喹后视网膜黄斑中心视锥系统功能变化情况。方法:回顾性研究。将2017-01/2019-11于解放军总医院第一医学中心眼科进行检查的类风湿性关节炎患者132例264眼纳入分析。根据服药时间分为6组:A组38例76眼未服药,B组38例76眼服药1a,C组17例34眼服药2a,D组18例36眼服药3a,E组13例26眼服药5a,F组8例16眼服药5a以上停药3a。比较各组患者最佳矫正视力(BCVA)、MFERG中央第一环视网膜反应区P 1波振幅密度值的变化情况。结果:A~F组患者BCVA(0.11±0.11、0.11±0.10、0.13±0.10、0.15±0.10、0.15±0.11、0.14±0.10LogMAR)无明显差异(F=1.287,P=0.270),但A组患者P 1波振幅密度值(122.68±1.87nV/deg 2)明显高于其他组(115.76±1.71、113.38±1.51、109.10±2.52、94.61±0.78、94.02±0.91nV/deg 2,均P<0.05)。结论:长期服用羟氯喹后,即使中心视力未发生改变,MFERG检查结果显示视网膜黄斑中心视锥系统随着服药时间延长,其功能呈下降趋势,且停药后视功能不能恢复。     

应用OCT观察羟氯喹对视网膜的早期影响

目的 通过OCT评估羟氯喹对视网膜神经纤维层（RNFL）的损害。方法 回顾性病例研究。对30例使用羟氯喹治疗少于5年并且没有发生眼底改变的患者和30例健康者进行视力、视野、眼底和OCT 的检查。结果 治疗期间视力、眼底和视野的检查均无异常。OCT发现服用羟氯喹组患者的内层黄斑区视网膜厚度内外圈各象限均有显著降低。结论 OCT能观察到羟氯喹对视网膜的早期损伤。     

白内障患者F-ERG表现及其临床意义的研究

目的：探讨晶状体混浊对闪光视网膜电流图（flash electroretinogram,F-ERG)的影响。以及白内障术前F－ERG评估视网膜功能的价值。方法：对一组白内障患者手术前后暗适应ERG、闪烁ERG检查。分析FERG的检查结果及其与术后视力、眼底情况的关系。结果：眼底正常组术前暗适应ERGb波振幅、峰时与正常对照组无显著差异，而眼底异常组与正常对照组有显著差异。术前暗适应ERGb波振幅与术后视力有关。结论：白内障手术前行FERG检查有助于视功能的评估及预测术后视力。     

Pattern ERG and psychophysical functions in Best's disease

The aim of the study was to asses the neurosensory retinal function in 12 patients (24 eyes) with different stages of Best's disease, by determining how pattern and full field flash ERG responses were related to visual acuity, stage of disease and extent of visual field loss. All patients had typically abnormal EOG responses and normal full field-flash ERG responses. Patients were stratified in two groups according to visual acuity. In the first group 12 eyes with visual acuity better than 0.5, all amplitudes and latencies of PERG P50 and N95 responses were in the normal range. Small central scotoma was detected by static perimetry in four of these eyes. In the second group of 12 eyes with visual acuity 0.5 or less, PERG showed reduced both P50 and N95 amplitudes in five eyes, and N95 solely, in two eyes. All patients had central scotomas detected by static perimetry. Progression of the disease, seen in deterioration of visual acuity and progression of central visual field defects, corresponded well with reduction of both PERG P50 and N95 amplitudes. There was no correlation found between visual acuity and EOG responses. Our results show that in Best's distrophy, pattern ERG is getting abnormal with progression of the disease, indicating relative preservation of neurosensory retina in initial stages of the disease. In contrast to EOG - being abnormal in all the patients regardless of the stage of disease - and full field-flash ERG - being normal in most of the patients - PERG gives opportunity for electrophysiological determination of the progression of the disease.     

Electrophysiological findings in familial exudative vitreoretinopathy

Three patients in a family with familial exudative vitreoretinopathy (FEVR) were studied especially electrophysiologically. Two cases showed abnormal ERG, namely reduction of amplitude of oscillatory potentials, a and b wave of bright white flash ERG, scotopic and photopic b waves. One case showed reduced Light peak/Dark trough ratio of EOG. Next, the electrophysiological findings of cases with FEVR reported in the literature were analyzed. The result was that FEVR has electrophysiological varieties but a statistical significant relationship between electrophysiological findings and visual acuity. That is, cases with abnormal ERG or EOG have more impaired visual acuity than normal ones. Furthermore, there was a tendency that eyes with abnormal ERG or EOG showed more disturbed color vision and advanced fundus findings than normal ones. These results seemed to be understandable by anatomically characteristic fundus feature of FEVR.presented at the 6th Meeting of the International Society of Genetic Eye Disease and 3rd International Symposium on Retinoblastoma, Amsterdam, the Netherlands, May 1–3, 1986.     

Chronic carbon disulphide poisoning: a 4 year follow-up study of the ophthalmological signs

Summary Thirty workers of a viscose rayon industry had a complete eye examination in 1979 including visual acuity, perimetry, colour vision testing, fluorescein angiography, ERG and EOG, for possible signs of chronic carbon disulphide poisoning. They were divided into two groups, group A included workers exposed to relatively high CS₂ levels (at least 50mg/m³), group B working in the relatively safe bleaching division. In both groups fundus anomalies and abnormal EOG's en ERG's were found. Twenty-nine of these thirty workers were reexamined in 1983. A number of them were no longer exposed to CS₂ for a period varying between 1 and 43 months. The fundus signs (pigmentary changes and vascular lesions) increased in frequency, even if the patient was no longer exposed. The light/dark ratio of the EOG after 4 years was decreased in comparison with the first EOG, although this was not statistically significant. The ERG improved on follow-up. This could be related either to a shift to supranormal amplitudes or to recovery from subnormal amplitudes after the patient was no longer exposed.     

一真性小眼球家系的临床及视觉电生理特征

目的了解家族性真性小眼球患者的眼部临床特征及视觉电生理特征。方法家系临床研究。于北京协和医院眼科收集一真性小眼球家系,分析其遗传方式和临床特点,并对家系成员中的患者进行详细眼科检查,包括视力、眼底、眼轴长度、光学相干断层扫描（OCT）、图形视觉诱发电位（PVEP）、图形视网膜电图（PERG）、全视野视网膜电图（ERG）等检查。结果该家系连续3代共11人,5例患者,每代均有患者且存在父子传递,属于常染色体显性遗传。因其中2例患者行动不便,部分病例资料从当地医院的检查记录中获得。先证者及其他4例患者就诊时最佳矫正视力均低于0.8 LogMAR。3例患者双眼眼轴长度均较正常人短,为17.27～18.85 mm,以前房和玻璃体腔长度缩短为主。3例患者视盘小、色红。3例患者OCT检查显示黄斑中心凹厚度明显增加（大于280 µm）。视觉电生理检查显示PVEP P100峰时及幅值正常,PERG各波正常;全视野ERG显示为a波及b波振幅增高,且明显高于本院年龄相匹配的正常人。结论真性小眼球可以呈常染色体显性遗传,患者视力低于正常,黄斑中心凹增厚,而全视野ERG表现为超高型。     

Preoperative electroretinogram for predicting postoperative visual function of vitrectomy

Vitrectomy was performed on 17 patients [19 eyes] who had dense vitreal opacity and precluding inspection of the ocular fundus. The preoperative visual acuity was light perception to 0.1, the postoperative visual acuity was 0.03 to 0.9. The preoperative electroretinogram [ERG] was tested on all patients. The correlation of the amplitudes of the ERG b-wave to the postoperative visual acuities were statistically analysed. The results showed that there was positive correlation of the amplitude of the preoperative scotopic bright ERG b-wave to postoperative visual acuity [r = 0.7709, p less than 0.01], and positive correlation of the amplitude of the preoperative photopic ERG b-wave to the visual acuity [r = 0.8086, p less than 0.01]. It suggests that the bigger amplitude of the preoperative ERG b-wave was, the better postoperative visual acuity was improved. Thus, the preoperative ERG could predict the outcome of vitrectomy in various ocular diseases with vitreal opacities and very low visual acuity.     

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。     

The ocular features in a father and a son with central areolar choroidal dystrophy

PURPOSE: To report the ocular features of a father and son with central areolar choroidal dystrophy (CACD) who had similar fundus appearance. CASE: Case 1. A 37-year-old man noticed impairment of his vision since several months prior to his visit to our hospital. His corrected visual acuity was 0.6 OD and 1.0 OS. Well demarcated chorioretinal atrophy with a width of 2-3 disc diameters in the macular area was observed in both ocular fundi. Optical coherence tomography (OCT) at the chorioretinal atrophy areas showed thinning of retinal thickness with a disappearance of a line corresponding to the outer segment of the photoreceptor cells, but thickening of a line of the retinal pigment epithelium. Electroretinogram(ERG) and electrooculogram(EOG) showed deteriorated responses. Case 2 was a 67-year-old man, the father of patient 1. His corrected visual acuity was 0.1 OD and 0.2 p OS. Fundus appearance was similar to that of case 1. His ERG and EOG also showed similar impaired responses. His OCT also showed findings similar to those of case 1, but the retina was thinner than in case 1 in the chorioretinal atrophy area. DISCUSSION :The rest of the retina outside the chorioretinal atrophy area in these CACD patients also seemed to be damaged because both the ERG and EOG showed damage. These two cases revealed that a CACD patient could maintain relatively good visual acuity, even though the chorioretinal atrophy had involved the foveal area, and also indications were that retinal functions had been damaged.     

Karl Lisch,MD: Remembered July 24, 1907 - February 5, 1999

Purpose: To report a novel VMD2 gene mutation in a Japanese family with Best disease and the clinical phenotype of the patients. Patients and methods: Mutational analysis for VMD2 was performed by direct sequencing in two members of a Japanese family with Best disease. Clinical examination included visual acuity, electro-oculography (EOG), and fundus examination. Results: A T990C mutation of the VMD2 gene was found in the 20-year-old boy and his 47-year-old mother. The boy had bilateral vitelliform cyst-like lesions in both eyes and showed a pathological Arden ratio of 1.0 on EOG. The mother had a normal fundus appearance with an Arden ratio of 1.0 on EOG. Conclusion: A novel disease-causing mutation in the VMD2 gene (T990C) was found in Japanese patients with Best disease.     

Reduced full-field electroretinogram (ERG) in a patient treated with methotrexate

PURPOSE: To examine retinal function in a patient with decreased vision possibly due to treatment with methotrexate. METHODS: Ophthalmological examination included testing of visual acuity (VA), fundus inspection, fundus photography, and kinetic perimetry. Retinal function was tested objectively with three electrophysiological methods: full-field electroretinography (ERG), multifocal electroretinography (mfERg) and also electro-oculography (EOG). RESULTS: A 13-year-old boy with psoriasis arthritis had been treated with methotrexate on a weekly basis for 8.5 years. After terminating treatment, his VA, which was reduced to 0.3 in both eyes initially, improved during the following 3 years but did not return to normal. No visual field defects were found with kinetic perimetry. The rod and cone responses in the full-field ERG were markedly reduced in b-wave amplitude initially, but grew slowly to nearly normal values 3 years later. After withdrawal of the drug, the mfERG demonstrated normal responses in the macular region. The Arden index in the EOG was normal. CONCLUSION: Chronic treatment with methotrexate may affect VA, and mat reversible reduce rod and cone function. In patients who use systemic medication and who vision is reduced, objective evaluation of retinal function with electrophysiological methods is recommended.