视觉诱发电位和视网膜电图在眼挫伤中的应用

本文通过对93例单眼钝挫伤患者的视觉诱发电位和视网膜电图检测结果进行分析，结果证明：眼挫伤视力为0．1以下者的VEP的P1波明显延长；眼挫伤视力为0．1以上者的ERG的a波下降（P＜0．001），b波延迟（P＜0．05）为明显，因而认为视觉诱发电位和视网膜电图是判断眼挫伤视力预后的客观指标。     

Adie瞳孔1例

患者，女，41岁。7a前照镜子时无意中发现双眼瞳孔大小不等，无视力改变及其他不适症状，未经诊治。今因高血压病住我院中医科治疗，遂来眼科咨询。患者发育正常，视力：右1．0，左1．0；眼压：右13mmHg（1kPa=7．5mmHg），左14mmHg；双眼角膜透明，前房深度可，房水清。右眼瞳孔直径约5．0mm，直、间接对光反射消失，集合反应迟钝，在暗室中可见瞳孔缓慢扩大，用强光照射时，有弱的缩瞳反应；左眼瞳孔直径约2．5mm，直、间接对光反射及集合反应灵敏，双眼底正常。无全身代谢性及胶原性疾病，无眼外伤史、家族史。颅脑CT及VEP均示正常。用0.0625％的匹罗卡品滴眼液滴双眼20min后，右眼瞳孔较前缩小，左眼瞳孔无变化。     

球后视神经炎患者的瞳孔对光反射特征

目的 了解球后视神经炎(RON)患者的瞳孔对光反射特征，探讨瞳 孔对光反射检查在RON诊断和治疗中的临床应用价值。 方法 用瞳孔测试仪分别检测3 5例临床确诊的RON患者35只患眼治疗前(发病期)后、对侧眼以及正常对照组50例100只眼的瞳孔对光反射。患者组年龄10~ 58岁，平均年龄30.4岁；对照组与患者组年龄、性别无差异 。检查的对光反射参数包括瞳孔面积、瞳孔对光反射的最大反应幅度、潜伏期和最大反应速度。 结果 在RON的发病期，患眼瞳孔对光反射的反应潜伏期延长、最大反应幅度减小，与正常照 组相比差异 有非常显著的统计学意义。治疗后，随着病情改善、视力恢复，患眼瞳孔对光反射的反应潜伏期、最大反应幅度等逐渐恢复，与发病期相比差异有统计学意义，但与正常对照组比较仍然有显著差异。患眼发病期和治疗后，对侧眼瞳孔也表现为反应潜伏期和最大反应幅度下降，但与对照组相比，其差异均无统计学意义。 结论 RON患眼的瞳孔对光反射反应潜伏期延长、最大反应幅度减小。瞳孔对光反射检查有于 对RON做出早期诊断并监测其病情变化。 (中华眼底病杂志，2006，22：370-372）     

挫伤性视神经病变所致的单眼盲与图形视觉诱发电位振幅关系的研究

目的探讨挫伤性视神经病变患者图形视觉诱发电位（P—VEP）振幅下降百分比与客观判断单眼盲的关系。方法回顾性分析31例单眼挫伤性视神经病变病例,将患者按伤眼视力≥0．05与〈0．05分为两组,比较两组间伤眼较对侧健眼P—VEP振幅下降百分比的差异,通过ROC曲线寻找P—VEP振幅下降百分比在两组间的临界值。结果两组患者的P—VEP振幅下降百分比具有统计学显著差异（P〈0．05）。60′方格的P—VEP振幅下降百分比的受试者工作特征曲线（ROC）的曲线下面积（AUC）为0．804,敏感性与特异性最佳点为42．68％,30′方格的AUC为0．719,敏感性及特异性最佳点为67．4％。结论在发生挫伤性视神经病变时,当伤眼较对侧健眼P—VEP振幅下降百分比在60′方格及30′方格中分别达到42．68％与67．4％时,对客观判断单眼盲诊断具有参考价值。     

视觉诱发电位对挫伤眼视神经损伤的评价

目的：探讨眼挫伤后视觉诱发电位（VEP）变化特征。方法：对71例（115眼）眼挫伤行VEP检查。视力≥0．1者行图形视觉诱发电位（P－VEP）检查（100眼，A组）；视力＜0．1者行闪光视觉诱发电位（F－VEP）检查（15眼，B组）。A组根据挫伤后视力情况又分为3个亚组。结果：A组所有伤眼P100波幅较正常值明显降低（P＜0．01），而蜂潜时夫明显改变（P＞0．05）；3个亚组间P100波幅值有明显差异（P＜0．01）。B组15眼P100与对侧健眼比较，峰潜时明显延长，波幅明显降低（P＜0．01）。结论：视觉诱发电位对眼挫伤后视神经损伤的诊断具有客观性和敏感性，有定量诊断价值。     

视觉诱发电位和量化评分表在眼球挫伤程度及其预后评价中的应用

目的 探讨视觉诱发电位(visual evoked potential,VEP)和量化评分表在眼球挫伤程度及其预后评价中的应用.方法 对90例(90眼)单眼外伤患者双眼VEP P100波潜伏期与振幅的变化进行比较,并对治疗2个月后最终矫正视力与治疗前按照量化评分表计算出的分值进行相关性分析.结果 行图形VEP检查的所有伤眼(42眼)P100波与健眼比较,潜伏期延迟(11.87±7.05)ms,振幅下降(4.24±3.16) μV；行闪光VEP检查的所有伤眼P100波与健眼比较,潜伏期延迟(13.58±7.87) ms,振幅下降(4.47±3.86) μV,差异均有显著统计学意义(均为P＜0.01).量化评分分值与治疗后最终矫正视力的直线回归方程为Y=1.097-0.069 X,量化评分与治疗后最终矫正视力呈高度负相关.结论 眼球挫伤后VEP P100波潜伏期明显延迟,振幅明显降低.所设计的眼球挫伤量化评分表能够为眼球挫伤提供准确的定量诊断和有效的预后预测.     

非动脉炎性前部缺血性视神经病变图形视觉诱发电位与视力相关性研究

目的探讨非动脉炎性前部缺血性视神经病变（NAION）图形视觉诱发电位（P—VEP）的特点及其与视力、视野的相关性。方法临床病例自身对照研究。收集2011年3月至2015年4月就诊于天津市眼科医院,53例62只眼NAION患者,进行P—VEP等检查,对侧健眼44只眼作为对照组,分析其P—VEP特点以及其与视力、视野相关性。结果62只眼NAION患者P—VEP15’棋盘格P100波潜时、振幅与对照组相比,差异有统计学意义（P〈0．05）,P—VEP15’棋盘格P100波振幅与视力差异有统计学意义（P〈O．05）,15’棋盘格P100波潜时与视野平均敏感度（mean sensitivitv,MS）差异有统计学意义（P〈0．05）。结论NAION患者P—VEP15’棋盘格p100波振幅越低视力越差,但与视野损伤不一致。P—VEP与视野联合应用更能评价NAION视功能损伤情况。     

多焦视诱发电位在原发性开角型青光眼诊断中的应用

目的通过检测正常人和原发性开角型青光眼（primary open angle glaucoma，POAG）患者的多焦视诱发电位（multlfocal visual evoked potential，mf—VEP）并与Octopus101视野检查等进行对比性研究，客观评价mf—VEP在POAG诊断中的应用价值。方法对32例（64眼）正常人和35例（67眼）POAG患者分别进行眼科常规检查、眼压测定、眼底照相、Octopus101视野和mf—VEP检查。将POAG患者的mf—VEP检查结果与正常人进行对比性研究，并与视野检查进行相关性分析。结果mf-VEP在正常人和POAG组间潜伏期和振幅存在明显差异，经统计学检验差异有显著性。POAG患者mf-VEP潜伏期和振幅值与视野平均光敏感度值具有显著相关性。POAG患者mf—VEP振幅降低区与视野缺损区具有对应性和一致性。结论mf—VEP能客观地反映POAG患者不同视野部位的视功能损害，为POAG患者的诊断和视功能监测提供了新的途径。     

儿童单眼视力缺陷的图形视觉诱发电位分析

目的：研究图形视觉诱发电位（P－VEP）判断儿童单眼视功能的三种方法（波幅差异比率法、波幅比率法、潜伏斯差异法）的敏感度和特异度，以寻找一种可靠、 有效的发现儿童单眼视力缺陷的VEP视力评估手段。方法：用P－VEP检查了178名正常儿童，建立每一种方法的正常值范围。用P－VEP测定两组具有单眼疾患的儿童（一组患眼视力正常，另一组患眼视力异常）。评估每种方法的敏感度和特异度。结果：三种方法在各年龄组均具有较高的特异度（0．83－0．94）。波幅差异比率法的敏感度在各年龄组均明显高于波幅比率法和潜伏期差异法。结论：VEP波幅差异比率法估计视力，在各年龄组均具有较高的敏感度和特异度，因而是发现单眼视力缺陷的较好的分析指标。     

眼科研究(1993年)第11卷文题分类索引

1.视力、视觉、视野低温对眼电生理的影响张晰单眼弱视与双眼弱视病儿视觉诱发电位 的分析杨继红等瞳孑L与视野阂值楼彪刚等视觉诱发电位与双眼视功能11视差刺激 VEP与立体视’杨东生高度近视眼视觉诱发电位的初步研究 王超英等纬线和经线静态视野检查法的比较 周和玫玻璃体出血对视网膜损伤的电生理研究 聂维嘉一等视觉眼电图诊断指标研究李文松等2.眼肌、斜视、屈光、调节慢性进行性眼外肌营养不良王志安等用国产肌电图仪检查上斜肌等69条眼外 肌的初步报告汪泽等3.眼睑、结膜、泪器春季卡他性结膜炎的近代研究概况谢汉兴误注液体石腊致…     

原发性开角型青光眼患者视野缺损和瞳孔的关系

目的：测量原发性开角型青光眼患者的瞳孔对光反射,探索青光眼患者视野缺损和瞳孔的关系。方法：连续选取2014－07／2015－10于我院就诊的原发性开角型青光眼患者86例115眼和健康个体16例23眼纳入本研究,所有受试者均接受全面的眼科检查、视野检查（ Humphrey , SITA Standard 24－2）和动态瞳孔测量（ MonCV3 Metrovision ）。依据视野检查结果和青光眼分期系统,将青光眼患者分为5个亚组,即1期亚组、2期亚组、3期亚组、4期亚组和5期亚组。瞳孔对光反射相关的测量指标包括：瞳孔直径（最小和最大瞳孔直径）、收缩和开大的潜伏时间、收缩和开大的持续时间、收缩和开大的速度、收缩幅度以及瞳孔收缩比例。使用SPSS 19．0统计软件包对测量结果进行统计分析。结果：青光眼组中4期亚组和5期亚组的最小瞳孔直径与对照组差异有统计学意义（P＝0．032,P＝0．014）;各组的瞳孔收缩速度相比,差异有统计学意义（ F＝648．675, P＜0．01）,其中5期亚组的瞳孔收缩速度小于其他亚组和对照组（P＜0．05）;3期、4期和5期亚组的瞳孔收缩比例与对照组差异有统计学意义（ P＜0．05）;瞳孔收缩速度、瞳孔收缩比例和最小瞳孔直径与青光眼的视野分期相关。结论：原发性开角型青光眼患者的瞳孔瞳孔收缩能力有所下降,瞳孔收缩能力的下降与视野缺损程度相关。     

Pupillary light reflexes in patients with Leber’s hereditary optic neuropathy

 Background: According to a recent pupillographic study, patients with Leber’s hereditary optic neuropathy (LHON) show the same pupillary behaviour as normals. Because this raises many questions concerning the real nature of LHON and challenges our concept of the afferent pupillary system, we tried to verify the results of this study. · Methods: Pupillary function was assessed in 34 normal subjects and 40 patients with LHON. Pupillary light reflexes were recorded by means of the Compact Integrated Pupillograph (CIP, AMTech). Under mesopic conditions 200-ms stimuli were presented at two different stimulus intensities. Latency, constriction amplitude and baseline diameter were defined automatically. Pupil light reflexes were compared between LHON patients and normals and between the better and the worse eye in 20 LHON patients with different visual acuities. · Results: For both stimuli there were significant differences in latency between LHON patients and controls. The latency of the pupil light reflex proved to be about 20 ms longer for LHON patients, and the amplitude was significantly smaller for the bright stimulus. Within LHON patients, the eyes with the worse visual acuity had a significantly smaller constriction amplitude than the eyes with the better visual acuity. · Conclusion: The results of our study confirm that LHON really is an optic nerve disease and that the pupillary light reflexes are not normal. Received: 5 January 1998 Revised version received: 28 February 1998 Accepted: 11 March 1998     

Effect of pupil size on multifocal pattern visual evoked potentials

The purpose of this study was to investigate the influence of pupil diameter on the amplitude and latency of multifocal visual evoked potentials (mfVEP). The multifocal objective perimeter (Accumap; Objectivision) was used to stimulate the visual field at 56 sites extending to 32 degrees using a pseudo-random pattern stimulus. The mfVEP were recorded using bipolar occipital electrodes, 7 min/eye. Ten normal subjects were recruited from the community and one eye was randomly selected for testing. The mfVEP were recorded at four different pupil diameters (2 mm, 4 mm, 6 mm, 8 mm), obtained by applying tropicamide (0.5%) or pilocarpine (2%) in different dilutions. Appropriate refractive correction was provided to overcome cycloplegia and achieve a visual acuity of 6/7.5 or better. Analysis revealed that at most pupil diameters the normalized full field amplitude did not show significant variation, except at the most miotic pupil diameter (2 mm), where the amplitude became reduced, based on 2-way anova and Tukey's T method. There was, however, significant correlation between latency and pupil area (correlation coefficient: upper field -0.63, lower field -0.76). The results suggest that even in the presence of mydriatics or miotics, the mfVEP test can be used to assess diseases that affect amplitude, provided near correction is used. The interpretation of latency, however, must be made with caution, as a borderline conduction defect with a dilated pupil may appear normal.     

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。     

Comparison of pupil perimetry and visual perimetry in normal eyes: decibel sensitivity and variability

PURPOSE: To compare the sensitivity and variability of pupil perimetry with visual perimetry at the same retinal locations in normal subjects. METHODS: Pupil perimetry was performed on the right and left eyes of 10 normal subjects using a computerized infrared pupillometer equipped to present perimetric light stimuli and record pupil light reflexes. Eleven locations were tested at different intensities along the horizontal meridian of each eye, and the decibel sensitivity of the pupil light reflex was compared with the visual threshold at the same location. RESULTS: The shape and height of the hill of vision (retinal sensitivity) was very similar between the right and left eyes of each individual using either pupil perimetry (R2 = 0.69) or standard threshold perimetry (R2 = 0.62) but was less similar between subjects. Comparisons between pupil and visual sensitivity revealed a lack of correlation at the same retinal location in normal eyes (R2 = 0.19). CONCLUSIONS: The high intereye correlation for either pupil or visual sensitivity may provide an important tool for detecting focal or asymmetric visual field damage. Although the basic shape of the sensitivity profile of pupil and visual responses was similar under the conditions of testing, the two did not correlate well within each eye among the normal subjects. This highlights that similarities do exist in the sensitivity profile of the two pathways, but they do not seem to vary in the same proportion between normal individuals.     

暗环境下瞳孔大小对对比度视力的影响

目的:探讨在暗环境下瞳孔大小对对比度视力的影响。方法:应用多功能电子视力测量仪(MFVA-100)及Allegroanalyzer波前像差仪测量42例84眼在暗环境中的对比度视力及瞳孔直径,以瞳孔直径的均值5.6mm为界分为两组,比较不同瞳孔大小范围时的对比度视力,并分析瞳孔大小与对比度视力的相关性。结果:在对比度25%和10%的情况下,瞳孔直径范围在(4.0～5.5)mm时的对比度视力分别为(0.158±0.097)及(0.374±0.099),优于范围为(5.6～7.2)mm时的对比度视力,差异有统计学意义(P<0.02),在对比度10%时的差异较对比度为25%时的差异小,在对比度100%和5%时,瞳孔直径范围为(4.0～5.5)mm与范围为(5.6～7.2)mm时两组间的对比度视力的差异无统计学意义;瞳孔直径范围为(4.0～5.5)mm和范围为(5.6～7.2)mm时,随直径的增加,各对比度下的对比度视力下降,瞳孔直径与对比度视力有明显的正相关(P<0.05)。结论:不同直径的瞳孔在一定条件下可明显影响对比度视力,从而影响夜间视觉质量,对术前暗环境下瞳孔大小的测量,是决定角膜屈光手术方式的重要指标之一。     

Pattern electroretinogram,visual evoked potential and psychophysical functions in maculopathy

To compare pattern electroretinograms and visual evoked potentials with psychophysical examinations, such as visual acuity, static (automated) perimetry and color vision in unilateral maculopathies of various origins, 20 patients with unilateral retinal diseases within the macula and the posterior pole were tested. Pattern electroretinography, visual evoked potential testing and static perimetry (Octopus program M1) were performed with three different test field sizes (20° × 20°, 10° × 10° and 6° × 6°). The best correlation in all three test field sizes was found between visual acuity, static perimetry and visual evoked potential. This result is surprising, since central area defined functions (visual evoked potentials, visual acuity) correlated well with a total area integrating function (mean defect in static perimetry). The pattern electroretinogram, which seems to reflect an area-related function as well, showed a correlation to static perimetry only in the smaller 10° × 10° and 6° × 6° fields and not a significant correlation in the 20° × 20° field. Smaller stimulation fields may therefore produce sharper results in pattern electroretinographic testing. There was no correlation between pattern electroretinograms and visual evoked potentials or visual acuity. The pattern electroretinogram was recorded under monocular and binocular viewing conditions. In 60% of the patients, the amplitude of the affected eye was more reduced in the monocular than the binocular viewing condition; the healthy fellow eye controlled stable fixation of the affected eye more readily during binocular pattern electroretinogram registration. The degree of the color vision disturbance (C-index, desaturated panel D-15 test) did not correlate to any of the other examinations.Abbreviations C-index confusion index - MAR minimal angle of resolution - RCT retino-cortical time     

Pupil light reflex in normal and diseased eyes: diagnosis of visual dysfunction using waveform partitioning

OBJECTIVE: To evaluate changes in pupil size (corresponding to neuronal firing) within different time windows of the pupil light reflex in patients and normal subjects to understand which segments of the pupil waveform are best able to differentiate normal from abnormal subjects. DESIGN: Comparative, observational case series. PARTICIPANTS: Forty-nine normal subjects and 25 patients with known unilateral or asymmetric visual field damage were tested. METHODS: A dual-channel infrared pupillograph was used to simultaneously record the right and left pupil diameters at a rate of 60 Hz. Each eye was stimulated alternately (30 degrees full-field, 200 milliseconds duration every 3 seconds) over 10 different stimulus intensities. The recorded waveform of the pupil light reflex was subdivided into six time windows based on landmarks corresponding to contraction onset, maximum contraction velocity, peak contraction, and maximum dilation velocity to assess which portion was most affected by disease. MAIN OUTCOME MEASURES: The linear correlation between pupil contractions elicited by right versus left full-field stimulation at different light intensities provided diagnostic parameters (slope, intercept, and correlation coefficient R(2)) that were useful for differentiating normal subjects from patients and for categorizing disease. Sensitivity and specificity of the time windows were evaluated with receiver-operator curve analysis. RESULTS: The diagnosis of asymmetric disease was greatest at time windows that included pupil contraction but not dilation. When the contraction phase was subdivided into an early phase and into a late phase, the late phase was the most diagnostic compared with the entire phase of contraction amplitude (onset to peak contraction). CONCLUSIONS: By use of a range of light intensity, the change in pupil size measured between the time at which maximum contraction velocity occurs and the time to peak contraction provided the best response parameter for objective diagnosis of asymmetric disease of the anterior visual pathway. The waveform of the pupil light reflex may be an expression of the firing of retinal ganglion cells. Therefore, understanding which segment of the pupil light reflex provides maximal diagnostic power may give insight into how disease affects the pattern of neuronal firing rate.     

视觉诱发电位在颌面外伤致视神经挫伤诊断及预后中的应用

目的:应用视觉诱发电位检查颌面外伤致视神经挫伤程度,确定视功能损伤程度及预后估计。方法:对颌面外伤引起的单侧挫伤眼65例65眼进行治疗前、治疗后视觉诱发电位(visual evoked potontial,VEP)检查,以自体的健眼作为对照。结果:损伤眼视力及VEP的P100潜伏期及波幅异常,视力损害越重,VEP改变越明显,且预后越差。结论:VEP是视神经挫伤早期诊断,判断预后的客观检查方法。     

NGF对视神经挫伤患者视力和VEP的影响及安全性分析

目的：探讨鼠神经生长因子(NGF)对视神经挫伤患者视力、视觉诱发电位(VEP)的影响。

方法：选取2013-01/2016-06视神经挫伤患者78例78眼,根据随机数字表法分为观察组和对照组各39例39眼,两组均给予醋酸泼尼松片、维生素及甲钴胺片治疗,观察组同时给予NGF治疗,连续治疗2个疗程(21d为一个疗程)。

结果：治疗前两组患者的视野缺损度、视野光敏感度差异无统计学意义(P>0.05); 治疗后,观察组的视野缺损度范围小于对照组(P<0.05),观察组的视野光敏感度显著高于对照组(P<0.05); 治疗前,两组患者的P100波潜伏期、P100波振幅差异无统计学意义(P>0.05); 治疗后,观察组患者的P100波潜伏期小于对照组(P<0.05)、观察组的P100波振幅显著高于对照组(P<0.05); 治疗后,观察组的视力显著优于对照组(P<0.05)。

结论：NGF治疗视神经挫伤能显著地改善患者视力、VEP指标,减小视野缺损、提升视野光敏感度。