急性黄斑区神经视网膜病变一例

患者女,19岁.因双眼前突发性黑影遮挡感半个月于2007年12月来我院就诊.无视物变形、畏光和色觉改变.在当地医院诊断为双眼球后视神经炎,予以泼尼松60 mg口服治疗6 d,视觉症状无明显好转.患者出现视觉症状前2 d患感冒,体温38.7℃.既往体格健康,无全身用药及遗传性疾病家族史.肝肾功能、血清蛋白、系统性红斑狼疮因子试验、类风湿因子测定等血液免疫学和生物化学检查未见异常,头颅磁共振成像(MRI)检查正常.眼科检查:视力:右眼0.2,+0.75 D矫正至1.0;左眼0.1,+0.50 D矫正至0.2.色觉检查正常.     

AccuMaP多焦视觉诱发电位客观视野检查在黄斑疾病视功能检测中的应用

目的 探讨AccuMap多焦视觉诱发电位(mfVEP)客观视野检查在黄斑疾病视功能检测中的应用价值.方法 临床确诊为黄斑疾病的37例患者46只眼纳入研究.采用AccuMap mfVEP客观视野计检测患者半径为2.0°、5.5°、10.0°、15.5°和24.0°中心视野的平均反应振幅值.应用概率灰度图和系统自动计算出的AccuMap视野损伤严重程度指数(ASI)表示视野区域缺失情况.同时,采用MP-1微视野计检测患者半径为2.0°、4.0°、6.0°、8.0°和10.0°中心视野的平均光敏感度(MS)和半径为10.0°中心视野的平均缺失敏感度(MD).对比分析患者最小视角对数(logMAR)最佳矫正视力(BCVA)、平均反应振幅、MS、ASI及MD之间的相关性.结果 AccuMap mfVEP客观视野计检测显示,46只患眼中43只眼ASI异常,且概率灰度图上有明确的视野缺失,占93.45%;3只眼ASI正常,且概率灰度图上无视野缺失,占6.55%.半径为2.0°、5.5°、10.0°、15.5°和24.0°中心视野的平均反应振幅值分别为(120.78±52.91)、(134.31±54.67)、(149.99±52.42)、(156.69±48.30)和(157.54±45.07)nV;ASI值平均为74.26±52.43.MP-1微视野计检测显示,半径为2.0°、4.0°、6.0°、8.0°和10.0°中心视野的MS值分别为(10.97±5.91)、(12.71±5.13)、(13.71±4.53)、(14.23±4.18)、(14.48±3.86)dB;半径为10.0°中心视野的MD值为(4.49±3.07)dB.ASI、各半径中心视野的平均反应振幅与患眼logMAR BCVA间均存在明显相关性(P＜0.05).半径为2.0°、5.5°、10.0°中心视野的平均反应振幅与半径为2.0°、6.0°和10.0°中心视野的MS呈明显正相关(r=0.477,0.432,0.433;P=0.001,0.003,0.003).ASI与半径为10.0°中心视野的MD呈明显正相关(r=0.729,P=0.000).结论 AccuMap mfVEP客观视野检查能客观反映黄斑功能改变,可应用于黄斑疾病的视功能检测.

Abstract：

Objective To evaluate the value of AccuMap multifocal visual evoked potential (mfVEP) objective perimetry in measuring visual function of macular diseases. Methods Forty-six eyes (37 patients)with macular diseases were studied. The mean mfVEP amplitudes of central visual field within radius 2.0°,5.5°, 10.0°, 15.5° and 24.0°were measured by AccuMap mfVEP objective perimetry. Automatically calculated AccuMap severity index (ASI) represented the visual field defects. Meanwhile, the mean sensitivity (MS) of central visual field within radius 2. 0°, 4.0°, 6.0°, 8. 0° and 10. 0° and mean defect (MD) of central visual field within radius 10.0° were assessed by MP-1 microperimeter. The correlations among those parameters including logMAR visual acuity, mean mfVEP amplitudes, MS, ASI and MD were analyzed. Results Among 46 affected eyes, AccuMap mfVEP objective perimetry showed abnormal ASI with visual field defects in 43 eyes (93.45%), normal ASI without visual field defects in three eyes (6. 55 %). The mean mfVEP amplitudes value of the central visual field within radius of 2.0°, 5.5°, 10. 0°,15.5°and 24.0° were (120.78±52.91), (134.31±54.67), (149.99±52.42), (156.69±48.30),(157.54±45.07) nV respectively. The mean ASI value was 74. 26±52.43. MP-1 showed that the MS values of central visual field within radius 2.0°, 4.0°, 6.0°, 8. 0° and 10. 0° were (10. 97±5.91), (12. 71±5. 13), (13. 71±4. 53), (14.23±4. 18), (14.48±3. 86) dB respectively. The MD value of central visual field within radius 10° was 4.49± 3.07. There was a significant correlation among ASI, the mean mfVEPamplitudes of central visual field with every radius and logMAR best corrected visual acuity (P＜0. 05). The mean mfVEP amplitudes of central visual field within radius 2. 0°, 5. 5°, 10.0° were positively correlated with the MS of central visual field within radius 2. 0°, 6. 0°, 10.0° (r=0. 477, 0. 432, 0. 433; P=0. 001,0. 003, 0. 003). Furthermore, ASI was also correlated with MD of central visual field within radius 10.0°(r=0. 729, P = 0. 000). Conclusions AccuMap mfVEP objective perimetry can reflect the changes of macular function objectively and can be used to assess the visual function of macular diseases.