应用AccuMap多焦视觉诱发电位客观视野检测法观察晶状体混浊对青光眼视野检测结果的影响

目的探讨AccuMap多焦视觉诱发电位客观视野检测法观察晶状体混浊对青光眼视野检测结果的影响及与Humphrey自动视野检测结果之间的相关性。方法观察和比较原发性青光眼伴有中等程度晶状体混浊患者白内障术前后AccuMap与Humphrey视野计检测结果。术前由同一位有经验的眼科医师观察并记录(采用LOCSⅢ标准)患者晶状体的混浊程度。结果符合入选标准并完成观察者共22例。(1)AccuMap视野检测平均振幅术前为(308.0±96.6)nV,术后为(382.6±146.7)nV,术前与术后平均振幅差异有统计学意义(P=0.01)。平均视野损害严重程度指数(accumapseverityindex,ASI)术前为90.0±54.8,术后为48.6±42.4,术后比术前ASI显著下降(P<0.001)。潜伏期术前后无明显变化,术前平均为(1207.5±67.7)ms,术后为(1191.2±61.9)ms(P=0.289)。(2)晶状体混浊程度与AccuMap振幅的变化AccuMap振幅的变化与晶状体混浊程度无明显相关性(Spearman秩相关分析,P=0.09)。(3)Humphrey视野计检测结果术前平均偏差(meandeviation,MD)为-12.2±7.8,术后为-9.6±8.8,术后与术前MD差异有统计学意义(P<0.001);而模式标准差(patternstandarddeviation,PSD)术前为6.5±3.2,术后为6.3±4.0,差异无统计学意义(P=0.748)。(4)ASI与MD比较术前、术后ASI分别与MD具有相关性(Pearson相关分析,术前P=0.013,术后P<0.001);且术后与术前ASI的变化与MD的变化也具有相关性(Pearson相关分析,P=0.017)。结论AccuMap视野检测法显示晶状体混浊影响青光眼患者的视野检测结果,其中振幅受影响更明显。与Humphrey视野检测结果比较,AccuMap检测的ASI与MD具有相关性。(中华眼科杂志,2006,42972-976)

Effects of lens opacity on AccuMap multifocal objective perimetry in glaucoma

OBJECTIVE: To investigate the effect of lens opacity on the performance of the multi-focal visual evoked potential (mfVEP) test in patients with glaucoma and its relationship with the Humphrey's automated static perimetry. METHODS: This is a prospective, non-randomized study. Twenty-two patients were enrolled with moderate cataract and primary glaucoma scheduled for cataract surgery with or without glaucoma surgery. Humphrey visual field and mfVEP test were preformed before surgery and after 6 - 8 weeks of post-operation. Lens opacity was evaluated with slit lamp according to LOCS III (lens opacity classification system, version III) by the same ophthalmologist. RESULTS: The improvement of AccuMap objective visual field was noted after lens removal in glaucoma patients. The amplitude of the AccuMap was significantly (P < 0.01) increased after cataract surgery compared to pre-operation (382.6 nV +/- 146.7 nV vs 308.0 nV +/- 96.6 nV). AccuMap severity index (ASI) was significantly (P < 0.001) decreased following lens removal compared with pre-operation (48.6 +/- 42.4 vs 90.0 +/- 54.8, P < 0.001). Latency was little changed before and after surgery (1207.5 ms +/- 67.7 ms, 1191.2 ms +/- 61.9 ms, respectively, P = 0.289). There were no correlations between the changes of amplitude and the degree of lens opacity (Spearman correction, P = 0.09). For Humphrey visual field, the mean deviation (MD) of pre- and post-operative was significantly (P < 0.001) affected by lens opacity (-12.2 +/- 7.8, -9.6 +/- 8.8, respectively, P < 0.001), but pattern standard deviation (PSD) had no such changes (6.5 +/- 3.2, 6.3 +/- 4.0, respectively, P = 0.748). There were well correlated between the ASI and the MD both pre- or post-operation (Pearson correction, P = 0.013, P < 0.001), and between the ASI changes and the MD changes after lens removal (Pearson correction, P = 0.017). CONCLUSIONS: Lens opacity affects the AccuMap objective visual field in patients with glaucoma, especially the amplitude of the AccuMap. The ASI is sensitively correlated with the MD of Humphrey perimetry.