早产儿全视野闪光视网膜电图检查

目的观察全视野闪光视网膜电图（F-ERG）在早产儿视网膜病变（ROP）中的变化及其评价早产儿视网膜功能的可行性。方法 4～12周龄早产儿84例（168眼）,其中ROP（＋）组30例,ROP（-）组54例。在睡眠状态下进行F-ERG检查,记录视杆反应、最大混合反应以及视锥反应。成人组为健康成年人15例（30眼）。F-ERG的记录遵循ISCEV2000年修订的临床视觉电生理国际标准化程序。结果 F-ERG各反应波形发生率3组比较,ROP（＋）组最低,差异均有统计学意义（视杆反应：χ2=50.710,P=0.000;最大混合反应：χ2=32.002,P=0.000;视锥反应：χ2=23.992,P=0.000）。ROP（＋）组和ROP（-）组视杆反应波形发生率低于视锥反应,差异均有统计学意义（χ2=20.306,P=0.000;χ2=12.706,P=0.000）。3组F-ERG各反应a波、b波隐含时及振幅的比较,差异均有统计学意义（视杆反应：b波隐含时F=66.405,P=0.000;b波振幅F=180.496,P=0.000。最大混合反应：a波隐含时F=9.536,P=0.000;a波振幅F=189.150,P=0.000;b波隐含时F=89.851,P=0.000;b波振幅F=278.984,P=0.000。视锥反应：a波隐含时F=37.526,P=0.000;a波振幅F=67.182,P=0.000;b波隐含时F=32.470,P=0.000;b波振幅F=145.631,P=0.000）。除视锥反应a波振幅和b波隐含时ROP（＋）组与ROP（-）组比较以及最大混合反应a波隐含时ROP（-）组与成人组比较外,ROP（＋）组余各反应a波、b波隐含时明显延长,振幅明显降低,差异均有统计学意义（P〈0.05）。结论出生后4～12周早产儿的视网膜功能仍处于发育过程中,视杆细胞较视锥细胞成熟晚;而ROP对其视网膜功能有一定的影响,且主要影响视杆细胞功能,其影响与病变程度有关。F-ERG可以作为评价早产儿视网膜功能的检测手段之一。

Findings of full-field flash electroretinogram in preterm infants

Background It is generally acknowledged that the visual function of preterm infants is underdeveloped.So the retinal function of retinopathy of prematurity（ROP） is worthwhile to be closely concerned.ObjectiveThis trial was to evaluate the change of retinal function in premature infants with full-field flash electroretinogram（F-ERG）.MethodsA cross-sectional study was designed in this trial.A total of 84 preterm infants（168 eyes） aged postnatal 4-12 weeks received F-ERG examination under the slumber state.Based on with or without ROP,the infants were assigned to with ROP group and without ROP group.The rod response,maximal rod-cone response and cone response of F-ERG were recorded respectively following the International Standard Protocal of ISCEV（2000 version）.The latency and amplitude of a-wave and b-wave of various responses were analyzed.Fifteen healthy adults volunteers（30 eyes） were recruited as the control group.This trial was approved by the Ethic Committee of this hospital and written informed consent was obtained from the parents of patients prior to any medical procedure.ResultsThe incidence of rod,maximal mixed and cone response was 41.67%,73.33% and 81.67% in the preterm infants with ROP,respectively,while 88.89%,99.07% and 100% in the preterm infants without ROP.And each of these responses was 100% in adults,showing significant difference among three groups（P0.05）.In with ROP group,the incidence of rod response was always lower than that of cone response in preterm infants,and there also was significant difference between these two responses（P0.05）.In addition,a-wave and b-wave of each response were observed.There was significant difference among three groups（P0.05）.Obviously,the latency was longest and the amplitude was lowest in preterm infants with ROP infants.ConclusionThe retinal function of premature infants is still in the development state at 4-12 weeks after birth.Evolvement of rod cells is later than that of cone cells.ROP impacts retinal function,especially that of the rod cells.F-ERG is a useful tool of evaluating retinal function in premature infants.