多焦视觉诱发电位和海德堡视网膜断层扫描检查在青光眼诊断中的比较

目的比较多焦视觉诱发电位（mVEP）和海德堡视网膜断层扫描（HRT）检查在诊断青光眼功能和结构改变时的灵敏度（Se）和特异度（Sp）以及检查结果的一致性。方法对49例青光眼患者和30例正常志愿者分别行Humphrey视野（HVF）、mVEP和HRT-Ⅱ检查,各选一侧眼纳入研究,评价诊断检查的真实性和可靠性以及3种检查的一致性。结果对照组视野平均缺损（MD）为（-0.4±1.8）dB,模式标准差（PSD）为（-0.4±1.8）dB。试验组MD为（-7.0±6.0）dB,PSD为（6.5±3.7）dB。mVEP的灵敏度、特异度和Kappa值分别为92%、97%和86.82%。HRT-Ⅱ的灵敏度、特异度和Kappa值分别为61%～82%、93%～97%和51.85%～71.73%。HVF和mVEP之间不同视野区域所显示的缺损呈现出高度一致性;而HVF和mVEP中视野缺损对应区域,与HRT-Ⅱ所显示的视盘结构异常一致性较差。HRT-Ⅱ诊断青光眼时moorfield回归分析分类、FSM判别函数和RB判别函数的ROC曲线下面积分别为：0.87（95%CI：0.76～0.92）、0.78（95%CI：0.68～0.89）、0.86（95%CI：0.73～0.91）。结论 mVEP和HRT-Ⅱ客观检查能探测青光眼损害,但一致性较差。HVF和mVEP检查的一致性优于各自与HRT-Ⅱ结构检查的一致性。但为了确保不漏诊,可考虑采用HVF、HRT-Ⅱ和mVEP三联平行诊断试验来提高青光眼诊断的灵敏度。

Comparison of multifocal visual evoked potential and Heidelberg retinal tomography in glaucoma diagnosis

Background The early diagnosis of glaucoma is very important for the effective treatment.Perimetry is thought to be a conventional examination for the diagnosis of glaucoma.But the subjective outcome is the primary limit for perimetry.So far multifocal visual evoked potential （mVEP） and Heidelberg retina tomography （HRT） have been used in the diagnosis of glaucoma.Objective Present trial was to compare the sensitivity,specificity and agreement of mVEP,HRT-Ⅱ and perimetry in diagnosis of glaucoma.Methods Forty-nine glaucoma patients and 30 matched normal volunteers accepted Humphrey visual field （HVF）,mVEP and HRT-Ⅱ tests.One eye per individual was included in the study.Individuals were evaluated with validity and reliability of diagnostic test.The agreement of these three tests was assessed using Kappa statistical method.Informed consent was obtained from all participants to include the data in this study,and the study followed the principles of the Helsinki Declaration.Results The mean deviation （MD） and pattern standard deviation （PSD） were （-0.4±1.8） dB and （-0.4±1.8） dB respectively in control group and （-7.0±6.0） dB and （6.5±3.7） dB in trial group.Sensitivity,specificity and Kappa values of mVEP were 92%,97% and 86.82% respectively and those of HRT-Ⅱwere 61%-82%,93%-97% and 51.85%-71.73% respectively.Topographic comparison of the presence of visual field defects on HVF and mVEP in different areas of the visual field showed good agreement.Comparison of optic nerve head structural abnormality with corresponding field defects areas between HVF and mVEP showed a poor to moderate agreement.The area under the curve of moorfield regression analysis,FSM discriminant function and RB discriminant function of HRT-Ⅱwas 0.87 （95%CI：0.76-0.92）,0.78 （95%CI：0.68-0.89） and 0.86 （95%CI：0.73-0.91） respectively.Conclusion The mVEP and HRT can indicate glaucomatous damage in both function and structure but show limited correlation.HVF and mVEP have better correlation with each other than with HRT.It remains important to look for the information both functional and structural changes in screen of glaucoma cases.