摘要
目的评价视网膜电图（electroretinogram，ERG）的明视负波反应（photopic negative response，PhNR）在开角型青光眼患者中的临床应用价值。方法应用美国ESPION视觉电生理仪及一次性使用的DTL微纤维电极测量67例（67眼）正常人（年龄为21～76岁）、41例（62眼）开角型青光眼患者（年龄为21～77岁）的PhNR。全视野刺激器由LED光源发光，选用蓝色背景光（亮度为10cd／m^2），刺激光为红色光（刺激光强度分别为1cd·s／m^2、5cd·s/m^2和7cd·s／m^2）。采用Humphrey C30-2程序检查患者的视野，根据视野检查结果将青光眼患者分为早期组12例（21眼），进展期组13例（17眼）和晚期组16例（24眼）。在记录视网膜电图时，患者的眼压控制在正常范围内。检查患者的眼底并测量视盘的杯盘比。结果正常人的明视ERG都有伴随b波的缓慢的负向电位，即PhNR，其振幅随年龄的增大而降低。青光眼患者的a波及b波的振幅和潜伏期与年龄匹配的正常值对照差异无显著性，但是PhNR振幅较正常值明显降低，甚至在视野敏感度轻度缺失的早期组患者就出现PhNR的振幅下降，并且随视野敏感度缺失的增加，进展期和晚期组患者PhNR的振幅下降更加明显。在全部青光眼患者中，PhNR的振幅与视野的平均偏差（mean deviation，MD）、模式标准差（pattern standard deviation，PSD）和垂直方向的杯盘比（C／D）存在明显的相关性（P〈0．01）。结论开角型青光眼患者的PhNR的振幅比正常对照组低，PhNR振幅降低与青光眼病情的严重程度相关，早期青光眼患者的PhNR振幅就出现下降，并随视野敏感度缺失的增加下降更加明显。PhNR振幅降低对青光眼有较高的敏感性和特异性。PhNR可以作为开角型青光眼的早期检测及其青光眼损伤进展的一个视功能评价指标。
Objective To evaluate the clinical application of the photopic negative response in open angle glaucoma. Methods Photopic negative responses （PhNR） were recorded from 67 normal subjects （67 eyes） with an age range of 21 to 76 years and 41 open angle glaucoma patients （62 eyes） with an age range, of 21 to 77 years. Disposable DTL electrodes and full-field Ganzfeld bfiof red flashes （stimulus intensities of 1 cd·s/m^2, 5cd·s/m^2 and 7 cd·s/m^2） on a blue baekgroued （ luminance of 10 cd/m^2 ） wexe used. Rashes were produced by light emitting diodes （LEDs）. The patients＇ visual fields were. tested with the Humphrey perimetry C30-2 procedure. All the patients were divided into groups according to the results of the perimetry testing： early stage group, 12 patients （21 eyes）, advanced stage group, 13 patiens （17 eyes）, and late stage group, 16 patients （24 eyes）. The intraocular pressures of patients were within the normal range while bering tested. The patients＇ fundus and optic cup to disc ratio were examined. Results The ERGs from the normal subjects showed a slow negative potential following the b-wave, the PhNR, that decreased slightly in amplitude with age. The a-and b-wave amplitudes and implicit times of POAG patients were similar to age-matched controls. In contrast, their PhNRs were smallex than those of normal subjects. PhNR amplitudes were reduced even when visual sensitivity losses were small in early stage patients and become even smaller as sensitvity losses increased in advanced and late stage patients. PhNR amplitudes were significantly correlated （ P 〈 0.01 ） with mean deviation （MD）, pattern standard deviation （PSD）, and vertical cup to disc ratio （C/D）. Conclusion PhNR amplitudes in POAG patients are smnaller than those of normal subjects. The decreases in PhNR amplitudes are correlated to the sverity of POAG. PhNR amplitudes are reduced when visual field sensitivity losses are mild in early stage patients and become even smaller as sens
出处
《眼视光学杂志》
2006年第5期273-277,共5页
Chinese Journal of Optometry & Ophthalmology
基金
中山眼科中心和加拿大渥太华大学眼科研究所合作研究
关键词
视网膜电图
明视负波反应
DTL电极
视野
青光眼
开角型
electroretinogram
photopic negative response
DTL electrode
perimetry
glaucoma, open angle
