人工角膜植入术前视觉电生理检查的意义

Role of Electrophysiology Testing in Preoperative Evaluation of Keratoprosthesis Patients

目的:评价在人工角膜植入术前进行视觉电生理检查的意义。方法:对因严重角膜化学伤、热烧伤、移植失败、终末期干眼症及爆炸伤行永久性人工角膜植入术的27例患者在术前进行闪光视网膜电图(Flash-electroretinogram,F-ERG)和闪光视诱发电位(Flash-visualevokedpotential,F-VEP)检查,将测定结果与术后两周的视力进行相关性分析。结果:27例中,术前明适应闪光VEP的潜伏期与术后视力呈正相关,r=0.614,p=0.001。F-VEP测定结果正常者14例、轻度异常9例,在术后视力均获得明显改善;中、重度异常者4例,其中3例术后视力得到一定程度改善,1例视力改善不明显。F-ERG的结果与视力亦呈正相关,但其可靠性不及F-VEP。结论:人工角膜植入术前进行视觉电生理测定有助于评估患者的视功能预后。

Objective： To evaluate the prognostic value of preoperative visual electrophysiology in patients with bilateral blindness who underwent keratoprosthesis implantation. Methods：Flash Electroretinogram （F-ERG） and Flash visual evoked potential（F-VEP） examinations were performed prior to keratoprosthesis surgery in 27 patients with corneal opacities due to severe chemical burns, graft failures, thermal burns, end-stage dry eye, ocular trauma. The relationship was analyzed between preoperative visual electrophysiology results and the postoperative corrected visual acuity. Results： Preoperative photopic VEP was significantly correlated with the postoperative visual acuity, r=0.614,p=0.001. Among the 27 eyes, the preoperative VEP was normal in 14 eyes, slightly reduced in 9 eyes, and these cases all had a good visual prognosis; VEP moderately or severely reduced in 4 eyes, there were 3 cases achieved improved postoperative visual acuity in some degree, and 1 case had poor visual prognosis. F-ERG was correlative with the visual outcome too, but F-VEP was more valuable to predict postoperative visual acuity. Conclusions： The data showed that preoperative visual electrophysiologic testings were helpful in selecting patients and predicting the visual outcome.