非动脉炎性前部缺血性视神经病变多焦视网膜电图特征及其与视力和黄斑中心区视网膜厚度的关系

Characteristics of multifocal eletrotetinogram in nonarteritic anterior ischemic optic neuropathy and its relationship with visual acuity and macular central retinal thickness

目的观察分析非动脉炎性前部缺血性视神经病变（NAION）的多焦视网膜电图（mfERG）特征及其与视力、黄斑中心区视网膜厚度（CRT）的关系。方法临床病例自身对照研究。经最佳矫正视力、眼底彩色照相、荧光素眼底血管造影及视野检查确诊为NAION的40例患者40只眼纳入研究。所有患眼及其对侧健康眼行傅立叶域光相干断层扫描（FD-OCT）及mfERG检查。FD-OCT测量受检眼黄斑中心凹周围区、黄斑旁中心凹区视网膜厚度及CRT。mfERG检测受检眼黄斑部视网膜功能。以黄斑中心凹为中心，将反应区由内向外呈同心圆划分为5个环区，分别为1环0．00°、2环5．44°、3环10．31°、4环16．31°、5环23．42°。以1环中心六边形为黄斑中心区。观察分析各环P1波、N1波振幅、潜伏时及P1波振幅密度。采用Spearman相关性分析法分析黄斑中心区P1波、N1波振幅及P1波振幅密度与视力、CRT的相关性。结果与对侧健康眼比较，患眼黄斑中心凹周围区视网膜厚度明显增厚，差异有统计学意义（P〈0．05）；黄斑旁中心凹区视网膜厚度及CRT略有增厚，但差异无统计学意义（P〉0．05）。与对侧健康眼比较，患眼1、2环P1波振幅密度明显降低，差异有统计学意义（P〈0．05）；3～5环P1波振幅密度无明显变化，差异无统计学意义（P〉0．05）。患眼1环P1波、N1波振幅均明显降低，差异有统计学意义（P％0．05）；2～5环P1波、N1波振幅及1～5环P1波、N1波潜伏时均无明显变化，差异无统计学意义（P〉0．05）。相关性分析结果显示，患眼黄斑中心区P1波振幅密度、振幅及N1波振幅与视力（r=-0．087、0．195、-0．134）、CRT（r=-0．154、0．365、0．412）均无明显相关性（P〉0．05）。结论NAION患眼1、2环P1波振幅密度及1环P1波、N1波振幅较对侧健康眼明显降低。患眼黄斑中心区P1波振幅密度、振幅及N1波振幅与视力、CRT均无明显相关性。

Objective To observe the characteristics of multifocal eletrotetinogram （mfERG） in nonarteritic anterior ischemic optic neuropathy （NAION） and its relationship with visual acuity and macular central retinal thickness （CRT）. Methods By means of patients self-contrast analysis. 40 patients （40 eyes） with NAION were collected underwent the examinations of best corrected visual acuity, fundus color photography, fundus fluorescein angiography and field of vision. All the disease and normal eyes had underwent the examination of frequency-domain optical coherence tomography （fdOCT） and mfERG. The CRT and retinal thickness about perifovea, parafovea were documented with fdOCT. All patients underwent the retinal macular function exam with mfERG. Centered by macular fovea, the reaction zone were divided into 5 rings from inside to outside by circles, ring 1 0.00°, ring 2 5.44°, ring 3 10.31°, ring 4 16.31°, ring 5 23.42°. Treated ring 1 hexagon as macular center, the amplitude densities of P1 wave, the amplitude of P1 and N1 wave, and the latencies of P1and N1 wave at every ring were observed. The relationship between mfERG characteristics and visual acuity or CRT were analyzed by Spearman correlation analysis. Results fdOCT revealed that there was significantly statistical difference in the retinal thickness about perifovea between disease eyes and contralateral eyes （P〈0.05）. The increase of CRT and retinal thickness about parafovea had no significantly statistical difference between diseases eyes and contralateral eyes （P〉0.05）.mfERG revealed that the decrease of amplitude densities about P1 wave at ring 1 to 2 had significantly statistical difference between two groups （P〈0.05） ; there were no significantly statistical difference in the amplitude densities of P1 wave at ring 3 to 5; the decrease of amplitude about P1 and N1 wave at ring 1 had significantly statistical difference between two groups （P 〈 0.05）. There was no significantly statistical difference in the amplitude of P1 and N1 wave at ring 2 to 5, the latencies of Pl and N1 wave at ring 1 to 5 （P〉0.05）. The correlation analysis revealed that the amplitude densities and amplitude of P1 wave at ring 1, amplitude of N1 wave at ring 1 had no effect on visual acuity （r=-0. 087, 0. 195, -0. 134; P〉 0.05） and CRT（r=-0.154, 0.365, 0.412; P〉0.05）. Conclusions Compared with contralateral eyes, the disease eyes were significantly decrease in amplitude densities of P1 wave at ring 1 to 2, amplitude of P1 and N1 wave at ring 1. There are no correlated between the amplitude densities of P1 wave at ring 1, amplitude of P1 and N1 wave at ring 1 and visual acuity or CRT.