分离格栅视觉诱发电位在开角型青光眼诊断中的应用

Application of isolated-check VEP in the diagnosis of patients with open-angle glaucoma

目的评价分离格栅视觉诱发电位(ic-VEP)在原发开角型青光眼(POAG)诊断和分级中的应用价值。方法选取原发性开角型青光眼患者85例(85眼),其中早期青光眼39例(39眼),中晚期青光眼46例(46眼),正常人56例(56眼)。所有受试者均进行Humphery 30-Ⅱ中央30°视野(MS)及柯谛亚电生理仪分离格栅模式检查(定量检查,刺激对比度分别为8%、14%、22%、32%)、神经节细胞复合体厚度(GCC)检查。结果早期青光眼平均8%SNR值小于1,中晚期青光眼平均8%及14%SNR值均小于1,早期及中晚期青光眼组梯度对比度刺激SNR值均显著小于正常(P<0.05)。ic-VEP SNR与黄斑区神经节细胞复合体厚度(GCC)及视野检查的平均光度敏值(MS)呈正相关。在早期青光眼中,14%SNR与GCC及MS相关;在中晚期青光眼中,32%SNR与GCA及MS相关。早期POAG中,8%-SNR或14%-SNR曲线下面积最大为0.902;中晚期POAG中,8%-SNR或14%-SNR曲线下面积最大为0.887。在早期青光眼中,ic-VEP及视野分级的加权Kappa值为0.416;中晚期青光眼中,加权Kappa值为0.689。结论 ic-VEP在POAG诊断中具有较高诊断效能及灵敏度。不同时期青光眼中,GCC及MS和不同对比度刺激的ic-VEP SNR相关。

Objective To explore the application value of ic-VEP in the diagnosis and grading of POAG. Methods A total of 85 patients with POAG（ 85 eyes） were selected,including 39 patients with early glaucoma（ 39 eyes）,46 patients with middle and late stages of glaucoma（ 46eyes） and 56 healthy people（ 56 eyes）. All subjects received Humphery 30-Ⅱ central 30° visual field（ MS） test,electrophysiological instrument isolated-check mode test（ quantitative tests,stimulus contrasts were respectively 8%,14%,22%,32%） and ganglion cell complex（ GCC） thickness test. Results Mean 8% SNR value of early glaucoma was less than 1,mean 8% and mean 14%SNR values of middle and late stages of glaucoma were both less than 1,gradient contrast stimulated SNR values of all stages of glaucoma were less than normal,and there were significant differences（ P〈0. 05）. The ic-VEP SNR was positive correlated with ganglion cell complex（ GCC） thickness and mean luminosity sensitivity（ MS） of visual field test. In early glaucoma,14% SNR was correlated with GCC and MS,while in middle and late stages of glaucoma,32% SNR was correlated with GCC and MS（ P〈0. 05）. AUC of 8% SNR or 14% SNR in early POAG was largest as 0. 902,and AUC of 8% SNR or 14% SNR in middle and late stages of POAG was largest as 0. 902. The weighted Kappa value of ic-VEP and visual field grading was 0. 416 in early glaucoma,and was 0. 659 in middle and late stages of glaucoma. Conclusion The ic-VEP has a high diagnostic efficacy and sensitivity for POAG. GCC and MS are correlated with ic-VEP SNR stimulated by different contrast in various stages of glaucoma.