多焦视网膜电图在原发性开角型青光眼诊断中的应用

Application of mfERG in the Diagnosis of Primary Open-Angle Glaucoma

目的：探讨多焦视网膜电图（mfERG）技术用于诊断原发性开角型青光眼（POAG）的准确性及实效性。方法：系列病例研究。于2014 年10 月至2016 年3 月在云南省第一人民医院门诊就诊并确诊的POAG患者中随机选取60例（86眼）作为青光眼组，其中早、中、晚期组分别为20例（27眼）、20例（29眼）、20 例（30 眼）。同时随机选取同期健康体检者60 例（120 眼）作为对照组。各组研究对象分别通过mfERG进行技术诊断，观察比较mfERG二阶反应各环与各象限的P1 波反应密度值及潜伏期。组间数据比较采用单因素方差分析和χ^2检验。结果：与对照组相比，早期青光眼组1～5环的P1波反应密度值无明显变化，差异无统计学意义，但颞下、颞上象限P1波反应密度值下降明显，差异有统计学意义（P 〈 0.05）。中期青光眼组2～5环及4个象限P1波反应密度值较对照组下降明显，差异均有统计学意义（P 〈 0.05）。晚期青光眼组1～5环及4个象限P1波反应密度值较对照组明显下降，差异均有统计学意义（P 〈 0.05）。早、中、晚期青光眼组1～5环及4个象限P1波的潜伏期均较对照组延长，差异均有统计学意义（P 〈 0.05）。各期青光眼组中，晚期青光眼组较早期青光眼组潜伏期延长更明显，差异有统计学意义（P 〈 0.05）。结论：mfERG 1～5 环P1波潜伏期和密度值的变化可在一定程度上反映青光眼视网膜的损害程度，对诊断早期POAG有一定的临床价值。

Objective： To explore the validity and effectiveness of multifocal electroretinogram （mfERG） technology in the diagnosis of primary open-angle glaucoma （POAG）. Methods： In this case-series study, 60 POAG patients （86 eyes） who were diagnosed in the First People＇s Hospital from October 2014 to March 2016 were enrolled in the glaucoma group. There were 20 cases （27 eyes） of early POAG, 20 cases （29 eyes） of middle POAG, and 20 cases （30 eyes） of late POAG. Another 60 healthy subjects （120 eyes） were enrolled in the normal control group. All subjects in both groups received an mfERG examination for diagnostic testing. The density values and latency period of the P1 wave in every second-order reaction ring and quadrant were observed and compared. All data were analyzed using one-way analysis of variance and the χ^2-test. Results： There was no change in the P1 wave density values in rings 1-5 between early glaucoma group and control group. However, the density values of the P1 wave in the inferior temporal and superior temporal quadrants in the early glaucoma group declined compared with those in control group （P〈0.05）. In the middle stage glaucoma group, the P1 wave response density value in rings 2-5 and the four quadrants declined compared with those in the control group （P〈0.05）. In the late glaucoma group, the density values of the P1 wave in rings 1-5 were also lower than those in the normal group （P〈0.05）. The latency periods of the P1 wave in rings 1-5 and in the four quadrants of every stage of glaucoma were prolonged compared with those in the control group （P〈0.05）. However, latency periods in the late glaucoma group were even more extended （P〈0.05）. Conclusions： The latency period and density changes of the P1 wave in rings 1-5 in mfERGs reflect retinal damage in glaucoma. These changes have clinical value in the diagnosis of early glaucoma.