视觉诱发电位检查在甲状腺相关眼病眶减压术中的应用

Application of visual evoked potential testing in the operation of orbital decompression for thyroid‐associated ophthalmopathy

目的:探讨视觉诱发电位(VEP)在甲状腺相关眼病(TAO)性视神经病变评估中的应用,为眶减压手术时机选择提供临床指导依据。方法:回顾性研究2019年7月至2020年6月确诊的112例TAO患者,观察指标为VEP和眼眶CT检查,对CT检查提示直肌肥大、视神经增粗同时伴VEP电位异常者12例作眼眶减压手术,其中7例行眶脂减压,5例行外侧壁开眶减压,所有患者于术前及术后1周、1月及3月行VEP检查,观察其手术前后视功能变化情况。结果:术后各时间点患眼P100波峰时较治疗前缩短(P<0.05);P100波幅值较治疗前升高(P<0.05)。术后3月,患眼P100峰时、波峰幅值与对侧眼峰时、波峰幅值比较,差异均无统计学意义(P>0.05),患者双眼VEP电位无明显差别。结论:眼眶减压术后1周VEP峰时开始缩短,幅值开始升高,术后3月双眼VEP电位无明显差别。可将VEP检测作为TAO患者常规检查,一旦其电位异常,即提示并发视神经病变,应及时做眼眶减压术。眼眶减压术可有效提高甲状腺相关眼病性视神经病变患者视功能,促进视神经功能改善。

Objective:To investigate the application of visual evoked potential(VEP)in the evaluation of thyroid associated ophthalmopathy(TAO)optic neuropathy,and to provide clinical guidance for the timing of orbital decompression.Methods:We retrospectively studied the clinical cases of TAO.Among the 112 patients with TAO diagnosed from July 2019 to June 2020,12 patients with rectus hy⁃pertrophy,optic nerve thickening indicated by CT examination,and abnormal VEP findings were in⁃cluded in this study,and all the 12 patients underwent orbital decompression surgery.In order to ob⁃serve the changes of visual function after operation,all patients were examined with VEP preopera⁃tively and at the end of 1 week,1 month,and 3 months,retrospectively after operation.Results:Af⁃ter operation,the peak time of P100 wave in the affected eyes at each time points decreased(P<0.05),and the amplitude of P100 wave increased(P<0.05).Three months after the operation,there was no significant difference in the peak time of P100 and peak amplitude of P100 between the af⁃fected eyes and the contra lateral eyes in the patients(P>0.05).Conclusion:The peak time of VEP began to shorten and the amplitude began to increase one week after the operation.There was no sig⁃nificant difference in the VEP of both two eyes in the patients after three months post⁃operation.VEP testing can be used as a routine examination for TAO patients.Once the finding is abnormal,it indi⁃cates that optic neuropathy is complicated,and orbital decompression should be performed in time.Orbital decompression can effectively improve the visual function and promote the improvement of op⁃tic nerve function of patients with thyroid associated ophthalmopathy optic neuropathy.