视网膜色素变性眼肌深层巩膜移植术患者图形视觉诱发电位分析

Analyses of pattern evoked potentials in retinitis pigmentosa with surgery

目的探讨视网膜色素变性(RP)患者的P-VEP特征及对RP患者眼肌深层巩膜移植术进行治疗前、后P-VEP变化加以比较,为跟踪疗效提供客观依据。方法采用MVT-3型多功能和多导程视觉电生理仪,分别测定棋盘格翻转刺激全视野、中央6°视野,以及遮盖中央、刺激6°以外周边视野时的P-VEP。结果在202例RP患者中有110例(54.5%),用上述3种刺激方式均记录不到P-VEP。全视野刺激能诱发P100波的为92例(45.5%),刺激中央视野可记录到P-VEP的为83例(41.1%),而刺激周边视野能记录到P-VEP的仅为48例(23.8%)。全视野刺激记录到的P100波平均振幅,RP组明显低于正常组的相应值,有非常显著的统计学意义(P<0.001)。用上述3种刺激方式从RP患者记录到的P100波峰潜伏期,与正常组的相应值相比,都明显延长,且都有显著的统计学意义(P<0.01)。施行了眼肌深层巩膜移植术的RP患者中,有42例在术后3～22(平均10.9)月,来院进行了P-VEP复查,手术前刺激中央视野能记录到P-VEP的为20例(47.6%),术后复查时已增加到26例(61.9%)(配对χ2检验,χ2=4.17,P<0.05)。不仅人数增加,而且振幅也明显增大。结论眼肌深层巩膜移植术使患者视力有明显好转,P-VEP也有明显改善。因此P-VEP可以作为对RP患者进行疗效评估的客观指标之一。

Aim To describe characteristics of pattern evoked potentials (P-VEP) in patients with retinis pigmentosa (RP) and to use P-VEP as one of objective me asures to assess the therapeutic efficacy of surgery. Methods P-VEP data were a utomatically acquired and analyzed by using the MVT-3 visual electrophysiologica l equipment, when the whole of the center of or the surrounding area of the visu al field in RP patients was respectively stimulated with a reverse checkerboard. Results Before surgical therapy, P-VEP of 202 patients with RP was examined. In 110 out of them, no detectable P-VEP could be recorded with all three kinds o f stimulation mentioned above. However, the residual P-VEP from 92(45.5%), 83(41 .1%) and 48(23.8%) of the RP patients could be recorded by stimulating the whole , center and surrounding area of their visual fields, respectively. Pooled mean amplitude of P100 elicited by stimulating the center of visual field in RP patie nts was significantly lower than that in normal subjects (P <0.001). All pooled mean latencies of the residual P100 induced by three kinds of stimulation were s ignificantly prolonged in RP patients group than those in normal control group ( P <0.01). After surgical therapy of 3 to 22 months, P-VEP in 42 RP patients was reexamined. The numbers of RP patients whose P-VEP could be recorded by stimulat ing the center of visual field, increased to 26(61.9%) from 20(47.6%) before sur gical therapy. Furthermore, the amplitude also increased markedly after surgical therapy. Conclusion The abnormal P-VEP in RP patients can be improved after su rgical therapy and P-VEP can bea objective measure for the diagnosis and the ass essment of the therapeutic efficacy in the RP patients.