视觉电生理和视野检查对原发性开角型青光眼早期诊断的敏感性

Electroretinogram combined with automated perimetry in primary openangle glaucoma

目的:探讨多种视觉电生理联合全自动视野计检查对原发性开角型青光眼早期诊断中的敏感性,为临床早期诊断提供客观敏感的指标。方法:选择10例(20眼)原发性开角型青光眼患者和正常对照者10例(20眼)分别进行闪光视网膜电图(FERG)、图形视网膜电图(PERG)、图形视觉诱发电位(PVEP)检查;还对正常对照组、青光眼组中各5例(10眼)进行多焦视网膜电图(mERG)检查;青光眼组10例(20眼)和正常对照组8例(16眼)行蓝黄视野(B/Y)、标准视野(W/W)检查。结果:PERG的异常率较高,PERG的潜伏期延长较敏感,mERG二阶反应黄斑区振幅下降,随离心度的增大,振幅逐渐变小,潜伏期延长,PVEP的P100波振幅降低,潜伏期延长。B/Y视野异常与W/W视野异常比较有显著差异(P <0.01)。结论:B/Y视野检查联合多种视功能检查对原发性开角型青光眼早期诊断较敏感。早期诊断中的B/Y视野敏感性高;若眼压差大,眼底C/D未出现改变,则PERG可作为较敏感观测指标。

AIM: To study the sensitivity of electroretinogram combined with automated perimetry in primary open-angle glaucoma.· METHODS: Ten normal individuals (20 eyes) and 10 patients(20 eyes) of primary open-angle glaucoma were examined with flare electroretinogram(FERG), pattern electroretinogram(PERG), and pattern visual evoked potential(PVEP); among whom 5 normal individuals (10 eyes) and 5 patients(10 eyes) were examined with multifocal electroretinogram; 8 normal individuals (16 eyes) and 10 patients(20 eyes) were tested with blue-on-yellow (B/Y) and white-on-white (W/W) automated perimetry.The results of the two groups were analyzed and compared.· RESULTS: PERG, PVEP, mERG, B/Y and W/W all changed in primary open-angle glaucoma group. There was magnificant difference between B/Y and W/W visual field (χ 2=10.827,P < 0.01). The rate of abnormal P-ERG was high and the latent period was prolonged in P-ERG. mERG in macula area declined significantly.· CONCLUSION: According to the type of open-angle glaucoma, different indexes can be used to test glaucoma. B/Y visual field has high sensitivity in the early diagnosis of glaucoma. Multifocal electroretinogram combined with B/Y automated perimetry has high sensitivity in the primary diagnosis of early open-angle glaucoma.·