【摘要】 目的：比较图形视网膜电图（pattern electroretinograms,PERG）、图形视诱发电位（pattern visual evoked potenlials,PVEP）、光学相干断层成像术（optical coherence tomography,OCT）测量视网膜神经纤维厚度的方法在原发开角型青光眼和正常眼压型青光眼早期诊断中的临床意义。方法：选择36例（72眼）早、中晚期青光眼患者，其中包括原发性开角型青光眼22例（44眼），正常眼压型青光眼14例（28眼）进行PERG，PVEP和OCT及视野检查，并对检查结果进行统计学分析，配对χ2检验比较各种检查方法在青光眼早期诊断中的敏感性。结果：PERG与PVEP差异具有显著性意义（P<0.01）,PERG与OCT差异具有显著性意义（P<0.01），PVEP与OCT差异无统计学意义。PERG，PVEP和OCT检查在早期青光眼的异常率分别为80%，37%和33%。结论：在青光眼的早期诊断中，PERG的敏感性高于OCT和PVEP,但PERG在诊断中的特异性可受到其他眼疾和多种因素的影响，但OCT对眼底的检查有其特异性，所以联合多种检查方法对青光眼的早期诊断和监测具有一定的临床意义。
【关键词】 视网膜电图；图形视诱发电位；视网膜神经纤维厚度；青光眼
Clinical significance of pattern electroretinogram and retinal nerve layer thickness in the early diagnosis of glaucoma
Yan Wang, HuaJie Chen, Li Zhu, Rong Wu, Wei Wang
Department of Ophthalmology, Huadong Hospital, Shanghai 200040, China
Abstract
AIM: To measure retinal nerve fiber thickness method by the diagnostic value of the pattern electroretinograms (PERG), the pattern visual evoked potentials (PVEP) and optical coherence tomography (OCT). And its clinical significance in primary open angle glaucoma (POAG) and normaltension glaucoma in the early diagnosis (NTG).
METHODS: Thirtysix cases (72 eyes) with early and advanced glaucoma, including primary open angle glaucoma in 22 cases (44 eyes), normaltension glaucoma 14 cases (28 eyes) for PERG, PVEP and OCT and vision inspection. And statistical analyse test results and, paired comparison of χ2 test method of examination in early diagnosis of glaucoma sensitivity.
RESULTS: PERG and PVEP difference was significant (P<0.01), PERG and OCT difference was significant (P<0.01), PVEP and OCT was no significant difference. PERG, PVEP and OCT examination in the early days of the abnormal rate of glaucoma were 80%, 37% and 33%.
CONCLUSION : The sensitivity of PERG is higher than those of OCT or PVEP in early diagnosis of glaucoma. The PERG combined with quantification of RNFL thickness by OCT may be more helpful to early diagnosis of glaucoma. But PERG may be subject to many factors in the diagnosis of other diseases. But the OCT examination of the fundus has its specificity. So it has clinical significance to unite so many kinds of examination methods for early diagnosis of glaucoma and monitoring.
KEYWORDS: pattern electroretinograms; pattern visual evoked potenlials; retinal nerve fiber layer; glaucoma
0引言
在早期开角型青光眼和正常眼压性青光眼的检查中自动静态视野计检查仍为监测指标之一，但监测到最小暗点之前通常有30%～50%视网膜节细胞已经丢失[1]，光学相干断层成像术（optical coherence tomography,OCT）检查结果与视野及视盘等相比敏感度较高但特异性较低，尤其近视患者和高龄者的结果易出现混淆[2]，本课题选择图形视网膜电图（pattern electroretinograms,PERG）联合OCT及自动静态视野计监测，比较各检查方法在青光眼的异常率，探讨PERG监测方法在青光眼早期诊断的临床价值。
1对象和方法
1.1对象 参照1987年全国选择原发性开角型青光眼病例青光眼学组推荐的标准选择原发性开角型青光眼病例，参照英国Moorfields眼科医院青光眼组的诊断标准及美国等国的诊断标准[3,4]选择正常眼压性青光眼病例。按视野程度分为早期和中晚期青光眼。选择原发性开角型青光眼患者22例44眼，正常眼压性青光眼患者14例28眼，共36例72眼，其中早期青光眼25眼，疑似青光眼的20眼，中晚期青光眼27眼。男24例，女12例，年龄25～83（平均54）岁。所有受检者符合以下条件：其裸眼视力或矫正视力≥0.5，无明显的严重的屈光间质混浊，无眼内手术史及眼底疾病等病史。未用扩瞳药物。正常对照组：选择正常人群20例40眼作为对照组。未用扩瞳药物，瞳孔≥0.3。
1.2方法 光学相干断层成像术（OCT）：采用ZEIZZ公司生产3000型进行测量扫描光波为红外光，波长860nm,视网膜神经纤维层厚度测量部位以视盘为中心，半径1.73mm的环形视网膜横断面，测量平均视网膜纤维层厚度和分象限厚度。图形视网膜电图（PERG）、图形视诱发电位（PVEP）：采用的德国ROLAND PETI port32型视觉电生理测试和分析系统进行图形电生理测试来测量视觉神经功能。PERG：刺激野为全视野，空间频率2c/d，翻转频率4Hz，对比度97%，平均亮度30cd/m2,叠加次数200次。PVEP：刺激野为全视野，空间频率0.46，0.92c/d，翻转频率0.9Hz，对比度97%，平均亮度30cd/m2,叠加次数200次。采用ZEISS HUMPHREY全自动视野计，视野标准为central 302 Threshold test。对青光眼组36例72眼，其中早期原发性青光眼25眼，疑似青光眼的20眼（在2a随访和检测中明确诊断为早期青光眼），中晚期青光眼27眼，对照组20例40眼进行PERG和PVEP的检查，对青光眼组72眼均进行了OCT和全自动静态视野检查。
统计学分析：两样本检测结果均数行方差检验，阳性数采用卡方χ2（Chisquare test）检验。
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