视网膜电图在视网膜中央静脉阻塞分型中的应用价值

我们选择不同的刺激条件，对３２例早期视网膜中央静脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＶＲＶＯ）患者进行视网膜电图（ｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ，ＥＲＧ）的检测。缺血型ＣＲＶＯｌ３例的ａ、ｂ波潜伏期延长，ｂ波振幅明显下降；非缺血型ＣＲＶＯ１９例的ａ、ｂ波潜伏期延长，ｂ波振幅表现为轻度降低、升高或正常。提示ｂ波振幅和ｂ／ａ值是区分缺血型与非缺血型ＣＲＶＯ的最敏感指标。我们还探讨了ＥＲＧ在早期ＣＲＶＯ分型中的应用价值。     

黄斑病变的明视视网膜电图及色觉变异

为了解黄斑病变的明视视网膜电图及色觉变异。应用明视视网膜电图（Ｉ１６红光刺激和Ｉ８白光刺激）和色觉试验（ＰａｎｅｌＤ－１５试验和ＦＭ１００－ｈｕｅ试验）同时检测视网膜前膜病人１２例（１５眼）和老年黄斑变性干性型病人１２例（１７眼）,了解两种检查的异常率并进行两种检查方法的比较。结果：受试患眼明视视网膜电图检查显示明视Ｉ１６红光和明视Ｉ８白光刺激的异常率分别为２４．３２％和１０．８１％,ＰａｎｅｌＤ－１５试验和ＦＭ１００－ｈｕｅ试验的异常率分别５６．７６％和７０．２７％。Ｘ２检验显示明视视网膜电图的异常率和两种色觉试验的异常率有显著性差异。结论：视网膜前膜和老年黄斑变性干性型等轻度黄斑病变可引起明视视网膜电图和色觉的改变,但明视视网膜电图的异常率低于色觉检查的异常     

视网膜电图检测对视网膜静脉阻塞视功能的评价

目的 探讨视网膜电图（ｅｌｅｃｔｒｏｒｅｔｉｏｇｒａｍ,ＥＲＧ）的检测对视网膜静脉阻塞（ｒｅｔｉｎａｌ ｖｅｉｎ ｏｃｃｌｕｓｉｏｎ,ＲＶＯ）视功能评价的可能性。方法 对２１例ＲＶＯ患者及２３例正常对照组分别进行ＥＲＧ检测,测ａ、ｂ波振幅、峰潜时和振汤电位振幅。结果 ＲＶＯ组最大反应ａ、ｂ波振幅对照组明显下降,峰潜时延长、振荡电位幅值也明显降低,ＣＲＶＯ与ＢＲＶＯ组间有显著差异,说明随病变程度而加     

视网膜电图与刺激光强的关系

视网膜电图（ＥＲＧ）各成分有不同的光敏感性。刺激光强由弱到强时，记录到的ＥＲＧ成分依次为暗适阈值反应（ＳＴＲ），ｂ波，ａ波和振荡电位（ＯＰｓ）。ＳＴＲ振幅和潜时与刺激光强呈线性相关，ｂ波振与刺激光强函数关系符合“Ｓ”型曲线方程Ｒ／Ｒｍａｘ＝Ｉ＾ｎ／（Ｉ＾ｎ＋Ｋ＾ｎ），但当刺激光强较强时，该曲线出现第二上升支。不同的刺激光强，ａ波有不同的形成，中等强度的刺激光强，ａ波为双谷型，由ａ１波和波２波组成。     

结晶样视网膜变性的视觉电生理改变探讨

目的探讨结晶样视网膜变性的视觉电生理改变。方法采用眼电图（ＥＯＧ）和视网膜电图（ＥＲＧ）检测１４例２８眼结晶样视网膜变性患者（病例组）和１５例３０眼正常人（对照组）、观察指标：（１）ＥＯＧ的基值电位（ＢＶＰ）、暗谷电位（ＤＴＰ）、暗谷时间（ＤＴＴ）、光峰电位（ＬＰＰ）、光峰时间（ＬＰＴ）、ＱＡｒ－ｄｅｎ、ＱＧｌｉｅｍ、（２）暗适应和明视ＥＲＧａ、ｂ波振幅、峰时值。采用ｔ检验对上述各项指标做两组间比较分析。结果病例组ＥＯＧ的ＢＶＰ、ＤＴＰ、ＬＰＰ、ＱＡｒｄｅｎＱＧｌｉｅｍ均较对照组明显降低,峰两组间有极显著性差异（Ｐ＜０．０１）;而ＥＯＧ的ＤＴＴ、ＬＰＴ与对照组比无明显改变,两组间无显著性差异（Ｐ＞０．０５）。病例组暗适应和明视ＥＲＧａ、ｂ波振幅、峰时值较对照组均有明显改变,两组间有极显著性差异（Ｐ＜０．０１）;但在２例早期患者中,其ＥＲＧａ、ｂ波振幅、峰时值均在正常范围。结论ＥＯＧ、ＥＲＧ作为客观定量的视功能检查方法,可为结晶样视网膜变性的视网膜功能损害程度提供客观指标。对结晶样视网膜变性早期患者ＥＯＧ可能较ＥＲＧ更具诊断价值。     

遗传性黄斑变性的闪光视网膜电图

遗传性黄斑变性的闪光视网膜电图中国医科大学附属第一医院眼科黄凯，吴献可闪光视网膜电图（以下称Ｆ－ＥＲＧ）是评价视网膜整体功能的重要客观指标。在一些眼底病的诊断及病变程度判定方面，应用越来越广泛。本文报告２４例眼遗传性黄斑变性的Ｆ－ＥＲＧｂ波检测结果，...     

多焦视网膜电图在糖尿病视网膜病变不同病期诊断的应用

目的：评价多焦视网膜电图（ＭＥＲＧ）在糖尿病性视网膜病变（ＤＲ）不同期诊断的应用价值。方法：对２４名（３５眼）正常人及６３名（９６眼）糖尿病患者分别进行眼科常规检查、眼压测定、眼底荧光血管造影（ＦＦＡ）、Ｏｃｔｏｐｕｓ视野及ＭＥＲＧ检测,并对ＭＥＲＧ与视野进行相关性分析,对比ＭＥＲＧ与其他视网膜功能检查方法的异常检出率。结果：ＭＥＲＧ总反应波的Ｐ１波反应密度在临床未见ＤＲ（ＮＤＲ）的糖尿病患者低于     

中心性浆液性脉络膜视网膜病变PERG和PVEP的研究

目的：观察中心性浆液性脉络膜视网膜病变（中浆）的图形视网膜电图（ＰＥＲＧ）和图形视诱发电位（ＰＶＥＰ）的表现。方法：检查９２例（１２０眼）正常人、５１例（５２眼）中浆患者的ＰＥＲＧ和ＰＶＥＰ。结果；患眼的ＰＶＥＰ的Ｐ１００潜伏期和ＰＥＲＧｂ波潜伏期延长，ＰＶＥＰ的Ｐ１００振幅ＰＥＲＧ的ｂ波振幅降低，中浆病情重，视力下降明显者，ＰＶＥＰ和ＰＥＲＧ的潜伏期改变最明显。结果：中浆患者的ＰＥＲＧ和ＰＶＥＰ     

视网膜分枝静脉阻塞的视网膜电图和图形视诱发电位的观察

目的：探讨视网膜电图（ｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ,ＥＲＧ）和视觉诱发电位（ｖｉｓｕａｌ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌ,ＶＥＰ）对视网膜静脉分枝阻塞（ｂｒａｎｃｈ ｒｅｔｉｎａｌ ｖｅｉｎ ｏｃｃｌｕｓｉｏｎ,ＢＲＶＯ）检测的意义。方法：根据眼底荧光血管造影（ｆｕｎｄｕｓ ｆｌｕｏｒｅｓｃｅｉｎ ａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）将ＢＲＶＯ分为缺血型（ｈｅｍｏｒｒｈａｇｉｃ ｒｅｔｉｎｏｐ     

复杂性视网膜脱离暗视视网膜电图的研究

目的 研究ＥＲＧ与孔源性视网膜脱离的关系及了解其预测ＰＶＲ形成的可能性及程度。方法 对４３例孔源性视网膜脱离伴ＰＶＲ患者手术前后分别行全视野暗视ＥＲＧ检查。结果 患者ＰＶＲ不同程度组ＥＲＧ的ａ、ｂ波振幅较正常眼降低,潜伏期延长;ＰＶＲ程度愈重,ＥＲＧ呈熄灭型所占比例愈大;ＥＲＧ振幅的降低与视网膜脱离的范围及持续时间有关;术后随着视网膜复位,ＥＲＧ明显改善。结论 复杂性视网膜脱离患者ＥＲＧ异常,并随ＰＶＲ程度加重异常更明显,指导临床上及早行ＥＲＧ检测,尽量减少ＰＶＲ的形成提供依据。     

The Electroretinogram in Patients with Retinal Vascular Occlusion

Purpose: to measure and analyze the electroretinogram (ERG) in patients with retinal vascular occlusion.Method: fifty-eight cases (59 eyes) of retinal vascular occlusion and the fellow eyes of 47 cases were tested with Ganzfeld ERG. The scotopic and photopic ERG, and oscillatory potentials were tested according to the ERG standard of ISCEV. Results: The abnormal rates of OPs and b wave were higher in retinal vascular occlusion. The abnormal ERG appeared mostly in CRVO among four types of retinal vascular occlusion. The comparisons of some amplitudes and latencies between the fellow eyes and the affected eyes showed statistically significant difference. Conclusion: The oscillatory potentials and b waves have important roles in evaluating the retinal function of patients with retinal vascular occlusions. There are some clinical significance for comparing ERG between the affected eye and the fellow eye.     

The photopic negative response of the flash electroretinogram in retinal vein occlusion

The photopic negative response (PhNR) has recently been shown to be severely affected in central retinal artery occlusion (CRAO), despite relative preservation of the cone b-wave compared to that in the healthy unaffected fellow eye. The aim of this study was to test how the PhNR of the flash electroretinogram (ERG) is affected in human retinal vein occlusion. PhNR was elicited with red stimuli (1 cd s/m², 5 cd s/m², and 7 cd s/m² with 4 ms duration) and blue background (10 cd/m²). Standard Ganzfeld flash ERG was produced according to the ISCEV standard for the clinical electroretinogram (2004). Sixteen patients with central retinal vein occlusion (CRVO), 14 patients with branch retinal vein occlusion (BRVO), and 16 controls were analyzed. The amplitude of the PhNRs was significantly smaller in the CRVO and BRVO eyes than those in the unaffected fellow or control eyes (p = 0.000). There was a significantly greater reduction of PhNR amplitudes than that of other waves including the OPs, rod b-wave, combined a-wave and b-wave, cone a-wave and b-wave, and 30 Hz flicker ERG. Thus, PhNR amplitude in retinal vein occlusion is severely affected. There is a potential role for PhNR in assessing inner retinal damage and evaluating the effect of treatment.     

视网膜中央静脉阻塞性黄斑水肿的OCT与ERG的对比分析

目的：观察视网膜中央静脉阻塞性黄斑水肿的黄斑区视网膜厚度与视网膜电图( electroretinogram, ERG )各项参数(Cone-a,Cone-b和30Hz)变化的关系。
　　方法：随机选择视网膜中央静脉阻塞患者25例25眼及25只对侧眼分别行明视闪光视网膜电图及光学相干断层扫描( optical coherence tomography,OCT)检查,明视闪光视网膜电图检查测各项参数的振幅和潜伏期, OCT测量黄斑区九部分的视网膜厚度,分析黄斑区形态参数与明视闪光视网膜电图各参数变化之间的关系。
　　结果：黄斑区除颞侧外七个部位视网膜厚度与 ERG 的Cone-b和30 Hz潜伏期相关。
　　结论：研究发现视网膜中央静脉阻塞患者的黄斑区视网膜厚度与内层视网膜功能密切相关。     

Genetic thrombophilia in patients with retinal vascular occlusion

Background: This study was carried out to determine the prevalence of genetic thrombophilia in patients with retinal vascular occlusion.Methods: We investigated 116 consecutive patients with central retinal vein occlusion (CRVO, n = 48), branch retinal vein occlusion (BRVO, n = 33), central retinal artery occlusion (CRAO, n = 21), branch retinal artery occlusion (BRAO, n = 14). All patients underwent comprehensive tests for coagulation disorders including determinations of protein C, protein S, lupus anticoagulants, prothrombin gene mutation (G20210A), resistance to activated protein C (APCR), and were screened for vascular disease risk factors. APC resistance was confirmed by a PCR method to detect the factor V R506Q mutation. A PCR method was also used to detect the G20210A mutation. For comparative purposes, we screened 209 consecutive patients with deep vein thrombosis (DVT) and 581 patients with coronary heart disease (control group) for APC resistance.Results: 13 (27%) of 48 patients with CRVO had the factor V R506Q mutation. The factor V R506Q mutation was detected in six (18%) of 33 patients with BRVO, but in only one patient with CRAO and in two patients with BRAO. Other thrombophilic defects were not detected. The APCR prevalence within the CRVO group was significantly increased when compared to the control group (8%). There was no significant difference in the factor V R506Q mutation prevalence between the CRVO group and the DVT group (19%).Conclusion: The factor V R506Q mutation is the most commoncause of genetic thrombophilia in patients with CRVO and has a similar prevalence as in DVT patients.     

合并视网膜大血管阻塞的系统性红斑狼疮的临床观察

目的：观察系统性红斑狼疮(SLE)合并视网膜大血管阻塞的临床特点。

方法：选取2010-01/2014-01我院收治的SLE合并视网膜大血管阻塞的患者17例21眼为试验组,另选取不合并视网膜病变的SLE患者30例60眼为对照组,完善眼部和全身检查及相关化验包括各种自身免疫抗体,记录临床症状和体征。

结果：试验组13例为单眼发病,4例为双眼发病,其中视网膜中央静脉阻塞(CRVO)7眼(33%),视网膜分支静脉阻塞(BRVO)9眼(43%),视网膜中央动脉阻塞(CRAO)3眼(14%),视网膜分支动脉阻塞(BRAO)1眼(5%),CRAO合并CRVO 1眼(5%)。试验组BCVA显著差于对照组; 皮肤红斑(76%)、发热(59%)、关节炎(53%)、中枢神经系统症状(头痛及精神神经异常)(76%)、胸膜炎(41%)发生率显著高于对照组; 抗ds-DNA抗体(100%)、抗磷脂抗体(65%)阳性率显著高于对照组; 补体C3降低(82%)、血沉升高(100%)、血小板减少(65%)发生率显著高于对照组。SLEDAI评分为20.24±4.66提示疾病处于中度及重度活动期。

结论：合并视网膜大血管阻塞的SLE患者,视力受损严重,全身多系统均有不同程度受累,且均为疾病中度及重度活动期。与APA、中枢神经系统病变可能存在相关性。     

Correlation of electroretinographic and fluorescein angiographic findings in unilateral central retinal vein obstruction

Background: In central retinal vein obstruction (CRVO), electroretinogram (ERG) abnormalities and extensive retinal capillary dropout (CD) in the fluorescein angiogram (FA) are good indicators of retinal ischemia. We retrospectively studied patients with unilateral CRVO and compared the ERG and FA results Methods: Single white flash ERG, photopic ERG, scotopic ERG and flicker ERG were recordered in 30 cases of unilateral CRVO. We analyzed the correlation between the ERG results and the presence/absence of extensive CD Results: The ERG b/a-wave amplitude ratios, photopic and scotopic b-wave amplitudes, and flicker amplitudes were significantly smaller (P<0.05) in eyes with extensive CD (n=12, 40%), than in eyes without (n=18, 60%). When the photopic or scotopic b-wave amplitudes were normal or supernormal, extensive CD on FA was absent in all eyes. When the b/a-wave ratios were 1.0 or when the b-wave amplitudes with white flash or flicker amplitudes were normal or supernormal, extensive CD was present in less than 32% of eyes Conclusion: These results suggest that the ERG results, especially the b/awave amplitude ratio, are significantly correlated with the presence/absence of CD on FA in CRVO.     

Electroretinograms and level of aqueous vascular endothelial growth factor in eyes with hemicentral retinal vein occlusion or branch retinal vein occlusion

Purpose

Hemicentral retinal vein occlusion (hCRVO) is a disease related to CRVO but not to branch retinal vein occlusion (BRVO). We reported a significant correlation between aqueous vascular endothelial growth factor (VEGF) levels and the implicit time of 30-Hz flicker electroretinogram (ERG) in CRVO eyes. The purpose of this study was to compare aqueous VEGF levels and ERG components between hCRVO and BRVO eyes.

Methods

The medical records of patients with macular edema secondary to hCRVO (12 eyes) or BRVO (16 eyes) and received an intravitreal injection of bevacizumab (IVB) at the Nagoya University Hospital from July 2009 to May 2013 were reviewed. Full-field ERGs were recorded before the IVB. Aqueous humor was collected just before the IVB to measure VEGF concentration. Differences in aqueous VEGF level and ERG components between hCRVO and BRVO eyes were determined.

Results

Mean aqueous VEGF concentration in hCRVO eyes was significantly higher than that in BRVO eyes (504 vs. 148 pg/ml, P < 0.05). The implicit time of 30-Hz flicker ERG was significantly longer in hCRVO than in BRVO eyes (33.5 vs. 29.8 ms, P < 0.01).

Conclusion

The significant difference in VEGF levels in aqueous and implicit times of 30-Hz flicker ERG suggest that retinal ischemia is more manifest in hCRVO than in BRVO eyes.     

视网膜中央静脉阻塞对侧眼视网膜电图的观察

本文对31例单眼视网膜中央静脉阻塞（centralretinalveinocclusion，CRVO）患者正常眼底的对侧眼进行了暗视ERGa、b波及OPs各子波峰时值、波幅和OP总合波幅的观察，结果表明，ERG的a、b波及OPs各子波峰时值均延迟，ERGb波波幅异常者占32％，其中b波超高者占29％，b波降低者占3％，OPs主要表现为O2波波幅的降低，异常率42％，异常率随着年龄的增大而增加。在OPs异常的患者中绝大多数存在着血液粘稠度的增高及血脂异常。提示O2波是观察视网膜血液循环障碍的敏感指标。全身因素可以同时影响双眼视网膜功能。     

Combined retinal vascular occlusion: Demography,clinical features,visual outcome,systemic co-morbidities,and literature review

Purpose:To document the clinical features, systemic association, and treatment outcome of patients with a combined retinal vein and artery occlusion (CRVAO) and review of literature.Methods:A retrospective chart review of patients diagnosed with CRVAO at a tertiary eye care center. Patient''s demographic details and associated ocular and systemic factors were recorded. Treatment included laser photocoagulation, anti-vascular endothelial growth factor (VEGF) intravitreal injection or transscleral cyclophotocoagulation (TSCPC), alone or in combination. At last, follow- up treatment response was measured in visual acuity status, regression of neovascularization, and control of intraocular pressure (IOP). All cases reported in the current decade were analyzed and compared with this study.Results:Seventeen eyes with CRVAO accounted for 0.3% of total vascular occlusion (total 5151 patients were seen in this period). The mean age was 48.12 ± 17.5 years (range: 12-87 years) and there were 9 females. Nine eyes had CRVO + CRAO; 6 eyes had BRVO + BRAO, and one patient each had CRVO + BRAO and CRAO + BRVO. Fluorescein angiography (FA) showed delayed ''arm to retina'' time (>20 seconds) in all 10 eyes and delayed arteriovenous transit time in 9 out of 10 eyes. Optical coherence tomography (OCT) showed hypereflective inner retinal layers (16 eyes) and neurosensory detachment (7 eyes). The most common systemic associations were hypertension and dyslipidemia (n = 7 people; 41.18%) each. Four patients (23.5%) had a plaque in carotid arteries with normal 2D echocardiography. Ten (59%) eyes were treated with intravitreal bevacizumab + laser; four (23.5%) eyes were treated with laser only, and three (17.6%) eyes were treated with laser + anti-VEGF + TSCPC. At last follow up, vision improved in 9 (52.9%) eyes; stable in 3 (17.7%) eyes, and reduced to perception of light in 5 (29.4%) eyes.Conclusion:Combined CRVAO is a rare emergency leading to acute vision loss. Early diagnosis and treatment for ocular complications and systemic evaluation for cardiovascular risk factors are needed.     

量化OCTA在视网膜静脉阻塞中的应用

目的:应用光学相干断层扫描血管成像技术(OCTA)测量视网膜静脉阻塞(RVO)患者黄斑区血流密度、黄斑中心凹无血管区(FAZ)面积和黄斑中心凹视网膜厚度。方法:选取RVO患者30例30眼,视网膜中央静脉阻塞(CRVO)和视网膜分支静脉阻塞(BRVO)患者各15例,双眼接受OCTA检查,获取黄斑中心3mm×3mm大小范围的血流密度、FAZ面积、黄斑中心凹视网膜厚度,以及双眼最佳矫正视力(BCVA)。比较患眼与健眼上述指标的变化及其与BCVA的相关性。结果:CRVO患者患眼黄斑区视网膜浅层毛细血管网(SVN)、深层毛细血管网(DVN)总血流密度较健眼降低[SVN:(43.07±4.95)%vs(50.09±2.86)%,DVN:(45.89±4.12)%vs(53.29±2.62)%,均P<0.01],与BCVA呈负相关(r_s=-0.6、-0.5,均P<0.05)。BRVO患者患眼SVN、DVN总血流密度较健眼降低[SVN:(45.62±3.04)%vs(52.10±2.98%),DVN:(49.21±3.80)%vs(55.52±3.33%),均P<0.01],与BCVA呈负相关(r_s=-0.5、-0.5,均P<0.05)。BRVO患眼病变区域与患眼未病变区域、健眼对应区域比较,SVN、DVN血流密度均下降(均P<0.01);患眼未病变区域DVN血流密度较健眼相应区域下降[(56.86±1.95)%vs(58.15±2.24)%,P=0.02];患眼病变区域DVN血流密度与BCVA呈负相关(r_s=-0.6,P=0.01)。CRVO、BRVO患眼SVN的FAZ面积较健眼明显扩大(CRVO:0.515±0.26mm²vs 0.27±0.08mm²,P<0.01;BRVO:0.376±0.12mm²vs 0.261±0.07mm²,P<0.01),且均与BCVA呈正相关(CRVO:r_s=0.6,P=0.01;BRVO:r_s=0.5,P=0.01)。CRVO、BRVO患眼黄斑中心凹视网膜厚度均较健眼增加(CRVO:431.2±191.3μm vs 235.5±18.2μm,P<0.01;BRVO:373.2±188.7μm vs 233.8±13.7μm,P=0.01),均与BCVA呈正相关(CRVO:r_s=0.9,P=0.01;BRVO:r_s=0.6,P=0.01)。结论:OCTA可作为测量RVO患者黄斑区血流密度、FAZ面积及黄斑中心凹视网膜厚度的有效工具。