眼挫伤的多焦视网膜电图研究
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摘要
眼挫伤是眼科常见的眼病,是造成视功能损害的重要原因之一。生理物理学检查包括视力、色觉和视野检查,但易受主观因素影响；B型超声波、电子计算机体层扫描等影像学检查虽然能够明确外伤的解剖学定位诊断,但对视功能损害的解剖位置却无法定位；荧光素眼底血管造影和吲哚青绿血管造影能够观察到视网膜的细微改变,但具有一定的创伤性,并且可能对药物过敏而引起全身严重并发症,导致发生生命意外。全视野视网膜电图在一定程度上对患者的视功能作出客观的评价,但不能准确定位损伤的部位。因此,在眼挫伤的临床研究中,迫切需要一种能够在短时间内同时记录视网膜不同区域视功能的电生理技术。20世纪90年代,Sutter发明了多焦视网膜电图,在短时间内记录大量局部反应,定位并发现微小病灶,从而克服了常规ERG对局部病变难以定位的缺陷。目前,国内外有关眼挫伤的视觉电生理报道,尤其是mfERG的报道甚少。本研究旨在通过对挫伤眼与对侧健康眼进行mf-ERG检查,探讨并分析挫伤眼的多焦视网膜电图的改变规律；评价挫伤眼的视功能；为眼挫伤的治疗及判断预后提供一种参考数据。期望对挫伤眼的早期诊治以及在伤情鉴定方面提供新的思路和方法。
方法
使用国特GT2000NV视觉电生理检测仪对46例挫伤眼进行多焦视网膜电图的检测,记录多焦视网膜电图的1环、2环、3环、4环及5环的a波与b波的隐含期和振幅密度,并与对侧健康眼作对照。同时对挫伤眼4个象限的a波与b波的隐含期和振幅密度进行比较分析。
结果
挫伤眼a、b波的隐含期延迟,差异没有显著性意义(p>0.05)；挫伤眼a、b波的振幅总和降低,具有显著性差异(p<0.05)。
挫伤眼伤后视力与1环b波振幅密度呈正相关(r=0.620,p<0.001),年龄与伤后视力、1环b波振幅密度无相关性。
1环、2环、3环、4环及5环的a波和b波的振幅密度与对侧健康眼相比均有显著性差异(p<0.05),而隐含期无显著性差异(p>0.05),挫伤眼4个象限b波隐含期与振幅密度的差异无显著性p>0.05)。
结论
挫伤眼多焦视网膜电图b波振幅密度比正常对照组降低,以1环改变最明显。
挫伤眼的视功能损害存在很大的不对称性,即只有离心度的差异,而没有象限性差异。
多焦视网膜电图能够客观反映挫伤眼的视功能损害程度,是评价眼挫伤时后极部视网膜功能的有效工具。
为临床提供了一条新的评价挫伤眼中心视力的客观检测途径。
Ocular blunt trauma is a common eye disease, it is an important visual function caused by one of the reasons. Physical examination including visual acuity color vision and visual field examination, but vulnerable to subjective factors; B-type ultrasonic, comprter tomography and other imaging studies although a clear injury to the anatomical localization diagnosis, but the anatomy of visual function location could not locate; fundus fluorescein angiography and indocyanine green angiography to observe subtle changes in the retina, but has some traumatic, and may be allergic to serious complications caused by the body, leading to occurrence of accidents of life. Ganzfeld electroretinogram, to some extent on the visual function in patients with an objective assessment, but can not accurately locate the site of injury. Therefore, in the study of ocular contusion of the urgent need for a short period of time can be recorded simultaneously in different areas of visual function in retinal electrophysiology.90 years of the 20th century, Sutter invented the mf-ERG, recorded a large number of local reactions in a short time, location and found that small lesions, to overcome the conventional ERG on the local lesion is difficult to locate defects. At present, domestic and foreign contusion visual electrophysiological reports, especially reports of little mf-ERG. This study was designed with the contralateral eye through the ocular contrsion were mf-ERG examination and analysis of eye contusion in the mf-ERG changes in law, evaluation of visual function of ocular contusion; for the treatment of ocular contusion and prognosis provided a kind of reference. Expectations on early diagnosis and treatment of eye contusion and injury assessment to provide new ideas and methods.
Methods
To test multifocal electroretinogram by means of GT2000NV electrophysi-ological instrument on 46 patients suffered from ocular blunt trauma. The latencies and amplitudes densities of a and b wave of ring 1、ring 2、ring 3、ring 4 and ring 5 of suffering eyes were compared with the other healthy eyes. The latencies and amplitu-ed densities of four quadrants'a and b wave were compared each other.
Results
The total value of eye contusion in response to a, b wave latencies delay, the difference was not statistically significant (p>0.05); contusion eyes a, b wave amplitude of the sum of lower significant difference (p<0.05).
The visual acuity in traumatized eyes were correlated positively with the amplitudes densities of b wave of ringl (r=0.620,p<0.001). The age was not correlated with the visual acuity in traumatized eyes and with the amplitudes densities of b wave of ring 1.
Amplitude densities of a and b wave of ringl1、ring 2、ring 3、ring 4 and ring 5 were significant difference (P<0.05), While the latencies did not change obviously compared with that in control group(P>0.05). There was no significant difference in the latencies and amplitude densities of b wave between four quadrants of traumatized eyes (P>0.05).
Conclusion
The amplitudes densities of b wave of ocular blunt trauma were reduced, especially the change of ringl.
The impairment of visual function, there is a big asymmetry with the ocular contusion, only the centrifugal degree of difference, but there is no difference between the quadrant.
The multi-focal electroretinogram are able to reflect objectively the damage of visual function. It is a promising tool to evaluate the posterior retinal function of traumatized eyes.
Provided to a new evaluation of the objective eye center detection means in the ocular blunt trauma.
方法
使用国特GT2000NV视觉电生理检测仪对46例挫伤眼进行多焦视网膜电图的检测,记录多焦视网膜电图的1环、2环、3环、4环及5环的a波与b波的隐含期和振幅密度,并与对侧健康眼作对照。同时对挫伤眼4个象限的a波与b波的隐含期和振幅密度进行比较分析。
结果
挫伤眼a、b波的隐含期延迟,差异没有显著性意义(p>0.05)；挫伤眼a、b波的振幅总和降低,具有显著性差异(p<0.05)。
挫伤眼伤后视力与1环b波振幅密度呈正相关(r=0.620,p<0.001),年龄与伤后视力、1环b波振幅密度无相关性。
1环、2环、3环、4环及5环的a波和b波的振幅密度与对侧健康眼相比均有显著性差异(p<0.05),而隐含期无显著性差异(p>0.05),挫伤眼4个象限b波隐含期与振幅密度的差异无显著性p>0.05)。
结论
挫伤眼多焦视网膜电图b波振幅密度比正常对照组降低,以1环改变最明显。
挫伤眼的视功能损害存在很大的不对称性,即只有离心度的差异,而没有象限性差异。
多焦视网膜电图能够客观反映挫伤眼的视功能损害程度,是评价眼挫伤时后极部视网膜功能的有效工具。
为临床提供了一条新的评价挫伤眼中心视力的客观检测途径。
Ocular blunt trauma is a common eye disease, it is an important visual function caused by one of the reasons. Physical examination including visual acuity color vision and visual field examination, but vulnerable to subjective factors; B-type ultrasonic, comprter tomography and other imaging studies although a clear injury to the anatomical localization diagnosis, but the anatomy of visual function location could not locate; fundus fluorescein angiography and indocyanine green angiography to observe subtle changes in the retina, but has some traumatic, and may be allergic to serious complications caused by the body, leading to occurrence of accidents of life. Ganzfeld electroretinogram, to some extent on the visual function in patients with an objective assessment, but can not accurately locate the site of injury. Therefore, in the study of ocular contusion of the urgent need for a short period of time can be recorded simultaneously in different areas of visual function in retinal electrophysiology.90 years of the 20th century, Sutter invented the mf-ERG, recorded a large number of local reactions in a short time, location and found that small lesions, to overcome the conventional ERG on the local lesion is difficult to locate defects. At present, domestic and foreign contusion visual electrophysiological reports, especially reports of little mf-ERG. This study was designed with the contralateral eye through the ocular contrsion were mf-ERG examination and analysis of eye contusion in the mf-ERG changes in law, evaluation of visual function of ocular contusion; for the treatment of ocular contusion and prognosis provided a kind of reference. Expectations on early diagnosis and treatment of eye contusion and injury assessment to provide new ideas and methods.
Methods
To test multifocal electroretinogram by means of GT2000NV electrophysi-ological instrument on 46 patients suffered from ocular blunt trauma. The latencies and amplitudes densities of a and b wave of ring 1、ring 2、ring 3、ring 4 and ring 5 of suffering eyes were compared with the other healthy eyes. The latencies and amplitu-ed densities of four quadrants'a and b wave were compared each other.
Results
The total value of eye contusion in response to a, b wave latencies delay, the difference was not statistically significant (p>0.05); contusion eyes a, b wave amplitude of the sum of lower significant difference (p<0.05).
The visual acuity in traumatized eyes were correlated positively with the amplitudes densities of b wave of ringl (r=0.620,p<0.001). The age was not correlated with the visual acuity in traumatized eyes and with the amplitudes densities of b wave of ring 1.
Amplitude densities of a and b wave of ringl1、ring 2、ring 3、ring 4 and ring 5 were significant difference (P<0.05), While the latencies did not change obviously compared with that in control group(P>0.05). There was no significant difference in the latencies and amplitude densities of b wave between four quadrants of traumatized eyes (P>0.05).
Conclusion
The amplitudes densities of b wave of ocular blunt trauma were reduced, especially the change of ringl.
The impairment of visual function, there is a big asymmetry with the ocular contusion, only the centrifugal degree of difference, but there is no difference between the quadrant.
The multi-focal electroretinogram are able to reflect objectively the damage of visual function. It is a promising tool to evaluate the posterior retinal function of traumatized eyes.
Provided to a new evaluation of the objective eye center detection means in the ocular blunt trauma.
引文
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