基础必备:视觉电生理检查全收录!

2021-09-23 梅斯医学整理 梅斯医学整理

视觉系统的临床电生理检查包括一系列非侵入性无创检测,为临床提供视觉系统不同 位置和细胞类型相关功能的客观指标。

视觉系统的临床电生理检查包括一系列非侵入性无创检测,为临床提供视觉系统不同 位置和细胞类型相关功能的客观指标。本文介绍了视觉电生理检查,包括全视野视网膜电图(ERG)、图形 ERG、多焦 ERG、眼电图和脑皮层产生的视觉诱发电位,分享给各位通道。

(一)全视野ERG

ISCEV标准全视野ERG是视网膜对短暂闪光的整体反应,可评估在明适应和暗适应条 件下视网膜的总体功能。全视野 ERG 可大体区分视网膜内层或外层的 功能障碍以及区分主要是视杆或视锥细胞系统的功能障碍。值得注意的是,全视野ERG主要由黄斑以外的视网膜产 生,而黄斑的作用很小。黄斑功能的电生理评估需 要使用不同技术,如图形ERG或多焦ERG

(二)图形ERG

ISCEV 标准图形 ERG 主要来源于黄斑区视网 膜的神经节细胞,在区分黄斑病变和整个视网膜病 变方面可作为全视野ERG的补充。图形ERG还可 以作为VEP检查更有意义的补充,排除黄斑原因导 致的VEP异常,并提供视网膜神经节细胞受累的附加评估。

瞬时图形 ERG 主要有 2 个组成部分具有诊断 价值,即正极性的P50波和负极性的N95波。这 2 个组成部分均反映了黄斑部视网膜神经节细胞的功能,但 P50波有 1个额外的外层视网膜信号成分输入。

对于部分黄斑病变外各种原因引 起的低视力疾病,P50波的存在有助于建立有效的 刺激质量和棋盘方格对比。比较标准和额外大视 野刺激下的图形 ERG 反应,可能有助于显示黄斑 功能障碍区域,尽管空间分辨率低于多焦ERG

(三)多焦ERG

ISCEV标准多焦ERG用于检测视锥 细胞系统功能,在以黄斑为中心的后极中央 40°~ 50°范围内,测量 61 103 个离散的六边形视网膜 区域。ISCEV标准刺激矩阵的六边形按比例排放, 从每个刺激区域引出可比较的反应幅度,从而导致 六边形的大小随离心度增加而增加。得到可靠的 检查结果需要受试者具有良好的固视。由于信号 小,需要使用角膜电极。

多焦ERG的空间分辨率优于图形ERG和全视 ERG,可明显显示后极部视网膜功能不全的局灶 中心区、环形区、半视野区或离散性旁中心区的特 征,但可靠的记录需要受试者具有良好的固视。若 功能不全区显示出相当好的径向对称性,则可采用 刺激模式的每个同心环中所有六边形的平均波形(环平均)帮助解读结果。

(四)眼电图

ISCEV 标准眼电图用于评估视网膜色素上皮 retinal pigmentepithelialRPE)细胞的功能。在 RPE 细胞顶部和基底部之间的电位差形成跨眼球 的偶极子,使得角膜成为相对于眼球后部的正电位。

正常眼电图光峰的形成不仅需要正常功能的RPE,还需要正常功能的视杆光感受器,其眼电图异常程度 与视杆细胞来源的 ERG 异常程度密切相关。当 ERG 显示正常或仅表现为视杆细胞介导的轻度异 常时,反应 RPE-光感受器复合物整体功能的眼电图评估最具有价值。任何原因导致视杆细胞重度 功能不全时,眼电图均会出现异常,此时无法反映 RPE功能的额外信息。

(五)VEP

ISCEV 标准 VEP 是一种检测可疑视神经疾病或视网膜后视觉通路功能障碍的重要客观方法。 VEP 是视觉皮层对视觉刺激产生的电流在头皮记录到的电位。

ISCEV 标准 VEP 描述了3种刺激诱发模式,即图形翻转模式、图形开关模式和弥散闪光刺激模 式。翻转棋盘方格用于记录图形翻转VEP,一般在 评估视神经功能上更有价值,但要求受试者有足够的固视能力和依从性。

正确解读图形VEP异常通 常需要补充评估以排除黄斑因素, 而闪光 ERG 可用于排除闪光 VEP 异常的视网膜因素。视神经疾病的 原因很多,VEP 可提示或支持可疑 诊断。

原文出处

国际临床视觉电生理学会.视觉电生理诊断流程指南.中华眼科杂志 2020 7 月第 56 卷第 7 Chin J Ophthalmol, July 2020, Vol. 56, No. 7

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    2022-03-02 ms8000001148047562

    学习

    0

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    2021-10-24 老兔

    这一直是较难的

    0

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    2021-10-16 ms3000001832271890

    学习

    0

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    2021-09-25 zywlvao
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    2021-09-25 245462683

    学习

    0

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    2021-09-24 学医无涯

    学习一下

    0