图形翻转视觉诱发电位检查对白内障术后视力评估的价值

Visual acuity assessment after cataract surgery by pattern reversal visual evoked potential

摘要:

目的：探讨图形翻转视觉诱发电位(pattern reversal visual evoked potential，PRVEP)检查对白内障术后视力评估的价值。

方法：回顾性分析2012-10/2013-05在同济医院眼科住院，并在白内障超声乳化术及人工晶状体植入手术前后接受PRVEP检查的的成年白内障患者72例114眼的病例资料，其中76眼为老年性白内障，38眼为并发性白内障。根据晶状体混浊程度及晶状体核硬度将数据分为两组：核硬度Ⅰ，Ⅱ，Ⅲ级为A组，核硬度Ⅳ，Ⅴ级为B组，应用统计学方法进行数据间的相关性分析。

结果：A组：(1)术前：视力平均值为0.344，PRVEP检查P₁₀₀波的潜伏期平均值为107ms，N₇₅-P₁₀₀波的振幅平均值为4.633μV； 术后：视力平均值为0.672，PRVEP检查P₁₀₀波的潜伏期平均值为104.37ms，N₇₅-P₁₀₀波的振幅平均值为4.400μV。(2)手术前后视力与P₁₀₀波的潜伏期呈显著负相关(P<0.01)； 手术前后视力与N₇₅-P₁₀₀波的振幅呈显著正相关(术前P<0.01，术后P<0.05)。(3)手术前后视力改善行数与P₁₀₀波的潜伏期变化值无相关性。B组：(1)术前：视力平均值为0.116，P₁₀₀波的潜伏期平均值为118.905ms，N₇₅-P₁₀₀波的振幅值为1.650μV； 术后：视力平均值为0.576，P₁₀₀波的潜伏期平均值为108.429ms，N₇₅-P₁₀₀波的振幅值5.132μV。(2)术前视力与P₁₀₀波的潜伏期呈现显著负相关(P<0.05)，而术后视力与P₁₀₀波的潜伏期没有相关性； 手术前后视力与N₇₅-P₁₀₀波的振幅没有相关性。(3)手术前后视力改善行数与P₁₀₀波的潜伏期变化值没有相关性。

结论：由白内障手术前后两组视力与PRVEP的P₁₀₀波的潜伏期及N₇₅-P₁₀₀波的振幅的相关性可知，PRVEP受患者术前视力(即屈光间质混浊程度)影响较大，PRVEP检查不能作为白内障术后视力预后的判断指标，白内障手术前的PRVEP检查没有临床意义。

Abstract:

AIM: To discuss visual acuity assessment after cataract surgery by pattern reversal visual evoked potential.

METHODS:Data of 72 adult cataract patients received PRVEP before and after phaco and IOL in Department of Ophthalmology, Tongji Hospital from October 2012 to May 2013 was analyzed retrospectively. A total of 114 eyes were studied, including 76 eyes with senile cataract and 38 eyes with complicated cataract. According to the degree of lens opacity and the hardness of lens nucleus, these data were divided into two groups: Group 1(gradeⅠ, Ⅱ, Ⅲ )and Group 2(grade Ⅳ, Ⅴ )and was statistically studied with correlation analysis.

RESULTS: Group 1:(1)Preoperative: the average of visual acuity was 0.344, the incubation time of P₁₀₀ wave was 107ms and the amplitude of N₇₅- P₁₀₀ wave was 4.633μV; postoperative: the average of visual acuity was 0.672, the incubation time of P₁₀₀ wave was 104.37ms and the amplitude of N₇₅- P₁₀₀ wave was 4.400μV.(2)The visual acuity before and after operation were both significantly negatively correlated with the incubation time of P₁₀₀ wave(P<0.01)and significantly positively correlated with the amplitude of N₇₅- P₁₀₀ wave(preoperative: P<0.01,postoperative: P<0.05);(3)The improved rows of the visual acuity before and after operation showed no relationship with the change of the incubation time of P₁₀₀ wave. Group 2:(1)Preoperative: the average of visual acuity was 0.116,the incubation time of P₁₀₀ wave was 118.905ms and the amplitude of N₇₅-P₁₀₀ wave was 1.650μV; postoperative: the average of visual acuity was 0.576, the incubation time of P₁₀₀ wave was 108.429ms and the amplitude of N₇₅- P₁₀₀ wave was 5.132μV.(2)The visual acuity before operation was significantly negatively correlated with the incubation time of P₁₀₀ wave(P<0.05),while the visual acuity after operation showed no relationship with the incubation time of P₁₀₀ wave; the visual acuity before and after operation showed no relationship with the amplitude of N₇₅- P₁₀₀ wave.(3)The improved rows of the visual acuity before and after operation showed no relationship with the change of the incubation time of P₁₀₀ wave.

CONCLUSION:According to the correlation among the visual acuity, the incubation time of P₁₀₀ wave and the amplitude of N₇₅- P₁₀₀ wave, PRVEP is significantly affected by preoperative visual acuity(the degree of opacity in refractive media). PRVEP is not helpful as an indicator of visual prognosis after cataract surgery, and PRVEP before cataract surgery has no clinical significance.