目的：分析光学相干断层扫描(OCT)联合分离格栅视觉诱发电位(Ic-VEP)在原发性开角型青光眼(POAG)诊治中的应用价值。

方法：前瞻性队列研究。选取2014-10/2018-05就诊我院的可疑青光眼患者32例32眼、早期POAG患者30例30眼、中晚期POAG患者25例25眼及正常人30例30眼，所有纳入人员均进行OCT、Ic-VEP、视野检查，对结果进行分析。

结果：Ic-VEP在早期POAG组敏感性为83%，特异性为93%； 信噪比(SNR)组间两两比较，8%SNR：早期POAG组与可疑青光眼组差异无统计学意义(P>0.05)，其余组间差异均有统计学意义(P<0.05)； 16%SNR及32%SNR：正常组与中晚期POAG组比较、可疑青光眼与中晚期POAG组比较、早期POAG组与中晚期POAG组比较，差异均有统计学意义(P<0.01)，其余组间差异均无统计学意义(P>0.05)。四组视网膜神经纤维层厚度(RNFL)参数均随病情加重变薄，各组间差异均有统计学意义(P<0.05)。四组视野平均缺损(MD)逐渐减小，可疑青光眼组与正常组差异无统计学意义(P=0.08)，其余组间差异有统计学意义(P<0.05)。8%SNR、平均RNFL及MD的ROC曲线下面积在可疑青光眼组分别为0.824、0.846、0.661； 在早期POAG组分别为0.898、0.969、0.889。

结论：OCT与Ic-VEP对POAG的早期变化有较高的诊断能力，并能评估视神经的损伤程度，可联合用于POAG的早期诊断和病情评估。

METHODS: Prospective cohort study. Totally 32 eyes of 32 suspected glaucoma cases, 30 eyes of 30 early POAG cases, 25 eyes of 25 moderate and late POAG cases were selected from the patients treated in our hospital from October 2014 to May 2018 were enrolled, and 30 eyes of 30 normal subjects were selected as control group. All subjects received OCT, Ic-VEP, visual field test, measurement results were analyzed.

RESULTS: The sensitivity and specificity of Ic-VEP in diagnose of early POAG was 83% and 93% respectively. The difference between the early POAG group and the suspected glaucoma group was no statistically significant in the signal-to-noise ratio of 8% SNR(P>0.05), but were statistically significant in other groups(P<0.05). The differences of 16%SNR and 32%SNR between the control group and the moderate and late POAG group, the suspected glaucoma group and the moderate and late POAG group, the early POAG group and the moderate and late POAG group were statistically significant(P<0.01), but were no statistically significant in other groups(P>0.05). The retinal nerve fiber layer(RNFL)thickness parameters in four groups became thinner with the aggravation of the disease, and the differences between the four groups were statistically significant(P<0.05). The mean defect of the four groups decreased gradually, there were no significant differences between the suspected glaucoma group and the control group(P=0.08), the differences between the other groups were statistically significant(P<0.05). The area under the ROC curve of 8%SNR, mean RNFL and MD in the suspected glaucoma group were 0.824, 0.846 and 0.661 respectively, the early POAG group of those were 0.898, 0.969, 0.889, respectively.

CONCLUSION: OCT and Ic-VEP have high diagnostic ability for the early changes of POAG and can evaluate the degree of optic nerve injury, which can be combined used for early diagnosis and efficacy evaluation of POAG.