Nagai N, Ohde H, Betsuin Y, Matsukura S, Kigasawa K, Mashima Y, Oguchi Y
Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Nippon Ganka Gakkai Zasshi. 2001 Jan;105(1):24-30.
We performed electrophysiologic tests on two patients with digitalis toxicity who first had photophobia and xanthopsia and revealed reversible reduced visual acuity and binocular central scotoma.
The patients were a 72-year-old male and a 54-year-old male who had symptoms of digitalis toxicity.
The corrected visual acuity was severely decreased during digitalis toxicity, 0.02 oculus dexter (OD) and 0.1 oculus sinister (OS) in case 1 and 0.04 OD and 0.2 OS in case 2. But visual acuity recovered as the blood levels of digitalis decreased to the normal level and the corrected visual acuity was 0.7 OD and 0.8 OS in case 1 and 0.8 OD and 0.9 OS in case 2. We recorded 30 Hz-flicker electroretinogram (ERG), single flash ERG, photopic ERG, and scotopic ERG when digitalis blood levels were elevated and normal. Decreased amplitudes of 30 Hz-flicker ERG and photopic ERG suggested that photoreceptor function was disturbed at digitalis toxicity and cone dysfunction was more severely disturbed than rod dysfunction.
30 Hz-flicker ERG, as well as electrocardiogram and digitalis blood level, is a relatively convenient and useful measure of digitalis toxicity. It is necessary consiler toxicity when severe visual dysfunction is observed in patients with digitalis therapy.
我们对两名患有洋地黄中毒的患者进行了电生理测试，这两名患者最初出现畏光和视物变黄症状，并伴有可逆性视力下降和双眼中心暗点。
患者为一名72岁男性和一名54岁男性，均有洋地黄中毒症状。
洋地黄中毒期间矫正视力严重下降，病例1右眼（OD）为0.02，左眼（OS）为0.1；病例2右眼为0.04，左眼为0.2。但随着洋地黄血药浓度降至正常水平，视力恢复，病例1右眼矫正视力为0.7，左眼为0.8；病例2右眼为0.8，左眼为0.9。在洋地黄血药浓度升高和正常时，我们记录了30Hz闪烁视网膜电图（ERG）、单次闪光ERG、明视ERG和暗视ERG。30Hz闪烁ERG和明视ERG的振幅降低表明，在洋地黄中毒时光感受器功能受到干扰，视锥细胞功能障碍比视杆细胞功能障碍受到的干扰更严重。
30Hz闪烁ERG以及心电图和洋地黄血药浓度是检测洋地黄中毒相对方便且有用的指标。在接受洋地黄治疗的患者中观察到严重视觉功能障碍时，有必要考虑中毒情况。
