Stiefelmeyer Sandra, Neubauer Aljoscha S, Berninger Thomas, Arden Geoffrey B, Rudolph Günther
Department of Ophthalmology, Ludwig-Maximilians-Universität, Mathildenstrasse 8, 80336 Muenchen, Germany.
Vision Res. 2004 Jan;44(1):103-12. doi: 10.1016/j.visres.2003.08.012.
The pattern ERG can be used to detect early glaucomatous change, because the response of cells in the inner retina from (typically) 20 degrees -40 degrees of area is reduced before perimetric abnormality is certain. The multifocal pattern electroretinogram (mfPERG) allows analysis of many local regions within this area. The aim of this study was to investigate whether in patients with presumed glaucoma the mfPERG permits diagnosis and discrimination from normals.
Measurements on 25 age-related normal eyes were compared to those on 23 eyes with different stages of glaucoma. A RETIScan system was used to generate a stimulus pattern of 19 hexagons, each consisting of six triangles. The triangles pattern-reversed black to white at 75 Hz. Those 19 hexagons were grouped into three stimulus regions: a central field, a middle, and a peripheral ring. The complete array subtended 48 degrees at the eye. The hexagons alternated between black and white, in a temporal pattern that followed a corrected binary m-sequence (length 512, 10 cycles with 39 s each). The amplitudes and latencies of positive responses at approximately 50 ms (P-50) and negative responses at approximately 95 ms (N-95) were analyzed.
In patients with glaucoma the P-50 and N-95 components of the mfPERG were significantly reduced for the central area and both outer rings compared to normal volunteers (p<0.001, Mann-Whitney-U). The most distinct reduction was observed for N-95 and the central ring. Changes in latencies were not conclusive. The reduction of the components increased with the stage of glaucoma. A predictive model for detecting early glaucomatous changes was designed based on P-50-N-95 with 88% sensitivity and 76% specificity.
In glaucoma a marked reduction of components, especially centrally is observed in the mfPERG. This hints to an early involvement of central ganglion cells and may be useful for future functional tests.
图形视网膜电图（ERG）可用于检测早期青光眼性改变，因为在视野异常确定之前，（通常）视网膜内层20度至40度区域内细胞的反应就已降低。多焦图形视网膜电图（mfPERG）能够分析该区域内的多个局部区域。本研究的目的是调查在疑似青光眼患者中，mfPERG是否有助于诊断以及与正常人进行鉴别。
将25只年龄相关性正常眼睛的测量结果与23只处于不同青光眼阶段眼睛的测量结果进行比较。使用RETIScan系统生成一个由19个六边形组成的刺激图案，每个六边形由六个三角形组成。三角形以75赫兹的频率进行黑白反转。这19个六边形被分为三个刺激区域：一个中心区域、一个中间区域和一个外周环。整个阵列在眼睛处的视角为48度。六边形在黑白之间交替，其时间模式遵循校正后的二进制m序列（长度为512，10个周期，每个周期39秒）。分析了大约50毫秒时的正向反应（P - 50）和大约95毫秒时的负向反应（N - 95）的振幅和潜伏期。
与正常志愿者相比，青光眼患者mfPERG的中心区域和两个外环的P - 50和N - 95成分显著降低（p < 0.001，曼 - 惠特尼 - U检验）。N - 95和中心环的降低最为明显。潜伏期的变化不具有决定性。成分的降低随着青光眼的阶段而增加。基于P - 50 - N - 95设计了一个检测早期青光眼性改变的预测模型，其灵敏度为88%，特异性为76%。
在青光眼中，mfPERG的成分明显降低，尤其是在中心区域。这提示中央神经节细胞早期受累，可能对未来的功能测试有用。
