Lachowicz Ewelina, Lubiński Wojciech
II Department of Ophthalmology, Pomeranian Medical University, Powstańców Wlkp. Street, 72, 70-111, Szczecin, Poland.
Doc Ophthalmol. 2018 Dec;137(3):193-202. doi: 10.1007/s10633-018-9659-5. Epub 2018 Oct 29.
Based on the available literature, it is suggested, in the clinical evaluation of the chiasmal tumors, that the following electrophysiological tests: visual evoked potentials to pattern-reversal stimulation, multifocal visual evoked potentials (mfVEPs), and pattern electroretinogram (PERG) play an important role in the diagnosis of the optic nerve and retinal dysfunction in the course of pituitary tumors.
Macroadenomas and also microadenomas may cause dysfunction of retinal ganglion cells (RGCs) and their axons, even in the absence of changes in the routine ophthalmological examination, retinal sensitivity in standard automated perimetry, and retinal nerve fiber layer thickness in optical coherent tomography. The most frequently observed changes in electrophysiological tests were as follows: in PVEPs-the crossed/uncrossed asymmetry distribution, altered waveform, increase in P100-wave peak time, and/or reduction in amplitude; in mfVEPs-the peak time prolongation and/or amplitude reduction in C1-wave; in PERG-the reduction in N95-wave amplitude and decreased N95:P50 amplitude ratio. Hemifield PVEPs were more often abnormal than full-field PVEPs. Multi-channel recording is recommended for the assessment of the anterior visual pathway. The use of mfVEP offers the possibility to register localized disturbances of the optic nerve and ganglion cells. Additionally, an amplitude of N95-wave reduction in PERG correlated with a lack of postoperative visual acuity recovery. The postoperative improvement in the visual field was found to be associated with a normal N95:P50 amplitude ratio. The RGCs dysfunction manifested by decrease in PhNR/b-wave amplitude ratio was associated with the worse visual fields outcome. A review of the literature summarizing the electrophysiological testing in the pituitary adenoma is discussed.
In patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.
根据现有文献，在视交叉肿瘤的临床评估中，建议采用以下电生理检查：图形翻转刺激视觉诱发电位、多焦视觉诱发电位（mfVEP）和图形视网膜电图（PERG），这些检查在垂体瘤病程中视神经和视网膜功能障碍的诊断中发挥重要作用。
大腺瘤以及微腺瘤均可导致视网膜神经节细胞（RGCs）及其轴突功能障碍，即使在常规眼科检查、标准自动视野计检查中的视网膜敏感度以及光学相干断层扫描中的视网膜神经纤维层厚度均无变化的情况下。电生理检查中最常观察到的变化如下：在图形翻转视觉诱发电位中——交叉/不交叉不对称分布、波形改变、P100波峰时间延长和/或波幅降低；在多焦视觉诱发电位中——C1波峰时间延长和/或波幅降低；在图形视网膜电图中——N95波幅降低以及N95:P50波幅比值降低。半视野图形翻转视觉诱发电位比全视野图形翻转视觉诱发电位更常出现异常。建议采用多通道记录来评估视觉通路前部。使用多焦视觉诱发电位能够记录视神经和神经节细胞的局部性障碍。此外，图形视网膜电图中N95波幅降低与术后视力未恢复相关。视野术后改善与正常的N95:P50波幅比值相关。视网膜神经节细胞功能障碍表现为PhNR/b波幅比值降低，与较差的视野结果相关。本文讨论了一篇总结垂体腺瘤电生理检查的文献综述。
对于垂体瘤患者，检测视觉通路早期功能障碍可能会改变治疗方案并降低不可逆视神经损伤的发生率。
