II Department of Ophthalmology, Pomeranian Medical University, SPSK-2, Powstańców Wlkp. 72, 70-111, Szczecin, Poland.
Clinic of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, SPSK-1, Szczecin, Poland.
Doc Ophthalmol. 2021 Oct;143(2):115-127. doi: 10.1007/s10633-021-09827-x. Epub 2021 Mar 20.
To evaluate the validity of electrophysiological tests in the early diagnosis of a ganglion cells and/or optic nerve dysfunction in patients with pituitary microadenoma.
66 eyes, from 33 patients with microadenoma with no evidence of the optic chiasm compression in magnetic resonance imaging (MRI) and the visual impairment in the routine ophthalmological examination, standard static perimetry (24-2 white on white) and optical coherence tomography (HD-OCT), were analysed. The pattern electroretinogram (PERG), standard pattern visual evoked potentials (PVEPs) and multichannel visual evoked potentials (mVEPs) (ISCEV standards) were performed. The results obtained from the electrophysiological tests were compared to the same number of age-matched healthy controls.
Statistically significant differences between the patients with microadenoma and healthy controls were detected in all electrophysiological tests (p < 0.001). The most frequent abnormalities were observed in mVEPs (25/33 patients, 75.8%; 43/66 eyes, 65.2%). The most frequent features registered in this test were: (1°4')-an increase in the P100wave latency from uncrossed fibres (13/33 patients, 39.39%; 21/66 eyes, 31.8%) and (0°16')-an amplitude reduction of this wave from the crossed fibres (11/33 patients, 33.33%; 19/66 eyes, 28.8%). The changes in PVEPs (15/33 patients, 45.5%; 25/66 eyes, 37.9%) and PERG (10/33 patients, 30.3%; 15/66 eyes, 22.7%) were also registered. Of all the tests and parameters analysed in the study, the greatest diagnostic value in detecting the visual pathway dysfunction in this group of patients was the amplitude of P100 wave from the crossed fibres of the mVEPs (1°4') with a sensitivity of 60.6% and a specificity of 93.8%. These parameters suggest that this type of dysfunction is downstream to the chiasm and can also indicate the visual pathway dysfunction severity.
In patients with microadenoma, the abnormalities in the electrophysiological tests are registered even without clinical evidence of visual impairment from the routine ophthalmological examination, SAP, OCT and chiasmal compression in MRI. The mVEPs have the most significant role in the diagnosis of the visual pathway dysfunction in patients with microadenoma.
评估电生理学检查在垂体微腺瘤患者的神经节细胞和/或视神经功能障碍早期诊断中的有效性。
分析 33 例垂体微腺瘤患者的 66 只眼，这些患者在磁共振成像（MRI）中没有视交叉受压的证据，且常规眼科检查没有视力障碍，进行标准静态视野检查（24-2 白对白纸）和光学相干断层扫描（HD-OCT），还进行了图形视网膜电图（PERG）、标准图形视觉诱发电位（PVEPs）和多通道视觉诱发电位（mVEPs）（ISCEV 标准）。将电生理学检查结果与相同数量的年龄匹配的健康对照组进行比较。
在所有电生理学测试中，患者与健康对照组之间存在统计学显著差异（p<0.001）。在 mVEPs 中观察到最常见的异常（25/33 例患者，75.8%；43/66 只眼，65.2%）。在该测试中记录到的最常见特征是：（1°4'）-未交叉纤维的 P100 波潜伏期增加（13/33 例患者，39.39%；21/66 只眼，31.8%）和（0°16'）-交叉纤维的此波振幅降低（11/33 例患者，33.33%；19/66 只眼，28.8%）。还记录到 PVEPs（15/33 例患者，45.5%；25/66 只眼，37.9%）和 PERG（10/33 例患者，30.3%；15/66 只眼，22.7%）的变化。在研究中分析的所有测试和参数中，mVEPs 的交叉纤维 P100 波振幅（1°4'）在检测该组患者视通路功能障碍方面具有最大的诊断价值，其灵敏度为 60.6%，特异性为 93.8%。这些参数表明，这种类型的功能障碍发生在视交叉之后，也可以表明视通路功能障碍的严重程度。
即使在常规眼科检查、SAP、OCT 和 MRI 中没有视交叉受压的临床证据，垂体微腺瘤患者的电生理学检查也会出现异常。mVEPs 在诊断垂体微腺瘤患者的视通路功能障碍方面具有最重要的作用。
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