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Elecrophysiological Tests As an Early Glaucoma Indicator a Cross Sectional Study : 1 2 3 Laila Hassan M Elshazly , Amal A

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Elecrophysiological Tests As an Early Glaucoma Indicator a Cross Sectional Study : 1 2 3 Laila Hassan M Elshazly , Amal A 国际眼科杂志摇 2017 年 1 月摇 第 17 卷摇 第 1 期摇 摇 http:/ / ies. ijo. cn 电话:029鄄82245172摇 摇 85263940摇 摇 电子信箱:IJO. 2000@ 163. com Brief Report · · Elecrophysiological tests as an early glaucoma indicator a cross sectional study : 1 2 3 Laila Hassan M Elshazly , Amal A. ElGohary , Iman A. Fahmy 1 b- wave and the PhNR / b - wave ratio were significantly Department of Ophthalmology, Memorial Institute of reduced P<0. 001 . The rise in IOP resulted in reduction Ophthalmology, Giza, Cairo 12511, Egypt ( ) 2 of PERG and PhNR amplitude. Department of Vision Science, Research Institute of KEYWORDS glaucoma electrophysiology photopic 誗 : ; ; Ophthalmology, Giza, Cairo 12511, Egypt negative response 3 Department of Ophthalmology, Research Institute of DOI:10. 3980 / j. issn. 1672-5123. 2017. 1. 06 Ophthalmology, Giza, Cairo 12511, Egypt Correspondence to : Laila Hassan M Elshazly. Memorial Citation : Elshazly LHM, ElGohary AA, Fahmy IA. institute of Ophthalmology, 3 -Al-Ahram Street, Giza, Cairo Elecrophysiological tests as an early glaucoma indicator: a cross 12511, Egypt. laihasan@ gmail. com Guoji Yanke Zazhi Int Eye Sci sectional study. ( ) 2017;17(1):26-29 Received: 2016-05-30摇 摇 Accepted: 2016-10-17 INTRODUCTION 电生理测试作为早期青光眼诊断指标的横断面 研究 laucomais a group of diseases characterized by optic nerve damage and visual field loss. It causes progressive 1 , 2 , Laila Hassan M Elshazly Amal A. ElGohary Iman A. G 3 loss of vision due to retinal ganglion cells atrophy, either by Fahmy [1] 作者单 位 1 埃 及 开 罗 吉 萨 纪 念 眼 科 学 研 究 所 眼 科 necrosis or apoptosis . The Early Manifest Glaucoma Trial 2 ( : 12511 ; 2 埃及开罗吉萨眼科研究所视力学 3 眼科 and the Ocular Hypertension Treatment ( OHT ) Study 12511 ; ) 通讯作者 suggested that the progression of glaucoma is slowed down by :Laila Hassan M Elshazly. laihasan@ gmail. com reducing IOP and the elevated IOP is a major risk factor for 摘要 developing glaucoma. About 25% to 30% , of the ganglion [2-3] 明视负向反应( )和图形视网膜电图( ) 的结果 cells is already lost when visual field losses are apparent . PhNR PERG 作为评估青光眼的诊断指标。 例对照组和 例早期 Early glaucoma diagnosis can detect patients with early retinal 10 15 青光眼患者接受了完整的眼科检查,包括视力测量,眼压 damage before visual field changes occur. Thus, therapy can ( )测量,眼底检查和视野检查。 同时进行图形视网膜 be applied before irreversible retinal damage and visual field IOP 电图和全视野视网膜点图纪录。 青光眼组的平均偏差和 loss. 图形平均标准偏差显著较低(P , P )。 The pattern electroretinogram ( PERG) reflects ganglion cell <0. 001 <0. 01 PERG , , 波 以 及 波 的 幅 值 显 著 较 低 ( P activity and is therefore a direct and promising approach to N95 PhNR b PhNR / b < )。 眼压升高降低了 与 的振幅。 assist early detection of glaucoma. PERG assesses the function 0郾 001 PERG PhNR 关键词:青光眼;电生理;明视负向反应 of retinal ganglion cells ( RGCs ) by isolating the magnocellular ganglion cell response using a reversing 引用: 电生理测试作为 checkerboard or grating pattern with no change in average Elshazly LHM,ElGohary AA, Fahmy IA. 早期青光眼诊断指标的横 断 面 研 究 国 际 眼 科 杂 志 luminance over time. PERG was used successively in early . 2017;17 diagnosis in primary open angle glaucoma (POAG) and ocular (1):26-29 [4] hypertension . PERG amplitude reduction can appear before [5] Abstract any significant visual field changes . PERG was not used The role of photopic negative response PhNR and widely because it requires refractive correction, clear ocular 誗 ( ) pattern electroretinogram PERG was assessed as media, good patient co - operation for proper placement of ( ) diagnostic indicator of glaucoma. Ten control subjects electrodes otherwise erroneous results can be produced. and 15 patients with early glaucoma underwent complete In conventional flash ERG, the photopic negative response ophthalmological examination including visual acuity (PhNR) is the slow negative potential following the b-wave, measurement intraocular pressure IOP measurement [6] , ( ) , originating from the inner retina . The PhNR amplitude is fundus examination and visual field examination. Pattern associated with cone - related RGCs function and it may be ERG and photopic full- field ERG were performed. Mean compared with the N95 of the PERG. Full - field PhNR deviation MD and pattern standard deviation PSD ( ) ( ) amplitude correlated with the mean deviation of the visual means were significantly reduced in glaucoma group P< [7] ( field . Therefore, its use as a relative measure of the retinal 0. 001 and P<0. 01 . The amplitudes of PERG N95 PhNR ) , , ganglion cells function in glaucoma diagnosis in patients with 26 Int Eye Sci Vol. 17 No. 1 Jan. 2017摇 摇 http / / ies. ijo. cn , , , : Tel 029鄄82245172摇 85263940摇 摇 Email IJO. 2000@163. com : : Figure 1摇 Diagram illustrating摇 A: a full-field ERG trace, showing a-wave(a), b wave(b), i-wave (i), and photopic negative response [9] [5] (PhNR) amplitudes ; B: PERG tracing . mild glaucoma. This study aimed to determine whether the com system ( Roland-Consult). The active ( HK) electrode PhNR elicited by transient white flash on white background was placed in the lower fornix and a silver electrode placed and PERG were characterizing for glaucoma diagnosis in close to the outer can thus for an ipsilateral temporal patients with mild glaucoma. reference. A silver electrode at the midfrontal position, served SUBJECTS AND METHODS as the ground. PERGs were recorded with black and white Patients were recruited from the outpatient clinic of the checkerboard pattern stimulus, reversing 4. 286 times per Research Institute of Ophthalmology and informed consent was second (square wave reversal, cycle time was 0. 232 second) obtained. Ten control subjects ( five men and five women) at a 97% contrast. The stimuli were generated on a monitor and 15 patients (6 males and 9 females ) with early glaucoma subtending viewing angle of 8. 5 degree at a distance of 80 ( MD 臆 - 6. 00 dB) underwent complete ophthalmological cm. The stimuli covered the whole screen, which was 30 cm examination, best corrected visual acuity, anterior segment wide and 37 . 5 cm high. The amplifier bandpass filters examination by slit lamp, IOP measurement by applanation were 5 -50 Hz. tonometry. Fundus examination was done after full mydriasis Each patient was refracted and viewed the checkerboard with to detect optic disc cupping and rim changes characteristic of an appropriately adjusted refractive correction. The pupil was glaucoma. Visual field was performed using Humphrey then dilated with phenylephrine hydrochloride 2. 5% eye automated VF analyzer, with the central 24-2 strategy. drops (Misr, Egypt) and tropicamide 1% eye drops (Alcon, Inclusion criteria were subjects of early primary open angle Egypt). The single flash photopic ERG was recorded with a glaucoma with high IOP ( measured with Goldmann Ganzfeld stimulator. The white Standard Flash was used, with -2 applanation tonometry at two different times) exceeding 22 a flash intensity of 3 cd. m at frequency of 0. 3 Hz and cycle mm Hg with additional risk factors such as glaucoma of the time of 3. 3 second, the rods being suppressed by a white -2 fellow eye or positive family history of glaucoma, normal and background with a luminance of 25 cd. m . reliable visual field test results, as defined below, and early The PhNR signal is the slow negative potential following a - glaucomatous optic cupping. Exclusion criteria were best and b - waves in photopic ERG. Amplitudes of waves were corrected visual acuity less than 6 / 9 (0. 8 decimal), any measured from baseline to the lowest point of the negative e. g secondary glaucoma ( . pigment dispersion or peak for PhNR and the a - wave and from the latter to the pseudoexfoliation syndrome ), diabetic retinopathy or other positive peak for the b -wave. The a -, b - wave and PhNR disease capable of causing visual field loss or optic disc peak latencies were calculated from the flash onset to the damage. Visual field examination ( Humphrey field peaks of waves. All electrophysiology traces were analyzer ), and electrophysiological tests were done as characterized by two negative and one positive deflection. The follows. PERG P50-N95 was measured from P50 peak to N95 tough. Visual Field Criteria 摇 Visual field defects, measured by The photopic ERG a-wave was measured from the baseline, static automated perimetry ( SAP, Humphrey Visual Field the b-wave measured from a-wave trough to b-wave peak. Analyzer, Humphrey Instruments, San Leonardo, CA). The The PhNR from baseline to the trough of the following negative SITA standard strategy was applied to program 24-2 white on wave. The PhNR ratio was calculated PhNR / b wave. Figure 1 white. Mean deviation (MD) was analyzed. The visual field ( A and B) shows illustration of the ERG and PERG tracings. RESULTS defect was described as glaucomatous based on European [8] Glaucoma Society guidelines and classified as early with MD All open - angle glaucoma patients were receiving ocular equal or less than -6. 00 dB. hypotensive therapy. Compared with the control group, the Electophysiological Examination 摇 Photopic ERG and IOP was not significantly higher in the open-angle glaucoma P t Pattern ERG recordings were recorded binocularly using Reti- due to effective medical treatment ( = 0. 12, -test) . MD 27 国际眼科杂志摇 2017 年 1 月摇 第 17 卷摇 第 1 期摇 摇 http:/ / ies. ijo. cn 电话:029鄄82245172摇 摇 85263940摇 摇 电子信箱:IJO. 2000@ 163. com Table 1摇 Results of the examined groups 摇 摇 摇 摇 摇 摇 摇 摇 n n Control( = 10 Glaucoma( = 15 P Group cases, 20 eyes) cases, 30 eyes) Age(a) 45. 3依7. 54 48. 13依7. 46 0. 197 IOP (mm Hg) 15. 5依1. 67 19. 7依2. 78 0. 12 Cup / disc ratio 0. 29依0. 08 0. 34依0. 07 0. 06 a MD (dB) -0. 45依0. 24 -2. 7依0. 98 <0. 001 a PSD (dB) 1. 5依0. 11 3. 50依1. 29 <0. 01 a-wave (滋V) 9. 13依0. 38 7. 92依0. 29 0. 059 a b-wave(滋V) 44. 75依3. 42 40.
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