图形翻转视觉诱发电位检查对白内障术后视力评估的价值

摘要

目的：探讨图形翻转视觉诱发电位（ pattern reversal visual evoked potential ，PRVEP）检查对白内障术后视力评估的价值。　　方法：回顾性分析2012-10/2013-05在同济医院眼科住院，并在白内障超声乳化术及人工晶状体植入手术前后接受PRVEP检查的的成年白内障患者72例114眼的病例资料，其中76眼为老年性白内障，38眼为并发性白内障。根据晶状体混浊程度及晶状体核硬度将数据分为两组：核硬度Ⅰ，Ⅱ，Ⅲ级为A组，核硬度Ⅳ，Ⅴ级为B组，应用统计学方法进行数据间的相关性分析。　　结果：A组：（1）术前：视力平均值为0．344， PRVEP检查P100波的潜伏期平均值为107ms，N75-P100波的振幅平均值为4．633μV；术后：视力平均值为0．672，PRVEP检查P100波的潜伏期平均值为104．37ms，N75-P100波的振幅平均值为4．400μV。（2）手术前后视力与P100波的潜伏期呈显著负相关（P＜0．01）；手术前后视力与N75-P100波的振幅呈显著正相关（术前P＜0．01，术后P＜0．05）。（3）手术前后视力改善行数与P100波的潜伏期变化值无相关性。B组：（1）术前：视力平均值为0．116，P100波的潜伏期平均值为118．905ms，N75-P100波的振幅值为1．650μV；术后：视力平均值为0．576， P100波的潜伏期平均值为108.429ms，N75-P100波的振幅值5．132μV。（2）术前视力与P100波的潜伏期呈现显著负相关（ P＜0．05），而术后视力与P100波的潜伏期没有相关性；手术前后视力与N75-P100波的振幅没有相关性。（3）手术前后视力改善行数与P100波的潜伏期变化值没有相关性。　　结论：由白内障手术前后两组视力与PRVEP的P100波的潜伏期及N75-P100波的振幅的相关性可知， PRVEP受患者术前视力（即屈光间质混浊程度）影响较大，PRVEP检查不能作为白内障术后视力预后的判断指标，白内障手术前的PRVEP检查没有临床意义。%AIM:To discuss visual acuity assessment after cataract surgery by pattern reversal visual evoked potential. METHODS:Data of 72 adult cataract patients received PRVEP before and after phaco and IOL in Department of Ophthalmology, Tongji Hospital from October 2012 to May 2013 was analyzed retrospectively. A total of 114 eyes were studied, including 76 eyes with senile cataract and 38 eyes with complicated cataract.According to the degree of lens opacity and the hardness of lens nucleus , these data were divided into two groups:Group 1 ( gradeⅠ, Ⅱ, Ⅲ ) and Group 2 ( grade Ⅳ, Ⅴ ) and was statistically studied with correlation analysis . RESULTS: Group 1: ( 1 ) Preoperative: the average of visual acuity was 0.344, the incubation time of P100 wave was 107ms and the amplitude of N75 -P100 wave was 4.633μV;postoperative:the average of visual acuity was 0.672, the incubation time of P100 wave was 104.37ms and the amplitude of N75-P100 wave was 4.400μV.( 2 ) The visual acuity before and after operation were both significantly negatively correlated with the incubation time of P100 wave ( P<0.01 ) and significantly positively correlated with the amplitude of N75 - P100 wave (preoperative:P<0.01,postoperative: P<0.05);(3) The improved rows of the visual acuity before and after operation showed no relationship with the change of the incubation time of P100 wave.Group 2 :(1)Preoperative:the average of visual acuity was 0.116, the incubation time of P100 wave was 118.905ms and the amplitude of N75-P100 wave was 1.650μV;postoperative: the average of visual acuity was 0.576, the incubation time of P100 wave was 108.429ms and the amplitude of N75-P100 wave was 5.132μV. ( 2 ) The visual acuity before operation was significantly negatively correlated with the incubation time of P100 wave(P<0.05),while the visual acuity after operation showed no relationship with the incubation time of P100 wave; the visual acuity before and after operation showed no relationship with the amplitude of N75-P100 wave.(3)The improved rows of the visual acuity before and after operation showed no relationship with the change of the incubation time of P100 wave. CONCLUSION:According to the correlation among the visual acuity, the incubation time of P100 wave and the amplitude of N75 -P100 wave, PRVEP is significantly affected by preoperative visual acuity ( the degree of opacity in refractive media) .PRVEP is not helpful as an indicator of visual prognosis after cataract surgery, and PRVEP before cataract surgery has no clinical significance.