弱视儿童扫描视觉诱发电位视力与国际标准视力的比较  

The study of sweep pattern visual evoked potential acuity(SPVEP-A)and international standard visual acuity in amblyopic children

作　　者：樊云葳[1] 李晓清[1] 田桂芬[1] 

机构地区：[1]北京大学第一医院小儿眼科,100034

出　　处：《眼科》2008年第4期269-273,共5页Ophthalmology in China

摘　　要：目的探讨扫描翻转图形视觉诱发电位(SPVEP)在弱视儿童客观视力评估的可行性。设计前瞻性病例研究。研究对象80例(148眼)弱视儿童及26例(52眼)正常视力儿童。方法弱视儿童进行扫描图形翻转视觉诱发电位视力(SPVEP-A)与国际标准E字视力检测;正常视力儿童进行SPVEP-A、传统瞬态图形视觉诱发电位(PVEP)视力(PVEP-A)与E字视力检测,对检测结果进行相关性分析。使用LKC公司UTES-E3000型视觉电生理仪检测SPVEP,选用0.2～18.8epd的25个空间频率正弦光栅连续刺激视网膜,经离散傅立叶分析,获得振幅。空间频率曲线,并将相关直线外推至0振幅,获得SPVEP视力。在PVEP检测中将典型VEP波形的最高空间频率作为PVEP视力。主要指标SPVEP-A、PVEP-A和E字视力。结果弱视患者矫正视力在0.1～0.8之间,SPVEP-A在0.35～0.9之间,SPVEP-A与E字视力的相关系数r=0.602(P<0.01)。SPVEP-A两次重复检测的相关系数r=0.448。轻度弱视SPVEP-A与E字视力的相关性(r=0.773)优于中重度弱视者(r=0.590)。正常儿童SPVEP-A与E字视力的相关系数r=0.424,PVEP-A与E字视力的相关系数r=0.679。SPVEP-A与E字视力比较存在高估、低估现象,在E字视力的低视力段,SPVEP-A存在高估现象;在E字视力的高视力段,SPVEP-A存在低估现象。结论扫描翻转图形视觉诱发电位是筛查弱视儿童客观视力的一种疗法。SPVEP-A与E字视力存在明显的正相关,但变异较大,应进一步提高检测的稳定性与准确性。Objective To evaluate the clinical application of sweep pattern visual evoked potential in assessing visual acuity （SPVEP-A） of amblyopic children. Design Prospective clinical study, Participants 80 patients （148 case） of amblyopic children and 26 children （52 case） with normal vision, Methods The correlation were analysed of SPYEP-A and E acuity in 80 amblyopic children and of SPVEP-A and PVEP-A in 26 children of normal visual. SPYEP-A was recorded with UTAS-E 3000（LKC） using gratings of 25 different spatial frequency from 0.2 to 18.8cpd as stimulus. The response were averaged and DFT on the monitor display. SPVEP-A was determined by extrapolate to 0 response amplitude, Both transient PVEP-A and SPVEP-A were examined in 26 normal children. The objective visual acuity in PVEP were determined with the highest spatial frequency which evoked a recognizable response. Main Out- come Measures SPVEP-A, PVEP-A and E acuity. Results SPVEP-A were from 0.35 to 0.9 among 80 patients with corrected E acu- ity from 0.1 to 0.8. The correlation coefficient of SVEP-A-1 with E acuity was 0.602 . The correlation coefficient of SPVEP-A.between reproducibility detection was 0.448. The correlation between SPVEP-A and E acuity in amblyopic slightly was higher than middle and severe amblyopia （r=0.773 vs r=0.590）.ln 26 normal children a correlation coefficient of 0.679 was obtained between E acuity and PVEP-A but 0.424 between E acuity and SPVEP-A. Higher evaluation or lower evaluation of E acuity was found in SPVEP-A in this study. Acuity was upestimated in lower scope of E acuity and underestimated in higher scope of E acuity. The reproducibility and variation were not satisified. Conclusion The sweep VEP is a objective method of amblyopic screening. There is significant positive correlation between SPVEP-A and E, but its variability is more great, so we should improve its stability and positive rate uheriorly.

关 键 词：弱视 SPVEP—A PVEP—A 客观视力 

分 类 号：R777.44[医药卫生—眼科] R776.1[医药卫生—临床医学]