《视觉神经生理学》特殊视网膜电图.ppt

Stargardt’s disease Stargardts disease A. Fundus. B. Standard ERGs, which are within normal limits. C. mfERG. First-order kernels are presented above and second-order kernels presented below. （二）视网膜脱离 评价术前视网膜功能及其术后恢复情况 与脱离的范围和累及黄斑的程度有关 反应密度降低，峰时延长 （三）视网膜色素变性 Retinitis pigmentosa 早期 中心凹外一阶反应的峰时延长，反应振幅明显下降或消失 中心凹内的峰时正常或轻度延长，反应振幅降低与视力有一定关系，并与视野改变相对应 晚期 整个测试野峰时延长、振幅降低 随离心度加大，变异更加明显 Fundus photograph of a patient with retinitis pigmentosa with the typical bone-spicule pigmentary changes (arrows). Left: photograph; right: fluorescein angiogram. Fundus photograph in patient with late-stage RP with the classic triad. Bone-spicule retinal pigmentation (black arrow), retinal vessel attenuation (white arrow) and waxy disc pallor (red arrow). Histological section through the human retina. Left: healthy retina; middle: retina of a patient with mid-stage RP; right: retina of a patient with late-stage RP. Dark adaptation. Dark adaptation of rods (green line) and cones (red line) in a healthy subject (top) and disturbed dark adaptation (loss of red-green dissociation) in RP patient (bottom). Scotopic electroretinography (ERG), ISCEV standard (International Society for Clinical Electrophysiology of Vision). Normal ERG responses in healthy subject (left) and extinguished responses in RP patient (right). Multifocal electroretinogram. Severely attenuated paracentral responses in RP patient (left) in comparison to normal responses in a healthy subject (right). Goldmann visual fields of a RP patient demonstrating progressive concentric constriction. Top: mid-stage RP; bottom: late-stage RP. （四）糖尿病性视网膜病变 密度下降，峰时延长 （五）青光眼 一阶和二阶反应密度下降，并且二阶反应较一阶反应、黄斑区较周边区下降更明显 分析黄斑区二阶反应和视乳头成分可能是检测青光眼早期损害的指标之一 Multifocal VEPs recorded from a patient with unilateral (right) glaucoma. RED Right eye Review Test 温故而知新 小 结 PERG是视网膜对交替图形刺激产生的电反应 评价黄斑功能，补充ERG的不足 评价是视网膜内层神经节细胞的功能 解释相同刺激的PVEP反应 多焦电生理包括mfERG和mfVEP， mfERG包括 一阶反应：是对单个输入信号的独立脉冲反应，代表对刺激的平均亮度反应，反映视觉系统反应的线性部分，主要起源于视网膜外层 二阶反应：前后两次刺激之间相互