目的：探索多焦视觉诱发电位（mfVEP）联合光学相干断层扫描（OCT）检查在诊断青光眼功能和结构改变的客观性及敏感性。方法对90例青光眼患者和30名正常人分别进行 Humphrey 视野计（ HVF）、mfVEP和OCT检查，按照青光眼视野损害程度分为轻度损害、中度损害、重度损害三组，每组选择30例，组成实验组90例。选取损害较轻的一眼纳入研究，评价mfVEP和OCT的敏感性、客观性。结果正常对照组平均视野缺损（mean deviation，MD）为（－0.93±0.97）dB，轻度损害组为（－3.16±1.76）dB，中度损害组为（－12.82±3.92）dB，重度损害组为（－27.10±3.73）dB。实验组各亚组患者的损害程度较正常对照组大，差异具有统计学意义。正常对照组视盘周平均视网膜神经纤维层（ Retinal nerve fiber layer， RNFL ）厚度为（109.14±6.48）μm，轻度损害组为（98.97±15.43）μm，中度损害组为（72.63±11.21）μm，重度损害组为（64.15±11.45）μm，实验组各亚组患者视盘周RNFL厚度较正常对照组薄，差异具有统计学意义，并且RNFL厚度随着青光眼损害程度的加重而变薄。正常对照组mfVEP平均振幅均方根（ root mean square，RMS）为（12.60±4.19）nV／deg2，轻度损害组为（11.23±6.36）nV／deg2，中度损害组为（10.38±4.95）nV／deg2，重度损害组为（8.03±3.89）nV／deg2，轻度损害组及中度损害组与正常对照组之间的差异无统计学意义，重度损害组与正常对照组之间的差异有统计学意义。正常对照组mfVEP的平均潜时为（104.37±24.95）ms，轻度损害组为（102.09±32.89）ms，中度损害组为（99.73±7.83）ms，重度损害组为（96.71±5.86），实验组各亚组与正常对照组相比差异无统计学意义。结论 OCT能客观反应青光眼患者神经纤维层的损害情况，mfVEP对晚期青光眼的诊断比较有价值，而且RMS比平均潜时有意义；mfVEP联合OCT以及HVF检查对诊断青光眼更有帮助。%Objce tive To explore the objectivity and sensitivity of multifocal visual evoked potential ( mfVEP) combined with optical coherence tomography( OCT)in the diagnosis of functional and structural change of glaucoma.Methods Ninety glaucoma patients( experimental group) and30 patients with normal eyesight( the control group) were taken Humphrey perimetry( HVF) , mfVEP and OCT examination.According to the extent of glaucoma-tous visual field damage,all glaucoma patients were divided into 3 subgroups:mild damage group, moderate damage group, severe damage group,with 30 cases in each group.One eye with lighter damage was selected for evaluating the sensitivity and objectivity of mfVEP and OCT.Results The average visual field defect ( mean deviation, MD) was (-0.93 ±0.97)dB in the control group, (-3.16 ±1.76)dB in mild injury group, (-12.82 ±3.92) dB in mod-erate damage group, (-27.10 ±3.73)dB in severe damage group.The extent of damage in each subgroup of the ex-perimental group was greater than that in the control group,showing a statistically significant difference; The average thickness of peripapillary retinal nerve fiber layer was (109.14 ±6.48)μm in the control group, (98.97 ±15.43)μm in the mild damage group, (72.63 ±11.21)μm in the moderate damage group, and (64.15 ±11.45)μm in the se-vere injury group, peripapillary RNFL thickness in each subgroup of experimental group was thinner than that in the control group,the difference was statistically significant, and RNFL thickness got more thinner with the increase of the extent of damage of glaucoma.The RMS of amplitude of mfVEP was ( 12.60 ±4.19 ) nV/deg2 in the control group, (11.23 ±6.36)nV/deg2 in the mild damage group, (10.38 ±4.95) nV/deg2 in the moderate damage group, and (8.03 ±3.89)nV/deg2 in the severe injury group, in all subgroups of experimental group,the difference between mild and moderate damage group and control group was not statistically significant, the difference between severe damage group and the control group was statistically significance.The average latent time of mfVEP was (104.37 ± 24.95)ms in the control group, (102.09 ±32.89)ms in the mild injury group,(99.73 ±7.83)ms in the moderate damage group, and (96.71 ±5.86)ms in the severe damage group, between each subgroup of experimental group, and the control group the difference was not statistically significant.Conclusion OCT can show the damage of the nerve fiber layer in patients with glaucoma objectively, mfVEP is more valuable for diagnosis of advanced glaucoma, and the RMS is more valuable than the average of latent time;mfVEP combined with OCT and HVF is more helpful in the diagnosis of glaucoma.
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