单眼先天性上睑下垂患儿图形视觉诱发电位分析

黄业贤等

[摘要] 目的 探讨单眼先天性上睑下垂患儿图形视觉诱发电位（P-VEP）的特点，评估P-VEP对上睑下垂患儿双眼视觉功能检测的意义。 方法 对53例2～4岁单眼先天性上睑下垂患儿进行P-VEP检查，比较双眼P-VEP的P100潜伏期及振幅是否存在差异。 结果 上睑下垂眼VEP P100波潜伏期较正常组延长中度与重度比较差异有统计学意义（P<0.05）。 结论 单眼先天性上睑下垂患者双眼P-VEP P100波振幅及潜伏期存在差异，根据患儿视觉发育程度进行手术时机选择的同时，应注意术后矫正弱视。

[关键词] 上睑下垂；视网膜电生理；图形视觉诱发电位

[中图分类号] R777.1 [文献标识码] B [文章编号] 2095-0616（2014）10-195-03

[Abstract] Objective To investigate the visual evoked potential （P-VEP） feature in patients with monocular congenital ptosis. To evaluate the significance of P-VEP in binocular vision. Methods P-VEP response was recorded in 53 monocular congenital ptosis children who were 2-4 years old. Then compared the differences of latency period and waver of P100 wave. Results Compared with normal eye，the latency period of ptosis eyes was longer and the amplitude was lower（P<0.01）.The differences of amplitude between mild ptosis eyes and midrange or severe ptosis eyes were significant （P<0.01） while they were not significantly between midrange and severe group.The differences of latency period between mild ptosis eyes and midrange eyes were not significant while they were significantlly between midrange and severe group（P<0.01，P<0.05）. Conclusion Patients with monocular congenital ptosis edured differences response of P-VEP P100 in amplitude and latency period between two eyes.Attention should be focused on mblyopia after surgery.

[Key words] Ptosis；Retinal electrophysiology；Visual evoked potentials

先天性上睑下垂是临床常见儿童眼病，表现为出生后即出现的单侧或双侧上眼睑不能正常上提，常常伴有弱视、屈光不正、屈光参差、斜视等眼部疾患[1-3]，以手术治疗为主，其治疗往往更重视手术效果，而忽略儿童双眼视觉发育、双眼视力平衡、下垂眼弱视治疗等综合因素。人类视觉发育相关研究显示：3岁以内是儿童视觉发育最敏感快速阶段[4]。图形视觉诱发电位（picture visual evoked potential，P-VEP）客观评估视功能，对视觉系统完整性诊断提供重要信息[5]。在临床上已经成为客观评估视力的重要检测方法。在儿科领域，通过检测视觉发育曲线.可以更好地对无法进行视力检查的幼小儿

童进行发育整体评估。我们总结分析了2011年1月～2013年12月在广州市妇女儿童医疗中心眼科确诊的53例2～4岁单眼先天性上睑下垂患儿P-VEP检查结果，探讨P-VEP反应对单眼上睑下垂患儿双眼视功能评估的意义。

1.2 方法

P-VEP检查：应用GT-2000NV视觉电生理检查系统（重庆国特医疗设备有限公司），刺激条件参照吴乐正等[6]的方法，稍加改动：用Ag-AgCl电极，作用电极安放在头部正中线枕骨粗隆上方1cm处的皮肤上，参考电极置于前额正中皮肤上，地电极置于右耳后乳突处皮肤，电极极间阻抗<5kΩ。……