The Photopic Negative Response in Idiopathic Intracranial Hypertension
The Photopic Negative Response in Idiopathic Intracranial Hypertension
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DOI：
10.1167/iovs.15-16586
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发表时间：
2015-06-01
影响因子：
4.4
通讯作者：
McAnany, J. Jason
中科院分区：
文献类型：
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作者：
Moss, Heather E.;Park, Jason C.;McAnany, J. Jason
目的。目的探讨视网膜神经节细胞（RGC）功能在特发性颅内高压（IIH）患者中的作用。我们测量了视障患者（n = 10）和视觉正常对照组（n = 15）在全视场、短亮度闪烁下引起的PhNR振幅和隐式时间。使用标准自动视野平均偏差（SAP-MD）评分评估IIH受试者的视觉功能。采用弗里森视神经乳头水肿分级量表（FPG）评价视神经结构。从光学相干断层扫描图像中提取黄斑神经节细胞复合体体积（GCCV）以评估RGC损失。IIH组的PhNR振幅中位数显著低于对照组（P = 0.015, Mann-Whitney Rank Sum [MW]），但内隐时间与对照组相似（P = 0.54， MW）。IIH组PhNR振幅与SAP-MD呈正相关（Pearson’s r = 0.78, P = 0.008）。神经节细胞复合体体积与SAP-MD （r = 0.72, P = 0.019）和PhNR振幅（r = 0.77, P = 0.009）均相关。多元线性回归模型显示，模型中加入FPG后，GCCV与PhNR振幅的相关性增强（r = 0.94, P < 0.0001），但GCCV与SAP-MD的相关性不明显（r = 0.74, P = 0.009）。IIH患者的光负反应幅度可以降低，这与视觉功能的临床测量（SAP-MD）有很好的相关性。在多变量模型中，它与慢性神经节细胞损伤（GCCV）的影像学指标和急性视神经头病理（FPG）的临床指标相关。需要进一步的研究来确定PhNR作为IIH诊断和监测标志物的临床应用。
PURPOSE. To evaluate the photopic negative response (PhNR) as an index of retinal ganglion cell (RGC) function in idiopathic intracranial hypertension (IIH).METHODS. Amplitude and implicit time of the PhNR, as elicited by full-field, brief-luminance flashes, was measured in IIH (n = 10) and visually normal control (n = 15) subjects. Visual function was assessed in IIH subjects using standard automated perimetry mean deviation (SAP-MD) scores. Optic nerve structure was evaluated using the Frisen papilledema grading scale (FPG). Macula ganglion cell complex volume (GCCV) was extracted from optical coherence tomography images to assess RGC loss.RESULTS. Median PhNR amplitude was significantly lower in IIH subjects compared with control subjects (P = 0.015, Mann-Whitney Rank Sum [MW]), but implicit time was similar (P = 0.54, MW). In IIH subjects, PhNR amplitude and SAP-MD were correlated (Pearson's r = 0.78, P = 0.008). Ganglion cell complex volume was correlated with both SAP-MD (r = 0.72, P = 0.019) and PhNR amplitude (r = 0.77, P = 0.009). Multivariate linear regression models demonstrated that the correlation between GCCV and PhNR amplitude was improved by accounting for FPG in the model (r = 0.94, P < 0.0001), but the correlation between GCCV and SAP-MD was not (r = 0.74, P = 0.009).CONCLUSIONS. Photopic negative response amplitude, which can be decreased in IIH subjects, correlates well with a clinical measure of visual function (SAP-MD). In multivariate models, it correlated with both an imaging measure of chronic ganglion cell injury (GCCV) and a clinical measure of acute optic nerve head pathology (FPG). Further studies are needed to determine the clinical utility of PhNR as a marker for diagnosis and monitoring of IIH.