Ординатура / Офтальмология / Английские материалы / Electrophysiology of Vision_Lam_2005

examination, blood pressure measurement, and a history of hypertension. Treatment is control of the hypertension.

Clinical electrophysiologic testing of patients with hypertensive retinopathy is seldom performed because of the reliance by most clinicians on retinal appearance. However, similar to diabetic retinopathy, reduced and delayed oscillatory potentials without any impairment of the a-wave and b-wave amplitudes on full-field ERG may occur in hypertensive patients with early or no retinopathy, indicating that the ERG is a sensitive indicator of mild disturbance of retinal circulation. Eichler et al. (66) found prolonged and reduced oscillatory potential wavelets in patients with mild hypertension and grade I hypertensive retinopathy. Likewise, Mu¨ ller et al. (67) noted reduced oscillatory potential wavelets O2 and O4 in 24 patients with hypertension of more than 10 years with grade I or grade II hypertensive retinopathy. Further, Rivalico et al. (68) performed full-field ERG performed initially and repeated after a mean period of eight months after treatment in 24 patients with untreated stage 1 hypertension and early or no hypertensive retinopathy. Increased systolic blood pressure correlated with reduced sum of the amplitudes of oscillatory potential wavelets O1, O2, and O3. After instituting medical antihypertensive therapy, oscillatory potential amplitudes did not improve significantly except in patients treated with angiotensinconverting enzyme inhibitors, presumably because of the vasodilation effects of the medications that may have increased retinal blood flow (69). Of note, Henkes and van der Kam (70) reported generalized supernormal full-field ERG responses in hypertensive patients without retinopathy, but this finding is not well studied by others.

With progression of hypertensive retinopathy, other ERG parameters including scotopic and photopic a-wave and b-wave responses become impaired due to retinal and choroidal ischemia. Talks et al. (71) performed full-field ERG and pattern VEP in 34 patients with grade III or grade IV hypertensive retinopathy. Analysis of the ERG a-wave was not reported, but the b-wave was significantly reduced and prolonged in all patients and the impairment persisted in

the 12 patients who had 2–4 years of follow up. In the same study, pattern VEP was significantly reduced and prolonged due to the retinopathy and anterior ischemic optic neuropathy if present. EOG light-peak to dark-trough amplitude ratio is reduced in some patients with hypertensive retinopathy, and EOG impairment is likely to parallel the degree of retinal and choroidal ischemia (72).

Idiopathic Polypoidal Choroidal Vasculopathy

Idiopathic polypoidal choroidal vasculopathy is a rare disorder characterized by polypoidal-shaped choroidal vascular lesions (73). The recognition of these particular lesions is enhanced by fluorescein or indocyanine green angiography. The orange subretinal lesions are variable in size and appear to be polypoidal dilations arising from a choroidal vascular network. Peripapillary lesions are common but macular lesions have also been described (74). Serosanguineous detachment of the retinal pigment epithelium may occur over the choroidal lesion. Other names for the disorder include posterior uveal bleeding syndrome and multiple recurrent serosanguineous retinal pigment epithelial detachment syndrome. Affected persons have a female to male ratio of about 5:1, and most cases are bilateral. The disease tends to affect pigmented individuals with blacks at the greatest risk in the United States. Decreased vision is the most common symptom.

Reports of electrophysiologic findings in idiopathic polypoidal choroidal vasculopathy are extremely scarce. In theory, multifocal ERG is more likely to detect localized areas of retinal dysfunction (than full-field ERG), and the VEP is likely to parallel ERG and macular function.

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