Purpose

To evaluate the validity of electrophysiological tests in the early diagnosis of a ganglion cells and/or optic nerve dysfunction in patients with pituitary microadenoma.

Methods

66 eyes, from 33 patients with microadenoma with no evidence of the optic chiasm compression in magnetic resonance imaging (MRI) and the visual impairment in the routine ophthalmological examination, standard static perimetry (24-2 white on white) and optical coherence tomography (HD-OCT), were analysed. The pattern electroretinogram (PERG), standard pattern visual evoked potentials (PVEPs) and multichannel visual evoked potentials (mVEPs) (ISCEV standards) were performed. The results obtained from the electrophysiological tests were compared to the same number of age-matched healthy controls.

Results

Statistically significant differences between the patients with microadenoma and healthy controls were detected in all electrophysiological tests (p < 0.001). The most frequent abnormalities were observed in mVEPs (25/33 patients, 75.8%; 43/66 eyes, 65.2%). The most frequent features registered in this test were: (1°4′)—an increase in the P100wave latency from uncrossed fibres (13/33 patients, 39.39%; 21/66 eyes, 31.8%) and (0°16′)—an amplitude reduction of this wave from the crossed fibres (11/33 patients, 33.33%; 19/66 eyes, 28.8%). The changes in PVEPs (15/33 patients, 45.5%; 25/66 eyes, 37.9%) and PERG (10/33 patients, 30.3%; 15/66 eyes, 22.7%) were also registered. Of all the tests and parameters analysed in the study, the greatest diagnostic value in detecting the visual pathway dysfunction in this group of patients was the amplitude of P100 wave from the crossed fibres of the mVEPs (1°4′) with a sensitivity of 60.6% and a specificity of 93.8%. These parameters suggest that this type of dysfunction is downstream to the chiasm and can also indicate the visual pathway dysfunction severity.

Conclusions

In patients with microadenoma, the abnormalities in the electrophysiological tests are registered even without clinical evidence of visual impairment from the routine ophthalmological examination, SAP, OCT and chiasmal compression in MRI. The mVEPs have the most significant role in the diagnosis of the visual pathway dysfunction in patients with microadenoma.

中文翻译：

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早期检测微腺瘤患者视觉通路功能障碍的电生理检测

目的

评估电生理检查在垂体微腺瘤患者神经节细胞和/或视神经功能障碍早期诊断中的有效性。

方法

66 只眼，来自 33 名微腺瘤患者，在磁共振成像 (MRI) 和常规眼科检查、标准静态视野检查（白底白字 24-2）和光学相干断层扫描（HD -OCT)，进行了分析。进行了模式视网膜电图 (PERG)、标准模式视觉诱发电位 (PVEP) 和多通道视觉诱发电位 (mVEP)（ISCEV 标准）。将从电生理测试获得的结果与相同数量的年龄匹配的健康对照进行比较。

结果

在所有电生理测试中检测到微腺瘤患者和健康对照之间存在统计学上的显着差异（p < 0.001)。在 mVEP 中观察到最常见的异常（25/33 名患者，75.8%；43/66 只眼，65.2%）。在该测试中记录的最常见特征是：（1°4'）——未交叉纤维的 P100 波潜伏期增加（13/33 名患者，39.39%；21/66 只眼睛，31.8%）和（0°16'） — 来自交叉纤维的这种波的振幅降低（11/33 名患者，33.33%；19/66 只眼睛，28.8%）。还记录了 PVEP（15/33 名患者，45.5%；25/66 眼，37.9%）和 PERG（10/33 名患者，30.3%；15/66 眼，22.7%）的变化。在研究分析的所有测试和参数中，检测这组患者视觉通路功能障碍的最大诊断价值是来自mVEPs（1°4'）交叉纤维的P100波幅度，灵敏度为60.6 % 和 93.8% 的特异性。

结论

在微腺瘤患者中，即使没有来自常规眼科检查、SAP、OCT 和 MRI 交叉压迫的视力障碍的临床证据，电生理测试的异常也会被记录下来。mVEPs 在微腺瘤患者视觉通路功能障碍的诊断中具有最重要的作用。