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Elektrophysiologische Untersuchungsmethoden in der Glaukomdiagnostik

Electrophysiological examination methods in glaucoma diagnostics

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Zusammenfassung

Für die Glaukomfrühdiagnostik sind derzeit 2 elektrophysiologische Methoden am vielversprechendsten: 1) Mit dem Pattern-ERG (PERG) können Augen mit einer okulären Hypertension 4 Jahre vor Auftreten einer Konversion mit Manifestation eines Gesichtsfelddefekts mit einer Sensitivität und Spezifität von ca. 75% identifiziert werden. Hierzu müssen der verwendete Reiz und das Auswerteprotokoll optimal angepasst sein (Verwendung bestimmter Karogrößen und Reizfrequenzen sowie Auswertung von Amplitudenverhältnissen auf verschiedene Karogrößen). Das PERG kann allerdings nur bei Patienten mit einem bestkorrigierten Visus ≥ 0,8 ohne wesentliche Medientrübungen reliabel verwendet werden, um falsch positive Ergebnisse zu vermeiden. 2) Die sog. „photopic negative response“, eine Komponente des Ganzfeld-ERGs, ist zwar etwas einfacher abzuleiten als das PERG und ist von optisch bedingten Visusreduktionen unbeeinträchtigt, jedoch ist sie nach bisherigen Ergebnissen dem PERG bezüglich der Glaukomfrühdiagnostik etwas unterlegen.

Abstract

The two currently used most successful techniques for early detection of glaucoma are described. (1) The pattern electroretinogram (PERG) allows detection of incipient glaucomatous damage in eyes with ocular hypertension up to 4 years ahead of manifest glaucoma with a sensitivity and specificity of approximately 75%. This is achieved by selecting optimized stimulation (check size and stimulation frequency) and analysis protocols (amplitude ratio to different check sizes). The major disadvantage is the requirement for best corrected visual acuity to be at least 0.8(decimal) to avoid false positive results. (2) The photopic negative response (PhNR), a component of the Ganzfeld ERG, does not suffer from optical factors reducing visual acuity. It is also affected in early glaucoma but so far has not achieved the same sensitivity and specificity as the PERG.

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  1. Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    C.M. Poloschek & M. Bach

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  2. M. Bach
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Correspondence to C.M. Poloschek.

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Poloschek, C., Bach, M. Elektrophysiologische Untersuchungsmethoden in der Glaukomdiagnostik. Ophthalmologe 109, 358–363 (2012). https://doi.org/10.1007/s00347-012-2546-7

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