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目的:通过评估比较治疗前后解剖结构和视功能的变化,包括视网膜神经纤维厚度、图形视觉诱发电位、传统视神经功能检查,早期检测乙胺丁醇毒性。方法:前瞻性研究,包括参加马来西亚理科大学医院的短期治疗观察项目的36例72眼结核病患者。视力和视神经功能检查由同一位研究者进行。同样,Humphrey自动视野检查、光学相干断层扫描(OCT)检查视网膜神经纤维厚度(RNFL)和图形视觉诱发电位(PVEP)均由同一位技术人员进行。在开始乙胺丁醇治疗前和治疗3mo后各进行检查一次。结果:乙胺丁醇治疗前后视力、彩色视觉、光亮度、红光反射和眼底检查无明显改变。然而,平均视野缺损在治疗后较前变差(P=0.010)。OCT和PVEP有显著变化,P100潜伏期延长、幅度降低,RNFL在各个象限均增厚(P<0.05)。结论:通过OCT检测RNFL厚度以及使用PVEP检测P100波峰潜伏期和幅度,可以在传统视神经功能检查异常之前,发现乙胺丁醇治疗后早期解剖结构和视功能的亚临床改变。
OBJECTIVE: To assess the changes of anatomy and visual function before and after treatment, including the thickness of retinal nerve fibers, the visual evoked potential of the optic nerve and the function of the traditional optic nerve to detect the toxicity of ethambutol. METHODS: Prospective studies, including 36 patients with 72 tuberculosis patients attending the Short-Term Treatment Observation Project at Malaysian University of Science Hospital. Visual acuity and optic nerve function tests by the same researcher. Similarly, Humphrey’s automatic field-of-view, optical coherence tomography (OCT) examination of retinal nerve fiber thickness (RNFL) and graphic visual evoked potential (PVEP) were performed by the same technician. Before starting ethambutol treatment and after treatment 3mo each check. Results: Ethambutol before and after treatment of visual acuity, color vision, brightness, red reflex and fundus examination no significant change. However, mean field defect worsened earlier after treatment (P = 0.010). There was a significant change in OCT and PVEP, prolongation of P100 latency, amplitude reduction, RNFL thickening in all quadrants (P <0.05). CONCLUSION: Subclinical changes in anatomy and visual function early after ethambutol treatment may be detected prior to abnormalities in the traditional optic nerve function by measuring the RNFL thickness by OCT and the P100 peak latency and amplitude using PVEP.