Mit klinischer Elektrophysiologie hinter die Netzhaut

Zusammenfassung

Elektrophysiologische Ableitungen von Netzhaut und Kortex sind zielführend, um auch postretinale Schädigungen im Rahmen ophthalmologischer und neuroophthalmologischer Diagnostik aufzudecken. Dabei dienen Musterelektroretinogramme (PERG) der Überprüfung der retinalen Ganglienzellen und visuell evozierte Potenziale (VEP) der Überprüfung der Sehbahn in ihrer Gesamtheit. Sie unterstützen damit die objektive Funktionsüberprüfung der Sehbahn sowie die Differenzialdiagnostik. Während konventionelle elektrophysiologische Verfahren nur bedingt geeignet sind, lokale gesichtsfeldspezifische Defekte aufzudecken, ist dies die Domäne der multifokalen Elektrophysiologie. Diese ermöglicht eine ortsaufgelöste Beurteilung mit dem multifokalen PERG (mfPERG) und dem multifokalen VEP (mfVEP) bis hin zur objektiven Gesichtsfeldtestung mit dem mfVEP. Entscheidend für den erfolgreichen Einsatz dieses Methodenspektrums ist allerdings die Berücksichtigung möglicher Störfaktoren bei der Durchführung der Messungen und bei der Interpretation der Ergebnisse. Dies wird im vorliegenden Artikel anhand einer Reihe typischer Anwendungsbeispiele verdeutlicht.

Abstract

Electrophysiological recordings from the retina and cortex are pivotal to reach beyond the retina for ophthalmological and neuro-ophthalmological diagnostic testing. Pattern electroretinograms (PERG) can be used to examine retinal ganglia cells and visual evoked potentials (VEP) help to investigate overall visual pathways. Thus, they support objective functional tests of visual pathways, as well as differential diagnosis. Conventional electrophysiology is of limited value in detecting local defects in the visual field. This gap is filled by applications of multifocal electrophysiology. This permits spatially resolved testing with multifocal PERG (mfPERG) and multifocal VEP (mfVEP), and eventually objective visual field testing with mfVEP. It is important for this spectrum of methods to consider possible confounds when performing the measurements and when interpreting the results. This is explained in the present article on the basis of a series of typical examples.

Schlüsselwörter

Elektrophysiologie - Neuroophthalmologie - Kortex

Key words

electrophysiology - neuro-ophthalmology - cortex

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