ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2020-3-398-406ophthalmology-1280Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHФотопический негативный ответ для оценки функции внутренней сетчатки: требования к регистрации и сравнение в глазах с естественной шириной зрачка и в условиях медикаментозного мидриазаРhotopic Negative Response for Testing the Function of Inner Retina: Registration Requirements and Comparison in the Eyes with Natural Pupil Width and in Conditions of Drug Mydriasishttps://orcid.org/0000-0003-4675-9648КотелинВ. И.KotelinV. I.

аспирант отдела глаукомы,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

Postgraduate of the Glaucoma Department,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

КирилловаМ. О.KirillovaM. O.

аспирант отдела глаукомы,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

Postgraduate of the Glaucoma Department,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

https://orcid.org/0000-0002-0161-5010ЗуеваМ. В.ZuevaM. V.

доктор биологических наук, профессор, начальник отдела клинической физио‑ логии зрения им. С.В. Кравкова, 

ул. Садовая-Черногрязская, 14/19, Москва, 105062

Professor, Dr. Sci. (Biology), Head of the Department of S.V. Kravkova Clinical Physiology of Vision,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

visionlab@yandex.ruЦапенкоИ. В.TsapenkoI. V.

кандидат биологических наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

Cand. Sci. (Biology), Senior Researcher, Department of S.V. Kravkova Clinical Physiology of Vision,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

https://orcid.org/0000-0001-8381-2124ЖуравлеваА. Н.ZhuravlevaA. N.

кандидат медицинских наук, научный сотрудник отдела глаукомы,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

PhD, researcher of the Glaucoma Department,

Sadovaya-Chernogryazskaya str., 14/19, Moscow

https://orcid.org/0000-0002-1929-3224КиселеваО. А.KiselevaO. A.

доктор медицинских наук, начальник отдела глаукомы,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

MD, Head of the Glaucoma Department,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

https://orcid.org/0000-0001-6541-8211БессмертныйА. М.BessmertnyA. M.

доктор медицинских наук, старший научный сотрудник отдела глаукомы,

ул. Садовая-Черногрязская, 14/19, Москва, 105062

MD, Senior Research Officer of the Glaucoma Department,

Sadovaya-Chernogryazskaya str., 14/19, Moscow, 105062

ФГБУ «Национальный медицинский исследовательский центр глазных болезней имени Гельмгольца» Министерства здравоохранения Российской ФедерацииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian Federation202023092020173398406Copyright © Котелин В.И., Кириллова М.О., Зуева М.В., Цапенко И.В., Журавлева А.Н., Киселева О.А., Бессмертный А.М., 20202020Котелин В.И., Кириллова М.О., Зуева М.В., Цапенко И.В., Журавлева А.Н., Киселева О.А., Бессмертный А.М.Kotelin V.I., Kirillova M.O., Zueva M.V., Tsapenko I.V., Zhuravleva A.N., Kiseleva O.A., Bessmertny A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1280Цель

Цель: оценить возможность регистрации фотопического негативного ответа (ФНО) без дилатации зрачка у здоровых лиц для определения дисфункции нейронов внутренней сетчатки.

Методы

Методы. Обследовано 12 здоровых лиц (23 глаза) в возрасте от 24 до 40 лет. Аномалии рефракции не превышали 0,5 диоптрии. ФНО оценивали в фотопической ЭРГ, записываемой на синем фоне на красные вспышки четырех интенсивностей (0,375; 0,75; 1,5; 3,0 кд·с/м2) с помощью прибора RETIport/scan21. Сначала ЭРГ регистрировали с естественным диаметром зрачка (3,5 ± 0,2 мм), затем запись повторяли после медикаментозного мидриаза (средний размер зрачка 8,7 ± 0,1 мм).

Результаты

Результаты. В глазах с физиологической величиной зрачка, по сравнению с медикаментозным мидриазом, значительно снижается амплитуда ФНО в ЭРГ на самый слабый стимул (0,375 кд·с/м2). Влияние размера зрачка на ФНО практически отсутствует в ответах на вспышки средней интенсивности. Этот феномен может быть связан с неравномерным распределением света по сетчатке при малом размере зрачка, влияние которого максимально в ответах на слабые вспышки. В ЭРГ на стимул максимальной яркости (3,0 кд·с/м2) имеются различия в амплитуде b-волны и ФНО, рассчитанной от пика b-волны, которые могут отражать уменьшение числа стимулируемых фоторецепторов при ганцфельд стимуляции сетчатки, когда зрачок не расширен.

Заключение

Заключение. Влияние размера зрачка на параметры ФНО наиболее значительно в ЭРГ при минимальной силе вспышки и снижается в ответах на вспышки большей яркости. При необходимости записи ЭРГ без медикаментозного мидриаза, особенно в скрининговых исследованиях, рекомендуется ограничить протокол оценкой ФНО от изолинии в фотопической ЭРГ на максимальные вспышки света и использовать относительный параметр — амплитудное отношение ФНО/b. 

Purpose

Purpose: To evaluate the possibility of registration of the photopic negative response (PhNR) without pupil dilatation in healthy individuals to determine the dysfunction of neurons of the inner retina.

Methods

Methods: 12 healthy persons (23 eyes) aged 24 to 40 years were examined. Refraction anomalies did not exceed 0.5 diopters. A PhNR was evaluated in photopic ERGs recorded on a blue background with red flashes of four intensities (0.375, 0.75, 1.5, 3.0 cd·s/m2) using the RETIport/scan21 (Roland Consult). First, ERG was recorded with the natural pupil (3.5 ± 0.2 mm). Then, the recording was repeated after drug mydriasis (average pupil size 8.7 ± 0.1 mm).

Results

Results. In eyes with natural pupil width, in comparison with drug mydriasis, PhNR amplitudes in responses to weakest stimuli (0.375 cd·s/m2) were significantly reduced. The effect of pupil size on the PhNR amplitude from a baseline was virtually absent in responses to higher strength flashes. This phenomenon can be associated with an irregular distribution of light over the retina with small pupil size, the effect of which is maximal in responses to weak flashes. For the maximal brightness stimuli (3.0 cd·s/m2), differences were found between groups of non-dilated and dilated pupils in the amplitudes of the b-wave and PhNR from the b-peak, which may reflect a decrease in the number of stimulated photoreceptors during ganzfeld stimulation when the pupil is not dilated.

Conclusion

Conclusion. The effect of pupil size on the parameters of the PhNR was most significant in the ERG with minimal flash strength and it decreases in responses to flashes of higher brightness. If it is necessary to record the ERG without drug mydriasis, especially in screening studies, it is recommended to limit the protocol to estimate the PhNR from a baseline in responses to maximal flashes, and use the relative parameter — the amplitude ratio of PhNR/b. Keywords: photopic negative response, electroretinography, pupil width

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The authors declare that there are no conflicts of interest present.