Microbial keratitis in southeast Brazil Floppy eyelid syndrome ...

CELLA WP, DANTAS AM, ET AL.
ference observed (p=0.03), revealing lower amplitudes in females
younger than 60 years-old (Figure 4).
Comparative analysis regarding age revealed increasing values
with aging for P1 amplitude in the right eye (p=0.01, Pearson’s
coefficient= 0.199), for P1 implicit time peak in both eyes (p=0.00
for both eyes, Pearson’s coefficient= 0.466 for the right eye and
0.392 for the left eye), for N1 implicit time peak in both eyes
(p=0.00 for both eyes, Pearson’s coefficient= 0.563 for the right eye
and 0.517 for the left eye), and for P1N1 duration in both eyes
(p=0.003 and Pearson’s coefficient= 0.246 for the right eye and
p=0.004 and Pearson’s coefficient= 0.237 for the left eye).
DISCUSSION
VEP elicited by bright flash lights (called flash VEP) represents
a strong and resistant visual cortex response that is impaired only in
cases of severe optic pathways lesions and can be used to investigate
unexplained visual loss (13-15) . VEP waveforms can vary among
normal individuals (15) and the parameters used to evaluate its
response are amplitude and implicit time. Amplitude is related to
the functional integrity of optic pathways, and implicit time is
related to the conduction of visual sign along optic pathways (16) .
Analyzing amplitude and implicit time allows to investigate physiopathology
of several neuro-ophthalmic disorders (17) . In addition,
topographic location can be determined using adequate stimulation
(for example, monocular stimulation evaluates pre-chiasmatic
lesions (18) ) or by association between different electrophysiological
techniques (for example, association with pattern reversal
ERG to detect macula or optic nerve lesions) (17) .
To analyze VEP implicit time peak, one must consider that
photoreceptors require 1-3 ms to produce an electrical potential
to be transmitted to bipolar cells and therefore to the retinal
ganglion cells, thereby generating an electrical potential. This first
potential generated by retinal ganglion cells occurs 20-30 ms after
Table 4. Descriptive data for P1 and N1 implicit time peaks and P1N1 duration according to age, including both genders, in 280
normal eyes. Each age group is composed by 20 right eyes and 20 left eyes. Implicit time and duration values are expressed in
milliseconds (ms)
Eye Wave Age group Mean (±pd) Median Minimum Maximum 95% CI
Right P1 implicit time 1-10 21.5 (±2.1) 21.5 17.5 25.5 20.5;22.4
11-20 22.5 (±1.2) 22.5 19.5 25.0 22.0;23.1
21-30 22.6 (±1.3) 23.0 20.0 25.0 22.0;23.2
31-40 23.3 (±1.4) 23.5 20.0 25.5 22.7;23.9
41-50 23.5 (±1.7) 23.7 20.5 28.0 22.7;24.3
51-60 23.4 (±1.5) 23.2 20.0 27.0 22.7;24.0
> 60 24.6 (±2.1) 24.7 20.0 28.5 23.6;25.5
N1 implicit time 1-10 39.9 (±2.7) 39.0 37.0 46.5 38.7;41.2
11-20 40.1 (±1.4) 40.0 38.5 45.0 39.5;40.7
21-30 41.1 (±1.5) 41.2 39.0 43.5 40.4;41.8
31-40 41.5 (±1.7) 42.0 38.0 45.0 40.7;42.3
41-50 41.8 (±1.7) 41.5 40.0 46.0 41.0;42.6
51-60 42.6 (±1.7) 42.0 40.5 47.0 41.8;43.3
> 60 44.2 (±2.6) 44.0 40.0 52.0 43.0;45.3
P1N1 duration 1-10 18.2 (±2.5) 17.5 14.0 24.0 17.1;19.3
11-20 17.5 (±1.7) 17.2 15.0 22.0 16.8;18.3
21-30 18.5 (±1.8) 18.7 16.0 22.5 17.7;19.2
31-40 18.1 (±1.8) 18.2 15.0 20.5 17.3;18.9
41-50 18.3 (±1.5) 18.0 15.5 21.0 17.6;19.0
51-60 19.2 (±1.8) 19.0 16.0 23.0 18.3;20.0
> 60 19.6 (±2.8) 20.0 15.0 25.0 18.3;20.8
Left P1 implicit time 1-10 20.4 (±4.5) 21.0 20.0 25.0 18.4;22.4
11-20 22.8 (±1.3) 23.0 20.0 25.0 22.2;23.4
21-30 23.0 (±2.0) 23.0 20.0 28.0 22.1;23.9
31-40 23.8 (±1.6) 23.0 21.0 27.0 23.0;24.5
41-50 23.2 (±1.9) 23.0 20.0 28.0 22.4;24.1
51-60 23.9 (±1.7) 24.0 20.0 27.0 23.1;24.7
> 60 24.5 (±2.2) 24.0 20.0 29.0 23.6;25.5
N1 implicit time 1-10 39.8 (±2.9) 39.0 36.5 47.5 38.5;41.1
11-20 40.1 (±1.5) 40.0 37.0 44.0 39.4;40.7
21-30 41.0 (±2.1) 40.5 37.5 46.0 40.0;42.0
31-40 41.3 (±1.9) 41.0 39.0 47.0 40.5;42.2
41-50 41.6 (±2.0) 41.0 38.5 46.0 40.7;42.4
51-60 41.8 (±2.0) 41.0 39.5 47.0 41.0;42.7
> 60 44.6 (±2.7) 44.0 40.0 52.0 43.4;45.8
P1N1 duration 1-10 18.3 (±2.5) 17.7 14.5 25.5 17.2;19.5
11-20 17.2 (±2.0) 17.0 12.0 21.0 16.3;18.1
21-30 18.0 (±1.9) 18.0 14.5 21.5 17.2;18.8
31-40 17.5 (±2.1) 17.0 13.0 22.0 16.6;18.5
41-50 18.3 (±1.8) 18.5 15.0 21.0 17.5;19.1
51-60 18.0 (±2.0) 18.0 14.0 22.0 17.1;18.9
> 60 20.1 (±2.2) 20.0 15.0 24.0 19.1;21.1
pd= pattern deviation; CI= confidence interval
Arq Bras Oftalmol. 2011;74(1):37-43
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