Objective Assessment of Visual Field Defects Caused by Optic Chiasm and Its Posterior Visual Pathway Injury

doi:10.12116/j.issn.1004-5619.2023.230309

Abstract

Abstract:

Objective To investigate the characteristics and objective assessment method of visual field defects caused by optic chiasm and its posterior visual pathway injury. Methods Typical cases of visual field defects caused by injuries to the optic chiasm, optic tracts, optic radiations, and visual cortex were selected. Visual field examinations, visual evoked potential （VEP） and multifocal visual evolved potential （mfVEP） measurements, craniocerebral CT/MRI, and retinal optical coherence tomography （OCT） were performed, respectively, and the aforementioned visual electrophysiological and neuroimaging indicators were analyzed comprehensively. Results The electrophysiological manifestations of visual field defects caused by optic chiasm injuries were bitemporal hemianopsia mfVEP abnormalities. The visual field defects caused by optic tract, optic radiation, and visual cortex injuries were all manifested homonymous hemianopsia mfVEP abnormalities contralateral to the lesion. Mild relative afferent pupil disorder （RAPD） and characteristic optic nerve atrophy were observed in hemianopsia patients with optic tract injuries, but not in patients with optic radiation or visual cortex injuries. Neuroimaging could provide morphological evidence of damages to the optic chiasm and its posterior visual pathway. Conclusion Visual field defects caused by optic chiasm, optic tract, optic radiation, and visual cortex injuries have their respective characteristics. The combined application of mfVEP and static visual field measurements, in combination with neuroimaging, can maximize the assessment of the location and degree of visual pathway damage, providing an effective scheme for the identification of such injuries.

Key words: forensic medicine, wounds and injuries, visual electrophysiology, visual pathway, field of view, optic chiasma, multifocal visual evoked potential （mfVEP）, optic nerve injury

CLC Number:

Jian XIANG, Xu WANG, Li-li YU, Kang-jia JIN, Ying-kai YANG. Objective Assessment of Visual Field Defects Caused by Optic Chiasm and Its Posterior Visual Pathway Injury[J]. Journal of Forensic Medicine, 2023, 39(4): 350-359.

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URL: http://www.fyxzz.cn/EN/10.12116/j.issn.1004-5619.2023.230309

http://www.fyxzz.cn/EN/Y2023/V39/I4/350

Figures/Tables 18

Fig. 1 Reciprocal diagram of mfVEP stimulus unitsand static visual field test sites

Fig. 2 Binocular static visual field imagesin the case with optic chiasm injury

Fig. 3 Binocular OCT images of optic disc in the case with optic chiasm injury

Fig. 4 Binocular FVEP images in the casewith optic chiasm injury

Fig. 5 Binocular mfVEP images in the casewith optic chiasm injury

Fig. 6 Craniocerebral CT images in the case with optic chiasm injury

Fig. 7 Binocular fundus photographs in the casewith right optic tract injury

Fig. 8 Binocular static visual field imagesin the case with right optic tract injury

Fig. 9 Binocular OCT images of optic disc in the case with right optic tract injury

Fig. 10 Binocular OCT images of posterior pole ofeyeball in the case with right optic tract injury

Fig. 11 Binocular FVEP images in the casewith right optic tract injury

Fig. 12 Binocular mfVEP images in the casewith right optic tract injury

Fig. 13 Binocular static visual field imagesin the case with left optic radiation injury

Fig. 14 Binocular mfVEP images in the casewith left optic radiation injury

Fig. 15 Craniocerebral MRI images in the casewith left optic radiation injury

Fig. 16 Binocular static visual field imagesin the case with left visual cortex injury

Fig. 17 Binocular mfVEP images in the casewith left visual cortex injury

Fig. 18 Craniocerebral CT images in the casewith left visual cortex injury

References 14

1	项剑，王旭. 多焦视诱发电位在法医学客观视野检查中的应用价值[J].中国法医学杂志，2013，28（4）：287-290. doi：10.13618/j.issn.1001-5728.2013.04.008 .
	XIANG J， WANG X. The application value of multifocal visual evoked potential in the objective perimetry test in clinical forensic medicine[J]. Zhongguo Fayixue Zazhi，2013，28（4）：287-290.
2	项剑，王旭，杨英恺，等. 正常视野与实验性暗区的多焦视诱发电位特征分析[J].中国法医学杂志，2014，29（1）：25-29. doi：10.13618/j.issn.1001-5728.2014.01.008 .
	XIANG J， WANG X， YANG Y K， et al. Multifocal VEP studies of normal visual fields and experimental scotoma[J]. Zhongguo Fayixue Zazhi，2014，29（1）：25-29.
3	童绎，魏世辉，游思维. 视路疾病基础与临床进展[M].北京：人民卫生出版社，2010：440.
	TONG Y， WEI S H， YOU S W. Basis and clinical progress of visual pathway disease[M]. Beijing： People’s Medical Publishing House，2010：440.
4	刘瑞珏，夏文涛. 眼科司法鉴定实务[M].北京：科学出版社，2014：114-118.
	LIU R J， XIA W T. Ophthalmologic forensic identification[M]. Beijing： Science Press，2014：114-118.
5	LEVIN L A， ARNOLD A C. 实用神经眼科学[M].张晓君，王宁利，译. 北京：人民卫生出版社，2007：241.
	LEVIN L A， ARNOLD A C. Neuro-ophthalmology： The practical guide[M]. ZHANG X J， WANG N L， transl. Beijing： People’s Medical Publishing House，2007：241.
6	金崇华，于春江. 视觉神经系统疾病定位诊断学[M].北京：人民卫生出版社，2013：128-129.
	JIN C H， YU C J. Localization diagnostics of visual nervous system diseases[M]. Beijing： People’s Medical Publishing House，2013：128-129.
7	MILLER N R， NEWMAN N J， BIOUSSE V， et al. Walsh and Hoyt精编临床神经眼科学[M].张晓君，魏文斌，译. 北京：科学出版社，2009：261，281.
	MILLER N R， NEWMAN N J， BIOUSSE V， et al. Walsh and Hovt’s clinical neuro-ophthalmology： The essentials[M]. ZHANG X J， WEI W B， transl. Beijing： Science Press，2009：261，281.
8	CHEN Y， WYATT H J， SWANSON W H， et al. Rapid pupil-based assessment of glaucomatous damage[J]. Optom Vis Sci，2008，85（6）：471-481. doi：10.1097/OPX.0b013e318177ec02 .
9	JAMES A C， KOLIC M， BEDFORD S M， et al. Stimulus parameters for multifocal pupillographic objective perimetry[J]. J Glaucoma，2012，21（9）：571-578. doi：10.1097/ijg.0b013e31821e8413 .
10	LI M， LIU X， LI Q， et al. The magnitude of the central visual field could be detected by active middle-late processing of ERPs[J]. Brain Res，2016，1650：41-50. doi：10.1016/j.brainres.2016.07.009 .
11	王旭. 视神经损伤的电视野检查及其与LED-VEP相关性[J].中国法医学杂志，2002，17（6）：323-325. doi：10.13618/j.issn.1001-5728.2002.06.001 .
	WANG X. Study on the correlation between the electric visual field and LED-VEP in case of optic nerve injury[J]. Zhongguo Fayixue Zazhi，2002，17（6）：323-325.
12	SOUSA R M， OYAMADA M K， CUNHA L P， et al. Multifocal visual evoked potential in eyes with temporal hemianopia from chiasmal compression： Correlation with standard automated perimetry and OCT findings[J]. Invest Ophthalmol Vis Sci，2017，58（11）：4436-4449. doi：10.1167/iovs.17-21529 .
13	项剑，王旭，于丽丽，等. 法医学视野客观评定范式研究——以视网膜、视神经及高位视路损伤致视野缺损为例[J].中国法医学杂志，2018，33（4）：355-360. doi：10.13618/j.issn.1001-5728.2018.04.007 .
	XIANG J， WANG X， YU L L， et al. Exploration of visual field evaluation methods in forensic science： An analysis of classical cases of visual field defects caused by injury to the retina， optic nerve， and higher visual pathway[J]. Zhongguo Fayixue Zazhi，2018，33（4）：355-360.
14	项剑，王旭，于丽丽，等. 应用传统VEP、多焦VEP进行视觉功能客观评定1例[J].法医学杂志，2020，36（6）：884-887. doi：10.12116/j.issn.1004-5619.2020.06.026 .
	XIANG J， WANG X， YU L L， et al. Objective evaluation of visual function using traditional VEP and multifocal VEP： A case report[J]. Fayixue Zazhi，2020，36（6）：884-887.

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