特发性黄斑裂孔手术前后视功能变化分析.docVIP

特发性黄斑裂孔手术前后视功能变化分析 　 作者：俞晓艺，林碧娟，杨安怀，邢怡桥 【关键词】 黄斑 【摘要】 目的 观察特发性黄斑裂孔（IMH）患者手术前后的视力（VA）、多焦视网膜电图（mfERG）的变化特征及其与形态学的关系,评估手术疗效。方法 收集行玻璃体切割术治疗的IMH 18只眼，术后随访1年，对患眼行VA、mfERG及光学相干断层扫描（OCT）检查，并与正常对照组（25只眼）进行比较分析。结果 术后1个月OCT证实17只眼（94.44%）黄斑裂孔完全闭合，1年内无复发。（2）术后1年VA较术前明显提高（P＜0.01），在术后6个月内最明显。（3）IMH眼术前mfERG一阶反应的1、2环P1波反应密度明显低于正常对照组（P＜0.05），典型三维地形图呈火山口样改变。术后1年mfERG三维地形图表现为中央峰逐渐恢复，1、2环P1波反应密度较术前明显增加（P＜0.05），但仍然低于正常对照组（P＜0.05）；而3、4、5环P1波反应密度始终未受明显影响（P＞0.05）；5个环的潜伏期也未受明显影响（P＞0.05）。（4）术后12个月时，患眼VA与mfERG一阶反应1、2环的P1波反应密度之间均呈正相关关系（P＜0.05）。结论 玻璃体切割术是治疗IMH的有效方法，患眼术后视功能明显提高。mfERG在视功能评估方面较VA更加客观、全面。 【关键词】 特发性黄斑裂孔；视力；多焦视网膜电图；光学相干断层扫描 Analysis of changes of visual function before and after successful idiopathic macular hole surgery 【Abstract】 Objective To observe the changes of visual acuity（VA）、multifocal electroretinogram（mfERG） and relationships to construction before and after successful idiopathic macular hole（IMH） surgery.Methods 18 eyes with vitreotomy for IMH were collected.They were examined by VA、 mfERG、optical coherence tomography（OCT） preoperatively and 1 year postoperatively and compared to 25 eyes of control group.Results （1）Postoperatively 17 eyes（94.44%） had anatomic closure of the macular hole confirmed by OCT in 1 month and no recurrence in 12 months.（2）VA of IMH eyes improved significantly postoperatively especially during 6 months later（P＜0.01）.（3）Before operation the mfERG topographies of IMH eyes seem like volcanoes because the response densities of wave P1 of ring 1 and ring 2 were lower than control group（P＜0.05） while the other three rings kept in normal（P＞0.05）. After surgeon center peaks of mfERG topographies reappeared,the response densities of wave P1of ring 1 and ring 2 were higher than before（P＜0.05） but still lower than control group（P＜0.05）. Latent time of all rings of IMH kept in normal（P＞0.05）.（4）One year postoperatively there were positive correlations between VA and mfERG（P＜0.01）.Conclusion Vitreotomy is useful for IMH,which can be evaluated by visual fun