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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)一阶反应的变化特征及其与形态学的关系,评估黄斑裂孔手术疗效。方法收集2005年11月至2008年3月在我院行玻璃体切割术治疗IMH的患者18例(18只眼),术后随访一年。分别在手术前和手术后1、3、6及12个月时,对患者行VA、mfERG及光相干断层扫描(OCT)检查,并与正常对照组(25只眼)进行比较,对结果进行统计分析。结果(1)18只IMH眼术后一个月经OCT证实有17只眼(占94.44%)黄斑裂孔完全闭合,1年内无复发,1只眼(占5.56%)一年内黄斑裂孔始终未闭合。(2)术后一年VA较术前明显提高(P<0.01),其中视力进步15只眼(占83.33%);视力不变2只眼(占11.11%);视力减退1只眼(占5.56%)。VA恢复在术后6个月内最明显(。3)IMH眼术前mfERG一阶反应的1环和2环P1波反应密度明显低与正常对照组(P<0.05),典型三维地形图呈火山口样改变。术后一年mfERG一阶反应的1环和2环P1波反应密度不断增加,持续到一年以后,三维地形图表现为中央峰逐渐恢复。术后12个月时,1环和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环、4环、5环P1波反应密度始终未受明显影响(P>0.05);五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环、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、真实,两者总体上具有一致性。
Objective To observe the changes of visual acuity (VA), multifocal electroretinogram (mfERG) first order response in patients with idiopathic macular hole (IMH) and its relationship with morphology before and after operation to evaluate the curative effect of macular hole surgery. Methods 18 patients (18 eyes) with vitrectomy were enrolled in our hospital from November 2005 to March 2008, and were followed up for one year. VA, mfERG and optical coherence tomography (OCT) were performed before surgery and at 1, 3, 6 and 12 months after surgery, respectively, and compared with the normal control group (25 eyes) Statistical Analysis. Results (1) Macular hole was completely closed in 17 eyes (18.4%) in 18 IMH eyes at one month after operation. There was no recurrence in 1 year and 1 eye (5.56%). Macular hole did not close within one year. (2) One year after operation, VA was significantly higher than that before operation (P <0.01), including 15 eyes (83.33%) with vision improvement, 2 eyes (11.11%) with unchanged eyesight, and 1 eyes with eyesight loss 5.56%). In the 6 months postoperatively, the most obvious (.3) IM response to preoperative mfERG first-order reaction in VA was significantly lower than that in the normal control group (P <0.05). The typical three-dimensional topographic maps Crater-like change. One-year mfERG first-order reaction and the second-order loop P1 wave density increased continuously. After one year, the three-dimensional topographic map showed a gradual recovery of the central peak. At 12 months after operation, the response of P1 wave in ring 1 and ring 2 was significantly increased (P <0.05), but still lower than that in control group (P <0.05) Wave response density has not been significantly affected (P> 0.05); the latency of five rings was not significantly affected (P> 0.05). (4) At 12 months after operation, there was a positive correlation between P1 wave response density of the 1st ring and the 2nd ring of mfERG in patients with VA (P <0.05). Conclusions Vitrectomy is an effective method for the treatment of IMH. The postoperative visual function is significantly improved. mfERG is more objective, comprehensive and true than VA in the assessment of visual function, and the two are generally consistent.