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目的 对比观察单纯玻璃体切割手术与玻璃体切割联合内界膜剥除(ILMP)手术对2期特发性黄斑裂孔(IMH)患眼视网膜电图(ERG)明视负波(PhNR)的影响.方法 前瞻性临床研究.临床确诊为2期IMH的23例患者23只眼纳入研究.所有患眼均采用国际标准视力表检测最佳矫正视力(BCVA);光相干断层扫描测量黄斑裂孔(MH)直径;闪光ERG检测PhNR振幅.将患眼随机分为单纯玻璃体切割手术组(A组)及玻璃体切割联合ILMP手术组(B组),分别为11例11只眼、12例12只眼.A、B组患眼平均BCVA(t=0.96,P=0.350)、MH直径(t=3.21,P=0.580)及PhNR振幅(t=0.98,P=0.353)比较,差异均无统计学意义.所有患眼均行闭合式25G微创三通道玻璃体切割手术,B组患眼同时联合ILMP.手术后随访时间3～6个月,平均随访时间4.3个月.对比分析手术前后A、B组患眼BCVA、MH闭合及PhNR振幅变化情况.结果 手术后3个月,A组11只眼中,MH解剖闭合10只眼,占90.9％;MH未闭合1只眼,占9.1％.B组12只眼MH均解剖闭合,MH解剖闭合率为100.0％.两组患眼的MH解剖闭合率比较,差异无统计学意义(P=0.462).手术后3个月,A、B组患眼平均BCVA分别为0.69±0.24、0.65±0.22;两组患眼之间平均BCVA比较,差异无统计学意义(t=0.49,P=0.722).手术后3个月,A组患眼PhNR振幅为(36.6±7.4) μV,较手术前有所下降,但差异无统计学意义(t=0.73,P=0.472);B组患眼PhNR振幅为(27.1±12.4) μV,较手术前明显下降,差异有统计学意义(t=3.56,P=0.002).手术后A、B组患眼PhNR振幅比较,差异有统计学意义(t=2.17,P=0.042).结论 与单纯玻璃体切割手术比较,玻璃体切割联合ILMP手术治疗IMH会明显降低PhNR振幅.

Objective To observe the electroretinogram (ERG) photopic negative response (PhNR) of idiopathic macular hole (IMH) in stage 2 by vitrectomy with or without internal limiting membrane peeling (ILMP).Methods Twenty-three stage 2 IMH patients (23 eyes) were enrolled in this prospective study.All patients received the best corrected visual acuity (BCVA),optical coherence tomography and flash-ERG examinations.The patients were randomly divided into group A (11 eyes,vitrectomy) and B (12 eyes,vitrectomy with ILMP).There was no significant difference in BCVA (t=0.96,P=0.350),diameter of macular hole (MH) (t=3.21,P=0.580) and the PhNR amplitude (t=0.98,P=0.353) in group A and B.All patients underwent 25G vitrectomy,ILMP was carried out in group B.The follow-up time was 3 to 6 months,with the mean follow-up time of 4.3 months.BCVA,MH closure rate and PhNR amplitude in group A and B were analyzed before and after surgery.Results Three months after surgery,10 eyes (90.9％) gained MH closure but 1 eye (9.1％) failed in group A.In group B,12 eyes (100.0％) gained MH closure.There was no significant difference in MH closure rate between the two groups (P=0.462).The mean BCVA of group A and B was 0.69 ± 0.24 and 0.65 ± 0.22,there was no significant difference between the two groups (t=0.49,P=0.722).The amplitude of PhNR in group A was (36.647.4) μtV,which was lower than the pre-surgery PhNR,but the difference was not significant (t=0.73,P=0.472).The amplitude of PhNR in group B was (27.1 ± 12.4) μV,which was lower than that the presurgery PhNR,and the difference was significant (t =3.56,P =0.002).The difference of PhNR amplitude in group A and B was statistically significant (t=2.17,P=0.042).Conclusion Compared with non-ILMP,vitrectomy combined with ILMP will significantly reduce the PhNR amplitude ofIMH in stage 2.