摘要目的 观察高度近视黄斑裂孔性视网膜脱离手术后黄斑结构及视网膜功能的变化.方法接受玻璃体切割联合玻璃体后皮质、内界膜剥除及硅油填充手术治疗的高度近视黄斑裂孔性视网膜脱离患者25例25只眼纳入研究.所有患者于手术前及手术后3个月行最佳矫正视力、光相干断层扫描( OCT)、MP-1微视野及多焦视网膜电图(mf-ERG)检查.观察手术前后患者视力,黄斑裂孔及黄斑部视网膜结构,固视情况,中心凹10°范围内及鼻上、鼻下、颞上、颞下4个区域的平均视网膜光敏感度(MS),1～6环N1、P1波平均振幅密度及潜伏期的变化情况.将视力转换为最小视角对数(logMAR)视力进行记录和统计分析.结果手术后3个月,患者平均logMAR视力较手术前提高,差异有统计学意义(t=8.265,P＜0.05).OCT检查显示,视网膜完全复位24只眼,占96％；黄斑部视网膜浅脱离1只眼,占4％.黄斑裂孔裸露型愈合21只眼,占84％；非裸露型愈合2只眼,占8％；未愈合型1只眼,占4％.MP-1微视野检查显示,恢复中心固视2只眼,占8％；弱中心固视4只眼,占16％；旁中心固视19只眼,占76％.固视稳定4只眼,16％；固视相对不稳定9只眼,占36％；固视不稳定12只眼,占48％.黄斑中心凹10.范围内MS值为(9.031±4.245) dB；4个象限间MS值差异有统计学意义(F=7.40,P=0.015).mf-ERG检查显示,中心凹视觉峰高度有所恢复且黄斑部视网膜振幅密度提高,总体呈小丘状.患眼1～6环N1、P1波平均振幅密度及潜伏期均较手术前好转,差异有统计学意义(P＜0.05).结论高度近视黄斑裂孔性视网膜脱离手术后,大多患眼黄斑裂孔愈合,视网膜复位,视力和固视情况明显改善.

abstractsObjective To observe the changes of anatomic structure and visual function after surgery in highly myopia patients with macular hole and retinal detachment (MHRD). Methods Twenty-five patients (25 eyes) with MHRD who underwent vitreous and internal membrane peeling surgery combined with silicone oil tamponade,were enrolled in this study.All the patients had undergone the examinations of logarithm of minimal angle of resolution (logMAR) visual acuity,optical coherence tomography (OCT),MP-1 microperimetry and multifocal electroretinogram (mf-ERG) before and three months after surgery.The visual acuity,structure of macular hole and macula,fixation point,mean sensitivity (MS) within 10 of macular area and four quadrants including supertemporal,supernasal,intranasal and infratemporal,average response densities of N1 and P1 waves at all 6 rings before and after surgery were observed.Results Three months after surgery,the logMAR visual acuity improved (t=8.265,P＜0.05).Twenty-four eyes (96％)were anatomically reattached,one eye (4％) was not anatomically reattached completely.The results of MP-1 microperimetry showed that foveal fixation was found in two eyes (8％),weak foveal fixation was found in four eyes (16％),paracentral fixation was found in 19 eyes (76％).There were four eyes (16％)with stable fixation,nine eyes (36％) with relatively unstable fixation and 12 eyes (48％) with unstable fixation.The MS value within 10 of macular area was (9.031±4.245) dB.The MS value difference among four quadrants was statistically significant (F=7.40,P=0.015).The mf-ERG results showed that the average response densities of N1 and P1 waves at all 6 rings were increased (P＜0.05).Conclusion The macular hole heals, retina remains reattached, visual acuity,and fixation are improved in the most of MHRD eyes after surgery.