糖尿病性黄斑水肿患者玻璃体手术后黄斑区视功能的转归

The conversion of macular function in diabetic macular edema after vitreous surgery

目的 动态分析糖尿病性黄斑水肿 (DME)患者玻璃体手术前后黄斑区视功能的变化。方法 16例(17只眼 )经视网膜光凝治疗无好转的DME患者,在玻璃体手术后连续随访 7个月,动态对照观察患者手术前后中心视力、多焦视网膜电图 (mfERG)和相干光断层扫描 (opticalcoherencetomography, OCT)检查结果,探讨其手术前后黄斑区视功能的变化规律及其与黄斑形态改变的相关性。结果 mfERG检查结果显示DME患者术后黄斑区视功能以P1波变化为主,随时间延长,视功能逐渐增强。与术前mfERG检查结果相比,P1波振幅和潜伏期波形均显示患者于术后 4至5个月视功能改善明显(P<0. 05);术后各时间段的P1波振幅比较,亦显示患者视功能从术后 4个月起改善明显 (P< 0. 05 )。术后黄斑区P1波振幅的增加与中心凹厚度的消退呈线性正相关(P<0 01)。结论 DME患者经玻璃体手术治疗后黄斑区视功能的改善呈进行性;术后黄斑区视功能的改善与水肿的消退呈一致性。

Objective To evaluate the conversion of macular function in diabetic macular edema (DME) after vitreous surgery. Methods Seventeen eyes of 16 patients were assessed after pars plana vitrectomy for DME. Multifocal electroretinogram (mfERG) techniques were used to evaluate the effects of treatment on macular visual function, and retinal foveal thickness was determined by optical coherence tomography before and after vitrectomy. Patients were followed up continually for 7 months. The correlation between the change of tomographic feaures and visual functions were analyzed. Results During the follow up period, the retinal function in macular areas recovered and the foveal thickness decreased gradually. While compared with preoperative values, the response of positive wave(P1) have shown decreases in implicit time and increases in amplitude since the forth and fifth postoperative month respectively ( P <0.05). While compared between each postoperative period, the P1 responses have increased significantly since the forth postoperative month. The correlation between the increase of P1 amplitude in macular area and the decrease of retinal foveal thickness was significant( r = 0.954, P <0.001). Conclusions Macular function get improvement gradually in DME after vitreous surgery; The restoration of macular function is coincident with the reduction of macular edema.