内界膜剥除与否对2期特发性黄斑裂孔患眼玻璃体切割手术后视网膜电图明视负波的影响

The electroretinogram photopic negative response of idiopathic macular hole （stage 2） by vitrectomy with or without internal limiting membrane peeling

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。

ObjectiveTo 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）.MethodsTwenty-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.ResultsThree 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 （36.6±7.4） μV, 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 pre-surgery 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）.ConclusionCompared with non-ILMP, vitrectomy combined with ILMP will significantly reduce the PhNR amplitude of IMH in stage 2.