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目的:观察对于特发性黄斑裂孔行25G玻璃体切除联合空气填充治疗后的解剖和视功能结果。方法:前瞻性干预性分析。27例(30眼)特发性黄斑裂孔患者接受25G经睫状体平坦部玻璃体切除术,同时行白内障超声乳化抽吸联合人工晶体置入和玻璃体腔无菌空气填充。所有患者在术前和术后3mo进行最佳矫正视力(logMAR视力)、视野检查和多焦视网膜电流图(multifocal electroretinography,mfERG)检查,使用OCT明确黄斑裂孔闭合情况。结果:首次手术后28眼的黄斑裂孔闭合,平均logMAR视力由术前的0.72±0.22提高到术后的0.29±0.18(P<0.001)。中心10°视野检查中,平均偏差(mean deviation,MD)由术前的-3.59±1.83 dB减少到术后的-2.51±1.36dB(P<0.001),平均模式标准差(pattern standard deviation,PSD)由术前的1.86±0.68 dB减少到术后的1.33±0.32 dB(P=0.001)。MfERG中可见术后中心凹和旁中心凹区域的平均振幅明显升高,而4-6环区域的平均潜伏期明显延长(P<0.05)。疾病病程长短(P<0.001)和1环区域的术前N1波振幅(P=0.001)对术后最佳矫正视力有预测作用。结论:特发性黄斑裂孔患者行25G玻璃体切除联合空气填充,术后保持1d的面向下体位,有很好的解剖成功率和视功能结果。
OBJECTIVE: To observe the anatomic and visual function results of 25G vitrectomy combined with air filling in patients with idiopathic macular hole. Methods: Prospective analysis of intervention. 27 patients (30 eyes) with idiopathic macular hole underwent pars plana vitrectomy with 25G transthoracic cataract and phacoemulsification combined with intraocular lens implantation and vitreous cavity sterile air filling. All patients underwent optimal corrected visual acuity (logMAR vision), visual field examination and multifocal electroretinography (mfERG) before and 3 months after surgery. OCT was used to confirm the closure of macular hole. Results: The macular hole was closed in 28 eyes after the first operation. The mean logMAR increased from 0.72 ± 0.22 before operation to 0.29 ± 0.18 after operation (P <0.001). During the 10 ° field test, the mean deviation (MD) decreased from -3.59 ± 1.83 dB preoperatively to -2.51 ± 1.36 dB postoperatively (P <0.001). The mean standard deviation (PSD) ) Decreased from 1.86 ± 0.68 dB preoperatively to 1.33 ± 0.32 dB postoperatively (P = 0.001). The average amplitude of postoperative fovea and parafoveal area was significantly increased in MfERG, while the average latency in 4-6 loop area was significantly longer (P <0.05). The duration of the disease (P <0.001) and preoperative N1 wave amplitude in the first annulus (P = 0.001) predicted the best corrected visual acuity after surgery. CONCLUSIONS: Idiopathic macular hole patients underwent 25G vitrectomy combined with air filling. The postoperative face-down position was maintained for 1 day, with good anatomic success rate and visual function.