MP-3联合mfERG评估内界膜剥除对特发性黄斑前膜术后黄斑功能的短期影响  

Evaluation of Short-Term Effect of Internal Limiting Membrane Peeling on Macular Function after Idiopathic Macular Epiretinal Membrane Surgery by MP-3 Combined with mfERG

作　　者：王仕旺 毛子清 李根 范慧敏 陈智萍 WANG Shi-wang;MAO Zi-qing;LI Gen;FAN Hui-min;CHEN Zhi-ping(Department of Ophthalmology,Affiliated Eye Hospital of Nanchang University,Nanchang 330006,China;Department of Ophthalmology,Zhangshu People’s Hospital,Zhangshu 331299,China)

机构地区：[1]南昌大学附属眼科医院眼科,南昌330006 [2]樟树市人民医院眼科,江西樟树331299

出　　处：《南昌大学学报（医学版）》2022年第5期46-53,共8页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生健康委科技计划项目(202210722)。

摘　　要：目的应用微视野计MP-3联合多焦视网膜电图(mfERG)评估特发性黄斑前膜(IMEM)术中内界膜(ILM)剥除对黄斑形态及视功能影响。方法将24例(24眼)IMEM患者随机分为非剥膜组12例(12眼)、剥膜组12例(12眼),均行23 G玻璃体切割术,非剥膜组单纯行黄斑前膜剥除,剥膜组联合ILM剥除。术后1、3个月随访,比较2组术前术后mfERG的第一个负峰(N1)和第一个正峰(P1)的1环、2环的潜伏期与振幅,最佳矫正视力(BCVA)的logMAR BCVA值,MP-3的视网膜平均光敏度(MS)、微视野暗点数(SP),黄斑区视网膜厚度(CMT);观察2组术中术后并发症及术后黄斑前膜复发情况。结果24例(24眼)患者均顺利完成手术。术后3个月2组logMAR BCVA值、CMT值均较术前显著减少(P<0.001),但2组间比较差异无统计学意义(P>0.05)。术后3个月非剥膜组SP值较术前减少,但差异无统计学意义(P>0.05),剥膜组较术前显著增加(P<0.01),2组术后3个月SP值比较差异有统计学意义(P<0.01);术后3个月2组MS值均较术前显著增加(P<0.01),且非剥膜组显著高于剥膜组(P<0.05)。术后3个月非剥膜组P1波1环和2环振幅较术前显著增加(P<0.05),剥膜组较术前显著下降(P<0.05),2组P1波1环和2环潜伏期均较术前轻度下降(P>0.05);2组N1波1环和2环振幅及潜伏期术后3个月与术前比较差异均无统计学意义(P>0.05)。2组术中未发生玻璃体出血、视网膜裂孔或脱离;术后3个月2组均无黄斑前膜复发,均未发生眼内炎、视网膜脱离、玻璃体出血,黄斑裂孔等并发症。结论黄斑前膜术中剥除ILM短期内对IMEM患者视力及黄斑厚度没有显著影响,但可能会增加术后黄斑区视野暗点,降低光敏感度,并对视网膜电生理功能造成损害。Objective To evaluate the effect of internal limiting membrane(ILM)peeling on macular morphology and visual function inidiopathic macular epiretinal membrane(IMEM)surgery by using MP-3 microperimetry and multifocal electroretinography(mfERG).Methods Twenty-four IMEM patients(24 eyes)were randomly divided into non-peeling group(12 eyes)and peeling group(12 eyes).All patients underwent 23G vitrectomy.Furthermore,the non-peeling group received macular epiretinal membrane peeling,and the peeling group received combined macular epiretinal membrane and ILM peeling.The patients were followed up 1 and 3 months after surgery.The mfERG latency and amplitude of the first negative peak(N1)and the first positive peak(P1)at ring 1 and ring 2 were recorded before and after surgery.The logMAR best corrected visual acuity(BCVA),mean retinal sensitivity(MS),scotoma points(SP)and central macular thickness(CMT)were compared between the two groups.In addition,intraoperative and postoperative complications and postoperative macular anterior membrane recurrence were observed in both groups.Results All the 24 patients completed the surgery successfully.At 3 months after operation,the logMAR BCVA and CMT were dramatically decreased in both groups(P<0.001),but the differences were not significant between the two groups(P>0.05).Although the SP was decreased 3 months after operation in non-peeling group,the change was not obvious(P>0.05).However,the SP was increased 3 months after surgery in peeling group,and there was a significant difference between the two groups(P<0.01).The MS was increased 3 months after surgery in both groups(P<0.01),and that in non-peeling group was higher than that in peeling group(P<0.05).Furthermore,at 3 months after operation,the amplitudes of P1 at ring 1 and ring 2 were increased in non-peeling group,but decreased in peeling group(P<0.05).The latency of P1 at ring 1 and ring 2 was slightly reduced in both groups(P>0.05).The latency and amplitude of N1 at ring 1 and ring 2 were not significantly altered in both

关 键 词：特发性黄斑前膜 内界膜剥除 微视野计MP-3 多焦视网膜电图 黄斑功能 

分 类 号：R774.5[医药卫生—眼科]