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[摘要]
目的：探讨玻璃体切除术治疗严重增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)Ⅵ期患者术后视功能的改善情况及影响视功能预后的因素，并用多焦视网膜电图(multifocal electroretinography，mfERG)评价视功能的改变。
方法：回顾性分析PDR Ⅵ期患者113例130眼经标准的玻璃体视网膜手术治疗后的临床资料，并根据术前OCT检查及术中所见，分为牵拉性视网膜脱离合并显著黄斑病变组(99例113眼)及未合并黄斑病变组(14例17眼)两组。行OCT及mfERG检查，对手术前后视力、mfERG P1波振幅密度、OCT形态学改变、手术并发症及预后等进行重点分析。
结果：术后视力改善率63.1%(82/130)，视力在0.05以上者从术前19眼(14.6%)提高到术后61眼(46.9%)，其中56眼视力>0.1。牵拉性视网膜脱离未合并黄斑病变组术后视力改善率(88.2%)及术后视力>0.1所占比例(94.1%)均高于合并显著黄斑病变组(59.3%和35.4%)，差异有统计学意义(P<0.05)。术后mfERG各环P1波反应密度较术前增加，并随着时间延长，改善更加明显(P<0.05)，牵拉性视网膜脱离未合并黄斑病变组术后mfERG(1+2)环P1波反应密度高于合并显著黄斑病变组(P<0.05)。
结论：PDRⅥ期患者玻璃体切除术后视功能改善； mfERG一阶反应的后极部各环P1波反应密度增加，且随时间延长，改善更加明显； 未合并黄斑病变组术后视功能改善优于合并显著黄斑病变组。
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[Abstract]
AIM: To assess the visual function prognosis after vitrectomy for patients with proliferative diabetic retinopathy(PDR)at stage Ⅵ and the impacting factors and to evaluate visual function using multifocal electroretinogram(mfERG).
METHODS: One hundred and thirteen cases(130 eyes)with PDR at stage VI treated with standard vitreoretinal surgery were retrospectively analyzed. According to the OCT examination before surgeries and ocular fundus during surgeries, the reviewed cases were divided into two groups: patients with traction retinal detachment and maculopathy(99 cases with 113 eyes)and without maculopathy(14 cases with 17 eyes). Eyes underwent OCT and mfERG examination. Visual acuity preoperative and postoperative, mfERGP1 wave amplitudes, morphology features of macular,complications and prognoses were analyzed.
RESULTS: The rate of improved visual acuity postoperatively was 63.1%(82/130). The vision was 0.05 or better in 19 eyes(14.6%)preoperatively, and in 61 eyes(46.9%)postoperatively, in which the vision of 56 eyes were >0.1. In patients without maculopathy, the rate of visual improvements were 88.2% and there were 94.1% with the vision >0.1, which were both better than patients with significant maculopathy group(59.3% and 35.4%), and the differences were significant(P<0.05).The amplitude densities of P1 wave in the 6 rings were markedly increased after vitrectomy, and they turned to be better with time(P<0.05).The amplitude densities of P1 wave in rings(1+2)of eyes without maculopathy were higher than eyes with maculopathy(P<0.05).
CONCLUSION: The visual function of eyes with PDR at stage VI is improved after vitrectomy. The amplitude densities of P1 wave in the 6 rings increase markedly after vitrectomy, and they turn to be better with time. The improvement of visual function in severe PDR without maculopathy group is better than that in severe PDR with maculopathy group after vitrectomy.
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