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±1.36 dB(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。

METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study. All patients underwent 25-gauge pars plana vitrectomy(PPV)combined with phacoemulsification and air tamponade. Best corrected visual acuity(BCVA, logMAR), perimetry and multifocal electroretinography(mfERG)were conducted before and after the operation. Anatomical changes were evaluated with optical coherence tomography(OCT).

RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy. The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively(P<0.001). In the visual field of central 10°, the average mean deviation(MD)decreased from -3.59±1.83 dB preoperatively to -2.51±1.36 dB postoperatively(P<0.001)and the average pattern standard deviation(PSD)decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively(P=0.001). The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly(P<0.05). The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA(P<0.001, P=0.001, respectively).

CONCLUSION: The 25-gauge PPV and air tamponade with 1 day prone positioning produce favorable anatomic and functional outcomes.