| 摘要： 目的 探讨多焦视网膜电图（mfERG）对外伤性视网膜脱离（RD）玻璃体视网膜手术（VRS）前后视网膜功能客观评价的意义。 方法 应用美国EDI公司的VERIS science 4.2视诱发反应图像系统对41例41只眼外伤性RD进行6个环形视网膜区域的检测，测试野23°，采用Burian-Allen接触镜电极，在3分38秒内（分16阶段）记录103个视网膜部位的反应。其中开放性外伤23只眼，闭合性外伤18只眼，轻度PVR（PVRC1及以下）27只眼，重度PVR(PVRC1以上)14只眼，记录其手术前后的N1、P1波振幅密度和潜时，并与正常对照组比较。 结果 所有外伤性RD眼于6个环mfERG的N1、P1波振幅密度降低，潜伏期延长，与正常对照组相比差异有显著性（P<0.05）。开放性外伤与闭合性外伤术前比较，闭合性外伤组在6个环的N1、P1波振幅密度均低于开放性外伤，但统计学差异无显著性(P >0.05)；两组术后比较，闭合性外伤组在6个环的N1、P1波振幅密度仍低于开放性外伤，统计学差异有显著性（P<0.05），两组手术前后的N1、P1波潜伏期差异均无显著性(P >0.05)。轻度PVR与重度PVR术前比较，重度PVR组在6个环的N1、P1波振幅密度低于轻度PVR组，统计学差异有显著性（P<0.05），两组潜伏期无明显差异(P >0.05)；术后比较，振幅密度及潜伏期差异均无显著性(P >0.05)。所有患者手术前后比较，术后6个环的N1、P1波振幅密度增加，潜伏期缩短，与术前相比统计学差异有显著性（P<0.05）。术后视力与mfERG总反应密度没有明显相关关系(P >0.05)，视力相同总反应密度变化较大。 结论 外伤性RD的VRS后视网膜功能有一定程度恢复，开放性外伤的视功能恢复要好于闭合性外伤，mfERG能对其进行客观定量评价。
Analyzing multifocal eiectroretinography in patients with traumatic retinal detachment before and after vitreoretinal surgery.
Wang Ying ,Cheng Song，Li Yan . Tianjin Eye Hospital, Tianjin , 300040, China.
ABSTRACT
Object To explore the value of multifocal electroretinogram (mfERG) in evaluating retinal function in traumatic retinal detachment(RD) before and after vitreoretinal surgery (VRS). Methods 41 patients (41 eyes) with traumatic RD were examined using a visual evoked response imaging system(VERIS science 4.2, EDI, America). The stimulus matrix consisted of 103 hexagons within a 23°degree visual field. The hexagon areas were scaled with eccentricity and were divided into 6 rings. A Burian-Allen contact lens electrode was used to record the responses from the 103 hexagons within 3 min 38 sec (16 segments). The 41 eyes included 23 eyes with open-globe injurys and 18 eyes with closed-globe injurys. 27 of the 41 eyes had slight proliferative vitreous retinopathy(PVR)(PVRB～PVRC1) and 15 had severe PVR (PVRC2～PVRD3). The amplitudes and latencies of N1 wave and P1 wave were recorded before and after surgery and were compared with those of the normal control group. Results In all the eyes with traumatic RD, the latencies of N1 wave and P1 wave in the 6 rings were significantly delayed and their amplitudes markedly decreased compared with the normal group（P<0.05）.In contrast to the closed-globe injury group, the open-globe injury group had lower pre-operative amplitudes of N1 wave and P1 wave in the 6 rings. But there was no significant difference between them (P >0.05) .The postoperative N1 and P1 amplitudes of the open-globe injury group were still lower than those of the closed group, which was statistically significant (P<0.05）. There was no significant difference in N1 and P1 latencies between the two groups both before and after surgery(P >0.05). Before surgery, the N1 and P1 amplitudes of the severe PVR group in the 6 rings were significantly lower than those of the slight PVR group (P<0.05), but there was no significant difference in N1 and P1 latencies between them(P >0.05). After operation, no significant difference was detected between the two groups both in amplitudes and in latencies(P >0.05). The amplitudes of N1 wave and P1 wave in the 6 rings increased and the latencies decreased after operation in all the patients. The changes were statistically significant (P<0.05. There was no significant correlation between vision and the total response after surgery(P >0.05). The response density varied at wide range in eyes with the same vision. Conclusion The retinal function in traumatic RD can be recovered to a certain extent after VRS. The retinal function of open-globe injury can recover better than closed. MfERG is useful to evaluate it objectively and quantitatively.
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