视网膜脱离眼的黄斑局部视网膜电图频谱分析

目的 了解视网膜脱离（ＲＤ）眼黄斑部光感受器细胞与光感受器后神经元细胞功能异常的情况。方法 １２０例ＲＤ患者１２８只眼的ＬＥＲＧ被记录分析，应用手提眼底镜式局部刺激器通过放大的瞳孔直视眼底监控固视状况，闪烁光频率３１Ｈz。结果 与对照组相比，ＬＥＲＧ的基波（lf)与二次谐波（２f）在ＲＤ眼振幅降低。lf的异常率在发病时间＜１周组、１－周组、２－周组与４－周与８周以上组分别为１５％、２５％、４７％、７６％和９１％，lf／２f呈升高趋势。在眼底镜下黄斑部脱离（４８眼）与不脱离（８０眼）两组中，lf与２f的下降差异有显著意义（Ｐ＜０．０５），２f在前组的下降差异有非常显著意义（Ｐ＜０．０１），而在后组则无显著变化（Ｐ＞０．０５），黄斑部脱离组的lf／２f比值长高（Ｐ＜０．０５）。手术后最佳矫正视力与复位前的ＬＥＲＧ振幅有显著相关。结论 ＲＤ眼的黄斑部光感受器细胞与光感受器后神经元的功能损害同时存在，ＲＤ伴黄斑脱离者的视网膜内层功能受损程度明显增加，ＲＤ眼的ＬＥＲＧ振幅与解剖复位后的视功能恢复有显著相关。

Fourier analysis of macular local electroretinogram in retinal detachment

OBJECTIVE: To understand the sites and physiological characteristics of macular dysfunction in retinal detachment (RD) by evaluating fundamental harmonic (1f) and second harmonic (2f) components of flicker local electroretinogram (LERG). METHODS: LERG were recorded in 128 eyes of 120 patients to a flicker sinusoidally to 31Hz with a hand-held stimulator with direct visualization of the fundus through dilated pupils. RESULTS: Compared to controls, patients showed losses of both fundamental and second harmonic amplitudes. The abnormality rates of fundamental amplitude in groups with RD affected time < 1 weeks, 1 approximately weeks, 2 approximately weeks, 4 approximately weeks and > 8 weeks were 15%, 25%, 47%, 76% and 91% respectively; and the abnormality of rates fundamental-second harmonic amplitude ratios (1f/2f) were 5%, 14%, 28%, 64% and 87% respectively. On average, 2f decreased more quikly than 1f and 1f/2f tended to increase with the course of disease. The results show both 1f and 2f descend in the RD eyes with or no macular detachment (P < 0.05). 2f just descend obviously in the 48 macular detachment eyes (P < 0.01), so that 1f/2f ascend in these eyes(P < 0.05). There was a significant relation between amplitudes of LERG in the detached eyes before surgery and best postoperational correct vision in the attached eyes. CONCLUSION: In the eyes with retinal detachment, both receptoral and postreceptoral sites contribute to macular dysfunction. The level of macular dysfunction in the eyes with or no macular detachment is different. It would be of clinical value to obtain a fundamental-second harmonic ratio in order to assess the disturbance in the different site of macular. In our opinion: macular flicker local electroretinogram is an important indicator of prognosis to the functional recovery of the attached eye after corrective surgery.