视网膜脱离眼的黄斑局部视网膜电图

目的：通过对视网膜脱离（retinal detachment,RD）眼的局部视网膜电图（local electroretinogram,LERG)记录分析，进一步了解RD眼黄斑部光感受器细胞与第二级神经元功能异常的情况，并对LERG与视功能预后的关系进行探讨。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，记录a波、b波与OPs各项成分。结果：与对照组相比，LERG的a波、b波与OPs的异常率：在＜1周组分别为15%、15%与10%；在1-2周组为35%、45%与50%；在2-4周组为46.86%、56.25%与62.5%；在4-8周组为76%、84%与88%；在8周以上组则为86.96%、91.30%与95.56%。a波与b波在脱离时间＜1周组与对照组无明显差异；1-2周组a波与b波开始开始有明显降低（P＜0.05)，随着发病时间的延迟，b波的下降较a波更为迅速，在2-4周则具有高度显著意义（P＜0.05)。b/a值在早期RP病变表现正常或轻度异常，伴随病程增加有降低趋势，在4-8周组即出现显著性降低（P＜0.05)。在眼底镜下黄斑部脱离的48只眼中，LERG各项成分的降低均有统计学意义；而在眼底镜下观测不到黄斑脱离的80只眼中，b波、OPs与OP2子波振幅也表现异常（P＜0.05)。结论：⑴在视网膜脱离眼，黄斑部光感受器与第二级神经元细胞的功能损害同时存在；⑵b波与a波的比值变化表明了内层与外层的相对损害程度，随着病情的发展，视网膜内层的损害有加重趋势；⑶RD伴黄斑脱离者的视网膜内外层功能受损程度明显增加，而镜下未脱离者也可存在功能的损害；⑷RD眼的OPs振幅可为视网膜内层循环功能的损害提供敏感性指标。研究认为：LERG对RD眼黄斑功能异常的客观定位诊断与视功能预后具有特定的临床意义。

Macular local electroretinogram in retinal detachment

Objective：To understand the sites and characteristics of maculardysfunction in retinal detachment（RD）by evaluating components of local electroretinogram（LERG）.Methods：LERG were recorded in 128 eyes of 120 patients of retinal detachment by using a hand-held stimulator with direct visualization of the fundus through dilated pupils.Results：Compared to controls，the patients showed losses of a-wave，b-wave and oscillatory potentials（OPs）amplitudes.The abnormality ratios of a-wave and OPs in RD affected time：＜1 week were 15％，15％ and 10％；1～2 weeks were 35％，45％ and 50％；2～4weeks were 46.86％，56.25％ and 62.5％；4～8 weeks were 76％，84％ and 88％；＞8 weeks were 86.96％，91.30％ and 95.56％ respectively.On average，b-wave decreased quicker than a-wave，and b／a tended to decrease with the course of disease.The results show a-wave，b-wave and OPs decreased significantly in the 48 RD eyes with macular detachment（P＜0.05），wnile amplitudes of b-wave，OPs and OP2 also decreased obviously in the other eyes（P＜0.05）.Conclusion：The results suggest that in the eyes with retinal detachment dysfunctions in both receptoral and postreceptoral sites contribute to macular dysfunction.In eyes without macular it also shows macular dysfunction，but the level of macular dysfunctions in eyes with macular detachment is greater than those without macular detachment.It would be of clinical value to obtain a a-wave and b-wave ratio in order to assess the disturbance in the different site of macula.In our opinion，LERG is an important indicator for prognosis of the functional recovery of the attached eye after corrective surgery.