目的：探究孔源性视网膜脱离行巩膜扣带(SB)术或玻璃体切除(PPV)术后视网膜微结构改变与视功能的相关性。

方法：前瞻性临床研究。选取视网膜脱离范围累及黄斑部的15～30岁孔源性视网膜脱离患者75例75眼，PVR等级B～C1级，赤道部后视网膜裂孔者行PPV术(PPV组，35眼)，赤道部前视网膜裂孔者行SB术(SB组，40眼)。术后随访6mo，观察两组患者最佳矫正视力(BCVA)和视网膜微结构变化。

结果：相较于SB组，PPV组术后发生椭圆体带和内界膜断裂的可能性为2.812倍(P=0.020)，发生视网膜下积液的可能性为0.115倍(P<0.001)，但两组患者术后发生层间积液的可能性无差异(P=0.700)，且随着观察时间的延长，两组患者发生椭圆体带和内界膜断裂、视网膜下积液、层间积液的可能性均逐渐降低。术后两组患者黄斑部神经上皮层和外核层厚度逐渐增加，BCVA逐渐改善，随着观察时间的延长，SB组患者神经上皮层厚度的增厚幅度较大，BCVA恢复更佳。

结论：椭圆体带和内界膜完整性、视网膜下积液、层间积液、黄斑部神经上皮层厚度是影响SB或PPV术后视功能恢复的关键因素。

METHODS: Prospective clinical study was conducted. With PVR grade B-C1, 75 patients with 75 eyes of aged 15-30 years who were macular-off retinal detachment were selected. PPV was performed for posterior equatorial retinal hiatus(35 eyes, PPV group), and SB was performed for anterior equatorial retinal hiatus(40 eyes, SB group).The patients in the two groups were followed up for 6mo to observe the changes in the best corrected visual acuity(BCVA)and retinal microstructures.

RESULTS: Compared with SB group, the probability of inner sensory layer/outer sensory layer and inner boundary membrane fracture after operation in PPV group was 2.812 times, with a statistically significant difference(P=0.020), and the probability of subretinal effusion was 0.115 times, with a statistically significant difference(P<0.001). There was no statistically significant difference(P=0.700)between the two groups. And with the extension of observation time, the possibility of inner sensory layer/outer sensory layer and inner boundary membrane, persistent subretinal fluid and interlayer effusion in the two groups of patients gradually decreased. After the operation, the thickness of the neurosensory retinal and outer nuclear layer in the two groups gradually increased, and BCVA gradually improved. With the prolonging of observation time, the thickness of the neurosensory retinal in SB group increased greatly, and BCVA recovered better.

CONCLUSION: The integrity of the inner sensory layer/outer sensory layer and inner boundary membrane, subretinal effusion, interlaminar effusion, and the thickness of the neurosensory retinal are the key factors affecting the recovery of visual function after SB or PPV.