Patel J I, Hykin P G, Cree I A
Department of Pathology, Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.
Br J Ophthalmol. 2006 Jun;90(6):697-701. doi: 10.1136/bjo.2005.087403. Epub 2006 Mar 15.
Diabetic cataract extraction can be frequently complicated by macular oedema, progression of retinopathy, or development of iris neovascularisation. The pathogenesis of these complications may be the result of changes in the concentration of angiogenic and anti-angiogenic cytokines in the immediate postoperative period. The study aims to prospectively analyse this.
Uneventful phacoemulsification with intraocular lens implant was performed in seven eyes of six patients with diabetic retinopathy ranging from severe non-proliferative to quiescent proliferative. Patients were reviewed 1 day, 1 week, 1 month, and 3 months after surgery with fundus fluorescein angiography (FFA) and aqueous sampling. Each sample was analysed for VEGF, HGF, Il-1 beta (pg/ml), and PEDF (microg/ml) by sandwich ELISA.
Clinically significant macular oedema (CSMO) occurred in one patient although increased macular hyperfluorescence occurred in three patients on FFA at 1 month. VEGF 165 concentration increased 1 day after surgery from a median baseline of 68 pg/ml (range 22-87 pg/ml) to 723 pg/ml (range 336-2071) at day 1. By 1 month it had decreased to 179 (range 66-811 pg/ml). HGF concentrations steadily increased over the month while IL-1 beta and PEDF concentrations demonstrated an acute rise on day 1 after surgery and then IL-1beta returned to baseline concentrations while PEDF decreased to below baseline.
These results confirm altered concentrations of angiogenic and antiangiogenic growth factors after cataract surgery, which may induce subclinical and clinical worsening of diabetic maculopathy.
糖尿病性白内障摘除术常并发黄斑水肿、视网膜病变进展或虹膜新生血管形成。这些并发症的发病机制可能是术后短期内血管生成和抗血管生成细胞因子浓度变化的结果。本研究旨在对此进行前瞻性分析。
对6例糖尿病视网膜病变患者的7只眼进行了顺利的超声乳化白内障吸除联合人工晶状体植入术，病变程度从严重非增殖性到静止增殖性不等。术后1天、1周、1个月和3个月对患者进行眼底荧光血管造影（FFA）和房水采样检查。通过夹心酶联免疫吸附测定法对每个样本分析血管内皮生长因子（VEGF）、肝细胞生长因子（HGF）、白细胞介素-1β（pg/ml）和色素上皮衍生因子（PEDF，μg/ml）。
1例患者发生了具有临床意义的黄斑水肿（CSMO），尽管有3例患者在术后1个月的FFA检查中出现黄斑高荧光增强。VEGF 165浓度在术后1天从基线中位数68 pg/ml（范围22 - 87 pg/ml）增加到第１天的723 pg/ml（范围336 - 2071 pg/ml）。到1个月时降至179（范围66 - 811 pg/ml）。HGF浓度在这1个月内稳步上升，而白细胞介素-1β和PEDF浓度在术后第1天急剧上升，然后白细胞介素-1β恢复到基线浓度，而PEDF降至基线以下。
这些结果证实了白内障手术后血管生成和抗血管生成生长因子浓度的改变，这可能导致糖尿病性黄斑病变的亚临床和临床恶化。
