Hikichi T, Yoshida A, Akiba J, Konno S, Trempe C L
Schepens Eye Research Institute, Boston, MA 02114, USA.
Am J Ophthalmol. 1995 May;119(5):571-5. doi: 10.1016/s0002-9394(14)70214-4.
We ascertained the natural course of stage 2 idiopathic macular holes to determine better treatment possibilities.
We reviewed 48 eyes with stage 2 idiopathic macular holes and followed them up for more than two years. At each examination, best-corrected Snellen visual acuity was measured by a physician masked to the hypothesis of the study.
Stage 2 lesions progressed to stage 3 or 4 during the follow-up period in 32 (67%) and 14 (29%) of 48 eyes, respectively; two eyes (4%) remained in stage 2. In 41 (85%) of 48 eyes, the hole size enlarged during the follow-up: 32 (94%) of 34 eyes had vitreomacular attachment and nine (64%) of 14 eyes had vitreomacular separation at the final examination, for a statistically significant difference in prevalence (P = .03). Visual acuity decreased two or more Snellen lines during the follow-up period in 34 (71%) of 48 eyes, the prevalence of which was significantly higher in eyes with vitreomacular attachment at the final examination (28 of 34, 82%) than in eyes with vitreomacular separation at the final examination (six of 14, 43%) (P = .01).
Even though vitreomacular separation may improve the prognosis of a macular hole, stage 2 lesions usually will develop an enlarged hole and decreased visual acuity.
我们确定了2期特发性黄斑裂孔的自然病程，以确定更好的治疗可能性。
我们回顾了48只患有2期特发性黄斑裂孔的眼睛，并对其进行了两年多的随访。每次检查时，由对研究假设不知情的医生测量最佳矫正视力。
在随访期间，48只眼中分别有32只（67%）和14只（29%）的2期病变进展为3期或4期；2只眼（4%）仍处于2期。在48只眼中，有41只（85%）在随访期间裂孔大小增大：在最后一次检查时，34只眼中有32只（94%）存在玻璃体黄斑粘连，14只眼中有9只（64%）存在玻璃体黄斑分离，患病率有统计学显著差异（P = .03）。在随访期间，48只眼中有34只（71%）的视力下降了两行或更多行，在最后一次检查时存在玻璃体黄斑粘连的眼中，其患病率（34只中的28只，82%）显著高于存在玻璃体黄斑分离的眼中（14只中的6只，43%）（P = .01）。
尽管玻璃体黄斑分离可能改善黄斑裂孔的预后，但2期病变通常会发展为裂孔扩大和视力下降。
