Thompson J T, Glaser B M, Sjaarda R N, Murphy R P
Retina Institute of Maryland, Baltimore 21204.
Am J Ophthalmol. 1995 Jan;119(1):48-54. doi: 10.1016/s0002-9394(14)73812-7.
We studied the progression of cataracts and visual acuity up to 36 months after vitrectomy and instillation of transforming growth factor beta-2 for treatment of full-thickness macular holes.
Sixty-four eyes with idiopathic and two with traumatic macular holes in this prospective consecutive series were divided into the following two groups: 56 phakic eyes were treated with 70, 330, or 1,330 ng of transforming growth factor beta-2 to study the progression of cataracts, and 31 phakic or pseudophakic eyes were treated with 1,330 ng of transforming growth factor beta-2 to study the long-term visual acuity after macular hole surgery.
Eyes in the cataract progression study had a mean preoperative nuclear sclerosis grade of 0.4, which increased to 2.4 on final lens examination at a mean of 12.4 months postoperatively. The amount of nuclear sclerosis increased progressively with duration of follow-up, and 16 (76%) of 21 eyes followed up for 24 months or more required cataract extraction. The mean preoperative posterior subcapsular cataract grade was 0.0 and increased only slightly to 0.25 on final lens examination. All eyes had initial successful closure of the macular hole, but the macular hole reopened in two eyes (between six and 12 months and at 19 months) for an overall success rate of 29 (93.5%) of 31 eyes at a mean of 19.5 months. The visual acuity increased two or more Snellen lines in 29 (93.5%) of 31 eyes. The final visual acuity was 20/40 or better in 23 (74%) of 31 eyes and the visual improvement was stable in eyes followed up for three years.
Nuclear sclerotic cataracts progress substantially after macular hole surgery with a long-acting intraocular gas tamponade. The visual acuity often decreases 12 or more months after vitrectomy because of cataract progression, but the visual results of vitrectomy and transforming growth factor beta-2 for macular holes are excellent when the cataracts are removed.
我们研究了玻璃体切割联合注射转化生长因子β-2治疗全层黄斑裂孔后长达36个月的白内障进展情况及视力变化。
在这个前瞻性连续系列研究中，64例特发性黄斑裂孔眼和2例外伤性黄斑裂孔眼被分为以下两组：56例有晶状体眼接受70、330或1330 ng转化生长因子β-2治疗以研究白内障进展情况，31例有晶状体或人工晶状体眼接受1330 ng转化生长因子β-2治疗以研究黄斑裂孔手术后的长期视力。
白内障进展研究中的患眼术前平均核硬化等级为0.4，术后平均12.4个月进行最终晶状体检查时升至2.4。核硬化程度随随访时间逐渐增加，21例随访24个月或更长时间的患眼中有16例（76%）需要进行白内障摘除。术前平均后囊下白内障等级为0.0，最终晶状体检查时仅轻微升至0.25。所有患眼黄斑裂孔最初均成功闭合，但有2例患眼黄斑裂孔重新开放（分别在6至12个月和19个月时），31例患眼中共有29例（93.5%）在平均19.5个月时成功闭合。31例患眼中有29例（93.5%）视力提高了两行或更多行。31例患眼中有23例（74%）最终视力达到20/40或更好，且随访三年的患眼视力改善情况稳定。
黄斑裂孔手术联合长效眼内气体填塞后，核性硬化性白内障进展显著。玻璃体切割术后，由于白内障进展，视力常于术后12个月或更长时间下降，但摘除白内障后，玻璃体切割联合转化生长因子β-2治疗黄斑裂孔的视力结果极佳。
