Takagi H, Otani A, Kiryu J, Ogura Y
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Japan.
Ophthalmology. 1999 Feb;106(2):249-56; discussion 256-7. doi: 10.1016/S0161-6420(99)90054-4.
To examine the efficacy of surgical removal of foveal hard exudates in diabetic macular edema and to determine the expression of vascular endothelial growth factor (VEGF) in the excised specimens.
Cohort study.
Seven eyes of six patients with massive subfoveal hard exudate due to diabetic macular edema were examined. The average age of the patient was 56 years (range, 46-60 years).
Pars plana vitrectomy for removal of massive foveal exudates was performed.
Preoperative and postoperative visual acuity and complications were recorded; immunohistochemical staining for VEGF and other cell markers for macrophage and pigment epithelial cells in excised specimens was performed.
Postoperative best-corrected visual acuity improved by two or more lines of Snellen equivalent in five eyes (71%) (P = 0.0061). VEGF, identified by anticytokeratin and CD68 antibodies, was expressed in pigment epithelial cells and macrophages invading the hard exudates.
Surgical removal of foveal hard exudates might be effective in low-vision patients with diabetic maculopathy. VEGF might play a role in the formation and persistence of foveal hard exudates in diabetic macular edema.
研究手术切除糖尿病性黄斑水肿患者黄斑中心凹硬性渗出物的疗效，并测定切除标本中血管内皮生长因子（VEGF）的表达。
队列研究。
对6例因糖尿病性黄斑水肿导致黄斑中心凹下大量硬性渗出物的患者的7只眼进行了检查。患者的平均年龄为56岁（范围46 - 60岁）。
行玻璃体切除术以清除黄斑中心凹大量渗出物。
记录术前和术后视力及并发症；对切除标本进行VEGF免疫组织化学染色以及巨噬细胞和色素上皮细胞的其他细胞标志物染色。
5只眼（71%）术后最佳矫正视力提高了两行或更多行Snellen视力表等效视力（P = 0.0061）。通过抗细胞角蛋白和CD68抗体鉴定的VEGF在侵入硬性渗出物的色素上皮细胞和巨噬细胞中表达。
手术切除黄斑中心凹硬性渗出物可能对糖尿病性黄斑病变导致视力低下的患者有效。VEGF可能在糖尿病性黄斑水肿黄斑中心凹硬性渗出物的形成和持续存在中起作用。
