PROGRESSION OF NUCLEAR SCLEROSIS AND LONG-TERM VISUAL RESULTS OF VITRECTOMY WITH TRANSFORMING GROWTH-FACTOR-BETA-2 FOR MACULAR HOLES
PROGRESSION OF NUCLEAR SCLEROSIS AND LONG-TERM VISUAL RESULTS OF VITRECTOMY WITH TRANSFORMING GROWTH-FACTOR-BETA-2 FOR MACULAR HOLES
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DOI：
10.1016/s0002-9394(14)73812-7
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发表时间：
1995-01-01
影响因子：
4.2
通讯作者：
MURPHY, RP
中科院分区：
文献类型：
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作者：
THOMPSON, JT;GLASER, BM;MURPHY, RP
目得：我们研究了玻璃体切除术和滴注转化生长因子β-2治疗全层黄斑裂孔后36个月白内障的进展和视力，方法：64只眼特发性黄斑裂孔和2只眼外伤性黄斑裂孔在这个前瞻性连续系列中被分为以下两组：56只有晶状体眼用70、330或1,330 ng转化生长因子β-2治疗以研究白内障的进展，31只有晶状体眼或人工晶状体眼用1,330 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个月时最终透镜检查时增加至2.4。随着随访时间的延长，核硬化的数量逐渐增加，21只眼睛中有16只（76%）随访24个月或更长时间需要白内障摘除术。平均术前后囊下白内障分级为0.0，最终透镜检查时仅略微增加至0.25。所有患眼的黄斑裂孔最初均成功闭合，但有2只眼（6 - 12个月和19个月）黄斑裂孔重新闭合，平均19.5个月时，31只眼中的29只眼（93.5%）的总体成功率。视力提高2行以上者29眼（93.5%）。31只眼中23只眼（74%）的最终视力为20/40或更好，随访3年视力改善稳定。结论：核巩膜白内障在黄斑裂孔手术后进行了长效眼内气体填充。由于白内障的进展，玻璃体切除术后12个月或更长时间的视力通常会下降，但玻璃体切除术和转化生长因子β-2治疗黄斑裂孔的视力结果在白内障摘除后非常好。
PURPOSE: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.