糖尿病性视网膜病变患者5年随访观察

目的 探讨糖尿病性视网膜病变(diabeticretinoPathy，DR)的进展与糖尿病病程及血糖控制水平之间的关系。方法 对确诊为糖尿病的患者散瞳详细检查眼底，共132例259眼为无视网膜病变或单纯型DR，定期门诊随访井检测血糖水平。结果 随访观察5a，发现有25眼进展至增生型糖尿病性视网膜病变(proliferative diabeticretinopathy，PDR)，其中血糖控制满意组的144眼中有5眼，占3．40％，而血糖控制不满意组的115眼中有20眼，占17．30％，两者比较，差异有显著性(p＜0．005)。结论 DR随着糖尿病痛程的延长而加重，并且与患者血糖水平控制密切关系。     

2型糖尿病视网膜病变荧光素眼底血管造影随访观察

目的长期动态随访观察汕尾地区确诊的2型糖尿病患者视网膜病变的进展。方法对确诊为糖尿病的50例100眼患者散瞳详细检查眼底,并行荧光素眼底血管造影检查。观察对象均为无视网膜病变或非增生性糖尿病性视网膜病变,定期门诊随访并检测血糖水平。结果定期随访5a后,发现有11眼进展至增生性糖尿病性视网膜病变,其中血糖控制满意60眼中有2眼,而血糖控制不满意40眼中有9眼,二者比较,差异有显著性（P〈0.005）。对糖尿病性黄斑水肿及增生前期、增生期视网膜病变行及时的光凝治疗,以避免视力下降。结论糖尿病视网膜病变发生的严重程度与糖尿病病程、血糖控制程度有关;行荧光素眼底血管造影检查,及时的光凝治疗,可以降低糖尿病视网膜病变引起的视力损伤。     

增殖型糖尿病性视网膜病变行全视网膜光凝后5a随访观察

目的:观察增殖型糖尿病性视网膜病变(proliferativediabetic retinopathy,PDR)行全视网膜光凝术(panretinalphotocoagulation,PRP)后5a的疗效及预后分析。方法:对92例149眼PDR患者行PRP治疗后的1,3,6,12mo进行复查,以后每6mo进行复查,并在3mo后均复查FFA,必要时补充光凝,随访5a。结果:视力提高52眼,保持不变71眼,下降26眼。5a后患者的最终矫正视力情况:≤0.01者19眼,～0.1者64眼,～0.5者58眼,>0.5者8眼。在激光后的随访期间血糖水平基本控制在正常范围内的63眼中,5a后只有6眼发生玻璃体积血、牵拉性视网膜脱离等严重并发症,占9.5%,而在血糖水平控制不满意的29眼中,有9眼(31%)发生上述情况。结论:通过早期发现、及时治疗和定期随访观察而减少糖尿病性盲是完全可能的。对于PDR患者,确诊后应立即进行PRP治疗,并制定定期随访计划,必要时应复查FFA或补充激光,同时,要向患者阐明,严格正规的内科治疗,将血糖控制在正常范围内,可有效地降低或延缓PDR发展的倾向。     

糖尿病视网膜病变的临床观察

目的　探讨糖尿病视网膜病变 (diabetic retinopathy,DR)由单纯型进展至增殖型 (proliferative dia-betic retinopathy,PDR)与诸因素的关系。方法　观察 6 8例 (116只眼 )经检眼镜及荧光眼底血管造影 (fundus fluo-rescein angiography,FFA)检查确诊为 DR的患者 ,其单纯型 DR进展至 PDR IV期的时间眼数及糖尿病性黄斑病变 (diabetic maculopathy,DM)的发展情况 ,并作统计分析。结果　单纯型 DR进展至 PDR IV期的百分率 2年为12 .7% ,5年为 2 9% ,且 > > ,差别具有显著性 (P <0 .0 0 5 )。DR的发展与糖尿病病程及血糖水平呈正相关 ,与高血压及肾脏病变有关。结论　早期发现 DR及 DR进展至 PDR的危险性因素 ,并进行有效的控制 ,是预防和减少 DR致盲的关键     

糖尿病性视网膜病变170例随访分析

目的：观察糖尿病性视网膜病变(DR)各期病程改变及进行危险因素分析。方法：单纯性Ⅰ,Ⅱ,Ⅲ期170例290眼。单纯型进展为增殖型糖尿病视网膜病变(PDR)Ⅳ期,随访2a为42眼14％,5a为98眼34％。结果：Ⅰ,Ⅱ,Ⅲ进展至Ⅳ期的发生率：Ⅲ期＞Ⅱ期,Ⅱ期＞Ⅰ期,差别均有显性(P＜0．05)。糖尿病黄斑水肿随随访年限增长而增加,初诊黄斑水肿70眼,2a内增至86眼,5a内增至110眼。视网膜静脉串珠状改变,视网膜内大量微血管异常和4个象限内存在出血和／或微血管瘤是单纯型进展至PDR的危险性病变。血糖控制不良,糖尿病病程长和高血压可能是单纯型进展至PDR的危险因素。结论：为预防或减少DR致盲,应早期发现DR,并给予长期随访。     

85例糖尿病视网膜病变的检测及激光治疗

目的 通过分析85例糖尿病患者的糖尿病性视网膜病变的检测阳性率及激光治疗疗效，讨论糖尿病性视网膜病变的早期诊断和及时有效的治疗在临床应用的重要意义。方法 通过对85例(170只眼)糖尿病患者进行糖尿病性视网膜病变(DR)的检眼镜检查及眼底荧光血管造影检查确诊，对有适应证者给予视网膜激光光凝治疗。结果 85例(170只眼)检眼镜下确诊率为20．5％(35只眼)，经眼底荧光血管造影检测确诊率为22．9％(39只眼)，39只眼中，DRⅠ期23只眼，DRⅡ期5只眼，DRⅢ期6只眼，DRⅣ期3只眼，DRⅤ期2只眼。嘱85例患者积极按照内分泌科医师的指导，控制血糖在正常水平，对DRⅢ期6只眼行格子样激光光凝治疗，DRⅣ期3只眼行全视网膜激光光凝治疗，DRⅤ期2只眼先行玻璃体切割术，术后两周内分行全视网膜光凝治疗。经2．5～3年随访观察：39只眼激光治疗后病情稳定。结论 糖尿病视网膜病变在治疗有效阶段缺少症状，晚期能导致双眼不可逆性盲。目前糖尿病视网膜病变有增多趋势，早期的准确诊断和及时有效的治疗，能减少糖尿病性盲的发生。     

老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

早期糖尿病患者糖尿病视网膜病变发生率的调查分析

为调查早期糖尿病患者（病程＜５年）糖尿病视网膜病变的发生率,对本院内分泌科住院治疗的糖尿病患者（经ＷＨＯＩＤＤＭ诊断标准确诊,病程＜５年）７２例,共１４４只眼,常规眼科会诊,双眼散瞳详细检查眼底,眼底镜下可疑及有明确病变的患者行ＦＦＡ检查确诊。结果：７２例患者１４４只眼中眼底镜下有明确病变的４例５只眼,可疑１４例,１８例患者均行眼底荧光血管造影（ＦＦＡ）检查,最后确诊有糖尿病视网膜病变的６例７只眼,占８．３％。结论：要高度重视早期糖尿病患者糖尿病视网膜病变的发生。     

氩激光视网膜光凝治疗糖尿病性视网膜病变

目的观察糖尿病性视网膜病变的光凝治疗效果。方法对136例(261只眼)糖尿病性视网膜病变患者,根据病变的程度行氩激光视网膜光凝治疗,并随访1年,观察光凝治疗变后患者的视力、眼底及荧光血管造影的变化,并进行分析和比较。结果在136例(261只眼)糖尿病性视网膜病变中,有效226只眼,总有效率 86．5％,其中增生前期糖尿病视网膜病变64只眼,有效60只眼,有效率93．7％;增生期糖尿病视网膜病变197只眼,有效眼166,有效率84．2％％。经统计学检验P<0．01,两者有显著差异。讨论对早期糖尿病性视网膜病变患者,如有光凝指征,应尽早行氩激光视网膜光凝治疗,这对于控制或延缓糖尿病性视网膜病变的进展,稳定患者视力有重要意义。     

早期糖尿病患者糖尿病视网膜病变发生率的调查分析

为调查早期糖尿病患者（病程＜５年）糖尿病视网膜病变的发生率。对本院内分泌科住院治疗的糖尿病患者（经ＷＨＯＩＤＤＭ诊断标准确诊，病程＜５年）７２例１４４只眼，双眼散瞳详细检查眼底，对可疑及有明确病变的患者行ＦＦＡ检查确诊。结果：７２例患者１４４只眼中眼底镜下有明确病变的４例５只眼，可疑１４例，该１８例患者行眼底荧光血管造影（ＦＦＡ）检查，最后确诊有糖尿病视网膜病变的６例７只眼，占８．３％。结论：要高度重视早期糖尿病患者糖尿病视网膜病变的发生     

Epidemiological and angiofluorographic aspects of diabetic retinopathy in Senegal

PURPOSE: Attempting to improve life expectancy among diabetics reveals degenerative complications, including diabetic retinopathy (DR) linked to microangiopathy. We assessed the incidence of diabetic retinopathy in its various forms amongst diabetics in Senegal. PATIENTS AND METHODS: We carried out a survey between March and October 1998. The 51 patients surveyed had been affected for more than 5 years. They were divided into two groups: insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD). Patients were aged 17-71 and included 27 IDD and 24 NIDD. Each patient was given both a biological checkup (blood sugar level, HBA1c, creatininemy, triglycerides, cholesterol, albuminaria and urinary glucose) and an ophthalmological checkup with angiography in fluorescence. RESULTS: Of the 51 patients studied, 26 presented a progression span of the disease of over 10 years. DR was detected in 62 eyes out of 102 (60.78%), with 37.25% of nonproliferating DR, 17.65% of preproliferating DR, and 5.88% of proliferating DR. Maculopathy was detected in 10 eyes (9.80%). Amongst the IDD patients, diabetic retinopathy accounted for 57.14% of diabetes, with a progression span of less than 10 years, compared to 84.62% for diabetes with a progression span of over 10 years. Amongst the NIDD patients, diabetic retinopathy accounted for 36.36% compared to 61.54%. DISCUSSION: Through these results, a connection can be made between diabetic retinopathy, the progression span of diabetes, the type of diabetes, and the other microangiopathies. We noted a rise in retinopathy that increased with the age of diabetes patients and their IDD group. CONCLUSION: A multidisciplinary support of diabetes ensures early detection of diabetic retinopathy; hence the need for closer collaboration between the endocrinologist and the ophthalmologist.     

糖尿病性视网膜病变的随访观察

随访糖尿病视网膜病变（ＤＲ）单纯型Ⅰ、Ⅱ、Ⅲ期８５例１４５眼,单纯型进展为增殖型糖尿病视网膜病变（ＰＤＲ）Ⅳ期者,随访２年为２１眼（１４％）,５年为４９眼（３４％）;Ⅰ、Ⅱ、Ⅲ进展至Ⅳ期的发生率,Ⅲ期〉Ⅱ期,Ⅱ期〉Ⅰ期,差别有显著性（Ｐ〈０．０５）。糖尿病黄斑水肿随访年限增长而增加,初诊黄斑水肿３５眼,２年内增至４３眼,５年内增至５５眼,视网膜静脉串珠状改变,视网膜内大量微血管异常和四个象限内存在出血和／或微血管瘤是单纯型进展至ＰＤＲ的危险性病变,血糖控制不良,糖尿病病程长和高血压可能是单纯型进展至ＰＤＲ的危险性因素。为预防或减少ＤＲ致盲,应早期发现ＤＲ,并给予长期随访。     

Four years incidence of diabetic retinopathy and effective factors on its progression in type II diabetes

PURPOSE: To study the 4 years incidence of diabetic retinopathy in patients with type II diabetes and effective factors on its progression. METHODS: Among diabetic patients referred to Yazd Diabetes Research Center, 120 patients with type II diabetes without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), postprandial blood sugar, triglyceride, and cholesterol were measured and height, weight, and blood pressure (BP) were recorded. Then patients were followed with eye examination yearly for 4 years. RESULTS: Four-year cumulative incidence of diabetic retinopathy was 47.5% (95% CI: 38.6-56.4). The retinopathy was mild nonproliferative diabetic retinopathy (NPDR) in 43 (35.8%) whereas 10 (8.3%) patients had moderate NPDR, 3 (2.5%) patients had severe NPDR, and only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in the second year, 24.4% in the third year, and 7.4% in the fourth year. Duration of diabetes, FBS, and systolic BP had statistically significant relation with grades of diabetic retinopathy. However, there was no significant association between age, sex, body mass index, triglyceride, cholesterol, method of treatment, smoking, and diastolic BP with grades of diabetic retinopathy. CONCLUSIONS: These data provide 4-year cumulative incidence of diabetic retinopathy in defined type 2 diabetic patients. The present study shows that duration of diabetes, hyperglycemia, and systolic BP appear to be the major factors associated with the development of any level of retinopathy in type 2 diabetic patients.     

Primary color P-VEP in diabetic retinopathy

148 normal eyes and 123 eyes of diabetic retinopathy patients were examined the red, green, blue primary color and black/white P-VEPs, with the conclusion that the latencies of P100 were significantly delayed in the diabetic group, particularly that of the blue color, which was also in positive correlation with the level of blood sugar and the duration of diabetes. The consistency of blue P-VEP with fluorescein angiographic examination in diabetic retinopathy was good, and the abnormality ratio of the former (73.0%) was higher than that of the latter (60.2%). The results indicated that S-wave cones were damaged more readily than were L-wave cones, and the blue P-VEP was sensitive in monitoring the injury to visual function in diabetes.     

Influence of clinical factors on blue-on-yellow perimetry for diabetic patients without retinopathy: comparison with white-on-white perimetry

PURPOSE: To investigate the influence of clinical factors (duration of diabetes mellitus, fasting blood sugar level, fructosamine concentration, and hemoglobin A1c) on blue-on-yellow (B-on-Y) perimetry compared with white-on-white (W-on-W) perimetry for diabetics without retinopathy. METHODS: Both B-on-Y perimetry and W-on-W perimetry were performed for 33 diabetics without retinopathy. Thirty-three subjects with healthy eyes served as age-matched controls. RESULTS: For both diabetic patients and controls, mean deviation (MD) and corrected pattern SD of perimetry showed no difference irrespective of B-on-Y or W-on-W perimetry. For diabetics, MD of B-on-Y perimetry decreased in proportion to the morbid period with diabetes mellitus, with the same being true with deterioration of the clinical factors. Multiple regression analysis disclosed no differences in MD of clinical factors for W-on-W perimetry, despite the duration of diabetes mellitus exerting a significant influence on MD of B-on-Y perimetry. CONCLUSION: Even at the premorbid stage of diabetic retinopathy, longer duration of diabetes mellitus and longer persistence of poorly controlled diabetes mellitus are associated with an insidious progress of dysfunction in the retinal blue cone system.     

Pulsatile ocular blood flow in diabetic retinopathy.

PURPOSE: To assess circulatory properties of eyes with progressive stages of diabetic retinopathy. METHODS: The intraocular pressure, pulse amplitude (PA) and pulsatile ocular blood flow (POBF) were measured with a pneumatonometer (OBF Labs UK Ltd). The eyes were grouped: (a) normal control, n = 26, (b) diabetes with no observable diabetic retinopathy (NDR), n = 18, (c) mild to moderate non-proliferative diabetic retinopathy (NPDR), n = 20, and (d) very severe pre-proliferative and proliferative diabetic retinopathy (PPDR/PDR), n = 12. RESULTS: The PA and POBF values were lower than normal values in the earliest stage (NDR). The POBF increased but was still below normal levels at the NPDR stage, and then increased to an above normal level in the PPDR/PDR stage of diabetic retinopathy. The PA was at normal levels in these later two stages. CONCLUSION: An initial decrease in pulsatile ocular blood flow is present with the onset of diabetes where no diabetic retinopathy has yet occurred. Subsequently, the pulsatile ocular blood flow increases with the severity of the retinopathy.     

Multifocal electroretinogram responses in Nepalese diabetic patients without retinopathy

Purpose

To determine neuroretinal function with multifocal electroretinogram (mfERG) in diabetic subjects without retinopathy.

Methods

Multifocal electroretinogram (mfERG) was performed in 18 eyes of 18 diabetic subjects without retinopathy and 17 eyes of 17 age and gender-matched healthy control participants. Among 18 diabetic subjects, two had type 1 and 16 had type 2 diabetes. MfERG responses were averaged by the retinal areas of six concentric rings and four quadrants, and 103 retinal locations; N1–P1 amplitude and P1-implicit time were analysed.

Results

Average mfERG N1–P1 amplitude (in nv/deg²) of 103 retinal locations was 56.3 ± 17.2 (mean ± SD) in type 1 diabetic subjects, 47.2 ± 9.3 in type 2 diabetic subjects and 71.5 ± 12.7 in controls. Average P1-implicit time (in ms) was 43.0 ± 1.3 in type 1 diabetic subjects, 43.9 ± 2.3 in type 2 diabetic subjects and 41.9 ± 2.1 in controls. There was significant reduction in average N1–P1 amplitude and delay in P1-implicit time in type 2 diabetic subjects in comparison to controls. mfERG amplitude did not show any significant correlation with diabetes duration and blood sugar level. However, implicit time showed a positive correlation with diabetes duration in type 2 diabetic subjects with diabetes duration ≥5 years.

Conclusions

This is the first study in a Nepalese population with diabetes using multifocal electroretinography. We present novel findings that mfERG N1–P1 amplitude is markedly reduced along with delay in P1-implicit time in type 2 diabetic subjects without retinopathy. These findings indicate that there might be significant dysfunction of inner retina before the development of diabetic retinopathy in the study population, which have higher prevalence of diabetes than the global estimate and uncontrolled blood sugar level.     

Anterior Capsular Phimosis Occluding the Capsulorhexis Opening after Cataract Surgery in a Diabetic Patient with High Hemoglobin A1C

ABSTRACT

Purpose: To report a case of complete occlusion of the capsulorhexis opening in a DM patient with high hemoglobin A1C level. Methods: A 77-year-old woman with non-insulin-dependent diabetes underwent uncomplicated phacoemulsification in both eyes. One year later, she presented again because of reduced vision (best-corrected visual acuity of 16/20 in the right eye, 6/20 in the left eye). Dilated examination revealed marked anterior capsular contraction in the right eye and anterior capsular phimosis totally occluding the capsulorhexis opening in the left eye. Results: The severity of diabetic retinopathy and her fasting blood sugar (225?mg/dl) and hemoglobin A1C level (8.5%) increased during the previous year. Uncorrected visual acuity of 18/20 (OS) was achieved after a neodymium:YAG (Nd:YAG) radial anterior capsulotomy was performed. Conclusion: Microvascular complications such as diabetic retinopathy or diabetic iritis can occur in patient with uncontrolled diabetes mellitus. The pathophysiology of anterior capsular phimosis in this patient is probably increased vascular permeability chronically associated with diabetes.