The Georgia diabetic retinopathy screening study

The diabetic retinopathy screening study represents a major collaborative effort of many volunteer groups interested in decreasing the risk of severe visual loss to Georgia citizens. Results of the present study have stimulated intense interest in screening more high risk persons, such as minorities, without the exclusion of whites. While age-related macular degeneration is the predominant cause of blindness in the U.S., diabetic retinopathy is a major new cause of blindness. With the continuation and completion of this study, we believe that many more of Georgia's citizens will seek ophthalmologic examinations and benefit from previous research regarding the use of laser photocoagulation and vitreoretinal surgery in preventing or reducing the risk of blindness. Since diabetic retinopathy requiring treatment can be present in patients with normal vision, such patients should obtain an annual dilated eye examination by an ophthalmologist. The value of statewide screening for undetected diabetic retinopathy, the determination of how and where to screen in order to give the most benefit to the potentially affected individuals and citizens of Georgia are only a few of the questions that may be answered when this study is completed. Moreover, to our knowledge this study is the first statewide screening for diabetic retinopathy in the United States.     

糖尿病视网膜病变的诊断与治疗研究进展

糖尿病视网膜病变是常见的严重糖尿病眼病,常造成视力减退或失明。该病严重影响着全球成千上万人的生活质量。糖尿病视网膜病变分为增殖性糖尿病视网膜病变与非增殖性糖尿病视网膜病变。糖尿病视网膜病变是糖尿病患者致盲的一个潜在因素,其诊断和治疗集中在疾病后期的血管畸形。本文就糖尿病视网膜病变的病因诊断和治疗的研究进展做一综述,可为基础与临床的深入研究和诊治提供借鉴与参考。     

A fast method to detect blood vessel in retinal image

Due to the increasing number of diabetic patients,the number of people affected by diabetic retinopathy is expected to increase.Diabetic retinopathy is a complication of diabetes and the most serious frequent eye disease in the world.Large-scale retinal screening for diabetic patients is necessary to prevent visual loss and blindness.The analysis of digital retinal images,obtained by the fundus camera,is viewed as a feasible approach because retinal blood vessels have been shown to change in diameter,branching angles,or tortuosity as a result of diabetic retinopathy.The morphological change can help identify the different stages of diabetic retinopathy.In addition,the acquisition of retinal image is nonintrusive and low cost.Automatic segmentation of the retinal blood vessel is a prerequisite for this analysis.1-3 This article presents a method to detect blood vessel based on sobel operators.4 Small and fast computation is the outstanding merit of this method.     

Diabetic retinopathy: management update

The objective of the study is to review the current knowledge and management of diabetic retinopathy. Current information from multi-centre controlled clinical trials and epidemiological studies in different parts of the world were used to review the epidemiology, pathophysiology, classification, clinical features and management of diabetic retinopathy. Diabetes mellitus affects all ocular tissues. Retinopathy, its most devastating ocular complication, presents with similar clinical picture in both types 1 and 2 diabetes. In Nigeria, diabetic retinopathy has an incidence of 33%; accounts for 16.7% of retinal diseases and leads to bilateral blindness in 22.2% of diabetics. Its incidence depends on both the duration of diabetes and the level of glycaemic control. Hypertension, dyslipaemia, hyperglycaemia and cigarette smoking aggravate retinopathy and adversely affect its response to treatment. Strict blood sugar control delays the onset of retinopathy and retards the progression of established disease. Timely laser and vitrectomy surgeries obviate severe visual loss in diabetic retinopathy. The role of medical therapy for diabetic retinopathy is still experimental. Diabetes occurs worldwide; diabetic retinopathy is increasing in incidence. Developed countries have clear guidelines on the care of diabetes and its complications. The need for similar guidelines in Nigeria is urgent.     

糖尿病视网膜病变虚-瘀-痰病机演变及防治思路

糖尿病视网膜病变是糖尿病常见并发症之一,致盲率高,严重影响患者生活质量。随着病程进展,患者眼底病变由轻度非增殖性病变到中度非增殖性病变再到重度非增殖性病变,最后到增殖性病变,其中医病机也相应存在着虚-瘀-痰的演变过程。本病病变以脾、肾、肝为主,其中脾虚为本病发病之本,脾虚日久及肾,导致脾肾两虚,肝肾同源,肾虚致肝阴肝血不足,目失所养,导致视物模糊等一系列症状。致病因素以瘀血、痰浊为主,脏气虚推动无力则血瘀,血瘀气滞,气滞水停日久化为痰浊,后期则痰瘀互结。本病防治根据其不同发展阶段分别以补虚、化瘀、消痰为治则,辨证用药,临床效果良好,可以明显改善患者眼部症状以及全身症状。     

Retinopathy of prematurity: an epidemic in the making

Objective To explore the etiology, incidence and methods to prevent and treat severe retinopathy of prematurity （ROP）,which is rapidly becoming a threat to the vision of babies in areas of the world where increasing numbers of premature babies are surviving.Data sources The data used in this review were mainly from Medline and PubMed published in English. The search term was ＂retinopathy of prematurity and premature birth＂.Study selection We discuss the historical perspectives, prevalence and incidence, classification and treatment methods of ROP in premature babies.Results Peripheral retinal ablation for eyes with severe ROP can help prevent progression to blindness and several large clinical trials have shown the effectiveness of this treatment in high risk eyes. As a greater proportion of VLBW and ELBW babies survive, the population of babies at risk increases. In various regions of the world, different identification criteria are used to determine which babies are at risk of blindness in order to provide timely diagnostic examinations and treatment as needed. Methods for preventiing ROP include better ante-natal and obstetric care leading to a reduction in the rate of prematurity, the use of ante-natal corticosteroids, and better neonatal care practices. Recent developments have indicated that management of oxygen supplementation is important for the prevention of severe ROP; however,there is not yet known what oxygen saturation target should be adopted. Sepsis increases severe ROP in very preterm infants. Genetic associations and a telemedicine approach may be explored to detect ROP. Treatment of anti-VEGF therapy are potentially useful in eyes with severe ROP, but long term effects are not yet known and such treatment should be used with great caution.Conclusions ROP is a potentially binding disease for premature babies which is becoming more prevalent with the development improving neonatal services in many countries in recent years. High priority should be placed on developing approaches to prevent ROP blindness by reducing preterm birth, improving care of premature babies in neonatal care units, and providing adequate ophthalmological services in those regions.     

Advances in optic nerve regeneration and neuroprotection strategies

The most common irreversible blindness diseases are age-related macular degeneration,glaucoma,and diabetic retinopathy which involve the optic nerve or retina.These diseases share a common condition of causing blindness-progressive neural cells loss of retina (photoreceptor cells,retinal ganglion cells (RGCs)).Although many advances in the treatment for these diseases have been achieved in recent years,the visual function often cannot be reversed.To improve the visual outcomes,the retinal neuron cells must be rescued.Optic nerve diseases including glaucoma were mostly studied for the effort to rescue the injured neurons and regenerate the neuron axons.     

The dimensions of ocular morbidity amongst the nursing home geriatrics population

A cross-sectional prevalence study amongst a nursing home elderly population was carried out at Rumah Sri Kenangan, Seremban, Negeri Sembilan between June 1995 until June 1996. A total of 204 cases of 60 years and older were examined in order to determine the ocular morbidity amongst them. It was found that 47.5% had low vision and 19.1% were legally blind. Cataract was found to be the leading cause of low vision and blindness occurring in 81.4% and 74.3% respectively. Glaucoma occurred in 1% of those who had low vision and none due to macular degeneration or diabetic retinopathy. The magnitude of visual impairment and blindness in this nursing home is high but is preventable and avoidable.     

激光光凝治疗糖尿病视网膜病变的疗效观察

目的评价眼底激光光凝治疗糖尿病视网膜病变（DR）的疗效。方法对78例（141眼）糖尿病视网膜病变患者采用VISULAS 532S眼底激光治疗仪进行视网膜激光光凝术,术后3月、6月、1年FFA复查,随访1年。结果 78例（141眼）中视力提高或无变化88.9%,视力下降11.1%,新生血管退行79.3%,黄斑水肿减轻78.6%。结论激光治疗糖尿病视网膜病变安全有效。选择合适时机和合理的激光参数对不同分期的DR行全视网膜光凝（PRP）是确保DR患者视力康复的关键。     

新生血管性青光眼的治疗进展

新生血管性青光眼(NVG)是具有严重致盲性的一种青光眼,归因于新生血管生成阻碍房水外流,通常继发于糖尿病性视网膜病变、缺血性视网膜中央静脉阻塞和眼部缺血综合征。NVG主要表现为封闭的房角,虹膜新生血管,严重的眼痛和视力通常较差以及非常高的眼压。因其病因复杂,治疗难度大,对患眼威胁甚大。尽管多年来已提出相当多的药物或手术治疗方式,但仍未找到一种可治疗大多数NVG以及预防失明的治疗方法。     

白内障摘除联合人工晶体植入术后糖尿病视网膜病变的激光治疗

目的:探讨白内障摘除联合人工晶体植入术后糖尿病(DM)视网膜病变的激光治疗效果。方法:白内障摘除联合人工晶状体置入术后120例DM网膜病变患者(180眼)均采用经眼底荧光血管造影(FFA)确定为增殖前期DM视网膜病变(PPDR)40眼、增殖期DM视网膜病变(PDR)140眼,采用全视网膜光凝治疗,随访6～24个月。结果:患者视力、视网膜病变改善的有效率为73.9%、76.1%。3个月后复查视力、眼底、FFA及彩色眼底像,新生血管大部分萎缩,视网膜水肿消退,无灌注区残留补充激光光凝。无黄斑水肿组治疗后的视力显著优于有黄斑水肿组,P<0.05。结论:白内障摘除联合人工晶状体置入,及时合理的激光治疗是确保DR患者视力稳定,降低致盲率的关键。     

Accelerated diabetic retinopathy in pregnancy--a real and present danger

A 36 year-old Malay lady with diabetes mellitus in pregnancy and poorly controlled hypertension developed rapid progression of diabetic retinopathy from no retinopathy to florid proliferative retinopathy over three months in her right eye. She had subsequent loss of vision due to vitreous haemorrhage in the peri-partum period. She had good final visual acuity with quiescent retinopathy following pars planar vitrectomy. A similar course was avoided in the left eye by timely pan retinal photocoagulation.     

人工智能诊断系统在视网膜疾病的研究进展

视网膜疾病是人类严重视力丧失的主要原因,糖尿病视网膜病变(DR)、青光眼视网膜病变、视神经病变及年龄相关性黄斑变性(AMD)等疾病的早期筛查及按时随访是疾病防治的重点。但由于眼科医生数量有限、难以开展大规模人工筛查。人工智能(AI)技术在眼科领域的应用为解决上述难题带来曙光。本文对AI在DR、青光眼视网膜病变及视神经病变、AMD等疾病诊断中的临床应用进行综述,探讨AI诊断系统在视网膜疾病教学中的应用,并指出目前AI诊断系统面临的问题,展望其在视网膜疾病领域的应用前景。     

Screening of diabetics for retinopathy by ophthalmic opticians

Diabetes mellitus is a major cause of blindness in England and Wales in those aged between 30 and 64. Photocoagulation can frequently prevent blindness provided the retinopathy is detected at an appropriate stage but unfortunately the benefits are small if the changes are advanced. Early detection of diabetic retinopathy by regular examination is needed. We have shown that ophthalmic opticians have the skill to detect retinal changes at a treatable stage. Out of 844 eye checks, 80 were reported by ophthalmic opticians to justify referral to an ophthalmologist and 20 of these required photocoagulation treatment. Of a sample of 197 patients rechecked by an ophthalmologist reported by ophthalmic opticians not to justify referral, only one needed treatment. With local agreement this system of detecting retinopathy could be easily applied anywhere in the United Kingdom. No extra personnel or facilities are needed.     

山东省桓台县盲与低视力状况调查

目的：调查2009年7月-2013年4月期间桓台县进行视力残疾重新鉴定的残疾人的等级分布、主要致残原因及性别差异,为地区防盲、治盲提供资料和依据。方法收集2009年7月-2013年4月期间桓台县进行视力残疾重新鉴定并明确诊断的视残患者560例。记录患者的眼部情况,根据第二次全国残疾人抽样调查视力残废分级标准,对患者进行分级并明确致残原因。不同致残原因所致盲和低视力频数分布的差异进行χ2检验。结果男性299名和女性261名,性别没有明显差异。560名视残患者中盲442例（78.93％）,其中一级372例（66.43％）,二级70例（12.50％）;低视力118例（21.07％）,其中三级50例（8.93％）,四级68例（12.14％）。白内障22例（3.93％）,其中盲4.1％,低视力3.4％。盲与低视力主要致病原因的构成不完全相同（χ2＝32.79, P＜0.01）。致盲病因主要为遗传、先天异常或发育障碍（29.4％）、视网膜、色素膜病变（23.5％）,而致低视力病因主要为视网膜、色素膜病变（32.4％）、遗传、先天异常或发育障碍（23.7％）。结论桓台县2009年7月-2013年4月期间确定的视力残疾中盲患者明显多于低视力患者,遗传、先天异常或发育障碍以及视网膜、色素膜病变分别是致盲和低视力的首要原因,其中白内障所占比率已明显下降。     

糖尿病视网膜病变的流行病学研究

糖尿病视网膜病变(DR)是20~74岁人群的主要致盲原因。DR的发生和进展与多种因素相关,早期诊断并积极治疗以防止或延缓其进展至关重要。采用流行病学调查的方法了解DR的流行情况及相关危险因素,为早期预防提供依据。本文就DR的流行病学调查方法、患病情况及相关危险因素简要综述。     

糖尿病性视网膜病变的诊断

糖尿病视网膜病变是糖尿病的严重并发症之一,其病理机制表现为视网膜血管瘤的形成、视网膜毛细血管和小动脉的阻塞、新生血管形成和纤维组织增生、视网膜脱离等。糖尿病视网膜病变在有效的治疗阶段缺乏症状,在晚期常导致不可逆性盲。因此,早期诊断及分级分期能有效地指导激光治疗,减少糖尿病性盲的发生。     

激光光凝治疗糖尿病视网膜病变的临床疗效观察

目的分析探讨激光光凝治疗糖尿病视网膜病变的疗效。方法回顾性分析2010年1月至2011年1月在我院治疗的52例糖尿病视网膜病变患者的临床资料。52例(104只眼)糖尿病性视网膜病变患者行激光光凝治疗后,定期观察视力,进行眼底及荧光素眼底血管造影检查,记录眼底新生血管、视网膜出血渗出、玻璃体积血等情况,观察1～12个月。结果光凝后,显效48眼(46.15%),有效41眼(39.42%),总有效率达85.57%,无效15眼(14.42%)。1～12个月后发生黄斑水肿者5眼,玻璃体积血6眼,经相应治疗后痊愈,无患者出现视网膜剥脱或青光眼。结论激光光凝术治疗糖尿病视网膜病变,可以提高患者的视力,减少视力的丧失机会,是一项安全、有效的治疗糖尿病视网膜病变的方法。     

氩离子激光治疗糖尿病视网膜病变的临床效果分析

目的探讨氩离子激光对糖尿病视网膜病变的治疗效果。方法回顾性分析我院2009年1月一2010年1月收治的80例（117只眼）糖尿病视网膜病变患者的临床资料,分析治疗效果。结果光凝术后FFA检查提示视网膜新生血管或无灌注区部分或全部退行者95只眼,有效率为82．9％,其中DR（Ⅱ）12只眼,有效率为92．3％（12／13）,DR（Ⅲ）39只眼,有效率为86．5％（37／43）,DR（Ⅳ）41只眼,有效率为78．8％（41／52）,DR（V）3只跟,有效率为333％（3／9）。统计分析显示四者比较差异有统计学意义（x2=6．947,P=0．018．〈0．05）;治疗后视力提高两行或以上有41只眼,占35％,视力维持不变的有52只眼,占44．4％,总有效率为85．4％。结论氩离子激光局部或全视网膜光凝术,可以有效地阻止糖尿病视网膜病变的进一步发展,挽救患者的视力,提高患者的生活质量。     

60岁及以上人群眼疾流行病学调查与治疗

目的调查门诊患者中≥60岁人群中眼疾患病率及其致盲与低视力的原因。方法将2007年1—12月我院眼科门诊患者2556例中≥60岁的患者634例作为调查对象。采用WHO盲与低视力标准，由专门眼科医生作外眼、前房、晶状体、眼底等检查，对所有视力〈0．3的患眼进行主要病原诊断及治疗。结果就诊634例中，盲及低视力患病率占10．57％，致盲及低视力的主要眼病依次为白内障（6．94％）、视网膜及视神经病变（1．58％）、角膜疾病（0．95％）、玻璃体病（0．79％）、青光眼（0．32％）。结论白内障仍占致盲和低视力病因的首位，今后防盲、治盲的重点应是白内障的手术复明。