糖尿病患者行白内障超声乳化术后视力及眼底的变化

目的 通过观察2型糖尿病患者行白内障超声乳化摘除及人工晶体植入术后视力及眼底的变化以评估糖尿病视网膜病变(DR)进展的相关危险因素。 方法 选取50例2型糖尿病伴非增殖型糖尿病视网膜病变(NPDR)且需单眼行白内障超声乳化及人工晶体植入术患者为研究对象,手术眼为手术组,非手术眼为非手术组。术后1、7 d及1、3个月,分别行最佳矫正视力(BCVA)及黄斑区光学相干断层扫描(OCT);术后3个月行FFA检查,分析DR进展的相关危险因素。 结果 手术组术后1 d~3个月视力明显改善(P<0.01),术后3个月BCVA呈下降趋势。手术组术后黄斑水肿发生率及DR进展率明显高于非手术组,差异有统计学意义(P<0.05或P<0.01)。Logistic回归分析结果显示,糖化血红蛋白(HbA1c)(OR=21.423)、糖尿病病程(OR=9.061)、NPDR程度(OR=2.486)为DR进展的危险因素。 结论 2型糖尿病NPDR患者行超声乳化及人工晶体植入术后BCVA明显改善,于术后3个月呈轻微下降趋势。糖尿病病程长、血糖控制差、术前DR加重是术后DR进展的危险因素。     

西南地区糖尿病视网膜病变远程系统筛查应用研究

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)远程筛查系统应用效果。方法构建省市县区及基层卫生服务中心四位一体的糖尿病视网膜病变防治远程筛查系统,采集各级卫生机构确诊糖尿病的病人共5921例的免散瞳眼底彩照,由第三方眼底读片中心采用和生视网膜图像分析软件对图片进行半自动化智能检测,通过人工审核进行最终结果判断。结果纳入5921例患者共11842眼中,获得可分析图像11140眼,其中1125只眼眼底无异常(10.09%),具有DR改变者2055眼(18.45%),轻度NPDR者325眼(2.92%),中度NPDR者1596眼(14.32%),重度NPDR者124眼(1.11%),PDR者10眼(0.89%);屈光介质浑浊者2283只眼(20.49%);动静脉交叉压迹者1336眼(11.99%);眼底具有近视弧形斑改变5274只眼(47.34%);其他眼病者310只眼(2.78%)。结论社区DR远程筛查系统可满足DR患者筛查的需求,同时可以实现对屈光介质混浊、近视眼底改变等眼病的初步筛查,对早期指导糖尿病患者进行眼科治疗具有积极作用。     

可元胶囊治疗单纯型糖尿病性视网膜病变的临床观察

目的 观察可元胶囊治疗单纯型糖尿病性视网膜病变(DR)的临床疗效和安全性。 方法 以自身前后对照方法观察50例单纯型DR患者服用羟苯磺酸钙1、2、3个月后的视力和荧光眼底血管造影的变化,以及应用生化检查分析患者血液流变学的变化。 结果 单纯型DR患者服用药物后全血黏度（H 及L）、红细胞压积均有明显下降,视功能改善的有效率为88%。治疗期间患者未出现明显不适及药物不良反应。结论 可元胶囊治疗单纯型糖尿病性视网膜病变安全有效。     

中医药治疗糖尿病视网膜病变的临床进展

糖尿病视网膜病变(DR)是糖尿病患者常见的眼底微血管病变,该病可致使视网膜呈现水平不一的病变。病变晚期患者视力严重受损,难以逆转,因此对该病的防治也十分重要。中医称该病为“消渴内障”,自古以来中医对该病有着特色的医治经验。近年来,随着国家大力发展中医药事业,中医药防治DR的文献逐渐增多,本文从中医治疗角度入手研究中医药治疗DR的临床治疗进展。     

黄斑局部光凝治疗糖尿病视网膜病变黄斑水肿的疗效观察

糖尿病视网膜病变(diabetic retinopathy,DR)是以微血管受损为主要特征的视网膜血管性疾病,黄斑水肿是DR引起视力丧失的主要因素[1].我们采用黄斑局部光凝(MLP)法治疗增生前期及增生期糖尿病视网膜病变黄斑水肿,效果满意.现总结如下.     

院内制剂糖网润燥丸改善早期糖尿病视网膜病变可能机制研究

目的 观察糖网润燥丸对糖尿病视网膜病变期患者视力、眼底、血糖、及相关炎症因子的影响。方法 回顾我院2021年1月1日至2021年4月30日收治糖尿病视网膜病变Ⅰ、Ⅱ、Ⅲ期患者60例,对照组患者口服羟苯磺酸钙分散片,治疗1组口服糖网润燥丸3 g, 3/日,治疗2组于羟苯磺酸钙分散片基础上予糖网润燥丸口服,疗程为3月,治疗前后完善眼底照相,空腹血糖(FBG)、餐后2小时血糖(PG2h)及糖化血红蛋白(HbA1c)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF),评估治疗后临床效果。结果 眼底改善情况治疗2组优于对照组及治疗1组(P<0.05),FBG、PG2h、HbA1c水平在治疗后2个治疗组均较对照组明显下降(P<0.05),IL-6、TNF-α、VEGF水平均明显降低,且治疗2组三项指标均明显低于治疗1组(P<0.05)。结论 糖网润燥丸在提高糖尿病早期视网膜病变患者视力,改善眼底病变情况方面有积极作用,辅助降糖、减轻炎症反应可能是其发挥疗效的可能机制。     

糖尿病性白内障超声乳化联合人工晶体植入术

目的探讨糠尿病性白内障患者行超声乳化联合人工晶体植入术的安全性和有效性.方法对糖尿病性白内障112例、132眼行超声乳化联合人工晶体植入术.结果手术均顺利完成,术中无严重并发症,术后并发症多数为眼前节反应,经药物治疗后均好转.结论对于糖尿病性白内障只要术前准备充分,多数(不合并眼底病变者)患者术后视力基本与非糖尿病性白内障术后无差别.因此,糖尿病性白内障应用超声乳化联合人工晶体植入术是安全有效的.     

白内障超声乳化人工晶体植入术与年龄相关性黄斑变性的相关性研究

目的 探讨白内障超声乳化吸除联合人工晶体植入术患者合并年龄相关性黄斑变性(AMD)的比率,分析术后影响视力恢复的因素及手术对AMD的影响。方法 回顾性分析白内障超声乳化吸除人工晶体植入术300眼并检查裸眼视力、眼前节及眼底,必要时检查最佳矫正视力(BCVA)。采用SPSS 13.0软件进行统计学分析,P＜0.05为差异有统计学意义。结果 ①术后第1天,BCVA＜0.3者45眼(15.00%),≥0.3者255眼(85.00%);术后3个月,BCVA＜0.3者18眼(6.00%),≥0.3者282眼(94.00%);②术后眼底正常者215眼,AMD 56眼、糖尿病性视网膜病变13眼、高度近视性视网膜病变7眼、视网膜静脉阻塞3眼、视网膜色素变性和视神经萎缩各2眼、黄斑裂孔和黄斑前膜各1眼;③白内障术后AMD以早中期患者多见,晚期较少,较术前视力均有提高;④白内障术前确诊合并AMD者11眼,术后3个月复查有1眼从早期发展至中期,余未见明显变化,差异无统计学意义(χ2 ＝0.234,P＝0.890)。结论 AMD是白内障超声乳化联合人工晶体植入术后影响视力恢复的主要眼底疾病,其次为DR和高度近视性视网膜病变。白内障手术患者合并AMD的比率为18.67%,其中以早中期最为常见。白内障超声乳化联合人工晶体植入术对AMD的发生发展没有明显影响,且能提高术后视力。     

糖尿病视网膜病变的转归

糖尿病(diabetic mellitus,DM)及其并发症已成为肿瘤和心脑血管疾病之外严重危害人类健康的疾病,随着人们生活水平的提高及人均寿命的延长,糖尿病的患病率逐年增加.而糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病微血管并发症中最重要的病变之一,和成年人致盲重要的原因之一.     

糖尿病性盲患者玻璃体手术后的脱盲率及未脱盲原因分析

目的 分析因增殖性糖尿病视网膜病变(PDR)致盲行玻璃体手术后脱盲率及未脱盲的原因。方法 对110例(142眼)符合盲标准并行玻璃体手术的糖尿病视网膜病变患者的临床资料进行分析,观察术后的脱盲率并分析未脱盲的原因。结果 研究所纳入的142只盲眼中,术后脱盲91眼,脱盲率为64.1%。未脱盲的主要原因包括术前牵拉性视网膜脱离、视网膜血管严重闭塞、视神经病变、弥漫性黄斑水肿和新生血管性青光眼等。结论 玻璃体手术可以使部分糖尿病性盲的患者脱盲,而未脱盲的原因较复杂,避免糖尿病性盲的关键在于早期预防和早期治疗。     

Association of different severity of diabetic retinopathy and hearing loss in type 2 diabetes mellitus

PurposeMicrovascular involvement in patients with diabetes mellitus is one of the causes of retinopathy, nephropathy, and neuropathy. The same pathologic processes may occur in the inner ear structures. This case-control study aimed to evaluate the hearing thresholds in type 2 diabetic patients with different severity of diabetic retinopathy (DR) and to compare these findings with controls.Materials and methodsWe evaluated the hearing threshold in four groups of eligible subjects aged 20–70 years. These groups were controls, diabetic patients with no-DR, with mild-moderate non-proliferative DR (NPDR), and with severe NPDR/proliferative DR (PDR). Each group consisted of 105 subjects. Speech-frequency and high-frequency hearing levels (SFHL and HFHL, respectively) were measured and log-transformed. Analysis of covariance was used. The prevalence rate of moderate or more hearing loss in the groups was estimated.ResultsIn total, 194 men and 226 women participated. The ratio of means of SFHL and HFHL between PDR and controls was 0.18 and 0.20, respectively. Hearing loss was prevalent in severe NPDR/PDR (adjusted prevalence ratio 3.36 for SFHL and 1.51 for HFHL) compared to controls. Also, the prevalence of high-frequency hearing loss was more in mild-moderate NPDR (adjusted prevalence ratio 1.33).ConclusionsThe magnitude of the increase in hearing impairment prevalence between the severe NPDR/PDR patients and controls was about 24% for both SFHL and HFHL. We recommend hearing assessment in the screening of the DR patients.     

Hearing disorders in patients with insulin-dependent diabetes mellitus

The cochlear and retrocochlear hearing function was evaluated in patients with long- and short-term insulin-dependent diabetes mellitus (IDDM) by means of psychoacoustic testing and auditory brain stem responses (ABR). Twenty patients with diabetic microangiopathy (median age 41 years, range 25-66 years) were examined. The median duration of their diabetes was 26 years (range 13-46 years). In addition, 19 patients without microangiopathy (median age 27 years, range 17-42 years) and with a median duration of the diabetes of 2 years (range 0-6 years) were examined. The metabolic control estimated by blood glucose concentration and glycosylated haemoglobin was identical in the two groups of IDDM patients. After correction for age and sex, no significant differences in hearing thresholds or discrimination scores were present between the two diabetic groups, or between the diabetic patients and an age- and sex-matched normal background population. In the patients with long-term IDDM, ABR produced abnormal responses in 40%, indicating the presence of diabetic encephalopathy, whereas ABR were abnormal in only 5% of the patients with short-term IDDM.     

Clinical study of the oral manifestations and related factors in type 2 diabetics patients

Diabetes Mellitus (DM) is reported with and associated to oral alterations, with conflicting results. The aim of this study was to identify the prevalence of oral soft tissue alterations in type 2 diabetes mellitus patients.Material and MethodsSocioeconomic variables, gender, heredity, capillary glucose control and local factors (prosthesis, dry mouth sensation) were analyzed in 196 diabetic and non-diabetic patients enrolled in HIPERDIA, at 41 Health Units of Natal, Brazil.Study DesignA case study.ResultsThe last blood glucose mean was 177.0 mg/dl for diabetics and 89.46 mg/dl for non-diabetics. Mean capillary blood glucose was elevated in diabetics (215.95 mg/dl); it was 102.31 mg/dl in non-diabetics. The family history confirmed the heredity nature of the disease in 68.8% of diabetic patients (n = 66) (p < 0.001); salivary flow was 49% (n = 47) in diabetics, and 34% (n = 34) in non-diabetics. Candidiasis was present in 30.5% of diabetic patients (n=29) and 36% of non-diabetics (n=36). Both groups had lesions in the palate - 81.4% (n = 35) in diabetics, and 71.1% in non-diabetics (n = 27) (p = 0.68).ConclusionThe alterations are not related to diabetes and are present independently of having or not type 2 Diabetes Mellitus.     

Nasal mucosal blood flow in patients with diabetes mellitus

Fifty patients with diabetes mellitus of varying duration were divided into two groups according to whether they were on treatment with insulin or not. Nasal mucosal blood flow was investigated and the results were compared with a reference material from healthy subjects, and were also related to the degree of retinopathy. Patients with diabetes mellitus had normal mucosal blood flow. There was no correlation between the duration of diabetes and nasal blood flow, nor was there any correlation between the degree of retinopathy and nasal blood flow. Diabetes mellitus does not seem to be accompanied by changes in blood flow in the nasal mucosa.     

Asymptomatic electronystagmographic abnormalities in patients with type I diabetes mellitus.

Only a few studies have investigated vestibular function in diabetes mellitus (DM), showing contradictory results. We have performed an electronystagmographic (ENG) evaluation of 46 individuals with type I DM and 37 healthy controls. No patient reported subjective vestibular symptoms. Duration of caloric-induced nystagmus (DN) was significantly lower (2.1 +/- 0.7 vs. 2.6 +/- 0.4 min, p less than 0.01), and central nystagmus frequency of caloric response also nonsignificantly tended to be decreased (37.4 +/- 16.5 vs. 41.7 +/- 12.7 beats/30s, p = 0.21) in DM patients, as compared to controls. The latter comparison achieved significance after exclusion of newly diagnosed diabetic patients (33.4 +/- 16.1 vs. 41.6 +/- 12.7 beats/s, p less than 0.05). Depressed caloric reactions were seen in 21.8% of patients. DN was lower in patients with microalbuminuria and retinopathy, but this was not observed after exclusion of newly diagnosed diabetic patients, all of whom had normal ENG responses and no chronic diabetic complications. The existence of a lower DN and central nystagmus frequency should be borne in mind when interpreting ENG tracings in patients with long duration type I diabetes mellitus.     

Auditory evaluation in patients with type 1 diabetes

OBJECTIVES: We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes. METHODS: Group 1 consisted of 40 patients with type 1 diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests). RESULTS: Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group 1 and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group 1 ears. All patients of group 2 presented normal audiograms and ABR tests. CONCLUSIONS: In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group 1 who had normal audiometric thresholds.     

The prevalence of diabetes in a series of patients with subglottic stenosis

Diabetes, which is present in 4 to 8% of adults in the United States, is a risk factor for surgical failure in laryngotracheal airway operations. We conducted a retrospective study to characterize a population of patients with subglottic stenosis-including the prevalence of diabetes, which has not been widely reported. We performed a retrospective chart review of 30 patients--22 women and 8 men, aged 17 to 77 years (mean: 47.5)--with subglottic stenosis who had presented to our facility between July 2001 and June 2004. Diabetes was present in 5 patients (16.7%); the prevalence of diabetes in our study was not significantly different from regional population-adjusted norms (8%). Although higher-grade stenosis was significantly more common in the diabetic patients than in the nondiabetic patients (p < 0.05), we were unable to conclude that diabetes plays an independent role in the development of subglottic stenosis. We intend to conduct a meta-analysis to assess the role that diabetes plays as both a risk factor for and an obstacle to the treatment of airway stenosis.