Diabetic retinopathy.

Diabetic retinopathy is the commonest cause of blindness amongst individuals of working age. The onset of retinopathy is variable. Regular ophthalmic screening is essential in order to detect treatable lesions early. Retinal laser therapy is highly effective in slowing the progression of retinopathy and in preventing blindness. As the sufferers of diabetes mellitus, the commonest endocrine disorder, now constitute approximately 1-2% of Western populations, concerted multidisciplinary effort must be made towards cost-effective community screening by the medical community.     

Retinopathy in a diabetic population

Aims and Objectives: The study was conducted with the aim to find out the prevalence of diabetic retinopathy among diabetics on treatment, to find out the presence of associated risk factors and to determine the knowledge of diabetic retinopathy among patients with diabetic mellitus. Methodology: Cross sectional screening of 316 diabetic patients on treatment presenting to Kalimati Diabetic Clinic and Kathmandu Medical College was done over a period of 8 months for the presence of diabetic retinopathy, associated risk factors and the knowledge of diabetic retinopathy. Results: 21% of the known diabetics had evidence of various grades of diabetic retinopathy although 75.3% of the enrolled patients had history of diabetes mellitus of less than 10 years. Associated risk factors were present in 66.46%. However, only 50% diabetics had the knowledge of diabetic retinopathy. Conclusion: As 21% of the diabetic patients on treatment had various grades of diabetic retinopathy and 50% of the diabetic patients were not aware of diabetic retinopathy, emphasis has to be given for the awareness of ocular involvement in diabetes mellitus such that blindness from retinopathy can be prevented. The responsibility lies on treating physicians or Diabetic Centres for referral of diabetic patients for ophthalmic evaluation. Similarly, control of associated risk factors like hypertension, hyperlipidemia is equally important. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Laser Photocoagulation.     

Alteration of timing of secretion of vascular endothelial growth factors is responsible for progression of diabetic retinopathy

Diabetic retinopathy is one of the most common complications in diabetes mellitus due to persistent hyperglycaemia. Various biochemical mechanisms have been suggested to cause this complication. The authors' present study which included 100 patients of type-2 diabetes mellitus with different stages of diabetic retinopathy and without retinopathy shows that initiation of diabetic retinopathy is associated with increased anaerobic glycolysis and accelerated oxidative stress. Progression of this complication is guided by increased secretion of vascular endothelial growth factors. It is our assumption that increased secretion of vascular endothelial growth factors in early part of this disease e.g. before occurrence of morphological abnormality may modify this complication.     

Diabetic retinopathy: a preventable scourge

In recent years, the India has witnessed a rapidly exploding epidemic of diabetes mellitus. It would not be hyperbolic to state that diabetes mellitus is the mother of morbidity of all vital organs. Diabetic retinopathy and its complications cause considerable ocular morbidity as well. With effective management strategies visual loss due to the disease can be controlled and further dissemination of the disease could be prevented. The key to proper management of diabetic retinopathy includes prophylaxis by controlling blood sugar, periodical screening of retina for early detection, prompt referral for prevention of progression by appropriate laser photocoagulation, surgical correction of various anatomical abnormalities, low vision aids and rehabilitative measures in patients with severe visual loss. Howerver, the awareness level of visual consequences of this widely prevalent disease even amongst diabetics is lacking.     

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。     

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。     

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。     

糖尿病致盲的局部和全身因素分析

本文检查了705例(1409只眼)糖尿病患者,对眼局部致盲原因和与盲有关全身因素进行了分析。双眼盲77例,占10.9％,单眼盲139例,占19.7％。盲目眼的局部原因以DR居首位,其中玻璃体出血、牵拉性视网膜脱离及新生血管性青光眼为主要致盲眼疾。全身相关因素显示,尿蛋白、收缩压、性别及病程与盲目密切相关,血糖与盲亦相关。     

糖尿病视网膜病变的视功能检测

糖尿病视网膜病变（diabetic retinopathy,DR）是糖尿病并发的一种严重的致肓性眼病,其复杂的病理变化破坏了视网膜的正常功能,导致视力不可逆性的损害。光学相干断层扫描技术（optical coherence tomography, OCT1）、多焦视网膜电图（muhifoeal ERG,mERG）、视觉诱发电位（visual evoked potential,VEP）作为新的无创性检查技术,能在早期发现视网膜功能的异常并追踪病情进展,在糖尿病视网膜病变的研究中得到了广泛的应用。本文就近年来糖尿病视网膜病变中有关视功能检测方法的研究进展做一综述。     

Application of Higher Order Spectra for the Identification of Diabetes Retinopathy Stages

Diabetic retinopathy (DR) is a condition where the retina is damaged due to fluid leaking from the blood vessels into the retina. In extreme cases, the patient will become blind. Therefore, early detection of diabetic retinopathy is crucial to prevent blindness. Various image processing techniques have been used to identify the different stages of diabetes retinopathy. The application of non-linear features of the higher-order spectra (HOS) was found to be efficient as it is more suitable for the detection of shapes. The aim of this work is to automatically identify the normal, mild DR, moderate DR, severe DR and prolific DR. The parameters are extracted from the raw images using the HOS techniques and fed to the support vector machine (SVM) classifier. This paper presents classification of five kinds of eye classes using SVM classifier. Our protocol uses, 300 subjects consisting of five different kinds of eye disease conditions. We demonstrate a sensitivity of 82% for the classifier with the specificity of 88%.     

Eye care guidelines for patients with diabetes mellitus.

Diabetic retinopathy is the leading cause of blindness in adults under age 65 in the United States. Risk is related to the stage of retinopathy. With new treatments available, it is imperative that diabetics be properly screened. Those with retinopathy of more than five years duration should be referred to an ophthalmologist. Since photocoagulation has been shown effective for treatment of macular edema and proliferative retinopathy, it is imperative that these patients be referred for timely evaluation.     

三七总皂苷及其制剂治疗糖尿病视网膜病变的研究进展

糖尿病视网膜病变（DR）是糖尿病常见的并发症,也是导致糖尿病患者失明的主要原因,严重影响糖尿病患者的生活质量。目前,临床上治疗DR的主要手段包括手术治疗、激光治疗以及药物治疗。其中,药物治疗能够对病情发展的多个环节进行干预,并减少激光治疗和手术治疗引起的相关并发症。然而,由于眼部结构的特殊性,导致药物的生物利用度较低,迫切需要寻求和开发疗效好、毒副作用低的药物以及合适剂型。中药具有历史悠久、来源广泛、多靶点协同作用等优点,在治疗DR方面具有独特优势。三七总皂苷是从中药三七中提取的主要有效活性成分群,目前已被证实具有治疗DR的作用。文章对三七总皂苷治疗DR的机制及其临床应用于DR的剂型进行分析与归纳,对三七总皂苷的药物剂型开发前景提出展望。     

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.     

糖尿病视网膜病变的发病机制

 糖尿病视网膜病变（diabetic retinopathy,DR）是糖尿病最主要的微血管并发症之一,是成人失明的重要原因。其发病机制复杂,多种生化异常牵涉其中,主要包括：多元醇途径亢进、蛋白激酶C激活、氧化应激增高、终末糖基化产物形成、生长因子和黏附分子表达增加等。本文就DR及其发病机制作一综述。     

Risk factors for retinopathy in diabetes mellitus in Kelantan, Malaysia

Few attempts have been made to determine the risk factors for diabetic retinopathy which is a major cause of visual impairment and blindness. One hundred and forty patients of diabetes mellitus were studied to determine the prevalence and types of retinopathy, and its relation to various risk factors. Nearly half (48.6%) of the patients suffered from retinopathy. The significant associated risk factors were long duration of diabetes, proteinuria and elevated serum creatinine level. However, there was no significant association between the prevalence of retinopathy and high levels of serum cholesterol, C-peptide levels, associated hypertension, and glycaemic control of diabetes mellitus. An effective screening programme for detection of retinopathy in the patients of diabetes as a regular practice is encouraged.     

2型糖尿病患者眼表改变的研究进展

糖尿病可引发视网膜病变、视神经病变、新生血管性青光眼和代谢性白内障等多种眼部并发症，在致盲性眼病中占有重要位置。既往对糖尿病性视网膜病变的相关研究较多，但对糖尿病性眼表改变研究较少。糖尿病导致的眼表改变包括泪腺、睑板腺、结膜、泪膜、角膜等的改变，如干眼、睑板腺功能障碍、角膜上皮损伤等。本文对2型糖尿病患者的眼表病变及其发病机制的研究进展进行综述，为临床诊断和治疗提供理论依据。     

STUDY OF DIABETIC EYE COMPLICATIONS OTHER THAN DIABETIC RETINOPATHY

In a series of 735 diabetics, a search for ocular signs other than diabetic retinopathy to help diabetes diagnosis suggests that reduced corneal s.ensitivity, somewhat high intraocular pressure and heightened dark adaptation threshold without significant cause all may in- dicate diabetes mellitus.     

Diabetic nephropathy--prevention and treatment

Diabetic nephropathy is a major cause of end stage renal failure. Non-insulin dependent diabetes mellitus (NIDDM) is more prevalent in our country than insulin dependent diabetes mellitus (IDDM). Nephropathy can be classified in IDDM patients in 5 stages which have been elaborated here. The major intervention to prevent or reduce the rate of progress in diabetic nephropathy is control of blood sugar, control of blood pressure, use of angiotensin converting enzyme inhibitors, restricting dietary protein intake, treatment with inhibitors of the formation of advanced glycosylation end products, treatment with aldose reductase inhibitors and treatment of dyslipidaemia. Once the patient of diabetic nephropathy reaches the end stage renal disease, renal replacement therapy is needed. The different modalities of renal replacement therapy are: Haemodialysis, continuous ambulatory peritoneal dialysis, kidney transplantation and kidney and pancreas transplantation. Renal replacement therapy in diabetics has to be individualised from patient to patient. Kidney transplantation is at present the option of choice.     

糖尿病视网膜病变中内质网应激和HIF-1对VEGF的调控机制研究进展

糖尿病视网膜病变（DR）是糖尿病严重的微血管并发症之一,可导致不可逆的失明,DR的基本病理改变是血一视网膜屏障破坏和新生血管形成,而血管内皮生长因子（VEGF）是公认的最重要的眼内新生血管生长因子。近来研究发现,内质网应激（ERS）和低氧诱导因子-1（HIF-1）能够调控VEGF的表达,共同促进DR的病程发展。该文就ERS和HIF-1对于VEGF的调控机制方面的研究进展进行综述。