Aspects of growth hormone control in diabetes

Growth Hormone (GH) has been implicated in the development of retinal new vessels that characterise diabetic proliferative retinopathy. Formerly, pituitary ablation was successful in causing such new vessels to regress but this approach has been largely superseded by panretinal photocoagulation. A clearer understanding of the GH abnormalities in diabetes might not only shed light on the process of retinal new vessel formation but could also provide a means for pharmacological suppression of GH in those patients not fully responding to laser photocoagulation. In this review, GH control in diabetes is considered with particular reference to studies in patients with diabetic retinopathy.     

Rapid resolution of severe retinal neovascularisation in proliferative diabetic retinopathy following adjunctive intravitreal bevacizumab (Avastin)

A 23‐year‐old aboriginal woman with severe bilateral proliferative diabetic retinopathy and left rubeotic glaucoma received bilateral pan‐retinal photocoagulation with adjunctive intravitreal bevacizumab. Six days post‐injection, there was almost complete resolution of new vessels.     

灯盏细辛联合激光光凝治疗糖尿病视网膜病变

目的:探讨灯盏细辛注射液联合视网膜激光光凝术治疗糖尿病视网膜病变的临床效果。 方法:糖尿病视网膜病变患者50例用灯盏细辛注射液联合视网膜激光光凝术治疗,对照组患者50例单纯采用羟苯磺酸胶囊口服,观察治疗前后的眼底改善和视力提高情况及血液流变学的改变。 结果:糖尿病视网膜病变患者用灯盏细辛注射液联合视网膜激光光凝术治疗后,能明显提高糖尿病视网膜病变患者的视力,明显改善患者眼部微循环,总有效率达90％,与对照组相比,差异有统计学意义（P<0.05）。 结论:灯盏细辛注射液联合视网膜激光光凝术治疗糖尿病视网膜病变,具有良好的临床疗效,能更好改善糖尿病视网膜病变的微循环状态,并延缓和改善糖尿病视网膜病变。     

Repeated intravitreal bevacizumab (Avastin®) treatment of persistent new vessels in proliferative diabetic retinopathy after complete panretinal photocoagulation

Acta Ophthalmol. 2011: 89: 76–81

Abstract.

Purpose: To evaluate the effect of repeated intravitreal injections of bevacizumab (Avastin^®) in patients with proliferative diabetic retinopathy and persistent new vessels after panretinal photocoagulation. Methods: In this prospective study we investigated 11 eyes of 10 diabetic patients with persistent new vessels after previous complete panretinal photocoagulation. Complete ophthalmological examinations were performed at baseline and during monthly follow‐up visits until the final follow‐up at 6 months. Colour fundus photography, fluorescein angiography (FA) and macular optical coherence tomography (OCT) were performed. The area of leakage (mm²) found in the FA was used to demonstrate the effect of bevacizumab on retinal new vessels. Patients received 1.0 mg of intravitreal bevacizumab at baseline and at each of the monthly follow‐up visits when reappearance of retinal new vessels was documented. Results: At the 1‐week follow‐up visit, 73% of the treated eyes showed complete regression of retinal new vessels. Eight eyes were assigned to retreatments at the 3‐month follow‐up because of the reappearance of retinal new vessels. After 6 months, 36% of the eyes were found to have reappearance of retinal new vessels. The retreatment rate was 1.9 ± 0.7 and the mean interval to retreatment was 2.9 ± 1.0 months. The mean leakage area decreased from 7.2 ± 2.6 mm² at baseline to 1.2 ± 0.9 mm² at the final follow‐up visit. BCVA increased from 59.2 ± 14.6 Early Treatment Diabetic Retinopathy Study (ETDRS) score (range 40–80) to 70.7 ± 8.5 at the final visit (p = 0.017). Conclusion: Intravitreal bevacizumab led to a significant reduction of retinal new vessels for a mean period of 2.9 months. A 3‐monthly retreatment regime might be a valid method to control retinal new vessels in diabetic patients with persistent new vessels.     

基层医院激光治疗糖尿病视网膜病变临床观察

目的：探讨基层医院全视网膜光凝治疗糖尿病视网膜病变的疗效。

方法：对55例92眼分别为增殖前期糖尿病视网膜病变(PPDR)、增殖期糖尿病视网膜病变(PDR)患者进行全视网膜光凝术,术后3, 6, 12mo行眼底荧光血管造影(FFA)及彩色眼底像, 新生血管未消退者和无灌注区尚存者追加光凝, 随访3～12mo。

结果：全视网膜光凝术后PPDR视力提高和视力不变者23眼(77%),视力下降者7眼(23%); PDR视力提高和视力不变者44眼(71%),视力下降者18眼(29%)。经过一次全视网膜光凝后,3mo复查FFA,新生血管未退、无灌注区未消失者追加光凝,PPDR有效率为29 眼(97%),PDR有效率为50 眼(81%); 13眼(14%)出现玻璃体出血转上级医院行玻璃体切割术。

结论：基层医院全视网膜光凝治疗糖尿病视网膜病变疗效良好。     

Photocoagulation for optic disc new vessels in diabetes mellitus

The effects of treatment by argon laser and xenon arc photocoagulation in 165 diabetic patients with optic disc new vessel formation have been studied retrospectively. Visual acuity and degree of new vessel formation have been assessed over a period of between six months and seven years of follow-up (mean 23 months). Visual acuity improved in 36% of treated eyes and remained unchanged in 34%. Improvement was most marked in those with initially poor acuity (less than 6/36). There was no association between improvement in visual acuity and regression of disc vessels, the latter occurring in 79% of treated eyes. Only 6% of eyes became blind during the period of follow-up, principally as a result of vitreous haemorrhage and retinal detachment. There was no difference between the results produced by the use of separate or combined argon laser and xenon arc photocoagulation on the regression of disc new vessels. However, our results suggest that argon laser treatment was more effective than xenon arc photocoagulation in improving visual acuity. These findings suggest that either form of treatment or a combination offers considerable benefit in the management of proliferative diabetic retinopathy, even when very severe at presentation.     

糖尿病视网膜病变激光治疗疗效观察

目的：探讨糖尿病视网膜病变激光治疗技术标准及疗效。方法：根据DRPSG(Diabetic Retinopathy Photocoagula-tion Study Group)制订的治疗技术规定，对350例410只眼分别为增殖前期糖尿病视网膜病变(proliferative diabetic retinopa-thy,PPDR)、增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)及糖尿病性黄斑水肿患者行激光治疗，按技术规定的光凝范围和光凝参数行标准全视网膜光凝(standard panretinal photocoagulation,S-PRP)和超全视网膜光凝(extra panretinal photocoagulation,E-PRP)及黄斑水肿行局限光凝或格栅光凝，术后3、6、12个月行FFA及彩色眼底像，新生血管未消退者和无灌注区尚存者追加光凝，随访3—42个月。结果：50只眼弥漫性黄斑水肿格栅光凝后，33只眼水肿减轻或消失，有效率66．0％，390只眼行全视网膜光凝，新生血管部分或全部消退281只眼，有效率为72．1％，410只眼中视力不变和增进325只眼，占79．3％。结论：按DRPS制订的治疗技术规定治疗糖尿病视网膜病变是行之有效的，激光治疗糖尿病视网膜病变更规范化。     

氩激光光凝结合活血化淤中药治疗糖尿病视网膜病变

目的比较氩激光光凝结合活血化淤中药与单纯视网膜光凝治疗糖尿病视网膜病变的疗效.方法观察了68例(124眼)糖尿病视网膜病变患者.其中40例(73眼)光凝结合中药;28例(51眼)单纯光凝.观察2组治疗后的视力、眼底变化及血液流变特性.结果光凝结合中药组达到最佳视力的时间,眼底出血、水肿吸收的时间较单纯光凝组明显缩短(P＜0.05),其血液的高黏、凝、聚状态明显改善.结论氩激光光凝结合活血化淤中药治疗糖尿病视网膜病变的疗效优于单纯氩激光光凝.     

Variability in photocoagulation treatment of diabetic macular oedema

Purpose: To establish whether differences in the assessment of diabetic macular oedema (DME) with either optical coherence tomography (OCT) or stereoscopic biomicroscopy lead to variability in the photocoagulation treatment of DME. Methods: The differences in the assessment of DME with either OCT or stereoscopic biomicroscopy were analysed by calculating the surface areas and the overlap of retinal thickening. Photocoagulation treatment plans of retinal specialists were compared by evaluating the number and location of planned laser spots. Results: The threshold for and dosage of photocoagulation differ depending upon whether the basis of retinal thickness diagnosis is clinical observation or OCT. The overlap in laser spot location based on the assessment of DME with OCT or biomicroscopy averages 51%. Among retinal specialists, the treatment plans differed in the laser spot count by six‐ to 11‐fold. Conclusion: Diabetic macular oedema photocoagulation treatment threshold and dosage of laser spots differ depending on whether thickness assessments are based on stereoscopic slit‐lamp biomicroscopy or OCT. In addition, retinal specialists differed in the number and placement of planned laser spots even when given identical information concerning DME and treatable lesions. This variability in the photocoagulation treatment of DME could lead to differences in patient outcome and laser study results.     

联合用药对DR患者视网膜血管血氧饱和度和血清Apelin水平的影响

目的：探讨复方樟柳碱注射液联合曲安奈德对糖尿病视网膜病变(diabetic retinopathy,DR)患者视网膜血管血氧饱和度和血清Apelin水平的影响。

方法：选取2014-06/2016-12我院收治的增殖性DR患者58例60眼为研究对象,根据随机数字表法分为对照组(29例30眼)和观察组(29例30眼)。对照组接受全视网膜激光光凝治疗,观察组在全视网膜激光光凝治疗术前玻璃体腔内注射曲安奈德,术后复方樟柳碱颞侧浅层皮下注射。比较两组患者的视力恢复情况、治疗前后视网膜血管血氧饱和度和血清Apelin水平变化情况、治疗后并发症情况。

结果：治疗后1mo,两组患者视力均明显增高,且观察组患者视力提高比例(90%)明显高于对照组(67%),差异有统计学意义(P<0.05)。治疗后1d,1、2mo不同时间点比较,观察组视野平均阈值敏感度均明显高于对照组,差异有统计学意义(P<0.05); 治疗后1mo两组患者视网膜动脉、静脉血管血氧饱和度均显著降低,差异有统计学意义(P<0.05),且观察组视网膜血管血氧饱和度均明显优于对照组,差异有统计学意义(P<0.05); 治疗后1mo两组血清Apelin水平显著降低,差异有统计学意义(P<0.05),且观察组血清Apelin水平水平显著低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为3%,对照组并发症发生率为17%,观察组并发症发生率明显低于对照组,但差异无统计学意义(P=0.109)。

结论：复方樟柳碱注射液联合曲安奈德治疗DR疗效显著,能够有效降低患者视网膜血管血氧饱和度和血清Apelin水平的影响,缓解视网膜缺血缺氧损伤,有利于术后视力恢复,安全性较好。     

糖尿病视网膜病变玻璃体切割术前激光治疗

目的:观察糖尿病视网膜病变(diabetic retinopathy,DR)玻璃体切割术前视网膜光凝治疗的结果。方法:2004-08/2007-08,观察44例(66眼)伴有广泛视网膜水肿和黄斑水肿的增殖前期和增殖期DR患者,均在我院做过玻璃体切割术,根据术前1mo是否行过视网膜光凝将其分为A组(术前视网膜光凝组)36眼,B组(术前无视网膜光凝组)30眼。年龄45～70岁,治疗后随诊6～26(平均12.3)mo。比较两组患者术中并发症,术后视力改善情况。结果:A组:术中见视网膜水肿消退30眼,视网膜出血5眼,医源性裂孔2眼,视网膜切开2眼,硅油填充3眼。B组:术中见视网膜水肿消退0眼,视网膜出血15眼,医源性裂孔8眼,视网膜切开8眼,硅油填充9眼。两组术中情况比较差异有统计学意义(P<0.05)。两组患者手术前后视力均有改善,A组视力改善30眼,B组视力改善19眼,两组视力改善情况比较差异有统计学意义(P<0.05)。结论:选择在玻璃体切割手术前近期行视网膜光凝对合并广泛视网膜水肿的DR,手术预后明显好于无视网膜光凝组,建议在玻璃体切割手术前尽可能使用光凝治疗。     

Aspects of growth hormone control in diabetes

Growth Hormone (GH) has been implicated in the development of retinal new vessels that characterise diabetic proliferative retinopathy. Formerly, pituitary ablation was successful in causing such new vessels to regress but this approach has been largely superseded by panretinal photocoagulation. A clearer understanding of the GH abnormalities in diabetes might not only shed light on the process of retinal new vessel formation but could also provide a means for pharmacological suppression of GH in those patients not fully responding to laser photocoagulation. In this review, GH control in diabetes is considered with particular reference to studies in patients with diabetic retinopathy.     

治疗高危增殖性糖尿病视网膜病变的两种不同光凝疗效比较

目的：比较两种不同光凝方案治疗高危糖尿病视网膜病变，为临床选择获得更好疗效的光凝参数提供参考。方法：高危增殖性糖尿病视网膜病变患者共36例(60只眼)，17例(30只眼)应用方案A全视网膜光凝，19例(30只眼)应用方案B全视网膜光凝，方案B与方案A相比，光斑较大、光凝反应较强及光凝范围较广泛。光凝治疗后3个月及6个月后复查眼底荧光血管造影，并酌情追加光凝。随访时间平均8．3个月。结果：抑制新生血管方面，两种治疗方案均有显著的疗效，方案B组较方案A组对新生血管具有更强的抑制作用(P＜0．01)。全视网膜光凝术后，两组视网膜前出血或少量玻璃体出血的发生率均有下降，方案B组比方案A组对视网膜前出血及玻璃体出血具有更强的治疗作用(P＜0．05)。结论：对严重致盲性疾病高危增殖性糖尿病视网膜病变，及时恰当的全视网膜光凝治疗是抑制新生血管及玻璃体大出血的极重要手段，而采用较大光凝斑，适当的光凝反应和较广泛的光凝范围可能获得更好的治疗效果。     

Photocoagulation for peripheral neovascularisation in diabetes.

A study of 90 eyes in 72 diabetic patients with peripheral retinal neovascularisation treated by photocoagulation indicated that the subsequent development of further peripheral or disc new vessels is infrequent if panretinal photocoagulation is the initial treatment procedure. Focal or sectorial treatment may be considered only if a small area of neovascularisation is present initially and provided regular follow-up can be guaranteed.     

非增殖期糖尿病性视网膜病变临床治疗分析

目的:探讨视网膜局部光凝术联合药物治疗非增殖性糖尿病性视网膜病变(non-proliferative diabetic retinopathy,NPDR)的效果。方法:利用532半导体绿激光机对III期糖尿病视网膜病变(diabeticretinopathy,DR)患者进行局部光凝,应用药物控制患者血糖、血压、血脂和血流变。结果:治疗后185眼中视力提高及稳定者168眼,有效率90.8%,视力下降及出现并发症者17眼(9.2%),治疗前后有显著的临床意义。结论:局部视网膜光凝术联合药物治疗NPDR安全有效。     

普罗布考辅助治疗增殖前期及增殖早期糖尿病视网膜病变

目的　观察半导体激光光凝联合普罗布考治疗增殖前期及增殖早期糖尿病视网膜病变患者视力、眼底改变以及血清８-羟基脱氧鸟苷（８-ｈｙｄｒｏｘｙ-２’-ｄｅｏｘｙｇｕａｎｏｓｉｎｅ,８-０ＨｄＧ）浓度的变化,以评估其临床治疗效果。方法　选取增殖前期及增殖早期糖尿病视网膜病变需行眼底激光治疗的患者６０例（６０眼）纳入研究,按治疗方法不同分成Ａ、Ｂ、Ｃ３组,Ａ组行眼底激光光凝加安慰剂治疗,Ｂ组行眼底激光光凝加ＶｉｔＣ口服,Ｃ组行眼底激光光凝加普罗布考口服,口服药连续服用３个月。用眼底荧光血管造影检查判断眼底病变及黄斑水肿改善情况,用光学相干断层扫描法检查患者黄斑区视网膜厚度的改变,患者空腹抽取静脉血送检,采用酶联免疫吸附试验（ＥＬＩＳＡ）测定血清８-０ＨｄＧ含量。治疗前及治疗后１个月、３个月、６个月、１２个月所有患者均复查眼底荧光血管造影、ＯＣＴ及测定血清８-０ＨｄＧ浓度。治疗后随访１２个月。结果　治疗后１个月、３个月、６个月,Ｃ组血清８-０ＨｄＧ浓度逐渐降低,与治疗前相比差异均有统计学意义（均为Ｐ＜０．０５）;但治疗后１２个月与６个月时相比,血清８-０ＨｄＧ浓度差异无统计学意义;治疗后３个月、６个月、１２个月,Ｃ组血清８-０ＨｄＧ与Ａ组、Ｂ组相比均显著下降,差异均有统计学意义（均为Ｐ＜０．０５）。Ｃ组末次随访时黄斑中心凹视网膜厚度为（２１４±１５）μｍ,与Ｂ组的（２４５±１９）μｍ及Ａ组的（２５８±２４）μｍ相比,差异均有统计学意义（均为Ｐ＜０．０５）,Ｃ组、Ｂ组和Ａ组对糖尿病视网膜病变患者眼底改善的总有效率分别为６５％、３５％及３０％,Ｃ组与Ｂ组、Ａ组眼底改善有效率相比差异均有统计学意义（均为Ｐ＜０．０５）。结论　血清８-０ＨｄＧ浓度是反映糖尿病视网膜病变预后的一个较为敏感的指标,普罗布考对增殖前期及增殖早期糖尿病视网膜病变具有辅助治疗效果,对糖尿病视网膜病变激光术后视功能具有保护作用。     

532nm激光治疗糖尿病视网膜病变的临床观察

目的:评估532nm激光治疗糖尿病视网膜病变(diabetic retinopathy,DR)的治疗效果。方法:应用532nm激光对糖尿病患者48例96眼[包括增殖前期糖尿病视网膜病变(PPDR)54眼,增殖期糖尿病视网膜病变(PDR)42眼(包括高危PDR20眼,非高危PDR22眼),合并黄斑水肿21眼]行视网膜光凝术。根据DR分期及病变严重程度行次全视网膜光凝(Sub-PRP)、标准全视网膜光凝(S-PRP)和超全视网膜光凝(E-PRP)及局限光凝和格栅样光凝,随访3mo～4a,观察视力和视网膜病变进展情况。必要时再补充激光治疗。结果:视力:提高或不变为有效,其中PPDR组有效45眼(83%),非高危PDR组有效18眼(82%),高危PDR组有效12眼(60%)。视网膜病变进展情况:视网膜水肿、渗出、出血部吸收,视网膜新生血管部分或全部消退为有效,其中PPDR组有效50眼(93%),非高危PDR组有效19眼(86%),高危PDR组有效13眼(65%)。结论:倍频532nm激光治疗DR安全有效,早期病变治疗效果好。及早发现和治疗病变,注意光凝方法和技巧,以及随访和跟踪治疗,是提高视网膜光凝疗效的关键。     

正确认识微脉冲激光治疗糖尿病性黄斑水肿的价值

微脉冲激光光凝是通过重复的阈值下极短脉冲光凝来降低组织损伤或实现选择性组织损伤的激光光凝方法.阈值下微脉冲激光与传统激光治疗糖尿病性黄斑水肿(diabetic macular edema,DME)具有相同的维持视力的作用,高密度/低强度微脉冲激光光凝可产生有效治疗效果的同时不对视网膜产生任何可检出的激光损害.微脉冲激光...     

Ocular oxygenation and the treatment of diabetic retinopathy

Retinal photocoagulation and vitrectomy both reduce diabetic macular edema and neovascularization in diabetic retinopathy. We suggest that this clinical effect is based on the effect these treatment modalities have on retinal oxygenation, and we present a theory to explain why retinal photocoagulation and vitrectomy influence edema and neovascularization in diabetic and other ischemic retinopathies.     

糖尿病视网膜病变的激光治疗进展

糖尿病视网膜病变(diabetic retinopathy,DR)是工作年龄人群第一位的致盲性疾病,其视力损害和失明的主要原因是增生性糖尿病视网膜病变和糖尿病黄斑水肿,视网膜激光光凝是目前治疗DR的最主要方法,但传统激光存在诸多副作用及并发症,为减少这些副作用并提高疗效,很多新的视网膜激光治疗系统随之出现,本文就近几年来有关DR的激光治疗进展进行综述.