玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变52眼分析

目的评价玻璃体切除联合白内障手术治疗增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）的临床效果。方法回顾性分析了2005年7月至2009年12月在我院行玻璃体切除联合白内障手术的PDR患者48例（52眼）,术后随访7个月以上,统计分析手术方式、术前、术后最终矫正视力、手术并发症等临床资料。结果硅油填充率随着糖尿病眼底病变发展而增加,VI期硅油填充率分别与IV期、V期相比差异显著,P〈0.01;随访期间,71.15%（37/52）术后视力提高,随着糖尿病眼底病变发展,术后视力提高率下降,IV、V、VI期术后视力提高率分别是100%、92.31%和62.16%,但各组间无显著差异,P〉0.05,其中视力0.1以上的眼数由术前的5眼（11.36%）增加到术后的33眼（75%）,术后视力显著好于术前,P〈0.01;一次性视网膜复位成功率100%。1眼术后玻璃体再次出血,7眼发生后发性白内障,硅油填充组6眼术后早期发生高眼压,4眼在术后不同时期发生硅油乳化。结论玻璃体切除联合白内障手术治疗PDR是安全有效的,有利于早期恢复患者视力,避免再次白内障手术。     

增生型糖尿病性视网膜病变前后段联合手术的疗效观察

目的 探析增生型糖尿病性视网膜病变前后段联合手术的临床疗效。方法 选取2015年10月~2017年4月在我院进行治疗的增生型糖尿病性视网膜病变患者90例,随机分为参照组和治疗组,每组45例。参照组给予单纯玻璃体切除术治疗,治疗组应用后三联手术治疗,对比两组患者治疗前后视力情况和并发症发生率。结果 经术前检测,两组患者视力情况相比,差异无统计学意义（P＞0.05）;经治疗后,治疗组患者术后视力恢复情况优于参照组,差异有统计学意义（P＜0.05）。治疗组患者的并发症发生率为20.00%,低于参照组的42.22%,差异具有统计学意义（P＜0.05）。结论 增生型糖尿病性视网膜病变患者行后三联手术（玻璃体切除术+超声乳化人工晶体植入术联合）治疗,术后并发症少,对促进视力的恢复具有一定的临床优势和可行性,推广应用价值较高。     

血管内皮生长因子与糖尿病性视网膜病变

随着糖尿病发病率的增高 ,其并发症——糖尿病性视网膜病变 (DR)已成为致盲的主要原因之一 ,并日益受到人们的重视。目前发现一种细胞生长因子——血管内皮生长因子 (VEGF)与糖尿病性视网膜病变的发生发展有着极为密切的关系。本文就 VEGF的生物学特点及其在 DR中的作用简要做一综述     

白内障术后糖尿病视网膜病变的综合治疗

目的观察激光光凝联合复方樟柳碱综合治疗白内障术后糖尿病视网膜病变（DR）的疗效。方法对50例（76眼）白内障术后DR患者施行激光光凝同时予复方樟柳碱注射液颞浅动脉旁皮下注射，以视力和眼底改变为疗效判断指标。结果白内障术后糖尿病视网膜病变稳定，黄斑水肿减轻或消退，视力稳定。结论白内障术后DR患者具有光凝指征应尽早综合治疗，对于控制糖尿病视网膜病变进展，提高白内障远期复明效果有重要意义。     

倾向性评分配比评估PPV联合PRP治疗糖尿病视网膜病变的效果研究

目的:探讨倾向性评分配比评估玻璃体切除术(PPV)联合广泛视网膜光凝术(PRP)治疗糖尿病视网膜病变的效果.方法:回顾性分析,采集2018年2月至2020年12月我院收治的117例糖尿病视网膜病变患者临床资料,将采用PRP治疗的65例患者临床资料纳入对照组,将采用PPV联合PRP治疗的52例患者临床资料纳入观察组,运用...     

增殖型糖尿病性视网膜病变的发病机理及治疗

糖尿病性视网膜病变是成年人失明的主要原因之一，而增殖糖尿病性视网膜病变更严重威胁着患者的视力。本文就目前有关其发病机理的研究和治疗作综述，论述高渗透压、高血糖、血管生长因子和视网膜组织损害四种因素与糖尿病性视网膜病变的关系以及影响糖尿病性视网膜病变发展的因素，并推断其可能发病过程，强调激光光激的有效性，提出抗垂体激素药物治疗时可能性     

糖尿病性视网膜病变的心理护理

目的调查研究糖尿病视网膜病变患者的心理特征，对患者进行针对性地护理，提高患者生存质量。方法阐述分析糖尿病视网膜病变患者的各种心理特征，从做好家庭、社会支持，建立良好的护患关系等方面对患者做好心理护理。结果能够更全面地对糖尿病视网膜病变患者进行心理护理。结论社会支持在糖尿病视网膜病变患者的心理护理中有举足轻重的作用。     

生蒲黄汤对糖尿病性视网膜病变所致玻璃体积血的辅助治疗效果

目的:探究生蒲黄汤辅助西医治疗糖尿病性视网膜病变(Diabetic retinopathy,DR)所致早期玻璃体积血的临床疗效及血流动力学的影响.方法:选取156例2018年3月～2020年3月在我院接受治疗的DR伴玻璃体积血患者,随机分为观察组和对照组(n=78)78.对照组予以常规基础治疗,观察组在此基础上口服生蒲黄汤150 g.治疗2 m后分别采用超声波、裂隙灯等检查测定玻璃体积血程度、视网膜中央动脉(Central artery of retina,CRA)血流动力学参数,如收缩期峰值速度(Peake systolic flow velocity,PSV)、舒张末期血流速度(End-diastolic flow velocity,EDV)、阻力参数(Resistance Index,RI),同时观察治疗效果.结果:治疗2 m后,两组患者PSV、EDV均有较明显提升,且观察组高于对照组(P<0.05);治疗2 m后,两组患者RI较治疗前均有较明显降低,且观察组低于对照组(P<0.05).治疗2 m后,观察组患者玻璃体积血Ⅰ～Ⅱ级率明显、治疗有效率均高于对照组(P<0.05).结论:生蒲黄汤辅助西医治疗DR所致早期玻璃体积血,可帮助患者提高治疗效果,改善血流动力学状况.     

壳聚糖抑制兔外伤性增生性玻璃体视网膜病变的作用*

背景：在眼科领域,已发现壳聚糖可以抑制青光眼手术瘢痕形成,但还未有明确的报道可以阻止和减缓增生性玻璃体视网膜病变的发生。 目的：观察壳聚糖对兔外伤性增生性玻璃体视网膜病变的防治作用及作用机制。 方法：用自体富含血小板血浆玻璃体内注射制备兔外伤性增生性玻璃体视网膜病变模型,并同时将生理盐水、5%壳聚糖、10%壳聚糖和15%壳聚糖溶液0.1 mL注入兔眼玻璃体内,在不同时间点观察壳聚糖对增生性玻璃体视网膜病变形成的防治作用。 结果与结论：对照组第10天就出现视网膜脱离,增生性玻璃体视网膜病变随着时间延长发展至更严重等级。壳聚糖组也发生增生性玻璃体视网膜病变,但其严重程度均低于对照组。10%和15%壳聚糖组给药5 d后,增生性玻璃体视网膜病变的临床分级显著低于对照组(P < 0.05)。组织学检查壳聚糖组未发现明显视网膜形态改变。结果说明壳聚糖玻璃体腔内注射是安全的,并能有效抑制兔外伤性增生性玻璃体视网膜病变的发生发展。 关键词：壳聚糖;增生性玻璃体视网膜病变;外伤性;自体富血小板血浆;兔 doi:10.3969/j.issn.1673-8225.2012.08.003     

超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离12例

目的：评价超声乳化与巩膜外冷凝联合手术治疗白内障合并视网膜脱离的疗效和可行性。方法：采用超声乳化白内障吸除联合间接眼底镜下巩膜外冷凝裂孔术，治疗白内障合并视网膜脱离12例（12只眼）。结果：术后所有病例白内障一次性摘除干净，10例视网膜复位，复位病例视力不同程度得到提高。结论：白内障超声乳化与巩膜外冷凝联合术是治疗白内障合并视网膜脱离行之有效的手术方法。     

The microenvironment of proliferative diabetic retinopathy supports lymphatic neovascularization

Proliferative diabetic retinopathy (PDR) is a major diabetic microvascular complication characterized by pathological angiogenesis. Several retinopathy animal models have been developed to study the disease mechanisms and putative targets. However, knowledge on the human proliferative disease remains incomplete, relying on steady‐state results from thin histological neovascular tissue sections and vitreous samples. New translational models are thus required to comprehensively understand the disease pathophysiology and develop improved therapeutic interventions. We describe here a clinically relevant model, whereby the native multicellular PDR landscape and neo(fibro)vascular processes can be analysed ex vivo and related to clinical data. As characterized by three‐dimensional whole‐mount immunofluorescence and electron microscopy, heterogeneity in patient‐derived PDR neovascular tissues included discontinuous capillaries coupled with aberrantly differentiated, lymphatic‐like and tortuous endothelia. Spatially confined apoptosis and proliferation coexisted with inflammatory cell infiltration and unique vascular islet formation. Ex vivo‐cultured explants retained multicellularity, islet patterning and capillary or fibrotic outgrowth in response to vitreoretinal factors. Strikingly, PDR neovascular tissues, whose matched vitreous samples enhanced lymphatic endothelial cell sprouting, contained lymphatic‐like capillaries in vivo and developed Prox1⁺ capillaries and sprouts with lymphatic endothelial ultrastructures ex vivo. Among multiple vitreal components, vascular endothelial growth factor C was one factor found at lymphatic endothelium‐activating concentrations. These results indicate that the ischaemia‐induced and inflammation‐induced human PDR microenvironment supports pathological neolymphovascularization, providing a new concept regarding PDR mechanisms and targeting options. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Effect of intravitreal bevacizumab on vascular endothelial growth factor expression in patients with proliferative diabetic retinopathy

Purpose

To investigate the effect of bevacizumab (Avastin; Genentech, San Francisco, CA, USA) on vascular endothelial growth factor (VEGF) expression and inflammation in fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR).

Materials and Methods

Fibrovascular membranes from 19 eyes of 18 patients with PDR were studied using immunohistochemistry and analyzed in the following 3 groups; group 1: 4 inactive PDR eyes, group 2: 10 active PDR eyes treated preoperatively with adjunctive intravitreal bevacizumab, group 3: five active PDR eyes not treated preoperatively with bevacizumab. Immunohistochemical staining for VEGF, CD31 and CD68 were done.

Results

The immunoreactivity to VEGF and CD 31-positive blood vessels was significantly higher in membranes from group 3 than group 1 (p = 0.007 for VEGF, 0.013 for CD 31-positive vessels). Intravitreal bevacizumab caused a reduction in VEGF expression and vascular densities in 4 out of 10 (40%) excised membranes from eyes with PDR. However, six membranes (60%) in group 2 still demonstrated relatively strong VEGF expression and high vascular density. Infiltration of macrophages was observed in 16 out of the 19 membranes, and the density of macrophages was increased in group 2 compared with group 1 (p = 0.043).

Conclusion

Intravitreal bevacizumab injections caused some reduction in VEGF expression and vascular densities in a limited number of active PDR patients. A single intravitreal bevacizumab injection may not be enough to induce complete blockage of VEGF and pathologic neovascularization in active PDR patients. Repeated injections, panretinal photocoagulation and/or PPV may be necessary following intravitreal bevacizumab to reinforce the anti-VEGF effect of the drug.     

Early diagnosis of diabetic retinopathy in primary care

Objective:

To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México.

Methods:

Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed.

Results:

In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women.

Conclusions:

The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.     

Polymorphism R25P in the gene encoding transforming growth factor‐beta (TGF‐β1) is a newly identified risk factor for proliferative diabetic retinopathy

Associations of the genetic polymorphisms in the promoter region and the signal peptide sequence of the transforming growth factor‐beta (TGF‐β₁) gene with proliferative diabetic retinopathy (PDR) in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) were studied. A total of 245 Caucasian subjects comprised the two groups: NIDDM patients with PDR (n = 73) and NIDDM patients without PDR (n = 172). Allele frequencies of common TGF‐β₁ polymorphisms (at positions ?988C/A, ?800G/A, ?509C/T, +869T/C (L10P), and +915G/C (R25P)) were determined by PCR‐based methodology. All polymorphisms were in strong linkage disequilibrium (P < 10^?2). Significantly higher frequencies of both the L allele and the R allele of the signal sequence polymorphisms in PDR subjects were found (after a correction for multiple comparisons, P_corr < 10^?2 and P_corr < 10^?4, respectively). Calculated odds ratios (ORs) for the LL and RR genotypes were 2.89 (95% confidence interval (CI), 1.6–5.1) and 19.73 (95% CI, 2.6?146.8), respectively. No significant differences between groups were found for the ?800G/A and ?509C/T polymorphisms. The ?988A allele was not represented in our sample. Multiple logistic regression identified age, diabetes duration, and R25P polymorphism as significant predictors (P = 0.002, P = 0.000003, and P = 0.007, respectively). The frequencies of genotype combinations of the ?800G/A, ?509C/T, L10P, and R25P TGF‐β₁ polymorphisms were significantly different between the PDR and non‐PDR groups (χ² = 37.83, df = 20, P < 10^?2). The frequency of haplotype consisting of majority alleles was found significantly associated with PDR (P < 0.03). The presented data indicate that the R25P polymorphisms in the TGF‐β₁ gene could be regarded as a strong genetic risk factor for PDR. © 2002 Wiley‐Liss, Inc.     

糖尿病视网膜病变玻璃体视网膜术后高眼压发生率及相关因素

目的探讨糖尿病视网膜病变(DRP)行玻璃体视网膜术后高眼压的发生率及相关因素。方法选择行玻璃体视网膜术治疗的DRP患者986例(1 326眼)为研究对象。分析术后高眼压的发生率,并且对比分析不同类型、不同分级、术前是否合并黄斑脱离、行硅油/C3F8充填、术中行全/补充视网膜光凝、是否晶状体切除患者高眼压发生率的差异。结果 1 326眼术后发生高眼压共计368例(27.8%)。增生型DRP患者术后高眼压发生率(34.0%)显著高于非增生型(17.2%)(χ2=30.648,P=0.000);DRP D级高眼压发生率为34.1%,显著高于B级(20.8%)(χ2=16.348,P=0.001);术前合并黄斑脱离患者高眼压发生率(30.4%)显著高于无黄斑脱离患者(22.7%)(χ2=8.834,P=0.003);术中充填硅油患者(39.1%)显著高于填充C3F8患者(24.0%)(χ2=28.088,P=0.000);术中全视网膜光凝者(32.8%)显著高于补充光凝患者(16.8%)(χ2=21.159,P=0.000);术中行晶状体切除者(40.5%)显著高于无晶状体切除者(25.9%)(χ2=15.532,P=0.000 1)。结论 DRP患者玻璃体视网膜术后高眼压的发生率高,并且与DRP类型、分级、术前合并黄斑脱离、术中填充物、视网膜光凝、晶状体切除等相关。     

Multiple factors in the prediction of risk of proliferative diabetic retinopathy

To identify risk factors for the development of proliferative diabetic retinopathy, we compared 111 patients with longstanding insulin-dependent diabetes who had proliferative retinopathy (cases) with 81 patients with diabetes of similar duration (an average of 26 years) who did not have proliferative diabetic retinopathy (controls). The cases had diabetes that was more difficult to manage, as evidenced by their more frequent blood sugar levels above 200 mg per deciliter (11 mmol per liter) on routine clinic visits (odds ratio, 1.6 for each increment of 10 per cent in the relative frequency), and they expended less effort in managing their diabetes, as indicated by their less frequent testing of urine for sugar (odds ratio, 0.3). Among those who did not have myopia, the cases also had an excess of the HLA-DR phenotypes 4/0, 3/0, or X/X (odds ratio, 10.0). Among those with myopia, these phenotypes did not carry an increased risk of proliferative retinopathy. These results support a multifactorial model for the development of proliferative diabetic retinopathy; however, the mechanisms of action of the identified factors remain unknown.     

初探糖尿病视网膜病变与糖尿病肾病的相关性

目的:分析糖尿病视网膜病变(DR)与糖尿病肾病(DN)之间的关系。方法:对236例二型糖尿病患者进行荧光素眼底血管造影(FFA)和12小时尿白蛋白排泄率(AER)的检查,根据眼底改变将病人分为三组,计算各组患者并发糖尿病肾病的比例,并做尿白蛋白排泄率与DR眼底改变的相关性分析。结果:DR临床前期组的病人中有5%并发DN,DR非增殖期组的病人中有42%并发DN,DR增殖期组的病人中有71%并发DN;AER与DR的眼底改变呈显著的正相关性。结论:糖尿病视网膜病变和糖尿病肾病临床表现密切相关,呈平行发展关系。     

A hemochromatosis-causing mutation C282Y is a risk factor for proliferative diabetic retinopathy in Caucasians with type 2 diabetes

Iron metabolism might be involved in the pathogenesis of type 2 diabetes and in the pathogenesis of diabetic retinopathy. C282Y and H63D mutations in the hemochromatosis (HFE) gene are associated with increased serum iron levels and consequently with hereditary hemochromatosis. In the present study, we searched for a relationship between C282Y and H63D gene mutations and the development of proliferative diabetic retinopathy in Caucasians with type 2 diabetes. For this purpose, 90 subjects with type 2 diabetes with proliferative diabetic retinopathy (PDR) were compared to 133 diabetic subjects without PDR. There was a significantly higher frequency of the C282Y heterozygotes in patients with PDR compared to subjects without it (OR=3.0, 95% CI=1.2–8.0; p=0.02), whereas no association was demonstrated between PDR and H63D genotypes (OR=1.1, 95% CI=0.6–2.2; p=0.7). Logistic regression analysis revealed that the C282Y mutation was a significant independent risk factor for the development of PDR (OR=6.1, 95% CI=1.2–30.5; p=0.027). These data suggest that heterozygosity for C282Y might be a novel risk factor for PDR in Caucasians with type 2 diabetes.     

糖尿病视网膜病变图像数据库建立及应用

目的评价基于糖尿病视网膜病变(DR)图像数据库的临床应用技术,探讨其在临床DR早期诊断中的作用。方法采集1100例DR患者的眼底图像,经过初选和归纳分析后选择300只眼,建立微型DR图像数据库及应用软件技术。对100例糖尿病患者的眼底照相和荧光素眼底血管造影(FFA)检查图像进行人工直接诊断,并进行基于DR图像数据库技术的虚拟FFA诊断,对两者各层诊断符合情况进行统计分析,确定其诊断一致性。结果在DR患者不同分期的层次中,FFA检查诊断相符程度均大于80%,人工直接诊断和虚拟FFA诊断的总符合率为90%。结论虚拟FFA诊断与DR眼底照相诊断有较高的一致性,该图像数据库的建立和应用技术可指导和规范临床DR的早期诊疗,也为有创性FFA检查在DR诊治中合理应用提供依据和参考。