1例糖尿病性视网膜病变患者的护理分析

糖尿病性视网膜病变是最常见的一种视网膜血管病。糖尿病性视网膜病变无特殊药物治疗,重点是预防,单纯型定期眼底检查,必要时眼底荧光血管造影,一旦患者进入增殖前期,考虑激光行全视网膜光凝,以防止新生血管生成。增殖型者,采用全视网膜光凝治疗新生血管并同时行眼内全视网膜光凝。此外,要积极控制血糖血压血脂。     

视网膜激光光凝治疗不同分期糖尿病视网膜病变的疗效分析

目的:分析视网膜激光光凝治疗不同分期糖尿病视网膜病变的疗效。方法:选取在本院治疗的糖尿病视网膜病变患者30例(2014年5月~2016年5月期间)作为观察对象,共60眼。根据不同分期,分为中度非增生性糖尿病性视网膜病变(NPDR)、重度NPDR以及增生性糖尿病性视网膜病变(PDR),分别为22眼、23眼以及15眼。所有患者均利用532激光仪器进行视网膜激光光凝治疗,对比治疗总有效率以及治疗前后的视力情况。结果:治疗后,中度NPDR患者的总有效率为77.27%,重度NPDR患者的总有效率为73.91%,PDR患者治疗的总有效率为86.67%。三种分期患者治疗的总有效率为81.67%。治疗后,患者的视力明显提高,低视力人数明显下降,均较治疗前改善,P<0.05。结论:采用视网膜激光光凝治疗不同分期糖尿病视网膜病变患者,可有效提高患者的视力,值得进一步推广应用。     

倍频Nd：YAG（532）激光治疗糖尿病性视网膜病变83例的护理报告

目的总结应用倍频Nd：YAG（532）激光治疗糖尿病性视网膜病变83例的护理体验。方法根据眼底血管荧光造影,应用倍频Nd：YAG（532）激光治疗83例（137眼）糖尿病性视网膜病变患者,配合医生做好诊断时的眼底血管荧光造影检查、术前的心理护理和术前准备、以及术后的宣教回访等护理工作。结果83例（137眼）糖尿病性视网膜病变患者的光凝有效率达89．7％。结论对糖尿病性视网膜病变患者及时进行激光光凝术,配合全面、细致、周到的护理,可使绝大部分患者避免失明,提高其生活质量。     

氩离子激光治疗近视眼视网膜病变的效果

我国是世界上近视眼发病率高的国家之一。临床工作中，通过我们对近视眼患者进行眼底检查，发现近视眼多数存在玻璃体及视网膜退行胜变，为防控视网膜病变的发展，我们对视网膜病变区施行预防性氩离子激光光凝治疗，现报告如下。     

基层医院糖尿病视网膜病变早期发现及治疗

目的：探讨基层医院糖尿病视网膜病变（DR）早期发现、早期诊治、长期随访。方法：观察住院、会诊患者、眼科门诊就诊患者1330例,已经临床确诊的153例（306眼）2型糖尿病患者。眼科检查包括视力检查,眼前节裂隙灯显微镜检查,眼压检查,以及散瞳直、间接检眼镜眼底或三面镜检查。根据检查情况确诊有无DR,并进行分期。随访1—2年。发现DR患者后均建议其到上级医院行跟底荧光血管造影（FFA）,DR3—4期患者建议行视网膜光凝治疗,DR5—6期患者建议行玻璃体切割加视网膜光凝治疗。结果：确诊为糖尿病患者306眼,患病率为11．5％,其中发生DR74眼,占糖尿病患者的24．18％。单纯型视网膜病变63眼,占糖尿病患者的20．59％,增殖性视网膜病变患者11眼,占糖尿病视网膜病变患者的3．59％。病程越长其DR发病率越高,年龄越大发病率越高,眼底改变也越严重,空腹血糖〉6．8mmol／L比空腹血糖≤6．8mmol／LDR发生率明显增加。结论：糖尿病视网膜病变（DR）是糖尿病严重并发症之一,也是目前主要致盲原因之一,应该早期发现、早期诊治、长期随访,预防糖尿病视网膜病变致盲的发生。     

视网膜光凝联合大活络胶囊治疗妊娠期糖尿病引起的眼底病变的疗效观察

目的:探讨视网膜光凝联合大活络胶囊治疗妊娠期糖尿病眼底病变的临床疗效。方法:选取妊娠期糖尿病眼底病变患者80例根据收治顺序分为观察组与对照组各40例,对照组患者给予激光光凝治疗,观察组患者在对照组的基础上加服大活络胶囊,对治疗后两组患者的视力改善、眼底荧光血管造影情况和眼底视网膜病变恢复情况等进行比较。结果:治疗3个月后观察组视力改善的显效率和总有效率分别为32.3%和80.0%,对照组分别为17.1%和67.1%,两组差异有统计学意义(P<0.05);眼底视网膜微动脉瘤数目和出血渗漏面积均显著小于对照组,眼底FFA改善的总有效率显著高于对照组,差异均有统计学意义(P<0.05);随访发现观察组中无复发病例,对照组中有1眼发生严重玻璃体出血。结论:视网膜光凝联合大活络胶囊治疗妊娠期糖尿病眼底病变疗效显著,视力改善明显,安全无复发,值得临床推广。     

上海市奉贤区农村地区糖尿病视网膜病变流行特征

目的了解上海市奉贤区农村地区糖尿病视网膜病变的患病情况及流行特征,探讨影响农村地区糖尿病性视网膜病变患病的影响因素。方法对奉贤区以农业人口为主的某社区的糖尿病患者进行视网膜病变筛查,对筛查对象的视力、身高体重、腰臀围等进行检查,并对糖尿病患者的基本信息进行询问调查。结果现场筛查应答率58.92%,社区糖尿病患者眼部并发症以糖尿病性视网膜病变为主,患病率37.33%;糖尿病视网膜病变患者眼底分期以非增殖性病变为主,占比90.91%,不同糖尿病性视网膜病变分期中男女性别构成比差异无统计学意义(χ~2=3.14,P0.05);非白内障患者糖尿病视网膜患病率高于白内障患者,差异有统计学意义(χ~2=7.48,P0.01);患者双眼眼底病变程度具有高度一致性,差异有统计学意义(Kappa=0.98,P0.01);糖尿病病程(t=3.64,P0.01)和空腹血糖高值(t=4.46,P0.01)是糖尿病性视网膜病变发生的危险因素;随着糖尿病患者病程的增加,糖尿病视网膜病变患病率呈上升趋势,差异有统计学意义(χ~2趋势=17.37,P0.01)。结论该区以农业人口为主的社区糖尿病患者视网膜病变患病率较高,社区医院应联合二级医院制定糖尿病性视网膜病变健康干预和随访管理措施,提高糖尿病患者眼底检查就诊率,降低糖尿病性视网膜病变的发病率。     

白内障术后糖尿病视网膜病变的光凝治疗

目的 观察白内障人工晶体植入术后糖尿病视网膜病变(DR)的氩激光光凝治疗疗效.方法 对39例(60眼)白内瘴术后DR患者施行激光光凝,以视力和跟底改变为疗效判断指标.结果 治疗前后视力提高者25眼,占41.6%,视力不变者30眼,占50%,总有效率91.67%,视力下降者5眼, 占8.33%,均为PDR.眼底情况,3个月后行FFA检查,显示光凝斑均匀清晰,新生血管萎缩, 视网膜水肿消退,出血部分吸收.56只眼在观察期间未出现明显的并发症.全视网膜出血、水肿、渗出吸收者54眼,有效率90%,视网膜新生血管消退52眼,有效率86.67%.无灌注区消失56眼,有效93.33%.黄斑水肿26眼中吸收或部分吸收者25眼占96.2%.不变1眼.结论 适时的白内障摘除联合IOL置入,合理及时的激光治疗,是控制糖尿病患者眼底病变继续恶化的重要手段.FFA是进行正确有效激光治疗的重要参考依据,而放置大直径IOL又是完善眼底激光治疗的先决条件.     

初诊2型糖尿病患者微血管病变与相关危险因素分析

目的:分析初诊2型糖尿病患者微血管病变(周围神经病变、视网膜病变、糖尿病肾病)与其相关危险因素关系.方法:对120例新诊断的2型糖尿病患者进行神经传导速度、眼底荧光造影和尿微量白蛋白及相关指标测定,计算微血管病变的患病率,并对相关因素分析.结果:(1)初诊患者中糖尿病周围神经病变的患病率为34.6%,糖尿病视网膜病变的患病率为15.4%,糖尿病肾病的患病率为13.4%.(2)年龄、空腹血糖、餐后2 h血糖、收缩压、舒张压、糖化血红蛋白、总胆固醇均为糖尿病周围神经病变的独立危险因素.(3)糖化血红蛋白、尿微量白蛋白、收缩压为糖尿病视网膜病变独立危险因素.结论:初诊2型糖尿病患者有一定微血管病变患病率,应强化对血压、血糖、血脂相关危险因素的干预以控制和延缓糖尿病微血管病变的发生、发展.     

眼底激光联合羟苯磺酸钙治疗Ⅲ-Ⅳ期糖尿病视网膜病变临床观察

目的探讨眼底激光联合羟苯磺酸钙治疗Ⅲ-Ⅳ期糖尿病视网膜病变(DR)临床效果。方法将我院自2010年5月至2012年5月期间210例(378眼)诊断为Ⅲ-Ⅳ期DR的患者随机分为观察组和对照组,观察组行全视网膜激光光凝+羟苯磺酸钙联合治疗,对照组进行单纯全视网膜激光光凝治疗,分别观察两组在激光光凝治疗期间及治疗结束后1-2周及1-2月时随访患者视网膜出血情况、视功能情况,并在激光治疗第3个月时进行眼底荧光血管造影(FFA)检查情况。结果观察组治疗1-2周后视网膜出血情况、视功能情况与对照组治疗后比较,差异无统计学意义(P>0.05);观察组治疗2周-2月后视网膜出血、渗出和水肿消退与对照组比较,差异有统计学意义(P<0.05);观察组治疗3月FFA显示新生血管消退和无灌注区激光覆盖与对照组比较,差异有统计学意义(P<0.05)。结论羟苯磺酸钙能缩短DR激光治疗后的恢复时间,促进视网膜出血的吸收,值得借鉴。     

全视网膜激光光凝术治疗糖尿病视网膜病变的疗效观察

目的:探讨全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:搜集2018年3月~2020年2月在本院接受治疗的96例糖尿病视网膜病变患者的病历资料并分为两组,观察组:46例已实施视网膜激光光凝术治疗患者;对照组:50例应用羟苯磺酸钙治疗的患者,对比两组患者治疗前后治疗效果及治疗后并发症发生情况。结果:观察组患者有效率82.6%(38/46)显著高于对照组患者68%(34/50)。观察组患者治疗后并发症发生率6.5%(3/46)显著低于对照组患者18%(9/50),P<0.05。结论:糖尿病视网膜病变患者应用全视网膜激光光凝术对比羟苯磺酸钙治疗可显著提高患者治疗有效率,治疗后患者并发症发生率下降,更适用于该疾病治疗。     

中药联合激光光凝术治疗增殖期糖尿病视网膜病变疗效观察

目的观察中药辨证分型联合激光光凝术治疗增殖期糖尿病视网膜病变(diabetic retinopathy,DR)的疗效。方法选择增殖期DR96例,将所有病例随机分为两组:治疗组和对照组,治疗组根据辨证论治应用中药颗粒制剂个体化治疗,联合激光光凝治疗,对照组采用单纯激光光凝治疗,经治疗两个月后统计疗效。结果治疗组总有效率为90.5%,对照组为77.6%,两组总有效率有显著性差异(P<0.05)。结论采用中药辨证分型联合激光光凝术治疗增殖期糖尿病视网膜病变(DR)比单纯使用激光光凝治疗更有效。     

眼底激光与药物对糖尿病视网膜病变的疗效

目的 探究对糖尿病视网膜病变采用眼底激光联合羟苯磺酸钙治疗的临床效果.方法 随机抽取2017年10月—2019年10月医院128例糖尿病视网膜病变的患者纳入实验研究范围,随机分为两组(试验组和对照组),分别采用眼底激光联合羟苯磺酸钙方式及单纯眼底激光手术方式进行治疗,分析治疗效果.结果 试验组术后3个月及术后半年的视力...     

Fundus imaging and the telemedical management of diabetes

Diabetes is the major preventable form of blindness among people of working age in the Western world, despite the improvements in laser photocoagulation treatments. It is known that regular glycaemic control and annual retinal screening of people with diabetes can reduce its incidence. Effective treatment needs to be available but also screening methods which are simple to perform and cost-effective should be implemented. It will be important in future to integrate digital images of the fundus into the health records of diabetic patients. Screening programmes for the detection of diabetic retinopathy aided by image-processing software for processing fundus images will save manpower and increase quality. Before this can happen, we need more clinical studies of store-and-forward techniques, so that they can be standardized and their effectiveness established against that of traditional analogue screening.     

玻璃体切除联合眼内光凝治疗糖尿病视网膜病变疗效观察

目的探讨玻璃体切除联合眼内光凝治疗糖尿病视网膜病变的临床疗效。方法某院于2009年2月～2011年2月对收治的糖尿病视网膜病变患者采用玻璃体切除联合眼内光凝治疗,术后随访3～6个月,观察所有患者的视力及并发症。结果 94例患者(102只眼)治疗后经过3～6个月随访发现102只眼中有10只眼视力恢复至0.4以上,视力0.02～0.4之间的眼数由术前49只增加到术后80只眼。术前发生视网膜脱离的41只眼在术后均获得复位,随访期间均未复发。该组102只眼中有12只眼在手术中发生医源性视网膜裂孔,经激光光凝封闭。术后有8只眼发生玻璃体积血,其中4只眼经过再次手术后得到治愈,1例在随访期间发生内吸收,而另外3只眼均放弃治疗;在光凝期间有3例出现玻璃体再出血,2只眼内吸收后自行消失,1只眼再次手术治愈;发生暂时性高眼压2眼;并发性白内障l眼,术后经超声乳化联合人工晶体植入后视力提高。结论玻璃体切除联合眼内光凝治疗糖尿病视网膜病变能显著改善手术预后,且术后并发症少,能迅速恢复患者视力,减少失明率,减少患者多次手术的痛苦。     

局部光凝联合复方血栓通治疗对糖尿病视网膜内微血管异常的影响

目的探讨局部光凝联合复方血栓通胶囊治疗糖尿病视网膜病变（DR）视网膜内微血管异常的疗效。方法 60例视网膜内微血管异常的DR患者,随机分为观察组30例（30眼）和对照组30例（30眼）,两组患者均采用原有的降血糖及降血压等内科治疗。观察组采用局部光凝治疗并加用复方血栓通胶囊,对照组采用全视网膜光凝治疗,疗程均为12周。观察两组视力、视网膜病变及黄斑水肿等情况。结果两组在提高视力、改善视网膜病变、消退黄斑水肿方面,差异均有显著性（P〈0.05）。结论应用局部光凝联合复方血栓通胶囊治疗糖尿病视网膜病变视网膜内微血管异常有较好的临床疗效。     

Magnesium deficiency and other risk factors for diabetic retinopathy

A case control study was carried out to detect the relation between magnesium deficiency and diabetic retinopathy and to study other risk factors for diabetic retinopathy. The study involved 30 cases with diabetic retinopathy, 30 diabetics and 30 non-diabetics with normal retina as controls. Serum magnesium was significantly lower in the diabetic control group than both other groups. Significant association between diabetic retinopathy and hypertension, poor control of blood sugar, irregularity in drug treatment, lack of routine fundus examination, high gravidity and low socioeconomic status were found. Multiple regression analysis was used to adjust for all variables mentioned. Magnesium deficiency was found to be statistically significantly associated with diabetic retinopathy after considering the effects of other variables.     

Disease Management by Prevention

Diabetic retinopathy is a significant cause of visual loss in developed countries. Data from epidemiological studies and controlled clinical trials have resulted in treatment strategies, which are highly successful in preventing blindness. These strategies involve measures that require both education and compliance of the individual with diabetes mellitus and the education of physicians and paramedical staff who deliver care to these patients. This paper presents the classification of diabetic retinopathy and the treatment strategies, both the preventive measures and the active treatment modalities used for diabetic retinopathy. Persons with diabetes should be invited from the first day of diagnosis to be active partners working towards the prevention of diabetic complications.The management of patients with diabetes includes essential medical preventive measures such as tight glucose level and blood pressure control and the lowering of serum cholesterol levels to successfully decrease the risk of microvascular complications, namely diabetic retinopathy, neuropathy and nephropathy. Persons with diabetes should also be aware of the importance of screening for diabetic retinopathy and the beneficial effects of timely laser photocoagulation and other surgical interventions.     

Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine

Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.