视觉诱发电位监测二硫化碳毒性视网膜病变

目的　探索使用图形视觉诱发电位 (VEP P)早期诊断二硫化碳 (CS2 )中毒性视网膜病变的可能性。方法　选择不同程度接触CS2 5年以上者 1 1 6人 (2 32眼 ) ,并以非接触者 32人 (64眼 )作对照组 ,检测P VEP,并根据接触的不同方式及浓度分组研究。比较各组VEP PP1 0 0 波波幅及潜伏时、潜时值差、波幅差值及A/L值。结果　每日长时间接触CS2 的中、低浓度组的VEP PP1 0 0 波波幅 (8.37±3 .2 0 ) μV及 (7.95± 3.34) μV ,较非接触组的 (9.64± 3.2 5) μV明显下降 (P <0 .0 5;P <0 .0 1 ) ,其A/L值降低。结论　VEP P有助于CS2 中毒性视网膜病变及视神经病变的早期诊断     

Primary antiphospholipid syndrome masquerading as diabetic retinopathy

BACKGROUND: Primary antiphospholipid syndrome (PAPS) is a thrombotic condition which characteristically includes ocular vaso-occlusive pathology. CASE: We present the case of a 47-year-old woman with PAPS presenting with retinal vascular leakage. OBSERVATIONS: Vascular leakage was an incidental finding on fundoscopy in a myopic Chinese woman, and initially this was diagnosed as diabetic retinopathy. However, a glucose tolerance test was negative. Subsequently, signs of retinal vaso-occlusion developed. Previous subclinical cerebral thrombosis, mild thrombocytopaenia and positive tests for antiphospholipid antibodies were consistent with the diagnosis of PAPS. Anticoagulation therapy with warfarin prevented further thrombotic episodes. CONCLUSION: The possibility of PAPS should be considered in patients presenting with retinal vascular disease without obvious vascular risk factors.     

早期糖尿病视网膜病变患者颜色视觉运动觉特性

目的研究早期糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＤＲ）患者的颜色视觉运动觉的改变，探讨ＤＲ早期诊断方法。方法在ＰＣ兼容机上，应用运动觉测试软件，由微机控制，于ＶＧＡ显示器产生等亮度的颜色光栅条纹和黑白光栅条纹运动，测试早期ＤＲ患者及正常对照者颜色视觉运动觉，并与色觉、视网膜电图（ＥＲＧ）振荡电位（ＯＰｓ）检查结果作比较。结果在时间和空间频率一致时，正常人可观察到等亮度的颜色光栅比黑白光栅运动慢。在黑白光栅亮度对比度为８０％，速度为２０．２ｍｍ／ｓ及１４．３ｍｍ／ｓ时，ＤＲ患者的蓝／黄运动觉和正常人比较，差异有非常显著性（Ｐ＜０．００１）。在黑白光栅亮度对比度为８０％，速度为２０．２ｍｍ／ｓ时，颜色视觉运动觉的异常率（６９．２％）比色觉异常率（４３．６％）及ＥＲＧＯＰｓ异常率（４８．９％）要高。结论颜色视觉运动觉检查提供了一种新的ＤＲ早期诊断方法     

早期糖尿病视网膜病变患者颜色视觉运动觉特性

目的 研究早期糖尿病视网膜病变(diabetic retinopathy,DR)患者的颜色视觉运动觉的改变，探讨DR早期诊断方法。方法 在PC兼容机上，应用运动觉测试软件，由微机控制，于VGA显示器产生等亮度的颜色光栅条纹和黑白光栅条纹运动，测试早期DR患者及正常对照者颜色视觉运动觉，并与色觉、视网膜电图(ERG)振荡电位(OPs)检查结果作比较。 结果 在时间和空间频率一致时，正常人可观察到等亮度的颜色光栅比黑白光栅运动慢。在黑白光栅亮度对比度为80%，速度为20.2mm/s及14.3mm/s时，DR患者的蓝/黄运动觉和正常人比较，差异有非常显著性(P<0.001)。在黑白光栅亮度对比度为80%，速度为20.2mm/s时，颜色视觉运动觉的异常率(69.2%)比色觉异常率(43.6%)及ERG OPs异常率(48.9%)要高。 结论 颜色视觉运动觉检查提供了一种新的DR早期诊断方法。(中华眼底病杂志,1998,14:135-138)     

The role of color vision disturbances in diagnostics of early diabetic retinopathy

PURPOSE: The evaluations of color vision sensitivity in children with type I diabetes mellitus without retinopathy. MATERIAL AND METHOD: We examined 96 young patients. They was divided into three groups: I: 35 children from 7 to 16 years old with insulin-dependent diabetes mellitus duration of 1-8 years, II: 30 children with type I diabetes lasting more then 8 years, III--31 non-diabetic subjects as a control-matched for age and sex, without visual or systemic symptoms. The examinations of colour vision sensitivity were done with the IF-2AII-color Anomaloscope. In all cases were tested the dynamic blue-green equation of Moreland and two variables were determined: setting (matching) range (SR), calculated mid point (matching mid point) (CMP). RESULTS: In the blue-green equation setting range (SR) was significantly (p < 0.01) enlarged in the II group (diabetes mellitus duration > 8 years) and calculated mid point (CMP) was shifted but no significant. The results indicate a diminution of the colour discriminating sensitivity in the short wavelength half of the visible spectrum and diminution of the blue cone sensitivity in early diabetic retinopathy. CONCLUSIONS: Blue-green colour vision testing with the anomaloscope may serve as an additional test in the diagnosis of early diabetic retinopathy in children without vascular changes at the eye fundus.     

多焦视网膜电图及彩色多普勒在糖尿病视网膜病变早期诊断中的应用比较

目的 比较多焦视网膜电图（mfERG）与彩色多普勒在糖尿病视网膜病变（DR）早期诊断中的应用.方法 采用横断面研究,运用mfERLG检测正常对照组22例（22眼）、糖尿病无DR组52例（52眼）及DR单纯期组32例（32眼）.在上述患者中运用彩色多普勒测量视网膜中央动脉（CRA）的血流.采用单因素方差分析方法以及S-N-K法进行统计学分析.结果 糖尿病患者中,无DR组mfERG环1至环3中P1波反应密度低于正常对照组（P＜0.05）;CRA的血流则无异常变化（P＞0.05）.在DR单纯期组,mfERG除上述指标异常以外,Pt波潜伏期也出现延长（P＜0.05）.CRA的流速比正常对照组及无DR组降低（P＜0.05）.结论 在DR的临床早期诊断中,mfERG比彩色多普勒检测CRA血流的方法更敏感.     

Ocular blood flow velocity determined by color Doppler imaging in diabetic retinopathy

PURPOSE: To measure and investigate changes of blood flow velocity by color Doppler imaging in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) in diabetic retinopathy (DR) and to compare the results with those in healthy control subjects. METHODS: In this investigation we included 44 eyes of 44 diabetic patients with different stages of DR forming group NPDR (11 eyes with mild and 11 eyes with moderate nonproliferative DR) and group SNPDR/PDR (19 eyes with severe nonproliferative and 3 eyes with proliferative DR) and 22 eyes of 22 healthy age- and sex-matched subjects forming control group HC. With color Doppler imaging we measured the peak systolic velocity (PSV, cm/s) and end-diastolic velocity (EDV, cm/s) of blood flow in the OA, CRA and PCA. The resistance index of each vessel was then calculated. Statistical analysis comparing the results of groups NPDR, SNPDR/PDR and HC was carried out. Statistical significance was set at p < 0.05. RESULTS: There was a statistically significant increase in PSV in the OA in group SNPDR/PDR compared with group HC (35.71 +/- 6.90 vs. 31.45 +/- 4.32 cm/s; mean +/- SD). There was a statistically significant decrease in PSV in the CRA in group NPDR compared with group HC (8.50 +/- 1.62 vs. 10.61 +/- 1.75 cm/s; mean +/- SD) and in group SNPDR/PDR compared with group HC (7.34 +/- 1.78 vs. 10.61 +/- 1.75 cm/s; mean +/- SD), also there was a statistically significant decrease in EDV in group SNPDR/PDR compared with group HC (2.05 +/- 0.53 vs. 3.00 +/- 0.81 cm/s; mean +/- SD). A statistically significant decrease in EDV in the PCA in group SNPDR/PDR compared with group HC (2.95 +/- 1.04 vs. 3.95 +/- 0.98 cm/s; mean +/- SD) was found, also there was a statistically significant increase in the resistance index in group SNPDR/PDR compared with group NPDR (0.72 +/- 0.05 vs. 0.67 +/- 0.07; mean +/- SD) and in group SNPDR/PDR compared with group HC (0.72 +/- 0.05 vs. 0.67 +/- 0.05; mean +/- SD). CONCLUSIONS: In this investigation, color Doppler imaging was used to determine significant changes of blood flow velocity in the OA, CRA and PCA in DR compared with healthy control subjects and the changes of blood flow velocity become further significant considering the progression of DR. This points to the presence of circulatory changes in the OA, CRA and PCA in diabetic patients with DR.     

彩色多普勒超声技术对糖尿病视网膜病变患者视网膜血流动力学的分析研究

目的：通过彩色多普勒超声技术观察糖尿病性视网膜病变(diabeticretinitis,DR)患者血流动力学的变化。

方法：选取2014-06/2017-05于我院就诊的糖尿病(diabetes mellitus,DM)患者96例96眼,根据眼底检查结果分为A、B、C三组,A组为单纯DM患者32例32眼; B组为糖尿病合并单纯性视网膜病变(NPDR)患者32例32眼; C组为糖尿病合并增殖性视网膜病变(PDR)患者32例32眼。同时选取健康志愿者30例30眼作为对照组。采用彩色多普勒超声技术检测患者眼部CRA(视网膜中央动脉)、PCA(睫状后动脉)、OA(眼动脉)血流动力学改变情况,并探讨糖尿病患者视网膜病变程度与糖化血红蛋白(HbA1c)、空腹血糖(FBG)、糖尿病病程的关系。

结果：各组CRA、PCA、OA血流动力学指标差异均有统计学意义(P<0.05)。A组与对照组CRA、PCA、OA的PSV比较,差异均无统计学意(P>0.05); C组CRA、PCA、OA的PSV与EDV最低、RI最高,与A、B组比较差异均有统计学意义(P<0.05)。各组HbA1c、FBG比较,差异均有统计学意义(P<0.05)。病程仅A组与C组间比较,差异有统计学意义(P<0.05)。

结论：彩色多普勒超声监测DM患者CRA、PCA、OA血流动力学改变,可了解患者视网膜的血流变化,对DM患者视网膜病变的预防和治疗有重要价值。     

胰激肽原酶治疗早期糖尿病性视网膜病变的初步研究

目的：探讨早期糖尿病性视网膜病变（diabetic retinopathy,DR)对视盘及黄斑部视网膜血流的影响及与吲哚青绿血管造影（indocyanine green angiography,ICGA)中黄斑部脉络膜血管充盈时间（choriocapillaris filling phase,CFP)、黄斑中心凹无血管区（foveal avascular zone,FAZ)的关系，评价胰激肽原酶肠溶片（pancreatic kiniogenase tablets，商品名：怡开）对视盘及黄斑部视网膜血流动力学的影响。方法：对30例（60只眼）早期DR及49例（98只眼）正常对照组进行ICGA与荧光素血管同步造影及共焦扫描激光多普勒视网膜血流分析仪(heilberg retina flowmeter,HRF)检查。结果：早期DR组的视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均低于正常对照组，二者差异有非常显著性意义（P＜0．01）；经怡开治疗后视盘及黄斑部视网膜的血流量、流速及红细胞移动速率均较治疗前有显著或非显著性意义（P＜0．01或P＜0．05）；CFP与黄斑视网膜的血流量、流速及红细胞移动速率呈负显著相关（P＜0．05）。结论：早期DR视盘及黄斑部视网膜毛细血管血流已发生改变，怡开可能改善DR患者的微循环障碍，HRF可评价其治疗效果。     

非立体眼底彩色照片读片评价糖尿病视网膜病变的可行性

目的:观察糖尿病视网膜病变(DR)眼底彩色照片读片结果的可信度及其影响因素,评价眼底彩色照片读片在DR诊断中的意义.方法:以13名无眼科知识及眼科临床工作经验者为普通读片人,1名DR专科教授为专业读片人,参考DR早期治疗研究组的读片法,13名读片人分别采用盲法对50张50°4个视野彩色眼底照片进行前后2次读片(前后读片),确认并记录11项眼底病变(毛细血管瘤和/或视网膜点状出血、线状和/或火焰状出血、硬性渗出、轮状硬性渗出、软性渗出、视网膜内细小血管异常、视网膜动脉白线化、静脉数珠状扩张、静脉襻形成、静脉白鞘化、新生血管).对比分析13名读片人之间前后读片结果的异同,运用κ、加权κ(κw)统计值及级内相关系数(ICC)方法评价普通读片人读片结果的可信赖性.结果:每一普通读片人前后2次读片结果比较,11项眼底病变κ为0.49～1.00(平均0.81～0.93);13个普通读片人之间读片结果比较,前读片κ为0.41～1.00(平均0.70～0.90)、后读片κ为0.37～1.00(平均0.63～0.89);普通读片人与专业读片人之间11项异常指标的读片结果比较,前读片κ为0.45～1.00(0.79～0.95)、κw为0.52～1.00(平均0.86～0.98);后读片κ为0.37～1.00(平均0.79～0.95)、κw为0.43～1.00(平均0.84～0.98).结论:眼底彩色照片读片在DR眼底异常的判断普查和随访观察中有较高的可信赖性;读片标准和读片方法是否统一是影响读片可信度的重要因素.     

眼轴长度对NPDR眼部彩色多普勒血流动力学的影响

目的：观察眼轴长度对非增殖期糖尿病视网膜病变( nonproliferative diabetic retinopathy,NPDR)眼部彩色多普勒血流动力学的影响。
　　方法：前瞻性比较病例系例。自2012-01/2013-12间我院眼科及内分泌科住院的糖尿病视网膜病变患者,排除中心视网膜有明显的水肿、出血、渗出及有明显的其它眼底病变者,依据眼科A/B超测量眼球轴长并根据眼轴长度将患者归类为眼轴长度正常组(22~<24 mm )、长眼轴组(24~<26mm)及超长眼轴组(26mm及以上),所有患者进行眼部彩色多普勒血流动力学指标测定,对有完整研究资料的患者248例248眼的研究指标进行统计学分析,观察眼轴长度与眼部彩色多普勒血流动力学指标的相关性。
　　结果：正常眼轴组与长眼轴组比较,长眼轴组OA的PSV (cm/s)无明显变化(t=1.362,P=0.20)、CRA 的 PSV (cm/s)较高(t=-2.335,P=0.02),PCA的PSV(cm/s)较高(t=2.756,P=0.01),PI(t=-2.371,-2.585,-2.67;P=0.02,0.01,0.01)及RI( t=2.348,2.462,2.293;P=0.02,0.01,0.03)相对较低,差异均有统计学意义(P<0.05)。正常眼轴组与超长眼轴组比较,超长眼轴组OA的PSV较低(t=3.290,P=0.00),CRA及PCA的PSV(t=-5.520,-4.900;P=0.00,0.00)高;PI(t=4.970,6.160,5.990;P=0.00,0.00,0.00);RI(t=-4.310,-5.230,-4.390;P=0.00,0.00,0.00)低,差异有统计学意义(P<0.01)。长眼轴组与超长眼轴组比较,超长眼轴组OA的PSV(cm/s)较慢,但两者比较无统计学意义(t=1.967,P=0.07)、CRA的PSV (cm/s)较低(t=-2.543,P=0.01),PCA的PSV(cm/s)较高(t=-2.198,P=0.04),PI(t=-2.331,-2.135,-4.191;P=0.03,0.03,0.00)及RI(t=2.570,2.360,2.490;P=0.01,0.02,0.01)相对较低,差异均有统计学意义(P<0.05)。
　　结论：糖尿病视网膜病变患者的眼轴长度与眼部彩色多普勒血流动力学指标有着明显的相关性。     

P-ERG在糖尿病性视网膜病变诊断和治疗中的应用研究

本实验对正常人20例(40眼)和64例糖尿病患者(128眼,其中无视网膜病者62眼,单纯型视网膜病变者58眼,增殖型视网膜病变者8眼),进行了图形视网膜电图(P-ERG)检测.并对进行光凝治疗的31眼在治疗前当日,治疗后7天、14天、30天、60天时分别测定P-ERG.结果显示,在糖尿病组中,当眼底尚未出现改变时,P-ERG各参数值已有变化,b波波幅降低,潜伏期延长(P＜0.01).随着糖尿病性视网膜病变(DR)的发展,变化更加显著,组间差异逐渐加大.P-ERG的b波波幅和潜伏期分别与糖尿病病程显著相关.光凝治疗后7天,P-ERG的b波波幅出现明显但暂时的降低,随后逐渐恢复到治疗前水平.b波潜伏期在治疗前后无明显变化.结果揭示P-ERG在DR的早期诊断方面具有高度敏感性,通过检测糖尿病者的P-ERG可以预测DR的发生、发展,估计DR的严重程度.同时P-ERG还可以做为对接受光凝治疗的DR者的视网膜功能的监测手段.     

Cryoapplication in diabetic retinopathy

Thirty-five patients with diabetic retinopathy were treated with cryoapplication. This was used as an alternative to Argon laser or Zenon photocoagulation because the media was opaque from vitreous hemorrhage or cataract. It was difficult or impossible to treat with photocoagulation.The clinical impression indicates that cryoapplication is effective, showing adequate pigmentation and chorioretinal scarring with regression of diabetic retinopathy changes. However patients with vitreo-retinal fibrosis became frequently worse weeks later. This is considered a contraindication.The use of cryoapplication in diabetic retinopathy is recommended in situations where the ocular media is not clear, such as vitreous hemorrhage and cataract. It can also be used if there is difficulty with laser photocoagulation following lens implantation.It may be valuable in some developing countries where photocoagulation is not available. Cryomachines are frequently used in eye camps. It is inexpensive and does not necessarily require electricity.     

Microperimetry in diabetic retinopathy

Diabetic retinopathy has an enormous impact on visual function, even before permanent visual acuity loss. Moreover, adequate functional tests are mandatory to diagnose and follow diabetic patients treated for diabetic macular edema (DME). More precisely, the visual function safety profile of any therapy for DME should be accurately investigated. Microperimetry offers the possibility to obtain an exact fundus-related quantification of retinal sensitivity, and it is changing the current approach to the functional investigation of diabetic retinopathy.     

Inflammation in diabetic retinopathy

Diabetes causes a number of metabolic and physiologic abnormalities in the retina, but which of these abnormalities contribute to recognized features of diabetic retinopathy (DR) is less clear. Many of the molecular and physiologic abnormalities that have been found to develop in the retina in diabetes are consistent with inflammation. Moreover, a number of anti-inflammatory therapies have been found to significantly inhibit development of different aspects of DR in animal models. Herein, we review the inflammatory mediators and their relationship to early and late DR, and discuss the potential of anti-inflammatory approaches to inhibit development of different stages of the retinopathy. We focus primarily on information derived from in vivo studies, supplementing with information from in vitro studies were important.