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。     

糖尿病肾病患者合并视网膜病变发生率的分析

目的　观察糖尿病肾病 (DN)患者合并糖尿病视网膜病变 (DR)的发生率 .方法　确诊糖尿病肾病患者 75例 ,未并发肾病的 2型糖尿病患者 79例 ,详细检查眼底 ,可疑患者行眼底荧光血管造影确诊 .结果　DN组和NDN组DR的发生率均随病程增高 ,病程 <15年 ,DN组DR的发生率较NDN组DR的发生率明显增高 .结论　对糖尿病肾病者更需高度重视DR的发生     

糖尿病肾病患者合并视网膜病变发生率的分析

目的观察糖尿病肾病(DN)患者合并糖尿病视网膜病变(DR)的发生率.方法确诊糖尿病肾病患者75例,未并发肾病的2型糖尿病患者79例,详细检查眼底,可疑患者行眼底荧光血管造影确诊.结果 DN组和NDN组DR的发生率均随病程增高,病程<15年,DN组DR的发生率较NDN组DR的发生率明显增高.结论对糖尿病肾病者更需高度重视DR的发生.     

增殖性玻璃体视网膜病变时细胞因子的变化

增殖性玻璃体视网膜病变 (ＰＶＲ)是临床眼科常见的眼底病变 ,现国内常采用玻璃体切割手术治疗 ,但部分病人手术后视力恢复不尽人意。近年来 ,虽对其发病机制进行了大量研究 ,但仍有许多问题尚待进一步探讨。为了解该病的发生、发展与免疫因素的关系 ,本文测定了 3 0例ＰＶＲ患者视网膜下液及血浆白细胞介素 1(ＩＬ - 1β)、白细胞介素 6(ＩＬ - 6)及白细胞介素 8(ＩＬ - 8)水平。现报道如下。对象和方法一、对象 :(一 )对照组 :3 1例 (男 2 2 ,女 9) ,年龄 2 4～ 5 4岁。均为来医院住院治病的视网膜脱离患者。实验时采集视网膜下液0 3 μ…     

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...     

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.     

糖尿病视网膜病变相关基因多态性的研究进展

糖尿病视网膜病变是目前国际上最主要的致盲性眼病之一,患病率日渐升高.其发生和发展与血糖水平、糖尿病病程、环境及遗传等多种因素有关.近些年来,随着基因多态性与糖尿病视网膜病变关系的研究不断深入和进展,已经筛选出了可能与之相关的数十 种基因,其中几种基因多态性已经被证实为糖尿病视网膜病变发生的独立危险因素.现将与糖尿病视网膜病变密切相关的基因多态性研究进展作一综述.     

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。     

糖尿病周围神经病变的相关危险因素分析

目的 探讨糖尿病周围神经病变(DPN)的相关危险因素及DPN与糖尿病视网膜病变(DR)的关系.方法 回顾性分析200例2型糖尿病(T2DM)住院患者的病史资料,根据是否合并DPN,分为DPN组(n=136)及非DPN组(NDPN组,n=64),比较两组的临床基本资料及DR发生率,采用Logistic回归分析探讨DPN的危险因素.结果 两组间比较,病程、体质指数(BMI)、糖化血红蛋白(HbA1c)、餐后2h血糖(2 hPG)、糖负荷2小时C肽(2 hC-P)、DR发生率差异均有统计学意义(P＜0.01).Logistic多因素回归分析显示,因素合并DR(P=0.023)、病程(P =0.008)、HbA1c(P=0.006)、BMI(P =0.000)及2 hC-P水平(P =0.065)差异具有统计学意义.结论 合并DR、病程、BMI、HbA1c及2 hC-P水平是DPN发生的危险因素,DPN与DR存在正相关平行关系.     

视网膜下液表皮生长因子与增殖性玻璃体病变关系的探讨

原发性孔源性视网膜脱离的病例中约10％将发生增殖性玻璃体视网膜病变(PVR),它一旦发生进一步治疗困难而且效果不能肯定,部分病例终将失明。到目前为止PVR被认为是一种细胞所介导的疾病,其中视网膜脱离发生后产生的视网膜下液(SRF)中所含的某些物质刺激了PVR形成的细胞     

Urinary 6-sulfatoxymelatonin level in diabetic retinopathy patients with type 2 diabetes

Melatonin is a powerful antioxidant. Decreased melatonin excretion has been reported to be associated with several oxidative stress-related diseases. The urinary metabolite of melatonin, 6-sulfatoxymelatonin (aMT6s), has proved to be a very reliable index of melatonin production. The present study aims to evaluate the level of urinary aMT6s in patients with type 2 diabetes mellitus and diabetic retinopathy. Urine samples were collected from 10 patients with diabetes and no diabetic retinopathy (NDR), 19 patients with nonproliferative diabetic retinopathy (NPDR), 38 patients with proliferative diabetic retinopathy (PDR), and 16 subjects without diabetes mellitus, who served as controls. The level of aMT6s in specimens was assayed by a commercial aMT6s ELISA kit, creatinine levels were also measured for each sample to get urinary aMT6s/creatinine ratio. Creatinine-adjusted urinary aMT6s values were compared among four groups. The urinary aMT6s (mean ± SD) levels were 9.95 ± 2.42, 9.90 ± 2.28, 8.40 ± 1.84 and 5.58 ± 1.33 ng/mg creatinine in the controls and in patients with NDR, NPDR, or PDR, respectively. The urinary aMT6s level of the PDR group was significantly lower than that of the control, NDR and DR groups. No significant difference was found among the control, NDR and DR groups. After adjustment for various factors (age, smoking, cancer, and coronary heart disease) that may influence the aMT6s level, the odds-ratio of urinary aMT6s comparing PDR patients to controls was 0.246 (95% confidence interval = 0.108-0.558, P = 0.001). Therefore, the urinary aMT6s level is significantly decreased in diabetic patients with PDR but not in diabetic patients without PDR, which indicates that decreased urinary aMT6s level may be associated with the pathogenesis of PDR.     

糖尿病视网膜病变的风险揭示与关键因素分析

目的：通过构建组合模型对糖尿病并发视网膜病变（DR）的患病风险进行预测,为DR的预防和诊断提供参考。方法：基于3000例糖尿病患者的生化检测数据,运用互信息作为评价标准筛选出与DR有关的特征因素,将其作为入模变量构建5种常见的模型,以准确率、精确率、召回率和AUC作为评价标准筛选出预测能力较优的3种模型,并运用Stacking方法构建组合模型。结果：通过互信息筛选出39个特征因素,发现随机森林模型、SVM模型以及Logistic回归模型这3种模型表现较优;构建的3种组合模型中,发现以SVM、Logistic为初级分类器,随机森林为次级分类器的组合模型预测能力最好,其AUC高达0.877。结论：组合模型相比单一模型具有更好的DR风险预测能力,更有助于DR的临床诊断。     

Stress reactivity of intraocular pressure after relaxation training in open-angle glaucoma patients

The present study was based on the hypothesis that stress may contribute to increased intraocular pressure (IOP) in open-angle glaucoma patients. It is investigated whether IOP reactivity to a mental stressor test (MST) can be influenced by relaxation training. Twenty three patients with open-angle glaucoma were randomly assigned either to a training group (TG) or to a waiting-list control group (CG). Prior to as well as after the completion of the training all patients were exposed to the MST. IOP and heart rate as well as self-ratings of psychological strain were assessed three times: (1) at baseline, (2) after exposition to the stressor, and (3) after a 10-min relaxation phase. Results provide evidence that the MST is a valid procedure to induce psychophysiological activation and that elevated IOP levels in open-angle glaucoma patients might be provoked by stressing situations. However, participation in the relaxation training did not influence IOP stress reactivity.     

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.     

频域光学相干断层扫描在早期糖尿病视网膜病变检测中的应用

目的:利用频域光学相干断层扫描(OCT)定性、定量检测并分析正常人群和眼底镜下无糖尿病视网膜病变的糖尿病患者的黄斑区视网膜的形态、厚度等改变,为糖尿病视网膜病变的早期发现及随访提供可靠的检测手段.方法:采用Cirrus HD-OCT的512×128扫描模式及5线高清扫描模式检测糖尿病患者双眼黄斑视网膜平均厚度、黄斑中心凹视网膜厚度及黄斑部9个分区的视网膜厚度,与正常对照组进行比较,并对结果行统计学分析.结果:糖尿病患者60例(120只眼),根据糖尿病视网膜病变分期标准,眼底均表现为无糖尿病视网膜病变(NDR).糖尿病NDR组与正常对照组相比,黄斑区视网膜厚度外环的鼻侧和颞侧与正常眼之间差异有统计学意义.其余各区的视网膜厚度与正常眼之间没有差异.结论:NDR组与正常对照组相比,黄斑区视网膜厚度外环的鼻侧和颞侧与正常眼之间有差异.这为在临床上早期发现糖尿病视网膜病变提供了客观依据,并便于随访观察.     

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.     

Intraocular matrix metalloproteinase 2 and 9 in patients with diabetes mellitus with and without diabetic retinopathy

Introduction

We aimed to investigate activities of metalloproteinases 2 (MMP-2) and MMP-9 in aqueous humour of patients with diabetes mellitus with various stages of diabetic retinopathy.

Material and methods

We included 36 samples of aqueous humour of patients suffering from diabetes mellitus, undergoing routine cataract surgery. Seven of them suffered from proliferative diabetic retinopathy (PDR), 3 had diabetic maculopathy and the remaining 26 had background or minimal background retinopathy only. Metalloproteinases 2 and MMP-9 activities in aqueous humour were measured by gelatin zymography combined with the densitometric imaging system. Total protein content in aqueous humour samples was also assessed.

Results

Metalloproteinases 2 activities were present in almost all samples of aqueous humour (32 of 36) and were 2.6-fold higher in patients who suffered from diabetic ocular complications (p < 0.0001). Activities of MMP-2 correlated well with the duration of the disease (correlation = 0.37, p = 0.03) and tended to correlate with total protein levels in aqueous humour (correlation = 0.43, p = 0.06). Metalloproteinases 9 activities were observed only in 2 of 7 patients with proliferative diabetic disease and the enzyme was absent from aqueous humour samples of patients without proliferative retinopathy.

Conclusions

Increased activities of MMP-2 in aqueous humour of patients with PDR may be related to the disease process and support the hypothesis that MMP-2 may be of particular importance in diabetic retinal neovascularization. MMP-9 may be activated at a certain disease stage only.     

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。     

糖尿病视网膜病MTHFR基因多态性及其与血浆同型半胱氨酸水平的关系

目的：研究亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase,MTHFR）基因多态性及血浆同型半胱氨酸水平与2型糖尿病视网膜病的关系。方法：应用聚合酶链反应－限制性内切酶片段长度多态性技术检测208例2型糖尿病患者（其中110例伴视网膜病）及57名正常对照的MTHFR C677T基因型，采用高效液相色谱法测定血浆同型半胱氨酸水平。结果：糖尿病视网膜病组MTHFR基因TT纯合基因型、CT杂合基因型及T等位基因频率（分别为28．18％、41．82％、49．09％）均明显高于糖尿病不伴视网膜病组（分别为18．37％、29．59％、33．16％）及正常对照组（分别为17．54％、28．07％、31．58％），基因型和等位基因频率分布差异均有显著性（P＜0．01），而MTHFR基因多态性在糖尿病不伴视网膜病组与正常对照组之间差异无显著性（P＞0．05），T等位基因与糖尿病视网膜病的发生密切相关（OR＝1．94，95％CI；1．31－2．88）。糖尿病视网膜病组、糖尿病不伴视网膜病组及正常对照组中，MTHFR基因有C677T突变者血浆同型半胱氨酸水平均显著高于无基因突变者。结论：MTHFR基因C677T位碱基突变致血浆同型半胱氨酸水平升高可能是糖尿病视网膜病发病的重要遗传因素。