凋亡是糖尿病视网膜微血管病变和神经元病变的细胞病理学基础

糖尿病视网膜病变(diabetic retinopathy,DR)不仅是视网膜微血管病变也是神经元病变.在早期糖尿病电生理和心理物理学的改变提示神经元病变出现在微血管病变之前.因此这些手段是目前发现最早期DR的方法.DR的细胞病理学基础是凋亡.但是把调控细胞凋亡作为治疗DR的方法却长期以来被忽视.最新的研究,应用细胞保护剂可以预防和逆转视网膜神经元凋亡,使这种治疗途径初现端倪.     

糖尿病视网膜病变发生发展的全身及眼局部相关因素

糖尿病性视网膜病变(diabetic retinopathy,DR)是最为常见的致盲性眼底病变之一,其发病机制不明。长期以来,早期对于糖尿病性视网膜病变的治疗只是单纯控制血糖,但这并不能完全阻止糖尿病性视网膜病变的进一步发展。因此,研究全身及眼局部相关因素的影响作用十分重要。近年来,国内外大量研究认为,许多全身及眼局部因素对糖尿病性视网膜病变发生发展起重要作用。本文综述此方面成果,为最终通过全身及眼局部的综合干预为早期防治糖尿病性视网膜病变提供思路。     

非增生型糖尿病视网膜病变合并糖尿病视神经病变的临床分类及表现

目的 观察非增生期糖尿病视网膜病变(NPDR)合并糖尿病视神经病变(DON)的临床分类及表现.方法 经荧光素眼底血管造影(FFA)检查确诊为NPDR的224例患者440只眼纳入研究.采用光相干断层扫描(OCT)检查观察视盘形态,测量视盘周围视网膜神经纤维层(RNFL)厚度.同时检测糖化血红蛋白(HbA1C)、血脂水平等全身相关指标.根据检查结果将合并DON的患者作为DON组,其余未合并DON的患者作为对照组.DON组患者进一步分为糖尿病视盘病变(DP)、缺血性视神经病变(AION)及视神经萎缩等3个亚组.观察DP、AION、视神经萎缩的发病率.分析各组间平均RNFL厚度及全身相关指标的差异.结果 224例440只眼中,合并DON者14例19只眼,占患眼的4.3％;未合并DON者210例421只眼,占患眼的95.7％.DON组14例19只眼中,DP 2例2只眼,占患眼的10.5％ AION 8例12只眼,占患眼的63.2％;视神经萎缩4例5只眼,占患眼的26.3％.DP组患眼均无明显视网膜病变.AION在无明显视网膜病变、轻度、中度、重度NPDR期的发病率比较,差异无统计学意义(x2=0.019,P＞0.05).与对照组比较,AION组视盘垂直径、水平径及视盘杯盘比(C/D)比值均较小,差异均有统计学意义(t=-2.425,-3.432,-3.871; P＜0.05);糖尿病病程明显延长,差异也有统计学意义(t=2.320;P＜0.05).结论 NPDR可发生DP、AION、视神经萎缩3种病变.AION患者视盘垂直径、水平径及视盘C/D比值均较小,糖尿病病程明显延长.     

糖尿病视网膜病变患者视网膜电图震荡电位与荧光素眼底血管造影的对比研究

糖尿病视网膜病变（diabetic retinopathy,DR）是主要致盲眼病之一。研究表明,约70％糖尿病患者出现全身小血管和微血管病变。眼底检查是诊断糖尿病视网膜病变最常用的方法,但对微小病变及视网膜轻度改变不能全面了解。     

增殖性糖尿病视网膜病变的手术时机

增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）是糖尿病患者主要致盲原因,我院在三年中统计2型糖尿病患者428例,大约26．5％的糖尿病患者有不同程度的视网膜病变,其中5．5％为增殖期糖尿病视网膜病变。糖尿病视网膜病变的黄斑水肿、渗出占9．5％,早期的增殖性糖尿病视网膜病变应进行激光治疗,严重的增殖性糖尿病视网膜病变是玻璃体切割手术的常见适应证。     

视网膜厚度分析仪在糖尿病视网膜病变中的应用

视网膜厚度分析仪(retinal thickness analzer,RTA)作为一种非侵入性检查手段,可以早期发现视网膜细微病变,对异常区域明确定位,对后极部视网膜厚度定量分析,有助于疾病的诊治。RTA已应用于糖尿病视网膜病变(diabetic retinopathy,DRP)的病程观察和疗效评价,本文就RTA的原理、在眼科及DRP中的应用进行综述。     

糖尿病视网膜神经变性机制的研究进展

糖尿病视网膜病变(diabetic retinopathy,DR)一直被认为是微血管病变。然而,大量的研究已经证实,DR不仅会引起视网膜的血管病变,也会引起视网膜神经退行性改变。越来越多的证据也表明,在DR早期未发生视网膜血管病变之前就已经出现了视网膜神经变性,且视网膜神经变性可能参与了微血管异常的发生发展。目前,糖尿病视网膜神经变性的机制尚不十分明确,现就近年来糖尿病视网膜神经变性机制的研究进展做一综述。     

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( diabetic retinopathy,DR)为糖尿病的严重并发症之一,是目前全球第二大致盲性疾病。早期的流行病学资料表明,其发生发展与血糖水平、糖尿病病程、血脂等多种因素相关。近年来,基因多态性与DR发生的相关性受到广泛关注。准确把握基因在DR发生发展过程中的作用机制及其表达的差异性,对DR早期诊断和防治具有重要意义。因此本文对DR发生有关的基因研究进展进行综述。     

糖尿病视网膜病变的早期病理改变

糖尿病视网膜病变(diabetic retinopathy,DR)的病理机制一直是研究的热点.经典理论认为视网膜微血管病变是DR最早的超微结构改变,但近年的研究表明,血-视网膜屏障的破坏和神经变性在DR的早期病变中也发挥着举足轻重的作用.甚至有学者发现在视网膜微血管病变以前就已出现了神经元的大量凋亡和胶质细胞的活化.     

糖尿病性视网膜病变玻璃体切割术后再出血的探讨

玻璃体切割术已成为目前治疗增殖型糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)主要手段之一.此手术可使发生严重出血而不能自行吸收的PDR患者视力得到明显提高,也可使大量玻璃体出血后机化增殖收缩致视网膜脱离的患者网膜复位、恢复部分视力[1].但是糖尿病性视网膜病变玻璃体切割术后玻璃体腔的再出血(postvit rectomy diabetic vitreous hemorrhage PDVH)是糖网玻切术后最常见的并发症之一,发生率为12％～63％[2-4].它不仅严重影响患者术后视力的恢复及医生对其眼底情况的常规检查,还可能使患者面临二次手术,以清除积血.部分严重患者可因长期高眼压或牵拉网脱致失明.现对其发生的原因及早期防治和处理做一综述.     

Mass community screening for diabetic retinopathy using a nonmydriatic camera with telemedicine

BACKGROUND: Diabetic retinopathy is a leading cause of blindness. Studies have shown the value of screening and early, timely treatment. Our aim was to measure the effectiveness and degree of acceptance of community screening for diabetic retinopathy using telemedicine. METHODS: In this prospective, population-based cross-sectional study, diabetics recruited through a regional multimedia campaign were surveyed and screened for retinopathy using a nonmydriatic camera and evaluated through telemedical imaging. RESULTS: Of the 291 diabetics recruited over a 3-week period (37% by the regional diabetes association and 30% by the media), 49.4% reported having their most recent eye examination within 1 year, 30.7% between 1 to 2 years, 9.7% over 2 years, and 10.1% had never had an exam. 98.6% found our screening method acceptable, with 95.1% wanting to return for their next screening and 91.2% stating it would increase their compliance to annual screening. INTERPRETATION: Telemedicine provided a reliable and highly acceptable method for diabetic retinopathy screening. It can attract a significant number of people with diabetes and potentially recruit patients who would otherwise be missed by the current methods of vision screening.     

Epidemic studies of diabetic retinopathy in China—a review

The prevalence of diabetic retinopathy (DR) is increasing dramatically as the population of patients with diabetes continues to rise. This paper wants to investigate the prevalence and risk factors of DR in China through reviewing the research from Pubmed about population-based epidemic studies. The results of observational studies suggested that the overall prevalence of DR was 1.6%-6.5% in population, 19.9%-43.1% in diabetes and 13.6% in population without diabetes, most of the DR were the mild type, macular edema and vision-threatening were 5.2% and 1.2%. The risk factors for DR were longer duration of diabetes, plasma glucose concentration, concentrations of HbA1c level, higher systolic blood pressure(BP), higher diastolic BP, male gender, rural region, and methods of diabetic treatment and so on. The prevalence of DR which was strongly related to duration of diabetes was higher with the increase of diabetes. DR would be the major leading cause of visual impairment in China, it is very important to prevent DR by early screening and any other methods.     

The worldwide epidemic of diabetic retinopathy

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.     

细胞因子与糖尿病视网膜病变的研究进展

糖尿病视网膜病变（DR）是一种发生进行性视力损害的糖尿病（DM）并发症,其特征是毛细血管闭锁、微循环障碍和局部缺血性视网膜新生血管形成,其确切的发病机制尚不清楚。最近有研究认为DR可能与视网膜毛细血管炎症反应有关。由于细胞因子能引起炎症反应和黏附分子表达,因此细胞因子增加单核细胞和内皮细胞黏附的过程被认为是DR发生发展过程中的关键事件。就血管内皮生长因子（VEGF）、转化生长因子-β（TGF-β）、碱性成纤维细胞生长因子（bFGF）等多种细胞因子在DR中的作用进行综述。     

尿微量白蛋白对早期糖尿病视网膜病变的临床意义

糖尿病视网膜病变是糖尿病非常重要的并发症之一。目前对于糖尿病视网膜病变的治疗并没有非常有效的治疗手段,所以在糖尿病视网膜病变的前期,早期发现与预防治疗显得格外的重要,近年研究发现尿微量蛋白与糖尿病视网膜病变密切相关,对于早期防治糖尿病视网膜病变具有重要意义,本文就尿微量白蛋白在早期的糖尿病视网膜病变中的临床意义作一综述。     

重视糖尿病患者早期视功能防治

糖尿病发病率在逐年增加,而糖尿病并发症之一的视网膜病变的发病率也在逐年上升,是糖尿病患者致盲的主要因素。糖尿患者视功能防治要从早做起,重视视力、眼底改变、荧光血管造影等检查,早期发现糖尿病视网膜病变,早期干预全身因素高血压、高血脂、肥胖、蛋白尿等,平稳控制血糖,积极实时激光光凝糖尿病视网膜病变,以延缓糖尿病视网膜病变的发生和发展,保存和恢复糖尿病患者的视功能。     

Vitreous hemorrhage in diabetic eyes previously treated with panretinal photocoagulation

Background Vitreous hemorrhage (VH) is a major cause of severe vision loss in diabetic patients. The aim of this study was to assess the incidence and risk factors for new VH in diabetics previously treated with panretinal photocoagulation (PRP) for proliferative retinopathy (PDR) in community base center. Methods Records of 192 diabetics (35 type 1, 157 type 2), undergoing PRP for diabetic retinopathy were retrospectively reviewed. Eyes presenting initially with high-risk PDR received PRP without delay, and eyes presenting initially with severe non proliferative retinopathy (NPDR) or early PDR had undergone central retinal photocoagulation (CRP), and then, when high risk PDR developed, received PRP treatment. Results VH had developed in 39% of the eyes despite PRP. Risk factors for VH in type 1 diabetes were: early onset and long duration of disease (23.8 versus 39.0 years of age, P = 0.007, and 25.8 versus 16.0 years, P = 0.002, respectively). In type 2, VH occurred with less follow-up and angiographic examinations (7.4% versus 3.8%, P = 0.027, and 33% versus 47%, P = 0.07, respectively). CRP decreased the risk for VH from 43 to 15%, P = 0.013. Conclusions In type 2 diabetes, regular ophthalmic follow-up and intensive PRP may reduce the risk for VH in eyes previously treated by PRP. In type 1, early onset disease and long duration are associated with higher incidence of VH.     

内脏脂肪素在糖尿病视网膜病变中的研究进展

糖尿病视网膜病变(DR)是继发于糖尿病的慢性视网膜微血管病变,可致糖尿病患者视力永久丧失。DR的发生与视网膜微血管功能障碍、视网膜组织水肿、出血和继发性新血管增殖有关。有研究显示,在糖尿病患者的脂肪组织、肝脏和肾脏中均发现内脏脂肪素高表达,并且该因子可能存在于视网膜组织中,对DR的发生发展具有一定调控性作用。本综述以内脏脂肪素与DR的相关研究为依据,对内脏脂肪素与DR的关系作论述。     

远程筛查在指导糖尿病视网膜病变治疗上的应用

目的探讨使用远程筛查方法指导糖尿病视网膜病变(DR)患者治疗方案的应用价值.方法使用自行设计的 DR 远程筛查程序在基层医院进行单视野的眼底彩色图像采集,通过网络即时将结果发送到眼科中心,由眼底病医师进行诊断,建议患者进行相应治疗,并对所有病例进行荧光素眼底血管造影检查(FFA),以 FFA 结果作为诊断标准,再次指导患者进行治疗,比较2种检查方法对指导治疗的一致性.结果根据 DR 国际临床分类法将患者分类,通过远程筛查方法及 FFA 检查方法所指导的治疗建议有良好的相关性.结论 DR 远程筛查程序能方便偏远地区糖尿病眼病患者进行筛查,对早期指导糖尿病患者进行眼科治疗具有积极作用.     

Therapeutic targeting of diabetic retinal neuropathy as a strategy in preventing diabetic retinopathy

Diabetes causes a panretinal neurodegeneration herein termed diabetic retinal neuropathy, which manifests in the retina early and progresses throughout the disease. Clinical manifestations include changes in the ERG, perimetry, dark adaptation, contrast sensitivity and colour vision which correlate with laboratory findings of thinning of the retinal neuronal layers, increased apoptosis in neurons and activation of glial cells. Possible mechanisms include oxidative stress, neuronal AGE accumulation, altered balance of neurotrophic factors and loss of mitohormesis. Retinal neural damage precedes and is a biologically plausible cause of retinal vasculopathy later in diabetes, and this review suggests that strategies to target it directly could prevent diabetes induced blindness. The efficacy of fenofibrate in reducing retinopathy progression provides a possible proof of concept for this approach. Strategies which may target diabetic retinal neuropathy include reducing retinal metabolic demand, improving mitochondrial function with AMPK and Sirt1 activators or providing neurotrophic support with neurotrophic supplementation.