早期糖尿病视网膜病变的视网膜电图分析

目的 分析早期糖尿病视网膜病变(DR)的闪光视网膜电图(F—ERG)和视网膜电图震荡电位(OPs)各参数的变化特点，寻找反映早期DR的敏感指标。方法 对16例(32只眼)正常人进行OPs和F-ERG检测。对27例(53只眼)糖尿病病人进行眼底荧光血管造影(FFA)、OPs和F—ERG检测。结果 OPs中Os波幅、O4波幅、OPs总波幅及F-ERG中b波峰潜时较其他指标敏感，其中O4波幅和b波峰潜时为最敏感指标，但均不能反映早期DR的严重程度。结论 OPs的O4波幅和F—ERG的b波峰潜时可作为早期糖尿病视网膜病变诊断的敏感指标。     

早期糖尿病视网膜病变药物治疗的药物经济学分析

目的：探讨不同方案治疗早期糖尿病视网膜病变的经济效果,找出既经济又有效的方案。方法：对目前临床常用的4种不同治疗方案（导升明、胰激肽原酶、复方血栓通胶囊、复方丹参滴丸,治疗时间均为90d）运用药物经济学方法进行成本-效果分析。结果：4种方案所需费用分别为1417.50元、810.00元、891.00元、656.10元;治疗有效率分别为94.25%、85.09%、85.17%、83.53%;成本-效果比分别为15.04、9.52、10.46、7.85。结论：复方丹参滴丸治疗效果较好,不良反应少,成本低廉。     

Retinopathy of prematurity: approaches to surgical therapy

Retinopathy of prematurity (ROP) is a vaso-proliferative disease with infiltration of the vitreous gel. Contraction of the infiltrate results in traction detachment with typical peripheral trough formation. Cryotherapy inhibits proliferation in the active stages of the disease (Stage 3, 'plus'). With development of traction detachment involving the macula (Stage 48) encircling buckling procedures should first be tried. Closed vitrectomy is considered when high retinal detachment and opacification by vitreous strands occur. The surgical technique is described. Anatomical (64%) and functional (43%) successes are reasonably high for Stage 4 cases, but disappointing (anatomical 40%, functional 16%) for Stage 5 ROP. Open funnels of detached retina fare better than closed ones. It is probably best to perform surgery not before the cicatricial stage, i.e. six months after birth.     

Retinopathy of prematurity in infants less than 29 weeks' gestation at birth

From January 1986 to December 1991 we examined the eyes of 206 infants born at Westmead Hospital, Neonatal Intensive Care Unit who were less than 29 weeks' gestation at birth to determine the incidence of retinopathy of prematurity. Eighty-five infants (41.3%) had no retinopathy of prematurity (ROP) in either eye, 82 infants had stages 1 or 2 ROP (39.8%), 29 had stage 3 ROP (14.1%) and 11 had stage 4 ROP (5.3%). Of these, cryotherapy was performed in 18; six now have bilateral retinal detachment and are blind The more severe stages of ROP were significantly associated with an increase in the number of days of oxygen supplementation, an increase in the number of days of mechanical ventilation and the presence of patent ductus arteriosus. Infants receiving steroids for mechanical ventilator dependence had a significantly greater chance of requiring cryotherapy (11 or 22 receiving steroids versus seven of 43 without steroids; P < 0.01).     

Diabetic retinopathy: different risk factors for exudates and haemorrhages

The retinae of 137 patients were examined ophthalmologically and for visual acuity at diagnosis of noninsulin dependent diabetes and again in 1982 and 1983, approximately 7 and 8 years later, when colour photographs were also taken. In 1983, 46% were without detectable retinopathy, 32% had haemorrhages (including microaneurysms) only, 4% exudates alone and 18% both lesions. Those with haemorrhages were more hyperglycaemic than those without retinopathy and those with exudates only. Indeed, those with exudates alone had lower mean glucose levels than those without retinopathy (p<0.05). Patients with exudates (± haemorrhages) had a lower percentage of the fatty acids of plasma cholesterol esters as linoleate than those without (p<0.05) but this did not hold for those developing haemorrhages. Different risk factors appear to operate in different features of diabetic retinophathy. In some respects exudate formation may be more akin to macro than to micro angiopathy.     

Recombinant α2(IV)NC1 domain of type IV collagen is an effective regulator of retinal capillary endothelial cell proliferation and inhibits pre-retinal neovascularisation

Background A recombinant form of the α2(IV)NC1 domain of type IV collagen has been shown to have potent anti-angiogenic activity although this peptide has not been studied in the context of proliferative retinopathies. In the current investigation we examined the potential for α2(IV)NC1 to regulate retinal microvascular endothelial cell function using a range of in vitro and in vivo assay systems. Materials and methods α2(IV)NC1 at concentrations between 0.1 and 1 μg/ml was added to retinal microvascular endothelial cells (RMECs) followed by assessment of cell attachment, proliferation and survival. This agent was also tested within a novel in vitro three-dimensional retinal angiogenesis assay and the number of angiogenic sprouts quantified. α2(IV)NC1 was also delivered intra-vitreally to mice with oxygen-induced proliferative retinopathy (OIR) and neovascularisation evaluated in comparison with vehicle-treated controls. Results RMECs treated with α2(IV)NC1 (0.1, 0.5 and 1 μg/ml) showed delayed attachment at 3 h post-seeding, although this deficit had been restored at the 6-h time point. BrdU assay of DNA replication revealed that confluent RMECs treated with α2(IV)NC1 showed no measurable response in comparison with vehicle-treated controls. By contrast, proliferation of sub-confluent RMECs was significantly reduced by α2(IV)NC1 at 0.5 μg/ml (P<0.01). α2(IV)NC1 also induced apoptosis in RMECs and inhibited angiogenesis of pre-existing retinal vascular networks in vitro (P<0.001). Intra-vitreal injection of α2(IV)NC1 in the OIR model significantly inhibited pre-retinal neovascularisation compared with vehicle-treated controls (P<0.001). Conclusion α2(IV)NC1 inhibits angiogenesis in the retinal microvasculature. This recombinant protein has potential for the treatment of neovascularisation in proliferative retinopathies. BioStratum Inc. did not sponsor this research in any way. None of the authors are paid consultants with this company.     

白细胞对早期糖尿病视网膜病变作用的研究

目的探讨白细胞在早期糖尿病大鼠视网膜毛细血管中粘附、堆积及其与视网膜微血管形态学变化的关系。方法健康成年雄性Wistar大鼠90只，随机分成正常对照组和链脲佐菌素（streptozotocin, STZ）诱导的糖尿病组各45只（3、7、14 d组各5只，30、90、180 d组各10只）。取大鼠右眼制备视网膜消化铺片，进行形态学观察及白细胞共有抗原（leukocyte common antigen, CD45）单克隆抗体免疫组织化学研究。结果正常对照组视网膜毛细血管中有少许CD45阳性细胞；糖尿病发生3 d后，CD45的表达明显增加，病程第14 d达高峰，以后基本稳定。病程90 d时，视网膜毛细血管已出现节段性膨大、囊样扩张及闭锁等形态学改变；病程180 d时，上述病变进一步加重。结论白细胞粘附发生在糖尿病视网膜病变（diabetic retinopathy, DR）的早期阶段，是DR在微血管水平病理变化的开端。白细胞粘附可能作为视网膜微血管形态学改变的基础，在DR的发生发展中起着重要作用。(中华眼底病杂志,2003,19:344-347)     

Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery

Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery.     

Diabetes mellitus and hearing loss

A prospective hearing survey was performed in a sample of 102 diabetic patients. The hearing data were compared with the hearing thresholds of three control population groups. A significant difference was found in the average hearing thresholds between the diabetic patients and all of the three control populations. Diabetic patients have worse hearing threshold levels especially at low and mid frequencies (P < 0.001). There was also a correlation between the duration of diabetes and hearing loss. No significant correlation was found between the different stages of diabetic retinopathy and the degree of hearing loss.     

The prevalence and expression of diabetes in a sample of optometric patients

The clinical characteristics of 100 consecutively presenting diabetic patients of an optometrist were investigated. This sample was drawn from 3798 patient first visits and represented 2.6% of the practice population sample. Diabetic retinopathy was present in 26% of the diabetic patients; this prevalence is similar to that found in diabetics examined in community based surveys. The ocular complications of diabetics observed in this study appeared to be similar to those of diabetics in the general community. The mean random blood glucose levels of the diabetics having retinopathy was not significantly different from those not having retinopathy. A first degree family history of diabetes was admitted by 46% of the diabetic subjects and was the most common associated clinical feature surveyed; a control group of non-diabetic subjects had a first degree family history of diabetes in 10% of cases. In seven patients, the diabetes was diagnosed as a result of signs detected at the optometric examination; these signs are listed. No newly diagnosed diabetic had diabetic retinopathy as a presenting sign. Ocular and systemic signs, other than diabetic retinopathy, were sought and a high prevalence of cardiovascular disease was detected in these diabetic patients. The vision of the diabetic patients was compared to that of 100 randomly selected age and sex matched controls; there was no significant difference in the visual acuity of the two groups. The implications of this finding are discussed. Guidelines for the detection and management of diabetic patients of optometrists are suggested.