玻璃体视网膜手术治疗晚期糖尿病视网膜病变的疗效

目的:探讨玻璃体视网膜手术治疗晚期增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床效果。方法:回顾性分析晚期增殖性糖尿病视网膜病变患者38例45眼经玻璃体视网膜手术治疗后的临床资料,分析手术后视力改善情况和手术的并发症。结果:随访患者45眼,术后视力0.05以上者从术前14眼(31.1%)提高到术后30眼(66.7%),其中22眼(73.3%)视力>0.1。术后并发症:高眼压、玻璃体出血、视网膜脱离、并发性白内障、视神经萎缩、新生血管性青光眼、眼球萎缩。结论:玻璃体视网膜手术是目前治疗晚期增殖性糖尿病视网膜病变的有效方法,正确掌握手术适应证,合理应用手术技术,及时准确地处理术后并发症,才能有效地改善晚期增殖性糖尿病视网膜病变患者视力。     

玻璃体切除治疗增殖性糖尿病视网膜病变

目的:评价玻璃体切除术治疗增殖性糖尿病视网膜病变的效果。方法:93例(139眼)增殖性糖尿病视网膜病变病例均行玻璃体切除术,术后平均随访(16.72±8.53)mo,对视力及手术失败的原因进行回顾性分析。结果:98眼(70.50%)视力得到提高,术后视力明显好于术前(P<0.001);手术失败的主要原因是视网膜脱离和黄斑病变。结论:玻璃体切除术是治疗增殖性糖尿病视网膜病变的有效方法。     

老年人非增殖性糖尿病视网膜病变的氩激光治疗

的　探讨老年人非增殖性糖尿病视网膜病变氩激光光凝的临床特点、时效性和疗效。方法　老年人非增殖性糖尿病视网膜病变 ,黄斑水肿组 32只眼 ,非黄斑水肿 2 7只眼。行氩离子兰绿激光光凝。结果　治疗 5 9只眼 (44例 ) ,随访 2 9.98± 11.75个月。激光光凝有效 5 4只眼 (91% ) ,视力进步 7只眼 ,视力不变 42只眼。 0 .2以上视力 42只眼 (71% )。随访期间 5只眼行老年性白内障手术 ,均恢复有用视力 ,眼底无黄斑水肿。结论　老年人非增殖性糖尿病视网膜病变者血糖控制不良及全身性疾病等 ,发生黄斑水肿比例较高 ,应及时施行激光光凝治疗。同时 ,因对侧眼增殖性糖尿病视网膜病变或其它眼底病致低视力时 ,适当放宽激光光凝标准 ,对保护老年人糖尿病患者视力有益     

次全视网膜光凝治疗中度非增殖性糖尿病视网膜病变的临床观察

目的 观察次全视网膜光凝治疗中度非增殖性糖尿病视网膜病变(NPDR)的临床效果.方法 对中度非增殖性糖尿病视网膜病变患者42例(62只眼)进行次全视网膜光凝,对其中合并有临床意义黄斑水肿的22只眼同时进行局部光凝.光凝后平均随访20个月,对光凝前、后的视力变化及视网膜病变进展程度进行评价.结果 激光治疗后绝大多数病眼的视力得以维持或有所提高.合并黄斑水肿的22只眼中有21只眼(95.45%)视力得以维持或有所提高.糖尿病视网膜病变的发展在激光治疗后大部分病变表现稳定(87.10%),加重者仅为12.90%.结论 对中度非增殖性糖尿病视网膜病变患者早期进行次全视网膜光凝,对合并有临床意义的黄斑水肿者同时进行局部光凝,可使大多数病眼的视力得以维持或提高,并具有稳定视网膜病变进展的作用.     

糖尿病性视网膜病变研究的最近进展

一、糖尿病视网膜病变治疗的进展光凝一无疑地,光凝已减少了糖尿病增殖性视网膜病变所致的严重视力损害(连续二次随访视力<0.025)的发病率。随机进行激光治疗的病例中,未治疗眼严重视力损害的4年发病率是28.5%,而治疗眼则降低到12%。使眼特别有可能引起严重视力损害的特征是:视神经乳头上的新生血管、玻璃体和视网膜前出血。遇有这些特征出现,严重视力损害2年危险率是25%或更多。     

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。     

马来亚大学医学中心门诊糖尿病患者视网膜病变的发病率(英文)

目的:评估马来亚大学医学中心眼科门诊的糖尿病性视网膜病变的发病率和它在糖尿病患者中的危险因素。方法:该横向研究包括100例近期被诊断为糖尿病患者的200眼。采集有关的眼部和全身病史并对所有的眼进行彻底散瞳眼底检查。视网膜病变的状况根据早期糖尿病性视网膜病变治疗研究(ETDRS)的结果进行分类。造成视网膜病变的危险因素是通过卡方检验进行分析的,P<0.05被认为有意义。结果:在我们的研究中,近期被诊断为糖尿病人群中糖尿病性视网膜病变的发病率为28%,Ⅱ型糖尿病患者中非增殖性视网膜病变的发病率(36%)比Ⅰ型糖尿病患者高(24%)。在两种类型的糖尿病患者中,视网膜病变的发病率与性别、年龄、种族、社会经济状况、糖尿病类型和体重指数无关。糖尿病病史较长并控制不良的患者,高血压者,伴有神经病变者,高脂血症以及有吸烟史者,视网膜病变的发病率明显高。结论:对糖尿病患者进行视网膜病变的基线筛查是可取的,因为早期发现,规律随访,合理的推荐给眼科医生并进行有效的治疗将减少以及避免患者严重的视力丧失。     

住院糖尿病人视网膜病变发生率调查及其危险因素分析

目的 调查济南市住院糖尿病患者中糖尿病视网膜病变的发生率,对其相关的危险因素进行分析.方法 对济南市多家医院的250例住院糖尿病患者进行问卷调查、实验室检查、眼部检查等,并按照国际最新糖尿病视网膜病变分期标准对调查资料进行分析.结果 住院糖尿病患者中糖尿病视网膜病变的发生率为56.4%,其中增殖性糖尿病视网膜病变占10.8%.多因素分析显示其危险因素为高血脂、肾损害、高血压、高糖化血红蛋白和糖尿病病程.结论 济南市住院糖尿病人中糖尿病视网膜病变的发生率较高.应加强对糖尿病病程较长、已出现早期肾损害的患者的随访和治疗,除控制好血糖外,还应重视对其血脂、血压的控制.     

糖尿病性视网膜病变治疗的新进展

糖尿病视网膜病变患者在下述情况下,可引起失明:(1)由于新生血管引起出血,或玻璃体混浊,以及增殖性糖尿病性视网膜病变。(2)视网膜水肿,类脂质沉着,视网膜前纤维增生,或黄斑部毛细血管阻塞。一、增殖性糖尿病性视网膜病变的治疗: (1)光凝固:为获得较好的疗效,必须在增殖性视网膜病变的早期实施光凝固治疗。因为增殖性视网膜病变的自然过程是逐渐形成瘢痕,在新生血管周围有致密的结缔组织围绕,而光凝固对比将无效。     

抗VEGF药物在PDR患者玻璃体切割手术前应用的临床研究

目的 探讨在增殖性糖尿病性视网膜病变患者进行玻璃体手术之前进行抗VEGF药物治疗对其手术难度、术中术后并发症及疗效情况等的影响.方法 选取安徽省立医院2018-08至2020-05诊断为增殖性糖尿病性视网膜病变(PDR)并拟予以23G玻璃体切割术进行治疗的患者43人50例患眼.将50例患眼分为眼内注药组与对照组,其中眼...     

Incidence of and risk factors for proliferative retinopathy and its association with blindness among diabetes clinic attenders

BACKGROUND: Proliferative diabetic retinopathy (PDR), a prevalent late-stage complication of diabetes, is associated with severe visual loss. The objectives of this report were to estimate the incidence of and risk factors for PDR using routinely collected data from a clinical information system at University Hospital Nottingham for insulin- and non-insulin-dependent (insulin-treated and non-insulin-treated) diabetes separately. We also attempted to assess the risk of blindness in these diabetes clinic attenders. METHODS: During a mean (standard deviation (SD)) follow-up period of 5.1 (2.9) (range 0.5-12.4) years, 3482 diabetic patients (1915 male and 1567 female) from three outpatient clinics at University Hospital, Nottingham were examined. The mean (SD) age of the participants was 49.3 (17.9) years with a mean duration of diabetes of 7.1 (8.7) years at registration. RESULTS: Among the 3482 patients who attended the clinic at least twice in the period 1979-1992, and who were free of PDR at registration, the overall incidence of PDR was 16.2 per 1000 person-years, based on 17,618 person-years of follow-up. The incidence rate of PDR was nearly three times as high among patients with non-proliferative diabetic retinopathy (NPDR) as in those without any retinopathy (42.1 vs. 15.0 per 1000 person-years). Based on a Cox's Proportional Hazards Model, significant independent predictors of PDR recorded at baseline were glycosylated haemoglobin (HbA1), systolic blood pressure, and longer duration of diabetes for patients without PDR or any retinopathy among insulin-dependent patients. Longer duration of diabetes was the only independent predictor of PDR for patients without PDR or any retinopathy in both insulin- and non-insulin-treated non-insulin-dependent patients. These clinic-based data clearly indicate the higher risk of PDR in non-insulin-dependent patients. Gender, age, BMI, creatinine, proteinuria and cigarette smoking, had no significant independent association with PDR when other covariates were considered in all groups. The risk of blindness was greater among those with PDR than those with NPDR in all three types of diabetes, but was substantial even for those without retinopathy. CONCLUSION: These data are of value in identifying those diabetes clinic attenders who may be most at risk.     

The prevalence of blindness and low vision in older onset diabetes mellitus and associated factors: a community-based study

PURPOSE: This community-based study was conducted to assess the prevalence and related factors of low vision and legal blindness in older onset diabetic patients (diagnosed at age 30 and older). METHODS: All known diabetic patients who live in the four primary health care center region Abidinpa?a Ankara, Turkey (total population: 96,348) were included in this cross-sectional study. The prevalence of known diabetes mellitus is 2.2%, of which 96.6% are older onset and 3.4% are younger onset. RESULTS: In the older onset diabetes group (1289 cases), 10.8% of the population had low vision and only 2.7% had legal blindness. Diabetic retinopathy (DR) was observed in 23.6% of the patients with low vision (42% proliferative DR) and in 62.9% of the patients with legal blindness (90.1 % proliferative DR). CONCLUSIONS: In older onset diabetic patients with low vision, nonproliferative retinopathy was a more frequent cause of impaired vision than proliferative retinopathy. Low vision and legal blindness caused by retinopathy were significantly associated with sex, age at examination, age at diagnosis, duration of diabetes, type of diabetes treatment, and hypertension in univariate analysis. However, in logistic regression analysis, low vision and legal blindness caused by retinopathy were found to be associated with longer duration of diabetes (> or =15 years), use of insulin, and hypertension.     

Incidence of blindness in southern Germany due to glaucoma and degenerative conditions

PURPOSE: To estimate population-based incidence rates of registered blindness separately, to determine its main causes. METHODS: The files of all newly registered blindness-allowance recipients in Württemberg-Hohenzollern, Germany (population: approximately 5 million), between 1994 and 1998 were reviewed. From ophthalmological reports on file the fulfillment of the German criteria for blindness (visual acuity of 1/50 or less or equivalent reduction of visual function) was ascertained, and the causes of blindness were obtained. Incidence rates of blindness due to macular degeneration, glaucoma, cataract, optic atrophy, and diabetic retinopathy were estimated. RESULTS: There were 3531 newly registered blindness-allowance recipients (67.1% female; mean age, 72.8 +/- 21.0 years). Standardized incidence rates in the general population (per 100,000 person-years; 95% confidence interval): All causes 12.27 (11.87-12.68), macular degeneration 5.29 (5.02-5.55), cataract 3.32 (3.11-3.52), optic atrophy 2.86 (2.66-3.05), glaucoma 2.43 (2.25-2.61), diabetic retinopathy 2.13 (1.96-2.30), other or unknown causes 5.17 (4.91-5.43). In many cases, blindness was attributable to more than one cause. Assuming that incidence rates are the same in other parts of the country, 9,939 (9,608-10,270) new cases of blindness were estimated to occur in Germany per year. CONCLUSIONS: The most common single cause of blindness was macular degeneration. Incidence rates of blindness due to such treatable conditions as glaucoma were also high. This finding suggests that the taking of measures for secondary prevention (e.g., early detection and optimal treatment of patients with glaucoma and diabetic retinopathy) should be intensified.     

Visual impairment and blindness in type 2 diabetics: Ife-Ijesa diabetic retinopathy study

Diabetes and blindness are important health issues globally; we determined the prevalence of blindness, diabetic retinopathy, and other eye diseases in Nigerian-type 2 diabetics. A prospective, cross-sectional study was conducted on consenting type 2 diabetic patients who had scheduled comprehensive eye examination including dilated funduscopy with +78DS. Visual status was graded using the WHO criteria. Approval from Institutional Ethics Committee was obtained. Primary outcome measures were the prevalence and causes of blindness as well as prevalence of diabetic retinopathy. Secondary outcome measures were the presence of other eye diseases. Data were analyzed using SPSS version 13. Two hundred and sixty-six eyes of 133 type 2 diabetic patients aged 22–89 years were studied; 69 (51.9 %) were males while 64 (48.1 %) were females. Five (3.8 %) patients were blind while 27 (20.3 %) were visually impaired. Cataract was the leading cause of blindness (60 %) and visual impairment was found in 59.3 %. Diabetic retinopathy was present in 37 (27.8 %) diabetic patients of which 5 (3.8 %) were proliferative. Diabetic macular edema was present in 31 (23.3 %) patients. Severe visual impairment and blindness were commoner in those with diabetic retinopathy. Refractive error 67 (25.2 %), cataract 63 (23.7 %), and chronic glaucoma 44 (16.5 %) were the most prevalent non-diabetic retinopathy eye diseases. High prevalence of blindness, diabetic retinopathy, and other diseases are seen in type 2 diabetics. Health education, early diagnosis as well as treatment of diabetic retinopathy and other diseases will largely alleviate these ocular morbidities.     

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。     

Diabetic retinopathy: are we really doing all we can for our patients?

Although it is now possible to significantly reduce the incidence of blindness secondary to diabetes mellitus, large numbers of diabetic patients still experience visual loss due to retinal complications of the disease. This implies that protocols for the diagnosis and treatment of diabetic retinopathy used in the various multicenter trials have not yet been transferred into routine clinical practice. In countries where ocular complications of diabetes have been managed on the basis of well-codified protocols for several years, the incidence of visual loss among diabetic patients has been significantly reduced. It is absolutely essential to introduce screening and treatment protocols for diabetic retinopathy promptly everywhere. Their application is within the reach of every ophthalmologist. Patients must be informed that it is important to have regular full ophthalmological examinations, before any symptoms occur; the guidelines for screening and management of retinopathy must be known and accepted by the medical community. Spreading this information among primary care physicians, ophthalmologists and diabetologists is a fundamental step in improving the health care of the diabetic patient.     

Blindness incidence in Germany. A population-based study from Württemberg-Hohenzollern

Few data on the incidence of blindness in Germany are available. We analysed causes of legal blindness for the region Württemberg-Hohenzollern (population 5.5 million) in order to help fill in this gap. Material and Methods: Population-based investigation on the incidence of legal blindness (visual acuity <1/50) based on materials from the social services. Age-dependent blindness incidences were modelled via logistic regression models. Results: 647 blind persons were newly registered in 1994 (blindness incidence 11.6/100,000). The blindness incidence is moderate in infants (4.5/100,000) and decreases further during childhood. At the age of 20 years, the incidence again rises to the former level and remains relatively constant. After the age of 60 years, the incidence increases sharply: 5-year odds ratios are 1.76 (CI: 1.68-1. 85) in women and 1.72 (CI: 1.60-1.84) in men. The blindness incidence is higher in women, 15.6/100,000, compared to 12.2/100,000 in men. The major causes of blindness are: macular degeneration, 3. 92/100,000; diabetic retinopathy, 2.01/100,000; glaucoma, 1.6/100, 000; high myopia, 0.77/100,000; optic atrophy, 0.68/100,000; central nervous system-triggered blindness; 0.56/100,000, and tapetoretinal degenerations, 0.52/100,000. Discussion: Due to monetary incentives for the blind persons, social service files offer accurate and complete data. Besides macular degeneration, glaucoma and diabetic retinopathy are major causes of blindness. Thus, this study suggests further blindness prevention activities for diabetic retinopathy and glaucoma.     

The occurrence and causes of registered blindness in diabetes patients in Arhus County, Denmark

PURPOSE: To report the occurrence of registered blindness among diabetes patients in Arhus County, Denmark during 1993-2002. METHODS: Data were obtained from a database of 7527 diabetes patients, which included all patients in the county who had been treated for or had experienced visual loss due to diabetic retinopathy since 1992. Of these, 1949 had type 1 diabetes and represented 90% of the type 1 diabetes patient population in the county, and 5459 had type 2 diabetes and represented 40% of the type 2 diabetes patient population in the county. RESULTS: The point prevalence of legal blindness was 0.6% for type 1 and 1.5% for type 2 diabetes patients at January 1st, 2003. In type 1 diabetes patients, the major cause of blindness was proliferative diabetic retinopathy (PDR) (66.2% of all blind eyes); in type 2 diabetes patients the major causes were age-related macular degeneration (21.9%), PDR (18.0%) and diabetic maculopathy (DMac) (18.5%). During 1993-2002 there was a significant decrease in the number of blind eyes secondary to PDR (p = 0.008) in type 1 diabetes patients, and a significant increase in the number of blind eyes secondary to DMac (p = 0.005) in type 2 diabetes patients. CONCLUSION: The major challenge in reducing diabetes-related blindness is related to the detection and treatment of an increased incidence of diabetic maculopathy in type 2 diabetes patients.     

Mayombian ethnic, vegetables low intake, insulin treatment, diabetic nephropathy and severe diabetic retinopathy are determinants of blindness in diabetic Africans

AIM:To determine the frequency and causes of blindness in diabetic Africans.METHODS:The study was a cross-sectional survey carried out among known black diabetics consecutively admitted at the Teaching Hospital, University of Kinshasa, between 2005 and 2007. Examination methods included interviewer-administered structured questionnaire, eye examinations (visual acuity, tonometry, funduscopy), and fasting plasma glycaemia test.RESULTS:Of the 227 patients examined, 15.9% had blindness. Univariate analyses showed significant association between female, severity of diabetic retinopathy, Mayombian ethnic group, use of insulin treatment, low intake of vegetables, diabetic nephropathy, open angle glaucoma and blindness in all diabetics. After logistic regression, only diabetic nephropathy, use of insulin treatment, macular oedema, Mayombian ethnic group and vegetables low intake were the independent risk factors of blindness in all diabetics. However, after logistic regression in the sub-group with diabetic retinopathy, only open angle glaucoma and proliferative diabetic retinopathy were the independent determinants of blindness.CONCLUSION:The majority of the causes of blindness in these diabetic Africans are avoidable. It is recommended that appropriate diabetes care, nutrition education, periodic eye examination and laser photocoagulation facilities should be provided for treating diabetics in sub-Saharan Africa.     

激光治疗糖尿病视网膜病变

目的:评价激光治疗糖尿病性视网膜病变(diabetic retinopathy,DR)的疗效。方法:用美国产532nm激光光凝115例(170眼)DR患者。术前行视力、裂隙灯、眼底、眼压、视野、眼底荧光素血管造影检查,术后随访3mo～1a,随访时查视力、散瞳查眼底、复查荧光素眼底血管造影。结果:视力提高112眼(65.8%);视力无变化53眼(31.1%);视力下降5眼(2.9%)。结论:激光治疗糖尿病视网膜病变疗效显著,是最为有效的方法,显著降低了致盲率,使部分患者视力提高。