因眼部并发症突出而误诊的糖尿病

糖尿病是由于胰岛素功能不足或胰岛素作用失调而引起代谢紊乱，出现血糖、尿糖过高的全身性疾病。伴随经济条件提高、高热量摄人及坐式生活增多、2型糖尿病发病率大幅上升，发病年龄提前，以并发症就诊者比较多见。近几年来，笔者遇到几例误诊的糖尿病患者，都与其眼部并发症突出有关。现报告如下。     

高压氧治疗的眼部并发症

高压氧在临床上的应用已不少见,它引起的神经系统和耳部的并发症已引起关注,而眼部并发症尚未得到充分重视.临床观察和动物研究发现,高压氧治疗可引起近视和核性白内障,偶尔引起严重的视力下降和中心暗点,甚至引起视网膜血管增殖性病变.本文就高压氧治疗眼部并发症及其发生机制、防治措施进行综述.     

艾滋病眼部并发症的资料分析

目的:通过调查分析,了解艾滋病眼部并发症的临床表现、治疗及预后。方法:收集赞比亚卡布韦总医院眼科2008-08/2009-08就诊患者。结果:艾滋病眼部并发症症状重,病程长,致盲率高。结论:充分认识、掌握艾滋病眼部并发症的临床表现,提高艾滋病的检出率,早发现、早治疗,提高艾滋病患者的生活质量。同时应强调预防是降低艾滋病发生率的关键。     

上海市艾滋病初诊患者眼部并发症及致盲原因调查分析

目的 调查上海市获得性免疫缺陷综合征(艾滋病,AIDS)初诊患者的眼部并发症的发生情况,分析其损害视力的主要因素,为防治视力损伤提供依据.方法 横断面研究.于2011年3月～2012年2月期间对上海市公共卫生临床中心就诊的AIDS初诊患者进行调查,进行一系列完整的眼科及全身检查.采用Snellen视力表检查裸眼远视力和最佳矫正远视力;采用裂隙灯和眼底镜进行眼前段和眼底检查.对录入数据按WHO视力损害标准分级,并分析肓和低视力损害的原因.对数据进行分类计数,求百分比,用卡方检验进行数据分析.结果 358例艾滋病初诊患者中,286名患者知情同意至眼科门诊参加检查,受检率79.9％.眼部并发症患病率58.4％(167/286),其中干眼症的患病率最高36.0％(103/286),其次是结膜炎19.9％(57/286)、巨细胞病毒性视网膜炎(CMVR) 8.39％ (24/286)等.致盲率据首位的是CMVR40.0％ (4/10),其次是均为30.0％(3/10)的视网膜微血管病变(HIVM)和青光眼等.致盲性眼病在CD4+F淋巴细胞水平低于250个/μl时高发.结论 上海市AIDS初诊患者眼部并发症患病率高于美国等国家,CMVR是主要损害视力的原因,建议加快建立健全CMVR的筛查和诊治网络,提高AIDS患者的生存质量.     

鼻咽癌放疗术后眼部并发症的临床分析

目的：探讨鼻咽癌放疗术后眼部并发症的临床特点、荧光素及吲哚菁绿血管造影特征、影响因素及其诊治方法。

方法：回顾性分析2007-03/2012-03我院眼科收治的因鼻咽癌放疗后视力下降的患者33例63眼的临床资料。

结果：所有患者均以进行性、无痛性单眼或双眼视力下降为主要临床表现。放射性视网膜病变48眼,其中视网膜中央动脉阻塞2眼,视网膜中央静脉阻塞3眼,色素上皮改变2眼,黄斑前膜1眼,其余40眼均出现后极部棉絮斑及出血。放射性视神经病变36眼,其中视神经边界清晰27眼,视神经边界不清9眼。黄斑区典型性脉络膜新生血管2眼,脉络膜转移灶1眼,脉络膜循环异常4眼,前部葡萄膜炎2眼,玻璃体积血7眼。

结论：鼻咽癌放疗术后眼部并发症复杂多样,最常见放射性视网膜病变和放射性视神经病变,少数表现为黄斑部脉络膜新生血管、动静脉阻塞、脉络膜循环异常等。     

高压氧治疗的眼部并发症

高压氧在临床上的应用已不少见,它引起的神经系统和耳郜的并发症已引起关注,而眼部并发症尚未得到充分重视。临床观察和动物研究发现,高压氧治疗可引起近视和核性白内障,偶尔引起严重的视力下降和中心暗点,甚至引起视网膜血管增殖性病变。本文就高压氧治疗眼部并发症及其发生机制、防治措施进行综述,     

人类免疫缺陷病毒感染的眼部并发症

近年来,随着高效抗逆转录病毒治疗法(HAART)的广泛应用,人类免疫缺陷病毒(HIV)和获得性免疫缺陷综合征(AIDS)相关眼部并发症的发病率显著降低。而HIV感染者和AIDS患者数量逐年增加,且生存率提高、生存时间延长,这导致发生眼部并发症的患者绝对数增多。其相关眼部并发症临床表现多变,几乎影响所有眼部结构。目前我国对HIV感染者和AIDS患者的眼部病变缺乏大样本和长期的系统观察,且临床诊疗中有误诊和漏诊的情况发生,这不但延误治疗,而且极易引起医源性传播,故医务工作者应加强对HIV/AIDS的了解。本文对HIV/AIDS患者常见眼部非感染性、机会性感染并发症和免疫重建炎症反应综合征(IRIS)进行综述,探讨HIV/AIDS眼部并发症的表现和研究进展。     

眼部碱烧伤相关因素分析

目的分析眼碱烧伤病因,探讨眼部碱烧伤的有效处理方法。方法对近6年来我院收治的眼部碱烧伤105例(155眼)进行临床分析。结果眼部碱烧伤占同期眼外伤患者的39.94%。其中电石烧伤25例(37眼)占23.81%,白灰烧伤58例(86眼)占55.24%,水泥烧伤15例(22眼)占14.29%,氨水烧伤7例(10眼)占6.67%。主要并发症:角膜炎、角膜溃疡、角膜门斑共88眼占56.77%,睑球粘连11眼占7.10%,假性翼状胬肉38眼占24.52%,其它18眼占11.61%。视力≤0.05者66眼占42.58%。结论眼部碱烧伤损害严重,病程长,并发症多,致盲率高,及时正确处理和积极预防眼部碱烧伤是必须的。     

重视糖尿病眼部并发症的诊断和治疗

糖尿病是糖代谢紊乱导致的全身性慢性疾病,高血糖、高血脂和高血压是糖尿病患者的主要特征,长期的高血糖环境引起人体组织和器官的微血管和大血管相关并发症,是目前全球劳动力人口致残率和致死率较高的疾病之一.糖尿病已经成为发展中国家严重的公共卫生问题,而糖尿病患者眼部并发症发病风险增加,发病率也逐年升高,成为不容忽视的致盲眼病.常见的糖尿病眼部并发症包括糖尿病视网膜病变(DR)、糖尿病性视神经病变(DN)、青光眼、白内障、糖尿病眼表疾病等,治疗棘手,因此糖尿病眼部并发症的预防、早期诊断和及时治疗是眼科医师面临的主要挑战.眼科医师在临床工作中应对糖尿病患者及其眼部并发症给予足够的重视,实时跟踪国内外关于糖尿病眼部并发症诊疗指南的更新和研究现状,对相关疾病做到早期发现、合理管理和及时治疗,降低糖尿病眼部并发症的致盲率和经济负担.     

外耳道炎患者健康知识、态度和实践的横断面研究

目的 描述外耳道炎患者健康知识、态度和实践的横断面研究,并分析其影响因素。方法 纳入2017年门诊符合条件的526例外耳道炎患者为研究对象,采用一般资料调查表、外耳道健康知识、态度和实践调查表进行问卷调查。结果 526例外耳道炎患者中,184例首次确诊外耳道炎(34.90%),342例患者发生次数≥2次(65.10%)。不同性别、挖耳习惯、清洁外耳道方式、外耳道进水处理比较,差异均有统计学意义(P值均<0.05)。多因素分析显示,性别、清洁外耳道方式为外耳道炎复发的影响因素。结论 性别和清洁外耳道方式是外耳道炎复发的影响因素,门诊护理人员应该加强外耳道健康知识宣教。     

Knowledge,attitude, and practice of ophthalmic manifestations in COVID-19 patients at a tertiary care center

Purpose:Since the start of the COVID-19 pandemic, various manifestations have been reported, including ophthalmic symptoms, especially with the different mutations and variants that have occurred over the last few years. In view of this, our study was conducted to gauge the knowledge, attitude, and practices of patients toward the ophthalmic manifestations of COVID-19.Methods:This was a hospital-based, cross-sectional, observational study. Patients who had tested positive for COVID-19 were asked to answer a detailed questionnaire about their knowledge of COVID-19 ophthalmic symptoms, their experience with the symptoms, and their attitude and practice toward the same. The data collected was analyzed using Microsoft Excel, and the Chi-squared test was used to determine significant differences in the results among different demographic profiles.Results:Our study found that 82 (39%) of the 210 participants were aware that COVID-19 could present with symptoms in the eyes. A total of 47 participants had experienced eye symptoms of COVID-19. Among them, only 15 (31.91%) consulted and received treatment from an ophthalmologist or general physician for the same. Most of them (59.57%) did not seek any treatment, and 8.5% self-medicated or used non-allopathic forms of medicine. The most common symptom was redness of the eyes, reported by 57.44% of those who had eye symptoms.Conclusion:Most people were unaware of ocular manifestations of COVID-19 and most of those who were aware were medical professionals. Amongst those who developed symptoms, only a minority sought medical treatment.     

Can pulsatile ocular blood flow distinguish between patients with and without diabetic retinopathy?

Purpose: Our aim was to determine if pulsatile ocular blood flow (POBF) measurements could distinguish between type 2 diabetes mellitus (DM) subjects with and without diabetic retinopathy (DR). Methods: Ninety‐eight DM subjects were recruited. POBF was measured using an Ocular Blood Flow tonometer and retinopathy was assessed using retinal digital photography. The duration of diabetes, blood pressure, glycosylated haemoglobin and plasma glucose level were also recorded. Results: Seventy‐two subjects had no DR and 26 subjects exhibited mild to moderate non‐proliferative DR. POBF was higher in those subjects with non‐proliferative DR but did not reach significance. Those subjects receiving insulin treatment had a significantly longer duration of DM, higher HbA1c and plasma glucose levels and greater incidence of non‐proliferative DR compared to subjects receiving oral hypoglycaemic agents, who in turn demonstrated higher levels of these parameters than those who were controlled by diet alone (ANOVA p < 0.05 in all cases). POBF was found to increase with level of management but not significantly so. Conclusions: A single measurement of POBF does not distinguish between subjects with and without mild/moderate non‐proliferative DR.     

2型糖尿病视网膜病变与糖尿病其他并发症的相关性

目的：探讨2型糖尿病视网膜病变（ diabetic retinopathy, DR）与糖尿病的全身并发症的相关性。方法：分析2型糖尿病住院患者702例,将其分为NDR组、DR组两组,DR组又分为非增生性糖尿病视网膜病变（non－proliferative diabetic retinopathy,NPDR）组和增生性糖尿病视网膜病变（ proliferative diabetic retinopathy, PDR）组,分析DR与糖尿病大血管并发症、糖尿病肾病（ diabetic nephropathy, DN ）、糖尿病周围神经病变（ diabetic peripheral neuropathy,DPN）,糖尿病周围血管性疾病（ peripheral vascular disease of diabetes mellitus, PVD）、糖尿病足（ diabetic foot,DF）、糖尿病酮症酸中毒（ diabetic ketoacidosis,DKA）等糖尿病并发症的相关性。结果：DR的发生、发展与高血压、高血脂、颈部血管硬化、斑块,下肢动脉硬化、斑块, DN、DPN、DF及PVD等并发症有关。 PDR与高血压、DPN关系密切。结论：血管内皮损伤、微循环障碍是DR及糖尿病的全身大、小血管并发症的共同病理基础。糖尿病患者出现全身并发症时,DR的患病率增加,尤其是合并高血压、DPN时,PDR的患病率增加。所以糖尿病患者尤其是出现全身并发症者必需定期行眼底检查,以早期发现、早期治疗DR,降低致盲率。     

糖尿病眼表病变的临床分析

目的:观察和分析糖尿病患者眼表受损害的情况。方法:对40例(80眼)糖尿病住院患者和25例(50眼)无糖尿病者(年龄匹配)做眼表检查,包括泪膜破裂时间(tear breaku time,BUT),泪液分泌试验(SchirmerⅠtest),角膜荧光素染色,结膜印迹细胞学检查。结果:糖尿病组有82%的患者主诉眼干涩和异物感,对照组为44%;糖尿病组和对照组的BUT分别为4.49±1.95s和6.76±4.11s(t检验,P=0.000)。糖尿病组的SchirmerⅠ试验值为4.48±2.68mm,明显低于对照组6.28±3.65mm(t检验,P=0.003)。Schirmer值<5mm者,糖尿病组占65%,对照组占30%(χ2=15.09,P=0.000)。角膜荧光素染色:糖尿病组阳性率为56%,对照组为26%(χ2=11.39,P=0.001)。糖尿病组的杯状细胞数明显少于对照组(P=0.000)。结论:糖尿病也容易引起患者的眼表损害,会诊时应该予以重视。     

眼表综合分析仪对糖尿病患者睑板腺功能障碍的临床意义

目的:分析眼表综合分析仪对糖尿病(DM)患者睑板腺功能障碍(MGD)的应用价值。方法:选择河北省眼科医院2017-05/2021-05期间收治的2型糖尿病(T2DM)患者,按病程分为3组,短病程组(DM病程<5a)37例,中病程组(5a相似文献   

Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study

Context:Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India.Aims:To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India.Results:In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 ± 11.7 years (range 21-98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001).Conclusions:Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow-ups.     

糖尿病2型患者眼表及泪液蛋白初步分析

目的:分析糖尿病2型患者眼表及泪液蛋白成分与正常泪液的异同。方法:糖尿病2型患者46例92眼;正常对照39例(78眼)。观察指标包括角膜知觉、泪膜破裂时间、角膜荧光素染色、SchirmerI试验及结膜印记细胞学检查,将糖尿病患者按病程DM≤5a,5a10a分为3组并分别测定各组泪液总蛋白和泪液主要蛋白质含量,同时通过不连续的SDS-PAGE蛋白电泳观察其形成的蛋白电泳条带,并与正常人的泪液对比。结果:糖尿病组分别与对照组比较,角膜知觉减退(Z=-2.488,P<0.05),SchirmerI测定值降低(t=-3.854,P<0.05),泪膜破裂时间缩短(t=-7.212,P<0.05),角膜荧光素染色阳性率增加(Z=-2.161,P<0.05),杯状细胞密度下降(t=-6.498,P<0.01),结膜鳞状化生程度增加(Z=-3.022,P<0.05),泪液总蛋白两组间比较差异无显著性,但糖尿病组与对照组比较,乳铁蛋白、溶菌酶及分泌性免疫球蛋白IgA浓度降低。结论:糖尿病患者易发生眼表异常,泪液SDS-PAGE有助于发现糖尿病患者泪液蛋白质的变化。     

2型糖尿病患者不同视网膜病变程度下眼表及角膜病变的临床研究

目的：研究2型糖尿病患者不同视网膜病变程度下眼表及角膜病变情况。

方法：纳入我院眼科就诊的2型糖尿病患者123例246眼,根据视网膜病变程度分为无糖尿病视网膜病变组46例92眼(non-diabetic retinopathy group,NDR)、非增殖性糖尿病视网膜病变组(non-proliferative diabetic retinopathy, NPDR)50例100眼和增殖性糖尿病视网膜病变组(proliferative diabetic retinopathy, PDR)27例54眼。通过干眼问卷和眼表疾病指数量表、角膜荧光素染色(FL)、基础泪液分泌试验(SⅠt)、泪膜破裂时间检测(BUT)及中央角膜厚度测量等临床检查,分析三组不同研究对象眼表不适症状、OSDI评分、FL阳性、SⅠt、角膜内皮细胞密度(CD)、BUT、角膜内皮细胞变异系数(CV)、中央角膜厚度(CCT)的差异。

结果：三组患者一般资料差异无统计学意义。眼痛、眼干涩、流泪、眼疲劳、烧灼感、视力波动等6项眼表不适症状在三组间比较差异具有统计学意义(均P<0.05),异物感、眼痒、眼红差异无统计学意义(均P>0.05); ODSI评分分级、FL阳性率、BUT、SⅠt、CD和CCT在三组间差异具有统计学意义(均P<0.05); CV在三组间比较差异无统计学意义(P>0.05)。

结论：2型糖尿病患者具有明显的眼表不适症状; 泪膜稳定性下降、泪液分泌量减少、角膜内皮细胞密度下降; 角膜荧光素染色阳性率增加; 糖尿病患者中央角膜厚度增加,且这些变化均与糖尿病视网膜病变程度有关。