上海市北新泾街道社区糖尿病眼病3年防治调查

The 3-year primary preventing and treating investigation of eye diseases in diabetic mellitus residents from Beixinjing block community of Shanghai city

目的:观察在上海市北新泾街道对患有糖尿病居民开展初级眼病防治干预的效果。方法:于2003-07/2005-12选择上海市北新泾街道社区所有患有糖尿病的居民为调查对象。采取建立三级眼病防治网络、扩大监测人群、加强健康教育、早期发现病变、早期处理等措施。采用Snellen国际标准视力表检查日常生活视力。若日常生活logMAR视力<0.15,则检查小孔视力。采用免散瞳数码眼底照相机获取45°后极部视网膜彩色图像。如果屈光间质混浊影响观察视网膜,则采用Mydorin-P滴眼液散瞳检查,但对于浅前房者不予散瞳。视力损伤眼(日常生活logMAR视力<0.52)则由检查医师根据检查结果,确定一个引起视力损伤的主要原因。以视力和糖尿病视网膜病变调查结果说明干预效果。分别于2003-07和2005-12完成两次大范围糖尿病患者眼病调查。结果:①干预措施开展顺利,糖尿病眼病建档率为90.68%(535/590)。②2005-12眼病调查时随机抽取255人,对调查资料进行样本代表性分析表明可以很好地代表总体。③255人510眼前后调查结果比较,日常生活视力下降2行或2行以上43眼(8.43%),保持在1行以内385眼(75.49%),提高2行或2行以上82眼(16.08%),视力提高的82眼中有17眼在调查间隔期内接受了白内障手术。④第1次调查时单眼和双眼盲总数9人,在第2次调查时已脱盲8人(88.89%),其中6人为接受了白内障手术复明,其余2人为药物控制眼病缓解或屈光不正得到矫正。但同时新发盲8人,其中2人为糖尿病性视网膜病变加重,3人为发生除糖尿病性视网膜病变外的其他视网膜病变,1人为白内障加重,1人为屈光不正未及时矫正,1人原因不明。⑤第1次调查诊断为患增殖型糖尿病性视网膜病变8眼,均病情控制稳定。但糖尿病性视网膜病变病情新发或加重41眼(16.60%)。结论:初级眼病防治干预措施已取得初步成效。

AIM： To observe the effectiveness of primary preventing and treating works of eye diseases in diabetic mellitus residents in Beixinjing blocks of Shanghai City. METHODS： A prospective study was given in the local diabetic mellitus residents in Beixinjing blocks of Shanghai City between July 2003 and December 2005. A 3-level eye disease health network was established first, and then the diabetic mellitus residents were followed regularly, given health education, diagnosed and treated as early as possible, etc. The daily visual acuity was recorded according to Snellen visual chart. If the daily visual acuity was lower than 0.15 （logMAR）, pinhole visual acuity was recorded. Non-mydric digital eye fundus camara was used for recording the 45° posterior pole retinal photograph. Mydorin-P solution was used for pupil dilation when dioptric media was not clear and affected the retina, but for subjects with shallow of anterior chamber, the mydriasis was not used. The main visual impairing disease was confirmed by the examiners when the daily visual acuity lower than 0.52 （logMAR）. The visual acuity and diabetic retinopathy degree were used to evaluate the results. Two prevalence studies were given to the diabetic mellitus residents in July 2003 and December 2005, respectively. RESULTS： （1）All the preventing and treating works went smoothly. The diabetic mellitus eye disease registration rate was 90.68% （535/590）. （2） Totally 255 diabetic mellitus residents were randomly sampled in December 2005, which represented the whole study group well. （3）The visual acuity decreased equal to or more than 2 lines in 43 eyes （8.43% of the 510 eyes in these 255 residents）, remained the same in 385 eyes （75.49%）, and increased equal to or more than 2 lines in 82 eyes （16.08%）, 17 eyes of which underwent cataract surgery during the study time. （4）In the first prevalence study, monocular or bilateral blindness was found in 9 residents, and 88.89% of them （8 eyes） rehabilitated from blindness by the end of 2005： 6 subjects underwent cataract surgery, 2 subjects healed by drug or refractive correction, respectively. But 8 newly blindness happened by the end of 2005： diabetic retinopathy worsened in 2 subjects, some other kinds of retinopathy happened in 3 subjects, cataract worsened in 1 subject, uncorrected refracive erreor happened in 1 subject, and the last one unknown. （5）The diabetic retinopathy of 8 eyes in these 255 residents, who diagnosed as proliferative degree in 2003, did not progress by the end of 2005. But 41 eyes （16.60%） newly occurred or worsened with diabetic retinopathy. CONCLUSION： The primary preventing and treating works of eye diseases in diabetic mellitus residents have shown its effectiveness.