糖尿病视网膜病变合并白血病的诊疗进展

Progress in diagnosis and treatment of diabetic retinopathy with leukemia

白血病是加重糖尿病视网膜病变(DR)的危险因素。DR合并白血病的患者常首诊于眼科,其眼底除了会出现视网膜静脉纡曲扩张、微动脉瘤和视网膜出血、渗出等典型DR表现,还会合并罗斯斑等白血病视网膜病变的表现。其在微血管异常轻微的病变早期就可能出现大量视网膜血管无灌注区及新生血管,同时玻璃体积血、纤维血管增生膜及牵引性视网膜脱离等并发症出现较早,病程进展迅速,视力预后不佳。白血病加重DR的原因包括高黏血症、恶性贫血及血小板减少症等加重视网膜缺血缺氧,肿瘤细胞直接浸润损害血管内皮,放射治疗及化学药物治疗的影响以及血管内皮生长因子水平升高等多方面。临床上,须警惕迅速进展的DR患者是否合并血液系统疾病等危险因素,对已确诊DR合并白血病的患者,应及时尽早行眼科治疗并缩短随访时间,这是防止该类患者视网膜病变突然恶化、提高患者视力预后的重要手段。

Combined with leukemia is a risk factor for aggravating diabetic retinopathy.A combination of diabetic retinopathy and leukemia can be expected to have a rapid progression and patients often visit the department of ophthalmology first.In addition to the typical manifestations of diabetic retinopathy such as retinal venous tortuous dilation,microaneurysm,retinal hemorrhage and exudation,patients may also be associated with leukemic retinopathy.Areas of extensive capillary non-perfusion and neovascularization may appear in the early stage of mild microangiopathy.Moreover,severe complications such as vitreous hemorrhage,neovascular membranes and traction retinal detachment appear earlier,which may be a prognostic indicator for poor vision.The causes of leukemia aggravating diabetic retinopathy include retinal ischemia due to hyperviscosity,anemia and thrombocytopenia,direct infiltration of tumor cells,chemotherapy and radiotherapy,high level of vascular endothelial growth factor.In clinic,rapidly progressing diabetic retinopathy should alert the ophthalmologist to the underlying hematological disorder.Patients with both diabetes and leukemia need to be screened much earlier and followed up at shorter intervals.Early detection and aggressive management may help preserve visual acuity in such cases.