糖尿病视网膜病变的全科医学管理

General practice management of diabetic retinopathy

糖尿病视网膜病变是糖尿病引起的微血管病变之一,是不可逆性致盲的眼病。根据其病程可分为根据其病程可分为非增殖期和增殖期,其中还包括糖尿病性黄斑水肿。全科医师需要检测量裸眼视力、矫正视力和眼压,通过裂隙灯显微镜评估眼前节以及眼底检查来评估眼部整体情况。控制血糖、血压、血脂对改善预后很重要。需要重视餐前、餐后血糖,糖化血红蛋白和代谢记忆,一线降血压药物包括血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体阻断剂,调脂药物首选他汀类,而非诺贝特有额外的视网膜保护作用。干预生活方式,宣教,早期发现也同样重要。全科医师需要进行眼底筛查和评分,及时转诊至眼科治疗。眼科治疗包括全视网膜激光光凝术、经平坦部玻璃体切除术、玻璃体抗血管内皮生长因子药物注射术。

Diabetic retinopathy is one of the microvascular diseases caused by diabetes,it is an irreversible blindness eye disease.According to its course,it can be divided into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy,including diabetic macular edema.The general practitioner needs to measure the uncorrected visual acuity,corrected visual acuity intraocular pressure,use the slit lamp microscope to exam the anterior segment and fundus to evaluate the overall condition of the eye.Controlling blood glucose,blood pressure and blood lipid is very important to improve the prognosis.Attach importance to pre-and postprandial blood glucose,glycosylated hemoglobin and metabolic memory should be carried out.The first-line antihypertensive drugs are angiotensin converting enzyme inhibitors and angiotensin II receptor blockers.Statins are the first choice for lipid-lowering drugs,fenofibrate has additional protective effect of retinal.Intervention in lifestyle,education and early detection are is important.The general practitioner needs to perform fundus screening and scoring,timely refer to ophthalmology department for treatment.Ophthalmic treatment includes panretinal laser photocoagulation,pars plana vitrectomy,and intravitreal injection of anti-vascular endothelial growth factor drugs.