糖尿病性白内障的认识与防治

糖尿病性白内障的分型真性糖尿病性白内障多发生于〈30岁血糖控制不好的年轻糖尿病患者。糖尿病白内障的晶体浑浊类型以皮质浑浊最常见,尤其是后囊下浑浊,其特点是进展较快,常常双眼同时发病。病变初期为无数分散的、雪花样或点状浑浊,浑浊位于囊膜下的皮质区,并且很快融合,数周或数月内完全浑浊,视力可见明显下降。此种类型称之为＂真性糖尿病性白内障＂,多是发生在患者血糖急剧升高和酸中毒时。

TRANSFORMING GROWTH FACTOR-β AND FIBROBLAST GROWTH FACTOR INDUCE LENS EPITHELIAL EXPLANT METAPLASIA:IMPLICATIONS FOR THE FORMATION OF SUBCAPSULAR OPACIFICATION

Objective. This study was to investigate the effects of transforming growth factor-β(TGFβ) and fi- broblast growth factor (FGF) in the subcapsular opacification formation of the lens. Methods. Lens epithelial explants from 10-day-old rats were cultured with TGFβ1 or TGFβ2 in the presence of FGF for 5 days, then were examined by light and electron microscopy, and by immunolocal- ization of smooth muscle(α-sm) actin and type I collagen. Results. In TGFβ/FGF-treated explants,extensive proliferation occured, with formation of spindle and star-shaped cells. These cells showed ultrastructure and biochemical features of fibroblast or myofibroblast. Prominent Golgi apparatus and rough endoplaic reticulum were observed in some cells. Intracellular micro- filaments with cytoplasmic dense babies and membrane associated dense bodies, features of smooth muscle cells, were also observed. Some cells showed reactivity to -sin actin antibody. TGFβ/FGF-treated ex- plants were strongly stained with type I collagen antibody. Condusion. In the presence of FGF, TGFβ1 and TGFβ2 induced lens epithelial cell (LEC ) proliferation and transformation into fibroblast or myofibroblast-like cells, with producing of abundant collagen matrix in the explants. The changes are similar to the metaplasia that occurrs in subcapsular opacification of the lens. The findings suggest that TGFβ and FGF plays a role in the pathogenesis of subcapsular opacification of the lens.

胶原性眼内接触镜（ICL）植入后白内障形成的风险较低

FDA的一项平均4．7年526眼的临床试验显示，胶原性眼内接触镜（ICL）植入1年内58％、2年内68％、3年内74％发生后囊下浑浊。7年以上累计慨率估计有临床意义的白内障为2％，术前近视〉12D、年龄〉40岁增加了白内障发生的风险。