1型与2型糖尿病并发增生型糖尿病视网膜病变患者的眼生物学测量值比较

目的评价1型与2型糖尿病并发增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者的眼生物学测量值的差异及其临床意义。方法回顾分析2014年9月至2016年7月我院收治的2型糖尿病并发PDR患者(年龄37~77岁)66例(67眼)、1型糖尿病并发PDR患者(年龄18~57岁)10例(19眼)及特发性黄斑裂孔患者(年龄21~74岁)35例(35眼)的眼轴长度、角膜内皮细胞数及年龄,比较三者之间生物学测量值差异性。结果1型糖尿病并发PDR患者眼轴长度为(21.74±0.68)mm,2型糖尿病并发PDR患者眼轴长度为(23.06±0.65)mm,特发性黄斑裂孔患者眼轴长度为(23.39±0.65)mm,三组数据差异具有统计学意义(P<0.001)。三组患者角膜内皮细胞数比较差异无统计学意义(P=0.103)。三组患者年龄比较差异有统计学意义(P<0.001)。结论1型与2型糖尿病并发PDR患者眼轴长度均小于正常眼轴长度,而1型糖尿病并发PDR患者眼轴较2型糖尿病并发PDR患者眼轴更短;且1型糖尿病并发PDR患者较2型糖尿病并发PDR患者发病时机早。

护网明目散治疗单纯型糖尿病性视网膜病变的临床研究

目的:观察护网明目散治疗阴虚血瘀型早期糖尿病视网膜病变的临床疗效。方法:临床采集Ⅱ型糖尿病并发单纯型糖尿病性视网膜病变患者60例,随机分为治疗组(Ⅰ组)和对照组(Ⅱ组),其中I组30例,Ⅱ组30例。治疗组服护网明目散,对照组用导升明,用药时间均为12周。治疗前后进行中医证候、视力和眼底检查,采用综合评定标准评价疗效。结果:护网明日散可显著改善中医证候,疗效明显好于对照组;明显提高早期糖尿病性视网膜病变患者视力、改善视网膜功能、促进视网膜微血管瘤吸收亦或抑制增加、促进视网膜出血吸收、减轻毛细血管渗漏。结论:护网明目散治疗阴虚血瘀证早期糖尿病性视网膜病变有明显效果。

眼球后血管动力学与非对称性糖尿病视网膜病变的关系

目的分析眼球后血管动力学与非对称性糖尿病视网膜病变的关系。方法选择我院2012年1月至2015年9月收治的35例非对称性DR患者,患者一眼为背景期视网膜病变(BDR),归为对照组;另一眼为增殖期视网膜病变(PDR),归为观察组。比较两组CCA、ICA、OA、CRA、CRV血流动力参数及颈动脉粥样斑块检出情况。结果观察组OA与CRA的PSV、EDV较对照组均明显下降,差异有统计学意义(P<0.05);观察组与对照组颈动脉粥样斑块检出率分别为65.7%、51.43%,比较两组检出率、CCA、ICA及CRV各项血流动力学参数,差异无统计学意义(P>0.05)。结论非对称性DR形成的重要因素与双眼灌注不平衡有关。

激光联合雷珠单抗治疗增殖型糖尿病视网膜病变疗效分析

目的研究分析针对增殖型糖尿病性视网膜病变(PDR)患者采取激光联合雷珠单抗进行治疗的相关临床疗效。方法选取该院2016年8月—2017年12月间收治的76例PDR患者为研究对象,全部患者均经过相应临床检测后确诊为增殖型糖尿病视网膜病变,将其随机分为两组,对照组采取常规的激光光凝治疗方案;实验组患者除常规治疗方法外联合雷珠单抗予以治疗,治疗后进行随访跟进临床疗效。结果通过研究发现采取不同治疗方案后,激光联合雷珠单抗相比常规治疗方案治疗效果更佳,实验组治疗后视力水平和总有效率明显高于对照组。两组患者视力差异有统计学义(P<0.05)。实验组患者玻璃体积血及黄斑水肿出现几率显著低于对照组。结论治疗PDR采用激光联合雷珠单抗治疗疗效良好,值得推广。

参萸明目合剂对糖尿病大鼠玻璃体及视网膜CTGF表达的影响

目的探讨参萸明目合剂对糖尿病视网膜病变(diabetic retinopathy,DR)大鼠玻璃体结缔组织生长因子(CTGF)含量及视网膜CTGF表达的影响。方法用链脲佐菌素制备糖尿病模型。参萸明目合剂组给予参萸明目合剂,羟苯磺酸钙组给予羟苯磺酸钙灌胃,观察大鼠全身情况,称量体重、检测血糖、血脂和玻璃体CTGF含量及视网膜CTGF的表达,并进行视网膜切片免疫组织化学染色。结果参萸明目合剂可明显改善DR大鼠的生存状况,降低DR大鼠血糖、血脂并可降低大鼠玻璃体CTGF含量和视网膜CTGF的阳性表达,对实验性糖尿病视网膜病变有一定防治作用。结论参萸明目合剂能有效的保护大鼠视网膜微血管,降低毛细血管的通透性,防止视网膜病变向增殖期进展。

糖尿病性视网膜病变患者血清VEGF、ES、TSP水平与眼底病变的相关性分析

目的探讨糖尿病性视网膜病变患者血清VEGF、ES、TSP水平与眼底病变的相关性。方法选取2017年1月至2020年12月本院收治的无眼底病变糖尿病患者120例、增殖性糖尿病视网膜病变患者120例、非增殖性糖尿病视网膜病变患者120例作为研究对象,同时选取同期在本院进行健康体检的人群120例作为参照对象。结果增殖性糖尿病视网膜病变组血管内皮细胞生长因子(VEGF)水平高于无眼底病变糖尿病组、非增殖性糖尿病视网膜病变组、参照组(P<0.05),增殖性糖尿病视网膜病变组内皮抑素(ES)水平低于无眼底病变糖尿病组、非增殖性糖尿病视网膜病变组、参照组(P<0.05),各组血清血小板反应蛋白(TSP)水平相比,无明显差异(P>0.05);糖尿病性视网膜病变患者血清VEGF水平与眼底病变呈正相关(r=0.456,P<0.05),与ES、TSP水平无明显的相关性(r=0.122,r=0.212,P>0.05)。结论糖尿病性视网膜病变患者的血清VEGF、ES、TSP水平会发生明显变化,且会通过改变VEGF水平影响糖尿病性视网膜病变进程。

羟丙磺酸钙在糖尿病微血管病变临床治疗分析

本文综述了羟丙磺酸钙在糖尿病微血管病变治疗中的疗效进行临床分析．临床应用中肯定了羟丙磺酸钙在糖尿病微血管病变并发症如糖尿病视网膜病变、糖尿病肾病、糖尿病足的治疗中有显著疗效。

眼底激光联合雷珠单抗治疗糖尿病性视网膜病变黄斑水肿的疗效评价

目的 分析糖尿病性视网膜病变黄斑水肿应用眼底激光联合雷珠单抗治疗的临床效果。方法 选择2021年6月至2022年3月宜兴眼科医院收治的60例糖尿病性视网膜病变黄斑水肿患者为研究对象,依据随机数字表法分为对照组与研究组,每组30例,对照组接受眼底激光治疗,研究组接受眼底激光联合雷珠单抗治疗,比较两组患者最佳矫正视力、黄斑中心凹厚度、临床治疗效果及并发症发生情况。结果 研究组治疗1、3个月后最佳矫正视力指标及临床疗效均高于对照组,且黄斑中心凹厚度、不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 采用眼底激光联合雷珠单抗治疗糖尿病性视网膜病变黄斑水肿具有积极意义,能有效改善视觉功能,降低黄斑中心凹厚度,安全性较高。

糖尿病慢性并发症与细胞凋亡及相关基因关系的述评

细胞凋亡是糖尿病慢性并发症发病机制之一。糖尿病肾病(DN)、糖尿病心肌病、糖尿病视网膜病变(DR)、糖尿病神经病变等多种DM慢性并发症的发生与细胞凋亡密切相关。其中凋亡相关基因BCL-2、Bax、Fas、BCL-XL、Pax-3及一些胞内信号转导分子等可能对组织细胞的凋亡进行调控。

早期糖尿病大鼠视感受器超微结构变化

目的 :探讨早期糖尿病视网膜病变 (糖网病 )视感受器的超微结构变化。方法 :选择健康成年 Wistar大鼠 ,随机分成正常对照组 (CON)、糖尿病 1月 (DM1 )、 3月 (DM3 )和 6月 (DM6)组。按 55mg/ kg体重一次性腹腔内注射链脲佐菌素 (STZ)诱导大鼠糖尿病。取大鼠视网膜制备超薄切片 ,透射电镜观察并计算机图像分析。结果 :病程 1月只见视杆细胞膜盘模糊不清 ,膜盘间隙略有扩大 ;病程 3月 ,膜盘间隙扩大明显 ,并发生局部断裂溶解。视杆细胞核固缩、异染色质浓集。视杆内节线粒体肿胀、甚至空泡变性。病程 6月 ,以上改变更加严重。结论 :糖网病早期大鼠即出现视感受器的形态学改变 ,随病程进展 ,呈现逐渐加重的趋势。

Erythropoietin Receptor Positive Circulating Progenitor Cells and Endothelial Progenitor Cells in Patients with Different Stages of Diabetic Retinopathy

Objective To investigate the possible involvement of erythropoietin （EPO）/erythropoietin receptor （EPOR） system in neovascularization and vascular regeneration in diabetic retinopathy （DR）. Methods EPOR positive circulating progenitor cells （CPCs： CD34^＋） and endothelial progenitor cells （EPCs： CD34^＋KDR^＋） were assessed by flow cytometry in type 2 diabetic patients with different stages of DR. The cohort consisted of age- and sex-matched control patients without diabetes （n=7）, non-prolif- erative DR （NPDR, n=7）, proliferative DR （PDR, n=8）, and PDR complicated with diabetic nephropathy （PDR-DN, n=7）. Results The numbers of EPOR^＋ CPCs and EPOR^＋ EPCs were reduced remarkably in NPDR corn pared with the control group （both P（0.01）, whereas rebounded in PDR and PDR-DN groups in varying degrees. Similar changes were observed in respect of the proportion of EPOR^＋ CPCs in CPCs （NPDR vs. control, P（0.01） and that of EPOR^＋ EPCs in EPCs （NPDR vs. control, P〈0.05）. Conclusion Exogenous EPO, mediated via the EPO/EPOR system of EPCs, may alleviate the impaired vascular regeneration in NPDR, whereas it might aggravate retinal neovascularization in PDR due to a rebound of EPOR^＋ EPCs associated with ischemia.

Association of C(-106)T Polymorphism in Aldose Reductase Gene with Diabetic Retinopathy in Chinese Patients with Type 2 Diabetes Mellitus

Objective To identify the possible association between C（-106）T polymorphism of the aldose reductase （ALR） gene and diabetic retinopathy （DR） in a cohort of Chinese patients with type 2 diabetes mellitus （T2DM）. Methods From November 2009 to September 2010, patients with T2DM were recruited and assigned to DR group or diabetic without retinopathy （DWR） group according to the duration of diabetes and the grading of 7-field fundus color photographs of both eyes. Genotypes of the C（-106）T polymorphism （rs759853） in ALR gene were analyzed using the MassARRAY genotyping system and an association study was performed. Results A total of 268 T2DM patients （129 in the DR group and 139 in the DWR group） were included in this study. No statistically significant differences were observed between the 2 groups in the age of diabetes onset （P=0.10） and gender （P=0.78）. The success rate of genotyping for the study subjects was 99.6% （267/268）, with one case of failure in the DR group. The frequencies of the T allele in the C（-106）T polymorphism were 16.0% （41/256） in the DR group and 19.4% （54/278） in the DWR group （P=0.36）. There was no signit^cant difference in the C（-106）T genotypes between the 2 groups （P=0.40）. Compared with the wild-type genotype, odds ratio （OR） for the risk of DR was 0.7 （95% CI, 0.38-1.3） for the heterozygous CT genotype and 0.76 （95% CI, 0.18-3.25） for the homozygous TT genotype. The risk of DR was positively associated with microalbuminuria （OR=4.61; 95% CI, 2.34-9.05） and insulin therapy （OR=3.43; 95% CI, 1.94-6.09）. Conclusions Microalbuminuria and insulin therapy are associated with the risk of DR in Chinese patients with T2DM. C（-106）T polymorphism of the ALR gene may not be significantly associated with DR in Chinese patients with T2DM.

Dan Huang Ming Mu Recipe Suppresses the Progression of Streptozotocin-induced Diabetic Retinopathy After Retinal Laser Photocoagulation in Brown Norway Rats via Down-regulating Vascular Endothelial Growth Factor and Up-regulating Pigment Epithelium-derived

Objective To analyze the effects of Dan Huang Ming Mu Recipe(DHMMR)(a pharmaceutical preparation from herbs and having the function of replenishing vital essence,removing heat,promoting blood circulation and excreting pathogenic water) on diabetic retinopathy(DR) after retinal laser photocoagulation through regulating the expression of vascular endothelial growth factor(VEGF) and pigment epithelium-derived factor(PEDF).Methods Forty male Brown Norway(BN) rats were randomly divided into blank group(group A,10 BN rats) and model group(30 BN rats).DR models were induced by 40 mg/kg streptozotocin(STZ) and the body weight and blood glucose of rats were monitored.After 12-week injection,fluorescein fundus angiography(FFA) and histopathological examination were detected to confirm the successful establishment of DR models.Subsequently,the right eyes of model group rats were conducted retinal laser photocoagulation with the left eyes having no retinal laser photocoagulation and rats of the model group were randomly divided into group B(the model control group),group C(the positive control group),and group D(the DHMMR group),with 10 rats in each group.Rats of the group A and the group B were given vehicle,and the group C were given calcium dobesilate suspension by gavage,and the group D were given DHMMR by gavage.After 4-week gavage,FFA was carried out to observe the fundus microvascular change.Then,the rats were sacrificed to do histopathological examinations and the serum levels of P-selectin,cAMP,cGMP,and the relative expression of the protein of VEGF and PEDF in retina were detected.Results After 12-week STZ injection,the blood glucose of the model group were pronouncedly higher than the blank group(P < 0.01).Fundus micro-hemangioma changes were observed in the rats of the model group through FFA,and the rats of the blank group did not see any changes.The pictures of HE staining showed that the retinal structure of the model group was more disordered than the blank group.After 4-week gavage,treatments with DHMMR showed dramatic reduction of serum levels of Pselectin,cAMP and cGMP compared with the group B(P < 0.01).FFA and histopathological examinations of DHMMR-treated rats revealed significantly suppression of retinal edema,fundus microvascular destruction and retinal destruction distinguishing from the group B.And the relative expression of VEGF protein of the group D and the group A was markedly lower than that of the group B(P < 0.01).The relative expression of PEDF protein of the group D and the group A was dramatically higher than that of the group B to the contrary(P < 0.01).Conclusions DHMMR demonstrates pronounced suppressive effects on the progression of DR after retinal laser photocoagulation,through down-regulating VEGF and upregulating PEDF.

Clinical evidence and potential mechanisms of Chinese medicines for the treatment of diabetic retinopathy

Diabetic retinopathy is one of the main causes of visual impairment and blindness on a global scale. At present, thelimitations of anti-vascular endothelial growth factor agents, steroids, laser photocoagulation, and vitreous surgery haveled to a growing awareness of the role of Chinese medicines in the treatment of diabetic retinopathy. This review firstdescribes the ingredients and characteristics of the formulae including Chinese herbal formulaes, Chinese patent drugsand ancient processed drugs and summarizes the application of Chinese medicines and their mechanisms of action in thetreatment of diabetic retinopathy. Due to the complexity of Chinese medicines, in-depth mechanisms, side effects of herb,and drug interactions need to be elaborated in future research. Chinese medicines have the potencial to protect theresidual eyesight and delay the progression of disease, thereby offering a beneficial, exploitable option in thetreatment/prevention of diabetic retinopathy.

CHANGES OF NAILFOLD MICROCIRCULATION IN PATIENTS OF TYPE II DIABETES MELLITUS WITH DIABETIC RETINOPATHY

Objective. To study the changes of microcirculation in patients with diabetic retinopathy(DR). Methods. Examination were performed in 153 cases of type Ⅱ diabetes mellitus, among them, 72 cases were male, 81 cases were female, mean age 57.0±10.0 years, mean disease course 8.2±7.5 years. All cases were examined fundi by ophthalmologist, urinary albumin excretion rate (UAE) in 24 hours was measured by radioimmunoassay. Moreover, we examined the blood glucose, blood pressure, blood viscosity and observed the changes of naifold microcirculation. Results.It was found that there were more evident disturbance of microcirculation, markedly slowed velocity of blood flow(P<0.05), significantly increased aggregation of blood cells(P<0.05) and exudation around the loop(P<0.05) in the group with DR, compared with the group without DR. Conclusion. It was more evident disturbance of nailfold microcirculation in patients with diabetic retinopathy.

Progress in the study of cancer-associated retinopathy in breast cancer patients

Cancer-associated retinopathy (CAR) typically has a sudden or progressive onset of severe visual loss and an ominous association with an occult malignancy which contains breast cancer. Pathologically, CAR is the degeneration of photoreceptors. But the precise mechanism has not been fully established, CAR may result from autoimmune mediated apoptosis. And in recent years, there also have been some results demonstrating that tumor derived angiogenic factors such as VEGF may also confer the development of CAR, which may offer novel avenues for the therapeutic intervention in CAR. Early initiation of immunosuppressive therapy is critical for vision preservation. Future developments in rapid identification and longitudinal quantification of antibody levels would enable individualized management in these patients. The goal of this review was to analyze the epidemiology, the clinical features, the diagnosis and management of retinopathy in the context of recent advances in the elucidation of breast cancer-associated retinopathy (BCAR) pathogenesis.

Phytochemicals in ocular health: Therapeutic potential and delivery challenges

Diabetic retinopathy(DR) and age-related macular degeneration(AMD) are the leading causes of blindness in adults. The impact of these conditions on the quality of life is increasing in significance with a rise in life expectancy. The role of hyperglycemia, oxidative stress and inflammatory responses in the development and/or progression of DR and AMD, and several other sight threatening ocular diseases, is well established. In proliferative retinopathy, signals sent by the retina for nourishment, triggers the growth of fragile and abnormal blood vessels. Changes in ocular pressure may lead to rupture of these blood vessels causing severe vision problems. Recent in vitro and preclinical studies demonstrate that certain phytochemicals possessing potent antioxidant and anti-inflammatory activity and ocular blood flow enhancing properties may be very useful in the treatment of, or as a prophylactic measure for, DR and AMD. Apart from these properties they have also been investigated for their anti-bacterial, hormonal, enzyme stimulation, and anti-angiogenic activities. The attractive aspect of these potential therapeutic candidates is that they can act on multiplepathways identified in the etiology of DR, AMD, cataract and other ocular diseases. However, results from clinical trials have been somewhat ambiguous, raising questions about the concentrations of these bioflavonoids achieved in the neural retina following oral administration. Unfortunately, as of date, an efficient noninvasive means to deliver therapeutic agents/candidates to the back-of-the eye is still not available. This review examines some of these promising natural agents and discusses the challenges encountered in delivering them to the posterior segment ocular tissues through the oral route.

Progress in the study of diabetic retinopathy

Diabetic retinopathy （DR） is one of the microvascular complications of diabetes, which could be divided intonon-proliferative DR and proliferative DR according to the severity of retinopathy. Diabetic microangiopathy notonly affects the eyesight of patients with diabetes, but also endangers the lives of patients. Therefore, DR has drawnmore and more attention from domestic and foreign scholars. The etiology and treatment of diabetes are reviewedto explore ways of treating diabetic retinopathy.

NITRIC OXIDE AND VEGF EXPRESSION IN ISCHEMIC-HYPOXIC RETINOPATHY

Objective To evaluate nitric oxide(NO)and vascular endothelial growth factor(VEGF)in vitreous humor and blood samples in patients with proliferative diabetic retinopathy(PDR)and in patients with branch retinal vein occlusion(BRVO).Methods NO concentrations were determined by using the Greiss reaction in plasma and vitreous humor samples.VEGF levels were assayed by ELISA.The patients in the studies were divided into four groups:16 patients with PDR,5 patients with BRVO,11 patients with rhegmatogenous retinal detachment(RRD),and 10 patients with idiopathic macular hole(IMH).Results The vitreous fluid levels of NO were significantly higher in patients with PDR(15.2μmol/L,4.6-50.9μmol/L)than those in the other three groups(F=5.13,P=0.005).The concentrations of VEGF were significantly higher in patients with PDR and BRVO(1507.2 μg/mL,50.71-3722.0μg/ml;838.8μg/mL,159.6-3328.0μg/mL)than those in the other two groups(F=6.84,P=0.0008),but highest in PDR(T=3.92,P=0.001).There was no significant difference between NO and VEGF in serum in four groups.There was no correlation between concentrations of NO and VEGF in four groups whatever in vitreous or plasma(all P>0.05).Conclusion The results suggest that higher levels of NO and VEGF may be related to the angiogenesis in DR.

An Effective Diagnosis of Diabetic Retinopathy with Aid of Soft Computing Approaches

DR （diabetic retinopathy） is a most probable reason of blindness in adults, but the only remedy or escape from blindness is that we have to detect DR as early. Several automated screening techniques are used to detect individual lesions in the retina. Still it takes more dependency of time and experts. To overcome those problems and also automatically detect DR in easier and faster way, we took into soft computing approaches in our proposed work. Our proposed work will discuss several amounts of soft computing algorithms, it can detect DR features （landmark and retinal lesions） in an easy manner. Processes includes are： （1） Pre-processing; （2） Optic disc localization and segmentation; （3） Localization of fovea; （4） Blood vessel segmentation; （5） Feature extraction; （6） Feature selection; Finally （7） detection of diabetic retinopathy stages （mild, moderate, severe and PDR）. Our experimental results based on Matlab simulation and it takes databases of STARE and DRIVE. Proposed effective soft computing approaches should improve the sensitivity, specificity and accuracy.